Crack Initiation of Printed Lines Predicted with Digital Image Correlation.

Printing of metallic films has been preferred over vacuum technologies for roll-to-roll processes because of faster processing times and lower processing costs. Films can be produced by depositing inks containing suspended metallic particles within a solvent and then heating the films to both remove the solvent and sinter the particles. The resulting printed structure and electrical and mechanical behavior of the printed films has been studied to better understand their electro-mechanical response to loading and eventual brittle fracture. This study evaluated the electro-mechanical behavior of 1.25-µm printed Ag films using in situ resistance and in situ imaging methods. Digital image correlation was utilized with confocal laser scanning microscope images to better visualize crack initiation during tensile straining. This technique showed that cracks initiated earlier in the thicker areas of the film (crests) than in lower areas (troughs) because of a higher density of printing defects and the increased thickness.

Association between femur size and a focal defect of the superior femoral neck.

Within each sex, there is an association between hip fracture risk and the size of the proximal femur, with larger femurs apparently more susceptible to fracture. Here, we investigate whether the thickness and density of the femoral cortex play a role in this association: might larger femurs harbour focal, cortical defects? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm(2)) in cohorts of 308 males and 125 females. Principal component analysis of the various femoral surfaces led to a measure of size that is linearly independent from shape. After mapping the data onto a canonical femur surface, we used statistical parametric mapping to identify any regions where CMSD depends on size, allowing for other confounding covariates including shape. Our principal finding was a focal patch on the superior femoral neck, where CMSD is reduced by around 1% for each 1% increase in proximal-distal size (p<0.000005 in the males, p<0.001 in the females). This finding appears to be consistent with models of functional adaptation, and may help with the design of interventional strategies for reducing fracture risk.

Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a Fracture Liaison Service.

BACKGROUND: A past history of low trauma fracture is a strong risk factor for future fractures in postmenopausal women and national guidance recommends treatment in the majority of such women AIM: To establish the prevalence of bone protective therapy use in postmenopausal women with a history of low trauma fracture Design and METHODS: Clinical audit of 1641 postmenopausal women presenting with a low trauma fracture to the Fracture Liaison Service at Addenbrooke's Hospital, Cambridge between January 2006 and December 2007. RESULTS: A total of 526 (31%) women presenting with a fracture had a past history of fracture, defined as a low trauma fracture after the age of 45 years. The wrist was the most common site of previous fracture, followed by hip, hand or foot, lower leg and humerus. Of these women, only 27.6% were receiving bone protective therapy with a bisphosphonate (89%) or other medication. Calcium and vitamin D supplements were received by 35.6%. The highest rates of treatment were seen for spine and hip fracture (61.9 and 49.3%, respectively). Only 45.1% of women aged 75 years and over with a previous history of fracture were receiving bone protective therapy. CONCLUSION: The results of our audit demonstrate low rates of treatment in postmenopausal women with a history of low trauma fracture. Better education of healthcare professionals, more consistent recording of fractures in primary care and the use of clearly defined care pathways that involve patients and their carers provide rational approaches to reducing this care gap.

Osteophytes, juxta-articular radiolucencies and cancellous bone changes in the proximal tibia of patients with knee osteoarthritis.

OBJECTIVE: To determine differences in tibial cancellous bone organisation in knee osteoarthritis (OA) between the central weight-bearing region and juxta-articular radiolucencies adjacent to small, medium or large marginal osteophytes. METHODS: Patients with medial compartment OA (n = 60; F = 39), mean (SD) age 60.0 (9.7) years, and non-OA reference subjects (n = 21; F = 5), mean (SD) age 36.8 (11.5) years, had x4 macroradiographs digitised by laser scanner. Using a modified Osteoarthritis Research Society (OARS) Atlas, right and/or left knees were graded according to marginal osteophyte size into those with small (n = 30), medium (n = 30) or large (n = 27) marginal osteophytes, identified as OPH1, OPH2 and OPH3, respectively. Non-OA knees (n = 30) were anatomically normal. Computerised method of Fractal Signature Analysis (FSA) quantified differences in cancellous bone structure between non-OA and osteophyte subgroups at two regions of interest (ROIs); central weight-bearing and tibial margin. RESULTS: Compared to non-OA, vertical trabecular number increased significantly (P < 0.05) in all osteophyte subgroups (width range 0.12-1.14 mm) within both ROIs. In OPH3, this increase was significantly (P < 0.05) greater compared to OPH2 in the central ROI, and to OPH2 and OPH1 in the marginal ROI at most trabecular widths (0.12-1.14 mm). In the marginal ROI, compared to non-OA, horizontal trabeculae number decreased in all osteophyte subgroups. This decrease was significantly greater in OPH3 compared to OPH2 and OPH1 at small to medium trabecular widths (0.12-0.54 mm). CONCLUSION: Compared to disease associated bone loss at the central ROI of the tibia, the extent of juxta-articular bone loss appears to be associated with the size of the marginal osteophytes.

A 2 yr longitudinal radiographic study examining the effect of a bisphosphonate (risedronate) upon subchondral bone loss in osteoarthritic knee patients.

OBJECTIVES: To determine whether risedronate (RIS) slows down trabecular bone loss in the medial compartment of the proximal tibia, a characteristic of patients with progressive knee osteoarthritis (OA). METHODS: Initially, 100 patients were randomly selected from each treatment group (each N approximately 300) comprising placebo and RIS 5 mg/day, 15 mg/day and 50 mg/week from a double blind, multi-centre, placebo-controlled, 2 yr investigation of OA knee patients in North America. Using fluoroscopic semi-flexed standard radiography, baseline and exit knee radiographs were digitized by laser scanner. Following computerized measurement of minimum medial compartment joint space width, each group was subdivided into joint space narrowing (JSN) non-progressor or JSN-progressor (JSN >or=0.6 mm measured at any point post-baseline). Computerized method of fractal signature analysis (FSA) quantified longitudinal changes separately in horizontal and vertical trabeculae in region of interest (three-fourth width of tibial compartment x 6 mm height) in the medial compartment. Following the initial study, all JSN-progressor knees within the entire patient cohort (N = 1232) were similarly analysed. RESULTS: OA knees in JSN non-progressor group had a slight decrease in FSA for vertical and horizontal trabeculae and showed no drug effect. In JSN-progressor knees, bone loss was greater in both placebo and RIS 5 mg/day groups compared with those in RIS 15 mg/day group in which trabeculae were retained, and in the RIS 50 mg/week group in which the vertical trabecular number increased significantly (P < 0.05). CONCLUSION: This preliminary study showed that patients with marked cartilage loss (JSN>or=0.6 mm) receiving RIS 15 mg/day retained vertical trabecular structure, and those receiving RIS 50 mg/week increased vertical trabecular number, thereby preserving the structural integrity of subchondral bone in knee OA.

Differences in trabecular structure between knees with and without osteoarthritis quantified by macro and standard radiography, respectively.

OBJECTIVE: To compare the sensitivity of standard and macro-radiography for quantifying cancellous bone differences between subjects with and without medial compartment knee osteoarthritis (OA). METHODS: Patients with medial compartment knee OA (n=24) and non-OA reference subjects (n=10) had a standard and a macro-radiograph (x4 magnification) of one knee. Fractal Signature Analysis (FSA), a computerised image analysis technique, measured differences in cancellous bone structure between OA and non-OA tibiae in all radiographs. RESULTS: Compared to non-OA, FSA of vertical trabeculae in macro-radiographs increased significantly (P<0.05) in the OA group at several trabecular widths (0.30-0.60mm, 0.7 mm, 0.98-1.14 mm) and in standard radiographs at a single trabecular width (0.48 mm). CONCLUSION: Compared to standard radiography, increased spatial resolution of macro-radiography allowed greater detection of trabecular bone differences between OA and non-OA knees. Nonetheless, difference was also detected in standard radiographs.

Inhaled steroids do not decrease bone mineral density but increase risk of fractures: data from the GIUMO Study Group.

Although the negative effect of systemic steroids on bone is well documented, there is not clear evidence about possible adverse effects of inhaled steroids on bone metabolism and fractures. A cross-sectional study was performed on 105 women suffering from bronchial asthma treated with inhaled steroids and 133 controls. Bone mineral density (BMD) was measured by quantitative ultrasonography (QUS) at the calcaneus and by dual X-ray absorptiometry (DXA), at both the lumbar spine and proximal femur. Patients suffering from bronchial asthma showed no statistically significant changes in BMD as measured by DXA or QUS, compared with controls. A higher prevalence of fractures was found in the group of women with bronchial asthma, with an age-adjusted odds ratio of 2.79 (95% CI: 1.19-6.54). Inhaled steroids do not appear to decrease BMD, but are associated with an increased risk of fracture in women.

Neurocisticercosis en España / Neurocysticercosis in Spain

No disponible

[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

Cancellous bone changes in hip osteoarthritis: a short-term longitudinal study using fractal signature analysis.

OBJECTIVE: To quantify changes to the trabecular structure in the femoral heads of patients with hip osteoarthritis (OA). METHODS: Patients with OA (n=14; F=7), mean (standard deviation age) 50.6 (10.1) years, had macroradiographs at approximately x4 magnification at baseline and 18 months later using a standardized protocol. Following digitization, computerized measurement was obtained of minimum hip joint space width and fractal signature analysis (FSA) measured longitudinal changes separately in the principal compressive (vertical) and horizontal trabeculae at the region of interest within the centre of the head. RESULTS: The patient group had mean annual rate of joint space narrowing of 0.14+/-0.36 mm/yr. FSA detected no significant changes in horizontal trabeculae, whereas the larger principal compressive (vertical) trabeculae (0.96 mm to 1.02 mm) increased significantly in thickness and the fine to medium trabeculae (0.18 mm to 0.54 mm) decreased significantly in number. CONCLUSION: The increased thickness of the larger trabeculae within the compressive structural element of the femoral head is a response to the increase in stress associated with an overall loss of trabeculae in this region, suggesting the presence of an osteoporosis within the femoral head in OA patients.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

[Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital]. / Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel.

INTRODUCTION: Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. PATIENTS AND METHODS: A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. RESULTS: The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). DISCUSSION AND CONCLUSIONS: Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure.

Características clínicas y terapéuticas de los pacientes con insuficiencia cardíaca en un hospital de tercer nivel / Clinical and therapeutic characteristics in patients with heart failure cared in a tertiary hospital

Introducción. La insuficiencia cardíaca tiene una elevada incidencia y prevalencia en nuestra población. Los objetivos marcados en nuestro estudio son describir el perfil del paciente que ingresa en los servicios de Medicina Interna de nuestro hospital con objeto de analizar los aspectos terapéuticos y conocer el grado de utilización de los distintos grupos farmacológicos. Material y métodos. Se realiza un estudio transversal recogiendo datos de las historias clínicas de los pacientes ingresados en el año 2002 en los sevicios de Medicina Interna del Hospital Clínico San Carlos de Madrid con el diagnóstico de insuficiencia cardíaca. El total de pacientes con dichas características es de 1.338. Calculando el tamaño muestral con una precisión del 5% y un intervalo de confianza del 95%, el número de historias analizadas es de 130 escogidas de un modo aleatorio. Los datos se recogen mediante un cuestionario que analiza diferentes variables clínicas y terapéuticas. Resultados. La media de edad es de 80,3 (desviación estándar: 9,64) años, siendo en su mayoría mujeres. La patología asociada más frecuente es la hipertensión arterial, existiendo en un 70,2% de los pacientes alguna enfermedad. Los diuréticos son los fármacos más utlizados y su prescripción aumenta al alta (p < 0,0001). Además se prescriben más cuanto peor es la clase funcional. Los bloqueadores beta se prescriben en el 7,1% de los pacientes, más en pacientes con fracciones de eyección superiores al 35% (p = 0,042). Discusión y conclusiones. En nuestro medio los pacientes con IC tienen una edad avanzada, presentan una importante comorbilidad y una clase funcional avanzada, siendo los diuréticos su tratamiento de base. Observamos que no existe homogeneización en cuanto al tratamiento con respecto a las últimas recomendaciones y que hay una escasa utilización de los fármacos que, como los bloqueadores beta, han demostrado un aumento de la supervivencia en la insuficiencia cardíaca

Introduction. Heart failure shows high incidence and prevalence in our population. Objectives of our study are to describe the profile of patients cared in the Internal Medicine Department of our hospital, in order to analyze the therapeutic characteristics and to know the degree of utilization of different pharmacological groups. Patients and methods. A cross-sectional study with collection of data from clinical records of patients admitted to 2002 with the diagnosis of heart failure in Internal Medicine Department of San Carlos Hospital in Madrid. Total patients with heart failure was 1,338. Calculating the sample size with a precision of 5% and a confidence interval of 95%, the number of randomly selected clinical records was 130. Data were obtained with a questionnaire for analysis of different clinical and therapeutic parameters. Results. The average age was 80.3 (SD: 9.64) years, and most patients were women. Most frequent associated pathology was hypertension, and in 70.2% patients a diagnosis of some disease was established. Diuretics were the drugs most utilized and its prescription increased at discharge (p < 0.0001). Furthermore, the higher the functional class the more diuretics were prescribed. Beta-blockers were prescribed in 7.1% patients, more frequently in patients with an ejection fraction higher than 35% (p = 0.042). Discussion and conclusions. Patients with heart failure in our environment have advanced age, shows important comorbidities, and suffer an advanced functional class heart failure, being the diuretics their essential treatment. We observed that there is no uniformity concerning the treatment with regard to the last recommendations, and that there is a limited utilization of drugs as beta-blockers that have demonstrated increase the survival of patients with heart failure

A partnership in burn care education - Nepal and australia.

This paper describes some of the issues related to an education partnership which has been developed over the last four years between the Royal Perth Hospital Burn Team in Australia and the Bir Hospital Burn Team in Kathmandu, Nepal. The paper provides an insight into the preparation and collaboration required from both teams and describes some practical ideas to assist those who may be considering educating others in a developing burn service outside their catchment area.

Dolor abdominal e inestabilidad hemodinámica en paciente con pluripatología / Abdominal pain, hypovolemic shock and comorbidity

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Angiomiolipomatosis renal y esclerosis tuberosa / Renal angiomyolipoma and tuberous sclerosis complex

No disponible

Quantitative radiographic assessment of cancellous bone changes in the proximal tibia after total knee arthroplasty: a 3-year follow-up study.

The objective of this study was to determine whether fractal signature analysis (FSA) of digitized macroradiographs of knees with prosthetic implants quantifies alterations in tibial trabecular structure surrounding the implant over a 3-year period. Nineteen knees (16 patients) with arthroplasty had macroradiographs (x4) at baseline and annually for 3 years. The regions of interest (ROIs) were located in the medial and lateral plateau, midstem, and apical sites. FSA of horizontal and vertical trabecular organization was measured at each ROI, and the changes at the yearly visits were compared to the baseline values. Compared to the baseline values, FSA of the first-year radiographs detected a significant ( P < 0.05) decrease in the number of vertical trabeculae in the medial compartment, and vertical, and horizontal trabeculae in the lateral compartment. During the second year, bone remodeling led to an increase in the number of horizontal trabeculae in the medial compartment, and vertical, and horizontal trabeculae in the lateral compartment. During the third year, there was a significant increase ( P < 0.05) in the number of vertical and some horizontal trabeculae in both the medial and lateral compartments. Overall trabecular changes were significantly greater in the lateral than in the medial compartment. Following total knee arthroplasty, the response of bone showed that the first year was characterized by trabecular loss in response to posttraumatic osteopenia following surgery. By the third year, this process had reversed, with a significant increase in mainly vertical and some horizontal trabeculae in both the medial and lateral compartments, with only the lateral compartment showing an overall loss in small- and medium-sized trabeculae by the end of the study period.