[Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. / Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Shock wave and mesenchymal stem cells as treatment in the acute phase of spinal cord injury: A pilot study.

INTRODUCTION: Spinal cord injury (SCI) is a complex pathology with thousands of patients worldwide. During the acute early phase, neural tissue shows some regenerative properties that disappear at the chronic phase. Shock Waves and Stem Cells have been proposed as a possible therapy. METHODS: Here, we analyse Shock Waves' immediate effect over spinal cord genetic response in the injured and healthy spinal cord and the effect of Shock Waves and combined Shock Waves plus Stem Cells distally grafted to treat the first month after spinal cord injury. RESULTS: The immediate application of shock waves increases VEGF (Vascular Endothelial Growth Factor) but reduces the BDNF (Brain-Derived Growth Factor) RNA (Ribonucleic acid) response. Shock wave therapy increases GFAP (Glial fibrillary acidic protein) positive cells and vascularity during the treatment's acute phase. CONCLUSION: Shock wave treatment seems to be enough to produce benefits in the acute phase of spinal cord injury, with no accumulative positive effects when mesenchymal stem cell graft is applied together.

Psychological readiness to return to sports after anterior cruciate ligament reconstruction in amateur sport. / Preparación psicológica para la reincorporación deportiva tras cirugía reconstructiva del ligamento cruzado anterior en el deportista aficionado.

INTRODUCTION: Return to sports (RTS) is maybe the main expectation for the patient after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to analyze the psychological readiness to RTS in a cohort of amateur sports after ACLR. MATERIAL AND METHODS: Retrospective study of a prospective database of patients treated with ACLR performed between January and December 2017. Psychological readiness to RTS after ACLR was evaluated with the short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. RESULTS: A total of 43 patients met the inclusion criteria. The mean age of the patients was 24.7 years. The mean follow-up was 32.5 months. All patients practiced any type of sports at final follow-up. The mean ACL-RSI score was 71.5. Fear of reinjury was mentioned by 14 patients (32.5%). Twenty-four patients (55.8%) pointed out that they did not practice sport at the pre-injury level. The mean ACL-RSI score was statistically significant lower in this group of patients (59.7 vs 87.3; P<.001). CONCLUSIONS: Fear of reinjury keeps after ACLR. Patients that they did not practice sport at the pre-injury level show lower scores in ACL-RSI for RTS.

Abnormalities in Cortical GABAergic Interneurons of the Primary Motor Cortex Caused by Lis1 (Pafah1b1) Mutation Produce a Non-drastic Functional Phenotype.

LIS1 (PAFAH1B1) plays a major role in the developing cerebral cortex, and haploinsufficient mutations cause human lissencephaly type 1. We have studied morphological and functional properties of the cerebral cortex of mutant mice harboring a deletion in the first exon of the mouse Lis1 (Pafah1b1) gene, which encodes for the LisH domain. The Lis1/sLis1 animals had an overall unaltered cortical structure but showed an abnormal distribution of cortical GABAergic interneurons (those expressing calbindin, calretinin, or parvalbumin), which mainly accumulated in the deep neocortical layers. Interestingly, the study of the oscillatory activity revealed an apparent inability of the cortical circuits to produce correct activity patterns. Moreover, the fast spiking (FS) inhibitory GABAergic interneurons exhibited several abnormalities regarding the size of the action potentials, the threshold for spike firing, the time course of the action potential after-hyperpolarization (AHP), the firing frequency, and the frequency and peak amplitude of spontaneous excitatory postsynaptic currents (sEPSC's). These morphological and functional alterations in the cortical inhibitory system characterize the Lis1/sLis1 mouse as a model of mild lissencephaly, showing a phenotype less drastic than the typical phenotype attributed to classical lissencephaly. Therefore, the results described in the present manuscript corroborate the idea that mutations in some regions of the Lis1 gene can produce phenotypes more similar to those typically described in schizophrenic and autistic patients and animal models.

SARC-F and SARC-CalF Scores as Mortality Risk Factors in Older Men with Cancer: A Longitudinal Study from Peru.

OBJECTIVES: We aimed to evaluate the role of SARC-F and SARC-CalF scores as risk factors for mortality in adults over 60 years of age with cancer of the Centro Médico Naval (CEMENA) in Callao, Peru during 2012-2015. METHODS: We performed a secondary analysis of data from a prospective cohort carried out from September 2012 to February 2013 in the Geriatrics Department of CEMENA. The outcome variable was mortality at two years of follow-up, while the exposure variable was the risk of sarcopenia assessed using the SARC-F and SARC-CalF scales. We carried out Cox proportional-hazards models to assess the role of SARC-F and SARC-CalF scores as risk factors for mortality. We estimated crude (cHR) and adjusted (aHR) hazard ratios (HR) with their respective 95% confidence intervals (95%CI). Likewise, we calculated the area under the curve (AUC) of both exposure variables in relation to mortality. RESULTS: We analyzed data from 922 elderly men with cancer; 43.1% (n=397) were between 60 and 70 years old. 21.5% (n=198) and 45.7% (n=421) were at risk of sarcopenia according to SARC-F and SARC-CalF, respectively, while the incidence of mortality was 22.9% (n=211). In the adjusted Cox regression model, we found that the risk of sarcopenia measured by SARC-F (aHR=2.51; 95%CI: 1.40-2.77) and SARC-CalF (aHR=2.04; 95%CI: 1.55-4.02) was associated with a higher risk of death in older men with cancer. In the diagnostic performance analysis, we found that the AUC for mortality prediction was 0.71 (95%CI: 0.68-0.75) for SARC-F and 0.80 (95%CI: 0.78-0.82) for SARC-CalF. CONCLUSIONS: The risk of sarcopenia evaluated by SARC-F and SARC-CalF scores was associated with an increased risk of mortality in older men with cancer. Both scales proved to be useful and accessible instruments for the identification of groups at risk of mortality.

Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru.

BACKGROUND: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly. OBJECTIVES: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients. DESIGN, SETTING, AND PARTICIPANTS: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed. MEASUREMENTS: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). RESULTS: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90). CONCLUSIONS: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.

ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells).

INTRODUCTION: Goblet cell carcinoma (GCC) is an appendicular neoplasia representing less than 5% of all appendicular tumors, found in 0.3-0.9% of the appendectomies, 35-58% of all appendicular neoplasms, and less than 14% of malign appendix tumors. The most frequent clinical presentation is abdominal pain associated with a picture of acute appendicitis. MATERIALS AND METHODS: We present 3 clinical cases of appendix GCC, 2 subjected to cytoreductory surgery plus intraperitoneal hyperthermic chemotherapy and a third, who is currently receiving neoadjuvant treatment with a good response to chemotherapy and who will be offered the same treatment as the first two patients. Given the unpredictable behavior of these tumors, the use of molecular markers could help us to predict their behavior and prognosis. In this context, the TP73 gene would make an interesting putative marker. ∆Np73 has been described as overexpressed in a great variety of tumor types including colon cancer and this up-regulation is associated with a poor prognosis. To evidence its role in this malignancy, we evaluate here the status of ∆Np73 in the primary tumor and normal counterpart tissues, in the metastatic implants and in healthy areas of the peritoneum from the appendicular GCC patients. In addition, we checked the expression levels of this p73 variant in the tumor and normal tissue of 26 patients with colon cancer. RESULTS: Remarkably, 2 patients showed significant ∆Np73 down-regulation in both the primary tumor and the implants. Case 1 presented a fourfold decrease of levels in the primary tumor and 20-fold decrease in the implants. Case 2 showed a seven- and fourfold down-regulation in the primary tumor and implants, respectively. However, Case 3 showed an up-regulation of 53- and threefold in the primary tumor and implants, respectively. CONCLUSION: Goblet cell carcinoma of the appendix is very rate. It tends to seed throughout the peritoneum, making aggressive surgical cytoreduction and chemotherapy viable treatment options. Investigation into the molecular basis of these tumors may improve the diagnosis, prognosis and therapeutic decisions regarding these patients. ∆Np73 seems a good candidate for further analysis in longer series.

Differential regulation of calcium channel coding genes by prolonged depolarization.

Calcium channels must be subjected to a very precise regulation in order to preserve cell function and viability. Voltage gated calcium channels (VGCC) represent the main pathway for calcium entry in excitable cells. This explains why depolarization induces a rapid-onset and short-term inactivation of calcium currents. Contrarily to this well-documented mechanism to maintain calcium below toxic levels, the regulatory pathways inducing longer-lasting changes and cell surface expression of functional calcium channels are largely unknown. Since calcium is a main player in the activity-dependent regulation of many genes, we hypothesize that calcium channel coding genes could be also subjected to activity-dependent regulation. We have used prolonged depolarization to analyze the effects of sustained intracellular calcium elevation on the mRNAs coding for the different alpha(1) pore-forming subunits of the calcium channels expressed in chromaffin cells. Our findings reveal that persistent depolarization is accompanied by a prolonged intracellular calcium elevation and reduction of calcium current. This calcium current inhibition could be mediated, at least partially, by the downregulation of the mRNAs coding for several alpha(1) subunits. Thus, we show here that depolarization inhibits the expression of Ca(V)1.1, Ca(V)1.2, Ca(V)1.3, Ca(V)2.2 and Ca(V)2.3 mRNAs, while the Ca(V)2.1 mRNA remains unmodified. Moreover, such downregulation of channels depends on calcium entry through the L-type calcium channel, as both mRNA and calcium current changes induced by depolarization are abrogated by L-type channel specific blockers.

Dimensioning of 10 Gbit/s all-optical packet switched networks based on optical label swapping routers with multistage 2R regeneration.

This paper describes both the experimental and theoretical investigations on the cascadability of all-optical routers in optical label swapping networks incorporating a multistage wavelength conversion with 2R regeneration. A full description of a novel experimental setup allows the packet by packet measurement up to 16 hops with 10 Gb/s payload showing 1 dB penalty with 10(-12) bit error rate. Similarly, the simulations on the system allow a prediction on the cascadability of the router up to 64 hops.

Analysis and design of arrayed waveguide gratings with MMI couplers.

We present an extension of the AWG model and design procedure described in [1] to incorporate multimode interference, MMI, couplers. For the first time to our knowledge, a closed formula for the passing bands bandwidth and crosstalk estimation plots are derived.

Geometrical optimization of the transmission and dispersion properties of arrayed waveguide gratings using two stigmatic point mountings.

In this paper, the procedure to optimize flat-top Arrayed Waveguide Grating (AWG) devices in terms of transmission and dispersion properties is presented. The systematic procedure consists on the stigmatization and minimization of the Light Path Function (LPF) used in classic planar spectrograph theory. The resulting geometry arrangement for the Arrayed Waveguides (AW) and the Output Waveguides (OW) is not the classical Rowland mounting, but an arbitrary geometry arrangement. Simulation using previous published enhanced modeling show how this geometry reduces the passband ripple, asymmetry and dispersion, in a design example.

Automatic tunable and reconfigurable fiberoptic microwave filters based on a broadband optical source sliced by uniform fiber Bragg gratings.

We demonstrate an automatic tunable transversal notch filter based on uniform fiber Bragg gratings and a broadband optical source. High tunability can be performed by stretching the fiber with the gratings written in series. Also, high sidelobe supression can be achieved by introducing tunable attenuators in a parallel configuration of the gratings.

Changes in colloid osmotic pressure in patients undergoing cardiothoracic surgery.

Measurements of plasma colloid osmotic pressure (COP) were made during and for 24 h after normothermic continuous flow cardiopulmonary bypass (CPB) in 20 adults exposed to sudden haemodilution by a crystalloid pump prime solution. Haematocrit, albumin and total protein were also measured. Within 5 min of starting bypass the mean COP fell to 45% pre-bypass value and remained at this level until bypass was discontinued. Following bypass, the oncotic pressure rose rapidly during the first hour to 84% of the prebypass value, and then more slowly until it reached the pre-bypass value 24 h later. The trend seen for plasma proteins and haematocrit was similar but the fall was smaller, 65-70% of the pre-bypass values. This significant difference in fall between plasma protein concentration and directly measured COP is explained by their non-linear relationship. Three patients died soon after bypass. They all showed significantly lower values of COP than the mean for the group as a whole at some stage (P less than 0.05).

Skin perfusion changes in experimental neuropathic pain: sciatic nerve constriction.

Laser Doppler flowmetry was used as a method of measurement of skin blood flow perfusion in an experimental rat model of neuropathic pain. The common sciatic nerve was microsurgically approached and four ligatures were loosely tied around the nerve (sciatic ligature group). Contralateral nerves were approached but not injured (sham procedure). All paws were studied before any surgical procedure (controls) and immediately, 24 h, 11 and 25 days after surgery. In each experiment, the skin perfusion was measured in the plantar surface of the hind paw, both in baseline conditions and after a heating test, where skin temperature around flowmeter probe reached 42 degrees C. The heating test produced an increase in skin perfusion that ranged between 70% and 80% in sham and normal paws. Nerve ligation induced no immediate changes in skin perfusion with a normal 65% increase after heating. However, 24 h later, baseline skin perfusion was significantly higher than preoperatively with smaller response to heating. This situation changed at 11 and 25 days, with baseline values significantly smaller than before surgery and responses to heating significantly higher. Nerve section in these previously ligated sciatic nerves produces a significant increase in skin perfusion. Our results suggest that vasomotor changes in the model of sciatic ligature are presumably related to a denervation hypersensitivity of skin blood vessels to vasoactive agents.

Skin perfusion changes after sciatic nerve transection in the rat.

Laser Doppler flowmetry was used as a method of measurement of skin blood flow perfusion in an experimental rat model of peripheral nerve section. The common sciatic nerve was microsurgically approached and cleanly severed (sciatic transection group). Contralateral nerves were approached but not injured (sham procedure). All paws were studied before any surgical procedure (controls) and immediately, 24 hours, 11 and 25 days after surgery. In each experiment, the skin perfusion was measured in the plantar surface of the hind paw, both in baseline conditions and after a heating test, where skin temperature around flowmeter probe reached 42 degrees C. Sham operated paws showed no differences from control unoperated paws. The heating test produced an increase in skin perfusion that ranged between 70% and 80% in sham and normal paws. Sciatic nerve section produces an immediate increase of 36.7% in blood flow with an additional increase of 27.5% after heating. In the following studies, on days 1, 11 and 25 baseline skin perfusion showed no changes in relation to preoperative values and heating induced only a small increase in perfusion.

Unreactive EEG: pattern in locked-in syndrome.

Locked-in syndrome (LIS) is a state of complete paralysis except for ocular movements in a conscious individual, normally resulting from brainstem lesions. We report three patients with acute brainstem strokes and LIS whose repeated EEG recordings exhibited an "alpha coma" pattern including an unreactive alpha rhythm to multimodal stimuli. This finding is of importance since preservation of consciousness is often difficult to ascertain in LIS and presence of unreactive alpha on unresponsive patients is normally equated with vegetative states and discards LIS. Failure to diagnose LIS results in abandonment of communication efforts with these tragically affected individuals. Alpha reactivity cannot define consciousness.

Comparative toxic and genotoxic effects of chloroacetanilides, formamidines and their degradation products on Vibrio fischeri and Chironomus riparius.

Toxic and genotoxic effects of alachlor, metolachlor, amitraz, chlordimeform, their respective environmentally stable degradation products 2,6-diethylaniline, 2-ethyl-4-methylaniline, 2,4-dimethylaniline, and two other related compounds, 3,4-dichloroaniline and aniline were compared. Acute toxicity tests with Chironomus riparius (96 h) and Vibrio fischeri (Microtox) and genotoxicity tests with a dark mutant of V. fischeri (Mutato) were carried out. Our results demonstrate that toxicity and genotoxicity of the pesticides are retained upon degradation to their alkyl-aniline metabolites. In the case of the herbicides alachlor and metolachlor, the toxicity to V. fischeri was enhanced upon degradation. Narcosis alone explains toxicity of the compounds to the midge, but not so for the bacteria suggesting a disparity in the selectivity of the test systems. All compounds showed direct genotoxicity in the Vibrio test. but amitraz and its metabolite were genotoxic at concentrations 10(3)-10(5) lower than all the other compounds. The observations indicate that stable aniline degradation products of the pesticides may contribute considerably to environmental risks of pesticides application and that genotoxic effects may arise upon degradation of pesticides.