Update on the status of the contamination by organotin compounds in sediment of Nuevo Gulf, Argentina. Insights from field and experimental studies.

Organotin compounds are persistent pollutants and are considered chemicals of high environmental concern. In the present study, the distribution and degradation of tributyltin were evaluated in field sediments and through an ex situ experiment. For this, sediment samples from two locations were analysed: Luis Piedrabuena Harbour, with higher maritime traffic, and Cerro Avanzado, which receives less impact from anthropogenic activities. The results indicated that pollution levels at Luis Piedrabuena Harbour have decreased compared with studies performed 9 years ago for the same area. On the contrary, traces of organotin compounds have been found for the first time at Cerro Avanzado. Moreover, the butyltin degradation index indicated that organotin compounds undergo an advanced degradation process in the collected samples at both sites. Ex situ experiments revealed a limited capacity of sediments to retain tributyltin, and suggested an active role of bioturbation activity in the degradation of these compounds. In addition, visualisation using chemometric techniques (principal components analysis) allowed a simpler analysis of two sediment characteristics: the degree of contamination and the degradation levels of organotin compounds.

Marinade injection of pork as a possible technological strategy to reduce boar taint: Response and attitude of the consumer.

Sensory evaluation by consumers allows validation of a solution for the food industry to overcome boar taint and market entire male pork with high levels of boar taint considered "unfit for human consumption". One possible technological strategy for improvement is the injection marination of entire male pork to help minimise the impact of boar taint and improve its marketability. The responses of 120 regular pork consumers, to entire males with high levels of boar taint and castrated pork, both injection-marinated, were evaluated. The results showed a similar response between entire and castrated male pork regardless of sex, and the detection of unpleasant odours and flavours (as farm/animal), thus offering a new alternative to the pork sector to mask the boar taint and revalue this pork. However, it was observed that consumer information on castration and animal welfare of entire male pork is scarce, and it is important to increase their knowledge so that they can place a value on this technological strategy with entire male pork and thus increase their purchase intention.

Treatment with oral or topical sirolimus in complex vascular anomalies in pediatrics. Experience in a third-level hospital. / Tratamiento con sirolimus oral o tópico en anomalías vasculares complejas en pediatría. Experiencia en un hospital terciario.

OBJECTIVE: The use of sirolimus in vascular anomalies is a special indication not authorized in its data sheet. The objective of this study was to increase the evidence of oral or topical use of sirolimus for this indication in the pediatric population. MATERIALS AND METHODS: An observational, retrospective study of patients under 18 years of age treated with oral or topical sirolimus for vascular anomalies was carried out. Diagnosis and location of lesions, administration route and dosage of sirolimus, blood levels of sirolimus in patients who received oral treatment, treatment duration, response, and toxicity were collected. RESULTS: 18 patients - 7 with oral treatment and 11 with topical treatment - were included. With oral sirolimus, the overall response rate was 85.7%. Sirolimus was discontinued in 2 cases - as a result of full resolution and progression. 57.1% of patients had adverse effects, most of which were mild. Dyslipidemia was the most frequent adverse effect. Blood levels were monitored in all patients for dose adjustment purposes. With topical treatment, the overall response rate was 72.7%. Sirolimus was discontinued in 3 cases -due to progression in 2 cases and to stability in 1. 27.3% of patients had adverse effects, with itching standing out as the most frequent one. CONCLUSIONS: The favorable results of sirolimus treatment in our patients seem to confirm its effectiveness and safety in vascular anomalies, which make it stand as a therapeutic option in pediatric patients. However, further research is required to establish the optimal treatment regimen, treatment duration, and potential long-term adverse effects.

OBJETIVO: El uso de sirolimus en anomalías vasculares es una indicación especial no autorizada en ficha técnica. El objetivo de este estudio es incrementar la evidencia del empleo por vía oral o tópica de sirolimus en esta indicación en población pediátrica. METODO: Estudio observacional retrospectivo de pacientes menores de 18 años tratados con sirolimus oral o tópico para anomalías vasculares recogiendo: diagnóstico y ubicación de lesiones, forma de administración y dosificación de sirolimus, niveles sanguíneos de fármaco en los pacientes con tratamiento oral, duración del tratamiento, respuesta y toxicidad. RESULTADOS: Se incluyeron 18 pacientes (7 con tratamiento oral y 11 tópico). Con sirolimus oral, la tasa de respuesta global fue 85,7%. Se interrumpió sirolimus en 2 casos: por resolución completa y por progresión. El 57,1% experimentó algún efecto adverso, en su mayoría leves; siendo la dislipemia el efecto adverso más frecuente. La monitorización de niveles sanguíneos fue empleada en todos los pacientes para el ajuste de dosis. Con el tratamiento tópico, la tasa de respuesta global fue 72,7%. Se interrumpió sirolimus en 3 casos: progresión en 2 casos y estabilidad en 1. El 27,3% experimentó algún efecto adverso, siendo el prurito el más frecuente. CONCLUSIONES: Los resultados favorables del tratamiento con sirolimus en nuestros pacientes parecen confirmar la efectividad y seguridad del fármaco en anomalías vasculares y lo posicionan como una opción terapéutica en pacientes pediátricos. Aun así, parece necesaria mayor investigación que trate de aclarar, entre otros, el régimen óptimo del tratamiento, la duración del mismo y los potenciales efectos adversos a largo plazo.

Consumer perception of entire male pork coated with spiced edible films as a new product to mask boar taint.

Pork production has undergone a shift towards the rearing of entire male pigs, however, its meat might carry with the presence of boar taint and it would be considered "unfit for human consumption". To offer a new alternative to the pork sector tailored to the needs of consumers, a viable option would be the use of edible spiced gelatin films to help minimize boar taint and improve its marketability. The responses of 120 regular meat consumers to entire pork with high levels of boar taint and castrated pork free of boar taint, both coated with spiced gelatin films were evaluated. They showed a similar response between entire and castrated male pork coated with spiced films, regardless of whether consumers usually detected unpleasant odours (as farm/animal) when consuming pork or not. Therefore, the new spiced films offer a new range of products to consumers as they contribute to the improvement of the sensory quality of entire male pork, especially among consumers who tend to buy new products.

A Methodology Based on Machine Learning and Soft Computing to Design More Sustainable Agriculture Systems.

Advances in new technologies are allowing any field of real life to benefit from using these ones. Among of them, we can highlight the IoT ecosystem making available large amounts of information, cloud computing allowing large computational capacities, and Machine Learning techniques together with the Soft Computing framework to incorporate intelligence. They constitute a powerful set of tools that allow us to define Decision Support Systems that improve decisions in a wide range of real-life problems. In this paper, we focus on the agricultural sector and the issue of sustainability. We propose a methodology that, starting from times series data provided by the IoT ecosystem, a preprocessing and modelling of the data based on machine learning techniques is carried out within the framework of Soft Computing. The obtained model will be able to carry out inferences in a given prediction horizon that allow the development of Decision Support Systems that can help the farmer. By way of illustration, the proposed methodology is applied to the specific problem of early frost prediction. With some specific scenarios validated by expert farmers in an agricultural cooperative, the benefits of the methodology are illustrated. The evaluation and validation show the effectiveness of the proposal.

Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial.

BACKGROUND: Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. OBJECTIVES: To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. METHODS: This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. RESULTS: The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). CONCLUSIONS: Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.

Increased functional activity, bottom-up and intrinsic effective connectivity in autism.

Sensory perceptual alterations such as sensory sensitivities in autism have been proposed to be caused by differences in sensory observation (Likelihood) or in forming models of the environment (Prior), which result in an increase in bottom-up information flow relative to top-down control. To investigate this conjecture, we had autistic individuals (AS) and neurotypicals (NT) perform a decision-under-uncertainty paradigm while undergoing functional magnetic resonance imaging (fMRI). There were no group differences in task performance and in Prior and Likelihood representations in brain activity. However, there were significant group differences in overall task activity, with the AS group showing significantly greater activation in the bilateral precuneus, mid-occipital gyrus, cuneus, superior frontal gyrus (SFG) and left putamen relative to the NT group. Further, when pooling the data across both groups, we found that those with higher AQ scores showed greater activity in the left cuneus and precuneus. Effective connectivity analysis using dynamic causal modelling (DCM) revealed that group differences in BOLD signals were underpinned by increased activity within sensory regions and a net increase in bottom-up connectivity from the occipital region to the precuneus and the left SFG. These findings support the hypothesis of increased bottom-up information flow in autism during sensory learning tasks.

Tic disorders and premonitory urges: validation of the Spanish-language version of the Premonitory Urge for Tics Scale in children and adolescents.

INTRODUCTION: Most people with persistent tics report an unpleasant sensation (premonitory urge) before the tic. In recent years, interest in these sensory phenomena has increased due to their important role in behavioural therapy. However, instruments for assessing these sensations remain scarce. Among the available instruments, the Premonitory Urge for Tics Scale (PUTS) is the most widely used. METHODS: We examined the psychometric properties and factor structure of the Spanish-language version of the PUTS in a sample of 72 children and adolescents with Tourette syndrome or persistent tic disorders. We analysed data from the total sample and by age group (children up to 10 years old and children/adolescents over 10). RESULTS: The PUTS presented good internal consistency and moderate correlations between items on the scale (except for item 1). Divergent validity was good, test-retest reliability was adequate, and a bifactorial structure was identified (one dimension related to mental phenomena reported in obsessive-compulsive disorder, and another related to the quality and frequency of premonitory urges). These results were replicated in both age groups, with lower divergent validity and test-retest reliability in the younger group. CONCLUSIONS: The Spanish-language version of the PUTS is a valid, reliable tool for assessing premonitory urges in both children and adolescents, especially after the age of 10.

[Platelet-rich plasma as a therapeutic option in heel fat pad syndrome]. / Plasma rico en plaquetas como opción terapéutica en el síndrome de la almohadilla grasa plantar.

Heel fat pad syndrome is the second most frequent cause of heel pain at Rehabilitation services. It is a structure damage of the plantar fat that leads to loss of cushioning in gait and plantar pain. It is due to degeneration or repeated trauma that causes alteration of the structure of the foot pad losing its compressibility and function. The diagnosis of heel fat pad syndrome is made by ultrasound study. Treatment is primarily based on conservative measures. Infiltration with platelet-rich plasma is proposed as a therapeutic option with the aim of improving pain and inflammation of the plantar fat pad. We report the first published case of ultrasound-guided infiltration with platelet-rich plasma as a treatment for heel fat pad syndrome.

Assessment of single-nucleotide variant discovery protocols in RNA-seq data from human cells exposed to mycotoxins.

Food and feed contamination by nonlegislated mycotoxins beauvericin (BEA) and enniatin B (ENB) is a worldwide health concern in the present. The principal objective of this work is to assess some of the existing protocols to discover the single nucleotide variants (SNVs) in transcriptomic data obtained by RNA-seq from Jurkat cells in vitro samples individually exposed to BEA and ENB at three concentration levels (1.5, 3 and 5 µM). Moreover, previous transcriptomic results will be compared with new findings obtained using a different protocol. SNVs rs201003509 in BEA exposed cells and the rs36045790 in ENB were found in the differentially expressed genes in all doses compared to controls by means of the Genome Analysis Toolkit (GATK) Best Practices workflow. SNV-RNA-seq complementary pipeline did not show any SNV. Concerning gene expression, discrepant results were found for 1.5 µM BEA exposed cells compared with previous findings. However, 354 overlapped differentially expressed genes (DEGs) were identified in the three ENB concentrations used, with 147 matches with respect to the 245 DEGs found in the previous results. In conclusion, the two discovery SNVs protocols based on variant calling from RNA-seq used in this work displayed very different results and there were SNVs found manually not identified by any pipeline. Additionally, the new gene expression analysis reported comparable but non identical DEGs to the previous transcriptomic results obtained from these RNA-seq data.

One-Pot Synthesis of MnOx-SiO2 Porous Composites as Nanozymes with ROS-Scavenging Properties.

The development of nanomaterials that mimic the activity of enzymes is a topic of interest, for the decomposition of reactive oxygen species (ROS). We report the preparation of a novel nanocomposite of MnOx needles covered with SiO2 porous material. The material was prepared in one pot with a two-step procedure. The material was characterized by EDX, SEM, TEM, XRD, nitrogen adsorption-desorption isotherms, and XPS. The synthesis protocol took advantage of the atrane method, favoring the nucleation and initial growth of manganese oxide needles that remained embedded and homogeneously dispersed in a mesoporous silica matrix. The final composite had a high concentration of Mn (Si/Mn molar ratio of ca. 1). The nanozyme presented bimodal porosity: intraparticle and interparticle association with the surfactant micelles and the gaps between silica particles and MnOx needles, respectively. The porosity favored the migration of the reagent to the surface of the catalytic MnOx. The nanozyme showed very efficient SOD and catalase activities, thus improving other materials previously described. The kinetics were studied in detail, and the reaction mechanisms were proposed. It was shown that silica does not play an innocent role in the case of catalase activity, increasing the reaction rate.

Immune surveillance for six vaccinable pathogens using paired plasma and dried blood spots in HIV infected and uninfected children in Kinshasa.

Child vaccination reduces infant mortality rates. HIV-infected children present higher risk of diseases than non-infected. We report the protection coverage rates for 6 vaccine-preventable diseases in a paediatric population from the Democratic Republic of the Congo (DRC) and the impact of HIV infection, providing the first data on the validity of dried blood samples (DBS) to monitor the immune protection. During 2016-2018 DBS from 143 children/adolescents were collected in Kinshasa (DRC), being 52 HIV-infected. Forty-two had a paired plasma sample. Protective IgG was quantified (VirClia-IgG,VIRCELL) to obtain the optimal cut-off in IgG detection in DBS. ROC curves were generated with R software and statistical analyses with Stata. Protective IgG levels varied across pathogens, not reaching herd immunity. HIV-infected presented lower vaccine protection than uninfected for all analyzed pathogens, except rubella, with statistically significant differences for measles (30.8% vs. 53.8%; p = 0.008) and tetanus (3.8% vs. 22%; p = 0.0034). New cut-offs were calculated when using DBS to improve test performance. We reinforce the necessity to increase pediatric vaccination coverage in Kinshasa, especially in HIV seropositive, with less capacity to maintain adequate antibody levels. DBS were useful to monitor vaccination coverage in seroprevalence studies in resource-limited settings, after optimizing the cut-off value for each pathogen.

On the body-mind nexus in chronic musculoskeletal pain: A scoping review.

BACKGROUND AND OBJECTIVE: Bodily experience disturbances are frequent among chronic musculoskeletal pain patients and associated with important pain-related psychosocial outcomes (e.g., disability, quality of life). However, the relationship between bodily experience and the psychological dimensions of chronic pain (e.g., affective, cognitive) has only recently garnered attention. This scoping review aimed to identify trends and gaps in research on the nexus between body awareness, body image, and body schema, and psychological processes/outcomes in adults with chronic musculoskeletal pain to inform future directions for research and practice. DATABASES AND DATA TREATMENT: This study was guided by Arksey and O'Malley's guidelines and PRISMA-ScR recommendations. Keywords related to body awareness/body image/body schema and pain were searched on PsycInfo and PubMed from database inception until 16 February 2021; 2045 articles were screened, and 41 met the inclusion criteria (i.e., primary quantitative studies investigating body awareness/body image/body schema in relation to pain-related psychological outcomes/processes in chronic musculoskeletal pain). RESULTS: The referred bodily experience constructs have been inconsistently defined. Body awareness was the most investigated construct, with consistent operationalization strategies. The links between body schema/body image and pain-related psychological processes/outcomes are still under-investigated. Most studies examined the role of bodily experience as a correlate/predictor of psychological outcomes/processes; overall, a better relationship with one's own body was associated with better pain-related psychological outcomes/processes. CONCLUSIONS: Our findings emphasize the relevance of further investigating body-mind relations in musculoskeletal pain and the development of therapies designed to improve the bodily experience within multidisciplinary treatment programmes. Suggestions for future research are discussed. SIGNIFICANCE: This scoping review identifies trends/gaps in current research on the relationship between body awareness/body image/body schema and pain-related psychological processes/outcomes in adults with musculoskeletal pain. Overall, findings suggest that better bodily experiences are associated to lower fear-avoidance beliefs, better self-regulation strategies and better chronic pain adjustment, being important targets in pain management interventions. Nonetheless, the results also emphasize the need to further investigate the causal relationships and other outcomes related to psychological resilience, as well as to develop gold standard treatments focused on bodily experience.

Delphi consensus on recommendations for the treatment of spinal muscular atrophy in Spain (RET-AME consensus).

INTRODUCTION: Spinal muscular atrophy (SMA) is a neurodegenerative disease caused by a biallelic mutation of the SMN1 gene, located on the long arm of chromosome 5, and predominantly affects the motor neurons of the anterior horn of the spinal cord, causing progressive muscle weakness and atrophy. The development of disease-modifying treatments is significantly changing the natural history of SMA, but uncertainty remains about which patients can benefit from these treatments and how that benefit should be measured. METHODOLOGY: A group of experts specialised in neurology, neuropediatrics, and rehabilitation and representatives of the Spanish association of patients with SMA followed the Delphi method to reach a consensus on 5 issues related to the use of these new treatments: general aspects, treatment objectives, outcome assessment tools, requirements of the treating centres, and regulation of their use. Consensus was considered to be achieved when a response received at least 80% of votes. RESULTS: Treatment protocols are useful for regulating the use of high-impact medications and should guide treatment, but should be updated regularly to take into account the most recent evidence available, and their implementation should be assessed on an individual basis. Age, baseline functional status, and, in the case of children, the type of SMA and the number of copies of SMN2 are characteristics that should be considered when establishing therapeutic objectives, assessment tools, and the use of such treatments. The cost-effectiveness of these treatments in paediatric patients is mainly influenced by early treatment onset; therefore, the implementation of neonatal screening is recommended. CONCLUSIONS: The RET-AME consensus recommendations provide a frame of reference for the appropriate use of disease-modifying treatments in patients with SMA.

Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study.

BACKGROUND: The management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD. METHODS: This prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I-III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded. RESULTS: We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate. CONCLUSIONS: Patients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD.

Impact on Survival of Pretransplant Portal Vein Thrombosis.

Portal vein thrombosis (PVT) still remains a major challenge in managing liver transplant recipients. The aim of this study was to describe PVT prevalence in our health district and identify potential risk factors involved. Although further research is needed to make some general appointments, we identified anticoagulation therapy before transplant as a potential protective factor against PVT.

[Rehabilitation and COVID disease: characterization and follow-up of hospitalized patients in Granada, Spain]. / Tratamiento rehabilitador de la infección por COVID: caracterización y seguimiento de pacientes hospitalizados en Granada, España.

OBJECTIVE: The characterization of a sample of patients hospitalized with complications of the COVID-19 infection regarding potential prognostic factors, clinical evolution, and impact of rehabilitation treatment on functional, motor, and respiratory outcomes. METHOD: Descriptive, retrospective, longitudinal study of a cohort of patients under rehabilitation treatment admitted at Virgen de las Nieves University Hospital in Granada from March to June 2020, assessed upon admission, discharge and at 3 rd month using physical condition scales (IFIS) and functional assessment: general (Rankin, Barthel), respiratory (mMRC, BORG) and gait (FAC). RESULTS: 30 patients with a mean age of 62.8 (54-70) years were included, 80% with comorbidity: hypertension 66.7%, obesity 36.7%, diabetes 33.3%. The mean hospital stay was 45.4 days, with 86.7% requiring ICU (29.1 days) and 76.7% of them required mechanical ventilation. An 86.7% of the patients presented with complications, mostly with polyneuropathy-myopathy of the critical patient (83.3%). At discharge, 80% required walking assistance. The functionality index showed a "U"-evolution at admission, discharge and at 3 rd month (Barthel 93.8; 60.0; 91.6 respectively). A greater functional decline (Barthel < 60) was found in male patients, COPD, HT, obesity, and elevated protein C reactive at admission; and a more favourable evolution in those with elevated D-dimer and lymphocyte values upon admission. CONCLUSIóN: Hospital admission for COVID-19 patients involve complications at the functional, respiratory and gait levels that are mostly serious but partially reversible at 3 months with rehabilitation treatment. Potential prognostic factors are described and deserve prospective studies.

The challenge of assessing the proper functioning conditions of coastal lagoons to improve their future management.

The sustainable management of coastal lagoon hydrosystems is a key issue for the socio-economic and environmental development of many coastal areas worldwide. Often maintained by direct or indirect groundwater supplies, they provide a large range of ecosystem services, from which human societies take advantage. Twenty years after its implementation, a large majority of the Mediterranean lagoons have still not reached the "good status" required by the WFD. Several questions then arise as to the representativeness of the WFD indicators or the relevance of the restoration objectives considering the complexity, evolutionary and unpredictable nature of lagoon hydrosystems. This study proposes an innovative, multidisciplinary, long-term approach to define the proper functioning conditions of a costal lagoon hydrosystems, i.e. all the factors that contribute to the functioning of coastal lagoon hydrosystems and the connectivity with other biodiversity reservoirs, be they ecological, hydrological, social or political. By considering the lagoons and all its hydrological, ecological and societal proper functioning conditions over almost 200 years, this approach makes it possible to assess the influence of past natural and anthropogenic disturbances and support the implementation of future relevant hydrosystem-based management plans which have to be coordinated and politically driven. Defining proper restoration and management objectives should ensure that ecological functions are maintained based on current and future ecosystem benefits and uses. Considering the highly unpredictable nature of coastal hydrosystems, the state of an ecosystem should not only be evaluated on ecological or chemical criteria but also take into account socio-economic and political indicators. The implementation of the 3rd river basin management plan of the WFD as soon as 2022 could be the appropriate occasion to reassess the restoration objectives towards more realistic goals and to give more significance to the definition of the "resilience capacity" of water bodies in place of inappropriate restricted restauration objectives.

Inestabilidad anterior de hombro con defecto óseo no crítico: ¿Bankart-Remplissage o Latarjet? / Anterior shoulder instability with non critical bone loss: Bankart-Remplissage or Latarjet?

Resumen: Introducción: Los defectos óseos se asocian a inestabilidad de hombro recidivante. Bankart-Remplissage (B+R) y Latarjet (L) son alternativas de tratamiento. Pocos estudios comparan ambas técnicas. Objetivo: Comparar evolución funcional, complicaciones y tasa de recidiva, entre B+R y L en pacientes con inestabilidad glenohumeral anterior con defecto óseo no crítico. Material y métodos: Estudio retrospectivo de cohortes, en pacientes operados entre 2010 y 2018. Ciento siete pacientes fueron reclutados, de éstos, se obtuvo información desde su ficha clínica. Se midió tamaño de Hill-Sachs (HS) y defecto glenoideo en tomografía axial computarizada (TAC). Se envió encuesta remota evaluando funcionalidad con SSV, WOSI, EVA y qDASH. Cuarenta y ocho pacientes completaron el seguimiento remoto (26 B+R y 22 L). Media de seguimiento de 3.8 años. Resultados: Al comparar ambos grupos no hubo diferencias significativas en WOSI, EVA, qDASH ni SSV. No hubo diferencia en el número de complicaciones (B+R: 13 [18.8%], L: 5 [13.2%], p = 0.16), reoperaciones (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41) ni reluxación (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41). En pacientes que realizan deporte de contacto o colisión, L tuvo mejor SSV (92.5 vs 72.5 p = 0.048) y WOSI total (98.3 vs 67.3 p = 0.043). B+R en extremidad dominante presentó mayor tasa de complicaciones (50 vs 9.1% p = 0.038). No se encontró asociación para complicaciones y reluxación según defecto glenoideo o número de luxaciones previo a cirugía. Conclusión: Bankart-Remplissage y Latarjet tienen similar resultado funcional y tasa de reluxación en nuestros grupos estudiados. Latarjet muestra mejor resultado funcional subjetivo en deportistas de contacto y menores complicaciones en extremidad dominante.

Abstract: Introduction: Significant Hill-Sachs lesions are associated with recurrent shoulder instability. Bankart-Remplissage (B+R) and Latarjet (L) are valid treatments for these injuries. Few studies compare both techniques. Objective: To compare functional outcome, complications and recurrent instability rate between B+R and L in patients operated for anterior shoulder instability (ASI) with significant Hill-Sachs (HS) lesions and non critical glenoid bone loss (NC-GBL). Material and methods: Retrospective cohort study with patients operated between 2010 and 2018 for ASI. 107 met inclusion criteria. Demographic data, complications, recurrence rate and subsequent procedures were obtained from their medical records. CT scan imaging was used to assess humeral and glenoid bone loss. Online questionnaires were sent for assesing functional outcomes with SSV, WOSI, VAS and qDASH. 48 patients completed the online assessment (26 B+R, 22 L). The mean follow-up was 3.8 years. Results: Comparing both groups, there were no differences in WOSI, SSV, EVA and qDASH. There was no difference in complication rate (B+R: 13 [18.8%], L: 5 [13.2%], p = 0.16), revisions (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41) and recurrent instability (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41). L in subgroup who practiced collision sports had better SSV (92.5 vs 72.5 p = 0.048) and WOSI (98.3 vs 67.3 p = 0.043). B+R in dominant extremity had worst complication rate (50 vs 9.1% p = 0.038). Association was not found between complications and recurrent instabillity according to glenoid bone defect or previous dislocation episodes. Conclusion: Significant Hill-Sachs lesions with NC-GBL, both Bankart-Remplissage and Latarjet achieve satisfactory results, with similar recurrent instability and functional outcomes. Latarjet has better subjetive funtional results in collision sports and less complication in dominant extremity compared to Bankart-Remplissage.