Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes.

Machine learning (ML) has not yet been used to identify factors predictive for post-operative functional outcomes following arthroscopic rotator cuff repair (ARCR). We propose a novel algorithm to predict ARCR outcomes using machine learning. This is a retrospective cohort study from a prospectively collected database. Data were collected from the Surgical Outcome System Global Registry (Arthrex, Naples, FL, USA). Pre-operative and 3-month, 6-month, and 12-month post-operative American Shoulder and Elbow Surgeons (ASES) scores were collected and used to develop a ML model. Pre-operative factors including demography, comorbidities, cuff tear, tissue quality, and fixation implants were fed to the ML model. The algorithm then produced an expected post-operative ASES score for each patient. The ML-produced scores were compared to actual scores using standard test-train machine learning principles. Overall, 631 patients who underwent shoulder arthroscopy from January 2011 to March 2020 met inclusion criteria for final analysis. A substantial number of the test dataset predictions using the XGBoost algorithm were within the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds: 67% of the 12-month post-operative predictions were within MCID, while 84% were within SCB. Pre-operative ASES score, pre-operative pain score, body mass index (BMI), age, and tendon quality were the most important features in predicting patient recovery as identified using Shapley additive explanations (SHAP). In conclusion, the proposed novel machine learning algorithm can use pre-operative factors to predict post-operative ASES scores accurately. This can further supplement pre-operative counselling, planning, and resource allocation. Level of Evidence: III.

Relevance of the voice in the process of gender affirmation in transsexual women: A cross-sectional study / Importancia de la voz en el proceso de afirmación de género en mujeres transexuales: Estudio transversal

Abstract Introduction Voice is a gender marker and can therefore be a source of gender dysphoria. There is a relationship between symptoms of anxiety and depression and voice-related difficulties in trans women (TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to voice feminization procedures is limited while the population demanding transgender healthcare is increasing. Objective To describe the degree of voice-related dysphoria experienced by TW that seek a voice feminization treatment. Method A descriptive, cross-sectional study, 26 TW completed quality of life (QoL) questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was measured. Results 77% of the participants were legally recognized as women, 96% were under HRT, and 27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a feminine voice that allows gender conformity was the main reason for seeking treatment. Discussion and conclusion Voice non-conformity affects QoL. None of the participants perceived their voice as feminine while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization treatments, it is difficult to define how to measure success.

Resumen Introducción La voz es un marcador de género y como tal puede ocasionar disforia de género. Existe una relación entre la ansiedad y la depresión y las dificultades relacionadas con la voz en mujeres trans (MT). La terapia de sustitución hormonal (TSH) en MT no feminiza la voz. El acceso a un tratamiento de feminización de voz es limitado, mientras que la población que demanda servicios de salud transgénero está aumentando. Objetivo Describir el grado de disforia relacionado con la voz de las MT que buscan un tratamiento de feminización de voz. Método Estudio descriptivo, transversal, 26 MT respondieron cuestionarios de calidad de vida (CV) y expresaron los motivos para buscar feminizar su voz. Se midió la frecuencia fundamental (f0). Resultados El 77% de las participantes eran reconocidas legalmente como mujeres, 96% tomaban TSH y 27% tenía antecedente de una cirugía de afirmación de género. La mediana de la f0 fue de 131 Hz. El puntaje medio en el Cuestionario de Voz para Mujeres Trans fue de 95 puntos (DE = 14.3) y tuvo una mala correlación con la f0. La expectativa principal fue lograr una voz femenina que permitiera una conformidad de género. Discusión y conclusión Una voz género-discordante afecta la CV. El 97% describió que su voz ideal sería femenina, pero ninguna percibió su voz como tal. La incapacidad para satisfacer las necesidades de afirmación de género tiene un efecto negativo sobre la CV. Mejorar el acceso a procedimientos de afirmación de género en instituciones públicas sin patologizar a las personas transgénero es una agenda pendiente. Existe evidencia de que los procedimientos de feminización de voz benefician a las MT, aunque se desconoce cuál es la mejor manera de medir el éxito.

Resultados de voz y calidad de vida en pacientes con parálisis cordal unilateral en abducción tratados con tiroplastia de medialización.

OBJETIVO: Evaluar los resultados funcionales y el impacto en la calidad de vida de pacientes con parálisis cordal unilateral en abducción (PCUA) de etiología variable, posoperados de tiroplastia de medialización con técnica de Netterville en el Instituto Nacional de Rehabilitación. MÉTODO: En los pacientes candidatos a tiroplastia de medialización se documentaron el tiempo máximo fonatorio y cuestionarios de funcionalidad (VHI-30) y calidad de vida (VRQoL) prequirúrgicos y 3 a 6 meses posquirúrgicos. Se utilizaron pruebas de comparación de medias para analizar los resultados. RESULTADOS: Se realizó tiroplastia de medialización en 27 pacientes con PCUA de 2013 a 2019. Todos tuvieron mejoría estadística y clínicamente significativa por el tiempo máximo fonatorio (media de 4.07 a 11.07 segundos), el VHI-30 (media de 81 a 29 puntos) y la VRQoL (media de 33 a 15 puntos). No se documentó ninguna complicación mayor. CONCLUSIONES: La tiroplastia de medialización es un tratamiento seguro que mejora de manera significativa la calidad de vida y la funcionalidad de los pacientes con PCUA. OBJECTIVE: To evaluate functional and quality of life results in patients with unilateral vocal fold paralysis (UVFAP) of different etiology, who underwent medialization thyroplasty, using Netterville's technique. METHOD: In patients eligible for medialization thyroplasty, maximum phonatory time was measured, quality of life (VRQoL) and functionality (VHI-30) questionnaires were applied before surgery and posteriorly at 3 and 6 months after surgery. Means comparison tests were used to analyze the results. RESULTS: Medialization thyroplasty was carried out in 27 patients presenting with UVFAP from 2013 to 2019. All had a statistically significant and clinically significant improvement. This was measure with maximum phonatory time (medium of 4.07 to 11.07 seconds), VHI-30 (medium of 81 to 29 points), and VRQoL (medium of 33 to 15 points). No mayor complications were documented. CONCLUSIONS: Medialization thyroplasty is a safe procedure that significantly improves functionality and quality of life in patients with UVFAP.

Subacute Thyroiditis Associated with COVID-19.

Subacute thyroiditis is a self-limiting inflammatory disorder, characterized by neck pain or discomfort, a tender diffuse goiter, and sometimes a transient episode of hyperthyroidism followed by euthyroidism and sometimes hypothyroidism. There is usually a normalization of thyroid function within a few weeks. Subacute thyroiditis has a higher incidence in summer and has been linked to a viral or bacterial upper respiratory postinfection inflammatory response. We hereby describe the case of a previously healthy 37-year-old female presenting with subacute thyroiditis associated with a very mild presentation of COVID-19. As most patients with SARS-Cov-2 are asymptomatic, we suggest to rule out SARS-Cov-2 infection in patients presenting with symptoms suggesting SAT.

Millennials' national and global identities as drivers of materialism and consumer ethnocentrism.

A major effect of globalization is one that occurs on the self-concept. This is especially the case for young consumers, and particularly for millennials. Despite this cohort's idiosyncrasies, little attention has been paid to the study of their consumer identities, an important aspect of self-concept. The current research addresses this gap by examining the way millennial consumers' global and national identities help explain two attitudinal outcomes associated with globalization: materialism and consumer ethnocentrism. Data were collected from millennials in two distinct socio-cultural contexts. A key finding suggests that distinct contexts (i.e., collectivist and ethnically homogeneous vs. individualistic and ethnically diverse) exhibit differences in the formation of materialism and consumer ethnocentrism among millennials. Additionally, results indicate that for similar consumer segments, each context's configuration of millennials shows differences in global and national identities. Implications for future researchers and practitioners are discussed.

Antibacterial hyaluronic acid/chitosan multilayers onto smooth and micropatterned titanium surfaces.

Bacterial contamination is a critical problem in medical implants, which are preferential sites for bacterial adhesion, leading to infections which can compromise health and immune system of patients. Commercial titanium alloys are the most commonly used materials for permanent implants in contact with bone, and the prevention of infections on their surface is therefore a crucial challenge for orthopaedic and dental surgeons. Thus, the aim of this work is to develop polysaccharide antibacterial coatings onto modified titanium surfaces with different surface topography, in order to act as reservoirs of antibacterial agents. For this, hyaluronic acid/chitosan polyelectrolyte multilayers were successfully developed after acid hydrolysis of Ti-6Al -4 V alloys. Surface modification could be monitorized by XPS spectroscopy, fluorescence confocal microscopy and contact angle measurements. Furthermore, the effect of surface micropatterning on the stability, hydrophilicity, capability to the loading and release of triclosan and the antibacterial properties of prepared multilayers against Staphylococcus aureus were also analysed.

Taenia asiatica: the most neglected human Taenia and the possibility of cysticercosis.

Not only Taenia solium and Taenia saginata, but also Taenia asiatica infects humans. The last species is not included in the evaluation of the specificity of the immunodiagnostic techniques for taeniasis/cysticercosis. There is currently no specific immunodiagnostic method for T. asiatica available. Therefore, due to the fact that molecular techniques (the only tool to distinguish the 3 Taenia species) are normally not employed in routine diagnostic methods, the 2 questions concerning T. asiatica (its definite geographic distribution and its ability to cause human cysticercosis), remain open, turning T. asiatica into the most neglected agent of human taeniasis-cysticercosis.

Estimated fumonisin exposure in Guatemala is greatest in consumers of lowland maize.

Fumonisin mycotoxins contaminate maize worldwide. Analysis of maize samples (n = 396) collected from fields in Guatemala from 2000 to 2003 found that lowland maize (<360 m) had significantly more fumonisin B1 than highland maize (>1200 m). For example, 78% of the lowland samples collected at harvest in 2002 contained >0.3 microg/g of fumonisin B1, whereas only 2% of the highland samples contained >0.3 microg/g. Maize from the 2002 crop collected from storage in the highlands just before the 2003 harvest contained significantly more fumonisin B1 compared with levels at harvest in 2002. All Fusarium-infected kernels analyzed from 9 random lowland locations in 2001 were infected with fumonisin-producing Fusarium verticillioides and no other Fusarium species, whereas in samples from the highlands, only 5% of the Fusarium-positive kernels were F. verticillioides. In 2005, maize samples (n = 236) from the 2004 crop were collected from local markets in 20 Departments across Guatemala. The analysis showed that maize from lowland locations was often highly contaminated with fumonisin and was frequently transported to and sold in highland markets. Thus, fumonisin exposure in the highlands will be greatest in groups that obtain their maize in the market place from commercial vendors. Based on a recall study and published consumption data, a preliminary assessment of daily intake of total fumonisins was estimated. Consumption of nixtamalized maize products made from >50% of the maize from commercial vendors in 2005 could result in exposure exceeding the recommended WHO provisional maximal tolerable daily intake.

Understanding the potential impact of transgenic crops in traditional agriculture: maize farmers' perspectives in Cuba, Guatemala and Mexico.

Genetically engineered transgenic crop varieties (TGVs) have spread rapidly in the last 10 years, increasingly to traditionally-based agricultural systems (TBAS) of the Third World both as seed and food. Proponents claim they are key to reducing hunger and negative environmental impacts of agriculture. Opponents claim they will have the opposite effect. The risk management process (RMP) is the primary way in which TGVs are regulated in the US (and many other industrial countries), and proponents claim that the findings of that process in the US and its regulatory consequences should be extended to TBAS. However, TBAS differ in important ways from industrial agriculture, so TGVs could have different effects in TBAS, and farmers there may evaluate risks and benefits differently. To evaluate some potential impacts of TGVs in TBAS we used the RMP as a framework for the case of Bt maize in Mesoamerica and Cuba. We interviewed 334 farmers in Cuba, Guatemala and Mexico about farming practices, evaluations of potential harm via hypothetical scenarios, and ranking of maize types. Results suggest high potential for transgene flow via seed, grain and pollen; differences in effects of this exposure in TBAS compared with industrial agriculture; farmers see some potential consequences as harmful. Perceptions of harm differ among farmers in ways determined by their farming systems, and are different from those commonly assumed in industrial systems. An RMP including participation of farmers and characteristics of TBAS critical for their functioning is necessary to ensure that investments in agricultural technologies will improve, not compromise these agricultural systems.

Experiencia del Centro de Investigaciones Clínicas con la ecografía del aparato locomotor / Experience of the Center for Clinical Research with echograpy of the locomotor apparatus

En julio de 2001 se introduce en el Centro de Investigaciones Clínicas la ecografía del aparato locomotor, estudio que con el tiempo hizo que creciera la cantidad de sujetos, dado la utilidad para especialistas en Ortopedia, Traumatología, Fisiatría y Reumatología a fin de llegar a un diagnóstico con certeza y en consecuencia indicar un tratamiento adecuado a los pacientes. Es un estudio que aporta datos no solo diagnósticos sino pronósticos en determinadas enfermedades, donde en muchos pacientes ha constituido el estudio de elección para decidir el tratamiento quirúrgico o no. Este trabajo se extendió hasta septiembre de 2003 donde fueron recepcionados 524 enfermos. La articulación del hombro y de rodilla fueron las principales indicaciones

Microdrop: dispensador automático de muestras y reactivas / Microdrop: automatic sample dispenser and reactive

The dispenser Microdrop is a laboratory work station for bioanalytical laboratories. The workstation combines into a single programmable system the capability of performing automatic transfer of liquid samples between of a plurality of receptacles...

Método tecnológico de la salud aplicación docente asistencial / Technological method health care teaching application

El método tecnológico de la salud fue elaborado en 1988 con el propósito de facilitar la confección del plan de studio y los programas de la Licenciatura en Tecnología de la Salud y que al mismo tiempo sirviera de guía metodológica para el quehacer del licenciado en las diferentes especialidades. Por su carácter integrador, su flexibilidad y la posibilidad de ser aplicado en todas las esferas técnicas de la salud, se convertiría en el elemento rector de este proceso técnico-docente-asistencial. Durante cinco años fue aplicado de manera experimental en la formación de técnicos medios en radiología con resultado satisfactorio, pero por falta de información no se divulgó lo suficiente. Fue retomado para la confección del plan de estudio del perfil de Imagenología en este nuevo modelo pedagógico; el cual ponemos a disposición de profesores, alumnos y personal graduado de esta carrera, para su aplicación en el desempeño de las competencias profesionales inherentes a su perfil ocupacional.

La familia: investigación y política pública / The family: research and public policy

Se reúne un extenso análisis de la familia en el campo social, económico y político, realizado por distintos especialistas e investigadores, quienes intercambiaron sus puntos de vista durante la reunión realizada el 18 de mayo de 1995, en celebración del Día Internacional de la Familia. El documento se divide en: 1. Prólogo 2. La familia y sus respuestas organizacionales ante la crisis 3. Familia y política pública 4. Familia, identidad y valores 5. Vida familiar y democratización de los espacios privados 6. Evaluación política y democratización 7. Balance de las políticas de bienestar en el D.F. 8. Construcción de una política social de estado 9. Familia y pobreza 10. La política social ante los cambios en la sociedad y en la familia 11. Empresa familiar, neoliberalismo y sociedades de bienestar

Angioplastía transluminal percutánea (ATP): experiencias preliminares obtenidas / Percutaneous transluminal angioplasty (PTA): preliminary experiences obtained

La angioplastía transluminal percutánea (ATP) abrió nuevas posibilidades terapéuticas en las estenosis y oclusiones desde su descripción por Dotter y Judkins en 1964 y el desarrollo del catéter balón por Gruntzin.1 El objetivo de este trabajo es presentar los resultados preliminares obtenidos con esta novedosa técnica en un grupo de 56 pacientes que fueron sometidos a ésta. La edad de los pacientes osciló entre 13 y 73 años. El 82,5% pertenecieron al sexo masculino y se obtuvieron resultados satisfactorios iniciales del 100

Evaluación nutricional comparada entre pacientes en hemodiálisis y diálisis peritoneal continua ambulatoria / Compared nutritional evaluation among patients in hemodialysis and ambulatory continuous peritoneal dialysis

Se estudiaron 30 pacientes, 21 en hemodiálisis y 9 en DPCA, con promedio de edades y de antigüedad en tratamiento comparables. Dos de los pacientes de DPCA son diabéticos tipo I. Se evaluó el estado nutricional de ambas poblaciones a través de: ingestas calórica y proteicas, albúmina sérica y los índices antropométricos: peso (P), área grasa del brazo (AGB) y área muscular del brazo (AMB), indicadores respectivamente de la reserva calórica y de las proteínas somáticas. En los pacientes en DPCA se incluye en la ingesta calórica la absorción peritoneal de dextrosa. Resultó que la ingesta diaria de calorías y proteínas fue mayor en pacientes en DPCA que la de los de hemodiálisis; dichas ingestas se adecuan a lo recomendado para cada tipo de tratamiento. Excluyendo los dos pacientes diabéticos, el grupo DPCA mostró los tres índices antropométricos en valores normales; en hemodiálisis se observó en promedio disminución leve del peso y del área muscular del brazo y reducción moderada a severa del área grasa del brazo. La albúmina sérica fue normal en hemodiálisis y subnormal en DPCA, con diferencia estadísticamente significatica. En conclusión, ambos grupos mostraron ingestas de proteínas y calorías dentro de lo recomendado para cada grupo de tratamiento, pero los pacientes en hemodiálisis conservaron mejor la albúmina sérica, en tanto que los de DPCA mostraron mayor reserva calórica y de proteínas somáticas