The Hertel classification can't predict the risk of humeral head osteonecrosis after osteosynthesis using an anterolateral approach

Background: Proximal humeral fractures can progress to osteonecrosis of the humeral head. Hertel developed a binary classification system (12 subtypes) and demonstrated that some patterns have more risk to develop osteonecrosis. Hertel described the prevalence and the risk factors for Humeral head osteonecrosis after osteosynthesis using a Deltopectoral approach. Few studies have evaluated the prevalence and the capacity of Hertel's classification to predict Humeral Head osteonecrosis following osteosynthesis of proximal Humeral fractures through the anterolateral approach. The objectives of this study were to correlate osteonecrosis predictors established by the Hertel classification with the risk of developing osteonecrosis and its prevalence after osteosynthesis using the anterolateral approach. Methods: This was a retrospective study of patients who underwent osteosynthesis of proximal humerus fractures using an anterolateral approach. Patients were divided into two groups: high risk for necrosis (group 1) and low risk for necrosis (group 2) according to Hertel's criteria. The overall prevalence of osteonecrosis and the prevalence in each group were calculated. A radiological examination was performed in the true anteroposterior (Grashey), scapular, and axillary views, before and after the operation (minimum 1 year after surgery). A Kaplan-Meier curve was used to assess the pattern of the temporal evolution of osteonecrosis. The groups were compared using the Chi-square test or Fisher's exact test. The unpaired t-test (parametric variables – age) and the Mann-Whitney test (non-parametric time between trauma and surgery) were used. Results: In total, 39 patients were evaluated. The postoperative follow-up time was 14.5 ± 3.3 months. The time to onset of necrosis was 14.1 ± 3.9 months. Sex, age, and time between trauma and surgery did not influence the risk of necrosis. Type 2, 9, 10, 11, and 12, or fractures with posteromedial head extension less than or equal to 8 mm, or diaphysis deviation greater than 2 mm, as well as grouping did not influence the risk for osteonecrosis. Conclusions: Hertel's criteria were not able to predict the development of osteonecrosis after osteosynthesis of proximal humerus fractures performed through the anterolateral approach. The total prevalence of osteonecrosis was 17.9% with a tendency toward an increased incidence after 1 year of surgical treatment

Functional evaluation of patients with surgically treated terrible triad of the elbow

Objectives: To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. Methods: A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. Results: 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86% good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnar nerve. Conclusion: The patients had stable elbow with good function, however with reduced range of motion233138141sem informaçã

O Estado Atual do Emprego de Antiagregantes Plaquetários e Anticoagulantes para Prevençao de Eventos Tromboembólicos na Fibrilaçao Atrial

A fibrilaçao atrial é uma condiçao clínica comum com alto potencial para eventos tromboembólicos. Com as recentes publicaçoes dos grandes ensaios randomizados na prevençao primária e secundária dos fenômenos tromboembólicos, tem sido possível caracterizar subgrupos de alto e baixo risco para estes eventos. Também, apesar de algumas diferenças nos resultados, é possível atualmente planejarmos uma terapia anticoagulante mais substanciada. As metanálises destes estudos mostram que o warfarin pode reduzir em até 70% o risco de tromboembolismo, mas, em somente 30% com a aspirina. Em praticamente todos os pacientes a melhor opçao terapêutica é a anticoagulaçao plena com warfarin, reservando a aspirina para os de baixo risco ou os com contra-indicaçao para o anticoagulante

O Estado Atual do Emprego de Antiagregantes Plaquetários e Anticoagulantes para Prevençao de Eventos Tromboembólicos na Fibrilaçao Atrial

A fibrilaçao atrial é uma condiçao clínica comum com alto potencial para eventos tromboembólicos. Com as recentes publicaçoes dos grandes ensaios randomizados na prevençao primária e secundária dos fenômenos tromboembólicos, tem sido possível caracterizar subgrupos de alto e baixo risco para estes eventos. Também, apesar de algumas diferenças nos resultados, é possível atualmente planejarmos uma terapia anticoagulante mais substanciada. As metanálises destes estudos mostram que o warfarin pode reduzir em até 70% o risco de tromboembolismo, mas, em somente 30% com a aspirina. Em praticamente todos os pacientes a melhor opçao terapêutica é a anticoagulaçao plena com warfarin, reservando a aspirina para os de baixo risco ou os com contra-indicaçao para o anticoagulante

Association of microsatellite markers with contents of oil and protein in soybean

O objetivo deste trabalho foi avaliar a associação de marcadores microssatélites localizados próximos a locos de caracteres quantitativos (QTL) descritos na literatura, com os teores de óleo e proteína de genótipos de soja cultivados no Brasil. Quarenta e nove genótipos de soja foram avaliados em Viçosa, MG (12/2009); Visconde do Rio Branco, MG (2/2010); e São Gotardo, MG (2/2010 e 10/2011). Utilizou-se o delineamento de blocos ao acaso, com três repetições. Os teores de óleo e proteína foram determinados por espectrometria do infravermelho. Foi observada ampla variabilidade genética para esses teores. Dos 65 marcadores microssatélites testados, 35 apresentaram associação significativa com pelo menos um dos teores, mas poucos foram consistentes com a mudança de ambiente. Ao se levar em conta a consistência da associação em todos os ambientes, os marcadores Satt239, Satt384 e Satt562 destacam-se para a seleção assistida quanto aos teores de óleo e de proteína, enquanto o Satt310 destaca-se para seleção quanto ao teor de óleo, e o Satt567, quanto ao de proteína.The objective of this work was to evaluate the association of microsatellite markers located close to quantitative trait loci (QTL) described in the literature, with contents of oil and protein soybean genotypes cultivated in Brazil. Forty-nine soybean genotypes were evaluated in Viçosa, MG (12/2009), Visconde do Rio Branco, MG (2/2010), and São Gotardo, MG (2/2010 and 10/2011). A randomized complete block design, with three replicates, was used. The oil and protein contents were determined by infrared spectroscopy. A high genetic variability was observed for oil and protein contents. Among the 65 tested microsatellite markers, 35 showed significant association with at least one of these contents, but few of them were consistent with the change of environment. Considering the consistency of the association in all environments, the markers Satt239, Satt384, and Satt562 stand out for assisted selection as to oil and protein contents, whereas Satt310 stands out for the selection as to oil content, and Satt567, as to protein content

Avaliação clínica da mortalidade precoce após fratura de quadril no idoso: estudo prospectivo / Clinical evaluation of early mortality following hip fracture in the elderly: a prospective study

Para avaliar a mortalidade precoce de idosos que apresentaram fraturas do quadril tratadas cirurgicamente neste hospital, no período de 11 de dezembro de 2020 a 30 de abril de 2021, foram realizados interrogatórios em busca de fatores que poderiam estar relacionados a esse desfecho, como sexo, idade, tipo de fratura, cirurgia realizada, comorbidades, tempo de internação até a cirurgia, tempo de internação total e complicações, incluindo óbito. Com uma amostra final de 74 (setenta e quatro) pacientes, 16 (dezesseis), 21,5%, evoluíram com morte nos primeiros 90 (noventa) dias. Este estudo demonstrou que elevados risco cirúrgico, tempo de internação hospitalar e tempo entre a data do trauma e o procedimento cirúrgico contribuíram para o aumento da morbimortalidade nesses pacientes. Além disso, a maioria desses pacientes eram mulheres e receberam transfusão sanguínea. Assim, é importante reduzir o tempo total de hospitalização e evitar transfusão sanguínea em pacientes sem sintomas de anemia ou com níveis de Hb ≥ de 8 g/dl.

Biometric analysis of protein and oil contents of soybean genotypes in different environments

The objective of this work was to identify by biometric analyses the most stable soybean parents, with higher oil or protein contents, cultivated at different seasons and locations of the state of Minas Gerais, Brazil. Forty-nine genotypes were evaluated in the municipalities of Viçosa, Visconde do Rio Branco, and São Gotardo, in the state of Minas Gerais, from 2009 to 2011. Protein and oil contents were analyzed by infrared spectrometry using a FT-NIR analyzer. The effects of genotype, environment, and genotype x environment interaction were significant. The BARC-8 soybean genotype is the best parent to increase protein contents in the progenies, followed by BR 8014887 and CS 3032PTA276-3-4. Selection for high oil content is more efficient when the crossings involve the Suprema, CD 01RR8384, and A7002 genotypes, which show high mean phenotypic values, wide adaptability, and greater stability to environmental variation