THE CEMENTED DOUBLE MOBILITY CUP IN HIP REVISION: DIFFERENT POSSIBILITIES OF USE.

Introduction: The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods: The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results: The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion: The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .

Introdução: Revisar os pacientes que foram submetidos à cirurgia de revisão protética de quadril neste hospital, considerados como pacientes com alto risco de luxação ou luxação recorrente, submetidos a cirurgia por acetábulo cimentado de dupla mobilidade (CMD). Analisando as diferentes formas de posicionamento desses copos, seus resultados clínicos e reluxações. Material e métodos: Os 69 casos correspondiam a 34 homens e 35 mulheres com uma idade média de 77,39 anos. O tempo médio de acompanhamento foi de 4,7536 anos. O tipo de intervenção realizada variou de acordo com a causa da intervenção, o estoque ósseo acetabular e o estado do copo primário. Nos casos em que houve uma boa fixação do metal primário, optouse por realizar uma cimentação do DMC cimentado na cúpula acetabular metálica firme existente, o que ocorreu em 23 casos. Nos casos em que houve um afrouxamento acetabular primário com um bom estoque ósseo disponível, cimentou-se um CMD (21 caixas). Nos casos em que havia um Paprosky tipo III, cimentou-se um DMC a um anel de reforço Bursch-Schneider juntamente com a colocação de um enxerto ósseo esponjoso (25 caixas). Resultados: A avaliação clínica realizada no final do acompanhamento, de acordo com a Escala MD, mostrou que o valor médio foi de 16,454 (DP 0,79472), com uma sobrevivência ao final do acompanhamento de 100% do DMC inserido. Conclusão: O uso do DMC cimentado pode ser uma boa solução para substituição do THA, especialmente em casos de reluxação ou risco de deslo-camento devido a fatores de predisposição pessoais ou técnicos. O uso destes DMC cimentados pode ser realizado diretamente ao osso, dentro da cúpula metálica fixa existente, ou cimentados a um anel de reforço, dependendo do defeito acetabular. Nível de Evidência III; Série de Casos Comparativos .

The cemented double mobility cup in hip revision: different possibilities of use / Acetábulo cimentado de dupla mobilidade em revisão de quadril: distintas possibilidades de uso

ABSTRACT Introduction: The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods: The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results: The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion: The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series.

RESUMO Introdução: Revisar os pacientes que foram submetidos à cirurgia de revisão protética de quadril neste hospital, considerados como pacientes com alto risco de luxação ou luxação recorrente, submetidos a cirurgia por acetábulo cimentado de dupla mobilidade (CMD). Analisando as diferentes formas de posicionamento desses copos, seus resultados clínicos e reluxações. Material e métodos: Os 69 casos correspondiam a 34 homens e 35 mulheres com uma idade média de 77,39 anos. O tempo médio de acompanhamento foi de 4,7536 anos. O tipo de intervenção realizada variou de acordo com a causa da intervenção, o estoque ósseo acetabular e o estado do copo primário. Nos casos em que houve uma boa fixação do metal primário, optouse por realizar uma cimentação do DMC cimentado na cúpula acetabular metálica firme existente, o que ocorreu em 23 casos. Nos casos em que houve um afrouxamento acetabular primário com um bom estoque ósseo disponível, cimentou-se um CMD (21 caixas). Nos casos em que havia um Paprosky tipo III, cimentou-se um DMC a um anel de reforço Bursch-Schneider juntamente com a colocação de um enxerto ósseo esponjoso (25 caixas). Resultados: A avaliação clínica realizada no final do acompanhamento, de acordo com a Escala MD, mostrou que o valor médio foi de 16,454 (DP 0,79472), com uma sobrevivência ao final do acompanhamento de 100% do DMC inserido. Conclusão: O uso do DMC cimentado pode ser uma boa solução para substituição do THA, especialmente em casos de reluxação ou risco de deslo-camento devido a fatores de predisposição pessoais ou técnicos. O uso destes DMC cimentados pode ser realizado diretamente ao osso, dentro da cúpula metálica fixa existente, ou cimentados a um anel de reforço, dependendo do defeito acetabular. Nível de Evidência III; Série de Casos Comparativos.

Global collision-risk hotspots of marine traffic and the world's largest fish, the whale shark.

Marine traffic is increasing globally yet collisions with endangered megafauna such as whales, sea turtles, and planktivorous sharks go largely undetected or unreported. Collisions leading to mortality can have population-level consequences for endangered species. Hence, identifying simultaneous space use of megafauna and shipping throughout ranges may reveal as-yet-unknown spatial targets requiring conservation. However, global studies tracking megafauna and shipping occurrences are lacking. Here we combine satellite-tracked movements of the whale shark, Rhincodon typus, and vessel activity to show that 92% of sharks' horizontal space use and nearly 50% of vertical space use overlap with persistent large vessel (>300 gross tons) traffic. Collision-risk estimates correlated with reported whale shark mortality from ship strikes, indicating higher mortality in areas with greatest overlap. Hotspots of potential collision risk were evident in all major oceans, predominantly from overlap with cargo and tanker vessels, and were concentrated in gulf regions, where dense traffic co-occurred with seasonal shark movements. Nearly a third of whale shark hotspots overlapped with the highest collision-risk areas, with the last known locations of tracked sharks coinciding with busier shipping routes more often than expected. Depth-recording tags provided evidence for sinking, likely dead, whale sharks, suggesting substantial "cryptic" lethal ship strikes are possible, which could explain why whale shark population declines continue despite international protection and low fishing-induced mortality. Mitigation measures to reduce ship-strike risk should be considered to conserve this species and other ocean giants that are likely experiencing similar impacts from growing global vessel traffic.

Increased 1-year mortality in haemodialysis patients with COVID-19: a prospective, observational study.

BACKGROUND: Dialysis confers the highest risk of coronavirus disease 2019 (COVID-19) death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis. METHODS: In a prospective, observational study, we analysed the long-term (1-year follow-up) serological and clinical outcomes of 56 haemodialysis (HD) patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first pandemic wave. COVID-19 was diagnosed by a positive polymerase chain reaction (PCR) test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19). RESULTS: After >1 year of follow-up, 35.7% of HD patients infected by SARS-CoV-2 during the first pandemic wave had died, 6 (11%) during the initial admission and 14 (25%) in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes and 40% from respiratory causes. In adjusted analysis, a positive SARS-CoV-2 PCR test for diagnosis {hazard ratio [HR] 5.18 [interquartile range (IQR) 1.30-20.65], P = 0.020}, higher baseline C-reactive protein levels [HR 1.10 (IQR 1.03-1.16), P = 0.002] and lower haemoglobin levels [HR 0.62 (IQR 0.45-0.86), P = 0.005] were associated with higher 1-year mortality. Mortality in the 144 patients who did not have COVID-19 was 21 (14.6%) over 12 months [HR of death for COVID-19 patients 3.00 (IQR 1.62-5.53), log-rank P = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 immunoglobulin G (IgG) decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months and 14/36 (38.8%) at 12 months. CONCLUSIONS: The high mortality of HD patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In HD patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived.

The dirty little secret of urate-lowering therapy: useless to stop chronic kidney disease progression and may increase mortality.

Hyperuricaemia is frequent in chronic kidney disease (CKD). Observational studies have shown an association with adverse outcomes and acquired hyperuricaemia (meaning serum urate levels as low as 1.0 mg/dL) in animal models induces kidney injury. This evidence does not justify the widespread use of urate-lowering drugs for asymptomatic hyperuricaemia in CKD. However, promising results from small, open-label studies led some physicians to prescribe urate-lowering drugs to slow CKD progression. Two recent, large, placebo-controlled trials (CKD-FIX and PERL) showed no benefit from urate lowering with allopurinol on the primary endpoint of CKD progression, confirming prior negative results. Despite these negative findings, it was still argued that the study population could be optimized by enrolling younger non-proteinuric CKD patients with better preserved glomerular filtration rate (GFR). However, in these low-risk patients, GFR may be stable under placebo conditions. Additionally, the increased mortality trends already identified in gout trials of urate-lowering therapy were also observed in CKD-FIX and PERL, sending a strong safety signal: 21/449 (4.7%) and 10/444 (2.2%) patients died in the combined allopurinol and placebo groups, respectively [chi-squared P-value 0.048; relative risk 2.07 (95% CI 0.98-4.34); P = 0.06]. Given the absent evidence of benefit in multiple clinical trials and the potentially serious safety issues, the clear message should be that urate-lowering therapy should not be prescribed for the indication of slowing CKD progression. Additionally, regulatory agencies should urgently reassess the safety of chronic prescription of urate-lowering drugs for any indication.

Terapia de presión negativa en pediatría / Negative pressure therapy in pediatrics

Introducción. La terapia de presión negativa es un recurso utilizado cada vez con mayor frecuencia en el manejo de heridas complejas en pediatría. El objetivo de este estudio fue describir la experiencia con esta terapia en diferentes situaciones clínicas. Métodos. Se llevó a cabo un estudio descriptivo retrospectivo en un grupo de pacientes pediátricos en quienes se utilizó la terapia de presión negativa entre el año 2010 y el 2015. Se analizaron las variables sociodemográficas, los diagnósticos que indicaron la terapia, el tiempo de uso, sus complicaciones y la mortalidad. Resultados. Se incluyeron 41 pacientes. La terapia se indicó en 39 casos con heridas localizadas en el abdomen, en uno con infección de los tejidos blandos perianales y en otro con una herida de esternotomía infectada. De las heridas abdominales, 14 fueron por complicaciones relacionadas con apendicitis aguda, 6 por enfermedades relacionadas con megacolon, 5 por obstrucción intestinal, 4 para el manejo de fístulas, 4 por enterocolitis necrosante del recién nacido, 3 por pancreatitis aguda y 3 por otras causas. El tiempo promedio de uso de la terapia fue de 7 días. Se presentaron fallas en el sistema de vacío en dos pacientes, pero no hubo complicaciones por el uso de la terapia. Dos pacientes fallecieron por complicaciones relacionadas con su enfermedad de base. Conclusión. La terapia de presión negativa es un recurso efectivo en el manejo de heridas complejas en la población pediátrica

Introduction. Negative pressure therapy is an increasingly used resource in the management of complex wounds in pediatrics. The objective of this study was to describe the experience with this therapy in different clinical situations. Methods. A retrospective descriptive study was conducted in a group of pediatric patients who received negative pressure therapy between 2010 and 2015. We analyzed the sociodemographic variables, the diagnoses that indi-cated the therapy, the time of use of the therapy, complications and mortality. Results. A total of 41 patients were included. Therapy was indicated in 39 cases with wounds located in the ab-domen, in one with infection of the perianal soft tissues, and in another with an infected sternotomy wound. Of the abdominal wounds, 14 were due to complications related to acute appendicitis, six due to diseases related to megacolon, five due to intestinal obstruction, four for the management of fistulas, four due to necrotizing enterocolitis of the newborn, three due to acute pancreatitis, and three due to other causes. The average time of use of the therapy was 7 days. Vacuum system failures occurred in two patients, but there were no complications from the use of therapy. Two patients died of complications related to their underlying disease.Conclusion. Negative pressure therapy is an effective resource in the management of complex wounds in the pediatric population

ACETABULAR RECONSTRUCTION IN PAPROSKY TYPE III DEFECTS.

Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.

Objetivos: A deficiência pélvica severa apresenta um problema difícil na artroplastia do quadril. Especificamente, os objetivos são restaurar o estoque ósseo pélvico, colocar o componente acetabular na posição anatômica correta e otimizar a estabilidade da articulação. Atualmente, existem muitas técnicas cirúrgicas para a cirurgia de revisão protética em defeitos do complexo acetabular, mas não há consenso sobre o melhor tratamento. Os objetivos deste trabalho são revisar casos de médio prazo operados por apresentar defeito ósseo grave (Paprosky tipo III) tratado com aloenxerto ósseo e gaiola anelar Bursch - Schneider anti protusio (BSAC). Métodos: Foi realizada uma revisão retrospectiva consecutiva das primeiras 23 reconstruções acetabulares complexas realizadas entre 2006 e 2011. Esta série inclui a curva de aprendizado do procedimento e tem um acompanhamento mínimo de 5 anos. Conclusão: Em conclusão, nosso estudo confirma a eficácia do uso de aloenxerto morselado congelado combinado com um anel de metal tipo BSAC durante a reconstrução acetabular. É necessário recuperar o centro de rotação do quadril em sua localização anatômica para o sucesso a longo prazo. Em casos de soltura maciça, o centro anatómico de rotação só pode ser restaurado pela reconstrução da densidade óssea usando um enxerto protegido por um anel que melhora a centralização da cabeça. Nível de Evidência tipo IV, Série de Casos.

Acetabular reconstruction in paprosky type iii defects / Reconstrução acetabular em defeitos por paprosky tipo iii

ABSTRACT Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.

RESUMO Objetivos: A deficiência pélvica severa apresenta um problema difícil na artroplastia do quadril. Especificamente, os objetivos são restaurar o estoque ósseo pélvico, colocar o componente acetabular na posição anatômica correta e otimizar a estabilidade da articulação. Atualmente, existem muitas técnicas cirúrgicas para a cirurgia de revisão protética em defeitos do complexo acetabular, mas não há consenso sobre o melhor tratamento. Os objetivos deste trabalho são revisar casos de médio prazo operados por apresentar defeito ósseo grave (Paprosky tipo III) tratado com aloenxerto ósseo e gaiola anelar Bursch - Schneider anti protusio (BSAC). Métodos: Foi realizada uma revisão retrospectiva consecutiva das primeiras 23 reconstruções acetabulares complexas realizadas entre 2006 e 2011. Esta série inclui a curva de aprendizado do procedimento e tem um acompanhamento mínimo de 5 anos. Conclusão: Em conclusão, nosso estudo confirma a eficácia do uso de aloenxerto morselado congelado combinado com um anel de metal tipo BSAC durante a reconstrução acetabular. É necessário recuperar o centro de rotação do quadril em sua localização anatômica para o sucesso a longo prazo. Em casos de soltura maciça, o centro anatómico de rotação só pode ser restaurado pela reconstrução da densidade óssea usando um enxerto protegido por um anel que melhora a centralização da cabeça. Nível de Evidência tipo IV, Série de Casos.

Short femoral stem in total hip arthroplasty: stable fixation and low complication rates in elderly patients.

BACKGROUND: We present the result of our experience in using a short femoral stem in elderly patients (>70 years of age) compared to patients younger than 70 years. METHODS: Data were prospectively collected on 138 patients who underwent 148 primary total hip arthroplasty (THA), with a conservative short stem between November 2010 and June 2014. The cohort was divided into 2 groups: the study group (group 1) comprised 57 patients (60 THA) over 70 years of age at the time of surgery, with a mean age of 75.4 years (range 70-87 years) and a mean follow-up of 26.7 months (range 9-48 months). The control group (group 2) comprised 81patients (88 THA) less than 70 years of age with a mean age of 57.4 years (range 33-69 years) and a mean follow-up of 27.3 months (range 9-54 months). Hip function in the 2 groups was compared preoperatively and postoperatively using the Merle D'Aubigne hip score (MD) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. RESULTS: At the latest follow-up, 1 calcar fracture was reported in a 54-year-old patient in the control group, which required fixation with a screw and had a favourable outcome. No cases of clinical or radiographic loosening were reported.Clinical results showed no statistically significant differences between the 2 groups. CONCLUSIONS: The use of the GTS conservative short stem in patients over 70 years old has shown very good results and low complication rates, comparable to those for patients younger than 70 years.

Bacterial antisense RNAs are mainly the product of transcriptional noise.

cis-Encoded antisense RNAs (asRNAs) are widespread along bacterial transcriptomes. However, the role of most of these RNAs remains unknown, and there is an ongoing discussion as to what extent these transcripts are the result of transcriptional noise. We show, by comparative transcriptomics of 20 bacterial species and one chloroplast, that the number of asRNAs is exponentially dependent on the genomic AT content and that expression of asRNA at low levels exerts little impact in terms of energy consumption. A transcription model simulating mRNA and asRNA production indicates that the asRNA regulatory effect is only observed above certain expression thresholds, substantially higher than physiological transcript levels. These predictions were verified experimentally by overexpressing nine different asRNAs in Mycoplasma pneumoniae. Our results suggest that most of the antisense transcripts found in bacteria are the consequence of transcriptional noise, arising at spurious promoters throughout the genome.

Vertical Movements and Patterns in Diving Behavior of Whale Sharks as Revealed by Pop-Up Satellite Tags in the Eastern Gulf of Mexico.

The whale shark (Rhincodon typus) is a wide-ranging, filter-feeding species typically observed at or near the surface. This shark's sub-surface habits and behaviors have only begun to be revealed in recent years through the use of archival and satellite tagging technology. We attached pop-up satellite archival transmitting tags to 35 whale sharks in the southeastern Gulf of Mexico off the Yucatan Peninsula from 2003-2012 and three tags to whale sharks in the northeastern Gulf off Florida in 2010, to examine these sharks' long-term movement patterns and gain insight into the underlying factors influencing their vertical habitat selection. Archived data were received from 31 tags deployed on sharks of both sexes with total lengths of 5.5-9 m. Nine of these tags were physically recovered facilitating a detailed long-term view into the sharks' vertical movements. Whale sharks feeding inshore on fish eggs off the northeast Yucatan Peninsula demonstrated reverse diel vertical migration, with extended periods of surface swimming beginning at sunrise followed by an abrupt change in the mid-afternoon to regular vertical oscillations, a pattern that continued overnight. When in oceanic waters, sharks spent about 95% of their time within epipelagic depths (<200 m) but regularly undertook very deep ("extreme") dives (>500 m) that largely occurred during daytime or twilight hours (max. depth recorded 1,928 m), had V-shaped depth-time profiles, and comprised more rapid descents (0.68 m sec-1) than ascents (0.50 m sec-1). Nearly half of these extreme dives had descent profiles with brief but conspicuous changes in vertical direction at a mean depth of 475 m. We hypothesize these stutter steps represent foraging events within the deep scattering layer, however, the extreme dives may have additional functions. Overall, our results demonstrate complex and dynamic patterns of habitat utilization for R. typus that appear to be in response to changing biotic and abiotic conditions influencing the distribution and abundance of their prey.

Comparative "-omics" in Mycoplasma pneumoniae Clinical Isolates Reveals Key Virulence Factors.

The human respiratory tract pathogen M. pneumoniae is one of the best characterized minimal bacterium. Until now, two main groups of clinical isolates of this bacterium have been described (types 1 and 2), differing in the sequence of the P1 adhesin gene. Here, we have sequenced the genomes of 23 clinical isolates of M. pneumoniae. Studying SNPs, non-synonymous mutations, indels and genome rearrangements of these 23 strains and 4 previously sequenced ones, has revealed new subclasses in the two main groups, some of them being associated with the country of isolation. Integrative analysis of in vitro gene essentiality and mutation rates enabled the identification of several putative virulence factors and antigenic proteins; revealing recombination machinery, glycerol metabolism and peroxide production as possible factors in the genetics and physiology of these pathogenic strains. Additionally, the transcriptomes and proteomes of two representative strains, one from each of the two main groups, have been characterized to evaluate the impact of mutations on RNA and proteins levels. This study has revealed that type 2 strains show higher expression levels of CARDS toxin, a protein recently shown to be one of the major factors of inflammation. Thus, we propose that type 2 strains could be more toxigenic than type 1 strains of M. pneumoniae.

Early clinical results of a new conservative hip stem.

Conservative stems conserve a larger amount of bone, and due to their biomechanical effect, they allow higher compression forces on the lateral column of the femur and reduce stress shielding. Since they conserve metaphyseal bone, short stems allow the use of conventional stems when revision surgery becomes necessary. The authors present the early results of a new bone conserving stem GTS (Biomet). A total of 80 patients (55 men and 25 women) were enroled in this prospective study and received 81 GTS stem (1 bilateral). Their mean age was 64.8 years (range 43-78) at the time of surgery. The mean follow-up was 16 months (range 6-24 month). The clinical assessment was performed by a single surgeon using the Merle d'Aubigné scale; radiographic complications were described. There was one calcar fracture, which required a fixation with a screw. No cases of clinical or radiological loosening were reported. GTS Conservative hip arthroplasty stem has proven to be an excellent implant for femoral hip replacement, with expectations that it may exceed the durability of other types of implants without harming the femoral diaphysis. This may facilitate eventual stem revision and give surgeons the opportunity of using a standard primary implant.

Factores asociados a mortalidad por neumonía nosocomial en un hospital público de Perú / Factors associated with nosocomial pneumonia mortalityin a public hospital in Peru

Objetivo: Determinar los factores asociados a mortalidad en pacientes con neumon¡a nosocomial en el Hospital Dos de Mayo, Lima-Perú entre el per¡odo enero 2006-diciembre 2010. Métodos: Se realizó un estudio de cohorte única, retrospectivo, de pacientes con diagnóstico de neumon¡a nosocomial. Los pacientes elegibles para el estudio fueron mayores de 18 años, tiempo de enfermedad y condicón de egreso conocido (alta o fallecido). Para el análisis de supervivencia se utilizó el método de Kaplan-Meier y regresión de Cox. Resultados: Se identificaron 658 pacientes con diagnóstico de neumon¡a nosocomial, el agente causal fue identificado en 173 (26,75%) casos. La edad media fue 58,4ñ19,6 años, fallecieron 238 (36,2%) pacientes, la mediana de supervivencia fue de 16 d¡as. El sexo masculino presentó un hazard ratio (HR) de 1,15 (IC 95%: 0,89 a 1,49). A los 10 y 20 d¡as la tasa de supervivencia fue de 70% y 40% en aquellos pacientes con Klebsiella, 85% y 75% en aquellos con Pseudomonas, y el 70% y 65% en aquellos con Staphylococcus aureus. En el análisis multivariado, se identificaron a la exposición a ventilación mecánica (HR 1,98; IC95% 1,35-2,89), el uso de una sonda nasogástrica (HR 1,33; IC95% 1,01-1,76) y la edad mayor de 65 años (HR 1,96; IC95% 1,51-2,55) como factores asociados a mortalidad, mientras que la resistencia a ceftazidima y amikacina presentó HR 1,45 (IC95% 0,74-2,84). Conclusiones: En la neumon¡a nosocomial, la exposición a ventilación mecánica, sonda nasogástrica y edad mayor de 65 años, se asoció con una menor supervivencia. Esto sugiere la instauración de medidas preventivas en este grupo de riesgo.

Objective: To determine factors associated with mortality in patients with nosocomial pneumonia at the Hospital Dos de Mayo, Lima-Peru between January 2006 to December 2010. Methods: Retrospective cohort study, patients eligible for the study were over 18 years of age, sick time record and known exit condition (discharge or deceased). For survival analysis we used the Kaplan-Meier and Cox regression. Results: We identified 658 patients diagnosed with nosocomial pneumonia, and the causative agent was identified in 173 (26,75%). The mean age was 58,4ñ19,6 years, 238 patientes died (36,2%); median survival time was 16 days. Male sex presented HR=1,15, 95%CI 0.89-1.49. At 10 and 20 days the survival rate was 70% and 40% in those with Klebsiella, 85% and 75% in those with Pseudomonas, and 70% and 65% in those with Staphylococcus aureus. In the multivariate analysis, we identified exposure to mechanical ventilation (HR 1,98; 95%CI 1,35 to 2,89), use of a nasogastric tube (HR 1,33; 95%CI 1,01 to 1,76) and age over 65 years (HR 1,96; (95%CI 1,51 to 2,55) as factors associated with mortality, while resistance to ceftazidime and amikacin present HR 1,45 (95%CI 0,74 -2,84). Conclusions: In nosocomial pneumonia, the exposure to mechanical ventilation, nasogastric tube and age over 65 years, are associated with lower survival. This suggests the introduction of preventive measures in this risk group.

An unprecedented aggregation of whale sharks, Rhincodon typus, in Mexican coastal waters of the Caribbean Sea.

Whale sharks, Rhincodon typus, are often perceived as solitary behemoths that live and feed in the open ocean. To the contrary, evidence is accumulating that they are gregarious and form seasonal aggregations in some coastal waters. One such aggregation occurs annually north of Cabo Catoche, off Isla Holbox on the Yucatán Peninsula of Mexico. Here we report a second, much denser aggregation of whale sharks (dubbed "the Afuera") that occurs east of the tip of the Yucatán Peninsula in the Caribbean Sea. The 2009 Afuera event comprised the largest aggregation of whale sharks ever reported, with up to 420 whale sharks observed in a single aerial survey, all gathered in an elliptical patch of ocean approximately 18 km(2). Plankton studies indicated that the sharks were feeding on dense homogenous patches of fish eggs, which DNA barcoding analysis identified as belonging to little tunny, Euthynnus alletteratus. This contrasts with the annual Cabo Catoche aggregation nearby, where prey consists mostly of copepods and sergestid shrimp. Increased sightings at the Afuera coincide with decreased sightings at Cabo Catoche, and both groups have the same sex ratio, implying that the same animals are likely involved in both aggregations; tagging data support this idea. With two whale shark aggregation areas, high coastal productivity and a previously-unknown scombrid spawning ground, the northeastern Yucatán marine region is a critical habitat that deserves more concerted conservation efforts.

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle dãAubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes. (AU)

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle dãAubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes. (AU)

Protesis total de cadera tras la falla de la osteotomia intertrocanterea de femur / Total hip arthroplasty after failed interthrochanteric osteotomy

Introduccion: Son bien conocidas las complicaciones y la incidencia de infecciones a corto plazo cuando se coloca una protesis total de cadera (PTC) despues de una osteotomia intertrocanterea de femur, pero no ocurre lo mismo con la experiencia a largo plazo. En el presente trabajo relatamos nuestra experiencia con 63 caderas intervenidas por presentar una falla de la osteotomia intertrocanterea con la colocacion de una PTC. Materiales y metodos: Se trataron en nuestro hospital 63 osteotomias intertrocantereas en 58 pacientes (35 mujeres y 23 varones) con una media de edad de 44,5 años (rango, 23 y 66 años) con la colocacion de una protesis de cadera tras la falla de una osteotomia intertrocanterea con avance de la coxartrosis. El seguimiento fue de 7,27 años (rango, 2-22 años). Los pacientes tenian osteotomia de varizacion en 31 casos, osteotomia de valguizacion en 17 casos y osteotomia de translacion en 15 casos. Resultados: En el seguimiento, 8 pacientes precisaron cirugia de revision de la PTC colocada, en 3 casos por infeccion de la protesis, en 4 casos por aflojamiento aseptico de la protesis y en un caso por sufrir una fractura periprotesica que requirio osteosintesis de la fractura. Los resultados al final del seguimiento fueron buenos en 42 pacientes (66,66 por ciento), con 16-18 puntos del baremo de Merle d’Aubigne, regulares en 17 casos (26,98 por ciento) y malos en 4 casos (6,34 por ciento). Conclusiones: La osteotomia intertrocanterea es un buen tratamiento de la coxartrosis en los pacientes jovenes.