PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center.

BACKGROUND: To evaluate the clinical outcomes using the PRECICE magnetic limb lengthening intramedullary nail for the correction of lower limb length discrepancies (LLD) in adults with posttraumatic nonunion or malunion defects in a Latin American center. METHODS: A retrospective review of 25 adult patients with LLD associated with posttraumatic nonunion or malunion defects of femur or tibia treated with the PRECICE nail between January 2018 and December 2020. The primary outcomes considered were lengthening length achieved in mm, incidence of complications and quality of life (EQ-5D-3 L questionnaire). RESULTS: Twenty-five cases (20 femoral and 5 tibial nails) were performed, with a median follow-up of 27 months (Interquartile range-IQR: 17.5 to 34.5). The average age was 36.5 ± 12.9 years; 10 cases were women. Fifteen cases had an LLD secondary to a malunion defect and 10 cases had an LLD secondary to a nonunion. PRECICE nails were inserted for the treatment of a median LLD of 40.0 mm (IQR: 30.2 to 74.2) in the femur and 30.0 mm (28.5 to 50.0) in the tibia. An accuracy of 100% was reported in 18 cases (Femur: 14 and tibia: 4) and consolidation was achieved in 22/25 cases with the PRECICE nail in situ. Complications were recorded in 9 (36%) cases (6/20 femur, 3/5 tibia), mainly related to the consolidation process (5/9). The median EQ-5D and EQ-VAS were 0.79 (IQR: 0.63 to 0.79) and 80.0 (IQR: 50.0 to 90.0), respectively. CONCLUSIONS: The results of this study demonstrated that the PRECICE nail is an effective device for the management of posttraumatic LLD during the treatment of nonunion or malunion bone defects of femur and tibia, offering a reasonable quality of life, despite its postoperative complication risk.

Multi-dimensional and region-specific planning for coal retirements.

Early retirement of coal-fired power is essential for remaining in line with the 2°C target set in the Paris Agreement. Plant age plays the major role in designing retirement pathways, however, this overlooks the economic and health costs associated with coal-fired power. We introduce multi-dimensional retirement schedules that account for age, operating cost, and air pollution hazards. Results show that regional retirement pathways vary substantially with different weighting schemes. Schedules based on age would retire capacity mostly in the US and EU, whereas those based on cost or air pollution would shift the majority of near-term retirements to China and India, respectively. Our approach emphasizes that a "one-size-fits-all" strategy is ineffective in addressing global phase-out pathways. It provides the opportunity for devising region-specific pathways that are sound to the local context. Our results involve emerging economies and highlight incentives for early retirement that surpass climate change mitigation and address regional priorities.

Harnessing underutilized gene bank diversity and genomic prediction of cross usefulness to enhance resistance to Phytophthora cactorum in strawberry.

The development of strawberry (Fragaria × ananassa Duchesne ex Rozier) cultivars resistant to Phytophthora crown rot (PhCR), a devastating disease caused by the soil-borne pathogen Phytophthora cactorum (Lebert & Cohn) J. Schröt., has been challenging partly because the resistance phenotypes are quantitative and only moderately heritable. To develop deeper insights into the genetics of resistance and build the foundation for applying genomic selection, a genetically diverse training population was screened for resistance to California isolates of the pathogen. Here we show that genetic gains in breeding for resistance to PhCR have been negligible (3% of the cultivars tested were highly resistant and none surpassed early 20th century cultivars). Narrow-sense genomic heritability for PhCR resistance ranged from 0.41 to 0.75 among training population individuals. Using multivariate genome-wide association studies (GWAS), we identified a large-effect locus (predicted to be RPc2) that explained 43.6-51.6% of the genetic variance, was necessary but not sufficient for resistance, and was associated with calcium channel and other candidate genes with known plant defense functions. The addition of underutilized gene bank resources to our training population doubled additive genetic variance, increased the accuracy of genomic selection, and enabled the discovery of individuals carrying favorable alleles that are either rare or not present in modern cultivars. The incorporation of an RPc2-associated single-nucleotide polymorphism (SNP) as a fixed effect increased genomic prediction accuracy from 0.40 to 0.55. Finally, we show that parent selection using genomic-estimated breeding values, genetic variances, and cross usefulness holds promise for enhancing resistance to PhCR in strawberry.

Unraveling the Deep Genetic Architecture for Seedlessness in Grapevine and the Development and Validation of a New Set of Markers for VviAGL11-Based Gene-Assisted Selection.

Seedless inheritance has been considered a quasi-monogenic trait based on the VvAGL11 gene. An intragenic simple sequence repeat (SSR) marker, p3_VvAGL11, is currently used to opportunely discard seeded progeny, which represents up to 50% of seedlings to be established in the field. However, the rate of false positives remains significant, and this lack of accuracy might be due to a more complex genetic architecture, some intrinsic flaws of p3_VvAGL11, or potential recombination events between p3_VvAGL11 and the causal SNP located in the coding region. The purpose of this study was to update the genetic architecture of this trait in order to better understand its implications in breeding strategies. A total of 573 F1 individuals that segregate for seedlessness were genotyped with a 20K SNP chip and characterized phenotypically during four seasons for a fine QTL mapping analysis. Based on the molecular diversity of p3_VvAGL11 alleles, we redesigned this marker, and based on the causal SNP, we developed a qPCR-HRM marker for high-throughput and a Tetra-ARMS-PCR for simple predictive analyses. Up to 10 new QTLs were identified that describe the complex nature of seedlessness, corresponding to small but stable effects. The positive predictive value, based on VvAGL11 alone (0.647), was improved up to 0.814 when adding three small-effect QTLs in a multi-QTL additive model as a proof of concept. The new SSR, 5U_VviAGL11, is more informative and robust, and easier to analyze. However, we demonstrated that the association can be lost by intragenic recombination and that the e7_VviAGL11 SNP-based marker is thus more reliable and decreases the occurrence of false positives. This study highlights the bases of prediction failure based solely on a major gene and a reduced set of candidate genes, in addition to opportunities for molecular breeding following further and larger validation studies.

Sistema de biofeedback para rehabilitación de marcha asistida por un exoesqueleto / Biofeedback System for Exoskeletqn Assisted Gait Rehabilitation / Sistema de biofeedback para reabilitação de marcha assistida por um exoesqueleto

Resumen Los robots proporcionan nuevas formas de terapia para pacientes con desórdenes neurológicos. Las terapias de marcha asistidas con exoesqueletos pueden incrementar la duración y la intensidad de los entrenamientos para los pacientes y reducir el esfuerzo físico del terapeuta. Sin embargo, el uso de estos dispositivos para el entrenamiento de la marcha limita la interacción física entre el terapeuta y el paciente, en comparación con la terapia manual. Una apropiada realimentación de las funciones corporales y biomecánicas en la interacción con el sistema robótico facilita la evaluación del desempeño del paciente, motivándolo en el reaprendizaje de la marcha con resultados superiores. Este artículo presenta el diseño de una interfaz de usuario para un exoesqueleto de miembros inferiores para asistencia en la marcha y en terapias de rehabilitación. Se consideraron aspectos técnicos y clínicos para proporcionar ventajas del exoesqueleto durante las terapias, estableciendo una herramienta de apoyo para la configuración, monitoreo y registro de los parámetros involucrados. Se propuso un esquema de realimentación sensorial para el paciente acerca de la actividad muscular, la presión ejercida en diferentes puntos de los pies y algunas variables biomecánicas. Finalmente, se valida la herramienta con sujetos sanos por medio de un test de usabilidad propuesto.

Abstract The inclusion of robots in rehabilitation allow advantages for generate newer therapies in neurologic disorder patients. Assistive gait therapies using robots, like exoskeletons, allow increase the time and intensity training for patients while the strenuous labor of therapist is reduced. However, the physic interaction between therapist and patient in training with robots is limited, in relation to the traditional manual therapy. An appropriated feedback of biological and biomechanics functions in the robot interaction during training provides an easier performance evaluation of the patient for the therapist. Further, biofeedback gives a motivation to the patient and encourages him for gait relearning with higher effects than conventional. This paper presents a user interface design for a lower limb exoskeleton for human gait assistance in rehabilitation. Clinical and technical criteria for increasing the advantages of the exoskeleton in therapy were considered. A biofeedback scheme about muscle activity, plantar pressure and some biomechanics variables, for the patient is proposed. Finally, a validation for this tool with healthy subjects by a usability test was carried out.

Resumo A inclusão de robôs na reabilitação fornecem vantagens que promovem novas formas de terapia em pacientes com desordens neurológicas. Terapias de marcha assistidas por exoesqueletos permitem o aumento da duração e da intensidade dos exercícios com os pacientes, reduzindo o esforço físico dos terapeutas. Não entanto, o uso desses dispositivos para o treino da marcha limita a interação física entre o terapeuta e paciente, em comparação com a terapia manual. Uma apropriada realimentação das funções corporais e biomecânicas na interação com o sistema robótico facilita a avaliação do progresso do paciente, motiva e incentiva ao paciente na reaprendizagem da marcha gerando efeitos superiores aos convencionais. Neste artigo apresenta-se o desenho de uma interface de usuário para um exoesqueleto de membros inferiores para assistência na marcha e nas terapias de reabilitação. São considerados aspectos técnicos e clínicos para fornecer maiores vantagens do exoesqueleto durante as terapias, estabelecendo uma ferramenta de suporte para configuração, monitoramento e registro dos parâmetros envolvidos. Foi proposto um sistema de realimentação sensorial para o paciente sobre a atividade muscular, a pressão em diferentes pontos dos pés e algumas variáveis biomecânicas. Finalmente, é apresentada a ferramenta de validação para indivíduos saudáveis utilizando um teste de usabilidade proposto.

A multimodal approach prevents instability after total hip arthroplasty: A 1 year follow-up prospective study.

INTRODUCTION: Joint dislocation is one of the most frequent complications after hip arthroplasty. Multiple strategies have demonstrated ability to prevent instability when used in isolation, but the effect when more than one intervention is implemented has not been measured. The purpose of this study is to assess the rate of dislocation after implementation of a protocol of combined strategies for prevention of instability. MATERIALS AND METHODS: Consecutive patients undergoing primary total hip replacement for hip osteoarthritis between February 2012 and June 2014 were included. A multimodal protocol including patient education, use of large femoral heads, posterior soft-tissue repair, and intraoperative adjustment of limb length and hip offset was applied. Dislocation episodes were documented trough medical records review and a telephonic follow-up at 3 and 12 months after surgery. RESULTS: During the period of study 331 patients were included, mean age was 66 years and 68.8% were females. Only 0.91% of patients were lost to follow-up. Eighty-nine percent of patients received all interventions. Cumulative dislocation rate at 3 months was 0.60% and 0.90% at 12 months. CONCLUSIONS: The implementation of a multimodal protocol for prevention of prosthesis instability produces a low rate of dislocation, which compares favorably with benchmarks. We recommend the use of a combination of multiple interventions to prevent this complication.

Impacto de un proyecto piloto de estimulación cognitiva sobre el bienestar psicoespiritual en adultos mayores / Impact of a cognitive stimulation pilot project on psychospiritual welfare in the elderly

El artículo presenta la experiencia de la aplicación de un proyecto de gestión tipo piloto que mejora la práctica de enfermería, enfocada en la estimulación cognitiva, con el fin de mejorar el bienestar psicoemocional en adultos mayores con base en la "Teoría de la Comodidad", desarrollada por Katherine Kolcaba. OBJETIVO: Mostrar el trabajo desarrollado en usuarios adultos mayores pertenecientes a un Centro de Salud en cuidados domiciliarios, con necesidad de estimulación cognitiva, con el fin de mejorar su bienestar psicoespiritual. MÉTODO: se realizó un proyecto piloto de gestión, para promover la comodidad/bienestar durante la recuperación en el hogar de Adultos Mayores, a través de una intervención para prevenir el deterioro cognitivo sustentada en las directrices del Ministerio de Salud de Chile, y la medición de aspectos empíricos como el bienestar psicoespiritual que se desprenden de los lineamientos de la teoría de la Comodidad. El proyecto se planeó, ejecutó y evaluó, durante Marzo a Diciembre del año 2016. La planeación se realizó mediante visitas de campo y matriz de marco lógico, aplicando el árbol de problemas. RESULTADOS: los adultos mayores sometidos a una intervención planificada de enfermería no progresaron con un deterioro cognitivo mayor y a su vez mejoraron su nivel de Comodidad en especial en el área Psicoemocional, demostrando que el uso de la teoría de rango medio de Kolcaba es útil como sustento teórico para este tipo de intervención.

The article presents the experience of the application of a pilot management project that improves nursing practice, focused on cognitive stimulation, in order to improve psycho-emotional welfare in the elderly based on the "Theory of Comfort", developed by Katherine Kolcaba. OBJECTIVE: To show the work developed in elderly users belonging to a Health Center in home care, with cognitive stimulation needs, in order to improve their psychospiritual welfare. METHOD: a pilot management project was carried out to promote comfort / welfare during the recovery in the Elderly Home Care, through an intervention, to prevent cognitive impairment, supported by the guidelines of the Ministry of Health of Chile, and the measurement of empirical aspects, such as psychospiritual welfare, that are derived from the guidelines of the Theory of Comfort. The project was planned, executed and evaluated from March to December 2016. The planning was carried out through field visits and logframe matrix applying the problem tree. RESULTS: older adults undergoing a planned nursing intervention did not progress with a greater cognitive deterioration and at the same time improved their Comfort level, especially in the Psycho-emotional area, demonstrating that the use of Kolcaba's mid-range theory is useful as a theoretical support for this type of intervention. CONCLUSION: a planned nursing intervention based on a theoretical reference, focused on cognitive impairment, has a positive impactin the welfare of the elderly with cognitive impairment.

Locally Contractive Dynamics in Generalized Integrate-and-Fire Neurons.

Integrate-and-fire models of biological neurons combine differential equations with discrete spike events. In the simplest case, the reset of the neuronal voltage to its resting value is the only spike event. The response of such a model to constant input injection is limited to tonic spiking. We here study a generalized model in which two simple spike-induced currents are added. We show that this neuron exhibits not only tonic spiking at various frequencies but also the commonly observed neuronal bursting. Using analytical and numerical approaches, we show that this model can be reduced to a one-dimensional map of the adaptation variable and that this map is locally contractive over a broad set of parameter values. We derive a sufficient analytical condition on the parameters for the map to be globally contractive, in which case all orbits tend to a tonic spiking state determined by the fixed point of the return map. We then show that bursting is caused by a discontinuity in the return map, in which case the map is piecewise contractive. We perform a detailed analysis of a class of piecewise contractive maps that we call bursting maps and show that they robustly generate stable bursting behavior. To the best of our knowledge, this work is the first to point out the intimate connection between bursting dynamics and piecewise contractive maps. Finally, we discuss bifurcations in this return map, which cause transitions between spiking patterns.

Accounting for noise when clustering biological data.

Clustering is a powerful and commonly used technique that organizes and elucidates the structure of biological data. Clustering data from gene expression, metabolomics and proteomics experiments has proven to be useful at deriving a variety of insights, such as the shared regulation or function of biochemical components within networks. However, experimental measurements of biological processes are subject to substantial noise-stemming from both technical and biological variability-and most clustering algorithms are sensitive to this noise. In this article, we explore several methods of accounting for noise when analyzing biological data sets through clustering. Using a toy data set and two different case studies-gene expression and protein phosphorylation-we demonstrate the sensitivity of clustering algorithms to noise. Several methods of accounting for this noise can be used to establish when clustering results can be trusted. These methods span a range of assumptions about the statistical properties of the noise and can therefore be applied to virtually any biological data source.

Alprazolam en el dolor crónico como equivalente depresivo-ansioso / Alprazolam in chronic pain as a deppresive-anxious equivalent

Diez pacientes con dolor crónico severo, sin evidencia aparente de patología orgánica fueron valorados en un estudio abierto con duración de siete semanas. Después de la primera semana con placebo, los pacientes fueron sometidos a manejo con medicación activa (alprazolam) realizándose evaluación semanal de los siguientes parámetros: escala visual análoga (EVA), récord de síntomas principales, escala de ansiedad de Hamilton (EAH), escala de depresión de Hamilton (EDH), escala de impresión global tanto del paciente como del médico, así como signos vitales. Al final del protocolo nueve pacientes fueron evaluables. Un análisis individual mostró respuestas favorables en la EVA, en EAH y en EDH. La dosis promedio efectiva del alprazolam fue de 2.5mg./día. Los efectos colaterales más frecuentes fueron somnolencia y resequedad de boca. Hubo 3 casos de hipotensión sostenida que determinaron la salida del estudio de esos pacientes