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Here, we describe a case of a 5-year-old show-jumping stallion presented with severe lameness, swelling, and pain on palpation of the left metacarpophalangeal joint (MCj). Diagnostic imaging revealed full and partial-thickness articular defects over the lateral condyle of the third metacarpus (MC3) and the dorsolateral aspect of the first phalanx (P1). After the lesion's arthroscopic curettage, the patient was subjected to an innovative regenerative treatment consisting of two intra-articular injections of equine synovial membrane mesenchymal stem/stromal cells (eSM-MSCs) combined with umbilical cord mesenchymal stem/stromal cells conditioned medium (UC-MSC CM), 15 days apart. A 12-week rehabilitation program was accomplished, and lameness, pain, and joint effusion were remarkably reduced; however, magnetic resonance imaging (MRI) and computed tomography (CT) scan presented incomplete healing of the MC3's lesion, prompting a second round of treatment. Subsequently, the horse achieved clinical soundness and returned to a higher level of athletic performance, and imaging exams revealed the absence of lesions at P1, fulfillment of the osteochondral lesion, and cartilage-like tissue formation at MC3's lesion site. The positive outcomes suggest the effectiveness of this combination for treating full and partial cartilage defects in horses. Multipotent mesenchymal stem/stromal cells (MSCs) and their bioactive factors compose a novel therapeutic approach for tissue regeneration and organ function restoration with anti-inflammatory and pro-regenerative impact through paracrine mechanisms.
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INTRODUCTION: Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? METHODS: We conducted a systematic review according to PRISMA guidelines and described our case series. RESULTS: Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6â¯h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75â¯h and 2, respectively. CONCLUSION: Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.
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Isquemia , Priapismo , Priapismo/inducido químicamente , Humanos , Masculino , Isquemia/inducido químicamente , Trastornos Relacionados con Cocaína/complicaciones , Pene/irrigación sanguínea , Adulto , Cocaína/efectos adversos , Persona de Mediana EdadRESUMEN
INTRODUCTION: Carbapenems (CR) have traditionally been the first line treatment for bacteremia caused by AmpC-producing Enterobacterales. However, CR have a high ecological impact, and carbapenem-resistant strains continue rising. Thus, other treatment alternatives like Piperacillin-Tazobactam (P-T) or Cefepime (CEF) and oral sequential therapy (OST) are being evaluated. METHODS: We conducted a retrospective, single-centre observational study. All adult patients with AmpC-producing Enterobacterales bacteremia were included. The primary endpoint was clinical success defined as a composite of clinical cure, 14-day survival, and no adverse events. We evaluated the evolution of patients in whom OST was performed. RESULTS: Seventy-seven patients were included, 22 patients in the CR group and 55 in the P-T/CEF group (37 patients received CEF and 18 P-T). The mean age of the patients was higher in the P-T/CEF group (71 years in CR group vs. 76 years in P-T/CEF group, p = 0.053). In the multivariate analysis, age ≥ 70 years (OR 0.08, 95% CI [0.007-0.966], p = 0.047) and a Charlson index ≥ 3 (OR 0.16, 95% CI [0.026-0.984], p = 0.048), were associated with a lower clinical success. Treatment with P-T/CEF was associated with higher clinical success (OR 7.75, 95% CI [1.273-47.223], p = 0.026). OST was performed in 47% of patients. This was related with a shorter in-hospital stay (OST 14 days [7-22] vs. non-OST 18 days [13-38], p = 0.005) without difference in recurrence (OST 3% vs. non-OST 5%, p = 0.999). CONCLUSIONS: Targeted treatment with P-T/CEF and OST could be safe and effective treatments for patients with AmpC-producing Enterobacterales bacteremia.
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Bacteriemia , Sepsis , Adulto , Humanos , Anciano , Estudios Retrospectivos , Cefepima/uso terapéutico , Bacteriemia/tratamiento farmacológico , Carbapenémicos/uso terapéutico , Combinación Piperacilina y Tazobactam/uso terapéuticoRESUMEN
Teratomas are gonadal or extragonadal neoplasms, derived from the three embryonic tissues, composed of germ cells of the neuroectoderm, mesoderm and ectoderm. Congenital orbital teratoma (OCT) commonly affects the left orbit, primarily affecting women over men at a ratio of 2:1. We present the case of a female patient of 9 days of extrauterine life with a left mature congenital orbital teratoma. The orbit and oculoplastic service performed an orbital exenteration and total resection of the tumor mass.
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Neoplasias Orbitales , Teratoma , Masculino , Humanos , Femenino , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Teratoma/diagnóstico por imagen , Teratoma/cirugía , Teratoma/congénito , Órbita , Evisceración OrbitariaRESUMEN
AIM: To compare the in vivo bone formation capacity of of biomaterials designed as bone substitutes with respect to iliac crest autograft, one based on carbonate hydroxiapatite and the other one on bioactive mesoporous glass. MATERIALS AND METHODS: Experimental study consisting on 14 adult female New Zeland rabbits where a critical defect was made in the rabbit radius bone. The sample was divided into four groups: defect without material, with iliac crest autograft, with carbonatehydroxyapatite scaffold, and with bioactive mesoporous glass scaffold. Serial X-ray studies were carried out at 2, 4, 6 and 12 weeks and a microCT study at euthanasia at 6 and 12 weeks. RESULTS: In the X-ray study, autograft group showed the highest bone formation scores. Both groups of biomaterials presented bone formation similar and greater than the defect without material, but always less than in the autograft group. The results of the microCT study showed the largest bone volume in the study area in the autograft group. The groups with bone substitutes presented greater bone volume than the group without material but always less than the autograft group. CONCLUSION: Both scaffolds seem to promote bone formation but are not capable of reproducing the characteristics of autograft. Due to their different macroscopic characteristics, each one could be suitable for a different type of defect.
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AIM: Compare bone formation capacity in vivo of two types of biomaterials designed as bone substitutes with respect to iliac crest autograft, one based on carbonate hydroxyapatites and the other one on bioactive mesoporous glass. MATERIALS AND METHODS: Experimental study consisting on 14 adult female New Zeland rabbits where a critical defect was made in the rabbit radius bone. The sample was divided into four groups: defect without material, with iliac crest autograft, with carbonatehydroxyapatite support, and with bioactive mesoporous glass support. Serial X-ray studies were carried out at 2, 4, 6 and 12 weeks and a microCT study at euthanasia at 6 and 12 weeks. RESULTS: In the X-ray study, autograft group showed the highest bone formation scores. Both groups of biomaterials presented bone formation similar and greater than the defect without material, but always less than in the autograft group. The results of the microCT study showed the largest bone volume in the study area in the autograft group. The groups with bone substitutes presented greater bone volume than the group without material but always less than in the autograft group. CONCLUSION: Both supports seem to promote bone formation but are not capable of reproducing the characteristics of autograft. Due to their different macroscopic characteristics, each one could be suitable for a different type of defect.
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Carbapenem-resistant Enterobacterales (CRE) infections are a major health problem. Intestinal colonization is a key factor in developing infection. However, factors associated with persistent colonization by CRE are unknown. The aim of the study was to identify factors associated with persistent CRE gut colonization. This is a retrospective, single-centre, observational study of adult patients with CRE gut colonization between January 2015 and January 2020. Epidemiologic characteristics, comorbidities, infectious events, duration of hospitalization and antimicrobial treatment received in the follow-up period were collected. Colonization was defined as isolation in at least 2 rectal swab culture samples of CRE. Decolonization was defined as 3 negative rectal swab cultures or 2 negative cultures and a negative molecular test. A cohort of 86 patients with CRE gut colonization was selected: 44 patients with spontaneous decolonization (DC) and 42 patients with persistent colonization (PC). The mean follow-up period was 24 months (IQR 14-33) in the DC group vs. 25 months (IQR 16-36) in the PC group (p = 0.478). Patient characteristics were similar between both groups. Colonization by other MDR microorganisms was high (44 patients, 51%) and slightly more common in the PC group (PC 60% vs. DC 43%, p = 0.139). The use of ceftazidime-avibactam was more common among the PC group (PC 33% vs. DC 14%, p = 0.041). We observed a higher percentage of antimicrobial therapy in the previous 30 days (PC 68% vs. DC 57%, p = 0.371) and 90 days (PC 81% vs. DC 82%, p = 0.353) in the PC group. Multivariable analysis showed that patients that have received ceftazidime-avibactam therapy (OR 4.9 95% CI [1.45-16.39], p = 0.010), and those colonized by other MDR microorganisms (OR 2.5, 95% CI [0.96-6.25], p = 0.060) presented a higher risk of PC. Ceftazidime-avibactam use and colonization by other MDR microorganisms might be associated with CRE persistent gut colonization.
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Infecciones por Enterobacteriaceae , Adulto , Humanos , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Estudios Retrospectivos , Carbapenémicos/uso terapéutico , Antibacterianos/uso terapéutico , Factores de RiesgoRESUMEN
Failure of second-generation tyrosine kinase inhibitors (2GTKI) is a challenging situation in patients with chronic myeloid leukemia (CML). Asciminib, recently approved by the US Federal Drug Administration, has demonstrated in clinical trials a good efficacy and safety profile after failure of 2GTKI. However, no study has specifically addressed response rates to asciminib in ponatinib pretreated patients (PPT). Here, we present data on responses to asciminib from 52 patients in clinical practice, 20 of them (38%) with prior ponatinib exposure. We analyzed retrospectively responses and toxicities under asciminib and compared results between PPT and non-PPT patients.After a median follow-up of 30 months, 34 patients (65%) switched to asciminib due to intolerance and 18 (35%) due to resistance to prior TKIs. Forty-six patients (88%) had received at least 3 prior TKIs. Regarding responses, complete cytogenetic response was achieved or maintained in 74% and 53% for non-PPT and PPT patients, respectively. Deeper responses such as major molecular response and molecular response 4.5 were achieved in 65% and 19% in non-PPT versus 32% and 11% in PPT, respectively. Two patients (4%) harbored the T315I mutation, both PPT.In terms of toxicities, non-PPT displayed 22% grade 3-4 TEAE versus 20% in PPT. Four patients (20% of PPT) suffered from cross-intolerance with asciminib as they did under ponatinib.Our data supports asciminib as a promising alternative in resistant and intolerant non-PPT patients, as well as in intolerant PPT patients; the resistant PPT subset remains as a challenging group in need of further therapeutic options.
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Antineoplásicos , Leucemia Mielógena Crónica BCR-ABL Positiva , Piridazinas , Antineoplásicos/efectos adversos , Resistencia a Antineoplásicos , Proteínas de Fusión bcr-abl/genética , Humanos , Imidazoles , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Niacinamida/análogos & derivados , Inhibidores de Proteínas Quinasas/efectos adversos , Pirazoles , Piridazinas/efectos adversos , Estudios RetrospectivosRESUMEN
Therapeutic options for bacteremia caused by carbapenem-resistant Enterobacterales (CRE) OXA-48-type are limited. The objective of this study was to analyze clinical success of CAZ-AVI compared with best available therapy (BAT) in patients with Klebsiella pneumoniae carbapenemase-producing OXA-48-type bacteremia (CRKp-OXA-48). We conducted a retrospective, single-center observational study in adult patients with CRKp-OXA-48 between December 2015 and May 2019. We collected the patients' clinical and epidemiological characteristics, antibiotic treatment (CAZ-AVI vs. BAT), and evolution. Factors associated with clinical success were analyzed using binary logistic regression. The study included 76 patients with CRKp-OXA-48-type bacteremia 33 received CAZ-AVI and 43 BAT. CAZ-AVI was mainly used in monotherapy (91%). Clinical success was more common in patients < 70-year-old (OR 4.79, 95% CI [1.435-16.002], p = 0.011) and CAZ-AVI treatment (OR 6.69, 95% CI [1.68-26.604], p = 0.007). Kaplan-Meier survival curve of 14-day mortality showed a lower mortality in patients who received CAZ-AVI (log rank 0.013). However, CAZ-AVI did not achieve statistical difference in IPTW for 14- and 30-day mortality (aOR 0.1, 95% CI [0.02-1.22], p = 0.076 and aOR 1.7, 95% CI [0.48-5.98], p = 0.413, respectively). CAZ-AVI treatment might be associated with a greater clinical success in CRKp-OXA-48 bacteremia.
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Bacteriemia , Enterobacteriaceae Resistentes a los Carbapenémicos , Adulto , Anciano , Antibacterianos/uso terapéutico , Compuestos de Azabiciclo , Bacteriemia/tratamiento farmacológico , Proteínas Bacterianas , Ceftazidima/uso terapéutico , Cefalosporinas , Combinación de Medicamentos , Humanos , Klebsiella pneumoniae , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , beta-LactamasasRESUMEN
The objective of this study was to describe prolonged surgical anaesthesia and recovery in fire salamanders (Salamandra salamandra) using tricaine methanesulfonate (MS-222). A total of 14 salamanders were anaesthetised for electromyography wire implantation. Sodium bicarbonate buffered solutions (0.5-4 g l-1) of MS-222 were prepared (adjusted to pH 7.0). Anaesthesia was induced by partial immersion in pre-oxygenated 3 g l-1 solution for 20 min. Buprenorphine (0.5 mg kg-1) was administered subcutaneously. During microsurgery, heart rate (HR), solution pH and temperature were recorded. Reflectance pulse oximeter (SpO2) (Masimo Rad-57) was recorded in two salamanders. Anaesthetic plane and MS-222 pH stability (pH 7.6) were maintained by renewing administration of oxygenated MS-222 solution (0.5-3 g l-1) onto swabs that partially covered the body. Recovery started at the end of surgery (MS-222 0 g l-1). Postoperatively, salamanders were given oral meloxicam (0.2 mg kg-1). Mean time for loss of righting reflex during induction was 13.7 ± 2.2 min. Duration of anaesthesia and time to recovery were 111 ± 24.2 and 31 ± 10.3 min, respectively. Due to complications, two salamanders did not recover. Baseline HR was 67.4 ± 34.5 beats/min, and it decreased significantly until recovery (p ≤ 0.0001). In two salamanders, baseline SpO2 was 85.5% ± 14.5, SpO2 during surgery was 61% ± 6.4, improving to 80.5% ± 2.1 on recovery.In conclusion, prolonged recovery anaesthesia is achievable with MS-222 dilutions in salamander. Reflectance SpO2 could prove valuable during immersion anaesthesia.
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Anestesia , Salamandra , Animales , Aminobenzoatos , Anestesia/métodos , MesilatosRESUMEN
ABSTRACT: Carbapenemase-producing Enterobacterales constitute a serious public health threat; however, information on the oxacilinasa (OXA-48)-type is limited. The objective of the study was to evaluate the risk factors associated with 14-day mortality for patients with bacteremia due to OXA-48 carbapenemase-producing Klebsiella pneumoniae.We conducted a retrospective, single-center observational study of adult patients with K. pneumoniae bacteremia, classifying the strains as carbapenem-susceptible K. pneumoniae (CSKp) and carbapenem-resistant K. pneumoniae (CRKp). All of the CRKp strains were the OXA-48-type.The study included 202 cases of bacteremia: 114 due to CSKp and 88 due to CRKp. The clinical cure rate was higher for the patients with CSKp (85% vs 69% for CSKp and CRKp, respectively; Pâ=â.010), while the 14-day mortality rate was lower (13% vs 30%, Pâ=â.005). An INCREMENT-CPE score ≥7 (HR 3.05, 95% CI 1.50-6.25, Pâ=â.002) was the only independent factor associated with 14-day mortality for the patients with Klebsiella spp. bacteremia. Other factors related to 14-day mortality were a rapidly fatal prognosis (McCabe) (HR 7.1, 95% CI 2.75-18.37, Pâ<â.001), dementia (HR 5.9, 95% CI 2.0-7.43, Pâ=â.001), and a high-risk source of infection (HR 2.7, 95% CI 1.06-6.82, Pâ=â.038).The most important factors associated with 14-day mortality for the patients with K. pneumoniae bacteremia was an INCREMENT-CPE score ≥7, dementia, a McCabe score indicating a rapidly fatal prognosis and a high-risk source of infection. We found no relationship between a poorer outcome and CRKp isolation or inadequate antibiotic therapy.
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Infecciones por Klebsiella/mortalidad , beta-Lactamasas/metabolismo , Adulto , Antibacterianos/uso terapéutico , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Carbapenémicos/uso terapéutico , Estudios de Casos y Controles , Farmacorresistencia Microbiana , Femenino , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Trans-olecranon fracture dislocations are the least frequent complex elbow instability. Proper surgical treatment should be performed to avoid postoperative complications. METHODS: A retrospective design study was performed. Patients that suffered from this injury, treated at our center from 2010 to 2016 were included. Fifteen patients were analyzed. Functional results were measured using DASH, MEPS and VAS scores. Average time from injury to first surgical treatment was 4.87 days. Radial head fracture was present in seven cases and coronoid process in three patients. Most frequent complication was hardware disturbances in five patients. Mean follow up was 3.65 years. RESULTS: Mean range of motion (ROM) was evaluated 1 year postoperatively: 129° flexion, 6° flexion contracture, and less than 5° deficit of pronation/supination. Clinical and functional results are encouraging, DASH 36.38, MEPS 100 and VAS 0.46. CONCLUSION: Trans-olecranon fracture dislocations could obtain functional range of movement, pain relief and good functional outcomes with a standardized protocol of surgical fixation. It is important to achieve proper ulnar fixation, focusing in reestablishing dorsal angulation, and also to treat radial head and coronoid injuries properly, if present.
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Articulación del Codo , Luxaciones Articulares , Inestabilidad de la Articulación , Olécranon , Fracturas del Radio , Fracturas del Cúbito , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Fijación Interna de Fracturas , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Salamanders and newts (urodeles) are often used as a model system to elucidate the evolution of tetrapod locomotion. Studies range from detailed descriptions of musculoskeletal anatomy and segment kinematics, to bone loading mechanics and inferring central pattern generators. A further area of interest has been in vivo muscle activity patterns, measured through electromyography (EMG). However, most prior EMG work has primarily focused on muscles of the forelimb or hindlimb in specific species or the axial system in others. Here we present data on forelimb, hindlimb, and epaxial muscle activity patterns in one species, Salamandra salamandra, during steady state walking. The data are calibrated to limb stride cycle events (stance phase, swing phase), allowing direct comparisons to homologous muscle activation patterns recorded for other walking tetrapods (e.g., lizards, alligators, turtles, mammals). Results demonstrate that Salamandra has similar walking kinematics and muscle activity patterns to other urodele species, but that interspecies variation does exist. In the forelimb, both the m. dorsalis scapulae and m. latissimus dorsi are active for 80% of the forelimb swing phase, while the m. anconaeus humeralis lateralis is active at the swing-stance phase transition and continues through 86% of the stance phase. In the hindlimb, both the m. puboischiofemoralis internus and m. extensor iliotibialis anterior are active for 30% of the hindlimb swing phase, while the m. caudofemoralis is active 65% through the swing phase and remains active for most of the stance phase. With respect to the axial system, both the anterior and posterior m. dorsalis trunci display two activation bursts, a pattern consistent with stabilization and rotation of the pectoral and pelvic girdles. In support of previous assertions, comparison of Salamandra muscle activity timings to other walking tetrapods revealed broad-scale similarities, potentially indicating conservation of some aspects of neuromuscular function across tetrapods. Our data provide the foundation for building and testing dynamic simulations of fire salamander locomotor biomechanics to better understand musculoskeletal function. They could also be applied to future musculoskeletal simulations of extinct species to explore the evolution of tetrapod locomotion across deep-time.
Padrones de actividad muscular epaxial y apendicular durante la cursorialidad de la salamandra-de-fuego, Salamandra salamandra Las salamandras y los tritones (urodelos) son utilizados con frecuencia como un sistema modelo para dilucidar la evolución de la locomoción en los tetrápodos. Los estudios previos varían de descripciones detalladas de la anatomía musculoesquelética y cinemática de los segmentos del cuerpo, a la mecánica de la capacidad de soporte de carga estructural ósea y la generación de padrones centrales. Otra área de interés ha sido los padrones de actividad muscular in vivo, medidos por electromiografía (EMG). Sin embargo, la mayoría de los trabajos anteriores con EMG se han centrado principalmente en los músculos de los miembros anteriores o posteriores en especies específicas o en el sistema axial de otras. En este trabajo, presentamos datos sobre los padrones de actividad muscular en los músculos de los miembros anteriores, posteriores y de la musculatura epaxial en una especie, Salamandra salamandra, durante la marcha continua. Los datos se calibran para los períodos del ciclo de caminar de los miembros (fase de soporte, fase de movimiento), lo que permite comparaciones directas con padrones de activación muscular homólogos registrados para otros tetrápodos cursoriales (por ejemplo, lagartos, caimanes, tortugas y mamíferos). Los resultados demuestran que Salamandra tiene padrones de cinemática cursorial y actividad muscular similares a otras especies de urodelos, pero con variación interespecífica. En los miembros anteriores, ambos los m. dorsalis scapulae y m. latissimus dorsi están activos en 80% de la fase de movimiento del miembro anterior, mientras que el m. anconaeus humeralis lateralis se activa en la transición de la fase de movimiento-soporte y permanece activo en 86% de la fase de soporte. En los miembros posteriores, ambos m. puboischiofemoralis internus y m. extensor iliotibialis anterior están activos en 30% de la fase de movimiento de los miembros posteriores, mientras que el m. caudofemoralis está activo durante el 65% de la fase de movimiento, permaneciendo activo durante la mayor parte de la fase de soporte. Con respecto al sistema axial, las porciones anterior y posterior del m. dorsalis trunci exhibe dos períodos de activación, un padrón consistente con la estabilización y rotación de la cintura pélvica y pectoral. Como sugirido anteriormente, la comparación de los tiempos de actividad muscular de Salamandra con otros tetrápodos cursoriales reveló similitudes en gran escala, lo que podría indicar la conservación de algunos aspectos de la función neuromuscular entre los tetrápodos. Nuestros datos proporcionan una base para la construcción y prueba de simulaciones dinámicas de la biomecánica locomotora de salamandras-de-fuego para comprender mejor las funciones musculoesqueléticas. Nuestros resultados también se pueden aplicar a futuras simulaciones musculoesqueléticas de especies extintas para explorar la evolución de la locomoción de tetrápodos en el tiempo profundo.
Padrões de atividade muscular epaxial e apendicular durante a cursorialidade da salamandra-de-fogo, Salamandra salamandra Salamandras e tritões (urodelos) são freqüentemente utilizados como um sistema modelo para elucidar a evolução da locomoção em tetrápodes. Estudos anteriores variam de descrições detalhadas da anatomia musculoesquelética e cinemática dos segmentos corporais, a mecânica da capacidade de carga estrutural óssea e geradora de padrões centrais. Uma outra área de interesse tem sido os padrões de atividade muscular in vivo, medidos por eletromiografia (EMG). No entanto, a maioria dos trabalhos anteriores de EMG concentrou-se principalmente nos músculos dos membros anteriores ou posteriores em espécies específicas ou no sistema axial de outras. Nesse trabalho, apresentamos dados sobre os padrões de atividade muscular nos membros anteriores, posteriores e musculatura epaxial em uma espécie, Salamandra salamandra, durante caminhada em modo contínuo. Os dados são calibrados para os períodos do ciclo de caminhada dos membros (fase de apoio, fase de movimento), permitindo comparações diretas com padrões de ativação muscular homólogos registrados para outros tetrápodes cursoriais (por exemplo, lagartos, jacarés, tartarugas e mamíferos). Os resultados demonstram que Salamandra possui padrões de cinemática cursorial e atividade muscular semelhantes à outras espécies de urodelos, mas com variação interespecífica. Nos membros anteriores, ambos os m. dorsalis scapulae e m. latissimus dorsi estão ativos em 80% da fase de movimento do membro anterior, enquanto o m. anconaeus humeralis lateralis é ativado na transição da fase de movimento-apoio e continua ativo em 86% da fase de apoio. Nos membros posteriores, ambos m. puboischiofemoralis internus e m. extensor iliotibialis anterior estão ativos em 30% da fase de movimento dos membros posteriores, enquanto o m. caudofemoralis está ativo por 65% da fase de movimento, permanecendo ativo na maior parte da fase de apoio. No que diz respeito ao sistema axial, as porções anterior e posterior do m. dorsalis trunci exibe dois períodos de ativação, um padrão consistente com a estabilização e rotação da cintura peitoral e pélvica. Como préviamente sugerido, a comparação dos tempos de atividade muscular de Salamandra com outros tetrápodes cursoriais revelou similaridades em larga escala, potencialmente indicando a conservação de alguns aspectos da função neuromuscular entre tetrápodes. Os nossos dados fornecem uma base para a construção e testagem de simulações dinâmicas da biomecânica locomotora de salamandras-de-fogo para se entender melhor as funções músculo-esqueléticas. Nossos resultados também podem ser aplicados a futuras simulações músculo-esqueléticas de espécies extintas para explorar a evolução da locomoção de tetrápodes no tempo profundo.
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The objective of this study was to identify the prognostic value for survival of blood parameters in the immediate post-caesarean surgery period in kids born from pregnancy toxaemia (PT) goats. This study involved 10 PT goats, in which a caesarean surgery was performed. Twenty-five kids were born after caesarean surgery of which 16 survived. A blood sample was collected from the jugular vein of the 10 goats and from the kids immediately after caesarean surgery (within 15 min). There were differences between the kids that survived and the kids that did not survive concerning the blood levels of pH (7.22 vs 7.00), base excess (- 9 vs - 18 mmol/L), pCO2 (46 vs 62 mmHg) and L-lactate (5.6 vs 16 mmol/L). Maternal ketoacidosis due to PT has a negative impact on the survival rate of the offspring. This appears to be associated to a metabolic acidosis of the offspring. However, the only blood parameter in which there was a strong association between the maternal and newborn kids was blood urea nitrogen (r = 0.97).
RESUMEN
INTRODUCTION: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. MATERIAL AND METHODS: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). RESULTS: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. DISCUSSION: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. CONCLUSION: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.
INTRODUCCIÓN: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. MATERIAL Y MÉTODOS: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). RESULTADOS: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head). La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. DISCUSIÓN: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. CONCLUSIÓN: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.
Asunto(s)
Articulación del Codo , Prótesis Articulares , Fracturas del Radio , Radio (Anatomía) , Humanos , Prótesis Articulares/efectos adversos , Diseño de Prótesis , Radio (Anatomía)/patología , Radio (Anatomía)/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Terrible triad of elbow is a complex lesion with a high rate of complications. Our goal is to analyse both clinical results and complications after performing protocolised surgery. MATERIAL AND METHODS: The database of our hospital was used during 2005-2015, collecting characteristics of the patient, the fracture, the surgery and the associated complications, as well as functional results and range of mobility. RESULTS: A total of 62 triads were obtained, of which 27 (43%) were women and 35 (56%) were men. All had a Kaplan lateral approach and those who needed it were complemented with a medial approach to repair the LCM. The radial head was synthesized in 14 (22%) cases, a prosthesis was placed in 45 (74%) cases and other actions in 3 (5%) cases. Osteosynthesis of the choroid process was performed by transosseous harpoon±suture in 41 (62%) patients and by synthesis in 12 (19%) cases. In 9 (14%) cases, no action was taken. In 100% of the cases the LCL was repaired and in 9 (14%) the LCM also had to be repaired. Twenty-two percent of the patients required ESA due to instability after the surgical technique. With respect to results, a range of mobility was obtained between 120°/-20° of flexoextension and 98°/85° of pronosupination. In terms of complications, we obtained a total of 17 (27%). CONCLUSIONS: Elbow triads are complex lesions where protocolised surgery is necessary, nevertheless the complication rate was 27% in our series.
Asunto(s)
Ligamentos Colaterales/cirugía , Fijación Interna de Fracturas/métodos , Complicaciones Posoperatorias/etiología , Fracturas del Radio/cirugía , Radio (Anatomía)/cirugía , Adolescente , Adulto , Anciano , Ligamentos Colaterales/lesiones , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Radio (Anatomía)/lesiones , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Resumen: Introducción: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. Material y métodos: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). Resultados: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head) . La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. Discusión: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. Conclusión: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.
Abstract: Introduction: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. Material and methods: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). Results: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. Discussion: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. Conclusion: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.
Asunto(s)
Humanos , Radio (Anatomía)/cirugía , Radio (Anatomía)/patología , Fracturas del Radio/cirugía , Fracturas del Radio/diagnóstico por imagen , Articulación del Codo , Prótesis Articulares/efectos adversos , Diseño de Prótesis , Estudios Retrospectivos , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
OBJECTIVE: The prevalence of Pneumocystis jirovecii colonization and its role in pulmonary disease remains unclear. PCR methods have shown an improved sensitivity in the detection of this fungus. It has been suggested that the PCR results be combined with another test such as IFA to create a diagnostic algorithm. METHODS: A multiplex nested-PCR procedure with a 16S rRNA gene as the internal amplification control was evaluated to determine the role of P. jirovecii in pulmonary disease. RESULTS: A 20% of the 199 bronchoalveolar lavage samples were PCR-positive, 13.5% samples were PCR-inhibited, and the rate of Pneumocystis-colonisation was 6.4%. The sensitivity, specificity, positive predictive value and negative predictive value of the nested-PCR were 100%, 93%, 70% and 100%, respectively. The sensitivity of the nested-PCR was higher than the current "gold standard" immunofluorescence assay (IFA) (p< 0.0001). PCR-negative and PCR-positive patients did not show any clinical or radiological differences in the medical variables studied. CONCLUSIONS: PCR could help the diagnosis of Pneumocystis pulmonary disease given the high negative predictive value of the technique. P. jirovecii DNA can frequently be detected in healthy population, so the analysis of the patient medical history is critical to make the correct clinical decision.
Asunto(s)
Enfermedades Pulmonares/complicaciones , Pneumocystis carinii , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Anciano , Anciano de 80 o más Años , Algoritmos , Líquido del Lavado Bronquioalveolar/microbiología , ADN Bacteriano/genética , Femenino , Humanos , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Pneumocystis carinii/genética , Valor Predictivo de las Pruebas , ARN Bacteriano/genética , ARN Ribosómico 16S/genéticaRESUMEN
Carpal coalitions are relatively frequent between bones in the same carpal row. Coalitions between bones of different rows, however, are very uncommon. We present a case of bilateral intercarpal coalition between the trapezium and scaphoid as an incidental finding, confirming its hereditary origin since a parent has the same bilateral coalition.
Asunto(s)
Anomalías Musculoesqueléticas/diagnóstico por imagen , Hueso Escafoides/anomalías , Hueso Trapecio/anomalías , Adolescente , Humanos , Masculino , Radiografía , Hueso Escafoides/diagnóstico por imagen , Hueso Trapecio/diagnóstico por imagenRESUMEN
How extinct, non-avian theropod dinosaurs moved is a subject of considerable interest and controversy. A better understanding of non-avian theropod locomotion can be achieved by better understanding terrestrial locomotor biomechanics in their modern descendants, birds. Despite much research on the subject, avian terrestrial locomotion remains little explored in regards to how kinematic and kinetic factors vary together with speed and body size. Here, terrestrial locomotion was investigated in twelve species of ground-dwelling bird, spanning a 1,780-fold range in body mass, across almost their entire speed range. Particular attention was devoted to the ground reaction force (GRF), the force that the feet exert upon the ground. Comparable data for the only other extant obligate, striding biped, humans, were also collected and studied. In birds, all kinematic and kinetic parameters examined changed continuously with increasing speed, while in humans all but one of those same parameters changed abruptly at the walk-run transition. This result supports previous studies that show birds to have a highly continuous locomotor repertoire compared to humans, where discrete 'walking' and 'running' gaits are not easily distinguished based on kinematic patterns alone. The influences of speed and body size on kinematic and kinetic factors in birds are developed into a set of predictive relationships that may be applied to extinct, non-avian theropods. The resulting predictive model is able to explain 79-93% of the observed variation in kinematics and 69-83% of the observed variation in GRFs, and also performs well in extrapolation tests. However, this study also found that the location of the whole-body centre of mass may exert an important influence on the nature of the GRF, and hence some caution is warranted, in lieu of further investigation.