Cirurgia paliativa do ombro em paralisia obstétrica do plexo braquial

A paralisia obstétrica do plexo braquial é rara originando disfunção grave e défice marcado da rotação externa e da abdução do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstétrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela técnica de L’Épiscopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesão (grupo A – lesão alta; grupo B – lesão completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento médio foi de 35 meses. A idade média aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuação média de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuação média de Mallet sobreponível (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia não influenciou o resultado clínico (pontuação média (grupo I) – 4.8; (grupo II) – 4.4). Não foram registadas complicações. A técnica de L’Épiscopo modificada por Hoffer é eficaz no tratamento paliativo do ombro em paralisia obstétrica do plexo braquial, permitindo recuperação da abdução e rotação externa do ombro. Está indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperação da função do cotovelo, punho e/ou mão. Idade superior a 4 anos não contra-indica a cirurgia desde que sejam excluídas alterações da articulação glenoumeral.

Identification of candidate cerebrospinal fluid biomarkers in parkinsonism using quantitative proteomics

INTRODUCTION

Neurodegenerative parkinsonian syndromes have significant clinical and pathological overlap, making early diagnosis difficult. Cerebrospinal fluid (CSF) biomarkers may aid the differentiation of these disorders, but other than α-synuclein and neurofilament light chain protein, which have limited diagnostic power, specific protein biomarkers remain elusive.

OBJECTIVES

To study disease mechanisms and identify possible CSF diagnostic biomarkers through discovery proteomics, which discriminate parkinsonian syndromes from healthy controls.

METHODS

CSF was collected consecutively from 134 participants; Parkinson's disease (n = 26), atypical parkinsonian syndromes (n = 78, including progressive supranuclear palsy (n = 36), multiple system atrophy (n = 28), corticobasal syndrome (n = 14)), and elderly healthy controls (n = 30). Participants were divided into a discovery and a validation set for analysis. The samples were subjected to tryptic digestion, followed by liquid chromatography-mass spectrometry analysis for identification and relative quantification by isobaric labelling. Candidate protein biomarkers were identified based on the relative abundances of the identified tryptic peptides. Their predictive performance was evaluated by analysis of the validation set.

RESULTS

79 tryptic peptides, derived from 26 proteins were found to differ significantly between atypical parkinsonism patients and controls. They included acute phase/inflammatory markers and neuronal/synaptic markers, which were respectively increased or decreased in atypical parkinsonism, while their levels in PD subjects were intermediate between controls and atypical parkinsonism.

CONCLUSION

Using an unbiased proteomic approach, proteins were identified that were able to differentiate atypical parkinsonian syndrome patients from healthy controls. Our study indicates that markers that may reflect neuronal function and/or plasticity, such as the amyloid precursor protein, and inflammatory markers may hold future promise as candidate biomarkers in parkinsonism.

Treatment planning in microwave thermal ablation: clinical gaps and recent research advances

Microwave thermal ablation (MTA) is a minimally invasive therapeutic technique aimed at destroying pathologic tissues through a very high temperature increase induced by the absorption of an electromagnetic field at microwave (MW) frequencies. Open problems, which are delaying MTA applications in clinical practice, are mainly linked to the extremely high temperatures, up to 120 °C, reached by the tissue close to the antenna applicator, as well as to the ability of foreseeing and controlling the shape and dimension of the thermally ablated area. Recent research was devoted to the characterisation of dielectric, thermal and physical properties of tissue looking at their changes with the increasing temperature, looking for possible developments of reliable, automatic and personalised treatment planning. In this paper, a review of the recently obtained results as well as new unpublished data will be presented and discussed.

Single and combined effects of body composition phenotypes on carotid intima-media thickness

BACKGROUND

Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima-media-thickness (cIMT) better than either measure alone.

OBJECTIVE

The objective of the study is to identify the ability of a combination of simple anthropometric screening tools or a combination of objective measures of body composition to predict cIMT.

METHODS

cIMT was assessed on the common carotid artery in 349 children aged 11-12 years old (183 girls). Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were dichotomized according to established criteria and indices of total body (TBFI) and abdominal (ABFMI) fat were assessed by dual-energy X-ray absorptiometry and categorized (increased risk ≥85%). Single and combined associations among anthropometric and laboratorial measures with the risk of having increased cIMT (≥85%) and discriminatory performance were tested with logistic regression analysis and Receiver Operator Curve analysis.

RESULTS

Children with higher total fatness (BMI and TBFI) or higher central pattern of fat accumulation (WC, WHtR and BFMI) were in higher risk for increased cIMT [odds ratio (OR): 2.08-3.24). The risk for increased cIMT was not higher among children who coupled high total and high central fatness (OR: 2.27-3.10).

CONCLUSIONS

Combination of total and central measures of fat does not improve the prediction of increased cIMT in children. Simple surrogate measures of fatness can be used to predict increased cIMT urging special attention to those children who exhibit increased abdominal fat.

Long-term outcomes and healthcare utilization following critical illness--a population-based study

BACKGROUND

The purpose of this study was to examine hospital mortality, long-term mortality, and health service utilization among critically ill patients. We also determined whether these outcomes differed according to demographic and clinical characteristics.

METHODS

We conducted a retrospective cohort study of adults (age ≥ 18 years) who survived admission to an intensive care unit (ICU) in Ontario, Canada, between 1 April 2002 and 31 March 2012, excluding isolated admissions to step-down or intermediate ICUs, coronary care ICUs, or cardiac surgery ICUs. Adults (age ≥ 18 years) who survived an acute hospitalization that did not include an ICU stay formed the comparator group. The primary outcome was mortality following hospital discharge. Secondary outcomes were healthcare utilization, including emergency room admissions and hospital readmissions during follow-up.

RESULTS

Over the study interval, 500,124 patients were admitted to ICUs and 420,187 (84%) survived to hospital discharge. Median follow-up for survivors was 5.3 (interquartile range 2.5, 8.2) years. Patients admitted to an ICU were more likely to subsequently visit the emergency department, be readmitted to the hospital and ICU, receive home care support, require rehabilitation, and be admitted for long-term care. Those requiring more resources within the ICU required more resources after discharge. One-third of patients admitted to the ICU died during long-term follow-up, with overall probabilities of death of 11% and 29% at 1 year and 5 years, respectively. In the adjusted analysis, there was an increasing hazard of death with increasing age, reaching a hazard ratio of 18.08 (95 % confidence interval 16.60-19.68) for those ≥ 85 years of age compared with those aged 18-24 years.

CONCLUSIONS

Healthcare utilization after hospital discharge was higher among ICU patients, and also among those requiring more healthcare resources during their ICU admission, than among all hospitalized patients as a group. One-third of ICU patients died within the 5 years following discharge, and age was the most influential determinant of outcome. These findings should help target post-ICU discharge services for high-risk groups and better inform goals-of-care discussions for elderly critically ill patients.

Room temperature magnetoelectric multiferroic behavior of 50 mol% Fe substituted PbTiO3 (PbTi0.5Fe0.5O3−δ) nanoparticles

The magnetic, ferroelectric and magnetoelectric measurements at room temperature corroborate the multiferroic nature of Pb(Fe_0.5Ti_0.5)O_3−δ nanoparticles with significant magnetoelectric coupling.

Cation export by overland flow in a recently burnt forest area in north-central Portugal

The current fire regime in the Mediterranean Basin constitutes a serious threat to natural ecosystems because it drastically enhances surface runoff and soil erosion in the affected areas. Besides soil particles themselves, soil cations can be lost by fire-enhanced overland flow, increasing the risk of fertility loss of the typically shallow and nutrient poor Mediterranean soils. Although the importance of cations for land-use sustainability is widely recognized, cation losses by post-fire runoff have received little research attention. The present study aimed to address this research gap by assessing total exports of Na(+), K(+), Ca(2+) and Mg(2+) in a recently burnt forest area in north-central Portugal. These exports were compared for two types of planted forest (eucalypt vs. maritime pine plantations), two types of parent materials (schist vs. granite) and for two spatial scales (micro-plot vs. hill slope). The study sites were a eucalypt plantation on granite (BEG), a eucalypt plantation on schist (BES) and a maritime pine plantation on schist (BPS). Overland flow samples were collected during the first six months after the wildfire. Cation losses differed strikingly between the two forest types on schist, being higher at the eucalypt than pine site. This difference was evident at both spatial scales, and probably due to the extensive cover of a needle cast from the scorched pine crowns. The role of parent material in cation export was less straightforward as it varied with spatial scale. Cation losses were higher for the eucalypt plantation on schist than for that on granite at the micro-plot scale, whereas the reverse was observed at the hill slope scale. Finally, cation yields were higher at the micro-plot than slope scale, in agreement with the general notion of scaling-effect in runoff generation.

Investigating Alfvénic wave propagation in coronal open-field regions

The physical mechanisms behind accelerating solar and stellar winds are a long-standing astrophysical mystery, although recent breakthroughs have come from models invoking the turbulent dissipation of Alfvén waves. The existence of Alfvén waves far from the Sun has been known since the 1970s, and recently the presence of ubiquitous Alfvénic waves throughout the solar atmosphere has been confirmed. However, the presence of atmospheric Alfvénic waves does not, alone, provide sufficient support for wave-based models; the existence of counter-propagating Alfvénic waves is crucial for the development of turbulence. Here, we demonstrate that counter-propagating Alfvénic waves exist in open coronal magnetic fields and reveal key observational insights into the details of their generation, reflection in the upper atmosphere and outward propagation into the solar wind. The results enhance our knowledge of Alfvénic wave propagation in the solar atmosphere, providing support and constraints for some of the recent Alfvén wave turbulence models.

A case of acquired Gitelman syndrome presenting as hypokalemic paralysis

We report a case of a young female patient who presented with weakness of upper and lower limbs. On evaluation, she had hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. Anti-Ro (SSA) antibody was positive. She had an acquired Gitelman syndrome due to primary Sjögren's syndrome (SS). SS presenting with features of Gitelman syndrome is very rare.