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Introduction: The implementation of multidisciplinary teams (MDTs) has been found to be effective for improving outcomes in oncology. Nevertheless, there is still a dearth of robust literature on patients with NSCLC. The aim of this study was to conduct a systematic review regarding the impact of MDTs on patient with NSCLC outcomes. Methods: Databases were systematically searched up to February 2023. Two reviewers independently performed study selection and data extraction. Risk of bias was evaluated using the Newcastle-Ottawa and certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation approach. Overall survival was the primary outcome. Secondary outcomes included mortality, length of survival, progression-free survival, time from diagnosis to treatment, complete staging, treatment received, and adherence to guidelines. A meta-analysis with a random-effect model was performed. Statistical analysis was performed with the R 3.6.2 package. Results: A total of 22 studies were included in the systematic review. Ten outcomes were identified, favoring the MDT group over the non-MDT group. Pooled analysis revealed that patients managed by MDTs had better overall survival (three studies; 38,037 participants; hazard ratio 0.60, 95% confidence interval [CI]: 0.49–0.75, I2 = 78%), shorter treatment time compared with patients in the non-MDT group (six studies; 15,235 participants; mean difference = 12.20 d, 95% CI: 10.76–13.63, I2 = 63%), and higher proportion of complete staging (four studies; 14,925 participants; risk ratio = 1.36, 95% CI: 1.17–1.57, I2 = 89%). Conclusions: This meta-analysis revealed that MDT-based patient care was associated with longer overall survival and better quality-of-care–related outcomes.

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The Original Lapidus procedure (OLP) consists of realigning the varus of the first metatarsal (M1) present in the hallux valgus (HV) deformities, by fusing the first tarsometatarsal joint (TMJ) and the M1 to the second metatarsal (M2). Compared to its modified version, some studies support that the OLP is more stable with less motion around the TMJ, which may prevent complications such as recurrence. However, fusion between M1 to M2 may not occur and its clinical and radiographic impact is still unknown. The aim of this study was to compare clinical, functional and radiographic outcomes in patients who underwent the OLP that evolved with and without fusion between the M1 and M2. Our null hypothesis was that they would have the same results. Methods: A retrospective and comparative study of twenty-nine patients (thirty-eight feet) with a mean follow-up of 18.03 (range, 6-51) months who underwent the OLP. They were divided in two different groups based on the presence of fusion and non-fusion between the M1 and M2 (Figure1). Twenty-three patients were included in the first group and fifteen in the second. Their average age was 48.74 (range,18-73) years. Twenty-five patients were female and four, male. Their mean body mass index (BMI) was 25.6 (range, 19.13-31.64). Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF- 12 comprises physical and mental health scales (PCS-12 and MCS-12). Radiographic parameters assessed were bony and soft tissue forefoot widths (BSFW), intermetatarsal-angle(IMA) and HV-angle(HVA). Intraclass Correlation Coefficients (ICC) were calculated for all radiographic measurements. Clinical, functional and radiographic measurements were compared between the two groups pre- and postoperatively using Student t Test. Results: The two groups were demographically similar in terms of mean age, BMI and follow-up time (p=.28, p=.84 and p=.06, respectively). Separately, patients from both groups presented significant improvements in all questionnaires (p

Category: Sports; Trauma Introduction/Purpose: Acute ankle ligamentar lesion is one of the most common injuries related to sports practice and daily activities. Excellent clinical results have been achieved with functional rehabilitation in up to 80% of the patients. However, 20% may develop chronic ankle instability (CAI) with continued pain and repeated sprains, requiring surgical treatment. The aim of this study was to present the long-term functional outcomes and return to sport activities in a group of nonathlete patients with CAI who underwent lateral ligament repair using the Brostrom-Gould technique (BGT). Methods: Medical charts of 89 patients who underwent the BGT were retrospectively reviewed. The average follow-up was 7.1 (3.1 - 13.4) years. The mean age was 31.2 (16 - 65) years. 62 (69.7%) patients were male and 27 (30.3%), female. Demographic and clinical data were collected from medical records. For clinical and functional analysis, the AOFAS hindfoot-ankle score was applied (preoperatively and at the last follow-up) and return to physical activities was assessed. Other variables regarding residual pain, associated lesions (osteochondral lesions of the talus, bony or soft tissue impingements, syndesmotic and peroneal tendon injuries), associated predisposing anatomical conditions (tarsal coalition, cavovarus feet, accessory navicular bone and os trigonum), postoperative range of motion and complications were evaluated as well. Pre- and postoperative AOFAS scores were compared using paired Mann-Whitney test. Linear regression was used to assess the association of the Δ-AOFAS and return to physical activities with the other variables analyzed. Results: Prior to surgery, mean AOFAS score was 64.3, and postoperatively, 97.27 (p

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: High ankle sprains or syndesmotic lesions can occur after an external rotation force in a dorsiflexed foot. These lesions may present isolated or combined with medial collateral ligaments lesions or fractures. Unstable lesions should be operatively treated since syndesmotic instability can cause pain, disability, chondral lesions and arthritis. A recent biomechanical cadaveric study suggested that syndesmosis suture button fixation with suture tape augmentation can restore stability to a pre injury level, while suture button alone was insufficient to restore stability and screw fixation was associated with overtightening of the syndesmosis. The purpose of this work is to describe a new minimally invasive arthroscopic technique that uses a synthetic tape to augment suture button fixation of syndesmotic instability. Methods: After arthroscopic debridement of the syndesmosis, one bone tunnel is made with a 4.0mm drill at the anterolateral distal tibia rim and at the anterior distal fibula just above the anterior talofibular ligament origin. A 4,75mm swivelock armed with a fibertape (Arthrex © ) is introduced at the distal fibula hole. After obtaining adequate syndesmotic reduction with the help of a reduction clamp, suture button fixation was made through a mini lateral access. The fibertape was then appropriately tensioned and inserted at the distal tibia hole with another 4,75mm swivelock. Adequate reduction was observed with the Mercedes-Benz sign and stability was confirmed arthroscopically. Results: Only a few patients were submitted to this technique. At short follow up, none of them presented with complications or complaints Conclusion: We believe that unstable syndesmotic treatment using the suture button fixation and anterior inferior tibiofibular arthroscopic augmentation with suture-tape described in this work can restore syndesmotic stability to pre injury levels with low morbidity and lesser complication rates compared to other techniques. Nonetheless, comparative clinical studies are still needed to confirm our hypothesis.

Category: Midfoot/Forefoot Introduction/Purpose: The Lapidus procedure (LP) is a powerful technique that often provides significant corrections of the hallux valgus (HV) deformities. In addition, it is described that forefoot width alters considerably with this technique, impacting in shoe wear. However, it has not yet been reported whether foot narrowing reflects on clinical and functional outcomes. This study aimed to evaluate the effect of variations in bony and soft tissue foot widths (BSFW) on clinical and functional outcomes after HV correction with the LP. Secondarily, we also tried to assess the relationship of standard radiographic measurements of HV with changes in BSFW. Methods: Forty-three feet in 35 patients with a mean follow-up of 18.5-months who underwent the LP were retrospectively reviewed. Bony width was measured from the most medial extent of the first metatarsal head to the most lateral extent of the fifth metatarsal head. Soft tissue width was measured considering the most medial and lateral shadow of the foot (Figure 1). Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12). HV radiographic parameters as intermetatarsal-angle (IMA), HV-angle (HVA) and sesamoid- subluxation (SS) were assessed. Intraclass Correlation Coefficients (ICC) were calculated for BSFW. Clinical, functional and radiographic measurements were compared. Linear regression was used to assess the correlation of Δ-BSFW with clinical, functional and radiographic results. We also evaluated our sample at the cut-off point of quartile-50% to assess whether a given measure of Δ-BSFW was related to clinical and functional outcomes. Results: Pre- and postoperative ICC was 0.95 for bony and soft tissue width measurements. Bony width changed significantly from 95.5mm to 84.2mm (11.8%) and soft tissue width from 107.12mm to 100.84mm (5.86%) (p

Category: Lesser Toes Introduction/Purpose: The plantar plate is a fibrocartilaginous structure that plays a fundamental role in the sagittal stability of the metatarsophalangeal joint (MTPJ). Traumatic and degenerative lesions affecting the plantar plate have the potential to cause instability, swelling, pain and deformity. Extensive plantar plate tears (grade IV) still challenge surgeons as primary repair is impossible, demanding a reconstructive procedure which, unfortunately, can be associated with high morbidity such as stiffness, persistence of discomfort, vascular compromise to the digit and amputation. The purpose of this work is to describe a new technique that uses a synthetic tape and one absorbable screw to achieve the MTPJ stabilization in plantar plate grade IV tears. We believe that this procedure can achieve better results than other techniques described in the literature. Methods: Two bone tunnels are made at the base of the proximal phalanx. Both medial and lateral tunnels are directed in a light oblique fashion from a distal-dorsal entry point to a proximal, justarticular plantar exit. Two new oblique dorsal-plantar bone tunnels - medial and lateral - are made at the distal metaphyseal metatarsal area. A #2 FiberTape is passed through the bone tunnels guided by a Nitinol wire, creating a mesh for the plantar stabilization of the MTPJ. Then both Fiber Tapes limbs are driven, with the help of a nitinol loop, through the plantar orifices of corresponding sides of the metatarsal bone tunnels, exiting in its dorsal aspect. One of the limbs of the tape is passed from dorsal to plantar trough the other metatarsal orifice. Both limbs are tensioned, and the toe should be kept at neutral sagittal position (flexion-extension). Fixation is made with a Biotenodesis screw. Results: Only a few patients were submitted to this technique. At one year follow up, none of them presented with complaints or complications. Conclusion: The surgical technique described in this article can change the way physicians treat plantar complex plantar plate tears when there is no viable biologic tissue to repair. A lesser complication rate it's also expected. Nonetheless comparative, and biomechanical studies are still needed to confirm our hypothesis.

Gliosarcoma, a variant of glioblastoma, is a rare and aggressive tumor of the central nervous system (CNS) composed of glial and sarcomatous tissues. Up to now, there are only 2 reported cases of gliosarcoma of the optical pathway. We report a case from March 2018 of a 53-year-old male patient presented with 6 months’ of right fronto-orbital pulsatile headache, behavior changes, and visual loss. The MRI study showed an expansile optic pathway lesion involving the chiasm and right optic nerve. The diagnosis of gliosarcoma was obtained by open brain biopsy and immunohistochemical analysis. Although gliosarcoma is rare, it should be considered a differential diagnosis even in optic pathway tumors in older patients. The experience of the neuropathologist with a trained eye can be the differential in the accurate diagnostic process.Optic pathway, Gliosarcoma, Glioblastoma, Magnetic resonance imaging

The growth of COVID-19 pandemic throughout more than 213 countries around the world have put a lot of pressures on governments and health services to try to stop the rapid expansion of the pandemic. During 2009, H1N1 Influenza pandemic, statistical and mathematical methods were used to track how the virus spreads around countries. Most of these models that were developed at the beginning of the XXI century are based on the classical susceptible–infected–recovered (SIR) model developed almost a hundred years ago. The evolution of this model allows us to forecast and compute basic and effective reproduction numbers (Rt and R0), measures that quantify the epidemic potential of a pathogen and estimates different scenarios.In this study, we present a traditional estimation technique for R0 with statistical distributions by best fitting and a Bayesian approach based on continuous feed of prior distributions to obtain posterior distributions and computing real time Rt. We use data from COVID-19 officially reported cases in Ecuador since the first confirmed case on February 29th. Because of the lack of data, in the case of R0 we compare two methods for the estimation of these parameters below exponential growth and maximum likelihood estimation. We do not make any assumption about the evolution of cases due to limited information and we use previous methods to compare scenarios about R0 and in the case of Rt we used Bayesian inference to model uncertainty in contagious proposing a new modification to the well-known model of Bettencourt and Ribeiro based on a time window of m days to improve estimations.Ecuadorian R0 with exponential growth criteria was 3.45 and with the maximum likelihood estimation method was 2.93. The results show that Guayas, Pichincha and Manabí were the provinces with the highest number of cases due to COVID-19. Some reasons explain the increased transmissibility in these localities: massive events, population density, cities dispersion patterns, and the delayed time of public health actions to contain pandemic.In conclusion, this is a novel approach that allow us to measure infection dynamics and outbreak distribution when not enough detailed data is available. The use of this model can be used to predict pandemic distribution and to implement data-based effective measures.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure (LP) is a powerful technique to correct hallux valgus (HV) deformities, with good long-term outcomes. However, postoperative complications may arise, as undercorrection of the deformity, nonunion, elevation and shortening of the first metatarsal (M1). The objective of this study was to correlate M1 shortening with transfer metatarsalgia, and clinical and functional outcomes in patients who underwent the LP. Methods: a retrospective review of 29 patients (36 feet) who were submitted to the LP for HV correction was performed. The average follow-up was 20 months. M1 length was analyzed using the Relative First Metatarsal Length (RML) measurement (Figure 1). When M1 shortens in relation to the second metatarsal, the RML measurements increase. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured. Clinical and functional analyses were based on the VAS for pain, AOFAS, LEFS and SF-12 health survey. SF-12 is divided into physical and mental health composite scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. Radiographic, clinical and functional measurements were compared using paired Wilcoxon signed-rank test and Student t test. Interobserver reliability of RML measurements was calculated using Intraclass Correlation Coefficients (ICC). A linear regression was performed to assess the correlation between RML and the clinical and functional questionnaires. Results: There was a significant M1 shortening of 2.28mm after the LP (p

Category: Arthroscopy; Sports Introduction/Purpose: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Maintenance of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. Methods: This is a retrospective study with patients diagnosed with multidirectional instability, submitted to an ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the VAS and the AOFAS Score at a mean of 14.8 months (5-27 months) in follow-up. Results: A total of 30 ankles (29 patients) were included in the study. AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (p=0.001) and was followed by significant improvement in the mean VAS (6.83; CI 0.37 to 0.95; CI 0.31). The majority of patients had associated procedures (53.3%) and a low complication rate was found (16.6%). Conclusion: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique can improve the clinical outcomes of these patients.

Category: Ankle; Trauma Introduction/Purpose: Diagnosis and treatment of ankle medial ligament lesions in malleolar fractures has always been a matter of controversy. Even when deltoid involvement is clear, the direct repair of this structure is not a consensus. Recently, deltoid reparation through an arthroscopic technique was described aiming to potentialize better clinical results and minimize complications. We intend to demonstrate safety and functional results of operated ankle fractures that had an arthroscopic deltoid repair. Methods: This is a retrospective study in patients diagnosed with ankle fractures associated with acute deltoid injuries submitted to malleolar fixation and deltoid arthroscopic repair between June 2016 and January 2020. All patients were evaluated for pain and function according to the Visual Analogue Scale (VAS) and the American Orthopaedic Foot & Ankle Society Score (AOFAS) at a minimum of 6 months in follow-up. Results: Between January 2016 and January 2020, 20 ankles with fractures or dislocations were operated and the deltoid ligament rupture was repaired arthroscopically. A mean follow-up of 14.45 months (6-48) was observed, and patients presented an average AOFAS of 93.5 (SD 7.25) and a VAS of 0.75 (SD 1.05). Three minor complications were noticed and no signs of medial chronic instability, loss of reduction or osteoarthritis were observed. Conclusion: The repair of the deltoid complex and the low morbidity of the arthroscopic technique used may improve the clinical outcomes of these patients. Additional studies, with a prospective and comparative methodology are required to sustain this proposal.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure (LP) for hallux valgus (HV) requires an adequate control of first metatarsal (M1) sagittal alignment to avoid dorsiflexion. Otherwise, clinical and functional impairment, including transfer metatarsalgia may occur. This study aimed to evaluate the effects of pre- and postoperative measurements of M1 sagittal alignment on clinical and functional outcomes, and whether these variations would lead to transfer metatarsalgia or not. Methods: 29 patients (36 feet) with a mean follow-up of 20 months after LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. M1 sagittal alignment analysis was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Decrease of FMDA means that the M1 dorsiflected (Figure 1). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were assessed. Radiographic, clinical and functional measurements were compared. Intraclass Correlation Coefficients (ICC) were calculated for FMDA and MA. Linear regression was used to assess the association of Δ-FMDA and Δ-MA with clinical and functional questionnaires. Based on that, we assessed our sample at different cut-off points to evaluate whether a given Δ-FMDA and/or Δ-MA measurement was significantly related to the Δ-Questionnaires. Results: Pre- and postoperative ICC of FMDA was 0.90 and 0.91 and MA was 0.94 and 0.88, respectively. FMDA showed significant variation after the LP, but MA did not. IMA and HVA improved significantly. Significant clinical and functional improvement were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between ΔFMDA with Δ-PCS-12 and Δ-LEFS (p=.028 and p=.02, respectively), meaning that excessive dorsiflexion of M1 as measured by FMDA led to a decrease in PCS-12 and LEFS. We found that at the cut-off point of quartile 50%, in which our sample was divided equally, patients with Δ-FMDA below 3.2 degrees of dorsiflexion had significantly improved results on Δ-PCS-12 compared to those with greater values (p=.029) (Figure 2). Conclusion: The present study showed that excessive dorsiflexion of M1 led to decreased outcome scores as measured by PCS- 12 and LEFS. It supports that M1 dorsiflexion should be avoided after the LP. However, slight dorsal deviation can occur and, even so, satisfactory outcomes can be obtained. Further prospective and comparative studies with larger populations are required to evaluate the effects of M1 inclination on clinical and functional outcomes.

Summary:. Morel-Lavallée lesion (MLL) is a closed degloving soft-tissue injury that results in the accumulation of a hemolymphatic fluid between the skin/superficial fascia and the deep fascia. This is a rare injury that may be challenging to diagnose, and necessitates early identification and treatment to achieve the best outcomes. We report the case of a 45-year-old male patient who was referred to our institution for large wound closure after undergoing debridement of a misdiagnosed MLL that became complicated by infection and sepsis. The patient was retrospectively diagnosed with a Stage VI MLL and had to undergo 4 operations with skin grafting and vacuum-assisted closure therapy playing an essential role in achieving tissue closure. This case was presented as a reminder of this rare diagnosis, and the importance of considering it when faced with a patient presenting with a relevant clinical picture post trauma. An early diagnosis is important because early intervention can prevent complications and lead to better outcomes. The misdiagnosis in the case of our patient and delayed treatment led to an aggressive debridement with a large wound that was challenging to close.

Background: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. Methods: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study. Results: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean ( P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%). Conclusion: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients. Level of Evidence: Level IV, retrospective case series.

Category: Ankle; Sports; Trauma Introduction/Purpose: Although there are several imaging options for diagnosing the syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. Recently, weight-bearing CT (WB-CT) has emerged as a new modality for the examination of syndesmosis; however, studies have shown that WB-CT is not superior to conventional computed tomography (CT), and axial loading has no benefit for the diagnosis of instability. This study aims to investigate which index test between a CT in a neutral position (CTNP) and a new CT test with stress maneuvers (CTSM) can more accurately diagnose syndesmotic instability. Methods: This diagnostic accuracy-test study consecutively selected individuals older than 18 years with an orthopedic evaluation suspected for acute syndesmotic injury. The accuracy of the index tests (CTNP and CTSM) were examined using magnetic resonance imaging (MRI) as the reference standard. The external rotation and dorsiflexion of the ankle guided the stress maneuvers. Comparison measurements between the injured syndesmosis and the uninjured contralateral side of the same individual investigated syndesmotic instability regarding the translational and rotational relationship between the fibula and tibia. Sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) value analyzed the diagnostic accuracies of the index tests. Results:: The population included in this study consisted of 64 patients (34 men, 30 women; age range 18-69 years; mean age 35 years). The CTNP exam showed a sensitivity of 18.7% (95% CI, 8 to 35), a specificity of 97% (95% CI, 85 to 99), a +LR of 6.3 (95% CI, 0.8 to 50), and a -LR of 0.8 (95% CI, 0.7 to 0.9). The CTSM exam showed a sensitivity of 91% (95% CI, 76 to 99), a specificity of 94% (95% CI, 80 to 98), a +LR of 15.4 (95% CI, 4 to 59), and a -LR of 0.09 (95% CI, 0.03 to 0.28). The CTSM reflected superior accuracy because the +LR was higher than that of the CTNP, and the confidence interval (CI) for the +LR does not contain 1. Conclusion:: Nevertheless, CTNP is used routinely, this study showed that the test was insufficient for the correct diagnosis, as it presented low sensitivity result. A CTNP with a normal result was not able to exclude syndesmotic instability. The use of the stress maneuver with external rotation and dorsiflexion was a decisive factor for the correct diagnosis, considering that the CTSM exhibited high sensitivity and captured a significantly greater number of true positive cases than the CTNP. This study confirmed CTSM as an accurate method for diagnosing syndesmotic instability and opened a new approach to investigate mild and moderate challenging cases.

Background: Lisfranc joint injuries can be due to direct or indirect trauma and while the precise mechanisms are unknown, twisting or axial force through the foot is a suspected contributor. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. The purpose of this study was to test a cadaveric model that includes axial load, foot plantarflexion and pronation-supination motion, which could re-create bone diastasis similar to what is seen in subtle Lisfranc injuries. Our hypothesis was that applying pronation and supination motion to a cadaveric model would produce reliable and measurable bone displacements. Methods: Twenty-four fresh-frozen lower leg cadaveric specimens were used. The medial (C1) and intermediate (C2) cuneiforms and the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (group 1), and between C1-C2, C1-M2, C1-M1, and C2-M2 in 12 matched specimens (group 2). Foot pronation and supination in addition to an axial load of 400 N was applied to the specimens. A 3D digitizer was used to measure bone distances. Results: After ligament injury, distances changed as follows: C1-C2 increased 3 mm (23%) with supination; C1-M2 increased 4 mm (21%) with pronation (no differences between groups). As expected, distances between C1-M1 and C2-M2 only changed in group 2, increasing 3 mm (14%) and 2 mm (16%), respectively (no differences between pronation and supination). M1-M2 and C2-M1 distances did not reach significant difference for any condition. Conclusions: Pronation or supination in addition to axial load produced measurable bone displacements in a cadaveric model of Lisfranc injury using sectioned ligaments. Distances M1-M2 and C2-M1 were not reliable to detect injury in this model. Clinical Relevance: This new cadaveric Lisfranc model included foot pronation-supination in addition to axial load delivering measurable bone diastasis. It was a reliable Lisfranc cadaveric model that could be used to test different Lisfranc reconstructions.

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Lisfranc joint injuries occur due to direct or indirect trauma, where a twisting or axial force is transmitted to the foot. Recently, new treatment options are being sought in order to use methods that allow a more physiologic fixation of this joint. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a synthetic neoligamentplasty in comparison to the traditional trans-articular screw fixation. Methods: 24 fresh frozen lower leg cadaveric specimens were utilized. The medial (C1) and intermediate (C2) cuneiforms, first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (Group 1), and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 matched specimens (Group 2). The groups were further divided in fixation with screws (G1 Screws and G2 Screws) and with Tape (G1 Tape and G2 Tape). The tape fixation group used a fixation technique described by this group, using FiberTape (Arthrex, Inc.). After ligament lesion and fixation, the construct rigidity was measured with the help of a 3D Digitizer arm, comparing the distances between the marked bones over a stress condition (pronation and supination of the forefoot). Results: Distance C1-C2 increased 3 mm after ligament injury (23% increase) with supination motion. C1-M2 increased 4 mm after ligament injury (21% increase) with pronation motion. Distances between C1-M1 and C2-M2 only changed in Group 2, increasing 3 mm (14%) and 2 mm (16%) respectively. Rigidity between C1-C2, C1-M1 and C2-M2 did not differ between the fixation with screws and with tape. The fixation with screws presented more rigidity in C1-M2 distance (p=0,03), but only in pronation stress. Conclusion: Pronation and supination motion of the forefoot relative to the hindfoot produces measurable joint displacements. Tape and Screws can produce the same rigidity after repairing Lisfrac Ligament injuries, except for distance C1-M2 in pronation stress.

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Acute avulsion fractures of the base of the fifth metatarsal are common and usually treated non- surgically with satisfactory outcomes. Forms of conservative treatments are described such as elasticated bandaging, immobilization in a cast, walking boot and hard-soled-shoes. The aim of this study was to compare the clinical and functional outcomes, time to return to the previous activities, time and rate of fracture healing of the patients with avulsion fracture of the base of the fifth metatarsal treated in a hard-soled-shoes (HSS) or in a walking boot (WB). Our null hypothesis is that a less rigid immobilization without restriction of the ankle yields the same final results. Methods: A retrospective and comparative study of 72 patients with acute avulsion fractures of the base of the fifth metatarsal treated with the WB or the HSS, from March 2014 to November 2018. The average age of the patients was 41,25 (range, 11-88) and there were 56 female and 16, male. 39 were treated with the WB and 33, with the HSS. Patients with comorbities that could interfere in the rate and time of bony healing (diabetes and inflammatory joint disease), associated ankle ligament lesions and loss of follow-up were excluded. Patients were followed regularly until they were clinically asymptomatic and able to return to their previous activities (work, daily activities, sports). We retrospectively reviewed medical records containing the visual analogue scale (VAS) for pain and the american orthopaedic foot and ankle society (AOFAS) score of each visit as well as radiographic exams to evaluate time and rate of fracture healing. Results: Patients of both groups had similar VAS and AOFAS scores in 8 (p=0,34 and p=0,83) and 12 (p=0,25 and p=0,79) weeks. Age and gender distribution in the two groups were equal (p=0,23 and p=0,34, respectively). Time taken to return to the previous activities were not significant different between both groups, with the HSS group taking 8,33 weeks and the WB taking 9,73 weeks (p=0,10). The mean time for bone consolidation was significant higher in the HSS group, taking 8,64 weeks while in the WB took 7,18 weeks (p

Category: Basic Sciences/Biologics, Sports, Trauma Introduction/Purpose: Lisfranc joint injuries occur due to direct or indirect trauma, where twisting forces are applied. Cadaveric models have been used to evaluate injury patterns and fixation methods, but a frequent limitation has been historically the small amount of joint displacement after injury, which hinders a correct evaluation of the damage degree and reconstruction effectiveness. Our hypothesis was that adding pronation and supination motion to a cadaveric model would produce reliable and measurable joint displacements. Methods: 24 fresh frozen lower leg cadaveric specimens were utilized. The medial (C1), intermediate (C2) cuneiforms, first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (Group 1), and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 matched specimens (Group 2). Supination and pronation motion of the forefoot relative to the hindfoot was obtained through internal and external rotation of the tíbia, using an Instrom machine. A 3D Digitizer was used to measure distances between the bones already mentioned. Results: Distance C1-C2 increased 3 mm after ligament injury with supination motion (p

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

Background:. The prevalence of depressive symptoms (DS) before cosmetic breast surgery was analyzed in the public (PbI) and private (PrI) institutions, comparing types of surgery and patients’ sociodemographic characteristics. Methods:. A cross-sectional, observational, analytical study to evaluate the prevalence of DS in 185 patients of 18–71 years of age requesting 4 different cosmetic breast surgeries (with and without implants) at public and private institutions. Patients were assessed using the Beck Depression Inventory and analyzed for statistical comparison. Results:. The most common surgical procedures were reduction mammoplasty in the PbI and augmentation mammoplasty in the PrI. The prevalence of the positive risk for depressive disorder (≥15 points in Beck Depression Inventory) in the PbI was 25.8%, whereas in the PrI: 11.4% (P = 0.012). Moderate and severe DS were, respectively, 120% and 242% higher in the PbI than in the PrI. No patients requesting mastopexy without implants had DS. The highest prevalence (51.4%) of DS occurred in patients with breast implants indications (augmentation mammoplasty and mastopexy with implants). The presence (P = 0.12) or absence (P = 0.33) of implant did not demonstrate a higher risk of DS. Among all patients, 7% answered positively to the statements on suicide ideation, with predominance within the group of implants (54.5%). There were significant differences between the PbI and PrI. Conclusions:. The prevalence of DS was high (18.9%), with the risk being 2.3 times greater in the PbI. Patients from PbI and PrI showed significant different profiles. Patients for breast implants showed a higher score for suicide ideation.

Category: Arthroscopy Introduction/Purpose: Various operative procedures have been used to treat osteochondral lesions of the talus. Among the new alternatives to treat these lesions, Autologous Matrix-Induced Chondrogenesis (AMIC®) has proven to provide satisfactory results through medium-term follow-up. The aim of this study is to report early post-operative clinical results of patients submitted to the AT-AMIC® technique and autologous bone graft, when necessary, for OLT’s at a six-month minimum follow-up. Methods: This is case series of 17 consecutive patients that were submitted to AT-AMIC®, between january of 2016 and april of 2017. 9 men and 8 women, between 15 and 67 years were diagnosed with OLTs with the typical history of deep ankle pain and corresponding magnetic resonance imaging injury. Surgery was proposed only after failure of conservative treatment of at least 3 months. Surgeries were performed by three different surgeons, with high arthroscopic experience. Patients answered the AOFAS score preoperatively and at the last follow-up, ranging from 6 to 18 months Results: Average size of OLTs were 1,12 cm2, with Raikin 4 location being the most common (70,5%). Calcaneal osteotomy was the most common associated procedure, with 17,6%. Average follow-up was 10,76 months. Average AOFAS before surgery was 46,35, increasing to 89,53 at the last follow-up. This difference was statistically significant with a p-value of

Summary:. Silicone chin implants are frequently used in cosmetic surgery to enhance a harmonic face. Obtaining an aesthetically pleasing face is increasingly becoming more important for people, and a considerable part of this goal can be achieved through different aesthetic modifications of the chin. The purpose of this study was to analyze the presence of bone resorption after the insertion of silicone chin implants, with lateral chin radiographs. Fifteen patients were studied, all of whom had a chin silicone implant inserted at least 1 year ago using the same surgical technique. The surgery was done intraorally with insertion of the silicone implant under the periosteum of the chin. Fourteen patients presented bone erosion, with the maximum of 2.0 mm erosion. However, none of them manifested any symptoms of this erosion. In conclusion, even though the majority of the patients presented with bone erosion, the results were minimal and completely asymptomatic; thus, this technique produced an excellent final result.

ABSTRACT: Objective: We report 2 patients who presented with clinical symptoms of acute upper airway obstruction from presumed supraglottic myxedema and compare their clinical presentation, diagnosis, and management with previously reported cases.Methods: Clinical data, laboratory results, imaging, and procedure reports were reviewed for both cases. A literature search was performed in MEDLINE using the terms “supraglottic myxedema,” “myxedema,” and “laryngeal edema.” Relevant references were selected and reviewed.Results: A 63-year-old man presented with confusion and facial and neck edema. The patient was subsequently intubated for airway protection. During intubation the epiglottis could not be visualized due to airway edema. Thyroid function testing revealed elevated thyroid-stimulating hormone (TSH) and low free thyroxine (FT4). Computed tomography (CT) scan of the neck without contrast noted nonspecific mild, diffuse edema within the subcutaneous soft tissues. A 70-year-old man with a history of papillary thyroid cancer treated with total thyroidectomy and radioactive iodine presented with sore throat, stridor, lower eyelid edema, and proptosis. Fiberoptic intranasal scope noted supraglottic edema. CT scan of the neck without contrast showed prominent pharyngeal mucosal thickening associated with retropharyngeal edema with resultant airway narrowing. TSH was elevated and FT4 was undetectable. Both patients required prolonged intubation that led to tracheostomy. Symptomatic improvement and resolution of airway edema was noted after treatment with levothyroxine and glucocorticoid therapy.Conclusion: These cases and the review of literature suggest that supraglottic myxedema is a rare complication of severe hypothyroidism. Medical management of hypothyroidism and airway support are preferred treatments. Glucocorticoids have unproven additional therapeutic benefit.Abbreviations: CT = computed tomography; FT4 = free thyroxine

Objective: To determine the number of brushings per day and periodontal self-perception in 12-year-old schoolchildren from the Machángara parish, in Cuenca Ecuador in 2016., Materials and Methods: A descriptive, retrospective, relational level study was conducted. The sample consisted of 205 records of 12-year-old schoolchildren residing in the Machángara parish, which belongs to the epidemiological map of oral health in Cuenca, performed by the Catholic University of Cuenca. For analysis of the data, descriptive statistics were used with frequencies and percentages for each of the variables and the Kendall Tau-b statistical test was performed to determine the correlation between the main variables of the study, according to a significance of 0.05., Results: 50.7% of adolescents were male, 49.3% female, and 94.1% were in public schools. It was found that 50.2% of the study population brushed three times a day, being 51.5% among females and 48.1% among males. The prevalence of periodontal self-perception was 85.4%: 86.1% in girls and 84.6% in boys. An inverse and significant negative correlation was found between the number of brushings per day and periodontal self-perception (Tau-b: -0.178; p: 0.004). Brushing frequency had an inverse and significant negative correlation with periodontal self-reporting for females (tau-b: -0.197; p value: 0.030) and a non significant correlation for males., Conclusion: There is an inverse and significant negative correlation between the frequency of daily brushing and periodontal self-perception. Educational strategies regarding oral health are needed for adolescents from the Machángara parish of Cuenca., Competing Interests: Potenciales conflictos de interés: Los autores declaran no tener conflictos de intereses de ningún tipo

Portus Ilicitanus (Picola, Alicante) was the main sea harbour of the Roman Colonia Iulia Ilici Augusta and as such played a crucial role in the supply of fundamental commodities to the Iberian Peninsula. Excavations yielded large quantities of glass in fourth- and early fifth-century contexts. Elemental analysis of 60 samples by laser ablation - inductively coupled plasma - mass spectrometry (LA-ICP-MS) confirmed that the glasses were imported from the Eastern Mediterranean. A majority of the glasses correspond to the HIMTa primary production group, which originates from Egypt. The statistical evaluation of published data of 589 HIMT glasses further revealed differential distribution patterns of the HIMTa and HIMTb subtypes between the Eastern and Western Mediterranean, suggesting chronological trends that are linked to wider geopolitical changes. This demonstrates the need for systematic large-scale approaches to identify supply patterns and possible factors underlying geographical differences and/or chronological developments.

Plasmacytoid blast dendritic cell neoplasia (NCDBP) is an uncommon malignant neoplasm, presenting clinically with cutaneous involvement and subsequent lymph node and bone marrow extension. It characteristically expresses the markers: CD56, CD4, and CD123. There is no optimal treatment, relapses are frequent, and the survival time is short. We present the case of an elderly patient with NCDBP who initially presented with cutaneous lesions, but experienced rapid systemic progression and did not, respond to treatment.

Introduction: The proximity of the roots of maxillary posterior teeth to the maxillary sinus floor can be associated with the development of chronic maxillary sinusitis (CMS). Therefore, this study evaluated the correlation between the presence of endodontic infection and periodontal disease in maxillary posterior teeth and the presence of CMS., Methods: A total of 83 patients (159 maxillary sinuses) were selected and underwent clinical dental examination to assess tooth mobility and pulp condition. In addition, cone-beam computed tomography was performed to evaluate the presence of periapical lesion and periodontal bone loss, and measure the distance from the root apex to the cortical of the maxillary sinus. The maxillary sinuses were divided into 2 groups: CMS and no maxillary sinusitis. Data were analyzed using χ 2 test and binary logistic regression analysis (P < .05)., Results: Periodontal disease was positively associated with CMS, leading to a 3.45-fold higher association between these disorders (P < .05). CMS was significantly more common in patients with periodontal disease or endodontic infection in close proximity with the maxillary sinus. Periodontal disease or endodontic infection that was more distant from the maxillary sinus was more common in patients with no maxillary sinusitis (P < .05). To the extent that the tooth is more distant from the maxillary sinus floor, the chance of presenting CMS is reduced up to 2.5-fold (P < .05)., Conclusion: Periodontal disease and proximity to the maxillary sinus are more common in cases of CMS, requiring a dental assessment and cone-beam computed tomography evaluation in patients with CMS with ineffective treatment., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

This study compared the effect of intermediate flush with distilled water delivered by conventional irrigation, EndoVac microcannula or Self-Adjusting File (SAF) system in the prevention of chemical smear layer (CSL) formation. Thirty human premolars were used. Canals were prepared with Reciproc system and 5.25% NaOCl. After chemomechanical preparation, samples were divided in 3 groups (n=10) according to the intermediate irrigation protocol with distilled water using: conventional irrigation, EndoVac microcannula or SAF. A final flush with 2% chlorhexidine solution was used and scanning electron microscopy was performed to assess protocol effectiveness. Two calibrated evaluators attributed scores according the presence or absence of CSL on the surface of the root canal walls at the coronal, middle and apical thirds, as follows: (1) no CSL; (2) small amounts of CSL; (3) moderate CSL; and (4) heavy CSL. Differences between protocols were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between each root canal third. SAF resulted in less formation of CSL when compared with the conventional irrigation and EndoVac microcannula (p<0.05). When root canal thirds were analyzed, conventional irrigation and EndoVac groups showed less CSL formation at coronal and middle thirds in comparison to the apical third (p<0.05). In SAF group, there was no difference among the thirds (p>0.05). It may be concluded that an intermediate flush of distilled water, delivered by the SAF system resulted in a better reduction of CSL formation during chemomechanical preparation.

Background/aims: Diastolic dysfunction (DD) and low levels of thyroid hormones (TH) are frequent found in chronic kidney disease; both are associated with all-cause and cardiovascular mortality. However, a link between them has not yet been established. The aim of this study was to analyze DD as a surrogate marker of fibrosis and its association with TH in incident patients on peritoneal dialysis (PD)., Methods: A cross-sectional study with 183 incident patients on PD with preserved ejection fraction was performed. Clinical and demographic data were registered. Serum total and free (t/f) triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone levels were determined by RIA kits, albumin and high-sensitivity C-reactive protein by conventional assays. Transthoracic 2D echocardiogram was performed for evaluation of left ventricular (LV) mass and ejection fraction. DD was evaluated using pulsed-wave tissue Doppler imaging., Results: Patients were 43 ± 12, 42% with diabetes mellitus (DM). Some degree of DD was found in 62% of patients; 18% had grade I DD, 8% grade II DD and 36% grade III DD. Patients with grade III DD were more likely to have diabetes, older, high LV mass and low serum albumin, t/fT3 and tT4 levels. In logistic multivariate regression analysis, it was found that diabetes (B = -0.86, 95% CI 0.182-0.992, p < 0.05), hypertension (B = -0.95, 95% CI 0.184-0.817, p = 0.01) and tT3 (B = -1.94, 95% CI 0.023-0.876, p < 0.05) were associated with grade III DD., Conclusions: High prevalence of grade III DD was found in incident patients on PD. In addition to DM and hypertension, tT3 was found to be an independent risk factor for grade III DD and more studies are needed to understand the reasons as to why this association is present., (© 2016 S. Karger AG, Basel.)

Unlabelled: The aim of this study was to evaluate the effect of argon plasma on dentin surface after use of 6% NaOCl. Sixty bovine incisors had their crowns removed, the roots split, and the segments planed. One hundred twenty segments of the cervical third were used. The samples were divided in two groups (n=60):, Control Group: immersed in 6% NaOCl, washed, dried and then immersed in 17% EDTA, washed and dried and Argon group: after treatment described for the CONTROL GROUP, non-thermal argon plasma was applied for 30 s. Ten samples were evaluated by scanning electron microscopy in each group. Other ten samples were analyzed by Fourier transform infrared spectroscopy (FTIR). Thirty samples were analyzed with a goniometer to measure the contact angle between the dentin surfaces and solutions, to determine the surface free energy. The last ten samples were used to evaluate the wettability of AH Plus sealer. Data were statistically analyzed using Kruskal Wallis and Mann-Whitney tests (p<0.05). The results of this study showed that argon plasma did not modify the surface topography. FTIR analysis showed chemical modifications after plasma treatment. Argon plasma increased the surface free energy of dentin and AH Plus wettability. In conclusion, argon plasma treatment modified chemically the dentin surface. This treatment increased the surface free energy and wettability of an epoxy resin root canal sealer, favoring its bonding to dentin surfaces.

Unlabelled: Plasma technology has the potential to improve the adherence of fibers to polymeric matrices, and there are prospects for its application in dentistry to reinforce the dental particulate composite. Objectives This study aimed to investigate the effect of oxygen or argon plasma treatment on polyethylene fibers., Material and Methods: Connect, Construct, InFibra, and InFibra treated with oxygen or argon plasma were topographically evaluated by scanning electron microscopy (SEM), and chemically by X-ray photoelectron spectroscopy (XPS). For bending analysis, one indirect composite (Signum) was reinforced with polyethylene fiber (Connect, Construct, or InFibra). The InFibra fiber was subjected to three different treatments: (1) single application of silane, (2) oxygen or argon plasma for 1 or 3 min, (3) oxygen or argon plasma and subsequent application of silane. The samples (25x2x2 mm), 6 unreinforced and 60 reinforced with fibers, were subjected to three-point loading tests to obtain their flexural strength and deflection. The results were statistically analyzed with ANOVA and the Bonferroni correction for multiple comparison tests., Results: SEM analysis showed that oxygen and argon plasma treatments promote roughness on the polyethylene fiber surface. X-ray photoelectron spectroscopy (XPS) analysis shows that both plasmas were effective in incorporating oxygenated functional groups. Argon or oxygen plasma treatment affected the flexural strength and deflection of a fiber reinforced composite. The application of silane does not promote an increase in the flexural strength of the reinforced composites., Conclusions: Oxygen and argon plasma treatments were effective in incorporating oxygenated functional groups and surface roughness. The highest strength values were obtained in the group reinforced with polyethylene fibers treated with oxygen plasma for 3 min.

The aim of this study was to evaluate the effect of plasma treatment using argon and oxygen gases, combined with fiber position on flexural properties of a fiber-reinforced composite. Eleven groups were evaluated, a non-reinforced control group and 10 groups reinforced with InFibra, a woven polyethylene fiber, varying according to the plasma treatment and fiber position. The samples were prepared using a stainless steel two-piece matrix. The three point bending test was performed in an EMIC testing machine. Flexural strength (FS) and flexural deflection (FD) were calculated from initial (IF) and final (FF) failure. Data were evaluated statistically using Kruskal-Wallis and Mann-Whitney tests (p<0.05). For IF, in all groups with fibers placed on the base, the FS and FD values were significantly higher than those positioned away from the base. The highest value of FS was obtained in the group treated with O 3 min (296.2 MPa) and the highest value of FD was obtained in the group treated with 1 min (0.109 mm). For FF the FS and FD values obtained for the groups with fibers positioned away from the base were similar or higher than those placed on the base. The highest FS value was obtained in the group treated with 1 min (317.5 MPa) and the highest FD value was obtained in the group treated with O 3 min (0.177 mm). Plasma treatment influenced FS and FD. Fiber position and plasma treatment affected the flexural properties of a fiber-reinforced composite.

Introduction: Dentin surface treatment with different substances might cause alterations in chemical and structural compositions of the human dentin. The aim of this study was to investigate the wettability of endodontic sealers in contact with dentin treated with 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) in the presence or absence of smear layer., Methods: Thirty-six dentin slices were used. They were irrigated with NaOCl and washed with distilled water (DW) to simulate irrigation during chemomechanical preparation. After this procedure, the samples were divided into 6 groups: group 1, DW (control); group 2, NaOCl + DW; group 3, CHX + DW; group 4, ethylenediaminetetraacetic acid (EDTA) + DW; group 5, EDTA + DW + NaOCl + DW; group 6, EDTA + DW + CHX + DW. The Ramé-Hart goniometer was used to measure the contact angle between the dentin surfaces and the AH Plus and Real Seal SE sealers. Data were statistically analyzed., Results: With regard to the contact angle between AH Plus and treated surfaces, the values of contact angle were lower when CHX was used, regardless of the presence or absence of smear layer. When Real Seal SE was evaluated, in the absence of smear layer, CHX presented lower values of contact angle. In the presence of smear layer, the use of NaOCl and CHX did not favor the spread of the sealer., Conclusions: The present study has revealed that smear layer removal and final flush with CHX favor the wettability of AH Plus and Real Seal SE sealers., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

With the evolution of bone densitometry, differences in technologies, acquisition techniques, reference databases, reporting methods, diagnostic criteria and terminology have developed and the International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences, the latest in 2007. The Brazilian Society for Clinical Densitometry (SBDens), with support from many Brazilian societies interested in bone health, gathered numerous specialists to discuss the ISCD proposals and to evaluate the validity of the extension of those norms to Brazilian population. The SBDens reunion of consensus made a very useful document to help the understanding and interpretation of bone densitometry and other methods of bone assessment.

Background: Climacteric symptoms have a direct relationship with biological and sociocultural factors and significantly impair the quality of life of women., Aim: To assess quality of life and factors affecting it in women aged 40 to 59 years., Material and Methods: The Menopause Rating Scale (MRS) was applied to 370 healthy women aged 49 +/- 6 years, that accompanied patients to public hospitals in Santiago., Results: Forty four percent of women were postmenopausal and 6% used hormone replacement therapy. Half of the group had less than 12 years of formal education and 67% had a couple. The mean number of children was 2.8 +/- 1.5. Total MRS score was 16.2 +/- 8.5. The higher score was given by the psychological domain (7.7 + 4.4), followed by the somatic domain (5.8 +/- 3.5). The urogenital domain had the lowest score (2.7 +/- 2.9). Eighty percent of women had moderate to severe climacteric symptoms. A logistic regression analysis showed that the postmenopausal condition was the factor that caused the greatest derangement in quality of life, followed by her parity. Formal education had the lowest impact., Conclusions: In this sample of women, menopause significantly deteriorated quality of life and sociocultural factors such as the parity also had an impact.

Background: The frequency of low-turnover bone disease (LTBD) in patients with chronic kidney disease (CKD) has increased in past years. This change is important because LTBD is associated with bone pain, growth delay, and higher risk for bone fractures and extraosseous calcifications. LTBD is a histological diagnosis. However, serum markers such as parathyroid hormone (PTH) and calcium levels offer a noninvasive alternative for diagnosing these patients., Objective: To describe the prevalence of LTBD in pediatric patients with renal failure undergoing some form of renal replacement therapy, using serum calcium and intact PTH levels as serum markers., Methods: In this cross-sectional study, 41 children with CKD undergoing dialysis treatment (31 on continuous ambulatory peritoneal dialysis and 10 on hemodialysis) were included. There were no inclusion restrictions with respect to gender, cause of CKD, or dialysis modality. The children were studied as outpatients. The demographic data, CKD course, time on dialysis, phosphate-binding agents, and calcitriol prescription were registered, as well as weight, height, Z-score for height, linear growth rate, and Z-score for body mass index. Serum calcium, phosphorus, aluminum, PTH, alkaline phosphatase, osteocalcin, glucose, creatinine, urea, cholesterol, and triglycerides were measured., Results: There were 20 (48.8%) children with both PTH < 150 pg/mL and corrected total calcium >10 mg/dL who were classified as having LTBD[(+)]; the remaining 21 (51.2%) children were classified as having no LTBD[(-)]. The LTBD(+) patients were younger (11.2 +/- 2.7 vs 13.2 +/- 2.4 years, p < 0.01) but they had no differences regarding Z-scores for height. Linear growth in 6 months was less than expected in both groups (-0.15 +/- 0.23 cm/month), but the difference between expected and observed growth was higher in the LTBD(+) group (-0.24 +/- 0.14 vs -0.07 +/- 0.28 cm/mo, p < 0.03). LTBD(+) patients also had lower serum creatinine (8.69 +/- 2.75 vs 11.19 +/- 3.17 mg/dL, p < 0.01), higher serum aluminum levels [median (range) 38.4 (9 - 106) vs 28.1 (9 - 62) microLg/L, p < 0.05], and lower systolic blood pressure (112.0 +/- 10.3 vs 125.0 +/-1 2.9 mmHg, p < 0.015) and diastolic blood pressure (76.0 +/- 9.7 vs 84.5 +/- 8.2 mmHg, p < 0.017). A significant correlation was found between PTH and alkaline phosphatase (r = 0.68, p < 0.001), but not between PTH and aluminum., Conclusion: The LTBD(+) biochemical profile was found in 48.8% of the children and was associated with impaired linear growth. Aluminum contamination, evidenced by higher serum aluminum levels, may have had a pathogenic role in these disorders. Higher systolic and diastolic blood pressure levels may be related to higher serum PTH levels.

We compared the characteristics of several cloned rabbit organic electrolyte (OE) transporters expressed in cultured cells with their behavior in intact rabbit renal proximal tubules (RPT) to determine the contribution of each to basolateral uptake of the weak acid ochratoxin A (OTA) and the weak base cimetidine (CIM). The activity of organic anion transporters OAT1 and OAT3 proved to be distinguishable because OAT1 had a high affinity for PAH (K(t) of 20 microM) and did not support estrone sulfate (ES) transport, whereas OAT3 had a high affinity for ES (K(t) of 4.5 microM) and a weak interaction with PAH (IC(50) > 1 mM). In contrast, both transporters robustly accumulated OTA. Intact RPT also accumulated OTA, with OAT1 and OAT3 each responsible for approximately 50%: ES and PAH each reduced uptake by approximately 50%, and the combination of the two eliminated mediated OTA uptake. The weak base CIM was transported by OAT3 (K(t) of 80 microM) and OCT2 (K(t) of 2 microM); OCT1 had a comparatively low affinity for CIM, and CIM uptake by OAT1 was equivocal. Intact RPT accumulated CIM, with TEA and ES reducing CIM uptake by 20 and 75%, respectively, suggesting that OAT3 plays a quantitatively more significant role in CIM uptake in the early proximal tubule than OCT1/2. In single S2 segments of RPT, ES and TEA each blocked approximately 50% of CIM uptake. Thus the fractional contribution of different OE transporters to renal secretion is influenced by their affinity for substrate and relative expression level in RPT.