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Traumatic spinal cord injury (SCI) is a devastating condition without an effective therapy. Cellular therapies are among the promising treatment strategies. Adult stem cells, such as mesenchymal stem cells, are often used clinical research for their immunomodulatory and regenerative potential. This study aimed to evaluate the effect of human adipose tissue-derived stem cells (ADSC) infusion through the cauda equina in rats with SCI. The human ADSC from bariatric surgery was isolated, expanded, and characterized. Wistar rats were subjected to blunt SCI and were divided into four groups. Two experimental groups (EG): EG1 received one ADSC infusion after SCI, and EG2 received two infusions, the first one after SCI and the second infusion seven days after the injury. Control groups (CG1 and CG2) received infusion with a culture medium. In vivo, cell tracking was performed 48 h and seven days after ADSC infusion. The animals were followed up for 40 days after SCI, and immunohistochemical quantification of myelin, neurons, and astrocytes was performed. Cellular tracking showed cell migration towards the injury site. ADSC infusion significantly reduced neuronal loss, although it did not prevent the myelin loss or enhance the area occupied by astrocytes compared to the control group. The results were similar when comparing one or two cell infusions. The injection of ADSC distal to the injured area was shown to be a safe and effective method for cellular administration in spinal cord injury.

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Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p > 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p > 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

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BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group ( P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

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Abstract Objective To compare the clinical results between conservative (CS) and surgical treatment (CXS) of A3 and A4 fractures without neurological deficit. Methods Prospective observational study of patients with thoracolumbar fractures type A3 and A4. These patients were separated between the surgical and conservative groups, and evaluated sequentially through the numeric rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5D (EQ-5D) quality of life questionnaire, and Denis work scale (DWS) up to 2.5 years of follow-up. Results Both groups showed significant improvement, with no statistical difference in pain questionnaires (NRS: CXS 2.4 ± 2.6; CS 3.5 ± 2.6; p> 0.05), functionality (RMDQ: CS 7 ± 6.4; CXS 5.5 ± 5.2; p> 0.05), quality of life (EQ-5D), and return to work (DWS). Conclusion Both treatments are viable options with equivalent clinical results. There is a tendency toward better results in the surgical treatment of A4 fractures.

Resumo Objetivo Comparar os resultados clínicos entre os tratamentos conservador (CS) e cirúrgico (CXS) das fraturas A3 e A4 sem déficit neurológico. Métodos Estudo prospectivo observacional de paciente com fraturas toracolombares tipo A3 e A4. Esses pacientes foram separados entre os grupos cirúrgico e conservador e avaliados sequencialmente através da escala numérica de dor (NRS), do questionário de incapacidade de Roland-Morris (RMDQ), do EuroQol-5D (EQ-5D) e da escala de trabalho de Denis (DWS) até 2,5 anos de acompanhamento. Resultados Ambos os grupos apresentaram melhora significante, sem diferença estatística nos questionários de dor (NRS: CXS 2,4 ± 2,6; CS 3,5 ± 2,6; p> 0,05), funcionalidade (RMDQ: CS 7 ± 6,4; CXS 5,5 ± 5,2; p> 0,05), qualidade de vida (EQ-5D) e retorno ao trabalho (DWS). Conclusão Ambos os tratamentos são opções viáveis e com resultados clínicos equivalentes. Há uma tendência a melhores resultados no tratamento cirúrgico das fraturas A4.

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ABSTRACT Objective: To evaluate the influence of intertransverse septal anesthetic block (BASIT) on postoperative pain in lumbar spine surgery. Methods: The study was carried out prospectively and observationally. Were included 105 patients who underwent posterior lumbar spine surgery, divided into two groups: 35 patients in the experimental group, who received BASIT at the end of the procedure, and 70 patients in the control group, without BASIT. Patients were assessed for low back pain (visual pain scale), opioid consumption on the 1st postoperative day, complications related to the procedure, and length of stay after surgery. Results: The sample consisted of 46 men and 59 women, with a mean age of 57.7 years (21 to 90 years). Mean postoperative pain in the experimental group was 1.88, and in the control group 2.11 (p<0.05). There was a trend towards less morphine use in the experimental group with p = 0.053. There was a statistical difference in morphine consumption between patients who did not previously use opioids and those who already used them (p 0.04). There was no difference between the groups regarding length of stay. Conclusion: Anesthetic blockade of the intertransverse septum reduced the consumption of opioids and the levels of low back pain after surgery (p<0.05), with no statistical difference in length of hospital stay or complications related to the technique. Level of Evidence II; Clinical Prospective Study.

RESUMO: Objetivo: Avaliar a influência do bloqueio anestésico do septo intertransverso (BASIT) sobre a dor pós-operatória em cirurgia de coluna lombar. Metodologia: O estudo foi realizado de modo prospectivo e observacional. Foram incluídos no estudo 105 pacientes submetidos à cirurgia da coluna lombar por via posterior e divididos em dois grupos: 35 pacientes no grupo experimental, que recebeu o BASIT ao final do procedimento e 70 pacientes no grupo controle, sem o BASIT. Os pacientes foram avaliados quanto à dor lombar (escala visual de dor), consumo de opioide no 1º dia pós-operatório, complicações referentes ao procedimento e tempo de internamento após a cirurgia. Resultados: A amostra consistiu em 46 homens e 59 mulheres, com média de idade de 57,7 anos (21 a 90 anos). A média de dor pós-operatória do grupo experimento foi 1,88 e no grupo controle 2,11 (p<0,05). Houve uma tendência a menor uso de morfina no grupo experimento com p = 0,053. Houve diferença estatística no consumo de morfina entre os pacientes que não utilizavam opioides previamente quanto comparados aos que já faziam uso (p 0,04). Não houve diferença entre os grupos quanto ao tempo de internamento nem eventos adversos relacionados à técnica. Conclusão: O bloqueio anestésico do septo intertransverso reduziu o consumo de opioides e os níveis de dor lombar após cirurgia (p<0,05), não havendo diferença estatística no tempo de internamento, nem intercorrências relacionadas a técnica. Nível de Evidência II; Estudo Prospectivo Clínico.

RESUMEN: Objetivo: Evaluar la influencia del bloqueo anestésico del septo intertransverso (BASIT) sobre el dolor posoperatorio en cirugía de columna lumbar. Método: El estudio se realizó de forma prospectiva observacional. Fueron incluidos en el estudio 105 pacientes sometidos a cirugía de columna lumbar posterior y se dividieron en dos grupos: 35 pacientes en el grupo experimental, recibieron BASIT al final del procedimiento, y 70 pacientes en el grupo control, sin BASIT. Los pacientes fueron evaluados por dolor lumbar (escala visual de dolor), consumo de opioides en el primer día postoperatorio, complicaciones relacionadas con el procedimiento y tiempo de estancia hospitalaria después de la cirugía. Resultado: La muestra consistió en 46 hombres y 59 mujeres, con una edad media de 57,7 años (21 a 90 años). El dolor postoperatorio medio en el grupo experimental fue de 1,88 y en el grupo control de 2,11 (p<0,05). Hubo una tendencia hacia un menor uso de morfina en el grupo experimental con p = 0,053. Hubo una diferencia estadística en el consumo de morfina entre los pacientes que no usaban previamente opioides en comparación con los que ya los usaban (p 0,04). No hubo diferencia entre los grupos con respecto a la duración de la estancia. Conclusión: El bloqueo anestésico del septo intertransverso redujo el consumo de opioides y los niveles de dolor lumbar posoperatorio (p<0,05), sin diferencia estadística en la estancia hospitalaria ni en las complicaciones relacionadas con la técnica. Nivel de Evidencia II; Estudio Clínico Prospectivo.

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ABSTRACT: Objective: Evaluation of the profile of the population with adolescent idiopathic scoliosis (AIS) treated at a center specializing in spine surgery in Curitiba-PR. Methods: Prospective multicenter study, being analyzed, at the moment, only data from the center in question. All patients referred from the basic health service for evaluation of deformity underwent panoramic radiography of the total spine to evaluate the curvature using the Cobb method, evaluation of skeletal maturity using the Risser classification, and the classification of scoliosis using the Lenke classification. Clinical photographs of all patients and an assessment of the quality of life using the SRS-30 questionnaire were also taken. Results: Thirty patients with scoliosis and a mean age of 14.63 ± 3 years were evaluated. Prevalence of female:male 1.5:1. Patients had a mean Cobb of 45.96°, and most were close to Risser 4 skeletal maturity (48.3%). 60% had a thoracic curve (Lenke 1), and 13.3% had a double curve (Lenke 3 or 6). 63.3% of cases had a delay in medical care, taking an average of 18 months between referral and consultation with a specialist. 60% of patients were referred for surgical treatment after the first appointment. Conclusion: The population sample of this center follows the literature. A Cobb >40° in the first consultation with a specialist and a high referral rate to surgery suggest the failure of early diagnosis and the need for public policies for better knowledge and assistance for adolescent idiopathic scoliosis. Level of Evidence IV; Descriptive Epidemiological Study.

RESUMO: Objetivo: Avaliação do perfil da população com escoliose idiopática do adolescente (EIA) atendida no centro especializado em cirurgia de coluna em Curitiba-PR. Métodos: Estudo multicêntrico prospectivo, sendo analisados, no momento, somente os dados do centro em questão. Todos os pacientes encaminhados do serviço de saúde básica para avaliação de deformidade foram submetidos a radiografia panorâmica de coluna total para avaliação da curvatura através do método de Cobb, avaliação da maturidade esquelética pela classificação de Risser e classificação da escoliose por Lenke. Foram, também, realizadas fotos clínicas de todos os pacientes e avaliação da qualidade de vida pelo questionário SRS-30. Resultados: Foram avaliados 30 pacientes com escoliose e idade média de 14,63 ± 3 anos. Prevalência de sexo feminino:masculino 1,5:1. Os pacientes apresentavam Cobb médio 45,96° e a maioria estava próxima da maturidade esquelética Risser 4 (48,3%). 60% apresentavam curva torácica (Lenke 1) e 13,3% dupla curva (Lenke 3 ou 6). 63,3% dos casos apresentaram atraso na assistência médica, demorando em média 18 meses entre o encaminhamento e a consulta com especialista. 60% dos pacientes foram encaminhados para tratamento cirúrgico após a primeira consulta com um especialista. Conclusão: A amostra populacional deste centro encontra-se consoante a literatura. Pelo Cobb >40° na primeira consulta com o especialista e a alta taxa de encaminhamento para cirurgia, fica demonstrado a falha do diagnóstico precoce e necessidade de políticas públicas para melhor conhecimento e assistência da escoliose idiopática do adolescente. Nível de evidência: IV; Estudo Epidemiológico Descritivo.

RESUMEN: Objetivo: Evaluación del perfil de la población con escoliosis idiopática del adolescente (EIA) tratada en un centro especializado en Curitiba-PR. Métodos: Estudio multicéntrico prospectivo, analizándose, por el momento, únicamente los datos del centro en cuestión. A todos los pacientes derivados del servicio básico de salud para evaluación de deformidad se les realizó radiografía panorámica de columna total para evaluación de la curvatura mediante el método de Cobb, evaluación de la madurez esquelética mediante la clasificación de Risser y clasificación de escoliosis mediante la clasificación de Lenke. También se tomaron fotografías clínicas de todos los pacientes y evaluación de la calidad de vida mediante el cuestionario SRS-30. Resultados: Se evaluaron 30 pacientes con escoliosis y edad media de 14,63 ± 3 años. Prevalencia femenino:masculino 1,5:1. Los pacientes tenían un Cobb medio de 45,96° y la mayoría estaba cerca de la madurez esquelética Risser 4 (48,3%). El 60% tenía curva torácica (Lenke 1) y el 13,3% tenía doble curva (Lenke 3 o 6). El 63,3% de los casos tuvo retraso en la atención médica, transcurriendo en promedio 18 meses entre la derivación y la consulta con un especialista. El 60% de los pacientes fueron derivados para tratamiento quirúrgico después de la primera cita. Conclusión: La muestra poblacional de este centro está de acuerdo con la literatura. Por Cobb > 40° en la primera consulta con un especialista y una alta tasa de derivación a cirugía, se sugiere el fracaso del diagnóstico precoz y la necesidad de políticas públicas para mejorar el conocimiento y la asistencia de la escoliosis idiopática del adolescente. Nivel de Evidencia IV; Estudio Epidemiológico Descriptivo.

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Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° ( p < 0.01), SL 30.7° ( p < 0.05), and SLC 18.8° ( p > 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

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Abstract Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° (p< 0.01), SL 30.7° (p< 0.05), and SLC 18.8° (p> 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Resumo Objetivo Avaliar os resultados radiográficos e comparar a lordose pós-operatória em técnica de artrodese intersomática lombar transforaminal (TLIF, na sigla em inglês), considerando como variável o posicionamento do dispositivo intersomático (cage) em relação ao espaço discal. Métodos Análise retrospectiva radiográfica de pacientes cirúrgicos, em nível único, por doença lombar degenerativa, aplicando-se TLIF e instrumentação pedicular posterior. Os pacientes foram divididos, conforme a posição do cage, em 2 grupos: 1. TLIF-A - cages na posição anterior do espaço discal; e 2. TLIF-P, cages na posição posterior do espaço discal (considerando-se o platô vertebral superior da vértebra inferior incluída na instrumentação, cages que ocuparam a superfície correspondente a 50% anterior da linha média, compuseram o grupo TLIF-A; opostamente, cages em posicionamento posterior compuseram o grupo TLIF-P). Procedeu-se à avaliação dos exames radiográficos ortostáticos em perfil no pré- e pós-operatórios, com a tomada das seguintes medidas: lordose lombar (LL) (ângulo L1-S1); lordose segmentar (LS) (L4-S1) e lordose segmentar do cage (LSC). Resultados Cem pacientes foram incluídos de 2011 a 2018, sendo 44 homens e 46 mulheres, com idade média de 50.5 anos (27-76 anos). Um total de 43 cages foram classificados como "anteriores" (TLIF-A) e 57, "posteriores" (TLIF-P); considerando o grupo TLIF- A, os resultados pós-operatórios médios foram: LL 50.7°, LS 34.9° e LSC 21.6°; para o grupo TLIF-P, comparativamente: LL 42.3° (p< 0,01), LS 30.7° (p< 0,05) e LSC 18.8° (p> 0,05). Conclusão O posicionamento anterior do cage em relação ao espaço discal correlaciona-se a melhora da lordose lombar e segmentar na radiografia em comparação com o posicionamento posterior do implante.

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PURPOSE OF THE STUDY: The objective of this prospective, parallel, randomized, single-center study is to evaluate the clinical success of a commercial ceramic bone graft substitute (CBGS) for autograft in eXtreme Lateral Interbody Fusion (XLIF) procedures. Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Cristiano Magalhães], Last name [Menezes]. Author 2 Given name: [Gabriel Carvalho], Last name [Lacerda]. Author 5 Given name: [Erica Godinho], Last name [Menezes]. Also, kindly confirm the details in the metadata are correct.yes METHODS: Forty-five adult subjects were consecutively enrolled and randomized into a single-level XLIF procedure using either CBGS or iliac crest bone graft autograft (30 and 15 subjects, respectively). The primary outcome was fusion rate at 12, 18, and 24 months. Secondary outcomes were pain and disability measured by HRQOL questionnaires. Kindly check and confirm whether the corresponding author and his corresponding affiliations is correctly identified.yes RESULTS: The fusion rates for both CBGS and autograft groups at the 24-month follow-up were 96.4% and 100%, respectively. For the CBGS group, mean ODI, mean back pain, and mean worst leg pain significantly improved at the 24-month follow-up by 76.7% (39.9-9.3), 77.6% (7.3-1.6), and 81.3% (5.1-1.0), respectively. For the autograft group, mean ODI, mean back pain, and mean worst leg pain significantly improved during the same time period by 77.1% (35.9-8.2), 75.6% (6.1-1.5), and 86.0% (6.6-0.9), respectively (all time points between groups, p < 0.05). CONCLUSION: The results of this prospective, randomized study support the use of CBGS as a standalone bone graft substitute for autograft in single-level XLIF surgery. The clinical performance and safety outcomes reported here are consistent with published evidence on CBGS. Improvements in patient-reported back pain, leg pain, and disability outcomes were comparable between the CBGS and autograft groups.

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Herbivory is ubiquitous. Despite being a potential driver of plant distribution and performance, herbivory remains largely undocumented. Some early attempts have been made to review, globally, how much leaf area is removed through insect feeding. Kozlov et al., in one of the most comprehensive reviews regarding global patterns of herbivory, have compiled published studies regarding foliar removal and sampled data on global herbivory levels using a standardized protocol. However, in the review by Kozlov et al., only 15 sampling sites, comprising 33 plant species, were evaluated in tropical areas around the globe. In Brazil, which ranks first in terms of plant biodiversity, with a total of 46,097 species, almost half (43%) being endemic, a single data point was sampled, covering only two plant species. In an attempt to increase knowledge regarding herbivory in tropical plant species and to provide the raw data needed to test general hypotheses related to plant-herbivore interactions across large spatial scales, we proposed a joint, collaborative network to evaluate tropical herbivory. This network allowed us to update and expand the data on insect herbivory in tropical and temperate plant species. Our data set, collected with a standardized protocol, covers 45 sampling sites from nine countries and includes leaf herbivory measurements of 57,239 leaves from 209 species of vascular plants belonging to 65 families from tropical and temperate regions. They expand previous data sets by including a total of 32 sampling sites from tropical areas around the globe, comprising 152 species, 146 of them being sampled in Brazil. For temperate areas, it includes 13 sampling sites, comprising 59 species. Thus, when compared to the most recent comprehensive review of insect herbivory (Kozlov et al.), our data set has increased the base of available data for the tropical plants more than 460% (from 33 to 152 species) and the Brazilian sampling was increased 7,300% (from 2 to 146 species). Data on precise levels of herbivory are presented for more than 57,000 leaves worldwide. There are no copyright restrictions. Please cite this paper when using the current data in publications; the authors request to be informed how the data is used in the publications.

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ABSTRACT Objective To describe the minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine and its viability in several affections of the region, demonstrating its indications, potential advantages, and necessary precautions, with an emphasis on the local anatomy, especially the diaphragm. Methods After a review of the literature, the initial experience of the Service is reported, comparing it to the published results. The surgical technique used is described with emphasis on the surgical anatomy of the diaphragm. Results The minimally invasive lateral retropleural approach to the thoracolumbar junction with the application of an expandable tubular retractor was described step-by-step in this study, with emphasis on the crucial points of technical execution, such as preoperative planning, access to the retropleural plane, and an orthogonal approach for adequate discectomy and/or corpectomy and subsequent implant placement. It can be used in the treatment of deformities, degenerative diseases, trauma, tumors, and infections and it allows for adequate interbody arthrodesis fusion rates associated with a smaller skin incision and less soft tissue damage, blood loss, and postoperative pain. Thus, it results in better postoperative mobility and a shorter hospital stay, which can also be observed in the data from initial experience of this Service. Conclusions The minimally invasive technique for the lateral retropleural approach to the thoracolumbar spine with the application of an expandable tubular retractor was shown to be promising and safe for the treatment of several spinal diseases despite the complex and challenging local anatomy and it presents advantages over the morbidity rates observed in the traditional approach. Level of evidence IV; Case series.

RESUMO Objetivo Descrever a técnica minimamente invasiva para acesso lateral retropleural à coluna toracolombar e sua viabilidade em diversas afecções da região, demonstrando suas indicações, vantagens em potencial e cuidados necessários, com destaque para a anatomia local, especialmente o diafragma. Métodos Após revisão da literatura, relata-se a experiência inicial do serviço, comparando-a aos resultados publicados. Descreve-se a técnica cirúrgica empregada, com ênfase na anatomia cirúrgica do diafragma. Resultados A técnica de acesso lateral retropleural minimamente invasivo à junção toracolombar, com aplicação de retrator tubular expansível, foi descrita passo a passo neste estudo, com destaque de pontos cruciais de execução técnica, tais como planejamento pré-operatório, acesso ao plano retropleural e abordagem ortogonal para discectomia e/ou corpectomia adequadas e posterior colocação de implante. Ela pode ser usada no tratamento de deformidades, doenças degenerativas, trauma, tumor e infecções e possibilita taxas adequadas de fusão pela artrodese intersomática associada à menor incisão de pele, dano aos tecidos moles, perda sanguínea e dor pós-operatória. Resulta, assim, em melhor mobilidade pós-cirúrgica e menor período de internação hospitalar, o que pode ser observado também nos dados da experiência inicial do Serviço. Conclusões A técnica de acesso lateral retropleural minimamente invasivo à junção toracolombar com aplicação de retrator tubular expansível mostra-se promissora e segura para tratamento de diversas doenças da coluna, apesar da anatomia local complexa e desafiadora e apresenta vantagens diante da morbidade decorrente da abordagem tradicional. Nível de evidência: IV; Série de casos.

RESUMEN Objetivo Describir la técnica mínimamente invasiva para acceso lateral retropleural a la columna toracolumbar y su viabilidad en diversas afecciones de la región, demostrando sus indicaciones, ventajas en potencial y cuidados necesarios, destacando la anatomía local, especialmente el diafragma. Métodos Después de revisión de la literatura, se relata la experiencia del Servicio, comparándola a los resultados publicados. Se describe la técnica quirúrgica empleada, con énfasis en la anatomía quirúrgica del diafragma. Resultados La técnica de acceso lateral retropleural mínimamente invasivo a la junción toracolumbar, con aplicación de retractor tubular expansible, fue descrita paso a paso en este estudio, con destaque de puntos cruciales de ejecución técnica, tales como planificación preoperatoria, acceso al plano retropleural y abordaje ortogonal para discectomía y/o corpectomía adecuadas y posterior colocación de implante. La misma puede ser usada en el tratamiento de deformidades, enfermedades degenerativas, trauma, tumor e infecciones y posibilita tasas adecuadas de fusión por artrodesis intersomática asociada a la menor incisión de piel, daño a los tejidos blandos, pérdida sanguínea y dolor postoperatorio. Resulta, así, en mejor movilidad postquirúrgica y menor período de internación hospitalaria, lo que puede ser observado también en los datos de la experiencia inicial del Servicio. Conclusiones La técnica de acceso lateral retropleural mínimamente invasivo a la junción toracolumbar con aplicación de retractor tubular expansible se muestra prometedora y segura para tratamiento de diversas enfermedades de la columna, a pesar de la anatomía local compleja y difícil, y presenta ventajas delante de la morbilidad del abordaje tradicional. Nivel de evidencia IV; Serie de casos.

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Endemism and rarity have long intrigued scientists. We focused on a rare endemic and critically-endangered species in a global biodiversity hotspot, Grevillea thelemanniana (Proteaceae). We carried out plant and soil analyses of four Proteaceae, including G. thelemanniana, and combined these with glasshouse studies. The analyses related to hydrology and plant water relations as well as soil nutrient concentrations and plant nutrition, with an emphasis on sodium (Na) and calcium (Ca). The local hydrology and matching plant traits related to water relations partially accounted for the distribution of the four Proteaceae. What determined the rarity of G. thelemanniana, however, was its accumulation of Ca. Despite much higher total Ca concentrations in the leaves of the rare G. thelemanniana than in the common Proteaceae, very few Ca crystals were detected in epidermal or mesophyll cells. Instead of crystals, G. thelemanniana epidermal cell vacuoles contained exceptionally high concentrations of noncrystalline Ca. Calcium ameliorated the negative effects of Na on the very salt-sensitive G. thelemanniana. Most importantly, G. thelemanniana required high concentrations of Ca to balance a massively accumulated feeding-deterrent carboxylate, trans-aconitate. This is the first example of a calcicole species accumulating and using Ca to balance accumulation of an antimetabolite.

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OBJECTIVE: To evaluate access to the technologies and education needed to perform minimally invasive spine surgery (MISS) in Latin America. METHODS: We designed a questionnaire to evaluate surgeons' practice characteristics, access to different technologies, and training opportunities for MISS techniques. The survey was sent to members and registered users of AO Spine Latin from January 6-20, 2020. The major variables studied were nationality, specialty (orthopedics or neurosurgery), level of hospital (primary, secondary, tertiary), number of surgeries performed per year by the spine surgeon, types of spinal pathologies commonly managed, and number of MISS performed per year. Other variables involved specific access to different technologies: intraoperative fluoroscopy, percutaneous screws, cages, tubular retractors, microscopy, intraoperative computed tomography, neuronavigation imaging, and bone morphogenetic protein. Finally, participants were asked about main obstacles to performing MISS and their access to education on MISS techniques in their region. RESULTS: The questionnaires were answered by 306 members of AO Spine Latin America across 20 different countries. Most answers were obtained from orthopedic surgeons (57.8%) and those with over 10 years of experience (42.4%). Most of the surgeons worked in private practice (46.4%) and performed >50 surgeries per year (44.1%), but only 13.7% performed >50 MISS per year, mainly to manage degenerative pathologies (87.5%). Most surgeons always had access to fluoroscopy (79%). Only 26% always had access to percutaneous screws, 24% to tubular retractors, 34.3% to cages (anterior lumbar interbody fusion, lateral lumbar interbody fusion, or transforaminal lumbar interbody fusion), and 43% to microscopy. Regarding technologies, 71% reported never having access to navigation, 83% computed tomography, and 69.3% bone morphogenetic protein. The main limitations expressed for widely used MISS technologies were the high implant costs (69.3%) and high navigation costs (49.3%). Most surgeons claimed access to online education activities (71%), but only 44.9% reported access to face-to-face events and 28.8% to hands-on activities, their limited access largely because the courses were expensive (62.7%) or few courses were available on MISS in their region (51.3%). CONCLUSIONS: Most surgeons in Latin America have limited resources to perform MISS, even in private practice. The main constraints are implant costs, access to technologies, and limited face-to-face educational opportunities.

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STUDY DESIGN: A multicenter, pilot study, for radiological assessment of thoracolumbar spine fractures was performed with the participation of 7 centers in Africa, Europe, Asia, and South America as a part of the AO Foundation network. OBJECTIVES: To determine the interobserver variability for computed tomography (CT) scan-based evaluation of posterior ligament complex (PLC) injury in thoracolumbar fractures. METHODS: Forty-two observers including 1 principal investigator at each participating center performed variability assessment. Each center contributed toward a total of 91 patient images with A3 or A4 thoracolumbar burst fractures (T11-L2) with or without suspected PLC injury. Pathological fractures, multilevel injuries, obvious posterior bony element injury and translation/dislocation injuries were excluded. Ten patients were randomly selected and commonly reported CT parameters indicating PLC injury, including superior inferior endplate angle, vertebral body height loss, local kyphotic deformity, interspinous distance and interpedicular distance were assessed for variability. Observer values were compared with an experienced gold rater in spinal trauma. Analysis of variability was performed for all observers, between the principal investigators and also between observers participating in each center. RESULTS: The studied parameters showed considerable variability in measurements among all observers and amongst all participating centers. The variability between the principal investigators was lower, but still substantial. The deviation of observer measurements from the gold rater were also significant for all CT parameters. CONCLUSIONS: CT-based radiological parameters previously reported to be suggestive of PLC injury showed considerable variability and magnetic resonance imaging verification of a PLC injury in all doubtful cases is suggested.

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Resumo Estudar documentos não é algo comum à Psicologia, porém, é um caminho pertinente para operar a problematização de nosso presente, que diz respeito a uma área tradicionalmente trabalhada pelos historiadores. Contudo, a Psicologia Social e Institucional tem buscado se apropriar dessa metodologia e, assim, aberto um campo relevante de estudos até então negligenciado pelos pesquisadores em Psicologia. Como nossa pesquisa se insere em um campo de estudos ainda pouco explorado pela Psicologia, acreditamos ser pertinente apresentar apontamentos sobre os embates que operaram no campo da história, para que se formasse uma visão mais ampla e abrangente sobre a noção de documento, além da abertura às novas temáticas com forte destaque ao movimento dos Annales. A partir dessa contextualização, procuramos focalizar a inserção das pesquisas históricas efetivadas por Michel Foucault, e a constituição de uma trilha de precauções metodológicas, denominada arqueogenealogia.

Resumen Aunque el estudio de documentos no sea algo común a la Psicología, es una forma pertinente de operar la problematización de nuestro presente, que se refiere a un área tradicionalmente trabajada por historiadores. Sin embargo, la Psicología Social e Institucional ha tratado de apropiarse de esta metodología y, por lo tanto, abierto un campo de estudios relevante hasta ahora descuidado por los investigadores en Psicología. Como nuestra investigación es parte de un campo de estudios aún poco explorado por la Psicología, creemos que es pertinente presentar notas sobre los enfrentamientos que operaron en el campo de la historia, para que se formase una visión más amplia e integral sobre la noción de documento, además de la apertura a las nuevas temáticas, con un fuerte énfasis en el movimiento de los Annales. Desde este contexto, buscamos centrarnos en la inserción de las investigaciones históricas llevadas a cabo por Michel Foucault, y en la constitución de un rastro de precauciones metodológicas, llamado arqueogenealogía.

Abstract To study documents is not something common to psychology, however, it is an effective way to operate the questioning of our present, which relates to an area traditionally crafted by historians. However, Social and Institutional Psychology has sought to appropriate this methodology and thus open up a relevant field studies previously neglected by researchers in psychology. As our research is part of a field of study still little explored by psychology, we believe it is pertinent to present notes on the clashes that operated in the field of history, towards the formation of a broader and more comprehensive view of the notion of document, as well as opening the new themes with a strong emphasis on the movement of the Annales. From this context, we seek to focus on the integration of historical research carried out by Michel Foucault, and the establishment of a trail of methodological precautions, denominated archeogenealogy.

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ABSTRACT Objective: To evaluate the influence of the MIS-TLIF technique on the spinopelvic parameters of patients submitted to lumbar arthrodesis up to three levels for the treatment of vertebral degenerative conditions without deformity. Methods: Retrospective radiographic evaluation of 52 patients submitted to the surgical treatment of lumbar arthrodesis using the MIS-TLIF technique in up to three levels. The spinopelvic parameters - pelvic incidence (PI), pelvic tilt(PT), lumbar lordosis (LL), segmental lordosis (Lseg), and the difference between lumbar lordosis and pelvic incidence (LL-PI mismatch) were analyzed in orthostatic lateral radiographs in the pre- and postoperative periods, with a minimum follow-up of 1 year. The patients were divided into three groups: PI <45°, PI between 45° and 55° and PI >55°. Results: Sixty-nine operated levels were evaluated in 15 patients with PI <45°, 19 with PI between 45° and 55° and 18 with PI >55°. The mean value of the pelvic incidence was 52.3° (± 11.5), lumbar lordosis 46.1° (pre)/45.6° (post); segmental lordosis 20.3° (pre)/20.6° (post); pelvic tilt 18.5° (pre)/18.2° (post); "mismatch" (PI-LL) 7° (pre)/ 6.6° (post), with no statistical difference among all parameters (p>0.05). Conclusions: The MIS-TLIF technique had no influence on postoperative spinopelvic parameters of patients undergoing lumbar arthrodesis surgery. Level of evidence: III. Retrospective comparative study.

RESUMO Objetivos: Avaliar a influência da técnica MIS-TLIF nos parâmetros espinopélvicos de pacientes submetidos à artrodese lombar até três níveis para tratamento de condições degenerativas vertebrais sem deformidade. Métodos: Avaliação radiográfica retrospectiva de 52 pacientes submetidos a tratamento cirúrgico de artrodese lombar pela técnica MIS-TLIF em até três níveis. Os parâmetros espinopélvicos - incidência pélvica (PI), versão pélvica (PT), lordose lombar (LL), lordose segmentar (Lseg), diferença entre lordose lombar e incidência pélvica ("mismatch" PI-LL) foram analisados em radiografias em perfil ortostático no pré e pós-operatório, com segmento mínimo de 1 ano. Os pacientes foram divididos em três grupos: PI<45°; PI entre 45° e 55°e PI> 55°. Resultados: Foram avaliados 69 níveis operados - PI < 45°, 15 pacientes; PI entre 45° e 55°, 19 e PI > 55°, 18. O valor médio da incidência pélvica foi 52,3° (+/- 11,5), lordose lombar 46,1° (pré) / 45,6° (pós); lordose segmentar 20,3° (pré) / 20,6° (pós); rotação pélvica 18,5° (pré) / 18,2° (pós); "mismatch" (PI-LL) 7° (pré) / 6,6°(pós), sem diferença estatística entre todos os parâmetros (p>0,05). Conclusão: A técnica MIS-TLIF não apresentou influência nos parâmetros espinopélvicos no pós-operatório de pacientes submetidos à cirurgia de artrodese lombar. Nível de evidência III. Estudo retrospectivo comparativo.

RESUMEN Objetivo: Evaluar la influencia de la técnica MIS-TLIF sobre los parámetros espinopélvicos de pacientes sometidos a artrodesis lumbar de hasta tres niveles para el tratamiento de condiciones vertebrales degenerativas sin deformidad. Métodos: Evaluación radiográfica retrospectiva de 52 pacientes sometidos a tratamiento quirúrgico de artrodesis lumbar por la técnica MIS-TLIF en hasta tres niveles. Los parámetros espinopélvicos como incidencia pélvica (IP), inclinación pélvica (PT), lordosis lumbar (LL), lordosis segmentaria (Lseg) diferencia entre lordosis lumbar e incidencia pélvica ("mismatch" LL-) se analizaron en radiografías laterales ortostáticas en el pre y postoperatorio, con seguimiento mínimo de 1 año. Los pacientes se dividieron en tres grupos: IP < 45°, IP entre 45° y 55° e IP > 55°. Resultados: Se evaluaron 69 niveles operados en 15 pacientes con IP < 45°, 19 con IP entre 45° y 55° y 18 con IP > 55°. El valor promedio de la incidencia pélvica fue 52,3° (± 11,5), lordosis lumbar 46,1° (pre)/45,6° (post), lordosis segmentaria 20,3° (pre)/20,6° (post), rotación pélvica 18,5° (pre)/18,2° (post), "mismatch" IP-LL 7° (pre)/6,6° (post), sin diferencia estadística entre todos los parámetros (p > 0,05). Conclusiones: La técnica MIS-TLIF no influenció los parámetros espinopélvicos en el postoperatorio de pacientes sometidos a cirugía de artrodesis lumbar. Nivel de evidencia: III. Estudio retrospectivo comparativo.

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The balance between the costs and benefits of fleshy fruit production depends on the feeding behavior of their seed dispersers, which might effectively disperse seeds to farther areas or drop beneath parent plants some diaspores they handle during frugivory bouts. Nevertheless, the consequences of variation in fruit handling by primary seed dispersers on the secondary removal of diaspores remains poorly understood. We conducted a field study to determine how variation in fruit handling by avian frugivores affects short-term secondary removal of Miconia irwinii (Melastomataceae) diaspores by the ground-dwelling fauna in campo rupestre vegetation, southeastern Brazil. We conducted factorial experiments manipulating: (1) different outcomes of primary fruit/seed removal by birds, (2) distances of diaspore deposition from conspecifics, and (3) the access of ants and vertebrates to diaspores. We showed that secondary removal of diaspores was highly variable at the population scale, with an overall low removal rate by the ground-dwelling fauna (13% seeds, 19% fruits). However, we found that gut-passed seeds embedded in bird feces were less removed than seeds expelled from fruits. Gut-passed seeds were more likely to be removed by ant species acting as secondary dispersers, whereas pulp-free seeds dropped by birds were likely to interact with potential seed predators, including ants and rodents. We found no clear effect of dispersal from parent plant vicinity on seed removal, but fruit removal was significantly higher near parent plants. Partially defleshed fruits were more removed than intact fruits. The removal of fruits by ant and vertebrate rescuers, including lizards and birds, might reduce the costs of interactions with less effective dispersers that drop partially defleshed fruits under parent plants. Our study highlights that variation in fruit handling by primary avian seed dispersers mediate subsequent interactions among discarded diaspores and ground-dwelling animals, potentially affecting final seed fates. Moreover, we argue that escape-related benefits of dispersal can be contingent on how primary dispersers handle and discard seeds.

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The extent of specialization/generalization continuum in fruit-frugivore interactions at the individual level remains poorly explored. Here, we investigated the interactions between the Neotropical treelet Miconia irwinii (Melastomataceae) and its avian seed dispersers in Brazilian campo rupestre. We built an individual-based network to derive plant degree of interaction specialization regarding disperser species. Then, we explored how intraspecific variation in interaction niche breadth relates to fruit availability on individual plants in varying densities of fruiting conspecific neighbors, and how these factors affect the quantity of viable seeds dispersed. We predicted broader interaction niche breadths for individuals with larger fruit crops in denser fruiting neighborhoods. The downscaled network included nine bird species and 15 plants, which varied nearly five-fold in their degree of interaction specialization. We found positive effects of crop size on visitation and fruit removal rates, but not on degree of interaction specialization. Conversely, we found that an increase in the density of conspecific fruiting neighbors both increased visitation rate and reduced plant degree of interaction specialization. We suggest that tracking fruit-rich patches by avian frugivore species is the main driver of density-dependent intraspecific variation in plants' interaction niche breadth. Our study shed some light on the overlooked fitness consequences of intraspecific variation in interaction niches by showing that individuals along the specialization/generalization continuum may have their seed dispersed with similar effectiveness. Our study exemplifies how individual-based networks linking plants to frugivore species that differ in their seed dispersal effectiveness can advance our understanding of intraspecific variation in the outcomes of fruit-frugivore interactions.

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17ß-Estradiol (E2) is an endogenous steroid in the human body. Its measurement is important for health and human biology understanding. However, E2 concentration in human plasma is in the range of pg/mL, which makes it difficult to detect. In this way, LC-MS/MS has been shown the most sensitive tool, although E2 is a weakly ionizable molecule. In this work, we validated a more sensitive and accurate method for E2 quantification in human plasma. Our extraction step ensured a cleaner chromatography, resulting in a precise measurement and highly reproducible method in the range of 2-150pg/mL. Moreover, we proved a long stability for E2 in several conditions. All results indicate that our developed method is robust and sensitive enough to apply in bioequivalence studies for E2 measurement in human plasma, even at very low concentrations.

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Resumo O artigo presente visa problematizar as práticas do Fundo das Nações Unidas para a Infância (UNICEF), em especial, as dirigidas às crianças e adolescentes pobres por meio de atividades de esportes, lazer e cultura como maneira de forjar segurança, saúde e prevenir situações de violência Esta agência atribui a este grupo social supostas situações de riscos, vulnerabilidades, carências e privações derivadas do pertencimento desta infância e adolescência às famílias pobres, não escolarizadas e pela moradia em comunidades na periferia das cidades. Os modos de vida deste segmento da população são desqualificados e o UNICEF se apresenta como uma agência transformadora destas condições. Os projetos deste organismo multilateral oscilam entre o adestramento disciplinar produtor de docilidade e utilidade ao governo da vida para criar liberdade com segurança por meio de políticas compensatórias, recomendadas como receitas e oferecidas como favores, deixando de lado o campo dos direitos em detrimento da economia política neoliberal.(AU)

Abstract The present article aimes to discuss the practices of the United Nations Fund for Children (UNICEF), in particular those targeted at poor children and adolescents through sports activities, leisure and culture as a way of forging safety, health and prevent this avency situations of violence attributed to this social group alleged situations of risks, vulnerabilities, needs and deprivation derived from this childhood and adolescence belonging to poor families, illiterate and living in communities on the outskirts of towns. The way of life of this population segment are disqualified and UNICEF presents itself as an agency transformins these conditions. Projects of this multilateral organization oscillate between the dressage discipline producer of docility and usefulness to the government to create freedom of life safely through compensatory policies, as recommended recipes and offered as favors, dropping the field to the detriment of the rights of political economy neoliberal.(AU)

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