Elevation of IL-17 Cytokines Distinguishes Kawasaki Disease From Other Pediatric Inflammatory Disorders.

OBJECTIVE: Kawasaki disease (KD) is a systemic vasculitis of young children that can lead to development of coronary artery aneurysms. We aimed to identify diagnostic markers to distinguish KD from other pediatric inflammatory diseases. METHODS: We used the proximity extension assay to profile proinflammatory mediators in plasma samples from healthy pediatric controls (n = 30), febrile controls (n = 26), and patients with KD (n = 23), multisystem inflammatory syndrome in children (MIS-C; n = 25), macrophage activation syndrome (n = 13), systemic and nonsystemic juvenile idiopathic arthritis (n = 14 and n = 10, respectively), and juvenile dermatomyositis (n = 9). We validated the key findings using serum samples from additional patients with KD (n = 37) and febrile controls (n = 28). RESULTS: High-fidelity proteomic profiling revealed distinct patterns of cytokine and chemokine expression across pediatric inflammatory diseases. Although KD and MIS-C exhibited many similarities, KD differed from MIS-C and other febrile diseases in that most patients exhibited elevation in one or more members of the interleukin-17 (IL-17) cytokine family, IL-17A, IL-17C, and IL-17F. IL-17A was particularly sensitive and specific, discriminating KD from febrile controls with an area under the receiver operator characteristic curve of 0.95 (95% confidence interval 0.89-1.00) in the derivation set and 0.91 (0.85-0.98) in the validation set. Elevation of all three IL-17-family cytokines was observed in over 50% of KD patients, including 19 of 20 with coronary artery aneurysms, but was rare in all other comparator groups. CONCLUSION: Elevation of IL-17 family cytokines is a hallmark of KD and may help distinguish KD from its clinical mimics.

Quality control-driven deep ensemble for accountable automated segmentation of cardiac magnetic resonance LGE and VNE images.

Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is the gold standard for non-invasive myocardial tissue characterisation. However, accurate segmentation of the left ventricular (LV) myocardium remains a challenge due to limited training data and lack of quality control. This study addresses these issues by leveraging generative adversarial networks (GAN)-generated virtual native enhancement (VNE) images to expand the training set and incorporating an automated quality control-driven (QCD) framework to improve segmentation reliability. Methods: A dataset comprising 4,716 LGE images (from 1,363 patients with hypertrophic cardiomyopathy and myocardial infarction) was used for development. To generate additional clinically validated data, LGE data were augmented with a GAN-based generator to produce VNE images. LV was contoured on these images manually by clinical observers. To create diverse candidate segmentations, the QCD framework involved multiple U-Nets, which were combined using statistical rank filters. The framework predicted the Dice Similarity Coefficient (DSC) for each candidate segmentation, with the highest predicted DSC indicating the most accurate and reliable result. The performance of the QCD ensemble framework was evaluated on both LGE and VNE test datasets (309 LGE/VNE images from 103 patients), assessing segmentation accuracy (DSC) and quality prediction (mean absolute error (MAE) and binary classification accuracy). Results: The QCD framework effectively and rapidly segmented the LV myocardium (<1 s per image) on both LGE and VNE images, demonstrating robust performance on both test datasets with similar mean DSC (LGE: 0.845±0.075; VNE: 0.845±0.071; p=ns). Incorporating GAN-generated VNE data into the training process consistently led to enhanced performance for both individual models and the overall framework. The quality control mechanism yielded a high performance (MAE=0.043, accuracy=0.951) emphasising the accuracy of the quality control-driven strategy in predicting segmentation quality in clinical settings. Overall, no statistical difference (p=ns) was found when comparing the LGE and VNE test sets across all experiments. Conclusions: The QCD ensemble framework, leveraging GAN-generated VNE data and an automated quality control mechanism, significantly improved the accuracy and reliability of LGE segmentation, paving the way for enhanced and accountable diagnostic imaging in routine clinical use.

Development of a Screening Algorithm for Lung Disease in Systemic Juvenile Idiopathic Arthritis.

OBJECTIVE: Lung disease (LD) is an increasingly recognized complication of systemic juvenile idiopathic arthritis (sJIA). As there are no currently available guidelines for pulmonary screening in sJIA, we sought to develop such an algorithm at our institution. METHODS: A multidisciplinary workgroup was convened, including members representing rheumatology, pulmonary, stem cell transplantation, and patient families. The workgroup leaders drafted an initial algorithm based on published literature and experience at our center. A modified Delphi approach was used to achieve agreement through three rounds of anonymous, asynchronous voting and a consensus meeting. Statements approved by the workgroup were rated as appropriate with moderate or high levels of consensus. These statements were organized into the final approved screening algorithm for LD in sJIA. RESULTS: The workgroup ultimately rated 20 statements as appropriate with a moderate or high level of consensus. The approved algorithm recommends pulmonary screening for newly diagnosed patients with sJIA with clinical features that the workgroup agreed may confer increased risk for LD. These "red flag features" include baseline characteristics (young age of sJIA onset, human leukocyte antigen type, trisomy 21), high disease activity (macrophage activation syndrome [MAS], sJIA-related ICU admission, elevated MAS biomarkers), respiratory symptoms or abnormal pulmonary examination findings, and features of drug hypersensitivity-like reactions (eosinophilia, atypical rash, anaphylaxis). The workgroup achieved consensus on the recommended pulmonary work-up and monitoring guidelines. CONCLUSION: We developed a pulmonary screening algorithm for sJIA-LD through a multidisciplinary consensus-building process, which will be revised as our understanding of sJIA-LD continues to evolve.

Prevalence and prognosis of anxiety, insomnia, and type D personality in patients with myocardial infarction: A Spanish cohort.

BACKGROUND: It has been suggested that patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) have more psycho-emotional disorders than patients with obstructive coronary artery disease (MICAD). The aim of this study is to compare the prevalence of anxiety, insomnia, and type D personality between MINOCA and MICAD and their impact on prognosis. METHODS: Patients with myocardial infarction undergoing coronary angiography were prospectively enrolled. Psychological questionnaires were completed by each patient during admission. RESULTS: Among a total of 533 patients, 56 had MINOCA and 477 had MICAD. There were no differences in the prevalence of anxiety and insomnia between both groups: trait anxiety median value (M) MINOCA = 18 (11-34) vs. MICAD M = 19 (12-27), p = 0.8; state anxiety MINOCA M = 19 (11-29) vs. MICAD M = 19 (12.2-26), p = 0.6; and insomnia MINOCA M = 7 (3-11) vs. MICAD M = 7 (3-12), p = 0.95. More MINOCA patients had type D personality (45.0% vs. 28.5%, p = 0.03). At 3-year follow-up, there were no differences in mortality between MINOCA and MICAD (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.28-2.17) in major adverse cerebral or cardiovascular events (MACCE) (HR 0.71, 95% CI 0.38-1.31). Scores of trait anxiety and negative affectivity were significantly associated with MACCE (HR 1.65, 95% CI [1.05-2.57]; HR 1.75, 95% CI [1.11-2.77], respectively). High insomnia levels were associated with greater mortality (HR 2.72, 95% CI [1.12-6.61]). CONCLUSIONS: Anxiety and insomnia levels were similar between patients with MINOCA and those with MICAD, whilst the prevalence of type D personality was higher in the MINOCA than in the MICAD group. Higher scores in trait anxiety, insomnia, and negative affectivity were related to a worse prognosis at 3-year follow-up.

Seropositividad a Chlamydophila psittaci en cotorras argentinas (Myiopsitta monachus) invasoras de la ciudad de Santiago de Chile

Introducción: Chlamydophila psittaci es una bacteria zoonótica e intracelular estricta, que provoca la psitacosis humana y su principal hospedero son las aves psitácidas. La cotorra argentina es un ave psitácida nativa de Sudamérica y actualmente considerada una especie invasora en 19 países, incluyendo Chile. Objetivo: Determinar positividad contra C. psittaci en muestras de suero y torulados de cotorras argentinas de vida libre capturadas en la Región Metropolitana de Chile. Métodos: Se analizaron 95 muestras de suero de pichones e individuos adultos de cotorras argentinas, a través de una prueba de ELISA indirecto utilizando un kit comercial. Posteriormente, se analizaron 40 tórulas nasotraqueales y cloacales de individuos adultos a través de una RPC en tiempo real específica para C. psittaci. Resultados: Se detectaron anticuerpos en muestras de suero de cinco individuos adultos de cotorras argentinas (n = 68), mientras que ninguno de los pichones analizados fue seropositivo (n = 27). Todas las muestras analizadas a través de RPC en tiempo real fueron negativas. Conclusión: Estos resultados demuestran por primera vez en Chile la exposición a C. psittaci en cotorras argentinas de vida libre, lo cual puede representar un riesgo importante para la transmisión de este patógeno a poblaciones humanas y animales.

Background: Chlamydophila psittaci is a zoonotic obligate intracellular bacterium that causes the human psittacosis, and its main host are psittacine birds. The monk parakeet is a psittacine bird native to South America, currently being considered an invasive species in 19 countries, including Chile. Aim: To determine positivity to C. psittaci in serum samples and swabs from free-ranging monk parakeets captured in the Metropolitan Region of Chile. Methods: Ninety-five serum samples from nestling chicks and adult monk parakeets were tested using an indirect ELISA test kit. Cloacal and nasotracheal swabs from 40 adult parakeets were further analyzed by C. psittaci-specific real-time PCR. Results: We found antibody titers in sera of five adult monk parakeets (n = 68) while none of the nestlings were seropositive (n = 27). All samples tested with real-time PCR were negative. Conclusions: Our results demónstrate for the first time in Chile the exposure to C. psittaci in free-ranging monk parakeets which may represent a significant risk of pathogen transmission to human and animal populations.

Incipient Wear Detection of Welding Gun Secondary Circuit by Virtual Resistance Sensor Using Mahalanobis Distance.

Wear of the secondary of the welding gun, caused by mechanical fatigue or due to a bad parameterization of the welding points, causes an increase in quality problems such as non-existent welds or a reduced weld nugget size. In addition to quality problems, this defect causes production stoppages that affect the final cost of the manufactured part. Different studies have focused on evaluating the importance of different welding parameters, such as current, in the final quality of the welding nugget. However, few studies have focused on preventing weld command parameters from degrading or changing. This investigation seeks to determine the wear of the secondary circuit to avoid variability in the current supplied to the welding point caused by this defect and the increase in circuit resistance, especially in industrial environments. In this work, a virtual sensor is developed to estimate the resistance of the welding arm based on previous research, which has shown the possibility of detecting secondary wear by analysing the duty cycle of the power circuit. From the data of the virtual sensor, an anomaly detection method based on the Mahalanobis distance is developed. Finally, an integral system for detecting secondary wear of welding guns in real production lines is presented. This system establishes performance thresholds based on the analysis of the Mahalanobis distance distribution, allowing monitoring of the secondary circuit wear condition after each welding cycle. The results obtained show how the system can detect incipient wear in welding guns, regardless of which part of the secondary the wear occurs, improving decision-making and reducing quality problems.

Real-Time Condition Monitoring System for Electrode Alignment in Resistance Welding Electrodes.

Electrode misalignment, produced by mechanical fatigue or bad adjustments of the welding gun, leads to an increase in expulsions, deformations and quality problems of the welding joints. Different studies have focused on evaluations of the influence of a misalignment of the electrodes and the final quality of the weld nugget. However, few studies have focused on determining a misalignment of the electrodes to avoid problems caused by this defect, especially in industrial environments. In this paper, a method for performing the condition monitoring of electrode alignment degradation was developed following previous research, which has shown the relationship between the misalignment of short-circuited electrodes and the magnetic field generated by them. This method was carried out by means of a device capable of measuring the magnetic field. Finally, an integral system for the detection of misalignments in real production lines is presented. This system set behavior thresholds based on the experimentation, allowing the condition monitoring of the alignment after each welding cycle.

Caracterización fenotípica y molecular de cepas de Klebsiella pneumoniae productores de carbapenemasas tipo OXA-48 circulantes en Chile

Introducción: La aparición y diseminación de Enterobacterales resistentes a carbapenémicos ha generado un gran impacto en las infecciones asociadas a la atención de salud en el mundo. Recientemente, en Chile se detectó un brote por Klebsiella pneumoniae productora de carbapenemasas tipo oxacilinasas (OXA) de la subfamilia tipo OXA-48, reportándose los primeros casos en pacientes hospitalizados mayoritariamente en la zona norte del país. Objetivo: Determinar los perfiles fenotípicos, genotípicos y de susceptibilidad antimicrobiana de 16 cepas referidas durante mayo del año 2021 desde las regiones de Antofagasta y Metropolitana al Laboratorio de Referencia del Instituto de Salud Pública. Metodología: Las cepas provenientes de muestras clínicas fueron analizadas mediante técnicas tradicionales (Kirby-Bauer y epsilometría) y automatizadas, además de técnicas colorimétricas, inmunocromatográficas y moleculares (RPC y PFGE). Resultados: Se detectó la presencia de los genes blaoxa-48 y blaoxa-232 con una resistencia inusual, tanto a carbapenémicos (ertapenem, imipenem y meropenem) como a cefalosporinas (cefepime, cefotaxima y ceftazidima), además de piperacilina/tazobactam y temocilina. Se detectaron dos subtipos por PFGE, siendo predominante el clon CL-Kpn-Spe-329 (93,8%) con dos mecanismos de resistencia identificados: carbapenemasa y β-lactamasa de espectro extendido (BLEE). Conclusión: Ante esta alerta epidemiológica es necesario unificar criterios existentes en la red asistencial nacional para la oportuna detección, vigilancia y control de posibles brotes de cepas productores de oxacilinasa tipo OXA-48.

Background: The appearance and spread of carbapenems-resistant Enterobacterales have generated a major impact on health care-associated infections worldwide. Recently, a Klebsiella pneumoniae outbreak expressing OXA-48 like-carbapenemases was detected in Chile, the first reported cases corresponded to hospitalized patients mainly from northern Chile. Aim: To characterize the phenotypic and genotypic profiles of antimicrobial susceptibility of 16 clinical isolates referred during May 2021 from Antofagasta and Metropolitan regions to the Reference Laboratory of Instituto de Salud Publica. Methods: Antimicrobial susceptibility of all strains was analyzed using traditional (Kirby-Bauer and epsilometry) and automated methods, and complemented with colorimetric, immunochromatographic and molecular (PCR and PFGE) techniques. Results: As a result of the genetic characterization, blaoxa-48 and blaoxa-232 genes were detected, showing the isolates an unusual resistance profile to both carbapenems (ertapenem, imipenem, and meropenem) and cephalosporins (cefepime, cefotaxime, and ceftazidine), as well as piperacillin/ tazobactam and temocillin. Two subtypes were detected by PFGE, with a predominant clone CL-Kpn-Spe-329 (93.8%), with two resistance mechanisms identified: carbapenemase and extended-spectrum β-lactamase (ESBL). Conclusion: Due to this epidemiological alert, it is essential the establishment of national guidelines for early detection, surveillance, and control of future outbreaks of OXA-48 like carbapenemases isolates.

An Unsupervised Condition Monitoring System for Electrode Milling Problems in the Resistance Welding Process.

Resistance spot welding is one of the most widely used metal joining processes in the manufacturing industry, used for structural body manufacturing, railway vehicle construction, electronics manufacturing, battery manufacturing, etc. Due to its wide use, the quality of welded joints is of great importance to the manufacturing industry, as it is critical for ensuring the integrity of finished products, such as car bodies, that withstand high levels of stress. The quality of the welding is influenced both by the programming of the welding and by the good condition of the mechanical part that carries out the welding. These mechanical factors, such as electrode geometry and wear, degrade over time. As the welding points are made, the geometry and properties of the electrodes change, so they undergo a milling process to remove impurities and return them to their initial geometry. Sometimes the milling is deficient, and the electrode continues to wear, causing welding problems such as loose spots and metal spatter. This article presents a method for condition monitoring of the milling process and weld wear based on existing data in real production lines. The use of unsupervised clustering methods is proposed to perform a check by which, using current and resistance data, the electrode wear is grouped. Specifically, a method using multidimensional k-means for the condition monitoring of electrode wear is established. This research gives a real and applicable solution for reducing the quality problems caused by milling defects and electrode wear in the production lines of high-production manufacturing industries, presenting a system for sending alarms based on the behavior of welding variables.

Autonomous Water Sampler for Oil Spill Response.

A newly developed water sampling system enables autonomous detection and sampling of underwater oil plumes. The Midwater Oil Sampler collects multiple 1-L samples of seawater when preset criteria are met. The sampler has a hydrocarbon-free sample path and can be configured with several modules of six glass sample bottles. In August 2019, the sampler was deployed on an autonomous underwater vehicle and captured targeted water samples in natural oil seeps offshore Santa Barbara, CA, USA.

Health Transparency and Communication on the Government Websites of Ibero-American Countries: The Cases of Chile, Colombia, Ecuador, and Spain.

Through the strategic use of health communication from their websites, government institutions can achieve greater promotion and prevent health issues for citizens, at whom such websites are aimed. Thus, the transparency of these sites is essential to favor issues such as participation, accountability, and good governance. In the present study, through content analysis, we examined how active transparency and communication in health is built through analyzing the information provided by the different administrative levels with competencies in this field (government, regions, and municipalities) from the following countries: Chile, Colombia, Ecuador, and Spain. The results were projected according to a double axis of analysis. On the one hand, we offer a description of the levels of management of this phenomenon (structural characteristics and available resources). On the other hand, we developed indices based on each of the countries to compare the typologies grouped in these Ibero-American countries. As a general conclusion, the results evinced insufficient transparency in common; however, the deficit was less in countries that had a public health system.

A hybrid underwater robot for multidisciplinary investigation of the ocean twilight zone.

Mesobot, an autonomous underwater vehicle, addresses specific unmet needs for observing and sampling a variety of phenomena in the ocean's midwaters. The midwater hosts a vast biomass, has a role in regulating climate, and may soon be exploited commercially, yet our scientific understanding of it is incomplete. Mesobot has the ability to survey and track slow-moving animals and to correlate the animals' movements with critical environmental measurements. Mesobot will complement existing oceanographic assets such as towed, remotely operated, and autonomous vehicles; shipboard acoustic sensors; and net tows. Its potential to perform behavioral studies unobtrusively over long periods with substantial autonomy provides a capability that is not presently available to midwater researchers. The 250-kilogram marine robot can be teleoperated through a lightweight fiber optic tether and can also operate untethered with full autonomy while minimizing environmental disturbance. We present recent results illustrating the vehicle's ability to automatically track free-swimming hydromedusae (Solmissus sp.) and larvaceans (Bathochordaeus stygius) at depths of 200 meters in Monterey Bay, USA. In addition to these tracking missions, the vehicle can execute preprogrammed missions collecting image and sensor data while also carrying substantial auxiliary payloads such as cameras, sonars, and samplers.

Identification of Coxiella burnetii in Tank Raw Cow Milk: First Findings from Chile.

Coxiella burnetii causes Q fever, an important zoonotic disease, and exposure is mainly associated with inhalation of contaminated aerosols. In South America, no systematic studies have been carried out. In Chile, the only official record of Q fever has been an outbreak of occupational context occurring in 1998 with eight confirmed human cases, all workers in the Agriculture and Livestock Service. Recently, in 2017 a Q fever outbreak was reported from dairy farm workers in two regions in southern Chile. This study determined the presence of C. burnetii in bulk tank milk samples from dairy farms obtained during this outbreak. A duplex real time quantitative PCR assay with primers and probes targeting two different gene sequences, IS1111 and com1, was used for diagnosis. C. burnetii was detected in 2 of 105 samples analyzed (2.1%). These results pose a potential public health risk as the milk from these farms was sold to the local human population. This is the first report on detecting C. burnetii in raw tank milk samples in Chile.

Análisis de la percepción de las madres frente a la estrategia comunicacional intramural para combatir la anemia en Perú. Estúdio de caso sobre la suplementación de micronutrientes a partir de un centro de salud en Lima / The analysis of the perception of mothers against the intramural communication as a strategy to combat anemia in Peru. A case study on micronutrient supplementation from a health center in Lima

RESUMEN Objetivo: Determinar sí la implementación de las estrategias comunicacionales influencian de manera efectiva para el posicionamiento de la suplementación en micronutrientes enmarcado en la normatividad peruana del tratamiento de anemia. Materiales y métodos: Se seleccionó una muestra de 27 madres, entre 20 a 30 años. Enfoque cualitativo. Entrevistas a profundidad, divididas en dos ejes de estudio: Posicionamiento (Recordación, Comportamiento, Actitud, Afecto y Atributo) y Estrategias (Sesiones Demostrativas, Sesiones Educativas, Persuasión y Atención del personal). Resultados: Las acciones comunicacionales generaron que las madres se informen sobre los micronutrientes, conozcan sus beneficios y efectos colaterales como la diarrea y estreñimiento. Respecto a la variable 'posicionamiento', sí existe recordación sobre el uso de los micronutrientes; y en el análisis de la variable 'estrategia' se generó conocimiento sobre la preparación de platos ricos en hierro, y mediante el uso de juegos educativos se persuadió la atención de los usuarios. Conclusión: Se evidenció la efectividad de la implementación de las estrategias comunicacionales. Los usuarios recibieron los mensajes durante su participación en las sesiones demostrativas que influenciaron en el empoderamiento de las madres con respecto a los cuidados que se debe tener para prevenir y combatir la anemia. Siendo evaluados mediante la percepción de las usuarias en cada uno de los criterios de posicionamiento.

ABSTRACT Objective: To determine if the implementation of communication strategies can influence effectively the positioning of micronutrient supplementation framed in the Peruvian regulations for the treatment of anemia. Resources and methods: We selected a group of 27 mothers, between 20 and 30 years. Qualitative approach. Interviews divided into two areas of study: Positioning (Reminder, Behavior, Attitude, Affection and Attribute) and Strategies (Demonstration Sessions, Educational Sessions, Persuasion and Staff Attention). Results: The actions of communication generated that the mothers are informed about the micronutrients, know their benefits and side effects such as diarrhea and constipation. Regarding the variable 'positioning' there is a recall about the use of micronutrients; and with the analysis of the 'strategy' variable, knowledge was generated about the preparation of iron-rich dishes and, through the use of educational games, users' attention was persuaded. Conclusion: It is an evidence that the efectiveness of implementation of communication strategies, where users received messages during their participations in demonstration sessions that influenced in empowement of the mothers regarding the cares they must have to prevent and fight the anemia being evaluated through the perception of users in each positioning criterion.

Taste Responsiveness of Spider Monkeys to Dietary Ethanol.

Recent studies suggest that frugivorous primates might display a preference for the ethanol produced by microbia in overripe, fermenting fruit as an additional source of calories. We, therefore, assessed the taste responsiveness of 8 spider monkeys (Ateles geoffroyi) to the range of ethanol concentrations found in overripe, fermenting fruit (0.05-3.0%) and determined taste preference thresholds as well as relative taste preferences for ethanol presented in sucrose solutions and in fruit matrices, respectively. Using a 2-bottle preference test of short duration (1 min), we found that spider monkeys are able to detect ethanol concentrations as low as 0.5%, that they prefer ethanol concentrations up to 3% over water, and that they prefer sucrose solutions and pureed fruit spiked with ethanol over equimolar sucrose solutions and pureed fruit without ethanol. However, when presented with an ethanol-spiked sucrose solution and a higher-concentrated sucrose solution without ethanol, the animals clearly preferred the latter, even when the sucrose-ethanol mixture contained 3 times more calories. These results demonstrate that spider monkeys are more sensitive to the taste of ethanol than rats and humans and that they prefer ecologically relevant suprathreshold concentrations of ethanol over water. Tests with sucrose solutions and pureed fruits that were either spiked with ethanol or not suggest that sweetness may be more important for the preferences displayed by the spider monkeys than the calories provided by ethanol. The present results, therefore, do not support the notion that dietary ethanol might be used by frugivorous primates as a supplemental source of calories.

Reconstruction of Radioscaphocapitate Ligament in Treatment of Ulnar Translation.

Background This article measures the life quality, clinical, and functional outcomes of a patient who had undergone reconstruction of the radioscaphocapitate ligament (RSL), using brachioradialis tendon in the treatment of ulnar translation of the carpus. Case Description We present a 36-year-old man with ulnar translation in his left, nondominant wrist, after fall accident. Reconstruction of the RSL was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 85 degrees and supination was 90 degrees and digit motion was full. Disabilities of the Arm, Shoulder and Hand score of 5, Visual Analog Scale of 0, and grip strength of 82% were obtained compared with the unaffected side. Wrist radiographic aspects showed radiocarpal joint congruency. The period of fixator treatment was 8 weeks. Good stability and joint congruency of the radiocarpal joint were obtained. Good radiographic, clinical, and functional results were obtained improving the quality of life of the patient. Literature Review The treatment of ulnar translation is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the type of intervention have been a matter of controversy in the literature. Would radiocarpal joint be stable when reconstruction of the RSL using brachioradialis tendon was obtained? Is it possible to reduce an ulnar translation with this technique? Clinical Relevance We would like to suggest that the radiocarpal ligament reconstruction will improve the outcome. We believe that this technique will make the wrist more stable and functional. We agree that the best time to perform the corrections is early. The authors prefer to first reconstruct the RSL and then the radiocarpal ligament suture or radioscapholunate arthrodesis.

Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life / Artroplastia de ulna distal no manejo dos pacientes com distúrbios pós-traumáticos da articulação radioulnar distal: mensuração da qualidade de vida

To measure the quality of life and clinical-functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension(r) prosthesis of the distal ulna.METHODS:Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé-Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications...

Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes com diagnóstico de osteoartrose da radioulnar distal submetidos ao tratamento cirúrgico pela técnica de artroplastia total da ulna com a prótese total ou parcial Ascension(r)da ulna distal. MÉTODOS: Foram avaliados 10 pacientes com 12 meses de seguimento de artroplastia total ou parcial de ulna distal. Todos apresentavam osteoartrose pós-traumática e ou instabilidade crônica e sintomática da articulação radioulnar distal. O estudo foi prospectivo. Sete pacientes tinham procedimentos prévios no punho (2-darrach, 3-Sauvé-kapandji, 2-reconstruções ligamentares do complexo da fibrocartilagem) e três apresentaram fraturas da ulna distal que evoluíram com dor, instabilidade e osteoartrose da radioulnar distal. Foram analisados a qualidade de vida (DASH), a porcentagem do grau de força de preensão palmar (kgf) e o arco de movimento de pronossupinação em relação ao lado não afetado, a dor (VAS), o retorno ao trabalho e a avaliação subjetiva da radiografia e das complicações...

Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate.

OBJECTIVE: To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. METHODS: Polyurethane models (Sawbone(®)) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. RESULTS: Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. CONCLUSION: Stabilization using the Acutrak(®) screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand(®)).

OBJETIVO: Comparar os parâmetros mecânicos entre dois métodos de estabilização por compressão: placa de compressão axial de 1,5 mm com o parafuso cônico de compressão usado como tutor intramedular. MÉTODOS: Foram usados modelos de poliuretano (Sawbone®) que simulam a fratura da falange proximal transversa, divididos em três grupos (placa lateral, parafuso cônico, sem implante). RESULTADOS: Há necessidade de uma maior força para resultar na fadiga da síntese com parafuso intramedular. Comprova-se, assim, a supremacia mecânica desse sobre o modelo com a placa lateral. CONCLUSÃO: A estabilização com o parafuso Acutrak®, no tratamento das fraturas no modelo adotado neste ensaio, apresenta resultados mecânicos superiores e estatisticamente significativos em comparação com a técnica de compressão axial com o uso da placa lateral (Aptus Hand ®).

Ensaio experimental para tratamento cirúrgico das fraturas transversas da falange proximal - Técnica com parafuso intramedular cônico de compressão versus placa de compressão lateral / Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate

Comparar os parâmetros mecânicos entre dois métodos de estabilização por com pressão: placa de compressão axial de 1,5 mm com o parafuso cônico de compressão usado como tutor intramedular. Métodos: Foram usados modelos de poliuretano (Sawbone(r)) que simulam a fratura da falange proximal transversa, divididos em três grupos (placa lateral, parafuso cônico, sem implante). Resultados: Há necessidade de uma maior força para resultar na fadiga da síntese com para fuso intramedular. Comprova-se, assim, a supremacia mecânica desse sobre o modelo com a placa lateral. Conclusão: A estabilização com o parafuso Acutrak(r), no tratamento das fraturas no modelo adotado neste ensaio, apresenta resultados mecânicos superiores e estatisticamente sig nificativos em comparacão com a técnica de compressão axial com o uso da placa lateral (Aptus Hand (r)).

To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. METHODS: Polyurethane models (Sawbone(r)) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. RESULTS: Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. CONCLUSION: Stabilization using the Acutrak(r) screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand(r)).

Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life.

OBJECTIVE: To measure the quality of life and clinical-functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension(®) prosthesis of the distal ulna. METHODS: Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé-Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications. RESULTS: The patients presented a mean range of motion of 174.5° (normal side: 180°). Quality of life was analyzed by applying the DASH questionnaire and the mean value found was 5.9. The mean pain score using the VAS was 2.3. The mean degree of palm grip strength (kgf) was 50.7, which represented 90.7% of the strength on the unaffected side. The complication rate was 10%: this patient presented slight dorsal instability of the ulna and persistent pain, and did not return to work. This patient is still being followed up in the outpatient clinic and occupational therapy sector, with little improvement. He does not wish to undergo a new procedure. The mean length of follow-up was 16.8 months, with a minimum of 10 and maximum of 36 months. CONCLUSION: This concept is subject to the test of time. Implantation of a prosthesis is a very interesting addition to the surgical arsenal for those who are specialists in hand surgery. Arthroplasty of the distal ulna is a safe and effective method with clinical-functional and quality-of-life improvements for patients and presents a low complication rate.

OBJETIVO: Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes com diagnóstico de osteoartrose da radioulnar distal submetidos ao tratamento cirúrgico pela técnica de artroplastia total da ulna com a prótese total ou parcial Ascension® da ulna distal. MÉTODOS: Foram avaliados 10 pacientes com 12 meses de seguimento de artroplastia total ou parcial de ulna distal. Todos apresentavam osteoartrose pós-traumática e ou instabilidade crônica e sintomática da articulação radioulnar distal. O estudo foi prospectivo. Sete pacientes tinham procedimentos prévios no punho (2-darrach, 3-Sauvé-kapandji, 2-reconstruções ligamentares do complexo da fibrocartilagem) e três apresentaram fraturas da ulna distal que evoluíram com dor, instabilidade e osteoartrose da radioulnar distal. Foram analisados a qualidade de vida (DASH), a porcentagem do grau de força de preensão palmar (kgf) e o arco de movimento de pronossupinação em relação ao lado não afetado, a dor (VAS), o retorno ao trabalho e a avaliação subjetiva da radiografia e das complicações. RESULTADOS: Os pacientes apresentaram, em média, o arco de movimento de 174,5° e o lado normal 180°. A qualidade de vida foi analisada pela aplicação do questionário DASH e o valor médio encontrado foi 5,9. A avaliação da dor, com o uso da escala VAS, foi de 2,3, em média. O grau de força de preensão palmar (kgf) foi de 50,7, em média, o que representa 90,7% da força do lado não acometido. A taxa de complicações foi de 10%. Esse paciente apresentou discreta instabilidade dorsal da ulna, dor persistente e não retornou ao trabalho. Esse paciente segue no ambulatório e no setor de terapia ocupacional, com pouca melhoria. Não deseja fazer novo procedimento. O tempo de seguimento, em média, foi de 16,8 meses, com mínimo de 10 e máximo de 36 meses. CONCLUSÃO: Esse conceito está a teste do tempo. A implantação de uma prótese é uma adição muito interessante ao arsenal cirúrgico para aqueles que são especializados em cirurgia da mão. A artroplastia de ulna distal é um método seguro, eficaz, com melhoria clínico-funcional e da qualidade de vida dos pacientes e apresenta baixo índice de complicações.