Spotting intruders: Species distribution models for managing invasive intertidal macroalgae.

Invasive macroalgae represent one of the major threats to marine biodiversity, ecosystem functioning and structure, as well as being important drivers of ecosystem services depletion. Many such species have become well established along the west coast of the Iberian Peninsula. However, the lack of information about the distribution of the invaders and the factors determining their occurrence make bioinvasions a difficult issue to manage. Such information is key to enabling the design and implementation of effective management plans. The present study aimed to map the current probability of presence of six invasive macroalgae: Grateloupia turuturu, Asparagopsis armata, Colpomenia peregrina, Sargassum muticum, Undaria pinnatifida, and Codium fragile ssp. fragile. For this purpose, an extensive field survey was carried out along the coast of the north-western Iberian Peninsula. Species distribution models (SDMs) were then used to map the presence probability of these invasive species throughout the study region on the basis of environmental and anthropogenic predictor variables. The southern Galician rias were identified as the main hotspots of macroalgal invasion, with a high probability of occurrence for most of the species considered. Conversely, the probability of presence on the Portuguese coast was generally low. Physico-chemical variables were the most important factors for predicting the distribution of invasive macroalgae contributing between 57.27 and 85.24% to the ensemble models. However, anthropogenic factors (including size of vessels, number of shipping lines, distance from ports, population density, etc.) considerably improved the estimates of the probability of occurrence for most of the target species. This study is one of the few to include anthropogenic factors in SDMs for invasive macroalgae. The findings suggest that management actions aimed at controlling these species should strengthen control and surveillance at ports, particularly in southern Galician rias. Early detection should be of main concern for risk assessment plans on the Portuguese coast.

Lipid mapping of the rat brain for models of disease.

Lipids not only constitute the primary component of cellular membranes and contribute to metabolism but also serve as intracellular signaling molecules and bind to specific membrane receptors to control cell proliferation, growth and convey neuroprotection. Over the last several decades, the development of new analytical techniques, such as imaging mass spectrometry (IMS), has contributed to our understanding of their involvement in physiological and pathological conditions. IMS allows researchers to obtain a wide range of information about the spatial distribution and abundance of the different lipid molecules that is crucial to understand brain functions. The primary aim of this study was to map the spatial distribution of different lipid species in the rat central nervous system (CNS) using IMS to find a possible relationship between anatomical localization and physiology. The data obtained were subsequently applied to a model of neurological disease, the 192IgG-saporin lesion model of memory impairment. The results were obtained using a LTQ-Orbitrap XL mass spectrometer in positive and negative ionization modes and analyzed by ImageQuest and MSIReader software. A total of 176 different molecules were recorded based on the specific localization of their intensities. However, only 34 lipid species in negative mode and 51 in positive were assigned to known molecules with an error of 5ppm. These molecules were grouped by different lipid families, resulting in: Phosphatidylcholines (PC): PC (34: 1)+K+ and PC (32: 0)+K+ distributed primarily in gray matter, and PC (36: 1)+K+ and PC (38: 1)+Na+ distributed in white matter. Phosphatidic acid (PA): PA (38: 3)+K+ in white matter, and PA (38: 5)+K+ in gray matter and brain ventricles. Phosphoinositol (PI): PI (18: 0/20: 4)-H+ in gray matter, and PI (O-30: 1) or PI (P-30: 0)-H+ in white matter. Phosphatidylserines (PS): PS (34: 1)-H+ in gray matter, and PS (38: 1)-H+ in white matter. Sphingomyelin (SM) SM (d18: 1/16: 0)-H+ in ventricles and SM (d18: 1/18: 0)-H+ in gray matter. Sulfatides (ST): ST (d18: 1/24: 1)-H+ in white matter. The specific distribution of different lipids supports their involvement not only in structural and metabolic functions but also as intracellular effectors or specific receptor ligands and/or precursors. Moreover, the specific localization in the CNS described here will enable us to analyze lipid distribution to identify their physiological conditions in rat models of neurodegenerative pathologies, such as Alzheimer's disease. This article is part of a Special Issue entitled: Membrane Lipid Therapy: Drugs Targeting Biomembranes edited by Pablo V. Escribá.

Haemostatic agents in apical surgery. A systematic review.

BACKGROUND: Blood presence in apical surgery can prevent the correct vision of the surgical field, change the physical properties of filling materials and reduce their sealing ability. OBJECTIVES: To describe which are the most effective and safest haemostatic agents to control bleeding in patients undergoing apical surgery. MATERIAL AND METHODS: We carried out a systematic review, using Medline and Cochrane Library databases, of human clinical studies published in the last 10 years. RESULTS: The agents that proved more effective in bleeding control were calcium sulphate (100%) and collagen plus epinephrine (92.9%) followed by ferric sulphate (60%), gauze packing (30%) and collagen (16.7%). When using aluminium chloride (Expasyl®), over 90% of the apical lesions improved, but this agent seemed to increase swelling. Epinephrine with collagen did not significantly raise either blood pressure or heart rate. CONCLUSIONS: Despite the use of several haemostatic materials in apical surgery, there is little evidence on their effectiveness and safety. The most effective haemostatic agents were calcium sulphate and epinephrine plus collagen. Epinephrine plus collagen did not seem to significantly raise blood pressure or heart rate during surgery. Aluminium chloride did not increase postoperative pain but could slightly increase postoperative swelling. Randomized clinical trials are needed to assess the haemostatic effectiveness and adverse effects of haemostatic materials in apical surgery.

Which is the most suitable local anaesthetic when inferior nerve blocks are used for impacted mandibular third molar extraction? A network meta-analysis.

The aim of this study was to compare the efficacy and safety of the different local anaesthetic agents for the extraction of impacted lower third molars. A network meta-analysis was performed of all published reports of randomized controlled clinical trials assessing efficacy (anaesthetic success and absence of need for supplementary anaesthesia during the surgical procedure) and/or safety (number of adverse events) of anaesthetic agents. Three electronic databases were searched, from their earliest records up to April 2019. Additionally, the grey literature was searched to identify further potential candidates for inclusion. Anaesthesia had to be delivered by an inferior alveolar nerve block, complemented with infiltration anaesthesia of the buccal nerve. The quality of the studies was assessed using the Cochrane Collaboration tool. This study included a total of 21 trials (2021 molars) assessing the efficacy and 19 trials (1977 molars) assessing the safety of 11 anaesthetic solutions. Seven of the studies included were considered to have a high risk of bias. The most effective local anaesthetic for the extraction of impacted mandibular third molars appeared to be 4% articaine, with significant differences when compared with 2% lidocaine, 0.5% bupivacaine, and 1% ropivacaine. Lidocaine is the safest local anaesthetic, although all investigated solutions can be used safely.

[Medial dislocation of the talus. Medium term evolution]. / Enucleación medial de astrágalo abierta. Evolución a medio plazo.

Fifty-seven year old patient with open medial dislocation of the left talus, with suprasyndesmotic fracture of the fibula, due to indirect traumatism. The following were carried out: washing, cleaning the talus and the soft parts, Friedrich, reduction, fixing with Kirschner needles, suture of the deltoid ligament, and osteosynthesis of the fibula. There were neither surface nor deep post-operational infections. The patient underwent six weeks of immobilisation and spent three months on discharge. Two years later there were no radiological signs of avascular necrosis. In the osseous gammagraphy carried out 18 months after the lesion, partial avascular necrosis of the talus was observed. Three years after the lesion, the patient was able to carry out a normal life, without pain in repose but with pain whilst moving, and mobility with limitation of dorsoinflection (-20 masculine). Five and a half years after the lesion, the patient presented sinking of the talar dome due to avascular necrosis, with painful symptomatology whilst moving, and tibiofibular distal diastasis, which required ankle arthrodesis.

Distal radial torus fracture in an adult. A new type of occult wrist fracture?

Torus or buckle fractures typically affect children who have suffered indirect minor wrist injuries. They are axial compression-type metaphyseal fractures of cortical and cancellous bone, which are stable and their treatment therefore consists in immobilisation of the joint for three to four weeks. We present an atypical case of distal radius torus fracture in a 19-year-old adult male, which has not been previously reported in adults and can be considered a new type of occult fracture. Knowledge of this possibility is mandatory to be able to make a differential diagnosis of wrist sprain in adults, and avoid performing superfluous complementary tests due to the persistence of pain and functional incapacity.

Acute haematogenous septic arthritis of a lumbar facet joint in an otherwise healthy adolescent.

Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted one month later due to clinical deterioration, and septic arthritis of left facet joint L3-L4 was confirmed by magnetic resonance imaging (MRI). The patient experienced a full recovery after treatment with systemic antibiotics (cefotaxime-cloxacilin) and rehabilitation. A high index of suspicion is necessary to diagnose this localization as a manifestation of lumbosciatalgia and/or limp in children. CT-scan or, preferably, MRI is mandatory to confirm this diagnosis.

[Primary recurrent medial subdislocation of both patellae. Long-term review of an exceptional case of miserably malalignment syndrome]. / Subluxación primaria recidivante medial de rótulas. Revisión a largo plazo de un caso asociado a síndrome de desalineación torsional severa.

We present a long-term review of a girl aged 11 years and 4 months with medial primary recurrent subluxation of both patellae of several months evolution associated with miserably malalignment syndrome. Not one case of medial recurrent dislocation of the patellae has been described previously. Three years previously following a jump she had suffered a right patellar luxation - self-reduced and not immobilised - followed by 10 subsequent episodes of subluxation and three more medial luxations. She could hardly walk autonomously due to persistent or habitual subluxation and patellofemoral pain, mainly in the right knee. Physical examination revealed habitual medial subluxation of both patellae, with clear medial patellar displacement, quadriceps amyotrophy and medial instability. The medial subluxation suppression test was positive. She showed excessive femoral anteversion of the hips (IR: 90 degrees, ER: 30 degrees), genu varum, neutral tibial torsion, patella alta, dysplastic trochlear grooves with medial condyle hipoplasia and both patellae were dysplastic (Wiberg type III). We performed a derotation subtrochanteric femoral osteotomy and bilateral proximal patellar realignment. Following surgery, bilateral stability of both sides permitted normal walking and running, as well as apprehension and the Smillie test (-), with a hip mobility of 65 degrees ER and 50 degrees IR. Fifteen years after the surgery the patient complains of antero-external knee pain in the right knee during prolonged walking, in getting up and down stairs and when in a prolonged sitting position, diagnosed as excessive lateral pressure syndrome.

[Effects on the elbow of radial head resection following isolated radial head fracture in young patients]. / Efectos sobre el codo de la resección de la cabeza radial por fractura aislada de la cabeza del radio en pacientes jóvenes.

BACKGROUND: Radial head resection has been a widely used procedure in cases of non-reconstructable radial head fracture. Some authors propose the use of radial head arthroplasty. The purpose of this study was to evaluate the long-term outcome of radial head resection for isolated fracture, without instability at the time of the fracture, and its radiological and functional repercussions at the elbow level. METHODS: We reviewed 44 clinical records with acute resection of the radial head following isolated radial head fracture, with absence of associated injuries, younger than forty, with a minimum follow-up of 15 years. Information was collected on elbow pain, biomechanical function, flexion and extension elbow strength and elbow instability compared with the non-affected side. A radiological study was conducted on all patients to determine the presence of degenerative changes, calcifications and measurement of the carrying angle. Outcomes were evaluated with Disabilities of the Arm, Shoulder and Hand score as an instrument to measure the patient's perceived disability. RESULTS: The group under study is made up of ten women and thirty-four men, with an average age at the time of fracture of 28.6 years (ranging from 15-40) and an average time since the fracture or follow-up time of 28.5 years (ranging from 16-38). The affectation was on the dominant side in thirty cases (23 right-handed and 7 left-handed). Thirty-nine patients (88.6%) had no elbow pain, and in all other cases was mild or moderate. Loss of mobility and strength was 1.5% for flexo-extension, 3.5% for prono-supination, 7.9% for flexion strength and 3.5% for extension strength. We appreciated four cases of valgus instability and two of postero-lateral instability. The average DASH score was 6.9 points. Radiographic changes of arthritis were present in 93.3% and 54.4% of calcifications. The mean increase of carrying angle was 7.7º compared with non-affected gide (ranking from 0.9-15.8º). CONCLUSION: Radial head resection for isolated fracture in young patients presents satisfactory results, with very low losses of elbow mobility and strength. Despite the high presence of osteoarthritic changes or lower clinical signs of instability, elbow pain and disability are very low. Our conclusion, based in these results, is that radial head resection is still a useful surgical procedure for isolated fractures even in young patients.

[Idiopatic chondrolysis of the hip. Long-term follow-up of a case]. / Condrolisis idiopática de cadera. Evolución a largo plazo.

Idiopathic chondrolysis of the hip is a very rare disease occurring during adolescence. Pain and limp are the most common symptoms and are a consequence of an accelerated loss of the articular cartilage with a lower range of move-ment producing rigidity in the last instance. The natural history is unpredictable and varies between complete and spon-taneous recovery and the ankylosis. The current recommended treatment is conservative, restricting the surgical option for residual stiffness. A clinical case of an eleven year old patient is presented. He consulted for a 2 year, torpid course of left groin pain with limp and rigidity. He received treatment with rest, discharge, analgesics and rehabilitation without any improvement initially. He was treated conservatively with NSAIDS, extremity discharge periods, soft traction in the hospital and at home and rehabilitation, recovering mobility and normal gait 6 years after the beginning of the symptoms. Twelve years after the onset of the symptoms the patient leads a normal life without symptoms and has a symmetric range of motion of both hips.

Cross-cultural adaptation of the Zurich Claudication Questionnaire.Validation study of the Spanish version.

BACKGROUND: In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffering from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish population. METHODS: The Zurich Claudication Questionnaire was translated and cross-culturally adapted to Spanish and the psychometric characteristics of the new version were then studied. Seventy-six patients were selected who were to undergo epidural steroid injection or were seen in the Hospital Complex of Navarre Spinal Unit. RESULTS: The Spanish version of the Zurich Claudication Questionnaire shows high Cronbach alpha internal consistency values, high reproducibility, a good correlation with the most important low back condition questionnaires used worldwide and good sensitivity for detecting clinical change in patients who undergo epidural steroid injection. CONCLUSION: This study resulted in a version of the Zurich Claudication Questionnaire or Swiss Spinal Stenosis Questionnaire translated and cross-culturally adapted to Spanish, with highly reliable, valid and sensitive psychometric characteristics. These proven properties make the Zurich Claudication Questionnaire available for the Spanish population, to evaluate outcomes and health status as perceived by patients with spinal stenosis and claudication syndrome.

Disc herniation with gas.

SUMMARY OF BACKGROUND DATA: Intradiscal gas is associated with tumors, infection, trauma, therapeutic and diagnostic spinal procedures, deposit illnesses, and disc degeneration. The existence of gas within the spinal canal has been seen on 17 occasions, of which 13 were associated with discal hernias. METHODS: In this study, 19 additional patients with intraspinal gas corresponding to discal hernias are presented, six of whom required surgical treatment. The association of intraspinal gas with intradural hernias frequently is reported in the literature, although this has not been proven in our group. Intrahernial gas is associated with patients who have chronic problems and with advanced age. CONCLUSION: Intrahernial gas is much more common than is indicated in the literature. This finding often goes unnoticed, and the association between intradiscal gas and intradural hernias should be kept in mind.

Intradural disc herniation associated with epidural gas.

STUDY DESIGN: A case report of a patient suffering from an intradural herniated disc associated with the presence of epidural gas. OBJECTIVE: To advise spine surgeons of the possible association of intradural disc herniation and epidural gas, to prevent overlooking intradural disc fragments during surgery. SUMMARY OF BACKGROUND DATA: Three cases of this rare association were published previously, something surprising given the relatively rare occurrence of intradural herniations and the presence of epidural gas. METHODS: A case is presented where such an association occurred, on the basis of preoperative examinations and intraoperative findings. The literature is reviewed for cases of herniated discs associated with epidural gas and for intradural herniations. RESULTS: During the open discectomy, after a negative epidural examination, an intradural examination was performed, revealing a disc herniation, which was removed. The patient's postoperative development was satisfactory. CONCLUSION: The possibility of an intradural herniated disc must always be considered when performing an open discectomy on a patient whose computed tomography scan reveals the presence of epidural gas. In the event that no clear disc herniation is found to justify the clinical symptoms or the previous radiologic findings, an intradural exploration may be indicated.

L5 root compression caused by degenerative spinal stenosis of the L1-L2 and L2-L3 spaces.

STUDY DESIGN: A severe bilateral L5 root lesion associated with spinal stenosis at L1-L2 and L2-L3 is described. OBJECTIVE: To describe clinical findings and the difficulty in obtaining a correct diagnosis of L5 Root Compression. SUMMARY OF BACKGROUND DATA: The disorder reported in this study has not been reported previously. Only one similar case has been described in the literature: an L5 root compression at L1-L2 caused by disc herniation. METHODS: Diagnosis was obtained by using computed tomography scanning, magnetic resonance imaging, and computed tomography myelography. The findings at L5-S1 were minimal to justify the patient's clinical symptoms, but a detailed study of the upper levels revealed spinal stenosis at L1-L2 and L2-L3, which could have been causing L5 and S1 root compression. A decompressive laminectomy and partial facetectomy in both levels were performed. RESULTS: The patient's pain and claudication disappeared, and clinical symptoms associated with the right L5 root improved. The left L5 root deficit remained stable. CONCLUSION: An unusual case of L5 root compression caused by degenerative stenosis of L1-L2 and L2-L3 is described.

Transverse stress fracture of the patella in a child.

Transverse stress fracture of the patella in a child is an exceptional injury in childhood. Only one case has been previously reported. The present study reports a new case of a 12-year-old boy with anterior knee pain misdiagnosed for 5 months as Sinding-Larsen-Johansson disease who developed sudden anterior right knee pain and pop while running in a soccer match. Surgery was performed. The evolution was favorable without any immobilization required and the patient achieved full recovery.

Open anterior dislocation of the hip in a child.

We report a case of a 10-year-old child with open anterior dislocation of the left hip. After debridement and reduction, he suffered deep infection and avascular necrosis of the hip and finally experienced its destruction.

Triplane fractures in the hand.

Two new cases of triplane fracture of the distal tibia are reported in the proximal phalanx of the thumb and the distal radius, respectively, of a 12-year-old girl and a 13-year-old boy. Neither fracture showed any displacement, achieving healing at 4 weeks of external immobilization. Triplane fractures can occur across growth plates other than the distal tibia. Because of the rapid physiologic physeal arrest, the potential for growth deformity is null. In cases without displacement, these fractures should be treated conservatively by external immobilization, as one would treat a one-plane fracture.

Complete dorsal tarsometatarsal dislocation of the first metatarsal.

The authors describe a rare case of Lisfranc's dislocation that occurred after a 13-year-old boy kicked the ground while playing soccer. He presented with complete pure dorsal tarsometatarsal dislocation of the first metatarsal. He was treated succesfully by closed reduction and percutaneous K-wire fixation. No complication was found and he returned to his preinjury lifestyle at 3 months. No sequelae are found 3.5 years later.

Fibrous dysplasia of both alae of the sacrum.

A case of monostotic fibrous dysplasia involving both alae of the sacrum is reported. Only 2 cases of monostotic sacral involvement were published previously. The lesion was detected in a 42-year-old man suffering from lumbosacral pain after minimal trauma. Radiographic studies revealed cystic images on both alae of the sacrum, with internal condensations and some liquid contents. A trephine biopsy did not produce enough diagnostic data, and a posterior surgical approach was elected. Curettage and refilling with allograft were performed. The pathologic anatomy study diagnosed a fibrous dysplasia. Two years after surgery, the patient was asymptomatic.

Volar dislocation of the first metacarpophalangeal joint. A case report and review of the literature.

After suffering traumatic volar dislocation of the first metacarpophalangeal joint, a 27-year-old patient was treated using closed reduction of the thumb. The patient regained full function and stability of the joint after 5 months. A review of the literature indicates that open reduction is the most common treatment for volar dislocation, but our case report suggests that conservative treatment using closed reduction can be highly effective.