Tratamiento quirúrgico con placa bloqueada en fracturas de fémur distal tipo C en pacientes mayores de 60 años

Objetivo. Determinar el resultado clínico, radiológico y complicaciones asociadas del tratamiento con placa bloqueada en fracturas distales de fémur tipo C en pacientes mayores de 60 años. Material y métodos. Estudio descriptivo retrospectivo de 16 pacientes. Se registraron variables epidemiológicas, comorbilidades, complicaciones y resultados clínicos y radiológicos. Resultados. Edad media de 75,3 años. El seguimiento medio fue de 13,5 meses. La flexión media postoperatoria de la rodilla fue de 61,6º. Sólo un 12,5% de los pacientes no referían gonalgia ni precisaban ayudas para la deambulación al final del seguimiento. Radiológicamente, en un 68,7% la translación femoral era mayor de 5 mm, y en un 31,3% la reducción en el plano lateral no era correcta. Se consiguió la consolidación de la fractura en 13 pacientes (86,6%), con un tiempo medio de 10,2 semanas. Como complicaciones hubo una pseudoartrosis, una consolidación viciosa y una infección. Discusión. El tratamiento de la fractura distal de fémur con placa bloqueada viene avalado en la literatura como un método fiable. Sin embargo, en nuestra serie, hemos tenido un alto porcentaje de malos resultados clínicos con presencia de dolor en la rodilla y necesidad de ayudas para la deambulación.Objective. To evaluate functional and radiographic results, and complications, after surgical treatment with locked plate in fractures of the distal femur in patients 60 years old or older. Material and methods. We reviewed 16 patients. We recorded epidemiological variables, comorbidities, functional and radiographic results. Results. Mean aged of 75,3 years. Mean follow-up of 13,5 months. Mean knee flexion of 61,6º. Only 12,5% of the patients did not refer knee pain and walked unaided. Radiologically, in 68,7% of the patients femoral translation was greater than 5 mm, and in 31,3% lateral reduction was not correct. Fracture healed in 13 patients (86,6%), in a mean time of 10,2 weeks. There were 1 nonunion, 1 malunion, and 1 infection. Discussion. Locked plating is a realiable treatment for distal femoral fractures. But, in our elderly serie, we experienced bad clinical results with high percentage of knee pain and walking aid

Fracturas de estrés en la escápula y factores de riesgo : a propósito de un caso y revisión de la literatura

Scapula stress fracture is an uncommon injury. Some cases have been described in sportsmen, handworkers, rotator cuff arthropathy and reversed shoulder arthroplasty; being infrequent the association with crutch´s repetitive load. Treatment should be individualized and depends of patient characteristics, comorbidities and displacement. The article describes a case of a scapular spine´s stress fracture, and a literature review is being performed. Case Report is an 86 year old woman with corticoids treatment history and ilio-pubic ramus fracture. She walked with a crutch since that fractures. Patient begins gradually with pain and limited mobility in shoulder without trauma. CT scan showed fracture of the scapula spine suggesting a stress fracture as the main diagnostic option. Conservative treatment was performed, obtaining good functional results and a DASH of 21.6 points

Phenotypic Characteristics and Copy Number Variants in a Cohort of Colombian Patients with VACTERL Association

VACTERL association (OMIM 192350) is a heterogeneous clinical condition characterized by congenital structural defects that include at least 3 of the following features: vertebral abnormalities, anal atresia, heart defects, tracheoesophageal fistula, renal malformations, and limb defects. The nonrandom occurrence of these malformations and some familial cases suggest a possible association with genetic factors such as chromosomal alterations, gene mutations, and inherited syndromes such as Fanconi anemia (FA). In this study, the clinical phenotype and its relationship with the presence of chromosomal abnormalities and FA were evaluated in 18 patients with VACTERL association. For this, a G-banded karyotype, array-comparative genomic hybridization, and chromosomal fragility test for FA were performed. All patients (10 female and 8 male) showed a broad clinical spectrum: 13 (72.2%) had vertebral abnormalities, 8 (44.4%) had anal atresia, 14 (77.8%) had heart defects, 8 (44.4%) had esophageal atresia, 10 (55.6%) had renal abnormalities, and 10 (55.6%) had limb defects. Chromosomal abnormalities and FA were ruled out. In 2 cases, the finding of microalterations, namely del(15)(q11.2) and dup(17)(q12), explained the phenotype; in 8 cases, copy number variations were classified as variants of unknown significance and as not yet described in VACTERL. These variants comprise genes related to important cellular functions and embryonic development

Light Curves of the Neutron Star Merger GW170817/SSS17a: Implications for R-Process Nucleosynthesis

On 2017 August 17, gravitational waves were detected from a binary neutron star merger, GW170817, along with a coincident short gamma-ray burst, GRB170817A. An optical transient source, Swope Supernova Survey 17a (SSS17a), was subsequently identified as the counterpart of this event. We present ultraviolet, optical and infrared light curves of SSS17a extending from 10.9 hours to 18 days post-merger. We constrain the radioactively-powered transient resulting from the ejection of neutron-rich material. The fast rise of the light curves, subsequent decay, and rapid color evolution are consistent with multiple ejecta components of differing lanthanide abundance. The late-time light curve indicates that SSS17a produced at least ~0.05 solar masses of heavy elements, demonstrating that neutron star mergers play a role in r-process nucleosynthesis in the Universe.Comment: Accepted to Scienc

No silver bullet for digital soil mapping: country-specific soil organic carbon estimates across Latin America.

Country-specific soil organic carbon (SOC) estimates are the baseline for the Global SOC Map of the Global Soil Partnership (GSOCmap-GSP). This endeavor is key to explaining the uncertainty of global SOC estimates but requires harmonizing heterogeneous datasets and building country-specific capacities for digital soil mapping (DSM).We identified country-specific predictors for SOC and tested the performance of five predictive algorithms for mapping SOC across Latin America. The algorithms included support vector machines (SVMs), random forest (RF), kernel-weighted nearest neighbors (KK), partial least squares regression (PL), and regression kriging based on stepwise multiple linear models (RK). Country-specific training data and SOC predictors (5 x 5 km pixel resolution) were obtained from ISRIC - World Soil Information. Temperature, soil type, vegetation indices, and topographic constraints were the best predictors for SOC, but country-specific predictors and their respective weights varied across Latin America. We compared a large diversity of country-specific datasets and models, and were able to explain SOC variability in a range between ~ 1 and ~ 60 %, with no universal predictive algorithm among countries. A regional (n = 11 268 SOC estimates) ensemble of these five algorithms was able to explain ~ 39% of SOC variability from repeated 5-fold cross-validation.We report a combined SOC stock of 77.8 +- 43.6 Pg (uncertainty represented by the full conditional response of independent model residuals) across Latin America. SOC stocks were higher in tropical forests (30 +- 16.5 Pg) and croplands (13 +- 8.1 Pg). Country-specific and regional ensembles revealed spatial discrepancies across geopolitical borders, higher elevations, and coastal plains, but provided similar regional stocks (77.8 +- 42.2 and 76.8 +- 45.1 Pg, respectively). These results are conservative compared to global estimates (e.g., SoilGrids250m 185.8 Pg, the Harmonized World Soil Database 138.4 Pg, or the GSOCmap-GSP 99.7 Pg). Countries with large area (i.e., Brazil, Bolivia, Mexico, Peru) and large spatial SOC heterogeneity had lower SOC stocks per unit area and larger uncertainty in their predictions. We highlight that expert opinion is needed to set boundary prediction limits to avoid unrealistically high modeling estimates. For maximizing explained variance while minimizing prediction bias, the selection of predictive algorithms for SOC mapping should consider density of available data and variability of country-specific environmental gradients. This study highlights the large degree of spatial uncertainty in SOC estimates across Latin America. We provide a framework for improving country-specific mapping efforts and reducing current discrepancy of global, regional, and country-specific SOC estimates

Night Myopia Studied with an Adaptive Optics Visual Analyzer

PURPOSE: Eyes with distant objects in focus in daylight are thought to become myopic in dim light. This phenomenon, often called "night myopia" has been studied extensively for several decades. However, despite its general acceptance, its magnitude and causes are still controversial. A series of experiments were performed to understand night myopia in greater detail. METHODS: We used an adaptive optics instrument operating in invisible infrared light to elucidate the actual magnitude of night myopia and its main causes. The experimental setup allowed the manipulation of the eye's aberrations (and particularly spherical aberration) as well as the use of monochromatic and polychromatic stimuli. Eight subjects with normal vision monocularly determined their best focus position subjectively for a Maltese cross stimulus at different levels of luminance, from the baseline condition of 20 cd/m(2) to the lowest luminance of 22 × 10(-6) cd/m(2). While subjects performed the focusing tasks, their eye's defocus and aberrations were continuously measured with the 1050-nm Hartmann-Shack sensor incorporated in the adaptive optics instrument. The experiment was repeated for a variety of controlled conditions incorporating specific aberrations of the eye and chromatic content of the stimuli. RESULTS: We found large inter-subject variability and an average of -0.8 D myopic shift for low light conditions. The main cause responsible for night myopia was the accommodation shift occurring at low light levels. Other factors, traditionally suggested to explain night myopia, such as chromatic and spherical aberrations, have a much smaller effect in this mechanism. CONCLUSIONS: An adaptive optics visual analyzer was applied to study the phenomenon of night myopia. We found that the defocus shift occurring in dim light is mainly due to accommodation errors

Vicious and Virtuous Cycles and the Role of External Non-government Actors in Community Forestry in Oaxaca and Michoacán, Mexico

Community forestry offers potential for socioeconomic benefits while maintaining ecosystem services. In Mexico, government and donor efforts to develop this sector focus on issues within forest communities. Often overlooked are effects of external non-government actors (NGOs and foresters) as links or barriers between communities and funding, capacity building, and technical support. To analyze the role of these actors, I analyze household survey and interview data from 11 communities with varying levels of vertical integration of forestry production in states with divergent records of community forestry, Oaxaca and Michoacán. Results suggest that strong community governance is necessary but not sufficient for vertical integration, and strong interactions with non-government actors are critical. These actors, operating within the existing framework of government regulations, have a range of incentives for engaging communities. Availability of these actors motivated by concern for community capacity instead of timber income may be a determinant of community forestry development

The Eighth Data Release of the Sloan Digital Sky Survey: First Data from SDSS-III

The Sloan Digital Sky Survey (SDSS) started a new phase in August 2008, with new instrumentation and new surveys focused on Galactic structure and chemical evolution, measurements of the baryon oscillation feature in the clustering of galaxies and the quasar Ly alpha forest, and a radial velocity search for planets around ~8000 stars. This paper describes the first data release of SDSS-III (and the eighth counting from the beginning of the SDSS). The release includes five-band imaging of roughly 5200 deg^2 in the Southern Galactic Cap, bringing the total footprint of the SDSS imaging to 14,555 deg^2, or over a third of the Celestial Sphere. All the imaging data have been reprocessed with an improved sky-subtraction algorithm and a final, self-consistent photometric recalibration and flat-field determination. This release also includes all data from the second phase of the Sloan Extension for Galactic Understanding and Evolution (SEGUE-2), consisting of spectroscopy of approximately 118,000 stars at both high and low Galactic latitudes. All the more than half a million stellar spectra obtained with the SDSS spectrograph have been reprocessed through an improved stellar parameters pipeline, which has better determination of metallicity for high metallicity stars.Comment: Astrophysical Journal Supplements, in press (minor updates from submitted version

The Ninth Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the SDSS-III Baryon Oscillation Spectroscopic Survey

The Sloan Digital Sky Survey III (SDSS-III) presents the first spectroscopic data from the Baryon Oscillation Spectroscopic Survey (BOSS). This ninth data release (DR9) of the SDSS project includes 535,995 new galaxy spectra (median z=0.52), 102,100 new quasar spectra (median z=2.32), and 90,897 new stellar spectra, along with the data presented in previous data releases. These spectra were obtained with the new BOSS spectrograph and were taken between 2009 December and 2011 July. In addition, the stellar parameters pipeline, which determines radial velocities, surface temperatures, surface gravities, and metallicities of stars, has been updated and refined with improvements in temperature estimates for stars with T_eff<5000 K and in metallicity estimates for stars with [Fe/H]>-0.5. DR9 includes new stellar parameters for all stars presented in DR8, including stars from SDSS-I and II, as well as those observed as part of the SDSS-III Sloan Extension for Galactic Understanding and Exploration-2 (SEGUE-2). The astrometry error introduced in the DR8 imaging catalogs has been corrected in the DR9 data products. The next data release for SDSS-III will be in Summer 2013, which will present the first data from the Apache Point Observatory Galactic Evolution Experiment (APOGEE) along with another year of data from BOSS, followed by the final SDSS-III data release in December 2014.Comment: 9 figures; 2 tables. Submitted to ApJS. DR9 is available at http://www.sdss3.org/dr

Syncytiotrophoblast derived extracellular vesicles transfer functional placental miRNAs to primary human endothelial cells

During the pregnancy associated syndrome preeclampsia (PE), there is increased release of placental syncytiotrophoblast extracellular vesicles (STBEVs) and free foetal haemoglobin (HbF) into the maternal circulation. In the present study we investigated the uptake of normal and PE STBEVs by primary human coronary artery endothelial cells (HCAEC) and the effects of free HbF on this uptake. Our results show internalization of STBEVs into primary HCAEC, and transfer of placenta specific miRNAs from STBEVs into the endoplasmic reticulum and mitochondria of these recipient cells. Further, the transferred miRNAs were functional, causing a down regulation of specific target genes, including the PE associated gene fms related tyrosine kinase 1 (FLT1). When co-treating normal STBEVs with HbF, the miRNA deposition is altered from the mitochondria to the ER and the cell membrane becomes ruffled, as was also seen with PE STBEVs. These findings suggest that STBEVs may cause endothelial damage and contribute to the endothelial dysfunction typical for PE. The miRNA mediated effects on gene expression may contribute to the oxidative and endoplasmic reticulum stress described in PE, as well as endothelial reprogramming that may underlay the increased risk of cardiovascular disease reported for women with PE later in life