Alternative Technique For Treatment Research Articles

Posterior Lumbar Element Enforcement by Decompression Alone with Interspinous Fixation without Interbody Fusion for the Surgical Management of Lumbar Spondylolisthesis.

In degenerative lumbar spondylolisthesis, interbody fusion surgery (IFS) has long been recommended as the gold standard of surgical management. However, IFS is less recommended for high-risk patients such as the elderly because it involves extensive surgery, with a long operation time and high volumes of blood loss, which lead to marked perioperative morbidity. We report an alternative primary and salvage treatment technique for high-risk lumbar spondylolisthesis through posterior lumbar element reinforcement using interspinous fixation (ISF) and decompression alone without interbody fusion. Plain radiographs, computed tomography scans, and magnetic resonance imaging, taken at different intervals, were used to measure local disc height (DH), vertebral body slippage (BS), and segmental motion angle (SMA). A visual analogue scale (VAS) and the Oswestry disability index (ODI) were applied pre-operation and at the last follow-up. The local SMA decreased significantly by 3.46±3.07°, from 10.61±3.42° preoperatively to 7.15±3.70 at the last follow-up (p<0.001). The DH decreased from 8.61±2.88 mm preoperatively to 8.41±2.48 mm at the last follow-up (p=0.074). The BS decreased from 3.49±4.29 mm preoperatively to 3.41±4.91 mm at the last follow-up (p=0.092). None of the patients reported worsening pain or an increased ODI after surgery, and there were no surgery-related complications. Posterior lumbar element reinforcement by decompression alone with SPIRE™ fixation is an alternative primary and salvage treatment option for select patients with spondylolisthesis.

The pertinence of resistin gene single nucleotide polymorphism G > A and its expression in oral cancer

Background/aimOral cancer (OC) is the leading cause of fatalities in Pakistan among males due to inadequate oral hygiene and chewing habits. However, genetic susceptibility patterns also play a critical role in disease progression. Since the frequency of Resistin (RETN) SNP (Single nucleotide polymorphism) rs3219175 is unknown; there is a requirement for early diagnosis of the OC. Therefore, the current study aims to determine the frequency of targeted SNP and develop a safe, simple, and fast alternative technique for better treatment using a real-time PCR assay with HRM (high-resolution melting curve) analysis. Materials and methodsA case-control study was conducted on 35 Oral squamous cell carcinomas (OSCC) diagnosed patients and 35 healthy individuals. HRM and RT-PCR results were analysed by the bioinformatics analyses. ResultsThe frequency of RETN SNP rs3219175 genotypes GG and GA in male patients was 16 (46 %) and 5 (14 %) respectively and in females 8 (23 %) and 6 (17 %) respectively. The chi-square test of independence consummated the assessment between males and females in both control and patients. The relation between these variables was significant (p < 0.05). The interaction network of String 8.3 demonstrates strong interactions at a high confidence score, which helps to characterize functional disorders that may be a causative factor for oral pathology. Reactome and KEGG data were acquired to rule out the pathway involvement of the targeted gene. MuPIT software was used to identify the 3D structure or RETN and their expected mutation effect. ConclusionThis study provides baseline data regarding the frequency of RETN SNP rs3219175 among the Pakistani population. For further clarification of their stage in cancer emergence and growth, large-scale studies must be conducted. This study might be helpful in the precision medicine approach and provide better therapeutic for OSCC patients.

Viewpoint: Genicular Nerve Hydrodissection for Knee Osteoarthritis Pain Management

Knee pain secondary to knee osteoarthritis is one of the most common reasons for consultation in patients 50 years old and above. Due to limitations of current management options for knee osteoarthritis, studies seeking alternative treatment techniques have emerged, including procedures targeting knee innervation. The effectiveness of nerve hydrodissection for managing neuropathies such as carpal tunnel syndrome has been demonstrated but has not been applied to nerves that innervate the knee to manage osteoarthritis. This article discusses the potential application of ultrasound-guided nerve hydrodissection to the anterior innervation of the knee, known as the genicular nerves, for pain management in patients with osteoarthritis. Keywords: Knee osteoarthritis, knee pain, nerve hydrodissection, genicular nerves, genicular nerve hydrodissection

Transprosthetic Fenestration With Electrified Wires. Experimental Evaluation of Three Multifilament Endografts.

In situ fenestration of aortic endografts is an alternative endovascular technique for treatment of complex aortic aneurysms. While this technique has been carried out also to pass stent-grafts in individual cases, its feasibility and safety using different stent-grafts needs to be evaluated. In a saline bath at water temperature of 37°C, a 0.018" Astato 30 guidewire was advanced through 3 different stent-grafts (RelayPro, Zenith and Endurant II) by applying external current of 180 W via an electrosurgery pencil. Puncture efficacy and quality of the fenestration after ballooning with a 6 mm percutaneous transluminal angioplasty (PTA) catheter were assessed. Then, balloon-expandable covered stents were deployed in the fenestrations and evaluated for stenosis, using microscopy and radiography. Crossing of the electrified guidewire was instantaneous in the Zenith (n:10) and RelayPro (n:10) groups but not in 3 of 10 punctures in the Endurant group (p<.05). The fenestration area created after PTA was significantly larger in the RelayPro (5.3 mm2 ± 1.8, interquartile range [IQR] 1.6) and Zenith group (6.7 mm2 ± 0.7, IQR 0.5) compared to Endurant (2.3 mm2 ± 0.4, IQR 0.5, p<.001). Fraying was observed in all groups while graft shredding was found in 8 cases after PTA of the Zenith and Endurant endografts and in 5 of the RelayPro group, but the difference was not significant. Vertical tearing was detected after RelayPro (2 out of 10) and Zenith (6 out of 10) fenestrations, no damage was found in the Endurant group (p<.01). Residual stenosis at the level of the fenestration after implantation of a 6 × 79 mm VBX stent had to be corrected in all Endurant cases with a high-pressure PTA catheter. No stenosis was found in the RelayPro and Zenith groups before and after flaring. The "electrified wire" technique is a feasible tool that can be used to perform in situ fenestration by perforation of the endograft fabric. Based on this experimental evaluation the "ideal graft" for this technique could not be identified. Long-term fatigue tests and comparison with other fenestration techniques are required. In situ endograft fenestration can be a useful technique in emergent aortic repair. Recently, the electrified wire technique has been proposed as alternative option to laser, radiofrequency and needle-based techniques. In comparison to these methods, the use of electrified wires can be performed without modifications of routine equipment. Additionally, the material costs can be substantially reduced. However, the effectiveness of this approach for fenestration of different prosthetic grafts is unknown. Based on our experimental studies, the electrified wire technique is feasible but the Endurant endograft requires more attempts, and the placement of a bridging stent should be completed with high-pressure balloons.

Effectiveness of whole-body electromyostimulation on knee pain and physical function in knee osteoarthritis: a randomized controlled trial

In a randomized, controlled study, whole-body electromyostimulation (WB-EMS) was investigated as a promising alternative treatment technique compared to conventional strength training for the management of knee osteoarthritis (OA). Seventy-two overweight participants with symptomatic knee OA were randomly assigned to WB-EMS (n = 36) or a usual care group (UCG, n = 36). For seven months, the WB-EMS group received three times per fortnight a WB-EMS training, while the UCG was prescribed six-times physiotherapeutic treatments. We observed significant effects for the primary outcome “pain”, as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS), with more favourable changes in the WB-EMS group vs UCG (between-group difference 9.0 points, 95%CI 2.9–15.1, p = 0.004). Secondary outcomes, including the other KOOS subscales (symptoms, function in daily living, function in sports/recreational activities and quality of life), 7 day pain diary, hip/leg extensor strength and lower limb function (30s sit-to-stand test), were also statistically significant in favour of the WB-EMS group. Overall, WB-EMS was found to be effective in relieving knee pain symptoms and improving physical function in individuals with symptomatic knee OA compared to usual care treatment. WB-EMS could be used as an alternative therapy in the management of knee OA; particularly for patients that cannot be motivated for conventional training.

Synthesis and Characterization of Composite WO3 Fibers/g-C3N4 Photocatalysts for the Removal of the Insecticide Clothianidin in Aquatic Media.

Photocatalysis is a prominent alternative wastewater treatment technique that has the potential to completely degrade pesticides as well as other persistent organic pollutants, leading to detoxification of wastewater and thus paving the way for its efficient reuse. In addition to the more conventional photocatalysts (e.g., TiO2, ZnO, etc.) that utilize only UV light for activation, the interest of the scientific community has recently focused on the development and application of visible light-activated photocatalysts like g-C3N4. However, some disadvantages of g-C3N4, such as the high recombination rate of photogenerated charges, limit its utility. In this light, the present study focuses on the synthesis of WO3 fibers/g-C3N4 Z-scheme heterojunctions to improve the efficiency of g-C3N4 towards the photocatalytic removal of the widely used insecticide clothianidin. The effect of two different g-C3N4 precursors (urea and thiourea) and of WO3 fiber content on the properties of the synthesized composite materials was also investigated. All aforementioned materials were characterized by a number of techniques (XRD, SEM-EDS, ATR-FTIR, Raman spectroscopy, DRS, etc.). According to the results, mixing 6.5% W/W WO3 fibers with either urea or thiourea derived g-C3N4 significantly increased the photocatalytic activity of the resulting composites compared to the precursor materials. In order to further elucidate the effect of the most efficient composite photocatalyst in the degradation of clothianidin, the generated transformation products were tentatively identified through UHPLC tandem high-resolution mass spectroscopy. Finally, the detoxification effect of the most efficient process was also assessed by combining the results of an in-vitro methodology and the predictions of two in-silico tools.

Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning.

To report the outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning (FGNMP). Retrospective case series. A total of 15 client owned dogs and two cats with 57 metabone fractures. Description of FGNMP and reporting of the following data: signalment, pre- and postoperative radiographs, intramedullary pin diameter used, anesthesia, surgery and coaptation times, duration to normal weightbearing and bone union, postoperative care and complications. Median surgery time was 54 min (range: 26-99), median duration of coaptation was 14 days (range: 1-5 weeks), median time to normal weightbearing was 16 days (range: 2-45) and median time to bone union was 6 weeks (range: 4-12). All cases had at least 12 months of post-surgical follow-up with a median follow-up of 18 months (range: 12-70). No major complications occurred. Mild radiographic changes associated with subchondral bone sclerosis were noted on follow-up radiographs in 13/57 fractures. All cases returned to normal gait and full (15) or acceptable (2) function. In this study, FGNMP was an effective and safe technique for metabone fracture repair, requiring only short-term external coaptation in most patients. Time to bone union and return to normal function compared favorably to previously reported techniques. Fluoroscopically guided normograde metabone pinning provides an alternative technique for treatment of metabone fractures.

An Alternative Endovascular Technique for Treatment of Pulmonary Arteriovenous Malformation: Microballoon-occluded Transcatheter Embolization Using n-butyl-2-cyanoacrylate.

To investigate the safety and efficacy of microballoon-occluded transcatheter embolization using n-butyl-2-cyanoacrylate (NBCA) in patients with a single pulmonary arteriovenous malformation (PAVM). From November 2017 to November 2020, this retrospective study included 38 previously untreated patients with a single PAVM who underwent microballoon-occluded transcatheter embolization using NBCA. All 38 patients had follow-up that included simple chest radiography and contrast-enhanced chest computed tomography (CT). A microballoon was successfully placed in a feeding artery of the PAVM to control the delivery of the NBCA cast in all 38 patients, with complete embolization of sacs and the feeding artery achieved in all cases. The mean diameters of the feeding artery, sac, and draining vein were 3.9 ± 0.9mm, 7.5 ± 2.6mm, and 4.6 ± 1.3mm, respectively. A fixed 1:2 NBCA/Lipiodol ratio was used, and the mean amount of embolic mixture per patient was 1.4mL (range 0.6-2.2mL). There were no complications related to microballoon adhesion and non-target embolization of the systemic circulation. Follow-up CT in all 38 patients with a mean delay of 34.5 ± 8.8months (range 20.7-56.5months) showed no continued perfusion of the PAVM. In our hands, microballoon-occluded n-butyl-2-cyanoacrylate embolization seemed to be safe and appeared to be clinically effective in patients with simple and complex types of single PAVM. Therefore, the present technique has the potential to become a standard treatment for a single PAVM.

Adsorption of Pb (II) ions on variable charge oxidic calcined substrates with chemically modified surface.

The paper describes lead ion adsorption on variable charge oxidic calcined substrates with chemically modified surfaces. Amphoteric oxides of iron, aluminum, titanium, and manganese, change their surface electric charge after acid or alkaline treatment, letting cationic or anionic adsorption reactions from aqueous solutions. This property allows using them as adsorbing substrate for heavy metals retention in water treatment systems. Substrate was prepared by extruding cylindrical strips from a saturate paste of the oxidic lithological material-OLM; dries it up and thermally treated by calcination. The study was performed by triplicated trial, on batch mode, using 2 grams samples of treated with NaOH 0.1N and non-treated substrate. Lead analysis was performed by AAS-GF. Freundlich and Langmuir models were used to fit results. Comparing differential behavior between treated and non-treated substrates showed the variable charge nature of the OLM. Results show L-type isotherms for the adsorption of Pb(II) ions on the activated substrate, suggesting good affinity between Pb(II) ions and OLM's surface. Average value of adsorption capacity ( K) for activated substrate (1791.73±13.06), is around four times greater than the non-activated substrate (491.54±31.97), during the adsorption reaction, 0.35 and 0.26 mmolH + of proton are produced on the activated and non-activated substrate respectively using a 1 mM Pb(II) solution and 72.2 and 15.6 mmolH + using a 10 mM Pb(II) solution. This acidification agrees with the theoretic model of transitional metals chemisorption on amphoteric oxides, present in lithological material used for the preparation of adsorbent substrates, confirming the information given by the L-type isotherms. Results suggest that these variable charge oxidic adsorbent substrate show great potential as an alternative technique for water treatment at small and medium scale using granular filtration system. The easiness and low price make them suitable to apply in rural media where no treating water systems is available.

Bioswales: As an Alternative Technique for Surface Groundwater Recharge Treatment in Urban Areas like Mumbai

The expeditious development and population growth in urban areas are connected to the environmental quality of the city, including the quality of water. Surface groundwater plays an immense role in the sustainability of urban areas. A variety of techniques are used and implemented for surface groundwater recharge treatment in urban areas. This study aims to assess the suitability of bioswales as an alternative technique for surface groundwater recharge treatment in urban areas like Mumbai. A bioswale is nothing but a narrow and shallow strip of a landscaped area that redirects and filters surface groundwater. It has a linear formation and is shallow in depth, and it is used to collect surface ground runoff water from non-porous surfaces such as structural rooftops of buildings, parking lots, tar and concrete roads, etc. The research methodology adopted is to study bioswales as an alternative system to enhance storm sewers, and traditional stormwater pipes in urban areas like Mumbai. These factors include construction techniques and Design, application/ Installation and maintenance, and the economic feasibility of the Bioswales system. The result indicates that bioswales can help by providing a way to conserve water, improve water quality, reduce pollution in waterways, and enhance biodiversity in urban areas like Mumbai. Keywords: Bioswale, Alternative technique, Surface ground water, Urban area, Mumbai.

Couvade Syndrome: An Overview

Expectant fathers who suffer from Couvade syndrome, also known as sympathetic pregnancy, are experiencing a variety of physical and psychological symptoms that are comparable to those of their pregnant partners. It is an intriguing and comparatively unknown condition. This review article offers a comprehensive analysis of Couvade syndrome, including information on its classification, prevalence, particular causes, management strategies, prognosis, prevention, and prospects for alternative treatment techniques. Our goal is to better understand, support, and communicate with pregnant couples by exploring this unusual and fascinating situation.

Constructed wetlands with recycled concrete for wastewater treatment in cold climate: Performance and life cycle assessment

This study investigated the technical, environmental, and economic feasibility of using recycled construction material (concrete) as substrate in constructed wetlands for cold climate decentralized domestic wastewater treatment. The wastewater treatment efficiency was examined, and life cycle assessment (LCA) and cost benefit analysis were performed. The technical feasibility was assessed in lab-scale two-stage wetland systems with recycled concrete or lava stone as substrates, which were operated at 22 °C and 5 °C with local wild plants and vegetables. The wetlands removed ∼85 % and ∼51 % of organics and ∼67 % and ∼34 % TN at 22 °C and 5 °C, respectively; no significant difference was found between concrete and lava stone. The heavy metal contents in the cultivated vegetables met WHO standards for human consumption, showing the feasibility of nutrient recovery from the treated wastewater. A comparative LCA of septic tank standalone, septic tank + constructed wetland (with recycled concrete), and gravity-driven ceramic membrane (GDCM) system was performed. This aims to illustrate the benefits of intensifying the existing treatment process (i.e., septic tank) with the constructed wetland, with an alternative membrane-based treatment technique as benchmark. The LCA results revealed that using waste materials as the substrate in constructed wetlands could reduce the environmental impact of wetlands. Installation of the wetland as posttreatment of the septic tank (1) could reduce ∼50 % of eutrophication potential without increasing global warming impact compared to the septic tank alone; (2) had ∼90 % higher global warming impact and ∼40 % lower eutrophication impact compared to GDCM. Economic analysis revealed that the total cost of septic tank + constructed wetland (0.143 €/m3) was comparable to the septic tank alone (merely 3.5 % difference), and 49 % lower than that of GDCM (with recycled membranes). Therefore, the septic tank + constructed wetland scenario could be favorable for sensitive areas with eutrophication potential regarding its technical, economical, and environmental feasibility.

Synthesis of Bamboo-based Activated Carbon through Physico-chemical Activation for Coal-runoff Wastewater Treatment

Bamboo-based activated carbon (BAC) has been successfully synthesized through a physico-chemical technique. The characteristics of BAC were investigated using Scanning Electron Microscopy (SEM), Fourier Transform Infra-Red (FTIR), and X-Ray Diffraction (XRD). Evaluating BAC performance on coal-runoff wastewater was carried out by varying contact times and adding low-level alum on remediation of pH and Total Suspended Solid (TSS). The results confirm that BAC performs well in stabilizing pH, indicated by the neutral pH, after 10 minutes of interaction. The TSS with BAC treatment and 1% BAC-Alum combination reduced the TSS value from 880 mg/L to levels below the threshold for wastewater quality standards, 387 mg/L and 73 mg/L, respectively. This combination can be an alternative coal-runoff wastewater treatment technique for better environmental quality.

Internal Light Sources-Mediated Photodynamic Therapy Nanoplatforms: Hope for the Resolution of the Traditional Penetration Problem.

Photodynamic therapy (PDT) is an alternative cancer treatment technique with a noninvasive nature, high selectivity, and minimal adverse effects. The indispensable light source used in PDT is a critical factor in determining the energy conversion of photosensitizers (PSs). Traditional light sources are primarily concentrated in the visible light region, severely limiting their penetration depth and making them prone to scattering and absorption when applied to biological tissues. For that reason, its efficacy in treating deep-seated lesions is often inadequate. Self-exciting PDT, also known as auto-PDT (APDT), is an attractive option for circumventing the limited penetration depth of traditional PDT and has acquired significant attention. APDT employs depth-independent internal light sources to excite PSs through resonance or radiative energy transfer. APDT has considerable potential for treating deep-tissue malignancies. To facilitate many researchers' comprehension of the latest research progress in this field and inspire the emergence of more novel research results. This review introduces internal light generation mechanisms and characteristics and provides an overview of current research progress based on the recently reported APDT nanoplatforms. The current challenges and possible solutions of APDT nanoplatforms are also presented and provide insights for future research in the final section of this article.

Adsorption of Pb (II) ions on variable charge oxidic calcined substrates with chemically modified surface

Background: The adsorption process is an alternative method for treating natural and waste waters, with heavy metals. Oxidic lithological materials, rich in iron and aluminum amphoteric oxides, with pH-dependent surface charges, are a reliable medium for ionic adsorption. Being thermally resistant, these materials can be used to prepare a calcined substrate which is chemically treated in an acid or alkaline solution to enlarge surface positive or negative charge density, making it possible anion as well as cation adsorption reactions from aqueous solutions. Oxidic lithological materials use is a low-cost alternative for filtering system because of its availability and ease of preparation and application. Methods: Present paper shows results of the adsorption reaction of Pb+2 ions on calcined substrates prepared with oxidic lithologic material. The study was performed on the substrate with chemically modified surface in alkaline medium as well as on non-treated surface. Results: Results show L-type isotherms for the adsorption on the activated substrate, indicative affinity between adsorbate and adsorbent. Average value of adsorption capacity (k) for activated substrate is around 3.7 times greater (1791.73±13.06) compared to the respective average k value for the non-activated substrate (491.54±31.97), during the adsorption reaction, 0.35 and 0.26 mmolH+ of proton are produced on the activated and non-activated substrate respectively using a 1 mM Pb+2 solution and 72.2 and 15.6 mmolH+ using a 10 mM Pb+2 solution. This acidification agrees with the theoretic model of transitional metals chemisorption on amphoteric oxides of Fe, Al, Ti and Mn present in lithological material used for the preparation of adsorbent substrates confirming the information given by the L-type isotherms. Conclusions: Results suggest that these oxidic lithologic materials show great potential as an alternative technique for water treatment and heavy metal retention from contaminated waters using a low-cost and reliable adsorption system.

Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review.

There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.

A Review on Adsorbable Organic Halogens Treatment Technologies: Approaches and Application

Halogen-containing organic substances have a detrimental and toxic impact on the environment and human health due to their high stability, carcinogenic effects, and ability to accumulate when ingested. The production and release of these substances have significantly increased in recent decades, resulting in a lack of effective treatment technologies. Adsorbable organic halogens (AOX), a specific parameter used to monitor pollution, represents the total amount of chlorinated, brominated, and iodinated organics that can be adsorbed on activated carbon from various environments. This paper provides an overview of selected articles from the past three decades (1990–2023) focusing on the primary natural and industrial sources of AOX. It also evaluates different determination techniques and a variety of removal approaches based on biological, physical, chemical, and combined processes. Additionally, the limitations and efficiency of these approaches are briefly characterized. While biochemical and physical methods have been limited by financial constraints and reduced efficiency, biological, chemical, and physicochemical techniques have shown significant potential in improving water quality. This knowledge can be valuable for the development of alternative water treatment techniques and underscores the importance of sustainable water usage.

Retrograde Drilling, Ossoscopy, and Autologous Bone Grafting: An Alternative Technique for Treatment of Osteochondral Lesion of the Talus Stage 2 and 3 in Adults.

Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. There are various surgical methods. A generally valid, stage-dependent therapeutic algorithm does not exist. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous bone grafting. The surgical technique was performed in 24 patients with medial or lateral OLTs, and the data were analyzed retrospectively. In our technique, the affected subchondral bone was overdrilled retrogradely and resected under arthroscopic visualization (ossoscopy) without violating the cartilage. The resulting defect was filled with autologous bone from the medial tibia metaphysis. Outcome parameters were the numeric rating scale (NRS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion (ROM). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed and a possible correlation with the clinical outcome scores was calculated. Data concerning complication rates were also collected. The mean surface size of the OLTs was 0.9 ± 0.3 cm2. The mean follow-up was 89 months. The AOFAS score improved significantly from 57.7 points preoperatively to 88.8 points at the final follow-up (P < .0001). The pain value measured by the NRS decreased significantly from 8 to a pain level of 2. ROM improved in 37.5% of the patients for dorsiflexion and 29.2% for plantarflexion. There were no significant correlations between the MOCART score and the AOFAS score or the pain value on NRS. Retrograde drilling, ossoscopy, and autologous bone grafting for OLTs is a promising technique with good long-term results. The patients' satisfaction rate, especially in OLT stages 2 and 3, was excellent. Level IV, case series.

Perfuração coronária durante intervenção coronária percutânea: descrição de uma técnica de salvamento

A coronary artery perforation during percutaneous coronary intervention is an uncommon (0.43%) but potentially severe event, with high risk of cardiac tamponade and death. Severe perforations require placing a covered stent, which is often unavailable. We describe an alternative and simple treatment technique, which can be performed using polytetrafluoroethylene from a balloon tied over a coronary stent.

Histological and Immunohistochemical Analysis of the Effects of Topical Melatonin Treatment Associated with Collagen Sponge and rhBMP-2 Protein on Bone Remodeling.

Extensive bone defect healing is an important health issue not yet completely resolved. Different alternative treatments have been proposed but, in face of a critical bone defect, it is still very difficult to reach a complete regeneration, with the new-formed bone presenting all morphological and physiological characteristics of a normal, preinjury bone. Topical melatonin use has shown as a promising adjuvant for bone regeneration due to its positive effects on bone metabolism. Thus, to search for new, safe, biological techniques that promote bone repair and favor defect healing, we hypothesized that there is a synergistic effect of melatonin treatment associated with rhBMP-2 to guide bone regeneration. This study aimed to investigate bone repair effects of topical melatonin administration in different concentrations (1, 10, and 100 µg), associated or not with rhBMP-2. Surgical-induced bone defect healing was qualitatively evaluated through histopathological analysis by light microscopy. Additionally, quantitative stereology was performed in immunohistochemistry-prepared tissue to identify angiogenic, osteogenic, and osteoclastogenic factors. Quantification data were compared between groups by the ANOVA/Tukey test and differences were considered significant when p &lt; 0.05. Our results showed that the presence of the scaffold in the bone defect hindered the process of bone repair because in the group treated with "blood clot + scaffold" the results of bone formation and immunolabeling were reduced in comparison with all other groups (treated with melatonin alone or in association with rhBMP-2). Statistical analysis revealed a significant difference between the control group (bone defect + blood clot), and groups treated with different concentrations of melatonin in association with rhBMP-2, indicating a positive effect of the association for bone repair. This treatment is promising once it becomes a new safe alternative technique for the clinical treatment of fractures, bone defects, and bone grafts. Our results support the hypothesis of the safe use of the association of melatonin and rhBMP-2 and have established a safe and effective dose for this experimental treatment.