Artrodese interfalângica: eficácia e retorno laboral com fios Kirschner e parafuso Acutrak®

A artrodese interfalângica (IF) é um procedimento osteoarticular frequente e os fios de Kirschner são os mais usados. Outras técnicas descritas são parafusos compressivos ou, recentemente, parafuso sem cabeça, completamente roscado, Acutrak® (Acumed LLC, Hillsboro, OR). Os autores propuseram comparar duas técnicas de artrodese IF: com fios Kirschner e parafusos Acutrak®. Trata-se de um estudo retrospectivo de 2009 a 2012 englobando 67 artrodeses. Destes foram excluídos doentes com infecção, osteopenia ou perda óssea como artrite reumatóide. Obteve-se um total de 53 artrodeses: 22 com fios Kirschner (grupo I) e 31 com parafusos Acutrak® (grupo II). Foi determinada a taxa e tempo de fusão, complicações e tempo de retorno laboral. Os resultados foram analisados pelo SPSS® 20 Statistics (p<0.05). No grupo I, verificou-se 77.3% de fusão com 9% de complicações menores. No grupo II ocorreu consolidação em 100%, na ausência de complicações. O tempo médio de fusão foi 9.6 (r: 6-14) semanas no grupo I e 5.1 (r: 4-8) semanas no grupo II. O retorno laboral foi às 11.5 semanas e 5.4 semanas, respectivamente. O parafuso Acutrak® permite uma artrodese mais eficaz que os fios Kirschner e retorno laboral precoce.

Assessing a bioremediation strategy in a shallow coastal system affected by a fish farm culture--application of GIS and shellfish dynamic models in the Rio San Pedro, SW Spain

An integrated multi-trophic aquaculture assessment for Pacific oyster (Crassostrea gigas) aquaculture as a bioremediation strategy in areas impacted by fish farm effluents in Rio San Pedro was assessed by combining geographic information system with carrying capacity models. Sites of 0.44 km(2) were evaluated considering constraints; physical factors, growth and survival factors, environmental quality factors, water and sediment quality criteria, factor suitability ranges, and Multi-Criteria Evaluation. Isleta and Flamenco are promising sites for oyster production, and Dorada is of marginal interest. Carbon and nitrogen removal from the water by algae and through detritus filtration was estimated. The biodeposition of organic material from longline leases was found to have little negative impact on sediment. The eutrophication results indicate that phytoplankton removal had a positive impact on water quality at the Dorada. This case study quantified the direct profitability and bioremediative environmental service advantages that fish-shellfish farms can have relative to fish monocultures.

Simultaneous measurements of the parallel and perpendicular ion temperature with a pinhole probe in the scrape-off-layer of the tokamak ISTTOK

A pinhole probe (PHP) for the simultaneous measurement of the parallel, T(parallel), and perpendicular, T(perpendicular), ion temperature has been designed and tested in the scrape-off-layer (SOL) plasma of the tokamak ISTTOK. The PHP consists of a tunnel immersed into the plasma parallel to magnetic field and an ion collector. One end of the tunnel is covered with a thin foil that has a pinhole sampling ions from the plasma. The other end of the tunnel (close to the negatively biased collector) is covered with a fine-mesh screen. The possibility of performing an analytical description of the PHP current-to-voltage characteristics obtained on the collector when biasing the tunnel simplifies the interpretation of the results. The PHP operation has been previously tested in T(parallel), T(perpendicular) measurements in low temperature weekly magnetized plasma [H. Mase, T. Honzava, and G. Miyamoto, J. Appl. Phys. 49(10), 5171 (1978)]. In this paper, the PHP operation in the SOL of the tokamak ISTTOK is described, and the first results of T(parallel) and T(perpendicular) measurements are presented. The obtained results demonstrate strong (~30%) variation of T(parallel) and T(perpendicular) on a time scale of 0.5 ms, and general predominance of T(parallel) > T(perpendicular) anisotropy (T(parallel mean)/T(perpendicular mean) ~ 1.5) during plasma shot.

Dynamical coupling between gradients and transport in fusion plasmas

The dynamical coupling between density gradients and particle transport has been investigated using similar experimental tools in the plasma boundary of different tokamak (JET, ISTTOK) and stellarator (TJ-II) devices, showing that the size of turbulent events is minimum in the proximity of the most probable density gradient. Experimental results were found to be consistent with results from two very different models of plasma turbulence and transport. The present findings, common to several plasma devices, suggest the importance of self-regulation mechanisms between plasma transport and gradients in fusion devices.

Clinical and radiological results following radial osteotomy in patients with Kienböck’s disease

Radial osteotomy is currently advocated for patients with Lichtman’s stages II and IIIA of Kienböck’s disease; its place in the treatment of patients with stage IIIB disease remains controversial. The purpose of this study was to evaluate the medium-term results of this procedure and to compare the outcome in patients with stage IIIB disease and those with earlier stages (II and IIIA). A total of 18 patients (18 osteotomies) were evaluated both clinically and radiologically at a mean follow-up of 10.3 years (4 to 18). Range of movement, grip strength and pain improved significantly in all patients; the functional score (Nakamura Scoring System (NSSK)) was high and self-reported disability (Disabilities of Arm, Shoulder and Hand questionnaire) was low at the final follow-up in all patients evaluated. Patients with stage IIIB disease, however, had a significantly lower grip strength, lower NSSK scores and higher disability than those in less advanced stages. Radiological progression of the disease was not noted in either group, despite the stage. Radial osteotomy seems effective in halting the progression of disease and improving symptoms in stages II, IIIA and IIIB. Patients with less advanced disease should be expected to have better clinical results.

Incidence of multiple sclerosis in Chile. A hospital registry study

OBJECTIVE

To study the incidence of MS in Chile by examining the hospitalizations across all geographical regions of the country and to examine whether there is a correlation between these rates and the latitude or ultraviolet radiation.

METHODS

This is a descriptive study examining the national registry of hospitalizations because of MS (code G35 in ICD-10) from January 1, 2001, to December 31, 2006. Incidence rates were calculated by gender and geographical region and standardized to the world population estimated for 2010.

RESULTS

A total of 6857 hospitalizations were analyzed. There were 935 individuals; 63.9% were women. The mean incidence rate for 2002-2006 period was 0,90 (95% CI: 0.75-1.05). The annualized incidence rates for regions from North to South were as follows: I Tarapaca 0.54 (95% CI: 0.0-1.21), II Antofagasta 0,93 (0.10-1.75), III Atacama 1.07 (0.0-2.31), IV Coquimbo 0.63 (0.01-1.24), V Valparaiso 0.83 (0.38-1.27), VI O'Higgins 0.72 (0.14-1.30), VII Maule 0.52 (0.06-0.98), VIII BIO BIO 0.81 (0.41-1.21), IX Araucanía 0.43 (0.0-0.86), X Los Lagos 0.91 (0.35-1.46), XI Aysen 0.99 (0.0-2.98), XII Magallanes 3.54 (0.57-6.51), and XIII Metropolitana 1.10 (0.84-1.36). There were no significant correlations between hospitalization rates and latitude, except for region XII. UV radiation levels showed significant differences only for region XII.

CONCLUSION

There is a moderate risk of MS in Chile. The southernmost region showed significantly higher incidence rates than those in the rest of the country (a cluster zone). We did not find any correlation between incidence rates and latitude or UV radiation.

Artoplastia trapeziometacarpiana tipo «ball-and-socket». Resultados a médio prazo

O objectivo deste estudo foi determinar os resultados a médio prazo de uma artroplastia retentiva da base do polegar utilizada para o tratamento da artrose trapezio-metacarpiana (TMC).

Reavaliamos clínica e radiograficamente 20 polegares (20 doentes) com um seguimento médio de 45 meses (R = 57-30).

Utilizando a pontuação de Buck-Gramko concluímos que funcionalmente 19 dos 20 doentes apresentavam um resultado considerado bom ou excelente. A avaliação da força e da mobilidade revelou resultados muito aproximados dos obtidos na mão não intervencionada.

A revisão radiográfica demonstrou a existência de áreas de osteólise rodeando o componente trapeziano em 2 casos, e extensas ossificações envolvendo a neo-articulação em dois casos adicionais.

Na nossa série registamos a presença de 4 complicações: duas fracturas do trapézio, uma luxação e uma perturbação sensitiva transitória.

A prótese trapézio-metacarpiana tem vindo a ganhar progressivamente mais adeptos, pois é clinicamente uma solução muito vantajosa devolvendo ao paciente uma articulação livre de dor, móvel e estável que lhe permite o rápido regresso a bons níveis de actividade e bem estar.

Contudo os achados radiográficos da nossa série levam-nos a recomendar a manutenção de uma atitude prudente e vigilante sobre estes casos que tem vindo a ser submetidos a artroplastias da TMC.

Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position?

Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30° seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face (p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.

Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity

CONTEXT

Body mass index (BMI) is widely used as a measure of overweight and obesity, but underestimates the prevalence of both conditions, defined as an excess of body fat.

OBJECTIVE

We assessed the degree of misclassification on the diagnosis of obesity using BMI as compared with direct body fat percentage (BF%) determination and compared the cardiovascular and metabolic risk of non-obese and obese BMI-classified subjects with similar BF%.

DESIGN

We performed a cross-sectional study.

SUBJECTS

A total of 6123 (924 lean, 1637 overweight and 3562 obese classified according to BMI) Caucasian subjects (69% females), aged 18-80 years.

METHODS

BMI, BF% determined by air displacement plethysmography and well-established blood markers of insulin sensitivity, lipid profile and cardiovascular risk were measured.

RESULTS

We found that 29% of subjects classified as lean and 80% of individuals classified as overweight according to BMI had a BF% within the obesity range. Importantly, the levels of cardiometabolic risk factors, such as C-reactive protein, were higher in lean and overweight BMI-classified subjects with BF% within the obesity range (men 4.3 ± 9.2, women 4.9 ± 19.5 mg l(-1)) as well as in obese BMI-classified individuals (men 4.2 ± 5.5, women 5.1 ± 13.2 mg l(-1)) compared with lean volunteers with normal body fat amounts (men 0.9 ± 0.5, women 2.1 ± 2.6 mg l(-1); P<0.001 for both genders).

CONCLUSION

Given the elevated concentrations of cardiometabolic risk factors reported herein in non-obese individuals according to BMI but obese based on body fat, the inclusion of body composition measurements together with morbidity evaluation in the routine medical practice both for the diagnosis and the decision-making for instauration of the most appropriate treatment of obesity is desirable.

Ion temperature fluctuation measurements using a retarding field analyzer

The retarding field analyzer (RFA) is a widely used diagnostic tool for the ion temperature measurement in the scrape-off-layer (SOL) of the thermonuclear plasma devices. However, the temporal resolution in the standard RFA application is restricted to the ms timescale. In this paper, a dc operation of the RFA is considered, which allows for the measurement of the plasma ion temperature fluctuations. The method is based on the relation for the RFA current-voltage (I-V) characteristic resulted from a common RFA model of shifted Maxwellian distribution of the analyzed ions, and the measurements of two points on the exponentially decaying region of the I-V characteristic with two differently dc biased RFA electrodes. The method has been tested and compared with conventional RFA measurements of the ion temperature in the tokamak ISTTOK SOL plasma. An ion temperature of T(i) = 17 eV is obtained near the limiter position. The agreement between the results of the two methods is within ∼25%. The amplitude of the ion temperature fluctuations is found to be around 5 eV at this location. The method has been validated by taking into account the effect of fluctuations in the plasma potential and the noise contamination, proving the reliability of the results obtained. Finally, constrains to the method application are discussed that include a negligible electron emission from the RFA grids and the restriction to operate in the exponentially decaying region of the I-V characteristic.

Association of increased visfatin/PBEF/NAMPT circulating concentrations and gene expression levels in peripheral blood cells with lipid metabolism and fatty liver in human morbid obesity

BACKGROUND AND AIMS

Nicotinamide phosphoribosyltransferase (NAMPT) is an adipokine with physiological effects on the control of glucose homeostasis as well as potentially involved in inflammation. The association of circulating NAMPT concentrations with obesity has not been clearly established. The aim of the present work was to evaluate the effect of obesity on circulating concentrations and gene expression levels of NAMPT in human peripheral blood cells (PBCs) as well as its involvement in inflammation, glucose and lipid metabolism.

METHODS AND RESULTS

Forty-four serum samples obtained from 14 lean and 30 obese volunteers were used to analyse the circulating concentrations of NAMPT. In addition, PBC, omental adipose tissue (OM) and liver biopsy samples obtained from a subgroup of subjects were used to determine transcript levels of NAMPT by Real-time PCR. Glucose and lipid profile as well as several inflammatory factors and hepatic enzymes were analysed. NAMPT circulating concentrations (P<0.01) and gene expression levels in PBC (P<0.05) were significantly increased in obese patients as compared to lean subjects. Total-cholesterol (P=0.016), HDL-cholesterol (P=0.036) and triglycerides (P=0.050) were significant and independent determinants of circulating concentrations of NAMPT (P<0.01). Moreover, a positive correlation (P<0.01) was found with the hepatic enzymes alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase after BMI adjustment.

CONCLUSION

Our work shows that NAMPT circulating concentrations and mRNA expression levels in PBC are increased in obese patients and that plasma NAMPT levels are related to inflammation, lipid metabolism and hepatic enzymes suggesting a potential involvement in fatty liver disease and in the obesity-associated inflammatory state.

Characteristics of four-channel Cherenkov-type detector for measurements of runaway electrons in the ISTTOK tokamak

A diagnostics capable of characterizing the runaway and superthermal electrons has been developing on the ISTTOK tokamak. In previous paper, a use of single-channel Cherenkov-type detector with titanium filter for runaway electron studies in ISTTOK was reported. To measure fast electron populations with different energies, a prototype of a four-channel detector with molybdenum filters was designed. Test-stand studies of filters with different thicknesses (1, 3, 7, 10, 20, 50, and 100 μm) have shown that they should allow the detection of electrons with energies higher than 69, 75, 87, 95, 120, 181, and 260 keV, respectively. First results of measurements with the four-channel detector revealed the possibility to measure reliably different fast electrons populations simultaneously.

Nitrogen and argon doped zinc oxide

In this work argon and nitrogen were implanted into ZnO single crystals in order to compare the influence of these non-magnetic elements in the magnetic and electrical behaviour of zinc oxide. The results indicate that both nitrogen and argon implantations induce magnetic defects in ZnO, although these do not remain stable upon annealing. The comparison between the electrical behaviour of argon and nitrogen implanted crystals indicates that mobile charge carriers exist in the argon implanted sample after annealing, but were not detected in the nitrogen implanted sample.

Back pain during pregnancy: a longitudinal study

OBJECTIVE

The goal of the present study was to evaluate the prevalence of back pain during four different periods of pregnancy and its action on each woman during this stage.

METHODS

The sample comprises of a group of 49 pregnant women aged between 20 and 39 years. The presence of back pain symptoms and severity were evaluated at 12, 20, 32 and 37 weeks of gestation in each woman, using one question of the NIH Record Activity (ACTRE).

RESULTS

The ANOVA for repeated measures was used to compare the four moments of evaluation (12 weeks, 20 weeks, 32 weeks and 37 weeks) in relation to back pain. A significant difference between the pain scores over the four moments were observed, being that higher pain scores were noted at 12, 32 and 37 weeks of gestation. We also verified that at 12 weeks of gestation 71.4% of women had back pain, while at 20 weeks only 16.3% confirmed pain. At 32 weeks 91.7% of women reported pain and at 37 weeks, 98% reported the same.

CONCLUSION

We found that back pain is prevalent during pregnancy and its intensity varies throughout this period.

Genomics and proteomics approaches to the study of cancer-stroma interactions

Background

The development and progression of cancer depend on its genetic characteristics as well as on the interactions with its microenvironment. Understanding these interactions may contribute to diagnostic and prognostic evaluations and to the development of new cancer therapies. Aiming to investigate potential mechanisms by which the tumor microenvironment might contribute to a cancer phenotype, we evaluated soluble paracrine factors produced by stromal and neoplastic cells which may influence proliferation and gene and protein expression.

Methods

The study was carried out on the epithelial cancer cell line (Hep-2) and fibroblasts isolated from a primary oral cancer. We combined a conditioned-medium technique with subtraction hybridization approach, quantitative PCR and proteomics, in order to evaluate gene and protein expression influenced by soluble paracrine factors produced by stromal and neoplastic cells.

Results

We observed that conditioned medium from fibroblast cultures (FCM) inhibited proliferation and induced apoptosis in Hep-2 cells. In neoplastic cells, 41 genes and 5 proteins exhibited changes in expression levels in response to FCM and, in fibroblasts, 17 genes and 2 proteins showed down-regulation in response to conditioned medium from Hep-2 cells (HCM). Nine genes were selected and the expression results of 6 down-regulated genes (ARID4A, CALR, GNB2L1, RNF10, SQSTM1, USP9X) were validated by real time PCR.

Conclusions

A significant and common denominator in the results was the potential induction of signaling changes associated with immune or inflammatory response in the absence of a specific protein.

Artroplastia total do punho na artrite reumatóide. Resultados dos primeiros 11 doentes operados

Sendo a artrite reumatóide, a principal indicação para a artroplastia total do punho, pretendemos com o este estudo, analisar a experiência com os implantes utilizados na nossa instituição. Avaliamos retrospectivamente 12 próteses colocadas em 11 doentes, utilizando a Universal 2 em 8 casos e a ReMotion em 4. Com um seguimento médio de 33 meses (rango = 15-59), obtivemos melhoria significativa da dor em todos os doentes; registamos incremento das amplitudes articulares e força, em média de 5,8º na flexão, 15,7º na extensão, 3,3º no desvio radial, 6º no cubital, de 22º na pronação, 26º na supinação e 5,4 e 1 kg para força de preensão da mão e de pinça. O DASH, avaliado na maioria dos doentes, teve melhoria média de 19 pontos. Como complicações houve um hematoma e uma deiscência com necrose dos bordos da ferida cirúrgica; um caso revelou sinais de descelamento do componente radial, no entanto sem repercussões significativas no resultado clínico e não registamos instabilidades. Até à data, nenhum doente foi reoperado. A artroplastia total punho revelou-se um procedimento eficaz no tratamento da artrite reumatóide, com uma baixa taxa de complicações. Apesar de não possuirmos tempo de evolução a longo prazo, os implantes revelaram uma fixação estável ao osso na grande maioria dos casos.

Prótese total do cotovelo: análise retrospectiva a médio prazo dos 10 primeiros casos

Actualmente, a artrite reumatóide e a artrose pós traumática constituem as principais indicações para a realização de uma artroplastia total do cotovelo. O objectivo deste estudo é analisar os resultados a médio prazo da experiência inicial na nossa instituição. Secundariamente quisemos procurar diferenças entre próteses não-constritivas e as semi-constritivas. Para tal foram revistos retrospectivamente dez casos consecutivos (oito de artrite reumatóide e dois de artrose pós-traumática) correspondentes a sete mulheres e dois homens com idade média de 48 anos com um seguimento médio de 34 meses. O valor médio da escala visual da dor baixou significativamente, de 7.9 para 2.4 (t = 3.145; p = 0.012), após a cirurgia. A flexão média foi 118.5º (r = 85-145) com défice de extensão médio de 24º (r = 5-50); pronação média de 84º (r = 75-90) e supinação 80.5º (r = 30-90). Em termos funcionais o Mayo Elbow Performance Score médio foi 87.5 (r = 55-100). Entre os dois conceitos de próteses utilizados a única diferença significativa encontrada foi um menor arco de mobilidade nas próteses não-constritivas: 77.5º vs 105.8º (t = 5.143; p = 0.014). Este estudo confirma a artroplastia total do cotovelo como uma opção válida na nossa instituição.

Limits on the spin-dependent WIMP-nucleon cross sections from the first science run of the ZEPLIN-III experiment

We present new experimental constraints on the WIMP-nucleon spin-dependent elastic cross sections using data from the first science run of ZEPLIN-III, a two-phase xenon experiment searching for galactic dark matter weakly interacting massive particles based at the Boulby mine. Analysis of approximately 450 kg x days fiducial exposure allow us to place a 90%-confidence upper limit on the pure WIMP-neutron cross section of sigma(n)=1.9x10(-2) pb at 55 GeV/c(2) WIMP mass. Recent calculations of the nuclear spin structure based on the Bonn charge-dependent nucleon-nucleon potential were used for the odd-neutron isotopes 129Xe and 131Xe. These indicate that the sensitivity of xenon targets to the spin-dependent WIMP-proton interaction could be much lower than implied by previous calculations, whereas the WIMP-neutron sensitivity is impaired only by a factor of approximately 2.