Frontal Plane Correction of Hallux Valgus Deformity With a Minimally Invasive Third Generation Tecnique: Short-Term Radiographic Outcomes of a Prospective Case Series.

A number of minimally invasive osteotomies have been described for the repair of hallux abducto valgus (HAV) deformities. However, there are no known published studies that evaluate the effects of minimally invasive surgery techniques on the reduction of frontal plane rotation in patients with HAV. The purpose of this study was to assess correction in the transverse and frontal planes in patients undergoing surgical repair of HAV deformity utilizing a modified percutaneous technique. One hundred and five feet in 105 patients with HAV deformity were treated with a third generation minimally invasive technique using a first metatarsal osteotomy that allowed for frontal plane correction in conjunction with an Akin osteotomy. The minimum follow-up time was 12 months. Preoperative and postoperative anteroposterior weightbearing x-ray images were assessed and four measurements were evaluated: hallux abductus angle (HAA), intermetatarsal angle (IMA), tibial sesamoid position and frontal plane rotation of the first metatarsal. There were statistically significant differences for each of the assessments between the preoperative and postoperative radiographs (p < .001). There was a mean reduction in the HAA of 23.5° ± 9.6°, in the IMA, 7.0° ± 3.5°, in the tibial sesamoid position, 2.6 ± 1.3, and an improvement in the assessment of first metatarsal pronation (1.4 ± 0.9). The overall complication rate was 18.1%, with 5.7% of the feet requiring reoperation. The minimally invasive procedure employed by the authors demonstrated suitable outcomes in reducing deformity in both the transverse and frontal planes.

Complications of Small Aperture Intracorneal Inlays: A Literature Review.

Presbyopia can be defined as the refractive state of the eye in which, due to a physiological decrease in the ability to accommodate, it is not possible to sustain vision without fatigue in a prolonged manner, along with difficulty focusing near vision. It is estimated that its prevalence in 2030 will be approximately 2.1 billion people. Corneal inlays are an alternative in the correction of presbyopia. They are implanted beneath a laser-assisted in situ keratomileusis (LASIK) flap or in a pocket in the center of the cornea of the non-dominant eye. The purpose of this review is to provide information about intraoperative and postoperative KAMRA inlay complications in the available scientific literature. A search was conducted on PubMed, Web of Science, and Scopus with the following search strategy: ("KAMRA inlay" OR "KAMRA" OR "corneal inlay pinhole" OR "pinhole effect intracorneal" OR "SAICI" OR "small aperture intracorneal inlay") AND ("complication" OR "explantation" OR "explanted" OR "retired"). The bibliography consulted shows that the insertion of a KAMRA inlay is an effective procedure that improves near vision with a slight decrease in distance vision. However, postoperative complications such as corneal fibrosis, epithelial iron deposits, and stromal haze are described.

Evolution of Portulacineae Marked by Gene Tree Conflict and Gene Family Expansion Associated with Adaptation to Harsh Environments.

Several plant lineages have evolved adaptations that allow survival in extreme and harsh environments including many families within the plant clade Portulacineae (Caryophyllales) such as the Cactaceae, Didiereaceae, and Montiaceae. Here, using newly generated transcriptomic data, we reconstructed the phylogeny of Portulacineae and examined potential correlates between molecular evolution and adaptation to harsh environments. Our phylogenetic results were largely congruent with previous analyses, but we identified several early diverging nodes characterized by extensive gene tree conflict. For particularly contentious nodes, we present detailed information about the phylogenetic signal for alternative relationships. We also analyzed the frequency of gene duplications, confirmed previously identified whole genome duplications (WGD), and proposed a previously unidentified WGD event within the Didiereaceae. We found that the WGD events were typically associated with shifts in climatic niche but did not find a direct association with WGDs and diversification rate shifts. Diversification shifts occurred within the Portulacaceae, Cactaceae, and Anacampserotaceae, and whereas these did not experience WGDs, the Cactaceae experienced extensive gene duplications. We examined gene family expansion and molecular evolutionary patterns with a focus on genes associated with environmental stress responses and found evidence for significant gene family expansion in genes with stress adaptation and clades found in extreme environments. These results provide important directions for further and deeper examination of the potential links between molecular evolutionary patterns and adaptation to harsh environments.

Variables perioperatorias que influyen en la morbimortalidad de pacientes operados de fractura de cadera / Perioperative variables that influence the morbidity and mortality of hip fracture operated patients

Introducción: la fractura de cadera es causa común de hospitalización, ocupa un lugar cimero en la morbilidad y mortalidad por enfermedad ortopédica. Objetivo: identificar las variables perioperatorias que influyen en la morbimortalidad de los pacientes que se operan de fractura de cadera en el Hospital Militar Central Dr. Carlos J. Finlay. Métodos: se realizó un estudio analítico, retrospectivo en 135 pacientes intervenidos quirúrgicamente entre enero y diciembre de 2014. Se dividieron en dos grupos para el análisis estadístico, fallecidos y vivos. Las variables estudiadas fueron: causa de muerte, tasas de mortalidad posoperatoria, factores clínicos y quirúrgicos pronósticos de muerte y principales complicaciones. Resultados: la tasa de mortalidad a los 30 días de operados fue 2,2 por ciento y al año 17,8 por ciento. Las principales causas de muerte fueron el infarto agudo de miocardio (45,8 por ciento) y el trombo embolismo pulmonar (16,7 por ciento). La probabilidad de morir los pacientes con cardiopatía isquémica o estado físico ASA 4 (American Society of Anesthesiologists) fue ocho veces superior, cinco veces más si presentaron anemia, cuatro veces mayor si recibieron anestesia general, transfusión de glóbulos intraoperatoria o alguna complicación postoperatoria, tres veces mayor en aquellos pacientes ASA 3 y pérdida sanguínea mayor de 500 mL, y se incrementa si la estadía supera los siete días. Las complicaciones más frecuentes fueron la anemia (33,3 por ciento) y la hipotensión arterial (16,7 por ciento). Conclusiones: se identificaron como factores pronósticos de muerte: el antecedente de cardiopatía isquémica, anemia preoperatoria, clasificación elevada del estado físico, uso de anestesia general, pérdidas sanguíneas mayores de 500 mL, uso de trasfusiones de glóbulos, estadía mayor de siete días y la aparición de complicaciones postoperatorias(AU)

Introduction: Hip fracture is a common cause of hospitalization, occupies a leading place in morbidity and mortality due to orthopedic disease. Objective: To identify the perioperative variables that influence the morbidity and mortality of the patients who undergo hip fracture surgery at the Central Military Hospital Dr. Carlos J. Finlay. Methods: a retrospective, analytical study was conducted in 135 patients surgically intervened between January and December 2014. They were divided into two groups for statistical analysis, deceased and alive. The variables studied were: cause of death, postoperative mortality rates, clinical and surgical prognostic factors of death and main complications. Results: The mortality rate at 30 days after surgery was 2.2 percent and 17.8 percent a year later. The main causes of death were acute myocardial infarction (45.8 percent) and pulmonary thrombus embolism (16.7 percent). The probability of dying due to ischemic heart disease or physical state ASA 4 was eight times higher, five times more if they had anemia, four times higher if they received general anesthesia, intraoperative blood transfusion or postoperative complication, three times higher in those patients ASA 3 and blood loss greater than 500 mL, and it increases if the hospitalization exceeds seven days. The most frequent complications were anemia (33.3 percent) and hypotension (16.7 percent). Conclusions: A history of ischemic heart disease, preoperative anemia, high physical status classification, use of general anesthesia, blood loss greater than 500 mL, use of blood transfusions, stay of more than seven days and appearance of postoperative complications(AU)

Phylogeny of Opuntia s.s. (Cactaceae): clade delineation, geographic origins, and reticulate evolution.

PREMISE OF THE STUDY: The opuntias (nopales, prickly pears) are not only culturally, ecologically, economically, and medicinally important, but are renowned for their taxonomic difficulty due to interspecific hybridization, polyploidy, and morphological variability. Evolutionary relationships in these stem succulents have been insufficiently studied; thus, delimitation of Opuntia s.s. and major subclades, as well as the biogeographic history of this enigmatic group, remain unresolved. METHODS: We sequenced the plastid intergenic spacers atpB-rbcL, ndhF-rpl32, psbJ-petA, and trnL-trnF, the plastid genes matK and ycf1, the nuclear gene ppc, and ITS to reconstruct the phylogeny of tribe Opuntieae, including Opuntia s.s. We used phylogenetic hypotheses to infer the biogeographic history, divergence times, and potential reticulate evolution of Opuntieae. KEY RESULTS: Within Opuntieae, a clade of Tacinga, Opuntia lilae, Brasiliopuntia, and O. schickendantzii is sister to a well-supported Opuntia s.s., which includes Nopalea. Opuntia s.s. originated in southwestern South America (SA) and then expanded to the Central Andean Valleys and the desert region of western North America (NA). Two major clades evolved in NA, which subsequently diversified into eight subclades. These expanded north to Canada and south to Central America and the Caribbean, eventually returning back to SA primarily via allopolyploid taxa. Dating approaches suggest that most of the major subclades in Opuntia s.s. originated during the Pliocene. CONCLUSIONS: Opuntia s.s. is a well-supported clade that includes Nopalea. The clade originated in southwestern SA, but the NA radiation was the most extensive, resulting in broad morphological diversity and frequent species formation through reticulate evolution and polyploidy.

Phylogenetic relationships and evolution of growth form in Cactaceae (Caryophyllales, Eudicotyledoneae).

PREMISE OF THE STUDY: Cactaceae is one of the most charismatic plant families because of the extreme succulence and outstanding diversity of growth forms of its members. Although cacti are conspicuous elements of arid ecosystems in the New World and are model systems for ecological and anatomical studies, the high morphological convergence and scarcity of phenotypic synapomorphies make the evolutionary relationships and trends among lineages difficult to understand. METHODS: We performed phylogenetic analyses implementing parsimony ratchet and likelihood methods, using a concatenated matrix with 6148 bp of plastid and nuclear markers (trnK/matK, matK, trnL-trnF, rpl16, and ppc). We included 224 species representing approximately 85% of the family's genera. Likelihood methods were used to perform an ancestral character reconstruction within Cactoideae, the richest subfamily in terms of morphological diversity and species number, to evaluate possible growth form evolutionary trends. KEY RESULTS: Our phylogenetic results support previous studies showing the paraphyly of subfamily Pereskioideae and the monophyly of subfamilies Opuntioideae and Cactoideae. After the early divergence of Blossfeldia, Cactoideae splits into two clades: Cacteae, including North American globose and barrel-shaped members, and core Cactoideae, including the largest diversity of growth forms distributed throughout the American continent. Para- or polyphyly is persistent in different parts of the phylogeny. Main Cactoideae clades were found to have different ancestral growth forms, and convergence toward globose, arborescent, or columnar forms occurred in different lineages. CONCLUSIONS: Our study enabled us to provide a detailed hypothesis of relationships among cacti lineages and represents the most complete general phylogenetic framework available to understand evolutionary trends within Cactaceae.

[Assessment of cervical cancer screening in the Health Service of Valdivia, Chile]. / Pesquisa y control del cáncer cérvico-uterino en el Servicio de Salud de Valdivia (1993-2003).

BACKGROUND: One of the best Public Health achievements in Chile has been the coverage of the program for detection and treatment or cervical cancer. AIM: To evaluate the results of the Cervical Cancer Screening Program in Valdivia Health Service (Southern Chile) between 1993 and 2003. MATERIAL AND METHODS: Retrospective review of the number of women in whom a Papanicolau smear was obtained in the last three years. The incidence of the disease was calculated using pathological diagnoses of precursor or invasive lesions. Mortality for cervical cancer was calculated using data from death certificates. RESULTS: During 2003, 79% of women age 25 to 64 years, and 77% of women aged 35 to 63 years (considered the highest risk group) were screened. We confirmed that the number of precursor lesions detected were increased along with the increasing screening coverage. The diagnosis of carcinoma in situ increased almost three times when compared with 1990 figures. Likewise, the diagnosis of early invasive cervical cancer behaved similarly. Mortality by cervical cancer also experienced a decrease, reaching 4.6 per 100.000 women over 15 years old in the Health Service of Valdivia. CONCLUSIONS: The sustained increase in cervical cancer screening coverage has had a favorable impact in the morbidity and mortality caused by the disease.