The application of FRAX in Ecuador

Introduction Intervention thresholds for the treatment of osteoporosis have been based historically on the measurement of bone mineral density. The development of FRAX® has permitted more accurate assessment of fracture risk. Objective The aim of the present study was to explore treatment paths and characteristics of women eligible for treatment in Ecuador based on FRAX. Methodology and methods A total of 2367 women aged 60–94 years were selected from the National Health, Welfare and Aging Survey (SABE) conducted in Ecuador. Probabilities of major osteoporotic and hip fracture were computed using the Ecuadorian FRAX model. The proportion of women eligible for treatment and bone mineral density assessment was determined based on age-specific intervention thresholds and a hybrid threshold was fixed from age 75 years. Results A total of 87 women (3.7%) had a prior fragility fracture and would be eligible for treatment for this reason. An additional 49 women were eligible for treatment in that MOF probabilities lay above the upper assessment threshold using age-specific thresholds. An BMD test would be recommended in 1131 women (48%) so that FRAX could be recalculated with the inclusion of femoral neck BMD. With the hybrid threshold, an additional 170 women were eligible for treatment and an BMD test recommended in 1218 women. Conclusions The hybrid threshold identifies more women eligible for treatment than age-specific thresholds. Although age-specific thresholds identify women at higher risk of fracture, the lower number of women identified results in fewer identified fracture cases. Resumen Introducción Los umbrales de intervención para el tratamiento de osteoporosis se han basado históricamente en la medición de la densidad ósea. El desarrollo del FRAX® ha permitido una evaluación más precisa del riesgo de fractura. Objetivo El objetivo del estudio fue explorar las rutas de tratamiento y las características de las mujeres elegibles para tratamiento en Ecuador con base en FRAX. Materiales y métodos Se seleccionó a 2.367 mujeres de 60 a 94 años de la encuesta SABE. Se calcularon las probabilidades de fracturas osteoporóticas principales y de cadera utilizando el modelo FRAX ecuatoriano. Se calculó la proporción de mujeres elegibles para tratamiento y evaluación de la densidad ósea, con base en umbrales de intervención específicos de la edad y de un umbral fijo a partir de los 75 años. Resultados Ochenta y siete mujeres (3,7%) tenían una fractura previa y eran elegibles para tratamiento. Utilizando umbrales específicos de edad, otras 49 mujeres eran elegibles para recibir tratamiento debido a que las probabilidades de fractura osteoporótica principal estaban por encima del umbral de evaluación superior. Se recomienda medir la densidad ósea en 1.131 mujeres para que el FRAX pueda ser recalculado con la inclusión de la densidad ósea del cuello femoral. Con el umbral híbrido, otras 170 mujeres fueron elegibles para tratamiento y la medición de la densidad ósea se recomendó a 1.218 mujeres. Conclusiones El umbral híbrido identifica a más mujeres elegibles para tratamiento que los umbrales específicos de la edad. Aunque estos últimos identifican a las mujeres con mayor riesgo de fractura, el menor número de mujeres identificadas resulta en menos casos de fractura identificados

Understanding Individual Differences for Tailored Smoking Cessation Apps

Finding ways to help people quit smoking is a high priority in health behavior change research. Recent HCI studies involving technologies using specific quitting techniques such as social support and SMS messaging to help people quit have reported some success. Early studies using computer generated print material report significant success of tailored versus non-tailored material, however, there is limited understanding on what aspects of digitally delivered quitting assistance should be tailored and how. To address this, we have conducted an empirical investigation with smokers to identify perceived importance of different types of help when quitting and the potential role of technology in providing such help. We found that people are highly individual in their approach to quitting and the kind of help they regard as relevant to their situation. Our contribution is a collection of empirically derived themes for tailoring smoking cessation apps to individual quitting needs. Author Keywords Smoking cessation; tailoring; individual differences; healt

Fracturas de las espinas tibiales en el niño y en el adulto

Presentamos una serie de 29 fracturas de las espinas tibiales en 27 pacientes, 11 niños y 16 adultos. Para su estudio hemos seguido la clasificación de Meyers y McKeever, siendo las fracturas tipo II las más frecuentes. Se registraron las lesiones asociadas de la rodilla, y la más frecuente fue la del ligamento lateral interno; encontramos 2 fracturas de Segond en niños. El tratamiento fue conservador en 7 casos y quirúrgico en los 22 restantes. Para evaluar el resultado final estudiamos el desplazamiento de la fractura, movilidad y laxitudes residuales de la rodilla y fuerza muscular. Usamos las escalas de Lysholm y de Tegner para la valoración funcional. Un estudio radiológico con 3 proyecciones se llevó a cabo en todos los pacientes. El tiempo medio de seguimiento fue de 9,7 años para el grupo de niños y de 8,2 para los adultos. Los resultados globales, de acuerdo con la escala de Lysholm, fueron excelentes, pero se registraron 11 laxitudes anteroposteriores y 4 laterales, aunque 11 de estos 15 pacientes permanecen asintomáticos. Muchas de estas laxitudes aparecen en fracturas anatómicamente reducidas. Sugerimos que debe realizarse estudio artroscópico en estos pacientes para detectar lesiones asociadas que empeoran el resultado.A series of 29 fractures of the tibial spine in 27 patients, 11 children and 16 adults. We followed Meyers and McKeever to classify the fractures, tipe II being the most frecuent. Associated injuries of the knee were registered, being medial collateal ligament the most frecuent. We found 2 Segond fractures in young patients. The treatment was conservative in 7 cases and surgical in the remaining 22. To evaluate the final result we studied the displacement of the fracture, mobility of the knee, anteroposterior and lateral inestabilities, muscle strength. We used the Lysholm and the Tegner rating systems to evaluate the functional result. A complete radiological evaluation (three views) was made in all the patients. The average follow-up times was 9.7 years for the children group, and 8.2 years for the adult group. The overall results according to the Lysholm rating scale were excellent, but 11 anteroposterior and 4 lateral laxities were registered, though 11 of the 15 cases remains asymptomatic. Many of theese laxities appeared in anatomically reduced fractures. We suggest that an arthroscopic study of the patients must be done to detect associated injuries that produces a worse final result

Artrodesis de rodilla por fracaso de la artroplatsia total

Veintiuna artrodesis de rodilla fueron realizadas en nuestro Servicio en los últimos 20 años. Se realiza un estudio retrospectivo con un seguimiento medio de 10 años. Las razones para la artrodesis fueron en 12 ocasiones (57%) infección de la artroplastia total, y en los 9 casos restantes (43%) aflojamiento aséptico. La artrodesis se realizó mediante fijación externa en un solo plano en 11 casos (52%), en biplano se colocó en 7 (33%), 2 casos con placas a compresión (9,5%) y el caso restante mediante un clavo intramedular (5%). La fusión después del procedimiento inicial se obtuvo solamente en 12 pacientes (57%) y añadiendo procedimientos adicionales totalizamos 19 rodillas fusionadas (90%). Las complicaciones encontradas fueron: 9 pseudoartrosis, 2 infecciones en el trayecto de las fichas, 2 roturas del material de fijación, una infección persistente que llevó a la amputación, y una parálisis del nervio ciático poplíteo externo.A total of 21 knee arthrodesis performed in the last 20 years was reviewed with an average follow-up of 10 years. Arthrodesis was performed following deep infection in 12 cases (57%) and aseptic loosening of the prostheses in the remaining 9 cases. TH artrodesis were performed using one-plane external fixation in 11 cases, two-planes external fixation in 7, compression plates in 2, intramedular nailing in only 12 patients. Using additional procedures we obtained 19 fused knees (90 %). The complications in this series were: Psuedarthrosis (9 cases), infection of the fixator pins (2 cases), infection of the fixator pins (2 cases), and broken osteosybrtesis components (2 cases), severe deep infection with final amputation of the limb (1 case), and CPE injury (1 case)

Reconstrucción ósea acetabular con cotilos no cementados y aporte de aloinjerto en la artroplastia total de cadera : estudio de 35 casos

Se han revisado 35 arlroplastias realizadas en 29 pacientes portadores de algún tipo de defecto óseo en el cotilo por fallo de prótesis total de cadera. En el presente estudio incluimos sólo las reconstrucciones acetabulares efectuadas con implantes no cementados. La edad media fue de 60 años (29/79), siendo 19 mujeres y 10 varones. Clasificamos los defectos óseos siguiendo a D'Antonio en segmentarios, cavitarios y mixtos, y para la reparación de dichos defectos utilizamos aloinjerto criopreservado en todos los casos excepto uno, tratado con injerto liofilizado. Valoramos los resultados desde un punto de vista clínico, subjetivo y objetivo (escala de Harris). Desde un punto de vista radiológico se analizaron las migraciones del implante acetabular, la existencia de zonas de radiolucencia, las osificaciones periarticulares y la incorporación o no del injerto óseo utilizado. Desde el punto de vista clínico obtuvimos un 60% de resultados excelentes y buenos, frente a un 40% de regulares y malos. Desde cualquier punto de vista el índice de aflojamiento del componente acetabular fue mucho mayor que el que puede obtenerse con cotilos no defectuososThirty five revision hip arthroplasties performed in 29 patients with acetabular bone defects were reviewed. In this series we only include the acetabular reconstruction performed using non cemented acetabular implants. The mean age of the patients was 60 years (29-79), 19 were female and 10 male. We classified the acetabular bone defects according to D'Antonio, in segmentary, cavitary and combined. To repair these defects, we used criopreserved allograft, except one case in which a liofilized allograft was used. The results were evaluated clinically (modified Harris hip score) and radiographically, looking for acetabular migrations, radiolucent lines, periarticular ossifications and bone graft incorporation. We obtained 60% of excellent and good results. There was 40% of poor and fair results. The acetabular loosening rate was higher than in revision hip arthroplasty without acetabular bone defects

Resultados a largo plazo de la patelectomía total

Desde el año 1981 hemos realizado 19 patelectomías totales, 9 por artrosis femoropatelar, 8 por dolor anterior de rodilla y 2 por fracturas conminutas. La edad media en el momento de la intervención era de 48 años (25-80); todos los pacientes con dolor anterior habían sido operados previamente. Con una evolución media de 7,8 años (3-14), hemos realizado una revisión clínica y radiológica. Según la escala de la Sociedad Internacional de Rodilla obtuvimos un 58% de resultados excelentes y buenos, resaltando que continúan con dolor todos los pacientes operados por artrosis y el 50% de los intervenidos por dolor anterior. La patelectomía total es una técnica cada vez menos utilizada, limitándose sus indicaciones a fracturas muy conminutas, artrosis femoropatelar en pacientes en los que estaría contraindicada la artroplastia total y en cuadros de dolor anterior de rodilla rebeldes a otros tratamientosNineteen total patelectomies were performed since 1981. The indication was femoropatellar osteoarthritis in nine cases, anterior knee pain syndrome in eight, and conminute fractures in two. The mean age of the group at the time of operation was 48 years (25-80). A1l the patients with anterior knee pain syndrome had been operated previously. With an average followup time of 7.8 years (3-14), vve reviewed our patients clinically and radiographically. We used the International Knee Society rating scale and found 58% of excellent and good results; 100% of the patients operated because of osteoarthritis and 50% of those operated because an anterior knee pain syndrome have pain at review. Total patellectomy is not a frequent technique. Today, the sole indications are very conminute fractures of the patella, femoropatellar osteoarthritis in those patients in which total knee arthroplasty is not indicated and in the anterior knee pain syndrome not improved with other treatments

Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy

This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning system and providing good accuracy in the dosage simulation

Factors associated with commencing smoking in 12-year-old students in Catalonia (Spain): a cross-sectional population-based study

<p>Abstract</p> <p>Background</p> <p>Over the last decade notable progress has been made in developed countries on monitoring smoking although experimenting with cigarettes and smoking in young people remains a serious public health problem. This paper reports a cross-sectional study at the beginning of the 3-year follow-up community study TA_BES. The aim was to study the prevalence of smoking in addition to determining predictive factors for when smoking commences in a representative population of 12-year-old first year compulsory secondary education students.</p> <p>Methods</p> <p>Twenty-nine secondary schools (N = 29) from an area of Catalonia participated in the study. In these schools 2245 students answered a questionnaire to study the attitudes, behaviors, and tobacco consumption in the subject's surrounding circle and family in relation to smoking; carbon monoxide measurements were taken by means of co-oximetry on 2 different occasions. A smoker was defined as a student who had smoked daily or occasionally in the last 30 days. For non-smokers the criteria of not considering was set up for those who answered that in the future they would not be smokers and considering those who answered that they did not rule out becoming a smoker in the future.</p> <p>Results</p> <p>Among the total 2245 students included in the analysis 157(7%) were classified as smokers. Among non-smokers we differentiated between those not considering smoking 1757 (78.3%) and those considering smoking 288 (12.8%).</p> <p>Age is among the factors related to commencing smoking. The risk of becoming a smoker increases 2.27 times/year. The influence of the group of friends with a very high risk for boys OR 149.5 and lower, albeit high, in girls OR 38.1. Tobacco consumption of parents produces different effects in young people. A smoking father does not produce alterations in the smoking behavior of young people. However having a smoking mother or former smoking is a risk factor for boys and a protective factor for girls.</p> <p>We detected a gradual risk of becoming a smoker by means of the co-oximetry test. A boy/girl with a test between 6 p.p.m and 10 p.p.m increased the probability of smoking by 2.29 and co-oximetry values > 10 p.p.m multiplied the risk 4 times over.</p> <p>Conclusions</p> <p>Results indicate that the age of commencing smoking is maintained in spite of prevalence having decreased in the last few years. The risk factors identified should be used to involve families and the educational community by offering them tobacco weaning programmes.</p

Machine Learning-Based Analysis in the Management of Iatrogenic Bile Duct Injury During Cholecystectomy: a Nationwide Multicenter Study

Background Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. Methods This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. Results We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. Discussion Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts