Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual ...characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (− 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (
ER-β
) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP). Concerning the
ER-β
SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (
p
< 0.0001,
p
= 0.0016 and
p
= 0.0001). Considering the PTT dysfunction group and comparing postmenopausal women versus premenopausal women adding men, the analysis showed significant differences in the allelic distribution (
p
= 0.0450): the allele A in postmenopausal women is a risk factor. The
ER-β
SNP rs1256049 did not show differences in the frequencies of alleles and genotypes between groups. The
ER-β
SNP rs4986938, but not ER -β SNPs rs1256049, may contribute to PTT insufficiency in the Brazilian population, with additional risk in postmenopausal women. Addition, in men the genetic factor could be more determinant.
In the present study, we evaluated the biogas production from the anaerobic co-digestion of raw glycerol (RG) in combination with swine manure (SM) and the interaction of the microbial community ...during anaerobic co-digestion. In the same way, different RG and SM concentrations were examined in the range of 6 to 15 g L
−1
and 7.5 to 22.5 g L
−1
, respectively. According to the results, the highest values for biogas yield and methane yield were observed in test 1(6 g RG/7.5 g SM) with 340 mL g
−1
COD, test 2 (6 g RG/22.5 g SM) with 330 mL g
−1
COD, test 4 (15 g RG/22.5 g SM) with 344 mL g
−1
COD, and test 5 (3.75 g RG/15 g SM) with 328 mL g
−1
COD. Although the concentration of substrates increases, glycerol remains between 20 and 21% of RG for both tests (2 and 5). An increase in the concentration of RG (> 21% w/w) generated inhibitory effects for the co-digestion process since there was an overload of organic acids, which increase the impurity concentration and lower the biogas yield. Thus, the microbial consortium is a function of the organic load of the RG/SM ratio. The greater the concentration of RG, the higher the population of clostridium and low biogas yield in anaerobic co-digestion.
Abstract The objective of this study was to evaluate the histopathological grade of malignancy in a series of lower lip squamous cell carcinomas (LLSCCs) using three histopathological grading systems ...(invasive front grading system, World Health Organization (WHO) grading system, and histological risk assessment), and to correlate this with clinical parameters (tumour size/extent, regional lymph node metastasis, and clinical stage). Haematoxylin–eosin-stained histological sections obtained from 59 cases of LLSCC were analyzed by light microscopy. Grading of the invasive tumour front showed a significant association between low grade of malignancy and the absence of regional lymph node metastasis ( P = 0.030) and initial clinical stage ( P = 0.043). No significant associations were observed between the clinical parameters analyzed and the WHO system ( P > 0.05). Using the risk assessment, a highly significant association was observed between the risk score and regional lymph node metastasis ( P = 0.004) and clinical stage ( P = 0.002). In addition, the lymphocytic infiltrate was significantly associated with regional lymph node metastasis ( P = 0.017) and clinical stage ( P = 0.040). The results of the present study suggest that, among the histopathological grading systems evaluated, the histological risk assessment is the best option to predict the biological behaviour of LLSCCs.
Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on ...the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-α) gene with PPT dysfunction.
A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-α gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism.
The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-α gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55-2.33).
The XbaI SNP in the ERα gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.
•Sural nerve injury is reported from 0 to 18% in percutaneous ankle procedures.•Most studies do not account for all attempts made at wire positioning.•The mean number of guidewires needed to achieve ...an acceptable position was 2.34.•The sural bundle was either injured or in direct contact with the guidewires in 73% of the time.
The objective of this cadaveric study was to identify the number of attempts necessary for a perfect positioning of the ankle fusion home run screw and the neurovascular and tendinous structures at risk.
Eleven cadaveric limbs were used. Guidewires were percutaneously placed into the distal posterolateral aspect of the leg, under fluoroscopic guidance, with the ankle held in neutral position. Malpositioned guidewires were not removed and served as guidance for the following wires. The number of guidewires needed to achieve an acceptable positioning of the implant was noted. Neurovascular and tendinous injuries were assessed, and the shortest distance between the closest guidewire and the soft tissue structures was measured using a precision digital caliper.
Mean number of guidewires needed to achieve acceptable positioning of the implant was 2.34 (SD 0.81, range 2–4). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon 5.35 mm (SD 2.74 mm); peroneal tendons 9.65 mm (SD 5.19 mm); posteromedial neurovascular bundle 12.78 mm (SD 7.14 mm). The sural bundle was in contact with the guide pin in 5/11 specimens (45.5%) and impaled in 3/11 specimens (27.3%). The average distance from the sural nerve bundle was 3.58 mm (SD 2.16 mm).
The placement of percutaneous ankle fusion home run screws is technically demanding requiring multiple attempts for acceptable placement. Important tendinous and neurovascular structures are in close proximity to the guidewires. The sural bundle was either injured or in direct contact with the guide wire in approximately 73% of the cases. When using a home run screw, a mini-open approach is recommended.
Level V, cadaveric study.
Background Posterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive ...effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-alpha) gene with PPT dysfunction. Methods A total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER-alpha gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism. Results The analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER-alpha gene showed significant differences in the frequency of genotypes between control and test groups (p = 0.01; OR 95% 1.14 (0.55-2.33). Conclusions The XbaI SNP in the ERalpha gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy. Keywords: Tendinopathy, Estrogen receptor, Genetic polymorphism, Risk factor
Spinal cord injuries has increased together with urban violence and show a high rates of incidence. Besides the onus to patient and society, it can also cause other serious complications to victims. ...Acute pancreatitis has an important impact on this disease and has been underdiagnosed in several patients.
The aim of this study was investigate the association of acute pancreatitis in acute spinal cord injuries. The secondary aim was to propose an investigation protocol to early diagnose and prevent it.
A prospective observational study was conducted in 78 patients who presented acute spinal cord injury (SCI) at our emergency department, confirmed by clinical and imaging examination, in according to the American Spinal Injury Association (ASIA) Classification. Exclusion criteria were chronic or associate diseases in spinal cord, pancreatic direct trauma, alcoholism and chronic pancreatic disease.
The association of acute pancreatitis in patients with SCI was 11.53%. The occurrence of pancreatitis or high levels of serum pancreatic enzymes in patients with ASIA A was 41.7% and only 4.17% in patients with ASIA E. In all, 55.2% of patients who presented pancreatitis or high levels of serum pancreatic enzymes had cervical level of SCI and 34.5% had thoracic level. Adynamic ileus was observed in 68.96% of this group.
We concluded that, in acute spinal cord injuries, the occurrence of acute pancreatitis or high serum levels of pancreatic enzymes are more frequent in patients with ASIA A Classification, cervical/thoracic level of spinal injury and adynamic ileus.
Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of ...fracture diagnosis can lead to poor functional outcomes.
The present study aims to evaluate the reliability of the Ottawa ankle rules and the orthopedic surgeon subjective perception to assess foot and ankle fractures after sprains.
A cross-sectional study was conducted from July 2012 to December 2012. Ethical approval was granted. Two hundred seventy-four adult patients admitted to the emergency department with foot and/or ankle sprain were evaluated by an orthopedic surgeon who completed a questionnaire prior to radiographic assessment. The Ottawa ankle rules and subjective perception of foot and/or ankle fractures were evaluated on the questionnaire.
Thirteen percent (36/274) patients presented fracture. Orthopedic surgeon subjective analysis showed 55.6% sensitivity, 90.1% specificity, 46.5% positive predictive value and 92.9% negative predictive value. The general orthopedic surgeon opinion accuracy was 85.4%. The Ottawa ankle rules presented 97.2% sensitivity, 7.8% specificity, 13.9% positive predictive value, 95% negative predictive value and 19.9% accuracy respectively. Weight-bearing inability was the Ottawa ankle rule item that presented the highest reliability, 69.4% sensitivity, 61.6% specificity, 63.1% accuracy, 21.9% positive predictive value and 93% negative predictive value respectively.
The Ottawa ankle rules showed high reliability for deciding when to take radiographs in foot and/or ankle sprains. Weight-bearing inability was the most important isolated item to predict fracture presence. Orthopedic surgeon subjective analysis to predict fracture possibility showed a high specificity rate, representing a confident method to exclude unnecessary radiographic exams.
Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual ...characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (- 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-beta) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Concerning the ER-beta SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p < 0.0001, p = 0.0016 and p = 0.0001). Considering the PTT dysfunction group and comparing postmenopausal women versus premenopausal women adding men, the analysis showed significant differences in the allelic distribution (p = 0.0450): the allele A in postmenopausal women is a risk factor. The ER-beta SNP rs1256049 did not show differences in the frequencies of alleles and genotypes between groups. The ER-beta SNP rs4986938, but not ER -beta SNPs rs1256049, may contribute to PTT insufficiency in the Brazilian population, with additional risk in postmenopausal women. Addition, in men the genetic factor could be more determinant.
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