Osteochondritis dissecans of the knee. Pearls and pitfalls of anatomical reduction and secure fixation

Osteochondritis dissecans of the knee is characterized by sterile necrosis of the subchondral bone and typically affects skeletally immature patients. When left untreated, osteochondritis dissecans can lead to early-onset osteoarthritis, resulting in pain and disability. This study shows the pearls and pitfalls of an arthroscopic technique of fixation performed successfully using a bioabsorbable nail for unstable osteochondritis dissecans lesions located in the medial femoral condyle of the knee

Arthroscopic medial compartment drive-through sign for knee medial collateral ligament complex injuries

Acute injuries of the knee medial collateral ligament complex concomitant with anterior cruciate ligament injuries are common. The exact site of the injury may be difficult to diagnose preoperatively on magnetic resonance imaging. This study describes an arthroscopic sign that helps determine the site of the knee medial collateral ligament complex injury. The “medial compartment drive-through sign,” visualized during arthroscopy, is described as an excessive opening of the medial compartment. If this excessive opening is above the meniscus, it corresponds to a femoral-sided injury; conversely, if the excessive opening is below the meniscus, then it is a tibial-sided injury. This allows a precise surgical incision to be made, thereby avoiding extensive approaches and possible wound-related complications

Isolated meniscotibial ligament rupture. The medial meniscus “belt lesion”

Ramp lesions play a major role in both anteroposterior and rotational instability following anterior cruciate ligament rupture. The meniscotibial ligament (MTL) is the most important structure to repair and is the primary stabilizer of the posterior horn of the medial meniscus. The posteroinferior insertion of the MTL on the posterior horn of the medial has been described, forming a posterior “belt.” Isolated MTL lesion diagnosis can be challenging, as the absence of a meniscocapsular ligament lesion prevents its correct visualization through transnotch vision. This article details a tech- nique to diagnose and repair the “belt lesion” of the medial meniscus

Presoaking ACL grafts in vancomycin decreases the frequency of postoperative septic arthritis. A cohort study of 29,659 patients, systematic review, and meta-analysis from the SANTI Study Group

Background: Presoaking anterior cruciate ligament (ACL) grafts in vancomycin has been reported to reduce the occurrence of septic arthritis (SA). However, strong recommendations for its universal use have been precluded by concerns regarding the fragility of previous meta-analyses. Purpose: The primary objective was to investigate whether presoaking ACL grafts in vancomycin was associated with a reduction in the rate of SA in a large series of patients. The secondary objective was to perform an updated systematic review and meta- analysis to determine the efficacy of vancomycin in reducing the rate of SA. Study Design: Cohort study and systematic review; Level of evidence, 3. Methods: A retrospective analysis of patients who underwent primary ACL reconstruction (ACLR) at our institution was undertaken. Rates of postoperative SA were determined and analyzed according to whether patients had received grafts presoaked in vanco- mycin. A systematic review of the literature and meta-analysis was performed. Odds ratios (ORs) for the risk of SA were calculated according to the inverse variance approach. Results were presented using forest plots, funnel plots, and the fragility index. Results: A total of 5300 patients underwent primary ACLR during the study period. The rate of SA was 0.34% (11/3228) in the control group and 0.05% (1/2072) in the presoaked group. There was a 5-fold greater risk of SA in patients who did not receive grafts presoaked in vancomycin (OR, 5.13 [95% CI, 1.16-48.30]; P 1⁄4 .04). Overall, 11 studies were included in the systematic review (29,659 ACLR procedures). The meta-analysis demonstrated a significantly greater risk of SA in those patients who did not receive grafts presoaked in vancomycin (OR, 14.39 [95% CI, 5.90-35.10]; fragility index 1⁄4 23). This finding held true for the subpopulation receiving hamstring tendon grafts (fragility index 1⁄4 16), but only a trend was demonstrated for bone–patellar ten- don–bone grafts. Conclusion: The meta-analysis demonstrated that presoaking ACL grafts in vancomycin was associated with significant reductions in the rates of SA when all graft types were analyzed together. This finding held true specifically for hamstring tendon autografts. The fragility index of these findings allows for a strong recommendation for the universal use of vancomycin presoaking. However, it should be noted that only a trend toward reduced SA rates was demonstrated with presoaking bone–patellar tendon– bone autografts in vancomycin

Presoaking ACL Grafts in Vancomycin Decreases the Frequency of Postoperative Septic Arthritis : A Cohort Study of 29,659 Patients, Systematic Review, and Meta-analysis From the SANTI Study Group

Presoaking anterior cruciate ligament (ACL) grafts in vancomycin has been reported to reduce the occurrence of septic arthritis (SA). However, strong recommendations for its universal use have been precluded by concerns regarding the fragility of previous meta-analyses. The primary objective was to investigate whether presoaking ACL grafts in vancomycin was associated with a reduction in the rate of SA in a large series of patients. The secondary objective was to perform an updated systematic review and meta-analysis to determine the efficacy of vancomycin in reducing the rate of SA. Cohort study and systematic review; Level of evidence, 3. A retrospective analysis of patients who underwent primary ACL reconstruction (ACLR) at our institution was undertaken. Rates of postoperative SA were determined and analyzed according to whether patients had received grafts presoaked in vancomycin. A systematic review of the literature and meta-analysis was performed. Odds ratios (ORs) for the risk of SA were calculated according to the inverse variance approach. Results were presented using forest plots, funnel plots, and the fragility index. A total of 5300 patients underwent primary ACLR during the study period. The rate of SA was 0.34% (11/3228) in the control group and 0.05% (1/2072) in the presoaked group. There was a 5-fold greater risk of SA in patients who did not receive grafts presoaked in vancomycin (OR, 5.13 [95% CI, 1.16-48.30]; P =.04). Overall, 11 studies were included in the systematic review (29,659 ACLR procedures). The meta-analysis demonstrated a significantly greater risk of SA in those patients who did not receive grafts presoaked in vancomycin (OR, 14.39 [95% CI, 5.90-35.10]; fragility index = 23). This finding held true for the subpopulation receiving hamstring tendon grafts (fragility index = 16), but only a trend was demonstrated for bone-patellar tendon-bone grafts. The meta-analysis demonstrated that presoaking ACL grafts in vancomycin was associated with significant reductions in the rates of SA when all graft types were analyzed together. This finding held true specifically for hamstring tendon autografts. The fragility index of these findings allows for a strong recommendation for the universal use of vancomycin presoaking. However, it should be noted that only a trend toward reduced SA rates was demonstrated with presoaking bone-patellar tendon-bone autografts in vancomycin

Joaquim Rodrigo’s Painting : A Particularity in the Portuguese Case

Capítulo da obra "RETHINKING EUROPE: ARTISTIC PRODUCTION AND DISCOURSES OF ART IN THE LATE 1940S AND 1950S.", que resultou da conferência ocorrida em 2018.In the postwar period, Portuguese art faced a politically-imposed isolation that prevented emerging artists from engaging and interacting with the rest of Europe. For these artisits, other geographical, cultural contexts were no more than remote possibilities of exchange: sometimes mythical places of an avant-garde known through magazine articles, sometimes places they had briefly visited in search of a more direct link with their time. Portugal lived in an established dictatorship known as Estado Novo (New State) that lasted until 1974. The regime's anti-modernism sought to eliminate all modern artistic practices in an attempt to preserve its traditional cultural values, strongly dominated by the government's fascist ideology. The absence of structures for the production, exhibition, and reception of modern art during the twentieth century contributed towards the lessening of modern pratices in the national context, hindering the development of knowledge updated by artists, critics, and audiences. In spite of these setbacks, overall Portuguese artists succeded in overcoming this aloofness to which the regime condemned them. Over time, these artists managed to find ways to a distant modernity - which had become predominant in the process of reconstructing a new world in the postwar period in Wetern Europe. [com o apoio à tradução da Fundação para a Ciência e a Tecnologia - FCT]info:eu-repo/semantics/publishedVersio

A study of backward going pp and π−\pi^{-} in νμCC\nu_{\mu}CC interactions with the NOMAD detector

Backward proton and $\pi^-$ production has been studied in $\nu_{\mu}CC$ interactions with carbon nuclei. Detailed analyses of the momentum distributions, of the production rates, and of the general features of events with a backward going particle, have been carried out in order to understand the mechanism producing these particles. The backward proton data have been compared with the predictions of the reinteraction and the short range correlation models.Comment: 29 pages, 14 figures, submitted to Nucl. Phys.

Gold Mining in the Peruvian Amazon: Global Prices, Deforestation, and Mercury Imports

Many factors such as poverty, ineffective institutions and environmental regulations may prevent developing countries from managing how natural resources are extracted to meet a strong market demand. Extraction for some resources has reached such proportions that evidence is measurable from space. We present recent evidence of the global demand for a single commodity and the ecosystem destruction resulting from commodity extraction, recorded by satellites for one of the most biodiverse areas of the world. We find that since 2003, recent mining deforestation in Madre de Dios, Peru is increasing nonlinearly alongside a constant annual rate of increase in international gold price (∼18%/yr). We detect that the new pattern of mining deforestation (1915 ha/year, 2006–2009) is outpacing that of nearby settlement deforestation. We show that gold price is linked with exponential increases in Peruvian national mercury imports over time (R2 = 0.93, p = 0.04, 2003–2009). Given the past rates of increase we predict that mercury imports may more than double for 2011 (∼500 t/year). Virtually all of Peru's mercury imports are used in artisanal gold mining. Much of the mining increase is unregulated/artisanal in nature, lacking environmental impact analysis or miner education. As a result, large quantities of mercury are being released into the atmosphere, sediments and waterways. Other developing countries endowed with gold deposits are likely experiencing similar environmental destruction in response to recent record high gold prices. The increasing availability of satellite imagery ought to evoke further studies linking economic variables with land use and cover changes on the ground

Vascular endothelial cell expression of JAK2V617F is sufficient to promote a pro-thrombotic state due to increased P-selectin expression

Thrombosis is the main cause of morbidity and mortality in patients with JAK2V617F myeloproliferative neoplasms. Recent studies have reported the presence of JAK2V617F in endothelial cells of some patients with myeloproliferative neoplasms. We investigated the role of endothelial cells that express JAK2V617F in thrombus formation using an in vitro model of human endothelial cells overexpressing JAK2V617F and an in vivo model of mice with endothelial-specific JAK2V617F expression. Interestingly, these mice displayed a higher propensity for thrombus. When deciphering the mechanisms by which JAK2V617F-expressing endothelial cells promote thrombosis, we observed that they have a pro-adhesive phenotype associated with increased endothelial P-selectin exposure, secondary to degranulation of Weibel-Palade bodies. We demonstrated that P-selectin blockade was sufficient to reduce the increased propensity of thrombosis. Moreover, treatment with hydroxyurea also reduced thrombosis and decreased the pathological interaction between leukocytes and JAK2V617F-expressing endothelial cells through direct reduction of endothelial P-selectin expression. Taken together, our data provide evidence that JAK2V617F-expressing endothelial cells promote thrombosis through induction of endothelial P-selectin expression, which can be reversed by hydroxyurea. Our findings increase our understanding of thrombosis in patients with myeloproliferative neoplasms, at least those with JAK2V617F-positive endothelial cells, and highlight a new role for hydroxyurea. This novel finding provides the proof of concept that an acquired genetic mutation can affect the pro-thrombotic nature of endothelial cells, suggesting that other mutations in endothelial cells could be causal in thrombotic disorders of unknown cause, which account for 50% of recurrent venous thromboses