Management of chronic unstable acromioclavicular joint injuries

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V

Preliminary hydrogeological characterization of an evaporite karst area (province of Cordoba, South Spain)

The northern sector of the Subbetic Domain in the Betic Cordillera is formed by an olistostrome unit known as the Chaotic Subbetic Complex (CSC). This megabreccia is basically made of Triassic (Keuper) clays and evaporites (gypsum, anhidrite and halite) as well as blocks of other lithologies (limestones, dolostones, sandstones, etc). Despite that low permeability has been traditionally assumed for these materials, water flow and storage through them is likely derived of their aquitard behavior, but also because of the highly permeable conduits generated by dissolution/karstification processes within the evaporite rocks. The geological complexity of the CSC materials determines their hydrogeological heterogeneity, with groundwater flow systems of different length and various scales from recharge areas to discharge zones. Three springs draining the CSC outcrops have been identified around an evaporitic karst plateau located between the Anzur River (to the North) and the Genil River (to the South), in the province of Cordoba (Spain). Data logger devices have been installed in two of them, located at the Anzur River (left margin), providing an hourly record of discharge, electrical conductivity and water temperature. Water samples have been collected fortnightly for subsequent chemical analysis. After two years of record, the results obtained show that the response of the springs to rainfall events is completely different between them. One has a clearly karstic behavior, with a rapid response to recharge whereas the other one is more inertial, and variations in its waters occur in a yearly scale. This is an evidence of the aforementioned hydrogeological heterogeneity of the CSC.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Continuous multi-criteria methods for crop and soil conservation planning on La Colacha (Río Cuarto, Province of Cordoba, Argentina)

Agro-areas of Arroyos Menores (La Colacha) west and south of Rand south of R?o Cuarto (Prov. of Cordoba, Argentina) basins are very fertile but have high soil loses. Extreme rain events, inundations and other severe erosions forming gullies demand urgently actions in this area to avoid soil degradation and erosion supporting good levels of agro production. The authors first improved hydrologic data on La Colacha, evaluated the systems of soil uses and actions that could be recommended considering the relevant aspects of the study area and applied decision support systems (DSS) with mathematic tools for planning of defences and uses of soils in these areas. These were conducted here using multi-criteria models, in multi-criteria decision making (MCDM); first of discrete MCDM to chose among global types of use of soils, and then of continuous MCDM to evaluate and optimize combined actions, including repartition of soil use and the necessary levels of works for soil conservation and for hydraulic management to conserve against erosion these basins. Relatively global solutions for La Colacha area have been defined and were optimised by Linear Programming in Goal Programming forms that are presented as Weighted or Lexicographic Goal Programming and as Compromise Programming. The decision methods used are described, indicating algorithms used, and examples for some representative scenarios on La Colacha area are given

Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma : Prospective Multicenter Randomized Clinical Trial

Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P =.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care

Constant-gain envelope tracking in a UHF outphasing transmitter based on continuous-mode class-E GaN HEMT PAs

A UHF outphasing transmitter, based on continuous-mode class-E power amplifiers (PAs) and implementing a constant-gain envelope tracking (ET) strategy, is presented in this paper. Drain terminating and biasing networks are designed to provide near optima impedance values at the fundamental and higher order harmonics to the selected GaN HEMT device. A high-efficiency wideband performance, 80% for a 630-890 MHz range, is obtained, besides being amenable for load-modulation through a compact outphasing scheme, incorporating a series Chireix combiner and an impedance transformer. Once characterized in a pure output power phasecoding regime, the observed limitation in dynamic range is overcome by operating the amplifiers in a sort of continuous class-J mode, while forcing the load impedance to follow a constant-gain trajectory. A 1c-WCDMA signal, with peak-toaverage power ratio (PAPR) of 8.4 dB is shown to be reproduced, satisfying the linearity requirements, with an average efficiency of 58%.This work was supported by the Ministry of Economy and Competitiveness (MINECO) through TEC2014-58341-C4-1- R, TEC2014-58341-C4-2-R and TEC2014-58341-C4-3-R projects, co-funded with FEDER. José R. Pérez-Cisneros also thanks the support to his stay at the Univ. of Cantabria provided by the pre-doctoral mobility grant EEBB-I-15-10447

Uso del benchmarking para la construcción de cursos e-Learning

El desarrollo adecuado de cursos e-learning implica que la fase de diseño instruccional tiene que ser cuidadosamente planeada. Cuando el personal que desarrolla un curso e-learning no tiene la formación adecuada como diseñador instruccional, el uso de modelos de diseño instruccional es una excelente guía para lograr superar esta fase. Sin embargo, es conveniente el uso de herramientas que permitan que esos modelos sean aplicables para equipos de trabajo sin formación formal como pedagogos. En este trabajo se presenta la adaptación al modelo de Bergman y Moore mediante el uso del benchmarking para hacer el diseño instruccional más accesible. La adaptación fue aplicada al desarrollo de un curso e-learning y los resultados muestran que el modelo se mejora con esta adaptación

Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation. A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19-82 years). The mean followup was 24 months (range 24-70 months). The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560). Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation

Specific genetic markers for detecting subtypes of dengue virus serotype-2 in isolates from the states of Oaxaca and Veracruz, Mexico

<p>Abstract</p> <p>Background</p> <p>Dengue (DEN) is an infectious disease caused by the DEN virus (DENV), which belongs to the <it>Flavivirus </it>genus in the family <it>Flaviviridae</it>. It has a (+) sense RNA genome and is mainly transmitted to humans by the vector mosquito <it>Aedes aegypti</it>. Dengue fever (DF) and dengue hemorrhagic fever (DHF) are caused by one of four closely related virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4). Epidemiological and evolutionary studies have indicated that host and viral factors are involved in determining disease outcome and have proved the importance of viral genotype in causing severe epidemics. Host immune status and mosquito vectorial capacity are also important influences on the severity of infection. Therefore, an understanding of the relationship between virus variants with altered amino acids and high pathogenicity will provide more information on the molecular epidemiology of DEN. Accordingly, knowledge of the DENV serotypes and genotypes circulating in the latest DEN outbreaks around the world, including Mexico, will contribute to understanding DEN infections.</p> <p>Results</p> <p>1. We obtained 88 isolates of DENV, 27 from Oaxaca and 61 from Veracruz. 2. Of these 88 isolates, 16 were serotype 1; 62 serotype 2; 7 serotype 3; and 2 serotype 4. One isolate had 2 serotypes (DENV-2 and -1). 3. Partial nucleotide sequences of the genes encoding C- prM (14 sequences), the NS3 helicase domain (7 sequences), the NS5 S-adenosyl methionine transferase domain (7 sequences) and the RNA-dependent RNA polymerase (RdRp) domain (18 sequences) were obtained. Phylogenetic analysis showed that DENV-2 isolates belonged to the Asian/American genotype. In addition, the Asian/American genotype was divided into two clusters, one containing the isolates from 2001 and the other the isolates from 2005–2006 with high bootstrap support of 94%.</p> <p>Conclusion</p> <p>DENV-2 was the predominant serotype in the DF and DHF outbreak from 2005 to 2006 in Oaxaca State as well as in the 2006 outbreak in Veracruz State, with the Asian/American genotype prevalent in both states. Interestingly, DENV-1 and DENV-2 were the only serotypes related to DHF cases. In contrast, DENV-3 and DENV-4 were poorly represented according to epidemiological data reported in Mexico. We found that isoleucine was replaced by valine at residue 106 of protein C in the isolates from these 2005–2006 outbreaks and in those from the 1997, 1998 and 2001 outbreaks in the Caribbean islands. We suggested that this amino acid change may be used as a signature for isolates arising in the Caribbean islands and pertaining to the Asian/American genotype. Other amino acid changes are specific for the Asian/American, Asian and American strains.</p

Mejora de Eficiencia y Linealidad de un amplificador de potencia con sintetizador de impedancias

Mediante la simulaci&oacute;n con Microwave Office del test a dos tonos para un amplificador de potencia (AP) de prop&oacute;sito general se demuestra que tanto la eficiencia como la linealidad mejoran seleccionando el esquema &oacute;ptimo de control de un sintetizador de impedancias (RMN) optimizado para eficienci