Implementing a comprehensive approach for evaluating significance and disturbance in protected karst areas to guide management strategies.

Many environmental studies have acquired an almost exclusively biotic perspective over the years, neglecting important key land characteristics like those of a geological and hydrological nature. This situation leads to incomplete, and even inappropriate, management strategies, particularly unjustified in the case of karst environments which form the basis of important protected areas around the world and are inherently very fragile environments compared to other natural systems. This study presents a holistic methodological approach to analyse the level of significance and disturbance in the Natural Park of Aralar (Basque Country, northern Spain) using two standardized indices: zonal Karst Significance Index (KSIZ) and zonal Karst Disturbance Index (KDIZ). The distribution of both indices in the park is based on the Geographic Information System (GIS). Thus, thematic maps regarding geological, geomorphological, biological, hydrological and cultural aspects provide the essential data for this work. The obtained results enable us to recognize the most significant and disturbed sectors of the park. These indices are subsequently combined to generate the Priority Management Index (PMI), which determine the different management needs of the territory. This comprehensive information not only serves efforts to better manage protected karst areas, but also to provide a snapshot view of the researched area to compare achieved results over time.

Preliminary tribological results of a new total temporary hip joint prosthesis spacer.

Temporary antibiotic-loaded cement spacers are widely used for treating chronic periprosthetic hip infections. The aim of this study is to evaluate the short-term tribological performance of ultra-high-molecular-weight polyethylene (UHMWPE) and (60Co) gamma-irradiated cross-linked UHMWPE (XLPE) self-mated systems as frictional pairs for temporary total hip spacers. A three-axial hip joint simulator, FIME II, was used to test the UHMWPE and XLPE self-mated systems under variable load profiles. A fetal bovine serum solution was used as a lubricant. After simulation tests, wear measurements of damaged coupled surfaces were made with a coordinate measuring machine. Finally, surfaces were characterized with scanning electron microscopy, Raman spectroscopy, Fourier transform infrared spectroscopy, and nanoindentation tests. The mass loss test results for UHMWPE were 11.91 ± 3.43 mg for the cups and 4.57 ± 0.92 mg for the heads. Whereas, the results for XLPE showed a significant reduction, with mean mass loss values of 6.59 ± 0.14 mg for the cups and 2.82 ± 0.59 mg for the heads, suggesting the viability of the self-mated XLPE contact pair for a temporary total hip spacer.

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial.

Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.

Tranexamic acid versus aminocapróic acid in multiple doses via the oral route for the reduction of postoperative bleeding in total primary hip arthroplasty: a prospective, randomized, double-blind, controlled study.

To compare the effects of oral ε-aminocaproic acid (EACA) as a hemostatic agent versus the use of oral tranexamic acid (TXA) administered in multiple doses pre and postsurgery in patients undergoing elective primary total hip arthroplasty (THA). We enrolled 102 patients that were randomly divided into two groups: received three oral doses of EACA (2000 mg per dose) or three oral doses of TXA (1300 mg per dose). The medication was given according to the following schedule: 2 h before surgery and 6 and 12 h after surgery. The variables analyzed to compare the effectiveness of the hemostatic agents were total blood loss, hidden blood loss, external blood loss, transfusion rate, intraoperative blood loss, decreases in hemoglobin and hematocrit values, surgical drainage output, visual analog scale, and surgical complications. There were no significant differences between any of the study variables for the group receiving oral TXA and the group receiving oral EACA (P > 0.05). Our study showed that the use of oral EACA was similar to its counterpart TXA regarding the evaluated parameters. TXA did not have superior blood conservation effects, safety profile, or differences in functional scales compared with EACA in THA. We consider the use of multiple oral doses of aminocaproic acid at the selected dose to be effective as a standard protocol to achieve less blood loss and a lower rate of transfusion and adverse events related to the medication in patients undergoing a THA.

Distribution and temporal variation of trace metal enrichment in surface sediments of San Jorge Bay, Chile.

Cu, Pb, and Hg concentrations were determined in surface sediment samples collected at three sites in San Jorge Bay, northern Chile. This study aims to evaluate differences in their spatial distribution and temporal variability. The highest metal concentrations were found at the site "Puerto", where minerals (Cu and Pb) have been loaded for more than 60 years. On the other hand, Hg does not pose a contamination problem in this bay. Cu and Pb concentrations showed significant variations from 1 year to another. These variations seem to be a consequence of the combination of several factors, including changes in the loading and/or storage of minerals in San Jorge Bay, the dredging of bottom sediments (especially at Puerto), and seasonal changes in physical-chemical properties of the water column that modify the exchange of metals at the sediment-water interface. Differences in the contamination factor and geoaccumulation index suggest that pre-industrial concentrations measured in marine sediments of this geographical zone, were better than geological values (average shale, continental crust average) for evaluating the degree of contamination in this coastal system. Based on these last two indexes, San Jorge Bay has a serious problem of Cu and Pb pollution at the three sampling locations. However, only Cu exceeds the national maximum values used to evaluate ecological risk and the health of marine environments. It is suggested that Chilean environmental legislation for marine sediment quality--presently under technical discussion--is not an efficient tool for protecting the marine ecosystem.

[Uso de etamsilato para reducir el sangrado posoperatorio y el índice de transfusión en la artroplastia total de cadera. Ensayo clínico controlado]. / Use of ethamsylate to reduce postoperative bleeding and transfusion index in total hip arthroplasty. A randomized clinical trial.

ANTECEDENTES: El sangrado secundario es una de las principales causas de morbilidad después de la cirugía. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologías, como metrorragias, sangrado intraventricular, prostatectomías, cirugías de catarata y amigdalectomías. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugía de reemplazo total de cadera. MÉTODO: La población se dividió en dos grupos. En el grupo control se realizó la hemostasia de manera convencional; en el grupo experimental se administró etamsilato. RESULTADOS: Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las características de la población entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirúrgicas entre ambos grupos, no se encontraron diferencias estadísticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificación del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirió significativamente (p = 0.62). CONCLUSIÓN: En este estudio no se demostró un efecto sobre la reducción de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato. BACKGROUND: Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery. METHOD: The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered. RESULTS: A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62). CONCLUSION: An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.

Non-Visually Performing Analytical Tasks on Statistical Charts.

This article proposes a natural language-based approach to accessibility of charts. Formal underpinnings are used to semantically annotate the constituent elements of a vector graphic to support accessing and modifying the content by natural language queries in a web interface. A prototype which lets blind users perform a number of analytical activities on bar charts is introduced.

Vida en ruralidad y su efecto sobre la salud de las personas mayores en el sur de Chile / Rural living and their effect about the health of the older people in the south of Chile

RESUMEN Introducción: La investigación vincula tres aspectos relevantes para la política social dirigida a personas mayores y sus condiciones de vida: situación de salud, pobreza y ruralidad. Objetivo: analizar las condiciones de vida propias de personas mayores de 60 años que viven en tres zonas rurales del sur de Chile y el efecto de estas sobre la salud y funcionalidad. Métodos: Se desarrolló una investigación cualitativa, sobre la base de un diseño interpretativo crítico. Se entrevistaron 22 personas de 60 a 80 años de edad, residentes de tres territorios rurales del sur de Chile: Forrahue, Pucatrihue y Neltume durante el segundo semestre del año 2018. Resultados: Los resultados permiten discutir sobre las condiciones de salud general de las personas entrevistadas, el efecto positivo de la actividad física y la combinación con la alimentación, los efectos del dolor crónico y de la asociatividad para el bienestar ante condiciones de vida adversa y aislada de zonas y recursos urbanos. Discusión: Las intervenciones sanitarias dirigidas hacia personas mayores de 60 años deben incorporar las variables de la territorialización de sus prácticas para el bienestar.

ABSTRACT Introduction: the research links three key aspects of social policy designed for seniors and their living conditions: health status, poverty and rurality. Objective: assess the specific living conditions of people older than 60 years of age living in three rural areas of southern Chile and their effects on health and general functioning. Methods: Qualitative research was conducted using a critical interpretive design wherein 22 people aged 60 to 80 were interviewed who are residents of three rural areas in southern Chile: Forrahue, Pucatrihue and Neltume during the second half of 2018. Results: the results enable a discussion of the general health conditions of the interviewees, the positive effects of physical activity in conjunction with diet, the effect of chronic pain and their connections to wellbeing in light of adverse living conditions, isolated from urban areas and resources. Discussion: the health interventions geared toward people over 60 years of age must incorporate variables related to the territorialization of such practices for wellbeing.

Ontology-based Semantic Support to Improve Accessibility of Graphics.

We aim to ease the process of authoring accessible graphics as well as taking a first step towards the long-term goal of allowing blind persons to access graphics autonomously. We are developing and experimenting with a hierarchical set of knowledge bases related to the presentation of visual objects and cues in the form of ontologies that will act as the formal, axiomatic underpinnings of an accessibility layer or, later on, a graphics reader/browser for blind and visually impaired people. The concept and prototypes of smart (or communicative) graphics [1], in which readers obtain information about the syntactic and semantic content through the use of e.g. a natural language interface, should be expanded by exploiting the benefits of formal semantics supported by domain- and task-aware ontologies describing the elements, visual cues and relations used for visualization or visual display.

[Platelet rich plasma versus oral paracetamol for the treatment of early knee osteoarthritis. Preliminary study]. / Plasma rico en plaquetas versus paracetamol oral para el tratamiento de la osteoartrosis temprana de rodilla. Estudio preliminar.

BACKGROUND: in the treatment of early osteoartrosis, analgesics and non-steroidal anti-inflammatory drugs are frequently used to relieve pain. Currently, platelet rich plasma is used as an alternative in the treatment of osteoartrosis. The aim of this study was to evaluate the effect of platelet rich plasma compared to paracetamol as a treatment for patients with knee osteoartrosis grade I. METHODS: we evaluated 42 patients who were randomized into two groups. Group one was treated with 5 mL of platelet rich plasma in two applications, while group two was treated with 1 gr of oral paracetamol every 8 hours for 30 days. Both patient groups received supervised physical rehabilitation during the 6 month observation period. Peripheral blood samples were taken to measure plasma IL-1ß, TNF-a and TGF-ß1 levels at day 0 and at 6 months post-treatment. Clinical evaluation was conducted using the KOOS at the start of the study and for every subsequent month during the study period. RESULTS: the Knee injury and Osteoarthritis Outcome Score (KOOS) for group one at the start of the treatment was measured at 30.1 points, whereas at the end, it was measured at 48.2 points, showing a clinical improvement of 60%. There were no statistically significant differences in IL-1ß and TNF-a levels between groups treated either with platelet rich plasma or paracetamol. CONCLUSIONS: Our patients treated with platelet rich plasma showed a statistically significant increase in the serum levels of TGF-ß1, which was associated with an improvement in the clinical evaluation used (KOOS).

Antecedentes: la osteoartrosis se caracteriza por dolor, rigidez articular y crepitación, con datos radiológicos específicos. El dolor se controla con analgésicos y antiinflamatorios no esteroides. En la actualidad, el plasma rico en plaquetas es una alternativa de tratamiento de esta enfermedad. Objetivo: comparar el efecto del plasma rico en plaquetas versus paracetamol en el tratamiento de pacientes con osteoartrosis de rodilla grado I. Material y métodos: ensayo prospectivo y experimental en el que se estudiaron 42 pacientes que se asignaron al azar a dos grupos. Al grupo 1 (experimental) se le indicaron 5 mL de plasma rico en plaquetas, en dos aplicaciones; el grupo 2 (control) se trató con 1 g de paracetamol oral cada 8 horas durante 30 días. Ambos grupos recibieron terapia física supervisada, con un tiempo de seguimiento total de seis meses. Para determinar las concentraciones de sangre periférica se tomaron muestras de IL-1ß, TNF-a y TGF-ß en plasma el día 0 y a los 6 meses. La valoración clínica se realizó con el Knee injury and Osteoarthritis Outcome Score (KOOS) al inicio y mensualmente durante el estudio. Resultados: los resultados de IL-1ß y TNF-a no mostraron diferencia significativa entre los grupos tratados con plasma rico en plaquetas y paracetamol. La escala KOOS para el grupo 1 al inicio del tratamiento fue de 30.1 puntos y al finalizar el tratamiento 48.2 puntos, con mejoría clínica de 60%. Conclusiones: los pacientes tratados con plasma rico en plaquetas tuvieron un incremento significativo en las concentraciones séricas de TGF-ß1 que se asoció con la mejoría clínica relacionada con el KOOS.

El uso del cemento en la artroplastía total de cadera / The use of cement in total hip arthroplasty

Desde el inicio del uso del metilmetacrilato como método de fijación en la Artroplastía Total de Cadera(ATC), se ha relacionado la aparición de líneas radiolúcidas (LR) periprotésicas y su progresión, con el diagnóstico de aflojamiento; en ocasiones en ausencia de sintomatología. El objetivo del presente estudio es la evaluación radiológica y correlación clínica de los pacientes en los cuales se realizó ATC y se utilizó metilmetacrilato como método de fijación, valorándose expedientes clínicos y radiológicos de 46 pacientes cuyos procedimientos fueron realizados de enero de 1986 a diciembre de 1995. Treinta y tres artroplastías fueron realizadas en 28 pacientes (16M: 12F) con una media de edad de 59.7 años, se evalúa el componente femoral y el acetabular comparando las radiografías mínimo de 3 años. Para valorar la estabilidad del componente acetabular se utilizaron las tres zonas descritas por Charnley, el nivel clínico de actividad fue evaluado de acuerdo a los criterios propuestos por Jhonston y cols. De los 33 componentes femorales, en las radiografías postquirúrgicas 30 presentaron LR, sólo 3 no la presentaron, de los 30 que sí la tuvieron, en 19 hubo progresión en la extensión de dicha línea, en 14 no progresó y en ninguno se presentó aflojamiento del componente femoral. De los 21 componentes acetabulares 20 presentaron LR en las radiografías postquirúrgicas, sólo una no la presentó, 7 componentes presentaron progresión en los controles radiográficos incluyendo la aparición de la LR en el componente que no la había presentado en las radiografías postquirúrgicas, 14 componentes no progresaron, 2 componentes presentaron aflojamiento aséptico, de estos 2, uno presentó LR en las radiografías postquirúrgicas y el otro no. En estos casos los pacientes fueron sometidos a una cirugía de revisión. Todos los pacientes evaluados clínicamente incluso los 2 que fueron sometidos a cirugía de revisión, no presentaron limitación para la marcha ni para realizar sus actividades cotidianas. Cuatro pacientes refirieron dolor leve en rodilla ipsilateral el cual se atenuaba con el reposo, 5 pacientes refirieron dolor no incapacitante en cadera contralateral que cedía al reposo...

Necrosis avascular atraumática de la cabeza femoral. Descompresión más injerto de peroné (Resultados preliminares) / Atraumatic necrosis of the femoral head. Core descompression and fibular bone grafting: preliminary results

Se realizó un estudio prospectivo, longitudinal, no comparativo en 11 pacientes (13 caderas con necrosis) de noviembre de 1993 a febrero de 1995. Los criterios de inclusión fueron: pacientes en estadios I, II o III de la clasificación de Ficat y Arlet. Fueron excluidos los pacientes en estadios IV O III en quienes una prótesis total pudo estar disponible. El examen físico fue ralizado de acuerdo con la escala funcional de Harris. Los cambios estructurales fueron determinados por radiografías y RMN. En todos los pacientes se realizó descompresión de la cabeza del fémur y se utilizó peroné para dar soporte estructural. Los resultados fueron evaluados clínicamante de acuerdo con la escala funcional de Harris, con radiografías simples y con RMN, en esto último sólo en 5 casos (38 por ciento). Los mejores resultados se obtuvieron en los estadios I (100 por ciento) y II (80 por ciento). Todos los casos en estadio III terminaron en reemplazo total de cadera. La importancia de un diagnóstico temprano es enfatizada para lo cual la resonancia magnética nuclear (RMN) es muy importante. Esta técnica es efectiva para el tratamiento de la necrosis avascular de la cabeza femoral en estadios tempranos