[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

[Epiphyseal fracture of the second metatarsal in adolescents: report of two cases]. / Fractura epifisaria del segundo metatarsiano en adolescentes: reporte de dos casos.

Epiphyseal fractures of the metatarsal head are a rare entity specially as an isolated injury and is rarely seen in patients with skeletal immaturity. Due lack of documentation for this type of fracture, the treatment of choice is uncertain. The purpose of the present study is to present two cases and treatment of epiphyseal fracture of the second metatarsal head, to our knowledge there are no publications for this injury.

Las fracturas epifisarias de la cabeza metatarsiana son una entidad poco frecuente, principalmente cuando se presentan de forma aislada y en raras ocasiones se ven en pacientes con inmadurez esquelética. Debido a la escasez de documentación para este tipo de fractura, el tratamiento de elección es incierto. El motivo del presente estudio es presentar dos casos de fractura epifisaria de la cabeza del segundo metatarsiano y su tratamiento, ya que para nuestro conocimiento no hay publicaciones al respecto.

[Anterior sternoclavicular dislocation, description of surgical technique]. / Luxación esternoclavicular anterior, descripción de técnica quirúrgica.

Sternoclavicular joint dislocation is an uncommon injury and is usually consequential to high-energy trauma. These can be classified as anterior or retro-sternal (posterior) dislocation. Sometimes they can be accompanied by injury to large vessels due to their anatomical proximity mainly retrosternal. Conceptually closed reduction is indicated as the first line of treatment in acute injuries and open reduction tends to be for failing the previous one. We present a case of anterior clavicular sternal dislocation, with recurrence after closed reduction under anesthesia and surgically operated with reconstruction and allograft use with favorable evolution six years after its surgical procedure.

La luxación esternoclavicular es una lesión poco frecuente y generalmente es consecuente a traumatismos de alto impacto. Éstas se pueden clasificar como luxaciones anteriores o retroesternales. En ocasiones pueden ser acompañadas de lesión a grandes vasos debido a su proximidad anatómica, principalmente las retroesternales. Conceptualmente la reducción cerrada está indicada como primera línea de tratamiento en fase aguda y la reducción abierta tiende a ser de segunda intención. Presentamos un caso de luxación esternoclavicular anterior, con recidiva posterior a reducción cerrada bajo anestesia e intervenido quirúrgicamente con reconstrucción y uso de aloinjerto con favorable evolución a seis años de su procedimiento quirúrgico.

Mitogenome of the blood feeding leech Haementeria acuecueyetzin (Hirudinida: Glossiphoniidae) from Tabasco, Mexico.

Here, we present the mitogenome of the blood feeding leech Haementeria acuecueyetzin (Hirudinida: Glossiphoniidae) based on specimens collected in Tabasco, Mexico. The circular genome is 14,985 bp in length, and consists of 13 protein-coding genes, 22 tRNA genes, two rRNA genes, and an AT-rich control region. Phylogenetic analysis based on the 13 protein-coding genes and two rRNA genes places H. acuecueyetzin sister to H. officinalis within the family Glossiphoniidae. Mitochondrial gene order in H. acuecueyetzin is consistent with other members of Clitellata with no evidence of gene gain/loss, duplication, or rearrangement.

[Early detection and stability of diagnosis in autism spectrum disorders]. / Deteccion precoz y estabilidad en el diagnostico en los trastornos del espectro autista.

INTRODUCTION: Early intervention for children with an autism spectrum disorder (ASD) depends on early and reliable detection. In general, diagnosis is stable, but evidence shows the need to go deeper into the factors that influence this stability. PATIENTS AND METHODS: A sample of 142 children with ASD (118 boys and 24 girls) with a median of 33 months of age and an interquartile range of 12 in the first evaluation. In the follow-up the median was 47 months and an interquartile range of 29. The following tests were applied to evaluate the children: Merrill-Palmer Scale-R, Leitter-R, WIPPSI-III, WISC-R and WISC-IV; as well as Vineland Scale and ADOS-G, based on clinical diagnosis to DSM-IV-R and DSM-5. For the evaluation of the diagnostic stability, contingency tables were performed for diagnostic assessments based on clinical judgment and the results of the ADOS-G. Repeated measures ANOVA was used to analyze the differences between measures of cognitive functioning, adaptive behavior and diagnosis. RESULTS: The clinical diagnosis based on DSM-IV-TR, DSM-5 and clinical judgment remains stable over time in 96% of cases. If the diagnostic stability is measured based on the results of ADOS-G (n = 30), 87% of cases diagnosed maintained the diagnosis. The ANOVA showed statistically significant differences for measures of within-subject factors and global social age, but not for diagnosis. CONCLUSION: The diagnostic stability can be improved by utilizing clinical judgment and the participation of a multidisciplinary team.

TITLE: Deteccion precoz y estabilidad en el diagnostico en los trastornos del espectro autista.Introduccion. La intervencion temprana en los niños con un trastorno del espectro autista (TEA) depende de una deteccion precoz y fiable. Aunque de manera general se habla de un diagnostico estable, se ha evidenciado la necesidad de profundizar mas en los factores que influyen en dicha estabilidad. Pacientes y metodos. Los participantes de la muestra fueron 142 menores con TEA (118 varones y 24 mujeres), con una mediana de 33 meses y un recorrido intercuartilico de 12 en la primera evaluacion, y con una mediana de 47 meses y un recorrido intercuartilico de 29 en el seguimiento. Los diagnosticos se realizaron con las siguientes pruebas: escala Merrill-Palmer revisada, escala de Leiter revisada, escala de inteligencia de Wechsler para preescolar y primaria III y escala de inteligencia de Wechsler para niños revisada y IV; ademas de la escala Vineland y la escala de observacion diagnostica del autismo generica (ADOS-G), basandose el diagnostico clinico en los criterios diagnosticos del Manual diagnostico y estadistico de los trastornos mentales, cuarta edicion, texto revisado (DSM-IV-TR), y quinta edicion (DSM-5). Para la evaluacion de la estabilidad diagnostica, se realizaron tablas de contingencia para las valoraciones del diagnostico en funcion del juicio clinico y los resultados de la ADOS-G. Resultados. El diagnostico clinico basado en los criterios del DSM-IV-TR, el DSM-5 y el juicio clinico se mantiene estable a traves del tiempo en un 96% de los casos. Si se valora la estabilidad diagnostica teniendo en cuenta los resultados del ADOS-G (n = 30), el 87% de los casos mantiene el diagnostico. El ANOVA muestra diferencias estadisticamente significativas para las medidas del factor intrasujeto del cociente intelectual y la edad social global, pero no para el diagnostico. Conclusiones. La estabilidad diagnostica se beneficia de un uso informado del criterio clinico y de la participacion de un equipo multidisciplinar.

CO2 capture systems based on saccharides and organic superbases.

In this report, novel systems, based on highly abundant saccharides, D-mannose, D-glucose, ß-cyclodextrin, alginic acid and mannitol, in combination with an organic superbase, tetramethylguanidine (TMG) or 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU), are studied for carbon dioxide capture. With D-mannose and D-glucose, several ratios of equivalents of alcohol groups of saccharide : superbase were tested: 1, 0.625, 0.5 and 0.25. High wt% values of CO2 uptake were obtained with TMG-based systems. However, TMG itself can react directly with CO2, and, in the presence of D-mannose, competition between carbonate and carbamate based products was established. In order to circumvent this competition and obtain exclusively the carbonate-based product, DBU was used instead as an organic superbase. In the D-mannose series the highest result was obtained with a D-mannose : DBU ratio eq. = 0.625 (13.9% CO2 uptake, 3.3/5 alcohol groups converted into carbonates). A more effective stirring system, designed to overcome the high viscosity of the products, allowed the use of a D-glucose : DBU = 1 : 1 ratio with 11.5 wt% of CO2 uptake and 2.47/5 alcohol groups converted into carbonates. Additionally a DSC thermal study was performed in order to study the stability/reversibility of the CO2 loaded systems.

Testes fitoquímicos em extratos foliares de Oeceoclades maculata Lindl. (Orchidaceae) / Phytochemical tests in Oeceoclades maculata Lindl. (Orchidaceae) leaf extracts

O presente trabalho teve por objetivo determinar a capacidade antioxidante de Oeceoclades maculata. A atividade foi determinada de acordo com a capacidade do extrato hidroalcoólico das folhas reduzir o radical DPPH. Os resultados obtidos permitem concluir que os conteúdos de polifenóis e flavonas/flavonóis são maiores no extrato preparado a frio (EBHF) do que no extrato preparado a quente (EBHQ), sugerindo que o aquecimento usado na preparação do extrato altera esses componentes ativos. Portanto, para esta espécie deve ser realizado o método de extração a frio para conservar as substâncias que possuem atividade antioxidante.

This work aimed to determine the antioxidant capacity of Oeceoclades maculata. The antioxidant activity was determined in accordance with the ability of the hydroalcoholic extract of the leaves to reduce the DPPH radical. The results showed that the polyphenol and flavonoid contents are greater in the cold extract (EBHF) than in the hot extract (EBHQ), which suggests that the heating effect in the preparation of the extract modifies these active compounds. Therefore, for this species, the cold extraction method must be carried in order to conserve the substances with antioxidant activity.

[Palivizumab for respiratory syncytial virus disease]. / Terapia con palivizumab nell'infezione da virus respiratorio sinciziale.

AIM: Palivizumab (Synagis, Abbott) is a humanized monoclonal antibody of IgG class currently used for prophylaxis of respiratory syncytial virus (RSV) infection. It neutralises the protein F of RSV, which allows the virus to penetrate inside the host cell and subsequently to form syncytia, causing clinical manifestations. Based on that, our aim was to assess if an early administration of palivizumab during RSV infection could positively modify the infection course, hence providing a therapeutic effect. METHODS: The study included eight infants hospitalized with a case history suggestive of severe RSV which made the use of oxygen therapy and, in five cases, mechanical ventilation necessary. The diagnosis was confirmed by the isolation of the virus in the nasopharyngeal aspirate; for all of them informed consent was obtained by the parents. All infants were treated with palivizumab (15 mg/kg i.m. in a single dose). RESULTS: All infants showed a significant clinical improvement and a fast recovery, with a consequent precocious dismissal. After 7 days, 6 infants had a negative nasopharyngeal aspirate. Palivizumab administration at the onset of RSV infection seems to work as a therapy. CONCLUSION: The limited number of the patients does not allow to formulate definitive conclusions but the present study suggests the usefulness of verifying these positive results through randomised controlled studies.

B lymphocyte subsets and their functional activity in the early months of life.

In the present study we evaluated B-cell subsets and their functional development in 74 newborns from birth to 6 months of life. Moreover, we evaluated natural antibody production in vitro. The results documented a predominance of naive B-lymphocytes at all time-points evaluated, decreasing from birth to 6 months (p=0.009). The percentages of CD27+IgD+ and CD27+IgDneg memory B-cells were very low at birth and significantly increased only at 6 months (p=0.02 and p less than 0.001, respectively). We found a significant increase only in in vitro stimulated IgG production at 6 months as compared to birth (p less than 0.001). Moreover, a lower secretion of anti-Pn IgM antibodies up to 6 months of age, as compared to controls was observed. Our results underline that the susceptibility and severe course of infection in the neonate can be attributed, at least in part, to the lack of pre-existing immunological memory and competent adaptive immunity.

Species differences in group size and electrosensory interference in weakly electric fishes: implications for electrosensory processing.

In animals with active sensory systems, group size can have dramatic effects on the sensory information available to individuals. In "wave-type" weakly electric fishes there is a categorical difference in sensory processing between solitary fish and fish in groups: when conspecifics are within about 1m of each other, the electric fields mix and produce interference patterns that are detected by electroreceptors on each individual. Neural circuits in these animals must therefore process two streams of information-salient signals from prey items and predators and social signals from nearby conspecifics. We investigated the parameters of social signals in two genera of sympatric weakly electric fishes, Apteronotus and Sternopygus, in natural habitats of the Napo River valley in Ecuador and in laboratory settings. Apteronotus were most commonly found in pairs along the Napo River (47% of observations; maximum group size 4) and produced electrosensory interference at rates of 20-300 Hz. In contrast, Sternopygus were alone in 80% of observations (maximum group size 2) in the same region of Ecuador. Similar patterns were observed in laboratory experiments: Apteronotus were in groups and preferentially approached conspecific-like signals in an electrotaxis experiment whereas Sternopygus tended to be solitary and did not approach conspecific-like electrosensory signals. These results demonstrate categorical differences in social electrosensory-related activation of central nervous system circuits that may be related to the evolution of the jamming avoidance response that is used in Apteronotus but not Sternopygus to increase the frequency of electrosensory interference patterns.

Electrosensory interference in naturally occurring aggregates of a species of weakly electric fish, Eigenmannia virescens.

The detection and identification of behaviorally relevant signals in the presence of competing signals in the environment is a major challenge of animal sensory systems. In weakly electric fish such as Eigenmannia virescens, the interactions between the autogenous electric field and the electric fields of nearby conspecifics can have profound effects on the perception of other behaviorally relevant electrosensory information. To better understand the natural signals that the nervous system of Eigenmannia experiences during the processing of electrosensory information, we examined the electrosensory milieu of Eigenmannia in the wild and in the laboratory. Recordings of the electric fields of Eigenmannia were made in 'black' and 'white' waters near the Napo River in eastern Ecuador. Fourier analysis revealed that Eigenmannia typically experience the electric fields of three to five conspecifics during the day and night in each habitat. The median difference in electric organ discharge frequencies between nearby Eigenmannia during the day was 23 Hz in black water habitats, 41 Hz in white water, and 37 Hz at night in both habitats: these signals are known to activate tuberous electroreceptors and downstream CNS circuits. There was no correlation between the number of individual Eigenmannia detected at recording sites and electric organ discharge frequencies. Further, Eigenmannia apparently do not maximize the frequency differences between conspecifics. In laboratory studies fish were preferentially observed in aggregates of two fish or more. Aggregate sizes observed in the laboratory were similar to those in the wild.

Reparation of a severe case of aplasia cutis congenita with engineered skin.

Aplasia cutis congenita (ACC) is an uncommon congenital malformation. It is characterized by defects of the skin that occur most frequently on the scalp along the midline, but can also be localized on the trunk, face and limbs, usually with a symmetrical distribution. When it is localized in the skull it can extend to the dura mater, leaving only the thin pia mater to protect the brain. The most common complications related to this disorder are infection, hemorrhage, and, in defects localized on the vertex, meningitis and bleeding from the sagittal sinus can occur with dramatic consequences. In those cases some authors suggest the use of local flaps even if this implies a surgical procedure. In this case a 2.540-kg baby was delivered at 40 weeks of gestation by eutocic delivery, and good adaptation to extrauterine life. At birth the baby showed a large cutaneous and osseous defect at the vertex measuring 68 cm(2), equal to almost one third of the calvarial surface, and extended to the dura mater through which it was possible to see the sagittal sinus and the brain surface with its vessels. Skull X-rays showed loss of normal radioopacity of the cranial vault with lack of ossification especially at the parietal level. In our patient we therefore decided to use a composite graft of cultured autologous fibroblasts and keratinocytes to provide coverage, avoiding any surgical procedure and patient morbidity. This technique consists first in an autograft of cultured fibroblasts which has proved to promote the production of type IV collagen, fibronectin and laminin whereby creating an ideal bed for the taking of the graft of cultured keratinocytes, to be put in place a week later. The use of a composite graft with both the derma-like and epithelial components has been also suggested to diminish scarring. Two months after the last graft area was completely closed.

A Bayesian network for diagnosis of primary bone tumors.

The authors developed a Bayesian network to differentiate among five benign and five malignant neoplasms of the appendicular skeleton using the patient's age and sex and 17 radiographic characteristics. In preliminary evaluation with physicians in training, the model identified the correct diagnosis in 19 cases (68%), and included the correct diagnosis among the two most probable diagnoses in 25 cases (89%). Bayesian networks can capture and apply knowledge of primary bone neoplasms. Further testing and refinement of the model are underway.

A case of non-immune hydrops fetalis with congenital cystic adenomatoid malformation of the left lung in a twin.

Hydrops fetalis is a rare condition that occurs in one out of every 1,400-4,000 pregnancies. There are two types, immune and non-immune. It can be caused by a maternal-fetal incompatibility due to the Rh factor or, more rarely, the Kell factor or due to other antigens to red corpuscles. Non-immune types of hydrops have a complex multiform pathogenesis and in 50% of the cases they are of idiopathic nature. The causes that could determine non-immune hydrops are manifold and in 50% of the cases they are of an idiopathic nature. Independently of the clinical condition, the presented case could be classified in those forms of pathogenesis in which there is the presence of a congenital cystic adenomatoid malformation (CAM), not encountered in the fetal ultrasound performed at the sixteenth week of pregnancy. The particularity of our case is due to the association of the fetal hydrops of the CAM type in only one of the two twins. The presented case is classified in those forms of hydrops that are expressed with a clinical trend towards a worse prognosis, characterized by the intrauterine death of the fetus or the birth of a hydropic fetus that does not survive because of respiratory insufficiency and cardiocirculatory collapse.

Reactive oxygen intermediates and eicosanoid production by kupffer cells and infiltrated macrophages in acute and chronic liver injury induced in rats by CCl4.

OBJECTIVE AND DESIGN: The aim of the present study was to characterize during acute and chronic liver injury induced by CCl4, macrophage phenotypes and whether a change in reactive oxygen intermediates (ROI) and eicosanoids production by Kupffer cells (KC) was observed. MATERIAL AND METHODS: Liver steato-necrosis and cirrhosis were induced in rats after 3 weeks and 9 weeks of CCl4 intoxication, respectively. Monocytes and tissue macrophages were identified by immunohistochemical study using monoclonal antibodies ED-1 and tissue macrophages using the antibody ED-2. The release of ROI and eicosanoids in response to the phorbol ester TPA (protein kinase activator) and to the calcium ionophore A23187 was assessed in cultivated cells. RESULTS: As compared to healthy controls, livers of rats with steato-necrosis or cirrhosis exhibited a significant increase of ED-1 and ED-2 positive cells. Only KC from rats with liver steato-necrosis were found to have higher A23187, TPA + A23187 or opsonized zymosan induced ROI production than healthy controls (p < 0.01). After TPA + A23187 or opsonized zymosan stimulation, KC from both rats with steato-necrosis or cirrhosis produced more TxB2 and leukotrienes and less PGE2 as compared to healthy controls (p <0.05). CONCLUSIONS: These results suggest an influx of monocytes into the liver during acute and chronic injury induced by CCl4. Functional changes of this inflammatory infiltrate have been demonstrated with an increase of ROI production only in the early stage of liver injury whereas a rise in KC leukotriene production and an imbalance between cytoprotective and cytotoxic prostanoids were observed at all stages of liver disease.

Hindfoot coronal alignment: a modified radiographic method.

Accurate clinical evaluation of the alignment of the calcaneus relative to the tibia in the coronal plane is essential in the evaluation and treatment of hindfoot pathologic condition. Previously described radiographic views of the foot and ankle do not demonstrate the true coronal alignment of the calcaneus relative to the tibia. Some of these views impose on the patient an unnatural posture that itself changes hindfoot alignment, whereas other methods distort the coronal alignment by the angle of the x-ray beam. Our purpose was to develop a modified radiographic view and measurement method for determining an angular measurement of hindfoot coronal alignment based on a cadaver study of the radiographic characteristics of the calcaneus and motion analysis of standing subjects. The view was obtained by having the subject stand on a piece of cardboard to create a foot template. The template was then positioned so that each foot was x-rayed perpendicular to the cassette while still maintaining the natural base of support. A method using multiple ellipses was developed to determine more accurately the coronal axis of the posterior calcaneus. A study using cadavers was performed in which radio-opaque markers were placed on multiple bony landmarks on the calcaneus. The tibia was held fixed in a vertical position, and the foot was x-rayed using the above techniques in different degrees of rotation without changing the relation of the calcaneus to the tibia. The radiographs of the modified Cobey and our view were examined to verify which markers were visible at different angles of rotation and how the hindfoot alignment measurements changed with foot rotation. To define further the differences between the views, an analysis of postural stability was conducted while the subjects were standing with the feet in the positions for imaging both the Buck modification of the Cobey view and our hindfoot alignment view. The combined results of the cadaver, radiographic measurement, and postural stability segments of the study reveal that this coronal hindfoot alignment view and measurement method is reproducible, more closely measures "true" coronal hindfoot alignment, and is more clinically applicable because the alignment is measured while the patient is standing with a normal angle and base of stance. The modified radiographic measurement method relies on posterior calcaneal anatomic landmarks, is less affected by rotation of the foot and ankle, and is reproducible between observers.

Expression of TNF-alpha and immunohistochemical distribution of hepatic macrophage surface markers in carbon tetrachloride-induced chronic liver injury in rats.

In liver injury induced by carbon tetrachloride, secondary hepatic injury occurs from inflammatory processes originating from products released by activated Kupffer cells, which play a central role in hepatic inflammation. The purpose of our study was to demonstrate, in rats, the relationships between a function of the hepatic macrophages, TNF-alpha production and the state of activation of these cells, characterized by their phenotype, in the different phases of the process and development of fibrosis in a carbon tetrachloride-induced cirrhosis model. The immunohistochemical localization of proinflammatory cytokine TNF-alpha and surface surface makers (ED1 and ED2) was studied in hepatitis and cirrhosis in response to 3 and 9 weeks ingestion of carbon tetrachloride. After carbon tetrachloride ingestion, accompanying the increased necrosis, immunohistochemical analysis of liver tissue sections demonstrated the significantly increased number of cells expressing ED1, ED2 and TNF-alpha, compared to normal. The number of cells expressing the surface phenotypic markers of liver macrophages increased and this change was concomitantly associated with an increased cellular expression of TNF-alpha. Local macrophage proliferation and influx of newly recruited blood monocytes resulted in an increase of the macrophage population. The populational changes involved difference in functional activity and enhanced TNF-alpha expression. This cytokine expressed in the carbon tetrachloride-induced inflammatory process is associated with the development of fibrosis and may contribute to disease severity.

[Archetypal aspects of aging: from Eros to Thanatos]. / Aspectos arquetípicos del envejecimiento: del Eros al Tánatos.

From a Junguian point of view, the different archetypal roles of the aging process, along the life cycle, are studied: eros, puer, logos, hero, persona, mascara, anima, animus, king, warrior, magician, lover, mother, virgin, afrodite, witch, self, senex, shadow, tanatos.