Is combining massive bone allograft with free vascularized fibular flap the children's reconstruction answer to lower limb defects following bone tumour resection?

SummaryPurpose of the studyBone tumours are frequent conditions in children, and their surgical resection may lead to extensive defects which reconstruction is often challenging. Indeed, local conditions do not promote bone healing, and the achieved surgical result requires to be life-lasting. Capanna suggested a reconstruction technique combining massive allograft and free vascularized fibular flap. The first one is intended to withstand mechanical stress, and the second one offers biological and vascular support to improve bone healing and prevent infections.Materiel and methodsWe report our experience with this technique when applied to the lower limb in a prospective study including seven children, with a mean follow-up of 44 months.ResultsBone healing was achieved by one single procedure in 85.7% of the cases, usually 7 months after surgery. Six out of seven patients achieved a final and long-lasting outcome, five of them following a simple surgical history. Partial weight-bearing was post-operatively allowed at about 2 months, full weight-bearing was initiated at about 5.5 months.DiscussionA low complication rate was reported despite the extent of the disease and the type of the surgical procedure. Capanna's combined reconstructive technique appears very efficient in the management of massive bone defects following tumour resection in children's lower limb.Level of evidenceLevel IV. Retrospective therapeutic study

Napa freática: Dinámica, variables de control y contenido de nitratos en suelos de pampa arenosa

A fin de estudiar la dinámica y control de la napa freática y el contenido de nitratos, en lotes agrícolas del Oeste bonaerense, se analizaron registros de ocho años de nivel freático y muestras de agua extraídas durante dos años. El modelo hidrológico DRAINMOD fue calibrado y validado en base a registros de freatímetros instalados en 12 lotes agrícolas, ubicados en un radio de 100 km. Las curvas de retención hídrica requeridas por el modelo fueron estimadas mediante funciones de pedotransferencia. Un segundo conjunto de freatímetros fue instalado en noviembre del 2011 para el muestreo mensual y análisis de la evolución del contenido de nitratos bajo diferentes cultivos en posiciones de loma, media-loma y bajo, durante dos campañas agrícolas. DRAINMOD fue evaluado para ser utilizado en la estimación del impacto de la variación climática interanual, uso de tierras y estructuras de control sobre la profundidad de la napa. En este aspecto, se analizaron estrategias de control del nivel freático, combinando drenes subterráneos con el nivel de consumo de rotaciones agrícolas y pasturas en toposecuencias. Considerando la totalidad de las observaciones, en calibración, el modelo predijo la profundidad de la napa con un error medio de 25 cm y una eficiencia (Nash-Sutcliffe) promedio de 0,88. Mientras que en validación el error medio fue de 39 cm y la eficiencia media fue de 0,73. Respecto a la concentración de N-NO3 en agua se observó un efecto significativo de la posición en el paisaje y de la profundidad de la napa. El 52% de las muestras superaron los 10 mg L-1, independientemente de la dosis de N aplicado como fertilizantes, y mayormente relacionado a las excesivas precipitaciones del invierno del año 2012.Esto implicaría que una proporción significativa de nitratos lixiviados, provendría del proceso natural de mineralización del carbono orgánica del suelo.Groundwater table depth and nitrate (NO3-N) concentration were studied in agricultural fields, in western Buenos Aires Province, Argentina. DRAINMOD, a process-based and field-scale hydrological model was calibrated and validated for studying groundwater table depth control strategies, at 12 farms located within a radius of 100 km, using records from 2004 to 2012. Pedotransfer functions were evaluated and applied to setup model inputs. A second set of observation wells were installed in 2011 to take monthly groundwater samples for studying NOsub -N concentration under different crops, at three landscape positions (upper, middle and lower hill) at seven farms. Model performance was evaluated in order to be used as a decision support system to estimate the impact of potential management, land use and climate scenarios, on groundwater table dynamics. Likewise, groundwater control strategies were analyzed for agricultural sandy soils of Western Pampa, combining tile drains, crop rotations and pastures, on the landscape. All observations considered, DRAINMOD predicted daily groundwater table depth with an average Nash-Sutcliffe efficiency (NSE) of 0.88, and an average RMSE of 25 cm. At validation, the model presented an average RMSE of 39 cm and NSE of 0.73. Drainmod was also used to estimate groundwater table changes under different land use changes, As for NO3-N concentration, a significant effect of the landscape position and water table depth was observed. Considering 10 mg L-1 NO3-N as a standard limit, 52% of the observations exceeded this value, regardless N fertilization rates and mostly related to unusual precipitations events during winter 2012. Results showed that a significant proportion of leached nitrate would came from the natural process of mineralization of soil organic matter.Instituto de Tecnología de AlimentosFil: Vázquez Amabile, Gabriel G. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola (AACREA). Unidad de Investigación y Desarrollo; Argentina. Universidad Nacional de La Plata. Escuela de Bosques. Posgrado en Manejo Integral de Cuencas Hidrográficas; ArgentinaFil: Bosch, Nicolas. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola (AACREA). Unidad de Investigación y Desarrollo; ArgentinaFil: Ricca, Alejandra Patricia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Tecnología de Alimentos; ArgentinaFil: Rojas, Dante Emanuel. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Tecnología de Alimentos; ArgentinaFil: Ortiz de Zárate, María L. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola (AACREA). Unidad de Investigación y Desarrollo; ArgentinaFil: Lascombes, Joaquín. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola (AACREA). Unidad de Investigación y Desarrollo; ArgentinaFil: Feiguín, María F. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola (AACREA). Unidad de Investigación y Desarrollo; ArgentinaFil: Cristos, Diego Sebastian. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Tecnología de Alimentos; Argentin

A 10.5-year follow-up of walking with unilateral spastic cerebral palsy.

The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years. Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t-tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed. Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, p < 0.001) were negatively correlated. SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group. This was a retrospective comparative therapeutic study (level III)