Combined Vertebral Augmentation for Vertebral Body Fracture With Contraindications for Traditional Techniques.

INTRODUCTION AND OBJECTIVE: A vertebral compression fracture (VCF) can be found in trauma, osteoporosis, and tumor pathology. The most frequent is the pathological fracture in osteoporotic vertebrae in the elderly. Percutaneous techniques of vertebral cementation allow treatment of A1-A2 AO spine fractures, improving pain control and spine stabilization and decreasing mobility and mortality. Traditionally, the selection of patients is fundamental for spine surgery success, with an absolute contraindication being posterior wall involvement (A3-A4 AO spine fractures) or VCF with a loss of height greater than 50%. In this report, we present a variant surgical technique combining percutaneous spine surgery with cementoplasty for patients with classical spine surgery contraindications. METHODS: Five patients with complex symptomatic VCF or A3-A4 AO spine fractures in pathologic bone with MRI short tau inversion recovery (STIR) sequence (+) were operated on with a combined technique (percutaneous kyphoplasty (KP) and vesselplasty). The visual analog scale (VAS) was used to measure postoperative pain. RESULTS: The procedure was performed within 60 days of the fracture in all patients. The mean hospital stay was two days. No patient developed major complications. All the patients had a satisfactory clinical (improvement in pain control) and radiological response at the perioperative period and at a 30-day follow-up. CONCLUSIONS: The combined percutaneous technique allows surgical resolution of cases previously considered contraindicated, especially in elderly patients and those with comorbidities, without involving higher cost, complications, surgical time, and hospital stay. We suggest a novel, safe, and effective variation of the vertebral cementoplasty technique.

[Lupus enteritis. Report of one case]. / Dificultades en el diagnóstico de enteritis lúpica: presentación de un caso.

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.

Dificultades en el diagnóstico de enteritis lúpica: presentación de un caso / Lupus enteritis: report of one case

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.

Unrestricted generation of pure two-qubit states and entanglement diagnosis by single-qubit tomography.

We present an experimental proof-of-principle for the generation and detection of pure two-qubit states that have been encoded in degrees of freedom that are common to both classical-light beams and single photons. Our protocol requires performing polarization tomography on a single qubit from a qubit pair. The degree of entanglement in the qubit pair is measured by concurrence, which can be directly extracted from intensity measurements-or photon counting-entering single-qubit polarization tomography.

Experimental display of the extended polarization coherence theorem.

We report experimental results that show the interplay between visibility, distinguishability, and the degree of polarization, as ruled by a recent extension of the polarization coherence theorem (PCT). Theorems of this kind address duality in both quantum and classical scenarios. We particularly focus on the inherent vector nature of the polarization degree of freedom and display various effects that lie beyond the scope of the original PCT. Our results exhibit features that can be shared by quantum and classical phenomena, whenever these phenomena reflect some hidden or exposed coherence.

Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. / Prevalencia de esofagitis eosinofílica: estudio multicéntrico en población pediátrica evaluada en 36 centros de gastroenterología de América Latina.

INTRODUCTION AND OBJECTIVE: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

Orbital angular momentum symmetry in a driven optical parametric oscillator.

We investigate the dynamics of a driven optical parametric oscillator under the injection of orbital angular momentum. The injected mode is adiabatically driven through arbitrary transformations on the Poincaré sphere of first-order paraxial beams. As a result, the down-converted beam conjugated to the seed is shown to follow a path imposed by a nontrivial symmetry on the Poincaré sphere. This symmetry allows controllable distinguishability between the spatial modes of the down-converted beams. In this Letter, we provide convincing experimental evidence of this effect.

Use of cryopreserved umbilical cord with negative pressure wound therapy for complex diabetic ulcers with osteomyelitis.

OBJECTIVE: The objective of this study was to evaluate the combined use of cryopreserved human umbilical cord (cUC) allograft and negative pressure wound therapy (NPWT) in treating complex diabetic foot ulcers (DFUs) with bone exposure and osteomyelitis. These types of wound are known to carry a high morbidity and mortality. METHODS: A single-center, retrospective chart review was performed to assess the efficacy of the combined use of cUC with NPWT, by the same surgeon, to help promote the closure of complex DFUs presenting with biopsy-proven osteomyelitis. Change in wound size and volume, time to wound closure, and number of cUC applications were assessed. RESULTS: We identified of 14 wounds in 13 patients, with an average initial wound area of (mean±standard devaition) 33.2±21.7cm2 and wound volume of 52±26.2cm3. All achieved complete re-epithelialisation with an average time to closure of 24.0±10.9 weeks, using between 2-5 cUC applications. No adverse events were noted and none of the wounds required limb amputation during the a follow-up of 24 months for each patient. CONCLUSION: The results suggest that combined use of cUC and NPWT may be effective in improving the healing of complex DFUs that present with osteomyelitis. Prospective, randomised controlled trials are warranted to confirm this efficacy as well as its potential applications in other chronic wounds.

Aerosol transmission of foot-and-mouth disease virus Asia-1 under experimental conditions.

Foot-and-mouth disease virus (FMDV) control measures rely on understanding of virus transmission mechanisms. Direct contact between naïve and infected animals or spread by contaminated fomites is prevented by quarantines and rigorous decontamination procedures during outbreaks. Transmission of FMDV by aerosol may not be prevented by these control measures and this route of transmission may allow infection of animals at distance from the infection source. Understanding the potential for aerosol spread of specific FMDV strains is important for informing control strategies in an outbreak. Here, the potential for transmission of an FMDV Asia 1 strain between pigs and cattle by indirect aerosol exposure was evaluated in an experimental setting. Four naïve calves were exposed to aerosols emitted from three infected pigs in an adjacent room for a 10h period. Direct contact between pigs and cattle and fomite transfer between rooms was prevented. Viral titres in aerosols emitted by the infected pigs were measured to estimate the dose that calves were exposed to. One of the calves developed clinical signs of FMD, whilst there was serological evidence for spread to cattle by aerosol transmission in the remaining three calves. This highlights the possibility that this FMDV Asia 1 strain could be spread by aerosol transmission given appropriate environmental conditions should an outbreak occur in pigs. Our estimates suggest the exposure dose required for aerosol transmission was higher than has been previously quantified for other serotypes, implying that aerosols are less likely to play a significant role in transmission and spread of this FMDV strain.

Procedimiento de frenotomía en infantes con láser / Frenectomy procedure in infants with laser

La anquiloglosia es una anormalidad congénita relativamente común del frenillo lingual, que impide los movimientos adecuados de la lengua y causa disturbios motores en este órgano. Esta alteración ocurre en 0.02% al 4.8% de los recién nacidos y está asociado en un 25% a 60% de dificultades durante el amamantamiento.El propósito del presente reporte de caso es mostrar las aplicaciones del Sistema Láser de Diodo Infrarrojo (940nm) para simplificar el abordaje quirúrgico de la anquiloglosia lingual en infantes y sus ventajas frente a la técnica convencional. (AU)

Ankyloglossia is a relatively common congenital abnormality of the lingual frenum that prevents tonge movements and causes motor disturbances in this organ. This alteration occurs in 0.02% to 4.8% of newborns and associated with 25% to 60% incidence of difficulties with breastfeeding.The purpose of this case report is to show applications of infrared Diode Laser System (940nm) to simplify the surgical approach lingual ankyloglossia in infants and its advantages over the conventional technique. (AU)

Experimental pig-to-pig transmission dynamics for African swine fever virus, Georgia 2007/1 strain.

African swine fever virus (ASFV) continues to cause outbreaks in domestic pigs and wild boar in Eastern European countries. To gain insights into its transmission dynamics, we estimated the pig-to-pig basic reproduction number (R 0) for the Georgia 2007/1 ASFV strain using a stochastic susceptible-exposed-infectious-recovered (SEIR) model with parameters estimated from transmission experiments. Models showed that R 0 is 2·8 [95% confidence interval (CI) 1·3-4·8] within a pen and 1·4 (95% CI 0·6-2·4) between pens. The results furthermore suggest that ASFV genome detection in oronasal samples is an effective diagnostic tool for early detection of infection. This study provides quantitative information on transmission parameters for ASFV in domestic pigs, which are required to more effectively assess the potential impact of strategies for the control of between-farm epidemic spread in European countries.

The Acute Effect of Fast and Slow Stepping Cadence on Regional Vascular Function.

The aim of this study was to determine if stepping cadence when controlling for total steps has a differential impact on regional vascular function. 16 young adults (21±2 years) performed fast (125 steps per min) and slow (80 steps per min) walking for a total of 3 000 steps on separate days. Doppler ultrasound was used to measure compliance, blood flow and shear rate of the common carotid artery and superficial femoral artery before walking and at 30 and 60 min after walking. Carotid compliance was significantly (p<0.05) elevated 60 min after fast (17.1±25.9%) and slow (24.1±27.3%) walking with no difference between cadences. Both fast and slow walking failed to increase femoral compliance, despite significant (p<0.05) dilation in the femoral artery that was observed at 30 (4.2±3.9%) and 60 min (3.9±5.4%) after fast walking. Consistent with this latter finding, femoral blood flow and shear rate were significantly (p<0.05) increased at 30 min after fast walking. These results indicate that a single bout of walking at a fast or slow stepping cadence increases compliance of large elastic arteries but has no acute effect on compliance of peripheral (leg) arteries.

A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study.

BACKGROUND: Diabetic neuropathy is a common and often debilitating condition for which available treatments are limited. Because a low-fat plant-based diet has been shown to improve glycemic control in individuals with type 2 diabetes, we hypothesized that such a diet would reduce painful symptoms of diabetic neuropathy. METHODS: In this 20-week pilot study, individuals with type 2 diabetes and painful diabetic neuropathy were randomly assigned to two groups. The intervention group was asked to follow a low-fat, plant-based diet, with weekly classes for support in following the prescribed diet, and to take a vitamin B12 supplement. The control group was asked to take the same vitamin B12 supplement, but received no other intervention. At baseline, midpoint and 20 weeks, clinical, laboratory and questionnaire data were collected. Questionnaires included an analog 'worst pain' scale, Michigan Neuropathy Screening Instrument, global impression scale, Short Form McGill Pain Questionnaire, Neuropathy Total Symptom Score, a weekly pain diary and Norfolk Quality of Life Questionnaire. RESULTS: After 20 weeks, body weight change with the intervention was -6.4 kg (95% confidence interval (CI) -9.4 to -3.4, P<0.001) in an effect size analysis. Electrochemical skin conductance in the foot improved by an average of 12.4 microseimens (95% CI 1.2-23.6, P=0.03) with the intervention in an effect size analysis. The between-group difference in change in pain, as measured by the McGill pain questionnaire, was -8.2 points (95% CI -16.1 to -0.3, P=0.04). Michigan Neuropathy Screening Instrument questionnaire score change was -1.6 points (95% CI -3.0 to -0.2, P=0.03). CONCLUSIONS: Improvements were seen in some clinical and pain measures. This pilot study suggests the potential value of a plant-based diet intervention, including weekly support classes, for treating painful diabetic neuropathy.

The Acute Respiratory Distress Syndrome: Mechanisms and Perspective Therapeutic Approaches.

Acute Respiratory Distress Syndrome (ARDS) is a severe lung inflammatory disorder with a 30-50% mortality. Sepsis and pneumonia are the leading causes of ARDS. On the cellular level there is pulmonary capillary endothelial cell permeability and fluid leakage into the pulmonary parenchyma, followed by neutrophils, cytokines and an acute inflammatory response. When fluid increases in the interstitium then the outward movement continues and protein rich fluid floods the alveolar spaces through the tight junctions of the epithelial cells. Neutrophils play an important role in the development of pulmonary edema associated with acute lung injury or ARDS. Animal studies have shown that endothelial injury appears within minutes to hours after Acute Lung Injury (ALI) initiation with resulting intercellular gaps of the endothelial cells. The Endothelial Cell (EC) gaps allow for permeability of fluid, neutrophils and cytokines into the pulmonary parenchymal space. The neutrophils that infiltrate the lungs and migrate into the airways express pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), and contribute to both the endothelial and epithelial integrity disruption of the barriers. Pharmacological treatments have been ineffective. The ARDS Network trial identified low tidal volume mechanical ventilation, positive end expiratory pressure and fluid management guidelines that have improved outcomes for patients with ARDS. Extracorporeal membrane oxygenation is used in specialized centers for severe cases. Prone positioning has recently proven to have significantly decreased ventilator days and days in the intensive care unit. Current investigation includes administration of mesenchymal stem cell therapy, partial fluid ventilation, TIP peptide nebulized administration and the continued examination of pharmacologic drugs.

Within herd transmission and evaluation of the performance of clinical and serological diagnosis of foot-and-mouth disease in partially immune cattle herds.

The control of foot-and-mouth disease (FMD) in vaccinated populations relies upon surveillance activities such as clinical inspections (CI) and serological monitoring. New evidence to refine current surveillance guidelines has been provided by evaluating (1) the diagnostic performance of CI and serological tests for detection of FMD virus (FMDV) non-structural proteins (NSP), and (2) the within-herd transmission of the virus in partially immune cattle. Data came from 23 affected herds during an epidemic of FMDV type O in Bolivia, in 2007. All cattle (n=957) in these herds were clinically inspected and serum samples were collected one month after the last animal with clinical signs was detected. Samples were tested for the presence of antibodies against NSP using the PANAFTOSA 3ABC-ELISA test and a subset of samples were tested using the enzyme-linked immunoelectrotransfer blot assay (EITB). Data from clinical and serological diagnoses were analysed using a Bayesian model. The sensitivity Se and specificity Sp of the tests, as well as the prevalence and the within-herd reproduction ratio R of FMDV were estimated. In addition, risk factors for infection were identified. The Se of CI, the 3ABC-ELISA and the EITB tests were estimated to be 0.30, 0.88 and 0.96 respectively. The estimated Sp, in the same order, were 0.88, 0.93 and 0.97. The within-herd prevalence of infected animals ranged from 0.04 to 0.91 and R ranged from 1.02 to 2.68. It was observed that cattle coming from areas with high vaccination coverage had a lower risk of becoming infected than home-bred cattle from the affected herds, where vaccination coverage was thought to be low. Although these estimates come from herds kept under specific conditions, they provide a reference for future surveillance design and can inform simulation models for surveillance and control of FMD in similar cattle populations.

Risk based surveillance for early detection of low pathogenic avian influenza outbreaks in layer chickens.

Current knowledge does not allow the prediction of when low pathogenic avian influenza virus (LPAIV) of the H5 and H7 subtypes infecting poultry will mutate to their highly pathogenic phenotype (HPAIV). This mutation may already take place in the first infected flock; hence early detection of LPAIV outbreaks will reduce the likelihood of pathogenicity mutations and large epidemics. The objective of this study was the development of a model for the design and evaluation of serological-surveillance programmes, with a particular focus on early detection of LPAIV infections in layer chicken flocks. Early detection is defined as the detection of an infected flock before it infects on average more than one other flock (between-flock reproduction ratio Rf<1), hence a LPAI introduction will be detected when only one or a few other flocks are infected. We used a mathematical model that investigates the required sample size and sampling frequency for early detection by taking into account the LPAIV within- and between-flock infection dynamics as well as the diagnostic performance of the serological test used. Since layer flocks are the target of the surveillance, we also explored whether the use of eggs, is a good alternative to sera, as sample commodity. The model was used to refine the current Dutch serological-surveillance programme. LPAIV transmission-risk maps were constructed and used to target a risk-based surveillance strategy. In conclusion, we present a model that can be used to explore different sampling strategies, which combined with a cost-benefit analysis would enhance surveillance programmes for low pathogenic avian influenza.

Ras regulates kinesin 13 family members to control cell migration pathways in transformed human bronchial epithelial cells.

We show that expression of the microtubule depolymerizing kinesin KIF2C is induced by transformation of immortalized human bronchial epithelial cells (HBEC) by expression of K-Ras(G12V) and knockdown of p53. Further investigation demonstrates that this is due to the K-Ras/ERK1/2 MAPK pathway, as loss of p53 had little effect on KIF2C expression. In addition to KIF2C, we also found that the related kinesin KIF2A is modestly upregulated in this model system; both proteins are expressed more highly in many lung cancer cell lines compared to normal tissue. As a consequence of their depolymerizing activity, these kinesins increase dynamic instability of microtubules. Depletion of either of these kinesins impairs the ability of cells transformed with mutant K-Ras to migrate and invade matrigel. However, depletion of these kinesins does not reverse the epithelial to mesenchymal transition (EMT) caused by mutant K-Ras. Our studies indicate that increased expression of microtubule destabilizing factors can occur during oncogenesis to support enhanced migration and invasion of tumor cells.