Clinical outcomes in patients with scaphoid non-union treated with the vascularized medial femoral condyle technique a case series.

INTRODUCTION: Non-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce. This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique. METHODS: Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength. RESULTS: Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE. CONCLUSIONS: The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.

Morphological, physical, and chemical characterization of coconut residues in Ecuador.

In agricultural countries, Agro-industrial residues are better treated with a circular production logic. This article analyzes the morphological, physical, mechanical, thermal, and chemical characteristics of the coconut fiber and endocarp in Portoviejo and Rocafuerte Cities, Ecuador, to establish a baseline of knowledge that can help to incorporate coconut residues into a matrix of a new material. Interviews were conducted to coconut producers in Portoviejo and Rocafuerte and a random sample of the residues was collected from these locations. Analyses were performed using the SEM, TGA and FRX tests. Concerning the fiber, it was observed a tubular morphology with concentric microfibrils, specific weight 0.69 g/cm3, tensile strength 228 MPa, modulus of elasticity 3.03 GPa, thermal behavior with important mass losses at 330 °C, in the calcinations to obtain oxides as SiO2, SO3, Al2O3, Fe2O3 at 600 °C and 650 °C. The endocarp has a morphology of superimposed and consolidated smooth layers, specific weight 1.29 g/cm3, loss of mass at 339 °C and in calcinations at 800 °C. This study can help to address solid vegetable waste managing challenges in coconut producing cities.

Risk assessment of occupational skin cancer among outdoor workers in southern Spain: local pilot study.

OBJECTIVE: Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain. METHODS: Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure. RESULTS: The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m2, equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen. CONCLUSIONS: This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers' health.

Casting Without Reduction Versus Closed Reduction With or Without Fixation in the Treatment of Distal Radius Fractures in Children: Protocol for a Randomized Noninferiority Trial.

BACKGROUND: Acute treatment for distal radius fractures, the most frequent fractures in the pediatric population, represents a challenge to the orthopedic surgeon. Deciding on surgical restoration of the alignment or cast immobilization without reducing the fracture is a complex concern given the remodeling potential of bones in children. In addition, the lack of evidence-based safe boundaries of shortening and angulation, that will not jeopardize upper-extremity functionality in the future, further complicates this decision. OBJECTIVE: The authors aim to measure functional outcomes, assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Physical Function v2.0 instrument. The authors hypothesize that outcomes will not be worse in children treated with cast immobilization in situ compared with those treated with closed reduction with or without percutaneous fixation. The authors also aim to compare the following as secondary outcomes: ulnar variance and fracture alignment in the sagittal and coronal planes, range of motion, pressure ulcers, pain control, radius osteotomy due to deformity, pseudoarthrosis cure, and remanipulation. METHODS: This is the protocol of a randomized noninferiority trial comparing upper-extremity functionality in children aged 5 to 10 years, after sustaining a distal radius fracture, treated with either cast immobilization in situ or closed reduction with or without fixation in a single orthopedic hospital. Functional follow-up is projected at 6 months, while clinical and radiographic follow-up will occur at 2 weeks, 3 months, and 9 months. RESULTS: Recruitment commenced in July 2021. As of January 2022, 23 children have been randomized. Authors expect an average of 5 patients to be recruited monthly; therefore, recruitment and analysis should be complete by October 2024. CONCLUSIONS: This experimental design that addresses upper-extremity functionality after cast immobilization in situ in children who have sustained a distal fracture of the radius may yield compelling information that could aid the clinician in deciding on the most suitable orthopedic treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT05008029; https://clinicaltrials.gov/ct2/show/NCT05008029. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34576.

Topical Bromfenac Sodium in Femtosecond Laser-Assisted Cataract Surgery.

PURPOSE: To evaluate the effect of preoperative 0.09% bromfenac ophthalmic solution for the reduction of intraoperative miosis and pain in patients who have undergone femtosecond laser-assisted cataract surgery. METHODS: This prospective randomized clinical study included 65 patients with senile cataracts in the absence of significant ocular comorbidity. The patients received 0.09% bromfenac ophthalmic solution or control placebo twice a day for 3 days before surgery. Pupil diameter was measured at the initiation and finalization of femtosecond laser-assisted cataract surgery, and pain quantification was assessed by an analogous pain scale after one day of follow-up. RESULTS: A total of 65 patients were randomly divided into two groups. Five patients were excluded due to defective coupling with the laser interface. Each of the 60 patients was randomized to receive preoperative topical treatment with either 0.09% bromfenac or 0.1% sodium hyaluronate. Baseline characteristics were similar between groups for age and gender. The mean change in horizontal and vertical pupil diameter from the preoperative to post-femtosecond laser measurements were significantly less in the bromfenac group than in the placebo group (0.43 ± 0.6 vs. 1.71 ± 0.9, P < 0.001 and 0.40 ± 0.6 vs. 1.78 ± 0.9, P < 0.001, respectively). Compared with untreated patients, the quantification of pain one day after the procedure was significantly lower in the 0.09% bromfenac group (46.7% with a score of 3 vs. 50% with a score of 1, P < 0.001, respectively). CONCLUSIONS: The maintenance of pupil dilation and the prevention of miosis were more effective in the 0.09% bromfenac group than in the control group. Likewise, the greater control of postoperative pain represented an additional significant benefit.

Traduccion, adaptacion cultural y validacion de una escala de funcion del miembro superior: DASH / Translation, cultural adaptation and validation of the DASH - upper extremity functional scale

Introducción El objetivo del estudio fue realizar la traducción, adaptación cultural y validación de una escala de función del miembro superior, denominada DASH, por sus siglas en inglés (discapacidad del brazo, el hombro y la mano). Materiales y métodos Se realizó un estudio metodológico de validación de escalas: traducción (constó de traducciones inglés-español, comité de expertos inicial, dos contratraducciones, un segundo comité de expertos y una traducción definitiva); evaluación de confiabilidad (pruebas de coherencia interna, test-retest y cambio mínimo detectable); respuesta al cambio (mediciones en pacientes antes y después de tratamiento), y estudio de validez (se hicieron pruebas de validez de apariencia, de constructo y de criterio). Resultados La prueba traducida fue aplicada a 338 pacientes con enfermedades de mano y hombro, 311 fueron utilizables. La consistencia interna, mediante alfa de Cronbach, se estimó > 0,96; el resultado del coeficiente de concordancia de Lin fue 0,86. El cambio mínimo detectable fue 15,88, la capacidad de respuesta al cambio mediante la prueba de la t de Student aplicada sobre la diferencia en la puntuación arrojó una p < 0,001; adicionalmente se corrió una correlación no paramétrica de Spearman entre la diferencia en la puntuación DASH y la diferencia en la escala visual analógica de cambio en estado de salud (EVA SALUD) y se obtuvo un r = 0,62 (p < 0,001). Discusión La escala DASH traducida y adaptada al español demostró una buena fiabilidad, estabilidad y capacidad de respuesta al cambio, logró discriminar entre diferentes enfermedades y tiene una validez estimada buena en cuanto a contenido, constructo y criterio.

Introduction The objective of the study was to perform translation, cultural adaptation and validation of a function scale of the upper limb, called DASH, for its acronyms in English (disability of the arm, shoulder and hand). Materials and methods A methodological study of scale validation was performed: translation (consisting of English-Spanish translations, initial expert committee, two backtranslations, a second committee of experts and a definitive translation); reliability assessment (internal consistency tests, test-retest and minimum detectable change); response to change (measurements in patients before and after treatment), and validity study (validity tests of appearance, construct and criteria were performed). Results The translated test was applied to 338 patients with hand and shoulder diseases, 311 were usable. The internal consistency, using Cronbach's alpha, was estimated to be > 0.96; The result of the Lin coefficient of agreement was 0.86. The minimum detectable change was 15.88, the ability to respond to change using the Student t test applied on the difference in score yielded a p <0.001; A nonparametric Spearman correlation was recorded between the difference in the DASH score and the difference in the visual analogue scale of change in health status (EVA HEALTH) with r = 0.62 (p <0.001). Discussion The DASH scale, translated and adapted to Spanish demonstrated good reliability, stability and responsiveness to change, managed to discriminate between different diseases and has an estimated validity in terms of content, construct and criteria.

Validación de la versión en español de la escala de función del miembro superior abreviada: Quick Dash / Validation of the Spanish version of the short Disabilities of the Arm, Shoulder and Hand Scale - Quick DASH

Introducción El objetivo del estudio es validar la versión corta de la escala de discapacidades de brazo, hombro y mano (QuickDASH) en español mediante pruebas de confiabilidad, consistencia y validez. Materiales y métodos Sobre 394 cuestionarios DASH de 298 sujetos participantes de un estudio previo, se corrieron pruebas de confiabilidad, consistencia, precisión, respuesta al cambio y validez. Resultados La confiabilidad medida mediante el coeficiente de concordancia de Lin fue de 0.8 IC95%: 0.67 a 0.93. La precisión transversal se estimó con intervalo de confianza de 95% en 12.72 y la precisión longitudinal (cambio mínimo detectable) se determinó en 20 puntos. Se obtuvo valores satisfactorios de capacidad de detectar respuesta al cambio y validez. Estas pruebas demostraron un comportamiento comparable entre el QuickDASH y el DASH ya validado en español. Discusión La versión abreviada de la escala perdió precisión tanto transversal como longitudinal debido a la disminución en la consistencia interna y en la estabilidad en la muestra estudiada, sin embargo conservó la capacidad de discriminar y de detectar cambio, estos resultados permiten recomendar su uso en ambiente clínico y de investigación. Nivel de Evidencia: II

Background aim of the study was to validate the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) in Spanish by testing reliability, consistency, and validity. Materials and methods A total of 394 DASH questionnaires, from 298 participants of a previous study, were tested for reliability, consistency, accuracy, validity and responsiveness to change. Results Reliability, measured by Lin concordance coefficient was 0.8, 95% CI: 0.67 to 0.93. Cross-sectional precision was estimated with a 95% confidence interval as 12.72, and longitudinal precision (minimum detectable change) was determined as 20 points. Satisfactory values regarding ability to detect response to change and validity were obtained. These tests showed comparable performance between QuickDASH and DASH and validated in Spanish. Discussion The shortened version of the scale lost both cross-sectional and longitudinal precision, due to the decrease in internal consistency and stability in the sample studied. As it retained the ability to discriminate and detect change, these results enable it to be recommended for use in the clinical and research setting. Evidence Level: II

Adaptive Control in Passive rehabilitation routines using ELLTIO / Control Adaptable en rutinas de rehabilitación pasiva utilizando ELLTIO

ABSTRACT: The Exoskeleton for Lower Limb Training with Instrumented Orthosis (ELLTIO) is a mechatronic device that can be used to assist in passive kinesitherapy to increase human muscles strength and resistance [1]. This paper presents an alternative for passive rehabilitation process using an exoskeleton for knee and ankle. The main idea is assist a pro fessional physiotherapist in the design and performance of exercises routines for his patients using the prototype. The knee and ankle joint's movements are recorded and storage during the exercises to propose a similar computer generated trajectories which the exoskeleton on should follow. An adaptive controller is implemented to track the trajectories and adapt the user parameters.

RESUMEN: El exoesqueleto para el entrenamiento de miembros inferiores con órtesis instrumentada (ELLTIO) por sus siglas en ingles "Exoskeleton for Lower Limb Training with Instrumented Orthosis" es un dispositivo mecatrónico que se puede utilizar para ayudar en la fisioterapia pasiva para aumentar la fuerza y resistencia de los músculos humanos. En este trabajo se presenta una alternativa para el proceso de rehabilitación pasiva utilizando un exoesqueleto de rodilla y tobillo. La idea principal es ayudar a un fisioterapeuta profesional en el diseño y ejecución de rutinas de ejercicios para sus pacientes utilizando el prototipo. Los movimientos de la articulación de la rodilla y el tobillo se registran y se almacenan durante los ejercicios para proponer trayectorias similares generadas por computadora que el exoesqueleto debe seguir. Se implementa un controlador adaptativo para rastrear las trayectorias y adaptar los parámetros del usuario.

ABEJAS VISITANTES DE Mimosa pigra L. (MIMOSACEAE): COMPORTAMIENTO DE PECOREO Y CARGAS POLÍNICAS / Bees visiting Mimosa pigra L. (Mimosaceae): foraging behavior and pollen loads

Se estudiaron las cargas polínicas de 13 taxones de abejas capturadas visitando a Mimosa pigra en la zona de influencia del Embalse Porce II (Antioquia, Colombia). De los 21 tipos polínicos encontrados, M. pigra presenta el mayor porcentaje acumulado de colecta; Mimosa pudica, Piper aduncum, Solanum diversifolium, Warszewiczia coccinea y Psidium guajava, en su orden, se pueden considerar fuentes alternativas de polen, para varias de las especies de abejas cuyas cargas polínicas fueron analizadas. Dentro de las especies de abejas capturadas visitando a M. pigra se pueden diferenciar varios grupos según el tipo y abundancia relativa de los tipos polínicos encontrados en sus cargas. Uno de ellos, incluye a siete especies de abejas con más del 85% de granos de polen de M. pigra; otro, con cuatro especies de abejas que colectaron más del 94,5% del polen en M. pigra y M. pudica. Adicionalmente, se encontraron especies como Trigona dorsalis con cargas de M. pigra (59,4%), de S. diversifolium (37,8%) y especies de abejas como Lasioglossum sp. 113, en cuyas cargas polínicas predominan los granos de polen de P. aduncum (61,8%) y de W.coccinea (36,4%), en contraste con los de M. pigra (1,3%). En cuanto a la riqueza de tipos polínicos colectados por las abejas sobresalen Trigona muzoensis (12 tipos polínicos) y T. dorsalis (10 tipos), lo cual refleja nichos tróficos más amplios para estas especies y deja duda sobre su constancia floral o hábitos de limpieza.

We studied the pollen loads of 13 taxa of wild bees visiting the flowers of Mimosa pigra on the influence zone of the Dam Project Porce II (Antioquia, Colombia). Out of 21 different pollen types, M. pigra represents the higuest percentage; Mimosa pudica, Piper aduncum, Solanum diversifolium, Warszewiczia coccinea and Psidium guajava, in that order, were also abundant, and are alternative sources of pollen for the different kinds of bees recorded. Among the species of bees collected, we differentiate several groups: one of them, includes seven species of bees whose pollen loads are in a high porcentaje of M. pigra (86% of pollen grains or above); another group of bees with high percentage (more than 94%) of pollen grains of Mimosa species (M. pigra and M. pudica); and the other two groups that include the bee species: Trigona dorsalis (who collected more than half of their pollen resources from M. pigra (59.4%) in addition to a high percentage of S. diversifolium (37.8%); the last kind of foragers includes Lasioglossum sp.113 who collected mostly pollen from species different to Mimosa (including P. aduncum with 61.8% of pollen grains, and W. coccinea with 36,4%) and only a small percentage of M. pigra (1,3%). In terms of the species of bees that collected a highest diversity of pollen grains, two species: Trigona muzoensis (12 pollen types) and T. dorsalis (10 pollen types) outstand other species of bees on on feeding niche and question either the bees capacity of cleaning or their floral constancy.