Artroplastia total de cadera Mittelmeier: estudio multicéntrico

—Hemos revisado 150 artroplastias de Mittelmeier implantadas hasta 1987 en tres hospitales. El periodo de seguimiento medio ha sido de 12,5 años (límites: 8-15). Entre las complicaciones inmediatas aparecieron dos infecciones profundas y cinco luxaciones. El 16% presentaron malos resultados clínicos y el 26% refieren dolor en el muslo. En el vástago femoral se apreció en 33 casos una esclerosis reactiva distal y en 69 se produjo algún grado de hundimiento. Fueron reintervenidos el 18% de los pacientes; en ocho por movilizaciones del vástago y en cuatro por deslizamientos cotiloideos. La artroplastia de Mittelmeier en evaluaciones a largo plazo presenta un elevado número de complicaciones sobre todo a nivel femoral lo que desaconseja su utilización.We have reviewed 150 arthroplasties of Mittelmeier implanted until 1987 in three hospitals. The mean follow-up has been 12,5 years (range: 8-15). Among the inmediate complications appeared two deep infections and five dislocations. A 16% of cases presented poor clinical results and 26% referred pain in the thigh. Distal sclerosis at the femoral stem was appreciated in 33 cases and in 69 some degree of collapse was produced. In 18% of the patients was necessary revision surgery; in eight by mobilizations of the stem and in four by socket displacements. The arthroplasty of Mittelmeier in long-term follow-up presents a high number of complications above all at femoral level what dissuades their utilization

Young Stellar Clusters Containing Massive Young Stellar Objects in the VVV Survey

This is an author-created, un-copyedited version of an article published in The Astronomical Journal. IOP Publishing is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at: at doi: https://doi.org/10.3847/0004-6256/152/3/74. © 2016. The American Astronomical Society. All rights reserved. IOPScience PublishingThe purpose of this research is to study the connection of global properties of eight young stellar clusters projected in the Vista Variables in the Via Lactea (VVV) ESO Large Public Survey disk area and their young stellar object population. The analysis in based on the combination of spectroscopic parallax-based reddening and distance determinations with main sequence and pre-main sequence ishochrone fitting to determine the basic parameters (reddening, age, distance) of the sample clusters. The lower mass limit estimations show that all clusters are low or intermediate mass (between 110 and 1800 Mo), the slope Gamma of the obtained present-day mass functions of the clusters is close to the Kroupa initial mass function. On the other hand, the young stellar objects in the surrounding cluster's fields are classified by low resolution spectra, spectral energy distribution fit with theoretical predictions, and variability, taking advantage of multi-epoch VVV observations. All spectroscopically confirmed young stellar objects (except one) are found to be massive (more than 8 Mo). Using VVV and GLIMPSE color-color cuts we have selected a large number of new young stellar object candidates, which are checked for variability and 57% are found to show at least low-amplitude variations. In few cases it was possible to distinguish between YSO and AGB classification on the basis of the light curves.Peer reviewedFinal Accepted Versio

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Resultados de la Técnica de Bristow-Helfet en el tratamiento de la luxación recidivante del hombro

En este artículo se hace una revisión de los resultados de los diecisiete ( 17) casos de Luxaciones Recidivantes de Hombro que los autores han tratado en su Servicio siguiendo la técnica de BRISTOW-HELFET. Se trata de una técnica de sencilla ejecución y los resultados anatómicos y funcionales son, habitualmente, satisfactorios, utilizando la técnica de Evaluación dle ROWE y ZARINS

Valoración de los resultados del tratamiento quirúrgico del pie plano estático

La deformidad fundamental del pie plano es el valgo de talón. Existe siempre un movimiento helicoidal en pronación del retropic y supinación del antepic. En este trabajo se hace una revisión de los pacientes tratados en nuestro Servicio a lo largo de diez años, que han sido sometidos a intervención quirúrgica, mayoritariamente artrodesis. - El fotopodograma constituye un excelente método para controlar la evolución de un pie plano. El pie plano por astrágalo vertical es irreductible desde el primer momento. Por ello el tratamiento quirúrgico del mismo será precoz. El resto de los pies planos se suelen curar con tratamiento conservador. Es infrecuente la indicación quirúrgica. En el adulto, la indicación quirúrgica viene dada por el dolor, ordinariamente secundario a artrosis. Está indicado artrodesar el arco interno y la articulación subastragalina. Si hay abducción del antepie, la idea de EVANS, de alargar el arco externo del pie, suele dar resultados satisfactorios

Contribution of volcanic ashes to the regional geochemical balance: The 2008 eruption of Chaitén volcano, Southern Chile

The environmental geochemical behaviour of the rhyolitic ashes from the 2008 eruption of Chaitén volcano, Southern Chile, has been studied. After the bulk characterisation, the potential contribution to the regional geochemical fluxes was examined using: i) single batch leaching tests to provide a rapid screening of the implied major and trace elements; and ii) column experiments to evaluate the temporal mobility of leached elements. The environmental concerns of these ashes are related to the fine grained component present in each sample (independent of distance from the source), in particular the presence of cristobalite, and the geochemical hazards posed by ash-water interaction. Leaching experiments show the fast dissolution of surface salts and aerosols, which dominate over glass dissolution during the first steps of the ash-water interaction. Chaitén ashes could transfer to the environment more than 1×10 10g or 10,000metric tonnes (mt) of Cl, S, Ca, Na, Si, and K; between 1000 and 10,000mt of F, Mg, and Al; between 100 and 1000mt of As, Pb, P, Fe, Sr, Zn, Mn, and Br; between 10 and 100mt of Ba, Li, Ti, Ni, Nb, Cu, Rb, Zr, V, Mo, Co, and Sc; and less than 10mt of Cr, Sb, Ce, Ga, Cs, and Y. These results show the fertilising potential of the ashes (e.g., providing Ca and Fe) but also the input of potentially toxic trace elements (e.g., F and As) in the regional geochemical mass balance. The Chaitén results evidence lower potentials for poisoning and fertilising than low silica ashes due to the lower contents released of practically all elements. © 2012 Elsevier B.V.We acknowledge the technical support of ICTJA-CSIC labGEOTOP and DRX Surveys (M. Rejas and J. Elvira) and the Scientific-Technical Surveys of the University of Barcelona in the analytical work. This study was carried out in the framework of the PEGEFA Working Group (Catalonian Government “Grup de Recerca Consolidat” 2009-SGR-972), and was partly funded by the Projects ASH and QUECA of the Spanish Ministry of Science and Technology (CGL2008-00099 and CGL2011-23307) and the FPU Grant of the Spanish Ministry of Education of one of the authors (F. Ruggieri, Ref. AP2006-04592).Peer Reviewe