Comparación de dos tipos de tratamiento ortopédico en las fracturas del cuello del 5º metacarpiano

Estudio prospectivo en el que se evalúa a 20 pacientes con fractura del cuello del quinto metacarpiano. Los pacientes fueron asignados de forma secuencial a un grupo de tratamiento con inmovilización con férula u otro grupo con vendaje funcional. Se realiza un seguimiento de 3 meses en el que se comparan parámetros clínicos como: dolor, movilidad metacarpo-falángica, fuerza de empuñadura y DASH test, y parámetros radiológicos como la angulación y acortamiento del metacarpiano. Tras el estudio estadístico, se concluye, que la inmovilización con férula mantiene algo más la reducción de la fractura y controla más el dolor que el vendaje funcional. El vendaje funcional permite una reincorporación laboral precoz sin diferencias en el resultado funcional con respecto a los pacientes en los que se aplicó inmovilización con férula.Prospective study evaluating 20 patients suffering fifth metacarpal neck fracture. The patients were sequentially assigned to a treatment group with splinting or taping. During the 3-months following-up, we compared clinical parameters such as: pain, metacarpophalangeal mobility, grip strength and DASH test, and radiological parameters as angulations and shortening of metacarpal. After the statistical study, we concluded, that the splinting maintains more the reduction of the fracture and controls more the pain than the taping. The taping allows an early return to normal working activity without differences in functional outcome compared to splinting group

Colgajo libre córtico-perióstico de la arteria genicular descendente en el tratamiento de la seudoartritis distal de tibia

Presentamos un caso de un varón de 35 años con pseudoartrosis aséptica de tibia distal con escaso defecto óseo, intervenido previamente mediante recambio del material de osteosíntesis e injerto de cresta iliaca, que fracasó. Tras estudio de las diferentes opciones de tratamiento, se le propuso estabilizar el foco mediante enclavado endomedular y aumentar la capacidad osteogénica con un colgajo córtico-perióstico de la arteria genicular descendente, según la técnica de Sakai. Discusión: El manejo terapéutico de la pseudoartrosis distal de tibia no está del todo resuelto. Cuando otras opciones no han sido efectivas, el clavo endomedular asociado al colgajo libre córtico-perióstico de la arteria genicular descendente puede ser una opción válida para el tratamiento. Esta técnica quirúrgica supone un trabajo coordinado entre los especialistas en traumatología y cirugía plástica.We present a case of 35 years old man presented with aseptic distal tibial nonunion without bone defect. Previous unsuccessful surgical attempt, consisting on revision of the internal fixation and iliac crest bone grafting, was performed. After studying the different treatment options, we suggested him to carry out an endomedular nail stabilization of the nonunion site in combination with a descending genicular corticoperiosteal free flap to provide osteogenetic enhancement, as described by Sakai. Discussion: The treatment protocol of the distal tibial nonunion still remains controversial. When other surgical attempts are unsuccessful, the combination of endomedular nailing and descending genicular corticoperiosteal free flap, may be useful. This surgical technique may require a coordinated work between orthopaedic and plastic surgeons

Reacción seudoséptica tras la infiltración de ácido hialurónico en el tratamiento de la artrosis de tobillo: a propósito de un caso

Muchos cirujanos ortopédicos utilizan las infiltraciones de ácido hialurónico como tratamiento sintomático de la artrosis. Generalmente su uso es seguro, pero en ocasiones puede presentar alguna reacción adversa que se debe conocer, como la reacción pseudoséptica. Presentamos un caso de un varón de 48 años que acude a urgencias con fiebre y signos inflamatorios en tobillo tras la segunda infiltración de ácido hialurónico. Se realizó un artrotomía de limpieza y el cultivo de la muestra resultó negativo. Discusión: La importancia de la reacción seudoséptica radica en que es una entidad clínica superponible a una verdadera artritis séptica pero que, a diferencia de la anterior, se resuelve con reposo y antiinflamatorios, y no produce alteraciones en el cartílago.Most of the orthopedists use intraarticular supplementation of hyaluronic acid to relieve osteoarthritis ´pain. Usually this treatment is safe but, sometimes it has some adverse events that should be known, as the pseudoseptic reaction or severe acute inflammatory reaction. We present a 48 years old man that presented fever and inflammatory reaction in his ankle after the second intraarticular injection of hyaluronate. An ankle arthrotomy was performed, but the culture results were negative. Discusion: We may consider the difference between this reaction and a real septic disease, that requires antibioterapy and, in most cases, surgery. Otherwise, the pseudoseptic reaction improves with rest and anti-inflammatory drugs, and does not suppose a damage to the cartilage

What is wrong with post‐fire soil erosion modelling? A meta‐analysis on current approaches, research gaps, and future directions

In the near future, a higher occurrence of wildfires is expected due to climate change, carrying social, environmental, and economic implications. Such impacts are often associated with an increase of post‐fire hydrological and erosive responses, which are difficult to predict. Soil erosion models have been proven to be a valuable tool in the decision‐making process, from emergency response to long‐term planning, however, they were not designed for post‐fire conditions, so they need to be adapted to include fire‐induced changes. In the recent years, there has been an increasing number of studies testing different models and adaptations for the prediction of post‐fire soil erosion. However, many of these adaptations are being applied without field validation or model performance assessment. Therefore, this study aims to describe the scientific advances in the last twenty years in post‐fire soil erosion modelling research and evaluate model adaptations to burned areas that aim to include: i) fire‐induced changes in soil and ground cover, ii) fire‐induced changes in infiltration, iii) burn severity, and iv) mitigation measures in their predictions. This study also discusses the strengths and weaknesses of those approaches, suggests potential improvements, and identifies directions for future research. Results show that studies are not homogeneously distributed worldwide, neither according to the model type used, nor by regions most affected by wildfires. During calibration, 73% of the cases involved model adaptation to burned conditions, and only 21% attempted to accommodate new processes. Burn severity was addressed in 75% of the cases, whilst mitigation measures were simulated in 27%. Additionally, only a minor percentage of model predictions were validated with independent field data (17%) or assessed for uncertainties (13%). Therefore, further efforts are required on the adaptation of erosion models to burned conditions to be widely used for post‐fire management decision.publishe

Electrification of Sub-Saharan Africa through PV/hybrid mini-grids: Reducing the gap between current business models and on-site experience

The absence of publicly available up-to-date costs breakdown data on photovoltaic (PV)/hybrid mini-grids in Sub-Saharan Africa (SSA) is a barrier that needs to be resolved in order to overcome challenges in rural electrification planning, regulation, life-cycle operation, financing, and funding. The primary aim of this research is to provide better understanding of the cost structures of PV/hybrid mini-grid projects in Sub-Saharan Africa. The review on existing literature reveals significant lack of transparency and inconsistencies in PV/hybrid mini-grid costs. This paper aims to support the fact that there still remains a strong need to reduce the gap between current business model concepts and successfully implemented scale-up electrification models. Based on the experience of PV/hybrid mini-grids projects implemented in various rural communities of SSA, we propose a multi-dimensional cost analysis with a standardised break-down of the real costs of installed projects. Subsequently, we assess the main social and environmental implications and we identify barriers that appear to hinder successful PV mini-grid planning and subsequent implementation in SSA. Africa has the unique opportunity to utilize renewable energy as a primary energy source. Indeed, the continent has the potential to bring electricity especially to its rural population by means of PV/hybrid mini-grids. However, the capability of public and private sector investors to preevaluate projects is limited by the lack of locally available information on PV/hybrid mini-grid costs or the reliability of data (when available). Multi-dimensional cost analysis of social and environmental impacts from this study highlight that PV/hybrid mini-grids offer a unique opportunity to create a standardised framework for quantifying costs of PV/hybrid mini-grids in SSA, that can support decision-making processes for designing viable business models. Findings show that there is a strong need to minimise the data quality gap between current business model and that of successfully implemented PV/hybrid mini-grids electrification projects. This gap could be mitigated through studying the issues that influence mini-grid costs (both hardware and software). In addition to understanding other factors that can influence project costs such as the market maturity and remoteness of the site, organisation capability, development approach, and level of community involvement. Regarding policy considerations, stronger political will coupled with proactive rural electrification strategies and targeted renewable energy regulatory framework would be essential in order to establish viable dynamic domestic market for off grid renewables. In the presented benchmarking analysis, the experiences of public and private development organisations are synchronized to contribute to the furthest extent possible to facilitate the assessment. Those include the disaggregation of component costs according to their unit in order to make comparison more accurate and include site-specific parameters in the discussion of costs.JRC.C.2-Energy Efficiency and Renewable

Prediction, validation, and uncertainties of a nation‑wide post‑fire soil erosion risk assessment in Portugal

Wildfires are a recurrent and increasing threat in mainland Portugal, where over 4.5 million hectares of forests and scrublands have burned over the last 38 years. These fire-affected landscapes have suffered an intensification of soil erosion processes, which can negatively affect soil carbon storage, reduce fertility and forest productivity, and can become a source of pollutants. The main objective of the present study is to produce a post-fire soil erosion risk map for the forest and shrubland areas in mainland Portugal and assess its reliability. To this end, the semi-empirical Morgan–Morgan–Finney erosion model was used to assess the potential post-fire soil erosion according to distinct burn severity and climate scenarios, and the accuracy of the predictions was verified by an uncertainty analysis and validated against independent field datasets. The proposed approach successfully allowed mapping post-fire soil erosion in Portugal and identified the areas with higher post-fire erosion risk for past and future climate extremes. The outcomes of this study comprise a set of tools to help forest managers in their decision-making for post-fire emergency stabilization, ensuring the adequate selection of areas for mitigation to minimize the economic and environmental losses caused by fire-enhanced soil erosion.publishe

Adipose-Derived Fatty Acid-Binding Proteins Plasma Concentrations Are Increased in Breast Cancer Patients.

BACKGROUND: Adipose tissue is an endocrine organ that could play a role in tumor progression via its secreted adipokines. The role of adipose-derived fatty acid-binding protein (FABP) 4 and FABP5 in breast cancer is presently under study, but their circulating levels in this pathology are poorly known. We analyzed the blood concentrations of FABP4 and FABP5 in breast cancer patients to determine whether there is an association between them and breast cancer. MATERIALS AND METHODS: We studied 294 women in the oncology department with a family history of breast cancer; 198 of the women had breast cancer, and 96 were healthy controls. The levels of FABP4, FABP5, lipid profile, standard biochemical parameter, and high-sensitivity C-reactive protein (hsCRP) were determined. We analyzed the association of FABP4 and FABP5 with breast cancer, while adjusting for demographic, anthropometric, and biochemical parameters. RESULTS: Breast cancer patients had a 24.8% (p < .0001) and 11.4% (p < .05) higher blood concentration of FABP4 and FABP5, respectively. Fatty acid-binding protein 4 was positively associated with age, body mass index (BMI), FABP5, very-low-density lipoprotein cholesterol (VLDLc), non-high-density lipoprote in cholesterol (non-HDLc), Apolipoprotein B 100 (ApoB100), triglycerides, glycerol, glucose, and hsCRP (p < .05), and was negatively associated with HDLc (p < .005) in breast cancer patients. Fatty acid-binding protein 5 was positively associated with BMI, FABP4, VLDLc, triglycerides, glycerol, and hsCRP (p < .05), and was negatively associated with HDLc and Apolipoprotein AI (ApoAI) (p < .05) in breast cancer patients. Using a logistic regression analysis and adjusting for age, BMI, hsCRP, non-HDLc, and triglycerides, FABP4 was independently associated with breast cancer (odds ratio [OR]: 1.091 [95% CI: 1.037-1.149]). Moreover, total cholesterol, VLDLc, non-HDLc, ApoB100, triglycerides, and hsCRP were significantly increased in breast cancer patients (p < .005). In contrast, the non-esterified fatty acids concentrations were significantly decreased in breast cancer patients (p < .05). CONCLUSION: Circulating FABP4 and FABP5 levels were increased in breast cancer patients compared with controls. The positive association of FABP4 with breast cancer was maintained after adjusting for important covariates, while the association with FABP5 was lost. Our data reinforce the role of adipose tissue and their adipokines in breast cancer. Despite these data, further studies must be performed to better explain the prognosis or diagnostic value of these blood parameters and their possible role in breast cancer. IMPLICATIONS FOR PRACTICE: We focus on the effect of adipose tissue on cancer, which is increasingly recognized. The association between adipocyte-derived adipokines and breast cancer opens new diagnosis and therapy perspectives. In this study, we provide original data concerning FABP4 and FABP5 plasma concentrations in breast cancer patients. Compared to control group, breast cancer patients show higher FABP4 and FABP5 blood levels. Our data suggest that, particularly, circulating FABP4 levels could be considered a new independent breast cancer biomarker. Our work translates basic science data to clinic linking the relationship between adipose tissue and lipid metabolism to breast cancer

The impacts of incentive policies on improving private investment for rural electrification in Nigeria – A geospatial study

In Nigeria, 86 million people lack electricity access, the highest number worldwide, predominantly in rural areas. Despite government efforts, constrained budgets necessitate private investors, who, without adequate incentives, are hesitant to commit capital due to perceived high risks. This study identifies three existing incentive policies—concessionary loans, capital subsidy, and financing productive use equipment—aimed at promoting rural electrification in Nigeria. Employing geospatial and regulatory analyses, we evaluate their impact on electrification planning across 22,696 population clusters. While all incentives encourage mini-grids and stand-alone systems, results show varied impacts, predominantly favouring mini-grids. Under the baseline, grid extension is optimal for 66% of clusters, followed by mini-grids (27%) and stand-alone systems (7%). Concessionary loans boost mini-grid and Stand-Alone Systems shares by 10% and 5%, respectively. Capital subsidies increase the mini-grid share to 41%, surpassing concessional loans (37%). Financing productive equipment enhances Stand-Alone Systems and mini-grid shares to 15% and 43%. Incentives impact LCOE, CAPEX, and OPEX, with average LCOE reducing to 0.31 EUR/kWh (concessionary loans), 0.30 EUR/kWh (capital subsidy), and 0.27 EUR/kWh (financing productive use). Financing productive uses proves decisively more effective in lowering costs for mini-grids and stand-alone systems than loans or capital subsidies. The important policy implications of this study reinforce the need for tailored incentives for distinct electrification options

Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.

Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required