Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis.

Osteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.

A Traceable DNA-Replicon Derived Vector to Speed Up Gene Editing in Potato: Interrupting Genes Related to Undesirable Postharvest Tuber Traits as an Example.

In potato (Solanum tuberosum L.), protoplast techniques are limited to a few genotypes; thus, the use of regular regeneration procedures of multicellular explants causes us to face complexities associated to CRISPR/Cas9 gene editing efficiency and final identification of individuals. Geminivirus-based replicons contained in T-DNAs could provide an improvement to these procedures considering their cargo capability. We built a Bean yellow dwarf virus-derived replicon vector, pGEF-U, that expresses all the editing reagents under a multi-guide RNA condition, and the Green Fluorescent Protein (GFP) marker gene. Agrobacterium-mediated gene transfer experiments were carried out on 'Yagana-INIA', a relevant local variety with no previous regeneration protocol. Assays showed that pGEF-U had GFP transient expression for up to 10 days post-infiltration when leaf explants were used. A dedicated potato genome analysis tool allowed for the design of guide RNA pairs to induce double cuts of genes associated to enzymatic browning (StPPO1 and 2) and to cold-induced sweetening (StvacINV1 and StBAM1). Monitoring GFP at 7 days post-infiltration, explants led to vector validation as well as to selection for regeneration (34.3% of starting explants). Plant sets were evaluated for the targeted deletion, showing individuals edited for StPPO1 and StBAM1 genes (1 and 4 lines, respectively), although with a transgenic condition. While no targeted deletion was seen in StvacINV1 and StPPO2 plant sets, stable GFP-expressing calli were chosen for analysis; we observed different repair alternatives, ranging from the expected loss of large gene fragments to those showing punctual insertions/deletions at both cut sites or incomplete repairs along the target region. Results validate pGEF-U for gene editing coupled to regular regeneration protocols, and both targeted deletion and single site editings encourage further characterization of the set of plants already generated.

Terapia de ressincronização cardíaca: análise do speckle tracking como preditor de boa resposta clínica / Cardiac resynchronization therapy: speckle tracking analysis as a predictor of good clinical response

A insuficiência cardíaca (IC) é uma complexa síndrome clínica, multifatorial, que reduz a sobrevida e aumenta morbidade. Representa uma das principais causas de hospitalização no Sistema Único de Saúde e lidera as internações por causas cardiovasculares, acontecendo sobretudo pacientes com faixa etária acima de 60 anos. O manejo da ICP por meio do controle de fatores de risco, diagnóstico precoce e tratamento adequado reduz a morbimortalidade...

Nivel de ansiedad en las gestantes programadas para cesáreas en el Hospital de Apoyo Huanta Ayacucho - 2016 / Level of anxiety in the pregnant women scheduled for cesarean section in the Support Hospital Huanta, Ayacucho-2016

Las intervenciones quirúrgicas han venido incrementándose como una forma de tratar algunas enfermedades quirúrgicas lo cual genera algún tipo de ansiedad en las gestantes. En tal sentido es que se ha desarrollado el presente estudio de investigación titulado "Nivel de Ansiedad en las Gestantes". Objetivo: determinar el nivel de ansiedad en las gestantes programadas para cesáreas en el Hospital de Apoyo Huanta, Ayacucho 2016. Metodología: tipo cuantitativo, método descriptivo de corte transversal, el área de estudio es en la sala de operaciones del Hospital Apoyo Huanta. Población: 32 gestantes encuestadas que ingresaron a sala de operaciones. Resultados: del 100 por ciento (32), el 93.7 por ciento (30) presentaron ansiedad de intensidad media y el 6.3 por ciento (2) presentaron ansiedad elevada. En relación a los aspectos psicológicos un 78.1 por ciento de las gestantes presentaron ansiedad media, el 12.5 por ciento ansiedad elevada y un 9.4 por ciento ansiedad ligera. En cuanto a los aspectos cognitivos un 90.6 por ciento de las gestantes presentaron ansiedad media y el 9.4 por ciento ansiedad elevada; en cuanto a los aspectos fisiológicos el 62.5 por ciento de las gestantes presentaron ansiedad de intensidad media, y el 37.5 por ciento ansiedad elevada. En conclusión: un alto porcentaje de gestantes encuestas que fueron programadas para cesárea presentaron un nivel de ansiedad de intensidad media.

The surgery has been increasing as a way to treat some surgical diseases which generates some anxiety in pregnant women. Thus it is that has developed this research study entitled "Level of anxiety in pregnant women". Objective: To determine the level of anxiety in pregnant women scheduled for Caesarean sections in the Support Hospital Huanta, Ayacucho 2016. Methodology: quantitative, descriptive method of cross section, the study area is in the operating room of the Hospital Support Huanta. Population: 32 surveyed pregnant women who entered the operating room. Results: 100 per cent (32), 93.7 per cent (30) had anxiety medium intensity and 6.3 per cent (2) had high anxiety. In relation to the psychological aspects 78.1 per cent of pregnant women had average anxiety, elevated anxiety 12.5 per cent and 9.4 per cent slight anxiety. As for the cognitive aspects 90.6 per cent of pregnant women showed average 9.4 per cent anxiety and high anxiety; as to the physiological aspects 62.5 per cent of pregnant women showed anxiety medium intensity, and 37.5 per cent high anxiety. In conclusion: a high percentage of pregnant surveys were scheduled for cesarean section showed a level of anxiety of medium intensity.

[Bilateral brachial plexus block. Case report and systematic review]. / Bloqueo bilateral del plexo braquial. Reporte de casos y revisión sistemática de la literatura.

BACKGROUND: The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. CLINICAL CASES: Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block. CONCLUSION: Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.

Genetically engineered Thompson Seedless grapevine plants designed for fungal tolerance: selection and characterization of the best performing individuals in a field trial.

The fungi Botrytis cinerea and Erysiphe necator are responsible for gray mold and powdery mildew diseases, respectively, which are among the most devastating diseases of grapes. Two endochitinase (ech42 and ech33) genes and one N-acetyl-ß-D-hexosaminidase (nag70) gene from biocontrol agents related to Trichoderma spp. were used to develop a set of 103 genetically modified (GM) 'Thompson Seedless' lines (568 plants) that were established in open field in 2004 and evaluated for fungal tolerance starting in 2006. Statistical analyses were carried out considering transgene, explant origin, and plant response to both fungi in the field and in detached leaf assays. The results allowed for the selection of the 19 consistently most tolerant lines through two consecutive years (2007-2008 and 2008-2009 seasons). Plants from these lines were grafted onto the rootstock Harmony and established in the field in 2009 for further characterization. Transgene status was shown in most of these lines by Southern blot, real-time PCR, ELISA, and immunostrips; the most tolerant candidates expressed the ech42-nag70 double gene construct and the ech33 gene from a local Hypocrea virens isolate. B. cinerea growth assays in Petri dishes supplemented with berry juices extracted from the most tolerant individuals of the selected population was inhibited. These results demonstrate that improved fungal tolerance can be attributed to transgene expression and support the iterative molecular and physiological phenotyping in order to define selected individuals from a population of GM grapevines.

[Ultrasonographic assessment of hemidiaphragm paralysis secondary to interscalene block]. / Evaluación ultrasonográfica de la parálisis hemidiafragmática secundaria a bloqueo interescalénico.

BACKGROUND: In shoulder surgery, interscalene brachial plexus block has an incidence of 100% hemidiaphragm palsy due to phrenic nerve block. Controling the hemidiaphragm becomes a security ventilation parameter. OBJECTIVE: identify and evaluate with ultrasound hemidiaphragm paralysis after interscalene block. METHODS: This prospective study included 50 patients scheduled for shoulder surgery with interscalene block using neurostimulation. Diaphragmatic movement was evaluated by ultrasound prior to placement of block and the end of the surgical procedure to make the comparison between the two measurements. RESULTS: Comparing the duration of the respiratory cycle at the start and the end of the surgical procedure, both normal and forced ventilation, there is a statistically significant difference of p < 0.001, as with the depth of the hemidiaphragm was found p < 0.001. 90% of patients had no adverse events, 8% had Horner's syndrome and 2% periauricular hypoesthesia. Hemidiaphragm paralysis was found in all cases, with a volume of 30 mL local anesthetic. CONCLUSIONS: Ultrasound is a reliable tool that allows real time viewing of the respiratory cycle and measurements of the diaphragm dome it serves to identify diaphragmatic hemiparesis.