Anatomía y función de la articulación coxofemoral. Anatomía artroscópica de la cadera

ResumenObjetivoLa anatomía de la cadera presenta una serie de peculiaridades que condicionan el tratamiento artroscópico de su patología. El objetivo de la presente publicación es describir los hallazgos anatómicos y biomecánicos más destacados para la aplicación clínica y terapéutica.MétodoDividiremos el capítulo en biomecánica de la cadera con aplicación clínica y las estructuras anatómicas según estén en el compartimento central o en periférico.ResultadosLa necesidad de tracción para poder acceder a la articulación y la dificultad de movilidad dentro de la misma, nos obliga a conocer la anatomía normal y sus variantes. En el compartimento central describiremos estructuras como el labrum, cartílago acetabular, ligamento redondo, fosita semilunar y cartílago de carga de la cabeza femoral. En el compartimento periférico se observará el cartílago de la cabeza, cara no articular del labrum, cápsula y diferentes plicas sinoviales.ConclusionesConocer la anatomía artroscópica y sus variantes, junto con nociones básicas de biomecánica de la cadera, nos permiten mejorar nuestra orientación en una articulación de difícil acceso.Relevancia clínicaEl conocimiento de la anatomía artroscópica y la biomecánica aplicada de la cadera nos permite acortar nuestra curva de aprendizaje quirúrgico en artroscopia de cadera.Nivel de evidenciaOpinión de expertos Nivel IV.AbstractObjectiveHip joint anatomy has a number of peculiarities that determine the arthroscopic treatment. The aim of this article is to describe the most significant anatomical and biomechanical findings for clinical and therapeutic applications.MethodWe divide the chapter into hip biomechanics with clinical application and anatomical structures of the central or peripheral compartment.ResultsAccess and mobility into the hip joint is difficult, and requires understanding the normal anatomy and its variants. In the central compartment, we describe important structures such as the labrum, acetabular cartilage, round ligament, acetabular cartilage, and cartilage of the femoral head. In the peripheral compartment, femoral head cartilage, non-articular labrum, capsule and synovial folds are described.ConclusionsUnderstanding hip arthroscopic anatomy and its variants, along with the basics of hip biomechanics, allow us to improve our orientation in a joint with a difficult access.Clinical relevanceThe knowledge of applied anatomy and arthroscopic hip biomechanics allows us to reduce our surgical learning curve in hip arthroscopy technique.Level of evidenceLevel IV Expert opinion

¿Es la escritura académica odontológica hispanoamericana un discurso matizado? Estudio de la atenuación en artículos de investigación

This paper is part of a wider research project which studies the academic writing of the dental Hispano-American community. It aims to describe and to analyze which hedging strategies are used and for what purpose in 40 dental research papers published in Hispano-American journals (1 Venezuelan, 1 Cuban and 2 Spanish) between 1999 and 2005. The frequency of use of hedges in the different rhetorical sections of the dental papers is analyzed: introduction, method, results, discussion and conclusions. In addition, we compare the use of hedging strategies according to the section, journal and nationality. It was found that impersonal constructions and approximators predominated, followed by shields. However, deictics and the compound hedges reported less frequency. Introduction and discussion were the most heavily hedged sections. Nevertheless, hedges were also registered, mainly impersonal type, in method and results sections. Conclusion was the least hedged section. Shields, deictics and compound hedges were found mainly in the introduction and the discussion sections. On the other hand, approximators, shields and impersonal constructions were used in all the sections. The comparisons of our results show statistically significant differences in the use of hedges according to the rhetorical section, and the nationality; we also found differences between the frequencies of use of the five hedging strategies. Hedging is a very frequent strategy in the dental Hispanic RP; therefore, we propose its formal teaching in the dental academic writing courses.&nbsp

Polyurethane Scaffold vs Fascia Lata Autograft for Hip Labral Reconstruction : Comparison of Femoroacetabular Biomechanics

The integrity of the acetabular labrum is critical in providing normal function and minimizing hip degeneration and is considered key for success in today's hip preservation algorithm. Many advances have been made in labral repair and reconstruction to restore the suction seal. To compare the biomechanical effects of segmental labral reconstruction between the synthetic polyurethane scaffold (PS) and fascia lata autograft (FLA). Our hypothesis was that reconstruction with a macroporous polyurethane implant and autograft reconstruction of fascia lata would normalize hip joint kinetics and restore the suction seal. Controlled laboratory study. Ten cadaveric hips from 5 fresh-frozen pelvises underwent biomechanical testing with a dynamic intra-articular pressure measurement system under 3 conditions: (1) intact labrum, (2) reconstruction with PS after a 3-cm segmental labrectomy, then (3) reconstruction with FLA. Contact area, contact pressure, and peak force were evaluated in 4 positions: 90º of flexion in neutral, 90º of flexion plus internal rotation, 90º of flexion plus external rotation, and 20º of extension. A labral seal test was performed for both reconstruction techniques. The relative change from the intact condition (value = 1) was determined for all conditions and positions. PS restored contact area to at least 96% of intact (≥0.96; range, 0.96-0.98) in all 4 positions, and FLA restored contact area to at least 97% (≥0.97; range, 0.97-1.19). Contact pressure was restored to ≥1.08 (range, 1.08-1.11) with the PS and ≥1.08 (range, 1.08-1.10) with the FLA technique. Peak force returned to ≥1.02 (range, 1.02-1.05) with PS and ≥1.02 (range, 1.02-1.07) with FLA. No significant differences were found between the reconstruction techniques in contact area in any position (P >.06), with the exception that FLA presented greater contact area in flexion plus internal rotation as compared with PS (P =.003). Suction seal was confirmed in 80% of PSs and 70% of FLAs (P = .62). Segmental hip labral reconstruction using PS and FLA reapproximated femoroacetabular contact biomechanics close to the intact state. These findings provide preclinical evidence supporting the use of a synthetic scaffold as an alternative to FLA and therefore avoiding donor site morbidity

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

Background: Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. Hypothesis: We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. Methods: This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. Results: The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, “type of surgery” was the only variable that showed a statistically significant association with HO (p = 0.007). Conclusion: Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature

European journalism observatory: An international consolidated platform for training and professional networks in the Faculty of Information Sciences

El objetivo principal de este proyecto Innova-Docenia era ampliar y consolidar una plataforma de formación internacional y consolidada, para alumnos y alumnas de la Facultad de Ciencias de la Información, como parte del European Journalism Observatory (EJO), fundado por el Instituto Reuters de la Universidad de Oxford. Se trataba de afianzar EJO Spain como plataforma de formación y escaparate de las acciones implementadas en España, donde la Universidad Complutense de Madrid se convertía en el socio español principal. El Observatorio Europeo de Periodismo (EJO), una red de instituciones independientes y sin ánimo de lucro del campo de la comunicación de 14 países, tiene como objetivo tender puentes entre la investigación y la práctica del periodismo en Europa y fomentar el profesionalismo y la libertad de prensa. Promueve el diálogo entre investigadores y profesionales de los medios. Acerca los resultados de la investigación a las personas que trabajan en los medios. Su objetivo es mejorar la calidad del periodismo, contribuir a una mejor comprensión de los medios y fomentar la libertad de prensa y la responsabilidad de los medios. Nació en 2004, como una red de varios socios europeos, coordinados por la Universidad de Lugano y la Universidad de Oxford. Fue diseñado para observar las tendencias en el periodismo y en los medios de comunicación, desde una perspectiva ética y deontológica muy amplia. Desde entonces, sus artículos, investigaciones y editoriales son publicados en las distintas páginas web de cada socio: https://es.ejo-online.eu/red-ej

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries