Detection of coca alkaloids in oral fluid from coca leaf (tea) consumers: using solid phase extraction to improve validation parameters and widen the detection window.

Hygrine and cuscohygrine, two coca leaf alkaloids, have been previously proposed as markers to differentiate legal and illegal cocaine consumption. This is a very common problem in some countries of South America, where the consumption of coca leaves has a long tradition. Analytical methods focusing on the assessment of coca leaf alkaloids, such as cuscohygrine, hygrine, tropacocaine and t-cinnamoylcocaine, in oral fluid are virtually non-existent in forensic toxicology laboratories worldwide due to their lack of application. However, the problem of differentiating legal and illegal cocaine use in criminal justice, DUID (drug-impaired driving) and WDT (workplace drug testing) programs is growing. Therefore, researchers are obliged to develop methods to measure coca leaf alkaloids (cuscohygrine, hygrine and t-cinnamoylcocaine) in biological matrices for further validation for routine analyses in forensic toxicology laboratories. This work aims to optimize a previously published separation method by protein precipitation in oral fluid by using solid-phase extraction (SPE) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) operating in multiple reaction monitoring (MRM) mode. The use of SPE allowed the matrix effect and the background to be reduced in the chromatograms due to the obtained cleaner extracts. Consequently, improved detection and quantification limits were reached. Findings showed that the detection windows for coca leaf alkaloids were longer than three hours in real oral fluid samples from volunteers who drank a cup of coca tea. These detection windows are quite higher than those previously obtained when using the method based on separation by protein precipitation.

Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP).

INTRODUCTION: Basicervical femoral neck fracture is associated with high rates of failure due instability patterns, mainly collapse and rotational instability. The purpose of this study was to evaluate the clinical-radiological results of a group of patients with a bascervical proximal femoral fractures treated with Percutaneous Compression Plate (PCCP). MATERIAL AND METHODS: Among 5817 patients with a hip fracture who were admitted in our hospital from January 2005 to December 2017, 234 factures (4%) were diagnosed of basicervical femoral fracture. 30 of them were treated with a PCCP, 22 women and 8 men, mean age was 81.2 years (63-94). Demographic and perioperative variables were collected. The patients were followed up at 1, 3 and 6 months clinically and radiologically. RESULTS: There were no intra-operative complications and no conversions to open surgery. There was no early implant failure. No surgical wound infection was diagnosed. Crude mortality was 13% the first year and 87% were able to walk at the 6 months. The last follow-up x-rays revealed 97% fracture healing and the collapse at fracture site occurred in 4 hips. No instances of cut-out were observed. In one case, a fatigue failure of the lag screws of a PCCP plate was observed at 3 months from osteosynthesis. CONCLUSION: PCCP is an appropriated implant for basicervical femoral neck fractures.

Biomechanical behavior of retrograde intramedullary nails in distal femoral fractures.

Fractures of the distal femur affect three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. Main indications of intramedullary nailing are for supracondylar fractures type A or type C of the AO classification. The main objective of the present work is to analyze, by means of FE simulation, the influence of retrograde nail length, considering different blocking configurations and fracture gaps, on the biomechanical behavior of supracondylar fractures of A type. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by the retrograde nail at a distal fracture with different fracture gaps: 0.5 mm, 3 mm y 20 mm, respectively. Besides, for each gap, three nail lengths were studied with a general extent (320 mm, 280 mm and 240 mm), considering two transversal screws (M/L) at the distal part and different screw combinations above the fracture. The study was focused on the immediately post-operative stage, without any biological healing process. In view of the obtained results, it has been demonstrated new possibilities of blocking configuration in addition to the usual ones, which allows establishing recommendations for nail design and clinical practice, avoiding excessive stress concentrations both in screws, with the problem of rupture and loss of blocking, and in the contact of nail tip with cortical bone, with the problem of a new stress fracture.

Salvage of cephalomedullary nail cutout with the variable angle proximal femoral plate.

INTRODUCTION: Excellent results have been published in the treatment of the trochanteric fractures in the elderly with cephalomedullary nails or compression hip screws but not free of complications. The perforation of the lag screw through the superior cortex of femoral neck or head followed by rotation and varus collapse of the head-neck fragment, also known as cut-out, is one of them. Probably total hip arthroplasty is the most common solution, but there is no systematic technique for treatment. The objective of this study is to evaluate the results obtained in the treatment of this complication using a variable angle femoral plate. MATERIAL AND METHODS: This retrospective study concerns patients over 65 years with peritrochanteric fractures treated with cephalomedullary nail with cut-out failure solved by re-osteosyntesis with variable angle femoral plate between 1st January 2000 and 31 st December 2017. The series includes 29 patients, 26 women and 3 men with average age 87,3. Patients were followed up clinically and radiologically at regular intervals until fracture consolidation at least 9 months. RESULTS: No patients died at the first 9 months after surgery. Fracture mean consolidation has occurred in all patients in 14th weeks (6-20). Operative time was 93,2 minutes (62-129) including removal of nail. No intraoperative complications were observed. Five patients experienced medical complications and two had a superficial wound infection. The mean tip-apex distance (TAD) was 5mm (2-7mm). The neck-shaft angle was 127 degrees. The mean valgization achieved was 32 degrees (15-40). Only one patient needed a second revision surgery due to aseptic hip joint subluxation after 8 weeks of the surgery solved with total hip arthroplasty. CONCLUSIONS: The use of variable angle femoral plate in the cut-out treatment is an attractive option which allows the valgization of the fracture to virtually physiological limits and the placement of the cephalic screw in the most sutiable position with good outcomes and few complications.

Is the mortality higher in patients who have suffered a hip fracture? / ¿Es mayor la mortalidad en los pacientes que han sufrido una fractura de cadera?

BACKGROUND AND OBJECTIVE: The aim of this study is to value whether patients who have suffered a hip fracture have a higher mortality than expected. MATERIAL AND METHODS: A prospective, observational study was carried out where patients with hip fracture were collected as a sample over a year. The study included 284 patients and a minimum follow-up was 2 years. The mean age of these patients was 84.26 years, with 21.48% (61/284) males and 78.5% (223/284) females. Survival and previous diseases that affect mortality, as risk factors, were collected and analyzed using the Kaplan-Meier method and the Cox regression model. Actual mortality was compared with that expected according to the Charlson Comorbidity Index, adjusted for age. RESULTS: Previous pathology was the main mortality factor, with heart disease being the most significant (OR 1.817, CI95%: 1.048; 3.149). The real mortality at one year of the sample was 22.5%, while the estimated annual mortality according to the Charlson Comorbidity Index was 29.68% (CI95%:44,36-15). CONCLUSIONS: Hip fracture does not cause an increase in mortality according to the Charlson Comorbidity Index estimate.

Complicaciones infrecuentes de las prótesis de mama / Uncommon complications of breast prostheses

Los implantes mamarios se asocian a complicaciones frecuentes ampliamente conocidas y estudiadas como la rotura y la contractura capsular. Sin embargo, debido al número cada vez mayor de pacientes portadoras de implantes mamarios, podemos encontrarnos con patología más infrecuente como la presencia de seroma o infección tardía, adenopatías en la cadena mamaria interna, granulomas en la cápsula del implante -que en algunos casos pueden extenderse más allá de la cápsula fibrosa-, tumores desmoides asociados a los implantes y el linfoma anaplásico de células grandes asociado a implantes mamarios. El objetivo de este artículo es revisar las principales complicaciones infrecuentes asociadas a los implantes mamarios y sus hallazgos radiológicos en las diferentes técnicas. Es importante un correcto manejo de esta patología, principalmente del seroma tardío, para diagnosticar precozmente el linfoma anaplásico de células grandes por su mayor transcendencia

Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions

Factores de riesgo en fractura periprotésica femoral tras artroplastia sustitutiva primaria de rodilla / Risk factors of periprosthetic femoral fracture after total knee arthroplasty

INTRODUCCIÓN Y OBJETIVOS: Las fracturas periprotésicas tras artroplastia primaria de rodilla cobran gran importancia en nuestro medio debido tanto al aumento de su incidencia, como al reto que suponen para el cirujano. Múltiples factores se han asociado a su producción. El objetivo del estudio fue identificar los factores de riesgo que podían influir en la aparición de estas fracturas, cuáles de todos ellos son modificables y generar un modelo de predicción de probabilidad de las mismas en función de dichos factores. MATERIAL Y MÉTODO: Estudio analítico, observacional, retrospectivo, no pareado, de 38 casos de fracturas periprotésicas femorales de rodilla y 80 controles con prótesis de rodilla. En total, fueron incluidos en el estudio 118 pacientes, 83 mujeres y 35 hombres con una edad media de 72,49 años. Se recogieron datos sociodemográficos, antecedentes médicos y consumo de fármacos, así como los relativos a la cirugía. Se realizó un análisis uni- y bivariante de los factores determinantes de fractura, usando un modelo de regresión logística para evitar el sesgo de confusión. RESULTADOS: De todos los factores estudiados según el modelo de regresión logística, se obtuvo que el sexo femenino (OR = 7,6), la demencia (OR = 5), la alteración motora/párkinson (OR = 19,3) y el sobrecorte femoral anterior (OR = 8,6) eran factores asociados al incremento de riesgo de este tipo de fracturas. CONCLUSIONES: Este trabajo permite concluir que hay factores de riesgo, como son el sexo femenino, la demencia y el párkinson, que aumentan la probabilidad de fractura periprotésica, que son inherentes al paciente y no son modificables. Sin embargo, existe algún otro totalmente modificable que puede evitarse siendo exigente y exhaustivo en la técnica quirúrgica, como es el sobrecorte femoral anterior

INTRODUCTION AND OBJECTIVES: Periprosthetic fractures after primary knee arthroplasty has great importance in our environment due to the increase in their incidence and to the challenge they pose to the surgeon. Multiple factors have been associated with its production. The objective of the study was to identify the risk factors that could influence the appearance of these fractures, which of them are all modifiable and generate a probability prediction model based on these factors. MATERIAL AND METHODS: Analytical, observational, retrospective, unpaired study of 38 cases of periprosthetic femoral knee fractures and 80 controls with knee prostheses. In total, 118 patients, 83 women and 35 men with a mean age of 72.49 years were included in the study. Sociodemographic data, medical history and drug consumption were collected, as well as those related to surgery. A univariate and bivariate analysis of the fracture determining factors was performed, using a logistic regression model to avoid confusion bias. RESULTS: Of all the factors studied according to the logistic regression model, it was obtained that female sex (OR = 7.6), dementia (OR = 5), motor/parkinson's alteration (OR = 19.3) and femoral overcut Previous (OR = 8.6) were factors associated with the increased risk of this type of fractures. CONCLUSIONS: This work allows us to conclude that there are risk factors such as female sex, dementia and parkinson's that increase the probability of periprosthetic fracture that are inherent to the patient and are not modifiable. However, there is any other totally modifiable that can be avoided by being demanding and thorough in the surgical technique, such as the anterior femoral overcut

Risk factors of periprosthetic femoral fracture after total knee arthroplasty. / Factores de riesgo en fractura periprotésica femoral tras artroplastia sustitutiva primaria de rodilla.

INTRODUCTION AND OBJECTIVES: Periprosthetic fractures after primary knee arthroplasty has great importance in our environment due to the increase in their incidence and to the challenge they pose to the surgeon. Multiple factors have been associated with its production. The objective of the study was to identify the risk factors that could influence the appearance of these fractures, which of them are all modifiable and generate a probability prediction model based on these factors. MATERIAL AND METHODS: Analytical, observational, retrospective, unpaired study of 38 cases of periprosthetic femoral knee fractures and 80 controls with knee prostheses. In total, 118 patients, 83 women and 35 men with a mean age of 72.49 years were included in the study. Sociodemographic data, medical history and drug consumption were collected, as well as those related to surgery. A univariate and bivariate analysis of the fracture determining factors was performed, using a logistic regression model to avoid confusion bias. RESULTS: Of all the factors studied according to the logistic regression model, it was obtained that female sex (OR = 7.6), dementia (OR = 5), motor/parkinson's alteration (OR = 19.3) and femoral overcut Previous (OR = 8.6) were factors associated with the increased risk of this type of fractures. CONCLUSIONS: This work allows us to conclude that there are risk factors such as female sex, dementia and parkinson's that increase the probability of periprosthetic fracture that are inherent to the patient and are not modifiable. However, there is any other totally modifiable that can be avoided by being demanding and thorough in the surgical technique, such as the anterior femoral overcut.

Uncommon complications of breast prostheses. / Complicaciones infrecuentes de las prótesis de mama.

Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions.

Enhanced microbial safety of channel catfish (Ictalurus punctatus) fillet using recently invented medium molecular weight water-soluble chitosan coating.

Chitosan with higher molecular weight exhibited higher antimicrobial efficacy against foodborne pathogens. However, the poor water solubility of higher or medium molecular weight chitosan limits its applications. To overcome the challenge, our research team searched for simple preparation procedure for fast-dissolving medium molecular weight chitosan in water. Throughout the process, we were able to obtain a higher concentration of medium molecular weight water-soluble (MMWWS) chitosan (400 kDa). The MMWWS chitosan showed physicochemical properties that are suitable for edible coating. Antibacterial activities of 400-kDa chitosan coating prepared in acetic acid (1% v/v) or aspartic acid (1% or 3% w/v) were examined. The surface of catfish cubes was inoculated with six foodborne pathogens and then coated with chitosan solutions. The survival of each pathogen was evaluated during shelf life storage. Compared with the control, 3% w/v chitosan coating in aspartic acid solution exhibited the most effective antibacterial activities among other coating treatments, completely inhibiting Vibrio parahaemolyticus on the surface of catfish. The study suggested that chitosan dissolved in aspartic acid has the potential for use as an alternative antimicrobial coating for catfish fillet.

Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia / Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity

OBJETIVO: Conocer si la introducción de criterios de derivación en la urgencia dermatológica modifica el número de pacientes y las patologías derivadas desde el servicio de Urgencias generales, así como el perfil del paciente que hace uso de este servicio. MATERIAL Y MÉTODOS: Estudio observacional que incluyó de forma consecutiva a los pacientes vistos en Urgencias de Dermatología del Hospital Príncipe de Asturias en un periodo de 31 días de 2015, de marzo a mayo, y en el mismo periodo en 2016. Como variables se recogieron sexo, edad, tiempo de evolución, día de la semana, pruebas complementarias, procedencia, motivo de consulta, diagnóstico y grupo, así como el cumplimiento de los criterios, el destino y si tenía cita previa. RESULTADOS: En 2015 acudieron 525 pacientes y 371 en 2016 (p < 0,001). Fueron atendidos 896 pacientes en total (14,45 pacientes/día); el 55,7% eran mujeres y el 44,3% varones. Se realizaron 121 diagnósticos diferentes, siendo los más frecuentes: otras dermatitis, toxicodermias y dermatitis atópica. Tan solo 32 enfermedades suponen el 70% de los diagnósticos. El 51,6% no cumplió los criterios de derivación urgente. CONCLUSIONES: La introducción de criterios de derivación ha permitido reducir el volumen de pacientes en un 30% en el año 2016. Otras dermatitis y las toxicodermias fueron los principales diagnósticos en ambos grupos. El perfil del paciente coincide con el descrito en la literatura

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P < .001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature

Discrimination between chewing of coca leaves or drinking of coca tea and smoking of "paco" (coca paste) by hair analysis. A preliminary study of possibilities and limitations.

BACKGROUND: Hair analysis is a suitable way to discriminate between coca chewers and consumers of manufactured cocaine using the coca alkaloids hygrine (HYG) and cuscohygrine (CUS) as markers. In the present preliminary study it was examined whether CUS and HYG can be detected in hair of occasional and moderate coca chewers or coca tea drinkers, whether CUS and HYG appear in hair of PACO consumers (smoking coca paste waste), and whether anhydroecgonine methyl ester (AEME) is a useful cocaine smoking marker in this context. METHOD: Three groups were included: 10 volunteers from Buenos Aires with occasional or moderate chewing of coca leaves or drinking coca tea, 20 Argentinean PACO smokers and 8 German cocaine users. The hair samples (1-4 segments) were analyzed by a validated LC-MS/MS method for cocaine (COC), norcocaine (NC), benzoylecgonine (BE), ecgonine methyl ester (EME), cocaethylene (CE), cinnamoylcocaine (CIN), tropacocaine (TRO), AEME, CUS and HYG. For comparison, eight samples of coca leaves or coca tea were analyzed. RESULTS: Only low concentrations of COC were found in hair of seven occasional users of coca leaves or coca tea (0.010-0.051 ng/mg). For three moderate chewers of coca leaves all compounds were detected including AEME but except TRO. The hair samples of PACO smokers contained much higher concentrations of COC (0.027-341 ng/mg, mean 37.4 ng/mg) and its metabolites. CUS was not found in these samples but traces of HYG were seen in 8 of 37 hair segments. AEME as a marker for coca smoking was detected in hair of 15 smokers. In comparison to COC, the concentrations of EME and CIN were higher for PACO smokers than for German cocaine consumers. AEME (56 ± 20 µg/g) was detected in all coca leave and coca tea samples which explains the detection of this substance in hair of coca chewers. Therefore, its use for differentiation between coca chewers and PACO smokers is limited. CONCLUSION: CUS remains to be the most suitable marker in hair for chewing coca leaves or drinking coca tea more frequently than two times per month since it does not appear in hair of Argentinean PACO smokers and German cocaine users. Contrary to a previous proposal, the ratios CIN/COC and EME/COC appeared not to be applicable as criteria for this purpose because of the higher concentration of these alkaloids in hair of PACO smokers. More research is needed to assess the value of AEME in hair of South American coca leave or cocaine users.

[Dermatological emergencies: a cross-sectional study of a hospital of intermediate complexity]. / Urgencias dermatológicas: estudio transversal de un hospital de complejidad intermedia.

OBJECTIVE: To determine if the introduction of some referral criteria in the dermatology emergency department has changed the number of patients referred from the emergency department, as well as the type of diseases, and the profile of the patient who uses this service. MATERIAL AND METHODS: A cross-sectional study was conducted on all consecutive patients attended in the emergency department of the Hospital Príncipe de Asturias during a 31-day period from March 2015 to May 2015 and in the same period in 2016. Variables collected were: gender, age, days from the onset, day of the week, complementary diagnostic tests, referral, reason for consultation, diagnosis and group, whether or not they met the criteria, destination, and whether or not they had a previous appointment. RESULTS: A total of 525 patients were seen in dermatology emergency department in 2015, and 371 in 2016 (P<.001). Of the 896 patients seen 55.7% were women and 44.3% men (14.45 patients per day). A total of 121 diagnoses were made, with the most common being: other dermatitis, drug reactions, and atopic dermatitis. Only 32 pathologies made up 70% of the diagnoses. More than half (51.6%) did not meet the referral criteria. CONCLUSIONS: The introduction of referral criteria has led to a reduction of 30% in the number of patients in 2016. The main diagnoses in both groups were other dermatitis and drug reactions. The profile of the patient is in accordance with the description in the literature.

Anillo de Burch-Schneider asociado a injerto óseo triturado, supervivencia y resultados clínicos en revisión acetabular / Burch-Schneider ring associated with morselized bone allografts, survival and clinical outcomes after acetabular revision surgery

Introducción y objetivos: La cirugía de revisión acetabular supone un reto por la aparición de defectos óseos que dificultan la fijación primaria de los implantes al extraer los componentes aflojados. Los anillos antiprotrusivos, como el de Burch-Schneider (BS) se han mostrado como aliados en defectos moderados o severos. El objetivo del estudio es evaluar resultados y supervivencia de este tipo de implantes en recambios acetabulares a medio plazo. Material y métodos: Estudio retrospectivo sobre una cohorte de 64 pacientes (67 recambios) con anillo de BS asociado a injerto triturado con un seguimiento mínimo de 2 años. Se recogen los datos relativos a resultados clínicos, incorporación de injertos, movilización de los implantes, supervivencia y complicaciones. Resultados: El seguimiento medio fue de 5,06 años (R=2,2-12). La escala de Merlé pasó de una mediana de 8 puntos a una mediana de 15 puntos al final del seguimiento (p<0,0001), con un 76,11% de resultados buenos o excelentes. La reproducción del centro de rotación anatómico se asoció con un mejor resultado (p<0,05). Se produjo incorporación total o subtotal de los injertos en el 97% de los pacientes, aunque esto no impidió una migración significativa del anillo según criterios de Gill en 6 casos. Se constató una supervivencia global del implante para cualquier causa del 93,4% a 5 años y del 84,6% a 10 años. Conclusiones: El anillo de BS presenta buenos resultados a medio y largo plazo permitiendo una reconstrucción anatómica en cirugía de revisión, además de permitir una reposición del stock óseo, estos resultados además son comparables y mejoran ampliamente a otros anillos

Introduction and objectives: Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. Material and methods: Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up. Data were collected regarding clinical outcomes, graft incorporation, implant mobilization, survival and complications. Results: The mean follow-up was 5.06 years (R=2.2-12). The Merle scale improved from 8 points to 15 points at the end of follow-up (P<.0001) with 76.11% of good or excellent results. Reproduction of the anatomical centre of rotation was associated with a better result (P<.05). There was total or subtotal incorporation of the bone allograft in 97% of the patients, although this did not prevent a significant migration of the ring according to Gill criteria in 6 cases. We observed an overall survival of the implant for any cause of 93.4% at 5 years, and 84.6% at 10 years. Conclusions: The BS reinforcement ring shows good results in the medium and long term enabling anatomical reconstruction in revision surgery as well as replacement of the bone stock. These results are also comparable and are a vast improvement on other rings

Burch-Schneider ring associated with morselized bone allografts, survival and clinical outcomes after acetabular revision surgery. / Anillo de Burch-Schneider asociado a injerto óseo triturado, supervivencia y resultados clínicos en revisión acetabular.

INTRODUCTION AND OBJECTIVES: Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. MATERIAL AND METHODS: Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up. Data were collected regarding clinical outcomes, graft incorporation, implant mobilization, survival and complications. RESULTS: The mean follow-up was 5.06 years (R=2.2-12). The Merle scale improved from 8 points to 15 points at the end of follow-up (P<.0001) with 76.11% of good or excellent results. Reproduction of the anatomical centre of rotation was associated with a better result (P<.05). There was total or subtotal incorporation of the bone allograft in 97% of the patients, although this did not prevent a significant migration of the ring according to Gill criteria in 6 cases. We observed an overall survival of the implant for any cause of 93.4% at 5 years, and 84.6% at 10 years. CONCLUSIONS: The BS reinforcement ring shows good results in the medium and long term enabling anatomical reconstruction in revision surgery as well as replacement of the bone stock. These results are also comparable and are a vast improvement on other rings.

La importancia de la restauración de la línea articular en la revisión de la artroplastía total de rodilla. Índices funcionales, calidad de vida y supervivencia / The importance of the restoration of the joint line in revision total knee arthroplasty. Clinical indexes, quality of life and survival

Resumen: Introducción: La reproducción de la correcta línea articular podría ser un buen índice para la obtención de resultados satisfactorios en la cirugía protésica de rodilla, aunque en la cirugía de revisión no se ha estudiado ampliamente. Es necesaria la búsqueda de un método sencillo y reproducible para evaluar esos resultados. Material y métodos: Se realizó un estudio retrospectivo entre Enero del 2000 y Diciembre del 2013. Se implantaron 97 artroplastías totales de revisión de rodilla. El grupo de estudio lo conformaron 67 pacientes. Para la realización de nuestro trabajo se evaluó la línea articular según el método descrito por Hofmann A. La evaluación de los resultados clínicos incluyó las siguientes variables primarias: flexión, extensión, rango de movimiento, WOMAC, SF-36, KSS (Knee Society Score) y KSS funcional. Se estudió la supervivencia de las artroplastías. Resultados: Las variables de flexión, extensión y rango de movimiento postoperatorio se correlacionaron estadísticamente con esta medición. El KSS se relacionó estadísticamente en su vertiente articular con la restauración de la línea articular. Para el resto de escalas, SF-36 y WOMAC, las puntuaciones fueron más altas pero no se correlacionó con la significación aceptada. Conclusión: Ante estos resultados podemos afirmar que la restauración de la correcta línea articular mejora los resultados clínicos de la cirugía de revisión de rodilla.

Abstract: Introduction: The reproduction of the anatomical joint line could be a good index to obtain good results in knee prosthesis surgery, although in revision surgery has not been enough studied. A search for a simple and reproducible method is needed to review these results. Material and methods: A retrospective study was conducted between January 2000 and December 2013. A total of 97 total revision knee arthroplasties were implanted. Finally, the study group consisted of 67 patients. To perform our study, the joint line was evaluated according to the method described by Hofmann A. The evaluation of the clinical results included the following main variables: Flexion, extension, range of motion, WOMAC, SF-36, KSS (Knee Society Score) and functional KSS. The survival of the arthroplasties was studied. (p = 0.05). Results: The variables of flexion, extension and range of postoperative movement are statistically correlated with this measure. The KSS was statistically related in its joint aspect with the restoration of the joint line. For the other scales, SF-36 and WOMAC, the figures were higher but did not correlate with the accepted p. Conclusion: In view of these results, we can say that the restoration of the anatomical joint line improves the clinical results of revision total knee arthroplasty.

Elaboración y validación del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» / Elaboration and validation of the «Attitudes questionnaire towards professional ethics in Physiotherapy»

Objetivo: En el contexto universitario resulta necesaria la elaboración y validación de cuestionarios para ser aplicados en la valoración de nuevos modelos formativos que garanticen la adquisición de la competencia ética. El objetivo de este estudio es presentar la elaboración, evaluación de la fiabilidad y unidimensionalidad del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» (CAEPFIS). Material y método: Se procedió a la elaboración de un cuestionario que analizara las actitudes hacia la ética profesional en estudiantes de Fisioterapia (CAEPFIS) mediante un estudio piloto con estudiantes de Fisioterapia de último curso (n=100). Se llevó a cabo un análisis de consistencia interna (alfa de Cronbach) y se detectaron y eliminaron los ítems indiferenciadores. Posteriormente, se analizó la unidimensionalidad del cuestionario (análisis factorial de componentes principales, prueba de esfericidad de Barlett y medida de adecuación muestral de Kaiser-Meyer-OIkin [KMO]). Finalmente, el cuestionario constó de 33 ítems. Se empleó Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, EE. UU.). Resultados: El CAEPFIS presenta una elevada consistencia interna (coeficiente alfa de Cronbach=0,898). Los ítems del CAEPFIS se acercan a la unidimensionalidad deseada (análisis factorial de componentes principales: KMO=0,762; χ2=1.871,874; df=528; p<0,001). El primer factor muestra una buena proporción de la varianza total, explica el 25,8% de la misma y todos los ítems presentan pesos por encima de 0,3. Conclusiones: El CAEPFIS muestra fiabilidad y unidimensionalidad para ser empleado como instrumento de recogida de datos para analizar las actitudes hacia la ética profesional en estudiantes de Fisioterapia

Purpose: In the university context the creation and validation of questionnaires to be applied in assessment of new teaching models that guarantee the acquisition of ethical competence is necessary. This study aims at presenting the creation, assessment of internal consistence and unidimensionality of the ‘Attitudes questionnaire towards professional ethics in Physiotherapy’ (CAEPFIS). Material and method: A questionnaire analyzing attitudes towards professional ethics in Physiotherapy students (CAEPFIS) was created by means of a study carried out with physiotherapy students in the last year of their degree (n=100). An analysis of internal consistency (Cronbach's Alpha) was carried out, whilst differentiator elements were detected and deleted. Afterwards, unidimensionality of the questionnaire was analyzed (factorial analysis of principal components, Barlett's test of sphericity and Kaiser-Meyer-OIkin KMO). Finally, the questionnaire comprised 33 items. Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, USA) was used. Results: CAEPFIS shows a high internal consistency (Cronbach's Alfa=0.898). Items of CAEPFIS are close to the desired unidimensionality (Factorial Analysis of Principal Components: KMO=0.762; χ2=1,871.874; df=528; p<0.001). The first factor shows a good proportion of total variance, explains the 25.8% of it and all items present weights higher than 0.3. Conclusions: CAEPFIS shows internal consistency and unidimensionality to be used as a tool of data collection to analyze attitudes towards professional ethics in physiotherapy students

Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial.

RATIONALE: Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. OBJECTIVES: To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. METHODS: 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. MAIN RESULTS: Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit - upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ. CONCLUSIONS: The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone. TRIAL REGISTRATION NUMBER: NCT02158065.

[The importance of the restoration of the joint line in revision total knee arthroplasty. Clinical indexes, quality of life and survival]. / La importancia de la restauración de la línea articular en la revisión de la artroplastía total de rodilla. Índices funcionales, calidad de vida y supervivencia.

INTRODUCTION: The reproduction of the anatomical joint line could be a good index to obtain good results in knee prosthesis surgery, although in revision surgery has not been enough studied. A search for a simple and reproducible method is needed to review these results. MATERIAL AND METHODS: A retrospective study was conducted between January 2000 and December 2013. A total of 97 total revision knee arthroplasties were implanted. Finally, the study group consisted of 67 patients. To perform our study, the joint line was evaluated according to the method described by Hofmann A. The evaluation of the clinical results included the following main variables: Flexion, extension, range of motion, WOMAC, SF-36, KSS (Knee Society Score) and functional KSS. The survival of the arthroplasties was studied. (p = 0.05). RESULTS: The variables of flexion, extension and range of postoperative movement are statistically correlated with this measure. The KSS was statistically related in its joint aspect with the restoration of the joint line. For the other scales, SF-36 and WOMAC, the figures were higher but did not correlate with the accepted p. CONCLUSION: In view of these results, we can say that the restoration of the anatomical joint line improves the clinical results of revision total knee arthroplasty.

INTRODUCCIÓN: La reproducción de la correcta línea articular podría ser un buen índice para la obtención de resultados satisfactorios en la cirugía protésica de rodilla, aunque en la cirugía de revisión no se ha estudiado ampliamente. Es necesaria la búsqueda de un método sencillo y reproducible para evaluar esos resultados. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo entre Enero del 2000 y Diciembre del 2013. Se implantaron 97 artroplastías totales de revisión de rodilla. El grupo de estudio lo conformaron 67 pacientes. Para la realización de nuestro trabajo se evaluó la línea articular según el método descrito por Hofmann A. La evaluación de los resultados clínicos incluyó las siguientes variables primarias: flexión, extensión, rango de movimiento, WOMAC, SF-36, KSS (Knee Society Score) y KSS funcional. Se estudió la supervivencia de las artroplastías. RESULTADOS: Las variables de flexión, extensión y rango de movimiento postoperatorio se correlacionaron estadísticamente con esta medición. El KSS se relacionó estadísticamente en su vertiente articular con la restauración de la línea articular. Para el resto de escalas, SF-36 y WOMAC, las puntuaciones fueron más altas pero no se correlacionó con la significación aceptada. CONCLUSIÓN: Ante estos resultados podemos afirmar que la restauración de la correcta línea articular mejora los resultados clínicos de la cirugía de revisión de rodilla.

Multiphoton luminescence imaging of chemically functionalized multi-walled carbon nanotubes in cells and solid tumors.

The intrinsic nonlinear photoluminescence (PL) property of chemically functionalized multi-walled nanotubes MWNTs (f-MWNTs) is reported in this study. f-MWNTs are imaged in fixed lung epithelial cancer cells (A549) and Kupffer cells in vitro, and in subcutaneously implanted solid tumors in vivo, for the first time, using multiphoton PL and fluorescence lifetime imaging (FLIM). Multiphoton imaging in the near-infrared excitation region (∼750-950 nm), employed in this study in a label-free manner, provides sensitivity and resolution optimal to track f-MWNTs within intra-cellular compartments and facilitates tumour imaging and sentinel lymph node tracking in vivo. Wider applications include employing this technique in live imaging of f-MWNTs in biological milieu to facilitate image-guided drug delivery.