Clinical and Functional Results of Broström-Gould Procedure With Suture Tape Augmentation: An Evaluation Using Three Scales.

The mechanical superiority of suture tape augmentation associated with the Broström-Gould procedure for treating lateral ankle instability has been reported. This study aimed to describe functional results using the visual analog scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) scale, and Short Form of Quality of Life Survey (SF-36) in patients with ankle lateral instability who underwent the modified Broström-Gould repair and suture tape augmentation and to determine the recurrence of injury and the impact on the perception of its stability. This retrospective cohort study included patients with lateral ankle instability treated using the modified Broström-Gould procedure and suture tape augmentation from December 2015 to July 2018 with a 6- to 36-month follow-up. Clinical and functional results were evaluated using the 3 aforementioned scales. p ≤ 0.05 was considered statistically significant. Twenty-eight patients were included, 18 (64%) males and 10 (36%) females (mean ± standard deviation age of 33.25 ± 12.73). The mean pre- and postoperative VAS scores were 6 ± 1.18 and 0.53 ± 0.92, respectively. The average pre- and postoperative AOFAS scores were 65.89 ± 15.08 and 94.60 ± 6.88, respectively; results were excellent (91 to 100) in 18 (64%) patients and good (81 to 90) in 10 (36%). Three patients experienced recurrence of injury treated with physical therapy, and their progress was satisfactory; stability perception was maintained. Excellent clinical and functional results were demonstrated in our study using suture tape augmentation in the modified Broström-Gould procedure, which probably protects against the recurrence of lateral ankle instability.

BCN Checkpoint: same-day confirmation of reactive HIV rapid test with Point Of Care HIV-RNA accelerates linkage to care and reduces anxiety.

BACKGROUND: The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non-clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. AIMS: This study explores the possibility of Point of Care PCR testing for a same-day confirmation. MATERIALS AND METHODS: Between March 2015 and September 2016 a POC PCR test (Xpert® HIV-1 Qual) was performed in parallel to the Western Blot test after a reactive HIV rapid test (Alere Determine™ HIV-1/2 Ag/Ab Combo and Alere™ HIV Combo). HIV confirmed positive cases received emotional support by peers, were informed and prepared for treatment initiation and rapidly linked to HIV clinic. RESULTS: During the study period 11 455 tests were performed to 7163 clients. A total of 249 reactive rapid HIV tests were found. For analysis a total of 33 cases were excluded due to the lack of PCR and/or WB test. Results of comparison of the 216 cases showed 194 concordant positive confirmations and 14 concordant negative results. In three cases PCR was positive and WB negative. In five cases PCR was negative and WB positive. CONCLUSION: The POC PCR assay is easy to use and feasible in a community-based center. Reducing time for confirmation to 90 min has been possible in 91.2% (197/216) of cases with positive PCR result. In cases of a negative PCR result an additional test (WB, Elisa or PCR quantitative) was needed to distinguish false positive results (6.5%) from viral load results below level of detection (2.3%). Clients expressed satisfaction with same-day confirmation and less anxiety.

Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer.

PURPOSE: The aim of this study was to evaluate the accuracy of serum procalcitonin (PCT) and C-reactive protein (CRP) for early diagnosis of postoperative intra-abdominal infections (PIAI) after elective surgery for colorectal cancer. METHODS: Prospective observational study including patients operated on for colorectal cancer between January and December of 2015 was performed. Serum PCT and CRP levels were measured before surgery and daily until postoperative day 3. RESULTS: One hundred twenty patients were included. Seven patients (5.8%) had PIAI. PCT levels were significantly higher in patients with PIAI on postoperative days 1 and 3, whereas CRP levels only were significantly more elevated on postoperative day 3. The ratio between CRP levels on postoperative day 3 and CRP levels on postoperative days 2 (CRP D3/CRP D2) and 1 (CRP D3/CRP D1) was significantly higher in patients with PIAI. PCT on postoperative day 3, for a cutoff of 0.45 ng/mL, had the best sensitivity (100%) with a specificity of 73.8%. The ratio CRP D3/CRP D1 yielded the higher specificity and positive predictive value (90.9 and 27.3%, respectively, for a cutoff of 1.8). The higher negative predictive value was obtained for PCT on postoperative days 1 and 3 (100%, with cutoff of 0.76 and 0.45 ng/mL, respectively) and for CRP on postoperative day 3 (100% with cutoff of 10 mg/dL). CONCLUSION: PCT and CRP serum levels are associated with the appearance of PIAI after colorectal cancer surgery, although the positive predictive values were low for both PCT and CRP. However, the negative predictive values were high.

Prevalence of Insomnia and Associated Factors in Outpatients With Generalized Anxiety Disorder Treated in Psychiatric Clinics.

Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder (GAD). In this cross-sectional, prospective, observational, and multicenter study, factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated. Using multivariate analyses, the factor most strongly associated with the presence of insomnia (ISI ≥ 8) was the severity of the disorder (Odds Ratio [OR]: 9.253 for severe GAD; 95% Confidence Interval [CI]: 1.914-44.730; p = 0.006), pain interference and symptoms of depression (OR: 1.018; 95% CI 1.003-1.033; p = 0.016 and OR: 1.059; 95% CI 1.019-1.101; p = 0.004, respectively). Insomnia was not related to quality of life. Our results show insomnia to be a common health condition among patients with GAD, associated with the severity of anxiety and depressive symptoms and pain interference.

Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study. / Carga de trabajo y cumplimiento por parte de las enfermeras de las medidas no farmacológicas para la prevención de la neumonía asociada a la ventilación mecánica. Estudio piloto.

OBJECTIVE: To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. METHODS: A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. VARIABLES: knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. RESULTS: Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. CONCLUSIONS: Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.

Energy transduction and signal averaging of fluctuating electric fields by a single protein ion channel.

We demonstrate the electrical rectification and signal averaging of fluctuating signals using a biological nanostructure in aqueous solution: a single protein ion channel inserted in the lipid bilayer characteristic of cell membranes. The conversion of oscillating, zero time-average potentials into directional currents permits charging of a load capacitor to significant steady-state voltages within a few minutes in the case of the outer membrane porin F (OmpF) protein, a bacterial channel of Escherichia coli. The experiments and simulations show signal averaging effects at a more fundamental level than the traditional cell and tissue scales, which are characterized by ensembles of many ion channels operating simultaneously. The results also suggest signal transduction schemes with bio-electronic interfaces and ionic circuits where soft matter nanodiodes can be coupled to conventional electronic elements.

Designing voltage multipliers with nanofluidic diodes immersed in aqueous salt solutions.

Membranes with nanofluidic diodes allow the selective control of molecules in physiological salt solutions at ambient temperature. The electrical coupling of the membranes with conventional electronic elements such as capacitors suggests opportunities for the external monitoring of sensors and actuators. We demonstrate experimentally and theoretically the voltage multiplier functionality of simple electrical networks composed of membranes with conical nanopores coupled to load capacitors. The robust operation of half and full wave voltage multipliers is achieved in a broad range of experimental conditions (single pore and multipore membranes, electrolyte concentrations, voltage amplitudes, and solid-state capacitances). The designed voltage multipliers operate in the liquid state and can be used in sensing devices because different electrical, optical, and chemical inputs are known to modulate the individual nanofluidic diode resistances in the electrical network.

Effect of processing on polyamine content and bioactive peptides released after in vitro gastrointestinal digestion of infant formulas.

This study examined the influence of processing on polyamines and peptide release after the digestion of a commercial infant formula designed for children during the first months of life. Polyamine oxidase activity was not suppressed during the manufacturing process, which implicates that polyamine concentrations were reduced over time and during infant formula self-life. In gel electrophoresis, in vitro gastrointestinal digestion of samples with reduced amount of enzymes and time of digestion shows an increase in protein digestibility, reflected in the increase in nonprotein nitrogen after digestion and the disappearance of ß-lactoglobulin and α-lactalbumin bands in gel electrophoresis. Depending on the sample, between 22 and 87 peptides were identified after gastrointestinal digestion. A peptide from ß-casein f(98-105) with the sequence VKEAMAPK and antioxidant activity appeared in all of the samples. Other peptides with antioxidant, immunomodulatory, and antimicrobial activities were frequently found, which could have an effect on infant health. The present study confirms that the infant formula manufacturing process determines the polyamine content and peptidic profile after digestion of the infant formula. Because compositional dissimilarity between human milk and infant formula in polyamines and proteins could be responsible for some of the differences in health reported between breast-fed and formula-fed children, these changes must be taken into consideration because they may have a great effect on infant nutrition and development.

Unusual records of deepwater teleosteans trawled off the western coast of Mexico.

The first records of three midwater species for the Mexican ichthyofauna (Holtbyrnia laticauda, Brama dussumieri and Cubiceps baxteri), caught off the coast of Baja California, Mexico, in mid 2014, are reported. As far as is known, they are the first verified specimens, geo-referenced and catalogued in a reference fish collection for the west coast of Mexico. The species' known distributions were extended northward in the eastern Pacific Ocean, ranging from 3495 to 8300 km.

Validation of a decision support tool for wastewater treatment selection.

Wastewater treatment selection is a complex task usually addressed by applying separate tools for the correct assessment of multi-criteria evaluation. Novedar_EDSS integrates technical, environmental, economic and social assessment capabilities in one single platform. The aim of this work is to evaluate and demonstrate the capabilities of this environmental decision support system (EDSS). For that purpose, 4 case studies of real projects were selected to validate the results in the EDSS by comparing them with those from the study of alternatives performed by the decision makers. Moreover, 1 conceptual case study was applied to support the selection of the most properly strategy for plant retrofitting. Results have demonstrated that the EDSS provides key aspects when deciding the retrofitting process to apply and, when compared to real projects, it recommends analogue treatments as those applied in the projects, ranking them in the same order. Therefore, results in the validation process performed show that this tool provides a reliable basis to support decision makers to select properly treatment alternatives in wastewater treatment plant pre-design.

Characterization of organic fouling in reverse osmosis membranes by headspace solid phase microextraction and gas chromatography-mass spectrometry.

Adsorption of organic substances on reverse osmosis (RO) membrane surfaces may form an organic film on the membrane, known as organic fouling, and cause flow-rate loss. This problem is mostly unavoidable as no pretreatment method exists for perfect removal of possible foulants, including organic compounds resulting from undesirable bioactivity. Understanding the characteristics of fouling layers is an essential step towards overall improvement of RO membrane operations. In this study, the organic fouling in RO membranes treating the effluent of a secondary treatment from an urban wastewater treatment plant was characterized. Headspace solid phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry has been used for the first time, to provide valuable information of organic fouling. Different polarity SPME fibers were tested for this purpose. In addition, the characterization of the organic fouling obtained by HS-SPME was compared with the results obtained by extraction using several organic solvents. The results indicated that more compound families can be identified by HS-SPME than by organic solvent extraction. Moreover, complementary organic analyses were done for better understanding of the organic fouling in RO membranes, such as total organic carbon and loss on ignition.

Adaptive multiclass classification for brain computer interfaces.

We consider the problem of multiclass adaptive classification for brain-computer interfaces and propose the use of multiclass pooled mean linear discriminant analysis (MPMLDA), a multiclass generalization of the adaptation rule introduced by Vidaurre, Kawanabe, von Bünau, Blankertz, and Müller (2010) for the binary class setting. Using publicly available EEG data sets and tangent space mapping (Barachant, Bonnet, Congedo, & Jutten, 2012) as a feature extractor, we demonstrate that MPMLDA can significantly outperform state-of-the-art multiclass static and adaptive methods. Furthermore, efficient learning rates can be achieved using data from different subjects.

Controversies in point-of-care 3D printing for oncological and reconstructive surgery with free software in oral and maxillofacial surgery: European regulations, costs, and timeframe.

The aim of this paper is to discuss the controversies surrounding the most recent European regulations, as well as the cost, for a 3D printing workflow using free-source software in the context of a tertiary level university hospital in the Spanish public health system. Computer-aided design and manufacturing (CAD/CAM) for head and neck oncological surgery with the printing of biomodels, cutting guides, and patient-specific implants has made it possible to simplify and make this type of highly complex surgery more predictable. This technology is not without drawbacks, such as increased costs and the lead times when planning with the biomedical industry. A review of the current European legislation and the literature on this subject was performed, and comparisons made with the authors' in-house 3D printing setup using free software and different 3D printers. The cost analysis revealed that for the cheapest setup with free software, it would be possible to amortize the investment from case 2, and in all cases the initial investment would be amortized before case 9. The timeframe ranged from 2 weeks with the biomedical industry to 72 h with point-of-care 3D printing. It is now possible to develop point-of-care 3D printing in any hospital with almost any budget.

Host-plant sex and phenology of Buddleja cordata Kunth interact to influence arthropod communities.

Intraspecific variation in plants is expected to have profound impacts on the arthropod communities associated with them. Because sexual dimorphism in plants is expected to provide consistent variation among individuals of the same species, researchers have often studied the effect it has on associated arthropods. Nevertheless, most studies have focused on the effect of sexual dimorphism in a single or a few herbivores, thus overlooking the potential effects on the whole arthropod community. Our main objective was to evaluate effects of Buddleja cordata's plant-sex on its associated arthropod community. We surveyed 13 pairs of male and female plants every 2 months during a year (June 2010 to April 2011). Every sampling date, we measured plant traits (water content and leaf thickness), herbivory, and the arthropod community. We did not find differences in herbivory between plant sex or through time. However, we found differences in water content through time, with leaf water-content matching the environmental seasonality. For arthropod richness, we found 68 morphospecies associated with female and 72 with male plants, from which 53 were shared by both sexes. We did not observe differences in morphospecies richness; however, we found sex-associated differences in the diversity of all species and differences on the diversity of the most abundant species with an interesting temporal component. During peak flowering season, male plants showed higher values on both parameters, but during the peak fructification season female plants showed the higher values on both diversity parameters. Our research exemplifies the interaction between plant-phenology and plant-sex as drivers of arthropod communities' diversity, even when plant sexual-dimorphism is inconspicuous, and highlighting the importance of accounting for seasonal variation. We stress the need of conducting more studies that test this time-dependent framework in other dioecious systems, as it has the potential to reconcile previous contrasting observations reported in the literature.

The metathoracic scent gland of the leaf-footed bug, Leptoglossus zonatus.

The metathoracic scent gland of 25-day-old adults of both sexes of the leaf-footed bug, Leptoglossus zonatus (Dallas) (Heteroptera: Coreidae), are described based on optical microscopy analysis. No sexual dimorphism was observed in the glandular composition of this species. The gland is located in the anteroventral corner of the metathoracic pleura between the middle and posterior coxal pits. The opening to the outside of the gland is very wide and permanently open as it lacks a protective membrane. In the internal part, there is a pair of metathoracic glands that consist of piles of intertwined and occasionally bifurcated cellular tubes or columns. These glands discharge their pheromonal contents into the reservoir through a narrow cuticular tube. The reservoir connects with the vestibule via two opposite and assembled cuticular folds that can separate muscularly in order to allow the flow of liquid away from the insect. The external part consists of an ostiole from which the pheromone is emitted. The ostiole is surrounded by a peritreme, a structure that aids optimum pheromone dispersion. The described gland is of the omphalien type.

Marine debris and associated organic pollutants in surface waters of Chiloé in the Northern Chilean Patagonia (42°-44°S).

We report the occurrence of plastics and associated persistent organic pollutants (POPs) in surface waters from Northern Chilean Patagonia. A total of 200 particles were found during the conducted survey. The highest number of particles found was 0.6 item m-3. We found that 53 % of the collected particles corresponded to plastic, with an average of 0.19 ± 0.18 item m-3. Microplastics (68 %) were the dominant size found in the area, followed by macroplastics (18 %) and mesoplastics (14 %). Most plastic particles were white (55 %) while others were <10 % each. Black and light blue represented 9 %; red, dark blue, and other colors 7 %; and green 6 %. Fragments were the most frequent shape of plastic debris (38 %), followed by Styrofoam (30 %) and fiber (27 %). Higher PBDE levels were found in the central zone, and those were higher than DDT, PeCB, HCB, and PCB levels. This study is the first report on POP occurrence in marine plastic debris from Chiloé Sea in the Northern Chilean Patagonia.

Adaptive classification on brain-computer interfaces using reinforcement signals.

We introduce a probabilistic model that combines a classifier with an extra reinforcement signal (RS) encoding the probability of an erroneous feedback being delivered by the classifier. This representation computes the class probabilities given the task related features and the reinforcement signal. Using expectation maximization (EM) to estimate the parameter values under such a model shows that some existing adaptive classifiers are particular cases of such an EM algorithm. Further, we present a new algorithm for adaptive classification, which we call constrained means adaptive classifier, and show using EEG data and simulated RS that this classifier is able to significantly outperform state-of-the-art adaptive classifiers.

[Translated article] A randomised clinical trial comparing screws and the TighRope® Knotless system in the treatment of acute injuries of syndesmosis.

BACKGROUND AND AIM: Classically acute syndesmosis injuries have been treated using screws. A few years ago more flexible implants appeared evolving to current TighRope® Knotless. The primary aim of this study is to compare clinical and radiographic outcome of both implants. MATERIAL AND METHODS: From April 2019 to September 2020 68 patients diagnosed with acute syndesmosis injury were randomised to use screws or TighRope® Knotless. Syndesmosis reduction was assessed using bilateral CT potsoperatively. Outcomes were clinically and radiologically assessed at three, six, and twelve months after surgery. RESULTS: No significant differences were identified in the AOFAS Scale between groups at three months (83.1 vs. 81.80; P=1.03), nor at six (88.27 vs. 88; P=.26) or at twelve (93.03 vs. 92.10; P=.93). There were also no differences in Olerud-Molander scale at three (65 vs. 61.50; P=3.5), six (82.33 vs. 80.67; P=1.67) and twelve months (92.67 vs. 90; P=2.67). Likewise, there were no differences in rate of postoperative malreduction (no cases in both groups), loss of reduction (three cases in screw group vs. four in TighRope® Knotless group, P=.54) or complications (P=1). CONCLUSIONS: Treatment of acute syndesmosis injuries with screws or the TighRope® Knotless implant is similar in both clinical and radiological results.

A randomized clinical trial comparing screws and the TighRope® Knotless system in the treatment of acute injuries of syndesmosis. / Ensayo clínico comparando el uso de tornillos y del sistema TighRope® Knotless en el tratamiento de las lesiones agudas de la sindesmosis.

BACKGROUND AND AIM: Classically acute syndesmosis injuries have been treated using screws. A few years ago more flexible implants appeared evolving to current TighRope® Knotless. The primary aim of this study is to compare clinical and radiographic outcome of both implants. MATERIAL AND METHODS: From April 2019 to September 2020 68 patients diagnosed with acute syndesmosis injury were randomized to use screws or TighRope® Knotless. Syndesmosis reduction was assessed using bilateral CT potsoperatively. Outcomes were clinically and radiologically assessed at three, six, and twelve months after surgery. RESULTS: No significant differences were identified in the AOFAS Scale between groups at three months (83.1 vs. 81.80; P=1.03), nor at six (88.27 vs. 88; P=.26) or at twelve (93.03 vs. 92.10; P=,93). There were also no differences in Olerud-Molander scale at three (65 vs. 61.50; P=3.5), six (82.33 vs. 80.67; P=1.67) and twelve months (92.67 vs. 90; P=2.67). Likewise, there were no differences in rate of postoperative malreduction (no cases in both groups), loss of reduction (three cases in screw group vs. four in TighRope® Knotless group, P=.54) or complications (P=1). CONCLUSIONS: Treatment of acute syndesmosis injuries with screws or the TighRope® Knotless implant is similar in both clinical and radiological results.

Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes.

INTRODUCTION: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients. PATIENTS AND METHODS: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors. RESULTS: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10 mL (range 10-25). Mean operative time was 185 min (range 120-170). Median number of nodes removed was 10.25 nodes (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48 hours but ranged from 24-96 hours within the series. CONCLUSIONS: The modified VEIL technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy.