Long-Term Survival and Predictors of Failure of Opening Wedge High Tibial Osteotomy

Objective: High tibial valgus osteotomy (HTO) is a widely accepted procedure indicated for varus knee with symptomatic osteoarthritis of the medial compartment. However, there is a lack of studies evaluating long term results of this procedure. The primary aim of this study was to evaluate the long-term survival of opening wedge high tibial osteotomy (HTO) for isolated osteoarthritis in the medial compartment of the knee. The secondary objective was to identify independent predictors of conversion to total knee arthroplasty (TKA). Methods: This is a long term retrospective study of 296 cases of open wedge HTOs performed at a single center (level of evidence IV) between January 2005 and August 2015. Opening wedge medial HTO was always performed after diagnostic arthroscopy. Eighty-three percent of the population (233 patients, 247 procedures) was followed up at a mean 11.6 years (6-17) by telephone interview, to evaluate the possible conversion to TKA. Mean age at the index operation was 42.8 years (range 15-70) and most patients were male (70%). Associated procedures (e.g., platelet rich plasma supplementation, microfractures, meniscectomy, etc.) were carried out at the time of the HTO in 80 (32%) cases. Survival of HTO and its association with age, sex, body mass index, smoking habit, preoperative severity of varus deformity, cartilage status at surgery, and associated procedures were evaluated. Kaplan-Meier and Cox regression analyses were performed. Results: Thirty-three of the 247 HTOs (13.4%) were converted to knee replacement, with 86.6% of the original procedures surviving at a mean 12-year follow-up. Kaplan-Meier survival estimates at 17 years for HTO were 75.5% (95% confidence interval [CI] 66.7-84.3). There was significant difference (P < 0.001) in the 17-year survival rate between obese (55.5%; 95% CI 35.3-75.6) and non-obese (79.7%; 95% CI 70.1-89.2) patients. The determinants of conversion to knee arthroplasty detected at multivariate Cox regression analysis were body mass index, severity of cartilage degeneration in the medial compartment (Outerbridge grade), and age. Conclusion: The long-term survival of open wedge HTO for osteoarthritis in the medial compartment of the knee is satisfactory. The risk of conversion to TKA is significantly increased in obese patients. Advanced age and severity of pre-existing cartilage damage may also contribute to the risk of conversion to TKA

Petrogenesis of Mediterranean lamproites and associated rocks: the role of overprinted metasomatic events in the postcollisional lithospheric upper mantle

High-MgO lamproite and lamproite-like (i.e. lamprophyric) ultrapotassic rocks are recurrent in the Mediterranean and surrounding regions. They are associated in space and time with ultrapotassic shoshonites and high-K calc-alkaline rocks. This magmatism is linked with the geodynamic evolution of the westernmost sector of the Alpine–Himalayan collisional margin, which followed the closure of the Tethys Ocean. Subduc- tion-related lamproites, lamprophyres, shoshonites and high-K calc-alkaline suites were emplaced in the Medi- terranean region in the form of shallow level intrusions (e.g. plugs, dykes and laccoliths) and small volume lava flows, with very subordinate pyroclastic rocks, starting from the Oligocene, in the Western Alps (northern Italy), through the Late Miocene in Corsica (southern France) and in Murcia-Almeria (southeastern Spain), to the Plio- Pleistocene in Southern Tuscany and Northern Latium (central Italy), in the Balkan peninsula (Serbia and Mac- edonia) and in the Western Anatolia (Turkey). The ultrapotassic rocks are mostly lamprophyric, but olivine latitic lavas with a clear lamproitic affinity are also found, as well as dacitic to trachytic differentiated products. Lamp- roite-like rocks range from slightly silica under-saturated to silica over-saturated composition, have relatively low Al2O3, CaO and Na2O contents, resulting in plagioclase-free parageneses, and consist of abundant K-feldspar, phlogopite, diopsidic clinopyroxene and highly forsteritic olivine. Leucite is generally absent, and it is rarely found only in the groundmasses of Spanish lamproites. Mediterranean lamproites and associated rocks share an extreme enrichment in many incompatible trace elements and depletion in High Field Strength Elements and high, and positively correlated Th/La and Sm/La ratios. They have radiogenic Sr and unradiogenic Nd iso- tope compositions, high 207Pb over 206Pb and high time-integrated 232Th/238U. Their composition requires an originally depleted lithospheric mantle source metasomatized by at least two different agents: (1) a high Th/ La and Sm/La (i.e. SALATHO) component deriving from lawsonite-bearing, ancient crustal domains likely hosted in mélanges formed during the diachronous collision of the northward drifting continental slivers from Gondwana; (2) a K-rich component derived from a recent subduction and recycling of siliciclastic sediments. These metasomatic melts produced a lithospheric mantle source characterized by network of felsic and phlogo- pite-rich veins, respectively. Geothermal readjustment during post-collisional events induced progressive melt- ing of the different types of veins and the surrounding peridotite generating the entire compositional spectrum of the observed magmas. In this complex scenario, orogenic Mediterranean lamproites represent rocks that charac- terize areas that were affected by multiple Wilson cycles, as observed in the Alpine–Himalayan Realm

Weather-Related Flood and Landslide Damage: A Risk Index for Italian Regions

The frequency of natural hazards has been increasing in the last decades in Europe and specifically in Mediterranean regions due to climate change. For example heavy precipitation events can lead to disasters through the interaction with exposed and vulnerable people and natural systems. It is therefore necessary a prevention planning to preserve human health and to reduce economic losses. Prevention should mainly be carried out with more adequate land management, also supported by the development of an appropriate risk prediction tool based on weather forecasts. The main aim of this study is to investigate the relationship between weather types (WTs) and the frequency of floods and landslides that have caused damage to properties, personal injuries, or deaths in the Italian regions over recent decades. In particular, a specific risk index (WT-FLARI) for each WT was developed at national and regional scale. This study has identified a specific risk index associated with each weather type, calibrated for each Italian region and applicable to both annual and seasonal levels. The risk index represents the seasonal and annual vulnerability of each Italian region and indicates that additional preventive actions are necessary for some regions. The results of this study represent a good starting point towards the development of a tool to support policy-makers, local authorities and health agencies in planning actions, mainly in the medium to long term, aimed at the weather damage reduction that represents an important issue of the World Meteorological Organization mission

Application of cupuassu shell as biosorbent for the removal of textile dyes from aqueous solution

AbstractThe cupuassu shell (Theobroma grandiflorum) which is a food residue was used in its natural form as biosorbent for the removal of C.I. Reactive Red 194 and C.I. Direct Blue 53 dyes from aqueous solutions. This biosorbent was characterized by infrared spectroscopy, scanning electron microscopy, and nitrogen adsorption/desorption curves. The effects of pH, biosorbent dosage and shaking time on biosorption capacities were studied. In acidic pH region (pH 2.0) the biosorption of the dyes were favorable. The contact time required to obtain the equilibrium was 8 and 18 h at 298 K, for Reactive Red 194 and Direct Blue 53, respectively. The Avrami fractionary-order kinetic model provided the best fit to experimental data compared with pseudo-first-order, pseudo-second-order and chemisorption kinetic adsorption models. The equilibrium data were fitted to Langmuir, Freundlich, Sips and Radke–Prausnitz isotherm models. For both dyes the equilibrium data were best fitted to the Sips isotherm model

MODELOS SINTÉTICOS DE APRENDIZAGEM PARA APLICAÇÃO DE INJEÇÃO PELAS VIAS INTRAMUSCULAR E SUBCUTÂNEA EM CÃES

Na Medicina Veterinária, a aplicação de injeções é uma das habilidades clínicas que pode causar ansiedade nos estudantes, interferindo na aprendizagem. O objetivo do presente estudo foi desenvolver e validar modelos sintéticos de aprendizagem para aplicação de injeção pelas vias intramuscular e subcutânea em cães. A metodologia incluiu a confecção de três modelos sintéticos, sendo um para administração de injeção intramuscular no membro pélvico, outro para injeção intramuscular nos músculos lombodorsais e um terceiro para injeção subcutânea. Foram utilizadas borrachas de silicone de diferentes densidades para a obtenção das consistências desejadas. Os modelos foram acoplados em manequins de pelúcia e passaram por avaliação de médicos veterinários experientes. Após ajustes sugeridos, os modelos foram utilizados em aula por 69 estudantes da disciplina de Semiologia Geral Veterinária. No final da aula, os estudantes responderam a um questionário, para opinar sobre o aprendizado com os modelos, que contava com questões em escala Likert de 5 pontos e questões abertas. A maioria dos estudantes (98,4%) concordou ou concordou fortemente quanto à contribuição dos métodos utilizados para seu aprendizado e 92,6% disseram se sentir mais confiantes para aplicação de injeção no animal vivo. Após aula com o modelo sintético, 20 estudantes tiveram a oportunidade de aplicar injeções pela via subcutânea em cães vivos, sendo que 100% dos estudantes concordaram ou concordaram fortemente que o modelo sintético auxiliou na realização da técnica de injeção no animal vivo. Os modelos se mostraram uma ferramenta eficiente para o aprendizado de aplicação de injeção pelas vias intramuscular e subcutânea em cães

Factors associated with phases of feeding behavior in users of popular restaurants in Belo Horizonte - MG, Brazil

RESUMO - Associaram-se as fases de mudança de comportamento alimentar de usuários de restaurantes populares aos aspectos: sociodemográfico, estado nutricional e hábito alimentar. Elaborou-se um estudo descritivo analítico, conduzido com 1.656 usuários de restaurantes populares de Belo Horizonte-MG. Coletaram-se dados sociodemográficos. Os estádios e fases de mudança do comportamento alimentar foram apurados por meio de questionários estruturados. Os fatores associados à fase de ação foram: mulheres, classes econômicas A e B, ensino superior, excesso de peso e bons hábitos alimentares. À fase de pré-ação associaram-se: homens, classes econômicas D e E, ensino fundamental, sem excesso de peso e hábito alimentar regular. Encontrou-se associação entre as variáveis estudadas.ABSTRACT - Phases of change in feeding behavior of users of popular restaurants were associated to: sociodemographic aspects, nutritional status and dietary habits. An analytical descriptive study was conducted with 1656 users of popular restaurants in Belo Horizonte-MG. Sociodemographic data, stages and phases of dietary change were assessed through structured questionnaires. The associated action phase factors were: women, economic classes A and B, higher education, overweight and good eating habits. To the pre-action phase the association was: men, economic classes D and E, elementary education, not overweight, and regular eating habits. An association between the studied variables was observed.info:eu-repo/semantics/publishedVersio

Quantitation of regional ejection fractions using gated tomographic imaging with Tc-99m-sestamibi

BACKGROUND: A new oro-dispersible film (ODF) formulation of sildenafil has been developed for the treatment of erectile dysfunction (ED) to overcome the drawbacks that some patients experience when taking the conventional film-coated tablet (FCT). AIM: To assess the effectiveness and safety of sildenafil ODF formulation in patients with ED who were using the conventional FCT. METHODS: From May 2017 through July 2017, 139 patients with ED were enrolled. Data from penile color-duplex ultrasound, medical history, hormonal evaluation, and patient self-administered questionnaires were collected. All patients were administered sildenafil 100-mg FCT for 4 weeks. Thereafter, they underwent a 2-week washout period and subsequently took sildenafil 75-mg ODF for 4 weeks. OUTCOMES: The International Index of Erectile Function (IIEF-15), Hospital Anxiety and Depression Scale (HADS), Patient Global Impressions of Improvement (PGI-I), and Clinician Global Impressions of Improvement (CGI-I) questionnaires were administered and severity of ED was classified as severe (IIEF-15 score ≤ 10), moderate (IIEF-15 score 11-16), or mild (IIEF-15 score = 17-25). RESULTS: All patients completed the final protocol. Differences in mean IIEF scores for erectile function, orgasmic function, sexual desire, and intercourse satisfaction were significantly in favor of sildenafil 100-mg FCT, whereas the mean score for overall satisfaction was in favor of sildenafil 75-mg ODF. A significant difference in changes in HADS score was found from washout to final follow-up (mean difference = -0.19; P < .01). For the ODF formulation, the median CGI-I score was 3.5 (interquartile range [IQR] = 2.5-4.5) and the median PGI-I score was 3.0 (IQR = 2.0-4.0). The median action time was 20.0 minutes (IQR = 15.0-30.0) and the median mouth time was 60.0 seconds (IQR = 30.0-120.0). CLINICAL IMPLICATIONS: The ODF formulation of a widely known drug, with the same safety and effectiveness of the FCT, was better appreciated by patients in overall satisfaction. STRENGTHS AND LIMITATIONS: This is the first clinical trial to assess the efficacy of a new formulation of sildenafil in patients with ED. The limitations of the study are related to the methodology used: it was not a case-control study and the patients were not drug-naïve for ED treatment. Therefore, only the "additional" side effects of the ODF formulation compared with FCT are reported. CONCLUSION: The new ODF formulation is as efficient and safe as the FCT formulation and offers a new choice of treatment to specialists for more precisely tailored therapy. Cocci A, Capece M, Cito G, et al. Effectiveness and Safety of Oro-Dispersible Sildenafil in a New Film Formulation for the Treatment of Erectile Dysfunction: Comparison Between Sildenafil 100-mg Film-Coated Tablet and 75-mg Oro-Dispersible Film. J Sex Med 2017;X:XXX-XXX

I.S.Mu.L.T. Achilles Tendon Ruptures Guidelines

This work provides easily accessible guidelines for the diagnosis, treatment and rehabilitation of Achilles tendon ruptures. These guidelines could be considered as recommendations for good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care for the individual patient and rationalize the use of resources. This work is divided into two sessions: 1) questions about hot topics; 2) answers to the questions following Evidence Based Medicine principles. Despite the frequency of the pathology andthe high level of satisfaction achieved in treatment of Achilles tendon ruptures, a global consensus is lacking. In fact, there is not a uniform treatment and rehabilitation protocol used for Achilles tendon ruptures

MODELOS PARA O ENSINO DO EXAME DA CAVIDADE ORAL EM ROEDORES E COELHOS

O exame da cavidade oral de roedores e coelhos domésticos é muito importante para o diagnóstico da síndrome do desgaste dentário inadequado, que leva ao hipercrescimento dentário e consequentemente a problemas sistêmicos. A anatomia da cavidade oral não favorece o exame, sendo indicado o uso de otoscópio para a observação dos dentes molares. O objetivo deste estudo foi criar modelos para o ensino da avaliação da cavidade oral de roedores e lagomorfos. Os modelos para avaliação com otoscópio foram confeccionados a partir de crânios de cadáveres éticos, silicone e tecido de pelúcia. Como complemento, foram confeccionados modelos de resina a partir de moldes obtidos de cadáveres e também disponibilizados sincrânios normais e alterados. Foi feita a validação dos modelos com a participação de médicos veterinários que trabalham com o otoscópio como ferramenta para avaliação da cavidade oral. Após a validação de conteúdo pelos experts, o modelo foi apresentado aos estudantes para validação de construto. Participaram do estudo 30 estudantes de medicina veterinária, que após aula teórica sobre odontologia de roedores e lagomorfos e aula prática com os modelos, responderam a um questionário. A maioria dos estudantes (98%) considerou os modelos realistas e a prática didática e citou que os modelos auxiliaram na melhor compreensão da avaliação dentária e no melhor entendimento anatômico dos dentes de roedores e lagomorfos. Com isso, pôde-se perceber que esse tipo de modelo para estudo e treinamento da odontologia de roedores e lagomorfos foi bem aceito pelos estudantes. Pela importância do estudo da odontologia veterinária como especialidade nesse grupo específico de animais, recomendamos que os modelos para exame da cavidade oral sejam introduzidos na rotina das universidades