Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures.

PURPOSE: Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures. METHODS: A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up (minimum three months postoperatively) were compared to those without malalignment with regard to demographics, fracture characteristics, intraoperative characteristics, and complications. RESULTS: The rate of malalignment was 13%. On multivariate analysis, multiplanar distal interlocking screw fixation (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.03-0.92) was associated with a decreased rate of final malalignment, while nail diameter > 10 mm was associated with a higher rate (OR, 4.05; 95% CI 1.25-13.11). Fibular fixation was not associated with malalignment. CONCLUSION: Multiplanar distal interlocking screws may protect against malalignment. Fibula fixation does not appear associated with a decreased rate of malalignment in distal tibia fractures treated with intramedullary nails. LEVEL OF EVIDENCE: III.

Bidirectional ventricular tachycardia due to digoxin-diuretic interaction in post-cardiac surgery patient: a case report.

Bidirectional ventricular tachycardia (BVT) is a rare form of malignant ventricular arrhythmia characterized by beat-to-beat alternation in the QRS axis. BVT is a hallmark of digitalis toxicity, but digoxin-induced BVT secondary to digoxin-diuretic interaction in cardiac surgery patients is not widely reported. We present the case of a 62-year-old woman undergoing mitral valve replacement with tricuspid annuloplasty who developed postoperative congestive heart failure and vasoplegic syndrome requiring norepinephrine, vasopressin, and loop diuretics. During postoperative care, she presented atrial fibrillation with rapid ventricular response, achieving rate control with digoxin, but later displayed hemodynamically stable BVT associated with digitalis toxicity. The case highlights the importance of physicians monitoring digoxin toxicity when prescribing digoxin to patients with a diuretic regimen, particularly loop diuretics. During digoxin-induced-BVT, supportive treatment, including discontinuing digitalis coupled with potassium and magnesium supplements, can be considered as long as digoxin-specific antibodies are unavailable, and the patient is hemodynamically stable.

La taquicardia ventricular bidireccional (TVB) es una arritmia rara caracterizada por alternancia latido a latido en el eje QRS. La TVB es característica de intoxicación digitálica; sin embargo, la TVB secundaria a interacción digoxina-diurético en pacientes posoperados de cirugía cardíaca no se ha reportado ampliamente. Presentamos el caso de una mujer de 62 años sometida a cirugía cardiaca que desarrolló falla cardiaca congestiva y síndrome vasopléjico en el posoperatorio por lo que requirió noradrenalina, vasopresina y diurético de asa. Durante la hospitalización presentó fibrilación auricular con respuesta ventricular rápida; se logró control con digoxina, pero posteriormente presentó TVB asociada a intoxicación digitálica. Este caso resalta la importancia de detectar intoxicación digitálica durante la prescripción de digoxina a pacientes con un régimen diurético, especialmente diuréticos de asa. Durante la TVB inducida por digoxina, el tratamiento de soporte se puede considerar cuando no haya disponible anticuerpos específicos para digoxina y el paciente este hemodinámicamente estable.

-A machine learning model to predict surgical site infection after surgery of lower extremity fractures.

PURPOSE: This study aimed to develop machine learning algorithms for identifying predictive factors associated with the risk of postoperative surgical site infection in patients with lower extremity fractures. METHODS: A machine learning analysis was conducted on a dataset comprising 1,579 patients who underwent surgical fixation for lower extremity fractures to create a predictive model for risk stratification of postoperative surgical site infection. We evaluated different clinical and demographic variables to train four machine learning models (neural networks, boosted generalised linear model, naïve bayes, and penalised discriminant analysis). Performance was measured by the area under the curve score, Youdon's index and Brier score. A multivariate adaptive regression splines (MARS) was used to optimise predictor selection. RESULTS: The final model consisted of five predictors. (1) Operating room time, (2) ankle region, (3) open injury, (4) body mass index, and (5) age. The best-performing machine learning algorithm demonstrated a promising predictive performance, with an area under the ROC curve, Youdon's index, and Brier score of 77.8%, 62.5%, and 5.1%-5.6%, respectively. CONCLUSION: The proposed predictive model not only assists surgeons in determining high-risk factors for surgical site infections but also empowers patients to closely monitor these factors and take proactive measures to prevent complications. Furthermore, by considering the identified predictors, this model can serve as a reference for implementing preventive measures and reducing postoperative complications, ultimately enhancing patient outcomes. However, further investigations involving larger datasets and external validations are required to confirm the reliability and applicability of our model.

Review of bone deficiency in total elbow arthroplasty revision.

Total elbow arthroplasty revision rates have been increasing over time due to the increasing use of the procedure with the accompanying increase in complications. The most common complications that typically require revision surgery include aseptic loosening, periprosthetic fractures, infection, and component failure. The associated instability has an overall revision rate reported to be as high as 13%. One important factor when performing a revision surgery is bone quality and bone loss; this represents a challenge during the clinical decision-making process. Currently, there are several strategies used to address bone loss such as arthrodesis, resection arthroplasty, impaction grafting, allograft-prosthetic composite reconstruction, and custom prostheses. The aim of this review article is to provide a comprehensive review of the current strategies to improve diagnosis of failed total elbow arthroplasty and improve management and outcomes of this patient population.

Influencia de la edad de la madre en los desenlaces perinatales y maternos / Influence of maternal age on perinatal and maternal outcomes

Resumen OBJETIVOS: Describir y comparar la influencia de la edad materna en los desenlaces maternos y perinatales. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y unicéntrico en el que se reunieron todos los partos ocurridos en el año 2020 en un hospital español. La edad de la mujer se categorizó en tres tramos (1: menores de 35 años; 2: más o menos mayores de 35 años y menores de 40 años; 3: mayores de 40 años). RESULTADOS: Se reunió una población de estudio de 1700 mujeres y encontró una clara correlación entre la edad materna avanzada y el riesgo de cesárea y una tendencia no significativa hacia una mayor cantidad de partos instrumentados. La edad materna avanzada es un factor de riesgo de sufrir distintas enfermedades relacionadas con el embarazo y con malos desenlaces perinatales. Puesto que la tendencia actual marca un aumento de este tipo de embarazos es indispensable conocer los riesgos obstétricos a fin de informar y asesorar correctamente a las embarazadas y llevar a cabo las actuaciones pertinentes que eviten las complicaciones más frecuentes. CONCLUSIONES: Existe mayor tasa de cesárea en embarazos en edad avanzada después de ajustar los factores de confusión. Los desenlaces fetales no se ven afectados por la edad materna ni con otros eventos perinatales.

Abstract OBJETIVE: To describe and compare the influence of maternal age on maternal and perinatal outcomes. MATERIALS AND METHODS: Observational, retrospective, single-center, retrospective study in which all deliveries that occurred in the year 2020 in a Spanish hospital were collected. The age of the women was categorized into three groups (1: under 35 years; 2: more or less older than 35 years and younger than 40 years; 3: older than 40 years). RESULTS: A study population of 1700 women was assembled and found a clear correlation between advanced maternal age and risk of cesarean section and a nonsignificant trend toward a higher number of instrumented deliveries. Advanced maternal age is a risk factor for various pregnancy-related diseases and poor perinatal outcomes. Since the current trend shows an increase in this type of pregnancies, it is essential to know the obstetric risks in order to correctly inform and advise pregnant women and to carry out the pertinent actions to avoid the most frequent complications. CONCLUSIONS: There is a higher rate of caesarean section in advanced age pregnancies after the confounding factors were adjusted. Fetal outcomes are not affected by maternal age, as well as other perinatal events.

Desempeño de PSI/PORT y SOFA para predicción de ventilación mecánica invasiva en neumonía por SARS-CoV-2 / Performance of PSI/PORT and SOFA in predicting mechanical invasive ventilation in SARS-CoV-2 pneumonia / Desempenho de PSI/PORT e SOFA para prever ventilação mecânica invasiva na pneumonia por SARS-CoV-2

Resumen Introducción: Son escasas las publicaciones sobre aplicación de escalas pronósticas para predecir el uso de ventilación mecánica invasiva (VMI) en neumonía por SARS-CoV-2. El objetivo del estudio fue evaluar el desempeño de las escalas PSI/PORT y SOFA para predecir el uso de VMI en pacientes con neumonía por SARS-CoV-2. Material y métodos: Estudio retrospectivo que incluyó pacientes hospitalizados con neumonía por SARS-CoV-2 del 01 de abril al 31 de mayo de 2020. Se realizó análisis de curvas ROC, calculando el área bajo la curva de las escalas PSI/PORT y SOFA, así como sensibilidad, especificidad y valores predictivos. Resultados: Se incluyó a 151 pacientes, con edad de 52 años (IQR 45-64); 69.5% eran hombres. Del total, 102 pacientes necesitaron VMI (67.5%). Las áreas bajo las curvas ROC para predecir VMI fueron: SOFA 0.71 (IC 95% 0.64-0.78) y PSI/PORT 0.78 (IC 95% 0.71-0.85). Al compararlas, no hubo significancia estadística (p = 0.08). Conclusiones: Las escalas SOFA y PSI/PORT pueden infraestimar la necesidad de VMI en la neumonía por SARS-CoV-2. En nuestro estudio, SOFA y PSI/PORT no tuvieron un buen desempeño para predecir el uso de VMI en pacientes hospitalizados con neumonía por SARS-CoV-2.

Abstract Introduction: There are few publications on the application of prognostic scales to predict the use of invasive mechanical ventilation (IMV) in SARS-CoV-2 pneumonia. Therefore, the study's objective was to evaluate the performance of PSI/PORT and SOFA in predicting the use of IMV in patients with SARS-CoV-2 pneumonia. Material and methods: A retrospective study that included hospitalized patients with SARS-CoV-2 pneumonia from April 01, 2020, to May 31, 2020. Analysis of ROC curves was performed, calculating the area under the curve for PSI/PORT and SOFA scores, as well as sensitivity, specificity, and predictive values. Results: 151 patients were included, aged 52 years (IQR 45-64); 69.5% were men. Of the total, 102 patients required IMV (67.5%). Area under the curve to predict IMV were: SOFA 0.71 (95% CI 0.64-0.78) and PSI/PORT 0.78 (95% CI 0.71-0.85). When comparing them, there was no statistical significance (p = 0.08). Conclusions: In patients with SARS-CoV-2 infection, SOFA and PSI/PORT may underestimate the need for IMV. In our study, SOFA and PSI/PORT score performed fair in predicting IMV use in hospitalized patients with SARS-CoV-2 pneumonia.

Resumo Introdução: Existem poucas publicações sobre a aplicação de escalas prognósticas para prever o uso de ventilação mecânica invasiva (VMI) na pneumonia por SARS-CoV-2. O objetivo do estudo foi avaliar o desempenho do PSI/PORT e SOFA para prever o uso de IMV em pacientes com pneumonia por SARS-CoV-2. Material e métodos: Estudo retrospectivo que incluiu pacientes internados com pneumonia por SARS-CoV-2 entre 1o de abril de 2020 e 31 de maio de 2020. Foi realizada análise da curva ROC, calculando a área sob a curva PSI/PORT e SOFA, bem como a sensibilidade, especificidade e valores preditivos. Resultados: Foram incluídos 151 pacientes, com idade de 52 anos (IQR 45-64); 69.5% eram homens. Do total, 102 pacientes necessitaram de VMI (67.5%). As áreas sob as curvas ROC para predizer VMI foram: SOFA 0.71 (IC 95% 0.64-0.78) e PSI/PORT 0.78 (IC 95% 0.71-0.85). Ao compará-los, não houve significância estatística (p = 0.08). Conclusões: SOFA e PSI/PORT podem subestimar a necessidade de VMI na pneumonia por SARS-CoV-2. Em nosso estudo, SOFA e PSI/PORT não tiveram bom desempenho na previsão do uso de VMI em pacientes hospitalizados com pneumonia por SARS-CoV-2.

Technical considerations and early results of magnetic compressive intramedullary nailing for humeral shaft delayed unions and nonunions.

Background: Expandable magnetic rods and intramedullary nails are being used in a number of innovative ways, including limb length discrepancy and scoliosis correction. However, recently, the full complement of these devices has been further explored, with the utilization of their compressive capacity to improve fracture healing. The purpose of the present study was to report on early results of compressive magnetic intramedullary nailing for humeral shaft delayed unions and nonunions. Methods: This retrospective case series was completed at a level 1 trauma center, with adult patients who underwent compressive intramedullary nailing from 2017 to 2021 for humeral shaft nonunion or delayed union. The primary indication for this procedure was nonunion in the setting of previous conventional fixation, but a subset of patients with atrophic nonunions and risk factors for recalcitrant nonunion were also included. Results: Fourteen patients, with a mean age of 51 ± 17 years, underwent compressive magnetic intramedullary nailing. Nine patients had previously underwent surgery, 6 of which had undergone multiple prior procedures. Five others were initially treated nonoperatively and underwent surgery 4.1 ± 2.9 months out from injury. Ten patients went on to union at a mean of 2.9 ± 2.4 months. One patient experienced hardware failure with nail cut-out at 2 weeks, and one required revision surgery for a wound infection. Three other patients were lost to follow-up, one of which was deceased for reasons unrelated to surgery. Conclusion: Compressive magnetic intramedullary nails are a viable solution for complex humeral shaft nonunions, particularly in the setting of previously well-fixed fractures and those at risk of recalcitrant nonunion. However, comparative and prospective studies looking at union rates and secondary procedures are needed to more clearly define their role in treatment and assure their safety, given recent concerns regarding osteolysis at the nail modular junction.

Coma mixedematoso asociado a infección por SARS-CoV-2 / Myxedema coma associated with SARS-CoV-2 infection / Coma mixedematoso associado à infecção por SARS-CoV-2

Resumen: Aunque se sabe que la infección por SARS-CoV-2 es una causa importante de enfermedad pulmonar, se han observado múltiples manifestaciones extrapulmonares asociadas a COVID-19. Existen en la literatura reportes de tirotoxicosis secundarios a COVID-19, pero los casos de hipotiroidismo descompensado por COVID-19 son escasos. Reportamos el caso de una paciente de 37 años con obesidad que presentó coma mixedematoso asociado a infección por SARS-CoV-2. El estado proinflamatorio secundario a obesidad, el daño directo a la glándula tiroidea por SARS-CoV-2 y la elevación de mediadores inflamatorios en sangre observados durante la infección viral podrían ser mecanismos que desencadenen el coma mixedematoso. En pacientes con COVID-19 severo es importante la búsqueda intencionada de signos de coma mixedematoso y su confirmación con un perfil tiroideo al ingreso hospitalario.

Abstract: Although SARS-CoV-2 infection is known to be an important cause of lung disease, multiple extrapulmonary manifestations associated with COVID-19 have been observed. There are reports of thyrotoxicosis secondary to COVID-19 in the literature, but cases of decompensated hypothyroidism due to COVID-19 are rare. We report the case of a 37-year-old female patient with obesity who presented myxedema coma associated with SARS-CoV-2 infection. The pro-inflammatory state secondary to obesity, direct damage to the thyroid gland by SARS-CoV-2, and the elevation of inflammatory mediators in the blood observed during viral infection could be mechanisms that trigger myxedema coma. In patients with severe COVID-19, the intentional search for signs of myxedema coma and its confirmation with a thyroid profile at hospital admission is important.

Resumo: Embora a infecção por SARS-CoV-2 seja conhecida por ser uma causa importante de doença pulmonar, foram observadas várias manifestações extrapulmonares associadas ao COVID-19. Há relatos na literatura de tireotoxicose secundária à COVID-19, mas os casos de hipotireoidismo descompensado por COVID-19 são raros. Relatamos o caso de um paciente de 37 anos com obesidade que apresentou coma mixedematoso associado à infecção por SARS-CoV-2. O estado pró-inflamatório secundário à obesidade, o dano direto à glândula tireoide pelo SARS-CoV-2 e a elevação de mediadores inflamatórios no sangue observados durante a infecção viral podem ser mecanismos que desencadeiam o coma mixedematoso. Em pacientes com COVID-19 grave, é importante a busca intencional de sinais de coma mixedematoso e sua confirmação com perfil tireoidiano na admissão hospitalar.

Versatility of use of fibrin glue in wound closure and vitreo-retinal surgery.

BACKGROUND: Fibrin glue is an absorbable blood-derived product, a biological tissue adhesive which imitates the final stages of the coagulation cascade, it produces a firm clot, forming a seal along the whole length of the wound, the resultant fibrin clot degrades physiologically into granulation tissue 2 weeks after the application. Biological glue has been used extensively in many forms of surgical procedures. Its use in eye surgery has grown lately as we have evidence that showed it was effective in securing conjunctival grafts in pterygium surgery, in securing wounds after glaucoma surgery and more importantly in 20G and 23G vitrectomy. PURPOSE: The aim of this study is to present our experience in the use of fibrin glue in vitreoretinal surgery. MATERIAL AND METHODS: We included 281 eyes of 221 patients who underwent vitreoretinal surgery during the period of May 2009 to July 2012, the preoperative diagnoses were as following: proliferative diabetic retinopathy, rhegmatogenous retinal detachment, macular hole, epiretinal membrane, luxation of cataratous nucleous and cortex, intraocular lens luxation, penetrating trauma, silicone extraction, phaco + IOL + vitrectomy + Ahmed valve implant, vitreous biopsy and optic nerve pit associated to macular detachment. The procedures were performed with Alcon Accurus Surgical System 20-gauge, 23-gauge or a combination of both. We used fibrin glue in all of the 20-gauge sclerotomies and leaking 23-gauge sclerotomies, scleral wound for IOL extraction, conjunctival peritomy for buckle implantation, conjunctiva in Ahmed valve implant, corneal graft in corneal perforation in trauma and leaking corneal wounds for phacoemulsification, in an optic pit, and in subretinal space in a giant retinal tear. RESULTS: We did not use any suture in any of the patients throughout the different procedures, there was no leakage in any wounds in the postoperative period, we found no inflammatory reaction, infection, and whenever we had excess amount, it was trimmed. Two patients presented a small dehiscence of the wound that was corrected in-office with a small amount of fibrin glue in the post-operative period. CONCLUSIONS: Fibrin glue reduces surgical time, it is a good sealant, safe, with minimal allergic or toxic reactions and inflammation, minimizes bleeding, easy to undo and that eventually degrades. This small series shows that fibrin glue is a viable alternative for tissue coaptation in vitreoretinal surgery. However, further studies are required before fibrin glue takes the place of sutures.

Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources.

PURPOSE: The recent outbreak of the novel coronavirus (SARS-CoV-2) has emphasised the need to minimise hospital admissions and utilisation of healthcare resources. The purpose of this study was to examine the outcomes of an outpatient surgery protocol for acute closed ankle fractures. METHODS: In this retrospective study, 262 patients underwent outpatient surgery for their closed ankle fractures at our level-1 trauma centre. A total of 196 patients met our inclusion criteria and were ultimately included in the final analysis. Our primary outcomes' measures included post-operative admission to the emergency department within 30 days after surgery and unplanned hospital readmission within 30 days after surgery. Our secondary outcome measure included the incidence of surgical site infection (SSI) within 12 weeks after surgery. RESULTS: Thirty-two patients (16.3%) had an unplanned emergency department visit within 30 days of fracture fixation and two patients (1.0%) required hospital readmission within 30 days of their surgery. Sixteen patients (8.2%) developed SSI, which included 11 (5.6%) superficial and five (2.6%) deep infections. CONCLUSION: Strategic outpatient management of acute closed ankle fractures is associated with acceptable rates of unplanned emergency department visits, hospital readmissions, and SSIs. In the context of the recent SARS-CoV-2 outbreak, outpatient management of these injuries may aide in the mitigation of nosocomial infections and the preservation of finite healthcare resources.

Thoracic surgery during the coronavirus disease 2019 (COVID-19) pandemic in Madrid, Spain: single-centre report.

OBJECTIVES: We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS: We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS: Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS: These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.

Black ascitic fluid in a patient with history of alcohol abuse: report of an unusual case and literature review.

The differential diagnosis for black ascites include pancreatic ascites (PA). In majority of cases described the ascitic fluid as amber or black-colored. We report the case of a 33-year-old man with a history of alcohol abuse who presented with 24 h of epigastric pain and abdominal distension. Laboratory results showed lipase of 1270 U/l, amylase of 442 U/l and albumin of 2 g/dl. A contrast computed tomography scan of the abdomen showed pancreatic necrosis with atrophy and free abdominal fluid. Paracentesis was performed, yielding opaque black ascitic fluid. An ascitic fluid analysis demonstrated amylase of 2769 U/l, albumin of 1.6 g/dl, was negative for malignant cells and tuberculosis. Serum-Ascites Albumin Gradient was resulted in 0.4. The diagnosis of chronic pancreatitis was suspected, and he received supportive care with pain medication and bowel rest. He was discharged with symptom free on Day 14 after admission.

Non-contact wide-angled visualization with chandelier-assisted scleral buckling for primary uncomplicated rhegmatogenous retinal detachment.

PURPOSE: To report our experience in non-contact wide-angled visualization with chandelier-assisted scleral buckling (SB) in uncomplicated primary rhegmatogenous retinal detachments (RRD). METHODS: Retrospective case series of 282 eyes that underwent non-contact wide-angled visualization with chandelier-assisted SB and were followed for a mean of 13.5 months. RESULTS: There were 160 male patients. The average age was 42.6 years old. There were 262 eyes that were phakic, 18 pseudophakic, and 2 aphakic. Two-thirds of eyes presented with the macula detached. Eyes had an average of 1.6 breaks. The single operation anatomic success rate was 85.1% (240/282). The pre-op visual acuity improved from 1.21 to 0.76 logMAR at 6 months (p < 0.0001). Complications included a case of scleral laceration, choroidal hemorrhage, 3 epiretinal membranes, 1 macular fold, and 4 eyes with buckle exposure. CONCLUSION: Non-contact wide-angled visualization with chandelier-assisted SB compares favorably with conventional SB for primary uncomplicated primary RRD.

Flexible robotic teleoperation architecture for intelligent oil fields.

Teleoperation virtual platforms allow people to send their skills and capacities into machines located in either relative close (few meters away) or far (different continents) locations. With the use of lightweight protocols, people can remotely control the actions and movements of robots so they can avoid physical interaction with dangerous or risky places. Oil and gas well-pads stations are working zones considered hazardous due to the various chemical substances used in their daily processes. This characteristic makes these places the perfect candidates for the implementation of teleoperation solutions in order to reduce the direct interaction of humans with different chemicals and risky situations. The following investigation focuses on the development of a base teleoperation scheme to perform inspection and maintenance tasks in the inside one of these hydrocarbon facilities. The proposed system aims to generate an easily scalable teleoperation solution using distributed control schemes and a lightweight communication protocol to remotely manipulate a KUKA mobile manipulator. As the first stage of this investigation, the main result focuses on the development of the generic control and communication functions that allow the physical testing of the system using a KUKA YouBOT mobile manipulator and the help of a qualified operator of the station.

Desempeño de las cadenas de suministro en un contexto de red / Desempenho das cadeias de suprimentos em um contexto de rede / Performance of supply chains in a network context

Resumen Este documento tiene por objeto analizar si la conectividad del trabajo en red, así como su forma de gobernanza, contribuye positiva o negativamente con el desempeño de las cadenas de suministro. Partiendo de la noción de que su desempeño dependerá de las destrezas que, a su interior se desarrollen para dar respuesta a situaciones de incertidumbre propias de un mercado globalizado. Es decir; se deberán adelantar estrategias y alianzas, acompañadas de una adecuada forma de gobernanza, para mejorar su rendimiento financiero y participación en el mercado. Para lograr el propósito, se delimito la búsqueda a artículos en idioma inglés, en las bases de datos, ScienceDirect, JSTOR, Proques y Emerald Journals, que tuviesen como objetivo analizar los resultados a partir de la integración de cadenas de suministro. Se seleccionaron dos artículos, que fueron sometidos a una rigurosa revisión sistemática a partir de un análisis estructurado del contenido. La investigación muestra que, al adoptar nuevas iniciativas y configuraciones de red, se logran mejorares rendimientos. Adicionalmente, y de forma teórica, se ha demostrado que la integración de la cadena de suministro genera ventajas competitivas; sin embargo, existen vacíos en la disciplina que permitan contribuir con estrategias que generan mayor rendimiento.

Abstract The purpose of this paper is to analyze whether the connectivity of networking, as well as its form of governance, contributes positively or negatively to the performance of supply chains. It is based on the notion that their performance will depend on the skills that are developed within them to respond to situations of uncertainty typical of a globalized market. In other words, strategies and alliances must be developed, accompanied by an appropriate form of governance, in order to improve financial performance and market participation. To achieve this purpose, the search was limited to English-language articles in the databases, ScienceDirect, JSTOR, Proques and Emerald Journals, whose objective was to analyze the results from the integration of supply chains. Two articles were selected and subjected to rigorous systematic review based on structured content analysis. The research shows that by adopting new initiatives and network configurations, higher yields are achieved. Additionally and theoretically it has been demonstrated that the integration of the supply chain generates competitive advantages; however, there are gaps in the discipline that allow contributing with strategies that generate greater performance.

Resumo O objetivo deste documento é analisar se a conectividade de rede, bem como sua forma de governança, contribui positivamente ou negativamente para o desempenho das cadeias de suprimentos. Partindo da noção de que seu desempenho dependerá das habilidades que, dentro deles, são desenvolvidas para responder a situações de incerteza típicas de um mercado globalizado. Ou seja, estratégias e alianças devem ser avançadas, acompanhadas de uma forma adequada de governança, a fim de melhorar seu desempenho financeiro e participação no mercado. Para atingir o objetivo, a busca limitou-se aos artigos em língua inglesa, nas bases de dados, ScienceDirect, JSTOR, Proques e Emerald Journals, que objetivaram analisar os resultados da integração das cadeias de suprimentos. Dois artigos foram selecionados, os quais foram submetidos a uma rigorosa revisão sistemática com base em uma análise estruturada do conteúdo. A pesquisa mostra que, ao adotar novas iniciativas e configurações de rede, melhor desempenho é alcançado. Adicionalmente, e teoricamente, foi demonstrado que a integração da cadeia de suprimentos gera vantagens competitivas; No entanto, existem lacunas na disciplina que permitem contribuir com estratégias que geram maior desempenho.

Inhibition of the Neuronal Calcium Sensor DREAM Modulates Presenilin-2 Endoproteolysis.

Deregulated intracellular Ca2+ and protein homeostasis underlie synaptic dysfunction and are common features in neurodegenerative diseases. DREAM, also known as calsenilin or KChIP-3, is a multifunctional Ca2+ binding protein of the neuronal calcium sensor superfamily with specific functions through protein-DNA and protein-protein interactions. Small-molecules able to bind DREAM, like the anti-diabetic drug repaglinide, disrupt some of the interactions with other proteins and modulate DREAM activity on Kv4 channels or on the processing of activating transcription factor 6 (ATF6). Here, we show the interaction of endogenous DREAM and presenilin-2 (PS2) in mouse brain and, using DREAM deficient mice or transgenic mice overexpressing a dominant active DREAM (daDREAM) mutant in the brain, we provide genetic evidence of the role of DREAM in the endoproteolysis of endogenous PS2. We show that repaglinide disrupts the interaction between DREAM and the C-terminal PS2 fragment (Ct-PS2) by coimmunoprecipitation assays. Exposure to sub-micromolar concentrations of repaglinide reduces the levels of Ct-PS2 fragment in N2a neuroblastoma cells. These results suggest that the interaction between DREAM and PS2 may represent a new target for modulation of PS2 processing, which could have therapeutic potential in Alzheimer's disease (AD) treatment.

Giant Dumbbell-Shaped Thoracic Schwannoma in an Elderly Patient Resected Through a Single-Stage Combined Laminectomy and Video-Assisted Thoracoscopy: Surgical Strategy and Technical Nuances.

BACKGROUND: Dumbbell-shaped schwannomas involving the spinal canal, the intervertebral foramen, and the thoracic cavity are rare lesions. Surgical treatment represents a challenge, and there is no consensus regarding ideal management. Two major surgical routes have been used: combined laminectomy and open thoracotomy or posterolateral extrapleural approach with wide bone removal. This report describes a relatively easy surgical strategy, combined laminectomy and thoracoscopy, which allows safe resection under an adequate view with low risk of spinal instability, pain, or respiratory problems. CASE DESCRIPTION: A 74-year-old man presented with rapidly progressing motor impairment caused by a dumbbell-shaped, 65-mm, Eden type III lesion at the T5 level. Magnetic resonance imaging showed an intraspinal-extradural mass extending into the chest cavity and causing severe spinal cord compression. The patient underwent single-stage surgery performed by a neurosurgical and thoracic team. The extradural and foraminal tumor components were first removed through a 1-level laminectomy with foraminotomy and without facetectomy. Subsequently, video-assisted thoracic surgery was performed to approach the anterior paraspinal component. Total tumor removal, confirmed with postoperative magnetic resonance imaging, was achieved. Pathologic diagnosis was schwannoma. The postoperative course was uneventful. The patient's neurologic deficits resolved, and he experienced minimal pain after the operation. CONCLUSIONS: A single-stage operation using combined laminectomy and video-assisted thoracic surgery is a safe and efficacious strategy for achieving total removal of dumbbell-shaped thoracic schwannomas, even in cases involving giant lesions and elderly patients.

Inverted ILM flap, free ILM flap and conventional ILM peeling for large macular holes.

BACKGROUND: To assess closure rate after a single surgery of large macular holes and their visual recovery in the short term with three different surgical techniques. METHODS: Prospective multicenter randomized controlled trial. We included treatment-naïve patients with diagnosis of large macular hole (minimum diameter of > 400 µm). All patients underwent a comprehensive ophthalmological examination. Before surgery, the patients were randomized into three groups: group A: conventional internal limiting membrane peeling, group B: inverted-flap technique and group C: free-flap technique. All study measurements were repeated within the period of 1 and 3 months after surgery. Continuous variables were assessed with a Kruskal-Wallis test, change in visual acuity was assessed with analysis of variance for repeated measurements with a Bonferroni correction for statistical significance. RESULTS: Thirty-eight patients were enrolled (group A: 12, group B: 12, group C: 14). The closure rate was in group A and B: 91.6%; 95% CI 61.52-99.79%. In group C: 85.71%; 95% CI 57.19-98.22%. There were no differences in the macular hole closure rate between groups (p = 0.85). All groups improved ≈ 0.2 logMAR, but only group B reached statistical significance (p < 0.007). CONCLUSIONS: Despite all techniques displayed a trend toward visual improvement, the inverted-flap technique seems to induce a faster and more significant recovery in the short term.

Microfluidics for exosome isolation and analysis: enabling liquid biopsy for personalized medicine.

Exosomes, the smallest sized extracellular vesicles (∽30-150 nm) packaged with lipids, proteins, functional messenger RNAs and microRNAs, and double-stranded DNA from their cells of origin, have emerged as key players in intercellular communication. Their presence in bodily fluids, where they protect their cargo from degradation, makes them attractive candidates for clinical application as innovative diagnostic and therapeutic tools. But routine isolation and analysis of high purity exosomes in clinical settings is challenging, with conventional methods facing a number of drawbacks including low yield and/or purity, long processing times, high cost, and difficulties in standardization. Here we review a promising solution, microfluidic-based technologies that have incorporated a host of separation and sensing capabilities for exosome isolation, detection, and analysis, with emphasis on point-of-care and clinical applications. These new capabilities promise to advance fundamental research while paving the way toward routine exosome-based liquid biopsy for personalized medicine.

Safety of intravitreal quinupristin/dalfopristin in an animal model.

AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.