Venous Thromboembolism Risk and Adherence to Pharmacological Thromboprophylaxis in Hospitalized Patients in Uruguay: First Nationwide Study.

INTRODUCTION: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels. AIM: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay. METHODS: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients. RESULTS: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk. CONCLUSIONS: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay.

Synthesis and Characterization of Bi4Ti3O12 Nanoparticles Obtained via Pulsed Laser Ablation in Liquids.

Bismuth titanate (BTO) nanoparticles were obtained by pulsed laser ablation in liquid media (PLAL). Distilled water, ethanol, isopropanol, and acetone were used as media for laser ablation experiments, in which the colloidal solutions were obtained. Laser ablation was carried out using the second harmonic and fundamental wavelength of a pulsed Nd:YAG laser (532 nm and 1064 nm, respectively) with laser fluences of 25 and 12 mJ/cm2, respectively. Transmission electron microscopy was utilized for morphological characterization. BTO nanoparticles obtained have spherical shapes with orthorhombic structure and the average size distribution depended on the liquid media nature. In alcohols, BTO NPs were spherical with a carbon layer around them. X-ray diffraction, UV-Vis absorption spectra, and X-ray photoelectron spectroscopy were used to confirm the structural, optical, and elemental properties of the ablated products. The presented results show that PLAL is a viable technique for the synthesis of high-quality BTO nanoparticles with enhanced optical properties for possible applications in photocatalysis.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius.

Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

THE USE OF ADHESIVE RADIOPAQUE GRIDS IN GENICULAR NERVE BLOCK BY RADIOSCOPY.

The performance of genicular nerve block requires an imaging method to guide the procedure. Radioscopy has the disadvantage of being radiation dependent. Objective: To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases. Methods: This is a cross-sectional study conducted with 23 orthopedists in which needles were positioned in a model with and without the use of adhesive radiopaque grids. The number of fluoroscopy shots necessary for proper positioning in three points (superior lateral, superior medial, and inferior medial) were registered. Results: A statistical difference was observed in the three blocking points studied. The number of radioscopies required for these three points were 12.1 ± 2.5 in the group without grid and 5.0 ± 1.8 in the group with grid. The superior medial point presented the greatest numerical difference and the inferior medial point the smallest. Conclusion: The use of adhesive radiopaque grids led to a statistically significant reduction in the number of radioscopies/fluoroscopies required to perform the genicular block. The use of this device increases the safety of the physician and patient by reducing radiation exposure in this procedure. Level of Evidence III, Level of Evidence II, Random Clinical Trial.

Para a realização do bloqueio de nervos geniculares é necessário guiar o procedimento por um método de imagem. A radioscopia possui a desvantagem de ser dependente de radiação. Objetivo: Avaliar se o uso de máscaras localizadoras diminui a exposição à radiação nesses casos. Métodos: Estudo transversal realizado com 23 ortopedistas, que realizaram o posicionamento de agulhas em um modelo com e sem o uso da máscara localizadora. Foi registrado o número de escopias necessárias para o posicionamento adequado em três pontos: superior lateral, superior medial e inferior medial. Resultados: Foi observada diferença estatística nos três pontos de bloqueio analisados. O número de radioscopias necessárias nos três pontos somados foi de 12,1 ± 2,5, no grupo sem máscara, e 5,0 ± 1,8, no grupo com máscara. O ponto superior medial foi o que apresentou a maior diferença numérica, e o inferior medial a menor. Conclusão: O uso da máscara localizadora reduziu de forma estatisticamente significativa o número de escopias necessárias para a realização do bloqueio genicular. O uso desse dispositivo aumenta a segurança do médico e do paciente por diminuir a exposição à radioscopia nesse procediment. Nível de Evidência III, Ensaio clínico randomizado aberto - Nível de recomendação B - nível de evidência 2b.

EGF-Receptor-Dependent TLR7 Signaling in Macrophages Promotes Glomerular Injury in Crescentic Glomerulonephritis.

Glomerulonephritis (GN) is a group of inflammatory diseases and an important cause of morbidity and mortality worldwide. The initiation of the inflammatory process is quite different for each type of GN; however, each GN is characterized commonly and variably by acute inflammation with neutrophils and macrophages and crescent formation, leading to glomerular death. Toll-like receptor (TLR) 7 is a sensor for self-RNA and implicated in the pathogenesis of human and murine GN. Here, we show that TLR7 exacerbates glomerular injury in nephrotoxic serum nephritis (NTN), a murine model of severe crescentic GN. TLR7-/- mice were resistant to NTN, although TLR7-/- mice manifested comparable immune-complex deposition to wild-type mice without significant defects in humoral immunity, suggesting that endogenous TLR7 ligands accelerate glomerular injury. TLR7 was expressed exclusively in macrophages in glomeruli in GN but not in glomerular resident cells or neutrophils. Furthermore, we discovered that epidermal growth factor receptor (EGFR), a receptor-type tyrosine kinase, is essential for TLR7 signaling in macrophages. Mechanistically, EGFR physically interacted with TLR7 upon TLR7 stimulation, and EGFR inhibitor completely blocked the phosphorylation of TLR7 tyrosine residue(s). EGFR inhibitor attenuated glomerular damage in wild-type mice, and no additional glomerular protective effects by EGFR inhibitor were observed in TLR7-/- mice. Finally, mice lacking EGFR in macrophages were resistant to NTN. This study clearly demonstrated that EGFR-dependent TLR7 signaling in macrophages is essential for glomerular injury in crescentic GN.

Assessing the Therapeutic and Toxicological Profile of Novel Acetylcholinesterase Reactivators: Value of In Silico And In Vitro Data.

Organophosphorus compounds (OP) make up an important class of inhibitors, mostly employed as pesticides, even as chemical weapons. These toxic substances act through the inhibition of the acetylcholinesterase (AChE) enzyme, which results in elevated synaptic acetylcholine (ACh) levels, leading to serious adverse effects under the cholinergic syndrome. Many reactivators have been developed to combat the toxic effects of these AChE inhibitors. In this line, the oximes highlight because of their good reactivating power of cholinesterase enzymes. To date, no universal antidotes can reactivate AChE inhibited by any OP agent. This review summarizes the intoxication process by neurotoxic OP agents, along with the development of reactivators capable of reversing their effects, approaching aspects like the therapeutic and toxicological profile of these antidotes. Computational methods and conscious in vitro studies, capable of significantly predicting the toxicological profile of these drug candidates, might support the process of development of these reactivators before entering in vivo studies in animals, and then clinical trials. These approaches can assist in the design of safer and more effective molecules, reducing related cost and time for the process.

The use of adhesive radiopaque grids in genicular nerve block by radioscopy / O uso de máscara localizadora no bloqueio de nervos geniculares por radioscopia

ABSTRACT The performance of genicular nerve block requires an imaging method to guide the procedure. Radioscopy has the disadvantage of being radiation dependent. Objective: To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases. Methods: This is a cross-sectional study conducted with 23 orthopedists in which needles were positioned in a model with and without the use of adhesive radiopaque grids. The number of fluoroscopy shots necessary for proper positioning in three points (superior lateral, superior medial, and inferior medial) were registered. Results: A statistical difference was observed in the three blocking points studied. The number of radioscopies required for these three points were 12.1 ± 2.5 in the group without grid and 5.0 ± 1.8 in the group with grid. The superior medial point presented the greatest numerical difference and the inferior medial point the smallest. Conclusion: The use of adhesive radiopaque grids led to a statistically significant reduction in the number of radioscopies/fluoroscopies required to perform the genicular block. The use of this device increases the safety of the physician and patient by reducing radiation exposure in this procedure. Level of Evidence III, Level of Evidence II, Random Clinical Trial.

RESUMO Para a realização do bloqueio de nervos geniculares é necessário guiar o procedimento por um método de imagem. A radioscopia possui a desvantagem de ser dependente de radiação. Objetivo: Avaliar se o uso de máscaras localizadoras diminui a exposição à radiação nesses casos. Métodos: Estudo transversal realizado com 23 ortopedistas, que realizaram o posicionamento de agulhas em um modelo com e sem o uso da máscara localizadora. Foi registrado o número de escopias necessárias para o posicionamento adequado em três pontos: superior lateral, superior medial e inferior medial. Resultados: Foi observada diferença estatística nos três pontos de bloqueio analisados. O número de radioscopias necessárias nos três pontos somados foi de 12,1 ± 2,5, no grupo sem máscara, e 5,0 ± 1,8, no grupo com máscara. O ponto superior medial foi o que apresentou a maior diferença numérica, e o inferior medial a menor. Conclusão: O uso da máscara localizadora reduziu de forma estatisticamente significativa o número de escopias necessárias para a realização do bloqueio genicular. O uso desse dispositivo aumenta a segurança do médico e do paciente por diminuir a exposição à radioscopia nesse procediment. Nível de Evidência III, Ensaio clínico randomizado aberto - Nível de recomendação B - nível de evidência 2b.

DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA: A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS.

Objective: Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods: Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results: Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion: High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study .

Objetivos: Determinar a incidência e os fatores de risco de complicações nas fraturas de alta energia das fraturas distais do fêmur fixadas com placa bloqueada lateral. Métodos: Foram incluídos 47 pacientes, sendo 87,2% homens e idade média de 38,9 anos. Os principais parâmetros radiográficos coletados foram o ângulo femoral distal lateral (AFDL), ângulo femoral distal posterior (AFDP), comprimento da cominuição, comprimento da placa, comprimento de trabalho dos parafusos, perda óssea, contato medial após a redução e contato placa-osso, localização da formação do calo e falha do implante. As complicações registradas foram não união, falha do implante e infecção. Resultados: Fraturas complexas C2 e C3 representaram 85,1% dos casos. As fraturas expostas corresponderam a 63,8% dos casos. O AFDL e AFDP médios foram 79,8° ± 4,0° e 79,3°± 6,0°, respectivamente. Os comprimentos de trabalho total, proximal e distal médios foram 133,3 ± 42,7, 60,4 ± 33,4 e 29,5 ± 21,8 mm, respectivamente. A taxa de infecção foi de 29,8% e o único fator de risco foi a fratura exposta (p = 0,005). A taxa de não união foi de 19,1%, com maior comprimento de trabalho (p = 0,035) e maior PDFA (p = 0,001) como fatores de risco. O local de formação do calo também influenciou na pseudoartrose (p = 0,034). Conclusões: Fraturas distais do fêmur de alta energia apresentam maior incidência de pseudoartrose e infecção. A não união tem como fatores de risco maior comprimento de trabalho, maior AFDL e ausência de formação de calo nos lados medial e posterior. O fator de risco para infecção foi a fratura exposta. Nível de evidência III; Estudo de Coorte Retrospectivo .

Overexpressed angiotensin-converting enzyme in neutrophils suppresses glomerular damage in crescentic glomerulonephritis.

While angiotensin-converting enzyme (ACE) regulates blood pressure by producing angiotensin II as part of the renin-angiotensin system, we recently reported that elevated ACE in neutrophils promotes an effective immune response and increases resistance to infection. Here, we investigate if such neutrophils protect against renal injury in immune complex (IC)-mediated crescentic glomerulonephritis (GN) through complement. Nephrotoxic serum nephritis (NTN) was induced in wild-type and NeuACE mice that overexpress ACE in neutrophils. Glomerular injury of NTN in NeuACE mice was attenuated with much less proteinuria, milder histological injury, and reduced IC deposits, but presented with more glomerular neutrophils in the early stage of the disease. There were no significant defects in T and B cell functions in NeuACE mice. NeuACE neutrophils exhibited enhanced IC uptake with elevated surface expression of FcγRII/III and complement receptor CR1/2. IC uptake in neutrophils was enhanced by NeuACE serum containing elevated complement C3b. Given no significant complement activation by ACE, this suggests that neutrophil ACE indirectly preactivates C3 and that the C3b-CR1/2 axis and elevated FcγRII/III play a central role in IC elimination by neutrophils, resulting in reduced glomerular injury. The present study identified a novel renoprotective role of ACE in glomerulonephritis; elevated neutrophilic ACE promotes elimination of locally formed ICs in glomeruli via C3b-CR1/2 and FcγRII/III, ameliorating glomerular injury.NEW & NOTEWORTHY We studied immune complex (IC)-mediated crescentic glomerulonephritis in NeuACE mice that overexpress ACE only in neutrophils. Such mice show no significant defects in humoral immunity but strongly resist nephrotoxic serum nephritis (less proteinuria, milder histological damage, reduced IC deposits, and more glomerular neutrophils). NeuACE neutrophils enhanced IC uptake via increased surface expression of CR1/2 and FcgRII/III, as well as elevated serum complement C3b. These results suggest neutrophil ACE as a novel approach to reducing glomerulonephritis.

Angioleiomioma en cavidad oral «una neoplasia rara en un sitio poco común¼. Reporte de un caso y revisión de la literatura / Angioleiomyoma in the oral cavity «a rare neoplasm in an unusual site¼. Case report and literature review

El angioleiomioma (AL) es una neoplasia benigna, bien circunscrita y de crecimiento lento, que representa 5% de las neoplasias de tejidos blandos y cuya etiología es desconocida. Se origina del músculo liso, mayormente de las paredes de los vasos sanguíneos; su localización es más frecuente en extremidades, siendo raros en la región de cabeza y cuello, y más aún en cavidad bucal. Histológicamente la lesión se caracteriza por ser un nódulo bien encapsulado con proliferación de fascículos de músculo liso maduro alrededor de la luz de los vasos sanguíneos, cuyas células suelen ser positivas a marcadores de inmunohistoquímica como alfa actina de músculo liso, desmina, HHF35, miosina, calponina y H-caldesmon. El tratamiento actual es la escisión quirúrgica completa con una tasa de recurrencia prácticamente nula. El objetivo es resaltar la importancia del diagnóstico y el manejo correcto de las lesiones intraorales a través de la presentación de un caso clínico de un leiomioma vascular localizado en región nasolabial, además de hacer la revisión de la literatura correspondiente (AU)

The angioleiomyoma (AL) is a benign neoplasm, well circumscribed and slow growing, that represents 5% of the soft tissue neoplasms, whose etiology is unknown. It originates from smooth muscle, mostly from the walls of blood vessels; regarding its location, it more frequently appears in the extremities, being rare in the head and neck region, and even more so in the oral cavity. Histologically, the lesion is characterized by being a well encapsulated nodule with proliferation of mature smooth muscle bundles around the lumen of the blood vessels, whose cells are usually positive for immunohistochemical markers such as alpha smooth muscle actin, desmin, HHF35, myosin, calponin and H-caldesmon. The current treatment is complete surgical excision having zero recurrence rate. The objective of the following article is to educate on the importance of correct diagnosis and management of intraoral lesions through the presentation of a clinical case of a vascular leiomyoma located in the nasolabial region, in addition to reviewing the corresponding literature (AU)

Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons.

BACKGROUND: Apophyseal injuries are common in children and adolescent athletes. These injuries are believed to be caused by repetitive overloading, which can create inflammatory and degenerative conditions in growing bone prominences. However, their prevalence, diagnosis, and treatment in young soccer players have been understudied. PURPOSE: To evaluate characteristics of apophyseal injuries in adolescent athletes at an elite soccer academy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All apophyseal injuries between July 2008 and June 2015 were evaluated. For each injury, the authors recorded the type and location, age of the player, injury date, imaging modalities, and time absent from training/competition. RESULTS: Over the 7 seasons of this study, 210 apophyseal injuries were documented, including 172 simple apophyseal injuries and 38 apophyseal avulsion fractures. The rate of apophyseal injuries was 0.35 per 1000 hours of training exposure. A total of 196 (93.3%) cases were primary injuries, and the rest (6.7%) were reinjuries. Ultrasonography was the most commonly used imaging modality for diagnosis (172 cases; 81.9%). The most common location of apophyseal injuries was the anterior inferior iliac spine (AIIS). Return to sport was faster in athletes with apophyseal injury at the ischiopubic ramus, those with simple apophyseal injuries, and younger athletes. CONCLUSION: The most common location for apophyseal injury among soccer players was the AIIS. Return to training and competition differed according to injury location, type of apophyseal injury, and age.

Distal femoral fractures from high-energy trauma: a retrospective review of complication rate and risk factors / Fraturas distais do fêmur por trauma de alta energia: uma revisão retrospectiva da taxa de complicações e fatores de risco

ABSTRACT Objective Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study.

RESUMO Objetivos Determinar a incidência e os fatores de risco de complicações nas fraturas de alta energia das fraturas distais do fêmur fixadas com placa bloqueada lateral. Métodos Foram incluídos 47 pacientes, sendo 87,2% homens e idade média de 38,9 anos. Os principais parâmetros radiográficos coletados foram o ângulo femoral distal lateral (AFDL), ângulo femoral distal posterior (AFDP), comprimento da cominuição, comprimento da placa, comprimento de trabalho dos parafusos, perda óssea, contato medial após a redução e contato placa-osso, localização da formação do calo e falha do implante. As complicações registradas foram não união, falha do implante e infecção. Resultados Fraturas complexas C2 e C3 representaram 85,1% dos casos. As fraturas expostas corresponderam a 63,8% dos casos. O AFDL e AFDP médios foram 79,8° ± 4,0° e 79,3°± 6,0°, respectivamente. Os comprimentos de trabalho total, proximal e distal médios foram 133,3 ± 42,7, 60,4 ± 33,4 e 29,5 ± 21,8 mm, respectivamente. A taxa de infecção foi de 29,8% e o único fator de risco foi a fratura exposta (p = 0,005). A taxa de não união foi de 19,1%, com maior comprimento de trabalho (p = 0,035) e maior PDFA (p = 0,001) como fatores de risco. O local de formação do calo também influenciou na pseudoartrose (p = 0,034). Conclusões Fraturas distais do fêmur de alta energia apresentam maior incidência de pseudoartrose e infecção. A não união tem como fatores de risco maior comprimento de trabalho, maior AFDL e ausência de formação de calo nos lados medial e posterior. O fator de risco para infecção foi a fratura exposta. Nível de evidência III; Estudo de Coorte Retrospectivo.

Desplazamiento de Tercer Molar Superior a Fosa Infratemporal: Reporte de Casos y Revisión de Literatura

RESUMEN: Dentro de las complicaciones transoperatorias de una cirugía de tercer molar se encuentra el desplazamiento del diente a espacios anatómicos adyacentes. Dicho accidente representa un porcentaje muy bajo de las complicaciones y se atribuye a una planeación y manejo clínico inadecuado. En este reporte se abordará específicamente el desplazamiento accidental de terceros molares superiores a la fosa infratemporal. Se realizó una búsqueda de información en la plataforma PubMed con las palabras claves "third molar displacement", obteniendo un total de 22 artículos según los criterios de inclusión. Se presentan dos casos de desplazamiento de tercer molar superior a fosa infratemporal manejados en el Centro Académico de Atención Odontológica (CAAD) del Tecnológico de Monterrey. El propósito del presente escrito es proponer un protocolo de manejo para dicha complicación.

ABSTRACT: One of the intraoperative complications of third molar surgery is the displacement of the tooth to adjacent anatomical spaces. This accident represents a small percentage of complications and is attributed to inadequate clinical planning and management. This report will specifically address the accidental displacement of upper third molars to the infratemporal fossa. A search was conducted by using the PubMed database with the keywords "third molar displacement", a total of 22 articles were included according to the inclusion criteria. Two cases of displacement of the upper third molar to the infratemporal fossa managed at the Centro Academico de Atencion Odontologica (CAAD) of the Tecnologico de Monterrey will be reported. The aim of this paper is to present a management protocol for this complication.

Síndrome antifosfolipídico obstétrico / Obstetric antiphospholipid syndrome / Síndrome antifosfolípide obstétrica

Resumen: El síndrome antifosfolipídico obstétrico puede ser causa de importante morbilidad materno-fetal. Los criterios diagnósticos se definen en 1999 (criterios de Sapporo) que son revisados en 2006 (Sydney), basados en criterios clínicos y de laboratorio. En el 2006 la sociedad internacional de hemostasis y trombosis propone los criterios que definen las morbilidades del embarazo vinculadas al mismo (pérdida fetal tardía, pérdida recurrente del embarazo, parto pretérmino, enfermedad tromboembólica). El objetivo terapéutico es prevenir complicaciones materno-fetal (trombosis maternas y prevenir complicaciones obstétricas). El tratamiento siempre debe ser individualizado según cada caso particular. Se realiza una revisión sobre las distintas situaciones posibles, finalizando con recomendaciones para el mismo.

Abstract: Obstetric antiphospholipid syndrome can be the cause of significant maternal-fetal morbidity. Diagnostic criteria are defined in 1999 (Sapporo criteria) which are revised in 2006 (Sydney), based on clinical and laboratory criteria. In 2006, the International Society of Haemostasis and Thrombosis proposed the criteria that define the morbidities of pregnancy related to it (late fetal loss, recurrent pregnancy loss, preterm delivery, thromboembolic disease). The therapeutic objective is to prevent maternal-fetal complications (maternal thrombosis and prevent obstetric complications). Treatment must always be individualized according to each particular case. A review is carried out on the different possible situations, ending with recommendations for the same.

Resumo: A síndrome antifosfolipídica obstétrica pode ser a causa de morbidade materno-fetal significativa. Os critérios diagnósticos são definidos em 1999 (critérios de Sapporo) que são revisados em 2006 (Sydney), com base em critérios clínicos e laboratoriais. Em 2006, a Sociedade Internacional de Hemostasia e Trombose propôs os critérios que definem as morbidades da gravidez a ela relacionadas (perda fetal tardia, perda recorrente da gravidez, parto prematuro, doença tromboembólica). O objetivo terapêutico é prevenir complicações materno-fetais (trombose materna e prevenir complicações obstétricas). O tratamento deve ser sempre individualizado de acordo com cada caso particular. É feita uma revisão sobre as diferentes situações possíveis, terminando com recomendações para o mesmo.

Dissecting cis-regulatory control of quantitative trait variation in a plant stem cell circuit.

Cis-regulatory mutations underlie important crop domestication and improvement traits1,2. However, limited allelic diversity has hindered functional dissection of the large number of cis-regulatory elements and their potential interactions, thereby precluding a deeper understanding of how cis-regulatory variation impacts traits quantitatively. Here, we engineered over 60 promoter alleles in two tomato fruit size genes3,4 to characterize cis-regulatory sequences and study their functional relationships. We found that targeted mutations in conserved promoter sequences of SlCLV3, a repressor of stem cell proliferation5,6, have a weak impact on fruit locule number. Pairwise combinations of these mutations mildly enhance this phenotype, revealing additive and synergistic relationships between conserved regions and further suggesting even higher-order cis-regulatory interactions within the SlCLV3 promoter. In contrast, SlWUS, a positive regulator of stem cell proliferation repressed by SlCLV3 (refs. 5,6), is more tolerant to promoter perturbations. Our results show that complex interplay among cis-regulatory variants can shape quantitative variation, and suggest that empirical dissections of this hidden complexity can guide promoter engineering to predictably modify crop traits.

Conserved pleiotropy of an ancient plant homeobox gene uncovered by cis-regulatory dissection.

Divergence of gene function is a hallmark of evolution, but assessing functional divergence over deep time is not trivial. The few alleles available for cross-species studies often fail to expose the entire functional spectrum of genes, potentially obscuring deeply conserved pleiotropic roles. Here, we explore the functional divergence of WUSCHEL HOMEOBOX9 (WOX9), suggested to have species-specific roles in embryo and inflorescence development. Using a cis-regulatory editing drive system, we generate a comprehensive allelic series in tomato, which revealed hidden pleiotropic roles for WOX9. Analysis of accessible chromatin and conserved cis-regulatory sequences identifies the regions responsible for this pleiotropic activity, the functions of which are conserved in groundcherry, a tomato relative. Mimicking these alleles in Arabidopsis, distantly related to tomato and groundcherry, reveals new inflorescence phenotypes, exposing a deeply conserved pleiotropy. We suggest that targeted cis-regulatory mutations can uncover conserved gene functions and reduce undesirable effects in crop improvement.

Fluid Balance, Sweat Na+ Losses, and Carbohydrate Intake of Elite Male Soccer Players in Response to Low and High Training Intensities in Cool and Hot Environments.

Hypohydration increases physiological strain and reduces physical and technical soccer performance, but there are limited data on how fluid balance responses change between different types of sessions in professional players. This study investigated sweat and fluid/carbohydrate intake responses in elite male professional soccer players training at low and high intensities in cool and hot environments. Fluid/sodium (Na+) losses and ad-libitum carbohydrate/fluid intake of fourteen elite male soccer players were measured on four occasions: cool (wet bulb globe temperature (WBGT): 15 ± 7 °C, 66 ± 6% relative humidity (RH)) low intensity (rating of perceived exertion (RPE) 2-4, m·min-1 40-46) (CL); cool high intensity (RPE 6-8, m·min-1 82-86) (CH); hot (29 ± 1 °C, 52 ± 7% RH) low intensity (HL); hot high intensity (HH). Exercise involved 65 ± 5 min of soccer-specific training. Before and after exercise, players were weighed in minimal clothing. During training, players had ad libitum access to carbohydrate beverages and water. Sweat [Na+] (mmol·L-1), which was measured by absorbent patches positioned on the thigh, was no different between conditions, CL: 35 ± 9, CH: 38 ± 8, HL: 34 ± 70.17, HH: 38 ± 8 (p = 0.475). Exercise intensity and environmental condition significantly influenced sweat rates (L·h-1), CL: 0.55 ± 0.20, CH: 0.98 ± 0.21, HL: 0.81 ± 0.17, HH: 1.43 ± 0.23 (p =0.001), and percentage dehydration (p < 0.001). Fluid intake was significantly associated with sweat rate (p = 0.019), with no players experiencing hypohydration > 2% of pre-exercise body mass. Carbohydrate intake varied between players (range 0-38 g·h-1), with no difference between conditions. These descriptive data gathered on elite professional players highlight the variation in the hydration status, sweat rate, sweat Na+ losses, and carbohydrate intake in response to training in cool and hot environments and at low and high exercise intensities.

Outcomes of bell-bottom technique compared to standard endovascular aneurysm repair.

OBJECTIVE: The bell-bottom technique is a widely used technique to treat aortoiliac aneurysms with preservation of the hypogastric arteries. The published data are scarce with conflicting results regarding the evolution. The aim of this study was to compare the outcomes of patients submitted to endovascular abdominal aortic aneurysm repair with standard technique (S-EVAR) versus bell-bottom technique. METHODS: This retrospective cohort study compared the outcomes of standard endovascular aneurysm repair (<16 mm iliac limbs) and bell-bottom technique (≥16 mm iliac limbs) in a tertiary vascular center between 2010 and 2015. The end points of this study were type IB endoleak, reintervention and 30-day mortality. The follow-up protocol included CT scans within 30 days of implantation and 12 months. Duplex ultrasound was performed yearly thereafter. RESULTS: Two hundred and three patients were treated with bell-bottom technique (n = 84, mean age 72.2 ± 8.9) and S-EVAR (n = 119, mean age 72.7 ± 8.4). The overall 30-day mortality was 1.9%, with no significant difference between groups. There was higher prevalence of coronary heart disease in the bell-bottom technique group compared to the S-EVAR group (41.6% vs. 18.4%, p < 0.01). One patient in the S-EVAR group (0.85%) and four patients in the bell-bottom technique (4.6%) developed type IB endoleak. The mean follow-up period was 35.2 ± 30.4 months. By Kaplan-Meier analysis, freedom from type IB endoleak in 80 months was 85.2% in the bell-bottom technique group and 98.7% in the S-EVAR group (p = 0.05). The freedom from reintervention in 80 months was 74.0% in the bell-bottom technique group and 94.1% in the S-EVAR group (p = 0.6). CONCLUSIONS: This study shows lower freedom from type IB endoleak in the bell-bottom group compared to the standard repair group. There is no significant difference in reoperation rate and 30-day mortality.

Motor-driven autonomous system for controlling beamline iris diaphragm apertures.

At the collinear apparatus for laser spectroscopy and applied sciences (COALA) at TU Darmstadt, collinear laser spectroscopy is applied to perform high-precision measurements of atomic transition frequencies and high voltages in an ultra-high vacuum beamline. In such laser spectroscopy beamlines, iris diaphragms are used to reduce ion beam divergence, and to ensure a good laser and ion beam overlap. Since the system that controls the diameter of the apertures presents strong hysteresis, an automated adjustment is desirable to enhance reproducibility in the aperture settings, and to reduce the effort in performing measurements where different diameters are required, especially in alternating collinear and anti-collinear measurements. To achieve this, the Iris Mover system was designed and implemented. The Iris Mover system consists of motor-driven iris apertures which can be easily controlled by users through a computer, and which accounts for hysteresis effects. Here, we explain the design process of the Iris Mover and demonstrate and discuss its functionality.