Sublingual sufentanil tablet system (SSTS) versus a single shot peri-nervous injection of ropivacaine for the management of postoperative pain after total knee arthroplasty: a single-center randomized trial.

INTRODUCTION: For several years, ropivacaine has been the standard-of-care for establishing postoperative femoral nerve block in total knee arthroplasty (TKA) setting and is still widely in use but new approaches such as the patient-controlled administration of sublingual sufentanil tablets system (SSTS) seem to offer good clinical results. Our aim is to compare the SSTS to single shot peri-nervous injection of ropivacaine (single shot) after TKA in terms of effectiveness in pain management and of time to recovery. MATERIALS AND METHODS: A total of 165 patients undergoing TKA were enrolled. Eighty-four patients were randomly allocated in the SSTS group and 81 patients in the single shot group. The primary objective of the study was to evaluate performance of Timed Up and Go test. Secondary objectives were to measure the length of stay, NRS pain scale, the adherence to the prescribed plan, the joint mobility, the frequency of rescue analgesic use, side effects and patients' satisfaction. RESULTS: Of all patients of the single shot group, 64 were withdrawn from the study as they unable to achieve pain control; only one patient was withdrawn from the SSTS group. Times for the "Timed Up and Go" test on the 3rd postoperative day were 8.4 ± 1.6 and 11.8 ± 3.6 in the SSTS group (n = 83) and single shot group (n = 17), respectively (p < .001). CONCLUSIONS: SSTS provides better pain management when compared to peri-nervous ropivacaine single shot injection after TKA.

Use of chloroprocaine in orthopedic day surgery: a brief report in a cohort of patients undergoing knee arthroscopy.

OBJECTIVE: Spinal anesthesia with local anesthetics is a viable alternative to general anesthesia in orthopedic surgery, and it is currently considered the standard of care for knee arthroscopy. The use of chloroprocaine may offer several potential advantages over other local anesthetics, including, above all, its rapid onset and short duration of action. The aim of the present retrospective study is to evaluate the post-surgical outcomes of patients who underwent knee arthroscopy using spinal anesthesia with chloroprocaine in an outpatient orthopedic setting. PATIENTS AND METHODS: Data from patients who underwent elective knee arthroscopy between January 2022 and December 2022 were collected for the present study. Spinal anesthesia with chloroprocaine 10 mg/mL was administered in the designated subarachnoid space (L3-L4 in the majority of patients). A dosage of 40 mg was used to obtain a satisfactory sensory and motor block. RESULTS: A total number of 302 patients met the inclusion criteria. No complications were reported during surgery in the present series of patients. None of the patients required bladder catheterization. In 84% of cases, the PADSS (Post-Anesthetic Discharge Scoring System) score at discharge was 10, whereas in 16% of cases, the PADSS score was 9. The mean time from anesthesia induction to first urination was 75±9.4 minutes, while the mean time from the anesthesia induction to the discharge from the hospital was 152±18.5 minutes. CONCLUSIONS: Spinal chloroprocaine for knee arthroscopy demonstrated a short motor block duration, resulting in a fast time to discharge. These limited data show that chloroprocaine may be safely and effectively applied in outpatient knee arthroscopy procedures. However, more studies, possibly with a randomized design, are required to confirm these findings.

Late Quaternary hydroclimate and vegetation changes in an upland lake in southeastern Amazonia.

An integrated approach considering facies, isotopic, and palynological analyses of lake sediments from the Serra Norte de Carajás, southeastern Amazonia, is presented in this work to refine paleoclimate and paleohydrological changes based on upland lake sediments during the late Quaternary. The sediments have a fining-upward deposition cycle typical of upland swamps/lakes. The origin of organic matter is autochthonous mainly related to C3 terrestrial plants, macrophytes and algae. The pollen records of Hedyosmum during the Early Pleistocene suggest lower temperatures than those observed along Holocene. In the transitional period between the Pleistocene and the Holocene, rainfall decreased, causing the retraction of the flooded area, favoring the development of marshy conditions. The Late and Middle Holocene were marked by higher temperatures and lower humidity. Afterward, the increased pollen concentration from canga and forest vegetation, macrophytes, palms, and algae suggested increased humidity in the Early Holocene. The relative contribution of forest pollen along the records indicated that drier conditions were not strong enough for an extensive expansion of canga over forested areas.

A rapid recovery protocol for hip and knee replacement surgery: a report of the outcomes in a referral center.

OBJECTIVE: The number of joint replacements is expected to dramatically increase, and the optimization of the available resources is fundamental to maintain high clinical standards while providing an efficient treatment to an increasing number of patients. The present study describes the outcomes of the application of a rapid recovery (RR) protocol in a referral center for hip and knee replacement surgery. PATIENTS AND METHODS: The medical records of every patient undergoing primary hip or knee replacement in 2019 were identified and all the relevant data were retrospectively extracted and compared to those of year 2016 (the last year before the onset of the rapid recovery protocol). The following outcomes were considered: 1) length of stay (LOS); 2) total number of TKR and THR; 3) pre- and post-operative subjective questionnaires; 4) NRS for pain at day 1 following surgery; 5) mean hemoglobin value at discharge; 6) number of blood transfusion performed; 7) complications following surgery. RESULTS: The mean LOS was significantly lower for patients managed through the rapid recovery protocol: 5.1 ± 1.4 days vs. 10.4 ± 2.3 days (p < 0.0001). The earlier discharge of patients promoted an overall increase in the total number of joint replacement procedures performed (2,806 in year 2019 vs. 2,236 in year 2016; p < 0.0001). Higher hemoglobin values at discharge were found in the RR group (10.6 ± 1.4 g/dl vs. 9.6 ± 1.2 g/dl, p = 0.049). No difference was observed in terms of clinical scores and overall complication rate. CONCLUSIONS: The application of a multimodal RR protocol for THR and TKR patients was able to reduce the length of stay and optimize the use of blood products, without increasing the risk of complications or jeopardizing the functional recovery.

Clinical efficacy of implementing a Patient Blood Management (PBM) Protocol in joint replacement surgery: a retrospective cohort study in a national referral center.

OBJECTIVE: The aging of population has dramatically broadened the total number of Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) performed worldwide. To optimize the number of blood transfusions performed, a multimodal and multidisciplinary approach was introduced, called Patient Blood Management (PBM). The aim of the present retrospective study is to evaluate the feasibility and clinical outcomes of a PBM protocol applied in a national referral center for joint replacement surgery. PATIENTS AND METHODS: Clinical reports of 9,635 patients undergoing primary THA or TKA, from 2014 to 2019, were screened. The trends of hemoglobin value at admission and at day 4 after surgery were analyzed. Furthermore, the trend of blood bags' requests and blood transfusions was longitudinally evaluated to assess the efficacy of our PBM protocol and its potential impact in reducing the length of stay in the hospital. RESULTS: In 2014, mean hemoglobin (Hb) levels at postoperative day 4 were 10.3 g/dl and 10.2 g/dl for TKA (unilateral and bilateral, respectively), and in 2019 were 11.3 g/dl and 11.6 g/dl (unilateral and bilateral, respectively, p=0.001). Total requested red blood cell (RBC) transfusions by each surgery over time have decreased for THA (277 in 2014 vs. 120 in 2019, p=0.001).  A correlation matrix analysis between Hb level, body mass index (BMI), age, days spent in orthopedic (OR) ward and number of requested transfusions showed that RBC bags transfusions were related to the length of the hospital stay. CONCLUSIONS: A timely application of a PBM protocol in the perioperative period of TKA and THA was significantly associated to the reduction of blood transfusions and total length of hospital stay, with clear benefits for both the patients and the hospital.

Conservation implications of genetic structure in the narrowest endemic quillwort from the Eastern Amazon.

The quillwort Isoëtes cangae is a critically endangered species occurring in a single lake in Serra dos Carajás, Eastern Amazon. Low genetic diversity and small effective population sizes (N e) are expected for narrow endemic species (NES). Conservation biology studies centered in a single species show some limitations, but they are still useful considering the limited time and resources available for protection of species at risk of extinction. Here, we evaluated the genetic diversity, population structure, N e, and minimum viable population (MVP) of I. cangae to provide information for effective conservation programs. Our analyses were based on 55 individuals collected from the Amendoim Lake and 35,638 neutral SNPs. Our results indicated a single panmictic population, moderate levels of genetic diversity, and N e in the order of thousands, contrasting the expected for NES. Negative FIS values were also found, suggesting that I. cangae is not under risk of inbreeding depression. Our findings imply that I. cangae contains enough genetic diversity to ensure evolutionary potential and that all individuals should be treated as one demographic unit. These results provide essential information to optimize ex situ conservation efforts and genetic diversity monitoring, which are currently applied to guide I. cangae conservation plans.

Effect of intravenous ferric carboxymaltose supplementation in non-anaemic iron deficient patients undergoing hip and knee arthroplasty.

Preoperative anaemia and non-anaemic iron deficiency are independent risk factors for perioperative blood transfusion, morbidity, and mortality. Although the efficacy to treat anaemia with iron infusion before elective surgery has been widely studied, the literature offers few data about the efficacy of treating iron deficient, non-anaemic patients before elective surgery. This retrospective study assessed the effect of preoperative ferric carboxymaltose (FC) administration on the concentration of Haemoglobin (Hb) in iron deficient, non-anaemic individuals following total knee or hip arthroplasty. A treatment group of 83 non-anaemic iron deficient individuals scheduled for arthroplasty were administered a 1000mg FC infusion over 15 minutes 4 weeks prior to surgery. In the control group (n=62) FC was not administered preoperatively. No individual from either group was given any iron supplement following the pre-operative visit. Blood tests were performed and analysed 4-weeks before surgery, on admission, and then 2-days, 4-days and 4-weeks postoperatively. Number of blood transfusions performed and adverse events were recorded. Hb concentration did not change substantially after iron supplementation prior to surgery. No difference in the number of blood transfusions was observed. In the treatment, group postoperative Hb concentration recovered significantly more quickly compared to control (p=0.0047). No adverse event was reported. The administration of FC in non-anaemic iron deficient individuals quickens the restoration of Hb concentration following THA or TKA procedures.

Isoetes dubsii and Isoetes santacruzensis, two new species from lowland areas in South America.

Isoetes dubsii sp. nov. and I. santacruzensis sp. nov., two new species from lowland areas in South America, are described, illustrated and compared to similar species. Isoetes dubsii can be distinguished from other species of the Brazilian Pantanal wetlands by a set of characters including leaves that are long, flexuous and trigonal in transverse section, tri-lobate stems, rudimentary velum, pustulate megaspores of 310‒390 µm diameter and laesurae of the megaspore at least four times wider than high. Isoetes santacruzensis has flexuous, filiform leaves, 0.4-0.8 mm wide at mid length and reaching up to 15 cm long, black or reddish-black sporangia, sclerified phyllopodia and sparsely verrucate megaspores of 320‒390 µm in diameter. We also include a key for species from the Brazilian Pantanal wetlands and Bolivia and spore images for all species that are discussed. Isoetes dubsii and I. santacruzensis are only known from their type localities and they may deserve special attention concerning their conservation status. However, based on our current knowledge on these species and according to IUCN Red List criteria, they are assessed here as data deficient (DD).

Mapping and quantification of ferruginous outcrop savannas in the Brazilian Amazon: A challenge for biodiversity conservation.

The eastern Brazilian Amazon contains many isolated ferruginous savanna ecosystem patches (locally known as 'canga vegetation') located on ironstone rocky outcrops on the top of plateaus and ridges, surrounded by tropical rainforests. In the Carajás Mineral Province (CMP), these outcrops contain large iron ore reserves that have been exploited by opencast mining since the 1980s. The canga vegetation is particularly impacted by mining, since the iron ores that occur are associated with this type of vegetation and currently, little is known regarding the extent of canga vegetation patches before mining activities began. This information is important for quantifying the impact of mining, in addition to helping plan conservation programmes. Here, land cover changes of the Canga area in the CMP are evaluated by estimating the pre-mining area of canga patches and comparing it to the actual extent of canga patches. We mapped canga vegetation using geographic object-based image analysis (GEOBIA) from 1973 Landsat-1 MSS, 1984 and 2001 Landsat-5 TM, and 2016 Landsat-8 OLI images, and found that canga vegetation originally occupied an area of 144.2 km2 before mining exploitation. By 2016, 19.6% of the canga area was lost in the CMP due to conversion to other land-use types (mining areas, pasturelands). In the Carajás National Forest (CNF), located within the CMP, the original canga vegetation covered 105.2 km2 (2.55% of the CNF total area), and in 2016, canga vegetation occupied an area of 77.2 km2 (1.87%). Therefore, after more than three decades of mineral exploitation, less than 20% of the total canga area was lost. Currently, 21% of the canga area in the CMP is protected by the Campos Ferruginosos National Park. By documenting the initial extent of canga vegetation in the eastern Amazon and the extent to which it has been lost due to mining operations, the results of this work are the first step towards conserving this ecosystem.

Four decades of land-cover, land-use and hydroclimatology changes in the Itacaiúnas River watershed, southeastern Amazon.

Long-term human-induced impacts have significantly changed the Amazonian landscape. The most dramatic land cover and land use (LCLU) changes began in the early 1970s with the establishment of the Trans-Amazon Highway and large government projects associated with the expansion of agricultural settlement and cattle ranching, which cleared significant tropical forest cover in the areas of new and accelerated human development. Taking the changes in the LCLU over the past four decades as a basis, this study aims to determine the consequences of land cover (forest and savanna) and land use (pasturelands, mining and urban) changes on the hydroclimatology of the Itacaiúnas River watershed area of the located in the southeastern Amazon region. We analyzed a multi-decadal Landsat dataset from 1973, 1984, 1994, 2004 and 2013 and a 40-yr time series of water discharge from the Itacaiúnas River, as well as air temperature and relative humidity data over this drainage area for the same period. We employed standard Landsat image processing techniques in conjunction with a geographic object-based image analysis and multi-resolution classification approach. With the goal of detecting possible long-term trends, non-parametric Mann-Kendall test was applied, based on a Sen slope estimator on a 40-yr annual PREC, TMED and RH time series, considering the spatial average of the entire watershed. In the 1970s, the region was entirely covered by forest (99%) and savanna (∼0.3%). Four decades later, only ∼48% of the tropical forest remains, while pasturelands occupy approximately 50% of the watershed area. Moreover, in protected areas, nearly 97% of the tropical forest remains conserved, while the forest cover of non-protected areas is quite fragmented and, consequently, unevenly distributed, covering an area of only 30%. Based on observational data analysis, there is evidence that the conversion of forest cover to extensive and homogeneous pasturelands was accompanied by systematic modifications to the hydroclimatology cycle of the Itacaiúnas watershed, thus highlighting drier environmental conditions due to a rise in the region's air temperature, a decrease in the relative humidity, and an increase in river discharge.

[Four years of screening cervical smears of cervical lesions]. / Quatre années de dépistage sur frottis cervical des lésions du col utérin.

Twelve thousand two hundred and eighty nine Pap smears were collected from public hospitals and from private practices during a four year period (January 1987 to December 1990). 4.2% of Pap smears exhibited condylomatous or dysplastic lesions. 94.5% of such lesions were encountered in Pap smears taken from the transformation zone and which contained endocervical cells. Therefore, these smears represent the only adequate sample for cervical cancer screening. In our study, a close concertation between biologists and clinicians results in an improvement of the smear quality. The percentage of those containing endocervical cells increased from 49% in 1987 to 72% in 1990. Then, more cervical lesions were encountered on smears of patients from a low socio-economic level. New techniques such as detection of human papillomavirus (HPV) DNA on routine Pap smears by in situ hybridization would allow to improve the cytological diagnosis of HPV infections, mainly for non specific cytological alterations (11% in our series for 1990) and for cytological aspects of dysplasia only. These results point out how a cervical cancer screening can be better carried out.

Comparative studies of the action of long duration alcohol drinking on rat pancreatic exocrine cells.

The influence of a long term ingestion of ethanol on the rat exocrine pancreas has been studied by electron microscopy. The comparison of micrographs from alcoholic and non alcoholic pancreas allowed us to compare the different organelles of acinar pancreatic cells. These data have been submitted to factorial analysis of correspondences. The ultrastructural modifications revealed out by this analysis are in good agreement with the hypothesis of an adaptation of exocrine cells to a chronic hyperfunctional state.

Ultrastructural observations on the hypothalamo-posthypophysical complex of the Brattleboro rat.

The hypothalamo-posthypophysial complex of the homozygous Brattleboro rat is characterized by a hyperactivity of its neurons. The neurosecretory fibers, especially in the neurohypophysis, show numerous signs of autophagy and tubular proliferation of the axoplasmic reticulum. These structural alterations, as well as the nematosomes of nucleolus-like bodies encountered in the perikarya, may be related to the chronic hyperactivity of the neurons. They can be reduced by administration of exogenous vasopressin. The numerous liposomes in the pituicytes are paralleled in the neuronal perikarya by a great number of lysosomes. Small dense core vesicles observed in the neurosecretory endings and perikarya may indicate a secretory product distinct from oxytocin and vasopressin. In the homozygous Brattleboro rat, endings of the aminergic type are more numerous than in the normal rat. With respect to the role they may play in the secretory processes, their increase might be secondary to the vasopressin deficiency.

Cytochemical duality of neurosecretory material in the hypothalamo-posthypophysial system of the rat as related to hormonal content.

Cytochemical methods using silver proteinate, silver methenamine an potassium ferrocyanide + OsO4 for ultrastructural detection of glycoproteins allow, in the posthypophysis and the magnocellular nuclei of the rat, differentiation of two types of fibres and neurons: one type containing negative granules with a homogenous content of low electron density, the second type containing granules which demonstrate a ring shaped deposit either of silver or of potassium ferrocyanide-osmium complex, likely to be related to a glycoprotein component. The difference between these two types is increased by prestaining "en bloc" with uranyl acetate before the silver proteinate reaction. A similar investigation was carried out on the vasopressin deficient Brattleboro rat; the neurosecretory material, present in some endings and neurons only, is of the nonreactive type, so that it appears justified to correlate the reactivity of granules with vasopressin, consequently to distinguish neurones and fibres containing vasopressin from those in which oxytocin is quantitatively the main hormonal peptide. This conclusion is strongly supported by the fact that percentages of reactive and negative endings, as determined on this basis in the posthypophysis of normal rats from two different strains, are in good agreement with biochemical data reported in the literature.

[Cytochemical ultrastructural study of the glycoproteins in the rat hypothalamo-post-pituitary complex]. / Etude cytochimique ultrastructurale des glycoprotéines dans le complexe hypothalamo-post-hypophysaire du rat

The results obtained with various methods applied to the cytochemical detection of carbohydrates at an ultrastructural level, confirm the existence of glycoproteins in neurosecretory material in the neurohypophysis as well as in the hypothalamic magnocellular nuclei. This glycoproteic component, however, is not present in all the secretory granules and, according to their cytochemical behaviour, it is possible to distinguish two types of neurosecretory fibres: one where all the granules respond negatively; the other where most of the granules are reactive. The existence of two types of neurons corresponding to these two fibres cannot yet be asserted, but seems very likely, perhaps connected with the hormonal duality of the magnocellular nuclei. The reactions are also positive on the Golgi apparatus, in accordance with its function in glycoprotein synthesis. But the difference of reactivity between the Golgi cisternae and the neurosecretory product suggests that glycoprotein synthesis is still going on in the neurosecretory granules outside the Golgi area.