Unscrambling the Role of Redox-Active Biometals in Dopaminergic Neuronal Death and Promising Metal Chelation-Based Therapy for Parkinson's Disease.

Biometals are all metal ions that are essential for all living organisms. About 40% of all enzymes with known structures require biometals to function correctly. The main target of damage by biometals is the central nervous system (CNS). Biometal dysregulation (metal deficiency or overload) is related to pathological processes. Chronic occupational and environmental exposure to biometals, including iron and copper, is related to an increased risk of developing Parkinson's disease (PD). Indeed, biometals have been shown to induce a dopaminergic neuronal loss in the substantia nigra. Although the etiology of PD is still unknown, oxidative stress dysregulation, mitochondrial dysfunction, and inhibition of both the ubiquitin-proteasome system (UPS) and autophagy are related to dopaminergic neuronal death. Herein, we addressed the involvement of redox-active biometals, iron, and copper, as oxidative stress and neuronal death inducers, as well as the current metal chelation-based therapy in PD.

Crossed anterior cerebral circulation in the anterior communicating artery complex, first case report with angiographic evidence.

INTRODUCTION: This case report illustrates a new variant in the anterior cerebral artery complex, identified during carotid angioplasty. CLINICAL CASE: A 50-year-old male patient diagnosed with left carotid stenosis was diagnosed and treated by a cerebral angiography. During the procedure, crossed circulation in the anterior cerebral artery was identified. The presence of this variation demanded to discard distal emboli or artery dissection. Angioplasty was performed and the patient followed up without neurological deficit. DISCUSSION: Among the most possible and prevalent variations in anterior circulation, none of them explain the phenomenon we observed. Therefore, a new variant is established. The knowledge about variants in cerebral circulation is important to rule out pathology. CONCLUSION: Cerebral diagnostic angiography has become more available and frequent because of the rising in endovascular tools to treat stroke patients. Considering this new variation and others is important to discard pathology.

Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis.

BACKGROUND: The morbidity and mortality of intracranial aneurysm rupture motivate the risk evaluation of the patient´s characteristics and aneurysm's morphology. Brain vessel variants lead to hemodynamic changes that could increase risk. This study aims to evaluate the fetal posterior cerebral artery (fPCA) as a risk factor for the formation, rupture, and recurrence of the posterior communicating artery (PComA) aneurysm. METHODS: A search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE databases for studies that evaluated the risk of appearance, rupture, and recurrence of PComA aneurysms with the presence of fPCA. Newcastle-Ottawa Scale and AXIS were used for quality assessment. The primary and secondary outcomes were evaluated and interpreted with an odds ratio (OR) and their 95% confidence intervals (CI). RESULTS: A total of 577 articles were reviewed. Thirteen studies were included for the qualitative analysis, and ten studies for the meta-analysis. All cohort studies were classified as poor quality, and all cross-sectional studies with moderate risk. The unadjusted OR resulted in 1.57 (n = 6, 95% CI 1.13-2.19, p = <0.001, I2 =0%) between the presence of fPCA and PComA aneurysm rupture. CONCLUSION: There is a significant association of aneurysm formation and rupture of PComA aneurysms in the presence of fPCA. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall.

Single sagittal craniosynostosis surgical treatment with the "Peau d́ours" technique. Single-center experience in Mexico.

Scaphocephaly (SC) is defined as an elongation of the anteroposterior axis of the skull resulting from the abnormal fusion of the sagittal suture. This study describes the "Peau d'ours" technique and results for correcting SC. We conducted a consecutive and retrospective analysis of patients treated from 2011 to 2016. We evaluated the gender, age, and surgical outcomes. A total of 53 patients were enrolled with a mean age of 19 months old. The advantages of this technique are healthy coronal and lambdoid suture preservation and symmetrical parietal bone flap opening. This technique is safe and simple to reproduce, allowing good surgical outcomes with a low incidence of secondary craniosynostosis. This technique is ideal for patients older than six months old.

Aged rats learn Morris Water maze using non-spatial search strategies evidenced by a parameter-based algorithm.

Spatial learning and memory are used by all individuals who need to move in a space. Morris water maze (MWM) is an accepted method for its evaluation in murine models and has many protocols, ranging from the classic parameters of latency, distance, and number of crossings to the platform zone, to other more complex methods involving computerized trajectory analysis. Algorithm-based SS analysis is an alternative that enriches traditional classic parameters. We developed a non-computerized parameter-based Search Strategy Algorithm (SSA), to classify strategies and detect changes in spatial memory and learning. For this, our algorithm was validated using young and aged rats, evaluated by two observers who classified the trajectories of the rats based on the effectiveness, localization, and precision to reach the platform. SSA is classified into 10 categories, classified by effectiveness, initial direction, and precision. Traditional measurements were unable to show significant differences in the learning process. However, significant differences were identified in SSA. Young rats used a direct search strategy (SS), while aged rats preferred indirect ones. The number of platform crossings was the only variable to show the difference in the intermediate probe trial. The parameter-based algorithm represents an alternative to the computerized SS methods to analyze the spatial memory and learning process in young and age rats. We validate the use of SSA as an alternative to computerized SS analysis spatial learning acquisition. We demonstrated that aged rats had the ability to learn spatial memory tasks using different search strategies. The use of SSA resulted in a reliable and reproducible method to analyze MWM protocols.

[Study of the vascular morphology of the lower limb nerves used as grafts]. / Estudio de la morfología vascular en los nervios de la extremidad inferior utilizados como injertos.

INTRODUCTION: The placement of a vascularized nervous graft is an option for acute nervous injuries treatment, as this has demonstrated a longer viability. OBJECTIVE: To carry out a macroscopic and microscopic analysis of the vascularity of the main lower limb nerves used as vascularized nervous grafts. MATERIALS AND METHODS: It was followed out a descriptive, transversal and non-comparative study to analyse the saphenous, the sural, the deep peroneal and the superficial peroneal nerves vascularity. This study was performed in two stages: 1) an in situ vascularity study and 2) a morphometric study. RESULTS: By the in situ study, it was demonstrated the following: the total length of the lower limb nerves used as graft, was in a decrease order: sural nerve (micro = 29.26 cm, +/- 4.05 cm), superficial peroneal nerve (micro = 28.61 cm, +/- 3.97 cm), deep peroneal nerve (micro = 26.64 cm, +/- 5.21 cm) and saphenous nerve (micro = 25.12 cm, +/- 4.42 cm). The morphometric study demonstrated that the dominant artery with the major diameter belongs to the saphenous nerve, with a diameter of 1.13 mm; then we have the superficial peroneal nerve with a 1.01 mm diameter, followed by the deep peroneal nerve with 0.91 mm, and finally the sural nerve with the smallest diameter, 0.85 mm. CONCLUSIONS: The saphenous nerve has the most appropriated morphological characteristics to be used as a vascularized graft; by the contrary the deep peroneal nerve represents the last option from all the nerves included in this study.

[New microsurgical model for the study of the morphological adaptative response of venous grafts]. / Nuevo modelo microquirúrgico para el estudio de la respuesta morfológica adaptativa de injertos venosos.

INTRODUCTION: Animal models have been developed for the study of the intimal hyperplasia, a common cause of venous graft stenosis. OBJECTIVE: To establish a venous graft animal model for the study of the morphologic adaptative response to the arterial circulation. MATERIAL AND METHODS: A venous graft was placed in the arterial circulation of the caudal extremity from Wistar rats. In order to develop the model, it was carried out a morphologic study of the caudal extremity blood vessels. Three possible sites were evaluated for the obtaining of the venous graft. RESULTS: Graft permeability and viability were observed only in one segment, between the muscular branches and the origin of the saphenous vein. The portion of vein that was obtained from one extremity, was placed in the arterial circulation of the opposite extremity. CONCLUSIONS: A venous graft animal model was established, using a femoral vein segment, between the muscular branches and the origin of the saphenous vein, placing it in the homonyme artery of the opposite extremity.

Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults.

We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (<1) or high (>1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals.

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study.

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders.

Exceso de mortalidad en México en 2020: una estimación preliminar a nivel nacional y estatal / Excess mortality in Mexico 2020: a preliminary estimate at national and state level

Resumen Como consecuencia directa o indirecta de la pandemia de COVID-19, junto con otros problemas de salud pública preexistentes, México se ha posicionado como uno de los países más afectados en cuanto al exceso de mortalidad, la cual está prácticamente generalizada, pero es heterogénea según el estado. Por ello, se tiene por objetivo cuantificarla a nivel nacional y estatal por medio del porcentaje de exceso de mortalidad (% 𝐸𝑀) y de diferencias en esperanzas de vida (𝐸𝑀𝑒𝑥 ) por sexo. En particular, para 𝐸𝑀𝑒𝑥 , se construyeron tablas de mortalidad con tasas específicas que se suavizan de manera controlada y por segmentos, con un enfoque no paramétrico. Los resultados mostraron una demasía en la población masculina y en algunos estados del país. Asimismo, respecto a 𝐸𝑀𝑒𝑥 , se evidenciaron fuertes retrocesos en la esperanza de vida en ciertos casos, incluida la capital del país: la Ciudad de México.

Abstract As a direct or indirect consequence of the COVID-19 pandemic, joint other punlic health problems, Mexico is one of the most affected countries in terms of excess mortality, which is generalized and heterogeneous at the state level. That is why, the papers aim is to quantify it at national and subnational level both through the percentage of excess mortality (% 𝐸𝑀) and using differences in life expectancies (𝐸𝑀𝑒𝑥 ) by sex. For (𝐸𝑀𝑒𝑥 ), mortality tables are constructed with specific rates that are estimated through a non-parametric approach so-called controlled and segmented smoothing. The results show the greatest excesses in male population and for some states of the country. Likewise, regarding 𝐸𝑀𝑒𝑥 , strong setbacks in life expectancy can be observed including the Mexico City.

Four-vessel occlusion model using aged male Wistar rats: a reliable model to resolve the discrepancy related to age in cerebral ischemia research.

Animal models of cerebral ischemia have typically been established and performed using young animals, even though cerebral ischemia (CI) affects primarily elderly patients. This situation represents a discrepancy that complicates the translation of novel therapeutic strategies for CI. Models of transient global CI using aged animals have demonstrated an apparent neuroprotective effect on CA1 hippocampal neurons; however, this effect is not completely understood. Our study used a model in which young (3-6 months) and aged (18-21 months) male Wistar rats were subjected to 15 min of transient global CI using the four-vessel occlusion (4 VO) model. We determined that the 4 VO model can be performed on aged rats with a slight increase in mortality rate. In aged rats, the morphological damage was completely established by the 4th day after reperfusion, displaying no difference from their younger counterparts. These results demonstrated the lack of a neuroprotective effect of aging on CA1 hippocampal neurons in aged male Wistar rats. This study determined and characterized the morphological damage to the CA1 area after 15 min of 4 VO in aged male Wistar rats, validating the use of this model in CI and aging research.

Spatial Dynamics of Internal Migration Flows of the Skilled and Unskilled in Mexico / Dinámica espacial de los flujos de migración interna de personas calificadas y no calificadas en México

Abstract The dynamics of the internal migration is a crucial element in the composition of the workforce of a certain region, so its analysis contributes to the better understanding of labor markets and sociodemographic changes in a region. In order to characterize the most recent patterns of migratory flows of skilled and unskilled labor, census data are considered for the periods 1995-2000, 2005-2010 and 2010- 2015. The analysis considers different indicators that describe the intensity and relative concentration of interstate migration. Changes in migratory patterns are evident; a lower concentration of internal migration whose effect is more marked for unskilled labor. That is, it is observed that the number of states that play a preponderant role in the redistribution of labor in Mexico has increased. The relationship of domestic labor mobility is evident to the regional transformation as a result of new geographical patterns of location of investment, production and economic agglomeration.

Resumen La dinámica de la migración interna en México es un elemento determinante en la composición de la mano de obra de cierta región, por lo que su análisis coadyuva, entre otras cosas, al mejor entendimiento de los mercados laborales y cambios sociodemográficos de la región. Con la finalidad de caracterizar los patrones más recientes de los flujos migratorios de la mano obra calificada y no calificada, se consideran datos censales para los periodos 1995-2000, 2005-2010 y 2010-2015. Con esto se estiman diferentes indicadores que describen la intensidad y concentración relativa de la migración interestatal. Se evidencian cambios en los patrones migratorios y una menor concentración de la migración interna, cuyo efecto es más marcado para la mano de obra no calificada. Es decir, se observa que el número de entidades que juegan un rol preponderante en la redistribución de la mano obra en México ha aumentado. La relación de la movilidad laboral interna se hace evidente con el dinamismo regional y como resultado de nuevos patrones geográficos de ubicación de inversión, producción y aglomeración económica.

Near-peer teaching strategy in a large human anatomy course: perceptions of near-peer instructors.

Near-peer teaching (NPT) is a strategy in which senior students assume the instructor role with junior peers (mentees). Senior students develop unique skills and knowledge through NPT, an experience which extends their learning beyond content mastery. Different teaching modules featuring NPT were utilized in the human anatomy course at the School of Medicine, Autonomous University of Nuevo Leon in Monterrey, Mexico. Modules included: Theory, Clinical Hour, Imaging Anatomy, and Laboratory. The aim of this study was to assess instructor participants' perceptions on the benefits of the NPT strategy in the anatomy classroom. A survey was administered to anatomy course instructors who utilized NPT strategies during winter, fall, and spring semesters of the 2012-2013 school year. A total of 120 instructors were enrolled in the study. There were different perceptions of instructors' roles. Theory and Imaging Anatomy instructors considered themselves to be information providers and resource developers, whereas Clinical Hour and Laboratory instructors saw themselves more as facilitators, role models, and planners. All instructors' opinions on the benefits of NPT were positive. Thus, in this article, the authors find NPT to be a strategy that promotes self-learning, a vital skill.

Safety ranges in V3 segment of the vertebral artery for surgical procedures at the craniocervical junction / Rangos de seguridad en el segmento V3 de la arteria vertebral para procedimientos quirúrgicos en la unión craneocervical

The aim of this study was to establish safety ranges for the third vertebral artery segment (V3) for craneocervical procedures. Injury to V3 represents a potentially catastrophic complication. Its tortuous path and complex relationship with neighboring structures, increasing the risk. Ten male adult cadavers (20 vertebral arteries) with arterial infiltration of red latex were studied. The length, angles and anatomical measurements were obtained between the selected surgical landmarks and the portions of V3 segment. The horizontal portion has a length of 32.7 ± 3.6 mm with an angulation of 115.1 ± 8.3 degrees. The mean distances of the horizontal portion were: from the midline to the V3 groove of C1 posterior arch (24.7 ± 6.3 mm); from C1 pars interarticularis to the V3 distal loop of V3 (8.9 ± 1.4 mm). The vertical portion has a length 32.5 ± 5.6 mm with an angulation of the proximal loop of 113.6 ± 5.8 degrees. The mean distances between the C2 spinous process to the medial surface of the distal loop (43.8 ± 4.2 mm); from the C1-C2 joint to the V3 vertical portion (9.5 ± 1.5 mm); from C2 pars interarticularis to V3 in the C2 transverse foramen (6.5 ± 3.4 mm); from C2 pars interarticularis to V3 in the C1 transverse foramen (17.5 ± 4.5 mm). We reported four potential sites where V3 can be injured during four different surgical procedures: exposure of the posterior arch of C1, and pars interarticularis of C1 in the horizontal portion and exposure of the C1C2 joint, and placement of C1-C2 transarticular screws one in the vertical portion. We provide measurements of redundancy and safety ranges to reduce the risk of injury to the V3 segment during craniocervical surgical procedures.

El objetivo de este estudio fue establecer rangos de seguridad en el tercer segmento de arteria vertebral (V3) para cirugías de la región craneocervicales. La lesión de V3 representa una complicación potencialmente catastrófica. Su tortuoso trayecto y compleja relación con las estructuras aledañas, aumenta el riesgo. Se estudiaron diez cadáveres adultos masculinos (20 arterias vertebrales) con infiltración arterial de látex rojo. La longitud, ángulos y medidas anatómicas se obtuvieron respecto a los puntos de referencia quirúrgicos y las porciones del segmento V3. La porción horizontal tiene una longitud de 32,7 ± 3,6 mm con una angulación de 115,1 ± 8,3 grados. Las distancias medias de la porción horizontal fueron: desde la línea media hasta el surco V3 del arco posterior C1 (24,7 ± 6,3 mm); desde C1 pars interarticularis hasta el bucle distal V3 de V3 (8,9 ± 1,4 mm). La parte vertical tiene una longitud de 32,5 ± 5,6 mm con una angulación del bucle proximal de 113,6 ± 5,8 grados. Las distancias medias entre el proceso espinoso C2 y la superficie medial del bucle distal (43,8 ± 4,2 mm); desde la unión C1-C2 hasta la porción vertical V3 (9,5 ± 1,5 mm); de C2 pars interarticularis a V3 en el foramen transversal C2 (6,5 ± 3,4 mm); de C2 pars interarticularis a V3 en el foramen transversal C1 (17,5 ± 4,5 mm). Informamos cuatro sitios potenciales donde la V3 puede lesionarse durante cuatro procedimientos quirúrgicos diferentes: exposición del arco posterior de C1 y pars interarticularis de C1 en la porción horizontal y exposición de la articulación C1-C2, y colocación de C1-C2 Tornillos transarticulares uno en la porción vertical. Proporcionamos mediciones de los rangos de redundancia y seguridad para reducir el riesgo de lesiones en el segmento V3 durante procedimientos quirúrgicos craneocervicales.

Autopercepción y satisfacción corporal de la población adulta mexicana por estados: una modelación probabilística con base en la Encuesta Nacional de Salud y Nutrición de México (ENSANUT) 2012 / Autoperception and satisfaction on adult mexican´s body by states: a probabilistic model based on the Mexican National Health and Nutrition Survey (ENSANUT) 2012

RESUMEN Objetivo:inferir el modelo probabilístico que represente a nivel estatal las discrepancias entre percepción y aspiración de la población mexicana en cuanto a su figura, a través de las denominadas siluetas de Stunkard, Sorenson y Schulsinger. Metodología: con muestras representativas a nivel estatal provenientes de la Encuesta Nacional de Salud y Nutrición (ENSANUT) 2012, se estimaron discrepancias entre distintos Índices de Masa Corporal (IMC): el medido y el autoreportado. Se utilizaron pruebas de bondad de ajuste y, con modelos ajustados de normalidad estadística, se calcularon probabilidades. Se aplicaron clusters jerárquicos a variables vinculadas con las discrepancias para identificar similitudes entre las muestras de los estados. Resultados: con la prueba Kolmogorov-Smirnov (KS), la Anderson-Darling (AD) y la Ji cuadrada (χ2) con una significancia del 1%, se ajustaron las discrepancias por sexo y estados, y en su mayoría se obtuvo una distribución normal. Se realizaron algunas estimaciones de probabilidades y se aplicó la regla empírica, con lo que se dimensionó la magnitud del posible conocimiento del IMC medido y de la satisfacción existente. Se identificaron grupos de estados que comparten similitudes en sus poblaciones en relación a variables estimadas. Conclusiones: se constató una percepción equivoca y una aspiración sistemática, permeadas de heterogeneidad ante un escenario de obesidad y sobrepeso que posee la mayor parte de la población mexicana.

ABSTRACT: Objective: to infer the probabilistic model of the discrepancy between how Mexicans perceive and aspire to be in their figure through the so-called Stunkard, Sorenson and Schulsinger silhouettes at state level. Methodology: we estimate discrepancies between different Body Mass Indexes (BMI): the measured and the auto reported. Then state samples are employed coming from the Mexican National Health and Nutrition Survey (ENSANUT) 2012. Goodness-of-fit tests are used, and, with adjusted normal models, specific probabilities are calculated. Some variables linked to discrepancies are taken into account for applying hierarchical clusters to identify similarities between states. Results: the Kolmogorov-Smirnov (KS), Anderson-Darling (AD) and Chi-square (χ2) tests were employed to model discrepancies by sex and state. The Normal distribution was recognized as appropriate. Some estimates of probabilities are made and the Empirical Rule is applied, which measures the magnitude of the possible knowing of the real BMI and the existing satisfaction. We identify groups of states that share similarities in their populations in relation to estimated variables. Conclusions: there is an erroneous perception and a systematic aspiration, permeated by heterogeneity in the face of a scenario of obesity or overweight in most mexicans.

Morphometric assessment of the lumbar pedicle isthmus by reformatted CT: variations according to age and gender

This work aims to determine the morphometric characteristics of the lumbar pedicle isthmus with surgical relevance to transpedicular procedures using reformatted computed tomography (CT) and to determine the possible variations in the diameters between genders and age groups. Observational, cross-sectional, descriptive and comparative anatomical studies were carried out. We analyzed 200 CT studies of Mexican patients of known age and gender. The images were analyzed using specialized software for reformatting that could determine cortical and endosteal diameters and cortical thickness at the level of the pedicle isthmus. The mean and standard deviation for each measurement parameter were determined, and a parametric correlation test was performed to compare the variations between the age groups of the same gender. Significant differences in the pedicle diameters between men and women were evident for most of the age groups (p <0.05). The cortical and endosteal pedicle width showed an increase from L1 to L5; the reverse was observed for cortical and endosteal pedicle height. No significant differences were evident with respect to age in the horizontal and vertical diameters for most of the generated study groups. The lateral cortical bone had the lowest scores of the study. The mean values of the morphometric characteristics of the pedicle isthmus obtained in this study will be helpful to conclusively define the pedicle dimensions and to improve the transpedicular approach to the lumbar spine

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Teaching skills to promote clinical reasoning in early basic science courses.

Basic and superior reasoning skills are woven into the clinical reasoning process just as they are used to solve any problem. As clinical reasoning is the central competence of medical education, development of these reasoning skills should occur throughout the undergraduate medical curriculum. The authors describe here a method of teaching reasoning skills in a clinical context during a human anatomy course.

Resilience does not predict academic performance in gross anatomy.

Few studies have evaluated resilience in an academic environment as it relates to academic success or failure. This work sought to assess resilience in regular and remedial students of gross anatomy during the first and second semesters of medical school and to correlate this personal trait with academic performance. Two groups of students were compared: the first group included first-year medical students in the regular course, and the second group included first-year medical students who did not pass the regular anatomy course and so were enrolled in the remedial course. Both groups completed anonymous surveys designed to gather demographic data and establish scores on the Connor-Davidson resilience scale, which includes 25 statements rated zero to four on a Likert scale (maximum score 100). The average resilience score was the same for both groups, 80 +/- 9. The average anatomy grades differed significantly between regular students (67+/- 15.0) and remedial students (61 +/- 12.0). While there was no overall correlation between resilience score and anatomy grade, regular students with resilience scores of 75 or greater showed slightly better academic performance than their classmates. Similarly, remedial students with resilience scores of 87 or greater faired better academically. Resilience does not predict academic performance in gross anatomy, and further work is necessary to identify those intrinsic and extrinsic factors that influence students' achievements.

A new morphological classification of the anterior inferior iliac spine: relevance in subspine hip impingement / Nueva clasificación morfológica de la espina iliaca anteroinferior: relevancia en el pinzamiento subespinoso de la cadera

Femoroacetabular impingement syndrome (FAI) is a clinical entity that has been recognized in recent years as a frequent cause of pain and the early development of hip arthrosis. Subspine hip impingement is characterized by the prominent or abnormal morphology of the anteroinferior iliac spine (AIIS), which contributes to the development of a clinical picture that is similar to FAI. The aims of this study were to propose a new morphological classification of the AIIS, to determine the prevalence of the different AIIS morphologies based on this classification and to correlate the presence of said morphologies with different gender and age groups. The sample consisted of 458 hemipelvises from individuals of known age and sex (264 men and 194 women). Each specimen was analyzed to determine the prevalence of each of the different morphologies of the AIIS based on the classification proposed as Type 1: the presence of a concave surface between the AIIS and the acetabular rim; Type 2A: the presence of a flat surface between the AIIS and the acetabular rim; Type 2B the presence of a convex surface between the AIIS and the acetabular rim; and Type 3: the AIIS protrudes inferiorly toward the anterior acetabulum. A prevalence of 69.87% was determined for Type 1 AIIS (320/458). In regard to abnormal morphology, prevalences of 17.90% (82/458), 3.71% (17/458) and 8.52% (39/458) were determined for type 2A, Type 2B and Type 3, respectively. The prevalence of abnormal AIIS morphology was 30.30% (80/264) in male specimens and 29.90% (58/194) in female specimens. This study demonstrates the prevalence of the different morphologies of the AIIS, providing information that will be useful in determining the role of the AIIS in the emergence of subspine hip impingement.

El Síndrome de Pinzamiento Femoroacetabular (PFA) es una entidad clínica reconocida en los últimos años como una causa de dolor y desarrollo de artrosis temprana de cadera. El pinzamiento subespinoso de la cadera se caracteriza por una espina iliaca anteroinferior (EIAI) prominente o con una morfología anormal, lo que contribuye al desarrollo de un cuadro clínico similar al PFA. El objetivo fue proponer una nueva clasificación morfológica de la EIAI y determinar las prevalencias de las distintas morfologías de la EIAI en base a la misma y correlacionarla con los distintos sexos y grupos de edad. La muestra consistió en un total de 458 hemipelvis, de sexo y edad conocidos (264 hombres y 194 mujeres). Cada pieza fue analizada para determinar la prevalencia de variaciones morfológicas de la EIAI en base a la clasificación propuesta. Tipo 1: presencia de una superficie cóncava entre la EIAI y reborde acetabular, Tipo 2A: presencia de una superficie plana entre la EIAI y el reborde acetabular, Tipo 2B: presencia de una superficie convexa entre la EIAI y el reborde acetabular y Tipo 3: la EIAI protruye hacia el acetábulo anterior o inferiormente. Se determinó una prevalencia de 69,87% para la EIAI Tipo 1 (320/458). En cuanto a las morfologías anormales, se determinó una prevalencia de 17,90% (82/458), 3,71% (17/458) y 8,52% (39/459) para los Tipos 2A, 2B y 3, respectivamente. La prevalencia de una morfología anormal en las EIAI de especímenes del sexo masculino fue de 30,30% (80/264) y en el sexo femenino 29,90% (58/194). Se evidencia la prevalencia de las diferentes morfologías que puede tener la EIAI; esta información será de ayuda para determinar el papel de la EIAI en la aparición del pinzamiento subespinoso de la cadera.