Artroplastia total de codo tras fractura de húmero distal en ancianos. Revisión de casos.

Osteosynthesis is the gold standard in most distal humerus fractures but in elderly patients, arthroplasty may be a better option. The aim of the study was to assess our results with total elbow arthroplasty after acute distal humerus fracture in the elderly. Retrospective study to evaluate clinical and functional results plus complications of all patients from our hospital with a total elbow arthroplasty performed for acute distal humeral fracture. 18 patients were included with a mean age of 77 years (63-87). The mean postoperative range of motion was 89º and the average MEPS and DASH score 80 and 26 respectively. There were 4 complications (22%) and no reoperations. Total elbow arthroplasty can be a good choice for distal humerus fracture, as long as they are indicated in patients with complex fractures, difficult to synthesize due to osteoporotic or severe comminution and with a low functional demand

Disociación espino-pélvica : a propósito de un caso

Spinopelvic dissociation is a relatively unknown injury, probably underdiagnosed. The term is applied to those fractures of the sacrum which combines a transverse fracture with sagittal fracture in both sacral wings, resulting in a mechanical separation between the spine and the pelvis. It?s really important to be alert in a high energy multiple trauma. The treatment of choice, except exceptions, is surgery. About associated complications, we must detect preoperative neurological injury of these patients due to it will be the main determinant of the long-term prognosis. The objective of this review it is to introduce this rare pathology with important implications through a clinical case

Cost-effectiveness analysis of antimuscarinics in the treatment of patients with overactive bladder in Spain: A decision-tree model

<p>Abstract</p> <p>Background</p> <p>Fesoterodine, a new once daily antimuscarinic, has proven to be an effective, safe, and well-tolerated treatment in patients with overactive bladder (OAB). To date, no analysis has evaluated the economic costs and benefits associated with fesoterodine, compared to antimuscarinics in Spain. The purpose of this analysis was to assess the economic value of OAB treatment with fesoterodine relative to extended release tolterodine and solifenacin, from the societal perspective.</p> <p>Methods</p> <p>The economic model was based on data from two 12-week, randomized, double-blind, and multicenter trials comparing fesoterodine and tolterodine extended released (ER). Treatment response rates for solifenacin were extracted from the published literature. Discontinuation and efficacy were based on the results of a 12-week multinational randomized clinical trial extrapolated to 52 weeks. Changes in health related quality of life were assessed with the King's Health Questionnaire, which was transformed into preference-based utility values. Medical costs included (expressed in € 2010) were antimuscarinics, physician visits, laboratory tests, incontinence pads and the costs of OAB-related comorbidities, fractures, skin infections, urinary tract infections, depression, and nursing home admissions associated with incontinence. Time lost from work was also considered. Univariate sensitivity analyses were also performed.</p> <p>Results</p> <p>At week 12, continents accounted for 50.6%, 40.6% and 47.2% of patients in the fesoterodine, tolterodine, and solifenacin groups, respectively. By week 52, the projected proportions of patients remaining on therapy were 33.1%, 26.5% and 30.8%, respectively. The projected quality- adjusted life years (QALY) gain (compared to baseline) over the 52-week simulation period were 0.01014, 0.00846 and 0.00957, respectively. The overall treatment cost was estimated at €1,937, €2,089 and €1,960 for fesoterodine, tolterodine and solifenacin, respectively. Therefore, treatment with fesoterodine resulted in similar overall costs and greater QALY gain than treatment with either tolterodine or solifenacin. Sensitivity analysis showed that these results were robust to all changes performed.</p> <p>Conclusions</p> <p>The results of this economic analysis suggest that fesoterodine is a cost-effective alternative to tolterodine and solifenacin for the treatment of patients with OAB in Spain. Fesoterodine provides additional health benefits while maintain a similar level of costs being a cost-effective treatment strategy from a societal perspective.</p

Highly Anomalous Energetics of Protein Cold Denaturation Linked to Folding-Unfolding Kinetics

Despite several careful experimental analyses, it is not yet clear whether protein cold-denaturation is just a “mirror image” of heat denaturation or whether it shows unique structural and energetic features. Here we report that, for a well-characterized small protein, heat denaturation and cold denaturation show dramatically different experimental energetic patterns. Specifically, while heat denaturation is endothermic, the cold transition (studied in the folding direction) occurs with negligible heat effect, in a manner seemingly akin to a gradual, second-order-like transition. We show that this highly anomalous energetics is actually an apparent effect associated to a large folding/unfolding free energy barrier and that it ultimately reflects kinetic stability, a naturally-selected trait in many protein systems. Kinetics thus emerges as an important factor linked to differential features of cold denaturation. We speculate that kinetic stabilization against cold denaturation may play a role in cold adaptation of psychrophilic organisms. Furthermore, we suggest that folding-unfolding kinetics should be taken into account when analyzing in vitro cold-denaturation experiments, in particular those carried out in the absence of destabilizing conditions

Habitability, the scale of sustainability

This paper will explore an alternative to so-called „sustainable‟ models and strategies currently applied in the field of building, architecture and urbanism. In front of irrational resource consumption and an ever-growing waste generation or other problems, seemingly inherent to the current industrial productive model and now transferred to the production of space, the most critical and concerned sectors within these disciplines keep on applying scale-segregated sustainable solutions, i.e. working and intervening at the scale of the single built unit, or at that of the urban model. Instead, the paper will explain ongoing research related to the possibilities of generating another model based in the concept of “global habitability”, that would allow the application of those and other new solutions and mechanisms at all scales in a much more holistic approach to the implementation of sustainability: working transversally and simultaneously, from the room to the city. If current strategies aim at an increase in efficiency exclusively based in the reduction of resource consumption and waste generation, the new model would propose a redefinition of the other term intervening, namely utility. The very subject of sustainability is changed here through this redefinition; no more space but activity, no more the object but the process. Utility and use within architecture can be identified with habitability, here understood as the achievement of adequate social and environmental conditions in order to satisfy the socially acknowledged basic needs of people. Two different factors would determine such idea of utility: on the one hand the conditions of matter‟, as an expression of requirements related to space, resource flows and equipment needed to develop an activity; and on the other hand, the conditions of „orgware‟ or „privacy‟, another term that would include synergy – as the relation between the level of individuality and the level of collectivity - and management, as a combination of time, control and legislation. The main aim of the paper will be thus to present this reformulation of the idea of „habitability‟ as the only effective strategy towards an implementation of sustainability in the field of building. A systemic intervention, re-thinking the utility of architecture from the smallest spatial unit (the room) and extending its scale to that of the urban services (i.e. providers of any need that can‟t be fulfilled within the dwelling), allows achieving the maximum efficiency in terms of resource consumption; whereas social focus, incorporating individual, collective and organizational demands, allows the strategy to take roots in society expanding, thus, the likelihood of its success