Assessing the effect of copper on growth, copper accumulation and physiological responses of grazing species Atriplex halimus: ecotoxicological implications.

Tolerance of plants to elevated concentrations of heavy metals in growth media and in its tissues leads to high degrees of metal bioaccumulation, which may pose a risk for humans and animals alike. Therefore, bio-accumulating plants need thorough evaluation from an environmental health point of view. A glasshouse experiment concerning the xerohalophyte Atriplex halimus was carried out to determine its tolerance and capacity to accumulate copper. We investigated the effect of Cu from 0 to 30 mmol l(-1) on the growth, photosynthetic apparatus and nutrient uptake of A. halimus by measuring gas exchange, chlorophyll fluorescence and photoinhibition. We also determined total Cu, sodium, potassium, magnesium, phosphorous, and nitrogen content in the plant. Our results indicated that A. halimus presented a high resistance to Cu-induced stress, since the plants were able to survive at concentrations higher than 15 mmol l(-1) Cu. However, this capacity was not reflected in its ability to accumulate and tolerate greater amounts of Cu in its tissues, since clear phytotoxicity symptoms were detected at tissue concentrations greater than 38 mg kg(-1) Cu. Thus, Cu increment caused a reduction in A. halimus growth, which was related to a decrease in net photosynthetic rate. This reduction was associated with the adverse effect of Cu on the photochemical apparatus and the reduction in the absorption of essential nutrients. The high resistance of A. halimus was largely related with the capacity of this species to avoid the absorption of great amounts of Cu. For all the above reasons, A. halimus could have the characteristics of a Cu-exclusion plant.

[Results of the treatment of irreparable rotator cuff ruptures with the use of the subacromial balloon]. / Resultados del tratamiento de roturas irreparables de manguito rotador con el uso del balón subacromial.

INTRODUCTION: arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience. MATERIAL AND METHODS: we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales. RESULTS: a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified. CONCLUSIONS: the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.

INTRODUCCIÓN: el tratamiento mediante cirugía artroscópica de las lesiones del manguito rotador ha desplazado a la cirugía abierta como primera opción de tratamiento. Existen diferentes técnicas quirúrgicas descritas para tratar las roturas masivas o no reparables. Desde hace unos años se viene utilizando un nuevo dispositivo que consiste en un balón subacromial biodegradable que actúa como espaciador entre la cabeza humeral y el acromion. Este trabajo pretende analizar los resultados de este implante. MATERIAL Y MÉTODOS: realizamos un estudio observacional y retrospectivo de todos los pacientes a los que se les implantó un balón subacromial en nuestro centro entre 2017 y 2019. Se evaluó a los pacientes pre y postoperatoriamente mediante las escalas de Constant, DASH y EVA. RESULTADOS: un total de 43 pacientes cumplieron los criterios de inclusión y el seguimiento mínimo de 24 meses. La puntuación media de la escala DASH pasó de 53.6 en la evaluación preoperatoria a 27.9 en la postoperatoria (p = 0.026). También se obtuvo una mejoría significativa en la escala de Constant, que pasó de una media de 37.9 a 61.8 (p = 0.037). En cuanto a la evaluación del dolor, la EVA media pasó de 7.44 a 3.38 (p = 0.916). En 90% de los pacientes no se objetivaron complicaciones ni necesidad de nuevas intervenciones. CONCLUSIONES: el balón subacromial ha mostrado resultados favorables en nuestra serie de pacientes, por lo que podría suponer una opción válida de tratamiento en pacientes con roturas no reparables del manguito rotador.

Mechanical characterization of Co/Cu multilayered nanowires.

The mechanical deformation properties of (110) Co/Cu multilayered nanowires were studied by Molecular Dynamics under uniaxial tensile and compressive stresses. The potential of the immiscible CoCu system was modeled by a second-moment tight-binding approximation. Stress-strain curves at different conditions were obtained and the elastic modulus and yield stress were analyzed. Both magnitudes are approximately independent of the strain rate, except at high values. They decrease linearly with increasing temperature. Below a volume-to-surface-area ratio, their values drastically increase and diverge from the bulk values. If the thickness of the Cu sublayers increases, the Young's modulus and yield stress decrease, although in a different way. The elastic modulus decreases linearly and the yield stress falls steeply whenever Cu is present in the nanowire, since the lattice distortion takes place firstly and fundamentally in Cu sublayers. The change in the axial stress at the interface is little significant on average and rather localized. Unlike, the transverse stress has a non-uniform distribution along the Cu sublayer, especially at the yield point. The Young's modulus and yield stress are larger in tension than in compression. Under tensile stress, nanowires slip via partial dislocation nucleation and propagation. Unlike, compressive deformation of nanowires takes place via both partial and full dislocations.

Optimism and prostate cancer-specific expectations predict better quality of life after robotic prostatectomy.

We examined the relations among generalized positive expectations (optimism), prostate-cancer specific expectations, and prostate cancer-related quality of life in a prospective sample of 83 men who underwent robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer. Optimism was significantly associated with higher prostate cancer-specific expectations, ß = .36, p < .001. In addition, optimism and prostate cancer-specific expectations were independent prospective predictors of better scores on the following prostate cancer-related quality of life scales: Sexual Intimacy and Sexual Confidence; Masculine Self-Esteem (specific expectations only), Health Worry, Cancer Control, and Informed Decision Making (ßs > .21, ps < .05). When considered simultaneously, both optimism and specific expectations contributed uniquely to better Health Worry and Cancer Control scores, optimism was a unique predictor of better Sexual Intimacy and Sexual Confidence scores, and specific expectations uniquely predicted higher scores on Informed Decision Making. Although optimism and prostate-cancer specific expectations are related, they contribute uniquely to several prostate cancer-related quality of life outcomes following RALP and may be important targets for quality of life research with this population.

[Results in the medium long term of the reverse shoulder prosthesis in the cuff arthropathy]. / Resultados a mediano plazo de la prótesis invertida en la artropatía de manguito.

INTRODUCTION: the final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. MATERIAL AND METHODS: retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. RESULTS: we achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. CONCLUSIONS: reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.

INTRODUCCIÓN: el estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. MATERIAL Y MÉTODO: retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. RESULTADOS: mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. CONCLUSIONES: la AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.

Vascular reactivity at rest and during exercise in middle-aged obese men: effects of short-term, low-intensity, exercise training.

OBJECTIVE: Although increased blood flow (BF) in exercising muscles is thought to be impaired in obese subjects and may contribute to physical inactivity, data are scarce in this regard and the involvement of endothelium dysfunction remains partly hypothetical. METHODS: A total of 16 middle-aged obese men (body mass index, BMI ≥ 30 kg m(-2)) and 16 normal-weight men (BMI<25 kg m(-2)), matched for age, were recruited. We used ultrasonography to compare intima-media thickness (IMT) and distensibility of the carotid artery, flow-mediated dilation (FMD), nitrate-dependent dilation (NDD) and peak BF during post-ischemic hyperemia in the brachial artery (a conduit artery), and leg BF during knee-extensor exercise (indicative of resistance vessel function) in obese and in normal-weight men. In addition, 10 obese men participated in an 8 week individualized low-intensity training program. RESULTS: Compared with normal-weight men, obese men had higher carotid IMT (0.50 ± 0.01 vs 0.62 ± 0.04 mm, P < 0.05) but lower carotid distensibility (0.26 ± 0.03 vs 0.11 ± 0.03 mm Hg(-1) 10(-2), P < 0.05), FMD (5.7 ± 0.4 vs 3.3 ± 0.5%, P < 0.05) and peak BF during post-ischemic hyperemia (398 ± 52 vs 229 ± 24%, P < 0.05), despite similar maximal shear rate, without NDD differences. Lower limb BF (ml min(-1) 100 g(-1)) increased significantly from rest to maximal exercise in both groups with lower values in obese men (at peak power, 36.9 ± 1.6 vs 31.5+2.2 ml min(-1) 100 g(-1), P < 0.05). Exercise training normalized carotid distensibility (0.14 ± 0.04 before vs 0.23 ± 0.03 mm Hg(-1) 10(-2) after training, P = 0.09) and FMD (2.7 ± 0.4 before vs 4.8 ± 0.5% after training, P < 0.05), but did not improve brachial post-ischemic peak BF or exercising leg BF. CONCLUSIONS: In obese men, conduit and resistance vessel reactivity is depressed, but a short-term low-intensity exercise training improves distensibility and endothelium dependent vasodilation in the large conduit artery, but not post ischemic or exercise muscle BF.

Dependence on temperature and energy of the heteroepitaxy of small metallic nanoclusters.

Deposition at different energies and temperatures of small metallic nanoclusters on metallic substrates is studied by molecular-dynamics simulations. Small-, Co/Cu(001), and large-misfit, Cu/Au(001) and Au/Cu(001), systems are considered. The rise in temperature improves the epitaxial order, although its effect is smaller in large-misfit systems. Thus, by increasing this parameter, non-epitaxial clusters can turn their structure into epitaxial in the case of Co/Cu(001), into aligned in Cu/Au(001), and into layered in Au/Cu(001). Therefore, the characteristics of the alignment are determined by the properties of the material. In addition, the influence of the initial structure is more marked in Co and Cu clusters, since they can reproduce locally other phases. Epitaxy can also be improved if the deposition energy is increased, although the deposited cluster loses its original shape progressively. Its effect is different depending mainly on the degree of misfit. An increase in energy (of up to 0.75 eV/atom) produces similar effects, but more noticeable, as a rise in temperature.

A prospective report of changes in prostate cancer related quality of life after robotic prostatectomy.

In this prospective, longitudinal study the authors examined changes in cognitive, emotional, and interpersonal components of prostate cancer-related quality of life in 71 men who underwent robotic-assisted prostatectomy for prostate cancer. They identified significant changes across several quality-of-life domains from presurgery to 3-months and 1-year postsurgery. Although some components of quality of life returned to baseline by one year postsurgery, decrements in sexual intimacy, sexual confidence, and masculine self-esteem were enduring. These data can be used to guide patients in their expectations for quality of life following robotic prostatectomy and highlight the need for multidisciplinary approaches aimed at improving men's sexual adjustment after this procedure.

Validation of a fully automatic photoplethysmographic device for toe blood pressure measurement.

OBJECTIVES: This study was designed to assess the accuracy and reliability of a new, portable, fully automated photoplethysmography (PPG) device for toe blood pressure (TBP) measurement. DESIGN: Within-subject comparison with conventional laser Doppler (LD) measurement. MATERIALS AND METHODS: Four TBP measurements were performed on both lower limbs, alternatively with LD and PPG in 200 patients recruited at the Nîmes University Hospital. Reproducibility was assessed by the intraclass correlation coefficient (ICC). The concordance between the two methods was evaluated by Lin's concordance correlation coefficient (CCC), in the whole population as well as in comorbidity subgroups. A potential bias was investigated with the Bland and Altman method. RESULTS: The ICC was 0.887 (95% confidence interval (CI) 0.852-0.913) and 0.893 (0.860-0.918) on the right side (n = 193), 0.905 (0.875-0.928) and 0.898 (0.866-0.922) on the left side (n = 188) for PPG and LD measurements, respectively. The CCC was 0.913 (0.885-0.934) on the right side and 0.915 (0.888-0.937) on the left side, and remained >0.8 regardless of co-morbidities. CONCLUSIONS: This new, fully automatic, photoplethysmographic device yielded reliable TBP measurements and showed good agreement with the reference LD system over a wide range of values.

Influence of the cluster orientation on the epitaxy: deposition of Co nanoclusters on Cu(001) surfaces.

Deposition at low energy of 147-atom icosahedral Co nanoclusters on Cu(001) substrates is studied by molecular-dynamics simulations. Atomic interactions were mimicked by a many-body potential based on the tight-binding second-moment approximation. Clusters were rotated by using the two first Euler angles, in the so-called "x-convention," and subsequently, they were deposited on the substrate. The dependence of the degree of epitaxy on these angles has been obtained. Epitaxy is also related to the initial number of (001)-oriented atoms, especially for extreme values of this latter quantity. A better epitaxial matching is connected with a larger spreading index. The explanation of the epitaxial behavior of the supported clusters resides mainly in the dynamical interaction between grains during approximately the first 40 ps. Whenever the newly-formed (001)-oriented grain competes against a large number of grains after the collision, a very low epitaxial matching is obtained.

Thrombosis of previously silent Persistent Sciatic Vein in non Klippel-Trenaunay syndrome patient.

Persistent Sciatic Vein (PSV) remains a rare condition with no associated malformative syndrome or concomitant Persistent Sciatic Artery (PSA). Very few case reports have been published. We report the case of a 73-year-old man who presented to the emergency room with tenderness, edema and pain of the left calf, for up to 3 days. Biology reported an elevated d-dimer level. Doppler ultrasound diagnosed proximal left deep popliteal vein thrombosis, extended to a large vein along the sciatic nerve in the posterior compartment of the thigh, and a patent superficial femoral vein. Anticoagulation therapy was initiated immediately for at least 3 months. PSV remains an understudied condition. While its prevalence is low in the general population, this anatomical condition is associated with some specific clinical situations, such as Klippel-Trenaunay syndrome (KTS) or early varicose recurrence, especially in the posterior thigh area. To our knowledge, this is the first case report of a thrombosed PSV in a patient without a KTS.

Interactive effects of soil water deficit and air vapour pressure deficit on mesophyll conductance to CO2 in Vitis vinifera and Olea europaea.

The present work aims to study the interactive effect of drought stress and high vapour pressure deficit (VPD) on leaf gas exchange, and especially on mesophyll conductance to CO(2) (g(m)), in two woody species of great agronomical importance in the Mediterranean basin: Vitis vinifera L. cv. Tempranillo and Olea europaea L. cv. Manzanilla. Plants were grown in specially designed outdoor chambers with ambient and below ambient VPD, under both well-irrigated and drought conditions. g(m) was estimated by the variable J method from simultaneous measurements of gas exchange and fluorescence. In both species, the response to soil water deficit was larger in g(s) than in g(m), and more important than the response to VPD. Olea europaea was apparently more sensitive to VPD, so that plants growing in more humid chambers showed higher g(s) and g(m). In V. vinifera, in contrast, soil water deficit dominated the response of g(s) and g(m). Consequently, changes in g(m)/g(s) were more related to VPD in O. europaea and to soil water deficit in V. vinifera. Most of the limitations of photosynthesis were diffusional and especially due to stomatal closure. No biochemical limitation was detected. The results showed that structural parameters played an important role in determining g(m) during the acclimation process. Although the relationship between leaf mass per unit area (M(A)) with g(m) was scattered, it imposed a limitation to the maximum g(m) achievable, with higher values of M(A) in O. europaea at lower g(m) values. M(A) decreased under water stress in O. europaea but it increased in V. vinifera. This resulted in a negative relationship between M(A) and the CO(2) draw-down between substomatal cavities and chloroplasts in O. europaea, while being positive in V. vinifera.

Abnormal vascular reactivity at rest and exercise in obese boys.

BACKGROUND: Obese children exhibit vascular disorders at rest depending on their pubertal status, degree of obesity, and level of insulin resistance. However, data regarding their vascular function during exercise remain scarce. The aims of the present study were to evaluate vascular morphology and function at rest, and lower limb blood flow during exercise, in prepubertal boys with mild-to-moderate obesity and in lean controls. MATERIALS AND METHODS: Twelve moderately obese prepubertal boys [Body Mass Index (BMI: 23.9+/-2.6 kg m(-2))] and thirteen controls (BMI:17.4+/-1.8 kg m(-2)), matched for age (mean age: 11.6+/-0.6 years) were recruited. We measured carotid intima-media thickness (IMT) and wall compliance and incremental elastic modulus, resting brachial flow-mediated dilation (FMD) and nitrate-dependent dilation (NDD), lower limb blood flow during local knee-extensor incremental and maximal exercise, body fat content (DEXA), blood pressure, blood lipids, insulin and glucose. RESULTS: Compared to lean controls, obese boys had greater IMT (0.47+/-0.06 vs. 0.42+/-0.03 mm, P<0.05) but lower FMD (4.6+/-2.8 vs. 8.8+/-3.2%, P<0.01) in spite of similar maximal shear rate, without NDD differences. Lower limb blood flow (mL min(-1).100 g(-1)) increased significantly from rest to maximal exercise in both groups, although obese children reached lower values than lean counterparts whatever the exercise intensity. CONCLUSIONS: Mild-to-moderate obesity in prepubertal boys without insulin resistance is associated with impaired endothelial function and blunted muscle perfusion response to local dynamic exercise without alteration of vascular smooth muscle reactivity.

Social-cognitive aspects of underserved Latinas preparing to undergo genetic cancer risk assessment for hereditary breast and ovarian cancer.

OBJECTIVES: As Latinos are a growing ethnic group in the United States, it is important to understand the socio-cultural factors that may be associated with cancer screening and prevention in this population. The socio-cultural factors that may affect preparedness to undergo genetic cancer risk assessment (GCRA) deserve particular attention. The pre-GCRA period can provide insight into variables that may influence how medically underserved Latinas, with limited health resources and access, understand hereditary cancer information and subsequently implement cancer risk management recommendations. This study explores social, cognitive and cultural variables in Latinas prior to undergoing GCRA. METHODS: The study sample consisted of low-income, underserved Latinas referred for GCRA because of a personal and/or family history of breast or ovarian cancer. Acculturation, cancer-specific fatalism, self-efficacy and social support were assessed prior to GCRA. RESULTS: Fifty Latinas (mean age=40.1+/-7.7) completed instruments; 86% had invasive cancer, 78% spoke primarily Spanish and 61% were of Mexican ancestry. Low levels of acculturation (n=50, mean=9.0+/-5.8) and cancer-specific fatalism (n=43, mean=5.6+/-3.2), but relatively high self-efficacy (n=49, mean=40.9+/-7.8) and social support (n=49, mean=37.3+/-8.7) were reported. Cancer-specific fatalism and self-efficacy were inversely correlated (r=-0.47, p=0.002). Those over age 38 at the time of cancer diagnosis reported higher acculturation (mean=11.4+/-7.2, p=0.02) and social support (mean=40.5+/-1.2, p=0.05). CONCLUSIONS: These findings suggest that medically underserved Latinas may already possess some of the necessary skills to successfully approach the GCRA process, but that special attention should be given to cultural factors.

Resultados del tratamiento de roturas irreparables de manguito rotador con el uso del balón subacromial / Results of the treatment of irreparable rotator cuff ruptures with the use of the subacromial balloon

Resumen: Introducción: el tratamiento mediante cirugía artroscópica de las lesiones del manguito rotador ha desplazado a la cirugía abierta como primera opción de tratamiento. Existen diferentes técnicas quirúrgicas descritas para tratar las roturas masivas o no reparables. Desde hace unos años se viene utilizando un nuevo dispositivo que consiste en un balón subacromial biodegradable que actúa como espaciador entre la cabeza humeral y el acromion. Este trabajo pretende analizar los resultados de este implante. Material y métodos: realizamos un estudio observacional y retrospectivo de todos los pacientes a los que se les implantó un balón subacromial en nuestro centro entre 2017 y 2019. Se evaluó a los pacientes pre y postoperatoriamente mediante las escalas de Constant, DASH y EVA. Resultados: un total de 43 pacientes cumplieron los criterios de inclusión y el seguimiento mínimo de 24 meses. La puntuación media de la escala DASH pasó de 53.6 en la evaluación preoperatoria a 27.9 en la postoperatoria (p = 0.026). También se obtuvo una mejoría significativa en la escala de Constant, que pasó de una media de 37.9 a 61.8 (p = 0.037). En cuanto a la evaluación del dolor, la EVA media pasó de 7.44 a 3.38 (p = 0.916). En 90% de los pacientes no se objetivaron complicaciones ni necesidad de nuevas intervenciones. Conclusiones: el balón subacromial ha mostrado resultados favorables en nuestra serie de pacientes, por lo que podría suponer una opción válida de tratamiento en pacientes con roturas no reparables del manguito rotador.

Abstract: Introduction: arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience. Material and methods: we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales. Results: a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified. Conclusions: the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.

Reliability of hemostasis biomarkers is affected by time-dependent intra-patient variability.

Essentials Nucleosomes and free DNA are two newly described biomarkers in venous thromboembolism (VTE). Reliability of nucleosomes, plasma free DNA and conventional hemostasis markers were studied. Hemostasis biological parameters vary over a short time-frame in VTE patients. Hemostasis biological parameters also vary over a short time-frame in healthy controls. SUMMARY: Background Previous studies have associated neutrophil-derived circulating nucleosomes and plasma free DNA with venous thromboembolism (VTE). However, there are few data concerning these two biomarkers and no studies have compared the reliability of nucleosomes and plasma free DNA against that of conventional hemostasis markers. Objectives We performed a 3-year prospective study of nucleosomes and plasma free DNA levels in comparison with conventional hemostatic biomarkers and blood cells. Patients/Methods Fifteen healthy controls and 22 randomly selected patients with a history of VTE were followed monthly for 6 months. The reliability of these markers was evaluated by the intraclass correlation coefficient (ICCs). Results and Conclusions In healthy controls and patients, we found a low reliability for nucleosomes and plasma free DNA, with ICCs at 0.538 (95% confidence interval [CI], 0.334-0.764) and 0.091 (95% CI, -0.026-0.328), respectively, in the healthy controls, and at 0.213 (95% CI, 0.042-0.463) and 0.161 (CI 95%, 0.008-0.398) in the patient group. For the conventional hemostasis biomarkers and for blood cells, reliability ranged from poor to good in the healthy volunteers and from poor to acceptable in the patient group. Our study shows for the first time that hemostasis biological parameters spontaneously vary over a short time-frame in VTE patients and, more surprisingly, in normal individuals. The clinical value of such intra-individual variations is currently unknown. This variability might mean reinterpreting diagnostic or prognostic models based on static evaluation of individuals. Studying the intrinsic value of individual patterns of markers' variability is warranted.

Anaphylactic shock with an ultrasound contrast agent.

Echo contrast agents, such as SonoVue®, (Bracco, Milan, Italy) are often used to enhance diagnosis. Although their use is safe, some rare side effects could be severe or even fatal. We are reporting a case of severe systemic allergic reaction after infusion of SonoVue®. After a brief review of the literature, the aim of this paper is to draw attention to this risk and recall the safety instructions coming with the use of ultrasound contrast agents.

Resultados a mediano plazo de la prótesis invertida en la artropatía de manguito / Results in the medium long term of the reverse shoulder prosthesis in the cuff arthropathy

Resumen: Introducción: El estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. Material y método: Retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. Resultados: Mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. Conclusiones: La AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.

Abstract: Introduction: The final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. Material and methods: Retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. Results: We achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. Conclusions: Reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.

From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability?

The auscultatory technique remains the point of reference for the validation of non-invasive blood pressure measurement devices, although the exact origin of the Korotkoff sounds is still debated and comparison with intra-arterial measurement shows limits and pitfalls. Automatic oscillometric devices are now widely used by nurses, physicians, and patients. However, many available devices have not been duly validated. Moreover, they calculate systolic and diastolic blood pressures using undisclosed algorithms. Therefore, these devices are not interchangeable, and their reliability may be questionable in some clinical situations. Nevertheless, oscillometry is increasingly used, beside NIBP, for the assessment of central blood pressure and systemic arterial wall stiffness. Awareness of its limits and causes of error is all the more necessary.

Impacto de la pandemia de la COVID-19 en el funcionamiento de un servicio público de Ortopedia y Traumatología: nuestro aprendizaje luego de la primera ola / Impact of the COVID-19 pandemic on the activity of a public orthopedics and traumatology service. Our insights after the first wave

Introducción: El objetivo principal fue comparar la actividad clínico-quirúrgica de nuestro Servicio de Ortopedia y Traumatología antes de la instauración del plan de contingencia frente a la pandemia de la COVID-19 y durante este, un aspecto relevante para establecer antecedentes que permitan guiar nuestro desempeño ante la segunda ola de casos y futuras contingencias semejantes. materiales y métodos: Estudio analítico observacional longitudinal ambispectivo de los pacientes atendidos en el Servicio de Ortopedia y Traumatología de un hospital del sistema público de la Ciudad Autónoma de Buenos Aires, durante el plan de contingencia frente a la pandemia de la COVID-19. Como variable de resultado primaria se valoró el número total de cirugías realizadas durante el período de estudio. Resultados: La pandemia se asoció con menos cirugías totales (p = 0,002), de Guardia (p = 0,000) y de Planta (p = 0,002). Las cirugías totales se redujeron un 81,5%. Las cirugías de urgencia representaron el 97%, diferencia significativa con el período fuera de la pandemia (p = 0,080). Además, el promedio de cirugías por día quirúrgico disponible fue significativamente menor (p = 0,000). Conclusiones: Creemos que la atención de la enfermedad ortopédica y el trauma musculoesquelético, adaptada a las obligaciones indicadas por el plan nacional y regional de contingencia frente a la pandemia, fue notoriamente menor que nuestro desempeño habitual. Si bien respondimos adecuadamente a las urgencias de nuestra especialidad queda pendiente la posibilidad de estratificar y considerar tipos de pacientes con cuadros pasibles de ser tratados, en forma gradual, durante la pandemia. Nivel de Evidencia: IV

Introduction: Our aim was to compare our activity in the Orthopedics and Traumatology service during the first wave of the COVID-19 pandemic. materials and methods: Ambispective longitudinal observational analytical study of patients treated in the Orthopedics and Traumatology Service of a public health hospital of Buenos Aires during the first wave of the COVID-19 pandemic. The primary outcome variable was the total number of surgeries performed during the study period. Results: The pandemic was associated with fewer total surgeries (p = 0.002), emergency department surgeries (p = 0.000) and elective surgeries (p = 0.002). Total surgeries were reduced by 81.5%. Emergency surgeries accounted for 97%, a significant difference with the non-pandemic period (p = 0.080). Additionally, the average number of surgeries per available surgical day was significantly lower (p = 0.000). Conclusions: We believe that, under the regulations indicated by the national and regional pandemic contingency plan, the care of orthopedic pathology and musculoskeletal trauma was notoriously lower than our usual performance. Although we responded adequately to the emergencies of our specialty, the possibility of stratifying and considering types of patients with conditions that could be treated gradually during the pandemic remains pending. Level of Evidence: IV