Artificial Neural Network for Automated Keratoconus Detection Using a Combined Placido Disc and Anterior Segment Optical Coherence Tomography Topographer.

Purpose: To assess the efficacy of an automated program for keratoconus and keratoconus suspect detection based on corneal measurements provided by a combined Placido disc and anterior segment optical coherence tomography (OCT) topographer. Methods: In a multicentric cross-sectional study, an artificial neural network (ANN) was created using 6677 eyes from an equal number of patients (classified as 2663 normal eyes, 1616 keratoconus eyes, 210 keratoconus suspect eyes, 1519 myopic postoperative eyes, and 669 abnormal eyes). Each group was randomly divided into a training set (70% of the dataset) and a validation set (the remaining 30%). A multilayer perceptron network with a backpropagation learning algorithm was developed for the study. Indexes used to train the ANN were based on curvature and elevation of both the anterior and posterior corneal surfaces and the new corneal OCT indexes-based on corneal, stromal, and epithelial thicknesses. Results: For keratoconus detection, our ANN showed an accuracy of 98.6%, precision of 96%, recall of 97.9%, and F1-score of 96.9%. For keratoconus suspect detection, our ANN showed an accuracy of 98.5%, precision of 83.6%, recall of 69.7%, and F1-score of 76%. Conclusions: Compared to previous literature, the addition of new OCT-based epithelial and stromal thickness indexes improves ANN detection capacity of keratoconus suspect eyes. For already stablished keratoconus our ANN detection capacity is excellent, but equivalent to previous evidence without incorporating such new OCT-based indexes. Translational Relevance: OCT-based epithelial and stromal thickness indexes improve ANN detection capacity of keratoconus on its early stages.

Enhancing the Automated Detection of Implantable Collamer Lens Vault Using Generative Adversarial Networks and Synthetic Data on Optical Coherence Tomography.

PURPOSE: To investigate the efficacy of incorporating Generative Adversarial Network (GAN) and synthetic images in enhancing the performance of a convolutional neural network (CNN) for automated estimation of Implantable Collamer Lens (ICL) vault using anterior segment optical coherence tomography (AS-OCT). METHODS: This study was a retrospective evaluation using synthetic data and real patient images in a deep learning framework. Synthetic ICL AS-OCT scans were generated using GANs and a secondary image editing algorithm, creating approximately 100,000 synthetic images. These were used alongside real patient scans to train a CNN for estimating ICL vault distance. The model's performance was evaluated using statistical metrics such as mean absolute percentage error (MAPE), mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2) for the estimation of ICL vault distance. RESULTS: The study analyzed 4,557 AS-OCT B-scans from 138 eyes of 103 patients for training. An independent, retrospectively collected dataset of 2,454 AS-OCT images from 88 eyes of 56 patients, used prospectively for evaluation, served as the test set. When trained solely on real images, the CNN achieved a MAPE of 15.31%, MAE of 44.68 µm, and RMSE of 63.3 µm. However, with the inclusion of GAN-generated and algorithmically edited synthetic images, the performance significantly improved, achieving a MAPE of 8.09%, MAE of 24.83 µm, and RMSE of 32.26 µm. The R2 value was +0.98, indicating a strong positive correlation between actual and predicted ICL vault distances (P < .01). No statistically significant difference was observed between measured and predicted vault values (P = .58). CONCLUSIONS: The integration of GAN-generated and edited synthetic images substantially enhanced ICL vault estimation, demonstrating the efficacy of GANs and synthetic data in enhancing OCT image analysis accuracy. This model not only shows potential for assisting postoperative ICL evaluations, but also for improving OCT automation when data paucity is an issue. [J Refract Surg. 2024;40(4):e199-e207.].

Rare X-linked variants carry predominantly male risk in autism, Tourette syndrome, and ADHD.

Autism spectrum disorder (ASD), Tourette syndrome (TS), and attention-deficit/hyperactivity disorder (ADHD) display strong male sex bias, due to a combination of genetic and biological factors, as well as selective ascertainment. While the hemizygous nature of chromosome X (Chr X) in males has long been postulated as a key point of "male vulnerability", rare genetic variation on this chromosome has not been systematically characterized in large-scale whole exome sequencing studies of "idiopathic" ASD, TS, and ADHD. Here, we take advantage of informative recombinations in simplex ASD families to pinpoint risk-enriched regions on Chr X, within which rare maternally-inherited damaging variants carry substantial risk in males with ASD. We then apply a modified transmission disequilibrium test to 13,052 ASD probands and identify a novel high confidence ASD risk gene at exome-wide significance (MAGEC3). Finally, we observe that rare damaging variants within these risk regions carry similar effect sizes in males with TS or ADHD, further clarifying genetic mechanisms underlying male vulnerability in multiple neurodevelopmental disorders that can be exploited for systematic gene discovery.

'Single-Seed-SpeedBulks:' a protocol that combines 'speed breeding' with a cost-efficient modified single-seed descent method for rapid-generation-advancement in oat (Avena sativa L.).

BACKGROUND: In plant breeding, one of the most cost-effective and efficient ways to increase genetic gain is to reduce the breeding cycle time. In general, modern breeding methods for self-pollinated crops should strive to develop fixed lines at the lowest possible cost and in the minimum possible amount of time. Previous studies on spring oat (Avena sativa L.) showed that combining high plant density with limited soil fertility and moisture levels in a growth media like sand effectively decreases the time and cost of generating fixed single-seed descent lines. More recently, 'speed breeding,' or the exposure to prolonged photoperiod regimes of 22 h, has been shown to decrease flowering time in oat significantly. The goal of this study was to combine 'speed breeding' with high-density planting in a limited soil fertility media to reduce further the costs and time required to develop oat single-seed-descent lines. RESULTS: We grew oat plants at low density in potting-mix (control), high density in potting-mix (HD-soil), and high density in sand (HD-sand) under 16 and 22 h of day length. We observed that oat plants grown in HD-sand and exposed to 22 h day length reduced their flowering time by around 20 and 5 days on average compared to those grown in control conditions at 16 and 22 h, respectively. We also observed that 85% of plants grown at high density in sand produced a single seed when grown in bulk conditions. In contrast, only 40% of plants grown at high density in potting-mix produced a single seed. CONCLUSIONS: Our novel protocol showed that oat plants grown in high-density bulks, using sand media and 22-hour day length, reduced their flowering time by 20 days compared to control conditions and produced plants with single seeds, following closely single-seed descent assumptions while significantly reducing labor costs and greenhouse space. This methodology can be deployed in oat breeding programs to help them accelerate their rate of genetic grain for multiple traits.

Deep Learning-Based Estimation of Implantable Collamer Lens Vault Using Optical Coherence Tomography.

PURPOSE: To develop and validate a deep learning neural network for automated measurement of implantable collamer lens (ICL) vault using anterior segment optical coherence tomography (AS-OCT). DESIGN: Cross-sectional retrospective study. METHODS: A total of 2647 AS-OCT scans were used from 139 eyes of 82 subjects who underwent ICL surgery in 3 different centers. Using transfer learning, a deep learning network was trained and validated for estimating the ICL vault on OCT. A trained operator separately reviewed all OCT scans and measured the central vault using a built-in caliper tool. The model was then separately tested on 191 scans. A Bland-Altman plot was constructed and the mean absolute percentage error (MAPE), mean absolute error (MAE), root mean squared error (RMSE), Pearson correlation coefficient (r), and determination coefficient (R2) were calculated to evaluate the strength and validity of the model. RESULTS: On the test set, the model achieved a MAPE of 3.42%, an MAE of 15.82 µm, a RMSE of 18.85 µm, a Pearson correlation coefficient r of +0.98 (P < .00001), and a coefficient of determination R2 of +0.96. There was no significant difference between the vaults of the test set labeled by the technician vs those estimated by the model: 478 ± 95 µm vs 475 ± 97 µm, respectively, P = .064). CONCLUSIONS: Using transfer learning, our deep learning neural network was able to accurately compute the ICL vault from AS-OCT scans, overcoming the limitations of an imbalanced data set and limited training data. Such an algorithm can assist the postoperative assessment in ICL surgery.

Proloterapia con dextrosa al 25% para el manejo del dolor en pacientes con fascitis planta / Prolotherapy with 25% dextrose for pain management in patients with plantar fasciitis

Introducción. La fascitis plantar (FP) es la principal causa de dolor en la parte inferior del talón y la proloterapia es una de las posibles opciones terapéuticas.Objetivo. Determinar el efecto de la proloterapia con dextrosa al 25% en la disminución del nivel de dolor en pacientes con FP.Metodología. Estudio de cohorte retrospectivo realizado en 70 pacientes con FP sometidos a proloterapia con dextrosa al 25% en una institución médica de Colombia en 2021. El nivel de dolor con el pie en reposo se midió con la escala visual análoga (EVA) en cada sesión de proloterapia, las cuales se realizaron a los 0, 1, 4, 7. 10 y 13 meses. Se realizó un análisis de varianza (ANOVA) con la prueba de Friedman y un análisis multivariado mediante modelos lineales mixtos para determinar la asociación entre variables. Resultados. Se realizaron 245 sesiones de proloterapia. La edad promedio fue 53 años y 80% de los pacientes eran mujeres. Las medianas de puntaje en la EVA fueron 9, 8, 6, 5, 4 y 2 en las 6 sesiones de proloterapia, respectivamente. Se evidenció una disminución progresiva del nivel de dolor a lo largo del tratamiento; sin embargo, solo hubo diferencias estadísticamente significativas desde la primera hasta la tercera sesión (p<0,05). Conclusiones. La proloterapia con dextrosa al 25% tuvo buenos resultados, ya que el nivel de dolor del pie en reposo disminuyó progresivamente, especialmente desde la primera sesión hasta la tercera

Introduction. Plantar fasciitis (PF) is the main cause of pain in the bottom of the heel and prolotherapy is one of the possible therapeutic options. Objective. Determine the effect of prolotherapy with 25% dextrose in reducing the level of pain in patients with PF.Methodology. Retrospective cohort study conducted in 70 patients with PF undergoing prolotherapy with 25% dextrose in a medical institution in Colombia in 2021. The level of pain with the foot at rest was measured with the visual analogue scale (VAS) in each session of prolotherapy, which were performed at 0, 1, 4, 7, 10 and 13 months. An analysis of variance (ANOVA) with the Friedman test and a multivariate analysis using linear mixed models were performed to determine the association between variables. Results. 245 prolotherapy sessions were carried out. The average age was 53 years and 80% of the patients were women. The median VAS scores were 9, 8, 6, 5, 4 and 2 in the 6 prolotherapy sessions, respectively. A progressive decrease in the level of pain is evident throughout the treatment; However, there were only statistically significant differences from the first to the third session (p<0.05). Conclusions. Prolotherapy with 25% dextrose had good results, since the level of foot pain at rest progressively decreased, especially from the first session to the third.

Identification of an Elite Core Panel as a Key Breeding Resource to Accelerate the Rate of Genetic Improvement for Irrigated Rice.

Rice genetic improvement is a key component of achieving and maintaining food security in Asia and Africa in the face of growing populations and climate change. In this effort, the International Rice Research Institute (IRRI) continues to play a critical role in creating and disseminating rice varieties with higher productivity. Due to increasing demand for rice, especially in Africa, there is a strong need to accelerate the rate of genetic improvement for grain yield. In an effort to identify and characterize the elite breeding pool of IRRI's irrigated rice breeding program, we analyzed 102 historical yield trials conducted in the Philippines during the period 2012-2016 and representing 15,286 breeding lines (including released varieties). A mixed model approach based on the pedigree relationship matrix was used to estimate breeding values for grain yield, which ranged from 2.12 to 6.27 t·ha-1. The rate of genetic gain for grain yield was estimated at 8.75 kg·ha-1 year-1 (0.23%) for crosses made in the period from 1964 to 2014. Reducing the data to only IRRI released varieties, the rate doubled to 17.36 kg·ha-1 year-1 (0.46%). Regressed against breeding cycle the rate of gain for grain yield was 185 kg·ha-1 cycle-1 (4.95%). We selected 72 top performing lines based on breeding values for grain yield to create an elite core panel (ECP) representing the genetic diversity in the breeding program with the highest heritable yield values from which new products can be derived. The ECP closely aligns with the indica 1B sub-group of Oryza sativa that includes most modern varieties for irrigated systems. Agronomic performance of the ECP under multiple environments in Asia and Africa confirmed its high yield potential. We found that the rate of genetic gain for grain yield found in this study was limited primarily by long cycle times and the direct introduction of non-improved material into the elite pool. Consequently, the current breeding scheme for irrigated rice at IRRI is based on rapid recurrent selection among highly elite lines. In this context, the ECP constitutes an important resource for IRRI and NAREs breeders to carefully characterize and manage that elite diversity.

Genetic and phenotypic characterization of rice grain quality traits to define research strategies for improving rice milling, appearance, and cooking qualities in Latin America and the Caribbean.

Rice (Oryza sativa L.)grain quality is a set of complex interrelated traits that include grain milling, appearance, cooking, and edible properties. As consumer preferences in Latin America and the Caribbean evolve, determining what traits best capture regional grain quality preferences is fundamental for breeding and cultivar release. In this study, a genome-wide association study (GWAS), marker-assisted selection (MAS), and genomic selection (GS) were evaluated to help guide the development of new breeding strategies for rice grain quality improvement. For this purpose, 284 rice lines representing over 20 yr of breeding in Latin America and the Caribbean were genotyped and phenotyped for 10 different traits including grain milling, appearance, cooking, and edible quality traits. Genetic correlations among the 10 traits ranged from -0.83 to 0.85. A GWAS identified 19 significant marker/trait combinations associated with eight grain quality traits. Four functional markers, three located in the Waxy and one in the starch synthase IIa genes, were significantly associated with six grain-quality traits. These markers individually explained 51-75% of the phenotypic variance depending on the trait, clearly indicating their potential utility for MAS. Cross-validation studies to evaluate predictive abilities of four different GS models for each of the 10 quality traits were conducted and predictive abilities ranged from 0.3 to 0.72. Overall, the machine learning model random forest had the highest predictive abilities and was especially effective for traits where large effect quantitative trait loci were identified. This study provides the foundation for deploying effective molecular breeding strategies for grain quality in Latin American rice breeding programs.

Efficacy of progressive thickness intrastromal corneal ring segments in the treatment of duck phenotype keratoconus.

PURPOSE: To evaluate clinical outcomes in patients with asymmetric duck phenotype keratoconus implanted with asymmetric progressive thickness intrastromal corneal ring segments (PT-ICRS, Keraring AS, Mediphacos, Belo Horizonte, Brazil), and to demonstrate improved visual acuity and symmetry in corneal flattening. METHODS: This single-center, retrospective, observational study evaluated the clinical outcomes at 1, 3, and 6 months after implantation of PT-ICRS in patients with duck phenotype keratoconus. After creating the intrastromal tunnel with a femtosecond laser, one 160-degree arc length PT-ICRS, either 150/250 µm or 200/300 µm, was implanted. Changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), manifest refraction spherical equivalent (MRSE), mean keratometry (Kmean), maximum keratometry (Kmax), Coma@5mm, and manifest and topographical astigmatism were documented. RESULTS: The study cohort included 23 eyes of 17 patients with a mean age of 24.6 years. From baseline to 6 months following implantation, mean UDVA improved from 0.70 logarithm of the minimum angle of resolution (logMAR) (20/100 Snellen) to 0.22 logMAR (20/33 Snellen), CDVA improved from 0.33 logMAR (20/42 Snellen) to 0.14 logMAR (20/27 Snellen), the mean sphere and MRSE decreased from -1.05 diopters (D) and -2.70 D to -0.25 D and -0.80 D, respectively, and the Kmean and Kmax improved from 46.5 D and 53.7 D to 44.6 D and 48.7 D, respectively. CONCLUSIONS: The Keraring AS ICRS offers a safe, effective means of improving visual acuity while reducing refractive error, mean and max keratometry, and aberrations in patients with duck phenotype keratoconus.

La Revista Colombiana de Ortopedia y Traumatología adopta formalmente la declaración CONSORT para estudios clínicos aleatorizados / Revista Colombiana de Ortopedia y Traumatología adopts the CONSORT statement

Con este mandamiento científico, los investigadores iluminan al resto de los mortales con el tipo de evidencia más rigurosa y confiable sobre la utilidad de las terapias y otras intervenciones para la atención al paciente y la salud pública. Sin embargo, la aleatorización plantea desde el punto de vista probabilístico un desafío matemático ampliamente conocido y descrito hace más de cien años en las paradoja de Bertrand, en el problema de las agujas del Conde de Buffon (Geoeges-Louis Leclerc) y varios otros ampliamente conocidos en probabilidad. Por lo tanto, la aleatorización "per se" no implica que la evidencia sea mejor, más rigurosa o más confiable. De hecho, cuando en probabilidad no se describe correctamente el método de aleatorización, se crea un sesgo por omisión. En ultimas, dicho sesgo, hace que un estudio no sea reproducible ni tampoco controvertible, eventos que son, ambos pilares indiscutibles del método científico.

Revista Colombiana de Ortopedia y Traumatología adopts the CONSORT statement / La Revista Colombiana de Ortopedia y Traumatología adopta formalmente la declaración CONSORT para estudios clínicos aleatorizados

With this scientific command, researchers illuminate the rest of the world with the most rigorous and reliable type of evidence about the usefulness of therapies and other interventions for patient care and public health. However, randomization poses a mathematical challenge widely known and described in probability more than a hundred years ago as the Bertrand paradox, Count Buffon needle problem (Geoeges-Louis Leclerc) and several others. Therefore randomization "per se" does not imply that the evidence is better, more rigorous, or more reliable. In fact, when the randomization method is not correctly described in probability, a default bias is created. Ultimately, this bias makes a study neither reproducible nor controversial, events that are both indisputable pillars of the scientific method.

Contingencia post-COVID / After COVID contingency

Han pasado casi dos años después del inicio de la pandemia originada por el COVID-19 en todo el mundo. La primera de este siglo, y la primera para los ocho mil millones de seres humanos en el planeta tierra. Enormes ajustes sociales, culturales, políticos y financieros vendrán ahora que el mundo está despertando de este sueño profundo, anestésico en que fue puesto por cuenta de las medidas de salubridad que incluyeron el aislamiento preventivo y el distanciamiento social. Durante este tiempo los seres humanos hemos replanteado enormes situaciones personales, sociales, educativas y de acceso a la salud. Para la Sociedad Colombiana de Cirugía Ortopédica y Traumatología (SCCOT), al igual que para sus miembros, han venido y vendrán múltiples cambios de ajuste frente a lo que llamamos nueva normalidad.

Interdisciplinariedad o transdiciplinariedad / Interdisciplinarity or transdisciplinarity

La interdisciplinariedad tiene su origen en ciencias afines al sicoanálisis a partí de los trabajos de Géza Róheim y Georges Devereux. Está basada en la necesidad de cruzar lo límites tradicionales entre varias disciplinas, o entre varias escuelas de pensamiento como consecuencia del surgimiento de nuevas necesidades o el desarrollo de nuevos enfoques teóricos o técnicos. La transdisciplinariedad en cambio, atraviesa los límites disciplinarios con el fin de crear un enfoque holístico. Es necesario recordar que el holismo es una posición metodológica y epistemológica cuyo postulado es analizar los sistemas y sus propiedades como un solo conjunto y no solo a través de las partes que componen este conjunto. Por lo tanto, la transdiciplinariedad facilita una forma sistémica de abordar un desafío. Contrario a la interdisciplinariedad, en la transdisciplinariedad se necesita un profundo conocimiento de las disciplinas involucradas y habilidades de moderación, mediación, asociación y transferencia del conocimiento para que el proceso transdisciplinario logre ser exitoso. Esto quiere decir que la transdisciplinariedad se enfoca en la resolución de problemas analizando el problema del individuo como una sola entidad; al individuo como un todo.

Interdisciplinarity or transdisciplinarity / Interdisciplinariedad o transdiciplinariedad

Interdisciplinarity has its origin in sciences related to psychoanalysis and is based on the early works of Géza Róheim and Georges Devereux. It is supported on the need to cross the traditional boundaries between various disciplines, or between various schools of thought as a consequence of the emergence of new needs or the development of new theoretical or technical approaches. However, transdisciplinarity crosses disciplinary boundaries in order to create a holistic approach. Recapping that holism is a methodological and epistemological concept whose postulate is to analyze systems and their properties as a single set and not only through the parts that make up this set. Therefore, transdisciplinary nature facilitates a systemic way of approaching a certain challenge. Contrary to interdisciplinarity, in transdisciplinarity, a deep knowledge of the disciplines involved and skills of moderation, mediation, association and knowledge transfer is needed for a transdisciplinary process to be successful. This means that transdisciplinarity focuses on problem solving by analyzing the problem as a single entity; like an everything.

Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción / Management recommendations for diabetic foot patients. Instructional course

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

Management recommendations for diabetic foot patients. Instructional course / Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Comparative Transcriptomics and Co-Expression Networks Reveal Tissue- and Genotype-Specific Responses of qDTYs to Reproductive-Stage Drought Stress in Rice (Oryza sativa L.).

Rice (Oryza sativa L.) is more sensitive to drought stress than other cereals. To dissect molecular mechanisms underlying drought-tolerant yield in rice, we applied differential expression and co-expression network approaches to transcriptomes from flag-leaf and emerging panicle tissues of a drought-tolerant yield introgression line, DTY-IL, and the recurrent parent Swarna, under moderate reproductive-stage drought stress. Protein turnover and efficient reactive oxygen species scavenging were found to be the driving factors in both tissues. In the flag-leaf, the responses further included maintenance of photosynthesis and cell wall reorganization, while in the panicle biosynthesis of secondary metabolites was found to play additional roles. Hub genes of importance in differential drought responses included an expansin in the flag-leaf and two peroxidases in the panicle. Overlaying differential expression data with allelic variation in DTY-IL quantitative trait loci allowed for the prioritization of candidate genes. They included a differentially regulated auxin-responsive protein, with DTY-IL-specific amino acid changes in conserved domains, as well as a protein kinase with a DTY-IL-specific frameshift in the C-terminal region. The approach highlights how the integration of differential expression and allelic variation can aid in the discovery of mechanism and putative causal contribution underlying quantitative trait loci for drought-tolerant yield.

An improved 7K SNP array, the C7AIR, provides a wealth of validated SNP markers for rice breeding and genetics studies.

Single nucleotide polymorphisms (SNPs) are highly abundant, amendable to high-throughput genotyping, and useful for a number of breeding and genetics applications in crops. SNP frequencies vary depending on the species and populations under study, and therefore target SNPs need to be carefully selected to be informative for each application. While multiple SNP genotyping systems are available for rice (Oryza sativa L. and its relatives), they vary in their informativeness, cost, marker density, speed, flexibility, and data quality. In this study, we report the development and performance of the Cornell-IR LD Rice Array (C7AIR), a second-generation SNP array containing 7,098 markers that improves upon the previously released C6AIR. The C7AIR is designed to detect genome-wide polymorphisms within and between subpopulations of O. sativa, as well as O. glaberrima, O. rufipogon and O. nivara. The C7AIR combines top-performing SNPs from several previous rice arrays, including 4,007 SNPs from the C6AIR, 2,056 SNPs from the High Density Rice Array (HDRA), 910 SNPs from the 384-SNP GoldenGate sets, 189 SNPs from the 44K array selected to add information content for elite U.S. tropical japonica rice varieties, and 8 trait-specific SNPs. To demonstrate its utility, we carried out a genome-wide association analysis for plant height, employing the C7AIR across a diversity panel of 189 rice accessions and identified 20 QTLs contributing to plant height. The C7AIR SNP chip has so far been used for genotyping >10,000 rice samples. It successfully differentiates the five subpopulations of Oryza sativa, identifies introgressions from wild and exotic relatives, and is useful for quantitative trait loci (QTL) and association mapping in diverse materials. Moreover, data from the C7AIR provides valuable information that can be used to select informative and reliable SNP markers for conversion to lower-cost genotyping platforms for genomic selection and other downstream applications in breeding.

Multiple Small-Effect Alleles of Indica Origin Enhance High Iron-Associated Stress Tolerance in Rice Under Field Conditions in West Africa.

Understanding the genetics of field-based tolerance to high iron-associated (HIA) stress in rice can accelerate the development of new varieties with enhanced yield performance in West African lowland ecosystems. To date, few field-based studies have been undertaken to rigorously evaluate rice yield performance under HIA stress conditions. In this study, two NERICA × O. sativa bi-parental rice populations and one O.sativa diversity panel consisting of 296 rice accessions were evaluated for grain yield and leaf bronzing symptoms over multiple years in four West African HIA stress and control sites. Mapping of these traits identified a large number of QTLs and single nucleotide polymorphisms (SNPs) associated with stress tolerance in the field. Favorable alleles associated with tolerance to high levels of iron in anaerobic rice soils were rare and almost exclusively derived from the indica subpopulation, including the most favorable alleles identified in NERICA varieties. These findings highlight the complex genetic architecture underlying rice response to HIA stress and suggest that a recurrent selection program focusing on an expanded indica genepool could be productively used in combination with genomic selection to increase the efficiency of selection in breeding programs designed to enhance tolerance to this prevalent abiotic stress in West Africa.

High Definition Liposculpture in Male Patients Using Reciprocating Power-Assisted Liposuction Technology: Techniques and Results in a Prospective Study.

BACKGROUND: High-definition liposculpture (HDL) consists of techniques developed to emulate an athletic and attractive surface anatomy. OBJECTIVES: The aim of this study was to describe our experience, including techniques and postoperative outcomes, when performing HDL with power-assisted liposuction (PAL) technology in male patients. METHODS: In this prospective study PAL was used for fat extraction and to perform HDL. Intraoperative data were collected and the techniques used were recorded. Postoperatively, photographs were taken, and data were collected regarding the use of compression garments and pain medication, return to work and full activity, and satisfaction levels. RESULTS: All patients were males, with an average age of 32.3 years and a body mass index of 26.45 kg/m2; the follow-up period averaged 7.6 months. Intraoperatively, all patients received HDL of the chest, abdomen, back, and upper arms, and fat transfer to the chest. The average operative time was 3.4 hours. None of patients had drains left intraoperatively. Postoperatively, all patients were completely off their pain medications by postoperative day 9. They received, on average, 3.7 sessions of lymphatic massage and wore compression garments for an average of 3 weeks. They returned to work 6.1 days after surgery and were back to full activity in 3.2 weeks. Minor complications were reported in 2 patients. Patient satisfaction was on average 9.8 (on a scale of 1-10) at 6 months. CONCLUSIONS: HDL with PAL technology is a safe procedure that delivers reproducible natural-looking results with high patient satisfaction rates, low risk of complications, and a relatively short and tolerable recovery process.