A comparison of three techniques for the osteosynthesis after minimal invasive osteotomies for hallux valgus.

PURPOSE: Third and fourth-generation minimal invasive osteotomies (MIO) for the treatment of hallux valgus (HV) have become popular procedures worldwide with promising results due to the improvement in the fixation method. The tricortical cannulated screw placement remains a complex procedure that is technically challenging and requires a long skill learning curve with high radiation exposure mainly in the form of intensifier shots (IS) required for the MIO fixation. This study aims to compare the number of X-ray IS required using three different techniques for the cannulated guide placement. METHODS: A retrospective cross-sectional observational and comparative study was conducted to assess the number of X-rays IS required for correct cannulated screw guide placement using three different techniques: traditional perforator, the drill and joystick, and K-wire first techniques. RESULTS: A total of 53 MIS procedures from thirty-one patients in two different hospitals were included. IS X-rays were 155.1 ± 29.7 in the traditional technique (n = 14), 143.0 ± 43.2 in the drill and joystick technique (n = 22), and 85 ± 18.7 in the K-wires first technique (n = 17), p = < 0.001 using one-way ANOVA. CONCLUSIONS: The K-wire first technique statistically significantly decreases X-ray IS numbers p ≤ 0.001. There were no statistically significant differences between the traditional (after osteotomy K-wire placement) and the drill and joystick techniques (p = 0.36).

Compositional Streamline-Based Modeling of Polymer Flooding Including Rheology, Retention, and Salinity Variation.

The chemical enhanced oil recovery (CEOR) technology that is most used worldwide is polymer flooding due to its proven commercial success at field scale, maturity, and versatility to combine with other technologies. So, there has been an increasing interest in expanding its applicability to more unfavorable mobility ratio conditions and adverse environments (such as high-temperature, high-salinity carbonate reservoirs, pH-sensitive polymers, and formations with active clays). Therefore, a requirement for successful field application is to find the design parameters of the process that balance material requirements and oil recovery benefits in a cost-effective manner, which is usually done through reservoir modeling. Polymer flooding predictive tools normally require detailed information and are based on time-consuming field reservoir simulations. Thus, for effective project management, a quick and sound tool is needed to screen for polymer flooding applications without giving up key physical-chemical phenomena that govern the oil recovery. In this research, we developed a two-dimensional polymer flooding model based on the streamlines approach. This is an alternative to having a multidimensional practical tool thoroughly representing the physical and chemical behavior of polymer flooding by considering key phenomena such as rheology behavior (shear thinning and shear thickening), salinity variations, permeability reduction, and polymer adsorption. Previously published streamline multidimensional models for polymer flooding lack the integrated modeling of the above-mentioned key phenomena. Additionally, the models to represent rheology and retention phenomena in the proposed tool consider a more complete description than the present streamline-based simulators. For the construction of streamlines, we considered a black oil formulation to estimate the pressure and saturation 2D distribution by applying the implicit in pressure and explicit in saturation method, coupled with an explicit formulation for the 2D composition computation. For saturation-composition along the streamlines, the 1D practical tool incorporated represents the polymer flooding key phenomena. The numerical algorithm used by the streamline-based tool is supported by laboratory experiments for waterflooding in homogenous porous media, analytical results for waterflooding in heterogeneous media, polymer flooding field scale simulation cases, and a CMG-STARS model built as a reference for waterflooding in both media (homogenous and heterogeneous) and for polymer flooding. The practical tool developed contributes to simplifying the upscaling from laboratory observations to field applications with better fitted numerical simulation models and to determining favorable scenarios; thus, it could assist in understanding how key parameters affect oil recovery without performing time-consuming CEOR simulations.

Genetic connectivity of the metapopulation of the coral Pocillopora verrucosa (Scleractinia: Pocilloporidae) in multi-use marine protected areas of the Gulf of California, and management implications / Conectividad genética de la metapoblación del coral Pocillopora verrucosa (Scleractinia: Pocilloporidae) en áreas protegidas multipropósito del Golfo de California, e implicaciones de manejo

Abstract Introduction: Estimates of contemporary connectivity of the broadcast spawning coral Pocillopora verrucosa between multi-use marine protected areas (MUMPAs) are required to assess MUMPA effectiveness and their ability to enhance resilience against disturbances. Objective: To determine the genetic structure and connectivity patterns between P. verrucosa demes inside the Gulf of California and evaluate the role and effectiveness of established MUMPAS in their protection and resilience. Methods: We assessed P. verrucosa connectivity along its peninsular range (∼350 km), including five locations and three MUMPAs in the Gulf of California using six microsatellite genetic markers. Results: Population structure was significant (F ST = 0.108***) when demes included clonal replicates; however, when these clones were removed from the analysis, the sexual individuals comprised a metapopulation panmixia (F ST = 0.0007 NS). To further understand connectivity patterns, an assignment test was carried out which identified ten recent between-deme migrants with a mean dispersal distance of 116.6 km (± 80.5 SE). No long-distance dispersal was detected. These results highlight the ecological importance of the Bahía de La Paz region, including Archipiélago de Espíritu Santo MUMPA. This region, located at the center of the species peninsular range, exports larva to downstream sink demes such as the Loreto (northwardly) and Cabo Pulmo (southwardly) MUMPAs. Of importance, inter-MUMPA spacing was larger than the mean larval dispersal by ~56 km, suggesting thar the designation of intermediate 'no-take' zones would enhance short-distance connectivity. Conclusion: This study contributes as a baseline for policymakers and authorities to provide robust strategies for coral ecosystem protection and suggest that protection efforts must be increased towards peninsular intermediate reefs to promote metapopulation resilience from natural and anthropogenic factors.

Resumen Introducción: La estimación de la conectividad en corales escleractinios, como P. verrucosa, dentro de una red de áreas marinas protegidas (MPA) preestablecidas es fundamental para garantizar la efectividad en su conservación e incrementar su resiliencia. Objetivo: Determinar la estructura genética y la conectividad entre los demes de P. verrucosa dentro del Golfo de California, y evaluar el papel y efectividad de la red preestablecida de áreas marinas protegidas. Métodos: Se evaluó la conectividad de P. verrucosa en cinco locaciones a lo largo del golfo incluyendo tres MPA usando seis marcadores microsatélites. Resultados: Se demostró que existe estructura poblacional adjudicada a la presencia local y heterogénea de individuos clones (F ST = 0.108***); pero al removerlos del análisis, los individuos de origen sexual conformaron una metapoblación en panmixia (F ST = 0.0007 NS). Así mismo, se identificaron 10 potenciales migrantes en la región con una dispersión promedio de 116.57 km (± 80.47 SE) y sin conexión entre localidades extremas. De relevancia, se identificó la importancia ecológica del área central o Bahía de La Paz y MPA Archipiélago Espíritu Santo, como fuente larvaria de corales a toda la región. Además, se determinó que el espacio inter-MPA fue mayor que la distancia de dispersión promedio larvaria mencionada, por lo que sería de importancia ecológica el establecimiento de MPAs intermedias que favorezcan la conectividad a distancias cortas. Conclusiones: Los resultados encontrados en el estudio son pertinentes y contribuyen como línea base para los tomadores de decisiones y autoridades, proporcionando la conectividad de la región para establecer las estrategias de protección apropiadas, sugiriendo aumentar la conservación de las subpoblaciones centrales, la cuales promueven la resiliencia metapoblacional de P. verrucosa ante factores ambientales y/o antropogénicos.

Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria / Expert consensus on multidisciplinary management and integrated approaches in heart failure. Continuity of care from hospital discharge to primary care

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

Human papillomavirus infections in Mexican women with normal cytology, precancerous lesions, and cervical cancer: type-specific prevalence and HPV coinfections.

The prevalence and genotype distribution of human papillomavirus (HPV) provides the basis for designing HPV prevention programs. The prevalence rates of type-specific HPV and coinfections in samples of Mexican women were investigated in 822 women aged 18-87 years. HPV detection was performed using a Linear Array™ genotyping test. HPV infection was found in 12.4% of controls, 46.3% of those with cervical intraepithelial neoplasia 1, and 100% of those with cervical intraepithelial neoplasia 3 or cervical cancer. HPV 16 was the most prevalent type in all diagnosis groups. The HPV types most frequently found in cervical cancers were 16, 18, 45, 52, 58, and 39; HPV types 16, 62, 51, 84, 18, 53, and CP6108 were the most prevalent in control women. Considering HPV-positive samples only, coinfections occurred most often in controls (63%) and were less frequent in those with cervical cancer (26%). The most frequent viral types in coinfections with HPV 16 in control women were HPV 62, 51, and 84; in women with cervical cancers, HPV 18, 39, and 70 were most common. In conclusion, in addition to HPV types 16 and 18, types 45, 39, 58, 52, and 71 were found in cervical cancers in Mexican women (78%); among them, only 65% were attributable to HPV types 16 and 18. Therefore, it is necessary to consider these viral types in the design of new vaccines, and to determine whether certain HPV types coinfecting with HPV 16 in precursor lesions determine tumor progression or regression.

Evaluation of DNA single and double strand breaks in women with cervical neoplasia based on alkaline and neutral comet assay techniques.

A hospital-based unmatched case-control study was performed in order to determine the relation of DNA single (ssb) and double (dsb) strand breaks in women with and without cervical neoplasia. Cervical epithelial cells of 30 women: 10 with low grade squamous intraepithelial lesions (LG-SIL), 10 with high-grade SIL (HG-SIL), and 10 without cervical lesions were evaluated using alkaline and neutral comet assays. A significant increase in global DNA damage (ssb + dsb) and dsb was observed in patients with HG-SIL (48.90 ± 12.87 and 23.50 ± 13.91), patients with LG-SIL (33.60 ± 14.96 and 11.20 ± 5.71), and controls (21.70 ± 11.87 and 5.30 ± 5.38; resp.). Pearson correlation coefficient reveled a strong relation between the levels ssb and dsb (r(2) = 0.99, P = 0.03, and r(2) = 0.94, P = 0.16, resp.) and progression of neoplasia. The increase of dsb damage in patients with HG-SIL was confirmed by DNA breakage detection-FISH (DBD-FISH) on neutral comets. Our results argue in favor of a real genomic instability in women with cervical neoplasia, which was strengthened by our finding of a higher proportion of DNA dsb.

[Molecular detection of human papillomavirus in women with cervical condylomas treated with trichloroacetic acid]. / Detección molecular del virus del papiloma humano en mujeres con condilomas cervicales tratadas con acido tricloroacético.

OBJECTIVES: 1) To determinate the presence of human papillomavirus (HPV) in women with cervical condylomas after the trichloroacetic acid application by the polymerase chain reaction (PCR) test, and 2) to validate the colposcopy test versus the PCR (gold standard). PATIENTS AND METHODS: A selected sample of 28 women of 18 to 45 years old with cervical condyloma acuminate, without evidence of cervical neoplasic lesion and with positive diagnosis of HPV with PCR was included. beta-globin gene was used as internal control and as DNA integrity marker. Women included in this study were divided in: treated group (n = 14), which were treated just one time with trichloroacetic acid to 90% in the cervix, the cul de sacs and the vagina areas, and placebo group (n = 14), which were treated with physiological saline. After eight weeks of being applied the treatment, each one of the 28 women was HPV diagnosed again by colposcopy and PCR. RESULTS: All women amplified for the beta-globin gene. In the treated group, 11/14 (78%) patients did not show amplification. The colposcopy showed two negative false, five positive false, one positive true and six negative true tests, revealing sensitivity of 33.33% and specificity of 54.54%. CONCLUSIONS: From the molecular point of view, this study showed that the trichloroacetic acid application causes physical destruction of the infected tissue, without detecting DNA damage due to the cellular desquamation. On the other hand, the colposcopy regarding the PCR is not an appropriate test for the diagnosis and follow-up of the HPV infection.

Validating polymerase chain reaction for detecting HPV in cervical intraepithelial neoplasia.

OBJECTIVE: To validate polymerase chain reaction (PCR) analysis for detecting HPV in Mexican women with cervical intraepithelial neoplasia, grade 2 and 3 (CIN 2/3) versus histologic evidence. STUDY DESIGN: A diagnostic test study was carried out. A sample of 25 selected women who were diagnosed by histology as having CIN 2/3 was analyzed. Biopsies were examined for HPV infection using light microscopy. The histologic criteria used for HPV infection included koilocytosis, dyskeratosis cells, bi/multinucleation, and parakeratosis. PCR was performed on each sample using commercial probes (MY09 and MY11), and then HPV typing was carried out by restriction fragment length polymorphism analyses. RESULTS: PCR revealed that 88% (22/25) of the women were HPV positive (19 high risk and 3 low risk). In contrast, histology revealed that 28% (7/25) of the women were HPV positive. The number of women infected with HPV was 3.14 times (88/28) more frequently detected with PCR procedure than with the histology. Using PCR as the gold standard, 4 values (true positive, false positive, false negative and true negative) were obtained (7, 0, 15 and 3), and histology had a sensitivity, specificity, and positive and negative predictive values of .32, 1.00, 1.00 and .17, respectively. There was a correlation between low-risk and high-risk for PCR (chi 2 with Yates correction = 6.32, P = .012). CONCLUSION: PCR is a powerful tool for the early detection of HPV infection and is independent of histologic criteria.

Estirpación electroquirúrgica de la zona de transformación realizada como procedimiento ambulatorio, en pacientes con citología cervical anormal / Electrosurgical resection of the transformation zone done as an ambulatory procedure in patients with anormal cervical cytolgy

Setenta y una pacientes con citología cervical anormal fueron sometidas a extiración electroquirúrgica de la zona de transformación, como parte del protocolo de diagnóstico y terapéutico. La extirpación se realizó en consultorio, en forma ambulatoria y mediante anestesia local con un promedio de 10 minutos en su realización. El espécimen obtenido fue aproximadamente de 2 x 2 cm en la superficie y de un cm en profundidad. La mortalidad fue de 9.8 por ciento y considerada menor. Solamente 2.8 por ciento requirió hospitalización. La aceptabilidad del procedimiento por la paciente fue mayor de 95 por ciento. Se concluye que ofrece una exactitud diagnóstica, con técnica de fácil realización y que puede ser una alternativa terpéutica