Sistema de doble movilidad. La solución francesa en pacientes añosos con fractura intracapsular de cadera y alto riesgo de luxación / Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation

OBJETIVO: En la actualidad continúa la controversia respecto al tratamiento quirúrgico más adecuado de la fractura de cuello femoral desplazada en pacientes añosos o con alto riesgo de luxación. En nuestro estudio nos enfocamos en reportar resultados clínicos, funcionales y radiográficos de este tipo de pacientes tratados con artroplastia total de cadera usando el sistema de doble movilidad con un seguimiento mínimo de 2 años. MATERIALES Y MÉTODOS: En el periodo de enero de 2015 a enero de 2016 los pacientes con fractura del cuello femoral desplazada asistidos en las centrales de emergencia de los hospitales que participaron en el estudio fueron seleccionados. De 137 pacientes, 41 cumplían con uno o más de los criterios de inclusión y aceptaron la indicación terapéutica recomendada. Los pacientes fueron sometidos a artroplastia total de cadera utilizando prótesis con sistema de doble movilidad (cementada o no cementada). Todos los pacientes fueron evaluados con el Mini-Mental State Examination y la distancia de caminata en el preoperatorio, a las 3 y 6 semanas, a los 3 y 6 meses, al año y en años subsecuentes. Las evaluaciones radiográficas fueron programadas a tiempos similares. RESULTADOS: Se evaluaron 41 pacientes, con un seguimiento promedio de 2,4 años (rango 2 a 3,2 años). La media de edad fue de 85,2 (rango 80 a 96 años). Cuatro pacientes fallecieron en el periodo de seguimiento por causas no asociadas a la cirugía, con el implante funcionando. Hubo un solo caso de infección a los 8 meses de la cirugía, tratado con una revisión en un tiempo. No se reportaron casos de luxación en esta serie. CONCLUSIÓN: La utilización del sistema de doble movilidad para el tratamiento de fracturas del cuello femoral desplazadas en pacientes con alto riesgo de luxación y añosos ha demostrado buenos resultados clínicos y radiológicos, que fundamentan la indicación sistemática de uso en nuestros servicios

OBJECTIVE: Actually there is a controversy about the treatment of hip fractures on older patients with high risk of dislocation. Our study is focused on report clinico-functional and radiographic results in this population treated with total hip replacement using a dual mobility system after a minimum follow up of 2 years. MATERIALS AND METHODS: In the period from January 2015 to January 2016 patients assisted at the Emergency Unit at the participant hospital were recluted for participation. A total of 137 patients were assisted and 41 fulfilled the inclusion criteria and accepted to participate. All patients received a total hip replacement with a dual mobility system (cemented or uncemented). The patients were evaluated with the Mini-Mental State Examination, walking distance test, preop and postop at 3 and 6 weeks, 3 months, 6 months, one year and subsequent years. Radiographic evaluation was scheduled with clinico-functional review. RESULTS: Forty-one patients included, follow up average 2.4 years (range 2 to 3.2 years). Mean age 85.2 (range 80 to 96 years). Four patients died during follow up due to causes not related to the total hip replacement and the implant was functioning. One case have an infection and was revised in one stage procedure. One case have an infection at 8 months follow-up and was revised in one stage procedure. There were no dislocations. CONCLUSION: The use of dual mobility system in this high dislocation risk population has shown good clinical and functional results, and support the sistematic indication in our services

Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation. / Sistema de doble movilidad. La solución francesa en pacientes añosos con fractura intracapsular de cadera y alto riesgo de luxación.

OBJECTIVE: Actually there is a controversy about the treatment of hip fractures on older patients with high risk of dislocation. Our study is focused on report clinico-functional and radiographic results in this population treated with total hip replacement using a dual mobility system after a minimum follow up of 2 years. MATERIALS AND METHODS: In the period from January 2015 to January 2016 patients assisted at the Emergency Unit at the participant hospital were recluted for participation. A total of 137 patients were assisted and 41 fulfilled the inclusion criteria and accepted to participate. All patients received a total hip replacement with a dual mobility system (cemented or uncemented). The patients were evaluated with the Mini-Mental State Examination, walking distance test, preop and postop at 3 and 6 weeks, 3 months, 6 months, one year and subsequent years. Radiographic evaluation was scheduled with clinico-functional review. RESULTS: Forty-one patients included, follow up average 2.4 years (range 2 to 3.2 years). Mean age 85.2 (range 80 to 96 years). Four patients died during follow up due to causes not related to the total hip replacement and the implant was functioning. One case have an infection and was revised in one stage procedure. One case have an infection at 8 months follow-up and was revised in one stage procedure. There were no dislocations. CONCLUSION: The use of dual mobility system in this high dislocation risk population has shown good clinical and functional results, and support the sistematic indication in our services.

Mortalidad en pacientes con síndrome de distress respiratorio / Mortality in patients with respiratory distress syndrome

INTRODUCCIÓN: La mortalidad del distress respiratorio agudo está disminuyendo, aunque hay poca evidencia sobre su pronóstico después del egreso hospitalario y la adecuada estratificación pronóstica con la nueva clasificación de Berlín. MÉTODOS: Se analizó retrospectivamente la mortalidad de pacientes con SDRA admitidos en la Unidad de Cuidados Críticos de1 Hospital Universitario de la ciudad de Buenos Aires, desde el 1 de 2008 hasta el 6 de 2011. Se definió SDRA por hipoxemia con PaO2/FiO2≤200 mmHg con al menos 10 cmH2O de PEEP y FiO2≥0,5 e infiltrados bilaterales en la radiografía de tórax en ausencia de edema agudo de pulmón cardiogénico en las primeras 72h de ventilación mecánica. Se registraron la mortalidad hospitalaria y a 6 meses, los factores asociados a mortalidad, la utilización de terapias de rescate, y la validez de la clasificación de Berlín para casos moderados y graves. RESULTADOS: Se incluyeron 98 pacientes; edad 59±19 años; 42,9% con comorbilidades mayores; APACHEII 22±7; SOFA (día 1) 8±3. La VM en posición prono se aplicó en 20,4% y en 12,2% rescates especiales (12 óxido nítrico y 1 ECMO). La mortalidad hospitalaria y a 6 meses fue de 37,7 y 43,8% respectivamente. Los factores asociados a mortalidad fueron: edad, shock séptico en las primeras 72 h, presión plateau (Ppl) >30cmH2O durante las primeras 72 h y la presencia de comorbilidades preexistentes. No hubo diferencia de mortalidad entre los grupos moderado y grave (41,2 vs. 36,8%; p = 0,25). CONCLUSIONES: En este estudio que incluyó pacientes con hipoxemia más grave y alto porcentaje con comorbilidades mayores, la mortalidad fue menor que en algunos estudios previos; no hubo incremento en la mortalidad después del egreso hospitalario. La clasificación de Berlín no diferenció el pronóstico entre los casos moderados y graves

INTRODUCTION: Mortality in Acute Respiratory Distress Syndrome (ARDS) is decreasing, although its prognosis after hospital discharge and the prognostic accuracy of Berlin's new ARDS stratification are uncertain. METHODS: We did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a Univeristy Hospital in Buenos Aires, between January 2008 and June 2011. ARDS was defined by PaO2/FiO2 lower than 200 mmHg under ventilation with at least 10 cm H2O of PEEP and a FiO2 higher or equal than 0.5. and the presence of bilateral infiltrates in chest radiography, in the absence of cardiogenic acute pulmonary edema, during the first 72 h of mechanical ventilation. Mortality associated risk factors, the use of rescue therapies and Berlin's stratification for moderate and severe ARDS patients were considered. RESULTS: Ninety eight patients were included; mean age was 59±19 years old, 42,9% had mayor co-morbidities; APACHE II at admission was 22±7; SOFA at day 1 was 8±3. Prone position ventilation was applied in 20,4% and rescue measures in 12,2% (12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation). Hospital and 6 months mortality were 37.7 and 43.8% respectively. After logistic regression analysis, only age, the presence of septic shock at admission, Ppl >30 cmH2O, and major co-morbidities were independently associated with hospital outcome. There was no difference between moderate and severe groups (41,2 and 36,8% respectively; p = 0,25). CONCLUSION: In this cohort, including patients with severe hypoxemia and high percentage of mayor co-morbidities, ARDS associated mortality was lower than some previous studies. There was no increase in mortality after hospital discharge. There was no difference in mortality between moderate and severe groups according to Berlin's definition

Mortality in patients with respiratory distress syndrome. / Mortalidad en pacientes con síndrome de distress respiratorio.

INTRODUCTION: Mortality in Acute Respiratory Distress Syndrome (ARDS) is decreasing, although its prognosis after hospital discharge and the prognostic accuracy of Berlin's new ARDS stratification are uncertain. METHODS: We did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a Univeristy Hospital in Buenos Aires, between January 2008 and June 2011. ARDS was defined by PaO2/FiO2 lower than 200 mmHg under ventilation with at least 10 cm H2O of PEEP and a FiO2 higher or equal than 0.5. and the presence of bilateral infiltrates in chest radiography, in the absence of cardiogenic acute pulmonary edema, during the first 72 hs of mechanical ventilation. Mortality associated risk factors, the use of rescue therapies and Berlin's stratification for moderate and severe ARDS patients were considered. RESULTS: Ninety eight patients were included; mean age was 59±19 years old, 42,9% had mayor co-morbidities; APACHE II at admission was 22±7; SOFA at day 1 was 8±3. Prone position ventilation was applied in 20,4% and rescue measures in 12,2% (12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation). Hospital and 6 months mortality were 37.7 and 43.8% respectively. After logistic regression analysis, only age, the presence of septic shock at admission, Ppl >30 cmH2O, and major co-morbidities were independently associated with hospital outcome. There was no difference between moderate and severe groups (41,2 and 36,8% respectively; p=0,25). CONCLUSION: In this cohort, including patients with severe hypoxemia and high percentage of mayor co-morbidities, ARDS associated mortality was lower than some previous studies. There was no increase in mortality after hospital discharge. There was no difference in mortality between moderate and severe groups according to Berlin's definition.

[Energy and mass transfer and the productivity of the main ecosystems of Siberia (according to the results of measurements by the method of turbulent pulsations). 2. Carbon exchange and productivity].

Using direct measurements of CO2 fluxes by the method of turbulent pulsations, it was shown that the studied middle-taiga pine forest, raised bog, true steppe, and southern tundra along the Yenisei meridian (approximately 90 degrees E) are stocks of carbon of different capacity in the annual output. The tundra starts to function as a stock of carbon from June; the forest and bog, from May; and the steppe, from the end of April. In the transitional seasons and winter, the ecosystems are a weak source of carbon: the tundra already in September; the forest and bog, from October; and the steppe, from November. The photosynthetic productivity of the forest and steppe ecosys- tems (480-530 g C/(m x year) exceeds 2-2.5 times the productivity ofbogs and tundras (200-220 g C/(m x year). The relationships between the thermal balance structure and CO2 exchange are shown. Possible feedbacks between the carbon exchange between the ecosystems and the atmosphere as a result of climate warming in the region are assessed.

Tanshinone VI inhibits the expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1.

This study investigated the possible antitumor mechanisms of action of Tanshinone VI, one of the components of Salvia miltiorrhiza Bunge, which is used in traditional Chinese herbal medicine. To this end, the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), were evaluated in-vitroin tumor necrosis factor-alpha (TNF-alpha)-stimulated endothelial cells, with, or without the addition of Tanshinone VI (10, 20, 30, or 40 mM) in the culture medium; the effects of Tanshinone VI on angiogenesis was also evaluated with an epithelial cell tube formation assay and its toxicity was evaluated with a colorimetric (MTT) cell viability assay. The results showed that the up-regulation of ICAM-1 and VCAM-1 induced by TNF-alpha was dose-dependently inhibited by Tanshinone VI, with restoration of control levels at the dose of 40 mM; Tanshinone VI also had a remarkable anti-angiogenesis effect, already at the dose of 10 mM, while none of the doses tested had significant effects on cell viability. These results indicate that the antitumor properties of Tanshinone VI can be ascribed to the inhibition of cell adhesion, due to blockage of the up-regulation of cell adhesion molecules, with the consequent inhibition of metastases formation and/or angiogenesis. The lack of toxic effects at the dosage used makes Tanshinone VI a good candidate for its therapeutic use in humans.

[Energy and mass exchange and the productivity of the main ecosystems of Siberia (from eddy covariance measurements). 1. Heat balance structure in the vegetation season].

Direct measurements of heat balance (turbulent heat transfer and evaporation heat consumption) by the method of turbulent pulsations in 1998-2000 and 2002-2004 were used to obtain information on the daily, seasonal, and annual dynamics of energy fluxes and mass transfer between the atmosphere and the typical ecosystems of Siberia (middle-taiga pine forest and raised bog, true four-grass steppe, with the use of data for typical tundra) along the Yenisei meridian (90 degrees E).

Percutaneous repair of Achilles tendon ruptures with Tenolig: quantitative analysis of postural control and gait pattern.

BACKGROUND: Surgical approach in Achilles tendon's rupture involved during the last years has becoming safer and less invasive as possible. Lots of study investigate the outcomes of the mini-invasive technique with Tenolig proving its good results, but never in the long-term. OBJECTIVES: Our study want to emphasize the effectiveness of this treatment exploring the postural and gait patterns in a 24-month follow up. METHOD: Patients did self-training exercises without specific supervision, instead of a particular postoperative rehabilitation protocol. We compared 21 patients to a control group of 19 health subjects using a clinical examination, a podobarometric and an optokinetic analysis. RESULTS: Data shows no differences in time-distance parameters, despite a reduction of propulsion phase data, confirmed also by kinetic analysis. Podobarometric results show only a decrease in the anterior pressure of the injured limb (p=0.09). In standing an increase of anterior-posterior oscillation of the COP (center of pressure) (p=0.03). CONCLUSIONS: The results underline the long-term outcome effectiveness of the technique but some functional alterations remain. This could be the reason of the weakness, which always affected the patients. Reduction of the triceps elongation and restoration of strength during the propulsion phase should be the key points in postoperative physiotherapy.

The carbon balance of Africa: synthesis of recent research studies.

The African continent contributes one of the largest uncertainties to the global CO(2) budget, because very few long-term measurements are carried out in this region. The contribution of Africa to the global carbon cycle is characterized by its low fossil fuel emissions, a rapidly increasing population causing cropland expansion, and degradation and deforestation risk to extensive dryland and savannah ecosystems and to tropical forests in Central Africa. A synthesis of the carbon balance of African ecosystems is provided at different scales, including observations of land-atmosphere CO(2) flux and soil carbon and biomass carbon stocks. A review of the most recent estimates of the net long-term carbon balance of African ecosystems is provided, including losses from fire disturbance, based upon observations, giving a sink of the order of 0.2 Pg C yr(-1) with a large uncertainty around this number. By comparison, fossil fuel emissions are only of the order of 0.2 Pg C yr(-1) and land-use emissions are of the order of 0.24 Pg C yr(-1). The sources of year-to-year variations in the ecosystem carbon-balance are also discussed. Recommendations for the deployment of a coordinated carbon-monitoring system for African ecosystems are given.

Accuracy of weight and height estimation in an intensive care unit.

We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. Attending physicians and nurses were asked to estimate patient's actual weight, predicted weight and height. The average percent errors in estimation of actual and predicted weight were 11.4 and 14.6%, respectively. Errors greater than 20% in patient's actual and predicted weight were observed in 15 and 24% of cases, respectively. The majority of height estimations (86%) had an error < 10%. There were non-significant differences between the estimations made by intensive care unit physicians and nurses. Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.

Optokinetic analysis of gait cycle during walking with 1 cm- and 2 cm-high heel lifts.

The use of orthotic heel lifts is proposed in many cases of Achilles tendon disorders as a first-line or conservative treatment. The use of heeled shoes induces a plantar flexion of the ankle joint with a consequent decrease in the tension forces acting onto the triceps surae. The question to address is how high must the heel be? Gait cycle using 1 cm- and 2 cm-high heel lifts was examined. Each measurement included kinetic and kinematic data on angular variation and moments and power at the hip, knee and foot. The study included 14 healthy subjects (5 males, 9 females) between 20 and 35 years of age. The data provided by the analysis of the force plate curve showed a statistically significant change in some parameters (plate forces, knee moments) which were deemed useful in the analysis of load transfer modalities. A very significant decrease (p=0.0001) was found in the amplitude of the curve expressing the force produced by the whole limb in response to ground reaction forces. This is expressed by a decrease in minimum values, suggesting a lower degree of energy absorption at heel strike, as well as maximum values reflecting the amount of energy generated at push off. This might suggest that by reducing energy absorption by the whole limb a 2-cm heel lift would have a protective effect for those muscles that are most significantly involved in this function, such as the tibiotarsal complex (triceps surae) and the knee complex (rectus femoris).

Inducing ovulation with hCG improves the fertility of dairy cows during the warm season.

This study was designed to assess the effects of human chorionic gonadotrophin (hCG), given within a timed artificial insemination program, on plasma progesterone concentrations and subsequent fertility in lactating dairy cows during the warm and cold seasons of the year. Cows were treated intramuscularly with GnRH-agonist (Day 0) and PGF(2alpha) (Day 7) followed by either GnRH-agonist (GPG treatment; 60 animals) or hCG (GPH treatment; 60 animals) on Day 9. All cows were fixed-time inseminated (TAI) 16-22h after the end of treatment. To determine plasma progesterone levels, blood was withdrawn from all animals on Days 3, 6, 9, 12 and 15 after TAI. During the warm period, the pregnancy rate recorded at TAI was similar for the GPG and GPH groups (20% vs. 23%) while the cumulative pregnancy rate within 30 days of TAI was lower (P<0.05) for the GPG than the GPH group (36% vs. 63%). No differences were observed during the cold period. During the warm period, embryo losses between Days 28 and 45 after TAI were greater (P<0.05) for the GPG group compared to the GPH group (36% vs. 5%) while again no differences emerged during the cold period. Mean plasma progesterone levels were higher (P<0.05) in the GPH group than GPG group on Days 3, 6 and 9 post-insemination. Our findings indicate that the use of hCG to induce ovulation in a timed artificial insemination protocol increases plasma progesterone levels and improves fertility in dairy cows during the warmer period of the year.

Europe-wide reduction in primary productivity caused by the heat and drought in 2003.

Future climate warming is expected to enhance plant growth in temperate ecosystems and to increase carbon sequestration. But although severe regional heatwaves may become more frequent in a changing climate, their impact on terrestrial carbon cycling is unclear. Here we report measurements of ecosystem carbon dioxide fluxes, remotely sensed radiation absorbed by plants, and country-level crop yields taken during the European heatwave in 2003. We use a terrestrial biosphere simulation model to assess continental-scale changes in primary productivity during 2003, and their consequences for the net carbon balance. We estimate a 30 per cent reduction in gross primary productivity over Europe, which resulted in a strong anomalous net source of carbon dioxide (0.5 Pg C yr(-1)) to the atmosphere and reversed the effect of four years of net ecosystem carbon sequestration. Our results suggest that productivity reduction in eastern and western Europe can be explained by rainfall deficit and extreme summer heat, respectively. We also find that ecosystem respiration decreased together with gross primary productivity, rather than accelerating with the temperature rise. Model results, corroborated by historical records of crop yields, suggest that such a reduction in Europe's primary productivity is unprecedented during the last century. An increase in future drought events could turn temperate ecosystems into carbon sources, contributing to positive carbon-climate feedbacks already anticipated in the tropics and at high latitudes.

Predicting the onset of net carbon uptake by deciduous forests with soil temperature and climate data: a synthesis of FLUXNET data.

We tested the hypothesis that the date of the onset of net carbon uptake by temperate deciduous forest canopies corresponds with the time when the mean daily soil temperature equals the mean annual air temperature. The hypothesis was tested using over 30 site-years of data from 12 field sites where CO(2) exchange is being measured continuously with the eddy covariance method. The sites spanned the geographic range of Europe, North America and Asia and spanned a climate space of 16 degrees C in mean annual temperature. The tested phenology rule was robust and worked well over a 75 day range of the initiation of carbon uptake, starting as early as day 88 near Ione, California to as late as day 147 near Takayama, Japan. Overall, we observed that 64% of variance in the timing when net carbon uptake started was explained by the date when soil temperature matched the mean annual air temperature. We also observed a strong correlation between mean annual air temperature and the day that a deciduous forest starts to be a carbon sink. Consequently we are able to provide a simple phenological rule that can be implemented in regional carbon balance models and be assessed with soil and temperature outputs produced by climate and weather models.