TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

PURPOSE

To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure.

METHODS

Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores.

RESULTS

The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples).

CONCLUSION

The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.

Sonographic Evaluation of Liver Hemodynamic Indices in Overweight and Obese Dogs

Background

Hepatic circulatory disturbances have been associated with obesity and fatty liver in humans. In the veterinary literature, however, there is limited information regarding the effects of different body condition scores (BCS) on liver hemodynamic indices in dogs.

Objectives

To investigate the influence of BCS on liver hemodynamic indices.

Animals

Fifty‐three client‐owned dogs of various breeds were included.

Methods

Prospective observational study. Dogs were divided into 3 BCS groups using a 5‐point scale: G1 – 12 ideal dogs, G2 – 21 overweight dogs, G3 – 20 obese dogs. Mean portal velocity (MPV), portal blood flow volume (PBFV), portal congestion index (PCI), hepatic artery resistivity index (HARI), and hepatic vein (HV) spectral wave were obtained by pulsed Doppler sonography. Alkaline phosphatase (ALP), gamma‐glutamyl transferase (GGT), and alanine aminotransferase (ALT) activities were determined. Liver enzymes activities and liver hemodynamic indices were compared among groups.

Results

Obese dogs had lower MPV, higher percentage of abnormal hepatic vein spectral wave and higher median ALP activity than did ideal dogs (P < 0.05). Overweight and obese dogs had lower PBFV than ideal dogs (P < 0.01). Overweight dogs had higher median GGT activity than ideal dogs (P < 0.05). No difference was observed for PCI, HARI and median ALT activity among the groups.

Conclusions and Clinical Importance

Obesity was associated with changes in portal vein indices and in HV spectral wave. These changes were accompanied by significant differences in some liver enzymes activities and could be a sign of early liver disease.

Sclerotherapy for Reticular Veins in the Lower Limbs: A Triple-Blind Randomized Clinical Trial

Importance

Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant.

Objective

To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2).

Design, Setting, and Participants

Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs.

Interventions

The patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins.

Main Outcomes and Measures

The primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas).

Results

Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09).

Conclusions and Relevance

Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group.

Trial Registration

clinicaltrials.gov Identifier: NCT02054325.

Eyelid fissure dimensions in Japanese and in Brazilians of European descent over 50 years of age

PURPOSE

To investigate differences in the palpebral fissure eyelid position in Japanese subjects and in Brazilian subjects of European descent over 50 years of age.

METHODS

A cross-sectional study evaluating 50 Japanese subjects and 50 Bra---zilian subjects of European descent over 50 years of age was performed to evaluate the effect of aging on eyelid position. Digital photographs were taken with the eyes in the primary position and transferred to a computer to be processed by Scion imaging software for evaluation of palpebral fissure width, height, and margin reflex distance (MRD). The data were statistically analyzed according to sex, age, and race.

RESULTS

The width of the eyelid fissure in Japanese subjects was higher than that in Brazilian subjects, whereas the height of the eyelid fissure and the MRD1 was higher in Brazilians than in Japanese (p<0.01). Width, height, and MRD1 were linearly associated with age only in the Japanese group (p<0.05); this association was observed only with width in the Brazilian group (p<0.05). There were no differences according to laterality in either group (p>0.05).

CONCLUSION

There are racial differences in age-related changes in the eyelids, which are more marked in Japanese subjects.

Cardiac, Metabolic and Molecular Profiles of Sedentary Rats in the Initial Moment of Obesity

BACKGROUND

Different types of high-fat and/or high-energy diets have been used to induce obesity in rodents. However, few studies have reported on the effects observed at the initial stage of obesity induced by high-fat feeding on cardiac functional and structural remodelling.

OBJECTIVE

To characterize the initial moment of obesity and investigate both metabolic and cardiac parameters. In addition, the role of Ca2+ handling in short-term exposure to obesity was verified.

METHODS

Thirty-day-old male Wistar rats were randomized into two groups (n = 19 each): control (C; standard diet) and high-fat diet (HF, unsaturated high-fat diet). The initial moment of obesity was defined by weekly measurement of body weight (BW) complemented by adiposity index (AI). Cardiac remodelling was assessed by morphological, histological, echocardiographic and papillary muscle analysis. Ca2+ handling proteins were determined by Western Blot.

RESULTS

The initial moment of obesity occurred at the 3rd week. Compared with C rats, the HF rats had higher final BW (4%), body fat (20%), AI (14.5%), insulin levels (39.7%), leptin (62.4%) and low-density lipoprotein cholesterol (15.5%) but did not exhibit alterations in systolic blood pressure. Echocardiographic evaluation did not show alterations in cardiac parameters. In the HF group, muscles were observed to increase their +dT/dt (C: 52.6 ± 9.0 g/mm2/s and HF: 68.0 ± 17.0 g/mm2/s; p < 0.05). In addition, there was no changes in the cardiac expression of Ca2+ handling proteins.

CONCLUSION

The initial moment of obesity promotes alterations to hormonal and lipid profiles without cardiac damage or changes in Ca2+ handling.

TECHNIQUES AND TACTICS IN BASKETBALL ACCORDING TO THE INTENSITY IN OFFICIAL MATCHES

ABSTRACT Introduction: Basketball is characterized as an intermittent sport in which currently stand out the highest intensity in which the actions occur, demanding for sport performance the optimum and homogeneous development of physical, technical, tactical, psychological and intellectual components. In this sense, the understanding of the game according to the technical and tactical actions performed and the knowledge of body’s responses are important for planning, monitoring and control of the training. Objective: The aim of this study was to describe the intensity of basketball tactical actions and the relationships between technical actions and intensity during the different game periods (GP). Methods: Ten athletes of the Brazilian male basketball elite participated in this study (27.60±5.54 years, 192.62±7.63 cm, 91.60±11.51 kg, 10.66±4.11% of body fat) in six official matches of the National Basketball League (LNB, Brazil). Anthropometric measures and motor tests were performed and tactical (defensive, offensive and transition), technical [shares number (SN) and efficiency ratio (ER)] and physical actions [percentage of lactate threshold heart rate (%HRthr)] were correlated. Spearman’s correlation coefficient was used between SN, ER and %HRthr. Results: The main results point to: (1) positive and significant relationship (except the 4th GP) between SN, ER and %HRthr; (2) tactical actions presented HR near the lactate threshold, being apparently the highest median for the transitions (107.4%HRthr). Conclusion: The game is intense, with moments of HRpeak, but the median is slightly above of HRthr, that it is where the best relationship between SN and ER occurs.

Food restriction increase the expression of mTORC1 complex genes in the skeletal muscle of juvenile pacu (Piaractus mesopotamicus)

Skeletal muscle is capable of phenotypic adaptation to environmental factors, such as nutrient availability, by altering the balance between muscle catabolism and anabolism that in turn coordinates muscle growth. Small noncoding RNAs, known as microRNAs (miRNAs), repress the expression of target mRNAs, and many studies have demonstrated that miRNAs regulate the mRNAs of catabolic and anabolic genes. We evaluated muscle morphology, gene expression of components involved in catabolism, anabolism and energetic metabolism and miRNAs expression in both the fast and slow muscle of juvenile pacu (Piaractus mesopotamicus) during food restriction and refeeding. Our analysis revealed that short periods of food restriction followed by refeeding predominantly affected fast muscle, with changes in muscle fiber diameter and miRNAs expression. There was an increase in the mRNA levels of catabolic pathways components (FBXO25, ATG12, BCL2) and energetic metabolism-related genes (PGC1α and SDHA), together with a decrease in PPARβ/δ mRNA levels. Interestingly, an increase in mRNA levels of anabolic genes (PI3K and mTORC1 complex: mTOR, mLST8 and RAPTOR) was also observed during food restriction. After refeeding, muscle morphology showed similar patterns of the control group; the majority of genes were slightly up- or down-regulated in fast and slow muscle, respectively; the levels of all miRNAs increased in fast muscle and some of them decreased in slow muscle. Our findings demonstrated that a short period of food restriction in juvenile pacu had a considerable impact on fast muscle, increasing the expression of anabolic (PI3K and mTORC1 complex: mTOR, mLST8 and RAPTOR) and energetic metabolism genes. The miRNAs (miR-1, miR-206, miR-199 and miR-23a) were more expressed during refeeding and while their target genes (IGF-1, mTOR, PGC1α and MAFbx), presented a decreased expression. The alterations in mTORC1 complex observed during fasting may have influenced the rates of protein synthesis by using amino acids from protein degradation as an alternative mechanism to preserve muscle phenotype and metabolic demand maintenance.

Importance of SERCA2a on early isolated diastolic dysfunction induced by supravalvular aortic stenosis in rats

Cardiac remodeling is defined as changes in shape and function of the heart in response to aggression (pressure overload). The sarcoplasmic reticulum calcium ATPase cardiac isoform 2a (SERCA2a) is a known factor that influences function. A wide spectrum of studies report a decrease in SERCA2a in heart failure, but none evaluate it's the role in early isolated diastolic dysfunction in supravalvular aortic stenosis (AoS). Our hypothesis was that SERCA2a participates in such dysfunction. Thirty-day-old male Wistar rats (60-80 g) were divided into AoS and Sham groups, which were submitted to surgery with or without aorta clipping, respectively. After 6 weeks, the animals were submitted to echocardiogram and functional analysis by isolated papillary muscle (IPM) in basal condition, hypoxia, and SERCA2a blockage with cyclopiazonic acid at calcium concentrations of 0.5, 1.5, and 2.5 mM. Western-blot analyses were used for SERCA2a and phospholamban detection. Data analysis was carried out with Student's t-test and ANOVA. AoS enhanced left atrium and E and A wave ratio, with preserved ejection fraction. Basal condition in IPM showed similar increases in developed tension (DT) and resting tension (RT) in AoS, and hypoxia was similar between groups. After cyclopiazonic acid blockage, final DT was equally decreased and RT was similar between groups, but the speed of relaxation was decreased in the AoS group. Western-blot was uniform in all evaluations. The hypothesis was confirmed, since functional parameters regarding SERCA2a were changed in the AoS group.

Higher Carotid Intima-Media Thickness in Subclinical Hypothyroidism Associated with the Metabolic Syndrome

BACKGROUND

The subclinical hypothyroidism (SH) and the metabolic syndrome (MS) have been associated with increased risk of atherosclerosis and cardiovascular disease (CVD). The measurement of carotid intima-media thickness (IMT) is capable of detecting early signs of atherosclerotic disease. The goal of the study was to compare the carotid IMT of patients with SH with and without the MS.

METHODS

Twenty-nine SH patients were subdivided into two groups: one with MS (SH + MS) and one without MS (SH - MS). The study also assessed a group of euthyroid patients (n = 31), also subdivided into two groups: one with MS (EU + MS) and one without MS (EU - MS). The clinical and laboratory data and the mean and maximum carotid IMT of the groups were compared.

RESULTS

Maximum (P = 0.012) and mean (P = 0.025) IMT were higher in the SH + MS group than in the SH-MS group. Maximum IMT was higher in the SH + MS group than in the EU + MS group (P = 0.048). Maximum IMT was positively correlated with fasting glucose (FG; R = 0.621; P < 0.01) and body mass index (R = 0.258; P = 0.041) and negatively correlated with low-density lipoprotein cholesterol (LDL-C) (R = -0.297; P = 0.017). Mean IMT was positively correlated with FG (R = 0.580; P < 0.01), systolic blood pressure (R = 0.292; P = 0.02), and triglycerides (R = 0.250; P = 0.048) and negatively correlated with LDL-C (R = -0.288; P = 0.022).

CONCLUSIONS

SH + MS patients have higher IMT than SH - MS or EU + MS patients, suggesting that SH may be one more CVD risk factor in patients with the MS.

Classification of different degrees of adiposity in sedentary rats

In experimental studies, several parameters, such as body weight, body mass index, adiposity index, and dual-energy X-ray absorptiometry, have commonly been used to demonstrate increased adiposity and investigate the mechanisms underlying obesity and sedentary lifestyles. However, these investigations have not classified the degree of adiposity nor defined adiposity categories for rats, such as normal, overweight, and obese. The aim of the study was to characterize the degree of adiposity in rats fed a high-fat diet using cluster analysis and to create adiposity intervals in an experimental model of obesity. Thirty-day-old male Wistar rats were fed a normal (n=41) or a high-fat (n=43) diet for 15 weeks. Obesity was defined based on the adiposity index; and the degree of adiposity was evaluated using cluster analysis. Cluster analysis allowed the rats to be classified into two groups (overweight and obese). The obese group displayed significantly higher total body fat and a higher adiposity index compared with those of the overweight group. No differences in systolic blood pressure or nonesterified fatty acid, glucose, total cholesterol, or triglyceride levels were observed between the obese and overweight groups. The adiposity index of the obese group was positively correlated with final body weight, total body fat, and leptin levels. Despite the classification of sedentary rats into overweight and obese groups, it was not possible to identify differences in the comorbidities between the two groups.

High-fat Diet Promotes Cardiac Remodeling in an Experimental Model of Obesity

BACKGROUND

Although nutritional, metabolic and cardiovascular abnormalities are commonly seen in experimental studies of obesity, it is uncertain whether these effects result from the treatment or from body adiposity.

OBJECTIVE

To evaluate the influence of treatment and body composition on metabolic and cardiovascular aspects in rats receiving high saturated fat diet.

METHODS

Sixteen Wistar rats were used, distributed into two groups, the control (C) group, treated with isocaloric diet (2.93 kcal/g) and an obese (OB) group, treated with high-fat diet (3.64 kcal/g). The study period was 20 weeks. Analyses of nutritional behavior, body composition, glycemia, cholesterolemia, lipemia, systolic arterial pressure, echocardiography, and cardiac histology were performed.

RESULTS

High-fat diet associates with manifestations of obesity, accompanied by changes in glycemia, cardiomyocyte hypertrophy, and myocardial interstitial fibrosis. After adjusting for adiposity, the metabolic effects were normalized, whereas differences in morphometric changes between groups were maintained.

CONCLUSION

It was concluded that adiposity body composition has a stronger association with metabolic disturbances in obese rodents, whereas the high-fat dietary intervention is found to be more related to cardiac morphological changes in experimental models of diet-induced obesity.

In vitro study of cyclosporine A 0.05 % on primary and recurrent pterygium fibroblasts

To compare the cyclosporine 0.05 % exposure effect on fibroblasts from primary and recurrent pterygium. Primary culture of fibroblasts from primary and recurrent pterygium was performed until the third passage, which was exposed to cyclosporine 0.05 % in a group and the other remaining unexposed (control group), in triplicates. After 3, 6, 12, and 17 days of exposure the viable cell counting was performed by hemocytometer. The results were statistically analyzed using the technique of analysis of non-parametric variance model for repeated measures with three factors. There was a significant reduction in both fibroblast proliferation, in primary as in the recurrent pterygium cultures exposed to cyclosporine when compared not exposed cultures, with statistical significance (P < 0.05). Comparing primary and recurrent pterygium that received the drug, there was no significant difference in cell proliferation in relation to primary or recurrent pterygium. Cyclosporine 0.05 % is effective in inhibiting fibroblast proliferation in culture, both in primary and as in recurrent pterygium.

Adhesion study of cultured human lens capsule cells on hydrophilic intraocular lenses coated with polyethylene glycol

PURPOSE

To evaluate the adhesion of human lens capsule cells on hydrophilic acrylic intraocular lenses (IOLs) coated with polyethylene glycol (PEG).

SETTING

Department of Ophthalmology, Faculty of Medicine, Universidade Estadual Paulista-Botucatu, São Paulo, Brazil.

DESIGN

Experimental study.

METHODS

Human anterior lens capsules obtained during cataract surgery were cultured and seeded (200 cells/IOLs) in triplicates on the surface of a copolymer comprising hydroxyethyl methacrylate, ethyl methacrylate, and methyl methacrylate IOLs (Loflex) treated or not treated with PEG. After 26 hours, the number of viable adherent cells was estimated by counting in a hemocytometer.

RESULTS

The coating of hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion (P < .05). Cells showing 2 distinct morphologic patterns-epithelial and dendritic-like-were observed during the in vitro establishment of the cultures. A tendency toward greater adhesion of dendritic-like cells was observed in untreated IOLs compared with treated IOLs (P = .095).

CONCLUSION

Coating hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion. This treatment might play a role in posterior capsule opacification prevention.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Multivariate analysis for animal selection in experimental research

BACKGROUND

Several researchers seek methods for the selection of homogeneous groups of animals in experimental studies, a fact justified because homogeneity is an indispensable prerequisite for casualization of treatments. The lack of robust methods that comply with statistical and biological principles is the reason why researchers use empirical or subjective methods, influencing their results.

OBJECTIVE

To develop a multivariate statistical model for the selection of a homogeneous group of animals for experimental research and to elaborate a computational package to use it.

METHODS

The set of echocardiographic data of 115 male Wistar rats with supravalvular aortic stenosis (AoS) was used as an example of model development. Initially, the data were standardized, and became dimensionless. Then, the variance matrix of the set was submitted to principal components analysis (PCA), aiming at reducing the parametric space and at retaining the relevant variability. That technique established a new Cartesian system into which the animals were allocated, and finally the confidence region (ellipsoid) was built for the profile of the animals' homogeneous responses. The animals located inside the ellipsoid were considered as belonging to the homogeneous batch; those outside the ellipsoid were considered spurious.

RESULTS

The PCA established eight descriptive axes that represented the accumulated variance of the data set in 88.71%. The allocation of the animals in the new system and the construction of the confidence region revealed six spurious animals as compared to the homogeneous batch of 109 animals.

CONCLUSION

The biometric criterion presented proved to be effective, because it considers the animal as a whole, analyzing jointly all parameters measured, in addition to having a small discard rate.