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The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci., Technique Video Video 1 In the schematic image, we see a complete radial tear of the medial meniscus. The arrows represent the path through which the suture threads will pass through the meniscal injury. The first arrow will cross the lesion obliquely from proximal to distal and from posterior to anterior. The second arrow will cross the meniscus horizontally, from anterior to posterior The third arrow will cross the lesion obliquely from distal to proximal and posterior to anterior, and the last arrow will cross the lesion horizontally again from posterior to anterior, closing the meniscal lesion. We demonstrate the technique of continuous suture, the hourglass technique, in a bovine anatomical model performed at the arthroscopy laboratory of the National Institute of Traumatology and Orthopedics of Brazil. We make a complete radial tear in the medial meniscus body. We prepare the meniscus 4 A-II suture device with an ultra-resistant wire. Tapes are also advised to be used in this type of injury. Initially, we cross the meniscus proximal and posterior of the radial tear; by palpation, we find the exit site of the meniscal suture device. We pull the shortest suture length, which should always be positioned for the anterior side of the suture device. We fix this end with a Kelly clamp. We return with the device to the interior of the joint and position the device by passing with a suture thread obliquely on the anterior and distal surface about 5 mm from the radial tear. We cross the meniscus, easily finding the region of exit of the meniscus 4 AII. We pull the formed loop on the posterior face of the device to gain length of the wire. After this step, we increase the anterior loop of the wire so that the end of the wire passing through the interior of the device is the same as that passing through the arthroscopic portal. We return the device to the inside of the joint again and cross the lesion with a horizontally, penetrating the meniscus in the posterior and distal region of the lesion. We find the device through the extra-articular surgical approach and repeat the steps to increase the loops. We return the device to the inside of the joint and cross the lesion with the suture in an oblique way again. We enter the meniscus with the device and form a new anterior loop in the extra-articular region. After repairing the loop, we return the device to the joint and cross the lesion horizontally from anterior to posterior, penetrating the meniscus about 10 mm posterior to the radial tear. We find the device on the extra-articular surface and pull the suture out of the Meniscus 4 AII. We then remain with 2 ends of the wires and 3 loops formed. We cut each loop and through a light traction and we observe which wire connect with other. And we start the sutures, making 3 to 4 stitches on each thread. We are able to observe the complete closure of the lesion inside the joint, completing the surgical procedure.

Resumo Objetivo Definir o perfil epidemiológico e as comorbidades associadas dos pacientes submetidos à artroplastia total do joelho (ATJ) em dois hospitais de referência. Métodos Durante o estudo observacional transversal, foram avaliados 294 pacientes submetidos à ATJ em 2 hospitais de atenção terciária. Coletou-se, por entrevista direta, o diagnóstico das comorbidades auto-relatadas. Foram calculados o índice de comorbidades funcionais (do inglês Functional Comorbidity Index, FCI) e o índice modificado de cinco fatores de fragilidade (do inglês 5-Factor Modified Frailty Index, mFI-5). Avaliou-se a incidência das comorbidades e a relação destas com os índices calculados. Resultados A maioria dos pacientes da amostra foram mulheres (p = 0,000) entre a sétima e oitava décadas de vida. A hipertensão arterial sistêmica foi a patologia mais comum, seguida de obesidade e diabetes mellitus. O ICF apresentou uma relação direta com sexo feminino (p = 0,038) e a obesidade (p Conclusão Os pacientes submetidos à ATJ são essencialmente portadores de comorbidades clínicas que podem influenciar negativamente os resultados funcionais e comprometer a segurança do procedimento. A identificação dos fatores de risco pode contribuir para a segurança e melhor seleção dos candidatos a ATJ.

Physical examination in the presence of a multiligament knee injury can be complex and challenging. Hence, stress radiography is a useful and inexpensive tool that is widely used in the assessment of this type of injury. It guarantees an objective analysis of the magnitude of knee instability, which may reduce the observer's interpretation bias in relation to the physical examination. However, for the radiographic analysis to be reproducible, it is necessary to standardize the technique to evaluate each of the main knee ligaments. This article aims to describe in detail how to perform stress radiography to assess the sufficiency of the posterior cruciate ligament and collateral ligaments in the context of a multiligament injury.

Objective The aim of the study is to assess whether delaying frozen embryo transfer (FET) after pre-implantation genetic testing for aneuploidy (PGT-A) cycle provides any benefit for reproductive outcomes. Methods Retrospective cohort study including a total of 913 frozen embryo transfers related to 5104 PGT-A cycles performed between May 2016 and March 2017 at IVI clinics. We compared the FET performed the month following the ovarian puncture (OPU) (n = 184) with the FET delayed one or more months (n = 700). The main outcome was clinical pregnancy rate (CPR) and the secondary outcomes were implantation (IR) and miscarriage rates. Results No significant statistical differences were detected between groups as regards patient age and cycle parameters. Similar results were also observed concerning metaphase II oocytes (11 ± 0.8 vs 10 ± 0.4, p = 0.03), number of blastocysts (4.3 ± 0.4 vs 3.8 ± 0.2, p = 0.122), euploid embryos (2.1 ± 0.3 vs 1.8 ± 0.1, p = 0.039), or transferred embryos (1.1 ± 0.1 vs 1.1 ± 0.2, p = 0.52). Finally, no significant differences were found in CPR (52.7% vs 54.9%, p = 0.33). The multivariate logistic regression showed that the number of euploid (OR = 1.170, 1.062–1.288; p = 0.001) and transferred embryos (OR = 2.530, 1.703–1.509; P Conclusions Delaying frozen embryo transfer after PGT-A cycles does not seem to improve outcomes in terms of pregnancy rates.

Objective: To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors. Methods: The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated: age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus. Results: In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk. Conclusion: The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study. RESUMO Objetivo: O objetivo do estudo foi avaliar a taxa de complicações da artroplastia total do joelho (ATJ) em pacientes octogenários e tentar identificar fatores preditivos. Métodos: Foi realizado um estudo envolvendo 140 pacientes, divididos em dois grupos (70 octogenários e 70 com idade abaixo de 80 anos), submetidos a ATJ no período de janeiro de 2014 a agosto de 2016. Os prontuários desses pacientes foram analisados buscando a presença de complicações ocorridas no prazo de um ano após a cirurgia. Em relação aos fatores de risco foram avaliados idade, sexo, raça, American Society of Anesthesiologists, Indice de Massa Corpórea, tabagismo, hipertensão arterial e diabetes. Resultados: No grupo-controle, a incidência de complicações foi de 7,1%. Já no grupo estudado foi significativamente maior, chegando a 34,3%. A razão de chances para complicações é 6,8, com intervalo de confiança ao nível de 95% igual a (2,4;19,1). A idade maior ou igual a 80 constitui, assim, fator de risco aumentado para a incidência de complicações pós-artroplastia total de joelho. Conclusão: A ocorrência de complicações após ATJ é significativamente maior no grupo dos octogenários. Nível de Evidência III, Estudo de caso-controle.

Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.

Objective: To evaluate intraobserver and interobserver reliability of the measurement of the mechanical axis of the lower limb by means of the panoramic radiograph of lower limbs by physicians with different levels of medical practice. Method: A retrospective cross-sectional study with preoperative and postoperative radiographic analysis of a group of 100 patients submitted to total knee arthroplasty. Results: It was observed that there is a highly significant intraobserver and interobserver agreement (p Conclusion: The panoramic radiograph of the lower limbs is a reliable method for measuring the mechanical axis of the lower limb in patients submitted to total knee arthroplasty, regardless of the level of medical practice of the evaluator.

Background: Tibial polyethylene wear is related late failure in total knee arthroplasty. The cruciate substitute design depending on the campost mechanism to secure the knee cinematics after a posterior stabilized total knee arthroplasty (PS-TKA). A post fracture can occur after damage failure of the post. Aim: Report a case of post refracture after a PS-TKA and review the lecture about post wear in PS-TKA. Case presentation: A 63 woman with a primary TKA had a diagnosis of polyethylene post fracture. The polyethylene exchange wasn’t enough and revisions of all components were necessary. Conclusion: In patient with previous well function, subtle swelling and giving away sings after PS-TKA, a post fracture must be excluded.

STUDY QUESTION Are there differences in the clinical outcomes of IUI among different populational groups (heterosexual couples, single women and lesbian couples)? SUMMARY ANSWER The outcome of donor IUI (D-IUI) is similar in all populational groups and better than that seen with autologous insemination. WHAT IS KNOWN ALREADY A vast body of literature on clinical outcome is available for counselling heterosexual couples regarding decisions related to ART. The reproductive potential of single women, lesbian couples and heterosexual couples who need donor semen is assumed to be better, but there is a scarcity of data on their ART performance to actually confirm it. STUDY DESIGN, SIZE, DURATION In this retrospective multicentric cohort study, a total of 7228 IUI treatment cycles performed in 3807 patients between January 2013 and December 2016 in 13 private clinics belonging to the same reproductive medicine group in Spain were included. Patients with previous IUI attempts were excluded from the study. Only 1.9% of cycles were lost to follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 5318 D-IUI cycles were performed in three different populational groups: heterosexual couples (D-HC, 1167 cycles), single women (SW, 2839 cycles) and lesbian couples (LC, 1312), while a total of 1910 autologous IUI cycles were performed in heterosexual couples (A-HC). This last one was considered the control group and was composed of cycles performed in couples with a male partner with sperm parameters equivalent to those requested from donors. In order to identify factors with an impact on clinical outcome, a multivariate logistic regression analysis was performed. Regarding live birth rate (LBR), mixed effect models were employed to control for the fact that different patients were submitted to different numbers of treatments. MAIN RESULTS AND THE ROLE OF CHANCE Parameters that were significant to the primary outcome (LBR) according to the multivariate analysis were the populational group (D-HC, SW, LC and A-HC) to which the patient belonged, female age and a diagnosis of low ovarian reserve. At the age range of good prognosis (≤37 years), LBR was similar in all groups that underwent D-IUI (18.8% for D-HC, 16.5% for SW and 17.6% for LC) but was significantly lower in the autologous IUI (A-HC) group (11%). For all these significant findings, the strength of the association was confirmed by P values LIMITATIONS, REASONS FOR CAUTION To the best of our knowledge, a smoking habit was the only known factor with a potential effect on ART outcome that could not be controlled for, due to the unavailability of this information in a significant percentage of the clinical files studied. Our study was not capable of precisely quantifying the impact of a diagnosis of low ovarian reserve on the LBR of both IUI and D-IUI, due to the number of cycles performed in patients with such diagnosis (n = 231, 3.2% of the total). WIDER IMPLICATIONS OF THE FINDINGS For the first time, a comparison among D-HC, SW, LC and A-HC was performed in a study with a robust sample size and controlling for potential sources of bias. There is now sound evidence that equivalent clinical outcome is seen in the three groups treated with donor semen (D-HC, SW and LC). Specifically, regarding the comparison between SW and LC, our findings rule out differences in LBR proposed by previous publications, with very similar clinical outcomes within the same age ranges. At age ranges of good prognosis (≤37 years), reproductive performance of D-IUI is significantly better than that seen in heterosexual couples undergoing autologous IUI, even when only cases of optimal sperm quality are considered in this last group. This finding is in agreement with the concept that, as a group, A-HC are more prone to have female factor infertility, even when their infertility assessment finds no contraindication to IUI. Age affects all these groups equally, with none of them reaching a 7% LBR after the age of 40 years. Our findings will be useful for the counselling of patients from the different populations studied here about ART strategies. STUDY FUNDING/COMPETING INTEREST(S) None.

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation. RESUMO O Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: crianças e adolescentes foi elaborado com a participação de nutricionistas, médicos nutrólogos e médicos hematologistas pediátricos de 10 centros brasileiros que são referência em transplante de células-tronco hematopoiéticas. O objetivo foi salientar a importância do estado nutricional e da composição corporal durante o tratamento, bem como as principais características relacionadas à avaliação nutricional do paciente. As intenções, ao se estabelecer o consenso, foram aprimorar e padronizar a terapia nutricional durante o transplante de células-tronco hematopoiéticas. O consenso foi aprovado pela Sociedade Brasileira de Transplante de Médula Óssea.

Study question To compare the impact on oocyte quality and reproductive outcomes in patients who received oocytes from donors stimulated with MPA versus GnRH antagonist protocol. Summary answer Compared to GnRH antagonist, MPA does not exert a major effect on oocyte quality and yields similar reproductive outcomes in egg donation recipients. What is known already Conventional ovarian stimulation (OS) protocols have classically used GnRH analogues, both agonists and antagonists, to avoid premature follicular luteinization. The oral administration of MPA or micronized progesterone during the follicular phase of OS has emerged as an attractive alternative to conventional protocols in the prevention of early luteinization. Compared to progesterone, MPA is characterized by a moderate-strong progestanic action, lower androgenic properties and does not interfere with the measurement of endogenous progesterone. In our group, administration of MPA during the follicular phase of OS has been included in the routine clinical practice of our donor program since late 2019. Study design, size, duration Multicentre, retrospective, observational, cohort study carried out in eleven private university-affiliated IVF centers. The present study included a total of 14,282 fresh ovum donation cycles performed from October 2017 to March 2020. Oocyte donors were recruited and stimulated under either MPA (n = 4,665) or GnRHa (n = 9,617) to suppress the pituitary during the follicular phase of OS, and GnRH agonist was administered to trigger final oocyte maturation in all the participants. Participants/materials, setting, methods Recipients were divided according to the protocol used for premature luteinization prevention during the follicular phase of the ovum donation matched-cycle: Group 1, recipients who received oocytes from donors treated with 10 mg/day of MPA (ProgeveraÒ); Group 2, recipients who received oocytes from GnRH antagonist (FyremadelÒ) down-regulated donor cycles. All the procedures were approved by an Institutional Review Board (1910-VLC–091-JG) and complied with Spanish law on assisted reproductive technologies (14/2006). Main results and the role of chance Regarding donoŕs baseline characteristics, age and antral follicle count were significantly different between groups, but not clinical differences. The length of ovarian stimulation was similar in both groups (10.7 days [95% Confidence Interval (CI) 10.5–10–8] vs 10.5 days [95% CI 10.0–11.00]). Despite slightly higher mean total dose of FSH administered in Group 1 compared to Group 2 (1.841 IU [95% CI 1.813–1.868] vs 1.739 IU [95% CI 1.723–1.754]), there were no differences in the total dose of hMG administered between both groups (967 IU [95% CI 901–1.034] vs 971 IU [95% CI 944–998]). With regard to IVF data, both the number of retrieved oocytes (22.9 [95% CI 22.4–23.4] vs 24.1 [95% CI 23.8–24.3]), and mature oocytes (18.7 [95% CI 18.3–19.1] vs 19.3 [95% CI 19.1–19.6]), were slightly lower in Group 1 compared to Group 2, whereas fertilization rate was significantly higher in Group 1 compared to Group 2 (82.1% [95% CI 81.7–82.6] vs 80.8% [95% CI 80.6–81.2]),. Regarding the clinical outcomes, no differences were observed in either implantation rate (58.7% [95% CI 56.7–60.7] vs 59.3% [95% CI 57.3–61.3]) or clinical pregnancy rate (59.5% vs 59.8%, P = 0.04) between both groups. Limitations, reasons for caution As a consequence of being a retrospective study, only association, and not causation, can be inferred from the results. A further limitation is that donors are healthy young women and do not perfectly match other populations, as infertile patients who may be older, low or high responders to OS. Wider implications of the findings: MPA emerges as an effective oral alternative to GnRH analogues for preventing premature luteinizing hormone surges in donors undergoing OS in ovum donation program. Compared with GnRH antagonists, MPA has advantages of being an oral administration route and providing easy access, yielding similar clinical results. Trial registration number 1910-VLC–091-JG

Study question Is adenomyosis associated with worse clinical and perinatal outcomes in ovum donation cycles? Summary answer Adenomyosis was associated with reduced live birth rate per embryo transfer but not with increased risk of miscarriage or worse perinatal outcomes than controls. What is known already The effect of adenomyosis on IVF/ICSI outcomes are controversial as studies addressing this issue are limited in number and heterogeneous. Conclusions withdrawn from previous works differ regarding the prospective or retrospective design of the study. Two different metanalysis conducted showed that adenomyosis reduced implantation and clinical pregnancy rate and increased miscarriage risk. However, current data regarding perinatal outcomes of assisted reproduction techniques cycles in patients diagnosed with uterine adenomyosis is scarce. Study design, size, duration A retrospective cohort study in which 3307 patients undergoing ovum donation cycles were included. Patients who underwent single embryo transfer (SET) between years 2018 and 2019 were included and divided into two groups: adenomyosis (n = 179) and controls (n = 3218). Participants/materials, setting, methods Inclusion criteria consisted of patients in an oocyte donation program who had fresh SET on day 5 blastocyst stage development. Patients diagnosed with miomas and/or severe endometriosis and those who had undergone previous uterine surgical interventions were excluded from the study. Cases consisted of patients with a history of either focal or diffuse adenomyosis diagnosed via transvaginal ultrasonography (TVUS). Main results and the role of chance Clinical pregnancy rate per embryo transfer was 82/179 (45.8%) in those women diagnosed with adenomyosis versus 1869/3218 (59.8%) in control group (OR = 0.57 95% CI. 0.41–0.78, p Limitations, reasons for caution This is an observational study and thus possible confounders cannot be completely excluded. Diagnostic of adenomyosis is complex and, despite imaging via TVUS is both sensitive and specific, different criteria may be combined in order to fully assess the diagnostic. Wider implications of the findings: Published literature has described how adenomyosis negatively impacts clinical outcomes in ART cycles; however, data regarding perinatal results is scarce. This study is of interest as it provides a first insight for clinicians showing that adenomyosis affects clinical but not perinatal outcomes in ovum donation cycle. Trial registration number Not applicable

The aim of the study is to investigate serum stem cell factor (SCF) concentrations as potential biomarker for oocyte retrieval efficiency in IVF patients with poor prognosis. A pilot case–control study was performed on 30 poor and 30 normal responders that were stimulated with antagonist protocol. SCF concentrations were evaluated in samples of serum and follicular fluid obtained by all patients on the day of oocyte retrieval. At the time of oocyte retrieval, follicular fluid from at least two follicles ≥ 14 mm and two follicles

Resumo Objetivo O objetivo do presente estudo foi avaliar os resultados do uso tópico intraoperatório do selante de fibrina humano livre de agentes estabilizadores de coágulo em pacientes com osteoartrite (OA) submetidos a artroplastia total de joelho (ATJ), buscando diferenças entre os grupos em relação à perda sanguínea, à necessidade transfusional, ao tempo de internação hospitalar, à percepção de dor, à amplitude de movimento e à incidência de complicações. Métodos Foram analisados prospectivamente um grupo de intervenção (Selante) com 32 pacientes e um grupo controle (Controle) com 31 pacientes, com OA sintomática dos joelhos, submetidos a ATJ. Resultados Os resultados foram semelhantes entre os grupos, em relação à perda sanguínea visível no dreno em 24 horas (Controle 276,5 mL ± 46,24 versus Selante 365,9 mL ± 45,73), à perda sanguínea total em 24 horas (Controle 930 mL ± 78 versus Selante 890 mL ± 67) e em 60 horas de pós-operatório (Controle 1.250 mL ± 120 versus Selante 1.190 mL ± 96), à necessidade de hemotransfusão (ocorreu em apenas 1 controle), ao tempo de dias na permanência hospitalar (Controle 5,61 ± 0,50 [n = 31] versus Selante 4,81 ± 0,36), dor pós-operatória e amplitude de movimento. O uso do agente selante de fibrina não se relacionou à ocorrência de complicações da cicatrização de ferida, de infecção ou de trombose venosa profunda. Conclusão Concluímos que o agente hemostático de fibrina humana não foi eficaz em reduzir o volume de sangramento e a necessidade de hemotransfusão ou em interferir no tempo de internação hospitalar, na percepção de dor e na amplitude de movimento. Seu uso não se relacionou a nenhuma complicação.

PURPOSE OF REVIEW: The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. The objective of this review is to summarize how this pandemic has affected the activity of a Reproductive Medicine Center, which established a series of measures in parallel with governments decisions and scientific societies. RECENT FINDINGS: The control measures adopted for restarting the healthcare activity should be equitable and inclusive. Moreover, this pandemic has implied changes in treatments and strategies to be alert regarding the daily changing information. Finally, for ensuring a safe practice both for patients and staff, it is important to detect asymptomatic patients, so Reproductive Medicine centers must take special care with screening and testing procedures. SUMMARY: The pandemic has pushed up toward a new reality in terms of Assisted Reproductive treatments, where social distance and responsibility are protagonists. We face a new challenge of balancing between responding to the committed efforts of infertile couples to achieve pregnancy and safeguarding the health of the future parents and their children during this time of pandemic.

Visceral leishmaniasis (VL) is a tropical and subtropical disease that is endemic in more than 80 countries around the world. A large number of leishmaniasis vaccine candidates are in various stages of development with preclinical and clinical trials ongoing. Several vaccine candidates are composed of an individual parasite antigen or a combination of antigens produced as a multiepitope vaccine. The efficacy of a vaccine can be improved by combining with some adjuvants, that promote a protective immune response, inducing long-term immunity. The discovery of Toll-like receptors (TLRs) has provided many information on the immunostimulatory effect of several bacterial components that can be connected to TLRs, improving the adaptive immune responses for vaccine formulations. New agonists of TLRs have been discovered and used to test new vaccine formulation showing good efficacy. This chapter aims to discuss the new vaccine candidates for leishmaniasis and the importance of the adjuvants used in the vaccine formulation.

Magnetic-activated cell sorting (MACS) can be used to separate apoptotic sperm with high proportions of fragmented DNA from the rest, thus improving the overall quality of the seminal sample. Therefore, the aim of this retrospective study was to investigate the efficiency of the MACS technique to increase reproductive outcomes in patients with high levels of sperm DNA fragmentation (SDF) undergoing intracytoplasmic sperm-injection (ICSI) cycles. In this study, we analyzed a total of 724 assisted-reproduction-technique (ART) cycles that were divided into two groups: the study group (n = 366) in which the MACS selection technique was performed after density-gradient centrifugation (DGC), and the control group (n = 358) in which only DGC was used for sperm selection. Reproductive outcomes were analyzed in both groups according to three different ART procedures: preimplantation genetic testing for aneuploidy (PGT-A), and autologous and oocyte-donation cycles. The MACS group showed significantly lower miscarriage rates in autologous ICSI cycles, higher pregnancy rates in oocyte-donation cycles, and a significant increase in live-birth rates in both autologous and oocyte-donation cycles. Overall, these results suggested that the MACS technique can be effectively used to eliminate sperm with high SDF levels, and therefore may help to improve reproductive outcomes in couples undergoing ART.

The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. Unfortunately, the disease has spread globally. On March 11th (2020) World Health Organization (WHO) declared Covid-19 a pandemic and has called governments to take urgent and aggressive action to change the course of the outbreak. Within the context of Assisted Reproduction, both reproductive medicine professionals and patients are also fighting against this unprecedented viral pandemic. In view of events, most of us had to make serious decisions, some of them with a lack of scientific evidence due to the circumstances and with the only objective of ensuring the safe care of our patients, reduce non-essential contacts and prevent possible maternal and fetal complications in future pregnancies. Pregnant women should not be considered at high risk for developing severe infection. Up to date, there are no reported deaths in pregnant women with Covid-19, while in the cases that have presented pneumonia because of Covid-19, the symptoms have been moderate and with a good prognosis in recovery.

Resumo Objetivo Avaliar de modo retrospectivo o resultado funcional dos pacientes submetidos a artrodese após falha séptica da artroplastia total de joelho. Métodos Foram avaliados 18 pacientes com tempo médio de 3,7 anos de seguimento. A cirurgia de artrodese foi realizada com placa do tipo dynamic compression plate (DCP) estreita, anterior e medial, ou fixador externo em dois planos da articulação (Orthofix Bone Growth Therapy, Lewisville, TS, EUA), a critério do cirurgião. Resultados O patógeno mais frequentemente encontrado foi o Staphylococcus aureus sensível a meticilina (38,9%). A discrepância de membros inferiores média foi de 3,63 cm. O da knee society score (KSS) médio foi de 68 pontos. Segundo a escala analógica visual de dor, 44% dos pacientes apresentaram pontuação zero no momento da avaliação, e 22,2% estavam muito insatisfeitos a despeito da consolidação óssea obtida. Os pacientes foram avaliados quanto à capacidade de deambular com ou sem auxílio de apoio. Conclusão A cirurgia de artrodese do joelho se mostrou eficiente quanto ao controle do processo infeccioso e diminuição das queixas álgicas, porém a satisfação com o procedimento é baixa.

Background The CYP19A1 gene, which encodes the enzyme responsible for androgen aromatization into estrogens, may play an important role in breast cancer aggressiveness. However, no study has evaluated CYP19A1 gene expression in the peripheral blood of women with relapsed breast cancer. Methods In this cross-sectional study, CYP19A1 gene expression was quantified by RT-PCR in the peripheral blood of 146 women with breast cancer who were first divided into two groups according to the expression of CYP19A1 (low and high); each group had 73 patients. Subsequently, women were divided into two groups: those without recurrence (control, n = 85) and those with recurrence (study, n = 61). Statistical analysis of the data was performed using ANOVA, the Mann-Whitney, Chi-square or Fisher’s exact test (p Results There were no significant differences between the relative expression of CYP19A1 mRNA in the low expression group and the high expression group according to the variables studied. There were no significant differences in CYP19A1 gene expression in the study and control groups (p = 0.8461). In the relapse group, CYP19A1 gene expression was significantly higher in the hybrid luminal subtype than in the triple-negative subtype (p = 0.0321), whereas it was significantly lower in HER2-negative cases than in HER2-positive cases (p Conclusions The present study found no significant differences between women with high and low expression of the CYP19A1 gene mRNA or between those in the study group and the control group. However, in women with recurrence, there was increased expression of CYP19A1 mRNA in those who had the luminal hybrid subtype and locoregional relapse and decreased expression in those negative for HER2.

There is little evidence that current control strategies for canine leishmaniosis (CanL), the veterinary disease caused by L. infantum infection, are having a positive impact. This is of critical importance because dogs are a primary reservoir for L. infantum and a significant source of parasite transmission to humans. Drugs intended primarily for human use are prohibited for the treatment of CanL because of concerns over the propagation of resistant parasites. Although allopurinol effectively decreases parasite burden in CanL the treatment needs to be maintained for life. We hypothesized that during the allopurinol-induced parasite reduction dogs may become capable of developing a more robust immune response that may permit more effective control of parasites. To test this, we investigated the clinical and parasitological impact of short-term treatment with allopurinol, either alone or in combination with a defined subunit vaccine, on dogs naturally infected with L. infantum. A total of 28 dogs were distributed as follows: untreated; oral allopurinol alone (20 mg/kg, once each day for 90 days); or allopurinol with immunization with the Leish-F2 antigen formulated with the Toll-like receptor (TLR) 4 agonist Second generation Lipid Adjuvant (SLA) in stable emulsion (SE; SLA-SE). Dogs that did not receive treatment had a progressive decline in their clinical condition and an increase in their infection levels, while treatment with allopurinol alone alleviated the clinical symptoms of CanL but did not generate sustained reduction in parasites. Concomitant immunization with Leish-F2 + SLA-SE, however, improved clinical condition while also providing long-term clearance of L. infantum from lymphoid tissues and systemic organs. These results have important implications for both the management of CanL and for limiting L. infantum transmission to humans. Keywords: Canine visceral leishmaniasis, Vaccine, Parasite, Drug, Clinical signs

The data collection protocol was used for research involving the anthropometric study of the knee in patients with osteoarthritis during total knee arthroplasty (TKA) surgery. These data allowed comparing the dimensions of the knees with the available implants, investigating the existence of possible variations between the sexes and correlating the measurements with quantitative and qualitative data for each individual. In addition, it made it possible to define the profile of patients undergoing TKA in our services.

The association between FokI polymorphism in the vitamin D receptor (VDR) gene and susceptibility to arterial hypertension (HT) is controversial. Thus, we evaluated the relation between FokI and HT according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE® (Medical Literature Analysis and Retrieval System Online)/PubMed, Scopus, and Cochrane Library CENTRAL databases. Data from case-control studies, including the number of participants, age, 25-hydroxyvitamin D concentrations, systolic and diastolic blood pressure values, FokI allele, and genotype frequency were extracted by 2 independent authors and OR was calculated with the 95% CI to assess the strength of the association between the FokI variant and odds of HT. In general and subgroup analyses, we used allelic (f compared with F), common (ff compared with FF + Ff), risk (ff + Ff compared with FF), and additive (ff compared with FF) models. Six case-control studies including 3140 cases and 3882 controls were reviewed in the meta-analysis. Global assessment revealed a correlation between FokI and reduced odds of HT in the additive/homozygote model (ff compared with FF; OR: 0.65; 95% CI: 0.45-0.94) and common/recessive model (ff compared with FF + Ff; OR: 0.75; 95% CI: 0.57-0.99). In Asian subjects, there was a significant reduction in the odds of HT in additive (ff compared with FF; OR: 0.84; 95% CI: 0.73-0.98) and risk models (ff + Ff compared with FF; OR: 0.87, 95% CI: 0.78-0.97), in particular, for Indians (South). In Africans, the statistically significant association occurred in the additive and common models. Allele f in the FokI polymorphism of the VDR gene was associated with reduced odds of HT in the general population based on the risk model. Thus, nutritional genomics can help understand the influence of nutrition on metabolic homeostasis pathways and the clinical consequences of hypertension. This study shows the need for healthy, anti-inflammatory, and antioxidant compounds to prevent or treat chronic complications.

Evidence suggests that polymorphisms in the gene encoding a vitamin D receptor might affect blood pressure. The objective of this systematic review was to investigate the association between hypertension and vitamin D receptor (Fok I) gene polymorphism. A literature search was performed according to the PRISMA guidelines using the MEDLINE®/PubMed, Scopus, Cochrane Library CENTRAL, SciELO, and LILACS databases. The quality of case-control or cohort studies and studies based on cross-sectional methodology was evaluated using the Newcastle-Ottawa Scale and the protocol of Loney and coauthors [25], respectively. In this systematic literature search, 215 publications were identified, of which 10 were analyzed, including seven case-control studies, two cross-sectional studies, and one cohort study. The association between Fok I polymorphism and hypertension was reported in 60% of the publications and the risk for hypertension was shown to be related to FF and ff genotypes. In addition, Fok I polymorphism was shown to increase plasma renin activity, which plays an important role in regulating blood pressure. However, no association was observed between Fok I polymorphism and serum vitamin D levels. In conclusion, Fok I polymorphism plays an important role in hypertension.

Background Total knee arthroplasty (TKA) is the treatment option for patients with severe osteoarthritis (OA) of the knee whose symptoms are refractory to conservative management. Unfortunately, the level of patient dissatisfaction is high, reaching up to 25%. The reasons for this dissatisfaction are multifactorial, but bone-implant mismatch significantly increases the chance of pain and functional limitation. Sex-specific prosthesis designs have been developed to overcome this issue, but their use is still controversial. The primary objective of this study was to evaluate possible sex differences in the shape of the distal femur in patients with osteoarthritis. Secondary objectives were to investigate interpersonal variability of the distal femur and to determine the number of femoral implant sizes required to meet shape variations. Methods and findings A cross-sectional observational study prospectively compared 294 knees of 293 patients with osteoarthritis according to sex (201 female/93 male). Six intraoperative measurements were performed on the distal femur (height and width of both lateral and medial condyles, total medial-lateral width of the femur, and intercondylar distance). Sex differences and interpersonal variability were analyzed by multiple linear regressions. Measurements were also correlated with patient height. An optimization analysis was used to estimate the number of femoral implant sizes required. There were significant sex differences in the distal femur, where men had higher values than women in all measurements. Great interpersonal variability was found. The height of the lateral condyle was correlated with patient height, but the correlation was not strong. Twenty-five femoral implant sizes were required to meet the shape variations in our sample. Conclusions The shape of the distal femur in patients with osteoarthritis shows great interpersonal variability, with men showing significantly higher values than women. A total of 25 different implant sizes would be necessary to adequately meet the variations observed in our study population.

The objective of this review was to investigate the effect of vitamin D3 supplementation on serum 25-hydroxyvitamin D concentration in individuals with single-nucleotide polymorphisms in the vitamin D receptor gene. The research was conducted on 241 articles found in the PubMed, Scopus, Science Direct, and Cochrane Library databases between November and December 2018. After article screening, three randomized double-blind placebo-controlled clinical trials were identified as eligible for this review. Participants were Australian, Brazilian, and Chinese individuals, who ingested doses of vitamin D3 ranging from 2000 IU to a megadose of 200,000 IU. The presence of the BB/Bb genotype of the BsmI polymorphism and the FokI G allele caused an increase in the serum concentrations of vitamin D after supplementation. Nonetheless, the few studies on this subject are not unanimous in their results. It is possible that differences among populations, sample sizes, doses, and time of supplementation have an impact on data and outcomes.

Knee nbsp arthrodesis nbsp above nbsp the nbsp knee nbsp amputation nbsp and nbsp resection nbsp arthroplasty nbsp is nbsp salvage nbsp procedures nbsp for nbsp patients nbsp with nbsp refractory nbsp infection nbsp after nbsp Total nbsp Knee nbsp Arthroplasty nbsp TKA nbsp The aim of this study was to review the literature of patients submitted to knee resection arthroplasty after septic failure of a TKA This literature review identified three case series with more than two years of follow up After the resection arthroplasty in a global analysis of nbsp the nbsp three nbsp studies nbsp the nbsp rate nbsp of nbsp infection nbsp control nbsp reached nbsp nbsp and nbsp with nbsp nbsp of nbsp patients nbsp showing satisfaction However only of them were able to walk without assistance

Resumo A ocorrencia de luxacao permanente da patela associada a osteoartrite grave e considerada rara e de tratamento dificil. A literatura e bastante controversa sobre o assunto. O objetivo do trabalho e relatar dois raros casos de osteoartrite grave com luxacao permanente da patela que foram submetidos a artroplastia total do joelho, alem da tecnica cirurgica relacionada e de uma revisao da literatura. A artroplastia total do joelho com o acesso parapatelar medial associado a uma liberacao lateral foi uma boa opcao cirurgica em pacientes com luxacao permanente da patela associada a osteoartrite avancada.

The occurrence of permanent patellar dislocation associated with severe osteoarthritis is considered rare and difficult to treat. Literature: The literature is quite controversial on the subject. The objective of the study is to report two rare cases of severe osteoarthritis with permanent dislocation of the patella that underwent total knee arthroplasty, in addition to a review of the literature on the subject and related surgical technique. Total knee arthroplasty with using the medial parapatellar approach associated with lateral release was a good surgical option in patients with permanent patellar dislocation associated with advanced osteoarthritis.

Resumo Objetivo Identificar as complicacoes clinicas e cirurgicas associadas ao uso de torniquete na artroplastia total de joelho em pacientes com ou sem calcificacao da arteria poplitea. Metodos O estudo foi feito de modo retrospectivo, analisou 64 pacientes com calcificacao da arteria poplitea e 57 pacientes como grupo controle. Resultados Os pacientes do grupo de casos eram significativamente mais velhos do que os pacientes do grupo controle. Entretanto, tal fato nao teve repercussao quanto ao desfecho clinico no periodo analisado. Nao houve complicacoes durante o ato cirurgico nos grupos estudados, bem como nao houve diferencas estatisticamente significantes entre a incidencia de intercorrencias locais ou sistemicas no periodo analisado. Conclusao O presente estudo observou baixos indices de complicacoes em pacientes submetidos a artroplastia total do joelho com uso de torniquete com ou sem calcificacao da arteria poplitea.

The purpose of this study was to evaluate the accuracy and reliability of pre-operative templating in predicting the size of femoral and tibial components and the effect of coronal deformity on templating accuracy. This was a retrospective study of 39 pre-operative templates prepared by three different surgeons with different levels of training. The accuracy and reliability measures were evaluated by alpha and kappa coefficients of agreement. The analysis of the effect of coronal deformity on the accuracy of the template was measured by the Spearman’s correlation test. Templating was accurate for the femoral component in 28.21% of anterposterior (AP) radiographs and 35.90% of lateral radiographs. Kappa coefficients were respectively 0.111 (95% confidence interval [95%CI]: –0.19 to 0.241) and 0.200 (95%CI: –0.010 to 0.401), indicating poor agreement. Templating accuracy for the tibial component were, respectively, 37.61% and 47.01% for AP and lateral views. Kappa coefficients were 0.186 (95%CI: –0.070 to 0.379) for the AP view and 0.315 (95%CI: –0.199 to 0.431) for the lateral view, showing poor and slight agreement respectively. Considering a margin of error of ±1 sizes, the agreement level improved for all components, particularly for tibia, where agreement levels become very good. The inter-observer agreement was fair for all components, except for the lateral view of the femoral component, whose agreement was good. The Spearman correlation test showed no correlation between accuracy of templating and coronal deformity. Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.

AIM To investigate factors associated with anterior open bite in individuals aged from 2 to 33 years with developmental disabilities. DESIGN This is a cross-sectional study. A total of 271 dental records were examined. The anterior open bite analyzed was determined based on clinic exam. These variables were also analyzed: gender, age, education level of mother, International Code of Diseases (ICD), mouth breathing, use of anticonvulsant drugs, hyperkinesis, pacifier use, thumb sucking, seizure, and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without anterior open bite. Variables with a p-value of < 0.25 in the bivariate analysis were incorporated into the logistic regression models. RESULTS Mouth breathers had a 2.60-fold (95% CI: 1.35-5.01) greater chance of exhibiting anterior open bite than nasal breathers. Pacifier users are more likely to have an anterior open bite (3.32-fold, 95% CI: 1.62-6.77). Individuals with reported involuntary movements had a 2.66-fold (95% CI: 1.26-5.63) greater chance of exhibiting anterior open bite. Users of anticonvulsants drugs had a 3.05 (95% CI: 1.57-5.92) greater chance of showing anterior open bite. CONCLUSION Involuntary movements, mouth breathing, using anticonvulsant drugs, and using pacifier are factors associated with anterior open bite in patients with developmental disabilities.

In recent years, folliculogenesis in women has been shown to occur in a wave-like pattern, with two or three waves of follicular development during one menstrual cycle. Moreover, it has been shown that follicles formed beyond the follicular phase have similar ovulation potential, opening new windows for assisted reproductive treatment (ART). Thus, the double stimulation strategy has been proposed as an attractive alternative to obtain a higher number of eggs and embryos in a shorter period of time, which would theoretically increase the cumulative live birth rate and reduce the time to pregnancy. In this protocol, controlled ovarian stimulation (COS) is performed twice in the same menstrual cycle, taking advantage of both the follicular and the luteal phase. The results obtained so far indicate that luteal phase stimulation is not inferior to follicular phase stimulation. Additionally, the double stimulation protocol has proved to be as safe as conventional COS, while improving reproductive outcomes when compared to single follicular phase stimulation. In this context, it also emerges as an interesting option for emergency fertility preservation in oncologic patients. However, the absence of randomized controlled trials and cost-effective analysis raises important concerns that need to be addressed in depth via well-designed studies.

Objective: To compare intraoperative measurements of the knee with those obtained by magnetic resonance imaging, in order to validate the latter method for use in anthropometric studies. Materials and Methods: We studied 20 knees in 20 patients with osteoarthritis, all of whom underwent total arthroplasty between August and December of 2013. We took six measurements in the distal femur and two in the proximal tibia. Using the information system of the institution, we made the measurements on magnetic resonance imaging scans that had been obtained in the axial plane. Intraoperative measurements were obtained using a caliper, after the initial cuts made during the arthroplasty. The anatomical parameters determined by magnetic resonance imaging were the same as those determined by intraoperative measurement. The intraclass correlation coefficient was used in order to assess the level of agreement in anthropometric measurements of the knee performed by magnetic resonance imaging and by intraoperative measurement. Results: Statistical analysis revealed a highly significant correlation between the knee anthropometric parameters of the knee determined by intraoperative measurement and those determined by magnetic resonance imaging. Conclusion: The dimensions of osteoarthritic knees measured by magnetic resonance imaging were similar to those measured intraoperatively. Therefore, magnetic resonance imaging can be considered a reliable method for use in large-scale anthropometric studies that will allow the available implants to be adapted and improved. Resumo Objetivo: Comparar a mensuração do joelho realizada por meio de ressonância magnética com a medida obtida intraoperatoriamente, a fim de validar o método para estudos antropométricos. Materiais e Métodos: Foram estudados 20 joelhos em 20 pacientes portadores de osteoartrite submetidos a artroplastia total, entre agosto e dezembro de 2013. Realizaram-se seis medidas no fêmur distal e duas na tíbia proximal. As mensurações nas imagens foram feitas no plano axial, por meio do sistema informatizado da instituição. As mensurações intraoperatórias foram obtidas utilizando-se um paquímetro, após os cortes iniciais da artroplastia. Os parâmetros anatômicos foram os mesmos. O coeficiente de correlação intraclasses foi utilizado para avaliar a concordância nas medidas antropométricas de joelho realizadas pela ressonância magnética e pelo paquímetro de forma intraoperatória. Resultados: A análise estatística revelou que existe concordância altamente significativa entre as medidas antropométricas do joelho conseguidas por meio do uso do paquímetro intraoperatoriamente e pela ressonância magnética. Conclusão: A mensuração das dimensões dos joelhos osteoartríticos por meio de ressonância magnética apresentou-se como método semelhante à mensuração intraoperatória, sendo confiável para a realização de estudos antropométricos amplos que permitam a adequação e melhoria de implantes disponíveis.

Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver. RESUMO A obtenção de radiografias em perfil axilar do ombro em situação de trauma agudo nem sempre é tarefa fácil. Os autores apresentam uma modificação inédita dessa incidência radiográfica, com o objetivo de avaliar a relação anatômica da cabeça umeral com a cavidade glenoide. A incidência é medida com o paciente sentado sobre a mesa de exames de raios X, com o membro acometido apoiado sobre ela. Os autores descrevem o caso de um paciente de 28 anos que sofreu um episódio de luxação glenoumeral anterior que foi claramente evidenciada pela radiografia modificada. A relação de concentricidade entre a cabeça umeral e a cavidade glenoide foi facilmente confirmada pela obtenção da referida incidência radiográfica obtida após a manobra de redução.

We compared gains in range of motion in patients who underwent manipulation within 12 weeks of total knee arthroplasty (TKA) and after this period. We also evaluated maintenance of the arc obtained from knee manipulation in late follow-up, along with factors associated with poorer outcomes.The study was divided into two groups according to the time after TKA; the surgeries took place between January 2008 and December 2014.When comparing the range of motion between early and late manipulations, the group that underwent manipulation within 12 weeks of the TKA exhibited better outcomes, but these were not statistically significant. We observed that 14.3% of cases retained the same range attained at the time of manipulation. In late evaluation after manipulation, 47.7% of the sample had a range of less than 90 degrees. The significant risk factors for recurrence of knee stiffness in the long term are poor range of motion before TKA and before manipulation, female sex, and secondary arthritis.Women previously diagnosed with secondary osteoarthritis and poor range of motion before TKA or manipulation are at higher risk for late stiffness.Comparar o ganho de arco de movimento entre os pacientes submetidos à manipulação antes de 12 semanas pós-artroplastia total do joelho (ATJ), e depois desse período. Além disso, avaliar tardiamente a manutenção do arco obtido com a manipulação do joelho e fatores relacionados com os piores resultados.O estudo foi dividido em dois grupos, de acordo com o tempo pós-ATJ. Os procedimentos ocorreram entre janeiro de 2008 e dezembro de 2014.Quando comparamos os arcos de movimento entre as manipulações precoces e tardias, o grupo submetido à manipulação em 12 semanas da ATJ apresentou melhores resultados, porém, sem significância estatística. Foi observado que 14,3% dos casos mantiveram a mesma amplitude alcançada no momento da manipulação. Na avaliação tardia, 47,7% da amostra obtiveram amplitude menor que 90 graus. Os fatores de risco significantes para recidiva tardia de rigidez são arco de movimento ruim antes da ATJ e antes da manipulação, sexo feminino e artrites secundárias.Mulheres com diagnóstico prévio de osteoartrite secundária e com arco ruim antes da ATJ ou da manipulação têm maior risco de rigidez tardia.

OBJECTIVE: To evaluate the hormonal profile, antral follicle count (AFC) and ovarian response of patients with hypogonadotropic hypogonadism (HH). DESIGN: Observational retrospective cohort including infertile women with HH undergoing assisted reproductive treatment (ART). SETTING: University-affiliated infertility center. PATIENT(S): Thirty-three women with HH who underwent ART between January 2007 and September 2018. The control group comprised 66 age-matched counterparts with tubal or male factor infertility. The patients with an abnormal karyotype, and those presenting primary or secondary amenorrhea due to other causes, were cautiously excluded. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The primary outcome was serum levels of anti-Müllerian hormone (AMH) and AFC. We also investigated whether HH impacts ovarian response and reproductive outcomes. RESULT(S): Although AFC was similar between groups, HH patients showed significantly higher AMH levels (4.6 ± 2.7 ng/mL vs. 3.0 ± 1.9, p = 0.010) and lower basal FSH and LH. While the HH group needed longer stimulation [13 days (11–26) vs. 10 (7–14), p

Granulocyte colony-stimulating factor (G-CSF) acts on reproductive function at different stages, but its effects on the early stages of embryo development are unknown. The aim of this study was to assess the effect of G-CSF administration during treatment with assisted reproductive technologies (ART) and early pregnancy on newborns.Retrospective study in women undergoing egg donation, with a study group including 33 live-born children from a pregnancy in which G-CSF was administered, and a control group of 3798 children in which this medication was not ordered during pregnancy. The analysis was of perinatal outcomes resulting from G-CSF treatment administered off-label compared with a control group.No significant differences were found in maternal age (40.9 ± 0.1 versus 38.9 ± 1.8, P = 0.055), body mass index (23.2 ± 0.2 versus 22.6 ± 1.5, P = 0.503), infant birthweight (2952 ± 200 versus 3145 ± 270 g, P = 0.184), gestational age (38 ± 1 versus 37 ± 1 weeks, P = 0.926) or length (50.2 ± 1.5 versus 48.7 ± 2.7 cm, P = 0.678) (between the control group and women treated with G-CSF, respectively). The prematurity rates of births before week 36 (10.0% versus 9.5%, P = 0.783) or week 32 (2.2% versus 0.0%, P = 0.585) were similar in the control and study groups, respectively. The incidence of low birthweight (2500 g; 19.6% versus 11.8%, P = 0.570) or very low birthweight (1500 g; 2.5% versus 0.0%, P = 0.454) was not significantly different between non-treated and G-CSF-treated women, respectively.Administration of G-CSF at embryo transfer and during early pregnancy in recurrent miscarriage patients with KIR-HLA-C mismatch undergoing egg donation ART treatment does not convey a higher risk of perinatal complications.

This research presents a numerical evaluation of shallow foundation using the discrete element method and parameters calibrated by means of a reduced laboratory model of an idealized soil For this evaluation the Yade software was used to analyze the influence of grain scale parameters mesoscale on the macroscopic behavior of the soil perceived as an assembly of isolated and interacting particles It was observed that despite the need for calibration the discrete element method showed an appropriate qualitative prediction of failure surfaces and a satisfactory quantitative prediction of ultimate load capacity

Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results.

INTRODUCTION: Leishmaniasis is a global public health concern. Currently available treatments are associated with considerable side effects. The use of nanotechnology has shown promise for improving efficacy and bioavailability and minimizing side effects. METHODS: This study investigated available literature, including patents and scientific articles, to identify advances in the use of nanotechnology for the treatment of leishmaniasis. RESULTS: Our findings revealed a stable number of patents and scientific articles published over the past five years. CONCLUSIONS: There is a need to intensify research on the use of nanotechnology for the treatment of leishmaniasis.

Objective: Evaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty. Methods: 101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: reduction of hemoglobin, total estimated blood loss, drain output, and postoperative blood transfusion rate. Results: Comparing the groups, there were statistically significant differences (p < 0.05) in the following parameters: reduction of hemoglobin, decreased hematocrit, estimated blood loss, and drain output. All values were lower in the tranexamic acid group. Only placebo group patients required blood transfusion. Conclusion: The use of intravenous tranexamic acid is effective to reduce bleeding in patients undergoing total knee arthroplasty. RESUMO Objetivo: Avaliar a eficácia do ácido tranexâmico na redução do sangramento em pacientes submetidos a artroplastia total de joelho. Métodos: Foram randomizados 101 pacientes em dois grupos: grupo ácido tranexâmico (n = 51) e grupo placebo (n = 50). Os pacientes foram comparados nos quesitos redução da hemoglobina, perda sanguínea total estimada, débito do dreno e taxa de hemotransfusão pós-operatória. Resultados: Na comparação entre os grupos, observou-se diferença estatística (p < 0,05) nos seguintes parâmetros: redução da hemoglobina, redução do hematócrito, perda sanguínea estimada e débito do dreno. Todos os valores foram menores no grupo do ácido tranexâmico. Somente pacientes do grupo placebo necessitaram de hemotransfusão. Conclusão: O uso de ácido tranexâmico intravenoso é eficaz para reduzir o sangramento dos pacientes submetidos a artroplastia total de joelho.

Given the estrogen-dependence associated with endometriosis, hyper-stimulation associated with assisted reproduction treatment may exacerbate the disease process and adversely affect endometrial receptivity and subsequent implantation. In this way, a freeze-all deferred embryo transfer (ET) approach may benefit patients with endometriosis, although controversy exists regarding the mechanism of endometriosis-associated infertility and benefits of deferred ET on endometrial receptivity. Hence, the purpose of this study was to compare in vitro fertilization (IVF) outcomes in women with endometriosis, diagnosed by histology, undergoing fresh versus deferred-ET after elective cryopreservation. Of the 728 women included, no significant differences were observed in baseline patient characteristics and response to gonadotrophin stimulation between fresh and deferred ET groups. Furthermore, no significant differences in implantation rate (49.7 vs. 49.9%, p = 0.73), clinical pregnancy rate (40.9 vs. 39.9%, p = 0.49), and miscarriage rate (9.4 vs. 9.9%, p = 0.63) were observed between fresh and deferred ET groups, respectively. Hence, contrary to previous studies, our results suggest that a deferred ET &ldquo, freeze-all&rdquo, IVF strategy does not improve early pregnancy outcomes among women with endometriosis. However, prospective studies are required to validate these findings and further insight into the etiology and pathogenesis of endometriosis-associated infertility are necessary to optimize IVF protocols in this population.

The number of total knee arthroplasties has increased exponentially and their indications have been expanded. This procedure presents challenging complications for orthopedic surgeons that are potentially catastrophic for patients. Here, a rare case of simultaneous bilateral periprosthetic fracture of the knee is reported, with discussion of the causal factors, possible management and prophylaxis.

The aim of this study was to characterize risk profiles for Leishmania infantum infection in a population living in an area endemic for visceral leishmaniasis. A cohort study was conducted between January 2004 and December 2006 with the participation of 430 individuals living in the city of Teresina, northeast Brazil, who were initially negative for the Montenegro test. Data analysis was performed using the classification and regression tree method. The cumulative incidence (CI) of Montenegro's test conversion was 35% at 18-month follow-up. Eight different risk profiles for L. infantum infection were identified. The profile with the highest risk (CI = 75%) comprised individuals with less than 4 years of education who had never lived outside Teresina. The profile with the lowest risk (CI = 5%) included highly educated subjects who had owned a dog for 5 years or more and lived in areas that received some type of intervention. These results show that there is a high degree of complexity involved in the risk for L. infantum infection and point out the need of developing new studies to perform a comprehensive analysis focused on investigating the interrelation between risk factors rather than their isolated roles on the determination of infection levels in urban areas.

INTRODUCTION: In Brazil, culling of seropositive dogs is one of the recommended strategies to control visceral leishmaniasis. Since infectiousness is correlated with clinical signs, control measures targeting symptomatic dogs could be more effective. METHODS: A cross-sectional study was carried out among 1,410 dogs, predictive models were developed based on clinical signs and an indirect immunofluorescence antibody test. RESULTS: The validated predictive model showed sensitivity and specificity of 86.5% and 70.0%, respectively. CONCLUSIONS: Predictive models could be used as tools to aid control programs in focusing on a smaller fraction of dogs contributing more to infection dissemination.