A doença de Alzheimer é entendida hoje como uma entidade clínico-biológica cuja caracterização deverá levar em conta a utilização de biomarcadores. Até recentemente, o uso de biomarcadores obrigava a realização de punção lombar ou à realização de PET. O surgimento de biomarcadores sanguíneos torna mais acessível a caracterização biológica da doença e é tido como um dos principais avanços na doença de Alzheimer. A sua utilização, contudo, deve ser criteriosa porque a sua interpretação pode ser difícil, sobretudo para a população geral, e o seu valor varia substancialmente mediante a população em que é usado. Nesta revisão narrativa, apresentamos o estado da arte dos biomarcadores de sangue na doença de Alzheimer, especificamente dados de investigação recente e aplicabilidade clínica.
Introduction The popularity of endoscopic surgery of the lumbar spine has increased exponentially over the last few years, linked to less surgical aggressiveness and early return to daily activities. The primary aim of this study was to assess if there was a clinical impact of the learning curve for the percutaneous endoscopy discectomy (PED). Methods Demographic and clinical data from patients who underwent PED due to lumbar disc herniation, between May 2019 and June 2022 was collected. Results 45 patients were included. We used the transforaminal approach in 51.1% of the patients while the remaining were through an interlaminar window. The median duration of surgery was 84 min (Interquartile range (IQR) of 68-92 min). As the surgeon acquired more experience, the duration of the surgery decreased, which was particularly expressive for the transforaminal approach. No relation was found between surgery duration and obesity (p = 0.725). Only one patient required conversion to open surgery and it was the same that had a dural injury. We had to re-operate 2 cases (4.4%). No positive correlation was found between the VAS score and the duration of surgery (p = 0.312) and between surgery duration and clinical recurrence (p = 0.211). Pain persistence was more common in patients with depression (p = 0.009). Conclusion The learning curve for PED can be successfully overcome without introducing a significant risk for patients. The transforaminal approach demonstrates more significant progression, while the interlaminar approach exhibits a more plateau-like pattern.
Acromioclavicular joint (ACJ) dislocation is a frequent shoulder injury, and high-grade cases often require surgical reconstruction. Although multiple techniques have been described, no single method has achieved consensus as the gold standard. The long head of the biceps tendon (LHBT) represents an attractive autologous option, as it is anatomically adjacent to the ACJ, preserves vascularity when used as a pedicled graft, and reduces donor-site morbidity. Building on prior anatomical studies, this cadaveric investigation describes and validates an arthroscopic technique for ACJ reconstruction using the LHBT. The graft is mobilized while maintaining its supraglenoid origin, passed through a clavicular tunnel under endoscopic and fluoroscopic guidance, and reinforced vertically with a suspensory (suture-button) device passing independently through a coracoclavicular tunnel, and with an acromioclavicular cerclage to enhance horizontal stability. The procedure proved feasible, reproducible, and safe with respect to anatomical landmarks and adjacent structures. Clinical relevance: This technique offers a biologically sound, minimally invasive alternative for ACJ reconstruction that may reduce morbidity and improve reproducibility compared with conventional graft-based procedures.
