The development of anin vitrohuman hair follicle organoid with a complexity similar to thatin vivo.

In vitrohair follicle (HF) models are currently limited toex vivoHF organ cultures (HFOCs) or 2D models that are of low availability and do not reproduce the architecture or behavior of the hair, leading to poor screening systems. To resolve this issue, we developed a technology for the construction of a humanin vitrohair construct based on the assemblage of different types of cells present in the hair organ. First, we demonstrated that epithelial cells, when isolatedin vitro, have similar genetic signatures regardless of their dissection site, and their trichogenic potential is dependent on the culture conditions. Then, using cell aggregation techniques, 3D spheres of dermal papilla (DP) were constructed, and subsequently, epithelial cells were added, enabling the production and organization of keratins in hair, similar to what is seenin vivo. These reconstructed tissues resulted in the following hair compartments: K71 (inner root-sheath), K85 (matrix region), K75 (companion layer), and vimentin (DP). Furthermore, the new hair model was able to elongate similarly toex vivoHFOC, resulting in a shaft-like shape several hundred micrometers in length. As expected, when the model was exposed to hair growth enhancers, such as ginseng extract, or inhibitors, such as TGF-B-1, significant effects similar to thosein vivowere observed. Moreover, when transplanted into skin biopsies, the new constructs showed signs of integration and hair bud generation. Owing to its simplicity and scalability, this model fully enables high throughput screening of molecules, which allows understanding of the mechanism by which new actives treat hair loss, finding optimal concentrations, and determining the synergy and antagonism among different raw materials. Therefore, this model could be a starting point for applying regenerative medicine approaches to treat hair loss.

Ecological modeling, biogeography, and phenotypic analyses setting the tiger cats' hyperdimensional niches reveal a new species.

Recently, the tiger-cat species complex was split into Leopardus tigrinus and Leopardus guttulus, along with other proposed schemes. We performed a detailed analysis integrating ecological modeling, biogeography, and phenotype of the four originally recognized subspecies-tigrinus, oncilla, pardinoides, guttulus-and presented a new multidimensional niche depiction of the species. Species distribution models used > 1400 records from museums and photographs, all checked for species accuracy. Morphological data were obtained from institutional/personal archives. Spotting patterns were established by integrating museum and photographic/camera-trap records. Principal component analysis showed three clearly distinct groups, with the Central American specimens (oncilla) clustering entirely within those of the Andes, namely the pardinoides group of the cloud forests of the southern Central-American and Andean mountain chains (clouded tiger-cat); the tigrinus group of the savannas of the Guiana Shield and central/northeastern Brazil (savanna tiger-cat); and the guttulus group in the lowland forests of the Atlantic Forest domain (Atlantic Forest tiger-cat). This scheme is supported by recent genetic analyses. All species displayed different spotting patterns, with some significant differences in body measurements/proportions. The new distribution presented alarming reductions from the historic range of - 50.4% to - 68.2%. This multidimensional approach revealed a new species of the elusive and threatened tiger-cat complex.

Rearranging the Bird's Nest Fungi: molecular review of internal clades in Cyathus (Nidulariaceae, Basidiomycota).

The genus Cyathus was established in 1768, but more in-depth taxonomic studies with the group only occurred after 1844. In the following years, changes in the infrageneric classification of Cyathus were proposed based mainly on morphology. With advances in phylogenetic studies, the morphological classifications were tested and a new subdivision into three groups was proposed in 2007. Based on the last two classifications, this work aims to expand and understand the internal phylogenetic relationships among the fungi of the genus Cyathus and examine how these relationships are reflected in the taxonomic classification, through molecular analyses covering most of the species in the group, based on materials obtained from type specimens deposited in major fungal collections worldwide, besides expanding sampling with tropical species. Molecular analyses followed the protocols available in the literature, including the design of specific primers for Cyathus. In the phylogenetic analysis, using Maximum Parsimony and Bayesian methods, sequences of ITS and LSU regions from 41 samples of 39 species of Cyathus, 26 were placed with some nomenclatural types. The monophyly of Cyathus was confirmed with maximum support in both tests, and the infrageneric groups of the most recent classification were unchanged, but the clade striatum showed segregation into four groups and three subgroups. The phylogenetic organization is supported morphological characters, and diagnoses are presented for each group, as well as a dichotomous key for the infrageneric separation.

Comparison of Cervical Stabilization with Transpedicular Pins and Polymethylmethacrylate versus Transvertebral Body Polyaxial Screws with or without an Interbody Distractor in Dogs.

OBJECTIVE: The main aim of this study was to compare the biomechanical properties of caudal cervical vertebral stabilization using bicortical transpedicular pins with polymethylmethacrylate (PMMA) versus transvertebral body polyaxial screws and connecting rods with or without an interbody distractor. STUDY DESIGN: Ten canine cervical vertebral columns (C2-T3) were used. Four models (intact, transvertebral body polyaxial screw with interbody distractor [polyaxial + distractor], transvertebral body polyaxial screw without interbody distractor [polyaxial - distractor] and bicortical transpedicular pins/polymethylmethacrylate [pin-PMMA]) were applied to C6-7 sequentially on the same specimens. Angular range of motion (AROM) in the form of flexion and extension was measured at C4-5, C5-6 and C6-7 in all groups. RESULTS: Treated vertebral specimens had significantly less AROM than unaltered specimens. There was no significant difference in AROM between the experimental groups at C6 and C7. Angular range of motion ratio in flexion-extension was 80.8, 72.7 and 78.3% for polyaxial + distractor, polyaxial - distractor and pin-PMMA groups, respectively, which were less than the intact group. There was no significant increase in the range of motion of the adjacent vertebrae after stabilization. CONCLUSION: Stabilization obtained with transvertebral body polyaxial screws was comparable to that from the well-established bicortical pins/PMMA construct. Association of an intervertebral distractor did not change AROM of the polyaxial screw constructs.

Impact of microstructure on cell behavior and tissue mechanics in collagen and dermal decellularized extra-cellular matrices.

Skin models are used for many applications such as research and development or grafting. Unfortunately, most lack a proper microenvironment producing poor mechanical properties and inaccurate extra-cellular matrix composition and organization. In this report we focused on mechanical properties, extra-cellular matrix organization and cell interactions in human skin samples reconstructed with pure collagen or dermal decellularized extra-cellular matrices (S-dECM) and compared them to native human skin. We found that Full-thickness S-dECM samples presented stiffness two times higher than collagen gel and similar to ex vivo human skin, and proved for the first time that keratinocytes also impact dermal mechanical properties. This was correlated with larger fibers in S-dECM matrices compared to collagen samples and with a differential expression of F-actin, vinculin and tenascin C between S-dECM and collagen samples. This is clear proof of the microenvironment's impact on cell behaviors and mechanical properties. STATEMENT OF SIGNIFICANCE: In vitro skin models have been used for a long time for clinical applications or in vitro knowledge and evaluation studies. However, most lack a proper microenvironment producing a poor combination of mechanical properties and appropriate biological outcomes, partly due to inaccurate extra-cellular matrix (ECM) composition and organization. This can lead to limited predictivity and weakness of skin substitutes after grafting. This study shows, for the first time, the importance of a complex and rich microenvironment on cell behaviors, matrix macro- and micro-organization and mechanical properties. The increased composition and organization complexity of dermal skin decellularized extra-cellular matrix populated with differentiated cells produces in vitro skin models closer to native human skin physiology.

Trabalho e Educação: Um Estudo de Caso com Professores de Escolas Rurais / Work and Education: A Case Study with Rural School Teachers / Trabajo y Educación: Un Estudio de Caso con Maestros de Escuelas Rurales

O presente artigo propõe analisar o contexto de trabalho dos professores de duas escolas rurais do interior do estado de São Paulo, com o intuito de demonstrar que o ambiente de trabalho pode estar relacionado aos riscos de adoecimento dos professores, considerando a perspectiva de saúde do trabalhador. Trata-se de um estudo de caso exploratório descritivo com enfoque quantitativo, que contou com a participação de 20 professores das duas escolas rurais. Os instrumentos de coleta de dados foram Questionário Sociodemográfico e Escala de Avaliação do Contexto de Trabalho (EACT), que abordam aspectos da organização, das condições de trabalho e das relações socioprofissionais. Os resultados apontaram para o nível crítico nos três fatores avaliados na escola "B", que indicaram aspectos tais como o número insuficiente de pessoas para realizar as tarefas, as tarefas repetitivas, entre outros. Na escola "A", o fator Organização do Trabalho foi avaliado de forma negativa, em itens como a falta de tempo para realizar a pausa de descanso e a rigidez das normas das tarefas. Esses aspectos revelam estado de preocupação nas escolas e merecem medidas de intervenção nesse ambiente a fim de minimizar riscos à saúde dos professores que atuam no contexto de escola rural. (AU)

This article proposes to analyze the work context of teachers who work at two rural schools in the country side of the state of São Paulo. It aims to demonstrate that the work environment may be related to the teachers' risk of illness according to the worker's health perspective. The study methodology consists in an exploratory descriptive case study with a quantitative focus, which counted on the participation of 20 teachers from both rural schools. The data collection instruments were a Sociodemographic Questionnaire and the Work Context Assessment Scale (EACT), which address the aspects of organization, working conditions as well as socio-professional relationships. The results pointed to a critical level with respect to the three evaluated factors in "B" school, indicating aspects such as the insufficient number of people to perform the tasks, which tend to be repetitive, among others factors. About the "A" school, the Work Organization factor was negatively assessed as the rest period tends to be short as well as the task rules tend to be very rigid. These aspects reveal a state of concern in schools and have shown the need of some intervention measures in this environment in order to minimize the risks to the health of the teachers who work at rural schools. (AU)

Este artículo propone analizar el contexto laboral de profesores de dos escuelas rurales del interior del estado de São Paulo, con el propósito de demostrar que el clima laboral puede estar relacionado con el riesgo de enfermedad de los profesores, considerando la perspectiva de salud del trabajador. Se trata de un estudio de caso, exploratorio, descriptivo con enfoque cuantitativo, con la participación de 20 profesores de las dos escuelas rurales. Los instrumentos de recopilación de datos fueron: Cuestionario Sociodemográfico y Escala de Evaluación del Contexto Laboral (EACT), que abordan aspectos de la organización, condiciones laborales y relaciones socioprofesionales. Los resultados apuntan al nivel crítico en los tres factores evaluados en la escuela "B", factores como: el número de personas es insuficiente para realizar las tareas, las tareas son repetitivas, entre otros. En la escuela "A" se valoró negativamente el factor Organización del Trabajo, ítems como: la falta de tiempo para tomar un descanso y la rigidez de las reglas de la tarea. Estos aspectos revelan un estado de preocupación en las escuelas y merecen medidas de intervención en el contexto para posibilitar un menor riesgo de salud para los profesores que trabajan en el contexto de escuela rural. (AU)

Excessive Prenatal Supplementation of Iodine and Fetal Goiter: Report of Two Cases Using Three-dimensional Ultrasound and Magnetic Resonance Imaging.

Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatment may be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Diagnosis of reoperated cervical non-union: Multicenter retrospective study about 45 patients.

INTRODUCTION: Non-union is one of the main complications of single- or multi-level cervical spine fusion, considerably impairing functional results. The aim of this study was to evaluate the respective contributions of imaging examinations in the diagnostic process, the challenge being to avoid inappropriate surgery and unnecessary complementary examinations. MATERIAL AND METHOD: A retrospective multicenter study included all patients managed for cervical spine non-union between 2008 and 2018. We evaluated the imaging examinations performed on each patient and determined signs of non-union in each image. RESULTS: The study included 45 patients in 4 centers: 55% female; mean age, of 48±8.0 years; 57% smokers. Systematic static radiography showed signs of non-union in 55% of cases. Dynamic X-ray was performed in 34% of patients, and showed hypermobility of the level in 80% of cases. CT supported diagnosis of non-union in 97% of cases, and MRI in 48%. SPECT-CT was positive in all cases of non-union. DISCUSSION: Dynamic X-ray is rarely prescribed, but frequently provided an objective measure of hypermobility of the level in non-union, justifying first-line use. Millimetric-slice CT was reliable for diagnosis. MRI is relevant only once diagnosis has been made, as part of preoperative work-up. Nuclear imaging can be useful in order to solve doubtful cases. CONCLUSION: In suspected cervical spine non-union, we recommend dynamic X-rays (flexion/extension) and CT-scan as first-line diagnosis examinations. LEVEL OF EVIDENCE: IV.

A perfusable vascularized full-thickness skin model for potential topical and systemic applications.

Vascularization of reconstructed tissues is one of the remaining hurdles to be considered to improve both the functionality and viability of skin grafts and the relevance ofin vitroapplications. Our study, therefore, sought to develop a perfusable vascularized full-thickness skin equivalent that comprises a more complex blood vasculature compared to existing models. We combined molding, auto-assembly and microfluidics techniques in order to create a vascularized skin equivalent representing (a) a differentiated epidermis with a physiological organization and correctly expressing K14, K10, Involucrin, TGM1 and Filaggrin, (b) three perfusable vascular channels with angiogenic sprouts stained with VE-Caderin and Collagen IV, (c) an adjacent microvascular network created via vasculogenesis and connected to the sprouting macrovessels. Histological analysis and immunostaining of CD31, Collagen IV, Perlecan and Laminin proved the integrity of vascular constructs. In order to validate the vascularized skin potential of topical and systemic applications, caffeine and minoxidil, two compounds with different chemical properties, were topically applied to measure skin permeability and benzo[a]pyrene pollutant was systemically applied to evaluate systemic delivery. Our results demonstrated that perfusion of skin reconstructs and the presence of a complex vascular plexus resulted in a more predictive and reliable model to assess respectively topical and systemic applications. This model is therefore aimed at furthering drug discovery and improving clinical translation in dermatology.

Excessive prenatal supplementation of iodine and fetal goiter: report of two cases using three-dimensional ultrasound and magnetic resonance imaging / Suplementação pré-natal excessiva de iodo e bócio fetal: Relato de dois casos utilizando ultrassonografia tridimensional e ressonância magnética

Abstract Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatmentmay be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

Resumo As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Animal modeling in bone research-Should we follow the White Rabbit?

Animal models are live subjects applied to translational research. They provide insights into human diseases and enhance biomedical knowledge. Livestock production has favored the pace of human social development over millennia. Today's society is more aware of animal welfare than past generations. The general public has marked objections to animal research and many species are falling into disuse. The search for an ideal methodology to replace animal use is on, but animal modeling still holds great importance to human health. Bone research, in particular, has unmet requirements that in vitro technologies cannot yet fully address. In that sense, standardizing novel models remains necessary and rabbits are gaining in popularity as potential bone models. Our aim here is to provide a broad overview of animal modeling and its ethical implications, followed by a narrower focus on bone research and the role rabbits are playing in the current scenario.

Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients.

BACKGROUND: Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used. HYPOTHESIS: Among patients with hangman's fracture, those with disc damage must be treated surgically. MATERIAL AND METHODS: A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely. RESULTS: We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up. CONCLUSION: Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation. LEVEL OF EVIDENCE: III.

Mannosylerythritol lipids ameliorate ultraviolet A-induced aquaporin-3 downregulation by suppressing c-Jun N-terminal kinase phosphorylation in cultured human keratinocytes.

Mannosylerythritol lipids (MELs) are glycolipids and have several pharmacological efficacies. MELs also show skin-moisturizing efficacy through a yet-unknown underlying mechanism. Aquaporin-3 (AQP3) is a membrane protein that contributes to the water homeostasis of the epidermis, and decreased AQP3 expression following ultraviolet (UV)-irradiation of the skin is associated with reduced skin moisture. No previous study has examined whether the skin-moisturizing effect of MELs might act through the modulation of AQP3 expression. Here, we report for the first time that MELs ameliorate the UVA-induced downregulation of AQP3 in cultured human epidermal keratinocytes (HaCaT keratinocytes). Our results revealed that UVA irradiation decreases AQP3 expression at the protein and messenger RNA (mRNA) levels, but that MEL treatment significantly ameliorated these effects. Our mitogen-activated protein kinase inhibitor analysis revealed that phosphorylation of c-Jun N-terminal kinase (JNK), but not extracellular signal-regulated kinase or p38, mediates UVA-induced AQP3 downregulation, and that MEL treatment significantly suppressed the UVA-induced phosphorylation of JNK. To explore a possible mechanism, we tested whether MELs could regulate the expression of peroxidase proliferator-activated receptor gamma (PPAR-γ), which acts as a potent transcription factor for AQP3 expression. Interestingly, UVA irradiation significantly inhibited the mRNA expression of PPAR-γ in HaCaT keratinocytes, whereas a JNK inhibitor and MELs significantly rescued this effect. Taken together, these findings suggest that MELs ameliorate UVA-induced AQP3 downregulation in HaCaT keratinocytes by suppressing JNK activation to block the decrease of PPAR-γ. Collectively, our findings suggest that MELs can be used as a potential ingredient that modulates AQP3 expression to improve skin moisturization following UVA irradiation-induced damage.

Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases.

PURPOSE: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. METHODS: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. RESULTS: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment. CONCLUSIONS: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.

Ameliorating effect of dipotassium glycyrrhizinate on an IL-4- and IL-13-induced atopic dermatitis-like skin-equivalent model.

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is not fully understood. Defects in skin barrier function and dysregulation of the Th2 immune response are thought to be pivotal in AD pathogenesis. In this study, we used keratinocytes and AD-like skin equivalent models using Th2 cytokines IL-4 and IL-13. The keratinocytes and AD-like skin model were used to investigate the effect of dipotassium glycyrrhizinate (KG), which is widely used as an anti-inflammatory agent for AD treatment. KG decreased AD-related gene expression in keratinocytes stimulated with Th2 cytokines. KG alleviated AD-like phenotypes and gene expression patterns and inhibited release of AD-related cytokines in the AD-like skin equivalent models. These findings indicate KG has potential effectiveness in AD treatment and AD-like skin equivalent models may be useful for understanding AD pathogenesis.

C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series.

INTRODUCTION: Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment. MATERIAL AND METHODS: The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base. RESULTS: Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001). CONCLUSION: Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended. LEVEL OF EVIDENCE: III.

Post mortem evaluation of spinal cord and protruded intervertebral discs in dogs without neurological abnormalities / Avaliação post mortem da medula espinhal e de discos intervertebrais protrusos em cães sem alterações neurológicas

The aim of this study was to verify the presence of protrusion of the intervertebral disc (IVD) causing compression of the spinal cord and/or roots of cauda equina in 30 dogs above seven years of age with no evidence of previous neurological abnormalities. After the occurrence of death or euthanasia, a laminectomy was performed from C2 to the sacral vertebra to verify the presence of IVD protrusions. The protruded IVD were macroscopically graded according to the Thompson scale, and the corresponding spinal cord segment was histologically analyzed for nervous tissue compression. Of the 30 dogs, twelve (40%) presented disc protrusion, and of these 12 dogs, seven (58%) presented more than one protruded disc. Disc protrusion was observed in 3.2% (25/780) of all IVD evaluated. Of the six chondrodystrophic dogs, five (83%) presented disc protrusion. Of the 24 nonchondrodystrophic dogs, seven (29%) presented IVD protrusion. The site that showed the highest frequency of protrusion was L4-L5 (6/25) followed by the L6-L7 region (3/25) and C6-C7 (3/25). Only two of the medullary segments evaluated showed histological changes, with presence of focal lymphocytic infiltration and multifocal mild hemorrhage in the gray matter. Under the conditions of this study, 40% of dogs older than seven years old showed IVD protrusions without showing neurological signs, with no abnormality of the nervous tissue in 92% of the evaluated segments. Thus, the protrusion of the IVD in some dogs, can only be a finding of no clinical relevance.(AU)

O objetivo do presente estudo foi verificar a presença de protrusão do disco intervertebral (DIV) causando compressão da medula espinhal e/ou raízes da cauda equina em cadáveres de cães, sem histórico de alterações neurológicas. Para isso, após a ocorrência de óbito ou realização de eutanásia em 30 cães com mais de sete anos de idade, sem histórico de alterações neurológicas, foi realizada a laminectomia entre C2 até a vértebra sacral para verificar a presença de protrusões do DIV. Os DIV protrusos foram graduados macroscopicamente quanto à degeneração segundo a escala de Thompson, e o segmentos medular correspondente à localização da compressão foi analisado microscopicamente em busca de lesões compressivas ao tecido nervoso. Quarenta por cento dos cães (12/30) apresentaram protrusão do DIV, e destes, 58% (7/12) apresentavam mais de um DIV protruso. A protrusão estava presente em 3,2% (25/780) de todos os DIV avaliados. Cães de raças condrodistróficas apresentaram protrusões em 83% dos casos (5/6) e raças não condrodistróficas em 29% (7/24). O local que apresentou maior frequência de protrusão foi L4-L5 (6/25), seguido da região L6-L7 (3/25) e C6-C7 (3/25). Apenas dois segmentos medulares avaliados na histopatologia apresentaram alterações, com presença de infiltrado linfoplasmocitário focal e hemorragia discreta multifocal na substância cinzenta. Nas condições do presente estudo, 40% dos cães com mais de sete anos de idade apresentaram protrusões do DIV sem que houvesse sinais neurológicos, com normalidade do tecido nervoso em 92% dos segmentos avaliados. Assim, a protrusão do DIV, em alguns cães, pode ser apenas um achado sem relevância clínica.(AU)

Physics behind the implants used for high strain fractures: literature review / A física por trás dos implantes utilizados para fraturas de alto strain: revisão de literatura

Whenever bone fractures occur, external forces produce continuous interfragmentary motion and a stabilization method is necessary. It is known that the mechanical conditions at the fracture site influence bone callus formation during healing process. To achieve primary (direct) bone healing, absolute stability at the fracture site is necessary. Perren's concept of strain determines that relative deformation at the fracture gap depends on the original gap's conformation. Simple fractures (without comminution) are considered high strain fractures since a small force applied to the fracture site results in great movement with deleterious effects on the healing process. The purpose of this study is to review the available literature regarding factors that influence the mechanics of high strain fractures in veterinary medicine, its treatment methods and implants available. Each fracture configuration requires special attention and critical care in choosing the osteosynthesis method and the type of stability required for consolidation to occur within the expected time. One must know the strain theory to become an orthopedic surgeon.(AU)

Quando fraturas ósseas ocorrem, forças externas produzem movimentação interfragmentária continuamente e um método de estabilização se faz necessário. É sabido que as condições mecânicas no local de fratura influenciam a formação de calo durante o processo de cicatrização óssea e para que cicatrização óssea primária seja obtida é necessária estabilidade absoluta no foco de fratura. O conceito de strain de Perren determina que a deformação relativa no foco de fratura estabilizado depende do tamanho da lacuna de fratura original. Fraturas redutíveis (sem cominuição) são consideradas de alto strain, pois uma pequena força aplicada a linha de fratura resulta em grande movimentação com efeito deletério ao processo de consolidação. O presente trabalho revisa a literatura disponível a respeito de fatores que influenciam a mecânica de fraturas de alto strain em medicina veterinária, seus métodos de tratamento e a física por trás dos implantes disponíveis. Cada configuração de fratura requer atenção especial e cuidado crítico na escolha do método de osteossíntese e no tipo de estabilidade necessária para que a consolidação ocorra no tempo esperado. Conhecimento da teoria do strain é mandatório para a formação de cirurgiões ortopédicos.(AU)

Effect of ultrafiltration on placental-fetal blood flow in pregnancy of woman undergoing chronic hemodialysis.

INTRODUCTION: Patient who was undergoing hemodialysis (HD) thrice weekly usually gain 1 to 4 kg of weight in interdialytic period, mainly due to fluid accumulation by ingestion of water. Ultrafiltration (UF) during HD will be need to remove fluid excess to avoid severe medical complications secondary to fluid overload. However, in pregnant woman UF can increase the episodes of intradialytic hypotension which may lead to placental ischemic injury and predispose to fetal distress. There is little information about safe fluid amount withdrawn by UF during pregnancy. METHODS: We prospectively study by obstetric Doppler ultrasonography the fluxometric parameters: pulsatility index (PI) and resistance index (RI) of fetal middle cerebral, uterine, and umbilical artery obtained at the beginning and the end of HD session, the acute and chronic effect of UF on placenta and fetus blood flow, as well as the fetal outcome in 1 pregnant woman on chronic HD. FINDINGS: We did not observe any acute harmful effect on fetal middle cerebral, placental and umbilical artery blood flow when UF rate of 2.1 ± 0.04 L (6 < 8 mL/h/kg) during HD session, no significant statistical difference was observed when compared PI and RI before and after UF and also when we compared these data with reference value on normal pregnancy to the same gestational age. DISCUSSION: UF rate of 6 < 8 mL/h/kg during HD did not bring any acute harmful effect on fetal middle cerebral, placental, and umbilical blood flow and the UF rate of 1.4 6 0.4 L (< 6 mL/h/kg) / HD session that was done in all others HD during pregnancy was safe, without any chronic fetal deleterious effect. Obstetric Doppler ultrasonography is a simple and noninvasive method to fetal follow-up and can aid to determine safe UF rate in pregnant women during gestation.

More than one fungus in the pepper pot: Integrative taxonomy unmasks hidden species within Myriostoma coliforme (Geastraceae, Basidiomycota).

Since the nineteenth century, Myriostoma has been regarded as a monotypic genus with a widespread distribution in north temperate and subtropical regions. However, on the basis of morphological characters and phylogenetic evidence of DNA sequences of the internal transcribed spacer (ITS) regions and the large subunit nuclear ribosomal RNA gene (LSU), four species are now delimited: M. areolatum comb. & stat. nov., M. calongei sp. nov., M. capillisporum comb. & stat. nov., and M. coliforme. Myriostoma coliforme is typified by selecting a lectotype (iconotype) and a modern sequenced collection as an epitype. The four species can be discriminated by a combination of morphological characters, such as stomatal form, endoperidial surface texture, and basidiospore size and ornamentation.