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A hemostasia é resultante do equilíbrio entre pró-coagulantes e anticoagulantes, envolvendo vasos, plaquetas, proteínas da coagulação e da fibrinólise e anticoagulantes naturais. Todos estes componentes estão inter-relacionados, constituindo os sistemas de coagulação, anticoagulação e fibrinólise. Muitos fatores, genéticos ou adquiridos, podem contribuir para romper este equilíbrio, levando a estados de hipo ou hipercoagulabilidade. Em doenças coronarianas como a angina e o infarto, há uma maior ativação das plaquetas e das proteínas da coagulação, favorecendo a formação de trombos. Na tentativa de restaurar a hemostasia, ocorre a intervenção do sistema fibrinolítico, o qual promove a lise do coágulo e desobstrui o vaso. Neste trabalho foram avaliados os mecanismos da coagulação e da fibrinólise e a proteína C, um anticoagulante natural. Foram estudados 20 pacientes com doenças coronarianas, notadamente angina de peito (n = 8) e infarto agudo do miocárdio (n = 12), além de pacientes potencialmente em risco de desenvolver doença cardiovascular (n = 17). O grupo infarto foi pareado com indivíduos sadios do ponto de vista clinicolaboratorial (grupo-controle, n = 12). Os resultados revelaram uma diferença significativa nos níveis de fibrinogênio nos grupos de angina e infarto quando comparados ao grupo-controle. Níveis de proteína C ativada também mostraram diferença significativa entre os grupos de risco e infarto. Os demais parâmetros hemostáticos avaliados não diferiram significativamente entre os grupos estudados, porém foi observada uma tendência à hipercoagulabilidade nos grupos de pacientes quando comparados ao grupo-controle.

The human protein Abelson kinase (Abl), a tyrosine kinase, plays a pivotal role in developing chronic myeloid leukemia (CML). Abl's involvement in various signaling pathways underscores its significance in regulating fundamental biological processes, including DNA damage responses, actin polymerization, and chromatin structural changes. The discovery of the Bcr-Abl oncoprotein, resulting from a chromosomal translocation in CML patients, revolutionized the understanding and treatment of the disease. The introduction of targeted therapies, starting with interferon-alpha and culminating in the development of tyrosine kinase inhibitors (TKIs) like imatinib, significantly improved patient outcomes. However, challenges such as drug resistance and side effects persist, indicating the necessity of research into novel therapeutic strategies. This review describes advancements in Abl kinase inhibitor development, emphasizing rational compound design from structural and regulatory information. Strategies, including bivalent inhibitors, PROTACs, and compounds targeting regulatory domains, promise to overcome resistance and minimize side effects. Additionally, leveraging the intricate structure and interactions of Bcr-Abl may provide insights into developing inhibitors for other kinases. Overall, this review highlights the importance of continued research into Abl kinase inhibition and its broader implications for therapeutic interventions targeting kinase-driven diseases. It provides valuable insights and strategies that may guide the development of next-generation therapies., (© 2024 Wiley-VCH GmbH.)

Introduction: Postural control involves the coordination of muscle synergies of lower limb for the performance of postural strategies. However, the relationship between muscle function and postural control of older adults with different levels of physical activity has not yet been fully elucidated. The aim of this study was to analyze the influence of muscle function of lower limb on postural control in tasks with disturbance in the visual and somatosensory systems of older adults with different levels of physical activity., Methods: 61 older adults participated in this study. The assessment of postural control was performed using posturography in tasks with visual and somatosensory systems disturbance. To assess peak torque and mean power of the lower limb, an isokinetic dynamometer was used. A regression test was performed to investigate the association between muscle function and posture. The regression model was adjusted for the level of physical activity., Results: The complexity of the task and level of physical activity influenced the association between muscle function and postural control. The conditions that involved simultaneous disturbance in the visual and somatosensory systems were the ones that showed the greatest combination of associations, regardless of the stance type., Conclusion: The ability to produce ankle and hip muscle power seems to be crucial for the postural control of the older adults in tasks that involve reducing the base of support associated with disturbances in the visual and somatosensory system. Physical activity programs for older adults should include strength and power training for the ankle, knee, and hip muscles, with emphasis on hip abductors., Competing Interests: Declaration of competing interest We have no conflict of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective  To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods  A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results  In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion  Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand., Competing Interests: Conflito de Interesses Os autores não têm conflitos de interesses a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.

Our aim was to evaluate musculoskeletal discomfort and the lifestyle of military police officers of administrative and tactical force departments. Military police officers were distributed into two groups: administrative (Adm, n = 15) and tactical force (TF, n = 16) departments. Their lifestyle was assessed using the Fantastic Lifestyle questionnaire. Moreover, physical activity quantification was assessed using the International Physical Activity questionnaire, and musculoskeletal discomfort was quantified using the Corlett diagram. The mean total time of physical activity was 546 ± 276 min per week. No differences ( p = 0.0832) were found between the Adm (454 ± 217 min) and TF (623 ± 301 min) groups. Concerning lifestyle, in general the sample presented very good (42%) and good (42%) style classification. For this parameter, no significant differences were found, but only a tendency was discovered (x 2 : 7.437; p = 0.0592); indeed, the TF presented a better classification (63%) of very good, compared to the Adm (53%) of good. No differences ( p > 0.05) were found in musculoskeletal perception of discomfort between the right and left sides ( p > 0.05) for all police officers and between the Adm and FT groups ( p > 0.05). Military police officers showed high and moderate risk for waist circumference and waist-to-hip ratio, respectively; however, lifestyle and total time of physical activity were considered adequate without differences between military administrative and tactical force sectors.

Introduction: Research indicates that self-rated health is associated with worse health outcomes in older adults. Thus, it is important to assess the association between built neighborhoods and self-rated health to establish strategies to improve the quality of life in the older adult population., Objective: To evaluate the association between the perceived characteristics of the built neighborhood and the negative self-rated health in Brazilian community-dwelling older adults., Methods: A cross-sectional study for finite random samples was performed with older adults who used the municipal public health service. The outcome was negative self-rated health using the question "How do you perceive your health?" The regular, bad, and very bad responses were grouped as negative self-perception. The exposure variables were the perceived characteristics of the built neighborhood, which was evaluated by the adapted version of the Neighborhood Environment Walkability Scale., Results: A total of 308 older adults were analyzed. Living close to food establishments (OR: 0.46; 95% CI: 0.25;0.85), fitness/bodybuilding gyms and/or clubs (OR: 0.51; 95% CI: 0.28;0.93), and safety to walk during the day (OR: 0.37; 95% CI: 0.16;0.87) and night (OR: 0.47; 95% CI: 0.26;0.84) were protective against negative self-rated health., Conclusion: Therefore, living in neighborhoods with better characteristics was less associated with negative self-rated health, demonstrating the importance of promoting strategies to improve the neighborhood infrastructure and this population's perception of health.

Objectives: Analyze the donor site morbidity of the dorsalis pedis neurovascular flap in traumatic injuries with hand tissue loss., Material and Methods: The study involved dorsalis pedis neurovascular flaps that were used to reconstruct the hands of eight male patients, between 1983 and 2003, aged between 21 and 53 years (mean 34.6, SD ± 10.5 years). The size of the lesions ranged from 35 to 78 cm2 (mean 53, SD ± 14.4 cm2). Surgical procedures were performed two to 21 days after the injuries had occurred. The patients were followed up for an average of 10.3 years (ranging 8-14, SD ± 2.1 years)., Results: Regarding the donor site, in one case there was hematoma formation, which was drained; in another case, the skin graft needed to be reassessed. All patients experienced delayed healing, with complete healing from 2 to 12 months after the surgery (mean 4.3, SD ± 3.2 months)., Conclusion: Despite the advantages of the dorsalis pedis neurovascular flap, we consider that the sequelae in the donor site is cosmetically unacceptable. Nowadays, this procedure is only indicated and justified when associated with the second toe transfer. Level of Evidence IV; Case series ., Competing Interests: All authors declare no potential conflict of interest related to this article.

The A-series is the most recent generation of chemical warfare nerve agents (CWA) which act directly on the inhibition of the human acetylcholinesterase (HssAChE) enzyme. These compounds lack accurate experimental data on their physicochemical properties, and there is no evidence that traditional antidotes effectively reactivate HssAChE inhibited by them. In the search for potential antidotes, we employed virtual screening, molecular docking, and molecular dynamics (MD) simulations for the theoretical assessment of the performance of a library of Mannich phenols as potential reactivators of HssAChE inhibited by the Novichok agents A-230, A-232, and A-234, in comparison with the commercial oximes pralidoxime (2-PAM), asoxime (HI-6), trimedoxime (TMB-4), and obidoxime. Following the near-attack conformation (NAC) approach, our results suggest that the compounds assessed would face difficulties in triggering the proposed nucleophilic in-line displacement mechanism. Despite this, it was observed that certain Mannich phenols presented similar or superior results to those obtained by reference oximes against A-232 and A-234 model, suggesting that these compounds can adopt more favourable conformations. Additional binding energy calculations confirmed the stability of the model/ligands complexes and the reactivating potential observed in the molecular docking and MD studies. Our findings indicate that the Mannich phenols could be alternative antidotes and that their efficacy should be evaluated experimentally against the A-series CWA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aims: It is important to identify the association between characteristics of the neighborhood environment, cognitive impairment and functional limitations to organize early and effective intervention strategies., Methods: A cross-sectional survey of 308 community-dwelling older adults was conducted. Logistic Regression analyses were performed to verify the associations between self-perceived characteristics of the neighborhood environment (Neighborhood Environment Walkability Scale), cognitive impairment (Mini-Mental State Examination) and functional limitations (mobility, lower limb muscle strength and balance)., Results: Significant negative associations were observed: (1) better infrastructure, traffic and safety and mobility limitation; (2) better infrastructure and muscle weakness; (3) better safety and balance limitation; and (4) better streets/sidewalks and cognitive impairment. On the other hand, positive associations were observed between poor safety with mobility limitation and muscle weakness., Conclusions: Our findings contribute to greater knowledge about neighborhood characteristics regarding mental and physical health in community-dwelling older adults., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest which could skew the results of this study., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: This study aims to present lines A1 and A2 in association with Kaplan's cardinal line (LCK), and relate them to the thenar motor branch of the median nerve (RMTNM) and to the deep branch of the ulnar nerve (RPNU)., Methods: Ten hands of five adult cadavers were dissected., Results: The RMTNM origin was positioned proximal to the LCK in all limbs. In two, the RMTNM was positioned exactly on the A1 line; in seven, it was on the ulnar side in relation to A1. In one, it was on the radial side relative to the A1. The origin of the RPNU was identified between the pisiform and the LCK in nine limbs; in one, the RPNU was positioned from the ulnar nerve in relation to A2; and in two, the A2 passed exactly at the point of division of the ulnar nerve into superficial branches and deep. We did not identify the positioning of the RPNU on the radial side of the A2 line., Conclusion: The impact of this study was to identify the anatomical trajectory of these nerves by detaching A1 and A2 along with the KCL, avoiding iatrogenic lesions during surgical procedures. Level of Evidence IV, Case Series. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Açaí, Euterpe oleracea Mart., is a native plant from the Amazonian and is rich in several phytochemicals with anti-tumor activities. The aim was to analyze the effects of açaí seed oil on colorectal adenocarcinoma (ADC) cells. In vitro analyses were performed on CACO-2, HCT-116, and HT-29 cell lines. The strains were treated with açaí seed oil for 24, 48, and 72 h, and cell viability, death, and morphology were analyzed. Molecular docking was performed to evaluate the interaction between the major compounds in açaí seed oil and Annexin A2. The viability assay showed the cytotoxic effect of the oil in colorectal adenocarcinoma cells. Acai seed oil induced increased apoptosis in CACO-2 and HCT-116 cells and interfered with the cell cycle. Western blotting showed an increased expression of LC3-B, suggestive of autophagy, and Annexin A2, an apoptosis regulatory protein. Molecular docking confirmed the interaction of major fatty acids with Annexin A2, suggesting a role of açaí seed oil in modulating Annexin A2 expression in these cancer cell lines. Our results suggest the anti-tumor potential of açaí seed oil in colorectal adenocarcinoma cells and contribute to the development of an active drug from a known natural product.

Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed., Subjects and Methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications., Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure., Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission - the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

The aim of this study was to alert the ophthalmic community to an atypical manifestation of ocular surface squamous neoplasia, which may delay diagnosis and treatment and result in a guarded visual prognosis and significant sequelae. A 61-year-old immunocompetent man presented with an initial diagnosis of necrotizing scleritis in the right eye for 3 months. He was treated with systemic prednisone but experienced persistent pain and low visual acuity. Conjunctival biopsy of the affected region confirmed the diagnosis of invasive ocular surface squamous neoplasia, which progressed with intraocular and orbital invasion; thus, exenteration was performed. Masquerade syndrome should be suspected in patients with nodulo-ulcerative lesions of the conjunctiva and sclera. This clinical can be more aggressive, with a greater likelihood of intraocular and orbital involvement. The earlier the diagnosis and treatment, the better the patient prognosis.

Physical Education is one of the categories featured in the SUS workforce. An ecological time series study, based on the National Registry of Health Establishments, was conducted to analyze the inclusion of Physical Education Professionals (PEFs) and residents in the SUS between 2009 and 2021. The scope of the article was to establish a panorama of the inclusion of Physical Education and analyze the distribution of PEFs and residents in the different regions. An increase of 476.01% in the number of PEFs and 10,366.67% among residents was revealed. The PEF rate per 100,000 inhabitants increased by 13.7% per year from 2009 to 2021, with an increase of 28.1% between 2009 and 2014 and 7.8% between 2014 and 2019, and a decrease of 3.4% between 2019 and 2021. The resident rate increased by 36.2% per year between 2009 and 2021, with a 45.9% increase between 2009 and 2017 and 18.7% between 2017 and 2021. Regional inequalities in the distribution of PEFs and residents were revealed, with the highest concentration, in 2021, in the Northeast and South regions, respectively. The increase in PEFs and residents in the SUS can be linked to policies and programs of physical exercise and activities, while the decrease is possibly related to the Previne Brasil Program and the COVID-19 pandemic.

Salicylate hydroxylase (NahG) is a FAD-dependent monooxygenase in which the reduced flavin activates O 2 coupled to the oxidative decarboxylation of salicylate to catechol or uncoupled from substrate oxidation to afford H 2 O 2 . This chapter presents different methodologies in equilibrium studies, steady-state kinetics, and identification of reaction products, which were important to understand the S E Ar mechanism of catalysis in NahG, the role of the different FAD parts for ligand binding, the extent of uncoupled reaction, and the catalysis of salicylate's oxidative decarboxylation. These features are likely familiar to many other FAD-dependent monooxygenases and offer a potential asset for developing new tools and strategies in catalysis., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: In 2016, the American College of Obstetricians and Gynecologists recommended antenatal corticosteroids in the late preterm period for women at risk for preterm delivery. Limited real-world evidence exists on neonatal outcomes, particularly for twin gestations, following the guideline change. The study objective is to determine the association of antenatal corticosteroids in late preterm singleton and twin pregnancies with respiratory complications and hypoglycemia in a real-world clinical setting., Methods: This is a retrospective cohort study comprising late preterm deliveries (4,341 mother-child pairs) within the Mount Sinai Health System, 2012-2018. The exposure of interest is antenatal corticosteroid administration of betamethasone during pregnancy between 34 0/7 and 36 6/7 weeks. Our primary outcomes are neonatal respiratory complications and hypoglycemia. Multivariable logistic regression was used to estimate the association between antenatal corticosteroid exposure and these two outcomes. We stratified the study population by singleton gestations and twins to minimize the potential confounding from different obstetric management between the two groups., Results: Among a total of 4,341 mother-child pairs (3,309 singleton and 1,032 twin mother-child pairs), 745 mothers received betamethasone, of which 40.94% (305/745) received the full course. Relative to no treatment, a full course of betamethasone was associated with reduced odds of respiratory complications (OR = 0.53, 95% CI:[0.31-0.85], p < 0.01) and increased odds of hypoglycemia (OR = 1.86, 95%CI:[1.34-2.56], p < 0.01) in singletons; however, the association with respiratory complications was not significant in twins (OR = 0.42, 95% CI:[0.11-1.23], p = 0.16), but was associated with increased odds of hypoglycemia (OR = 2.18, 95% CI:[1.12-4.10], p = 0.02). A partial course of betamethasone (relative to no treatment) was not significantly associated with any of the outcomes, other than respiratory complications in twins (OR = 0.34, 95% CI:[0.12-0.82], p = 0.02)., Conclusions: Exposure to antenatal corticosteroids in singletons and twins is associated with increased odds of hypoglycemia. Among singletons, exposure to the full dosage (i.e. two doses) was associated with decreased odds of respiratory complications but this was only the case for partial dose among twins. Twin gestations were not studied by the Antenatal Late Preterm Steroids trial. Therefore, our study findings will contribute to the paucity of evidence on the benefit of antenatal corticosteroids in this group. Health systems should systematically monitor guideline implementations to improve patient outcomes., (© 2022. The Author(s).)

Introduction: At the beginning of the medical career, the orthopedic surgeon in academic training needs valid methodologies for training complex surgeries in tissues that simulate real situations. With training in animal tissue, adapted to approach human tissue, it is possible to simulate procedures and decisions that will be necessary in real situations., Objective: This study consists in presenting a simple and reproducible simulation model for surgical repair of tendons by training on fresh tendons fixed on a wooden frame., Methodology: The model construction consists of a flat piece of Medium Density Fiberboard (MDF) and two threaded hooks were used on the board, to which Nylon threads are attached to tie the tendon, allowing a satisfactory simulation of a human tendon., Conclusion: This is a simple, inexpensive, and effective method for tendon suturing training, through which the trainee can develop repair techniques and basic surgical principles, such as instrument handling, safety, and sharps disposal. This approach aims to improve the trainee's skills and dexterity when placed in live surgery. The surgical techniques developed include the modified Kessler and Bunnel sutures. Level of Evidence IV, Descriptive Study ., Competing Interests: All authors declare no potential conflict of interest related to this article.

Abstract: Rodrigues, GM, Machado, S, Faria Vieira, LA, Ramalho de Oliveira, BR, Jesus Abreu, MA, Marquez, G, Maranhão Neto, GA, and Lattari, E. Effects of anodal transcranial direct current stimulation on training volume and pleasure responses in the back squat exercise following a bench press. J Strength Cond Res 36(11): 3048-3055, 2022-This study aimed to investigate the effects of anodal transcranial direct current stimulation (a-tDCS) on volume-load and pleasure responses in a back squat following a bench press. Twelve male subjects advanced in resistance training (RT) (age, 25.5 ± 4.4 years) completed 2 experimental trials in a counterbalanced crossover design: a-tDCS and sham conditions. The stimulus was applied over the left dorsolateral prefrontal cortex for 20 minutes using a 2-mA current intensity in a-tDCS condition and 1 minute of active stimulus in the sham condition. Immediately after stimulation, subjects performed the bench press followed by the back squat. The exercise protocol consisted of 3 sets of maximum repetitions at an intensity of 80% of 1 repetition maximum. The volume-load, perceived pleasure, and arousal responses were measured during the RT protocol. The results indicated that volume-load was higher in the a-tDCS condition than in the sham condition for both exercises ( p = 0.02), with large effect for the back squat ( p = 0.045; d = 0.96). The higher volume-load was obtained by increasing the number of repetitions across all sets for the bench press ( p ≤ 0.0001) and only in the first set for the back squat ( p = 0.01). The circumplex model analysis showed a higher pleasure in the bench press and a tendency toward a higher pleasure in the a-tDCS condition. Anodal tDCS may be used as an ergogenic resource for increasing the back squat volume after performing the bench press in resistance-trained male subjects., (Copyright © 2021 National Strength and Conditioning Association.)

The addition of reproductive fluids (RF) to the culture media has shown benefits in different embryonic traits but its long-term effects on the offspring phenotype are still unknown. We aimed to describe such effects in pigs. Blood samples and growth parameters were collected from piglets derived from in vitro-produced embryos (IVP) with or without RF added in the culture media versus those artificially inseminated (AI), from day 0 to month 6 of life. An oral glucose tolerance test was performed on day 45 of life. We show here the first comparative data of the growth of animals produced through different assisted reproductive techniques, demonstrating differences between groups. Overall, there was a tendency to have a larger size at birth and faster growth in animals derived from in vitro fertilization and embryo culture versus AI, although this trend was diminished by the addition of RFs to the culture media. Similarly, small differences in hematological indices and glucose tolerance between animals derived from AI and those derived from IVP, with a sex-dependent effect, tended to fade in the presence of RF. The addition of RF to the culture media could contribute to minimizing the phenotypical differences between the in vitro-derived and AI offspring, particularly in males.

Objective: To report the use of the serratus anterior free tissue transfer in the treatment of traumatic injuries., Methods: Twenty-six free flaps or serratus pedicled flaps were performed for reconstruction of traumatic extremity injuries., Results: Complete flap survival was recorded in 20 limbs and 3 patients had circulatory complications. Even with the review of vascular anastomoses, partial flap necrosis could not be prevented and required a skin graft after debridement in the necrotic area. Another flap also required reexploration as a result of heavy congestion due to impaired venous return. Superficial wound infection was found in three patients and treated with conservative measures. Regarding the donor area, seroma formation was found in 8 cases; drainage was necessary in 2, and the others were resolved spontaneously. In 2, bruises formed and were later drained. In 1 limb there was long thoracic nerve injury and scapular winging., Conclusion: According to this study, the serratus anterior muscle flap is an excellent tool for treating small complex lesions in the extremities. Level of Evidence IV; Case series ., Competing Interests: All authors declare no potential conflict of interest related to this article.

The acute respiratory syndrome caused by the SARS-CoV-2, known as COVID-19, has been ruthlessly tormenting the world population for more than six months. However, so far no effective drug or vaccine against this plague have emerged yet, despite the huge effort in course by researchers and pharmaceutical companies worldwide. Willing to contribute with this fight to defeat COVID-19, we performed a virtual screening study on a library containing Food and Drug Administration (FDA) approved drugs, in a search for molecules capable of hitting three main molecular targets of SARS-CoV-2 currently available in the Protein Data Bank (PDB). Our results were refined with further molecular dynamics (MD) simulations and MM-PBSA calculations and pointed to 7 multi-target hits which we propose here for experimental evaluation and repurposing as potential drugs against COVID-19. Additional rounds of docking, MD simulations and MM-PBSA calculations with remdesivir suggested that this compound can also work as a multi-target drug against SARS-CoV-2.Communicated by Ramaswamy H. Sarma.

This work establishes local diagnostic reference levels (DRLs) in interventional radiology based on adult patient body mass index (BMI). The monitoring was carried out from 23 institutions and patient data from 3015 procedures were collected, being 907 Catheterism (CAT), 921 Percutaneous transluminal coronary angioplasty (PTCA) and 1187 CAT/PTCA and 6 BMI ranges were taken, going from under 18 up to 40 kg·m-2. It is presented that 18 initial DRL values to be used in the county of Minas Gerais. The overall 75th kerma-area product (KAP), commonly considered DRL, in Gy·cm2, is 94.6(SD 119)-CAT, 88.6(SD 121)-PTCA and 33.0(SD 47.6)-CAT/PTCA. In considering KAP-BMI individual values, one obtain the min-max ranges, in Gy·cm2, 3.2-BMI A to 101-BMI B for CAT, 65-BMI A to 102-BMI F for PTCA and 10.4-BMI A to 59.2-BMI E for CAT/PTCA. The KAP-BMI approach has shown to be feasible as a DRL optimization process., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Preeclampsia is a heterogeneous and complex disease associated with rising morbidity and mortality in pregnant women and newborns in the US. Early recognition of patients at risk is a pressing clinical need to reduce the risk of adverse outcomes. We assessed whether information routinely collected in electronic medical records (EMR) could enhance the prediction of preeclampsia risk beyond what is achieved in standard of care assessments. We developed a digital phenotyping algorithm to curate 108,557 pregnancies from EMRs across the Mount Sinai Health System, accurately reconstructing pregnancy journeys and normalizing these journeys across different hospital EMR systems. We then applied machine learning approaches to a training dataset (N = 60,879) to construct predictive models of preeclampsia across three major pregnancy time periods (ante-, intra-, and postpartum). The resulting models predicted preeclampsia with high accuracy across the different pregnancy periods, with areas under the receiver operating characteristic curves (AUC) of 0.92, 0.82, and 0.89 at 37 gestational weeks, intrapartum and postpartum, respectively. We observed comparable performance in two independent patient cohorts. While our machine learning approach identified known risk factors of preeclampsia (such as blood pressure, weight, and maternal age), it also identified other potential risk factors, such as complete blood count related characteristics for the antepartum period. Our model not only has utility for earlier identification of patients at risk for preeclampsia, but given the prediction accuracy exceeds what is currently achieved in clinical practice, our model provides a path for promoting personalized precision therapeutic strategies for patients at risk., (© 2022. The Author(s).)

5 fluorouracil (5FU), an antineoplastic drug, is often utilized in the therapeutic regimen for several types of cancer, including the hepatoblastoma in children. The effects of 5FU on the population of ovarian preantral follicles, which is the largest oocyte reservoir, is still poorly understood. The integrity of the ovarian preantral follicle pool is important for lifelong fertility. The better understanding of such effects may favor intervention strategies to protect fertility in 5FU-treated children and women coping with cancer. To analyze the effects of 5FU on isolated murine secondary follicles in vitro, ovaries were collected from young mice (28-30 days old), and secondary follicles were isolated and cultured for 12 days in basic culture medium, with or without 5FU at concentrations of 0.3 mM, 1 mM, 3 mM, 10 mM, and 30 mM. In the in vitro study, we analyzed the percentage of morphologically normal follicles, antrum formation, follicular diameter, and hormone production. On day 12, oocytes were recovered for in vitro maturation. 5FU treatment did not alter the percentage of morphologically normal follicles. On day 12, only 1, 10, and 30 mM 5FU significantly reduced the percentage of antrum. From day 4 onwards, 5FU treatments significantly reduced follicle diameter. The meiosis resumption rate was significantly lower in all 5FU treatments. 5FU concentrations ≥3 mM reduced estradiol levels. In conclusion, 5FU does not affect follicular morphology. However, 5FU deleteriously affects follicular growth, estradiol production, and oocyte maturation in isolated ovarian follicles., Competing Interests: Declaration of competing interest The authors declare that no conflict of interest could be perceived as prejudicing the impartiality of the research reported., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The dosimetry of intraoral radiography procedures is of great interest since dental examinations are among the most numerous radiological procedures. Usually, the surveys are performed using measurements free in air. The entrance surface air kerma ( K e ) can be estimated from measurements of incident air kerma and the use of backscatter factors (BSF). The purpose of this work is to calculate BSF values suitable for intraoral radiography. In addition to specific intraoral radiography, a comprehensive reassessment of internationally recommended BSF values was performed through Monte Carlo simulations. Moreover, the K e was estimated using the calculated BSF values for a sample of 44 intraoral radiography systems. The interpolation of intraoral radiography BSF values from reference data can lead to an overestimation of up to 10% and 6% in comparison with the values calculated in this work for monoenergetic photons and x-ray spectra, respectively. Such discrepancy may be relevant when defining diagnostic reference levels (DRLs) or performing quality control tests. The calculations for a sample of 44 intraoral radiography systems showed that the majority of the equipment operates with an entrance surface air kerma higher than 3.5 mGy. In the case of adopting a single value to estimate K e , the use of BSF equal to 1.2 results in less dispersion compared to calculated values in this work and the use of 1.1 can underestimate K e values up to 12%., (© 2021 IOP Publishing Ltd.)

This paper presents a discussion regarding regression models, especially those belonging to the location class. Our main motivation is that, with simple distributions having simple interpretations, in some cases, one gets better results than the ones obtained with overly complex distributions. For instance, with the reverse Gumbel (RG) distribution, it is possible to explain response variables by making use of the generalized additive models for location, scale, and shape (GAMLSS) framework, which allows the fitting of several parameters (characteristics) of the probabilistic distributions, like mean, mode, variance, and others. Three real data applications are used to compare several location models against the RG under the GAMLSS framework. The intention is to show that the use of a simple distribution (e.g., RG) based on a more sophisticated regression structure may be preferable than using a more complex location model.

Purpose: 5-Fluorouracil (5-FU), an anti-cancer drug, has been used for hepatoblastoma (HB) chemotherapy in children, who may have impaired  ovarian follicle pool reserve with lasting effects to reproduction. Therefore, this study aimed to investigate 5-FU effects on survival, growth, and morphology of ovarian preantral follicles from C57BL6J young mice., Methods: Experiments were carried-out both in vivo and in vitro. Mice were treated with 5-FU injection (450 mg/kg i.p) or saline and sacrificed 3 days after to obtain ovaries for histology and molecular biology. Ovaries for in vitro studies were obtained from unchallenged mice and cultured under basic culture medium (BCM) or BCM plus 5-FU (9.2, 46.1, 92.2 mM). Preantral follicles were classified according to developmental stages, and as normal or degenerated. To assess cell viability, caspase-3 immunostaining was performed. Transcriptional levels for apoptosis (Bax, Bcl2, p53, Bax/Bcl2) and Wnt pathway genes (Wnt2 and Wnt4) were also analyzed. Ultrastructural analyses were carried-out on non-cultured ovaries. In addition, β-catenin immunofluorescence was assessed in mouse ovaries., Results: The percentage of all-types normal follicles was significantly lower after 5-FU challenge. A total loss of secondary normal follicles was found in the 5-FU group. The highest 5-FU concentrations reduced the percentage of cultured normal primordial follicles. Large vacuoles were seen in granulosa cells and ooplasm of preantral follicles by electron microscopy. A significantly higher gene expression for Bax and Bax/Bcl2 ratio was seen after 5-FU treatment. A marked reduction in β-catenin immunolabeling was seen in 5-FU-challenged preantral follicles. In the in vitro experiments, apoptotic and Wnt gene transcriptions were significantly altered., Conclusion: Altogether, our findings suggest that 5-FU can deleteriously affect the ovarian follicle reserve by reducing preantral follicles survival.

Background: Seminal plasma (SP) plays a crucial role in sperm protection and functionality. However, the effect of SP on the sperm cryopreservation is dependent on the stallion and SP composition. The use of epididymal spermatozoa incubated in the presence of SP could help the identification of the components of SP that are able to confer protection upon the spermatozoa during freezing., Objective: The aims of this study were (i) to identify SP components involved in the potential protection of epididymal spermatozoa during the freeze-thawing process and (ii) to identify and evaluate the proteins likely related to sperm freezability, using two-dimensional difference gel electrophoresis (2D-DIGE)., Materials and Methods: Epididymal spermatozoa from 4 stallions were incubated with SP (80%, v/v) or without SP (control) before freezing. Sperm parameters were evaluated after thawing (viability, chromatin condensation, acrosomal integrity, reactive oxygen species [ROS]) and SP composition: total antioxidant capacity (TAC), fatty acid composition, total protein concentration, and protein components by 2D-DIGE., Results: After thawing, the proportions of viable and acrosome-intact spermatozoa were higher than control when SP from two stallions was used (F and O). The SP of all stallions reduced ROS production in comparison with the control. After analyzing the SP components, it was found that total protein concentration, TAC, polyunsaturated fatty acids (PUFA), and eight specific proteins identified by 2D-DIGE were different between stallions., Discussion: These studies allow the identification of SP components that could be involved in sperm protection or cryotolerance. Use of this information could help in the selection of stallions according to their semen freezing capacity., Conclusion: The composition of the SP probably contributes to semen cryotolerance capacity. Total protein, TAC, PUFA, and some proteins such as cysteine-rich secreted protein 3 could be used as biomarkers for the selection for sperm cryotolerance., (© 2020 American Society of Andrology and European Academy of Andrology.)

Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location., Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded., Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps., Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Chemotaxis is a spermatozoa guidance mechanism demonstrated in vitro in several mammalian species including porcine. This work focused on follicular fluid (FF), periovulatory oviductal fluid (pOF), the medium surrounding oocytes during in vitro maturation (conditioned medium; CM), progesterone (P4), and the combination of those biofluids (Σ) as chemotactic agents and modulators of spermatozoa fertility in vitro. A chemotaxis chamber was designed consisting of two independent wells, A and B, connected by a tube. The spermatozoa are deposited in well A, and the chemoattractants in well B. The concentrations of biofluids that attracted a higher proportion of spermatozoa to well B were 0.25% FF, 0.25% OF, 0.06% CM, 10 pM P4 and 0.25% of a combination of biofluids (Σ2), which attracted between 3.3 and 12.3% of spermatozoa ( p < 0.05). The motility of spermatozoa recovered in well B was determined and the chemotactic potential when the sperm calcium channel CatSper was inhibited, which significantly reduced the % of spermatozoa attracted ( p < 0.05). Regarding the in vitro fertility, the spermatozoa attracted by FF produced higher rates of penetration of oocytes and development of expanded blastocysts. In conclusion, porcine reproductive biofluids show an in vitro chemotactic effect on spermatozoa and modulate their fertilizing potential.

Objective  To analyze the anatomical variations of the motor branches of the radial nerve in the elbow region. The origin, course, length, branches, motor points and relationships with neighboring structures were evaluated. Materials and Methods  Thirty limbs from15 adult cadavers were dissected and prepared by intra-arterial injection of a 10% glycerin and formaldehyde solution. Results  The first branch of the radial nerve in the forearm went to the brachioradialis muscle (BR), originating proximally to the division of the radial nerve into superficial branch of the radial nerve (SBRN) and posterior interosseous nerve (PIN) in all limbs. The branches to the extensor carpi radialis longus muscle (ECRL) detached from the proximal radial nerve to its division into 26 limbs, in 2, at the dividing points, in other 2, from the PIN. In six limbs, the branches to the BR and ECRL muscles originated from a common trunk. We identified the origin of the branch to the extensor carpi radialis brevis muscle (ECRB) in the PIN in 14 limbs, in the SBRN in 12, and in the radial nerve in only 4. The branch to the supinator muscle originated from the PIN in all limbs. Conclusion  Knowledge of the anatomy of the motor branches of the radial nerve is important when performing surgical procedures in the region (such as the approach of the proximal third and the head of the radius, release of compressive syndromes of the posterior interosseous nerve and radial tunnel, and distal nerve transfers) in order to understand the order of recovery of muscle function after a nerve injury., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To analyse the anatomical variations of the median nerve motor branches in the elbow region., Methods: Twenty upper limbs of 10 adult male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde. All cadavers belonged to the institution anatomy laboratory., Results: We found a great variability within the distribution of median nerve branches leading to forearm muscles. Only three limbs (14%) presented the normal standard of innervation described in anatomy treatises. The pronator teres muscle (PTM), flexor carpi radialis (FCR), palmaris longus (PL), and the flexor digitorum superficialis (FDS) received exclusive innervation from the median nerve in all forearms. The anterior interosseous nerve (AIN) also originated from the median nerve in all dissected limbs., Conclusion: A thorough understanding of the anatomy of the median nerve branches is important for performing surgeries such as: approach to the proximal third of the forearm, alleviation of pronator teres and anterior interosseous nerve compression syndromes, and distal nerve transfers. It also enables a better understanding the recovery of muscle function after a nerve injury. Level of Evidence IV, Case series. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Oxidative stress is one of the most detrimental factors that affect oocyte developmental competence and embryo development in vitro. The impact of anethole supplementation to in vitro maturation (IVM) media on oocyte maturation and further bovine in vitro embryo production was investigated. Oocytes of slaughterhouse-derived bovine ovaries were placed in IVM with anethole at different concentrations of 30 (AN30), 300 (AN300), and 2000 μg/mL (AN2000), or without (control treatment). The oocytes were assessed for maturation rates, and for reactive oxygen species (ROS) and ferric reducing antioxidant power (FRAP) levels, and mitochondrial membrane potential. Embryo development was assessed by cleavage and blastocyst rates, and embryo cell number. The percentage of metaphase II oocytes were similar among the treatments (range, 77%-96%). Anethole at 300 μg/mL was the only treatment that yielded higher cleavage and embryo development (morula and blastocyst) rates compared to the control treatment. The ROS production in the oocytes after maturation did not differ among treatments. However, oocytes treated with anethole at 300 μg/mL had higher (P < .05) FRAP and mitochondrial membrane potential compared to the control treatment. Furthermore, AN300 treatment increased (P < .05) the average number of total cells in blastocysts compared to the control and AN30 treatments. The use of anethole at 300 μg/mL during IVM is suggested to improve the quantity and quality of bovine embryos produced in vitro. The beneficial effects of anethole on embryonic developmental competence in vitro seems to be related to its capacity to regulate the redox balance and improve mitochondrial function in oocytes and embryos.

Mycoplasma bovis is an important etiologic agent of bovine mycoplasmosis in cattle. Different transmission routes have been described, including those related to reproduction. The presence of mycoplasma in semen has led to its appearance in infection-free areas through artificial insemination (AI). Semen was recently reported to be the initial source of two M. bovis mastitis outbreaks in two closed dairy herds in Finland. This questions the effectiveness of the antimicrobials currently used in semen extenders to control the pathogens in contaminated semen. They should be re-evaluated, or alternative measures to antimicrobials should be tested to obtain M. bovis - free semen. This in vitro study aimed to assess different strategies to reduce the risk of transmission of M. bovis through AI technologies. The viability of M. bovis (PG45, NCTC 10131) in bull semen diluted (DS) in a Tris-citrate-fructose solution was tested, after the addition of enrofloxacin, doxycycline or a Lactobacillus spp.-based probiotic. The data show the susceptibility of the pathogen to the addition of 0.125 μg/mL of enrofloxacin or 0.0625 μg/mL of doxycycline and to the addition of the probiotic at a concentration of 3.24 × 10 6 colony forming units (CFU)/mL or 3.24 × 10 8 CFU/mL in DS. The Tris-citrate-fructose medium negatively affected the viability of M. bovis , although this effect was lower than that observed after the addition of the probiotic and antimicrobials ( p < 0.05). Our results may support new strategies for reducing the risk of M. bovis transmission through AI., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results

Objective  The purpose of the present study was to analyze the structures in the radial tunnel that can cause posterior interosseous nerve entrapment. Methods  A total of 30 members of 15 adult cadavers prepared by intra-arterial injection of a 10% solution of glycerol and formalin were dissected. All were male, belonging to the laboratory of anatomy of this institution. Results  The branch for the supinator muscle originated from the posterior interosseous nerve in all limbs. We identified the Frohse arcade with a well-developed fibrous constitution in 22 of the 30 dissected limbs (73%) and of muscular constitution in 8 (27%). The distal margin of the supinator muscle presented fibrous consistency in 7 of the 30 limbs (23.5%) and muscular appearance in 23 (76.5%). In the proximal margin of the extensor carpi radialis brevis muscle, we identified the fibrous arch in 18 limbs (60%); in 9 (30%) we noticed the arcade of muscular constitution; in 3 (10%) there was only the radial insertion, so that it did not form the arcade. Conclusion  The Frohse arcade and the arcade formed by the origins of the extensor carpi radialis brevis are normal anatomical structures in adult cadavers. However, from the clinical point of view, these structures have the potential to cause entrapment of the posterior interosseous nerve., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses.

Objective: This anatomical study aimed to analyze the possibility of transferring the radial nerve branches destined to the brachioradialis (BR), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and supinator (SM) muscles to innervate the AIN., Methods: Ten limbs from five male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formalin., Results: The presence of only one branch to the BR muscle was noted in 7 limbs and two branches were noted in three limbs. In two members of a common trunk with branch to the ECRL. In eight cases, we identified one branch for the ERLC and two branches in two cases. We identified only one branch for the ECRB, while in six limbs, two branches were noted, penetrating the muscular body at two different points. We identified at least two branches innervating the supinator muscle. The AIN was detached from the median nerve distal to the intercondylar line of the humerus. In seven limbs, it originated from the nervous fascicles of the posterior region of the median nerve and from the posterolateral fascicles in three limbs. The flexor pollicis longus and flexor digitorum profundus muscles received more than one branch of the AIN in all limbs., Conclusion: The radial nerve branches for the ECRL, ECRB, and supinator muscles can be transferred directly to the AIN or to one of its branches after intraneural dissection, without tension even in elbow movements. Level of Evidence IV; Case series. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Objective  To define the anatomy pattern and the incidence of Riché-Cannieu anastomosis, that is, median and ulnar communication in the palmar aspect of the hand. Materials Methods  A total of 80 anatomical dissections were performed on 60 hands of 30 cadavers from 1979 to 1982, and on 20 hands from 2012 to 2015. All of these procedures were performed at the Department of Anatomy of our institution. The incidence of Riché-Cannieu anastomosis and the innervation of the thenar muscles were studied. Results  Riché-Cannieu anastomosis was identified in every dissected hand (100%). The extramuscular Riché-Cannieu anastomosis was recorded in 57 hands, and the intramuscular, in 19 hands. The association of extra- and intramuscular Riché-Cannieu anastomoses occurred in four hands. The ulnar component always originated from the deep branch. The anastomotic branch arising from the median nerve originated from the motor thenar branch (recurrent branch) of the median nerve in most of the observations. The median-ulnar double innervation only to the deep head of the flexor pollicis brevis was identified in 29 of 80 hands. The double innervation only of the superficial head of the flexor pollicis brevis was found in 13 hands. In 12 hands, the deep head of the flexor pollicis brevis was absent. The double innervation of the superficial and deep heads of the flexor pollicis brevis occurred in 14 hands. The oblique head of the adductor pollicis received double innervation in 12 hands. The deep head of the flexor pollicis brevis and the oblique head of adductor pollicis were doubly-innervated in nine hands. The transverse head of the adductor pollicis received double innervation in two hands. Double innervation of the deep head of the flexor pollicis brevis and the transverse head of the adductor pollicis were found in one hand. Conclusion  According to the present study, Riché-Cannieu anastomosis should be considered a normal anatomical neural connection, not an anatomical variation. Knowledge of this anastomosis is essential because the presence of such neural communication may result in confusing clinical, surgical, and electromyographic findings in cases of median or ulnar damage or entrapment., Competing Interests: Conflitos de Interesse Os autores declaram não haver conflitos de interesse.

Objective  To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods  A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results  To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion  In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears., Competing Interests: Conflitos de Interesse Os autores declaram não haver conflitos de interesse.

Background: As compared with singleton gestations, twin pregnancies are associated with a significantly higher risk of preterm birth and maternal complications as well as fetal and neonatal morbidity and mortality. Multifetal pregnancy reduction is a technique developed in the 1980s to reduce the fetal number in higher-order multiple pregnancies to reduce the risk of adverse pregnancy outcomes, most importantly preterm birth., Objective: The objective of the study was to compare pregnancy outcomes and loss rates in elective twin pregnancy reduction to ongoing twin gestations in a large contemporary cohort., Study Design: This was a retrospective review of dichorionic diamniotic twin gestations that underwent first-trimester ultrasound at our institution from January 2008 to September 2016. Planned elective 2-to-1 multifetal pregnancy reductions at less than 15 weeks' gestation were compared with ongoing dichorionic diamniotic twin gestations. Data were collected via chart review. Demographics between 2-to-1 reduced singletons and ongoing twins were assessed using a Student t test or a Wilcoxon rank-sum test, as appropriate, for continuous variables and χ 2 or Fisher exact tests, as appropriate, for categorical variables. Univariable and multivariable logistic regressions were used to compare pregnancy outcomes between ongoing twins and reduced singletons adjusting for maternal age, body mass index, race, in vitro fertilization, use of chorionic villus sampling, prior term birth, and prior preterm birth., Results: Of 1070 dichorionic diamniotic twin pregnancies identified, completed follow-up data were available and analyzed for 855 patients (79.9%). Among those, 250 (29.2%) were 2-to-1 singletons and 605 (70.8%) were ongoing twins. Reduced singleton patients were slightly older, more likely white, and had lower body mass index. They were also more likely to have undergone in vitro fertilization (63.6% vs 48.8%), had chorionic villus sampling (92% vs 37.5%), and had prior term births (54% vs 35.7%). Compared with 2-to-1 singletons, the adjusted odds of having preterm delivery at 37 weeks for ongoing twins were 5.62 times (95% confidence interval, 3.67-8.61; P < .001) and 2.22 times (95% confidence interval, 1.20-4.11; P < .001) at 34 weeks. While intrauterine growth restriction, placental abruption, and gestational diabetes were not significant, ongoing twins were more likely to have a cesarean delivery (odds ratio, 5.53, 95% confidence interval, 3.60-8.49; P < .001) and preeclampsia (odds ratio, 3.33, 95% confidence interval, 1.60-6.96; P < .001) after adjusting for maternal characteristics. There were also significant differences between groups for preterm premature rupture of membranes and low birthweight at less than the fifth and 10th percentiles. Total pregnancy loss (at 24 and 20 weeks) was similar between singleton and ongoing twins (4% vs 2.5%, P = .23, and 3.6% vs 1.7%, P = .09 for respective weeks). There were no significant differences in the rate of unintended pregnancy loss (2.4% vs 2.3%; P = .94) and the rate of intrauterine fetal death greater than 24 weeks (1.2% vs 0.7%; P = .43) in reduced singleton versus ongoing twin group, respectively., Conclusion: In our study, patients who elected to reduce to a singleton pregnancy had a higher gestational age of delivery and lower rates of preterm birth and pregnancy complications without an increased risk of pregnancy loss., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed., Methods: Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle., Results: This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs., Conclusion: In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.

Background: It is unknown how variations in surgical entry time in primary cesarean delivery (CD) may affect operative outcomes and maternal morbidity., Objective: Determine whether performing a primary CD in labor emergently ("stat") is associated with adverse maternal outcomes., Study Design: Retrospective cohort study of patients who underwent primary CD at The Mount Sinai Hospital during the years of 2011-2016. Women with a singleton pregnancy and without a prior uterine scar attempting a trial of labor were included. An emergent CD was defined as a skin-to-uterine incision (I-U) time of ≤3 minutes. Subjects were dichotomized into those with an I-U time of ≤3 minutes or ≥5 minutes., Results: 1722 patients underwent primary CD and met eligibility criteria. 72 patients with an I-U time of 4 minutes were removed from the analysis. 196 patients (11.9%) had an I-U time ≤3 minutes and 1454 patients (88.1%) had an I-U time ≥5 minutes. There were no differences in any outcomes between groups. The likelihood of transfusion, hysterectomy, or admission to the intensive care unit (ICU) was 1.5% in the emergent group and 1.0% in the control group (p = .334). Postpartum length of stay was also similar between the groups (3.3 versus 3.2 days, p = .259). When 384 patients with I-U times >10 minutes were excluded, surgical outcomes remained similar between groups. Among the subgroup of patients who reached the second stage of labor, surgical outcomes were also similar between groups., Conclusions: Emergent primary CD is not associated with increased maternal morbidity.