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Brain edema is a complication of radiation used to treat brain metastasis (BM) in which the brain parenchyma accumulates fluid and ions, often leading to the suspension of systemic anticancer treatment. While brain edema is often attributed to disruption of the Blood Brain Barrier (BBB), RTx induces cytotoxic-edema, a premorbid cellular process whereby extracellular Na+ and other cations enter into neurons and astrocytes and accumulate intracellularly, resulting in osmotic expansion of the cells and necrotic cell death. Aquaporin 4 (AQP4) is a main regulator of osmotic expansion (water intake) in astrocytes and we have shown that RTx upregulates AQP4 in astrocytes and leads to astrocytic swelling in vitro. However, whether pharmacological modulation of AQP4 could be used to prevent cytotoxic brain edema in RTx-treated BM and its impact on metastatic tumor progression remains unknown. Goal: To determine if the FDA-approved drug Topiramate (TPM), an anti-epileptic drug able to inhibit AQP4) can prevent astrocytic swelling in vitro, reduce RTx-induced brain edema and modulate brain metastatic progression. Results: Electron microscopy of brain cortex from mice treated with 35 Gy RTx showed acute astrocytic end-feet swelling and increase in AQP4 expression compared with non-irradiated mice. A single 8 Gy dose increased astrocytic cell area of human astrocytes by 4.8 fold compared with non-irradiated cells 24 h after RTx. This increased cell-swelling did not result from senescence-associated cellular hypertrophy, as staining of senescent β-galactosidase positive (SA-β-Gal+) cells showed that Rtx-induced astrocytic area only increased significantly in non-senescent (SA-β-Gal- cells). shAQP4s reduced AQP4 levels by 60% and 50%, respectively, and significantly reduced RTx-induced astrocytic swelling. Since there are no FDA-approved AQP4 inhibitors, we tested whether the AQP4-blocking function of TPM could be sufficient to prevent cytotoxic edema, prevent BBB dysfunction and protect from necrotic cell death in vitro. TPM pretreatment did not alter radiation-induced ERK1/2 or AKT activation (a known maker of radioprotection) in astrocytes, but TPM decreased radiation-induced PARP-cleavage, pP38 and pJNK levels. TPM prevented loss of Trans-electric epithelial resistance (TEER) of Rtx-treated astrocytes, but was not able to protect astrocytes from ultimate cell death. Immunohistochemical analysis of a cohort of breast cancer BM showed heterogeneous AQP4 expression in cancer cells ranging from 1.6% to 91% AQP4+ tumoral areas and from 0.6% to 86.9% in stroma. AQP4 inhibition using shRNAs decreased proliferation and survival of AQP4 + 231BR, and EO711 cells in vitro. However, TPM did not alter survival of AQP4+ or AQP4- cells in vitro, suggesting that while AQP4 expression is important for survival of AQP4+ cells in vitro, the inhibition of AQP4 function by TPM is not sufficient to decrease their growth. To determine if TPM could decrease brain edema without negatively impacting tumor progression, female NSG mice were injected intracardially with JmT1BR3 AQP4-cells and ten days later randomized to (1) RTx + vehicle, (2) RTx + TPM (2 days prior to irradiation), (3) Non-RTx + vehicle, and (4) Non-RTx + TPM. TPM decreased brain-water content (a marker of brain edema) in irradiated mice as compared with vehicle-treated mice, without alteration of metastatic burden 21 days post-injection. However, a similar study using AQP4+ E0711 cells in C57Bl6 mice showed TPM was less effective in decreasing brain water content and resulted in a significant increase in extracranial metastatic tumor burden, suggesting that TPM can promote tumor progression by non-tumor intrinsic mechanisms. Conclusions: while TPM shows promise in preventing RTx-induced brain edema, our results show a potential pro-tumorigenic mechanism for TPM that warrants further investigation. Citation Format: Maria J. Contreras-Zarate, Karen ALvarez-Eraso, Nicole Tsuji, Peter Kabos, D.Ryan Ormond, Sana Karam, Diana Cittelly. AQP4 inhibition prevents cytotoxic edema of AQP4+ astrocytes but promotes tumor growth of AQP4+ breast cancer brain metastasis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-09.

Rationale: Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. Objectives: To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. Methods: We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. Results: Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (B = 0.417; p = 2.1e - 6, R2 = 0.156) and nocturnal CIS (B = 0.411; p = 7.7e - 6, R2 = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. Conclusions: The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. Trial registration: Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.

Safety zones to avoid nerve injury at proximal incision of posterior minimally invasive plate osteosynthesis for humerus fracture have been scarcely studied. The purpose of this study was to describe the location of axillary and radial nerves (RN) in magnetic resonance imaging to establish safety zones.Fifty-two magnetic resonance imaging studies of the entire humerus were reviewed. The mean age was 50.6 ± 12.1 years, with 37 female patients. The distance of the axillary nerve (AN; distal portion, humeral midpoint) and RN (medial border, midpoint, and lateral border of the humerus) was measured in relation to the posterolateral acromion angle, acromioclavicular axis, and transepicondylar axis. Univariate analysis (Student'sThe AN location at the humerus was 54.9 ± 6.4 mm (20.1% humeral length [HL]) in relation to posterolateral acromion angle and 63.2 ± 6.1 mm (23.2% HL) in relation to acromioclavicular axis. The RN location was 100.2 ± 17.1 mm (36.6% HL) at the humerus medial border, 118.0 ± 21.5 mm (43.1% HL) at the humerus midpoint, and 146.0 ± 24.4 mm (53.6% HL) at the humerus lateral border. In relation to transepicondylar axis, it was 175.4 ± 15.6 mm (64.3% HL), 156.0 ± 19.0 mm (57.2% HL), and 127.4 ± 21.2 mm (46.7% HL), respectively. Nerves location was related to HL, independent of gender.The main finding of our study is that the location of the AN and RN in relation to the humerus is related to the HL and can be used to predictably define the safe zones to avoid nerve injury in the proximal incision of posterior minimally invasive plate osteosynthesis for humerus fractures.

Background: Younger women with breast cancer have increased risk of development of brain metastases irrespective of the tumor subtype. We have shown that pre-menopausal levels of 17-β-Estradiol (E2) contributes to the promotion of brain metastases by influencing the tumor microenvironment. E2 promotes brain metastasis (BM) of estrogen receptor negative (ER¯) BC cells by inducing neuroinflammatory ER+ astrocytes in the brain niche to secrete pro-metastatic factors critical for early brain colonization. Ovarieoctomy (OVX) in combination with the aromatase inhibitor (Letrozole) prevented brain colonization of triple negative (TNBC) (ER-PR-HER2-) human xenografts (MDA231BR/NSG) and murine models (E0711/C57Bl6, 4T1/BALBc) through paracrine activation of EGFR and TRKB, pathways involved in increased invasion and early tumor initiation. Yet, the extent to which E2-depletion therapies can decrease progression of established BM in combination with current standard of care for brain metastasis remains unknown. Goal: Current standard of care (SOC) for patients with TNBC brain metastasis includes irradiation (SRS, whole brain) and immunotherapy (PD-1/PDL-1 inhibitors). The goal of this study was to assess how E2-depletion therapies affects brain immune function in the context of SOC for brain metastatic progression of TNBC. Results: To assess whether E2-depletion could decrease BM progression in a model that mimics standard of care for BM, TNBC E0771-GFP-luc cells were injected intracardially in syngeneic ovariectomized (OVX)-female C57Bl6 mice supplemented with pre-menopausal levels of E2. Seven days after injection (when cancer cells have colonized), mice received a single 15Gy dose brain irradiation and were randomized to continue receiving E2, E2 withdrawal (E2WD) or E2WD plus the aromatase-inhibitor letrozole (E2WD+LET). Brain metastatic burden significantly decreased in E2WD and E2WD+Letrozole treated mice as compared to E2-treated mice. Injection of E0711 cells in immunocompromised NSG mice or in the absence of brain irradiation abolished this effect, suggesting that E2-depletion therapies decrease BM progression through boosting radiation-induced anti-tumor immunity. Accordingly, there were no differences in BM progression in E2, E2WD or E2WD+let treated mice in a xenograft model (F2-7 TNBC cells) in NSG mice, even in the presence of brain irradiation. Immune-profiling of brains from OVX+E2, OVX and OVX+Let C57BL6 mice carrying BMs showed dynamic changes in immune populations at early and late stages of brain metastatic colonization. At early stages post brain colonization (3 days post ic injection) E2-treated mice showed a decreased fraction of CD11b+CD45Int CD206+ microglia/CNS macrophages as compared to OVX+LET-treated mice, without significant changes in the fraction of infiltrated lymphocytes, suggesting E2 represses early immunosurveillance through repression of microglia/CNS macrophage activation. At later stages of brain colonization (7 days post ic injection), E2-treated mice showed an increased fraction of proinflammatory microglia and decreased fraction of T and B cells as compared to OVX or OVX+let treated mice. While E2-depletion increased the recruitment of T cells to the brain niche, the fraction of CD279 (PD1+) brain T cells was similar among groups. Ongoing studies assess the efficacy of E2-depletion therapies in combination with brain radiation and PD-1 inhibitors to decrease metastatic burden and improve survival in preclinical models. Conclusion: Our results support the hypothesis that estradiol promotes brain metastatic progression by stimulating an immunosuppressive brain microenvironment. As such, FDA-approved E2-depletion therapies (aromatase inhibitors and selective-estrogen modulators) could be used in combination with brain irradiation and PD-1 inhibitors to promote a more effective anti-tumoral immune response. Citation Format: Diana Cittelly, Maria J. Contreras-Zarate, Karen ALvarez-Eraso, Vesna Tesic, Nicole Tsuji, Leanna Chafee, Sana Karam, D. Ryan Ormond, Peter Kabos. Estradiol represses anti-tumoral immune response to promote progression of triple-negative breast cancer brain metastases [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS5-07.

Scapular notching is a radiographic finding associated with the use of a reverse shoulder prosthesis. The morphological characteristics of the glenoid neck have been scarcely explored as a relevant factor in relation to scapular notching. The objective of this study is to measure the length of the glenoid neck in a three-dimensional CT reconstruction of a healthy population and to simulate the scapular notching free range of motion for the "long neck" and for the "short neck" groups.CT scans of 214 shoulders were reviewed, excluding incomplete, poor quality, or altered studies. 100 CT scans were finally processed. The mean age was 51.7 years (SD 19.4; range, 15-84 years), with 49 female and 51 male patients. For each of the scapulae, four morphometric measurements were obtained: anterior glenoid neck (AGN), middle glenoid neck (MGN), posterior glenoid neck (PGN) and alternative posterior glenoid neck (aPGN). Using 3D software, we simulated a reverse shoulder prosthesis, and the scapular notching free range of motion was registered. Differences between measurements were evaluated with an unpaired t-test using StataIC16®. P-values0.05 were considered significant. The intraobserver and interobserver correlation was evaluated with the intraclass correlation coefficient.The AGN measured 7.43 ± 2.52 mm (range, 1.72-13.3 mm); MGN measured 8.05 mm ± 1.93 (range, 2.92-13.2 mm); PGN measured 7.26 ± 2.6 mm (range, 2-13.4 mm); and aPGN measured 8.97 ± 2.3 mm (range, 4.08-15.4 mm). The scapular notching free range of motion for the "long neck" group was 74.98° ± 7.35 (range, 55-83°) and for the "short neck" group, it was 62.93° ± 6.84 (range, 45-70°) (p = 0.0004).Measurement of posterior glenoid neck length exhibits excellent reliability and reproducibility, as well as being associated to the scapular notching free range of motion.Basic, retrospective, CT images research.

Background Complicated grief (CG) resulting from poor adaptation to the death of a close person may have predisposed the presence of other mental health problems in older adults in Peru during the COVID-19 pandemic. The aim of our study was to assess the association between CG and the presence of anxiety, depression, and suicidal risk in older adults in Peru in the context of COVID-19 pandemic. Methods We conducted a cross-sectional analysis using data from the "Socioemotional evaluation form" applied in 2020 to assess the presence of mental health problems in older adults being attended in the Peruvian Social Security (EsSalud). For our study we included older adults who reported the death of a close person during the last 6 months when this assessment was performed. CG, depression, anxiety, and risk of suicide was originally evaluated using validated questionnaires. The association between CG and the presence of mental health problems was calculated through multivariate analysis where prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results Of the 249 older adults included, 175 (70.3%) were female with a median age of 71 years (interquartile range: 9) and 35 (14.1%) reported the presence of CG. It was found that CG in this population was associated with the presence of anxiety (PR: 1.35, 95% CI: 0.98 to 1.85), depression (PR: 1.44, 95% CI: 1.06 to 1.95), and suicidal risk (PR: 2.84, 95% CI: 1.06 to 7.59). Conclusions CG predisposes the presence of mental health problems in older adults in Peru. It is important to implement measures that facilitate its prevention and proper management of this condition in this population, especially in context of high population mortality such as the COVID-19 pandemic.

BackgroundBrain edema is a common complication of brain metastases (BM) and associated treatment. The extent to which cytotoxic edema, the first step in the sequence that leads to ionic edema, vasogenic edema and brain swelling, contributes to radiation-induced brain edema during BM remains unknown. This study aimed to determine whether radiation-associated treatment of BM induces cytotoxic edema and the consequences of blocking the edema in pre-clinical models of breast cancer brain metastases (BCBM).MethodsUsingin vitroandin vivomodels, we measured astrocytic swelling, trans-electric resistance (TEER) and aquaporin 4 (AQP4) expression following radiation. Genetic and pharmacological inhibition of AQP4 in astrocytes and cancer cells was used to assess the role of AQP4 in astrocytic swelling and brain water intake. An anti-epileptic drug that blocks AQP4 function (topiramate) was used to prevent cytotoxic edema in models of BM.ResultsRadiation-induced astrocytic swelling and transient upregulation of AQP4 within the first 24 hours following radiation. Topiramate decreased radiation-induced astrocytic swelling, loss of TEER in astrocytesin vitro, and acute short term treatment (but not continuous administration), prevented radiation-induced increase in brain water content without pro-tumorigenic effects in multiple pre-clinical models of BCBM. AQP4 was expressed in clinical BM and breast cancer cell lines, but AQP4 targeting had limited direct pro-tumorigenic or radioprotective effects in cancer cells that could impact its clinical translation.ConclusionsPatients with BM could find additional benefits from acute and temporary preventive treatment of radiation-induced cytotoxic edema using anti-epileptic drugs able to block AQP4 function.Key pointsRadiation induces cytotoxic edema via acute dysregulation of AQP4 in astrocytes in preclinical models of BM.Pharmacologic blockage of AQP4 function prevents water intake, astrocytic swelling and restores TEERin vitro.Pre-treatment with single-dose Topiramate prevents brain radiation-induced brain edema without direct tumor effects in pre-clinical models of BCBM.IMPORTANCE OF THE STUDYIn this study we describe a novel role for astrocytic swelling and cytotoxic edema in the progression of radiation-induced brain edema during BM treatment. While radiation-induced edema has been fully attributed to the disruption of the blood-brain barrier (BBB) and ensuing vasogenic effects, our results suggest that cytotoxic edema affecting astrocytes in the acute setting plays an important role in the progression of brain edema during BM standard of care. Current standard of care for brain edema involves pre-treatment with steroids and the use of bevacizumab only after clinically significant edema develops. Both interventions are presumed to target vasogenic edema. This study suggests that patients with BM could find additional benefits from acute and temporary preventive treatment of radiation-induced cytotoxic edema using an already FDA-approved anti-epileptic drug. Such early prevention strategy can be easily clinically implemented with the goal of minimizing treatment-related toxicities.

International audience; Background. Hepatocellular carcinoma (HCC) is the third most frequent cancer of digestive tract tumors in Peru, with a high mortality rate of 17.7 per 100,000 inhabitants. A significant number of HCC cases in Peru do not follow the classic clinical epidemiology of the disease described in other parts of the world. Those patients present with a distinct transcriptome profile and a singular tumor process, suggesting a particular type of hepatocarcinogenesis in a portion of the Peruvian population. Aim. Our aim was to understand the clinical and biologic involvement of the epigenetic profile (methylation) and gene expression (transcriptome) of HCC in Peruvian patients. Methods. HCC and liver transcriptome and DNA methylation profiles were evaluated in 74 Peruvian patients. Results. When grouped by age, there was greater DNA methylation in younger patients with HCC but no differences with respect to the transcriptomic profile. A high prevalence of the hepatitis B virus (HBV) (> 90%) was also observed in the younger patients with HCC. Enrichment analyses in both molecular profiles pinpointed PRC2 as an important molecular effector of that liver tumor process in Peruvian patients. Conclusion. HCC in Peruvian patients has a unique molecular profile, associated with the presence of HBV, as well as overall DNA hypermethylation related to undifferentiated liver cells or cellular reprogramming.; Introducción. En Perú, el carcinoma hepatocelular (CHC) ocupa el tercer lugar en incidencia entre los tumores del sistema digestivo, y tiene una alta tasa de mortalidad, 17.7 por 100,000 habitantes. La mayoría de los casos reportados no presentan la epidemiología clínica clásica del CHC observado en otras partes del mundo. Además, se ha identificado que estos pacientes presentan un perfil transcriptómico distinto y un proceso tumoral singular, sugiriendo un proceso particular de hepatocarcinogénesis en una fracción de la población peruana. Objetivo. El presente estudio busca comprender la implicancia clínica y biológica del perfil epigenético (metilación) y de expresión de los genes (transcriptómico) del CHC en los pacientes peruanos. Métodos. Se evaluó el perfil de transcriptómico y de metilación de ADN de hígado y CHC en 74 pacientes peruanos. Resultados. El agrupamiento por edades mostró una mayor metilación del ADN en los pacientes jóvenes con CHC, en contraste no se observaron diferencias en el perfil transcriptómico. Adicionalmente, también se evidenció una alta prevalencia del virus de hepatitis B (VHB) (> 90%) en los pacientes jóvenes con CHC. El análisis de enriquecimiento en ambos perfiles moleculares demostró que PRC2 es posiblemente uno de los principales actores moleculares en este proceso tumoral hepático en pacientes peruanos. Conclusión. El CHC peruano presenta un perfil molecular único, asociado a la presencia del VHB, y con una hipermetilación global del ADN asociado a células hepáticas indiferenciadas o a una reprogramación celular.

Calea ternifolia Kunth (Asteraceae), the “dream herb”, is an important medicinal plant that grows from Mexico to Costa Rica. The plant is highly valued for rituals and for treating several illnesses including anorexia, upset stomach, diabetes, periodic fevers, diarrhea, bile problems, and skin diseases. This comprehensive literature survey on C. ternifolia was performed up to January 2021. Our review focuses on traditional uses, botanical aspects, chemical constituents, quality control tests, as well as pharmacological and toxicological studies. Data were recorded using online scientific databases including Scopus, PubMed, Google Scholar, Taylor and Francis Imprints, National Center for Biotechnology Information, Science Direct, JSTOR, and SciFinder. The information was assembled from research articles, relevant books on herbal medicinal plants and the history of medicinal plants from Mexico, theses, reports, and web pages. The more significant botanical and ethnomedical aspects were recorded including the discovery of the oneirogenic use (enhancer of dreams) of C. ternifolia by the Chontal Indigenous communities in Oaxaca, Mexico. The plant contains sesquiterpenes and flavonoids as the major constituents. Some properties associated with the plant’s traditional uses have been demonstrated including spasmolytic, antidiabetic, antidepressant, anti-inflammatory, and antinociceptive effects. The plant’s toxicity will be discussed in this paper. Solid pharmacological research provided evidence supporting the use of the dream herb for oneiromancy.

En este trabajo se propone un sistema que permite monitorear en tiempo real el consumo de agua total en el hogar utilizando tecnologías inalámbricas y que a través de una aplicación celular (APP) de uso amigable permite llevar un seguimiento del consumo de agua. Los resultados permiten registrar y tasar el consumo de agua a nivel doméstico. El sistema se constituye por un medidor de flujo de caudal que permite monitorear el consumo de agua en la toma central de una casa habitación, los datos medidos se envían a un sistema de control que se encarga de procesar y redireccionar los datos vía Bluetooth® a una aplicación para el celular que se puede descargar e instalar fácilmente. En la propuesta se incluye una base de datos que permite guardar un historial de los datos medidos para posterior consulta por parte del usuario. La aplicación envía además (cuando está en uso) mensajes recordatorios sobre el cuidado del agua y puede emitir una alerta cuando se sobrepasa el umbral de consumo regular registrado en el hogar.

Background The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the health insurance. Methods An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the health insurance. Negative binomial regression was used to compare rates. Statistical analyzes were performed with Stata v.14 software. Results 39,366 RCSs were performed, with a total rate for the period of 32.36 per 100,000 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 100,000/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the health insurance, the public system corresponds to 21.3 per 100,000 and the private system to 72 per 100,000, the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001). Conclusion RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ health insurance, with higher rates observed for the private sector.

Introducción: La fractura diafisaria de húmero es frecuente y, en la actualidad, se privilegia el tratamiento quirúrgico. La consolidación en mala rotación puede causar un deterioro de la función y artrosis a largo plazo. Con las técnicas mínimamente invasivas, es difícil manejar la rotación intraoperatoria al no tener una visión directa de la reducción fracturaria. Objetivo: Describir criterios radiográficos para la reducción rotatoria en las fracturas diafisarias de húmero. Materiales y Métodos: Estudio retrospectivo de radiografías de húmero comparando criterios radiográficos del húmero distal entre radiografías con rotación interna (sin retroversión proximal) y rotación externa (con retroversión fisiológica). Criterios estudiados: sobreproyección del epicóndilo lateral por sobre el capitellum >50%, esclerosis del borde inferior de la fosa olecraneana, esclerosis del borde lateral de la fosa olecraneanay asimetría de la fosa olecraneana. Resultados: El 97% de las 200 radiografías estudiadas cumplió con los criterios de inclusión y exclusión. Sobreproyección del epicóndilo por sobre el capitellum: 83,3% de los casos; esclerosis del borde inferior de la fosa olecraneana: 30%, esclerosis del borde lateral de la fosa olecraneana: 86,6% y asimetría: 80% de ellas. Todos los criterios con significancia estadística (p