Atypical Presentation and Management of Fibrodysplasia Ossificans Progressiva

We report a case of an 18-year-old woman, with bilateral acute inflammatory pain on the hip area, during the premenstrual period, and progressive increase in volume and rigidity of both hips. Bilateral exuberant soft tissue calcifications were present on the radiographic exams, and the patient also presented with bilateral short-length hallux valgus. A heterozygous mutation in the protein kinase domain of ACVR1 gene was found, allowing the diagnosis of fibrodysplasia ossificans progressive. Due to the relation between the disease flares and the premenstrual period, the patient was put into a chemically induced amenorrhea, with no new inflammatory crises since.This case illustrates the importance of an accurate diagnosis to prevent unnecessary diagnostic procedures, as well as the need to develop specific treatment strategies to address each patient's particular needs.info:eu-repo/semantics/publishedVersio

Effects of dark or of red, blue or white light on germination of subterranean clover seeds

Dry or imbibed seeds of the negatively photoblastic burr burying subterranean clover cv. ‘Seaton Park’ were treated with dark or with red, blue or white light to evaluate the effects of light on seed germination. Dry seeds treated with constant white light, red light or blue light during 8 days and subsequently incubated in dark had final germination and duration of germination reduced, and the distribution of germination changed from highly asymmetric to symmetric respectively. Imbibing seeds incubated under constant blue or white light had final germination strongly reduced seven days after sowing (7.3% and 50.1% of the germination under dark) with significant differences between them. After transferral to dark, true complete recovery of germination of seeds treated with white light was observed 19 days after sowing, but only partial recovery in seeds treated with blue light. Results of dry and imbibed seeds are consistent with no activity of phytochromes, as expected in negatively photoblastic seeds. Results of dry seeds are seemingly contradictory because total germination data imply the inactivity of red and blue light photoreceptors, the opposite being implied by duration and shape of germination. A tentative hypothetical solution for the contradiction is presented. Results of imbibed seeds are fully consistent with cryptochromes but not with phototropins mediation of responses to light of seed germination in ‘Seaton Park’. The ecological and adaptive significance of such responses are discussed in the framework of light attenuation in soil and the requirement and ability of subterranean clover ‘Seaton Park’ to bury seeds

Sternoclavicular Joint Septic Arthritis in a Healthy Adult: a Rare Diagnosis with Frequent Complications

We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.info:eu-repo/semantics/publishedVersio

Carpal Synovitis with Capitate Bone Tuberculosis in a Child

We present a 10-year-old boy with 2-month duration non-traumatic wrist pain and inflammatory signs. Due to elevated inflammatory markers on blood tests, with an increase in radiocarpal and intercarpal joints synovial fluid and no bony lesions, the patient was submitted to wrist arthrocentesis for the suspicion of septic arthritis. The patient did not improve on conventional treatment, however. An MRI showed synovitis around the carpus and a lytic lesion of the capitate bone due to osteomyelitis. A biopsy was able to identify the causative agent as Mycobacterium tuberculosis, and the patient was treated with antibiotics. He improved significantly, with no pain and signs of normal capitate bone remodelling on the last radiograph.info:eu-repo/semantics/publishedVersio

Is Bilateral Hallux Valgus Chevron Osteotomy a Safe Procedure for Ambulatory Surgery?

Introduction: Several osteotomies of the first metatarsal have been described for treatment of hallux valgus but chevron osteotomy is one of the most common and well-established procedure for treating this deformity. Although there is a trend towards considering bilateral surgery there is lack of publications addressing bilateral treatment in ambulatory units. The aim of this study is to analyze results of bilateral and unilateral distal chevron osteotomies associated with lateral soft tissue release as ambulatory procedures. Materials and methods: A retrospective review was made about the patients treated at our ambulatory unit over a period of five years. Initially, general information as patient's satisfaction's rate and return to normal activity's time and evaluation of standardized follow-up charts and records made by the surgeon were recorded. Secondly, the hallux metatarsophalangeal interphalangeal scale developed by the American Orthopedic Foot & Ankle Society was used. Results: A total of 194 patients with 230 feet operated were included in this study. We found 29 patients that didn't meet the inclusion criteria and were excluded. The unilateral group was composed by 139 feet and the bilateral group by 52 feet. The improvement between preoperative and discharge clinical and radiographic results was significant independently in both groups. A total of 14% of complications were found in our study, 19% in the unilateral group and 12% at the bilateral group. None of them required revision surgery. Conclusion: Bilateral distal chevron osteotomies, associated with lateral soft tissue release, are safe and effective ambulatory procedures. It was found a satisfactory deformity correction in moderate HV. Both patients that underwent unilateral and bilateral procedures had similar clinical and radiological outcomes with no increase in complications or return to normal activity time. With this study it was demonstrated that bilateral chevron osteotomies can be performed as ambulatory procedures.info:eu-repo/semantics/publishedVersio

Femtosecond laser impact on calcium phosphate bioceramics assessed by micro-Raman spectroscopy and osteoblastic behaviour

The present work is an investigation of the biological response to the presence of grooves 3 µm deep, 15 µm wide and spaced by 100 µm, produced with femtosecond laser on ß-tricalcium phosphate (ß-TCP). The heat affected zone generated by the laser irradiation was investigated. Micro-Raman spectroscopy showed a transformation from ß-TCP phase into a-TCP phase, localised inside the grooves. The X Ray Diffraction analyses, correlated with micro-Raman data, confirmed that the use of femtosecond pulsed laser enables to limit the thermal impact. A selection of optimised process parameters allowed to obtain ß-TCP micro-patterned surfaces avoiding any phase transformation. The increase of the wettability with the micro-patterning, compared to smooth surfaces, was highlighted. An improvement of the osteoblastic proliferation was also demonstrated. Finally, the tendency of cell elongation along the grooves direction showed the ability of osteoblastic cells to adapt their morphology to the support topography on which they grow.The authors are grateful to the JECS Trust for funding the visit of Marie Lasgorceix to the Laboratory INEB (Contract N°2015106). Marie Lasgorceix also acknowledges the Walloon Region for financial support, within the “BEWARE” program (convention n°1510392) co-funded by Wallonia and European Union (FP7 – Marie Curie Actions) . The authors are grateful to Dr Sylvain Desprez (Materia Nova, Mons, Belgium) for micro-Raman analyses. This publication is based on the work of COST Action MP1301, funded by COST (European Cooperation in Science and Technology) www.cost.eu

Efficacy and cytotoxicity of binary mixtures as root canal filling solvents

Objectives: This study reports the efficacy of two solvent mixtures on the dissolution of gutta-percha and AH Plus sealer, together with the cytotoxicity. Methods: Methyl ethyl ketone (MEK), orange oil, tetrachloroethylene, MEK/tetrachloroethylene (1:1), MEK/orange oil (1:1), and chloroform (control) were tested. Twelve groups (n = 15) of standardized stainless-steel molds filled with softened gutta-percha cones and twelve (n = 15) filled with AH Plus were immersed in the corresponding mixture or individual solvent, in an ultrasonic bath, for either 2 or 5 min. The effect of the solvents was assessed qualitatively by a topographical analysis (scanning electron microscopy) and chemical analysis (Fourier transform infrared spectroscopy), and quantitatively by a weight loss and viscoelastic property (dynamic mechanical analysis) evaluation. The cytotoxicity was assessed on MG63 human osteoblastic cells. Results: The mixtures did not show the formation of new compounds. Both presented significantly higher efficacies compared to their individual solvents, suggesting a synergistic effect. Their dissolution efficacy was similar to that of chloroform, showing high cytocompatibility. Conclusions: The proposed strategy, incorporating ultrasound agitation and profiting from the synergy of adequate solvents, might enhance root canal cleanliness allowing a single-step procedure to dissolve gutta-percha and the sealer remnants, while assuring cytocompatibility with the periapical tissues.This article was supported by National Funds through FCT—Fundação para a Ciência e a Tecnologia,I.P.-V., within CINTESIS, R & D Unit (reference UIDB/4255/2020)

Amination of polymeric braid structures to improve tendon healing: an experimental comparison

Several polymers are researched for tendon repair as polyethylene terephthalate (PET) and polylactic acid (PLA). These are biocompatible and useful in scaffolding repair though with minimal success due to long-term failure. There is a need to improve such scaffolds' design and physical–chemical nature. This work concerns surface functionalization of polymeric braids (PET and PLA) that fulfill the high mechanical demands of tissues such as tendons. The functionalization aims to incorporate amine groups in the braids' surface, improve cell adhesion, and consequently, the poor healing rate of these tissues and the biointegration of the braids. Two approaches are compared: the direct application of NH3 plasma and the surface grafting of EDA after O2 plasma activation. X-ray photoelectron spectroscopy (XPS) shows that amine groups are effectively introduced onto the samples' surfaces. Besides, the plasma parameters chosen do not compromise the topography and tensile behavior of the braids. Resazurin assay and scanning electron microscopy show that the NH3 treatment improves cell–biomaterial interaction as improved cell adhesion and proliferation are observed. Both approaches are safe for biomedical applications. The NH3 plasma approach is more environmentally friendly, faster, and easier to scale-up, showing potential for application in the final hybrid medical devicepublishe

Artroplastia Unicompartimental do Joelho Oxford Phase 3. Resultados a Médio Prazo

Introdução: A artroplastia unicompartimental evoluiu nos últimos 40 anos, sendo hoje em dia considerada uma estratégia cirúrgica apropriada para a osteoartrose do compartimento interno da articulação do joelho. Desenvolvimentos nos instrumentos cirúrgicos, desenho do implante, abordagem cirúrgica e selecção dos doentes levaram a uma grande melhoria dos resultados pós-operatórios e aumento da longevidade das próteses unicompartimentais do joelho. Comparada com a prótese total, tem como vantagens a preservação óssea, menos complicações pós‐operatórias (perdas sanguíneas, dor pós‐operatória, taxa de infecção, trombose venosa profunda (TVP) e tromboembolismo pulmonar (TEP)), manutenção da normal cinemática do joelho, alta precoce e reabilitação mais rápida. A prótese unicompartimental Oxford phase 3 foi introduzida em 1998 e é uma prótese cimentada com menisco móvel de polietileno. Material e Métodos: Foi realizado um estudo retrospectivo das artroplastias unicompartimentais do joelho Oxford phase 3 realizadas no nosso serviço. Desde 2006 realizaram-se 37 artroplastias unicompartimentais (num total de 34 doentes). Sete dos quais não compareceram à avaliação pós-operatória e por isso foram excluídos do estudo. Todos os doentes incluídos no estudo foram avaliados clínica e radiograficamente. Foram revistos os processos de consulta e do internamento. Registou-se a idade,sexo, classificação ASA (American Society of Anesthesiologists), grau de satisfação, flexão‐extensão actual, Oxford knee score pré e pós‐operatório e alterações radiográficas a salientar. Resultados: O follow‐up médio foi de 47 meses (10 ‐ 83 meses). A idade média dos doentes é de 64 anos, com predomínio do sexo feminino. O ASA médio foi de 2,4. Um dos doentes foi submetido a conversão para artroplastia total do joelho por falência do componente tibial. Há 2 doentes não satisfeitos com a cirurgia (que corresponde aos doentes em que o Oxford knee score piorou). Há 1 doente pouco satisfeito e 23 satisfeitos ou muito satisfeitos. Todos os doentes conseguem fazer extensão completa e a média de flexão é 111º. A média do Oxford knee score pré‐operatório é de 17,4 (5 ‐ 30) e pós‐operatório é 36,6 (11 ‐ 48). Radiologicamente, há uma média de desvio em varo de 1,68º (varo 8º ‐ valgo 5º). Ocorreu artrose femoro‐tibial externa em três casos (dois dos quais também com artrose femoro‐patelar),um caso com slope tibial exagerado (19º), um caso com componente femoral em varo (15º), um caso com componente tibial demasiado grande com protusão interna, um caso de extrusão do menisco de polietileno, um caso com o componente tibial em valgo e um caso com falência deste (descelamento?) com provável necessidade de conversão para artroplastia total. Dos doentes não avaliados não há registo de conversão para artroplastia total do joelho ou outras complicações. Discussão: A larga maioria dos doentes encontram‐se satisfeitos ou muito satisfeitos, havendo uma melhoria do Oxford knee score para mais do dobro. Não se registaram complicações pós‐operatórias imediatas. Das artropastias unicompartimentas realizadas só uma foi convertida para artroplastia total e outra provavelmente a necessitar de conversão, com uma longevidade de 94,6% aos 47 meses (em média). Conclusão: A artroplastia unicompartimental do joelho demonstrou‐se uma excelente opção para doentes com osteoartrose não-inflamatória do compartimento interno do joelho. Para se obterem bons resultados os doentes devem ser criteriosamente seleccionados. Considerando a curva de aprendizagem necessária para o sucesso da cirurgia, a pouca experiência da maioria dos cirurgiões que colocaram as próteses não teve influência nos resultados finais, estando de acordo com a literatura existente, provando que a artroplastia unicompartimental do joelho tem bons resultados clínicos e funcionais. Um maior tempo de follow-up será necessário para se avaliar a longevidade das próteses unicompartimentais