The effects of a prehabilitation programme based on therapeutic exercise, back care education, and pain neuroscience education in patients scheduled for lumbar radiculopathy surgery: A study protocol for a randomised controlled trial.

The aim of this present clinical trial is to evaluate the effectiveness of a multicomponent prehabilitation programme administered through educational videos versus another programme based on written exercise recommendations, in patients scheduled for lumbar radiculopathy surgery. This study will be a multicentre, controlled, randomised, parallel clinical trial. One hundred participants undergoing lumbar radiculopathy surgery who meet the established inclusion criteria will be recruited at different Spanish hospitals. The experimental group will follow a 4-week prehabilitation programme combining therapeutic exercise, back care education, and pain neuroscience education delivered through videos designed for consumption at home. The control group will be provided with written instructions to perform therapeutic exercises during the same prehabilitation time period. The primary outcome of the study will be disability, assessed using the Spanish version of the Oswestry Disability Index. The secondary outcomes will be pain perception, health-related quality of life, fear avoidance, kinesiophobia, catastrophising, anxiety, depression, physical activity, and the treatment satisfaction of the patients. This study will provide evidence for the effectiveness of a home-based multicomponent prehabilitation programme that addresses some already identified barriers to patient attendance in face-to-face programmes. Understanding the medium and long-term effects of pre-surgery lumbar muscle training and pain neuroscience education administered via instructional videos watched by patients at home, will help improve the design of prehabilitation programmes in this population while also improving the cost-effectiveness of such interventions.

Biosynthetic gene clusters with biotechnological applications in novel Antarctic isolates from Actinomycetota.

Actinomycetota have been widely described as valuable sources for the acquisition of secondary metabolites. Most microbial metabolites are produced via metabolic pathways encoded by biosynthetic gene clusters (BGCs). Although many secondary metabolites are not essential for the survival of bacteria, they play an important role in their adaptation and interactions within microbial communities. This is how bacteria isolated from extreme environments such as Antarctica could facilitate the discovery of new BGCs with biotechnological potential. This study aimed to isolate rare Actinomycetota strains from Antarctic soil and sediment samples and identify their metabolic potential based on genome mining and exploration of biosynthetic gene clusters. To this end, the strains were sequenced using Illumina and Oxford Nanopore Technologies platforms. The assemblies were annotated and subjected to phylogenetic analysis. Finally, the BGCs present in each genome were identified using the antiSMASH tool, and the biosynthetic diversity of the Micrococcaceae family was evaluated. Taxonomic annotation revealed that seven strains were new and two were previously reported in the NCBI database. Additionally, BGCs encoding type III polyketide synthases (T3PKS), beta-lactones, siderophores, and non-ribosomal peptide synthetases (NRPS) have been identified, among others. In addition, the sequence similarity network showed a predominant type of BGCs in the family Micrococcaceae, and some genera were distinctly grouped. The BGCs identified in the isolated strains could be associated with applications such as antimicrobials, anticancer agents, and plant growth promoters, among others, positioning them as excellent candidates for future biotechnological applications and innovations. KEY POINTS: • Novel Antarctic rare Actinomycetota strains were isolated from soil and sediments • Genome-based taxonomic affiliation revealed seven potentially novel species • Genome mining showed metabolic potential for novel natural products.

Synthesis, Characterization and Catechol-Based Bioinspired Adhesive Properties in Wet Medium of Poly(2-Hydroxyethyl Methacrylate-co-Acrylamide) Hydrogels.

Hydrogels consist of crosslinked hydrophilic polymers from which their mechanical properties can be modulated for a wide variety of applications. In the last decade, many catechol-based bioinspired adhesives have been developed following the strategy of incorporating catechol moieties into polymeric backbones. In this work, in order to further investigate the adhesive properties of hydrogels and their potential advantages, several hydrogels based on poly(2-hydroxyethyl methacrylate-co-acrylamide) with N'N-methylene-bisacrylamide (MBA), without/with L-3,4-dihydroxyphenylalanine (DOPA) as a catecholic crosslinker, were prepared via free radical copolymerization. 2-Hydroxyethyl methacrylate (HEMA) and acrylamide (AAm) were used as comonomers and MBA and DOPA both as crosslinking agents at 0.1, 0.3, and 0.5 mol.-%, respectively. The polymeric hydrogels were characterized by Fourier transform infrared spectroscopy (FT-IR), thermal analysis and swelling behavior analysis. Subsequently, the mechanical properties of hydrogels were determined. The elastic properties of the hydrogels were quantified using Young's modulus (stress-strain curves). According to the results herein, the hydrogel with a feed monomer ratio of 1:1 at 0.3 mol.-% of MBA and DOPA displayed the highest rigidity and higher failure shear stress (greater adhesive properties). In addition, the fracture lap shear strength of the biomimetic polymeric hydrogel was eight times higher than the initial one (only containing MBA); however at 0.5 mol.-% MBA/DOPA, it was only two times higher. It is understood that when two polymer surfaces are brought into close contact, physical self-bonding (Van der Waals forces) at the interface may occur in an -OH interaction with wet contacting surfaces. The hydrogels with DOPA provided an enhancement in the flexibility compared to unmodified hydrogels, alongside reduced swelling behavior on the biomimetic hydrogels. This approach expands the possible applications of hydrogels as adhesive materials, in wet conditions, within scaffolds that are commonly used as biomaterials in cartilage tissue engineering.

Design Path for a Social Robot for Emotional Communication for Children with Autism Spectrum Disorder (ASD).

Children with autism spectrum disorder (ASD) have deficits in social interaction and expressing and understanding emotions. Based on this, robots for children with ASD have been proposed. However, few studies have been conducted about how to design a social robot for children with ASD. Non-experimental studies have been carried out to evaluate social robots; however, the general methodology that should be used to design a social robot is not clear. This study proposes a design path for a social robot for emotional communication for children with ASD following a user-centered design approach. This design path was applied to a case study and evaluated by a group of experts in psychology, human-robot interaction, and human-computer interaction from Chile and Colombia, as well as parents of children with ASD. Our results show that following the proposed design path for a social robot to communicate emotions for children with ASD is favorable.

Mammals' sperm microbiome: current knowledge, challenges, and perspectives on metagenomics of seminal samples.

Bacterial growth is highly detrimental to sperm quality and functionality. However, during the last few years, using sequencing techniques with a metagenomic approach, it has been possible to deepen the study of bacteria-sperm relationships and describe non-culturable species and synergistic and antagonistic relationships between the different species in mammalian animals. We compile the recent metagenomics studies performed on mammalian semen samples and provide updated evidence to understand the importance of the microbial communities in the results of sperm quality and sperm functionality of males, looking for future perspectives on how these technologies can collaborate in the development of andrological knowledge.

Maternal anxiety, exposure to the COVID-19 pandemic and socioemotional development of offspring.

The COVID-19 pandemic context may predispose mothers to increased maternal psychopathology, which may be associated with offspring socioemotional development. The aim of this study is to analyze the relationships between prenatal anxiety and depression and exposure to the COVID-19 pandemic with offspring socioemotional development, controlling for postnatal anxiety and depression. A total of 105 mother-child dyads were assessed in pre- and postnatal periods. Questionnaires were used to assess the impact of the pandemic, indicators of psychopathology, and the socioemotional development of the offspring. Results suggest that negative pandemic experiences are indirectly associated with offspring socioemotional development via prenatal maternal anxiety symptomatology and after controlling for postnatal anxiety and depression. These indicators predispose to emotional deficits and increase the risks of psychopathological and neurodevelopmental disorders. It is important to adopt health policies that provide timely assessment of development in early childhood to reduce the risks associated with these deficits.

Monitoring Insect Resistance to Bt Maize in the European Union: Update, Challenges, and Future Prospects.

Transgenic maize producing the Cry1Ab toxin of Bacillus thuringiensis (Bt maize) was approved for cultivation in the European Union (EU) in 1998 to control the corn borers Sesamia nonagrioides (Lefèbvre) and Ostrinia nubilalis (Hübner). In the EU since then, Cry1Ab is the only Bt toxin produced by Bt maize and Spain is the only country where Bt maize has been planted every year. In 2021, about 100,000 hectares of Bt maize producing Cry1Ab were cultivated in the EU, with Spain accounting for 96% and Portugal 4% of this area. In both countries, Bt maize represented less than 25% of all maize planted in 2021, with a maximum regional adoption of 64% Bt maize in northeastern Spain. Insect resistance management based on the high-dose/refuge strategy has been implemented in the EU since 1998. This has been accompanied by monitoring to enable early detection of resistance. The monitoring data from laboratory bioassays show no decrease in susceptibility to Cry1Ab had occurred in either pest as of 2021. Also, control failures have not been reported, confirming that Bt maize producing Cry1Ab remains effective against both pests. Conditions in the EU preventing approval of new genetically modified crops, including maize producing two or more Bt toxins targeting corn borers, may limit the future effectiveness of resistance management strategies.

Clinical Outcome and Histological Findings After Induced Leakage of PMMA Loaded With Methotrexate and Cisplatin During Vertebroplasty: Experimental Model in Pigs.

STUDY DESIGN: Animal experimental model. OBJECTIVE: To study the clinical behavior and histological changes in the spinal cord, nerve roots and perivertebral muscles of the spine after induced leakage of polymethylmethacrylate (PMMA) loaded with antiblastic drugs during vertebroplasty in an animal model of pigs. METHODS: We performed vertebroplasty on 25 pigs. The animals were divided into 3 groups: vertebroplasty with PMMA alone (control group), vertebroplasty with PMMA loaded with methotrexate (MTX) and vertebroplasty with PMMA loaded with cisplatin (CYS). At 2 vertebral levels, epidural and prevertebral, massive cement leaks were induced. Animals were evaluated daily. Two weeks later, the pigs were sacrificed, and the tissues that came in contact with the cement were analyzed. RESULTS: The clinical results for each of the groups were reported. The control group had no clinical alterations. In the MTX group, 2 pigs died before 1 week due to pneumonitis. In the CYS group, 4 animals had motor impairment, and 3 of the 4 had paraplegia. The histological results were as follows: the control and MTX groups showed synovial metaplasia, inflammatory reaction, crystal deposits, and giant cell reaction in the dura mater and muscle and all the animals in the CYS group had spinal cord and muscular necrosis. CONCLUSIONS: Massive cement leak after vertebroplasty with PMMA loaded with cisplatin is extremely toxic to the spinal cord and muscles around the spine. Therefore, its use cannot be recommended for the treatment of vertebral metastases. Using PMMA loaded with methotrexate seems to be a safe procedure, but further research is needed.

Bacteria and Boar Semen Storage: Progress and Challenges.

Porcine breeding today is based on artificial insemination with chilled semen. This is stored at 5 °C with antibiotic supplementation to avoid bacteriospermia. There are many negative consequences on sperm quality and functionality as a result of bacterial contamination, as well as on the health of the sow. Nowadays, various techniques are being developed to reduce the indiscriminate use of antibiotics and thus avoid the generation of antibiotic resistance genes. This review aims to inform about the bacterial contamination consequences of storing liquid semen from boar and to provide an update on current methods and alternatives to antibiotic use in cold storage.

Comprehensive Genome Analysis of Neisseria meningitidis from South America Reveals a Distinctive Pathogenicity-Related Prophage Repertoire.

Neisseria meningitidis, a bacterium that colonizes in the human nasopharynx, occasionally causes invasive meningococcal disease leading to meningitis or septicemia. Different serogroups and lineages (clonal complexes) are related to the occurrence and epidemiology of N. meningitidis. Despite vaccines for most serogroups, N. meningitidis lineages causing unusual clinical manifestations and a higher fatality rate compared to other lineages have been reported in South America. The present study focused on exploring the diversity of N. meningitidis prophages from South America and their relationship with the epidemiological variables of these strains. We found a high diversity of prophages among the different clonal complexes. By comparing them with previously described N. meningitidis phages and prophages, we revealed groups of prophages sharing similar compositions, which could be useful for prophage comparison in N. meningitidis. Furthermore, we observed a high correlation between the prophage content and epidemiological features, e.g., pathogenicity or clonal complex. Additionally, a distinctive filamentous prophage named here as IMSAR-11 (Invasive Meningococci from South America Related to cc11) was identified. Interestingly, two versions of IMSAR-11, circular and chromosomally integrated, were found. Overall, this study reinforces the importance of the genomic characterization of circulating N. meningitidis lineages to generate new targets for lineage monitoring, diagnosis, or appropriateness of vaccine development. Further studies are necessary to understand the role of these prophages in the persistence, dispersal, and virulence of N. meningitidis in the world.

Evidencias de validez de la tarea de los dedos en una modalidad de administración asincrónica / Validity evidence of the finger task in an asynchronous administration modality

La batería de Autorregulación Cognitiva -TAC-es una herramienta informatizada para la evaluación de los principales procesos ejecutivos en una modalidad de administración presencial. Aunque sus características técnicas hacen viable su administración en una modalidad remota y asincrónica aún no cuenta con evidencias de validez y confiabilidad de sus puntuaciones en una modalidad de administración no presencial. Por ello, este estudio propone obtener evidencias de las propiedades psicométricas de la Tarea de los Dedos -TAC-en su modalidad de administración remota y asincrónica para la evaluación de la Inhibición comportamental y la flexibilidad cognitiva en personas adultas. Para cumplir con este objetivo, se analizó la presencia de dos efectos experimentales que aportan validez de constructo y se comparó su desempeño en las dos modalidades de administración. Finalmente, se analizó la confiabilidad de las puntuaciones a través del método de división por mitades. Los resultados obtenidos aportan evidencia empírica de las propiedades psicométricas del instrumento(AU)

The cognitive self-regulation battery -TAC-is a computerized tool designed to evaluate the work memory, three inhibitory processes and cognitive flexibility. There is still no evidence of validity and reliability of their scores in remote administration mode. The goal of this work is to obtain evidence of reliability and validity for the tac fingers task in remote and asynchronous administration mode for cognitive flexibility and behavioral inhibition evaluation in the adult population. It was analyzed iftwo experimental effects were detected. Its presence indicates the activation or participation of cognitive flexibility and behavioral inhibition in the resolution of activities proposed by the task. Also, the performance of the participants in both modalities was compared. The internal consistency was analyzed through the method of division by halves. The results obtained provide empirical evidence of psychometric properties of TAC fingers task for evaluation of cognitive flexibility and behavioral inhibition in the adult population(AU)

Osteotomies of the second phalanx of the great toe: A clinical experience.

BACKGROUND: At the time of the first report on the feasibility of corrective osteotomies of the distal phalanx (DP) of the great toe there were no published studies addressing this type of surgery. Along this line, and throughout our clinical experience, this paper tries to show the clinical benefits of hallux DP osteotomies when correcting interphalangeal valgus deformities (IHV) of the great toe, either with open or percutaneous procedure. MATERIAL AND METHODS: This is a review of 18 cases in which a DP osteotomy was performed in 2 different institutions, 8 cases were performed using open technique and 10 cases percutaneously. The correction obtained was analyzed by measuring the distal articular set angle (DASA), obliquity angle (AP1), asymmetry angle (AP2), and global distal phalanx deviation (GDPD) angle before and after the surgery on dorso-plantar weight-bearing radiographs in all cases. Clinical results were also recorded. RESULTS: Excellent clinical and radiological results were achieved with both techniques in all patients with no complications. The average DP angular deformity correction in terms of AP1, AP2 and GDPD angles were 4.58º ± 5.55º, 8.95º ± 4.77º and 16.53º ± 7.26 respectively. In 10 cases an Akin osteotomy was associated. CONCLUSION: In cases with valgus deviation in the hallux DP, a corrective osteotomy of the DP alone or associated to osteotomy of the PP should be considered as a useful tool. The technique is feasible and has no technical difficulties for an orthopedic surgeon with experience on feet surgery.

More than a year of pandemic: Longitudinal assessment of anxiety and depressive symptoms in the argentine general population during the COVID-19 outbreak.

The COVID-19 pandemic has radically changed daily life and the way we interact with others. It has also brought negative psychological consequences: several studies have reported increased levels of distress symptomatology at the onset of the pandemic. However, few longitudinal studies have been carried out, and even fewer in low- and middle-income countries. Therefore, the aim of this study was to analyse longitudinally the anxiety and depressive symptomatology of the Argentine general population during the first 13 months of the pandemic. The total sample included 988 adults (ages 18-77) from different regions of Argentina. Open-access surveys were distributed via social media at five time points (March, April, May, August 2020 and April 2021). Depression and anxiety symptoms were assessed through the Beck Depression Inventory-II and the State-Trait Anxiety Inventory. Mixed repeated-measures ANOVA were applied, with time as a within-subjects factor, and socioeconomic status, gender, and age group as between-subjects factors. Results showed a progressive increases in anxiety (F (27.78, 3417.60) = 62.88, p < 0.01, ηp2  = 0.060) and depression (F (3.42, 3373.75) = 84.78, p < 0.01, ηp2  = 0.079) symptoms in the general population throughout the pandemic (except for a slight decrease in anxiety in Wave 2). All of the between-subjects factors showed significant effects on both types of symptoms: female gender, younger age and lower income were associated with greater depression and anxiety in all waves. A time-age interaction effect was found (F (10.26, 3364.05)  = 2.99, p < 0.01, ηp2  = 0.009): after the third wave, depressive symptoms tended to decrease or stabilise in the young adult group, whereas there was a positive linear increase in the older groups. This study provided evidence that anxiety and depression symptoms tend to increase during crisis contexts, and that this effect is even more pronounced for certain vulnerable population groups. Mental health monitoring and support interventions should be included in government strategies to deal with the long-term impact of the pandemic.

[Prevalence of neurocognitive disorders in a rural area of Argentina] / Prevalencia de trastornos neurocognitivos en una región rural Argentina.

Aim: To carry out a cognitive screening to detect cases of Neurocognitive Disorders (NCD) 60 and over years adults and estimate its prevalence in the eastern area of Tucumán. Methods: A neuropsychological assessment was carried out. Groups were formed according to the presence and severity of NCD. Results: 257 subjects participated in the study (X = 69.9 years, SD = 7.2; 60.7% of female gender). The prevalence of neurocognitive disorders was estimated at 51.17% with 90% confidence and a precision (d) of 4%. Main Conclusion: The prevalence exceeded the estimation for Argentina. From the tests it was observed that the lower the educational level and the older the age, the risk of developing neurocognitive disorders would increase. This work demonstrated the ability to develop large-scale epidemiological studies in public health, articulating the activity of the different healthcare centers, given the lack of studies about the matter in our country.

Objetivos: realizar un screening cognitivo para detectar casos de trastornos neurocognitivos (TNC) en adultos mayores de 60 años y estimar su prevalencia en el Este de Tucumán. Métodos: Se realizó una evaluación neuropsicológica de cribado. Para el análisis de los datos se conformaron grupos según la presencia y severidad de TNC. Resultados: 257 sujetos participaron en el estudio (X = 69.9 años; DS=7.2; 60,7% género femenino). Se estimó la prevalencia de trastornos neurocognitivos en 51,17% con un 90% confianza y una precisión (d) del 4%. Conclusión principal: La prevalencia superó los datos estimados para Argentina. A partir de las pruebas se observó que  a menor nivel educativo y a mayor edad,  aumentaría el riesgo para desarrollar trastornos neurocognitivos. Este trabajo demostró la capacidad de desarrollar estudios epidemiológicos a gran escala en el sistema sanitario público, articulando la actividad de los diferentes centros de salud, ante la escasez de estudios de este tipo en nuestro país.

Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection.

INTRODUCTION AND OBJECTIVES: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. PATIENTS: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. RESULTS: Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). CONCLUSIONS: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission.

INTRODUCTION & OBJECTIVES: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. MATERIALS & METHODS: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. RESULTS: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7-47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4-16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9-21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1-14.6); P < .0001). After excluding patients with history of chronic liver disease, abnormal liver tests on admission were independently associated with death [OR 1.5 (CI 1.1-2.0); P = 0.01], and severe COVID-19 (2.6 [2.0-3.3], P < .0001), both adjusted by age, gender, diabetes, pneumonia and body mass index >30. CONCLUSIONS: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. CLINICALTRIALS.GOV: NCT04358380.

Análisis clínico-radiológico comparativo de tallos femorales no cementados planos de primera vs. segunda generación / Comparative clinical-radiological analysis of first-generation vs. second-generation flat cementless femoral stems

Introducción: El diseño del implante femoral es imprescindible para su adaptación a los distintos tipos de canales. El objetivo del estudio fue comparar la adaptabilidad del implante y el tipo de contacto de los tallos femorales planos de segunda generación. Materiales y Métodos: Se analizó a los pacientes sometidos a un reemplazo total de cadera bilateral en nuestra institución, entre 2007 y 2020, a quienes se les colocó un tallo de primera generación (Accolade TMZF) en una cadera y de segunda generación (Accolade II) en la contralateral. Se estudiaron las variables demográficas, la adaptación y el llenado del canal. Se analizó el Harris Hip Score modificado y el índice WOMAC. Resultados:Se incluyó a 42 pacientes (84 casos).En el grupo 1 (Accolade TMZF), la ocupación del canal fue del 81% y, en el grupo 2 (Accolade II), del 84%. En el grupo 1, el contacto fue tipo 1 (60%), tipo 2 (16%) y tipo 3 (24%). En el grupo 2, fue tipo 1 (88%), tipo 2 (7%) y tipo 3 (5%). El Harris Hip Score modificado para el grupo 1 fue 88 y, para el grupo 2, 87,5. El puntaje WOMAC para el grupo 1 fue 2,5 y, para el grupo 2, de 3. Conclusión: La adaptabilidad del implante es fundamental para la estabilidad primaria y su osteointegración/fijación biológica. En nuestra muestra, es más precisa con tallos de segunda generación debido a las modificaciones del diseño. Nivel de Evidencia: IV

Introduction: The design of the femoral implant is essential for its adaptation to the different types of femoral canals. The objective of this study is to describe the adaptability of the implant and the type of fixation (fill and fit) of second-generation flat femoral stems compared to first-generation femoral stems. Materials and Methods: We described the radiological characteristics of patients who had undergone bilateral total hip replacement between 2007 and 2020 in our institution with both a first-generation Accolade TMZF (Stryker Orthopedics) and a second-generation Accolade II (Stryker Orthopedics) flat cementless femoral implant. Demographic variables, adaptation, and canal filling were studied. The modified Harris Hip Score and the WOMAC index were analyzed. Results: Forty-two patients (84 cases) were included in the sample. In group 1 (Accolade TMZF) we obtained an average canal fill of 81% and in group 2 (Accolade II), we obtained an average of 84%. In group 1, the type of fixation (fit) was type 1 (60%), type 2 (16%) and type 3 (24%). In group 2, it was type 1 (88%), type 2 (7%) and type 3 (5%). The modified Harris Hip Score for group 1 was 88 and, for group 2, 87.5. The WOMAC score for group 1 was 2.5 and for group 2 it was 3. Conclusion: The adaptability of the implant is essential for primary stability and its osseointegration/biological fixation. This adaptability is more precise with second-generation flat femoral stems. Level of Evidence: IV

Psychological and cognitive evaluation of autism in a patient with MOMO syndrome: a case report and literature review. / Evaluación psicológica y cognitiva de autismo en un paciente con síndrome de MOMO: reporte de caso y revisión de la literatura.

MOMO is an acronym for macrosomia, obesity, macrocephaly and ocular abnormalities. The syndrome was first described in 1993, with a total of nine patients published thus far. All the cases presented intellectual disability and in one case autism was described. We present a new case of a patient with MOMO syndrome, who consulted for hallucinatory phenomena. He completed a neuropsychological, clinical and cognitive evaluation, showing a borderline intelligence quotient and fulfilled the criteria for autism spectrum disorder. This is the first neurocognitive evaluation of a patient with MOMO, supporting the use of standardized scales in order to assess the autism and other psychiatric comorbidities in patients with genetics syndromes.

MOMO es un acrónimo para los términos macrosomía, obesidad, macrocefalia y anomalías oculares. El síndrome fue descrito por primera vez en 1993, con un total de nueve pacientes publicados a la fecha. Todos los casos reportaron discapacidad intelectual y en un caso se describió a un paciente con autismo. Presentamos un nuevo caso de paciente con síndrome de MOMO que consultó por fenómenos alucinatorios. Se completó una evaluación neuropsicológica, clínica y cognitiva, en donde se demostró un cociente intelectual limítrofe y se corroboraron los criterios para trastorno del espectro autista. Ésta es la primera evaluación neurocognitiva de un paciente con MOMO, la que apoya el uso de escalas estandarizadas a fin de evaluar el autismo y otras comorbilidades psiquiátricas en pacientes con síndromes genéticos.

Stress Fracture of the Fifth Metatarsal in Foot Deformity Secondary to Neuromuscular Disease: Experiences of Deformity Correction Treatment-A Report of 3 Cases and Review of the Literature.

Fractures at the proximal metaphyso-diaphyseal junction of the fifth metatarsal are associated with high rates of delayed union. When these fractures are the result of repeated stress in patients with equinovarus hindfoot, which in turn is caused by neurological disorders, delayed union is the rule. Therefore, in neurological patients with stress fractures, optimal treatment would be to achieve a plantigrade foot enabling them to relieve the fifth metatarsal overload, which prevents the consolidation. We report 3 cases of fifth metatarsal stress fracture resulting from an equinovarus hindfoot deformity caused by a neuromuscular disease. Our surgical indication was to correct the foot deformity with no direct action on the fracture. Once a good alignment (plantigrade foot) was obtained, stress causing the fracture disappeared, and union was achieved with optimal biomechanical function in all 3 fractures. When stress fracture of the fifth metatarsal is caused by a secondary foot deformity, treating the deformity can lead to healing the fracture efficiently and should be considered prior to indicating surgical stabilization of the fracture itself. Primary treatment of the fracture with no correction of the deformity leads to therapeutic failure. LEVELS OF EVIDENCE: Therapeutic, Level IV.