[Results of the treatment of irreparable rotator cuff ruptures with the use of the subacromial balloon]. / Resultados del tratamiento de roturas irreparables de manguito rotador con el uso del balón subacromial.

INTRODUCTION: arthroscopic surgical treatment of rotator cuff tendon injuries has replaced open surgery as the first treatment option. Different surgical techniques have been described for massive or irreparable ruptures, and recently, a new device that consists of a biodegradable subacromial spacer between the humeral head and the acromion has been used. The present study aims to analyse the results of this implant in our experience. MATERIAL AND METHODS: we conducted an observational and retrospective study of all patients undergoing subacromial spacer implantation at our centre from 2017 to 2019. Patients were assessed pre- and postoperatively using the Constant, DASH and VAS scales. RESULTS: a total of 43 patients met the inclusion criteria and the minimum follow-up of 24 months. The mean DASH scale score went from 53.6 at preoperative assessment to 27.9 at postoperative assessment (p = 0.026). There was also a significant improvement in the Constant scale from a mean of 37.9 to 61.8 (p = 0.037). In terms of pain assessment, the mean VAS went from a mean of 7.44 to 3.38 (p = 0.916). In 90% of patients no complications or need for further interventions were objectified. CONCLUSIONS: the subacromial balloon has shown favorable results in our series of patients, so it could be a valid treatment option in patients with non-repairable rotator cuff tears.

INTRODUCCIÓN: el tratamiento mediante cirugía artroscópica de las lesiones del manguito rotador ha desplazado a la cirugía abierta como primera opción de tratamiento. Existen diferentes técnicas quirúrgicas descritas para tratar las roturas masivas o no reparables. Desde hace unos años se viene utilizando un nuevo dispositivo que consiste en un balón subacromial biodegradable que actúa como espaciador entre la cabeza humeral y el acromion. Este trabajo pretende analizar los resultados de este implante. MATERIAL Y MÉTODOS: realizamos un estudio observacional y retrospectivo de todos los pacientes a los que se les implantó un balón subacromial en nuestro centro entre 2017 y 2019. Se evaluó a los pacientes pre y postoperatoriamente mediante las escalas de Constant, DASH y EVA. RESULTADOS: un total de 43 pacientes cumplieron los criterios de inclusión y el seguimiento mínimo de 24 meses. La puntuación media de la escala DASH pasó de 53.6 en la evaluación preoperatoria a 27.9 en la postoperatoria (p = 0.026). También se obtuvo una mejoría significativa en la escala de Constant, que pasó de una media de 37.9 a 61.8 (p = 0.037). En cuanto a la evaluación del dolor, la EVA media pasó de 7.44 a 3.38 (p = 0.916). En 90% de los pacientes no se objetivaron complicaciones ni necesidad de nuevas intervenciones. CONCLUSIONES: el balón subacromial ha mostrado resultados favorables en nuestra serie de pacientes, por lo que podría suponer una opción válida de tratamiento en pacientes con roturas no reparables del manguito rotador.

Resultados a mediano plazo de la prótesis invertida en la artropatía de manguito / Results in the medium long term of the reverse shoulder prosthesis in the cuff arthropathy

Resumen: Introducción: El estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. Material y método: Retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. Resultados: Mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. Conclusiones: La AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.

Abstract: Introduction: The final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. Material and methods: Retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. Results: We achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. Conclusions: Reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.

[Results in the medium long term of the reverse shoulder prosthesis in the cuff arthropathy]. / Resultados a mediano plazo de la prótesis invertida en la artropatía de manguito.

INTRODUCTION: the final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. MATERIAL AND METHODS: retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. RESULTS: we achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. CONCLUSIONS: reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.

INTRODUCCIÓN: el estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. MATERIAL Y MÉTODO: retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. RESULTADOS: mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. CONCLUSIONES: la AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.

Impacto de la pandemia de la COVID-19 en el funcionamiento de un servicio público de Ortopedia y Traumatología: nuestro aprendizaje luego de la primera ola / Impact of the COVID-19 pandemic on the activity of a public orthopedics and traumatology service. Our insights after the first wave

Introducción: El objetivo principal fue comparar la actividad clínico-quirúrgica de nuestro Servicio de Ortopedia y Traumatología antes de la instauración del plan de contingencia frente a la pandemia de la COVID-19 y durante este, un aspecto relevante para establecer antecedentes que permitan guiar nuestro desempeño ante la segunda ola de casos y futuras contingencias semejantes. materiales y métodos: Estudio analítico observacional longitudinal ambispectivo de los pacientes atendidos en el Servicio de Ortopedia y Traumatología de un hospital del sistema público de la Ciudad Autónoma de Buenos Aires, durante el plan de contingencia frente a la pandemia de la COVID-19. Como variable de resultado primaria se valoró el número total de cirugías realizadas durante el período de estudio. Resultados: La pandemia se asoció con menos cirugías totales (p = 0,002), de Guardia (p = 0,000) y de Planta (p = 0,002). Las cirugías totales se redujeron un 81,5%. Las cirugías de urgencia representaron el 97%, diferencia significativa con el período fuera de la pandemia (p = 0,080). Además, el promedio de cirugías por día quirúrgico disponible fue significativamente menor (p = 0,000). Conclusiones: Creemos que la atención de la enfermedad ortopédica y el trauma musculoesquelético, adaptada a las obligaciones indicadas por el plan nacional y regional de contingencia frente a la pandemia, fue notoriamente menor que nuestro desempeño habitual. Si bien respondimos adecuadamente a las urgencias de nuestra especialidad queda pendiente la posibilidad de estratificar y considerar tipos de pacientes con cuadros pasibles de ser tratados, en forma gradual, durante la pandemia. Nivel de Evidencia: IV

Introduction: Our aim was to compare our activity in the Orthopedics and Traumatology service during the first wave of the COVID-19 pandemic. materials and methods: Ambispective longitudinal observational analytical study of patients treated in the Orthopedics and Traumatology Service of a public health hospital of Buenos Aires during the first wave of the COVID-19 pandemic. The primary outcome variable was the total number of surgeries performed during the study period. Results: The pandemic was associated with fewer total surgeries (p = 0.002), emergency department surgeries (p = 0.000) and elective surgeries (p = 0.002). Total surgeries were reduced by 81.5%. Emergency surgeries accounted for 97%, a significant difference with the non-pandemic period (p = 0.080). Additionally, the average number of surgeries per available surgical day was significantly lower (p = 0.000). Conclusions: We believe that, under the regulations indicated by the national and regional pandemic contingency plan, the care of orthopedic pathology and musculoskeletal trauma was notoriously lower than our usual performance. Although we responded adequately to the emergencies of our specialty, the possibility of stratifying and considering types of patients with conditions that could be treated gradually during the pandemic remains pending. Level of Evidence: IV

Thrombosis of previously silent Persistent Sciatic Vein in non Klippel-Trenaunay syndrome patient.

Persistent Sciatic Vein (PSV) remains a rare condition with no associated malformative syndrome or concomitant Persistent Sciatic Artery (PSA). Very few case reports have been published. We report the case of a 73-year-old man who presented to the emergency room with tenderness, edema and pain of the left calf, for up to 3 days. Biology reported an elevated d-dimer level. Doppler ultrasound diagnosed proximal left deep popliteal vein thrombosis, extended to a large vein along the sciatic nerve in the posterior compartment of the thigh, and a patent superficial femoral vein. Anticoagulation therapy was initiated immediately for at least 3 months. PSV remains an understudied condition. While its prevalence is low in the general population, this anatomical condition is associated with some specific clinical situations, such as Klippel-Trenaunay syndrome (KTS) or early varicose recurrence, especially in the posterior thigh area. To our knowledge, this is the first case report of a thrombosed PSV in a patient without a KTS.

Reliability of hemostasis biomarkers is affected by time-dependent intra-patient variability.

Essentials Nucleosomes and free DNA are two newly described biomarkers in venous thromboembolism (VTE). Reliability of nucleosomes, plasma free DNA and conventional hemostasis markers were studied. Hemostasis biological parameters vary over a short time-frame in VTE patients. Hemostasis biological parameters also vary over a short time-frame in healthy controls. SUMMARY: Background Previous studies have associated neutrophil-derived circulating nucleosomes and plasma free DNA with venous thromboembolism (VTE). However, there are few data concerning these two biomarkers and no studies have compared the reliability of nucleosomes and plasma free DNA against that of conventional hemostasis markers. Objectives We performed a 3-year prospective study of nucleosomes and plasma free DNA levels in comparison with conventional hemostatic biomarkers and blood cells. Patients/Methods Fifteen healthy controls and 22 randomly selected patients with a history of VTE were followed monthly for 6 months. The reliability of these markers was evaluated by the intraclass correlation coefficient (ICCs). Results and Conclusions In healthy controls and patients, we found a low reliability for nucleosomes and plasma free DNA, with ICCs at 0.538 (95% confidence interval [CI], 0.334-0.764) and 0.091 (95% CI, -0.026-0.328), respectively, in the healthy controls, and at 0.213 (95% CI, 0.042-0.463) and 0.161 (CI 95%, 0.008-0.398) in the patient group. For the conventional hemostasis biomarkers and for blood cells, reliability ranged from poor to good in the healthy volunteers and from poor to acceptable in the patient group. Our study shows for the first time that hemostasis biological parameters spontaneously vary over a short time-frame in VTE patients and, more surprisingly, in normal individuals. The clinical value of such intra-individual variations is currently unknown. This variability might mean reinterpreting diagnostic or prognostic models based on static evaluation of individuals. Studying the intrinsic value of individual patterns of markers' variability is warranted.

Anaphylactic shock with an ultrasound contrast agent.

Echo contrast agents, such as SonoVue®, (Bracco, Milan, Italy) are often used to enhance diagnosis. Although their use is safe, some rare side effects could be severe or even fatal. We are reporting a case of severe systemic allergic reaction after infusion of SonoVue®. After a brief review of the literature, the aim of this paper is to draw attention to this risk and recall the safety instructions coming with the use of ultrasound contrast agents.

Ictus en una mujer joven afecta de migraña sin aura / Stroke in a young woman suffering migraine without aura

No disponible

From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability?

The auscultatory technique remains the point of reference for the validation of non-invasive blood pressure measurement devices, although the exact origin of the Korotkoff sounds is still debated and comparison with intra-arterial measurement shows limits and pitfalls. Automatic oscillometric devices are now widely used by nurses, physicians, and patients. However, many available devices have not been duly validated. Moreover, they calculate systolic and diastolic blood pressures using undisclosed algorithms. Therefore, these devices are not interchangeable, and their reliability may be questionable in some clinical situations. Nevertheless, oscillometry is increasingly used, beside NIBP, for the assessment of central blood pressure and systemic arterial wall stiffness. Awareness of its limits and causes of error is all the more necessary.

[B-mode sonography visualizing microemboli flow in the main cerebral arteries]. / Visualisation du passage de micro-emboles cérébraux par ultrasonographie en mode B-Flow.

In a patient with a mechanical prosthetic aortic valve admitted for transient amnesia, transcranial duplex Doppler and B-mode sonography visualized the transit of microemboli along the main cerebral arteries. Gaseous microemboli resulting from a cavitation phenomenon at valve closure were seen as high-intensity transient signals (HITS). To our knowledge, this is the first report of microemboli flow visualized in B-mode.

[Unusual consequences of foam sclerotherapy]. / Des conséquences insolites d'une sclérothérapie à la mousse.

Neurological disorders are rare complications of foam sclerotherapy. Visual disturbances and headache are the most commonly reported events and are thought to be equivalent to migraine with aura. Exceptionally, strokes have been reported. Papillary fibroelastoma is a rare cardiac tumor, which may embolize in cerebral arteries. We report the case of a patient in whom neurological disorders occurred during a session of foam sclerotherapy, and led to the discovery of a cardiac fibroelastoma.

Moldes individualizados para alineación de la artroplastía primaria de rodilla / Individualized molds for alignment of primary knee arthroplasty

Introducción: Los sistemas de bloque de corte específicos (BCE) se han presentado como una interesante medida para obtener una correcta alineación en la artroplastía de rodilla, aunque se desconoce cuál de todos los métodos existentes para realizar la planificación es el adecuado. Material y métodos: Se ha diseñado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineación. Se analizaron parámetros radiográficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusión, tiempo quirúrgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadísticamente significativas entre los dos sistemas de alineamiento específicos y el sistema convencional (p > 0.05), aunque se objetivó una mayor precisión con estos sistemas, siendo discretamente superior en el sistema Signature. También se observó un menor tiempo quirúrgico en los pacientes intervenidos con los BCE, ligeramente inferior en los intervenidos con el sistema Visionaire (p > 0.05). Conclusiones: Los nuevos sistemas BCE pueden ser útiles para mejorar la alineación en la artroplastía de rodilla así como disminuir el tiempo quirúrgico. A la espera de series mayores que corroboren estos datos, los autores recomiendan estos sistemas en aquellos casos en los que los sistemas convencionales no sean adecuados.

Introduction: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. Material and methods: A prospective study was designed to compare two PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. Results: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). Conclusions: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

[Individualized molds for alignment of primary knee arthroplasty]. / Moldes individualizados para alineación de la artroplastía primaria de rodilla.

INTRODUCTION: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. MATERIAL AND METHODS: A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. RESULTS: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). CONCLUSIONS: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

Effects of sub-lethal glyphosate concentrations on growth and photosynthetic performance of non-target species Bolboschoenus maritimus.

Glyphosate use has increased over the last decades for the control of invasive plant species in wetland ecosystems. Although glyphosate has been considered 'environmentally' safe, its repeated use could increase the toxicological risk derived from diffuse pollution of surface and groundwater on non-target vegetation. A glasshouse study was designed to determine the effect produced by the addition of different sub-lethal doses of glyphosate herbicides (5-30 mg L(-1)) to the nutrient solution on the growth and photosynthetic apparatus of Bolboschoenus maritimus. Although B. maritimus plants were able to grow and survive after 20 d of exposure to glyphosate, the presence of this herbicide affected their growth, through a direct interaction with the root system. Particularly, at 30 mg L(-1) glyphosate, B. maritimus showed ca. 30% of biomass decrease. The reduction in B. maritimus growth was due to a decrease in net photosynthetic rate (A), which ranged between values ca. 11.5 and 5.5 µmol m(-2)s(-1) CO2 for the control and the highest glyphosate treatment, respectively. The response of A to glyphosate could be largely accounted for by non-stomatal limitations, since stomatal conductance was similar in all glyphosate treatments. Thus, A decrease was prompted by the negative impact of herbicide on photochemical (PSII) apparatus, the reduction in the absorption of essential nutrients, the reduction of photosynthetic pigments and possibly the reduction in Rubisco carboxilation capacity. Moreover, glyphosate excess caused photoinhibitory damage. In conclusion, in this study we have shown that herbicide water pollution could be a source of indirect phytotoxicity for B. maritimus.

Assessing the effect of copper on growth, copper accumulation and physiological responses of grazing species Atriplex halimus: ecotoxicological implications.

Tolerance of plants to elevated concentrations of heavy metals in growth media and in its tissues leads to high degrees of metal bioaccumulation, which may pose a risk for humans and animals alike. Therefore, bio-accumulating plants need thorough evaluation from an environmental health point of view. A glasshouse experiment concerning the xerohalophyte Atriplex halimus was carried out to determine its tolerance and capacity to accumulate copper. We investigated the effect of Cu from 0 to 30 mmol l(-1) on the growth, photosynthetic apparatus and nutrient uptake of A. halimus by measuring gas exchange, chlorophyll fluorescence and photoinhibition. We also determined total Cu, sodium, potassium, magnesium, phosphorous, and nitrogen content in the plant. Our results indicated that A. halimus presented a high resistance to Cu-induced stress, since the plants were able to survive at concentrations higher than 15 mmol l(-1) Cu. However, this capacity was not reflected in its ability to accumulate and tolerate greater amounts of Cu in its tissues, since clear phytotoxicity symptoms were detected at tissue concentrations greater than 38 mg kg(-1) Cu. Thus, Cu increment caused a reduction in A. halimus growth, which was related to a decrease in net photosynthetic rate. This reduction was associated with the adverse effect of Cu on the photochemical apparatus and the reduction in the absorption of essential nutrients. The high resistance of A. halimus was largely related with the capacity of this species to avoid the absorption of great amounts of Cu. For all the above reasons, A. halimus could have the characteristics of a Cu-exclusion plant.

[Perception of rare diseases by the primary care physicians]. / Percepción de las enfermedades raras por el médico de atención primaria.

OBJECTIVES: Identify the elements that lead to the perception that primary health care physicians (PHCP) have as regards rare diseases (RD) as a whole, and to analyse the characteristics of these patients with rare diseases. METHODS: Descriptive cross-sectional study. Surveys completed by PHCP during the years 2008-2010 were used to explore socio-demographic data, health care facilities, manpower, and services, knowledge level, expectations, means of obtaining available information, and training-support preferences of RD. RESULTS: A total of 260 questionnaires were analysed. The average level of knowledge was 3.68 (SD 1.93), of interest 7.34 (SD 2.02), and of importance 7.51 (SD 1.69). Less than one quarter (20.4%) of responders had done some training activity. Care at home (6.38, SD 2.07) is the most valued long term care option, emphasising the need of primary prevention (7.63 SD 1.5). Over one-third (35%) applied for some aid, mainly economic (37.4%). Internet is their main source of information (71.2%), and an average of 7.85 (SD 2.38) perceived the need for specific continuing training. By registered lists, each professional attends a mean of 2.45 (SD 3.69) patients with RD, 1.604% having temporary work disability, 1.479% having some disability and 1.62% with a dependence situation. The follow up of RD patients was: at Hospital level 55.72%, by special reference units 44.34%, by specialists 39.75%, and exclusively at PHCP level 14.46%. CONCLUSIONS: PHCP have a low level of knowledge of RD, although a high interest, with emphasis on primary prevention, the importance of the family environment, genetic counselling and health education. They rarely request medical resources for RD. Internet is their main source of information, and prefer specific continuing education courses.

Percepción de las enfermedades raras por el médico de atención primaria / Perception of rare diseases by the primary care physicians

Objetivos. Identificar los elementos que integran la percepción que tienen los médicos de atención primaria (AP) con respecto a las enfermedades raras (ER) en su conjunto y analizar las características de estos pacientes. Métodos. Estudio de corte transversal descriptivo mediante encuestas cumplimentadas por médicos de AP. Se incluyen variables sociodemográficas, sociosanitarias, grado de conocimiento, expectativas, forma de obtener información y preferencias de formación sobre ER, durante los años 2008-2010. Resultados. Se analizan 260 encuestas. El grado medio de conocimiento es de 3,68 (DE 1,93), de interés 7,34 (DE 2,02) y de importancia 7,51 (DE 1,69). El 20,4% han realizado alguna actividad formativa. La atención domiciliaria (6,38; DE 2,07) es la opción sociosanitaria más valorada; considerando más necesaria la prevención primaria (7,63; DE 1,5). El 35% solicita alguna ayuda, principalmente económica (37,4%). Internet resulta su fuente principal de información (71,2%) y una media de 7,85 (DE 2,38) percibe la necesidad de cursos de formación continuada específicos. Por cupo existen 2,45 (DE 3,69) pacientes con ER, en situación de incapacidad laboral transitoria (ILT) el 1,604%, presenta discapacidad el 1,479% y dependencia el 1,62%. Realizando seguimiento hospitalario el 55,72%, en unidades de referencia el 44,34%, por especialista de zona el 39,75% y únicamente por AP el 14,46%. Conclusiones. Existe un grado de conocimiento bajo en ER por parte del médico de AP, aunque un gran interés, priorizando la prevención primaria, la importancia del entorno familiar, el consejo genético y la educación sanitaria. El médico de AP solicita escasos recursos para las ER. Internet es su fuente principal de información y prefiere los cursos de formación continuada específicos (AU)

Objectives. Identify the elements that lead to the perception that primary health care physicians (PHCP) have as regards rare diseases (RD) as a whole, and to analyse the characteristics of these patients with rare diseases. Methods. Descriptive cross-sectional study. Surveys completed by PHCP during the years 2008-2010 were used to explore socio-demographic data, health care facilities, manpower, and services, knowledge level, expectations, means of obtaining available information, and training-support preferences of RD. Results. A total of 260 questionnaires were analysed. The average level of knowledge was 3.68 (SD 1.93), of interest 7.34 (SD 2.02), and of importance 7.51 (SD 1.69). Less than one quarter (20.4%) of responders had done some training activity. Care at home (6.38, SD 2.07) is the most valued long term care option, emphasising the need of primary prevention (7.63 SD 1.5). Over one-third (35%) applied for some aid, mainly economic (37.4%). Internet is their main source of information (71.2%), and an average of 7.85 (SD 2.38) perceived the need for specific continuing training. By registered lists, each professional attends a mean of 2.45 (SD 3.69) patients with RD, 1.604% having temporary work disability, 1.479% having some disability and 1.62% with a dependence situation. The follow up of RD patients was: at Hospital level 55.72%, by special reference units 44.34%, by specialists 39.75%, and exclusively at PHCP level 14.46%. Conclusions. PHCP have a low level of knowledge of RD, although a high interest, with emphasis on primary prevention, the importance of the family environment, genetic counselling and health education. They rarely request medical resources for RD. Internet is their main source of information, and prefer specific continuing education courses (AU)

Mechanical characterization of Co/Cu multilayered nanowires.

The mechanical deformation properties of (110) Co/Cu multilayered nanowires were studied by Molecular Dynamics under uniaxial tensile and compressive stresses. The potential of the immiscible CoCu system was modeled by a second-moment tight-binding approximation. Stress-strain curves at different conditions were obtained and the elastic modulus and yield stress were analyzed. Both magnitudes are approximately independent of the strain rate, except at high values. They decrease linearly with increasing temperature. Below a volume-to-surface-area ratio, their values drastically increase and diverge from the bulk values. If the thickness of the Cu sublayers increases, the Young's modulus and yield stress decrease, although in a different way. The elastic modulus decreases linearly and the yield stress falls steeply whenever Cu is present in the nanowire, since the lattice distortion takes place firstly and fundamentally in Cu sublayers. The change in the axial stress at the interface is little significant on average and rather localized. Unlike, the transverse stress has a non-uniform distribution along the Cu sublayer, especially at the yield point. The Young's modulus and yield stress are larger in tension than in compression. Under tensile stress, nanowires slip via partial dislocation nucleation and propagation. Unlike, compressive deformation of nanowires takes place via both partial and full dislocations.