Diagnosis and treatment of posterior interosseous nerve entrapment: Systematic review

Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to summarize such methods. Eletronic searches related terms, held in databases (1980-2016): Pubmed (via Medline), Lilacs (via Scielo) and Google Scholar. Through pre-defined protocol, we identified relevant studies. We excluded case reports. Aspects of diagnosis and treatment were synthesized for analysis and tables. Quantitative analyzes were followed by their dispersion variables. Fourteen studies were included. All studies were considered as level IV evidence. Most studies consider aspects of clinical history and provocative maneuvers. There is no consensus on the use of electromyography, and methods are heterogeneous. Studies have shown that surgical treatment (muscle release and neurolysis) has variable success rate, ranging from 20 to 96.5%. Some studies applied self reported scores, though the heterogeneity of the population does not allow inferential analyzes on the subject. few complications reported. Most studies consider the diagnosis of compressive radial nerve syndromes essentially clinical. The most common treatment was combined muscle release and neurolysis, with heterogeneous results. There is a need for comparative studies.Univ Sao Paulo, Dept Orthoped & Traumatol, Escola Paulista Med, Sao Paulo, SP, BrazilUniversidade de São Paulo, Escola Paulista de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, BrazilWeb of Scienc

Magnetic bearings with double crossed loops modelled with T-A formulation and electric circuits

The application of High-Temperature Superconductor (HTS) coils made of coated conductors has been investigated for many years. A possible configuration for such coils is the jointless loop, also known as the ring coil. The double crossed loop coil (DCLC) has been successfully applied in superconducting magnetic bearings (SMBs). The design of SMBs with DCLCs requires flexible modelling to allow all parts of the device to be represented. This work proposes the T-A formulation with a thin-film approximation for modelling SMB with DCLCs in the finite element analysis framework. A 2D representation of the system is coupled with an external electric circuit to model the continuity of the lines that represent the parts of each jointless loop. To couple the T-A formulation and the circuit, an average of the total electric field, with both resistive and inductive components, is applied to the circuit. The total current computed by the circuit is applied to the T-A formulation. The proposed methodology was validated by comparison with levitation force experimental data. Two types of tests were simulated: five levitation force tests and three guidance force tests. It is shown that there is a limit to the behaviour of the levitation force related to the high-loss state. Below this limit, the stack of DCLCs behaves as an equivalent bulk. Beyond this limit, a high-loss state appears as a linear growth of the levitation force. It is also shown that this high-loss state in vertical displacement influences the lateral force

TMJ response to mandibular advancement surgery: an overview of risk factors

Objective: In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. Results: A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. Conclusions: Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery

Resposta de pacientes hipertensos sob tratamento medicamentoso de acordo com os níveis pressóricos

Introdução: Análises pregressas evidenciam o baixo percentual de controle da pressão arterial (PA) em indivíduos hipertensos sob tratamento medicamentoso. O objetivo desta pesquisa foi avaliar a PA de pacientes sob tratamento farmacológico. Metodologia: A pesquisa foi realizada nas Unidades de Saúde da Família do município de Itaperuna - RJ., durante os meses de fevereiro a julho de 2017.  Resultados: Foram avaliados 215 pacientes (60% do sexo feminino e 40% do sexo masculino) com idade média de 59,79 ± 12,64 anos sendo 61,86% brancos, 24,19% negros e 13,95% pardos. A maioria possuía ensino fundamental incompleto (39,07%) e se encontrava na classe D (37,21%) conforme a classificação socioeconômica. A maioria dos pacientes (62,33%) encontrava-se sob tratamento com mais de um medicamento anti-hipertensivo. As principais classes de medicamentos anti-hipertensivos verificadas no tratamento dos pacientes incluíram os betabloqueadores (46,51%) seguidos dos BRA (40,93%) e diuréticos (39,53%). Os níveis pressóricos dos pacientes variaram de 110 a 220 mmHg para a PAS e de 60 a 140 mmHg para a PAD, sendo que 33,02% dos pacientes apresentaram níveis pressóricos superiores ao limite de normalidade. Conclusões: Os medicamentos mais usados no tratamento e controle da HAS não são os mais eficazes atualmente e um número expressivo de pacientes sob tratamento não apresenta níveis pressóricos normalizados, em especial aqueles sob tratamento com dois medicamentos anti-hipertensivos. A pesquisa deixa clara a necessidade de melhor acompanhamento dos pacientes pelos profissionais de saúde quanto à resposta à terapia medicamentosa a fim de que se possa realmente prevenir danos maiores em órgãos-alvo.

Cyclosporine A impairs bone repair in critical defects filled with different osteoconductive bone substitutes.

The aim of this study was to assess the influence of cyclosporine administration on the repair of critical-sized calvaria defects (CSDs) in rat calvaria filled with diverse biomaterials. Sixty animals were divided into two groups: the control (CTR) group (saline solution) and the cyclosporine (CCP) group (cyclosporine, 10 mg/kg/day). These medications were administered daily by gavage, beginning 15 days before the surgical procedure and lasting until the day the animals were euthanized. A CSD (5 mm Ø) was made in the calvaria of each animal, which was allocated to one of 3 subgroups, according to the biomaterial used to fill the defect: coagulum (COA), deproteinized bovine bone (DBB), or biphasic calcium phosphate ceramics of hydroxyapatite and β-phosphate tricalcium (HA/TCP). Euthanasia of the animals was performed 15 and 60 days after the surgical procedure (n = 5 animals/period/subgroup). Bone repair (formation) assessment was performed through microtomography and histometry, while the analyses of the expression of the BMP2, Osteocalcin, and TGFβ1 proteins were performed using immunohistochemistry. The CSDs not filled with biomaterials demonstrated lower bone formation in the CCP group. At 15 days, less bone formation was observed in the CSDs filled with DBB, a smaller volume of mineralized tissue was observed in the CSDs filled with HA/TCP, and the expression levels of BMP2 and osteocalcin were lower in the CCP group compared to the CTR group. The use of cyclosporine impaired bone repair in CSD, and this effect can be partially explained by the suppression of BMP2 and osteocalcin expression

Ressecção de metástase hepática de sarcomas de partes moles

OBJETIVO: Avaliar os resultados do tratamento cirúrgico de pacientes portadores de metástases hepáticas de sarcomas de partes moles, com ênfase na identificação de fatores prognósticos e estudo de sobrevida. MÉTODO: Foi realizada análise retrospectiva de pacientes submetidos a ressecções hepáticas por sarcomas de partes moles metastáticos para fígado no Instituto Nacional de Câncer - MS entre 1992 e 2002. Fatores demográficos, características do tumor primário e dos tumores metastáticos, intervalo de surgimento de metástases, tipo de ressecção e resultados de sobrevida global e livre de doença, considerados a partir da operação para o tumor metastático foram considerados. Os dados obtidos foram analisados estatisticamente através dos softwares SPSS versão 8 e EpiInfo 2002.. RESULTADOS: O tumor primário era localizado no trato gastrintestinal em cinco pacientes, no retroperitônio em quatro e nos dois restantes no útero e no músculo deltóide. Leiomiossarcoma foi a linhagem histológica em 10 casos e dermatofibrossarcoma no caso restante, com grau de diferenciação tumoral G2 em seis casos e G3 em cinco. A extensão da ressecção hepática foi a segmentectomia em cinco pacientes, a lobectomia em quatro e as ressecções maiores em dois pacientes. Dois pacientes tiveram ressecções extra-hepáticas associadas. A ressecção foi completa em sete pacientes, persistindo doença residual macroscópica em quatro pacientes. Pela análise multivariada a sobrevida foi afetada pela radicalidade da ressecção, com 49 meses para as cirurgias completas e 15 meses para as incompletas (p< 0,05) e pelo grau de diferenciação tumoral, com 49 meses para os tumores G2 e 15 meses para os G3 (p< 0,0447). CONCLUSÕES: As ressecções hepáticas para metástases de sarcomas de partes moles podem aumentar a sobrevida destes pacientes, particularmente quando completas e para tumores de baixo grau de diferenciação

Epigenetic control of adamantinomatous craniopharyngiomas

Introduction: Studies addressing the methylation pattern in adamantinomatous craniopharyngioma (ACP) are lacking. Objective: To identify methylation signatures in ACPs regarding clinical presentation and outcome. Methods: Clinical and pathology data were collected from 35 ACP patients (54% male; 18.1 years [2-68]). CTNNB1 mutations and methylation profile (MethylationEPIC/Array-Illumina) were analyzed in tumoral DNA. Unsupervised machine learning analysis of this comprehensive methylome sample was achieved using hierarchical clustering and multi-dimensional scaling. Statistical associations between clusters and clinical features were achieved using Fisher’s test and global biological process interpretations were aided by Gene Ontology enrichment analyses. Results: Two clusters were revealed consistently by all unsupervised methods (ACP-1: n=18; ACP-2: n=17) with strong bootstrap statistical support. ACP-2 was enriched by CTNNB1 mutations (100% vs 56%, P=0.0006), hypomethylated in CpG Island (CGI),non-CGI sites, and globally (P<0.001), and associated with greater tumor size (24.1 vs 9.5cm3, P=0.04). Enrichment analysis highlighted pathways on signaling transduction, transmembrane receptor, development of anatomical structures, cell-adhesion, cytoskeleton organization, and cytokine binding, and also cell-type specific biological processes as regulation of oligodendrocytes, keratinocyte, and epithelial cells differentiation. Conclusion: Two clusters of ACP patients were consistently revealed by unsupervised machine learning methods, being one of them significantly hypomethylated, enriched by CTNNB1 mutated ACPs, and associated with increased tumor size. Enrichment analysis reinforced pathways involved in tumor proliferation and in cell-specific tumoral microenvironment.Data Availability The data generated or analyzed during this study are included in this published article and have been deposited in NCBI's Gene Expression Omnibus (GEO) and are accessible through GEO Series accession number GSE239695 (https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE239695)