26Postoperative diagnosis and outcome in patients with revision arthroplasty for aseptic loosening

BACKGROUND: The most common cause of implant failure is aseptic loosening (AL), followed by prosthetic joint infection (PJI). This study evaluates the incidence of PJI among patients operated with suspected AL and whether the diagnosis of PJI was predictive of subsequent implant failure including re-infection, at 2 years of follow up. METHODS: Patients undergoing revision hip or knee arthroplasty due to presumed AL from February 2009 to September 2011 were prospectively evaluated. A sonication fluid of prosthesis and tissue samples for microbiology and histopathology at the time of the surgery were collected. Implant failure include recurrent or persistent infection, reoperation for any reason or need for chronic antibiotic suppression. RESULTS: Of 198 patients with pre-and intraoperative diagnosis of AL, 24 (12.1 %) had postoperative diagnosis of PJI. After a follow up of 31 months (IQR: 21 to 38 months), 9 (37.5 %) of 24 patients in the PJI group had implant failure compared to only 1 (1.1 %) in the 198 of AL group (p 20 CFU) and peri-prosthetic tissue culture were 87.5 % vs 66.7 %, respectively. Specificities were 100 % for both techniques (95 % CI, 97.9-100 %). A greater number of patients with PJI (79.1 %) had previous partial arthroplasty revisions than those patients in the AL group (56.9 %) (p = 0.04). In addition, 5 (55.5 %) patients with PJI and implant failure had more revision arthroplasties during the first year after the last implant placement than those patients with PJI without implant failure (1 patient; 6.7 %) (RR 3.8; 95 % CI 1.4-10.1; p = 0.015). On the other hand, 6 (25 %) patients finally diagnosed of PJI were initially diagnosed of AL in the first year after primary arthroplasty, whereas it was only 16 (9.2 %) patients in the group of true AL (RR 2.7; 95 % CI 1.2-6.1; p = 0.03). CONCLUSIONS: More than one tenth of patients with suspected AL are misdiagnosed PJI. Positive histology and positive peri-implant tissue and sonicate fluid cultures are highly predictive of implant failure in patients with PJI. Patients with greater number of partial hip revisions for a presumed AL had more risk of PJI. Early loosening is more often caused by hidden PJI than late loosening

El imaginario tecnológico de Domingo Faustino Sarmiento: representaciones y arquetipos de América (1845-1885)

The paper explores the technical dimension of Domingo Faustino Sarmiento’s imaginary and its influence on the construction of representations concerning nature, human types, progress of nations, and scientific personalities. As we will see, the influential Argentine statesman and writer creates, from a technologistic perspective, a wide variety of images and archetypes which can be traced in different publications. The aim of this paper is then to present these different types of symbolic features as a result of his technological attitude and to expose them according to a division that comprises four categories: the first one is devoted to images of an hostile nature; the second one examines the human archetypes he considers; the third one deals with the model nations (in particular, as a result of his trip to the United States), and the fourth one focuses on the treatment of scientists and engineers as heroes and agents of progress.El artículo examina la dimensión técnica del imaginario de Domingo Faustino Sarmiento y su influencia en la construcción de representaciones sobre la naturaleza, los tipos humanos, el progreso de las naciones, la educación y los personajes científicos. Como se verá, el influyente estadista argentino crea desde una mirada tecnologista una amplia variedad de imágenes y arquetipos que pueden reconocerse en diversas obras. El propósito del trabajo es pues la presentación de estos símbolos como un resultado de su actitud tecnológica y su exposición siguiendo una división que comprende cuatro categorías: la primera dedicada a las imágenes de una naturaleza hostil; la segunda a los arquetipos humanos; la tercera a las naciones modelo (en especial, como resultado de su viaje a Estados Unidos) y la cuarta al tratamiento de la figura del científico y del tecnólogo como héroes y agentes del progreso

Identification of Histological Patterns in Clinically Affected and Unaffected Palm Regions in Dupuytren's Disease

Dupuytren's disease is a fibro-proliferative disease characterized by a disorder of the extracellular matrix (ECM) and high myofibroblast proliferation. However, studies failed to determine if the whole palm fascia is affected by the disease. The objective of this study was to analyze several components of the extracellular matrix of three types of tissues—Dupuytren's diseased contracture cords (DDC), palmar fascia clinically unaffected by Dupuytren's disease contracture (NPF), and normal forehand fascia (NFF). Histological analysis, quantification of cells recultured from each type of tissue, mRNA microarrays and immunohistochemistry for smooth muscle actin (SMA), fibrillar ECM components and non-fibrillar ECM components were carried out. The results showed that DDC samples had abundant fibrosis with reticular fibers and few elastic fibers, high cell proliferation and myofibroblasts, laminin and glycoproteins, whereas NFF did not show any of these findings. Interestingly, NPF tissues had more cells showing myofibroblasts differentiation and more collagen and reticular fibers, laminin and glycoproteins than NFF, although at lower level than DDC, with similar elastic fibers than DDC. Immunohistochemical expression of decorin was high in DDC, whereas versican was highly expressed NFF, with no differences for aggrecan. Cluster analysis revealed that the global expression profile of NPF was very similar to DDC, and reculturing methods showed that cells corresponding to DDC tissues proliferated more actively than NPF, and NPF more actively than NFF. All these results suggest that NPF tissues may be affected, and that a modification of the therapeutic approach used for the treatment of Dupuytren's disease should be considered.This work was supported by CTS-115 (Tissue Engineering Group), University of Granada/Spain

Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding

GOODS-ALMA 2.0: starbursts in the main sequence reveal compact star formation regulating galaxy evolution prequenching

Compact star formation appears to be generally common in dusty star-forming galaxies (SFGs). However, its role in the framework set by the scaling relations in galaxy evolution remains to be understood. In this work we follow up on the galaxy sample from the GOODS-ALMA 2.0 survey, an ALMA blind survey at 1.1 mm covering a continuous area of 72.42 arcmin2 using two array configurations. We derived physical properties, such as star formation rates, gas fractions, depletion timescales, and dust temperatures for the galaxy sample built from the survey. There exists a subset of galaxies that exhibit starburst-like short depletion timescales, but they are located within the scatter of the so-called main sequence of SFGs. These are dubbed starbursts in the main sequence and display the most compact star formation and they are characterized by the shortest depletion timescales, lowest gas fractions, and highest dust temperatures of the galaxy sample, compared to typical SFGs at the same stellar mass and redshift. They are also very massive, accounting for ∼60% of the most massive galaxies in the sample (log(M*/M⊙) > 11.0). We find trends between the areas of the ongoing star formation regions and the derived physical properties for the sample, unveiling the role of compact star formation as a physical driver of these properties. Starbursts in the main sequence appear to be the extreme cases of these trends. We discuss possible scenarios of galaxy evolution to explain the results drawn from our galaxy sample. Our findings suggest that the star formation rate is sustained in SFGs by gas and star formation compression, keeping them within the main sequence even when their gas fractions are low and they are presumably on the way to quiescence

Objetivo Madrid: planes de ocupación y concepción del orden público durante la Guerra Civil española

This article looks at Spanish Civil War and violence in those days from a different point of view. On the one hand, I try to explain the military coup of July 1936 as a reaction against the experience of Modernity in the spanish cities, focusing on Madrid. On the other, I try to go in depth into the functional logic of violence instead of the hegemonic historiographical proposals. It is necessary to explain the sequence 2nd Republic-Coup-War in the mid-long range to understand the significance of Francoist Public Order model. Using the occupation plan for Madrid by Franco’s Headquarters and Servicio de Recuperación de Documentos paperwork, this article attempts to get the Dictatorship’s view about public space and sociocultural transformations in the early decades of XXth Century.El presente texto pretende ofrecer una nueva visión sobre la Guerra Civil y la violencia ejercida en su marco. Por un lado, trata de explicar la sublevación de 1936 como una reacción al proceso de Modernidad experimentado principalmente en la España urbana, y concretamente en Madrid. Por otro, procura adentrarse en la lógica funcional de la violencia en detrimento de los presupuestos exterministas dominantes en la historiografía española. Es necesario ampliar la secuencia explicativa II República-sublevación-guerra para comprender el 18 de julio desde unos parámetros más dilatados, que proyectan las expresiones de la violencia durante el conflicto hacia la posguerra a través de la gestión del orden público. Mediante el Servicio de Recuperación de Documentos y del Cuartel General del Generalísimo se documenta el plan de ocupación para Madrid. Una fuente sin duda novedosa para comprender la concepción franquista de lo que debía ser el espacio público y comprobar cómo se materializaron las bases sobre las que debía construirse el rechazo a los cambios producidos en el primer tercio del siglo xx, percibidos como una amenaza a los valores tradicionales

Modality matters for the expression of inducible defenses: introducing a concept of predator modality

Background: Inducible defenses are a common and widespread form of phenotypic plasticity. A fundamental factor driving their evolution is an unpredictable and heterogeneous predation pressure. This heterogeneity is often used synonymously to quantitative changes in predation risk, depending on the abundance and impact of predators. However, differences in `modality', that is, the qualitative aspect of natural selection caused by predators, can also cause heterogeneity. For instance, predators of the small planktonic crustacean Daphnia have been divided into two functional groups of predators: vertebrates and invertebrates. Predators of both groups are known to cause different defenses, yet predators of the same group are considered to cause similar responses. In our study we question that thought and address the issue of how multiple predators affect the expression and evolution of inducible defenses. Results: We exposed D. barbata to chemical cues released by Triops cancriformis and Notonecta glauca, respectively. We found for the first time that two invertebrate predators induce different shapes of the same morphological defensive traits in Daphnia, rather than showing gradual or opposing reaction norms. Additionally, we investigated the adaptive value of those defenses in direct predation trials, pairing each morphotype (non-induced, Triops-induced, Notonecta-induced) against the other two and exposed them to one of the two predators. Interestingly, against Triops, both induced morphotypes offered equal protection. To explain this paradox we introduce a `concept of modality' in multipredator regimes. Our concept categorizes two-predator-prey systems into three major groups (functionally equivalent, functionally inverse and functionally diverse). Furthermore, the concept includes optimal responses and costs of maladaptions of prey phenotypes in environments where both predators co-occur or where they alternate. Conclusion: With D. barbata, we introduce a new multipredator-prey system with a wide array of morphological inducible defenses. Based on a `concept of modality', we give possible explanations how evolution can favor specialized defenses over a general defense. Additionally, our concept not only helps to classify different multipredator-systems, but also stresses the significance of costs of phenotype-environment mismatching in addition to classic `costs of plasticity'. With that, we suggest that `modality' matters as an important factor in understanding and explaining the evolution of inducible defenses