Randomized clinical trial on the usefulness of 3D printing in intra-articular fractures of the distal radius. / Ensayo clínico aleatorizado sobre la utilidad de la impresión 3D en las fracturas intraarticulares de radio distal.

OBJECTIVES: We evaluated the utility of 3D printing technology for preoperative planning in the treatment of intra-articular fractures of the distal radius in relation to the improvement of surgical technique, radiological and clinical results. MATERIAL AND METHODS: A total of 30 patients with 2B and C fractures of the AO classification were operated on by a single surgeon with a volar plate, randomly divided into two groups, 15 of them with conventional planning (Rx and CT) and 15 adding a 3D model of the fracture and the previous simulation of the intervention. Simulation time, surgical time in minutes, radioscopy time in minutes, loss of material expressed in lost screws were recorded. Clinical evaluation based PRWE questionnaire and full radiographic analysis was done for all patients with a mean follow-up of 6 months by an independent, blinded observed. RESULTS: No statistically significant differences were observed in the PRWE questionnaire (p=0.22), nor were we observed differences in the radiological values, except in relation to the articular step (p=0.028), which represents statistical significance, but in both groups the median was of 0.0 (0.0-0.0). We also did not see statistically significant differences in surgical times (p=0.745), radioscopy (p=0.819) or in the loss of synthesis material (p=0.779). CONCLUSIONS: 3D printing has not improved the parameters studied in relation to routinely operated patients.

Reducing rumen starch fermentation of wheat with three percent sodium hydroxide has the potential to ameliorate the effect of heat stress in grain-fed wethers.

Selection for high productivity has resulted in ruminants adversely affected by heat stress (HS) due to their high metabolic rate and feed intake. One mechanism to ameliorate HS is to reduce the forage-to-concentrate ratio in the diet, although the inclusion of readily fermentable grains can reduce heat tolerance. The aim of these experiments was to investigate a chemical method for reducing the rate of fermentation of wheat and its effect on improving heat tolerance in sheep. In the first experiment, fermentation kinetics and buffered rumen fluid pH variation during in vitro incubation of corn, wheat, and 3% NaOH-treated wheat grains were compared. This experiment showed that corn and 3% NaOH-treated wheat had a slower (-23 and -22%, respectively; < 0.001) rate of gas production and elevated buffered rumen fluid pH ( < 0.001) compared with wheat. In the second experiment, 31 Merino × Poll Dorset wethers were housed in 2 climate-controlled rooms and were fed either corn grain plus forage (42.7% starch; were fed either corn grain plus forage (CD), wheat grain plus forage (WD) or 3 % NaOH-treated wheat plus forage (TWD) during 3 experimental periods: period 1 (P1), which consisted of 7 d of thermoneutral conditions (18 to 21°C and 40 to 50% relative humidity) and 1.7 times maintenance feed intake; period 2 (P2), which consisted of 7 d of HS (28 to 38°C and 30 to 50% relative humidity) and the same feed intake as in P1; and period 3 (P3), which consisted of 7 d of HS as in P2 and 2 times maintenance feed intake in a randomized control experiment. Water was offered ad libitum. The impact of HS was quantified by increases in rectal temperature, respiration rate (RR), and flank skin temperature (FT); variations in blood acid-base balance; and glucose, NEFA, and heat shock protein 70 (HSP-70) plasma concentrations. All physiological variables were elevated during HS, especially when wethers had greater feed intake (P3). Wethers fed CD had lower RR, rectal temperature, and FT than wethers fed WD ( < 0.001) and wethers fed TWD had lower RR and FT than wethers fed WD during HS ( < 0.05). There were reductions in blood CO, HCO3, and base excess concurrent with increases in blood partial pressure of O and pH during HS ( < 0.05). Heat stress reduced plasma NEFA and glucose concentrations whereas it increased prolactin ( < 0.05). Prolactin and HSP-70 plasma concentrations were greater for WD-fed wethers ( < 0.001) associated with Prolactin and HSP-70 plasma concentrations were greater for WD fed wethers (P < 0.001) during HS. These data indicate that the slow rate of rumen fermentation of CD and TWD can reduce the heat released during feed fermentation in the rumen, improving heat tolerance in sheep.

Colgajo fasciocutáneo safeno interno desdoblado / Splitting a fasciocutaneous internal saphenous flap

La cobertura de defectos de tejidos blandos en el tercio distal de la pierna y pie con exposición ósea y tendinosa, representa un reto para el cirujano plástico dado que las opciones reconstructivas para esta zona son limitadas. En la actualidad, este tipo de defectos se tratan frecuentemente con colgajos libres, si bien los colgajos fasciocutáneos continúan siendo una buena alternativa de menor complejidad y mayor disponibilidad en todos los centros, a diferencia de las técnicas microquirúrgicas. El colgajo safeno interno es una de las opciones locales disponibles, de fácil ejecución y escasa morbilidad en el área donante, y el desdoblamiento de los tejidos que lo componen (fascia - piel y subcutáneo) facilita la cobertura de defectos secundarios sin tener que recurrir a un nuevo colgajo, con todo lo que ello implica. Presentamos un caso de colgajo safeno interno desdoblado de una forma no descrita previamente para cobertura de un defecto secundario en tercio distal de la pierna tras fractura abierta y osteosíntesis, cuyos resultados postoperatorios fueron satisfactorios y sin complicaciones tras 18 meses de seguimiento (AU)

Covering defects of soft tissue on the distal half of legs and feet with bone and tendon exposure represents a challenge to the plastic surgeon because the options for reconstruction of this part of the body are limited. Nowadays, this kind of defects are most frequently treated with free flaps, although the fasciocutaneous flaps are still a good choice with less complexity and they are available in most of the plastic surgery centers, unlike the microsurgical techniques. The internal saphenous flap is one of the available local options; its easy execution, the minimal morbidity of the donor area and the splitting of the tissues involved (fascia, skin and subcutaneous tissue) facilitate the coverage of secondary defects, without the needing of new flaps in the future, with all the implications it represents. We present a clinical case of a fasciocutaneous internal saphenous flap, splitted in a way unreported previously, to cover a secondary defect on the distal third of the leg after an open fracture that required osteosynthesis, whose results were satisfactory and without complications after a follow up of 18 months (AU)