Investigating the Metabolism of Estrogens in Ligilactobacillus salivarius Strains Isolated from Human Milk and Vaginal Microbiota.

The interplay between enterohepatic circulation and the gut microbiota is the main driver determining systemic levels of estrogens and their metabolites. Nevertheless, the role of potentially probiotic microorganisms in estrogen metabolism has not been investigated so far. In this work, we have explored the ability of six Ligilactobacillus salivarius strains isolated from human milk and vaginal samples to degrade and/or conjugate parental estrogens in vitro and under aerobic conditions. The quantification of estrogens and their derivatives was carried out in cell-free supernatants by LC-QQQ-MS. All the tested L. salivarius strains achieved an average degradation rate of estrone and estriol of 98% and 55%, respectively, whereas 17ß-estradiol was preferentially conjugated (up to 40%). The presence of seven out of ten genes encoding enzymes relevant for estrogen metabolism was further confirmed by PCR, highlighting their genetic potential for degrading, conjugating and/or deconjugating estrogens. The tested L. salivarius strains may be considered potential probiotics affecting the fate of endogenous estrogens. Clinical trials targeting populations with estrogen-dependent conditions will be required to elucidate the true potential of these strains for the restoration and maintenance of a healthy host estrobolome.

Modified Arthroscopic Latissimus Dorsi Transfer at the Infraspinatus Footprint With Anterior Extracortical Fixation.

Massive irreparable cuff tears may represent as many as 20% to 40% of total cases of operated rotator cuff tears and can be a challenging clinical problem. Many treatment options have been proposed for their treatment. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before they develop glenohumeral arthritic changes. This technique aims at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The modified arthroscopic latissimus dorsi transfer at the infraspinatus footprint with anterior extracortical fixation rebalances the pair of forces acting on the shoulder, stabilizing it in the transverse plane, minimizing the risk of latissimus dorsi transferred rupture and associated complications.

Anterior Shoulder Instability Treated Through an Anterior Arthroscopic Approach.

Anterior shoulder instability remains one of the main indications for shoulder surgery. We present a modified way of treating anterior shoulder instability in the beach-chair position from an anterior arthroscopic approach through the rotator interval. This technique opens the rotator interval, which increases the working area and allows us to work without cannulae. Through this approach, we can treat all injuries comprehensively and, if necessary, switch to other arthroscopic techniques used for instability such as arthroscopic Latarjet or anterior ligamentoplasties.

Anterior Shoulder Ligamentoplasty as a Treatment for Multidirectional Shoulder Instability.

Multidirectional shoulder instability represents an ongoing challenge for orthopaedic surgeons, and multiple techniques have been described to treat this condition. We present a modified anterior shoulder ligamentoplasty, in which we perform an inferior glenohumeral ligament (IHGL) anteroinferior and posteroinferior plication and, subsequently, an anterior reinforcement ligamentoplasty with an allograft through the subscapularis tendon, with humeral and glenoid fixation. This arthroscopic technique allows shoulder stability in the throwing position, as the humeral head is not uncovered in abduction, and external rotation by ascending the subscapularis tendon.