Artroscopía del tobillo en el tratamiento de la fractura de Bosworth / Ankle arthroscopy in treatment of Bosworth fracture

Resumen: La fractura de Bosworth corresponde a un patrón de fractura-luxación del tobillo con luxación fija del segmento proximal de la fíbula posterior al maléolo posterior de la tibia. Es una lesión poco frecuente que requiere un alto índice de sospecha para su diagnóstico. La luxación fija de la fíbula impide la reducción cerrada, por lo que se impone una reducción abierta y la osteosíntesis de los fragmentos de fíbula y/o tibia. Presentamos un caso clínico de una paciente que sufrió esta lesión asociada a fractura del maléolo interno; fue sometida a tratamiento quirúrgico, asimismo se procedió a la artroscopía anterior del tobillo para evaluar la estabilidad de la sindesmosis, exéresis de fragmentos osteocondrales libres, desbridamiento y microfracturas de lesiones condrales inestables del astrágalo. Un año después la paciente permanece con dolor residual ocasional y un rango de movimiento normal comparado con el tobillo contralateral. La fractura de Bosworth es una lesión grave y poco frecuente que requiere un diagnóstico precoz y tratamiento quirúrgico urgente. La utilización de la artroscopía en su tratamiento agudo permite el diagnóstico y tratamiento de la patología intraarticular asociada y asiste en la evaluación de la reducción adecuada de la fractura y de la estabilidad de la sindesmosis tibiofibular.

Abstract: The Bosworth fracture is a pattern of fracture-dislocation of the ankle joint with fixed dislocation of the proximal part of the fibula behind the posterior malleolus. It is a rare injury, which requires high index of suspicion for diagnosis. Fixed dislocation of the fibula does not allow for closed reduction, so open reduction and fixation of fibula or tibia is required. We present a case report of a patient who suffered a Bosworth fracture, with associated medial malleolus fracture. She underwent surgical treatment with open reduction and internal fixation of the fibula and tibia. We also performed anterior arthroscopy of the ankle, to evaluate the tibiofibular syndesmosis, remove loose osteochondral fragments, and perform debridement and microfracture of unstable chondral lesions of the talus. One year after injury, she remains with occasional pain and a normal range of motion comparing to the contralateral ankle joint. Bosworth fracture is a serious and rare injury, which requires early diagnosis and urgent surgical treatment. Performing ankle arthroscopy in the acute treatment of the Bosworth fracture allows for diagnosis and treatment of associated intra-articular injuries, as well as assisting with adequate fracture reduction and evaluation of the tibiofibular syndesmosis stability.

A 3D in vitro model to explore the inter-conversion between epithelial and mesenchymal states during EMT and its reversion.

Epithelial-to-mesenchymal transitions (EMT) are strongly implicated in cancer dissemination. Intermediate states, arising from inter-conversion between epithelial (E) and mesenchymal (M) states, are characterized by phenotypic heterogeneity combining E and M features and increased plasticity. Hybrid EMT states are highly relevant in metastatic contexts, but have been largely neglected, partially due to the lack of physiologically-relevant 3D platforms to study them. Here we propose a new in vitro model, combining mammary E cells with a bioengineered 3D matrix, to explore phenotypic and functional properties of cells in transition between E and M states. Optimized alginate-based 3D matrices provided adequate 3D microenvironments, where normal epithelial morphogenesis was recapitulated, with formation of acini-like structures, similar to those found in native mammary tissue. TGFß1-driven EMT in 3D could be successfully promoted, generating M-like cells. TGFß1 removal resulted in phenotypic switching to an intermediate state (RE cells), a hybrid cell population expressing both E and M markers at gene/protein levels. RE cells exhibited increased proliferative/clonogenic activity, as compared to M cells, being able to form large colonies containing cells with front-back polarity, suggesting a more aggressive phenotype. Our 3D model provides a powerful tool to investigate the role of the microenvironment on metastable EMT stages.

[Ankle arthroscopy in treatment of Bosworth fracture]. / Artroscopía del tobillo en el tratamiento de la fractura de Bosworth.

The Bosworth fracture is a pattern of fracture-dislocation of the ankle joint with fixed dislocation of the proximal part of the fibula behind the posterior malleolus. It is a rare injury, which requires high index of suspicion for diagnosis. Fixed dislocation of the fibula does not allow for closed reduction, so open reduction and fixation of fibula or tibia is required. We present a case report of a patient who suffered a Bosworth fracture, with associated medial malleolus fracture. She underwent surgical treatment with open reduction and internal fixation of the fibula and tibia. We also performed anterior arthroscopy of the ankle, to evaluate the tibiofibular syndesmosis, remove loose osteochondral fragments, and perform debridement and microfracture of unstable chondral lesions of the talus. One year after injury, she remains with occasional pain and a normal range of motion comparing to the contralateral ankle joint. Bosworth fracture is a serious and rare injury, which requires early diagnosis and urgent surgical treatment. Performing ankle arthroscopy in the acute treatment of the Bosworth fracture allows for diagnosis and treatment of associated intra-articular injuries, as well as assisting with adequate fracture reduction and evaluation of the tibiofibular syndesmosis stability.

La fractura de Bosworth corresponde a un patrón de fractura-luxación del tobillo con luxación fija del segmento proximal de la fíbula posterior al maléolo posterior de la tibia. Es una lesión poco frecuente que requiere un alto índice de sospecha para su diagnóstico. La luxación fija de la fíbula impide la reducción cerrada, por lo que se impone una reducción abierta y la osteosíntesis de los fragmentos de fíbula y/o tibia. Presentamos un caso clínico de una paciente que sufrió esta lesión asociada a fractura del maléolo interno; fue sometida a tratamiento quirúrgico, asimismo se procedió a la artroscopía anterior del tobillo para evaluar la estabilidad de la sindesmosis, exéresis de fragmentos osteocondrales libres, desbridamiento y microfracturas de lesiones condrales inestables del astrágalo. Un año después la paciente permanece con dolor residual ocasional y un rango de movimiento normal comparado con el tobillo contralateral. La fractura de Bosworth es una lesión grave y poco frecuente que requiere un diagnóstico precoz y tratamiento quirúrgico urgente. La utilización de la artroscopía en su tratamiento agudo permite el diagnóstico y tratamiento de la patología intraarticular asociada y asiste en la evaluación de la reducción adecuada de la fractura y de la estabilidad de la sindesmosis tibiofibular.

Occurrence of Toxoplasma gondii antibodies in birds from the Atlantic Forest, state of São Paulo, Brazil.

Avian are considered important intermediate hosts for Toxoplasma gondii because they serve as source of infection for Felidae, which shed environmentally resistant oocysts after ingesting infected tissues. Little is known of epidemiology of toxoplasmosis in wild birds. In the present study, antibodies to T. gondii were determined in 202 wild birds of 37 species captured in seven small areas of the Atlantic Forest, in the state of São Paulo, Brazil, and provided information on possible associated risk factors. Antibodies to T. gondii were assayed by the modified agglutination test (MAT) and found in 73 (36.1%) of 202 birds with titers of 1:5 in 16 samples, 1:10 in 26 samples, 1:20 in 17 samples, 1:40 in 10 samples, 1:80 in three samples, and 1:160 in one sample. No association was observed between T. gondii seropositivity and the local where the birds were collected. Seropositivity was higher in birds that lived on the forest floor (p<0.001; U=1230.0), and in omnivorous birds (p=0.007; U=3939.0). T. gondii antibodies were reported for the first time in 23 species of birds enlarging the host range of this parasite. Notably, T. gondii antibodies were found in 83.3% (15/18) of the Rufous-bellied Thrush (Turdus rufiventris).

Oleanolic acid inhibits the activity of the multidrug resistance protein ABCC1 (MRP1) but not of the ABCB1 (P-glycoprotein): possible use in cancer chemotherapy.

The effects of oleanolic acid (OA) on ABCB1 and ABCC1 activities were studied in a cell line constitutively expressing both proteins. It was observed that OA did not alter ABCB1 activity, but inhibited the activity of ABCC1 protein. This inhibition was reversible and only occurred in the presence of OA. In addition, OA did not alter the expression of ABCC1 mRNA. These results suggest that OA could be a good choice in the treatment of MDR tumours, either as a chemotherapic itself in tumours bearing ABCB1, or as an adjuvant in the chemotherapy of ABCC1 expressing tumours.