[Hallux valgus mild and moderate; treatment by minimally invasive surgery and its follow-up to 2 years]. / Hallux valgus leve y moderado; tratamiento mediante cirugía de invasión mínima y su seguimiento a 2 años.

INTRODUCTION: The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology. MATERIAL AND METHODS: We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery. RESULTS: Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale. CONCLUSION: The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.

INTRODUCCIÓN: El hallux valgus es una de las patologías más frecuentes y complejas en la ortopedia. Afecta a los tejidos blandos y óseos del primer dedo. Se encuentran descritas múltiples técnicas para su corrección, todas con un último fin: lograr restaurar el ángulo fisiológico del primer dedo mediante una osteotomía estable y con el menor dolor postquirúrgico posible. Las técnicas de invasión mínima han venido ganando adeptos desde los años 2000 como una alternativa para el tratamiento de esta patología. MATERIAL Y MÉTODOS: Se incluyeron pacientes con diagnóstico de hallux valgus leve o moderado en los que se realizó un procedimiento mínimamente invasivo para corregir la deformidad del primer dedo del pie. Se realizó una osteotomía distal de Reverdin/Isham en el primer metatarsiano y una osteotomía de Akin en la falange proximal, una liberación capsular lateral y una tenotomía abductora. Estos casos fueron seguidos durante 24 meses después de su cirugía. RESULTADO: Nuestros pacientes presentaron una adecuada corrección de la sintomatología dolorosa, retorno a la movilidad articular prequirúrgica y una adecuada satisfacción personal con 87.3% de buenos resultados. Encontramos una mejoría importante en la escala de Kitaoka. Tenemos una adecuada corrección angular para una osteotomía distal. CONCLUSIONES: Las técnicas de invasión mínima para la corrección de hallux valgus moderado y leve son una adecuada herramienta. Nuestros pacientes se encuentran satisfechos con los resultados estéticos y funcionales.

New contributions to the ORP & DO time profile characterization to improve biological nutrient removal.

Changes in the oxidation-reduction potential (ORP), pH and dissolved oxygen (DO), along with organic load and nutrient removal in a municipal wastewater treatment plant (WWTP) have been monitored throughout one year. The "nitrate knee" and the "nitrate break point" in ORP profiles, the "nitrate apex" and the "ammonia valley" in pH profiles and the "DO elbow" in DO profiles have been identified. Furthermore, these bending points have been correlated with the oxygen uptake rate (OUR), the temperature in the vessel and the aeration and non-aeration time profiles by using Principal Component Analysis (PCA). The data have been previously split up into wet and dry weather cycles by means of a K-means clustering algorithm. Finally, two new parameters have been defined: the "ORP Arrow", which is closely related to the inhibition of the denitrification process, and the "Oxygen Rise Average Slope" (ORAS), which shows the oxygen transfer rate.

Host conservatism, host shifts and diversification across three trophic levels in two Neotropical forests.

Host-parasite systems have been models for understanding the connection between shifts in resource use and diversification. Despite theoretical expectations, ambiguity remains regarding the frequency and importance of host switches as drivers of speciation in herbivorous insects and their parasitoids. We examine phylogenetic patterns with multiple genetic markers across three trophic levels using a diverse lineage of geometrid moths (Eois), specialist braconid parasitoids (Parapanteles) and plants in the genus Piper. Host-parasite associations are mapped onto phylogenies, and levels of cospeciation are assessed. We find nonrandom patterns of host use within both the moth and wasp phylogenies. The moth-plant associations in particular are characterized by small radiations of moths associated with unique host plants in the same geographic area (i.e. closely related moths using the same host plant species). We suggest a model of diversification that emphasizes an interplay of factors including host shifts, vicariance and adaptation to intraspecific variation within hosts.

[Corneal biomechanics]. / Biomecánica de la córnea.

OBJECTIVE: To review the corneal biomechanic concepts and to analyse, clarify and understand their relevance in refractive surgery. MATERIALS AND METHODS: A literature review has been done using different databases. RESULTS: Corneal biomechanic concepts are not new and are applied implicitly in numerous surgical procedures. Their origin is related to tonometry studies, but they gained in popularity when they were linked to the treatment of keratoconus, a pathology in which the mechanical properties of the cornea are altered. Factors determining corneal stability were thus defined. Corneal biomechanics have also been used following refractive surgery to study post-operative keratectasia and to improve ablation patterns, which ignores the corneal response. The new ablation systems need to include the biomechanical factors, which motivate research conducted in physical-mathematical models and in corneal wound healing, improving our knowledge about the corneal biomechanical response. CONCLUSIONS: The corneal biomechanic concepts have gained in popularity with the advent of refractive surgery, although they did exist previously. Their relevance is linked to improvements in the ablation systems used in an attempt to obtain more accurate and reliable results.

Biomecánica de la córnea / Corneal biomechanics

Objetivo: Realizar una revisión sobre la biomecánica de la córnea desde sus orígenes hasta la actualidad, con el objetivo de analizar, esclarecer y comprender su relevancia en la cirugía refractiva.Material y método: Se realizó una búsqueda bibliográfica sobre el tema usando diversas fuentes.Resultados: El concepto de la biomecánica de la córnea no es reciente y está implícito en diversos actos quirúrgicos. Su origen se relaciona con los estudios de tonometría, aunque su existencia adquiere mayor popularidad cuando se relaciona con el queratocono, donde se reconoce que una estructura alterada se deforma ante una fuerza que no puede tolerar. Se definen los factores que rigen la estabilidad de la estructura de la cornea. Posteriormente se vincula a la cirugía refractiva para estudiar las ectasias post-quirúrgicas y mejorar los patrones de ablación que interpretan a la córnea como una estructura inerte y carente de respuesta. Se reconoce que el factor biomecánico debe ser incluido como una variable más en los nuevos sistemas de ablación, lo cual incentiva su estudio y con los avances de la investigación (modelos físico-matemáticos, cicatrización corneal) se comienza a caracterizar su respuesta.Conclusiones: La biomecánica de la córnea toma auge al vincularse a la cirugía refractiva, aunque su concepto existía previamente. Su relevancia actual esta ligada al perfeccionamiento de los sistemas de ablación y su mayor conocimiento permitirá obtener resultados cada vez más precisos y estables en el tiempo

Objective: To review the corneal biomechanic concepts and to analyse, clarify and understand their relevance in refractive surgery.Materials and Methods: A literature review has been done using different databases.Results: Corneal biomechanic concepts are not new and are applied implicitly in numerous surgical procedures. Their origin is related to tonometry studies, but they gained in popularity when they were linked to the treatment of keratoconus, a pathology in which the mechanical properties of the cornea are altered. Factors determining corneal stability were thus defined. Corneal biomechanics have also been used following refractive surgery to study post-operative keratectasia and to improve ablation patterns, which ignores the corneal response. The new ablation systems need to include the biomechanical factors, which motivate research conducted in physical-mathematical models and in corneal wound healing, improving our knowledge about the corneal biomechanical response.Conclusions: The corneal biomechanic concepts have gained in popularity with the advent of refractive surgery, although they did exist previously. Their relevance is linked to improvements in the ablation systems used in an attempt to obtain more accurate and reliable results

Phylogeny and patterns of floral diversity in the genus Piper (Piperaceae).

With ∼1000 species distributed pantropically, the genus Piper is one of the most diverse lineages among basal angiosperms. To rigorously address the evolution of Piper we use a phylogenetic analysis of sequences of the internal transcribed spacers (ITS) of nuclear ribosomal DNA based on a worldwide sample. Sequences from a total of 51 species of Piper were aligned to yield 257 phylogenetically informative sites. A single unrooted parsimony network suggested that taxa representing major geographic areas could potentially form three monophyletic groups: Asia, the South Pacific, and the Neotropics. The position of Pothomorphe was well supported among groups of New World taxa. Simultaneous phylogenetic analysis of an expanded alignment including outgroups suggested that taxa from the South Pacific and Asia formed a monophyletic group, provisionally supporting a single origin of dioecy. Within the Neotropical sister clade, resolution was high and strong bootstrap support confirmed the monophyly of several traditionally recognized infrageneric groups (e.g., Enckea [including Arctottonia], Ottonia, Radula, Macrostachys). In contrast, some of the species representing the highly polytypic subgroup Steffensia formed a clade corresponding to the previously recognized taxon Schilleria, while others were strongly associated with several of the more specialized groups of taxa. The distribution of putatively derived inflorescence and floral character states suggested that both umbellate and solitary axillary inflorescences have multiple origins. Reduction in anther number appears to be associated with highly packaged inflorescences or with larger anther primordia per flower, trends that are consistent with the suppression of later stages of androecial development.

Surfactant protein A is decreased in a rat model of congenital diaphragmatic hernia.

We hypothesized that the expression of surfactant protein A (SP-A) would be altered in developing lungs from rat fetuses with congenital diaphragmatic hernia (CDH) induced by maternal ingestion of 2,4-dichlorophenyl-p-nitrophenyl ether (Nitrofen) on Day 9 of gestation. We compared our findings in fetuses exposed to Nitrofen with a CDH with those in Nitrofen-exposed fetuses without a CDH, and control fetuses whose mothers received olive oil only, the vehicle for Nitrofen. In late gestation, immunocytochemistry using a polyclonal rabbit antihuman SP-A antibody revealed decreased amounts of this protein in lungs from fetuses with CDH. Using immunoblotting, the relative amount of SP-A on Day 21 of gestation was also decreased in lung tissue from fetuses with CDH compared with the other groups. Abnormalities of mRNA for SP-A were observed in both groups of Nitrofen-exposed fetuses compared with control rats. These findings suggest that there is decreased expression of SP-A in rat fetuses with CDH secondary to Nitrofen exposure.

Ontogeny of cyclooxygenase-1 and cyclooxygenase-2 gene expression in ovine lung.

Prostacyclin is a key mediator of pulmonary vascular and parenchymal function during late fetal and early postnatal life, and its synthesis in whole lung increases during that period. The rate-limiting enzyme in prostacyclin synthesis in the developing lung is cyclooxygenase (COX). We investigated the ontogeny and cellular localization of COX-1 (constitutive) and COX-2 (inducible) gene expression in lungs from late-gestation fetal lambs, 1-wk-old newborn lambs (NB1), and 1- to 4-mo-old newborn lambs (NB2). COX-1 mRNA abundance rose progressively from fetal to NB1 to NB2, increasing 12-fold overall. In parallel, immunoblot analysis revealed a progressive increase in COX-1 protein, rising fourfold from fetal lambs to NB2. COX-2 mRNA levels increased fivefold from fetal to NB1 but were similar in NB1 and NB2. However, COX-2 protein was not detectable by immunoblot analysis in any age group. Immunohistochemistry for COX-1 showed intense immunostaining in endothelial cells at all ages. COX-1 was also expressed in airway epithelium at all ages, with a greater number of epithelial cells staining positively in NB2 compared with fetal and NB1 groups. In addition, COX-1 was expressed in airway smooth muscle from NB1. COX-2 immunostaining was absent in all age groups. These findings indicate that there is differential expression of COX-1 and COX-2 in the developing lung and that the enzymes are expressed in a cell-specific manner. The developmental upregulation in COX-1 may optimize the capacity for prostaglandin-mediated vasodilation, bronchodilation, and surfactant synthesis in the newborn lung.

Pulmonary gastrin-releasing peptide expression in anencephaly.

Gastrin-releasing peptide (GRP) is a developmentally regulated bioactive peptide believed to function as a pulmonary growth factor. It is produced by pulmonary neuroendocrine cells, found within the conducting and respiratory epithelium, as isolated cells and in clusters known as neuroepithelial bodies (NEBs). Deficient GRP expression has been reported in pulmonary hypoplasia (PH) associated with oligohydramnios and diaphragmatic hernia. To assess further the role of GRP in maldeveloped lung we reviewed the postmortem records and histologic lung sections, stained with H&E and anti-GRP antiserum, from 11 infants with anencephaly and 11 age-matched controls. Cells immunoreactive for GRP were quantified (isolated versus NEBs) in airways and airspaces per mm2 for a standard area. PH was present in five anencephalic infants. There was no difference in the total number of GRP-positive cells, number of NEBs, size of NEBs, or number of GRP-positive cells in airways or alveoli in either group regardless of lung development. A greater proportion of the GRP-positive cells was present in the airways in anencephalic infants with PH (58%) compared with anencephalic infants without PH (40%) (P = .018). There were no differences when comparing these groups with control infants and no differences in the density of airways in each of these groups. We conclude that deficient GRP expression is not a feature of lung hypoplasia in anencephalic infants. The altered distribution of GRP-positive cells in anencephalic infants with PH may be a reflection of the structural abnormalities or accompanying altered cellular maturity.

Myxoid chondrosarcoma with a translocation involving chromosomes 9 and 22.

Myxoid chondrosarcoma is an uncommon neoplasm thought to be derived from mesenchymal chondrocytic cells. Although cytogenetic abnormalities have been reported in sarcomas, too few cases have been studied to determine the frequency of nonrandom chromosomal changes in mesenchymal tumors. In this article, we describe a chondrosarcoma with a nonrandom reciprocal translocation t(9;22)(q22;q11). The cellular homologue to the retrovirus transforming gene of simian sarcoma virus is located on chromosome #22, and its possible significance in this case is discussed.

Familial partial 14 trisomy.

Four children in the same family have 47, +der (14), t(9;14) (p24;q21). Their mothers are sisters with 46,XX,t(9;14) (p24;q21). Clinical features of the children are similar to those of others reported to have partial 14 trisomy.