Tissue engineering as a remarkable tool for cartilage repair

Articular cartilage is a very specialized tissue with outstanding load-bearing capacity. It consists mainly of a dense extracellular matrix (ECM) with chondrocytes embedded on it. Cartilage has very low capacity of self-repair and regeneration after traumatic, degenerative or inflammatory injury. Current available surgical treatments for cartilage repair present several drawbacks, such as possible implant rejection or infection, or the need for revision after some years of implantation. Autologous chondrocyte implantation (ACI) is an autologous therapy that was proposed as a basis for tissue engineering strategies to repair cartilage (1). Modifications on various aspects of this surgical technique have been developed, comprising the use of natural-based scaffolds as supports for chondrocyte expansion (2). Many strategies and systems have been developed along the years for cartilage regeneration and repair. Scaffolds play a major role in those strategies, as they provide the support for cell growth and to promote extracellular matrix production. Both natural based (3) or synthetic scaffolds (4) have been successfully used as supports for chondrogenic differentiation or cartilage-like tissue production. The interest in cells cross-talk and communication has been growing in the past years, revealing that signalling pathways are pivotal elements when understanding the tissue formation and its repair mechanisms (5). Chondrocytes release morphogenetic signals that influence the surrounding cells, for example, stem cells, to differentiate into the chondrogenic lineage (5). In fact, the increased cartilage formation on co-cultures using stem cells and articular chondrocytes has been reported (6). Therefore, the study of co-cultures using chondrocytes and undifferentiated cells is a very promising strategy to develop engineered cartilage

Perfil nutricional dos militares de uma unidade militar da cidade de Anápolis em Goiás

A avaliação nutricional fornece informações a respeito do estado nutricional. Existem diversos métodos para avaliar este estado, tais como: peso, altura, IMC, pregas ou dobras cutâneas, circunferência braquial e abdominal. Nas classes militares, a aptidão física é um fator determinante e níveis inadequados nutricionais influenciam negativamente tanto no ingresso quanto ao sistema promocional da carreira militar. Na pesquisa foram avaliados militares submetidos à avaliação do teste de avaliação do condicionamento físico. A base da pesquisa consistiu na análise de dados que são organizados e tabelados em planilhas. O objetivo do trabalho foi avaliar o estado nutricional de militares de uma unidade militar da cidade de Anápolis. O grupo analisado apresentou 56,39% de eutrofia e 36,42% sobrepeso, o índice de gordura corporal foi muito bom e adequado, e o risco de doenças cardiovasculares resultou em normal e moderado. ABSTRACTNutritional profile of a military unit in the city of Anápolis in GoiásThe nutritional evaluation provides information regarding nutritional status. There are several methods to evaluate this State, such as: weight, height, BMI, pleats or skinfolds, brachial and abdominal circumference. Military classes, physical fitness is a determining factor, namely, low levels of physical fitness influencing negatively both the ticket promotional system of military career. In the research were evaluated and submitted to an evaluation of military test of fitness assessment. The basis of the research consisted in the analysis of data that is organized and tabulated in Excel type spreadsheets. The aim of this work was to evaluate the nutritional status of military personnel of a military unit city of Annapolis. The analyzed presented 56.39% of eutrophy and 36.42% overweight, body fat index was very good and suitable, and the risk of cardiovascular diseases resulted in normal and moderate

“Bone-shot fracture” – An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report

Case: A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. Conclusion: This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon

Impact of biological agents and tissue engineering approaches on the treatment of rheumatic diseases

The treatment of rheumatic diseases has been the focus of many clinical studies aiming to achieve the best combination of drugs for symptom reduction. Although improved understanding of the pathophysiology of rheumatic diseases has led to the identification of effective therapeutic strategies, its cure remains unknown. Biological agents are a breakthrough in the treatment of these diseases. They proved to be more effective than the other conventional therapies in refractory inflammatory rheumatic diseases. Among them, tumor necrosis factor inhibitors are widely used, namely Etanercept, Infliximab, or Adalimumab, alone or in combination with disease-modifying antirheumatic drugs. Nevertheless, severe adverse effects have been detected in patients with history of recurrent infections, including cardiac failure or malignancy. Currently, most of the available therapies for rheumatic diseases do not have sufficient tissue specificity. Consequently, high drug doses must be administrated systemically, leading to adverse side effects associated with its possible toxicity. Drug delivery systems, by its targeted nature, are excellent solutions to overcome this problem. In this review, we will describe the state-of-the-art in clinical studies on the treatment of rheumatic diseases, emphasizing the use of biological agents and target drug delivery systems. Some alternative novel strategies of regenerative medicine and its implications for rheumatic diseases will also be discussed.The authors state that there is no conflict of interests, including financial, relationships, or affiliations relevant for the subject. M. Alves da Silva and A. Martins acknowledge the Portuguese Foundation for Science and Technology for their Ph.D. grants and European NoE EXPERTISSUES (NMP3-CT-2004-500283)

Cost effectiveness of outpatient lumbar discectomy

Background: Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure. Methods: This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated. Results: Outpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from €135,753 to €345,755/QALY, higher than the predefined threshold of €60,000/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group. Conclusion: This is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective

Chondroitin sulfate immobilization at the surface of electrospun nanofiber meshes for cartilage regeneration

Aiming at improving the biocompatibility of biomaterial scaffolds, surface modification presents a way to preserve their mechanical properties and to improve the surface bioactivity. In this work, chondroitin sulfate (CS) was immobilized at the surface of electrospun poly(caprolactone) nanofiber meshes (PCL NFMs). The immobilization was performed with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS). Contact Angle, SEM, Optical Profilometry, FTIR, X-ray photoelectron spectroscopy techniques confirmed the CS-immobilization in PCL NFMs. Furthermore, CS-immobilized PCL NFMs showed lower roughness and higher hydrophilicity than the samples without CS. Human articular chondrocytes (HACs) were cultured on electrospun PCL NFMs with or without CS immobilization. It was observed that HACs proliferated through the entire time course of the experiment in both types of scaffolds. SEM observations revealed that HACs maintained their typical morphology and produced extracellular matrix. Glycosaminoglycans quantification showed increased values over time. Quantitative-PCR of cartilage-related genes revealed over-expression of Aggrecan, Collagen type II, COMP and Sox9 on both types of NFMs tested, with higher values for PCL. In conclusion, CS immobilization in PCL NFM was achieved successfully and provides a valid platform enabling further surface functionalization methods in scaffolds to be developed for cartilage tissue engineering

Análise da Revisão Cochrane: Fixação com Parafusos Pediculares de Fraturas Traumáticas da Coluna Vertebral Torácica e Lombar. Cochrane Database Syst Rev. 2013;05:CD009073.

Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic.info:eu-repo/semantics/publishedVersio

The influence of patterned nanofiber meshes on human mesenchymal stem cell osteogenesis

A specially designed electroconductive collector enables the electrospinning of P-NFM composed of areas of parallel/uniaxially aligned fibers and areas of random/orthogonal nanofiber distribution. The biological relevance of P-NFM is demonstrated using hBMSCs as an autologous cell source. The structures induce cell orientation along the uniaxially aligned fibers, mainly during earlier culturing periods under basal and osteogenic differentiation conditions. The microtopography of the P-NFM also controls the deposition of mineralized extracellular matrix along the pre-defined fiber direction. Genotypic characterization confirms the successful differentiation into the osteogenic lineage.European Integrated Project GENOSTEM (LSH-STREP-CT-2003-503161); European Network of Excellence EXPERTISSUES (NMP3-CT-2004-500283); Portuguese Foundation for Science and Technology for the project Naturally Nano (POCI/EME/58982/2004) and the PhD grant SFRH/BD/24382/2005

Presença / ausência de espinhos em progênies de pupunha (Bactris gasipaes) do projeto RECA como fonte de sementes.

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