[Effectiveness of a multidimensional therapeutic program for aged people attending senior centers]. / Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile.

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile / Effectiveness of a multidimensional therapeutic program for aged people attending senior centers

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

There is direct relationship between bone bridge length and coracoclavicular fixation resistance to failure: Biomechanical study in a porcine model.

BACKGROUND: This study aims to evaluate the relation between coracoclavicular resistance to failure and the distance between clavicular tunnels. The hypothesis is that a greater clavicular bone bridge between tunnels achieves a stronger coracoclavicular fixation. METHODS: Descriptive Laboratory Study. Thirty-six (36) coracoclavicular models were constructed utilizing porcine metatarsals. Coracoclavicular stabilizations were performed using a subcoracoid loop fixation configuration through two clavicular tunnels, tied at the clavicle's superior cortex using a locking knot. Models were randomly assigned to 1 of 3 experimental groups of variable bone bridge length between clavicular tunnels: 5 mm, 10 mm, and 15 mm. Each group had 12 models. Fixation resistance was assessed through the ultimate failure point under an axial load to failure trial. Failure patterns were documented. A one-way ANOVA test was used, and a Tukey post hoc as needed (P < 0.05). FINDINGS: Mean strength per bone bridge length: 5 mm = 312 N (Range: 182-442 N); 10 mm = 430 N (Range: 368-595 N); 15 mm = 595 N (Range: 441-978 N). The 15 mm group had a significantly higher ultimate failure point than the other two groups: 5 mm (P < 0.001) and 10 mm (P < 0.001). All fixations systematically failed by a superior cortex clavicle fracture at the midpoint between tunnels. INTERPRETATION: A direct relationship between bone bridge length and coracoclavicular resistance to failure was demonstrated, being the 15 mm length a significantly higher strength construct in a tied loop model.

Author Correction: Space lidar observations constrain longwave cloud feedback.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Nacimiento anómalo de la arteria coronaria izquierda desde la arteria pulmonar, síndrome de ALCAPA. Primer reporte de caso en Uruguay / Anomalous origin of the left coronary artery from the pulmonary artery, ALCAPA syndrome. First case report in Uruguay / Nascimento anômalo da artéria coronária esquerda a partir da artéria pulmonar, síndrome de ALCAPA. Relato do primeiro caso no Uruguai

Resumen: El nacimiento anómalo de la arteria coronaria izquierda desde la arteria pulmonar (síndrome de ALCAPA) es una rara entidad con una mortalidad de 90% durante el primer año de vida. Este hecho hace que su presencia en el adulto sea excepcional. Presentamos el primer caso reportado en nuestro país en un adulto. Se trata de una paciente de 32 años en estudio por historia de ángor de esfuerzo en la que el ecocardiograma brindó elementos sugestivos de esta entidad que se confirmó con coronariografía. Se intervino quirúrgicamente de forma exitosa con técnica de Takeuchi.

Summary: The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare entity with a high infant mortality rate during first year of life reaching up to 90%. This fact makes this condition extremely uncommon among adults. We report for the first time in our country an adult presentation in a 32-year-old woman. This patient presented with a history of exertional angina and a transthoracic echocardiogram showed suggestive clues for the diagnosis of ALCAPA, then confirmed with coronary angiography. The patient underwent successfull surgical correction with Takeuchi technique.

Resumo: O nascimento anômalo da artéria coronária esquerda a partir da artéria pulmonar (síndrome de ALCAPA) é uma entidade rara com uma mortalidade de 90% durante o primeiro ano de vida. Este fato faz com que sua apresentação da idade adulta seja excepcional. Apresentamos o primeiro caso reportado dessa síndrome no nosso país. Se trata de uma paciente de 32 anos em estudo por uma historia de angina de esforço na qual o ecocardiograma brindou elementos sugestivos dessa entidade sendo confirmada posteriormente com angiografia coronaria. Se realizou uma intervenção cirúrgica exitosa com a técnica de Takeuchi.

Space lidar observations constrain longwave cloud feedback.

Some of the most challenging questions in atmospheric science relate to how clouds will respond as the climate warms. On centennial scales, the response of clouds could either weaken or enhance the warming due to greenhouse gas emissions. Here we use space lidar observations to quantify changes in cloud altitude, cover, and opacity over the oceans between 2008 and 2014, together with a climate model with a lidar simulator to also simulate these changes in the present-day climate and in a future, warmer climate. We find that the longwave cloud altitude feedback, found to be robustly positive in simulations since the early climate models and backed up by physical explanations, is not the dominant longwave feedback term in the observations, although it is in the model we have used. These results suggest that the enhanced longwave warming due to clouds might be overestimated in climate models. These results highlight the importance of developing a long-term active sensor satellite record to reduce uncertainties in cloud feedbacks and prediction of future climate.

Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot.

BACKGROUND: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). METHODS: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. RESULTS: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. CONCLUSION: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.

Evaluación biomecánica de reparación de roturas del tendón patelar: ¿es mejor doble Bunnell paralelo o perpendicular? / Biomechanical comparison of two patellar tendon repair techniques: is double Bunnell better parallel or perpendicular?

INTRODUCCIÓN: En tendón patelar, se ha probado que agregar un segundo punto Bunnell dispuesto perpendicular al punto clásico, es más resistente, sin embargo, esa técnica dispuesta paralelamente no ha sido evaluada. PROPÓSITO: Comparar la resistencia entre la técnica doble Bunnell dispuesta en perpendicular y en paralela. MÉTODO: 28 muestras frescas de tendones patelares porcinos, asignadas aleatoriamente a 2 grupos. Grupo 1: 14 muestras reparadas con doble Bunnell perpendicular. Grupo 2: 14 muestras reparadas con doble Bunnell paralelo. Todas realizadas con la misma sutura ultrarresistente. Con una máquina computarizada de tracción, se aplicó tracción axial continua hasta el fallo. Se registró el punto máximo de fallo (PMF) y el modelo de falla mecánica. Análisis estadístico con t-student (p < 0,05). RESULTADOS: Grupo 1: PMF = 342 ± 50,7 Newton. Todas las muestras sufrieron avulsión central, preservando fibras perimetrales. Grupo 2: PMF = 358 ± 34,1 Newton. Todas las muestras sufrieron un split longitudinal del tendón. Sin diferencia significativa entre los grupos (p = 0,340). CONCLUSIÓN: Este estudio no demostró diferencias significativas en la resistencia de una técnica de doble Bunnell paralelo versus perpendicular, aplicada en un modelo experimental de tendón patelar. RELEVANCIA CLÍNICA: Ambas técnicas tienen propiedades biomecánicas similares y dejan un remanente de tejido tendinoso luego del fallo que permitiría una segunda reparación directa, potencialmente sin necesidad de requerir el uso de injertos.

INTRODUCTION: In the patellar tendon, a second Bunnell stitch arranged perpendicular to the classic configuration has increased the resistance of the repair, however, the effect of a double parallel technique has not been evaluated. PURPOSE: To compare the resistance between a patellar tendon repair with Double Bunnell technique arranged in parallel or perpendicular. METHOD: 28 fresh porcine patellar tendon samples were randomly assigned to 2 groups. Group 1: 14 samples repaired with a perpendicular Double Bunnell technique. Group 2: 14 samples repaired with a parallel Double Bunnell technique. All performed with the same ultraresistant suture. The samples were fixed to a computerized traction machine, applying continuous axial traction, until failure. The ultimate failure point (UFP) and the mechanical failure model were recorded. Statistical analysis included student́s t-test (p < 0.05). RESULTS: Group 1: UFP = 342 ± 50.7 Newton. All samples suffered a central avulsion, preserving the perimetral tendon fibers. Group 2: UFP = 358 ± 34.1 Newton. All samples suffered a longitudinal split of the tendon. No significant difference was found among groups (p = 0.340). CONCLUSION: This biomechanical study showed no significant differences in the strength of a tendon repair using a parallel versus a perpendicular double Bunnell technique. CLINICAL RELEVANCE: Both techniques have similar biomechanical properties and leave a remnant of tendon tissue after the failure that would allow a second direct repair, potentially without requiring the use of grafts.

51. Endocarditis infecciosa primaria mural del ventrículo izquierdo

Historia clínica: paciente de 16 años, sexo masculino, sin antecedentes patológicos. Cuadro de dos semanas de evolución de fiebre hasta 41 ºC, sin otros fenómenos acompañantes. Del examen se destaca: hemorragias en astilla. Temperatura axilar 39 ºC. Cardiovascular: ritmo regular de 92 cpm, ruidos cardiacos normales, sin soplos. Resto del examen sin alteraciones. Pruebas complementarias: estudios paraclínicos: hemograma: hemoglobina 10 g/dl, leucocitos: 241.000/ml (neutrófilos: 90%), velocidad de eritrosedimentacion 120 s. Proteína C reactiva 214 mg/l. TAC tórax-abdómen-pelvis: infarto esplénico. Hemocultivos: Staphylococcus aureus meticilino resistente. ETT: masa hiperecogénica con movilidad independiente a nivel del ápex del VI, pediculada, plilobulada, de 22 por 10 mm. Evolución clínica: se realiza resección quirúrgica de la masa y tratamiento antibiótico con vancomicina y gentamicina, con buena evolución posoperatoria. El estudio patológico de la masa resecada fue compatible con una vegetación, y el cultivo de la misma desarrolló Staphylococcus aureus meticilino resistente. Diagnóstico: endocarditis infecciosa aguda primaria mural del ventrículo izquierdo. Discusión: presentamos un caso de endocarditis infecciosa primaria mural del ventrículo izquierdo en un paciente sin cardiopatía predisponente ni endocarditis valvular concomitante. Esta es una entidad infrecuente y existen pocos casos reportados. Habitualmente su diagnóstico es tardío, presentándose muchas veces con fenómenos embólicos al momento del diagnóstico. Son factores de riesgo la inmunodepresión, la adicción a drogas intravenosas y la cirugía reciente. La ecocardiografía precoz es una herramienta de suma importancia para su diagnóstico, ya sea transtorácica o transesofágica, mientras que el diagnóstico por resonancia nuclear magnética se realiza en aquellos casos en que la ecocardiografía no es concluyente. El germen más frecuentemente implicado es el Staphylococcus aureus. Dada la escasa evidencia, se plantea una conducta similar a la de la endocarditis infecciosa.

38. CIA: cierre transcatéter. Valor agregado del ETE 3D en la toma de decisiones. Caso clínico

Historia clínica: paciente de 36 años de edad, sexo femenino, HTA de reciente diagnóstico. Asintomática. Del examen físico cardiovascular se destaca: R2 desdoblado. ECG: bloqueo incompleto de rama derecha. ETT: comunicación interauricular (CIA) tipo ostium secundum (OS). Dilatación de cavidades derechas. Qp/Qs: 1,6. Presión pulmonar sistólica 35 mmHg. Pruebas complementarias: se realiza ETE bidimensional (ETE2D) que evidencia CIA tipo OS con extensión anterior de 15 por 13 mm, con borde aórtico de 2 mm y presencia de buenos bordes en el resto de sus sectores. Septum impresiona firme, no aneurismático. ETE tridimensional (ETE3D) evidencia CIA de forma oval con eje mayor anteroposterior de 17 mm, en posición descrita, de 13 mm de eje menor y borde aórtico de 2,7 mm. Evolución clínica: se decide cierre transcatéter con dispositivo Amplatzer bajo anestesia general y monitoreo con ETE2D. Presión arteria pulmonar 26/7/13 mmHg. Por oximetría Qp/Qs 2,4. Por técnica de balón oclusor diámetro máximo de CIA de 17 mm. A pesar del borde aórtico subóptimo y tomando en consideración la buena calidad del resto de los bordes, la forma oval de orificio y el arco relativamente escaso del mismo en la topografía yuxta-aórtica, se decide proceder al implante, seleccionándose dispositivo no 19. Luego de desplegar ambos discos se corrobora posición con ecocardiografía. Se libera dispositivo luego de maniobra de Minnesota. Ecografía de control del dispositivo: mínimo shunt residual central, sin cabalgamiento sobre aorta. Diagnóstico: CIA OS con extensión anterior, con relevancia hemodinámica y anatomía favorable para cierre transcatéter. Discusión: el cierre percutáneo de CIA tipo OS es de elección cuando la anatomía lo permite. Las medidas exactas, forma, posición y relaciones anatómicas del defecto son imprescindibles. La vista "in face" del septum interauricular con ETE3D permite una valoración complementaria más precisa de su morfología. Presentamos un caso clínico en el que el ETE3D agregó información adicional a la aportada por el ETE2D, la cual fue determinante para planificar un exitoso procedimiento de cierre.

Cell Adhesion and Proliferation on Sulfonated and Non-Modified Chitosan Films.

Three types of chitosan-based films have been prepared and evaluated: a non-modified chitosan film bearing cationizable aliphatic amines and two films made of N-sulfopropyl chitosan derivatives bearing both aliphatic amines and negative sulfonate groups at different ratios. Cell adhesion and proliferation on chitosan films of C2C12 pre-myoblastic cells and B16 cells as tumoral model have been tested. A differential cell behavior has been observed on chitosan films due to their different surface modification. B16 cells have shown lower vinculin expression when cultured on sulfonated chitosan films. This study shows how the interaction among cells and material surface can be modulated by physicochemical characteristics of the biomaterial surface, altering tumoral cell adhesion and proliferation processes.

Biocompatibility assessment of spark plasma-sintered alumina-titanium cermets.

Alumina-titanium materials (cermets) of enhanced mechanical properties have been lately developed. In this work, physical properties such as electrical conductivity and the crystalline phases in the bulk material are evaluated. As these new cermets manufactured by spark plasma sintering may have potential application for hard tissue replacements, their biocompatibility needs to be evaluated. Thus, this research aims to study the cytocompatibility of a novel alumina-titanium (25 vol. % Ti) cermet compared to its pure counterpart, the spark plasma sintered alumina. The influence of the particular surface properties (chemical composition, roughness and wettability) on the pre-osteoblastic cell response is also analyzed. The material electrical resistance revealed that this cermet may be machined to any shape by electroerosion. The investigated specimens had a slightly undulated topography, with a roughness pattern that had similar morphology in all orientations (isotropic roughness) and a sub-micrometric average roughness. Differences in skewness that implied valley-like structures in the cermet and predominance of peaks in alumina were found. The cermet presented a higher surface hydrophilicity than alumina. Any cytotoxicity risk associated with the new materials or with the innovative manufacturing methodology was rejected. Proliferation and early-differentiation stages of osteoblasts were statistically improved on the composite. Thus, our results suggest that this new multifunctional cermet could improve current alumina-based biomedical devices for applications such as hip joint replacements.

Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation (T.C. PTNS) versus extended release oxybutynin (E.R.O.) in patients with overactive bladder. MATERIALS AND METHODS: Seventy female patients were randomized to receive either 10mg E.R.O. daily or T.C. PTNS, using a TENS machine program with the 20Hz, 200 cycles/s, and normal stimulation setting for two 30-min sessions, each week for a 12-week period. Pre-treatment and after the 12-week intervention, each patient completed a 3-day voiding diary and a self-report quality of life questionnaire (OAB-q). Statistical analysis was performed using Stata V12.1. RESULTS: Sixty-four patients completed the treatment protocol. There were no significant differences between study groups in terms of age, body mass index, past hormone replacement therapy, smoking habits, menopause status, and parity. Prior to treatment, there were also no significant differences in the analysis of the 3-day voiding diary or in the OAB-q questionnaire results. Following the 12-week study, there was a statistically significant reduction in frequency of urination, urgency episodes, and urge incontinent episodes compared to pre-treatment values. However, there were no significant differences in these values between intervention groups after 12-weeks of therapy. There was a similar improvement in OAB-q scores in both treatment groups following therapy, and the T.C. PTNS group showed a statistically significant improvement over the E.R.O. in domain 2 of the OAB-q questionnaire. The other two domains showed similar improvement in both study groups. CONCLUSION: T.C. PTNS and E.R.O. demonstrated similar improvements in subjects with OAB in a 12-week study.

First evidence of neosaxitoxin as a long-acting pain blocker in bladder pain syndrome.

INTRODUCTION AND HYPOTHESIS: Neosaxitoxin is a phycotoxin whose molecular mechanism of action shows a reversible inhibition of voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of neosaxitoxin as a long-acting pain blocker in the treatment of bladder pain syndrome (BPS). METHODS: Five patients with a diagnosis of BPS received a total dose of 80 µg of neosaxitoxin in an isoosmotic solution of 0.9 % NaCl, pH 6.5. Infiltration was performed via cystoscopy under spinal anesthesia. Questionnaires were administered immediately before and 7, 30 and 90 days after the procedure to measure the patients' reported pain severity and quality of life. RESULTS: This study, for the first time, showed the effect of blocking the neuronal transmission of pain by local infiltration of neosaxitoxin into the bladder submucosa. All five patients successfully responded to the treatment. Furthermore, the analgesic effect lasted for the entire 90 days of follow-up without the need for a second infiltration, and no adverse reactions to neosaxitoxin were detected. CONCLUSIONS: Neosaxitoxin infiltration was shown to be a safe and effective intervention to control pain related to BPS. It was well tolerated by patients, who experienced extended pain relief and associated beneficial effects over a follow-up of 90 days. These results confirm the effectiveness of neosaxitoxin as a long-acting local pain blocker.

Biomechanical evaluation of various suture configurations in side-to-side tenorrhaphy.

BACKGROUND: Side-to-side tenorrhaphy is increasingly used, but its mechanical performance has not been studied. METHODS: Two porcine flexor digitorum tendon segments of equal length (8 cm) and thickness (1 cm) were placed side by side. Eight tenorrhaphies (involving sixteen tendons) were performed with each of four suture techniques (running locked, simple eight, vertical mattress, and pulley suture). The resulting constructs underwent cyclic loading on a tensile testing machine, followed by monotonically increasing tensile load if failure during cyclic loading did not occur. Clamps secured the tendons on each side of the repair, and specimens were mounted vertically. Cyclic loading varied between 15 N and 35 N, with a distension rate of 1 mm/sec. Cyclic loading strength was determined by applying a force of 70 N. The cause of failure and tendon distension during loading were recorded. RESULTS: All failures occurred in the monotonic loading phase and resulted from tendon stripping. No suture or knot failure was observed. The mean loads resisted by the configurations ranged from 138 to 398 N. The mean load to failure, maximum load resisted prior to 1 cm of distension, and load resisted at 1 cm of distension were significantly lower for the vertical mattress suture group than for any of the other three groups (p < 0.031). CONCLUSIONS: All four groups sustained loads well above the physiologic loads expected to occur in tendons in the foot and ankle (e.g., in tendon transfer for tibialis posterior tendon insufficiency). None of the four side-to-side configurations distended appreciably during the cyclic loading phase. The vertical mattress suture configuration appeared to be weaker than the other configurations. CLINICAL RELEVANCE: For surgeons who advocate immediate loading or motion of a side-to-side tendon repair, a pulley, running locked, or simple eight suture technique appears to provide a larger safety margin compared with a vertical mattress suture technique.

Chitosan scaffolds containing calcium phosphate salts and rhBMP-2: in vitro and in vivo testing for bone tissue regeneration.

Numerous strategies that are currently used to regenerate bone depend on employing biocompatible materials exhibiting a scaffold structure. These scaffolds can be manufactured containing particular active compounds, such as hydroxyapatite precursors and/or different growth factors to enhance bone regeneration process. Herein, we have immobilized calcium phosphate salts (CPS) and bone morphogenetic protein 2 (BMP-2)--combined or alone--into chitosan scaffolds using ISISA process. We have analyzed whether the immobilized bone morphogenetic protein preserved its osteoinductive capability after manufacturing process as well as BMP-2 in vitro release kinetic. We have also studied both the in vitro and in vivo biocompatibility of the resulting scaffolds using a rabbit model. Results indicated that rhBMP-2 remained active in the scaffolds after the manufacturing process and that its release kinetic was different depending on the presence of CPS. In vitro and in vivo findings showed that cells grew more in scaffolds with both CPS and rhBMP-2 and that these scaffolds induced more bone formation in rabbit tibia. Thus chitosan scaffolds containing both CPS and rhBMP-2 were more osteoinductive than their counterparts alone indicating that could be useful for bone regeneration purposes, such as some applications in dentistry.

Ubicación de la zona de inervación del músculo flexor corto del pulgar en individuos sanos de ambos sexos / Flexor pollicis brevis muscle innervation zone location in healthy individuals of both sexes

El músculo flexor corto del pulgar (FCP) se localiza en la eminencia tenar y tiene un importante rol en las funciones del dedo pulgar. Existen escasos antecedentes acerca de la distribución de las zonas de inervación (ZI) de este músculo y las posibles diferencias entre individuos de diferente sexo. El conocimiento de la localización de las ZI del FCP podría ser de ayuda en el tratamiento de la mano espástica, sirviendo para definir el sitio de inyección de la toxina botulínica. El objetivo de esta investigación fue describir las ubicaciones de las ZI del FCP usando electromiografía de superficie, y hacer una comparación entre individuos de sexo masculino y femenino. Treinta jóvenes voluntarios sanos, participaron en este estudio (15 hombres: 21.5 +/- 2.6 años, 70.7 +/- 7.2 kg y 175.0 +/- 5.5 cm. 15 Mujeres: 19.9 +/- 1.4 años, 57.9 +/- 11.1 kg y 161.9 +/- 6.6 cm). Las ZI fueron identificadas mediante la grabación de los potenciales de acción de las unidades motoras del FCP, usando un arreglo de dieciséis electrodos de superficie. Los potenciales fueron grabados durante contracciones isométricas al 10 por ciento de la contracción voluntaria máxima. Las localizaciones de las ZI fueron expresadas en forma absoluta y relativa en relación a un sistema de referencia construido en la palma de la mano, en base a referencias anatómicas. No existieron diferencias significativas en las ubicaciones de las ZI entre los participantes de sexo masculino y femenino de la muestra evaluada. Para el grupo de participantes en este estudio, las ZI del FCP se encontraron al 41.9 por ciento de la distancia comprendida entre el extremo palpable más distal y medial de la interlínea articular metacarpofalángica del pulgar y la línea que nace en el vértice palpable del extremo proximal de la primera falange del tercer dedo pasado por el pliegue longitudinal radial.

The flexor pollicis brevis (FPB) is a muscle of the thenar eminence that plays an important role in thumb function. There is data about its innervation zone (IZ) distribution and sex differences. Knowing the location of the ZI of FPB could be helpful in treating spastic hand, serving to define the site of injection of the botulinum toxin. The aim of this study was to describe the IZ location in the FPB using surface electromyography (sEMG), and also make a comparison between male and female subjects. Thirty young healthy volunteers participated in this study (15 males: 21.5 +/- 2.6 years, 70.7 +/- 7.2 kg y 175.0 +/- 5.5cm. 15 Females: 19.9 +/- 1.4 years, 57.9 +/- 11.1 kg y 161.9 +/- 6.6 cm). The IZ was identified by recording the action potentials of the FPB motor units, using a sixteen-electrode array. The action potentials were recorded during isometric contractions at 10 percent of maximum voluntary contraction. The location of the IZ was expressed as absolute and relative values in relation to a reference system constructed in the palm of the hand, based on anatomic references. There were not significant differences in the location of the IZ between male and female subjects. Of all the subjects, the IZ of the FPB was found at the 41.9 percent of the distance between the most distal and medial palpable extreme of the metacarpophalangeal joint line of the thumb and the line which rises at the palpable apex of the proximal side of the first phalanx of the third finger passing through the radial longitudinal fold.

Biomarkers of age effect on renal function in Down syndrome.

OBJECTIVE: To assess differences in kidney function between Down syndrome (DS) individuals and a control group related to aging. METHODS: Creatinine (Cr) and specific gravity (SG) were assessed by spectrophotometric and refractometric assays in urine samples of 103 individuals with DS and 82 age-matched controls. RESULTS: Significantly lower levels of Cr and SG were found in DS after puberty. Significant correlations were found between SG and age as well as between Cr and SG in DS and controls (p ≤ 0.05). CONCLUSIONS: Premature aging in kidneys of DS patients could lead to an impaired renal function.

Relación entre el rendimiento en la prueba de estación unipodal y la velocidad del centro de presión en adultos mayores / Relationship between unipedal stance test score and center of pressure velocity in elderly

Introducción. Las caídas frecuentes son uno de los problemas de salud más importantes en los adultos mayores (AM). La prueba de estación unipodal (PEU) valora la estabilidad postural y es utilizada en la medición del riesgo de caídas. Sin embargo, existe poca información acerca de su relación con parámetros posturográficos (PP) que caracterizan a la estabilidad postural. Dentro de los PP que mejor describen la estabilidad postural se encuentra la velocidad del centro de presión (VCdP). El objetivo de este trabajo es examinar la relación entre el rendimiento en la PEU y la VCdP en adultos mayores. Material y métodos. Una muestra de 38 AM sanos fue dividida en dos grupos, según el rendimiento en la PEU: sujetos con bajo rendimiento en la PEU (BR, n=11) y alto rendimiento en la PEU (AR, n=27). En ambos grupos se examinó la correlación entre el tiempo de la PEU y VCdP media (VmCdP) registrada durante un examen posturográfico. Resultados. Se encontró una correlación inversa entre el tiempo de la PEU y la VmCdP en ambos grupos. Sin embargo, esta fue mayor el grupo de BR (r=−0,69; p=0,02) en comparación al grupo AR (r=−0,39; p=0,04). Conclusiones. En base a los resultados obtenidos en esta investigación, es posible concluir que el rendimiento en la prueba de estación unipodal tiene una relación inversa con la VmCdP, especialmente en sujetos con bajo rendimiento en la PEU(AU)

Introduction. Frequent falls are one of the most important health problems in the elderly population. The unipedal stance test (UPST), asses postural stability and is used in fall risk measures. Despite this, there is little information about its relationship with posturographic parameters (PP) that characterizes postural stability. Center of pressure velocity (CoPV) is one of the best PP that describes postural stability. The aim of this study was to analyze the relation between UST score and CoPV in elderly population. Materials and methods. A sample of 38 healthy elderly subjects where divided in two groups according to their UPST score, low performance (LP, n=11) and high performance (HP, n=27). The correlation between UPST score and COP mean velocity (CoPmV), recorded from a posturographic test, was analyzed between both groups. Results. An inverse correlation between UPST score and CoPmV was found in both groups. However, this was higher in the LP group (r=−0.69, P=.02) compared to the HP (r=−0.39, P=.04). Conclusions. Based on the results of this investigation, it may be concluded that the achievement on UPST has an inverse relationship with CoPmV, especially in subjects with low performance in the UPST(AU)

Evaluation of urinary biomarkers of oxidative/nitrosative stress in children with Down syndrome.

AIMS: It has been suggested that oxidative stress plays a key role in the pathogenesis of Down syndrome (DS). However, urinary biomarkers of oxidative stress have been little studied in this condition. Thus, we aimed to assess a set of urinary oxidative/nitrosative stress biomarkers in children with DS, with and without hypothyroidism, which comprise: 8-hydroxy-2'-deoxyguanosine (8-OHdG), isoprostane 15-F(2t)-IsoP, thiobarbituric acid-reacting substances (TBARS), advanced glycation end products (AGEs), dityrosine (diTyr), hydrogen peroxide (H(2)O(2)) and nitrite/nitrate (NOx). MAIN METHODS: Fluorimetric and spectrophotometric assays were performed in children with DS (n=26), some of them taking levothyroxine for hypothyroidism (n=7), and their non-Down siblings (n=19). KEY FINDINGS: We found that only levels of diTyr were increased in DS, although no differences were obtained when hypothyroid DS children were excluded. Levels of 8-OHdG, 15-F(2t)-IsoP, TBARS, AGEs, H(2)O(2) and NOx did not differ neither between DS and controls nor between hypothyroid DS children and DS without hypothyroidism diagnosed. However, diTyr is increased in hypothyroid DS children compared with controls. Negative correlations with age were obtained for 8-OHdG, diTyr and NOx in DS and controls and for 8-OHdG, 15-F(2t)-IsoP, TBARS and AGEs in DS. SIGNIFICANCE: Increased oxidative stress in children with DS cannot be explained by the urinary levels of 8-OHdG, 15-F(2t)-IsoP, TBARS, AGEs, diTyr, H(2)O(2) and NOx, at least with the assays used. Nonetheless, urinary diTyr could be used as oxidative/nitrosative stress biomarker in hypothyroid DS children. The present work presents evidence of a probable renal impairment in children with DS receiving levothyroxine for hypothyroidism.