Impact of subtrochanteric fractures in the geriatric population: better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry.

BACKGROUND: Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. HYPOTHESIS: Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. MATERIALS AND METHODS: Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. RESULTS: A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. CONCLUSIONS: Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. LEVEL OF EVIDENCE: IV.

Luxación esternoclavicular posterior / Posterior sternoclavicular dislocation / Luxação posterior esternoclavicular

La luxación esternoclavicular posterior es una patología extremadamente infrecuente, que se presenta, sobre todo, en varones jóvenes como consecuencia de un traumatismo de alta energía. Hasta en un 25% de los casos pueden aparecer complicaciones potencialmente letales por compresión de estructuras mediastínicas, que requieren de la reducción urgente de la luxación. El diagnóstico radiográfico puede ser difícil, siendo de gran utilidad la tomografía computerizada para determinar el tipo y grado de desplazamiento, así como la relación anatómica con las estructuras mediastínicas. Se presenta el caso de una paciente de 14 años de edad que presentó una luxación esternoclavicular posterior traumática aguda tras una caída practicando karate

Posterior sternoclavicular joint dislocation is an extremely rare condition, usually seen in males after high energy concussion. Potentially lethal complications may appear in 25% of cases, due to compression of mediastinic structures. Radiological diagnose may be difficult, why computed tomography is usually used to determine type and grade of displacement and relation with mediastinic structures. We present a case of a 14 year-old woman who presented a posterior sternoclavicular dislocation due to a fall while playing karate

A luxação posterior esternoclavicular é a condição extremamente rara, que ocorre principalmente em homens jovens, como resultado de trauma de alta impacto. Em até 25% dos casos, podem acontecer complicações potencialmente fatais por compressão de estruturas do mediastino, que exigem a redução urgente da luxação. O diagnóstico radiográfico pode ser difícil, sendo a tomografia computadorizada considerada útil para determinar o tipo e grau de deslocamento e a relação anatômica com as estruturas do mediastino. Aqui se apresenta o caso de um jovem de 14 anos que apresentou uma luxação esternoclavicular posterior traumática aguda após uma queda durante a prática de karatê

Synthesis of enantioenriched azo compounds: organocatalytic Michael addition of formaldehyde N-tert-butyl hydrazone to nitroalkenes.

The unprecedented diaza-ene reaction of formaldehyde N-tert-butyl hydrazone with nitroalkenes can be efficiently catalyzed by an axially chiral bis-thiourea to afford the corresponding diazenes in good to excellent yields (60-96%) and moderate enantioselectivities, up to 84 : 16 er; additional transformation of diazenes into their tautomeric hydrazones proved to be operationally simple and high-yielding, affording bifunctional compounds which represent useful intermediates for the synthesis of enantioenriched ß-nitro-nitriles and derivatives thereof.

Hydraulic differences along the water transport system of South American Nothofagus species: do leaves protect the stem functionality?

Hydraulic traits were studied for six Nothofagus species from South America (Argentina and Chile), and for three of these species two populations were studied. The main goal was to determine if properties of the water conductive pathway in stems and leaves are functionally coordinated and to assess if leaves are more vulnerable to cavitation than stems, consistent with the theory of hydraulic segmentation along the vascular system of trees in ecosystems subject to seasonal drought. Vulnerability to cavitation, hydraulic conductivity of stems and leaves, leaf water potential, wood density and leaf water relations were examined. Large variations in vulnerability to cavitation of stems and leaves were observed across populations and species, but leaves were consistently more vulnerable than stems. Water potential at 50% loss of maximum hydraulic efficiency (P(50)) ranged from -0.94 to -2.44 MPa in leaves and from -2.6 to -5.3 MPa in stems across species and populations. Populations in the driest sites had sapwood and leaves more vulnerable to cavitation than those grown in the wettest sites. Stronger diurnal down-regulation in leaf hydraulic conductance compared with stem hydraulic conductivity apparently has the function to slow down potential water loss in stems and protect stem hydraulics from cavitation. Species-specific differences in wood density and leaf hydraulic conductance (K(Leaf)) were observed. Both traits were functionally related: species with higher wood density had lower K(Leaf). Other stem and leaf hydraulic traits were functionally coordinated, resulting in Nothofagus species with an efficient delivery of water to the leaves. The integrity of the more expensive woody portion of the water transport pathway can thus be maintained at the expense of the replaceable portion (leaves) of the stem-leaf continuum under prolonged drought. Compensatory adjustments between hydraulic traits may help to decrease the rate of embolism formation in the trees more vulnerable to cavitation.

Synthesis and Diels-Alder cycloadditions of exo-imidazolidin-2-one dienes.

An efficient and versatile synthesis of novel exo-imidazolidin-2-one dienes is described. This involves the base-assisted condensation/cyclization cascade reaction of the monoimino derivatives of diacetyl with a series of isocyanates. This methodology enables preparation of symmetrical dienes, as long as the substrates have the same N substituent. Moreover, use of different N-substituted starting materials leads to formation of nonsymmetrical dienes. The reactivity of these dienes was evaluated in Diels-Alder reactions, showing a high reactivity.

Género y espacialidad: análisis de factores que condicionan la equidad en el espacio público urbano / Gender and space: analysis of factors conditioning equity in the public space

Este artículo discute la investigación sobre género en el espacio público a través de tres perspectivas diferentes: las representaciones sociales y usos diferenciados del espacio, la división de roles en los espacios públicos y privados y la planeación urbana del espacio. El trabajo recoge y analiza algunos estudios que complementan el estado del arte y la literatura sobre las mujeres y el espacio en los que se da evidencia sobre la manera como las mujeres han sido segregadas del espacio público y son víctimas de las desigualdades de género. Ni el espacio público ni el género existen de forma absoluta, por el contrario, ambas categorías son construidas por el orden social y reproducidas por las prácticas sociales. Finalmente se dan algunas recomendaciones para la planeación y la investigación con el fin de contribuir a dar respuesta a las necesidades de las mujeres en el espacio público.

This article discusses gender research in urban public space through three different perspectives: the social representations and differentiated uses of space, the division of roles in public and private spaces, and urban planning of public space. The paper gathers and analyses some studies that complement the state of art and literature on women and space giving evidence on how women have been segregated from public space and are victim of gender inequalities. Public space does not exist absolutely nor gender; instead both are socially constructed by social order and reproduced by social practices. Finally, some suggestions for urban planning and research are given in order to respond women’s needs in public space.

Pseudoxantoma elástico con complicaciones tardías y asociaciones infrecuentes / Pseudoxanthoma elasticum with late complications and unusual associations

El pseudoxantoma elástico (PXE) es un trastorno hereditario poco común del tejido conectivo, que se caracteriza por lesiones cutáneas, oculares y cardiológicas originadas por fragmentación y calcificación de las fibras elásticas. La mayoría de casos se hereda con un patrón autosómico recesivo, y, en menos proporción, autosómico dominante. El propósito del presente reporte es dar a conocer un caso de pseudoxantoma elástico con complicaciones tardías y asociaciones infrecuentes, como son una ECV (enfermedad cerebro vascular) recidivante, abortos recurrentes, la presencia de un bocio multinodular unilateral derecho, fibromatosis uterina gigante no sintomática, hipertensión arterial, y un antecedente no bien clarificado con respecto a la presencia de diabetes mellitus.

Pseudoxanthoma elasticum (PXE) is connective tissue's rare inherited disorder, characterized by skin, eye and cardiac lesions, originated by fragmentation and calcification of elastic fibers. Most cases are inherited with an autosomal recessive pattern, and in a little proportion, with an autosomal dominant pattern. This paper has the purpose of reporting a case of pseudoxanthoma elasticum with late complications and unusual associations, such as recidivated stroke, recurrent aborts, right multinodular unilateral goiter, giant uterine fibromatosis, arterial hypertension, and an unclear antecedent of diabetes mellitus.

Factores de riesgo de retraso mental en estudiantes del Centro Educativo Especial de Mollendo - 1997

El presente trabajo investigó los factores asociados al retraso mental en la población de estudiantes del Centro Educativo Especial de la localidad de Mollendo. El estudio es de tipo descriptivo, retrospectivo, transversal, para el cual se realizó una ficha clínica de entrevista donde se evaluaron las variables en estudio, entrevistando a los padres de familia y evaluando a los sujetos de estudio. Asimismo, se revisaron las historias clínicas del Centro Educativo. El retraso mental estuvo presente en los 42 sujetos evaluados, el 58.38 por ciento de los cuales fueron varones. El 85.72 por ciento de ellos tenían edades entre 6 y 15 años, más del 90 por ciento presentaban retraso mental leve a moderado, y el 85.72 por ciento recibían educación especial. El 100 por ciento presentaron algún grado de desnutrición. El 69.06 por ciento pertenecían a un nivel socioeconómico bajo, hubo una diferencia significativa en cuanto al grado de instrucción entre padres y madres a favor de los primeros. No encontramos asociación entre asfixia perinatal y retraso mental. Los principales factores asociados a R.M. prenatales que encontramos, fueron la alimentación materna inadecuada, las enfermedades durante el embarazo (infecciones urinarias vulvovaginitis y enfermedades hipertensivas del embarazo) y hábitos nocivos (alcohol, tabaco). Los principales factores natales asociados a R.M. que encontramos, fueron la atención empírica del parto, el bajo peso al nacimiento y la dificultad respiratoria. Entre los factores postnatales asociados a R.M., sólo pudimos identificar a la deprivación social. Consideramos que, en todo lo que se refiere a retraso mental, aún nos queda mucho por aprender, ya que es una condición tan característica de tantas enfermedades, que pensamos que no hemos hecho más que dar un pequeño paso en el camino hacia su comprensión. Esperamos que el tiempo nos brinde la oportunidad de poder perseverar en el mismo.

Identificación intraoperatoria del glandulas paratiroides mediante tinción selectiva con azul de metileno

La identificación de las glándulas paratiróides durante la cirugía, reduce el riesgo de hipoparatiroidismo postoperatorio. Este riesgo paratiroideo aumenta a partir del momento en que la cirugía de la tiroides es bilateral, radical o cuando se trata de una reintervención. Historicamente se han realizado varios trabajos con el fin de facilitar la identificación de las paratiroides. El presente trabajo permite una nueva técnica de reconocimiento paratiroideo intraoperatorio con tinción mediante el uso de azul de metileno y que muestra resultados positivos, en cuento a localización de un 88 por ciento con un índice de confiabilidad de un 94.11 por ciento. Se reconocieron 43 glándulas paratiroides por tinción en 25 pacientes. Los efectos colaterales fueron mínimos. La mortalidad nula. Se sugiere que este método debería ser usado sistematicamente en las cirugías de tiroides, mas si ésta es bilateral, en cáncer de tiroides y en las reintervenciones.