Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Single Peroneus Longus Tendon Graft.

The peroneus longus tendon seems a viable graft option for knee ligament reconstructions, with adequate biomechanical properties and low morbidity after harvesting. The objective of this article is to describe a combined anterior cruciate ligament and anterolateral ligament reconstruction technique using a single peroneus longus tendon graft harvested from the infra malleolar region to ensure sufficient length.

Hyperboloidal approach for static spherically symmetric spacetimes: a didactical introduction and applications in black-hole physics.

This work offers a didactical introduction to the calculations and geometrical properties of a static, spherically symmetric spacetime foliated by hyperboloidal time surfaces. We discuss the various degrees of freedom involved, namely the height function, responsible for introducing the hyperboloidal time coordinate, and a radial compactification function. A central outcome is the expression of the Trautman-Bondi mass in terms of the hyperboloidal metric functions. Moreover, we apply this formalism to a class of wave equations commonly used in black-hole perturbation theory. Additionally, we provide a comprehensive derivation of the hyperboloidal minimal gauge, introducing two alternative approaches within this conceptual framework: the in-out and out-in strategies. Specifically, we demonstrate that the height function in the in-out strategy follows from the well-known tortoise coordinate by changing the sign of the terms that become singular at future null infinity. Similarly, for the out-in strategy, a sign change also occurs in the tortoise coordinate's regular terms. We apply the methodology to the following spacetimes: Singularity-approaching slices in Schwarzschild, higher-dimensional black holes, black hole with matter halo, and Reissner-Nordström-de Sitter. From this heuristic study, we conjecture that the out-in strategy is best adapted for black hole geometries that account for environmental or effective quantum effects. This article is part of a discussion meeting issue 'At the interface of asymptotics, conformal methods and analysis in general relativity'.

Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients. / Associação entre Hipertensão Arterial Sistêmica com Marcadores Laboratoriais, Composição Corporal, Apneia Obstrutiva do Sono e Variabilidade da Frequência Cardíaca em Adultos Obesos.

BACKGROUND: Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks. OBJECTIVE: The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association. METHODS: Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted. RESULTS: The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm2(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804). CONCLUSIONS: Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

FUNDAMENTO: A hipertensão arterial sistêmica (HAS) é uma doença multifatorial, altamente prevalente e associada a riscos à saúde. OBJETIVO: O objetivo deste estudo foi investigar a associação entre HAS e marcadores laboratoriais, antropométricos, de variabilidade da frequência cardíaca (VFC) e de apneia obstrutiva do sono e, em segundo plano, analisar a sensibilidade e especificidade das variáveis que são fatores independentes na associação. MÉTODOS: Estudo transversal com 95 pacientes obesos atendidos em um ambulatório de referência em obesidade em Salvador, BA, Brasil. Os dados da HAS foram obtidos dos prontuários eletrônicos. A amostra foi estratificada em Grupo Normotenso (GN) e Grupo Hipertenso (GH), sendo medidos marcadores laboratoriais, composição corporal, polissonografia e VFC para avaliar a associação da HAS com as variáveis preditoras. Para as análises, adotou-se p<0,05. RESULTADOS: A média da idade do GN foi de 36,3 ± 10,1 e GH 40,4 ± 10,6 anos, 73,7% eram mulheres no GN e 57,9% no GH; 82,4% no GH apresentavam resistência à insulina. No modelo de regressão logística multivariado com ajustes para idade, sexo, altura e saturação de oxi-hemoglobina, a HAS foi inversamente associada à glicose plasmática em jejum mg/dL (odds ratio [OR] = 0,96; intervalo de confiança de 95% [IC] = 0,92-0,99) e área de gordura visceral (AGV) cm2 (OR = 0,98; IC 95% = 0,97-0,99). A área sob a curva AGV foi de 0,728; IC 95% (0,620-0,836) e glicemia de jejum 0,693; IC 95% (0,582-0,804). CONCLUSÃO: Menores concentrações de AGV e glicemia de jejum foram inversamente associadas à HAS. Além disso, tanto a glicemia de jejum quanto o AGV mostraram alta sensibilidade para triagem de HAS.

Tibiotalocalcaneal Arthrodesis: A Retrospective Comparison Between Nails and Lateral Locking Plate Complications.

Background: Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. Methods: We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. Results: We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. Conclusion: No significant differences were found in the complication rates between the 2 implants. Level of Evidence: Level V, Case series.

Eccentric, but not concentric muscle contraction induce inflammation and impairs fibrinolysis in healthy young men.

Different types of muscle contraction can cause different damage to the musculature and differences in inflammatory responses. Acute increases in circulatory inflammation markers can influence the crosstalk between coagulation and fibrinolysis processes, increasing the risk of thrombus formation and detrimental cardiovascular events. The aim of this study was to analyze the effects of concentric and eccentric exercise on hemostasis markers, C-reactive protein (CRP), and the relationship between these variables. Eleven healthy subjects with a mean age of 25.4 ± 2.8, non-smokers, with no history of cardiovascular disease and blood type O, randomly performed an isokinetic exercise protocol consisting of 75 concentric (CP) or eccentric (EP) contractions of knee extension, divided into five sets of 15 repetitions combined with 30-s rest. Blood samples for analysis of FVIII, von Willebrand factor, tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1), and CRP were collected pre, post, 24 h, and 48 h after each protocol. Increased levels of CRP at 48 h in EP versus CP (p = 0.002), increased PAI-1 activity 48 h in EP versus CP (p = 0.044), and a reduction in t-PA at 48 h when compared with post-protocol in both protocols (p = 0.001). A correlation was found between CRP and PAI-1 at 48 h of PE (r2 = 0.69; p = 0.02). This study showed that both EP and CP increase the clotting process, albeit only the exercise performed eccentrically induces inhibition of fibrinolysis. This is possibly due to the increase in PAI-1 48 h after the protocol, which correlates with the increase in inflammation as demonstrated by the CRP levels.

Molecular aspects of COVID-19 and its relationship with obesity and physical activity: a narrative review

Abstract BACKGROUND: Severe acute respiratory syndrome coronavirus 2 has several mechanisms of action related to inflammatory responses, especially in individuals diagnosed with obesity. This hyperinflammatory clinical profile resulting from the association between obesity and coronavirus disease 2019 (COVID-19) may be attenuated by regular physical activity. OBJECTIVE: The aim of this study was to review the evidence on the consequences of physical inactivity and physical activity on COVID-19 in patients with obesity. DESIGN AND SETTING: Narrative review at the Bahiana School of Medicine and Public Health in Salvador, Brazil. METHODS: We searched evidence on the association of COVID-19 with physical activity and obesity using the following keywords: "covid-19," "physical activity," and "obesity". The databases used were MEDLINE (PubMed), ScienceDirect, and Virtual Health Library. Studies published from 2019 to 2021 and available in Portuguese, English, and Spanish were included. The final search was conducted on September 26, 2021. RESULTS: We identified 661 studies in the database, among which 71 were considered for inclusion in the narrative review of the molecular aspects of COVID-19 and its relationship with physical activity and obesity. CONCLUSION: This literature review enabled the perception of the relationship between the molecular mechanisms of COVID-19 and obesity. Regular physical activity had various benefits for the inflammatory condition of the studied population, highlighting moderate-intensity.

Molecular aspects of COVID-19 and its relationship with obesity and physical activity: a narrative review.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 has several mechanisms of action related to inflammatory responses, especially in individuals diagnosed with obesity. This hyperinflammatory clinical profile resulting from the association between obesity and coronavirus disease 2019 (COVID-19) may be attenuated by regular physical activity. OBJECTIVE: The aim of this study was to review the evidence on the consequences of physical inactivity and physical activity on COVID-19 in patients with obesity. DESIGN AND SETTING: Narrative review at the Bahiana School of Medicine and Public Health in Salvador, Brazil. METHODS: We searched evidence on the association of COVID-19 with physical activity and obesity using the following keywords: "covid-19," "physical activity," and "obesity". The databases used were MEDLINE (PubMed), ScienceDirect, and Virtual Health Library. Studies published from 2019 to 2021 and available in Portuguese, English, and Spanish were included. The final search was conducted on September 26, 2021. RESULTS: We identified 661 studies in the database, among which 71 were considered for inclusion in the narrative review of the molecular aspects of COVID-19 and its relationship with physical activity and obesity. CONCLUSION: This literature review enabled the perception of the relationship between the molecular mechanisms of COVID-19 and obesity. Regular physical activity had various benefits for the inflammatory condition of the studied population, highlighting moderate-intensity.

Associação entre Hipertensão Arterial Sistêmica com Marcadores Laboratoriais, Composição Corporal, Apneia Obstrutiva do Sono e Variabilidade da Frequência Cardíaca em Adultos Obesos / Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients

Resumo Fundamento A hipertensão arterial sistêmica (HAS) é uma doença multifatorial, altamente prevalente e associada a riscos à saúde. Objetivo O objetivo deste estudo foi investigar a associação entre HAS e marcadores laboratoriais, antropométricos, de variabilidade da frequência cardíaca (VFC) e de apneia obstrutiva do sono e, em segundo plano, analisar a sensibilidade e especificidade das variáveis que são fatores independentes na associação. Métodos Estudo transversal com 95 pacientes obesos atendidos em um ambulatório de referência em obesidade em Salvador, BA, Brasil. Os dados da HAS foram obtidos dos prontuários eletrônicos. A amostra foi estratificada em Grupo Normotenso (GN) e Grupo Hipertenso (GH), sendo medidos marcadores laboratoriais, composição corporal, polissonografia e VFC para avaliar a associação da HAS com as variáveis preditoras. Para as análises, adotou-se p<0,05. Resultados A média da idade do GN foi de 36,3 ± 10,1 e GH 40,4 ± 10,6 anos, 73,7% eram mulheres no GN e 57,9% no GH; 82,4% no GH apresentavam resistência à insulina. No modelo de regressão logística multivariado com ajustes para idade, sexo, altura e saturação de oxi-hemoglobina, a HAS foi inversamente associada à glicose plasmática em jejum mg/dL (odds ratio [OR] = 0,96; intervalo de confiança de 95% [IC] = 0,92-0,99) e área de gordura visceral (AGV) cm2 (OR = 0,98; IC 95% = 0,97-0,99). A área sob a curva AGV foi de 0,728; IC 95% (0,620-0,836) e glicemia de jejum 0,693; IC 95% (0,582-0,804). Conclusão Menores concentrações de AGV e glicemia de jejum foram inversamente associadas à HAS. Além disso, tanto a glicemia de jejum quanto o AGV mostraram alta sensibilidade para triagem de HAS.

Abstract Background Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks. Objective The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association. Methods Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted. Results The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm2(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804). Conclusions Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

Gravitational Waves from Extreme-Mass-Ratio Systems in Astrophysical Environments.

We establish a generic, fully relativistic formalism to study gravitational-wave emission by extreme-mass-ratio systems in spherically symmetric, nonvacuum black hole spacetimes. The potential applications to astrophysical setups range from black holes accreting baryonic matter to those within axionic clouds and dark matter environments, allowing one to assess the impact of the galactic potential, of accretion, gravitational drag, and halo feedback on the generation and propagation of gravitational waves. We apply our methods to a black hole within a halo of matter. We find fluid modes imparted to the gravitational-wave signal (a clear evidence of the black hole fundamental mode instability) and the tantalizing possibility to infer galactic properties from gravitational-wave measurements by sensitive, low-frequency detectors.

Histoarchitecture of the fibrillary matrix of human fetal posterior tibial tendons.

Adult tendons are highly differentiated. In mature individuals, tendon healing after an injury occurs through fibrotic tissue formation. Understanding the intrinsic reparative properties of fetal tendons would help to understand the maturation tissue process and tendon tissue repair. The present study evaluated the evolution of histoarchitecture, cellularity and the distribution of collagens I, III and V in the posterior tibial tendon in human fetuses at different gestational ages. Morphological profiles were assessed in nine fresh spontaneously aborted fetuses (Group I: five fetuses aged between 22 and 28 weeks of gestation; Group II: four fetuses aged between 32 and 38 weeks of gestation), characterized by a combination of histology, fluorescence and immunohistochemistry. In Group I, the posterior tibial tendon showed statistically significant greater cellularity and presence of collagen III and V than in Group II tendon, which showed a predominance of collagenous I and a better organization of the extracellular matrix compared with Group I tendons. In addition, a statistically significant higher rate of CD90, a marker of mesenchymal cells, was found in Group I tendons. In fetuses with gestational age between 22 and 28 weeks, the posterior tibialis tendons showed a thin and disorganized fibrillar structure, with an increase in collagen III and V fibers and mesenchymal cells. In the posterior tibialis tendons of fetuses with gestational age between 32 and 38 weeks, the fibrillar structure was thicker with a statistically significant increase in type I collagen and decreased cellularity.

Gravitational Wave Signatures of Black Hole Quasinormal Mode Instability.

Black hole (BH) spectroscopy has emerged as a powerful approach to extracting spacetime information from gravitational wave (GW) observed signals. Yet, quasinormal mode (QNM) spectral instability under small scale perturbations has been recently shown to be a common classical general relativistic phenomenon [J. L. Jaramillo et al., Phys. Rev. X 11, 031003 (2021)PRXHAE2160-330810.1103/PhysRevX.11.031003]. This requires assessing its impact on the BH QNM spectrum, in particular on BH QNM overtone frequencies. We conclude (i) perturbed BH QNM overtones are indeed potentially observable in the GW waveform, providing information on small-scale environment BH physics, and (ii) their detection poses a challenging data analysis problem of singular interest for LISA astrophysics. We adopt a twofold approach, combining theoretical results from scattering theory with a fine-tuned data analysis on a highly accurate numerical GW ringdown signal. The former introduces a set of effective parameters (partially relying on a BH Weyl law) to characterize QNM instability physics. The latter provides a proof of principle demonstrating that the QNM spectral instability is indeed accessible in the time-domain GW waveform, though certainly requiring large signal-to-noise ratios. Particular attention is devoted to discussing the patterns of isospectrality loss under QNM instability, since the disentanglement between axial and polar GW parities may already occur within the near-future detection range.

Effects of Protein Supplementation Associated with Resistance Training on Body Composition and Muscle Strength in Older Adults: A Systematic Review of Systematic Reviews with Meta-analyses.

BACKGROUND: There are some controversial findings regarding the benefits of combining protein supplementation with resistance training in order to optimize adaptations to training in older adults. OBJECTIVE: The aim of this review was to summarize the evidence from meta-analyses assessing the effects of protein supplementation combined with resistance training on body composition and muscle strength in the older population. METHODS: We included systematic reviews with meta-analyses of randomized clinical trials that examined the effects of protein and/or amino acid supplementation associated with resistance training compared with resistance training alone on lean body mass, muscle mass, and muscle strength in older people. The search was performed using the MEDLINE (PubMed), Embase, Cochrane Database of Systematic Reviews, Google Scholar, and OpenGrey databases. Methodological quality was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 checklist, and the quality of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation system. The pooled effect estimates were computed from the standardized mean difference and the 95% confidence interval achieved by each meta-analysis, using random effects models. RESULTS: Five reviews were included, all of moderate methodological quality. In the analyses, protein supplementation combined with resistance training was associated with greater increases in lean body mass and muscle mass when compared with resistance training alone. However, no differences were observed between the interventions on muscle strength increases. The quality of evidence ranged from moderate to very low. CONCLUSION: Protein supplementation associated with resistance training induces greater increases in lean body mass compared with resistance training alone. In addition, it is suggested that the use of protein supplementation enhances gains in muscle mass but does not promote greater increases in muscle strength.

Cardiometabolic effects of early v. delayed time-restricted eating plus energetic restriction in adults with overweight and obesity: an exploratory randomised clinical trial.

This exploratory study investigated the effects of early v. delayed time-restricted eating (TRE) plus caloric restriction (CR) on body weight, body composition and cardiometabolic parameters in adults with overweight and obesity. Adults (20-40 years) were randomised to one of three groups for 8 weeks: early time-restricted eating (eTRE; 08.00-16.00) plus CR, delayed time-restricted eating (dTRE; 12.00-20.00) plus CR or only CR (CR; 08.00-20.00). All groups were prescribed a 25 % energy deficit relative to daily energy requirements. Thirteen participants completed the study in the eTRE and CR groups and eleven in the dTRE group (n 37). After the interventions, there was no significant difference between the three groups for any of the outcomes. Compared with baseline, significant decreases were observed in the body weight (eTRE group: -4·2 kg; 95 % CI, -5·6, -2·7; dTRE group: -4·8 kg; 95 % CI, -5·9, -3·7; CR: -4·0 kg; 95 % CI, -5·9, -2·1), fat mass (eTRE group: -2·9 kg; 95 % CI, -3·9, -1·9; dTRE group: -3·6 kg; 95 % CI, -4·6, -2·5; CR: -3·1 kg; 95 % CI, -4·3, -1·8) and fasting glucose levels (eTRE group: -4 mg/dl; 95 % CI, -8, -1; dTRE group: -2 mg/dl; 95 % CI, -8, 3; CR: -3 mg/dl; 95 % CI, -8, 2). In a free-living setting, TRE with a energetic deficit, regardless of the time of day, promotes similar benefits in weight loss, body composition and cardiometabolic parameters. However, given the exploratory nature of our study, further investigation is needed to confirm these findings.

Destabilizing the Fundamental Mode of Black Holes: The Elephant and the Flea.

Recent work applying the notion of pseudospectrum to gravitational physics showed that the quasinormal mode spectrum of black holes is unstable, with the possible exception of the longest-lived (fundamental) mode. The fundamental mode dominates the expected signal in gravitational wave astronomy, and there is no reason why it should have privileged status. We compute the quasinormal mode spectrum of two model problems where the Schwarzschild potential is perturbed by a small "bump" consisting of either a Pöschl-Teller potential or a Gaussian, and we show that the fundamental mode is destabilized under generic perturbations. We present phase diagrams and study a simple double-barrier toy problem to clarify the conditions under which the spectral instability occurs.

Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence.

"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals. At the same time, with the popular and scientific dissemination of the concepts of intermittent fasting and time-restricted feeding, well-controlled clinical trials have emerged showing the safety or even possible benefits of skipping breakfast. In this comprehensive literature review, we discuss recent evidence regarding breakfast intake, cardiovascular outcomes and cardiovascular risk markers. Overall, breakfast omission appears to be associated with a higher risk for atherosclerotic and adverse cardiovascular outcomes. However, caution should be employed when deciphering these data as many complex, unmeasured confounders may have contributed. Unfortunately, long-term randomized, clinical trials with detailed dietary control that have assessed clinical outcomes are sparse. Notwithstanding the observational findings, current trials conducted so far-albeit apparently smaller number-have shown that breakfast addition in subjects who do not habitually consume this meal may increase body weight, particularly fat mass, through caloric excess, whereas skipping breakfast may be a feasible strategy for some people aiming for calorie restriction. To date, definitive benefits of breakfast omission or consumption are not supported by the best evidence-based research, and the question of whether skipping breakfast per se is causally associated with cardiovascular outcomes remains unresolved.

Chronic aerobic exercise prevents high-fructose diet-induced impairment in blood pressure in healthy young adults: a double-blind, randomised clinical trial.

The purpose of the study was to verify the effect of 4 weeks of a high-fructose diet (HFD) associated with aerobic training on the risk factors for cardiometabolic diseases. Twenty-one young adults were randomised into three groups: HFD (HFD: 1 g/kg body weight of fructose/day), high-glucose diet (HGD: 1 g/kg body weight of glucose/day) and high-fructose diet and exercise (HFDE: 1 g/kg body weight of fructose/day + 3 weekly 60-minute sessions of aerobic exercise). Before and after the 4 weeks of the intervention, blood samples were taken and flow-mediated dilatation, insulin resistance index, pancreatic beta cell functional capacity index, insulin sensitivity index and 24-h blood pressure were evaluated. HFD showed an increase in uric acid concentrations (P = 0·040), and HGD and HFDE groups showed no changes in this outcome between pre- and post-intervention; however, the HFDE group showed increased uric acid concentrations from the middle to the end of the intervention (P = 0·013). In addition, the HFD group showed increases in nocturnal systolic blood pressure (SBP) (P = 0·022) and nocturnal diastolic blood pressure (DBP) (P = 0·009). The HGD group exhibited decreases in nocturnal SBP (P = 0·028) and nocturnal DBP (P = 0·031), and the HFDE group showed a decrease in 24-h SBP (P = 0·018). The consumption of 1 g/kg of fructose per day may increase uric acid concentrations and blood pressure in adults. Additionally, aerobic exercises along with fructose consumption attenuate changes in uric acid concentrations and prevent impairment in nocturnal blood pressure.

Congenital Clubfoot - Is the Ponseti Method the Definitive Solution?

Congenital clubfoot is one of the most common deformities at birth. The inadequacy or absence of treatment causes serious limitations for people with this condition. The initial treatment using the Ponseti method ensures functional results superior to other treatment modalities previously proposed. However, recurrences and neglected feet are still a challenge today. An understanding of the pathophysiology of the disease, as well as of the anatomy and local biomechanics and a thorough clinical and radiological evaluation of patients are essential to understanding the limits of the method and choosing the best treatment.

Congenital Clubfoot - Is the Ponseti Method the Definitive Solution? / Pé torto congênito - O método Ponseti é a solução definitiva?

Abstract Congenital clubfoot is one of the most common deformities at birth. The inadequacy or absence of treatment causes serious limitations for people with this condition. The initial treatment using the Ponseti method ensures functional results superior to other treatment modalities previously proposed. However, recurrences and neglected feet are still a challenge today. An understanding of the pathophysiology of the disease, as well as of the anatomy and local biomechanics and a thorough clinical and radiological evaluation of patients are essential to understanding the limits of the method and choosing the best treatment.

Resumo O pé torto congênito é uma das deformidades mais comuns ao nascimento. A inadequação ou ausência do tratamento provoca sérias limitações aos portadores desta condição. O tratamento inicial pelo método Ponseti garante resultados funcionais superiores a outras modalidades de tratamento propostas anteriormente, porém as recidivas e os pés negligenciados ainda são um desafio na atualidade. O entendimento da fisiopatologia da doença, da anatomia e biomecânica local e uma minuciosa avaliação clínica e radiológica dos pacientes são imprescindíveis para entendermos o limite do método e escolhermos o melhor tratamento.

Syndecan Family Gene and Protein Expression and Their Prognostic Values for Prostate Cancer.

Prostate cancer (PCa) is the leading cause of cancer-associated mortality in men, and new biomarkers are still needed. The expression pattern and protein tissue localization of proteoglycans of the syndecan family (SDC 1-4) and syntenin-1 (SDCBP) were determined in normal and prostatic tumor tissue from two genetically engineered mouse models and human prostate tumors. Studies were validated using SDC 1-4 and SDCBP mRNA levels and patient survival data from The Cancer Genome Atlas and CamCAP databases. RNAseq showed increased expression of Sdc1 in Pb-Cre4/Ptenf/f mouse Pca and upregulation of Sdc3 expression and downregulation of Sdc2 and Sdc4 when compared to the normal prostatic tissue in Pb-Cre4/Trp53f/f-;Rb1f/f mouse tumors. These changes were confirmed by immunohistochemistry. In human PCa, SDC 1-4 and SDCBP immunostaining showed variable localization. Furthermore, Kaplan-Meier analysis showed that patients expressing SDC3 had shorter prostate-specific survival than those without SDC3 expression (log-rank test, p = 0.0047). Analysis of the MSKCC-derived expression showed that SDC1 and SDC3 overexpression is predictive of decreased biochemical recurrence-free survival (p = 0.0099 and p = 0.045, respectively), and SDC4 overexpression is predictive of increased biochemical recurrence-free survival (p = 0.035). SDC4 overexpression was associated with a better prognosis, while SDC1 and SDC3 were associated with more aggressive tumors and a worse prognosis.