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Purpose The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. Methods Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. Results After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. Conclusions Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy. Clinical Trials Trial protocol registration number: RBR-5symrd (http://www.ensaiosclinicos.gov.br).

BACKGROUND Lumbar kyphosis is a complex spinal deformity occurring in approximately 8% to 20% of patients with myelomeningocele. The resulting gibbosity may cause pressure ulcers, difficulty lying down in the supine position and sitting on the ischia without support, decreasing quality of life (QOL). Surgery is generally performed to correct kyphosis and maintain vertebral alignment, but high complication rates have been reported. Despite satisfactory radiological results, the impact of surgery and its complications on health-related QOL (HRQOL) has not yet been established. QUESTIONS/PURPOSES Among children with myelomeningocele undergoing corrective surgery for lumbar kyphosis: (1) What is the risk of complications and reoperation after this procedure? (2) Does this procedure improve HRQOL scores in these patients? METHODS Between 2012 and 2013, five surgeons at three centers treated 32 patients for myelomeningocele-related kyphosis with kyphectomy and posterior instrumentation. During that period, all surgeons used the same indications for the procedure, which were progressive postural decompensation and chronic ulceration at the apex of the deformity. Data were prospectively collected, and all patients who underwent surgery were considered in this retrospective study. The legal guardians of one patient declined to sign the informed consent form, resulting in 31 patients included. A total of 9.7% (3 of 31) were lost to follow-up before the 2-year period, and the remaining 90.3% (28 of 31) were seen at a mean of 3 years (± 9 months) after surgery. The average age was 10 years, 7 months (± 21 months) at the time of surgery. The patients had a mean kyphosis angle of 130° ± 36° before surgery. This technique involved posterior fixation using S-shaped rods inserted through the foramina of S1 and pedicle screws inserted in the thoracic spine. The patients' caregivers answered both the generic and specific (neuromuscular module) Pediatric Quality of Life Inventory questionnaires preoperatively and 2 years postoperatively. The minimum clinically important difference (MCID) considered for the instruments used was 5. RESULTS Reoperation was performed in 68% of patients (19 of 28), mostly to treat deep infection. In all, 18% of patients (five of 28) underwent implant removal to control infection. Eleven percent (three of 28) had a loss of reduction and pseudarthrosis. The HRQOL increased from 71 ± 11 preoperatively to 76 ± 10 postoperatively (p < 0.001), resulting in a 5-point increase (95% CI 3 to 7) in the generic questionnaire score and from 71 ± 13 to 79 ± 11 (p < 0.001), resulting in an 8-point increase (95% CI 5 to 10) in the neuromuscular Paediatric Quality of Life Inventory questionnaire score, mainly in the physical health domain on both questionnaires. CONCLUSIONS Kyphectomy was associated with a high risk of complications and reoperations and did not seem to deliver a substantial clinical benefit for patients who underwent the procedure. Most of our HRQOL score improvements were below the minimum clinically important difference for the Pediatric Quality of Life Inventory questionnaires. Although it seems that surgeons lack a better surgical alternative when facing the challenging health impairments these patients suffer, efforts should be made to improve the technique and reduce surgical complications. Additionally, patients and caregivers should be advised of the high reoperation rate and notified that the procedure may not result in a better QOL and should thus be avoided when possible. Future studies should verify whether decreasing the complication rate could imply improvement in the HRQOL of these patients after surgery. LEVEL OF EVIDENCE Level IV, therapeutic study.

Polyunsaturated fatty acids such as arachidonic and eicosapentaenoic acids are the precursors of eicosanoid metabolites (e.g prostaglandins and prostacyclins) which regulate inflammatory and immune response processes in fish organs. The present research studies the differential production of PGI2, PGI3, PGE2 and PGE3 by primary liver and head kidney cells isolated from salmon and challenged with single or combined ARA and/or EPA. There was a significant increase in the production of PGE2 and PGI3 in both types of cells after exposure to single and combined fatty acids. Increased production of PGE3 was only detected in liver cells after exposure to ARA+EPA. The levels of PGI2 in liver cells were significantly increased after exposure to all the tested fatty acid systems, while the production levels in head kidney cells were only significant after exposure to ARA or ARA+EPA, but not to EPA, where the production was non-significantly decreased compared to the control cells. In general, liver cells synthetized higher prostaglandin levels than prostacyclins, and the opposite was observed in head kidney cells, which synthetized highly remarkable amounts of prostacyclin compared to liver cells. The overall production for both types of cells and various fatty acid systems were characterized by a high proportion of the omega-3 fatty acid metabolites (PGE3+PGI3) compared to the omega-6 counterpart (PGE2+PGI2). Some potential production mechanisms are proposed and comprehensively discussed. The results of the present research are the first to deliver the differential production of prostacyclins and prostaglandins by liver and head kidney cells from salmon, thereby paving the way for understanding the significance of these prostanoids in fish physiology and disease.

Earlier studies have indicated that a high inclusion of n-6 fatty acids (FA) in feeds for Atlantic salmon can affect the stress response. To test this hypothesis, Atlantic salmon (Salmo salar) were fed diets containing varying dietary n-6/n-3 FA ratios and different absolute levels of n-6 and n-3 FAs. The fish were divided into two different stress challenge groups, where one group was exposed to three weekly hypoxia challenges for 4 weeks (repeated stress), while one group was left undisturbed. At the end of the experiment, both groups were exposed to an acute stressor (lowering of water level). Thus, effects of the diets on acute stress, repeated stress and the combined effect of these could be investigated. In general, there were few effects of the repeated stress, while fish in all diet groups responded strongly to the acute stress based on several stress markers. Dietary n-6/n-3 ratio did not affect growth, all fish appeared phenotypically healthy, and all groups were able to mount an acute stress response. However, there was an interaction between diet and repeated stress on cortisol response after acute stress, possibly indicating altered hypothalamic-pituitary adrenal axis reactivity in fish fed high n-6/n-3 FA ratio. Hepatic levels of prostaglandin D2 (PGD2) and leukotriene B4 responded differently to acute stress depending on the dietary n-6/n3 FA ratio, indicating an altered acute stress response. Additionally, increasing the dietary n-6/n-3 FA content led to higher levels of PGD2 and PGE2 as well as higher liver triacylglycerol. In summary, the results suggest that increasing the dietary n-6/n-3 FA ratio in salmon feeds can affect the way they respond to stressors in an aquaculture setting, possibly affecting the fish robustness.

Objective: To evaluate awareness of prostate cancer in the population of the city of São Paulo. Methods: A total of 392 adults were randomly interviewed on public spaces in the city of São Paulo, and answered a questionnaire that addressed demographic questions and specific knowledge about the prostate cancer. A score was used to assess awareness of cancer in general, and of prostate cancer, considering satisfactory knowledge a score of 6 points. Results: The mean age was 36.9 years (standard deviation of ±12.6) and 58.2% of participants were male. No previous contact with information related to prostate cancer was reported by 45.5% of participants. For these cases, a greater proportion was observed among men aged over 50 years. As to the score, the mean was 3.7 (standard deviation of ±1.3), with a positive correlation among higher scores, higher income and education level. Less than 5% of participants believed they should only search for prostate cancer screening when symptomatic. Finally, among the less frequent responses to risk factors for prostate cancer, is “ethnic origin” (2.8%). Conclusion: Even though most participants did not have a satisfactory score, the level of awareness demonstrated in this study seems superior to that of other populational series. Hence it suggested the assessed population understood some essential concepts in prostate cancer, such as the importance of screening and the follow-up. The efforts made by the Sociedade Brasileira de Urologia on educational campaigns partially explain this. However, working in some concepts, like identifying risk factors for prostate cancer, might optimize screening outcomes. RESUMO Objetivo: Avaliar o conhecimento da população da cidade de São Paulo em relação ao câncer de próstata. Métodos: Foram entrevistados randomicamente 392 adultos em espaços públicos da cidade de São Paulo, os quais responderam a um questionário que abordava questões demográficas e de conhecimentos específicos sobre o câncer de próstata. Um escore foi utilizado para avaliar o conhecimento de câncer em geral e do câncer de próstata, considerando um conhecimento satisfatório com escore de 6 pontos. Resultados: A média de idade foi de 36,9 anos (desvio-padrão de ±12,6), e 58,2% dos participantes eram do sexo masculino. Ausência de contato anterior com informações relacionadas ao câncer de próstata foi relatada por 45,5% dos participantes. Nesses casos, maior proporção foi observada entre os homens com mais de 50 anos. Quanto ao escore, a média foi 3,7 (desvio-padrão de ±1,3), com correlação positiva entre maiores escores e maiores renda e escolaridade. Menos de 5% dos participantes acreditavam que só deveriam procurar o rastreamento do câncer de próstata quando sintomáticos. Por fim, entre as respostas menos frequentes aos fatores de risco para câncer de próstata, encontrou-se “etnia” (2,8%). Conclusão: Embora a maioria dos participantes não tenha apresentado escore satisfatório, o nível de conhecimento revelado neste estudo parece superior ao de outros estudos populacionais. Assim, sugere-se que a população avaliada tenha compreendido alguns conceitos essenciais do câncer de próstata, como a importância do rastreamento e do acompanhamento. Os esforços da Sociedade Brasileira de Urologia nas campanhas educacionais explicam parcialmente isso. No entanto, trabalhar em alguns conceitos, como identificar fatores de risco para câncer de próstata, pode otimizar os resultados do rastreamento.

There is extensive evidence to believe that the endocannabinoid system plays an important role in energy homeostasis through a variety of mechanisms. This study aimed to analyze the association between polymorphism rs12720071 of the cannabinoid type 1 receptor (CNR1) gene with dyslipidemia and overweight in young, healthy Mexicans. The association was analyzed with a logistic regression model and expressed as odds ratio (OR). A total of 148 individuals agreed to participate. Overall, the serum concentrations of lipids were found to be in the normal range. However, females presented higher levels of cholesterol and low-density lipoprotein (LDL) than males [probability value (p) = 25) [OR = 3.57; 95% confidence interval (CI): 1.05-12.20; p = 0.04], than males. Our results suggest that this polymorphism could influence BMI in young females.

Intoxicações por plantas do gênero Baccharis representam uma importante causa de morte em animais de produção. Baccharis coridifoliae Baccharis megapotamica são as espécies mais comuns e importantes. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Baccharis megapotamicavar. weirii em caprinos. Onze caprinos jovens, de um total de 152, foram afetados por uma doença aguda fatal. Os casos ocorreram em uma pequena propriedade rural no município de Viamão, Rio Grande do Sul, Brasil. Grande quantidade de exemplares de Baccharis megapotamicavar. weirii em estágio de floração, foram encontrados onde os caprinos estavam. As plantas cresceram em áreas úmidas e alagadas. Os caprinos afetados tinham entre seis meses a um ano de idade e todos apresentaram sinais clínicos caracterizados por apatia, anorexia, prostração, diarreia, desidratação, desconforto abdominal, timpanismo, decúbito e morte. O curso clínico variou aproximadamente de 12 a 24 horas. Dos onze caprinos acometidos, três foram necropsiados. As alterações presentes em todas as necropsias incluíam desidratação, conteúdo líquido no rúmen, avermelhamento, erosões e úlceras da mucosa dos pré-estômagos, e avermelhamento na mucosa do abomaso e intestino. Um dos caprinos apresentou marcada hemorragia dos linfonodos mesentéricos. As lesões histológicas de todos os caprinos necropsiados incluíam hiperemia, hemorragia, alterações degenerativas, necróticas e ulcerativas variadas no revestimento epitelial do rúmen, retículo e omaso, e na mucosa do abomaso e de alguns segmentos do intestino delgado. Necrose do tecido linfoide foi observada em linfonodos mesentéricos e em agregados linfoides no intestino e folículos do baço. Poisoning by the toxic species of Baccharis is an important cause of death in farm animals. Baccharis coridifolia and Baccharis megapotamica are the most common and most important of this genus. Epidemiological, clinical and pathological aspects of a natural outbreak of intoxication by Baccharis megapotamica var. weiriiare described in goats. Eleven young goats from a herd of 152 goats were affected by an acute fatal disease. The cases occurred in a small farm in the municipality of Viamão, State of Rio Grande do Sul, southern Brazil. Large patches of blooming Baccharis megapotamica var. weirii were observed in the pastures where the goats were held, especially in wet and flooded spots. Affected goats were between six months to one year old and all showed signs including apathy, anorexia, weakness, diarrhea, dehydration, abdominal pain, bloat, decubitus and death. The clinical course was 12-24 hours. Three out of the eleven goats dead from the toxicosis were necropsied. Changes present in all necropsied goats included dehydration, liquid contents in the rumen, reddening, erosions and ulcers in the mucosae of the forestomachs, abomasum, and intestine. One goat had marked hemorrhage of mesenteric lymph nodes. Histological lesions of all animals included hyperemia as well as degenerative, necrotic, and ulcerative changes in the epithelial lining of rumen, reticulum, and omasum. Mucosae of the abomasum and of some sections of small and large intestines were also affected. Necrosis of lymphoid tissue was observed in mesenteric lymph nodes and in the lymphoid aggregates in intestine and in the follicles of spleen.

The aim of this study was to compare how different dietary vegetable oil n-6/n-3 ratios affect gene responses involved in inflammation, signaling pathways, fatty acid synthesis and oxidation, oxidation and apoptosis as well as eicosanoid production in salmon head kidney tissues and isolated head kidney leukocytes. Salmon smolts (200 g) were fed four different diets where the main lipid components were palm oil (n-6/n-3 ratio = 0.7), rapeseed oil (n-6/n-3 ratio = 0.9), and soybean oil (n-6/n-3 ratio = 2.4) and a high soybean oil diet with an n-6/n-3 ratio = 4. Both head kidney tissue and leukocytes isolated from head kidneys were sampled from the four diets, but from different fish. Leukocytes isolated from the head kidneys were seeded into culture wells and added lipopolysaccharide (LPS) to induce inflammatory responses. Controls without LPS were included. Head kidney leukocytes and the tissues should have the same phenotype reflecting the different diets. Interleukin 1β (IL-1β) transcription was elevated in head kidney tissue and especially in LPS treated leukocytes isolated from soybean oil (n-6/n-3 = 2.4) fed salmon, which confirmed the suitability of the in vitro model in this experiment. Leukocytes, treated with LPS, and isolated from salmon fed the soybean oil diet (n-6/n-3 = 2.4) also upregulated tumor necrosis factor alpha (tnf-α), cyclooxygenase (cox2), prostaglandin D and E synthase (ptgds, ptges), fatty acyl synthase (fas), 5 and 6 desaturases (5des, 6 des) and a fatty acid translocase protein (cd36) when compared to the other diets. The results suggest that diets with a specific n-6/n-3 ratio influence the transcription of pro-inflammatory genes and may be cross-linked to transcription of selected fatty acid metabolism genes. Salmon fed the palm oil diet (n-6/n-3 = 0.7) showed a lower expression of inflammatory genes. Instead, peroxisome proliferator activated receptor β1 (pparβ1), acyl coenzyme A (aco), apoptosis regulator (bax) and superoxide dismutase (sod) were upregulated in leukocytes in vitro, while head kidney tissue transcription of a dendritic marker (cd83) was lower than measured in tissues from fish fed the other diets. The concentration of LTB4 (10-20 ng/mL) were relatively constant in leukocyte supernatants, all diets. Head kidney leukocytes from soybean oil (n-6/n-3 = 2.4) fed fish produced LPS induced PGE2 (mean 0.5 ng/mL) while leukocytes isolated from palm oil diet (n-6/n-3 = 0.7) secreted very high amounts of LTB5 (50-70 ng/mL). In addition, equal amounts of LPS induced PGE2 and PGE3 (mean 0, 5 ng/mL) were produced, indicating that the n-6/n-3 ratio of this saturated fatty acid may have a specific impact on eicosanoid production in the head kidney of salmon.

This study assess which pathways and molecular processes are affected by exposing salmon head kidney cells or liver cells to arginine supplementation above the established requirements for growth support. In addition to the conventional mono cultures of liver and head kidney cells, co cultures of the two cell types were included in the experimental set up. Responses due to elevated levels of arginine were measured during inflammatory (lipopolysaccharide/LPS) and non -inflammatory conditions. LPS up regulated the genes involved in polyamine turnover; ODC (ornithine decarboxylase), SSAT (spermidine/spermine-N1-acetyltransferase) and SAMdc (S-adenosyl methionine decarboxylase) in head kidney cells when co cultured with liver cells. Regardless of treatment, liver cells in co culture up regulated ODC and down regulated SSAT when compared to liver mono cultures. This suggests that polyamines have anti-inflammatory properties and that both salmon liver cells and immune cells seem to be involved in this process. The transcription of C/EBP β/CCAAT, increased during inflammation in all cultures except for liver mono cultures. The observed up regulation of this gene may be linked to glucose transport due to the highly variable glucose concentrations found in the cell media. PPARα transcription was also increased in liver cells when receiving signals from head kidney cells. Gene transcription of Interleukin 1β (IL-1β), Interleukin-8 (IL-8), cyclooxygenase 2 (COX2) and CD83 were elevated during LPS treatment in all the head kidney cell cultures while arginine supplementation reduced IL-1β and IL-8 transcription in liver cells co cultured with head kidney cells. This is probably connected to p38MAPK signaling as arginine seem to affect p38MAPK signaling contrary to the LPS induced p38MAPK signaling, suggesting anti-inflammatory effects of arginine/arginine metabolites. This paper shows that co culturing these two cell types reveals the connection between metabolism and inflammation, suggesting different pathways and candidate biomarkers to be further explored.

Mucosal alterations after Roux-en-Y gastric bypass for morbid obesity have not been clearly evaluated. This study aims to analyze the mucosal alterations (proliferative status (Ki-67); apoptosis (caspase-3 and BCL-2); hormonal function (gastrin)) in the excluded stomach. Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 μm thick were examined for immunoexpression using the streptavidin–biotin–peroxidase method. The two groups were comparable for age, gender, gastritis, intestinal metaplasia, and Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standard deviation (SD) = 11.7) in the control group and 29.6 (SD = 7.9) in the cases, p = 0.0003. Ki-67 proliferative index in cases (body = 24.7 %, antrum = 24.9 %) was significantly higher compared to controls (body = 15.0 % and antrum = 17.7 %), p = 0.002 and 0.01, respectively. Caspase-3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31 %), p = 0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions in the control and cases. Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of relevance in long-term follow-up.

Reduced mitochondrial fatty acid (FA) β-oxidation can cause accumulation of triglyceride in liver, while intake of eicosapentaenoic acid (EPA) has been recommended as a promising novel therapy to decrease hepatic triglyceride content. However, reduced mitochondrial FA β-oxidation also facilitates accumulation of EPA. To investigate the interplay between EPA administration, mitochondrial activity and hepatic triglyceride accumulation, we investigated the effects of EPA administration to carnitine-deficient mice with impaired mitochondrial FA β-oxidation. C57BL/6J mice received a high-fat diet supplemented or not with 3% EPA in the presence or absence of 500 mg mildronate/kg/day for 10 days. Liver mitochondrial and peroxisomal oxidation, lipid classes and FA composition were determined. Histological staining was performed and mRNA level of genes related to lipid metabolism and inflammation in liver and adipose tissue was determined. Levels of pro-inflammatory eicosanoids and cytokines were measured in plasma. The results showed that mildronate treatment decreased hepatic carnitine concentration and mitochondrial FA β-oxidation and induced severe triglyceride accumulation accompanied by elevated systemic inflammation. Surprisingly, inclusion of EPA in the diet exacerbated the mildronate-induced triglyceride accumulation. This was accompanied by a considerable increase of EPA accumulation while decreased total n-3/n-6 ratio in liver. However, inclusion of EPA in the diet attenuated the mildronate-induced mRNA expression of inflammatory genes in adipose tissue. Taken together, dietary supplementation with EPA exacerbated the triglyceride accumulation induced by impaired mitochondrial FA β-oxidation. Thus, further thorough evaluation of the potential risk of EPA supplementation as a therapy for NAFLD associated with impaired mitochondrial FA oxidation is warranted.

Boelaert et al. [1] compared UPLC–MS/MS with ELISA assays for the determination of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), two endogenous inhibitors of nitric oxide (NO) synthesis [2], in serum of patients with chronic kidney disease (CKD) and healthy subjects.[...]

Vegetable oils (Vo) are an alternative to fish oil (Fo) in aquaculture feeds. This study aimed to evaluate the effect of dietary soybean oil (Vo diet), rich in linoleic acid, and of dietary fish oil (Fo diet) on the development of spinal deformities under bacterial lipopolysaccharide (LPS)-induced chronic inflammation conditions in Atlantic salmon, Salmo salar L. Fish [25 g body weight (BW)] were fed the experimental diets for 99 days. On day 47 of feeding (40 g BW), fish were subjected to four experimental regimes: (i) intramuscular injections with LPS, (ii) sham-injected phosphate-buffered saline (PBS), (iii) intraperitoneally injected commercial oil adjuvant vaccine, or (iv) no treatment. The fish continued under a common feeding regime in sea water for 165 more days. Body weight was temporarily higher in the Vo group than in the Fo group prior to immunization and was also affected by the type of immunization. At the end of the trial, no differences were seen between the dietary groups. The overall prevalence of spinal deformities was approximately 14% at the end of the experiment. The Vo diet affected vertebral shape but did not induce spinal deformities. In groups injected with LPS and PBS, spinal deformities ranged between 21% and 38%, diet independent. Deformed vertebrae were located at or in proximity to the injection point. Assessment of inflammatory markers revealed high levels of plasma prostaglandin E₂ (PGE₂) in the Vo-fed and LPS-injected groups, suggesting an inflammatory response to LPS. Cyclooxigenase 2 (COX-2) mRNA expression in bone was higher in fish fed Fo compared to Vo-fed fish. Gene expression of immunoglobulin M (IgM) was up-regulated in bone of all LPS-injected groups irrespective of dietary oil. In conclusion, the study suggests that Vo is not a risk factor for the development of inflammation-related spinal deformities. At the same time, we found evidence that localized injection-related processes could trigger the development of vertebral body malformations.

Nowadays, rehabilitation robots represent a field in which a variety of robotic devices have been proposed. One example of such devices is lower-limb rehabilitation robots. Specifically, the knee joint is one of the joints whose rehabilitation is foreseen as a potential task for a robot device. This paper describes the design of a robot for knee diagnosis and rehabilitation. First, we established the design specification by studying the mobility needed at the robot’s end-effector to deal with diagnosis and rehabilitation treatments for knee injuries. The analysis led us to conclude that \(4^{\circ }\) of freedom (DoF), two translation (2T) and two rotational (2R), are needed in order to meet the design specifications. After that, we chose a parallel robot with a 3-UPS/RPU architecture from several conceptual designs of 4 DoF (2T2R) parallel robots. For the chosen robot, we developed the inverse kinematic model, and also we established the preliminary dimensions of the robot. Through simulations, we found the workspace of the robot showing that its end-effector is able to follow a prescribed task taken from studying the leg motion. Finally, we built a prototype, which is currently undergoing dynamic modelling, parameter identification and control design stages.

Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis. Objetivos:A cifose lombar em pacientes com mielomeningocele é uma deformidade complexa cujo tratamento é eminentemente cirúrgico. O objetivo deste estudo é resumir os resultados e complicações obtidos pela equipe, em 2012, com relação a esse grupo de pacientes.Método:Foi feita análise retrospectiva dos prontuários e radiografias de pacientes operados consecutivamente em 2012. A técnica utilizada foi descrita originalmente por Dunn-McCarthy e consiste em cifosectomia e fixação posterior utilizando-se hastes moldadas em "S" através dos forames de S1 associados a parafusos pediculares na coluna torácica.Resultados:Foram incluídos seis pacientes no estudo. A idade à realização da cirurgia foi de 11 anos e 7 ± 22 meses e o peso foi 29,1 ± 11,9 kg. O procedimento durou 271 ± 87 minutos, com a retirada de uma ou duas (média de 1,5) vértebras do ápice da cifose. O tempo de internação foi de 10 ± 9 dias. A cifose lombar que media 116,3 ± 37 graus no pré-operatório foi reduzida para 62,5 ± 21 graus. Todos os pacientes passaram a sentar sem apoio e a deitar na posição supina. Quatro pacientes evoluíram com infecção pós-operatória e necessitaram de limpeza cirúrgica no seguimento. Um paciente teve o implante retirado após um ano, devido à soltura da haste no sacro.Conclusão:A técnica cirúrgica utilizada permite resultados funcionais excelentes na correção da cifose lombar em pacientes com mielomeningocele, apesar das altas taxas de complicações. É preciso realizar estudos com maior número de pacientes e tempo de seguimento para se avaliar se a utilização de parafusos pediculares diminuirá a taxa de soltura e pseudoartrose. Objetivos:La cifosis lumbar en pacientes con mielomeningocele es una deformidad compleja cuyo tratamiento es principalmente quirúrgico. El objetivo de este estudio es resumir los resultados y complicaciones obtenidos por el equipo en 2012, con respecto a este grupo de pacientes.Método:Se realizó un análisis retrospectivo de las historias clínicas y las radiografías de los pacientes intervenidos consecutivamente en 2012. La técnica fue descrita originalmente por Dunn-McCarthy y constituye en cifosectomía y fijación posterior con los tallos en forma de "S" a través de los forámenes de S1 asociados con tornillos pediculares en la columna torácica.Resultados:Se incluyeron 6 pacientes en el estudio. La edad a la cirugía fue de 11 años y 7 ± 22 mmeses y el peso fue 29,1 ± 11,9 kg. El procedimiento duró 271 ± 87 minutos, con la eliminación de una o dos (media 1,5) vértebras desde el ápice de la cifosis. El tiempo de hospitalización fue de 10 ± 9 días. La cifosis lumbar midiendo 116,3 ± 37 grados antes de la operación se redujo a 62,5 ± 21 grados. Todos los pacientes empezaron a sentarse sin apoyo y acostarse en la posición supina. Cuatro pacientes desarrollaron infección postoperatoria y requirieron limpieza quirúrgica en el seguimiento. Un paciente tuvo el implante retirado después de un año debido al aflojamiento del tallo en el sacro.Conclusión: La técnica quirúrgica utilizada permite excelentes resultados funcionales en la corrección de la cifosis lumbar en pacientes con mielomeningocele a pesar de altas tasas de complicaciones. Es necesario realizar estudios con mayor número de pacientes y tiempo de seguimiento para evaluar si el uso de tornillos pediculares puede reducir el aflojamiento y la pseudoartrosis.

Future feed for farmed fish are based on untraditional feed ingredients, which will change nutrient profiles compared to traditional feed based on marine ingredients. To understand the impact of oils from different sources on fish health, n-6 and n-3 polyunsaturated fatty acids (PUFAs) were added to salmon head kidney cells, in a fully crossed design, to monitor their individual and combined effects on gene expression. Exposing salmon head kidney cells to single fatty acids, arachidonic acid (AA) or decosahexaenoic acid (DHA), resulted in down-regulation of cell signaling pathway genes and specific fatty acid metabolism genes as well as reduced prostaglandin E2 (PGE2) secretion. Eicosapentaenoic acid (EPA) had no impact on gene transcription in this study, but reduced the cell secretion of PGE2. The combined effect of AA + EPA resulted in up-regulation of eicosanoid pathway genes and the pro-inflammatory cytokine, tumor necrosis factor alpha (TNF-α), Bclx (an inducer of apoptosis) and fatty acid translocase (CD36) as well as increased cell secretion of PGE2 into the media. Adding single fatty acids to salmon head kidney cells decreased inflammation markers in this model. The combination AA + EPA acted differently than the rest of the fatty acid combinations by increasing the inflammation markers in these cells. The concentration of fatty acid used in this experiment did not induce any lipid peroxidation responses.

Primary head kidney leukocytes from Atlantic cod were isolated to evaluate the use of arachidonic acid and eicosapentaenoic acid by cyclooxygenases and the production of prostaglandins E 2 and E 3 . The expression of cyclooxygenase genes and selected interleukin genes like Interleukin 1β, Interleukin 6, interleukin 8 and interleukin 10 were monitored. Increasing concentrations of eicosapentaenoic acid and arachidonic acid in equal amounts increased cyclooxygenase2 transcription as well as cell secretion of prostaglandin E 2 . Even though the ratio of the two fatty acids was 1:1, the ratio between prostaglandin E 2 and E 3 was 50:1. The addition of arachidonic acid alone increased prostaglandin E 2 secretion but did not induce cyclooxygenase2 transcription. However, when the concentration of eicosapentaenoic acid was increased, maintaining arachidonic acid constant, both prostaglandin E 3 and prostaglandin E 2 production was induced and the prostaglandin E 2 production was higher than in cell cultures only added arachidonic acid. An up-regulation of cyclooxygenase2 transcription was also observed. The addition of the two fatty acids also affected the immune response by alteration of leukocytic cytokines gene expression. According to our results the Cyclooxygenase in cod seem to prefer arachidonic acid as substrate. Therefore, we suggest that the shift from marine oils (rich in n-3 fatty acids) to plant oils (higher in n-6 fatty acids) in the diet of commercially reared Atlantic cod could have negative effects on the whole organism through the increase in the production of prostaglandins belonging to those derived from n-6 fatty acids.

OBJETIVO: A haste intramedular (HIM) é o padrão ouro no tratamento das fraturas diafisárias da tíbia. Uma das complicações frequentes é a dor no joelho após o procedimento. MÉTODOS: Vias alternativas, como a suprapatelar para a introdução da haste como opção para evitar a dor no joelho no período pós-operatório tardio, têm sido estudadas. A questão é se nesta nova via ocorre alguma lesão às estruturas intra-articulares do joelho. RESULTADOS: Este estudo analisa a via suprapatelar e o risco para as estruturas adjacentes através da sua reprodução em 10 joelhos de cinco cadáveres. CONCLUSÃO: Foi visto facilidade para a localização do ponto de entrada por esta via, lesando apenas a gordura de Hoffa. Em três dos nossos casos houve lesão da superfície condral, sendo um obstáculo de difícil transposição e indicando necessidade de fabricação de material específico para minimizar a lesão das estruturas intra-articulares por essa via. OBJECTIVE: Intramedullary nails are the gold standard for treating tibial shaft fractures. Knee pain is a frequent complication after the procedure. Alternative routes such as the suprapatellar approach for nail insertion are seen as an option for avoiding late postoperative knee pain. The question is whether this approach might give rise to any injury to intra-articular structures of the knee. METHODS: This study analyzed the suprapatellar approach and the risk to adjacent structures by reproducing it in 10 knees of five cadavers. RESULTS: This approach was seen to make it easy to locate the entry point, with lesions only occurring in the Hoffa fat. In three of our cases, there were lesions of the chondral surface, which is an obstacle that is difficult to overcome. CONCLUSION: There is a need to develop specific material to minimize injury to intra-articular structures when using this route.

Kine Gregersen1,2, Jørgen Valeur1,3, Kristine Lillestøl1,3, Livar Frøyland2, Pedro Araujo2, Gülen Arslan Lied1,3, Arnold Berstad1,31Institute of Medicine, University of Bergen, 2National Institute of Nutrition and Seafood Research; 3Department of Medicine, Section for Gastroenterology, Haukeland University Hospital, Bergen, NorwayBackground: Food hypersensitivity is commonly suspected, but seldom verified. Patients with subjective food hypersensitivity suffer from both intestinal and extraintestinal health complaints. Abnormalities of the enterochromaffin cells may play a role in the pathogenesis. The aim of this study was to investigate enterochromaffin cell function in patients with subjective food hypersensitivity by measuring serum chromogranin A (CgA) and 5-hydroxytryptamine (5-HT, serotonin) in gut lavage fluid.Methods: Sixty-nine patients with subjective food hypersensitivity were examined. Twenty-three patients with inflammatory bowel disease and 35 healthy volunteers were included as comparison groups. CgA was measured in serum by enzyme-linked immunosorbent assay. Gut lavage fluid was obtained by administering 2 L of polyethylene glycol solution intraduodenally. The first clear fluid passed per rectum was collected and 5-HT was analyzed by liquid chromatography tandem mass spectrometry.Results: Serum levels of CgA were significantly lower in patients with subjective food hypersensitivity than in healthy controls (P = 0.04). No differences were found in 5-HT levels in gut lavage fluid between patients with subjective food hypersensitivity and the control groups. There was no correlation between serum CgA and gut lavage 5-HT.Conclusion: Decreased blood levels of CgA suggest neuroendocrine alterations in patients with subjective food hypersensitivity. However, 5-HT levels in gut lavage fluid were normal.Keywords: food hypersensitivity, chromogranin A, serotonin, gut lavage fluid, liquid chromatography

Objective: Intramedullary nails are the gold standard for treating tibial shaft fractures. Knee pain is a frequent complication after the procedure. Alternative routes such as the suprapatellar approach for nail insertion are seen as an option for avoiding late postoperative knee pain. The question is whether this approach might give rise to any injury to intra-articular structures of the knee. Methods: This study analyzed the suprapatellar approach and the risk to adjacent structures by reproducing it in 10 knees of five cadavers. Results: This approach was seen to make it easy to locate the entry point, with lesions only occurring in the Hoffa fat. In three of our cases, there were lesions of the chondral surface, which is an obstacle that is difficult to overcome. Conclusion: There is a need to develop specific material to minimize injury to intra-articular structures when using this route.

BACKGROUND: The uncoupling protein 1 (UCP1) is a hallmark of brown adipocytes and pivotal for cold- and diet-induced thermogenesis. METHODOLOGY/PRINCIPAL FINDINGS: Here we report that cyclooxygenase (COX) activity and prostaglandin E(2) (PGE(2)) are crucially involved in induction of UCP1 expression in inguinal white adipocytes, but not in classic interscapular brown adipocytes. Cold-induced expression of UCP1 in inguinal white adipocytes was repressed in COX2 knockout (KO) mice and by administration of the COX inhibitor indomethacin in wild-type mice. Indomethacin repressed beta-adrenergic induction of UCP1 expression in primary inguinal adipocytes. The use of PGE(2) receptor antagonists implicated EP(4) as a main PGE(2) receptor, and injection of the stable PGE(2) analog (EP(3/4) agonist) 16,16 dm PGE(2) induced UCP1 expression in inguinal white adipose tissue. Inhibition of COX activity attenuated diet-induced UCP1 expression and increased energy efficiency and adipose tissue mass in obesity-resistant mice kept at thermoneutrality. CONCLUSIONS/SIGNIFICANCE: Our findings provide evidence that induction of UCP1 expression in white adipose tissue, but not in classic interscapular brown adipose tissue is dependent on cyclooxygenase activity. Our results indicate that cyclooxygenase-dependent induction of UCP1 expression in white adipose tissues is important for diet-induced thermogenesis providing support for a surprising role of COX activity in the control of energy balance and obesity development.

Compared with soy oil, 10 days treatment with seal oil (SO), 10mLx3 daily, self-administrated through a nasoduodenal feeding tube, relieves joint pain in patients with inflammatory bowel disease (IBD). This randomized, controlled, double blind pilot trial compares SO and whale oil (WO) administered similarly by duodenal tube, for 10 days in 18 patients with IBD-related joint pain (n=9 per group). Other long chain n-3 polyunsaturated fatty acids were prohibited 7-days prior to and during study. Significant changes from baseline to study end were observed in both groups: reduced plasma arachidonic acid to eicosapentaenoic acid ratio and prostaglandin E(2) (PGE(2)) levels (tendency in WO group), decreased IBD-related joint pain and IBD-disease activity, and improved quality of life. These changes were not significantly different between SO and WO groups. Inhibition of cyclooxygenase is consistent with amelioration of IBD-related joint pain, but, as active control was used, effects need confirmation.

RESUMO: Lesões podais em ovinos são causas importantes de perdas econômicas por quedas na produtividade, na reprodução, por gastos com tratamentos ineficientes e com o descarte de animais afetados. Dessa forma, os objetivos foram descrever as principais características das lesões podais observadas em ovinos da Mesorregião Sudoeste do Rio Grande do Sul, seus aspectos epidemiológicos e a importância da ocorrência desses distúrbios para a criação de ovinos nessa região. Foram coletados dados epidemiológicos e clinicopatológicos de rebanhos ovinos da região entre abril de 2014 e abril de 2015 através de visitas técnicas em propriedades rurais. Foram avaliados rebanhos ovinos em 27 propriedades rurais localizadas em diferentes municípios, dos quais 21 registraram a ocorrência de lesões podais com relato de perdas econômicas significativas. Aproximadamente 1.700 ovinos, em média 10% dos rebanhos, apresentavam diferentes graus de claudicação decorrente de lesões podais que variavam de brandas a severas. Verificou-se que diversos fatores como clima e manejo foram favoráveis para o desenvolvimento das lesões podais e essas podem estar associadas a diferentes distúrbios e agentes etiológicos. No entanto, embora essas condições sejam importantes, o controle e a prevenção tem se mostrado ineficientes. Observou-se ainda que a pododermatite infecciosa dos ovinos (Footrot), parece ser a principal doença podal na região e atualmente pode ser considerada uma doença negligenciada.

After an 11-day baseline period, groups of eight healthy men received isoxicam, 200 mg once a day, or piroxicam, 20 mg once a day, for 28 days. Fecal blood loss (FBL) was quantitated by the 51Cr-labeled erythrocyte method. FBLs for both isoxicam and piroxicam were only slightly higher than baseline for the first 3 drug dosing days, confirming the results of a previously published 4-day study of piroxicam, but FBL subsequently steadily increased, with maxima occurring for most subjects receiving isoxicam in 2 or 3 weeks and for most subjects receiving piroxicam in 3 or 4 weeks. This implies that dosing for 7 days or less, as is frequent in FBL studies of nonsteroidal anti-inflammatory drugs, may be insufficient to detect the peak drug-induced FBL. In week 4, FBL for both drugs was elevated approximately 0.6 ml/day over baseline. FBLs in week 4 were comparable to those reported for naproxen and less than those reported for indomethacin and acetylsalicylic acid. Statistical analyses of weekly plasma drug minimum concentrations suggest steady state was reached at week 2 for isoxicam and week 3 for piroxicam. There were large between-subject variations in steady-state plasma drug concentrations for both drugs. One subject in each drug group indulged in excessive alcohol consumption during the medication period, with a concomitant significant increase in FBL, which suggests exacerbation of the drug effect. Clinical Pharmacology and Therapeutics (1985) 38, 533–537; doi:10.1038/clpt.1985.219

e16131 Background: Induction chemotherapy (IC) followed by chemoradiation (CRT) is an attractive approach in locally-advanced, high-risk rectal cancer. Additionally, aspirin has shown potential to lower recurrence rate in colorectal cancer, and improve outcomes alongside CRT in rectal cancer, with higher rate of tumor downstaging. Methods: Randomized, double-blind phase 2 trial to evaluate induction treatment with XELOX, followed by capecitabine-based chemoradiotherapy with aspirin or placebo in a high risk population selected by MRI. The aim of this study was to evaluate MRI response after total neoadjuvant treatment with aspirin or placebo. Results: Of the 25 pts who started treatment between January 2018 and March 2019, 4 pts did not complete (1 pt grade 5 diarrhea; 1pt treatment adherence). Median age was 55yo (32.9 - 73.6), 8 pts (32%) were women, and 80% had 3 or more high-risk criteria. 20 pts (80%) showed symptom improvement in the first cycle of IC. Of the 21 patients who finished treatment until interim analysis, 11 pts received aspirin (2 pts had MRI complete response (CR), 3 pts had minor/no response, and 3 pts had progression disease (PD)). 10 pts received placebo (4 MRI CR, 3 pts had minor/no response, and no PD). Conclusions: Aspirin added to chemoradiotherapy was safe but did not improve response to total neoadjuvant treatment. The study was closed due absence of benefit. Clinical trial information: NCT03170115 .