Cardiorespiratory function of patients undergoing surgical correction of Scheuermann's hyperkyphosis

The aim of this study was to analyze the impact of surgical correction of the thoracic deformity on the cardiorespiratory function of patients with moderate-severe Scheuermann’s hyperkyphosis (SK). A series of 23 adolescents with SK who underwent surgery through an only posterior approach using all pedicle screw constructs were included in the study. Cardiorespiratory parameters were measured during a maximal exercise tolerance test before and 2 years after surgery. Heart rate, oxygen saturation (SatO2), maximum oxygen uptake (VO2 max), ventilatory capacity at maximal exercise (VEmax), and energy costs were recorded. There were statistically significant differences in the forced vital capacity (FVC) (P < 0.05), total VO2max (ml/min) (P < 0.01), maximum expired volume (VEmax) per minute (P < 0.01) and cardiovascular efficiency (HR/VO2 ratio) (P < 0.05). None of these changes were clinically relevant. There were no changes in the VO2max per kg of body mass. The magnitude of the kyphosis correction did not correlate with the change in normalized VO2max or VEmax. In conclusion, patients with moderate-severe SK improve their baseline respiratory limitations and the tolerance to maximum exercise 2 years after surgery. However, the slight cardiorespiratory functional improvements should not necessarily be attributed to the surgery, and could also be caused solely by the residual growth of the lungs and thorax. Furthermore, respiratory functional changes are under thresholds considered as clinically relevant.

Species-specific differences in C-5 sterol desaturase function influence the outcome of azole antifungal exposure.

The azole antifungals inhibit sterol 14α-demethylase (S14DM), leading to depletion of cellular ergosterol and the synthesis of an aberrant sterol-diol that disrupts membrane function. In Candida albicans , sterol diol production is catalyzed by the C-5 sterol desaturase enzyme encoded by ERG3 . Accordingly, mutations that inactivate ERG3 enable the fungus to grow in the presence of the azoles. The purpose of this study was to compare the propensity of C-5 sterol desaturases from different fungal pathogens to produce the toxic diol upon S14DM inhibition and thus contribute to antifungal efficacy. The coding sequences of ERG3 homologs from C. albicans ( CaERG3 ), Candida glabrata ( CgERG3 ), Candida auris ( CaurERG3 ), Cryptococcus neoformans ( CnERG3 ), Aspergillus fumigatus ( AfERG3A-C ) and Rhizopus delemar ( RdERG3A/B ) were expressed in a C. albicans erg3Δ/Δ mutant to facilitate comparative analysis. All but one of the Erg3p-like proteins (AfErg3C) at least partially restored sterol C-5 desaturase activity, and to corresponding degrees rescued the stress and hyphal growth defects of the C. albicans erg3Δ/Δ mutant - confirming functional equivalence. Each C-5 desaturase enzyme conferred markedly different responses to fluconazole exposure in terms of the minimal inhibitory concentration (MIC) and residual growth observed at supra-MIC concentrations. Upon fluconazole-mediated inhibition of S14DM, the strains expressing each homolog also produced varying levels of 14α-methylergosta-8,24(28)-dien-3β,6α-diol. The RdErg3A and AfErg3A proteins are notable for low levels of sterol diol production and failing to confer appreciable azole sensitivity upon the C. albicans erg3Δ/Δ mutant. These findings suggest that species-specific properties of C5-sterol desaturase may be an important determinant of intrinsic azole sensitivity.

Mechanisms of Azole Resistance and Trailing in Candida tropicalis Bloodstream Isolates

Objectives: Azole-resistant Candida tropicalis has emerged in Asia in the context of its trailing nature, defined by residual growth above minimum inhibitory concentrations (MICs). However, limited investigations in C. tropicalis have focused on the difference of genotypes and molecular mechanisms between these two traits. Methods: Sixty-four non-duplicated C. tropicalis bloodstream isolates collected in 2017 were evaluated for azole MICs by the EUCAST E.def 7.3.1 method, diploid sequence type (DST) by multilocus sequencing typing, and sequences and expression levels of genes encoding ERG11, its transcription factor, UPC2, and efflux pumps (CDR1, CDR2 and MDR1). Results: Isavuconazole showed the highest in vitro activity and trailing against C. tropicalis, followed by voriconazole and fluconazole (geometric mean [GM] MIC, 0.008, 0.090, 1.163 mg/L, respectively; trailing GM, 27.4%, 20.8% and 19.5%, respectively; both overall p < 0.001). Fourteen (21.9%) isolates were non-WT to fluconazole/voriconazole, 12 of which were non-WT to isavuconazole and clustered in clonal complex (CC) 3. Twenty-five (39.1%) isolates were high trailing WT, including all CC2 isolates (44.0%) (containing DST140 and DST98). All azole non-WT isolates carried the ERG11 mutations A395T/W and/or C461T/Y, and most carried the UPC2 mutation T503C/Y. These mutations were not identified in low and high trailing WT isolates. Azole non-WT and high trailing WT isolates exhibited the highest expression levels of ERG11 and MDR1, 3.91- and 2.30-fold, respectively (both overall p < 0.01). Conclusions: Azole resistance and trailing are phenotypically and genotypically different in C. tropicalis. Interference with azole binding and MDR1 up-regulation confer azole resistance and trailing, respectively.

Ginocchio valgo punto per punto: quello che deve sapere il pediatra

Knee valgus is one of the most frequent paediatric orthopaedic problems based on the evaluation by the paediatricians. Most cases are physiological variants that resolve spontaneously with growth, however pathological cases require surgical treatment. Therefore, the paediatrician must know how to distinguish between the two entities from the beginning, sending the child to the specialist when necessary, thus respecting the correct timing for treatment. The most frequent condition is idiopathic knee valgus, which occurs when the physiological variant persists after the age of 8 without spontaneous resolution. Children who always need specialist evaluation are those who on physical examination show a tibiofemoral angle greater than 15° with an intermalleolar distance of about 10 cm that persists beyond 10 years of age. The gold standard treatment in these children is growth-guided hemiepiphysiodesis, namely a simple and minimally invasive procedure that reshapes the altered angle of the knees through the application of the 8-plate. The correction is based on the presence of residual growth of the physical cartilages, therefore it should not be performed too late, but not before 10 years of age.

Comparison of skeletal anchorage and tooth-borne maxillary protraction followed by fixed appliance in Class III malocclusion

Summary Objectives The purpose of this study was to compare the results of skeletal anchorage (SAMP) and tooth- borne (TBMP) maxillary protraction followed by fixed appliance in growing skeletal Class III patients. Materials and methods Patients treated with maxillary protraction were selected and classified into two groups (SAMP: n = 19, mean age = 11.19 years; TBMP: n = 27, mean age = 11.21 years). Lateral cephalograms taken before treatment (T0), after the maxillary protraction (T1), and after the fixed appliance treatment (T2) were analysed and all variables were statistically tested to find difference between the two groups. Results Compared to the TBMP, the SAMP showed significant forward growth of maxilla (Co-A point and SN-Orbitale) and improvement in intermaxillary relationship (ANB, AB to mandible plane, and APDI) after the overall treatment (T0–T2), with no significant sagittal changes in maxilla or mandible throughout the fixed appliance treatment (T1–T2). Limitations In maxillary protraction, effects of skeletal anchorage were retrospectively compared with those of dental anchorage, not with Class I or III control. Conclusions and implications After maxillary protraction, skeletal and tooth-borne anchorage did not cause significant differences in the residual growth of maxilla throughout the phase II treatment. Orthopaedic effects with skeletal anchorage showed appropriate stability in maxilla and intermaxillary relationship even after fixed appliance treatment.