Complex network analysis techniques for the early detection of the outbreak of pandemics transmitted through air traffic.

Air transport has been identified as one of the primary means whereby COVID-19 spread throughout Europe during the early stages of the pandemic. In this paper we analyse two categories of methods - dynamic network markers (DNMs) and network analysis-based methods - as potential early warning signals for detecting and anticipating COVID-19 outbreaks in Europe on the basis of accuracy regarding the daily confirmed cases. The analysis was carried out from 15 February 2020, around two weeks before the first COVID-19 cases appeared in Europe, and 1 May 2020, approximately two weeks after all the air traffic in Europe had been shut down. Daily European COVID-19 information sourced from the World Health Organization was used, whereas air traffic data from Flightradar24 has been incorporated into the analyses by means of four alternative adjacency matrices. Some DNMs have been discarded since they output multiple time series, which makes it very difficult to interpret their results. The only DNM outputting a single time series does not emulate the COVID-19 trend: it does not detect all the main peaks, which means that peak heights do not match up with the increase in the number of infected people. However, many combinations of network analysis based methods and adjacency matrices output good results (with high accuracy and 20-day advance forecasts), with only minor differences from one to another. The number of edges and the network density methods are slightly better when dynamic flight frequency information is used.

Lesiones de SLAP. Experiencia sobre 100 casos / SLAP injuries. Experience about 100 cases

Introducción y objetivos: Las lesiones de SLAP tienen una frecuencia del 3.9% al 12%, siendo hasta del 35% en deportistas de contacto. Nuestro objetivo es revisar esta patología en nuestro centro, a propósito de 100 pacientes. Material y métodos: Estudio observacional, descriptivo y retrospectivo, sobre 100 pacientes. Analizamos edad media, sexo, lateralidad, profesión, tipo de SLAP, lesiones asociadas, técnica quirúrgica, complicaciones, test de Rowe, Constant y UCLA, entre otros datos.Resultados91% varones, 9% mujeres. Edad media de 41.2 ± 10.1 años, 69% derechos y 31% izquierdos. Hallazgos intraoperatorios: SLAP predo-minante, tipo II (62%). Lesiones del manguito rotador (21%), Bankart (8%) y Hill-Sachs (8%). Descompresión subacromial en el 52.3% y repa-ración del SLAP en el 64.8%, con 1.3 ± 0.9 arpones por paciente. Resultados: medios finales: Test Rowe: 81.5 ± 18.9 puntos; test de Constant 64.3 ± 18.8 puntos; test UCLA 25.4 ± 7.6 puntos. En las tipo II, realizamos una reinserción labral en el 78.5% de los casos, sin diferencias en cuanto a Constant respecto tenotomía/tenodesis: 65.2 +/- 18.3 frente a 55.1 +/- 18 puntos, p>0.05. Segui-miento 2 +/- 0.5 años. Conclusiones: Las lesiones de SLAP suponen una causa de omalgia a considerar. Su tratamiento artroscópico permite obtener resultados favorables y diagnosticar-tratar otras patologías concomitantes. En nuestra experiencia, en los casos tipo II realizamos reinserción labral, obteniendo mejores resultados que cuando se realizaba otra técnica, como la tenodesis, aunque de modo no significativo. (AU)

Introduction and objectives: SLAP lesions have a frequency of 3.9% to 12%, being up to 35% in contact sportsmen. Our objective is to review this pathology in our center, regarding about 100 patients. Material and methods: Observational, descriptive and retrospective study about 100 patients. We analyzed mean age, sex, laterality, type of SLAP, associated lesions, surgical technique, complications, Rowe, Con-stant and UCLA tests, among other data.Results91% males, 9% females. Mean age 41.2 ± 10.1 years, 69% right and 31% left. Intraoperative findings: predominant SLAP, type II (62%). Rota-tor cuff (21%), Bankart (8%) and Hill-Sachs (8%) injuries. Subacromial decompression in 52.3% and SLAP repair in 64.8%, with 1.3 ± 0.9 anchors per patient. Final mean results: Rowe test: 81.5 ± 18.9 points; Constant test 64.3 ± 18.8 points; UCLA test 25.4 ± 7.6 points. In type II, we performed labral reinsertion in 78.5% of the cases, with no differences in terms of Constant with re-spect to tenotomy/tenodesis: 65.2 +/- 18.3 vs. 55.1 +/- 18 points, p>0.05. Follow up 2 +/- 0.5 years. Conclusions: SLAP lesions are a cause of omalgia to be considered. SLAP`s arthroscopic treatment al-lows to obtain favorable results and to diagnose and treat other concomitant pathologies. In our experience, in type II cases we performed labral reinsertion, obtaining better results than another technique, such as tenodesis, although it was not significative. (AU)

Lipoma arborescente en hombro, una inusual causa de omalgia / Orborescent lipoma on the shoulder, an unusual cause of omalgia

Introducción: El lipoma arborescente supone tan sólo el 3-5% de los lipomas. El tratamiento artroscópico de esta lesión, junto a una sutura de manguito, son infrecuentes, describiéndose sólo 5 casos, de los cuales sólo 4 presentaban roturas de manguito. Nuestro objetivo es presentar un caso y revisar esta patología. Material y Métodos: Paciente de 55 años, varón, con omalgia derecha. Ecografía: Derrame articular subdeltoideo con mamelones hiperecogénicos, sesiles. RNM: Derrame articular con formaciones ramificadas interiores con señal grasa. Tendinosis, rotura parcial del supraespinoso. Tras ausencia de respuesta conservadora, realizamos sinovectomía artroscópica, descompresión subacromial, biopsia, bursec-tomía y sutura de manguito. Resultados: Lipoma arborescente. Tras 5 meses de rehabilitación, alcanzó un Constant de 92 puntos.DiscusiónEl lipoma arborescente se presenta de modo primario, o bien secundariamente a Artritis Reumatoide, Psoriasis, traumatismos repetitivos, artritis séptica o de modo concomitante a Diabetes o Tuberculosis. Su diagnóstico diferencial es con la sinovitis villonodular pigmentada, ostocondramatosis sinovial, liposarcoma o el hemangioma sinovial. El tratamiento consiste en infiltraciones de corticoides, sinovectomía de radioisótopos (Y-citrato coloidal) o la sinovectomía quirúrgica, abierta o artroscópica, pudiendo tratar lesiones asociadas. Como conclusión, el lipoma arborescente es una causa infrecuente de omalgia y cuyo tratamiento artroscópico obtiene resultados favorables, de modo menos invasivo.(AU)

Introduction: The arborescent lipoma accounts for only 3-5% of lipomas. Arthroscopic treatment of this lesion, together with a cuff suture, is unusual, with only 5 cases described, of which only 4 presented cuff tears. Our aim is to present a case and review this pathology. Material and Methods: 55-year-old male patient with right shoulder pain. Ultrasound: Subdeltoid joint effusion with sessile, hyperechoic pedicles. MRI: Joint effusion with interior branching formations with a fat signal. Tendinosis, partial rupture of the supraspinatus. After the absence of a conservative response, we performed arthroscopic synovectomy, subacromial decompression, biopsy, bursectomy, and rotator cuff suture. Results: Arborescent lipoma. After 5 months of rehabilitation, he reached a Constant’s score of 92 points.Discussion: Arborescent lipoma presents primarily, or secondarily to Rheumatoid Arthritis, Psoriasis, repetitive trauma, septic arthritis or concomitantly to Diabetes or Tuberculosis. Its differential diagnosis is with pigmented villonodular synovitis, synovial ostochondramatosis, liposarcoma or synovial hemangioma. Treatment consists of corticosteroid infiltrations, radioisotope synovectomy (Y-colloidal citrate) or surgical, open or arthroscopic synovectomy, which can treat associated lesions. In conclusion, arborescent lipoma is an infrequent cause of shoulder pain and whose arthroscopic treatment obtains favorable results, in a less invasive way.(AU)

Osteoporosis transitoria migratoria en miembros inferiores / Transient migratory osteoporosis in lower limbs

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Reparación de roturas del ligamento cruzado anterior con sistema aperfix / Anterior cruciate ligament reconstruction with the aperfix system

Introducción: la reconstrucción del Ligamento Cruzado Anterior (LCA) con isquiotibiales resistiría 1216 N, con una pérdida extensora de sólo un 3%. Nuestro objetivo es revisar nuestra experiencia con este procedimiento con el sistema Aperfix®. Material y métodos: Estudio observacional, descriptivo y retrospectivo. Tamaño muestral de 224 casos, seguimiento mínimo de 12 meses. Analizamos entre otros: filiación, movilidad, R.N.M., tiempo quirúrgico y escala Lysholm. Analizamos diferencias estadísticas entre el abordaje femoral desde el portal anteromedial o desde el túnel tibial, mediante los test t de Student, U de Mann Whitney y Chi Cuadrado, con S.P.S.S. 20.0. Resultados: Edad media de 36.5 ± 8.7 años, Lachmann previo en el 96.8% y Pívot Shift previo positivo en el 51.4%, lesiones meniscales asociadas en el 73.8%. Tiempo quirúrgico: 87.1± 18.9 minutos, Lachmann postquirúrgico en el 17.4% y Pívot Shift negativo en el 98.9%. Flexión final de 128.1 ± 5.2°, 95.8 ± 7 puntos de escala final de Lysholm. Complicaciones en el 11%. Altas por mejoría en el 98.9%. No hallamos diferencias significativas entre ambas formas de realización del túnel femoral. Sólo con respecto al tiempo quirúrgico, p=0.004, siendo éste algo mayor cuando se realizada desde el portal anteromedial. Conclusiones: En nuestra experiencia, la ligamentoplastia con el sistema Aperfix® mejora la escala Lysholm, con escasas complicaciones y buen resultado funcional. No hallamos grandes diferencias en cuanto a la realización del túnel femoral, sólo un mayor tiempo quirúrgico cuando se realiza desde el portal anteromedical.

Introduction: reconstruction of the anterior cruciate ligament (A.C.L.) with hamstring grafts would resist 1216 N, with an extensor loss of only 3%. Our goal is to review our experience with this procedure with the Aper x® system. Material and methods: Observational, descriptive and retrospective study. Sample size of 224 cases, minimum followup of 12 months. We analyzed among others: liation, mobility, M.R.I., surgical time and Lysholm’s scale. We analyzed statistical differences between femoral approach from anteromedial portal or from tibial tunnel, using the Student t, Mann Whitney U and Chi Square tests, with S.P.S.S. 20.0. Results: Mean age was 36.5 ± 8.7 years, Lachmann’s test previous surgery was positive in 96.8% and Pivot Shift in 51.4%. There were associated meniscal injuries in 73.8%. Surgical time was 87.1 ± 18.9 minutes. Post-surgical Lachmann’s test was positive at 17.4% and post-surgical Pivot Shift was negative at 98.9%. Final exion was 128.1 ± 5.2°, with 95.8 ± 7 points at Lysholm’s scale. There were complications in 11%. 98.9% of patients returned to their previous jobs. We did not nd signi cant differences between both forms of femoral tunneling. Only with respect to surgical time, p = 0.004, it was longer for cases operated by means of anteromedial portal. Conclusions: In our experience, ligamentoplasty with the Aper x® system improves Lysholm’s scale, with a few complications and good functional outcome. We do not nd great differences in performance of femoral tunnel, only a longer surgical time when it was performed from the anteromedial portal.

Tratamiento artroscópico de la condromatosis sinovial, una inusual causa de omalgia / Arthroscopic treatment of synovial chondromatosis, an unusual cause of shoulder pain

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Terapia por presión negativa en el manejo de heridas complejas en traumatología. Innovación e indicación / Negative Pressure Therapy for treatment of complex wounds in Orthopaedic Surgery. Innovation and Indication

La terapia por presión negativa (TPN) es una modalidad terapéutica complementaria ampliamente difundida en la actualidad para el manejo de heridas complejas en el ámbito de la Traumatología y Ortopedia. Los dispositivos más modernos permiten adicionar a esta terapia la instilación intermitente de soluciones (Terapia por Presión Negativa con Instilación Intermitente, TPNII) para una mayor efi cacia del tratamiento. En el presente trabajo se revisarán los fundamentos de la terapia, así como sus principales indicaciones, recomendaciones de uso y nuestra experiencia clínica con el mismo

Negative Pressure Therapy (NPT) is an adjuvant method of treatment broadly widespread for management of complex wounds in the fi eld of Orthopaedic Surgery. Modern devices also allow intermitent instillation of different types of lavage solutions (Negative Pressure Therapy with Intermitent Instillation, NPTII), increasing the effi cacy of treatment. The present article reviews the basis of the described therapy as well as its main indications, recommendations of use and our personal clinical experience with the device

Tratamiento coadyuvante a la reparación artroscópica del manguito rotador con plasma rico en plaquetas / Coadjutant treatment for arthroscopic repair of a rotator cuff with plasma rich in platelets

Objetivos: Tras una acromioplastia aumenta a nivel subacromial T.G.F.-beta1 (p = 0.0001), P.D.G.F.-AB (p = 0.02) y bF.G.F. (p < 0.0001). La aplicación de plasma rico en plaquetas (P.R.P.) aportaría en mayor cuantía estos factores. Nuestro objetivo es comparar clínicamente, ecográficamente y biomecánicamente un grupo de 10 pacientes tratado con P.R.P., frente a otros 10 pacientes sin P.R.P., intervenidos con igual técnica artroscópica. Material y método: Estudio prospectivo, aleatorizado, evidencia I. Analizamos variables de filiación, clínicas, operatorias, tests Constant, D.A.S.H. (Disability Arm Shoulder Hand), análisis ecográfico y biomecánico. Seguimiento mínimo: 9 meses. Resultados: El tiempo rehabilitando con P.R.P. fue 5.7 ± 1.1 meses, frente a 7.5 ± 2.7 meses, sin P.R.P. Hubo diferencias ecográficas (3 meses) favorables para el PRP en grosor tendinoso (p=0.05), menor anchura y longitud de la zona desnuda humeral (p=0.02 y p=0.02). Hubo diferencias (9 meses), a favor del grupo con PRP en tests Constant (p=0.05), E.V.A. (Escala Visual Analógica) (p=0.04) y D.A.S.H. (p=0.04). No hubo diferencias biomecánicas, (9 meses), salvo en extensión y flexión (90º y 70º), mejores cuando se aplicaba PRP. Conclusiones: La aplicación de P.R.P. en la cirugía artroscópica de las roturas del manguito rotador, en nuestra experiencia, estaría indicada, ya que mejoraría los tests de Constant, E.V.A. y D.A.S.H., a los 9 meses de la cirugía. Mejoraría el grosor tendinoso, y disminuiría la anchura y longitud de la zona “calva” humeral, a los 3 meses. Mejoraría biomecánicamente la flexoextensión. Sin afectar al tiempo quirúrgico, reduciría la rehabilitación, la tasa de reintervenciones, con mejor satisfacción (AU)

Objectives: After acromioplasty, subacromial levels for TGF-beta1 (p = 0.0001), PDGF-AB (p = 0.02) and bFGF (p< 0.0001) increased. The application of plasma rich in platelets (PRP) would contribute greatly to these factors. Ourobjective is to clinically, ultrasonographically and bio-mechanically compare a group of 10 patients, treated with PRP, in comparison with another 10 patients without PRP undergoing the same arthroscopic technique Material and method: Prospective, randomized and evidence based study, in which we analyzed a number of variables,including background, clinical data, surgical data, Constant tests, DASH (Disability Arm Shoulder Hand), ultrasound and biomechanical analysis. Minimum follow-up: 9 months. Results: the rehabilitation time with PRP was 5.7 ± 1.1 months, in comparison with 7.5 ± 2.7 months without PRP. There were ultrasound differences (3 months) favorable for PRP in thickness (p=0.05), lesser width and length in the bare humeral zone (p=0.02 and p=0.02). There were differences (9 months) in favor of the PRP group in the Constant tests (p=0.05), CVAS (Cosmetic Visual Analogue Scale) (p=0.04) and DASH (p=0.04). There were no bio-mechanical differences (9 months), except in extension and flexion (90º and 70º), with improvements with the application of PRP. Conclusions: The application of PRP in surgical arthroscopy of the rotator cuff, in our experience, would be indicated, as it improves most of the Constant tests, CVAS and DASH 9 months after surgery. It improves tendineus thickness while decreasing the width and length of the bare humeral area after 3 months. It bio-mechanically improves flexion-extension. Without affecting the surgical time, it reduces rehabilitation, the re-intervention rate and offers improved satisfaction (AU)

Arthroscopic arthrodesis of the shoulder: Fourteen-year follow-up.

Shoulder arthrodesis is indicated in infections, brachial paralysis, irreparable rotator cuff tears, osteoarthritis without indication of prosthesis, rescue after arthroplasty, or after surgery for cancer. Arthroscopic arthrodesis is exceptional. Our aim is presenting our result after 14 years of follow-up of one patient. We present a case report of a 17-year-old male patient. He suffered fracture of left scapula (type V, Ideberg), fracture of left clavicle (type I, Craig), and fracture of left distal ulna. We realized osteosynthesis of clavicle (plate and screws) with the aim of treating this floating shoulder. Electromyography showed partial axonotmesis of axilar nerve. After 7 months of follow-up, axonotmesis was still present. We realized arthroscopic shoulder arthrodesis (three cannulated screws). Fourteen years later, shoulder movement was as follows: Flexion, 0-90°; maximum abduction, 40° with shoulder atrophy; Constant, 47 points; and UCLA, 17 points, without pain. Arthrodesis with screws reaches a subjective benefit in 82% of patients. Percentage of pseudarthrosis is less than in patients treated with plates, although the risks of infections, fractures, and material removal are greater than in patients treated with plates. Shoulder arthroscopic arthrodesis is exceptional, but it allows minimal surgical aggression.

Síndrome de Maroteaux-Lamy en un niño de 10 años / Maroteaux-Lamy’ Syndrom in a 10 years old child

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Omalgia en paciente con colitis ulcerosa / No disponible

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