Exploring Potential Surrogate Systems for Studying the Early Steps of the Sporisorium scitamineum Pathogenesis.

Despite its global importance as a primary source of table sugar and bioethanol, sugarcane faces a significant threat to its production due to diseases. One of these diseases, sugarcane smut, involves the emergence of a whip-like structure from the host apical shoot. The slow onset of this pathogenesis is the most substantial challenge for researchers to investigate the molecular events leading to resistance or susceptibility. In this study, we explored the early interaction between the smut fungus Sporisorium scitamineum and foliar tissues of the model plants Arabidopsis thaliana and Nicotiana benthamiana. Upon inoculation with the fungus, A. thaliana showed a compatible reaction, producing lesions during fungus colonization, whereas N. benthamiana showed signs of nonhost resistance. In addition, we propose a sugarcane detached leaf assay using plants cultivated in vitro to reveal sugarcane smut response outcomes. We used two sugarcane genotypes with known contrasting reactions to smut in the field. Although there is no evidence of sugarcane smut fungus infecting host leaves naturally, the sugarcane detached leaf assay enabled a rapid assessment of disease outcomes. Different symptoms in the detached leaves after inoculation distinguished smut-susceptible and smut-resistant sugarcane genotypes. Microscopic observations and gene expression analysis of S. scitamineum candidate effectors confirmed the fungal growth and its restriction on the compatible and incompatible interactions, respectively. These findings offer new prospects into the disease phenotyping of S. scitamineum, which could greatly expedite the comprehension of the initial stages of the pathogenesis and predict smut resistance in sugarcane genotypes.

Prospective cohort of parameters of glycemic and lipid metabolism after abdominoplasty in normal weight and formerly obese patiens.

Background: Obesity poses a major risk for cardiovascular diseases, while it is almost a consensus that intra-abdominal adiposity has a more deleterious effect for metabolic syndrome. In this sense, it is speculated that lipectomy or liposuction would be metabolically harmful, as it changes the abdominal-superficial adipose tissue ratio. However, the literature has shown conflicting evidence. Methods: In order to evaluate the possibility of metabolism alteration resulting from body coutouring surgery, a prospective cohort was implemented with 35 patients who underwent abdominoplasty, including some with a history of massive weight loss. Fasting blood glucose, fasting plasma insulin, triglycerides, total cholesterol and fractions were requested preoperatively and in the third postoperative month. The groups were also compared with each other. Results: No statistically significant variation between the exams collected in the preoperative period and those collected after abdominoplasty was found. There was a statistically significant difference in LDL (low-density lipoprotein; p = 0.033) and non-HDL (non-high-density lipoprotein) cholesterol (p = 0.020) between the two control tests of the groups surveyed. There were also differences in comorbidities (p = 0.006) and complications (p <0.001) between the groups. Conclusions: Abdominoplasty was not able of changing tests that assess glycemic and lipid metabolism three months after the operation. Our attention was drawn to the fact that patients who had massive weight loss had better control of LDL cholesterol (p = 0.033) and non-HDL cholesterol (p = 0.020), despite having higher weight and body mass index (p <0.001).

A Bacterial Type Three Secretion-Based Delivery System for Functional Characterization of Sporisorium scitamineum Plant Immune Suppressing Effector Proteins.

The facultative biotrophic basidiomycete Sporisorium scitamineum causes smut disease in sugarcane. This study applied an assay to identify S. scitamineum candidate effectors (CEs) with plant immunity suppression activities by delivering them into Nicotiana benthamiana cells via the type-three secretion system of Pseudomonas fluorescens EtHAn. Six CEs were individually cloned into the pEDV6 vector and expressed by P. fluorescens EtHAn for translocation into the plant cells. Three CEs (g1052, g3890, and g5159) could suppress pattern-triggered immunity (PTI) responses with high reproducibility in different coinfiltration experiments with P. syringae pv. tomato DC3000. In addition, three CEs (g1052, g4549, and g5159) were also found to be AvrB-induced suppressors of effector-triggered immunity (ETI), demonstrating for the first time that S. scitamineum can defeat both PTI and ETI responses. A transcriptomic analysis at different stages of infection by the smut fungus of three sugarcane cultivars with contrasting responses to the pathogen revealed that suppressors g1052, g3890, g4549, and g5159 were induced at the early stage of infection. By contrast, the two CEs (g2666 and g6610) that did not exhibit suppression activities expressed only at the late stage of infection. Moreover, genomic structures of the CEs and searches for orthologs in other smut species suggested duplication events and further divergence in CEs evolution of S. scitamineum. Thus, the transient assay applied here demonstrated the potential of pEDV6 and P. fluorescens EtHAn as biological tools for identifying plant immune suppressors from S. scitamineum.

Leaping into the Unknown World of Sporisorium scitamineum Candidate Effectors.

Sporisorium scitamineum is a biotrophic fungus causing sugarcane smut disease. In this study, we set up a pipeline and used genomic and dual transcriptomic data previously obtained by our group to identify candidate effectors of S. scitamineum and their expression profiles in infected smut-resistant and susceptible sugarcane plants. The expression profile of different genes after infection in contrasting sugarcane genotypes assessed by RT-qPCR depended on the plant genotypes and disease progression. Three candidate effector genes expressed earlier only in resistant plants, four expressed in both genotypes, and three later in susceptible plants. Ten genes were cloned and transiently expressed in N. benthamiana leaves to determine their subcellular location, while four localized in more than one compartment. Two candidates, g3890 having a nucleoplasmic and mitochondrial location and g5159 targeting the plant cell wall, were selected to obtain their possible corresponding host targets using co-immunoprecipitation (CoIP) experiments and mass spectrometry. Various potential interactors were identified, including subunits of the protein phosphatase 2A and an endochitinase. We investigated the presence of orthologs in sugarcane and using transcriptome data present their expression profiles. Orthologs of sugarcane shared around 70% similarity. Identifying a set of putative fungal effectors and their plant targets provides a valuable resource for functional characterization of the molecular events leading to smut resistance in sugarcane plants and uncovers further opportunities for investigation.

Grisel Syndrome: Case Report

We report a case of a rare disease, Grisel syndrome, which manifests as a kind of rotational fixation of the atlas on the axis, resulting from an infectious process of the upper airways. In the present report, we discuss etiology, clinical presentation, diagnosis, treatment and outcome after intervention.

Genome sequencing and transcript analysis of Hemileia vastatrix reveal expression dynamics of candidate effectors dependent on host compatibility.

Coffee leaf rust caused by the fungus Hemileia vastatrix is one of the most important leaf diseases of coffee plantations worldwide. Current knowledge of the H. vastatrix genome is limited and only a small fraction of the total fungal secretome has been identified. In order to obtain a more comprehensive understanding of its secretome, we aimed to sequence and assemble the entire H. vastatrix genome using two next-generation sequencing platforms and a hybrid assembly strategy. This resulted in a 547 Mb genome of H. vastatrix race XXXIII (Hv33), with 13,364 predicted genes that encode 13,034 putative proteins with transcriptomic support. Based on this proteome, 615 proteins contain putative secretion peptides, and lack transmembrane domains. From this putative secretome, 111 proteins were identified as candidate effectors (EHv33) unique to H. vastatrix, and a subset consisting of 17 EHv33 genes was selected for a temporal gene expression analysis during infection. Five genes were significantly induced early during an incompatible interaction, indicating their potential role as pre-haustorial effectors possibly recognized by the resistant coffee genotype. Another nine genes were significantly induced after haustorium formation in the compatible interaction. Overall, we suggest that this fungus is able to selectively mount its survival strategy with effectors that depend on the host genotype involved in the infection process.

Evaluation of the discal height gain and lumbar lordosis variation obtained by the techniques of transforaminal and posterior lumbar intersomatic fusion / Avaliação do ganho de altura discal e lordose lombar obtido pelas técnicas de fusão intersomática transforaminal e posterior

ABSTRACT Objective: Evaluate the discal height and lumbar lordosis gains, comparatively, according to the two lumbar arthrodesis techniques, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), used in the treatment of spinal degenerative diseases. Methods: The present study, retrospective, was done with 60 patients who underwent decompression and 1 level lumbar arthrodesis in the Hospital Santa Casa de Misericórdia de Vitória (HSCMV), between January 2010 and December 2015. The patients were divided in two groups of 30 each, according to the utilized intersomatic arthrodesis technique: TLIF or PLIF. All patients presented pathologies at the L4-L5 level. In this study, the discal height gain and lumbar lordosis variation were evaluated by analyzing spinal radiographies of the pre and post-operatory periods from patients of the two groups, measured by the software Surgimap®. In addition, the pain intensity in the post-operatory period was estimated by the Visual Analog Scale for Pain (VAS Pain). Results: Both techniques presented a gain in the discal height in the post-operatory. There was no statistically significant difference between the discal height variation obtained with the PLIF technique when compared to the TLIF technique (p = 0.139). In the same way, there was no statistically significant difference in the lumbar lordosis variation between the two studied groups (p = 0.184). By the EVA Pain analysis, there was no significant difference in the pain intensity in the post-operatory period between both arthrodesis surgeries. Conclusion: There is no difference in the discal height gain and lumbar lordosis variation, as well as in the pain intensity in the post-operatory periods, in patients who underwent 1 level intersomatic arthrodesis when comparing the PLIF and TLIF techniques.

RESUMO Objetivo: Avaliar o ganho de altura discal e lordose lombar, comparativamente, conforme as duas técnicas de artrodese lombar, fusão intervertebral lombar transforaminal (TLIF) e fusão intervertebral lombar posterior (PLIF), usadas para o tratamento de doenças degenerativas da coluna vertebral. Métodos: O presente estudo, retrospectivo, foi feito com 60 pacientes submetidos a descompressão e artrodese lombar de um nível em nossa instituição de janeiro de 2010 a dezembro de 2015. Os pacientes foram divididos em dois grupos de 30 cada, conforme a técnica de artrodese intersomática TLIF ou PLIF. Todos apresentavam patologias no nível de L4-L5. Neste estudo, avaliaram-se o ganho de altura discal e a variação na lordose lombar por meio da análise das radiografias de coluna vertebral do período pré e pós-operatório dos pacientes dos dois grupos, mensurados por meio do programa de computador Surgimap®. Além disso, estimou-se a intensidade de dor no período pós-operatório por meio da Escala Visual Analógica (EVA). Resultados: Ambas as técnicas apresentaram ganho de altura discal no pós-operatório. Não existiu diferença estatisticamente significativa entre a variação da altura discal obtida com a técnica PLIF quando comparada com técnica TLIF (p = 0,139). Da mesma forma, não houve diferença estatisticamente significativa entre a variação de lordose lombar observada entre os dois grupos (p = 0,184). Por meio da análise da EVA, não houve diferença significativa na dor no período pós-operatório entre ambas as cirurgias de artrodese. Conclusão: Não houve diferença no ganho de altura discal e lordose lombar, assim como na intensidade de dor no período pós-operatório, em pacientes submetidos a artrodese intersomática de um nível quando comparadas as técnicas PLIF e TLIF.

Evaluation of the discal height gain and lumbar lordosis variation obtained by the techniques of transforaminal and posterior lumbar intersomatic fusion.

OBJECTIVE: Evaluate the discal height and lumbar lordosis gains, comparatively, according to the two lumbar arthrodesis techniques, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), used in the treatment of spinal degenerative diseases. METHODS: The present study, retrospective, was done with 60 patients who underwent decompression and 1 level lumbar arthrodesis in the Hospital Santa Casa de Misericórdia de Vitória (HSCMV), between January 2010 and December 2015. The patients were divided in two groups of 30 each, according to the utilized intersomatic arthrodesis technique: TLIF or PLIF. All patients presented pathologies at the L4-L5 level. In this study, the discal height gain and lumbar lordosis variation were evaluated by analyzing spinal radiographies of the pre and post-operatory periods from patients of the two groups, measured by the software Surgimap®. In addition, the pain intensity in the post-operatory period was estimated by the Visual Analog Scale for Pain (VAS Pain). RESULTS: Both techniques presented a gain in the discal height in the post-operatory. There was no statistically significant difference between the discal height variation obtained with the PLIF technique when compared to the TLIF technique (p = 0.139). In the same way, there was no statistically significant difference in the lumbar lordosis variation between the two studied groups (p = 0.184). By the EVA Pain analysis, there was no significant difference in the pain intensity in the post-operatory period between both arthrodesis surgeries. CONCLUSION: There is no difference in the discal height gain and lumbar lordosis variation, as well as in the pain intensity in the post-operatory periods, in patients who underwent 1 level intersomatic arthrodesis when comparing the PLIF and TLIF techniques.

OBJETIVO: Avaliar o ganho de altura discal e lordose lombar, comparativamente, conforme as duas técnicas de artrodese lombar, fusão intervertebral lombar transforaminal (TLIF) e fusão intervertebral lombar posterior (PLIF), usadas para o tratamento de doenças degenerativas da coluna vertebral. MÉTODOS: O presente estudo, retrospectivo, foi feito com 60 pacientes submetidos a descompressão e artrodese lombar de um nível em nossa instituição de janeiro de 2010 a dezembro de 2015. Os pacientes foram divididos em dois grupos de 30 cada, conforme a técnica de artrodese intersomática TLIF ou PLIF. Todos apresentavam patologias no nível de L4-L5. Neste estudo, avaliaram-se o ganho de altura discal e a variação na lordose lombar por meio da análise das radiografias de coluna vertebral do período pré e pós-operatório dos pacientes dos dois grupos, mensurados por meio do programa de computador Surgimap®. Além disso, estimou-se a intensidade de dor no período pós-operatório por meio da Escala Visual Analógica (EVA). RESULTADOS: Ambas as técnicas apresentaram ganho de altura discal no pós-operatório. Não existiu diferença estatisticamente significativa entre a variação da altura discal obtida com a técnica PLIF quando comparada com técnica TLIF (p = 0,139). Da mesma forma, não houve diferença estatisticamente significativa entre a variação de lordose lombar observada entre os dois grupos (p = 0,184). Por meio da análise da EVA, não houve diferença significativa na dor no período pós-operatório entre ambas as cirurgias de artrodese. CONCLUSÃO: Não houve diferença no ganho de altura discal e lordose lombar, assim como na intensidade de dor no período pós-operatório, em pacientes submetidos a artrodese intersomática de um nível quando comparadas as técnicas PLIF e TLIF.

Epidemiology Profile of Traumatic Spine Injury of a Spinal Cord Service in the State of Espírito Santo

Objective To analyze the epidemiological profile of patients with traumatic spinal cord injury (SCI) undergoing surgical procedures in the state of Espírito Santo, Brazil. Methods A cross-sectional, descriptive study was performed based on the analysis of 70 medical records of patients who underwent surgery due to traumatic SCI in the state of Espírito Santo, Brazil. Results Males comprised 79% of the patients. The average age of the occurrence of the traumatic SCI was 44 years; automobile accidents were the main cause of trauma (44%). Half of the patients had lesions in the cervical region, and 46% were classified as Frankel A, according to the Frankel scale. In the first 60 days after surgery, the main complication presented by the patients was urinary tract infection (UTI). Half of the patients were from the metropolitan area. Conclusion Patients undergoing surgery for traumatic SCI in the state of Espírito Santo are predominantly men, with a mean age of 44 years, with cervical spine injury due to car accidents, from the metropolitan area, and whose main complication was UTI.

Objetivo Analisar o perfil epidemiológico dos pacientes com traumatismo raquimedular (TRM) submetidos a procedimentos cirúrgicos no estado do Espírito Santo, Brasil. Métodos Foi realizado um estudo transversal e descritivo, baseado na análise de 70 prontuários de pacientes submetidos a procedimento cirúrgico em decorrência de TRM no estado do Espírito Santo, Brasil. Resultados Um total de 79% dos pacientes era do sexo masculino. A média de idade foi de 44 anos, sendo acidente automobilístico a causa principal de trauma (44%). Metade dos pacientes apresentou lesão em região cervical, e 46% foram classificados como Frankel A, de acordo com a escala Frankel. Nos primeiros 60 dias após a cirurgia, a principal complicação apresentada pelos pacientes foi infecção do trato urinário (ITU). Metade dos pacientes era proveniente da região metropolitana do estado. Conclusão Os pacientes submetidos a procedimento cirúrgico por TRM no estado do Espírito Santo são predominantemente homens, com idade média de 44 anos, lesão da coluna cervical por acidente automobilístico, e provenientes da região metropolitana. A principal complicação apresentada foi ITU.

Postoperative complications of suction drain in patients submitted to 1-level lumbar arthrodesis / Complicações pós-operatória do dreno de sucção em pacientes submetidos a artrodese lombar de um nível / Complicaciones postoperatório del dreno de succión en pacientes sometidos a artrodesis lumbar de un nivel

ABSTRACT Objective: To evaluate the complications inherent in the use or not of continuous suction drain in postoperative period of patients undergoing 1-level lumbar arthrodesis. Methods: An analytical, comparative, randomized study was performed with a sample of 60 patients submitted to 1-level 360o lumbar arthrodesis with TLIF technique, 30 of whom used the suction drain for three days after surgery and another 30 did not use the suction drain in the postoperative period. The complications that occurred on the 3rd, 14th, and 28th postoperative days of patients of both groups and the Visual Analog Scale for pain were evaluated and compared. The complications assessed were seroma, superficial infection and suture dehiscence. Results: A total of 23.3% surgical wound complications were found, the most frequent being seroma (16%). In total, each group presented seven complications. There were no statistical differences observed in the evaluation of seroma, infection, wound dehiscence on the 3rd, 14th, and 28th postoperative days in both groups. Conclusion: The use or not of suction drain in 1-level lumbar surgeries does not interfere with complications such as seroma, infection, and suture dehiscence.

RESUMO Objetivo: Avaliar as complicações inerentes à utilização ou não de dreno de sucção contínua em pós-operatório de pacientes submetidos a artrodese lombar de um nível. Métodos: Estudo analítico, comparativo, randomizado, com uma amostra de 60 pacientes submetidos a artrodese lombar de 360º em um nível com técnica TLIF, sendo que 30 utilizaram o dreno de sucção por três dias no pós-operatório e outros 30 não utilizaram o dreno de sucção no pós-operatório. Foram avaliadas e comparadas as complicações surgidas no 3°, 14° e 28° dias pós-operatório dos pacientes de ambos os grupos e a Escala Visual Analógica para dor. As complicações avaliadas foram seroma, infecção superficial e deiscência de sutura. Resultados: Encontrou-se um total de 23,3% de complicações da ferida cirúrgica, sendo a mais frequente o seroma (16%). No total das complicações cada grupo apresentou sete. Não foram observadas diferenças estatísticas na avaliação de seroma, infecção, deiscência de sutura no 3º, 14º e 28º dia de pós-operatório em ambos os grupos. Conclusão: A utilização ou não de dreno de sucção em cirurgias lombares em um nível não interfere no surgimento das complicações como seroma, infecção e deiscência de sutura.

RESUMEN Objetivo: Evaluar las complicaciones inherentes a la utilización o no de drenaje de succión continua en el postoperatorio de pacientes sometidos a artrodesis lumbar de un nivel. Métodos: Estudio analítico, comparativo, aleatorizado, con una muestra de 60 pacientes sometidos a artrodesis lumbar de 360o de un nivel con técnica TLIF, siendo que 30 utilizaron el drenaje de succión por tres días en el postoperatorio y otros 30 no utilizaron el drenaje en el postoperatorio. Se evaluaron y compararon las complicaciones surgidas en los días 3, 14 y 28 de días del postoperatorio de los pacientes en ambos grupos y la escala analógica visual para el dolor. Las complicaciones evaluadas fueron seroma, infección superficial y dehiscencia de sutura. Resultados: Se encontró un total de 23,3% de complicaciones de la herida quirúrgica, siendo el seroma la más frecuente (16%). En el total de las complicaciones cada grupo presentó siete. No se observaron diferencias estadísticas en la evaluación de seroma, infección, dehiscencia de sutura en el 3o, 14o y 28o día de postoperatorio en ambos grupos. Conclusión: El uso o no de drenaje de succión en cirugías lumbares de un nivel no interfiere en la aparición de complicaciones como seroma, infección y dehiscencia de sutura.

Polyethylene cellulose nanofibrils nanocomposites.

This paper investigates the use of an aqueous dispersion of polyethylene copolymer with a relatively high content of acrylic acid as a compatibilizer and as an alternative medium to obtain polyethylene CNF nanocomposites. The CNF content was varied from 1 to 90wt% and the appearance, optical, thermal, mechanical and rheological properties, as well the morphology of the films were evaluated. The PE/CNF films are transparent up to 20wt% of NFC indicating a good dispersion of CNF, but a poor distribution, with PE-rich and CNF-rich regions observed by SEM. Improved mechanical properties were achieved, with a 100% and 15,900% increase in the Young's modulus with 1wt% and 90wt% NFC, respectively. The rheological behavior indicated good melt processability. According to these results, aqueous polyolefin dispersions seem to be a promising, easy and relatively fast route for obtaining cellulose/polyolefins nanocomposites with low to high contents of cellulose nanofibrils.

Gene expression profiling describes the genetic regulation of Meloidogyne arenaria resistance in Arachis hypogaea and reveals a candidate gene for resistance.

Resistance to root-knot nematode was introgressed into cultivated peanut Arachis hypogaea from a wild peanut relative, A. cardenasii and previously mapped to chromosome A09. The highly resistant recombinant inbred RIL 46 and moderately resistant RIL 48 were selected from a population with cv. Gregory (susceptible) and Tifguard (resistant) as female and male parents, respectively. RNA-seq analysis was performed on these four genotypes using root tissue harvested from root-knot nematode infected plants at 0, 3, 7 days after inoculation. Differential gene expression analysis provides evidence that root-knot nematodes modulate biological pathways involved in plant hormone, defense, cell signaling, cytoskeleton and cell wall metabolism in a susceptible reaction. Corresponding to resistance reaction, an effector-induced-immune response mediated by an R-gene was identified in Tifguard. Mapping of the introgressed region indicated that 92% of linkage group A09 was of A. cardenasii origin in Tifguard. RIL46 and RIL 48 possessed 3.6% and 83.5% of the introgression on A09, respectively. Within the small introgressed region carried by RIL 46, a constitutively expressed TIR-NBS-LRR gene was identified as the candidate for nematode resistance. Potential defense responsive pathways include effector endocytosis through clathrin-coated vesicle trafficking, defense signaling through membrane lipid metabolism and mucilage production.

The Hemileia vastatrix effector HvEC-016 suppresses bacterial blight symptoms in coffee genotypes with the SH 1 rust resistance gene.

A number of genes that confer resistance to coffee leaf rust (SH 1-SH 9) have been identified within the genus Coffea, but despite many years of research on this pathosystem, the complementary avirulence genes of Hemileia vastatrix have not been reported. After identification of H. vastatrix effector candidate genes (HvECs) expressed at different stages of its lifecycle, we established an assay to characterize HvEC proteins by delivering them into coffee cells via the type-three secretion system (T3SS) of Pseudomonas syringae pv. garcae (Psgc). Employing a calmodulin-dependent adenylate cyclase assay, we demonstrate that Psgc recognizes a heterologous P. syringae T3SS secretion signal which enables us to translocate HvECs into the cytoplasm of coffee cells. Using this Psgc-adapted effector detector vector (EDV) system, we found that HvEC-016 suppresses the growth of Psgc on coffee genotypes with the SH 1 resistance gene. Suppression of bacterial blight symptoms in SH 1 plants was associated with reduced bacterial multiplication. By contrast, HvEC-016 enhanced bacterial multiplication in SH 1-lacking plants. Our findings suggest that HvEC-016 may be recognized by the plant immune system in a SH 1-dependent manner. Thus, our experimental approach is an effective tool for the characterization of effector/avirulence proteins of this important pathogen.

Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery / Avaliação do equilíbrio espinopélvico dos pacientes com espondilolistese degenerativa L4L5 e hérnia de disco L4L5 submetidos a cirurgia

ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. CONCLUSION: This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

RESUMO OBJETIVO: Correlacionar o equilíbrio espinopélvico com o desenvolvimento de espondilolistese degenerativa e hérnia discal. MÉTODOS: Estudo retrospectivo de caráter descritivo, no qual foram avaliados 60 pacientes, 30 portadores de espondilolistese degenerativa no nível L4-L5 e 30 portadores de hérnia de disco no nível L4-L5, todos submetidos a tratamento cirúrgico. RESULTADOS: Os pacientes portadores de hérnia de disco lombar no nível L4-L5 apresentaram uma média da inclinação pélvica (TILT) de 8,06, da inclinação sacral (SLOP) de 36,93 e da incidência pélvica (IP) de 45. Nos pacientes portadores espondilolistese degenerativa no nível L4-L5 foi observada uma média da TILT de 22,1, da SLOP de 38,3 e da IP de 61,4. CONCLUSÃO: O presente artigo reforça a descoberta de que as elevadas médias obtidas da TILT e da IP estão relacionadas com o surgimento da espondilolistese degenerativa e ainda conclui que os mesmos ângulos, quando baixos, aumentam o risco para hérnia de disco.

Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery.

OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. CONCLUSION: This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

OBJETIVO: Correlacionar o equilíbrio espinopélvico com o desenvolvimento de espondilolistese degenerativa e hérnia discal. MÉTODOS: Estudo retrospectivo de caráter descritivo, no qual foram avaliados 60 pacientes, 30 portadores de espondilolistese degenerativa no nível L4-L5 e 30 portadores de hérnia de disco no nível L4-L5, todos submetidos a tratamento cirúrgico. RESULTADOS: Os pacientes portadores de hérnia de disco lombar no nível L4-L5 apresentaram uma média da inclinação pélvica (TILT) de 8,06, da inclinação sacral (SLOP) de 36,93 e da incidência pélvica (IP) de 45. Nos pacientes portadores espondilolistese degenerativa no nível L4-L5 foi observada uma média da TILT de 22,1, da SLOP de 38,3 e da IP de 61,4. CONCLUSÃO: O presente artigo reforça a descoberta de que as elevadas médias obtidas da TILT e da IP estão relacionadas com o surgimento da espondilolistese degenerativa e ainda conclui que os mesmos ângulos, quando baixos, aumentam o risco para hérnia de disco.

Analysis of the secondary curves in patients undergoing selective arthrodesis Lenke I / Análise das curvas secundárias em pacientes submetidos a artrodese seletiva Lenke I / Análisis de las curvas secundarias en pacientes sometidos a artrodesis selectiva Lenke I

Objective : To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods : Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results : The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion : Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

Objetivo : Avaliar radiograficamente o comportamento das curvas secundárias nos planos coronal e sagital em pacientes portadores de EIA classificados como Lenke I, que foram submetidos a tratamento cirúrgico de artrodese seletiva por via posterior. Métodos : Estudo retrospectivo no qual foram analisados 40 pacientes portadores de EIA, sendo 33 do sexo feminino. A mensuração dos parâmetros radiográficos utilizados seguiu o preconizado por Cobb. Resultados : A média de correção das curvas torácicas proximal, principal e lombar foi de 34,73%, 75,06% e 64,64% respectivamente. Conclusão : O tratamento cirúrgico por artrodese seletiva em casos de EIA Lenke tipo I proporciona correção das curvas compensatórias no plano coronal e manutenção do plano sagital.

Objetivo : Evaluar radiográficamente el comportamiento de las curvas secundarias en el plano coronal y sagital en pacientes con EIA clasificados como Lenke I, que se sometieron a tratamiento quirúrgico selectivo por artrodesis por vía posterior. Métodos : Estudio retrospectivo, que analizaron a 40 pacientes con EIA, siendo 33 del sexo femenino. La medición de los parámetros radiológicos utilizados siguió las recomendaciones de Cobb. Resultados : La corrección media de las curvas torácica proximal, principal y lumbar fue 34,73%, 75,06% y 64,64%, respectivamente. Conclusión : El tratamiento quirúrgico mediante artrodesis selectiva de los casos de EIA Lenke tipo I proporciona la corrección de las curvas de compensación en el plano coronal y el mantenimiento en el plano sagital.

Comparison of the effectiveness of radicular blocking techniques in the treatment of lumbar disk hernia / Comparação da eficácia das técnicas de bloqueio radicular no tratamento da hérnia de disco lombar / Comparación de la eficacia de las técnicas de bloqueo radicular en el tratamiento de la hernia de disco lumbar

Objective : Compare the interlaminar blocking technique with the transforaminal blocking, with regard to pain and the presence or absence of complications. Methods : Prospective, descriptive and comparative, double-blind, randomized study, with 40 patients of both sex suffering from sciatic pain due to central-lateral or foraminal disc herniation, who did not respond to 20 physiotherapy sessions and had no instability diagnosed on examination of dynamic radiography. The type of blocking, transforaminal or interlaminar, to be performed was determined by draw. Results : We evaluated 40 patients, 17 males, mean age 49 years, average VAS pre-blocking of 8.85, average values in transforaminal technique in 24 hours, 7, 21, and 90 days of 0.71, 1.04, 2.33 and 3.84, respectively; the average VAS post-blocking for interlaminar technique was 0.89, 1.52, 3.63 and 4.88. The techniques differ only in the post-blocking period of 21 days and overall post-blocking, with significance of p=0.022 and p=0.027, respectively. Conclusion : Both techniques are effective in relieving pain and present low complication rate, and the transforaminal technique proved to be the most effective.

Objetivos : Comparar a técnica de bloqueio interlaminar com a de bloqueio transforaminal, quanto ao quadro álgico e a presença ou não de complicações. Métodos : Estudo prospectivo, de caráter descritivo e comparativo, duplo-cego e randomizado, do qual participaram 40 pacientes, de ambos os sexos, portadores de lombociatalgia por hérnia discal, do tipo centrolateral ou foraminal, que não responderam a 20 sessões de fisioterapia e não tiveram instabilidade diagnosticada em exame de radiografia dinâmica. O tipo de bloqueio interlaminar ou transforaminal a ser realizado foi determinado por meio de sorteio. Resultados : Foram avaliados 40 pacientes, 17 do sexo masculino, com média de idade de 49 anos, média da EVA pré-bloqueio de 8,85, valores médios na técnica transforaminal em 24 horas, 7, 21 e 90 dias foram 0,71, 1,04, 2,33 e 3,84, respectivamente; a média da EVA pós-bloqueio pela técnica interlaminar foi 0,89, 1,52, 3,63 e 4,88. As técnicas diferem apenas no período de 21 dias pós-bloqueio e no pós-bloqueio global, com significâncias p = 0,022 e p = 0,027, respectivamente. Conclusão : Ambas as técnicas são eficazes no alívio da dor e apresentam baixa taxa de complicação, sendo a técnica transforaminal a de melhores resultados.

Objetivo : Comparar la técnica de bloqueo interlaminar con la técnica de bloqueo transforaminal con respecto al dolor y la presencia o ausencia de complicaciones. Métodos : Estudio prospectivo, descriptivo y comparativo, doble ciego y aleatorizado, que incluyó a 40 pacientes de ambos sexos que sufrían de dolor ciático por hernia de disco de tipo de centro-lateral o foraminal, que no respondieron a 20 sesiones de fisioterapia y no tenían diagnóstico de inestabilidad en la exploración por radiografía dinámica. El tipo de bloqueo, transforaminal o interlaminar, a ser realizado se ha determinado por sorteo. Resultados : Se evaluaron 40 pacientes, 17 hombres, edad media 49 años, EVA promedio pre-bloqueo de 8,85, valores medios de la técnica transforaminal en 24 horas, 7, 21 y 90 días de 0.71, 1,04, 2,33 y 3,84, respectivamente; la EVA post-bloqueo promedio de la técnica interlaminar fue de 0,89, 1,52, 3,63 y 4,88. Las técnicas difieren solamente en el período de 21 días post-bloqueo y en el post-bloqueo global, con significaciones de p = 0,022 y p = 0,027, respectivamente. Conclusión : Ambas técnicas son eficaces para aliviar el dolor y tienen una baja tasa de complicaciones, siendo que la técnica transforaminal presentó mejores resultados.

Densidade mineral óssea estimada pelo Osteorisk em pacientes com escoliose idiopática do adolescente / Bone mineral density estimated by osteorisk in patients with adolescent idiopathic scoliosis

OBJETIVO: Considera-se a prevalência de osteoporose em portadores de Escoliose Idiopática do Adolescente (EIA) maior do que na população adolescente em geral.Uma alternativa à radiologia para caracterização da densidade mineral óssea pode ser através de índices correlativos, como o Osteorisk, de fácil acesso e baixo custo, que auxilia o médico na solicitação da Densitometria Óssea. Por considerarmos que a osteoporose pode interferir na evolução e no tratamento da EIA fomos motivados a realizar este estudo. Nosso objetivo foi avaliar subjetivamente a densidade mineral óssea através do índice Osteorisk em pacientes portadores de EIA. MÉTODOS: Foram avaliados pacientes saudáveis, (grupo controle, n=30) e pacientes com EIA (n=30), dos quais obtivemos idade, peso e altura, sendo estabelecido o Osteorisk. Feito teste t de Student não-pareado, com p< 0,05 significante. RESULTADOS: O valor médio do Osteorisk encontrado para os pacientes com EIA foi de 6,38 ± 2,2 enquanto que no grupo controle foi de 8,27 ± 2,14, o que representa baixo risco para o desenvolvimento de osteoporose em ambos os grupos. Quando comparadas estas médias entre os grupos, foi observado menor Osteorisk no grupo EIA. CONCLUSÃO: Nosso trabalho demonstrou existir baixo risco para o desenvolvimento de osteoporose nos pacientes com EIA. Nível de Evidência I, Estudo prospectivo.

OBJECTIVE: The prevalence of osteoporosis in patients with Adolescent Idiopathic Scoliosis (AIS) is believed to be higher than in the general adolescent population. An alternative to radiology for the characterization of bone mineral density may be through correlative indexes like the Osteorisk index, which is easy to access and low in cost, and which helps the doctor in the request for Bone Densitometry. Our belief that osteoporosis can affect the evolution and treatment of AIS was what motivated us to conduct this study. Our objective was to subjectively evaluate bone mineral density by the Osteorisk index in patients with AIS. METHODS: Healthy patients (control group, n=30) and patients with AIS (n = 30) were evaluated, documenting age, weight and height, and establishing the Osteorisk. The unpaired Student t test was performed, with a level of significance of p <0.05. RESULTS: The mean Osteorisk found for the patients with AIS was 6.38 ± 2.2 while in the control group, it was 8.27 ± 2.14, which represents a low risk of developing osteoporosis in both groups. Comparing these means between the groups, a lower Osteorisk was observed in the AIS group. CONCLUSION: Our study showed that there is low risk of developing osteoporosis in patients with AIS. Level of Evidence I, prospective study.

Bone mineral density estimated by osteorisk in patients with adolescent idiopathic scoliosis.

OBJECTIVE: The prevalence of osteoporosis in patients with Adolescent Idiopathic Scoliosis (AIS) is believed to be higher than in the general adolescent population. An alternative to radiology for the characterization of bone mineral density may be through correlative indexes like the Osteorisk index, which is easy to access and low in cost, and which helps the doctor in the request for Bone Densitometry. Our belief that osteoporosis can affect the evolution and treatment of AIS was what motivated us to conduct this study. Our objective was to subjectively evaluate bone mineral density by the Osteorisk index in patients with AIS. METHODS: Healthy patients (control group, n=30) and patients with AIS (n = 30) were evaluated, documenting age, weight and height, and establishing the Osteorisk. The unpaired Student t test was performed, with a level of significance of p <0.05. RESULTS: The mean Osteorisk found for the patients with AIS was 6.38 ± 2.2 while in the control group, it was 8.27 ± 2.14, which represents a low risk of developing osteoporosis in both groups. Comparing these means between the groups, a lower Osteorisk was observed in the AIS group. CONCLUSION: Our study showed that there is low risk of developing osteoporosis in patients with AIS. Level of Evidence I, Prospective study.

Oclusão arterial aguda de stent fêmoro-poplíteo / Acute femoropopliteal artery stent obstruction

A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.

Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best therapeutic approach in this group of patients. We report a clinical case in which stent fragmentation and endarterectomy enabled femoropopliteal below knee bypass and limb revascularization.