ARTHROSCOPIC TREATMENT OF ACUTE ACROMIOCLAVICULAR JOINT DISLOCATION USING SUTURE ANCHORS

Objective: To present the clinical and radiographic results of a case series of patients with acute acromioclavicular dislocation (MD) treated by arthroscopic coracoclavicular fixation with suture anchors. Method: Twenty patients with AAD with less than 30 days since the injury were submitted to a coracoclavicular stabilization procedure using 2 suture anchors placed at the base of the coracoid process. Each suture anchor was connected to 2 strands of No.2 nonabsorbable-braided sutures, which were passed through the holes drilled in the clavicle and tied to the upper surface of the clavicle. The coracoclavicular distance was measured and compared to the opposite side using radiographic evaluation. Constant and UCLA scores were used to determine clinical and functional evaluation after 6 months. Results: Of the initial twenty cases, six were submitted to a new surgical procedure and were excluded from the study. Of the fourteen patients remaining, only two maintained the initial reduction, while the remainder presented some degree of reduction loss. The Constant and UCLA score averages were 94.79 (82-100) and 32.64 (26-35) respectively. Conclusion: The technique had a high incidence of reduction loss after 6 months of follow up. The clinical and functional evaluation was satisfactory, with a high average score. Level of Evidence: Level III, retrospective study.

EVALUATION OF FUNCTIONAL GAIN OF THE ELBOW FOLLOWING STEINDLER SURGERY FOR BRACHIAL PLEXUS INJURY

Objective: To evaluate the gain in strength and range of motion after modified Steindler surgery of the elbow in patients with lesions of the upper trunk of the brachial plexus. Method: From 1998 to 2007, eleven patients with traumatic closed upper trunk lesion of the brachial plexus were studied. All the patients had development of at least 1 year of injury and degree of strength of elbow flexion ranging from M1 to M3. The patients underwent Steindler surgery with at least 6 months of follow-up. Pre- and post-operative assessments were carried out to determine gain in muscle strength, range of motion of the elbow, and DASH scale score. Results: Of the eleven patients studied, nine (82%) achieved a level of strength equal to or greater than M3 (MRC) with good functional recovery. Two (18%) reached strength level M2 (MRC). We observed that the patients had an average postoperative gain in range of motion of the elbow of 43.45 degrees. The average elbow flexion after surgery was 88 degrees. There was an improvement in elbow function, as demonstrated in the DASH Scale, in 81% of the patients studied. Conclusion: Modified Steindler surgery was effective in the treatment of patients with injuries of the upper trunk of the brachial plexus, with statistically significant gains in range of motion. In all the cases studied, there was some degree of gain in strength and range of elbow flexion, the gain being correlated with the initial muscle strength. Level of Evidence: Level II, prospective clinical trial.

Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome

Background: Fat accumulation in the upper region of the body is common in polycystic ovary syndrome (PCOS) and is associated with metabolic complications. The present study aimed to assess the relationship between trunk circumference, metabolic indicators, and abdominal and visceral fat in obese PCOS women. Methods: The weight, fat mass, and subcutaneous arm fat (SAF) of 30 obese PCOS women and 15 healthy controls matched for age and body mass index were evaluated by bioelectrical impedance analysis. Trunk (TrC), neck (NC) and hip circumferences were measured, and the trunk/hip (Tr/H) ratio was determined. Total abdominal fat (TAF), visceral fat (VF) and trunk fat (TrF) were determined by computed tomography. Biochemical evaluation included glycaemia, insulinaemia, testosterone and lipid profile, insulin resistance (IR) was assessed by the QUICKI index. Results: In the PCOS group, there were positive correlations between NC and TAF (r = 0.49, P < 0.0006), TrC and VF (r = 0.62, P = 0.01), and NC and VF (r = 0.70, P < 0.0002). There was good correlation between TrC and TrF (r = 0.69, P = 0.003). TrF correlated with triglycerides levels positively (r = 0.44, P = 0.02). Women with PCOS and IR had a larger quantity of VF and TrF, but a smaller amount of SAF. Within the PCOS group, women with Tr/H ratio above the median had higher basal insulin levels and lower QUICKI indices compared to women presenting a Tr/H ratio below the median. Conclusions: TrC is associated with important metabolic variables in PCOS, proving to be a valuable and innovative tool for assessment of body adiposity distribution in obese PCOS women.

Discordant Nadir GH After Oral Glucose and IGF-I Levels on Treated Acromegaly: Refining the Biochemical Markers of Mild Disease Activity

Biochemical markers for remission on acromegaly activity are controversial. We studied a subset of treated acromegalic patients with discordant nadir GH levels after oral glucose tolerance test (oGTT) and IGF-I values to refine the current consensus on acromegaly remission. We also compared GH results by two GH immunoassays. From a cohort of 75 treated acromegalic patients, we studied 13 patients who presented an elevated IGF-I despite post-oGTT nadir GH of <= 1 mu g/l. The 12-h daytime GH profile (GH-12 h), nadir GH after oGTT, and basal IGF-I levels were studied in patients and controls. Bland-Altman method showed high concordance between GH assays. Acromegalic patients showed higher mean GH-12 h values (0.71+/-0.36 vs. 0.31+/-0.28 mu g/l; p<0.05) and nadir GH after oGTT (0.48+/-0.32 vs. 0.097+/-0.002 mu g/l; p<0.05) as compared to controls. Nadir GH correlated with mean GH-12 h (r=0.92, p<0.05). The mean GH-12 h value from upper 95% CI of controls (0.54 mu g/l) would correspond to a theoretical normal nadir GH of <= 0.27 mu g/l. Patients with GH nadir <= 0.3 mu g/l had IGF-I between 100-130% ULNR (percentage of upper limit of normal range) and mean GH-12 h of 0.35+/-0.15, and patients with GH nadir >0.3 and <= 1 mu g/l had IGF-I >130% ULNR and mean GH-12 h of 0.93+/-0.24 mu g/l. Our data integrate daytime GH secretion, nadir GH after oGTT, and plasma IGF-I concentrations showing a continuum of mild residual activity in a subgroup of treated acromegaly with nadir GH values <= 1 mu g/l. The degree of increased IGF-I levels and nadir GH after oGTT are correlated with the subtle abnormalities of daytime GH secretion.

Histometric Study of Alveolar Bone in Rats Submitted to Ethanol During Lactation

The present work studied the adverse effects of maternal exposure of rats to alcohol during lactation, on the development of their offspring. Histometric evaluation by karyometry and of the alveolar bone at the level of the first upper molar of the sucking was perfomed. Two groups of animals, one coming from mothers exposed to drinking water containing 20% ethanol during the total lactation period and the other of controls coming from mothers receiving only alcohol-free drinking water during this period. On the 21 first day of lactation the young of each group were aleatorily selected and following anesthesia, their heads severed; after histological treatment, serial 6 mu m sections on the frontal plane at the molar level, stained with hematoxilin and eosin, were obtained. The experimental results produced, suggest that sucking from ethanol-treated mothers, show retarded post-natal growth, their alveolar bones presenting scarce, little calcified trabeculae, and a more abundant bone marrow compared to controls.

Bacterial leakage evaluation of root canals filled with different endodontic sealers

Objective. The objective of this study was to evaluate the sealing ability of AH Plus, Epiphany, Acroseal, Endofill, and Polifil after active lateral condensation technique, by using a bacterial test, during 64 days. Study design. One hundred bovine incisors were cleaned and shaped; then they were filled with the endodontic sealers and adapted into a microcentrifuge tube. The setup root/microcentrifuge tube was added to glass flasks containing Brain Heart Infusion broth. A culture of Enterococcus faecalis was inserted into the upper chamber of each assembly. Daily leakage was evaluated through the broth turbidity. Results. The results were submitted to statistical analysis (Kaplan-Meier method, Kruskal-Wallis and Dunn tests). Conclusions. AH Plus and Endofill had the worst sealing ability when compared with Polifil, which showed the least leakage. Acroseal and Epiphany showed a tendency toward having an intermediate behavior; however, there was no significant difference among Acroseal, Epiphany, and the other sealers. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e56-e60)

Microbiological Shelf Life of Pasteurized Milk in Bottle and Pouch

Shelf life of pasteurized milk in Brazil ranges from 3 to 8 d, mainly due to poor cold chain conditions that prevail throughout the country and subject the product to repeated and/or severe temperature abuse. This study evaluated the influence of storage temperature on the microbiological stability of homogenized whole pasteurized milk (75 degrees C/15 s) packaged in high-density polyethylene (HDPE) bottle and low-density polyethylene (LDPE) pouch, both monolayer materials pigmented with titanium dioxide (TiO(2)). The storage temperatures investigated were 2, 4, 9, 14, and 16 degrees C. Microbiological evaluation was based on mesophilic and psychrotrophic counts with 7 log CFU/mL and 6 log CFU/mL, respectively, set as upper limits of acceptability for maintaining the quality of milk. The microbiological stability for pasteurized milk packaged in HDPE bottle and stored at 2, 4, 9, 14, and 16 degrees C was estimated at 43, 36, 8, 5, and 3 d, respectively. For milk samples packaged in LDPE pouch, shelf life was estimated at 37, 35, 7, 3, and 2 d, respectively. The determination of Q(10) and z values demonstrated that storage temperature has a greater influence on microbiological shelf life of pasteurized milk packaged in LDPE pouch compared to HDPE bottle. Based on the results of this study, HDPE bottle was better for storing pasteurized milk as compared to LDPE pouch.

Biogeography of Glandulocaudinae (Teleostei : Characiformes : Characidae) revisited: phylogenetic patterns, historical geology and genetic connectivity

The biogeography of the Glandulocaudinae ( former Glandulocaudini) is reviewed. The major pattern of diversification presented by this group of freshwater fishes can be clearly associated to the main aspects of the tectonic evolution of the southern portion of the Cis-Andean South American Platform. The phylogenetic relationships within the group suggest that the clade represented by Lophiobrycon is the sister-group of the more derived clade represented by the genus Glandulocauda and Mimagoniates. Lophiobrycon and Glandulocauda occur in areas of the ancient crystalline shield of southeastern Brazil and their present allopatric distribution is probably due to relict survival and tectonic vicariant events. Populations of Glandulocauda melanogenys are found in contiguous drainages in presently isolated upper parts of the Tiete, Guaratuba, Itatinga, and Ribeira de Iguape basins and this pattern of distribution is probably the result of river capture caused by tectonic processes that affected a large area in eastern and southeastern Brazil. The species of Mimagoniates are predominantly distributed along the eastern and southeastern coastal areas, but M. microlepis is additionally found in the rio Iguacu and Tibagi basins. Mimagoniates barberi occurs in both SW margin of the upper rio Parana basin and the lower Paraguay and Mimagoniates sp. occurs in the upper Paraguay river basin. Tectonic activations of the Continental Rift of Southeastern Brazil along the eastern margin of the Upper Parana basin promoted population fragmentation responsible of the present day distribution presented by Glandulocauda melanogenys. We hypothesize that occurrence of Mimagoniates along the lowland area around the Parana basin was due to a single or a multiple fragmentation of populations along the W-SW border of the upper Parana Basin, probably due to the major tectonic origin of the Chaco-Pantanal wetland foreland basins since the Miocene as well as Cenozoic tectonic activity along the borders of the upper Parana basin, such as in the eastern Paraguay, in the Asuncion Rift. Distributional pattern of Mimagoniates suggests that its initial diversification may be related to the tectonic evolution of the Chaco-Pantanal foreland basin system and a minimum age of 2.5 M.Y are proposed for this monophyletic group. Previous hypotheses on sea level fluctuations of the late Quaternary as being the main causal mechanism promoting cladogenesis and speciation of the group are critically reviewed. Phylogeographic studies based on molecular data indicate significant differences among the isolated populations of M. microlepis. These findings suggest that a much longer period of time and a paleogeographic landscape configuration of the Brazilian southeastern coastal region explain the present observed phylogenetic and biogeographic patterns.

A Survey of Fungal Contamination on Books in Public Libraries with Mechanical and Natural Ventilation

Libraries are very propitious environments for the growth of fungi. The great concentration of organic material available for these microorganisms, and often with the lack of adequate ventilation or climate control, would favour this situation. This study was conducted in 2003 to determine the predominant genera of fungi in public libraries by a survey of fungi contaminating the upper surface of books, with and without air conditioning in the city of Sao Paulo, Brazil, in the winter and summer, during the respective periods with high and low levels of airborne fungi in that city. Six libraries were chosen, located on the campus of the University of Sao Paulo, three of them with air conditioning and the other three with natural ventilation. In these six libraries, 31 genera of fungi were identified in total. The genera and frequency of contaminant fungi recovered differed significantly between the libraries with and without air conditioning and in the samples collected in the summer as opposed to the winter. Cladosporium was the most frequent in the libraries with and without air conditioning, and in the winter. Aspergillus was isolated more often in the summer.

UNIFORM DISSIPATIVENESS, ROBUST SYNCHRONIZATION AND LOCATION OF THE ATTRACTOR OF PARAMETRIZED NONAUTONOMOUS DISCRETE SYSTEMS

In this series of papers, we study issues related to the synchronization of two coupled chaotic discrete systems arising from secured communication. The first part deals with uniform dissipativeness with respect to parameter variation via the Liapunov direct method. We obtain uniform estimates of the global attractor for a general discrete nonautonomous system, that yields a uniform invariance principle in the autonomous case. The Liapunov function is allowed to have positive derivative along solutions of the system inside a bounded set, and this reduces substantially the difficulty of constructing a Liapunov function for a given system. In particular, we develop an approach that incorporates the classical Lagrange multiplier into the Liapunov function method to naturally extend those Liapunov functions from continuous dynamical system to their discretizations, so that the corresponding uniform dispativeness results are valid when the step size of the discretization is small. Applications to the discretized Lorenz system and the discretization of a time-periodic chaotic system are given to illustrate the general results. We also show how to obtain uniform estimation of attractors for parametrized linear stable systems with nonlinear perturbation.

Study of metals transfer from environment using teeth as biomonitor

We investigated chronic incorporation of metals in individuals from poor families, living in a small, restrict and allegedly contaminated area in Sao Paulo city, the surroundings of the Guarapiranga dam, responsible for water supply to 25% of the city population. A total of 59 teeth from individuals 7 to 60 years old were collected. The average concentrations of Pb, Cd, Fe, Zn, Mn, Ni and Cr were determined with an Atomic Absorption Spectrophotometer. The concentrations of all metals as function of the individuals` age exhibited a remarkable similarity: peaks between 7 and 10 years and sharply decreasing at higher ages, which could be attributed to alimentary habits and persistence to metals exposure all along the individuals` life span. From all the measured metals, lead and cadmium were a matter of much more concern since their measured values are close to the upper limits of the world wide averages. (C) 2009 Elsevier Ltd. All rights reserved.

Geochemistry of iron and manganese in soils and sediments of a mangrove system, Island of Pai Matos (Cananeia - SP, Brazil)

Five zones along a transect of 180 m were selected for study on the Island of Pai Matos (Sao Paulo, Brazil). Four of the zones are colonised by vascular plants (Spartina SP, Laguncularia LG, Avicennia AV and Rhizophora RH) and were denominated soils, and the other zone, which lacks vegetation, was denominated sediment (SD). The geochemical conditions differed significantly in soils and sediment and also at different depths. The soils were oxic (Eh > 350 mV) or suboxic (Eh: 350-100 mV) at the surface and anoxic (Eh < 100 mV) at depth, whereas in the sediment anoxic conditions prevailed at all depths, but with a lower concentration of sulphides in the pore water and pyrite in the solid fraction. Under these geochemical conditions Fe is retained in the soils, while the Mn tends to be mobilized and lost. The most abundant form of iron oxyhydroxide was lepidocrocite (mean concentration for all sites and depths, 45 +/- 19 mu mol g(-1)), followed by goethite (30 19 mu mol g(-1))and ferrihydrite (19 +/- 11 mu mol g(-1)),with significant differences among the mean concentrations. There was a significant decrease with depth in all the types of Fe oxyhydroxides measured, particularly the poorly crystalline forms. The pyrite fraction was an important component of the free Fe pool (non-silicate Fe) in all soils as well as in the sediment, especially below 20 cm depth (mean concentration for all sites and depths, 60 +/- 54 mu mol CI). Furthermore, the mean concentration of Fe-pyrite for all sites and depths was higher than that obtained for any of the three Fe oxyhydroxides measured. The Fe-AVS was a minor fraction, indicating that the high concentrations of dissolved Fe in the soils in the upper area of the transect result from the oxidation of Fe sulphides during low tide. Mossbauer spectroscopy also revealed that most of the Fe (III) was associated with silicates, in this case nontronite. The presence of crystals of pyrite associated with phyllosilicates in samples from the upper layer of the soils may indicate that pyritization of this form of Fe(III) is more rapid than usually reported for ocean bed sediments. The sequential extraction of Mn did not reveal any clearly dominant fraction, with the Mn-carbonate fraction being the most prevalent, followed by exchangeable Mn and oxides of Mn, whereas pyrite-Mn and Mn associated with crystalline Fe-oxides were present at significantly lower concentrations. The high concentration of dissolved Mn found in the soils in the lower part of the transect is consistent with the fact that the solubility is determined by the carbonate fraction. Unlike for Fe, in the soils in the higher zone, which are subject to intense drainage during low tide, there was loss of Mn, as reflected by the concentration of total Mn. (C) 2008 Elsevier B.V. All rights reserved.

An inductor-free realization of the Chua`s circuit based on electronic analogy

Although literature presents several alternatives, an approach based on the electronic analogy was still not considered for the implementation of an inductor-free realization of the double scroll Chua`s circuit. This paper presents a new inductor-free configuration of the Chua`s circuit based on the electronic analogy. This proposal results in a versatile and functional inductorless implementation of the Chua`s circuit that offers new and interesting features for several applications. The analogous circuit is implemented and used to perform an experimental mapping of a large variety of attractors.

Upper limit on the cosmic-ray photon fraction at EeV energies from the Pierre Auger Observatory

From direct observations of the longitudinal development of ultra-high energy air showers performed with the Pierre Auger Observatory, upper limits of 3.8%, 2.4%, 3.5% and 11.7% (at 95% c.l.) are obtained on the fraction of cosmic-ray photons above 2, 3, 5 and 10 EeV (1 EeV equivalent to 10(18) eV), respectively. These are the first experimental limits on ultra-high energy photons at energies below 10 EeV. The results complement previous constraints on top-down models from array data and they reduce systematic uncertainties in the interpretation of shower data in terms of primary flux, nuclear composition and proton-air cross-section. (C) 2009 Elsevier B.V. All rights reserved.

Analysis of Agonist and Antagonist Effects on Thyroid Hormone Receptor Conformation by Hydrogen/Deuterium Exchange

Thyroid hormone receptors (TRs) are ligand-gated transcription factors with critical roles in development and metabolism. Although x-ray structures of TR ligand-binding domains (LBDs) with agonists are available, comparable structures without ligand (apo-TR) or with antagonists are not. It remains important to understand apo-LBD conformation and the way that it rearranges with ligands to develop better TR pharmaceuticals. In this study, we conducted hydrogen/deuterium exchange on TR LBDs with or without agonist (T(3)) or antagonist (NH(3)). Both ligands reduce deuterium incorporation into LBD amide hydrogens, implying tighter overall folding of the domain. As predicted, mass spectroscopic analysis of individual proteolytic peptides after hydrogen/deuterium exchange reveals that ligand increases the degree of solvent protection of regions close to the buried ligand-binding pocket. However, there is also extensive ligand protection of other regions, including the dimer surface at H10-H11, providing evidence for allosteric communication between the ligand-binding pocket and distant interaction surfaces. Surprisingly, C-terminal activation helix H12, which is known to alter position with ligand, remains relatively protected from solvent in all conditions suggesting that it is packed against the LBD irrespective of the presence or type of ligand. T(3), but not NH(3), increases accessibility of the upper part of H3-H5 to solvent, and we propose that TR H12 interacts with this region in apo-TR and that this interaction is blocked by T(3) but not NH(3.) We present data from site-directed mutagenesis experiments and molecular dynamics simulations that lend support to this structural model of apo-TR and its ligand-dependent conformational changes. (Molecular Endocrinology 25: 15-31, 2011)