Triple Barrel Free Fibula Flap for Sternal Stabilization: A Case Report.

Sternal non-union is a rare complication of median sternotomies following cardiac surgery. It results in sternal instability and is associated with a high rate of morbidity. Patients with sternal non-union usually complain of pain and sternal clicking with movement of the chest wall. Diagnosis is confirmed on computed tomography showing a gap between two sternal halves. Surgical correction of sternal instability is challenging. The key objective is to reconstruct a thoracic cage that allows for biomimesis and preserves normal physiologic cardiac and pulmonary functions all whilst achieving an aesthetically pleasing result. In this article, we describe a novel technique for sternal instability reconstruction using a triple-barrel vascularized free fibula flap fixed with rib titanium plates. This approach provides rigid long-lasting stability while preserving chest wall biomechanics.

La désunion sternale est une complication rare des sternotomies pour chirurgie cardiaque. Il en résulte une instabilité sternale responsable d'une morbidité élevée comme la douleur et le cliquetis lors des mouvements thoraciques. Le scanner confirme le diagnostic en montrant la solution de continuité entre les 2 moitiés du sternum. La reconstruction chirurgicale est complexe. Son but est de reconstruire une cage thoracique solide, permettant des fonctions cardiaque et respiratoire normales tout en assurant une esthétique satisfaisante. Nous décrivons ici une nouvelle technique de reconstruction sternale par lambeau libre fibulaire tripartitionné fixé par des plaques costales en titane. Elle permet une stabilisation pérenne de la cage thoracique et la restauration de sa mécanique.

Characterization of controlled trials on probiotic supplementation to dairy calves: A scoping review.

The objective of this scoping review was to identify, describe, and characterize the literature on probiotic supplementation in dairy calves. Eligible studies were nonrandomized, quasi-randomized and randomized controlled trials in English, Spanish, or Portuguese that evaluated the effect of probiotic supplementation on growth and health of dairy calves. The search strategies were based on a modification of the PICO (Population, Intervention, Comparator, Outcome) framework and used synonyms and words related to "dairy calves" (population), "probiotics" (intervention), and "growth and health measurements" (outcomes). No restrictions for publication year or language were applied. Searches were conducted in Biosis, CAB Abstracts, Medline, Scopus, and the Dissertations and Theses Database. In total, the search identified 4,467 records, of which 103 studies (110 controlled trials) met the inclusion criteria. The studies were published between 1980 and 2021 and originated from 28 countries. Trials were randomized (80.0%), nonrandomized (16.4%), and quasi-randomized (3.6%), ranging in sample size from 5 to 1,801 dairy calves (mode = 24; average = 64). Enrolled calves were frequently Holstein (74.5%), males (43.6%), and younger than 15 d at the beginning of probiotic supplementation (71.8%). Often, trials were conducted in research facilities (47.3%). Trials evaluated probiotics with single or multiple species of the same genus: Lactobacillus (26.4%), Saccharomyces (15.4%), Bacillus (10.0%), Enterococcus (3.6%), or multiple species of various genera (31.8%). Eight trials did not report the probiotic species used. Lactobacillus acidophilus and Enterococcus faecium were the species most supplemented to calves. The duration of probiotic supplementation ranged from 1 to 462 d (mode = 56; average = 50). In trials with a constant dose, it ranged from 4.0 × 106 to 3.7 × 1011 cfu/calf per day. Most probiotics were administered mixed solely into feed (88.5%; whole milk, milk replacer, starter, or total mixed ration) and less frequently orally as a drench or oral paste (7.9%). Most trials evaluated weight gain (88.2%) as a growth indicator and fecal consistency score (64.5%) as a health indicator. Our scoping review summarizes the breadth of controlled trials evaluating probiotic supplementation in dairy calves. Differences in intervention design (mode of probiotic administration, dose, and duration of probiotic supplementation) and outcomes evaluation (type and methods) justify future efforts toward standardized guidelines in clinical trials.

Use of antimicrobials in the treatment of calf diarrhea: a systematic review.

The objective of this study was to conduct a systematic review of the scientific literature evaluating the efficacy and comparative efficacy of antimicrobials (AMs) for the treatment of diarrhea in calves. Eligible studies were non- and randomized controlled trials evaluating an AM intervention against a positive and negative control, with at least one of the following outcomes: fecal consistency score, fever, dehydration, appetite, attitude, weight gain, and mortality. Four electronic databases were searched. Titles and abstracts (three reviewers) and full texts (two reviewers) were screened. A total of 2899 studies were retrieved; 11 studies met the inclusion criteria. The risk of bias was assessed. Most studies had incomplete reporting of trial design and results. Eight studies compared AMs to a negative control (placebo or no treatment). Among eligible studies, the most common outcomes reported were diarrhea severity (n = 6) and mortality (n = 6). Eligible studies evaluated very different interventions and outcomes; thus, a meta-analysis was not performed. The risk of bias assessment revealed concerns with reporting of key trial features, including disease and outcome definitions. Insufficient evidence is available in the scientific literature to assess the efficacy of AMs in treating calf diarrhea.

Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages.

BACKGROUND: There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally. METHODS: A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. RESULTS: Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance. CONCLUSION: Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

Effect of prebiotics on growth and health of dairy calves: A protocol for a systematic review and meta-analysis.

Prebiotic supplementation has been studied as a means to enhance growth and health in dairy calves; however, results seem to be inconsistent across studies. The first objective of the future review is to identify, summarize, appraise, and discuss the current literature on the prebiotic supplementation for dairy calves. The second objective is to evaluate the effect of prebiotic supplementation on growth and health of dairy calves. Eligible studies will be non-randomized and randomized controlled trials in English, Spanish, or Portuguese that examined the supplementation of prebiotics to dairy calves (up to 6 months of age) and reported growth or health outcomes. The main growth outcomes will be average daily gain, feed efficiency, and main health outcomes will be fecal score and diarrhea incidence. A search will be conducted in Biosis, CAB Abstracts, Medline, Scopus, and the Dissertations and Theses Database with the support of a UC Davis librarian. Two reviewers independently will screen the titles and abstracts of retrieved studies. The screening of full manuscripts will be performed by one reviewer. The data extraction will be executed based on pre-tested forms. Risk of bias will be assessed using the Cochrane Risk of Bias 2.0 tool. If feasible, a random-effects meta-analysis will be conducted. Heterogeneity will be evaluated with I2 statistic. If possible, publication bias will be investigated by using funnel plots, Begg's adjusted rank correlation, and Egger's test. The certainty of the evidence will be determined using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. The proposed review will contribute to the current knowledge on prebiotic supplementation for dairy calves; this information may guide management decision at the farm level and identify gaps of knowledge to be addressed in future research. The protocol is registered in Open Science Framework (https://osf.io/ar5g2/) and available in the Systematic Reviews for Animals and Food (http://www.syreaf.org/contact/).

From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015.

Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.

Beyond the borders of keloid formation: A case report.

The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.

Mechanical failure of a Fogarty catheter in a microsurgical procedure: a case report.

Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

First Report of Tobacco mild green mosaic virus in Capsicum chinense in Venezuela.

In July 2003, noticeable deformations of leaves were observed on a local variety of Capsicum chinense, also called 'Aji dulce', from a pepper plantation located in Venezuela, (Monagas State). 'Aji dulce' is a basic ingredient of the Venezuelan gastronomy with an estimated cultivated area of 2,000 ha. The seeds of this local pepper are obtained by the growers who reproduce and multiply their own seeds every year. Seeds of affected plants were sent to our laboratory, and a group of approximately 100 seeds was sown in a controlled greenhouse that belongs to the Polytechnic University of Valencia, Spain. Three months later, obvious curling and bubbling developed on the leaves of the plants. Extracts of symptomatic plants tested negative for Tomato mosaic virus (ToMV), Tobacco mosaic virus (TMV), Pepper mild mottle virus (PMMV), and Tobacco etch virus (TEV) by double-antibody sandwich enzyme-linked immunosorbent assays (DAS-ELISA) with policlonal antibodies specific to each virus (Loewe Biochemica GMBH, Sauerlach, Germany; Phyto-Diagnostics, INRA, France). Total RNA was isolated from 0.5 g of original seed sent from Venezuela and from 25 samples of leaves of plants grown in the greenhouse with an RNeasy Plant Mini Kit (Qiagen Sciences, Germantown, Maryland). The RNA isolated was used in reverse transcription-polymerase chain reaction (RT-PCR) with specific primers for Tobacco mild green mosaic virus (TMGMV) (1) predicted to amplify a 530 bp of the coat protein region. From all samples, a RT-PCR product of the expected size was obtained and then sequenced. BLAST analysis of one sequence (GenBank Accession No. DQ460731) showed high levels of identity with TMGMV isolates, with more than 99% nucleotide identity with the DSMZ PV-112 isolate (GenBank Accession No. AJ429096). The symptomatology observed on pepper plants, the TMGMV RT-PCR assay, and the consensus of sequenced regions with TMGMV lead us to conclude that TMGMV was the causal agent of the diseased C. chinense plants. Although TMGMV has a wide plant host range occurring worldwide (1), to our knowledge, this is not only the first time TMGMV has been detected in Venezuela, but also the first report of TMGMV in C. chinense in Venezuela and the first reliable probe of the TMGMV seed transmission. Reference: (1) J. Cohen et al. Ann. Appl. Biol. 138:153, 2001.

Distribución espacial de Anopheles pseudopunctipennis en las Yungas de Salta, Argentina / Spatial distribution of Anopheles pseudopunctipennis in the Yungas de Salta rainforest, Argentina

OBJETIVO: Comparar la abundancia de Anopheles pseudopunctipennis, y otros anofelinos, en tres zonas silvestres y modificadas por el hombre, a fin de verificar en qué medida tales diferencias ambientales afectan la distribución espacial de estos mosquitos. MÉTODOS: Se realizaron muestreos mensuales (diciembre de 2001 a diciembre de 2002), con trampas de luz CDC con CO2, en cada sitio de muestreo (selva, borde de selva y peridomicilio). En el peridomicilio, además, dos operadores aspiraron mosquitos posados sobre las paredes. Se estimaron índices de diversidad y abundancia de especies, y se intentó caracterizar a los ambientes estudiados mediante ANOVA, cálculo de cosenos y análisis de agrupamientos. RESULTADOS: Anopheles pseudopunctipennis fue la especie más abundante. Se colectaron también An. argyritarsis, An. nuneztovari, An. rangeli y An. strodei. Excepto An. nuneztovari que no se capturó en el peridomicilio, las demás se colectaron en los tres ambientes. No hubo diferencias en los índices de diversidad, ni tampoco entre los ambientes estudiados; sin embargo, el análisis de agrupamiento separó el borde de la selva, donde todas las especies fueron más abundantes en general. CONCLUSIONES: El borde de la selva fue el ambiente que presentó la mayor abundancia, representando, además del peridomicilio, un ambiente de alto riesgo para la transmisión del paludismo.

First Report of Tobacco as a Natural Host of Tomato yellow leaf curl virus in Spain.

Two begomovirus species, Tomato yellow leaf curl Sardinia virus (TYLCSV) and Tomato yellow leaf curl virus (TYLCV), have been identified as causal agents of tomato yellow leaf curl disease (TYLCD) in Spain. TYLCSV was reported in Spain in 1992 and TYLCV in 1997 on tomato crops (3). TYLCV was also reported in common bean (Phaseolus vulgaris L.) and pepper (Capsicum annuum L.) crops in southern Spain in 1997 and 1999, respectively. During the summer of 2004, symptoms of yellowing, crumpling, and necrosis of new leaves were observed sporadically in young, field-grown tobacco (Nicotiana tabacum L.) plants in the Badajoz Province. These tobacco plants were next to tomato crops where TYLCV was detected for the first time in Badajoz in 2003. In September 2004, four symptomatic tobacco plants were selected for double antibody sandwich enzyme linked immunosorbent assay (DAS-ELISA) and polymerase chain reaction (PCR) identification analyses. Serological analyses were carried out in two repetitions and with the following polyclonal antisera: Potato virus Y (PVY) (Loewe Biochemica, Sauerlach, Germany); Tobacco mild green mosaic virus (produced in our laboratory); Tobacco mosaic virus (BIO-RAD, Marnes-La-Coquette, France); and Tomato spotted wilt virus (Loewe Biochemica). A simplified method of duplex PCR was used for a rapid, sensitive, and simultaneous detection of TYLCSV and TYLCV (2). Mixed infections of PVY and TYLCV were detected in all four tobacco samples tested. TYLCV infection was confirmed using the primer pair TY-1/TY-2 specific for the coat protein (CP) gene of begomoviruses (1). The CP fragment was digested with the restriction enzyme AvaII, and the pattern obtained corresponded to that obtained from TYLCV-infected tomato that served as a positive control. Two PCR products from different tobacco samples were sequenced and both showed 100% identity with the corresponding region (Almería) of TYLCV (GenBank Accession No. AJ489258) and 99% with TYLCV-Mild (Spain) (GenBank Accession No. AJ519441), confirming the diagnosis. The symptoms observed in the tobacco plants can not be attributed solely to TYLCV since the virus was present in a mixed infection with PVY. However, tobacco infected with TYLCV may serve as an important alternate host for TYLCV in the tomato cropping system. To our knowledge, this is the first report of N. tabacum as a natural host of TYLCV in Spain. References: (1) G. P. Accotto et al. Eur. J. Plant Pathol. 106:179, 2000. (2) P. Martínez-Culebras et al. Ann. Appl. Biol. 139:251, 2001. (3) J. Navas-Castillo et al. Plant Dis. 81:1461, 1997.

Reconstrucción Mamaria con colgajo TRAM: análisis de la respuesta psicológica / Breast reconstruction with TRAM flap: study of the psicological response

En los últimos años el colgajo TRAM ha sido una de las técnicas más utilizadas en todo el mundo para la reconstrucción mamaria. Aunque es una técnica que requiere de experiencia y de un equipo bien entrenado en el manejo de la reconstrucción mamaria, presenta un grado de morbilidad no despreciable. A pesar de lo anterior, el grado de satisfacción y los beneficios a nivel psico-social son sobresalientes, por lo tanto se evaluó de una manera más objetiva esta respuesta. El estudio se efectuó con 19 pacientes con colgajo TRAM pediculado, a las cuales se les aplicó un cuestionario estructurado, que permitió hacer un análisis de carácter retrospectivo, tomando en cuenta las tres etapas del proceso (antes de recibir el diagnóstico, durante el proceso de la mastectomía y después de la reconstrucción). Asimismo, se evaluaron los siguientes aspectos: impacto emocional, ansiedad, angustia, depresión, y trastornos del temperamento, entre otros. Entre los principales resultados se observó que el 74% de las pacientes relaciona sus mamas con aspectos de estética corporal, 90% comenta que el diagnóstico de la enfermedad fue una de las experiencias más traumáticas de su vida. Posteriormente a la reconstrucción, 84% de la población entrevistada sintió que su vida cambió desde el momento en que se sometieron a la cirugía y argumentan el volver a sentir entusiasmo, y sentirse completas de nuevo. Además, el 100 % recomendaría este procedimiento reconstructivo a aquellas mujeres que tengan que vivir la experiencia de la mastectomía (AU)

During the last years TRAM flap has been one of the most utlilized techniques for breast reconstruction around the world. It is a technique which requires a well trained and experienced team in breast reconstruction and can have an important rate of morbility. In spite of that, the satisfaction rate and psico-social benefites are remarkable. Therefore, this study asseses in an objetive way that response. The study reviewed 19 patients with pediculated TRAM flaps to whom was applied a structured questionnaire which allowed a retrospective analysis, taking into account the three parts of the process ( before the diagnosis, after the mastectomy and after the reconstruction ). Also the fallowing aspects were evaluated: emotional impact, anxiety, anguish, depression and mood disorders among others. In the review 74% of the patients relate their breast with aspects of body esthetics ; for 90% the diagnosis of the disease was one of the most traumatic experience in their life. After the reconstruction, 84% of the population felt that its life changed since the moment they were operated on. Now, they feel enthusiastic and “whole” again. Also the 100% of the patients recommended the operation to others patients who have lived the mastectomy experience (AU)

Mesectodermal leiomyoma of ciliary body.

A 37-year-old woman had a mass in her left ocular globe. Uveal melanoma was suspected and enucleation was performed. Microscopically, the lesion proved to be a typical case of mesectodermal leiomyoma of the ciliary body. According to some authors, the peculiar neural appearance of this tumor could be the reflection of its probable origin from mesectodermal smooth muscle. Immunohistochemical analysis showed reactivity for muscle-specific actin and negativity for desmin, S-100 protein, HMB-45, EMA, and GFAP. Our results do not support the proposed neuroectodermical origin of this tumor, since coexpression of muscular and neural markers was not observed.

Adhesive strips: a simple and inexpensive trick for finger holding in hand surgery.

Many finger holding devices have been developed to retract digits and provide exposure during hand surgery. We describe a simple, and cheap trick to keep fingers out of the way using adhesive strips that has proven efficient and helpful.

[Lepiota bruneoincarnata fatal intoxication]. / Intoxicación fatal por Lepiota bruneoincarnata.

Mushroom poisoning does not occur very often but in autumn the incidence increases. The seriousness of symptoms in some cases justifies the revision of this issue just the event of one family cases occurred recently in our environment. In this paper we are presenting two cases of intoxication by Lepiota bruneoincarnata in two patients of the same family who suffers visceral involvement with a hepatic strike down and death in one of the patients. The rarity, and seriousness of symptoms together with the similarity with intoxication by Amanita phalloides seem very interesting to us to be published.

Intoxicación fatal por Lepiota bruneoincarnata / Lepiota bruneoincarnata fatal intoxication

La intoxicación por setas no suele ser habitual, pero es de elevada incidencia en el periodo otoñal y la gravedad de los síntomas, en algunos casos, justifica la revisión del tema, a propósito de un caso familiar acaecido recientemente en nuestro medio.En este artículo presentamos dos casos de intoxicación por Lepiota bruneoincarnata en dos pacientes de la misma familia, que desarrollaron afectación visceral con alteración de la función hepática, con desenlace fatal en uno de ellos.La rareza, gravedad de los síntomas y su semejanza con las intoxicaciones por Amanita phalloides nos ha parecido interesante para su publicación (AU)

Importancia de la revisión bibliográfica en la redacción del trabajo científico / The importance of bibliographic review when writing a scientific paper

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