17,18 The functional analysis was performed weekly in the two gro

17,18 The functional analysis was performed weekly in the two groups (GI and GII). At the end of the experiment (after 30 days) the animals were sacrificed in a CO2 chamber sellekchem and the musculoskeletal tissue (soleus and gastrocnemius) and nerve tissue (sciatic nerve) were collected, immersed in 10% buffered formaldehyde for 24 hours and afterwards dehydrated in an increasing concentration of ethanol, diaphanized in xylol and embedded in paraffin. The paraffin blocks were sectioned in a rotary microtome, with 4��m-thick histological sections. The sections were gathered on glass slides and stained with Hematoxylin and Eosin (HE) and Gomori Trichrome. The histological analysis was performed using a conventional microscope. For the statistical analysis we used the Prism 4.

0 software for Student’s t-test, considered significant when the p-value was below 0.05. RESULTS During the ischemic procedure we were able to observe that the animals presented cyanosis, and a decrease in the limb temperature. After removal of the tourniquet and post-anesthetic reestablishment of the animals’ functions, it was noted that the animals presented important claudication, which improved over a few weeks and resumed four weeks after the experiment. We present below the experimental results obtained. The Figures show the temporal evolution over the four weeks of evaluation (frequency of rearing and of crossing). Figure 1 presents the results of the exploratory behavior assessment. The mean number of rearings of the animals was used as a measurement of the degree of recovery from the injury.

A higher number of rearings indicates faster recovery of the animal’s muscle movements. In figure 1 we can see the animals’ recovery over the weeks of evaluation. In the first two weeks, the two groups evaluated presented similar mean rearings. We can also observe the increase in the number of rearings of the two groups from the first to the second week, which may correspond to the start of the animal’s muscle recovery. From the third week on, it is possible to clearly observe the effect of the kinesiotherapy treatment, since Group II (experimental) presented an increase in the number of rearings, while the control group obtained a much lower mean number of rearings.

The results show that, for the experimental scenario used, the kinesiotherapy Carfilzomib treatment brought about a significant improvement at the end of the four-week period in the recovery of the muscle movements of the experimental group in relation to the control group of 150%, with significant statistical difference (p=0.0331). Figure 1 Mean rearings presented by group I (control) and group II (experimental) during the 4 weeks of evaluation.* Significantly different Figure 2 presents the number of crossings of the circular arena. The mean values of the five animals from each group evaluated during the four weeks of evaluation are presented here.

6% of the cases In the specific cases of multiple finger

6% of the cases. In the specific cases of multiple finger CC5013 amputations, another surgical technique that can be used is heterotopic replantation. This technique was used in 8.3% of the cases of digital replantation included in this study. Primary coverage with microsurgical flaps was necessary in 8.3% of the cases. (Figure 2) Figure 2 Surgical techniques applied. Of the 43 cases, four had to be readdressed for review of the microsurgical anastomoses. Of these, one case evolved with survival of the limb and three cases with regularization after loss of replantation, which results in a survival rate of 93%. As regards the last item of data analyzed, but not the least important, we sought to estimate patient satisfaction with the replanted limb.

Not all the patients are fully satisfied in terms of function expected for the replanted limb, but all the patients declare they are more satisfied having their original limb replanted than making use of prostheses. DISCUSSION Since 1962, the year in which the first successful replantation was described in the world, surgical techniques in replantation and microsurgical techniques have evolved at a surprising speed.3,5,18 Thanks to the advances of instruments, optics and specialization among microsurgeons, today we have access to a technology that allows us to acquire a wealth of details and affords the dexterity to perform microsurgeries with increasing safety and success. In replantation cases, factors that previously represented absolute contraindications for its performance, due to microsurgical technical advances, are currently relative contraindications.

2,9,10,19 Technically speaking, replantation after avulsion injuries is more laborious,7 but can be executed by a qualified microsurgeon, and it is possible to use various microsurgical techniques. In the bibliographical survey carried out for the performance of this trial, we did not find many case series with such a significant casuistry as that obtained in our study. We believe that the shortage of studies referring to replantation in amputations after avulsion injuries is due to the fact that until recently avulsion injuries were considered a contraindication to the replantation procedure.12 In evaluating the results obtained in this study, we observed that the average age was 26 years. Most of the patients were of working age, and suffered accidents during the work period.

Male predominance, the greater AV-951 involvement of the upper limbs and of the dominant side (right, in the majority of the population), reinforces the idea that the population most susceptible to traumatic amputations is made up of manual workers. The greater frequency of involvement of the male sex, between the third and fourth decades of life, was also observed in other studies.4,8,20,21 The level of amputation that predominated in this study, was amputation of the thumb (23 of the 43 cases).

17,18 The functional analysis was performed weekly in the two gro

17,18 The functional analysis was performed weekly in the two groups (GI and GII). At the end of the experiment (after 30 days) the animals were sacrificed in a CO2 chamber http://www.selleckchem.com/products/ldk378.html and the musculoskeletal tissue (soleus and gastrocnemius) and nerve tissue (sciatic nerve) were collected, immersed in 10% buffered formaldehyde for 24 hours and afterwards dehydrated in an increasing concentration of ethanol, diaphanized in xylol and embedded in paraffin. The paraffin blocks were sectioned in a rotary microtome, with 4��m-thick histological sections. The sections were gathered on glass slides and stained with Hematoxylin and Eosin (HE) and Gomori Trichrome. The histological analysis was performed using a conventional microscope. For the statistical analysis we used the Prism 4.

0 software for Student’s t-test, considered significant when the p-value was below 0.05. RESULTS During the ischemic procedure we were able to observe that the animals presented cyanosis, and a decrease in the limb temperature. After removal of the tourniquet and post-anesthetic reestablishment of the animals’ functions, it was noted that the animals presented important claudication, which improved over a few weeks and resumed four weeks after the experiment. We present below the experimental results obtained. The Figures show the temporal evolution over the four weeks of evaluation (frequency of rearing and of crossing). Figure 1 presents the results of the exploratory behavior assessment. The mean number of rearings of the animals was used as a measurement of the degree of recovery from the injury.

A higher number of rearings indicates faster recovery of the animal’s muscle movements. In figure 1 we can see the animals’ recovery over the weeks of evaluation. In the first two weeks, the two groups evaluated presented similar mean rearings. We can also observe the increase in the number of rearings of the two groups from the first to the second week, which may correspond to the start of the animal’s muscle recovery. From the third week on, it is possible to clearly observe the effect of the kinesiotherapy treatment, since Group II (experimental) presented an increase in the number of rearings, while the control group obtained a much lower mean number of rearings.

The results show that, for the experimental scenario used, the kinesiotherapy Brefeldin_A treatment brought about a significant improvement at the end of the four-week period in the recovery of the muscle movements of the experimental group in relation to the control group of 150%, with significant statistical difference (p=0.0331). Figure 1 Mean rearings presented by group I (control) and group II (experimental) during the 4 weeks of evaluation.* Significantly different Figure 2 presents the number of crossings of the circular arena. The mean values of the five animals from each group evaluated during the four weeks of evaluation are presented here.

ACKNOWLEDGEMENTS The authors thank Sanofi-Aventis(r) for donating

ACKNOWLEDGEMENTS The authors thank Sanofi-Aventis(r) for donating the medication for this study. Footnotes Colorectal cancer Study conducted at LIM 41 – Laboratory of Medical Investigation of the Musculoskeletal System and in the Group of Osteometabolic and Degenerative Diseases of the Department of Orthopedics and Traumatology of the School of Medicine of Universidade de S?o Paulo. Citation: Zelada F, Almeida AM, Pailo AF, Bolliger Neto R, Okazaki E, Rezende MU. Viscosuplementation in patients with hemophilic arthropathy. Acta Ortop Bras. [online]. 2013;21(1):12-17. Available from URL: http://www.scielo.br/aob.
Chronic low back pain is one of the main complaints of patients with musculoskeletal disorders. It is defined by the presence of pain in the lumbar region lasting for more than 7-12 weeks.

1 It entails restriction of the capability for work, limitation for social activities, emotional problems 2 and reduced quality of life. 3 Chronic low back pain is frequently associated with depression. 4 Between 16.4 and 73.3% of the patients with chronic low back pain present depression. 5 The presence of depression is associated with the greater intensity and persistence of pain, 6 greater incapacity, 2 , 7 higher economic cost 2 and more adverse life events. The literature investigated did not produce any trials that were aimed at studying the impact of depression on the characteristics of chronic low back pain and on the fear of movement (kinesiophobia). The aim of the present study was to describe characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain associated with depression, in comparison to patients with chronic low back pain without depression.

METHOD This is a cross-sectional observational study, conducted in the outpatient physiotherapy section of a state government institution, on patients diagnosed with chronic low back pain. The study was carried out in the period from August 2008 to August 2009. The participants who agreed to take part in the study signed the informed consent form. The project was approved by the Institutional Review Bureau (Report no. 307/08). The inclusion criteria were: patients of both sexes, from 18 to 60 years of age, diagnosed with chronic low back pain at least three months previously.

Patients with neurological diseases (cerebrovascular accident, cerebral palsy and Parkinson’s disease), patients who had suffered any type of recent fracture, patients who were in a postoperative process of any nature, those with important acute diseases in physiotherapeutic treatment, Cilengitide patients with chronic cancer pain and patients with chronic low back pain with nonmusculoskeletal causes were excluded. A total of 193 individuals, referred by orthopedists for outpatient physiotherapy treatment, were included in the study. The interviews were held by a single investigator, previously trained to apply the instruments.

2 mm/mm tapered master gutta-percha cone However, lateral conden

2 mm/mm tapered master gutta-percha cone. However, lateral condensation, unlike vertical selleckbio condensation, does not create a homogenous mass of gutta-percha. Therefore, filling with a master cone with a larger taper may be advantageous because a larger and more uniform mass of gutta-percha is introduced into the root canal.30 Gordon et al indicated that the single cone results were not significantly different from the lateral condensation results, indicating that the method was comparable with lateral condensation.25 Obturating straight root canals in vitro with laterally condensed .06 tapered gutta-percha master cones that match the shape of .06 tapered nickel-titanium rotary instruments prevent complete bacterial penetration as effectively as laterally condensed .02 tapered master cones.

30 If a round shape is made in the canal preparation, a well-fit single cone with sealer can be used for adequate obturation, and there have been multiple studies in which a single cone method of obturation was successfully used.25,31�C33 In the present study, root canals were instrumented with ProFile .04 tapered NiTi rotary instruments to improve preparation of a uniformly round space. MetaSEAL is recommended for use exclusively with cold compaction or single-cone techniques;14 therefore, the single cone technique was used during the obturation of the canals using a .04 tapered gutta-percha or Resilon. Although the match-taper single-cone technique was used, the sealer thickness was increased from the apical to coronal regions in all samples.

The thinnest sealer was observed at the apical region and the thickest sealer was observed at coronal region (Figure 1a, b and c). When the distribution of the gaps or voids was evaluated, only the AH Plus group showed 100% gap or void-free interfaces at the apical region. This result shows that maximizing the solid nucleus of gutta-percha and minimizing the amount of sealer is an effective method to prevent gap or void formation, at least for AH Plus. On the other hand, decreasing the sealer thickness with Resilon or gutta-percha could not prevent gap or void formation in the MetaSEAL (10%) and Epiphany groups (20%) (Table 2, Figure 7). Structural deficiencies are generally originated from the air trapped in the sealer mass during mixing or transferring of the sealer.

22 Mutal et al indicated that the presence of structural deficiencies also depend on the physical properties of the sealer, such as density or flow.22 Unlike Epiphany and AH Plus, the MetaSEAL consists Anacetrapib of powder and liquid. The material has a long working time (30 min) and an 8 min curing time (unpublished data by Parkell). All the samples were light-cured from the coronal region for 40 s as in Epiphany Group. The results indicated that 20% of samples showed void formation at the median, and 90% of the samples were gap or void-free at both the apical and coronal regions.

Presence of coxofemoral dislocation: only one hip presented later

Presence of coxofemoral dislocation: only one hip presented lateral subluxation. The others appeared reduced. Heterotopic ossification: selleck Belinostat of the 30 hips analyzed, in five we identified heterotopic ossification – classified by Brooker et al.7 as degree II and III, while four hips presented increase of coxofemoral periarticular density and one was in topography lateral to the ilium. (Figures 2 and and33) Figure 2 Heterotopic ossification (degree II) present in the enhanced periarticular region. Figure 3 Note the exuberant periarticular heterotopic ossification in the right hip (degree III) and degenerative alterations in the left hip. Other findings: increase of anterior acetabular coverage and shepherd’s crook deformity of the femur were identified in one hip, while radiolucent image was observed in the femoral head in another hip, compatible with a probable diagnosis of osteoid osteoma.

DISCUSSION Most of the time, spinal cord-injured patients cannot rely on proprioception to assist in joint protection, due to their neurological impairment. These individuals only have anatomical mechanisms as protective factors. Possible trauma, caused even by minimal manipulation, leads to potential risks of neuropathic arthropathy due to chondrolysis and erosion of the articular cartilage.8,9 As a consequence of this process, other abnormalities may arise, such as bone fissures, formation of subchondral cysts, osteophytes, decrease and impairment of the joint space and articular incongruity, suggesting the early onset of osteoarthritis in these patients.

The radiographic findings of these patients with spinal cord injury in this study indicate a high rate of articular impairment of the hip after a few years of clinical evolution of the neuromotor deficit. Only seven (23%) of the hips evaluated had no evidence of damage to the articular surface. However, as there is a multidisciplinary follow-up of these patients at the Laboratory of Biomechanical Rehabilitation of the Musculoskeletal System, the expected total incidence of degenerative alterations was lower. The prevalence of heterotopic ossification found in the patients studied (5 of the 30 hips: 16.6%) was close to the parameters described in the literature.2-4 This comorbidity is associated with joint pain and limitation of range of motion, which implies difficulty in the handling of these individuals, both for hygiene care and for rehabilitation, producing a deterioration in the quality of life.

The radiograph, besides being a highly accessible, low-cost examination, enables a good evaluation of bone structures, favoring the identification of a great deal of degenerative and morphologic joint alterations. It Cilengitide is also the examination of choice for the detection of heterotopic ossification, which is a frequent condition in spinal cord injury patients.10 Therefore, it should be used routinely in the assessment of these patients.