Intrasynovial autograft for reconstruction of chronic large rotator cuff tears in a rabbit model: biomechanical, computed tomography, and histological results

BACKGROUND

Rotator cuff (RC) tears are a common cause of shoulder dysfunction and pain, posing significant challenges for orthopedic surgeons. Grafts have been proposed as a solution to augment or bridge torn tendons, but optimal clinical outcomes are not always achieved due to poor graft integration, suboptimal mechanical properties, and immunological reactions. The aim of this study was to investigate the biomechanical, CT and histological results of RC reconstruction using an intrasynovial tendon autograft, in a chronic large tear subscapularis rabbit model.

METHODS

Twenty-six adult male Zealand white rabbits were used in this study. Large defects in the subscapularis tendons were produced bilaterally in 20 rabbits. After 6 weeks, secondary procedures were performed to the right shoulder of the rabbits, which were reconstructed with an intrasynovial interposition autograft (graft group). The left shoulder did not undergo any further treatment (defect group). The specimens were randomly divided into two equal time groups and underwent biomechanical testing, CT analysis, and histological evaluation at 6, and 12 weeks after reconstruction. In addition, 6 rabbits that were not operated, were used as a control group.

RESULTS

At 12 weeks post-repair, the graft group exhibited a significant increase in ultimate failure load compared to the defect group (p < 0.05). Furthermore, the 12-week graft group demonstrated comparable stiffness to that of the control group. CT analysis indicated no significant progression of intramuscular fat accumulation in both graft groups, in contrast to the 12-week defect group when compared to the control group. Finally, histological evaluation revealed a gradual integration of the graft with the host tissue at 12 weeks.

CONCLUSION

Our study suggests that intrasynovial flexor tendon autografts hold promise as an effective interposition graft for the reconstruction of chronic large RC tears, as they improve the biomechanical and biological properties of the repaired tendon. Nonetheless, further investigations in preclinical large animal models are warranted to validate and extrapolate these findings to human studies.

Repair of chronic and large rotator cuff tears using extra-synovial autografts: An experimental study in rabbits

Purpose

To investigate whether and how extra-synovial autografts can enhance the reconstruction of chronic and large rotator cuff tears in a rabbit subscapularis model.

Methods

Twenty rabbits were used to create a large subscapularis tear bilaterally. Six weeks later, the right shoulder of each rabbit was operated to repair the tear with an extra-synovial autograft, whereas the left shoulder did not undergo any surgery. At 6 and 12 weeks after the second procedure, the specimens underwent biomechanical and histological evaluation. Six more rabbits were used only as a normal reference.

Results

Biomechanical evaluation demonstrated that the ultimate load to failure of the Graft group (184.1 ± 35.7 N) was significantly higher (p = 0.04) than that of the Defect group (144.5 ± 32.2 N) at 12 weeks after repair, rising to 76% of the normal subscapularis tendon tensile strength. Histological analysis revealed an enhanced healing environment with neoangiogenesis and decreased inflammatory response at the repair site. Moreover, the tendon maturing score of the Graft group increased substantially from 6 (15.8 ± 0.9) to 12 (23.1 ± 0.6) weeks after repair (p = 0.01).

Conclusion

In vivo data support the efficacy of extra-synovial autograft interposition in repairing chronic and large rotator cuff tears in a rabbit subscapularis model. The autografts were capable of enhancing the biomechanical properties of the repaired tendons, as evidenced by increased tensile strength, and forming new connective tissue simulating a fibrocartilage zone, as revealed by histological evaluation.

Level of Evidence

N/A.

PFO closure for the prevention of cerebrovascular events in high-risk individuals: an updated and across-the-board meta-analysis

Introduction

Patent foramen ovale (PFO) closure has emerged as a secondary prevention option in patients with PFO and cerebrovascular events. Despite its seemingly established efficacy, its associated long-term outcomes – including safety – remain unclear.

Purpose

To ascertain the extent to which PFO percutaneous closure is able to improve long-term clinical outcomes in patients with cryptogenic vascular events.

Methods

We systematically searched MEDLINE, Embase and Cochrane CENTRAL for randomized controlled trials (RCTs) and observational studies comparing PFO percutaneous closure with antithrombotic therapy, in what concerns recurrent cerebrovascular and serious adverse events, as well as mortality. A composite of stroke and transient ischemic attack (TIA) was the primary endpoint. Data related to RCTs, patients with high-risk PFO features, subjected to PFO closure with the most represented device and with antiplatelet therapy as control were further investigated separately. Study-specific odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random- (DerSimonian-Laird method) or a fixed-effects (Mantel-Haenszel method) model.

Results

Literature search yielded 2145 references, of which 26 – 8 regarding RCTs – were included. Patients undergoing PFO closure reached 4304, whereas 4180 were treated with antithrombotic therapy. PFO closure was significantly associated with lower stroke/TIA recurrence (OR 0.35 [0.24–0.53], I2=58%). Moreover, such reduction met statistical significance for both stroke (OR 0.34 [0.21–0.54], I2=29%) and TIA (OR 0.53 [0.34–0.82], I2=39%), individually. Subgroup analyses focusing only on RCTs and on studies featuring the most represented device confirmed these trends, while the effects were even more pronounced in patients with high-risk PFO characteristics and in those controlled with antiplatelet therapy. On the other hand, PFO closure was not associated with neither lower all-cause (OR 0.76 [0.46–1.27], I2=0%) nor lower cardiovascular mortality (OR 0.92 [0.37–2.29], I2=0%). Moreover, neither a composite of serious adverse events (SAEs) (OR 1.10 [0.94–1.29], I2=0%) nor major bleeding episodes (OR 0.75 [0.40–1.38], I2=23%) differed significantly between groups. However, PFO closure was associated with increased odds of procedure- or device-related complications (OR 12.94 [5.56–30.13], I2=0%) and atrial fibrillation or flutter (OR 3.35 [1.78–6.30], I2=30%).

Conclusion

In patients with history of cryptogenic vascular events, when compared with medical management, PFO percutaneous closure is indeed associated with a reduction in the odds of recurrent stroke and TIA. However, mortality seems not to be impacted by this apparently enhanced effect. While general SAEs and major bleeding are comparable between both approaches, PFO closure may bring upon procedure- or device-related complications and increase the odds of atrial fibrillation or flutter.

Funding Acknowledgement

Type of funding sources: None.

Does early repair of traumatic rotator cuff tears provide better outcomes? A systematic review

Our aim was to systematically review literature of trauma related rotator cuff tears in order to evaluate the outcome and healing integrity in relation to time of surgery. Our research question was whether earlier surgical repair leads to superior functional results. This review was conducted according to PRISMA statement. A literature search of Pubmed, Embase, Cohrane was conducted, with two researchers assessing studies for eligibility and quality. A total of 20 studies, published between 1980 and 2019, met the inclusion criteria and were divided into two groups based on duration of symptoms before surgery. Group A comprised of studies in which duration was < 3 months and Group B > 3 months. Within each group there was a statistically significant improvement in the CS from pre-operative to post-operative outcome, but the improvement for Group A was statistically higher in comparison to Group B (P=0.01). Nevertheless, there was no significant difference in the final outcome for the two groups (P=0.29). The re-tear rate per 100 patients was calculated 28.5(±7.2) for Group A, and 17.2 (±12.56) for Group B (P=0.056). Our results suggest that functional outcome and tendon healing may not be valid arguments for early surgical repair. Therefore, repair of traumatic RCTs could be recommended whenever technically possible.

COVID-19 infection could be a risk factor for dementia?

Introduction

Since the COVID-19 pandemic start in early 2020, there have been reports of a high prevalence of neuropsychiatric symptoms. Cognitive impairment is being increasingly recognized as an acute and possibly long-term sequel of the disease. According to recent data, limited evidence point to SARS-CoV-2 having a preferential neurotropism for the frontal lobes, as suggested by behavioral and dysexecutive symptoms, frontotemporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET. Nevertheless, there isn’t a specific biomarker.

Objectives

Brief literature review about the relationship between COVID-19, cognitive impairement onset and risk for dementia.

Methods

Non-systematic review through PubMed research using the terms “COVID-19”, “SARS-CoV-2”, “pandemics”, “cognitive impairement”, “dementia” and “risk factor”.

Results

Direct neuronal infection via angiotensin-converting enzyme 2 receptor (ACE2R), hyperinflammation, brain ischemia related to respiratory failure or thromboembolic strokes, and severe psychological stress are the mechanisms more associated with a deleterious effect on cognition. The relation between SARS-CoV-2 infection and neurodegenerative diseases is still unclear. However, the high expression of the ACE2R in the brain, may explain the acute brain damage and could also be the basis for later neurodegenerative changes. The potentially long-term nature of the deficits makes it important to do an early identification, management, rehabilitation and follow-up of the patients exhibiting cognitive symptoms.

Conclusions

Given the reports of brain damage by SARS-CoV-2, there are concerns that this damage may substantially increase the incidence of neurodegenerative diseases and promote dementia. Further long-term studies may be required to identify the relationships between SARS-CoV-2 infection and risk for dementia.

Disclosure

No significant relationships.

Nitrous Oxide in Treatment Resistant Major Depression: Should We Laugh About It?

Introduction

Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD).

Objectives

TRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo.

Methods

The authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base.

Results

Since 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects.

Conclusions

There appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo.

Disclosure

No significant relationships.

Mental Health Refugees - Difficulties from the country of origin to the receiving country – A review

Introduction

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced as a result of persecution, conflict, violence, human rights violations. However, little is known about their long-term mental health.

Objectives

This review aimed to assess prevalence of mental disorders and to identify the main factors associated with the development of mental disorders among refugees.

Methods

We searched MEDLINE databases using the key terms “refugees” and “global mental health” without language or date restriction. Articles were considered for inclusion in the review if they comprised a population of refugees. Three studies were identified.

Results

Our review showed a great heterogeneity in the prevalence of mental disorders that affect migrants showing an overall prevalence of 20% of these pathologies among them. War-related factors are more associated with Post Traumatic Stress Disorder and post-migration-related factors (acculturation, economic uncertainty and ethnic discrimination) are more associated with mood, anxiety and substance use disorders.

Conclusions

Existing evidence suggests that mental disorders tend to be highly prevalent in refugees many years after resettlement. The increased risk is not only caused by the past adversities in the country of origin but also by the post-migration-related factors. Thus, there is a need for more consistent and rigorous research from a methodological point of view on the mental health of refugees, allowing to find measures to protect and promote their mental health.

Disclosure

No significant relationships.

COVID-19 induced psychosis. Should we be concerned?

Introduction

Coronaviruses traditionally are considered to cause pulmonary diseases, often accompanied by gastrointestinal symptoms. Since the COVID-19 pandemic start in early 2020, there have been reports of a high prevalence of neuropsychiatric symptoms. Recent data show significant rates of neuropsychiatric diagnosis over the subsequent 6 months post-infection. Some of the data suggest the COVID-19 as a cause of new-onset psychotic symptoms in patients with no psychiatric history. Delusions, hallucinations, disorganized thoughts, and confusion were the most frequently reported psychotic features which low doses of antipsychotics seem to be helpful.

Objectives

Brief literature review about the relationship between COVID-19 and new-onset psychotic symptomatology.

Methods

Non-systematic review through PubMed research using the terms “COVID-19”, “SARS-CoV-2”, “pandemics”, “psychotic symptoms” and “psychosis”.

Results

The severity of the infection, especially in those with the need for hospitalization/intensive care, seems to have a clear effect on the gravity of subsequent neuropsychiatric symptoms, namely psychosis. Viral invasion of the central neural system, hypercoagulable states, and neuroinflammation are potential associated mechanisms. It’s important to consider the effect of therapies that may have the potential to cause psychosis (eg steroids). According to recent literature, around 0.9-4% of people exposed to the COVID-19 virus develop psychotic episodes, which is much higher than the incidence in the general population.

Conclusions

Post-COVID-19 related psychosis has been reported in different nations. The pathophysiology is yet not clear, although the hyperinflammatory response has been suggested as the main mechanism for the neuropsychiatric manifestations. Given the high number of case reports with similar presentations, it’s important to proceed with more investigations.

Disclosure

No significant relationships.

The impact of SARS-CoV-2 pandemic on suicidal ideation admissions: a single adolescent and young adult psychiatry center experience

Introduction

The COVID-19 pandemic and the lockdown brought about a sense of fear and anxiety around the globe. This phenomenon led to both short and long term psychosocial and mental health implications for children and adolescents.

Objectives

To evaluate the effect of COVID-19 pandemic on hospital admissions for suicidal ideation in a Portuguese adolescent and young adult psychiatry service.

Methods

We conducted a single-center, retrospective study including adolescent and young adult patients (15-25 years old) admitted to our service with suicidal ideation within a year before and a year after the declaration date of SARS-CoV-2 disease as a pandemic. Patients were divided in two groups: Group A - patients admitted before the pandemic (March 11, 2019 and March 11, 2020) and Group B – patients admitted after the pandemic declaration (March 12, 2020 and March 12, 2021). The groups characteristics and outcomes were assessed and compared.

Results

A total of 647 admissions were assessed (Group A, n= 372 and Group B, n=275). Demographic characteristics were similar between groups. 75 patients (vs 25 patients) were admitted with suicidal ideation in the year before the pandemic. There was a lower proportion of patients admitted with suicidal ideation during the year after the pandemic year - OR 0.374 (95% CI 0.228-0.614, P<0.001).

Conclusions

Our study showed a decrease in admissions for suicidal ideation in this service in the year after the pandemic. More studies are needed to understand the factors that may justify this decline and evaluate the longer effects of this pandemic in mental health.

Disclosure

No significant relationships.

Treating Patients with Aripiprazol: A Safe Gamble?

Introduction

Aripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating.

Objectives

Currently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject.

Methods

The authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base.

Results

Overall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone.

Conclusions

Attributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered.

Disclosure

No significant relationships.

The Influence of Smoking on Healing of Scaphoid Non-union after a Vascularized Pedicle Bone Flap Operation: A Review and Meta-analysis

BACKGROUND

The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing.

MATERIALS AND METHODS

Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG.

RESULTS

Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001).

CONCLUSIONS

A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.

The Influence of Smoking on Healing of Scaphoid Non-union after a Vascularized Pedicle Bone Flap Operation: A Review and Meta-analysis

BACKGROUND

The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing.

MATERIALS AND METHODS

Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG.

RESULTS

Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001).

CONCLUSIONS

A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.

The Influence of Smoking on Healing of Scaphoid Non-union after a Vascularized Pedicle Bone Flap Operation: A Review and Meta-analysis

Background

The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing.

Materials and Methods

Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG.

Results

Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001).

Conclusions

A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.

Floating Elbow in Adults: A Systematic Review and Meta-Analysis

Background

We aimed to systematically review all papers examining floating elbow injuries in adults.

Material and Methods

MEDLINE, Cochrane Bone, Joint and Muscle Trauma, PROSPERO, and Scopus databases were searched up to August 31, 2020. Included studies had as a primary or secondary outcome the functional outcomes after a floating elbow injury on patients aged 17 or older. Methodological quality of the included studies was assessed.

Results

Thirty-two studies met the inclusion criteria. Patients were male at 73,1%. Median age of the patients was 33,0 years and median time of follow-up was 19,5 months. Articular surfaces were affected at 24,4%, whereas 51,2% of the fractures was open. Approximately, 34,9% of the patients suffered neural injury. Ipsilateral and multiple-system injuries were present in 34,8% and 76,3 % of the cases, respectively. Multivariate analysis showed that intra-articular and nerve damage, open fractures and multi-system injuries affected range of motion, union and complications. Sex, age, vascular damage and ipsilateral injuries of the patient did not adversely impact the outcome. All of the included studies were classified as very-low quality of evidence.

Conclusions

The current knowledge regarding the characteristics of floating elbow in adults is limited, albeit we were able to provide possible pre-operative predictor outcomes.

Can biochemical endpoints improve the sensitivity of the biomonitoring strategy using bioassays with standard species, for water quality evaluation?

The Water Framework Directive (WFD) was adopted in 2000 and is a common framework for water policy, management and protection in Europe. The WFD assesses specific parameters; however, it ignores indicators of ecosystem functioning and sub-individual performance. Reservoirs are strongly influenced by anthropogenic activities that promote their imbalance. Bioassays and biomarkers are useful tools to link the chemical, ecological and toxicological assessments in water quality assessments. These approaches can be complementary to WFD methodologies, allowing the detection of impacts on the ecosystem. This study evaluated if the biochemical parameters can improve the sensitivity of the biomonitoring strategy using bioassays with the standard species Daphnia magna, in the assessment of the ecological quality of water reservoirs. To this end, water samples of Portuguese reservoirs were analysed in three sampling periods (Autumn 2018 and Spring, Autumn 2019). In parallel, a physicochemical characterization of waters was performed. D. magna feeding rate assays were performed for 24 h. After exposure, metabolism, oxidative stress and lipid peroxidation biomarkers were evaluated. Feeding rate assays showed sensitivity to different reservoirs. Biomarkers showed a higher sensitivity and can therefore improve the sensitivity of the biomonitoring strategy using bioassays. Bioassays and biomarkers approach allowed to highlight potential sources of stress, more related to the quality of the seston than to chemical contamination. This work highlights the complementarity between bioassays and biomarkers to identify ecotoxicological effects of surface waters, and can be extremely useful, especially in cases where the biotic indices are difficult to establish, such as reservoirs.

Stemless reverse total shoulder arthroplasty: a systematic review of contemporary literature

PURPOSE

Reverse shoulder prostheses are increasingly used for treatment of rotator cuff tear arthropathy and other degenerative shoulder diseases. In recent years, aiming for bone stock preservation has led to the design of metaphyseal humeral components without a stem. The aims of this study were to evaluate the complication and reintervention rates, as well as the clinical and radiographic outcomes in patients who underwent reverse shoulder arthroplasty (RSA) with stemless implants.

METHODS

A systematic review of the literature was completed until May 2020 using PubMed, EMBASE, CINAHL and Cochrane databases, according to PRISMA guidelines.

RESULTS

The literature search revealed 2942 studies, of which 13 were included in this review, with a total of 517 patients and a mean follow-up between 6.4 and 101.6 months. The total complication rate was 6.5%, while 3.3% were humeral associated complications. Finally, the rate of shoulders that underwent a reintervention was 6.7%, with 1.4% relating to a humeral component reason. Stemless RSA led to substantial improvements in patient reported outcome measures and range of motion across all studies. Scapular notching was reported in 15.2%, and lucencies around humeral component were reported in 0.8% of shoulders.

CONCLUSION

Stemless RSA resulted in low complication and reintervention rates at the mid-term follow-up. The reported clinical and radiological outcomes showed that these prostheses have at least equivalent outcomes with their stemmed counterparts. Further studies are required to investigate the long-term longevity and performance of the stemless humeral implants.

LEVEL OF EVIDENCE

Level IV; Systematic Review.

Assessment of water quality in Aguieira reservoir: Ecotoxicological tools in addition to the Water Framework Directive

To assess the ecological potential (EP), the Water Framework Directive (WFD) uses specific parameters but ignores ecosystem functioning and individual/subindividual biological responses. The heavily modified water bodies (reservoirs) are strongly influenced by human activities that promote their imbalance, with a loss or compromise the biodiversity and the functioning of these ecosystems. This work aims to determinate the EP according physical, chemical and biological parameters of WFD and evaluate the functionality and sensitivity of ecotoxicological tools in the evaluation of water quality of Aguieira reservoir. Four sampling sites were defined in Aguieira reservoir and sampling was conducted in autumn 2018, spring and autumn 2019. WFD showed overall that Aguieira reservoir presented moderate EP. The autumn samples and the two reservoir upstream sites had the worst classification. These results were complemented by a set of ecotoxicological assays (growth inhibition of Raphidocelis subcapitata and Spirodela polyrhiza, and feeding rate of Daphnia longispina) using three natural water treatments. R. subcapitata was the most sensitive species, indicating the presence of a risk that is not detected by chemical analysis, nor by organisms of different trophic levels. D. longispina only showed sensitivity in A3 and A4 in autumn, however this results was difficult to interpret since no reason can be observed to respond the F1 lower feeding rate observed in almost sites. S. polyrhiza, as well as the total chlorophyll, lipid peroxidation, and proline content did not show sensitivity, since no discrimination among the water treatments were recorded. The relevance of bioassays is associated with the fact that an integrated response to a complex mixture can be obtained, which can contain more substances than the measured ones. Thus, we may conclude that WFD are insufficient to draw conclusions about water quality, and the growth inhibition of Raphidocelis subcapitata assay is an important parameter to complement the WFD. In addition, species of different trophic levels are recommended for ecotoxicological analyses due to differences in species sensitivities.

Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

Effects of transients in LIGO suspensions on searches for gravitational waves

This paper presents an analysis of the transient behavior of the Advanced LIGO (Laser Interferometer Gravitational-wave Observatory) suspensions used to seismically isolate the optics. We have characterized the transients in the longitudinal motion of the quadruple suspensions during Advanced LIGO's first observing run. Propagation of transients between stages is consistent with modeled transfer functions, such that transient motion originating at the top of the suspension chain is significantly reduced in amplitude at the test mass. We find that there are transients seen by the longitudinal motion monitors of quadruple suspensions, but they are not significantly correlated with transient motion above the noise floor in the gravitational wave strain data, and therefore do not present a dominant source of background noise in the searches for transient gravitational wave signals. Using the suspension transfer functions, we compared the transients in a week of gravitational wave strain data with transients from a quadruple suspension. Of the strain transients between 10 and 60 Hz, 84% are loud enough that they would have appeared above the sensor noise in the top stage quadruple suspension monitors if they had originated at that stage at the same frequencies. We find no significant temporal correlation with the suspension transients in that stage, so we can rule out suspension motion originating at the top stage as the cause of those transients. However, only 3.2% of the gravitational wave strain transients are loud enough that they would have been seen by the second stage suspension sensors, and none of them are above the sensor noise levels of the penultimate stage. Therefore, we cannot eliminate the possibility of transient noise in the detectors originating in the intermediate stages of the suspension below the sensing noise.

First Demonstration of Electrostatic Damping of Parametric Instability at Advanced LIGO

Interferometric gravitational wave detectors operate with high optical power in their arms in order to achieve high shot-noise limited strain sensitivity. A significant limitation to increasing the optical power is the phenomenon of three-mode parametric instabilities, in which the laser field in the arm cavities is scattered into higher-order optical modes by acoustic modes of the cavity mirrors. The optical modes can further drive the acoustic modes via radiation pressure, potentially producing an exponential buildup. One proposed technique to stabilize parametric instability is active damping of acoustic modes. We report here the first demonstration of damping a parametrically unstable mode using active feedback forces on the cavity mirror. A 15 538 Hz mode that grew exponentially with a time constant of 182 sec was damped using electrostatic actuation, with a resulting decay time constant of 23 sec. An average control force of 0.03 nN was required to maintain the acoustic mode at its minimum amplitude.

Exposure to electromagnetic fields from laptop use of "laptop" computers

Portable computers are often used at tight contact with the body and therefore are called "laptop." The authors measured electromagnetic fields (EMFs) laptop computers produce and estimated the induced currents in the body, to assess the safety of laptop computers. The authors evaluated 5 commonly used laptop of different brands. They measured EMF exposure produced and, using validated computerized models, the authors exploited the data of one of the laptop computers (LTCs) to estimate the magnetic flux exposure of the user and of the fetus in the womb, when the laptop is used at close contact with the woman's womb. In the LTCs analyzed, EMF values (range 1.8-6 μT) are within International Commission on Non-Ionizing Radiation (NIR) Protection (ICNIRP) guidelines, but are considerably higher than the values recommended by 2 recent guidelines for computer monitors magnetic field emissions, MPR II (Swedish Board for Technical Accreditation) and TCO (Swedish Confederation of Professional Employees), and those considered risky for tumor development. When close to the body, the laptop induces currents that are within 34.2% to 49.8% ICNIRP recommendations, but not negligible, to the adult's body and to the fetus (in pregnant women). On the contrary, the power supply induces strong intracorporal electric current densities in the fetus and in the adult subject, which are respectively 182-263% and 71-483% higher than ICNIRP 98 basic restriction recommended to prevent adverse health effects. Laptop is paradoxically an improper site for the use of a LTC, which consequently should be renamed to not induce customers towards an improper use.

[Working hypothesis of simplified techniques for the first mapping of occupational hazards in handicrafts. Part two: physical and chemical risks]

Craft features a strong link with tradition which preserves and perpetuates techniques created and consolidated over time, in a particular historical, cultural and geographical situation. Italy is home to excellent craftsmanship: fashion, furniture, giftware, design. The framework law for the craft n. 433/1985 defines the craft business carried on by the craftsman for a predominant objective of producing goods, including semi-finished or services. The D.L.gs 81/2008 defines the manner in which the employer must conduct risk assessment in the workplace and process the risk assessment document. The aim of the study is to provide employers with a simple methodology that allows the drafting of the first mapping of hazards/dangers identificating risk sources in the working process. The developed methodology is expressed as a model of information gathering, which brings to a first overview of all major risk indicators that may arise in the craftsmanship.

Electromagnetic fields produced by incubators influence heart rate variability in newborns

BACKGROUND

Incubators are largely used to preserve preterm and sick babies from postnatal stressors, but their motors produce high electromagnetic fields (EMFs). Newborns are chronically exposed to these EMFs, but no studies about their effects on the fragile developing neonatal structure exist.

AIM

To verify whether the exposure to incubator motor electric power may alter autonomous nervous system activity in newborns.

MATERIAL AND METHODS

Heart rate variability (HRV) of 43 newborns in incubators was studied. The study group comprised 27 newborns whose HRV was studied throughout three 5-minute periods: with incubator motor on, off, and on again, respectively. Mean HRV values obtained during each period were compared. The control group comprised 16 newborns with constantly unrecordable EMF and exposed to changes in background noise, similar to those provoked by the incubator motor.

RESULTS

Mean (SD) total power and the high-frequency (HF) component of HRV increased significantly (from 87.1 (76.2) ms2 to 183.6 (168.5) ms2) and the mean low-frequency (LF)/HF ratio decreased significantly (from 2.0 (0.5) to 1.5 (0.6)) when the incubator motor was turned off. Basal values (HF = 107.1 (118.1) ms2 and LF/HF = 1.9 (0.6)) were restored when incubators were turned on again. The LF spectral component of HRV showed a statistically significant change only in the second phase of the experiment. Changes in background noise did not provoke any significant change in HRV.

CONCLUSION

EMFs produced by incubators influence newborns' HRV, showing an influence on their autonomous nervous system. More research is needed to assess possible long-term consequences, since premature newborns may be exposed to these high EMFs for months.

[Lumboscopic drainage of retroperitoneal abscess. Case report]

Existing reports evaluate the management of infected pancreatic necrosis. Most of the authors choose between percutaneous and retroperitoneoscopic drainage. The high morbidity and mortality of this pathology distorts the objective evaluation of the treatment employed. With present a case of infected pancreatic collection favorably resolved with retroperitoneoscopic drainage evidencing the low morbidity of this technique.

Synthesis and characterization of membranes obtained by graft copolymerization of 2-hydroxyethyl methacrylate and acrylic acid onto chitosan

Chitosan based membranes to be applied on wound healing as topical drug delivery systems were developed by graft copolymerization of acrylic acid (AA) and 2-hydroxyethyl methacrylate (HEMA) onto chitosan using cerium ammonium nitrate as chemical initiator. Evidence for graft copolymerization of the vinyl monomers onto chitosan was obtained by FTIR and DMTA. Swelling degree, cytotoxicity, thrombogenicity and haemolytic activity of these membranes were evaluated. Chitosan-graft-AA-graft-HEMA showed to be the best matrix for drug delivery systems than chitosan-graft-AA because it retains good swelling properties, but the content in HEMA has improved cytocompatibility, hemocompatibility and thrombogenic character.

Cirugía laparoscópica en el tratamiento de enfermedades adrenales: experiencia en 200 casos

OBJECTIVE

We report our experience in laparoscopic adrenalectomy, after adopting the laparoscopic technique for 10 years as a primary option for suprarenal surgery.

METHODS

We included 200 laparoscopic adrenal surgeries performed consecutively in 183 patients with surgical adrenal pathology between November 1994 and November 2005. Sixty-seven (36.6%) patients were male and 116 (63.4%) were female, with an average age of 49.1 years (age range 8 months to 78 years).

RESULTS

The most frequents clinical diagnosis were hyperaldosteronism (17.5%), metastatic cancer (15.8%), pheochromocytoma (15.3%), Cushing syndrome (7.1%), adrenal cyst (4.9%) and myelolipoma (2.7%). A total of 164 total adrenalectomies, 29 partial adrenalectomies and 7 marsupializations of adrenal cysts were performed. Mean surgical time was 82.6 minutes (range 25 to 240 minutes) and mean hospitalization time was 2.5 days (range 1-10 days). The size of the suprarenal gland and/or tumor varied between 1 and 14 cm (average 5.6 cm). The rate of complication was 6%. In 8 of the patients, there was another laparoscopic procedure besides the adrenal surgery: cholecystectomies (2), marsupialization of a renal cyst (2), block nephrectomy (2), partial nephrectomy for a tumor (1) and pancreatic cystectomy (1). One patient underwent a right laparoscopic adrenalectomy and an ipsilateral percutaneous nephrolithotomy.

CONCLUSION

The accumulated experience with 200 laparoscopic adrenal procedures has allowed the management of endocrine pathologies, such as, aldosteroma, pheochromocytoma, Cushing syndrome and rare entities, such as, cysts, myelolipomas in a suitable manner. Additionally, it has permitted us to extend the benefits of a minimally invasive procedure for large adrenal masses and selected oncology cases.

Complicaciones de la nefrectomía laparoscópica

OBJECTIVE

To report the complications and their respective management in our series of laparoscopic nephrectomy.

MATERIAL AND METHODS

Between November 1992 and March 2004, 319 patients underwent laparoscopic ablative renal surgery: 152 were women and 167 were men, mean age was 45 years (range: 0,5-82 years). There were 70 radical nephrectomies, 16 radical nephroureterectomies, 63 partial nephrectomies, 124 simples nephrectomies, 15 simples nephroureterectomies, 8 heminephrectomies and 23 living donor nephrectomies.

RESULTS

The complication rate was 5.64%. The most frequent complications were bleeding (2.5%) and retroperitoneal haematoma (1.2%). There was not statically difference in complications rate by age, sex, or approach via: transperitoneal versus retroperitoneal. Complication rate was alike with laparoscopic or hand assisted technique. There was not mortality in the series.

CONCLUSIONS

We have a low complication rate in laparoscopic nephrectomy. We believe that laparoscopy is a safe technique for patients that require ablative renal surgery when the surgical team has experience in advanced laparoscopic surgery.

Desderivación urinaria; de Bricker a Studer. A propósito de dos casos

We present two cases of urinary undiversion from an ileal loop (Bricker) to an orthotopic neobladder. Due to miss adaptation to the stoma, two patients demanded reconversion to a continent urinary diversion. We proceed to change their urinary diversion to an ileal neobladder (Studer), one by open surgery and the other by laparoscopic surgery. In both cases immediate postoperative went uneventful. Both patients are continent, satisfied with their new situation, and without metabolic complications. Urinary undiversion from an ileal conduit to an orthotopic neobladder is technically feasible by open or laparoscopic surgery. It is a valid alternative for patients with complications due to their urinary diversion or miss adaptation to the cutaneous stoma.

Reduction of exposure of newborns and caregivers to very high electromagnetic fields produced by incubators

The aims of this paper is to measure whether ferromagnetic panels sufficiently reduce the high electromagnetic fields (EMF) to which newborns are exposed in incubators and to which caregivers are exposed when working near the incubators. We measured EMF at mattress level in three neonatal incubators with and without ferromagnetic panels between the electric motor and the mattress. We then measured the EMF at the level of the maximum emission point for caregivers, i.e., near the display panel. The ferromagnetic panels were (a) 5 mm thick iron, (b), (c), (d) respectively, one, two, and three sheets of 0.3 mm thick mu-metal. The weight of iron sheet was 4 g/cm2, and mu-metal 0.2 g/cm2. The use of the ferromagnetic panels significantly reduced the EMF. No significant difference in attenuation was recorded using one, two, or, three sheets of mu-metal, or a single sheet of iron. One, two, and three sheets of mu-metal reduced EMFs by 77%, 82%, and 84.3%, respectively; the reduction with iron was 80%. EMF values measured in incubators were higher than those to which the general population is exposed. The use of ferromagnetic panels significantly reduces the level of EMFs to which neonates and caregivers are exposed.

[Vibration risk during neonatal transport]

AIM

The aim of this paper is to assess the entity of the mechanical vibrations which newborn and medical staff are exposed to and to evaluate the possible risks connected with excessive exposure.

METHODS

Vibrations during a simulated emergency ambulance transport were studied. Vibration values with an accelerometer at the level of the incubator's mattress and at passengers' and pilot's seat level were measured. Mean accelerations (awz) and peak accelerations (awpeak), measured using a ponderation filter, according with ISO standard 2631, were considered.

RESULTS

Inside the incubator an acceleration mean value of 1.33 (+/-0.13) m/s(2) and peak values of 11.8 (+/-0.1) m/s(2) were found. On passengers' seats the awz findings were 0.55 m/s(2) (+/-0.13) and 0.56 m/s(2) (+/-0.08) while awpeak respectively 4.8 m/s(2) (+/-0.1) and 10.2 m/s(2) (+/-0.1). On pilot's seat a mean acceleration of 0.48 m/s(2) (+/-0.08) and an awpeak value of 4.5 m/s(2) (+/-0.1) were found.

CONCLUSION

Peak vibration values which newborns are exposed to (11.8 m/s(2)) are high, when compared with acceleration of gravity (9.8 m/s(2)); this can provoke repeated jerks. Environmental stress can easily alter the stability of an ill newborn and interfere with care manoeuvres. Decreasing vibrations in neonatal transport unit could increase the safety of newborns, reducing the risks which newborns are actually exposed to.

Treatment of Complete Obstruction of the Nasolacrimal System by Temporary Placement of Nasolacrimal Polyurethane Stents: Preliminary Results

AIM

To assess the efficacy of the temporary placement of polyurethane nasolacrimal stents as a treatment for complete post-saccal obstruction of the lacrimal apparatus.

MATERIALS AND METHODS

Polyurethane nasolacrimal stents were inserted under radiological guidance in nine patients with grade IV epiphora due to complete obstruction of the lacrimal system, at the junction of the lacrimal sac and duct (eight patients) or in the lacrimal duct (one patient). On average, the stents were removed 4 months (range: 3-6 months) after insertion. Dacryocystography was performed immediately before and after each stent was removed. Subsequently, periodic clinical and radiological examinations were performed until recurrence of the epiphora, at which point follow-up concluded.

RESULTS

All patients remained free of epiphora and clinical inflammation while the stents were in place, but re-obstruction of the lacrimal system occurred in all patients less than 2 months after the stents were removed. Adhesion of three stents to the lacrimal tract was observed upon removal. In seven cases the dacryocystography results at the end of follow-up revealed changes in the configuration of the lacrimal apparatus.

CONCLUSION

Based on our preliminary experience, temporary placement of polyurethane stents would not appear to be an efficacious therapeutic option for treating epiphora caused by post-saccal obstruction.

[Cauda equina meningioma in a girl: presentation of a case and review of the literature]

Meningiomas are unusual in childhood, and the intraspinal location is very uncommon. Those arising from lumbar dura matter are the most rare among spinal neoplasms of meningeal origin. We present the case of a 12-years-old girl with a cauda equina meningioma. As in previously reported cases, the initial complain was back pain with radicular irradiation. The girl had few neurological findings, with pyramidal signs of both lower limbs as single neurological impairment. She underwent surgical treatment through an open door laminoplasty and the tumour was completely removed without neurological deficit. After 2-year of follow-up she remains asymptomatic.

The peroxisome proliferator-activated receptor delta promotes lipid accumulation in human macrophages

The peroxisome proliferator-activated receptors (PPARs) are a family of fatty acid-activated transcription factors which control lipid homeostasis and cellular differentiation. PPARalpha (NR1C1) controls lipid oxidation and clearance in hepatocytes and PPARgamma (NR1C3) promotes preadipocyte differentiation and lipogenesis. Drugs that activate PPARalpha are effective in lowering plasma levels of lipids and have been used in the management of hyperlipidemia. PPARgamma agonists increase insulin sensitivity and are used in the management of type 2 diabetes. In contrast, there are no marketed drugs that selectively target PPARdelta (NR1C2) and the physiological roles of PPARdelta are unclear. In this report we demonstrate that the expression of PPARdelta is increased during the differentiation of human macrophages in vitro. In addition, a highly selective agonist of PPARdelta (compound F) promotes lipid accumulation in primary human macrophages and in macrophages derived from the human monocytic cell line, THP-1. Compound F increases the expression of genes involved in lipid uptake and storage such as the class A and B scavenger receptors (SRA, CD36) and adipophilin. PPARdelta activation also represses key genes involved in lipid metabolism and efflux, i.e. cholesterol 27-hydroxylase and apolipoprotein E. We have generated THP-1 sublines that overexpress PPARdelta and have confirmed that PPARdelta is a powerful promoter of macrophage lipid accumulation. These data suggest that PPARdelta may play a role in the pathology of diseases associated with lipid-filled macrophages, such as atherosclerosis, arthritis, and neurodegeneration.

Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

OBJECTIVE

Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI.

METHODS

The patients were divided into three different age groups (60/69, 70/79, and > or =80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the interventionist discretion.

RESULTS

We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or =80 year old patients (p=.022), and the death rate was higher in > or =70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064).

CONCLUSION

Elderly patients (> or =70 years) presented with adverse clinical and angiographic profiles and patients > or =80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or =70 years had a higher death rate.

Histone H2A is required for normal centromere function in Saccharomyces cerevisiae

Histones are structural and functional components of the eukaryotic chromosome, and their function is essential for normal cell cycle progression. In this work, we describe the characterization of two Saccharomyces cerevisiae cold-sensitive histone H2A mutants. Both mutants contain single amino acid replacements of residues predicted to be on the surface of the nucleosome and in close contact with DNA. We show that these H2A mutations cause an increase-in-ploidy phenotype, an increased rate of chromosome loss, and a defect in traversing the G(2)-M phase of the cell cycle. Moreover, these H2A mutations show genetic interactions with mutations in genes encoding kinetochore components. Finally, chromatin analysis of these H2A mutants has revealed an altered centromeric chromatin structure. Taken together, these results strongly suggest that histone H2A is required for proper centromere-kinetochore function during chromosome segregation.