1,996 research outputs found
Fracturas Pélvicas: una visión moderna
Las fracturas pélvicas se presentan con severidad variable, desde lesiones de baja energía, habitualmente
por compresión lateral, hasta lesiones secundarias a un traumatismo de alta energía con inestabilidad
del anillo pélvico, frecuentes lesiones asociadas y altas tasas de morbilidad y mortalidad. El tratamiento inicial de
estas severas lesiones se sustenta en la aplicación de protocolos de soporte vital avanzado, disminuir el sangrado
pélvico con medidas que reduzcan el volumen de la pelvis y estabilicen la lesión, como la fijación externa y ante
inestabilidad persistente técnicas de angiografía-embolización o empaquetamiento. Tras la estabilización inicial
del paciente el objetivo será la restauración anatómica del anillo pélvico predictora de la recuperación funcional.
Las técnicas de estabilización definitiva actuales evolucionan hacía técnicas menos invasivas y percutáneas con
el paciente preferentemente decúbito supino. A pesar de los avances en el tratamiento, el dolor, la disfunción sexual
o persistencia de problemas neurológicos crónicos se asocian a las lesiones más graves1-3.Pelvic fractures have a wide spectrum of severity depending on the strength of the trauma, ranging
from low energy injuries, usually by lateral forces, until secondary lesions to high-energy trauma with pelvic ring
instability, and high rates of morbidity and mortality. High-energy pelvic fractures require advanced life support
and the first step in treatment is to reduce pelvic bleeding with external fixation and to continuing instability
embolization angiography techniques or packing. Later, when patient is hemodynamically stable the goal is to
achieve an anatomical reconstruction of pelvic ring which is considered nowadays the most powerful predictor of
functional recovery. Less invasive and percutaneous stabilization techniques have emerged in recent years. Nevertheless,
despite the progress in treatment, pain, sexual dysfunction or chronic persistent neurological problems
are associated with more severe injuries1-3
Tratamiento del choque femoroacetabular mediante miniabordaje anterior. Resultados a corto plazo
El tratamiento quirúrgico del choque femoroacetabular (CFA) es un práctica clínica cada vez más frecuente en nuestra especialidad. Objetivo. Analizar los resultados clínicos y radiológicos de una primera serie de pacientes diagnosticados de CFA intervenidos mediante miniabordaje anterior. Material y métodos. Estudio prospectivo de 30 pacientes con una edad media de 36,2 años y un seguimiento mínimo de 12 meses. La valoración clínica se ha realizado mediante las escalas SF-36, WOMAC y NAHS. Evaluamos la corrección radiológica de la deformidad y la progresión o no del grado de coxartrosis. Resultados. Se obtuvo una corrección adecuada de la deformidad en el 93% de los casos, 27 de los 30 pacientes presentaron una mejoría clínica significativa en los test realizados. La complicación más frecuente fue la meralgia parestésica del femorocutáneo (5 casos), 1 paciente precisó de sustitución protésica por evolución del grado de coxartrosis. Conclusiones. El tratamiento del CFA mediante mini abordaje anterior es un procedimiento seguro y reproducible. Permite la corrección de las anormalidades anatómicas y la obtención de resultados clínicos satisfactorios en una cohorte de pacientes jóvenes.Surgical treatment of femoroacetabular impingement (FAI) is an increasingly common clinical practice in our speciality. Aim. To analyze the clinical and radiological results of a first series of patients diagnosed with a FAI treated with anterior mini-open approach. Material and methods. Prospective study of 30 patients with a mean age of 36.2 years with a minimum follow-up of 12 months was made. Clinical assessment was performed using the SF-36, WOMAC and NAHS scales. We evaluate the correction of the radiologic deformity and progression of the osteoarthritis grade. Results. An adequate correction of the deformity in 93% of cases was obtained, 27 of the 30 patients showed significant clinical improvement in all tests performed. The most common complication was meralgia paresthesia of the femoro-cutaneous nerve (5 cases), 1 patient required prosthetic replacement for progression of the osteoarthritis grade. Conclusions. FAI treatment by mini-open approach is a safe and reproducible procedure. This technique allows correction of anatomical abnormalities and obtains satisfactory clinical outcomes in a cohort of young patients
Tratamiento quirúrgico de las metástasis diafisarias de huesos largos en pacientes oncológicos estadio IV
La incidencia de enfermedad metastásica ósea se ha incrementado debido a la mayor supervivencia
de los pacientes con cáncer. El esqueleto es la tercera localización mas frecuente de metástasis procedentes de
tumores primarios. Se evalúan las indicaciones quirúrgicas para evitar la aparición de fracturas patológicas y
los resultados obtenidos en metástasis diafisarias de huesos largos. Cincuenta lesiones han sido tratadas en 48
pacientes. En todos los casos se estabilizó con un clavo intramedular. La supervivencia media fue de 11 meses (2
días-48 meses). Al final del seguimiento la puntuación media en la escala MSTS fue 25/30 y 27/30 para miembro
superior e inferior respectivamente. Debe considerarse la radioterapia postoperatoria para disminuir la progre
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sión de la enfermedad. Hay múltiples factores a tener en cuenta en el tratamiento de pacientes con metástasis
óseas incluyendo comorbilidades, características histológicas del tumor primario, la expectativa de vida y acti
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vidad del paciente y el dolor.The incidence of metastatic bone disease is increasing as patients with cancer living longer. The
skeleton is the third most common site for metastasis that originates from primary carcinomas. We evaluated the
indications for surgery to prevent pathological fractures and the results obtained in metastases of the diaphyseal
long bones. Fifty metastases bone lesion were treated in 48 patients. In all cases an intramedullary nail was in
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serted. The chance of surviving was 11 moths average (2 days-48 moths). At follow-up, the MSTS average was
25/30 and 27/30 for superior and inferior limb respectively. To minimize disease progression postoperative ex
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ternal-beam irradiation should be considered. There are multiples factors to consider in the treatment of patients
with bone metastasic, including comorbidities, the histological characteristics of the primary tumor, the expected
life span of the patient, the patient ?s activity level and pain
Prótesis de pirocarbono en fracturas complejas de cabeza de radio.
Presentamos los resultados de un estudio observacional retrospectivo sobre 23 casos de fracturas
complejas de cabeza de radio tratadas mediante la implantación de una prótesis cabeza radio de pircocarbono (Mo
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Pyc). La distribución por sexos fue 10 hombres y 13 mujeres, y la edad media de 54 años. El seguimiento medio fue
de 70 meses (48-93 meses). La principal causa fue una fractura de cabeza de radio no reconstruible con inestabilidad
asociada de codo. La evaluación clínica se realizó con la Mayo Elbow Performance Score (MEPS). Radiográficamen
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te se valoró la congruencia articular, el tamaño de la prótesis, la radiolucencia periprotésica, la osificación heterotópica
y la osteoartritis. Al final del seguimiento la media de la escale MEPS fue 82/100, con 84 % resultados de excelentes
y buenos. La flexión media fue de 130º, extensión -30º, pronación 76º y supinación 77º. La estabilidad del codo
fue buena en todos los casos y no observamos migración proximal del radio. Observamos radiolucencia alrededor
del vástago en 5 pacientes, pero sin aparente repercusión clínica. Las complicaciones fueron una paresia del nervio
interóseo posterior con recuperación funcional al cabo de 11 semanas, 2 pacientes presentaron "overstuffing" con
subluxación posterior asociada que necesitó realizar exéresis de la cabeza y una osificación heterotópica con repercu
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sión sobre el balance articular que necesitó 2 cirugías, todos ellos con resultados clínicos aceptables. Los resultados
son alentadores.The authors present the results of a retrospective observational study of 23 cases of a complex radial
head fractures treated by pyrocarbon radial head prosthesis (MoPyc). This modular radial head prosthesis is compo
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sed of a cementless titanium stem and a 15º angulated neck. The gender distribution was 10 men and 13 women, ave
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rage age 54 years. The mean follow-up was 70 months (48-93 months). The main etiology was a radial head fracture
with elbow instability. Clinical evaluation was performed using the Mayo Elbow Performance Score (MEPS). Was
assessed radiographically joint congruity, the size of the prosthesis, periprosthetic radiolucency, heterotopic ossifica
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tion and osteoarthritis. At follow-up, the MEPS average was 82/100, with 84% of good and excellent results. Elbow
flexion averaged 130º, extension -30º, pronation 76º and supination 77º. Elbow stability was good in all the cases, and
no proximal migration of the radius occurred. Asymptomatic bone lucencies were found in five cases around the
stem. Complications included paresis of the posterior interosseous nerve with functional recovery after 11 weeks, 2
patients had "overstuffing" associated with posterior subluxation and they need to perform excision of the head and
one heterotopic ossification with articular impact on balance that needs two surgeries, all of them with acceptable
clinical results. The preliminary results are encouragin
On environment difficulty and discriminating power
The final publication is available at Springer via http://dx.doi.org/10.1007/s10458-014-9257-1This paper presents a way to estimate the difficulty and discriminating power of
any task instance. We focus on a very general setting for tasks: interactive (possibly multiagent)
environments where an agent acts upon observations and rewards. Instead of analysing
the complexity of the environment, the state space or the actions that are performed by the
agent, we analyse the performance of a population of agent policies against the task, leading
to a distribution that is examined in terms of policy complexity. This distribution is then
sliced by the algorithmic complexity of the policy and analysed through several diagrams
and indicators. The notion of environment response curve is also introduced, by inverting the
performance results into an ability scale. We apply all these concepts, diagrams and indicators
to two illustrative problems: a class of agent-populated elementary cellular automata, showing
how the difficulty and discriminating power may vary for several environments, and a multiagent
system, where agents can become predators or preys, and may need to coordinate.
Finally, we discuss how these tools can be applied to characterise (interactive) tasks and
(multi-agent) environments. These characterisations can then be used to get more insight
about agent performance and to facilitate the development of adaptive tests for the evaluation
of agent abilities.I thank the reviewers for their comments, especially those aiming at a clearer connection with the field of multi-agent systems and the suggestion of better approximations for the calculation of the response curves. The implementation of the elementary cellular automata used in the environments is based on the library 'CellularAutomaton' by John Hughes for R [58]. I am grateful to Fernando Soler-Toscano for letting me know about their work [65] on the complexity of 2D objects generated by elementary cellular automata. I would also like to thank David L. Dowe for his comments on a previous version of this paper. This work was supported by the MEC/MINECO projects CONSOLIDER-INGENIO CSD2007-00022 and TIN 2010-21062-C02-02, GVA project PROMETEO/2008/051, the COST - European Cooperation in the field of Scientific and Technical Research IC0801 AT, and the REFRAME project, granted by the European Coordinated Research on Long-term Challenges in Information and Communication Sciences & Technologies ERA-Net (CHIST-ERA), and funded by the Ministerio de Economia y Competitividad in Spain (PCIN-2013-037).José Hernández-Orallo (2015). On environment difficulty and discriminating power. Autonomous Agents and Multi-Agent Systems. 29(3):402-454. https://doi.org/10.1007/s10458-014-9257-1S402454293Anderson, J., Baltes, J., & Cheng, C. T. (2011). Robotics competitions as benchmarks for ai research. The Knowledge Engineering Review, 26(01), 11–17.Andre, D., & Russell, S. J. (2002). State abstraction for programmable reinforcement learning agents. 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Vástagos monobloque de recubrimiento completo en cirugía de revisión femoral. Resultados a largo plazo de 80 casos.
Bone stock lost and anatomical changes in the proximal femur make femoral revision surgery a complex procedure where the implant chooses will be essential. With the aim of evaluating the clinical and radiological results of the fully coated monoblock stems, we retrospectively studied 80 consecutive cases of femoral revision surgery operated by our hip team. The mean follow-up was 8.6 years. The average score on the Harris Hip Score was 81,2 points. We achieved better results in patients with less bone defects (Paprosky I, II and IIIA) in contrast to those with Paprosky type IIIB defects (p=0.005), in patients with a single previous surgery (p=0.031), in patients under 65 years (p=0.009) and in those who did not suffer complications (p=0.024). The survival rate was 96.1% at 10 years if we consider as failure the removal of the stem due to aseptic loosening and 89.9% if we consider revision of the stem as a failure due to any cause. After the results obtained, we think that fully coated stems provide a solid and stable fixation in femoral revision surgery. However, worst results obtained in patients with bigger bone defects make other options to be considered
Infección protésica de cadera : recambio en dos tiempos en una serie de 50 casos
Chronic infection in hip replacement is an important complication with a complex treatment, that is solved by adequate antibiotic therapy together with single-stage exchange or two-stage exchange. We present a descriptiveand retrospective study of a series of 50 consecutive patients operated on in our center with a diagnosis of chronic infection of the hip prosthesis between 2007 and 2018 with a two-stage exchange.At a mean follow-up of 52 months, the overall implant survival was 89%, with a 91% infection cure rate. The most frequent microorganism isolated was Staphylococcus epidermidis. The mean score achieved on the HHS was 82,4 points and 1.67 points on the visual analogue scale. We obtained better functional results (p=0,021) in those patients who had a preformed antibiotic-loaded spacer in the first surgical stage.As complications, we recorded four cases of prosthetic reinfection (8,7%), three cases of dislocation (6,5%), and one case of postsurgical hematoma (4,6%).No case of neurovascular injury or component loosening was recorded.According to the showed results, we consider that two-stage revision procedure, although it is a demanding surgery, is an effective method for the treatment of periprosthetic hip infection, with high implant survival and erradication of the infection
Choque extraarticular de cadera secundario a consolidación viciosa tras fractura-avulsión de la espina ilíaca antero inferior : a propósito de un caso
The anterior inferior iliac spine (AIIS) avulsion fractures are uncommon, caused by a sudden contraction of the rectus femoris muscle with hyperextension of the hip and knee flexion. We present the clinical case of a 32-year-old mansuffering from pain in his right hip for several years with a history of a AIIS avulsion fracture in his childhood. He presented pain with flexion and internal rotation of the right hip. Physical examination and imaging tests revealed an extra-articular hip impingement secondary to a malunited fracture of AIIS. The patient underwent surgery performing AIIS osteoplasty and excision of the ossification by an anterior mini-open approach. After surgery he was able to re-join sports activity. Malunited fracture of AIIS can cause an extra-articular hip impingement in young sports patients. The treatment by surgical excision of the hypertrophic spine through an anterior mini-open approach allows the correction of the deformity and an early reincorporation to sports activities
Evaluation in artificial intelligence: From task-oriented to ability-oriented measurement
The final publication is available at Springer via http://dx.doi.org/ 10.1007/s10462-016-9505-7.The evaluation of artificial intelligence systems and components is crucial for the
progress of the discipline. In this paper we describe and critically assess the different ways
AI systems are evaluated, and the role of components and techniques in these systems. We
first focus on the traditional task-oriented evaluation approach. We identify three kinds of
evaluation: human discrimination, problem benchmarks and peer confrontation. We describe
some of the limitations of the many evaluation schemes and competitions in these three categories,
and follow the progression of some of these tests. We then focus on a less customary
(and challenging) ability-oriented evaluation approach, where a system is characterised by
its (cognitive) abilities, rather than by the tasks it is designed to solve. We discuss several
possibilities: the adaptation of cognitive tests used for humans and animals, the development
of tests derived from algorithmic information theory or more integrated approaches under
the perspective of universal psychometrics. We analyse some evaluation tests from AI that
are better positioned for an ability-oriented evaluation and discuss how their problems and
limitations can possibly be addressed with some of the tools and ideas that appear within
the paper. Finally, we enumerate a series of lessons learnt and generic guidelines to be used
when an AI evaluation scheme is under consideration.I thank the organisers of the AEPIA Summer School On Artificial Intelligence, held in September 2014, for giving me the opportunity to give a lecture on 'AI Evaluation'. This paper was born out of and evolved through that lecture. The information about many benchmarks and competitions discussed in this paper have been contrasted with information from and discussions with many people: M. Bedia, A. Cangelosi, C. Dimitrakakis, I. GarcIa-Varea, Katja Hofmann, W. Langdon, E. Messina, S. Mueller, M. Siebers and C. Soares. Figure 4 is courtesy of F. Martinez-Plumed. Finally, I thank the anonymous reviewers, whose comments have helped to significantly improve the balance and coverage of the paper. This work has been partially supported by the EU (FEDER) and the Spanish MINECO under Grants TIN 2013-45732-C4-1-P, TIN 2015-69175-C4-1-R and by Generalitat Valenciana PROMETEOII2015/013.José Hernández-Orallo (2016). 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Measurement of the cross-section and charge asymmetry of bosons produced in proton-proton collisions at TeV with the ATLAS detector
This paper presents measurements of the and cross-sections and the associated charge asymmetry as a
function of the absolute pseudorapidity of the decay muon. The data were
collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with
the ATLAS experiment at the LHC and correspond to a total integrated luminosity
of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements
varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the
1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured
with an uncertainty between 0.002 and 0.003. The results are compared with
predictions based on next-to-next-to-leading-order calculations with various
parton distribution functions and have the sensitivity to discriminate between
them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables,
submitted to EPJC. All figures including auxiliary figures are available at
https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13
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