Comparison of droplet digital PCR vs real-time PCR for Yersinia enterocolitica detection in vegetables.

Yersiniosis - the 4th most commonly reported zoonosis in the European Union - is caused by the consumption of food contaminated with the bacterium Yersinia enterocolitica. The number of human cases and contaminated food samples is probably underestimated since conventional molecular methods currently proposed for Yersinia enterocolitica detection proved to have several limitations. Critical issues associated with the detection of Yersinia enterocolitica in meat and/or meat product has already been investigated, whereas data on the possible limits of the molecular methods for Yersinia enterocolitica detection in vegetables are still lacking. According to ISO method (ISO 18867:2015), real-time polymerase chain reaction (rtPCR) should be adopted for Yersinia enterocolitica detection, even if it proved to be affected by some biases. Recently, Droplet Digital PCR (ddPCR) has been introduced as a useful tool to detect and quantify different pathogenic bacteria in complex food matrices. However, its potential application for Yersinia enterocolitica detection in vegetables has never been investigated before. In the present study two molecular platforms (rtPCR and ddPCR) were used to evaluate the pathogen's behaviour in experimentally contaminated leafy greens (Lactuca sativa L.) and to assess the rate of detection achievable after the incubation for eleven days at different temperatures. By comparing, noticeable differences emerged between the two technical approaches: only ddPCR allowed the detection of the pathogen in leafy greens when contaminated at low levels. Moreover, results of the present work highlighted the importance of length and temperature of incubation on the survival and/or the growth of Yersinia enterocolitica in vegetables: at 18 and 25 °C the concentration of the pathogen considerably decreases along incubation. Based on data, the use of rtPCR leads to an underestimation of the true prevalence of pathogenic Y. enterocolitica in vegetables, while temperature and time currently proposed for Y. enterocolitica (25 °C for 24 h), allow optimizing detection. To conclude, ddPCR may be undoubtedly proposed as a reliable alternative strategy for the quick detection of the pathogen in food samples.

Head pre-cooling improves 5-km time-trial performance in male amateur runners in the heat.

This study aimed to evaluate the effect of head pre-cooling on the 5-km time-trial performance of amateur runners in the heat. In a counterbalanced design, 15 male amateur runners (22.6 ± 3.5 y; VO2 max in heat 42.3 ± 4.4 mLO2 /kg/min) completed two 5-km time trials performed in the heat (35°C, 50% relative humidity). In one trial (HCOOL), participants underwent 20 min of head cooling in a temperate environment (23°C, 70% relative humidity) prior to exercise. In another trial (CON), exercise was preceded by 20 min of rest under the same temperature conditions. Exercise time was shorter in HCOOL (25 min and 36 s ± 3 min) compared to CON (27 ± 3 min; p = 0.02). Rectal temperature was reduced during the pre-exercise intervention in HCOOL (p < 0.001), but not in CON (p = 0.55). Relative changes in rectal temperature and mean head temperature were lower throughout HCOOL when compared with CON condition (p = 0.005 and p = 0.022, respectively). Mean skin temperature, heart rate, and rating of perceived exertion did not differ between HCOOL and CON conditions throughout exercise (p = 0.20, p = 0.52 and 0.31, respectively). Thermal comfort was lower in HCOOL condition in pre-exercise (p = 0.014) with no differences observed throughout exercise (p = 0.61). 5-km running performance in a hot environment was improved after a 20-min head cooling intervention, suggesting that this method may be practical as pre-cooling strategy and easily administered to both professional and amateur runners alike.

Low-fat, lactose-free and leucine-enriched chocolate cow milk prototype: A preliminary study on sensorial acceptability and gastrointestinal complaints following exhaustive exercise.

BACKGROUND: Chocolate milk has gained recent scientific support as a recovery drink. However, it is known that high exercise-demand triggers gastrointestinal discomfort which continues post-exercise, thereby hindering this nutritional strategy. In addition, those who are lactose intolerant cannot benefit from a milk-based beverage. Thus, the aim of this preliminary study was to develop a low-fat, lactose-free, and leucine-enriched chocolate cow milk prototype (CML) representing nutrition-related recommendations for football players, as well as assess athletes' individual subjective outcomes for gastrointestinal complaints and sensorial acceptability in a field-based setting following strenuous team-sport physical demands. METHODS: This study followed a single group and repeated-measured design with 10 football players (23 ± 2 yrs., 74 ± 14 kg, 174 ± 5 cm) who consumed CML following a 90-min football match simulation protocol (FMP). The total CML intake to achieve 0.150 g leucine·kg [BW]·h- 1 occurred in aliquots of 50, 30 and 20% at 0-, 45- and 75-min post-FMP, respectively. Athletes were evaluated by the prevalence, the type and severity (bloating, nausea, flatulence, and gastric reflux) of gastrointestinal complaints and sensorial acceptability (overall perception, appearance, consistency, and flavour) after drinking each aliquot in a 4-h recovery period. RESULTS: The CML showed higher scores for "Product Acceptability Index" (88%) and sensorial acceptability (~ 8 in 9-point hedonic scale). Kendall's W with bootstrapped resample (95%CI) revealed agreement among respondents as "moderate" (overall perception, flavour) to "strong" (appearance, consistency) and with no significant agreement differences between rater response in the timeline analysis (0.57 up to 0.87; p > 0.05). Agresti-Caffo add-4 analysis (95% confidence interval, [95%CI]) revealed no differences in each time-point analysis versus baseline for athletes classified as having severe gastrointestinal symptoms, but confirmed concern with bloating (three athletes showed a transient response at 2-h and only one continued until 3-h; p = 0.051). CONCLUSIONS: These preliminary findings suggest that CML presents good taste and high acceptability by the sampled athletes. Thus, CML may be an alternative sport drink for immediate post-workout supplementation to overcome the energy deficit, offer co-ingested leucine, maintain palatability and adherence including lactose intolerance following a team sport-specific fatigue. TRIAL REGISTRATION: RBR-2vmpz9 , 10/12/2019, retrospectively registered.

Muscle Damage-Based Recovery Strategies Can Be Supported by Predictive Capacity of Specific Global Positioning System Accelerometry Parameters Immediately a Post-Soccer Match-Load.

ABSTRACT: da Silva, CD, Machado, G, Fernandes, AA, Teoldo, I, Pimenta, EM, Marins, JCB, and Garcia, ES. Muscle damage-based recovery strategies can be supported by predictive capacity of specific global positioning system accelerometry parameters immediately after soccer match-load. J Strength Cond Res 35(5): 1410-1418, 2021-Soccer match-load can be linked to recovery kinetic markers. However, match variability hinders the magnitude of relationship between parameters of interest. Therefore, we examined the correlation between 21 global positioning system accelerometry (GPS-A) parameters and changes in serum creatine kinase (CK) concentrations, muscle soreness (MS), and perceptive recovery quality (PRQ) assessed at baseline (1 h before) and post (0 minute, 2, 4, and 24 hours) a standardized 90-minute match-simulation in 20 university players. Global positioning system accelerometry (15 Hz) data were tested as manufacturer and configurable thresholds. Four GPS-A parameters showed moderate to very large correlations with CK changes at all time points (average speed [avgSP, r = 0.75 to r = 0.84]; running symmetry foot strikes [RSfst, r = 0.53-0.63]; running series [RunS, r = 0.53-0.61]; and acceleration distance [AccD ≥ 1.5 m·s-2; r = 0.46-0.61]). Sprint count (≥2 m·s-2), AccD (≥2.5 m·s-2) and speed exertion (SpEx) had a moderate to large correlation (r = 0.46-0.56) with CK changes from 2 to 24 hours. Changes in MS at 0 minute had large correlation with avgSP (r = 0.53) and moderate with deceleration distance (≥-2 and ≥-3 m·s-2; r = 0.47, r = 0.48, respectively). The PRQ changes had moderate inverse correlation with avgSP at 0 minute (r = -0.39) and SpEx at 2 h (r = -0.69). Our results suggest that during a simulated soccer protocol with a standard workload, only the avgSP has practical application for predicting CK changes over 24 hours, allowing for a decision-making toward a postgame recovery based on previously known CK cutoff points. Global positioning system accelerometry parameters and subjective variables did not demonstrate relevant correlation.

Yersinia enterocolitica detection in pork products: Evaluation of isolation protocols.

Conventional methods for Yersinia enterocolitica detection in food samples are generally considered inadequate. Problems arise from the presence of the so-called "background flora", coupled to the low contamination level of the pathogen. Since, data on the microbial ecology occurring in competitive microflora are still lacking, MALDI TOF MS was used for strains 'identification after enrichment in PSB or ITC broths, and after plating on selective CIN medium at different incubation times. SYBR Green Real time PCR was used for the Y. enterocolitica strains' detection (4/O:3, 1A/O:5) in experimentally contaminated foods, as well as in naturally contaminated samples. A higher number of different bacterial genera (10 on CIN and 18 on PCA) was recorded after enrichment in PSB, whilst enrichment in ITC led to recovery of 6 and 10 genera on CIN and PCA, respectively. Yersiniaceae was the dominant family on the first day of incubation, but on the second day the percentage of isolation considerably decreased. By testing experimentally contaminated samples, substantial difficulties were encountered. The biotype 1A was always detected, whereas strain 4/O:3 proved to be poorly competitive. Based on the data, the enrichment media PSB and ITC, currently proposed for Y. enterocolitica detection, need to be improved to promote a successful pathogen's recovery.

External Validity of the T-SAFT90: A Soccer Simulation Including Technical and Jumping Activities.

PURPOSE: To examine the physiological, muscle-damage, endocrine, and immune responses to a modified soccer-simulation protocol to include technical and jumping activities characteristic of match play (the Technical Soccer-Specific Aerobic Field Test; T-SAFT90). METHODS: Eighteen university players (age 23 [2] y, stature 175 [5] cm, body mass 74 [11] kg) performed the 90-minute protocol, with acute physiological responses monitored via heart rate, ratings of perceived exertion (6-20 scale), and body mass changes. Creatine kinase, myoglobin, cortisol, and leukocyte subset concentrations were measured at baseline, immediately (0 h), and 24 hours post T-SAFT90. RESULTS: T-SAFT90 incurred an average heart rate equivalent to 87% (5%) of maximum, 16 (2) a.u. ratings of perceived exertion, and a 1.5% (1.0%) body mass deficit. Moderate to large proliferation of leukocyte subsets (P ≤ .01; leukocytes: 6.4-fold; neutrophils: 5.5-fold; lymphocytes: 2.0-fold) and increases in cortisol (2.3-fold) were observed at 0 hours (effect size = 1.13-3.52), each returning to baseline by 24 hours (P > .45; effect size = 0.05-0.50). Myoglobin peaked immediately post T-SAFT90 (4.8-fold), whereas creatine kinase (24 h: 6.0-fold) showed a delayed time course (both P ≤ .001; very large effects; effect size = 2.66 and 3.43, respectively). CONCLUSIONS: The magnitude and time course of the physiological, immune, endocrine, and muscle-damage markers observed during and following T-SAFT90 are similar to values reported in match-play literature, demonstrating external validity of the simulation.

Avian haemosporidians in the cattle egret (Bubulcus ibis) from central-western and southern Africa: High diversity and prevalence.

We described the geographic distribution of 82 haemosporidian lineages (Plasmodium, Haemoproteus, and Leucocytozoon) in the cattle egret sampled in five countries in central-western and southern Africa. Seventy-three lineages have not previously been reported. We determined the prevalence of three haemosporidians in the samples. We investigated the influence of the internal environment of the host and environmental variables on the Plasmodium diversity and whether environmental variables may explain spatial variations in the prevalence of Plasmodium. We screened DNA from 509 blood samples from nestlings in 15 African colonies for infection by sequencing the cytochrome b gene of parasites. The molecular phylogenetic analysis was performed using Bayesian methods and including sequences from the MalAvi and GeneBank databases. We found 62 new Plasmodium lineages in a clade with MYCAME02, which is a lineage described in waterbirds and recently identified in birds of prey as Plasmodium paranucleophilum. Two Haemoproteus lineages identified in cattle egret formed a distinct group with Haemoproteus catharti and MYCAMH1 (Haemoproteus spp.). Seven Leucocytozoon lineages found in the cattle egret clustered with Leucocytozoon californicus. We found different Plasmodium diversities among the colonies sampled, demonstrating that the internal environment of the host is not the primary determinant of diversity. A linear mixed-effects multivariate model showed that precipitation was positively associated with Plasmodium diversity when controlling for the effects of temperature, colony composition (mixed and non-mixed species) and country. Moreover, a generalized mixed model showed that temperature was positively associated with the prevalence of Plasmodium when controlling for precipitation, elevation and country. We conclude that the cattle egret is a good model for future haemosporidian studies, as we found a significant number of new lineages in this host, which occupies regions with different climate characteristics where environmental variables exert an influence on the diversity and prevalence of Plasmodium.

Match internal load in youth elite soccer players is period, playing position and intermittent running capacity dependent

The aims of this study were: i) to verify whether player internal load (PIL) monitored via heart rate (HR) varies with game-time and playing position; ii) whether intermittent running capacity (IRC) is related to the maintenance of within-match PIL in elite youth (U-15) soccer players. Method: Twenty-one elite soccer players (14±0.5 yrs, 172±7 cm, 63±6 kg) had their heart rate monitored (beats/min) in five matches and were tested twice for IRC (Yo-YoIR2, distance [m]) over a seven-week competitive season. Percentage of maximal heart rate (%HRmax) and time spent (TS%) in five zones (Z1[<70%]; Z2[71-85%]; Z3[86-90%]; Z4[91-95%] and Z5[>96%]) were our PIL indexes. Data from three complete games in the same position of each player were analyzed and matches halves, time intervals (T1 to T6), and playing positions (fullbacks, central defenders and forwards [N=5 each], midfielders [N=6]) were compared, and the relationship between IRC and within-match PIL was determined. Results: PIL was higher in 1st (86±3%) than in the 2nd half (84±4%; p<.001). The 2nd half had more TS% in Z1 and Z2 (p<.05). PIL in T4 was the lowest (p<.01), and in T6, it was lower than T1 and T2 (p<.01). Fullbacks and midfielders showed higher PIL and higher TS% in Z4 (p<.05) than the other positional roles. The average IRC correlated with PIL in T6 (r=.56, p<.01) only. Conclusion: In conclusion, the internal load in elite youth (U-15) soccer players varies with game-time and playing position; and their IRC is related to the maintenance of within-match PIL.(AU)

Physical Activity during a Prolonged Congested Period in a Top-Class European Football Team.

PURPOSE: The aim of the present study was to examine the variation in physical activity of elite soccer players within successive prolonged periods of fixture congestion over 5 months of competition during the competitive season 2011-2012. METHODS: Sixteen international players, classified into 6 positions (central defenders: CD; full-backs: FB; central defensive midfielders: CDM; wide midfielders: WM; central attacking midfielders: CAM; forwards: FW), were examined during the French First League, French Cup, and UEFA Champion's League matches. The total distance covered at light (<12 km.h(-1)), sustained-cruising (>18-21 km.h(-1)), high (>21-23 km.h(-1)), very high (>23-25 km.h(-1)), sub-maximal (>25-27 km.h(-1)), and maximal (>27 km.h(-1)) intensity running (IR) were measured and analysed using a semi-automatic match analysis system (Amisco Pro™). RESULTS: No differences were observed between congested and non-congested periods (two vs. one match a week, respectively) for the total distance covered at all the speed thresholds over 18 km.h(-1), with no variation in physical fitness over the 5 studied months. Specifically to the playing positions, regardless of the congestion periods, FB and WM covered more distance than CDM over 21km.h(-1); FB, WM and FW covered similar distances for all running intensities; and CD and CDM covered shorter distance during non-congested compared to congested periods (P<0.05) at light-IR. CONCLUSION: The present study reveals that prolonged congested match fixture did not affect the high-intensity physical activity of top-class soccer players during official games during a 5 months fixture period.

Inferred kinship patterns reveal low levels of extra-pair paternity in the endangered Neotropical Jabiru Stork (Jabiru mycteria, Aves: Ciconiiformes).

The present study inferred the genetic mating system in a natural breeding population of the Jabiru Stork (Jabiru mycteria), a Neotropical wading bird considered endangered in part of its distribution range. Based on data from eight microsatellite loci, maximum-likelihood kinship reconstruction techniques, parentage assignment analyses and effective population size (Ne) estimates were applied to samples collected in the Brazilian Pantanal wetland (N = 45 nestlings from 20 nests; N = 17 shed adult feathers from 11 nests). The relationship diagnosis was determined for most of the complete clutches (86.66 %): 92.31 % were full siblings and 7.69 % were half siblings. Shed feathers collected from the nests matched the genetic parents of the offspring in 80 % of cases. Feathers collected from the ground below the nests were compatible with the putative parents in 41.67 % of cases. A mean Ne of 35 reproductive individuals was inferred, corresponding to an Ne/Nc ratio of 0.09, which is similar to the ratio found in populations of a number of different wild animals. The higher proportion of full siblings identified in the broods suggests that genetic monogamy is the prevalent mating system in the Jabiru Stork, while the detection of half siblings suggests some degree of extra-pair paternity. The present findings are in agreement with previous ecological observations of social monogamy in this species, despite the isolated evidence of extra-pair copulation events. This study also demonstrates the usefulness of a noninvasive approach to sampling adults and performing parentage and relatedness analyses in an elusive, threatened species.

New insights into mutable collagenous tissue: correlations between the microstructure and mechanical state of a sea-urchin ligament.

The mutable collagenous tissue (MCT) of echinoderms has the ability to undergo rapid and reversible changes in passive mechanical properties that are initiated and modulated by the nervous system. Since the mechanism of MCT mutability is poorly understood, the aim of this work was to provide a detailed morphological analysis of a typical mutable collagenous structure in its different mechanical states. The model studied was the compass depressor ligament (CDL) of a sea urchin (Paracentrotus lividus), which was characterized in different functional states mimicking MCT mutability. Transmission electron microscopy, histochemistry, cryo-scanning electron microscopy, focused ion beam/scanning electron microscopy, and field emission gun-environmental scanning electron microscopy were used to visualize CDLs at the micro- and nano-scales. This investigation has revealed previously unreported differences in both extracellular and cellular constituents, expanding the current knowledge of the relationship between the organization of the CDL and its mechanical state. Scanning electron microscopies in particular provided a three-dimensional overview of CDL architecture at the micro- and nano-scales, and clarified the micro-organization of the ECM components that are involved in mutability. Further evidence that the juxtaligamental cells are the effectors of these changes in mechanical properties was provided by a correlation between their cytology and the tensile state of the CDLs.

Exercise intensity and technical demands of small-sided games in young Brazilian soccer players: effect of number of players, maturation, and reliability.

The aims of this study were to examine in young soccer players (a) the effect of varying the number of players on exercise intensity (EI) and technical actions during small-sided games (SSGs), (b) the reliability of EI and technical actions, and (c) the influence of the players' maturation on EI and involvements with the ball (IWBs). Sixteen male soccer players (mean ± SD; age 13.5 ± 0.7 years, height 164 ± 7 cm, and weight 51.8 ± 8 kg) completed 2 bouts of 3 vs. 3 (SSG3), 4 vs. 4 (SSG4), and 5 vs. 5 (SSG5) training. Exercise intensity was measured using heart rate and expressed as a percentage of maximal heart rate (%MHR). Technical actions were quantified from video recordings. Maturation stage was determined with the Tanner scale. Exercise intensity in SSG3 (89.8 ± 2%MHR) was higher (p < 0.003) than that in SSG5 (86.9 ± 3%MHR). The EI in the first set (86.8 ± 4%MHR) was lower (p < 0.001) than that in the second (89.1 ± 3%MHR) and in the third set (89.4 ± 3%MRH). No effects of number of players were found in IWB, passes, target passes, tackles, and headers. Significantly more crosses, dribbling, and shots on goal were observed during SSG3 compared to during SSG4 or SSG5 (p < 0.05). The typical error for EI, expressed as coefficient of variation, ranged from 2.2 to 3.4%. The reliability for the most frequent technical actions ranged from 6.8 to 19.3%. The level of maturation was not correlated with either EI or IWB. These results extend previous findings with adult players suggesting that SSGs can provide an adequate training stimulus for young players and are feasible for groups with heterogeneous maturation levels.

Paralisia de Bell subsequente a ritidoplastia / Bell’s palsy subsequent to rhytidectomy

A paralisia facial periférica é uma entidade que pode deixar sequelas estéticase funcionais importantes nos pacientes. De acordo com a literatura, a paralisia de Bell (PB) é a causa mais comum, representando de 50 a 80% dos casos. Porém deve ser considerada como diagnóstico de exclusão. Estima-se uma prevalência ligeiramente maior entre as mulheres e sua incidência é bimodal, com picos na terceira e oitava décadas de vida. A maioria dos pacientes evolui para a recuperação dentro de algumas semanas, embora seja comum uma piora do quadro nas primeiras 48 horas. O tratamento deve ser realizado no sentido de prevenir complicações e as condutas medicamentosas não estão consagradas. Como fatores de risco para a PB têm sido relatados hipertensão arterial, diabete mellitus, gravidez, puerpério e infecção pelo vírus herpes tipo I. Embora existam vários fatores de risco associados à PB, em relação à cirurgia de face-lifting existe apenas um caso relatado na literatura. Relato do Caso: No presente estudo, os autores descrevem o segundo caso de paralisia de Bell após a cirurgia de face-lifting.

The peripheral facial palsy is a disease that can leave significant aestheticaland functional sequelae in patients. According to medical literature, Bell’s palsy (BP) is the most common cause, representing from 50 to 80% of the cases. However, it must be considered as an exclusion diagnosis. A slightly higher prevalence is estimated in women and its incidence is bimodal with peaks in the third and eighth life decades. Most patients recover within weeks, though a worsening degree may be common in the first 48 hours. Treatment must be performed to prevent complications and the medical procedures are not universally accepted. The following have been mentioned as BP risk factors: arterial hypertension, mellitus diabetes, pregnancy, puerperium and infection caused by type I herpesvirus. Although there are several BP associated risk factors, regarding face-lifting surgery there is only one reported case in medical literature. Case Report: In the present study, the authors describe the second case of Bell’s palsy after face-lifting surgery.

Abnormal pressure waves in headache sufferers with bilateral transverse sinus stenosis.

INTRODUCTION: Bilateral transverse sinus stenosis (BTSS) has been reported to be associated with idiopathic intracranial hypertension without papilloedema in headache sufferers. SUBJECTS AND METHODS: To test the accuracy of short-term cerebrospinal fluid (CSF) pressure monitoring through a lumbar needle for detection of elevated intracranial pressure in headache sufferers with BTSS, we prospectively performed lumbar puncture in order to measure lumbar CSF opening pressures and to monitor, for 1 h, the CSF pressure in 48 consecutive headache sufferers with BTSS and in 50 consecutive headache sufferers with normal appearance of transverse sinuses or stenosis of one transverse sinus. RESULTS: Of the 48 headache sufferers with BTSS, 18 (37.5%) had elevated CSF opening pressure and abnormal pressure waveforms, but short-term CSF pressure monitoring revealed abnormal pressure waves associated with elevated mean CSF pressure also in 26 (86.6%) out of 30 patients who had normal opening pressures. None of the 50 headache sufferers with normal appearance of transverse sinuses or stenosis of one transverse sinus had abnormal pressure waves and elevated CSF pressures. CONCLUSIONS: In this study, short-term CSF pressure monitoring through a lumbar needle revealed abnormal pressure waves and elevated mean CSF pressures in the majority of headache sufferers with BTSS who had normal CSF opening pressures. These findings demonstrate the accuracy of short-term CSF pressure monitoring through a lumbar needle in estimating CSF pressure; they also highlight that a single-spot opening pressure measurement has a low accuracy for recognition of increased intracranial pressure in headache sufferers with BTSS.

The upper limit of normal CSF opening pressure is related to bilateral transverse sinus stenosis in headache sufferers.

There are limited data on the relationship between normal cerebrospinal fluid (CSF) opening pressure and bilateral transverse sinus stenosis (BTSS); there are also several conflicting reports about the upper limit of normal CSF opening pressure. To evaluate the influence of BTSS on the upper limit of normal CSF opening pressure, we prospectively recorded lumbar CSF opening pressures in 217 adult patients with neurological symptoms who underwent cerebral magnetic resonance venography (MRV). The CSF opening pressures ranged between 65 and 286 mmH(2)O (mean = 149.3, s.d. = 47.5). The upper limit of opening pressure in patients with both normal appearance of transverse sinuses and unilateral transverse sinus stenosis on MRV (n = 167) was 195 mmH(2)O with a range of 65-195 mmH(2)O. All patients with BTSS were headache sufferers, and the upper limit of opening pressure in patients with BTSS (n = 50) was 286 mmH(2)O with a range of 91-286 mmH(2)O. All patients with opening pressures > 200 mmH(2)O displayed BTSS, whereas only 13% of patients with a pressure < 200 mmH(2)O displayed BTSS. Our findings demonstrate that the upper limit of normal CSF opening pressure is related to BTSS, and they also highlight that headache sufferers with opening pressures > 200 mmH(2)O should be tested for BTSS by MRV.

Análise do comportamento histopatológico do melanoma fundamental para uma boa prática na cirurgia plástica / Histopathological melanoma behavior analysis fundamental for a good practice

Introdução: O cirurgião plástico trata pacientes com os mais variados tipos de lesões depele, sendo que invariavelmente se defronta com o melanoma, que constitui uma lesãomaligna de pele e mucosas e representa 3% a 4% das neoplasias malignas da pele. É ocarcinoma cutâneo mais agressivo. Método: Foram estudados 116 casos de melanomadiagnosticados no laboratório de patologia. Os dados obtidos em relação a gênero, idade,margens, espessura de Breslow, nível de clark, índice mitótico e presença ou ausência deregressão, e ulceração foram cruzados e analisados estatisticamente. Resultados: No estudo,67,2% dos pacientes correspondiam a mulheres e 32,8%, a homens. A idade média foi de56 anos. Não houve diferença de idade estatisticamente significante entre os sexos. Houvepredominância histológica do tipo difusão superficial com 62,7% e nodular com 18,1%. Nãohouve associação estatisticamente significante entre: regressão e índice BC, sexo e índiceBC, tipo histológico e regressão, tipo histológico e sexo, índice mitótico e tipo histológicodo tumor, invasão angiolinfática, margens livres ou comprometidas ou com presença ouausência de regressão (p > 0,005). Houve forte associação estatisticamente significante entreinvasão angiolinfática e índice Bc, tipo histológico e índice Bc, tipo histológico e invasãoangiolinfática, tipo histológico e ulceração, e na relação índice mitótico e índice Bc (p <0,005). Conclusão: O tratamento desta afecção necessita de um profundo conhecimento deseu comportamento histológico, pois baseado neste conhecimento é planejado o tratamentocirúrgico inicial, sendo possível prever o prognóstico e evolução da doença.

Introduction: The plastic surgeon often treats patients with the most varied types of skininjuries, and, undoubtedly faces the melanoma, which consist a malignancy of skin andmucosa and represents 3% to 4% of the malignant skin neoplasias. It is the most aggressivecutaneous carcinoma. Methods: Were studied 116 diagnosed cases of melanoma atthe pathology laboratory. The collected data concerning gender, age, margins, Breslow’sthickness, Clark’s level, mitotic index and presence or absence of regression, and ulcerationwere statistically analyzed and compared. Results: The patients corresponded 67.2%to women and 32.8% to men. The average age was of 56 years. There was no statisticallysignificant difference between the genders. There was a histological predominance of thesuperficial diffusion type with 62.7% and nodular with 18.1%. There was no statisticallysignificant association between: regression and BC index, sex and BC index, histological typeand regression, histological type and sex, mitotic index and histological type of the tumor,angiolymphatic invasion, free or implicated margins or with either presence or absence ofregression (p > 0.005). There was a statistically significant strong association between angiolymphaticinvasion and BC index, histological type and BC index, histological type andangiolymphatic invasion, histological type and ulceration, and in the relationship mitoticindex and BC index (p < 0.005). Conclusion: The treatment of this pathology demands aprofound knowledge of its histological behavior, as based on this knowledge the initial surgicaltreatment is planned, enabling foreseeing the prognosis and evolution of the disease.

Tratamento cirúrgico do melanoma cutâneo com o auxílio da cintilografia do linfonodo sentinela: estudo de 16 casos / Radioguided sentinel lymph node on surgical treatment of malignant cutaneous

Introdução: O melanoma cutâneo representa 3 a 4% das neoplasias malignas da pele. É ocarcinoma cutâneo mais agressivo, possuindo as mais altas taxas de morbidade e mortalidade.Objetivo: Descrever um estudo sobre o tratamento cirúrgico da lesão primária do melanomacutâneo, juntamente com a pesquisa do linfonodo sentinela por cintilografia realizadacom tecnécio 99. Método: Foram estudados dezesseis casos, no período de março de 2003 ajunho de 2006, sendo todos os pacientes submetidos ao mesmo protocolo de tratamento. Ospacientes foram avaliados quanto a idade, sexo, cor, características da lesão, estadiamentoassociado ao tratamento da lesão e da metástase linfonodal, quando presente. Resultados: Amaioria dos pacientes estudados era do sexo feminino (75%), e a faixa etária mais comumfoi de 41 a 60 anos. A localização da lesão cutânea primária foi predominante no tronco,e o tipo histológico mais encontrado foi o melanoma superficial. Com relação à espessurae ao estadiamento da lesão, os tipos mais encontrados foram: III de Clark, 1,51 a 4 mm deBreslow e IA. Conclusão: Concluiu-se que o uso da cintilografia do linfonodo sentinelae sua biópsia é de grande valor no estadiamento destes tumores, restringindo a indicaçãode linfadenectomias alargadas e, consequentemente, reduzindo a morbidade a curto prazo.

Introduction: The melanoma skin represents 3 to 4% of malignancies of the skin. It is themost aggressive skin cancer, with the highest rates of morbidity and mortality. Objective:To report a study of surgical treatment for primary lesions of cutaneous melanoma andthe sentinel lymph node detection through labeled technetium-99 cintilography. Method:Sixteen subjects, who had been studied from March 2003 to June 2006, were submittedto the same treatment protocol. Patients were analyzed according to age, sex, skin color,characteristics, treatment and stage of lesion as well as of lymph node metastasis, whenpresent. Results: Most patients were female (75%), and the most common age group was41 to 60 years. The primary location of the skin lesion was predominant in the trunk, andhistological type found more common was superficial melanoma. About the thickness andstaging types of injury were more found: Clark III, 1.51 to 4 mm Breslow and IA. Conclusion:One highlights the great importance of the sentinel lymph node in the tumoral stagingas well as its helpfulness in choosing the appropriate management in each case. It leads toa restriction of the enlarged lymphadenectomy procedure and, consequently, a reduction inshort-term morbidity.

Bilateral transverse sinus stenosis and idiopathic intracranial hypertension without papilledema in chronic tension-type headache.

Previous MR studies have established that bilateral transverse sinus stenosis (BTSS) predicts idiopathic intracranial hypertension without papilledema (IIHWOP) in migraine. However, it is uncertain whether BTSS identifies IIHWOP in patients with chronic tension-type headache (CTTH): using cerebral MR venography this study aimed to address this question.In a prospective study from February 2002 to December 2006, 198 consecutive patients with CTTH underwent MR venography. Of these patients, 58 underwent lumbar puncture to measure cerebrospinal fluid (CSF) pressure. MR venography and lumbar puncture were also performed in 45 age-matched control subjects. BTSS was considered present when the signal flow was poor or lacking (flow gap) in the mid-lateral portion of both transverse sinuses. IIHWOP was diagnosed if the patient met the diagnostic criteria for idiopathic intracranial hypertension and did not have papilledema. Among the 198 patients with CTTH who underwent MR venography, 18 (9%) had BTSS. Thirteen of these 18 patients with BTSS underwent lumbar puncture, and nine (69.2%) had IIHWOP. CSF opening pressure was normal in all 45 patients as well as in all 45 controls with normal MR venography.These data suggest that BTSS on MR venography is associated with increased intracranial pressure in the absence of papilledema in patients with headache mimicking CTTH.

Postpartum headache: is your work-up complete?

OBJECTIVE: Headache is a common finding in the postpartum period, and there are limited data describing the cause and treatment of women with postpartum headache. Our objective was to describe our experience with women who were hospitalized for postpartum headache and to develop a management algorithm for these women. STUDY DESIGN: Data for 95 women with headache >24 hours after delivery from 2000-2005 were reviewed retrospectively. Maternal assessment included an evaluation for benign and serious causes of headache that included preeclampsia, dural puncture, and neurologic lesions. Neurologic imaging were performed on the basis of initial neurologic findings and clinical course. Outcomes that were studied included cause, a need for cerebral imaging, neurologic findings, maternal complications, and long-term follow-up evaluations. RESULTS: The mean onset of headache was 3.4 days (range, 2-32 days) after delivery. Tension-type/migraine headache was the most common cause (47%). Preeclampsia/eclampsia and spinal headache comprised 24% and 16% of cases, respectively. Anesthesia evaluation was required in 15 patients because of suspected spinal headache; blood patch was required in 12 of these patients. Cerebral imaging was performed in 22 patients because of focal neurologic deficits and/or failure to respond to initial therapy; 15 of these women (68%) had abnormal findings. Ten patients had serious cerebral pathologic findings, such as hemorrhage, thrombosis, or vasculopathy. There were no deaths; 2 women had minor residual neurologic damage on follow-up evaluation. CONCLUSION: The evaluation of persistent headaches that develop >24 hours after delivery must be performed in a stepwise fashion and requires a multidisciplinary approach. Preeclampsia should be considered initially in women with hypertension and proteinuria. Normotensive women should be evaluated initially for tension-type/migraine headache or spinal headache. Patients with headache that is refractory to usual therapy and patients with neurologic deficit require cerebral imaging to detect the presence of life-threatening causes.

Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine.

BACKGROUND: The headache profile of patients with idiopathic intracranial hypertension without papilledema (IIHWOP) may be indistinguishable from that of migraine. Bilateral transverse sinus stenosis (BTSS) has been found in the majority of patients with IIHWOP. The frequency of BTSS associated with IIHWOP in patients with migraine is unknown. OBJECTIVE: To detect the frequency of BTSS in adult patients with migraine and to investigate whether the presence of BTSS identifies patients with IIHWOP. METHODS: In a prospective study from December 2000 to November 2005, 724 consecutive patients with recurrent headaches who fulfilled International Headache Society diagnostic criteria for migraine underwent cerebral MR venography (MRV). A portion of these patients underwent a lumbar puncture (LP) to measure CSF pressure. MRV and LP were also performed in 70 age-matched control subjects. RESULTS: Six hundred seventy-five of the 724 patients with migraines had normal MRV. Seventy of these 675 patients underwent LP, and all of them had normal CSF pressure. Forty-nine (6.7%) of the 724 patients with migraine had BTSS. Twenty-eight of these 49 patients with BTSS underwent LP, and 19 (67.8%) had IIHWOP. The headache profiles of patients with BTSS and IIHWOP did not differ from those of patients with normal MRVs and CSF pressures within normal limits. CSF pressure was normal in both patients and controls with normal MRV. CONCLUSIONS: Of patients with migraine, 6.7% had bilateral transverse sinus stenosis; 67.8% of these patients had idiopathic intracranial hypertension without papilledema (IIHWOP). These results suggest that patients with migraine who present bilateral transverse sinus stenosis on cerebral MR venography should undergo lumbar puncture to exclude IIHWOP.