Primary Total Arthroplasty in Stiff Knees

Knee with less than a 50° arc of motion can be considered “stiff.” The surgical exposure in total knee arthroplasty (TKA) is technically challenging in the stiff knees. Other problems like longer operative time, patellar maltracking, rupture or avulsion of patellar tendon, difficulty in flexion-extension gap balancing, bone avulsion, or fracture in the distal femur can occur during TKA. It is not uncommon, and the surgeon needs an extensile surgical approach as early quadriceps release or tibial tubercle osteotomy for adequate exposure. The TKA postoperative outcome is suboptimal with less arc of motion, superficial wound problems, deep infection, and higher late revision surgeries. The rehabilitation protocol should take into account improvements in the range of motion in comparison with the preoperative status, and the patient expectations must be realistic

O direito constitucional ao trabalho e as pessoas com deficiência: uma análise sob a ótica da lei brasileira de inclusão

O presente trabalho tem por objetivo realizar um estudo sobre o Direito Constitucional ao Trabalho, mais especificamente no que se refere à inclusão das pessoas com deficiência no âmbito laboral. Buscaremos analisar as principais fontes de regulamentação pertinentes à matéria, explanando os fundamentos norteadores do direito ao trabalho, demonstrando que a inclusão destes indivíduos no mercado de trabalho ainda é um assunto gerador de discussão e polêmica. No entanto, é um direito que deve ser concretizado, já que se trata um direito social estabelecido constitucionalmente. A materialização da legislação existente e a mudança de uma concepção social excludente, atrelados a um planejamento inclusivo, são fatores necessários para que os mais diversos tipos de barreiras sejam afastados destes indivíduos. Palavras-chave: Inclusão. Acessibilidade. Deficiência. Trabalho. Classificação “Journal of Economic Literature (JEL)”: K.31 Abstract: The purpose of this study is to carry out an investigation on Labor Constitutional Law, more specifically, regarding the inclusion of people with disabilities in the workplace. We will analyze the main sources of regulation inherent to the matter, explaining the guiding principles of the right to work and demonstrating that the inclusion of these individuals in the labor market is still a source of discussion and controversy. Nevertheless, it is a right that must be fulfilled since it is a constitutionally established social right. The materialization of the existing legislation and the change of an exclusionary social conception, linked to an inclusive planning, are necessary factors so that the most diverse types of barriers are removed from these individuals. Keywords: Inclusion. Accessibility. Deficiency. Job. Journal of Economic Literature (JEL): K.3

Prevalence of Pain on Palpation of the Inferior Pole of the Patella Among Patients with Complaints of knee Pain

CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands

Evaluation of skin temperature, reactive C protein, and hemosedimentation speed variation in uncomplicated primary knee total arthroplasty

OBJECTIVE: To study the variation of skin temperature values (deltaT) on operative site, of reactive C protein (RCP) and of hemosedimentation speed (HSS) in patients submitted to primary knee total arthroplasty (KTA), in an attempt to establish a correlation among its curves over time. MATERIALS AND METHODS: This prospective clinical study evaluated 29 patients followed up during 12 weeks, with measurements of skin temperature in both knees and RCP and HSS serum dosages. RESULTS: After comparing the variables tested (deltaT, RCP and HSS), no statistical correlation was observed for both the Pearson s test (parametric test) and the Spearman s test (non-parametric test) among variables. Skin temperature variation follows a different pattern from that observed both for RCP and for HSS, with no correlation among curves. A standard curve was established for the three variables, and a statistically significant reduction was seen in RCP and HSS values from pre- to post-operative period. CONCLUSION: No correlation was observed between skin temperature and HSS and RCP levels in patients submitted to uncomplicated primary KTA.OBJETIVO: Estudar a variação dos valores da temperatura cutânea (deltaT) do sítio operatório, da proteína C reativa (PCR) e da velocidade de hemossedimentação (VHS) em pacientes submetidos a artroplastia total do joelho (ATJ) primária, tentando estabelecer correlação entre suas curvas ao longo do tempo. MATERIAL E MÉTODOS: Esse estudo clínico prospectivo, avaliou 29 pacientes acompanhados por 12 semanas, sendo aferida a temperatura cutânea em ambos os joelhos e realizada dosagem sérica da PCR e VHS. RESULTADOS: Após a comparação entre as variáveis testadas (deltaT, PCR e VHS), observou-se tanto para o teste de Pearson (avaliação paramétrica), quanto para o de Spearman (avaliação não-paramétrica) que não houve correlação estatística entre elas. A variação da temperatura cutânea segue um padrão diferente do observado tanto para a PCR quanto para a VHS, não existindo correlação entre as curvas. Foi estabelecida a curva padrão das três variáveis, verificando-se redução estatisticamente significativa nos valores da PCR e da VHS entre o pré e o pós-operatório. CONCLUSÃO: Não foi observada correlação entre a temperatura cutânea e os níveis de VHS e PCR em pacientes submetidos a ATJ primária, isenta de complicações.UNIFESPUFMG Faculdade de Medicina Departamento do Aparelho locomotorUFMG Serviço de Ortopedia do HCUNIFESPSciEL

Synthesis of a chitosan nanoparticle suspension and its protective effects against enamel demineralization after an in vitro cariogenic challenge

Objective: Our study aims to synthesize, characterize, and determine the effects of a ChNPs suspension on human enamel after cariogenic challenge via pH-cycling. Methodology: ChNPs were synthesized by ion gelation and characterized by Transmission Electron Microscopy (TEM) and Dynamic Light Scattering. Forty enamel blocks were divided into four groups (n=10/group): (i) ChNPs suspension; (ii) chitosan solution; (iii) 0.05% sodium fluoride (NaF) solution; and (iv) distilled water. Specimens were exposed to cariogenic challenge by cycling in demineralization solution (3 h) and then remineralized (21h) for 7 days. Before each demineralization cycle, the corresponding solutions were passively applied for 90 s. After 7 days, specimens were examined for surface roughness (Ra) and Knoop hardness (KHN) before and after the cariogenic challenge; % KHN change (variation between initial and final hardness), and surface topography by an optical profilometer. The data were analyzed by repeated-measures ANOVA, One-way ANOVA, and Tukey tests (α=0.05). Results: TEM images showed small spherical particles with diameter and zeta potential values of 79.3 nm and +47.9 mV, respectively. After the challenge, all groups showed an increase in Ra and a decrease in KHN values. Optical profilometry indicated that ChNPs- and NaF-treated specimens showed uneven roughness interspersed with smooth areas and the lowest %KHN values. Conclusion: The ChNPs suspension was successfully synthesized and minimized human enamel demineralization after a cariogenic challenge, showing an interesting potential for use as an oral formulation for caries prevention

Neorickettsia sp. in coatis (Nasua nasua) in Brazil

Abstract The genus Neorickettsia comprises trematode-associated bacteria that can cause diseases in animals and humans. Despite detection of Neorickettsia antigens in the intestine of coatis kept in captivity in southern Brazil through immunohistochemistry, the molecular identity of the bacteria in South American procyonids remains elusive. The aim of the present study was to investigate the occurrence of Neorickettsia sp. in blood samples from coatis in central-western Brazil. Between March 2018 and January 2019, animals were captured and recaptured in two areas of the Cerrado (Parque Estadual do Prosa, PEP; and Vila da Base Aérea, VBA) located in the city of Campo Grande, state of Mato Grosso do Sul, central-western Brazil. All captures were performed according to convenience. DNA from 97 blood samples was subjected to nested PCR (nPCR) targeting a fragment of the 16S rRNA gene of Neorickettsia sp. Six samples (3.6%; five from VBA and one from PEP) from different coatis were positive in nPCR based on the 16S rRNA. The sequences obtained (~500 bp) showed ˃ 99% similarity to N. risticii. Phylogenetic analysis clustered the sequences detected in the present study in a clade with N. risticii. This is the first molecular detection of Neorickettsia sp. in coatis in Brazil

Análise das propriedades mecânicas de mistura asfáltica produzida com hidróxido de cálcio / Analysis of mechanical properties of asphalt mixture produced with calcium hydroxide

Este estudo buscou avaliar a viabilidade da utilização do resíduo sólido hidróxido de cálcio em composições asfálticas. Para isso, foram produzidas duas misturas asfálticas, uma confeccionada com hidróxido de cálcio, codificada por CA-CAL, e a outra composição asfáltica com cimento Portland, codificada por CA-REF. Para atingir o objetivo foram realizados os ensaios de resistência à tração por compressão diametral (RTCD), módulo de resiliência (MR) e módulo dinâmico (MD). Após a realização dos ensaios mecânicos, constatou-se que, sob as condições analisadas, a composição asfáltica produzida com hidróxido de cálcio torna-se uma alternativa promissora como material aplicável em pavimentos rodoviários, atuando como substituto do fíler tradicional (cimento Portland), constituindo-se, assim, uma aplicação sustentável do resíduo em questão.

Conventional Versus Biological Therapy for Prevention of Postoperative Endoscopic Recurrence in Patients With Crohn's Disease: an International, Multicenter, and Observational Study

Background/AimsPostoperative endoscopic recurrence (PER) occurs in nearly 80% of patients 1 year after ileocecal resection in patients with Crohn's disease (CD). Biological agents were more effective in reducing the rates of PER in comparison with conventional therapy, in prospective trials. The aim of this study was to compare the PER rates of biological versus conventional therapy after ileocecal resections in patients with CD in real-world practice.MethodsThe MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database is a retrospective analysis of PER rates in CD patients after ileocecal resection, from 7 referral centers in 3 different countries. All consecutive patients who underwent ileocecal resections between 2008 and 2012 and in whom colonoscopies had been performed up to 12 months after surgery, were included. Recurrence was defined as Rutgeerts' score ≥i2. The patients were allocated to either biological or conventional therapy after surgery, and PER rates were compared between the groups.ResultsInitially, 231 patients were evaluated, and 63 were excluded. Of the 168 patients in the database, 96 received anti-tumor necrosis factor agents and 72 were treated with conventional therapy after resection. The groups were comparable regarding age, gender, and perianal disease. There was longer disease duration, more previous resections, and more open surgical procedures in patients on biologicals postoperatively. PER was identified in 25/96 (26%) patients on biological therapy and in 24/72 (33.3%) patients on conventional therapy (P=0.310).ConclusionsIn this retrospective observational analysis from an international database, no difference was observed between biological and conventional therapy in preventing PER after ileocecal resections in CD patients