External fixation of ankle fractures in the geriatric patient

Introducción: La incidencia de fracturas está aumentando, actualmente nos encontramos con 187 casos por 100.00 Habitantes /año. Dentro de los pacientes en edad geriátrica el incremento ha sido aún más notorio, pasando a ser la tercera fractura más frecuente en esta franja de edad. En ausencia de graves comorbilidades sistémicas, la fijación interna ofrece mejores resultados en el tratamiento de fracturas de tobillo inestables independientemente de la edad. Sin embargo, los pacientes de edad avanzada presentan numerosas comorbilidades asociadas como la obesidad, la osteoporosis o las alteraciones vasculares que aumentan el riesgo de padecer complicaciones de partes blandas tras la cirugía. Objetivos: Se propone el uso de la reducción percutánea y fijación externa como alternativa a la reducción abierta y fijación interna, en pacientes ancianos tras el estudio de las complicaciones y los factores de riesgo. Material y métodos: De 122 pacientes mayores de 65 años tratados por fracturas de tobillo desde febrero de 2015 hasta octubre del 2018 con seguimiento mínimo de 4 meses, se estudian retrospectivamente 102 pacientes. Se estudian los siguientes parámetros: sexo, edad, consumo de alcohol, tabaco, tóxicos o corticoides, HTA, DM, arteriopatía periférica, IMC, tipo de traumatismo, fecha de la intervención quirúrgica, fijación externa pre-intervención quirúrgica, fijación externa como tratamiento definitivo, reducción abierta y fijación interna, luxación, días desde el traumatismo hasta la intervención quirúrgica, hospitalización post-intervención quirúrgica, tiempo de consolidación de la fractura y presencia de complicaciones de partes blandas. Estudio estadístico SPSS 20.0 con nivel de significación p<0,05. Resultados: La edad media es de 75 años, siendo 25 varones y el resto mujeres. En 94 pacientes se realizó RAFI frente a 8 en los que se realizó tratamiento definitivo con fijación externa. El 23.52% (n= 24) consumía alcohol, el 7.84% (n= 8) eran fumadores, el 74.54% (n= 76) presentaban HTA, el 4.90% (n= 5) tomaban corticoides, el 24.50% (n= 25) padecían DM, el 31.37% (n= 32) tenían arteriopatía, el IMC medio fue de 27.51 y sólo un 3.92% (n=4) eran fracturas por alta energía. En total hubo 26 pacientes que desarrollaron complicaciones de partes blandas, Conclusión: Los pacientes tratados mediante fijación externa como tratamiento definitivo presentan, en comparación con la fijación interna una ligera mayor tasa de arteriopatía periférica crónica (no significativo), mayor edad y mayor estancia hospitalaria post-cirugía. Existe una asociación estadística importante entre artropatía y necesidad de terapia VAC y/o necesidad de cobertura plástica.Grado en Medicin

La justícia restaurativa: una transformació ètica de la justícia penal tradicional

La justícia restaurativa neix a principis dels anys setanta del passat segle XX en un context de crítica al sistema penal. L’apriorisme del càstig, l’abandonament de la víctima i els efectes lesius i discriminatoris d’un model penal ineficaç són els fonaments de la seva posició. A canvi, propugna la implementació d’un paradigma en el que la reparació del dany que el delicte genera sobre la vida de les persones és la finalitat principal. La justícia restaurativa com a activitat pràctica consisteix en el desenvolupament de processos d’intervenció social centrats en abordar les necessitats de les víctimes, promoure la responsabilització dels ofensors, així com la participació de persones de la comunitat en un diàleg voluntari dirigit a la reparació del dany. En aquesta tesi explorem la dimensió eminentment ètica de la seva proposta i, des d’aquí, la seva capacitat per transformar la justícia penal tradicional. Finalment dirigim la nostra atenció cap a la figura de la persona professional per tal de comprovar si el model de l’ètica de les virtuts pot acomodar-se a la naturalesa de l’activitat que realitza i, des d’aquest model, presentem una proposta d’ethos virtuós de la persona mediadora.La justicia restaurativa nace a principios de los años setenta del pasado siglo XX en un contexto de crítica al sistema penal. El apriorismo del castigo, el abandono de la víctima y los efectos lesivos y discriminatorios de un modelo penal ineficaz son los fundamentos de su posición. A cambio, propugna la implementación de un paradigma en el que la reparación del daño que el delito genera sobre la vida de las personas es la finalidad principal. La justicia restaurativa como actividad práctica consiste en el desarrollo de procesos de intervención social centrados en abordar las necesidades de las víctimas, promover la responsabilización de los ofensores, así como la participación de personas de la comunidad en un diálogo voluntario dirigido a la reparación del daño. En esta tesis exploramos la dimensión eminentemente ética de su propuesta y, desde aquí, su capacidad para transformar la justicia penal tradicional. Finalmente dirigimos nuestra atención hacia la figura de la persona profesional para comprobar si el modelo de la ética de las virtudes puede acomodarse a la naturaleza de la actividad que realiza y, desde este modelo, presentamos una propuesta de ethos virtuoso de la persona mediadora.Restorative justice appeared in the early 1970s in a context of severe criticism of the criminal system. This critical position is based on the harmful and discriminatory impact of an ineffective system, as well as the punishment paradigm and the marginalisation of the victim. Instead, it advocates for the implementation of a model where restoration of the harm that crime causes to people's lives is the primary purpose. Restorative justice as a practical activity consists in a process focused on addressing the needs of victims, promoting the responsibility of the offender and the participation of the community in a voluntary dialogue aimed at repairing the harm. In this dissertation we explore the eminently ethical dimension of its proposal and, from there, its ability to transform traditional criminal justice. Finally, we turn our attention to the role of the practitioner in order to check whether the model of virtue ethics can be applied to the activity and, from this model, we propose a virtuous ethos for the mediator in criminal matters

Representar el movimiento / Presentar lo móvil

This article is proposed as an analysis of the artistic works which were interested in including movement representation or pointing to the attainment of kinetic art. Before incorporating the real movement in art works, there have been different attempts to represent it: by poses, instant grasp, or action narrative suggestion, and also by giving form to different movement stages. Thus, in this study we define two possible itineraries: “Representing the Movement” goes through the different approximations to movement representation from the pictorial and photographic practice, and “Presenting the Movable” does the same from the sculpture. We will travel through the path that covers the first trials to represent and fix something that moves in order to conquer the movable art itself, where the work becomes process and event, and it is developed, finally, into a time and space expanded action.This article is proposed as an analysis of the artistic works which were interested in including movement representation or pointing to the attainment of kinetic art. Before incorporating the real movement in art works, there have been different attempts to represent it: by poses, instant grasp, or action narrative suggestion, and also by giving form to different movement stages. Thus, in this study we define two possible itineraries: “Representing the Movement” goes through the different approximations to movement representation from the pictorial and photographic practice, and “Presenting the Movable” does the same from the sculpture. We will travel through the path that covers the first trials to represent and fix something that moves in order to conquer the movable art itself, where the work becomes process and event, and it is developed, finally, into a time and space expanded action

Significance of long chain polyunsaturated fatty acids in human health

In the last decades, the development of new technologies applied to lipidomics has revitalized the analysis of lipid profile alterations and the understanding of the underlying molecular mechanisms of lipid metabolism, together with their involvement in the occurrence of human disease. Of particular interest is the study of omega-3 and omega-6 long chain polyunsaturated fatty acids (LC-PUFAs), notably EPA (eicosapentaenoic acid, 20:5n-3), DHA (docosahexaenoic acid, 22:6n-3), and ARA (arachidonic acid, 20:4n-6), and their transformation into bioactive lipid mediators. In this sense, new families of PUFA-derived lipid mediators, including resolvins derived from EPA and DHA, and protectins and maresins derived from DHA, are being increasingly investigated because of their active role in the “return to homeostasis” process and resolution of inflammation. Recent findings reviewed in the present study highlight that the omega-6 fatty acid ARA appears increased, and omega-3 EPA and DHA decreased in most cancer tissues compared to normal ones, and that increments in omega-3 LC-PUFAs consumption and an omega-6/omega-3 ratio of 2–4:1, are associated with a reduced risk of breast, prostate, colon and renal cancers. Along with their lipid-lowering properties, omega-3 LC-PUFAs also exert cardioprotective functions, such as reducing platelet aggregation and inflammation, and controlling the presence of DHA in our body, especially in our liver and brain, which is crucial for optimal brain functionality. Considering that DHA is the principal omega-3 FA in cortical gray matter, the importance of DHA intake and its derived lipid mediators have been recently reported in patients with major depressive and bipolar disorders, Alzheimer disease, Parkinson’s disease, and amyotrophic lateral sclerosis. The present study reviews the relationships between major diseases occurring today in the Western world and LC-PUFAs. More specifically this review focuses on the dietary omega-3 LC-PUFAs and the omega-6/omega-3 balance, in a wide range of inflammation disorders, including autoimmune diseases. This review suggests that the current recommendations of consumption and/or supplementation of omega-3 FAs are specific to particular groups of age and physiological status, and still need more fine tuning for overall human health and well being

Echium acanthocarpum hairy root cultures, a suitable system for polyunsaturated fatty acid studies and production

<p>Abstract</p> <p>Background</p> <p>The therapeutic and health promoting role of highly unsaturated fatty acids (HUFAs) from fish, <it>i.e. </it>eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) are well known. These same benefits may however be shared by some of their precursors, the polyunsaturated fatty acids (PUFAs), such as stearidonic acid (SDA, 18:4 n-3). In order to obtain alternative sources for the large-scale production of PUFAs, new searches are being conducted focusing on higher plants oils which can contain these n-3 and n-6 C18 precursors, <it>i.e. </it>SDA and GLA (18:3n-6, γ-linolenic acid).</p> <p>Results</p> <p>The establishment of the novel <it>Echium acanthocarpum </it>hairy root cultures represents a powerful tool in order to research the accumulation and metabolism of fatty acids (FAs) in a plant particularly rich in GLA and SDA. Furthermore, this study constitutes the first example of a <it>Boraginaceae </it>species hairy root induction and establishment for FA studies and production. The dominant PUFAs, 18:2n-6 (LA, linoleic acid) and 18:3n-6 (GLA), accounted for about 50% of total FAs obtained, while the n-3 PUFAs, 18:3n-3 (ALA, α-linolenic acid) and 18:4n-3 (SDA), represented approximately 5% of the total. Production of FAs did not parallel hairy root growth, and the optimal productivity was always associated with the highest biomass density during the culture period. Assuming a compromise between FA production and hairy root biomass, it was determined that sampling times 4 and 5 gave the most useful FA yields. Total lipid amounts were in general comparable between the different hairy root lines (29.75 and 60.95 mg/g DW), with the major lipid classes being triacylglycerols. The FAs were chiefly stored in the hairy roots with very minute amounts being released into the liquid nutrient medium.</p> <p>Conclusions</p> <p>The novel results presented here show the utility and high potential of <it>E. acanthocarpum </it>hairy roots. They are capable of biosynthesizing and accumulating a large range of polyunsaturated FAs, including the target GLA and SDA fatty acids in appreciable quantities.</p

Cambio climático, información y riesgos financieros: ¿horizontes lejanos?

Artículo de revistaLas notas a los estados financieros (memoria) y, en el caso de las entidades de crédito, los informes de Pilar 3 completan y complementan la información contenida en el balance y en la cuenta de resultados, lo que contribuye a una mejor estimación del importe y del calendario de los flujos de caja esperados, y de los riesgos asociados a estos. El desafío del cambio climático introduce factores novedosos que afectan a la materialización de dichos riesgos, y desde distintos ámbitos y organismos se están desarrollando normas que tratan de determinar qué información pública —más allá de la contenida en la memoria y en los informes de Pilar 3— podría ofrecer una mejor perspectiva acerca de esos factores. En este artículo se repasan las iniciativas en marcha en este ámbito de la divulgación (disclosure) sobre riesgos financieros del cambio climático, centrándose en las más relevantes a escala internacional: las promovidas por la International Financial Reporting Standards Foundation, el European Financial Reporting Advisory Group y la autoridad bursátil de Estados Unidos (la Securities and Exchange Commission). Se exponen el contexto y las motivaciones, la evolución actual de dichas propuestas y su contenido fundamental, y se discuten los canales a través de los cuales se están tratando de integrar las iniciativas entre sí y de vincular este tipo de información con la de los estados financieros, con el fin de evitar una fragmentación que podría afectar a la estabilidad financiera

Reproduction in the externally brooding sea anemone Epiactis georgiana in the Antarctic Peninsula and the Weddell Sea

14 pages, 8 figures, 2 tablesExternal parental care is uncommon among actiniarians but common in Epiactis species. Here, several aspects of reproduction are analyzed for of one of them, Epiactis georgiana. Samples were collected in December, January, February, March, and April in the Antarctic Peninsula and the eastern Weddell Sea, during 1998, 2000, 2002, and 2003. Most sexually mature individuals of E. georgiana are male or female, but some are hermaphrodites. This is the first report of hermaphroditism in E. georgiana, which is the third species of the genus with this sexual pattern. The results suggest that oogenesis starts in December and that at least two generations of oocytes overlap; a third generation is often brooded externally. Putative fertilization is likely internal, and larvae and/or embryos are externally brooded on the distal part of the adult column until an advanced developmental stage. Apparently E. georgiana reproduces seasonally, probably releasing the embryos/larvae in the last months of the austral spring (December). Inter-individual variability was observed in gametogenesis. In addition, specimens from the Antarctic Peninsula were larger than those from the Weddell Sea. This study represents the first step in understanding the reproductive mode of E. georgianaSpecial thanks are addressed to Prof. Dr. Wolf Arntz (Alfred-Wegener-Institute, Bremerhaven, Germany) who made possible our participation in several Antarctic projects and cruises. We extend our acknowledgements to the officers and crew of the R/V Polarstern and many colleagues on board during the EASIZ, ANDEEP, and BENDEX cruises for their valuable assistance. Thanks to M. Conradi (Universidad de Sevilla) who collected a considerable amount of the material analyzed in this manuscript. Comments from M. Daly, D. Fautin, and an anonymous reviewer substantially improved this manuscript. Support was provided by a MCT-CSICgrant (I3P-BPD2001-1) to E. Rodríguez and Spanish CICYT projects: ANT97-1533-E, ANT98-1739-E, ANT99-1608-E, REN2001-4269-E/ANT, REN2003-04236, and CGL2004-20141-E. This is a contribution to the SCAR program, Ecology of the Antarctic Sea Ice Zone (EASIZ) and ANDEEP contribution 159Peer reviewe

Tratamiento odontológico integral en paciente adulto e infantil

La caries dental es una de las enfermedades crónicas más comunes en todo el mundo y tiene una gran importancia médica, social y económica. Además, esta enfermedad se da en todos los grupos de edad, aunque son especialmente vulnerables a ella los niños y los ancianos. En el presente trabajo, se exponen dos casos clínicos que corresponden a un paciente geriátrico y a uno infantil que acuden al Servicio de Prácticas Odontológicas de la Universidad de Zaragoza. Ambos pacientes presentan un cuadro clínico de policaries. El primer caso (1650), corresponde a una paciente de 71 años que presenta numerosas lesiones cariosas, facetas severas de desgaste dental y maloclusión. Basándonos en la evidencia científica actual, se expone el diagnóstico, opciones terapéuticas y pronóstico adecuados al caso. El segundo caso (3644), corresponde a una paciente infantil que presenta un episodio de policaries en estado avanzado, tanto en dentición temporal como permanente. Se establece un diagnóstico y plan terapéutico en que se incluye tratamiento preventivo, quirúrgico, conservador y de mantenimiento de espacio

Barley-ß-glucans reduce systemic inflammation, renal injury and aortic calcification through ADAM17 and neutral-sphingomyelinase2 inhibition

In chronic kidney disease (CKD), hyperphosphatemia-induced inflammation aggravates vascular calcification (VC) by increasing vascular smooth muscle cell (VSMC) osteogenic differentiation, ADAM17-induced renal and vascular injury, and TNFα-induction of neutral-sphingomyelinase2 (nSMase2) to release pro-calcifying exosomes. This study examined anti-inflammatory β-glucans efficacy at attenuating systemic inflammation in health, and renal and vascular injury favoring VC in hyperphosphatemic CKD. In healthy adults, dietary barley β-glucans (Bβglucans) reduced leukocyte superoxide production, inflammatory ADAM17, TNFα, nSMase2, and pro-aging/pro-inflammatory STING (Stimulator of interferon genes) gene expression without decreasing circulating inflammatory cytokines, except for γ-interferon. In hyperphosphatemic rat CKD, dietary Bβglucans reduced renal and aortic ADAM17-driven inflammation attenuating CKD-progression (higher GFR and lower serum creatinine, proteinuria, kidney inflammatory infiltration and nSMase2), and TNFα-driven increases in aortic nSMase2 and calcium deposition without improving mineral homeostasis. In VSMC, Bβglucans prevented LPS- or uremic serum-induced rapid increases in ADAM17, TNFα and nSMase2, and reduced the 13-fold higher calcium deposition induced by prolonged calcifying conditions by inhibiting osteogenic differentiation and increases in nSMase2 through Dectin1-independent actions involving Bβglucans internalization. Thus, dietary Bβglucans inhibit leukocyte superoxide production and leukocyte, renal and aortic ADAM17- and nSMase2 gene expression attenuating systemic inflammation in health, and renal injury and aortic calcification despite hyperphosphatemia in CKD.A grant to A.S.D. and M.J.M. from IRBLleida and Agrotecnio Research collaborative projects from the Consell Social at Lleida University supported initial work, Instituto de Salud Carlos III and co-funded by European Union (ERDF/FEDER) (FIS PI11/00259, PI14/01452, PI17/02181), Plan de Ciencia, Tecnología e Innovación 2013–2017 y 2018–2022 del Principado de Asturias (GRUPIN14-028, IDI-2018-000152), RedInRen from ISCIII (ISCIII-RETIC REDINREN RD16/0009). Investigator support included: NC-L by GRUPIN14-028 and IDI-2018-000152, LM-A by GRUPIN14-028, SP by FICYT; MVA and PV by Educational Grant 2 A/2015 from ERA-EDTA CKD-MBD Working Group; PV and AC by ERA-EDTA fellowships 2011 and 2012; JR-C by MINECO (“Juan de la Cierva” program, FJCI-2015-23849); A.S.D. by Asociación Investigación de Fisiología Aplicada. A.S.D. and M.J.M. are members of the Campus Iberus (Ebro Valley Campus of International Excellence)