The influence of implant design and limb alignment on in vivo wear rates of fixed-bearing and rotating-platform knee implant retrievals.

Analysis of polyethylene (PE) wear in knee implants is crucial for understanding the factors leading to revision in total knee arthroplasty. Importantly, current experimental and computational methods for predicting insert wear can only be validated against true in vivo measurements from retrievals. This study quantitatively investigated in vivo PE wear rates in fixed-bearing (FB) (n = 21) and rotating-platform (n = 53) implant retrievals. 3D surface geometry of the retrievals was measured using a structured light scanner. Then, a reference surface that included the deformation, but not the wear that the retrievals had experienced in vivo, was constructed using a fully automatic surface reconstruction algorithm. Finally, wear volume was calculated from the deviation between the worn and reconstructed surfaces. The measurement and analysis techniques were validated and the algorithm was found to produce errors of only 0.2% relative to the component volumes. In addition to quantifying cohort-level wear rates, the effect of mechanical axis limb alignment on mediolateral wear distribution was examined for a subset of the retrievals (n = 14 + 26). Our results show that FB implants produce significantly (p = 0.04) higher topside wear rates (24.6 ± 10.1 mm3/year) than rotating-platform implants (15.3 ± 8.0 mm3/year). This effect was larger than that of limb alignment, which had a smaller and nonsignificant influence on overall wear rates (+4.5 ± 11.6 mm3/year, p = 0.43). However, increased varus alignment was associated significantly with greater medial compartment wear in both the FB and rotating-platform designs (+1.7 ± 1.3%/° and +1.8 ± 1.6%/°). Our findings emphasize the importance of implant design and limb alignment on wear outcomes, providing reference data for improving implant performance and longevity.

Physiological Plasticity as a Strategy to Cope with Harsh Climatic Conditions: Ecophysiological Meta-Analysis of the Cosmopolitan Moss Ceratodon purpureus in the Southern Hemisphere.

Determining the physiological tolerance ranges of species is necessary to comprehend the limits of their responsiveness under strong abiotic pressures. For this purpose, the cosmopolitan moss Ceratodon purpureus (Hedw.) Brid. is a good model due to its wide geographical distribution throughout different biomes and habitats. In order to disentangle how this species copes with stresses such as extreme temperatures and high radiation, we designed a meta-analysis by including the main photosynthetic traits obtained by gas exchange measurements in three contrasting habitats from the Southern Hemisphere. Our findings highlight that traits such as respiration homeostasis, modulation of the photosynthetic efficiency, adjustment of the optimal temperature, and switching between shade and sun-adapted forms, which are crucial in determining the responsiveness of this species. In fact, these ecophysiological traits are in concordance with the climatic particularities of each habitat. Furthermore, the photosynthetic trends found in our study point out how different Livingston Island (Maritime Antarctica) and Granite Harbour (Continental Antarctica) are for plant life, while the population from the Succulent Karoo Desert (South Africa) shares traits with both Antarctic regions. Altogether, the study highlights the high resilience of C. purpureus under abrupt climate changes and opens new perspectives about the wide spectrum of physiological responses of cryptogams to cope with climate change scenarios.

Continuous monitoring of chlorophyll a fluorescence and microclimatic conditions reveals warming-induced physiological damage in biocrust-forming lichens.

Purpose: Biocrust communities, which are important regulators of multiple ecosystem functions in drylands, are highly sensitive to climate change. There is growing evidence of the negative impacts of warming on the performance of biocrust constituents like lichens in the field. Here, we aim to understand the physiological basis behind this pattern. Methods: Using a unique manipulative climate change experiment, we monitored every 30 minutes and for 9 months the chlorophyll a fluorescence and microclimatic conditions (lichen surface temperature, relative moisture and photosynthetically active radiation) of Psora decipiens, a key biocrust constituent in drylands worldwide. This long-term monitoring resulted in 11,847 records at the thallus-level, which allowed us to evaluate the impacts of ~2.3 °C simulated warming treatment on the physiology of Psora at an unprecedented level of detail. Results: Simulated warming and the associated decrease in relative moisture promoted by this treatment negatively impacted the physiology of Psora, especially during the diurnal period of the spring, when conditions are warmer and drier. These impacts were driven by a mechanism based on the reduction of the length of the periods allowing net photosynthesis, and by declines in Yield and Fv/Fm under simulated warming. Conclusion: Our study reveals the physiological basis explaining observed negative impacts of ongoing global warming on biocrust-forming lichens in the field. The functional response observed could limit the growth and cover of biocrust-forming lichens in drylands in the long-term, negatively impacting in key soil attributes such as biogeochemical cycles, water balance, biological activity and ability of controlling erosion. Supplementary Information: The online version contains supplementary material available at 10.1007/s11104-022-05686-w.

Height-to-Diameter Ratio and Porosity Strongly Influence Bulk Compressive Mechanical Properties of 3D-Printed Polymer Scaffolds.

Although the architectural design parameters of 3D-printed polymer-based scaffolds-porosity, height-to-diameter (H/D) ratio and pore size-are significant determinants of their mechanical integrity, their impact has not been explicitly discussed when reporting bulk mechanical properties. Controlled architectures were designed by systematically varying porosity (30-75%, H/D ratio (0.5-2.0) and pore size (0.25-1.0 mm) and fabricated using fused filament fabrication technique. The influence of the three parameters on compressive mechanical properties-apparent elastic modulus Eapp, bulk yield stress σy and yield strain εy-were investigated through a multiple linear regression analysis. H/D ratio and porosity exhibited strong influence on the mechanical behavior, resulting in variations in mean Eapp of 60% and 95%, respectively. σy was comparatively less sensitive to H/D ratio over the range investigated in this study, with 15% variation in mean values. In contrast, porosity resulted in almost 100% variation in mean σy values. Pore size was not a significant factor for mechanical behavior, although it is a critical factor in the biological behavior of the scaffolds. Quantifying the influence of porosity, H/D ratio and pore size on bench-top tested bulk mechanical properties can help optimize the development of bone scaffolds from a biomechanical perspective.

Shape fidelity, mechanical and biological performance of 3D printed polycaprolactone-bioactive glass composite scaffolds.

Direct ink writing (DIW) is a promising extrusion-based 3D printing technology, which employs an ink-deposition nozzle to fabricate 3D scaffold structures with customizable ink formulations for tissue engineering applications. However, determining the optimal DIW process parameters such as temperature, pressure, and speed for the specific ink is essential to achieve high reproducibility of the designed geometry and subsequent mechano-biological performance for different applications, particularly for porous scaffolds of finite sizes (total volume > 1000 mm3) and controlled pore size and porosity. The goal of this study was to evaluate the feasibility of fabricating Polycaprolactone (PCL) and bio-active glass (BG) composite-based 3D scaffolds of finite size using DIW. 3D-scaffolds were fabricated either as cylinders (10 mm diameter; 15 mm height) or cubes (5 × 5 × 5 mm3) with height/width aspect ratios of 1.5 and 1, respectively. A rheological characterization of the PCL-BG inks was performed before printing to determine the optimal printing parameters such as pressure and speed for printing at 110 °C. Microstructural properties of the scaffolds were analyzed in terms of overall scaffold porosity, and in situ pore size assessments in each layer (36 pores/layer; 1764 pores per specimen) during their fabrication. Measured porosity of the fabricated specimens-PCL: x¯ =46.94%, SD = 1.61; PCL-10 wt%BG: x¯ = 48.29%, SD = 5.95; and PCL-20 wt% BG: x¯=50.87%, SD = 2.45-matched well with the designed porosity of 50%. Mean pore sizes-PCL [x¯ = 0.37 mm (SD = 0.03)], PCL-10%BG [x¯ = 0.38 mm (SD = 0.07)] and PCL-20% BG [x¯ = 0.37 mm (SD = 0.04)]-were slightly fairly close to the designed pore size of 0.4 mm. Nevertheless there was a small but consistent, statistically significant (p < 0.0001) decrease in pore size from the first printed layer (PCL: 0.39 mm; PCL-10%BG: 0.4 mm; PCL-20%BG: 0.41 mm) to the last. SEM and micro-CT imaging revealed consistent BG particle distribution across the layers and throughout the specimens. Cell adhesion experiments revealed similar cell adhesion of PCL-20 wt% BG to pure PCL, but significantly better cell proliferation - as inferred from metabolic activity - after 7 days, although a decrease after 14 days was noted. Quasi-static compression tests showed a decrease in compressive yield strength and apparent elastic modulus with increasing BG fraction, which could be attributed to a lack of adequate mechanical bonding between the BG particles and the PCL matrix. The results show that the inks were successfully generated, and the scaffolds were fabricated with high resolution and fidelity despite their relatively large size (>1000 mm3). However, further work is required to understand the mechano-biological interaction between the BG particle additives and the PCL matrix to improve the mechanical and biological properties of the printed structures.

Climate change leads to higher NPP at the end of the century in the Antarctic Tundra: Response patterns through the lens of lichens.

Poikilohydric autotrophs are the main colonizers of the permanent ice-free areas in the Antarctic tundra biome. Global climate warming and the small human footprint in this ecosystem make it especially vulnerable to abrupt changes. Elucidating the effects of climate change on the Antarctic ecosystem is challenging because it mainly comprises poikilohydric species, which are greatly influenced by microtopographic factors. In the present study, we investigated the potential effects of climate change on the metabolic activity and net primary photosynthesis (NPP) in the widespread lichen species Usnea aurantiaco-atra. Long-term monitoring of chlorophyll a fluorescence in the field was combined with photosynthetic performance measurements in laboratory experiments in order to establish the daily response patterns under biotic and abiotic factors at micro- and macro-scales. Our findings suggest that macroclimate is a poor predictor of NPP, thereby indicating that microclimate is the main driver due to the strong effects of microtopographic factors on cryptogams. Metabolic activity is also crucial for estimating the NPP, which is highly dependent on the type, distribution, and duration of the hydration sources available throughout the year. Under RCP 4.5 and RCP 8.5, metabolic activity will increase slightly compared with that at present due to the increased precipitation events predicted in MIROC5. Temperature is highlighted as the main driver for NPP projections, and thus climate warming will lead to an average increase in NPP of 167-171% at the end of the century. However, small changes in other drivers such as light and relative humidity may strongly modify the metabolic activity patterns of poikilohydric autotrophs, and thus their NPP. Species with similar physiological response ranges to the species investigated in the present study are expected to behave in a similar manner provided that liquid water is available.

Status of the neuromyelitis optica spectrum disorder in Latin America.

BACKGROUND: Neuromyelitis optica spectrum disorders (NMOSD) is an increasing diagnostic and therapeutic challenge in Latin America (LATAM). Despite the heterogeneity of this population, ethnic and socioeconomic commonalities exist, and epidemiologic studies from the region have had a limited geographic and population outreach. Identification of some aspects from the entire region are lacking. OBJECTIVES: To determine ethnic, clinical characteristics, and utilization of diagnostic tools and types of therapy for patients with NMOSD in the entire Latin American region. METHODS: The Latin American Committee for Treatment and Research in MS (LACTRIMS) created an exploratory investigational survey addressed by Invitation to NMOSD Latin American experts identified through diverse sources. Data input closed after 30 days from the initial invitation. The questionnaire allowed use of absolute numbers or percentages. Multiple option responses covering 25 themes included definition of type of practice; number of NMOSD cases; ethnicity; utilization of the 2015 International Panel criteria for the diagnosis of Neuromyelitis optica (IPDN); clinical phenotypes; methodology utilized for determination of anti-Aquaporin-4 (anti- AQP4) antibodies serological testing, and if this was performed locally or processed abroad; treatment of relapses, and long-term management were surveyed. RESULTS: We identified 62 investigators from 21 countries reporting information from 2154 patients (utilizing the IPDN criteria in 93.9% of cases), which were categorized in two geographical regions: North-Central, including the Caribbean (NCC), and South America (SA). Ethnic identification disclosed Mestizos 61.4% as the main group. The most common presenting symptoms were concomitant presence of optic neuritis and transverse myelitis in 31.8% (p=0.95); only optic neuritis in 31.4% (more common in SA), p<0.001); involvement of the area postrema occurred in 21.5% and brain stem in 8.3%, both were more frequent in the South American cases (p<0.001). Anti-AQP4 antibodies were positive in 63.9% and anti-Myelin Oligodendrocyte Glycoprotein (MOG) antibodies in 4.8% of total cases. The specific laboratorial method employed was not known by 23.8% of the investigators. Acute relapses were identified in 81.6% of cases, and were treated in 93.9% of them with intravenous steroids (IVS); 62.1% with plasma exchange (PE), and 40.9% with intravenous immunoglobulin-G (IVIG). Therapy was escalated in some cases due to suboptimal initial response. Respondents favored Rituximab as long-term therapy (86.3%), whereas azathioprine was also utilized on 81.8% of the cases, either agent used indistinctly by the investigators according to treatment accessibility or clinical judgement. There were no differences among the geographic regions. CONCLUSIONS: This is the first study including all countries of LATAM and the largest cohort reported from a multinational specific world area. Ethnic distributions and phenotypic features of the disease in the region, challenges in access to diagnostic tools and therapy were identified. The Latin American neurological community should play a determinant role encouraging and advising local institutions and health officials in the availability of more sensitive and modern diagnostic methodology, in facilitating the the access to licensed medications for NMOSD, and addressing concerns on education, diagnosis and management of the disease in the community.

Structure-function assessment of 3D-printed porous scaffolds by a low-cost/open source fused filament fabrication printer.

Additive manufacturing encompasses a plethora of techniques to manufacture structures from a computational model. Among them, fused filament fabrication (FFF) relies on heating thermoplastics to their fusion point and extruding the material through a nozzle in a controlled pattern. FFF is a suitable technique for tissue engineering, given that allows the fabrication of 3D-scaffolds, which are utilized for tissue regeneration purposes. The objective of this study is to assess a low-cost/open-source 3D printer (In-House), by manufacturing both solid and porous samples with relevant microarchitecture in the physiological range (100-500 µm pore size), using an equivalent commercial counterpart for comparison. For this, compressive tests in solid and porous scaffolds manufactured in both printers were performed, comparing the results with finite element analysis (FEA) models. Additionally, a microarchitectural analysis was done in samples from both printers, comparing the measurements of both pore size and porosity to their corresponding computer-aided design (CAD) models. Moreover, a preliminary biological assessment was performed using scaffolds from our In-House printer, measuring cell adhesion efficiency. Finally, Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) was performed to evaluate chemical changes in the material (polylactic acid) after fabrication in each printer. The results show that the In-House printer achieved generally better mechanical behavior and resolution capacity than its commercial counterpart, by comparing with their FEA and CAD models, respectively. Moreover, a preliminary biological assessment indicates the feasibility of the In-House printer to be used in tissue engineering applications. The results also show the influence of pore geometry on mechanical properties of 3D-scaffolds and demonstrate that properties such as the apparent elastic modulus (Eapp) can be controlled in 3D-printed scaffolds.

High nitrogen contribution by Gunnera magellanica and nitrogen transfer by mycorrhizas drive an extraordinarily fast primary succession in sub-Antarctic Chile.

Chronosequences at the forefront of retreating glaciers provide information about colonization rates of bare surfaces. In the northern hemisphere, forest development can take centuries, with rates often limited by low nutrient availability. By contrast, in front of the retreating Pia Glacier (Tierra del Fuego, Chile), a Nothofagus forest is in place after only 34 yr of development, while total soil nitrogen (N) increased from near zero to 1.5%, suggesting a strong input of this nutrient. We measured N-fixation rates, carbon fluxes, leaf N and phosphorus contents and leaf δ15 N in the dominant plants, including the herb Gunnera magellanica, which is endosymbiotically associated with a cyanobacterium, in order to investigate the role of N-fixing and mycorrhizal symbionts in N-budgets during successional transition. G. magellanica presented some of the highest nitrogenase activities yet reported (potential maximal contribution of 300 kg N ha-1  yr-1 ). Foliar δ15 N results support the framework of a highly efficient N-uptake and transfer system based on mycorrhizas, with c. 80% of N taken up by the mycorrhizas potentially transferred to the host plant. Our results suggest the symbiosis of G. magellanica with cyanobacteria, and trees and shrubs with mycorrhizas, to be the key processes driving this rapid succession.

Warming reduces the cover, richness and evenness of lichen-dominated biocrusts but promotes moss growth: insights from an 8 yr experiment.

Despite the important role that biocrust communities play in maintaining ecosystem structure and functioning in drylands world-wide, few studies have evaluated how climate change will affect them. Using data from an 8-yr-old manipulative field experiment located in central Spain, we evaluated how warming, rainfall exclusion and their combination affected the dynamics of biocrust communities in areas that initially had low (< 20%, LIBC plots) and high (> 50%, HIBC plots) biocrust cover. Warming reduced the richness (35 ± 6%), diversity (25 ± 8%) and cover (82 ± 5%) of biocrusts in HIBC plots. The presence and abundance of mosses increased with warming through time in these plots, although their growth rate was much lower than the rate of lichen death, resulting in a net loss of biocrust cover. On average, warming caused a decrease in the abundance (64 ± 7%) and presence (38 ± 24%) of species in the HIBC plots. Over time, lichens and mosses colonized the LIBC plots, but this process was hampered by warming in the case of lichens. The observed reductions in the cover and diversity of lichen-dominated biocrusts with warming will lessen the capacity of drylands such as that studied here to sequester atmospheric CO2 and to provide other key ecosystem services associated to these communities.

Recent Warming and Cooling in the Antarctic Peninsula Region has Rapid and Large Effects on Lichen Vegetation.

The Antarctic Peninsula has had a globally large increase in mean annual temperature from the 1951 to 1998 followed by a decline that still continues. The challenge is now to unveil whether these recent, complex and somewhat unexpected climatic changes are biologically relevant. We were able to do this by determining the growth of six lichen species on recently deglaciated surfaces over the last 24 years. Between 1991 and 2002, when mean summer temperature (MST) rose by 0.42 °C, five of the six species responded with increased growth. MST declined by 0.58 °C between 2002 and 2015 with most species showing a fall in growth rate and two of which showed a collapse with the loss of large individuals due to a combination of increased snow fall and longer snow cover duration. Increased precipitation can, counter-intuitively, have major negative effects when it falls as snow at cooler temperatures. The recent Antarctic cooling is having easily detectable and deleterious impacts on slow growing and highly stress-tolerant crustose lichens, which are comparable in extent and dynamics, and reverses the gains observed over the previous decades of exceptional warming.

Improved appreciation of the functioning and importance of biological soil crusts in Europe: the Soil Crust International Project (SCIN).

Here we report details of the European research initiative "Soil Crust International" (SCIN) focusing on the biodiversity of biological soil crusts (BSC, composed of bacteria, algae, lichens, and bryophytes) and on functional aspects in their specific environment. Known as the so-called "colored soil lichen community" (Bunte Erdflechtengesellschaft), these BSCs occur all over Europe, extending into subtropical and arid regions. Our goal is to study the uniqueness of these BSCs on the regional scale and investigate how this community can cope with large macroclimatic differences. One of the major aims of this project is to develop biodiversity conservation and sustainable management strategies for European BSCs. To achieve this, we established a latitudinal transect from the Great Alvar of Öland, Sweden in the north over Gössenheim, Central Germany and Hochtor in the Hohe Tauern National Park, Austria down to the badlands of Tabernas, Spain in the south. The transect stretches over 20° latitude and 2,300 m in altitude, including natural (Hochtor, Tabernas) and semi-natural sites that require maintenance such as by grazing activities (Öland, Gössenheim). At all four sites BSC coverage exceeded 30 % of the referring landscape, with the alpine site (Hochtor) reaching the highest cyanobacterial cover and the two semi-natural sites (Öland, Gössenheim) the highest bryophyte cover. Although BSCs of the four European sites share a common set of bacteria, algae (including cyanobacteria) lichens and bryophytes, first results indicate not only climate specific additions of species, but also genetic/phenotypic uniqueness of species between the four sites. While macroclimatic conditions are rather different, microclimatic conditions and partly soil properties seem fairly homogeneous between the four sites, with the exception of water availability. Continuous activity monitoring of photosystem II revealed the BSCs of the Spanish site as the least active in terms of photosynthetic active periods.

Extreme phenotypic variation in Cetraria aculeata (lichenized Ascomycota): adaptation or incidental modification?

BACKGROUND AND AIMS: Phenotypic variability is a successful strategy in lichens for colonizing different habitats. Vagrancy has been reported as a specific adaptation for lichens living in steppe habitats around the world. Among the facultatively vagrant species, the cosmopolitan Cetraria aculeata apparently forms extremely modified vagrant thalli in steppe habitats of Central Spain. The aim of this study was to investigate whether these changes are phenotypic plasticity (a single genotype producing different phenotypes), by characterizing the anatomical and ultrastructural changes observed in vagrant morphs, and measuring differences in ecophysiological performance. METHODS: Specimens of vagrant and attached populations of C. aculeata were collected on the steppes of Central Spain. The fungal internal transcribed spacer (ITS), glyceraldehyde-3-phosphate dehydrogenase (GPD) and the large sub-unit of the mitochondrial ribosomal DNA (mtLSUm), and the algal ITS and actin were studied within a population genetics framework. Semi-thin and ultrathin sections were analysed by means of optical, scanning electron and transmission electron microscopy. Gas exchange and chlorophyll fluorescence were used to compare the physiological performance of both morphs. KEY RESULTS AND CONCLUSIONS: Vagrant and attached morphs share multilocus haplotypes which may indicate that they belong to the same species in spite of their completely different anatomy. However, differentiation tests suggested that vagrant specimens do not represent a random sub-set of the surrounding population. The morphological differences were related to anatomical and ultrastructural differences. Large intercalary growth rates of thalli after the loss of the basal-apical thallus polarity may be the cause of the increased growth shown by vagrant specimens. The anatomical and morphological changes lead to greater duration of ecophysiological activity in vagrant specimens. Although the anatomical and physiological changes could be chance effects, the genetic differentiation between vagrant and attached sub-populations and the higher biomass of the former show fitness effects and adaptation to dry environmental conditions in steppe habitats.

Impresión basilar asociada a malformación de Arnold-Chiari en el adulto / Basilar impression associated to a malformation of Arnold-Chiari in the adult

La malformación de Arnold-chiari (MACh) es una condición en la cual el cerebelo protruye hacia el canal espinal, puede estar asociada a otras anomalías tales como mielomeningocele, sisingomielia y espina bífida, los síntomas generalmente se inician durante la infancia, o más tardíamente, y se caracterizan por cefalea y signos de disfunción cerebelosa y de otras estructuras de fosa posterior. Presentamos una paciente adulta con esta patología, en la que las manifestaciones más destacadas son cefalea, signos cerebelosos y disfunción del bulbo raquídeo, asociados a fenómenos de impresión basilar. Revisamos las manifestaciones clínicas, diagnóstico, evolución y manejo de esta entidad.

Crisis epilépticas en la enfermedad vascular cerebral / Seizures in vascular cerebral disease

Hemos estudiado las características de las crisis epilépticas que se presentaron en los primeros 15 días de ocurrido un ataque vascular cerebral. El número de pacientes incluido fue 1517. Entre aquellos con hemorragia intracerebral, el porcentaje de crisis observadas llegó a 14.68 por ciento (53/361) en tanto que, en los de enfermedad vascular isquémica la cifra fue de 2.6 por ciento (30/1156). Analizando los subtipos de isquemia, se encontró que las crisis fueron más frecuentes en la embolia cardiogénica, 14.77 por ciento disminuyendo a 1.98 por ciento en la isquemia por ateroesclerosis y no se detectaron crisis en los pacientes con isquemia asociada a arterioloesclerosis u otra patogenia vascular cerebral diferente a las tres citadas. El mayor número de crisis ocurrió al inicio del ictus vascular y en las primeras 24 horas (100 por ciento en la isquemia y 80 por ciento en la hemorragia). Los hallazgos electroencefalográficos más significativos fueron: actividad focal (50.79 por ciento de pacientes con crisis epilépticas) y actividad lenta difusa (36.51 por ciento). Finalmente, se analizó estadísticamente el posible valor predictivo de mortalidad que puede tener la presencia de crisis epilépticas durante el período agudo de la enfermedad vascular cerebral, encontrándose una significativa asociación (p<0.001) entre los pacientes afectados con isquemia cerebral.

Long-term outcome after valve replacement with the omnicarbon prosthesis.

BACKGROUND AND AIM OF THE STUDY: The study aim was to determine whether long-term prognosis was affected by valve replacement with a tilting-disc prosthesis. METHODS: Surgical data were recorded prospectively for all (n = 153) valve replacement cases with the Omnicarbon prosthesis during the period February 1985 to January 1986. A rheumatic valvular pathology was present in 105 patients (68.6%). There were 78 (51%) aortic (AVR), 51 (33%) mitral (MVR) and 24 (16%) double (DVR) valve replacements. The follow up was 99% complete (n = 151). RESULTS: Mean follow up was 10.2+/-4.4 years (total 1,472 patient-years (pt-yr)). Survival at 10 years was 68+/-4% (71+/-5% AVR, 61+/-7% MVR), and this fell to 57+/-4% at 14 years. No structural failure was observed. Thromboembolic and hemorrhagic events were rare, with actuarial freedom from thromboembolism of 94+/-2% and 91+/-3% at 10 and 14 years, respectively. This low incidence of thromboembolism encouraged an ease in anticoagulation; hence the AVR and MVR cohorts had a median INR of 2.8, but a higher INR (3.4) was maintained in DVR patients. All prostheses had acceptable hemodynamic performance. No cases of hemolytic anemia were detected, and mean blood counts were within normal ranges. Lactate dehydrogenase values indicated minimal hemolysis, and were lowest after AVR (median LDH 93% normal) and highest after DVR (median LDH 136% normal). Functional evaluation showed an improvement in NYHA class that remained stable over 14 years. At follow up, 95% (75/79) of patients were in NYHA class I or II. CONCLUSION: Survival and quality of life after Omnicarbon valve implantation exceeded the authors' expectations. Functional capacity remains good, and valve-related complication rates are low. The Omnicarbon tilting-disc valve has been shown to provide reliable and satisfactory service in the long term.

Síndrome epiléptico secundario a ganglioglioma / Epilepsy syndrome secondary to ganglioglioma

Los gangliogliomas son considerados usualmente como tumores mixtos (componente neuronal I gial) del sistema nervioso central y representan aproximadamente el 1 por ciento de todas las neoplasias intracraneales. Presentamos a continuación el caso de un paciente que presenta crisis epiléptica psíquica secundariamente generalizada. Se evalúa el caso con estudio neurofisiologico y de neuroimagenes. Se recomienda biopsia cerebral para precisar la etiología del síndrome epiléptico y definir el tratamiento. Se aprecia la evolución del cuadro clínico, con buena respuesta a terapia antiepileptica.

The gangliogliomas is usually considered as mixed tumors (component neuronal/gial) of the central nervous system and they represent 1 per cent of all the neoplasiams intracranneals approximately. We present a case of a patient that presents focal (psychic) epileptic crisis secondarily widespread. The case is evaluated with studies neurophyisiologic and neuroimage. Cerebral Biopsy is recommended to specify the etiology of the epilectic syndrome and to define the treatment.The evolution of the clinical square is appreciated, with good answer to therapy antiepilectic.