Category:
Trauma; Hindfoot
Introduction/Purpose:
The surgical reconstruction of the Achilles tendon has evolved in favor of the use of percutaneous techniques over the traditional approach with wide ...approaches to reduce the complications inherent to this procedure. These percutaneous techniques can present lesions of the sural nerve. The objective of this study is to evaluate the distance of this structure with respect to the instruments used in the Dresden technique.
Methods:
Dissections were made in 16 anatomical pieces (ankles) to which a reproduction of the complete Achilles lesion was previously made and reconstructed using the technique to be studied. After this, the distance of the instrument position with respect to the sural nerve was measured, as well as other relevant measures, and the presence or absence of nerve injury was evaluated.
Results:
None of the pieces there was lesion of the sural nerve neither by direct injury nor by entrapment, in addition, an approximate distance of 10mm of the nerve was found with respect to the entry site of the percutaneous needles as described by the technique. The location of the nerve was always external to the Crural Fascia. We demonstrate a safety area in which the instruments can be used without lesions of the sural nerve.
Conclusion:
The technique described by Amlang with the use of Dresden instruments has a low rate of cutaneous complications and infection compared to the traditional approach for this injury, we find that if the risk of presenting injury is performed properly of the sural nerve is low and its reproduction, for the repair of Achilles injuries, should be considered as the first option over traditional open management.
In this study, we assess the feasibility of cryopreservation of L. synagris sperm for short- (10days) and long-term (12month) storage using a combination of intracellular (DMSO or MeOH) and ...extracellular (egg yolk or milk) cryoprotectants, and two freezing protocols. Milt was mixed with a cryogenic solution (8% extracellular cryoprotectant, and 5%, 8%, 10% or 12% intracellular cryoprotectant) to a ratio of 1:2 (milt: medium), stored in 0.5mL French straws and frozen using two protocols for each experiment: a Slow freezing curve (dry ice–nitrogen liquid vapor–liquid nitrogen, ca. 15°C−min) and a Fast freezing curve (dry ice–liquid nitrogen, ca. 30°C−min), for 10minutes during each stage. Milt was then thawed in an ambient temperature water bath (28–30°C). Activation of thawed milt was effective with either saline (450nM NaCl) or bicarbonate (3.5% NaHCO3) solutions, but the best results were obtained with artificial sea water (ASW) at 870mOsmol/kg. After 10days or 12months of storage, three-factor interactions were found between extenders, cryoprotectant concentrations and the two freezing curves for movement duration, % motility and % viability. All of the three post-thaw sperm components assessed were two to three times greater for the DMSO trials than for the MeOH trials. There was almost no difference in sperm viability and motility between the DMSO extenders with egg yolk or milk after 10days or 12months. Greater short- and long-term spermatozoa survival and post-thaw motility were found when semen was diluted 1:2 with extenders of 10% DMSO, 8% egg yolk/milk and 1% Ringer Solution, using a three-step cooling regime with a freezing rate of ca. −15°C−min. This study represents the first report of cryopreservation of L. synagris sperm, however further research is needed to improve the effectiveness of the cryopreservation protocol for broad-scale application, taking into account the effects of French straws of greater volume on cooling and freezing rates, and the effect of different thawing rates on spermatozoa properties and fertilization success.
► Lower intracellular cryoprotectant concentrations had less toxic effects on sperm ► Artificial sea water shows the best results in sperm activation after cryopreservation ► Post-thaw sperm components assessed were 2 to 3 times greater for the DMSO trials ► Cryoprotectants showed greater post-thaw semen features with a freezing rate of 15°C−min ► We report a short- and long-term protocol for L. synagris sperm cryopreservation.
Abstract
The tones of iron oxide pigments range from yellow, red, brown and green to black. Iron oxide pigments are non‐toxic and have a nanometric particle size, which makes them ideal for use as ...pigments. The current study synthesised synthetic inorganic pigments based on iron oxides using the alkaline precipitation method. This approach to the synthesis of iron oxide pigments makes them less expensive for obtaining reproducible colours. Iron salts (iron (III) chloride, iron (III) nitrate, iron (II) sulphate ferrous sulphate and iron (III) sulphate) have been combined with alkaline solutions (sodium hydroxide, potassium hydroxide and ammonium hydroxide) to form coloured iron oxides, which are widely known as natural inorganic pigments. The 12 samples produced in four different colours (red, yellow, brown and black) were left in aqueous suspension and dispersed in commercial real white estate paint, to evaluate their behaviour as pigments. Structural characterisation (X‐ray diffractometry), composition (X‐ray fluorescence by dispersive energy), thermal analysis (i.e. thermogravimetric analysis and the differential thermal analysis) and spectroscopy (FTIR and photoacoustic), as well as colorimetry, were performed. The phases indexed by X‐ray diffractometry were goethite, haematite, magnetite and lepidocrocite. The inorganic pigments produced are compatible with natural inorganic pigments. They also showed dispersion compatibility in commercial white paint without changing the surface coating powder and are therefore an alternative to synthetic inorganic pigments.
To describe adaptations in the provision of rehabilitation services proposed by scientific and professional rehabilitation organizations to avoid interruptions to patients rehabilitation process and ...delays in starting rehabilitation in patients with COVID-19.
A narrative review approach was used to identify the recommendations of scientific and professional organizations in the area of rehabilitation. A systematic search was performed in the main data-bases in 78 international and regional web portals of rehabilitation organizations. A total of 21 publications from these organizations were identified and selected.
The results are presented in 4 categories: adequacy of inpatient services, including acute care services and intensive care unit for patients with and without COVID-19; adequacy of outpatient services, including home-based rehabilitation and tele-rehabilitation; recommendations to prevent the spread of COVID-19; and regulatory standards and positions during the COVID-19 pandemic expressed by organizations for protecting the rights of health workers and patients.
Health systems around the world are rapidly learning from actions aimed at the reorganization of rehabilitation services for patients who are in the process of recovery from acute or chronic conditions, and the rapid response to the rehabilitation of survivors of COVID-19, as well as from efforts in the prevention of contagion of those providing the services.
The S5‐methylation test, an alternative to cytology and HPV16/18 genotyping to triage high‐risk HPV‐positive (hrHPV+) women, has not been widely validated in low‐middle‐income countries (LMICs). We ...compared S5 to HPV16/18 and cytology to detect cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) and CIN3+ in hrHPV+ women selected from a randomized pragmatic trial of 2661 Colombian women with an earlier‐borderline abnormal cytology. We included all hrHPV+ CIN2 and CIN3+ cases (n = 183) age matched to 183 <CIN2 hrHPV+. Baseline specimens were HPV‐genotyped and tested by S5‐methylation, blinded to cytology, histology and initial HPV results. We evaluated the test performance of predefined S5‐classifier (cut‐point 0.8) and a post hoc classifier at a different cut‐point (3.1). S5 sensitivity for CIN2+ was 82% (95% confidence interval CI 76.4‐87.5) and for CIN3+ 77.08% (95% CI 65.19‐88.97). S5 sensitivity was higher than HPV16/18 sensitivity (48.1%, 95% CI 40.85‐55.33) or cytology (31.21%, 95% CI 24.50‐37.93) but with lower specificity (35%, 95% CI 28.1‐42). At cut‐point 3.1, S5 sensitivity for CIN2+ (55.2%, 95% CI 48‐62.4) or CIN3+ (64.6%, 95% CI 51.0‐78.1) was also superior to HPV16/18 (P < .05) or cytology (P < .0001). At this cut‐point S5 specificity (76%, 95% CI 69.8‐82.1 for <CIN2) was higher than HPV16/18 (67.21%, 95% CI 60.41‐74.01, P = .0062) and similar to cytology (75.57%, 95% CI 69.34‐81.79, P = 1). HPV16/18 plus cytology sensitivity was similar to S5 for CIN3+, however, false‐positive rate was higher (50.27% vs. 24.04%). High sensitivity is crucial in LMICs, S5‐methylation exceeded HPV16/18 or cytology sensitivity with comparable specificity for CIN2+ and CIN3+ in hrHPV‐positive Colombian women. Furthermore, S5 triage had comparable sensitivity and significantly fewer false positives than cytology and HPV16/18 combination.
What's new?
For cervical cancer screening, testing HPV16/18 types has lower specificity than cytology, but a high false positive rate. Here, the authors evaluated the S5 classifier test, which is based on DNA methylation. They found that for triaging women who test positive for high risk HPV, S5 had better sensitivity and fewer false positives than cytology plus HPV16/18. This paper represents the first time that S5 methylation has been tested head‐to‐head with cytology and HPV16/18 testing in a LMIC. As affordable methylation tests become available, this strategy may prove useful for triage in low resource settings.
In the context of opportunistic cervical cancer screening settings of low‐and‐middle‐income countries, little is known about the benefits of high‐risk human papillomavirus (hrHPV) testing on ...high‐grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC‐US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC‐US) (RC) and hrHPV testing (colposcopy if hrHPV‐positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20 to 69 years with ASC‐US in routine care. Participants (n = 2661) were evenly randomized into three arms (n = 882 IC, n = 890 RC, n = 889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality‐control external panel (QC). The primary endpoint was the first QC‐diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow‐up (between enrolment and exit visit) and exit visit. The trial is completed. Colposcopy was done on 88%, 42% and 52% of participants in IC, RC and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (P = .821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2‐year routine follow‐up (relative proportion 0.35, 95% CI 0.09‐0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC‐US cytology.
What's new?
Guidelines for high‐risk human papillomavirus (hrHPV) testing in cervical cancer screening were introduced in Colombia in 2014 but have yet to be adopted in clinical practice. Moreover, follow‐up for screen‐positive women, including those with atypical squamous cells of undetermined significance (ASC‐US) cytology is limited. Here, hrHPV testing for follow‐up of women with ASC‐US cytology was compared with two approaches currently available in Colombia, immediate colposcopy and repeat cytology at two‐year routine follow‐up. Compared to immediate colposcopy, hrHPV testing reduced the burden of high‐grade cervical abnormalities by 65 percent and colposcopy referral by 41 percent.
The initial phase of the COVID-19 pandemic changed the nature of course delivery from largely in-person to exclusively remote, thus disrupting the well-established pedagogy of the Genomics Education ...Partnership (GEP; https://www.thegep.org). However, our web-based research adapted well to the remote learning environment. As usual, students who engaged in the GEP's Course-based Undergraduate Research Experience (CURE) received digital projects based on genetic information within assembled
genomes. Adaptations for remote implementation included moving new member faculty training and peer Teaching Assistant office hours from in-person to online. Surprisingly, our faculty membership significantly increased and, hence, the number of supported students. Furthermore, despite the mostly virtual instruction of the 2020-2021 academic year, there was no significant decline in student learning nor attitudes. Based on successfully expanding the GEP CURE within a virtual learning environment, we provide four strategic lessons we infer toward democratizing science education. First, it appears that increasing access to scientific research and professional development opportunities by supporting virtual, cost-free attendance at national conferences attracts more faculty members to educational initiatives. Second, we observed that transitioning new member training to an online platform removed geographical barriers, reducing time and travel demands, and increased access for diverse faculty to join. Third, developing a Virtual Teaching Assistant program increased the availability of peer support, thereby improving the opportunities for student success. Finally, increasing access to web-based technology is critical for providing equitable opportunities for marginalized students to fully participate in research courses. Online CUREs have great potential for democratizing science education.
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