Lunar Lithium-7 Sensing (δ7Li): Spectral Patterns and Artificial Intelligence Techniques.

Lithium, a critical natural resource integral to modern technology, has influenced diverse industries since its discovery in the 1950s. Of particular interest is lithium-7, the most prevalent lithium isotope on Earth, playing a vital role in applications such as batteries, metal alloys, medicine, and nuclear research. However, its extraction presents significant environmental and logistical challenges. This article explores the potential for lithium exploration on the Moon, driven by its value as a resource and the prospect of cost reduction due to the Moon's lower gravity, which holds promise for future space exploration endeavors. Additionally, the presence of lithium in the solar wind and its implications for material transport across celestial bodies are subjects of intrigue. Drawing from a limited dataset collected during the Apollo missions (Apollo 12, 15, 16, and 17) and leveraging artificial intelligence techniques and sample expansion through bootstrapping, this study develops predictive models for lithium-7 concentration based on spectral patterns. The study areas encompass the Aitken crater, Hadley Rima, and the Taurus-Littrow Valley, where higher lithium concentrations are observed in basaltic lunar regions. This research bridges lunar geology and the formation of the solar system, providing valuable insights into celestial resources and enhancing our understanding of space. The data used in this study were obtained from the imaging sensors (infrared, visible, and ultraviolet) of the Clementine satellite, which significantly contributed to the success of our research. Furthermore, the study addresses various aspects related to statistical analysis, sample quality validation, resampling, and bootstrapping. Supervised machine learning model training and validation, as well as data import and export, were explored. The analysis of data generated by the Clementine probe in the near-infrared (NIR) and ultraviolet-visible (UVVIS) spectra revealed evidence of the presence of lithium-7 (Li-7) on the lunar surface. The distribution of Li-7 on the lunar surface is non-uniform, with varying concentrations in different regions of the Moon identified, supporting the initial hypothesis associating surface Li-7 concentration with exposure to solar wind. While a direct numerical relationship between lunar topography and Li-7 concentration has not been established due to morphological diversity and methodological limitations, preliminary results suggest significant economic and technological potential in lunar lithium exploration and extraction.

Associated Risk Factors and Impact in Clinical Outcomes of Multiorgan Failure in Patients with TBI.

BACKGROUND: Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. METHODS: This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. RESULTS: A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58-8.60] and odds ratio 5.20 [95% confidence interval 3.53-7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. CONCLUSIONS: MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring.

Método simple para minimizar la discrepancia en la longitud de las extremidades y restaurar el offset en la artroplastia total de cadera / A Simple method to minimize limb length discrepancy and restore offset in total hip arthroplasty

Introducción: Existen más de 20 técnicas diferentes para corregir la discrepancia de miembros inferiores. El método que aquí se evalúa se basa en una clavija fija posicionada en el ala ilíaca asociada a un "calibre" móvil, con otra clavija con la que se marca la referencia en el trocánter mayor. Objetivo: Evaluar la confiabilidad de este dispositivo de medición usado durante la artroplastia total de cadera para restaurar la longitud del miembro inferior y el offset femoral. Materiales y Métodos: Se formaron dos grupos: grupo A con pacientes en quienes no se había usado el dispositivo y grupo B con pacientes en quienes sí se había usado el dispositivo. Se realizaron las mediciones en la radiografía panorámica de pelvis obtenida con el paciente de pie, antes de la cirugía y 3 meses después. Resultados: Se obtuvo una muestra de 80 pacientes (40 por grupo). Se logró corregir la discrepancia de la longitud de los miembros, pero no se hallaron diferencias estadísticamente significativas en la corrección promedio, entre ambos grupos (p = 0,07). Sin embargo, al analizar la varianza en la corrección de la discrepancia de la longitud de cada grupo se obtuvo una diferencia estadísticamente significativa (p <0,001). Conclusiones: Este dispositivo que permite una medición cuantificable más objetiva no asegura una corrección de la discrepancia de la longitud exacta a 0 mm, pero sí permite trabajar dentro de un rango más confiable y seguro. Nivel de Evidencia: III

Introduction: There are more than 20 different techniques to correct lower limb length discrepancy. The method evaluated in this study is based on a fixed pin in the iliac wing connected to a mobile gauge and another pin in the greater trochanter with which the reference is marked. The objective is to evaluate the reliability of this measurement device used during THA to restore lower limb length and femoral offset. Materials and Methods: Two groups were formed: Group A (patients who did not use the device) and Group B (patients who did use the device). Measurements were taken in the pre-surgery panoramic pelvic radiograph with the patient standing and three months later. Results: A sample of 80 patients was obtained, with 40 in each group. The difference in limb length could be corrected in each group, however the average correction achieved by both groups did not result in a statistically significant difference (p=0.07). However, when the variance in the correction of the difference in length of each group was examined, a statistically significant difference (p<0.001) was obtained. Conclusions: We can conclude that while this device, which serves as a more objective quantifiable measurement technique, does not guarantee a correction of the exact length discrepancy to 0 mm, it does allow us to work within a more dependable and safe range. Level of Evidence: III

Prevalencia y resultados de cultivos positivos inesperados en revisiones de reemplazo total de cadera presumiblemente asépticas / Prevalence and outcomes of unexpected positive cultures in presumed aseptic revision total hip arthroplasty

Introducción: Las tasas de infección periprotésica, a veces, son subestimadas, ya que muchos casos de presunta falla aséptica pueden deberse a una infección no reconocida. Los objetivos de este estudio fueron: 1) estimar la prevalencia de cultivos positivos intraoperatorios inesperados, 2) determinar si las comorbilidades o los factores de riesgo de los pacientes tuvieron relación con la presencia de cultivos positivos inesperados, 3) determinar la supervivencia del implante en un seguimiento mínimo de 12 meses. Materiales y Métodos: Se realizó un estudio retrospectivo y observacional. En las historias clínicas electrónicas, se identificaron todas las revisiones de artroplastia total de cadera de una única institución entre 2014 y 2021. Resultados: De las 49 revisiones de artroplastia total de cadera en un tiempo, 9 pacientes (18,4%) tuvieron un resultado positivo inesperado. Los microorganismos aislados fueron: Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). Ninguna comorbilidad tuvo significancia estadística para favorecer cultivos positivos inesperados en las revisiones asépticas. El 2% de la muestra, con un período de seguimiento de 49 meses, se reinfectó. Conclusiones: Nuestro estudio arrojó una prevalencia de cultivos positivos inesperados del 18,4%. Ninguno de los factores de riesgo reportados en la bibliografía se asoció con un mayor riesgo de cultivos positivos inesperados, excepto los niveles altos de velocidad de sedimentación glomerular. Nuestros hallazgos son compatibles con los publicados y sugieren que los cultivos positivos inesperados en revisiones presumiblemente asépticas no tienen consecuencias significativas en la supervivencia del implante. Nivel de Evidencia: III

Introduction: Periprosthetic infection rates are sometimes underestimated, given that many cases of presumed aseptic failure may be due to unrecognized infection. The objectives of this study were: (1) to estimate the prevalence of unexpected positive intraoperative cultures; (2) to determine if any of the patient's comorbidities or risk factors were related to the presence of unexpected positive cultures; (3) to determine the implant survival during a follow-up of at least 12 months. Materials and Methods: A retrospective and observational study was carried out where, through electronic medical records, all revision total hip arthroplasties (THAs) from a single institution between 2014 and 2021 were identified. Results: Out of 49 single-stage revision THAs, 9 patients (18.4%) had an unexpected positive culture. The isolated microorganisms were Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). In addition, when we evaluated the comorbidities of the patients, none had statistical significance in favoring unexpected positive cultures in aseptic revisions. We discovered that 2% of our sample with a follow-up period of 49 months developed reinfection. Conclusion: Our study showed a prevalence of unexpected positive cultures of 18.4%. None of the risk factors reported in the literature was associated with a higher risk of unexpected positive cultures, except for high ESR values. Our findings in the analyzed sample suggest that unexpected positive cultures in presumably aseptic revisions do not have significant consequences on implant survival, as found in the literature. Level of Evidence: III

Osteosíntesis en fracturas femorales periprotésicas de cadera Vancouver tipos B1 y C. Análisis multicéntrico / Osteosynthesis in Vancouver type B1 and C periprosthetic hip fractures of the femur. A multicenter analysis

Introducción: Nuestro objetivo fue analizar los resultados del tratamiento con osteosíntesis en pacientes con fracturas Vancouver tipos B1 y C, evaluar las complicaciones, las reintervenciones y la tasa de mortalidad en este grupo. Materiales y métodos: Estudio multicéntrico, retrospectivo. Se estableció una base de datos que incluía a 53 pacientes con fracturas periprotésicas de fémur Vancouver tipos B1 y C tratadas con osteosíntesis, desde 2008 hasta 2021, en dos centros hospitalarios de alta complejidad. Resultados: La fijación proximal más utilizada fue con tornillos bicorticales más lazadas de alambre. El tipo de fractura según la clasificación de Vancouver se correlacionó con un valor significativo en el uso de tornillos de compresión interfragmentaria (p 0,001), con un total de 13 pacientes (24,52%), 9 en fracturas Vancouver tipo C. El tiempo de consolidación promedio fue de 4 meses, con un puntaje promedio del Harris Hip Score de 68. Doce pacientes (22,64%) tuvieron complicaciones: retraso de la consolidación (7 casos; 13,2%), falla de la osteosíntesis con trazo de fractura a nivel distal del tallo (un caso; 1,88%), una nueva osteosíntesis por falla a nivel del material de osteosíntesis (un caso; 1,88%) y tres fallecieron (5,66%). Conclusiones: El manejo de las fracturas femorales periprotésicas es un tema complejo y desafiante. El tratamiento con osteosíntesis constituye un método exitoso que requiere de la aplicación de principios actuales de técnicas mínimamente invasivas que, junto con una fijación proxi-mal estable, mejoran las posibilidades de éxito. Nivel de Evidencia: IV

Introduction: Our objective was to analyze the results of osteosynthesis treatment in patients with Vancouver type B1 and C fractures, evaluate complications, reinterventions and the mortality rate in this group. Materials and methods: Multicenter, retrospective study. A database was established that included 53 patients with Vancouver type B1 and C periprosthetic femoral fractures treated with osteosynthesis, from 2008 to 2021, who were evaluated in two high-complexity hospital centers. Results: The most used proximal fixation was bicortical screws and wire loops. The type of fracture according to the Vancouver classification correlated with a significant value in the use of interfragmentary compression screws (p 0.001), with a total of 13 patients (24.52%), 9 in Vancouver type C fractures. Mean consolidation was 4 months, with a mean Harris Hip Score of 68. Twelve patients (22.64%) had complications: delayed union (7 cases; 13.2%), failed osteosynthesis with fracture at the distal level of the stem (one case; 1.88%), one new osteosynthesis due to failure at the level of the osteosynthesis material (one case; 1.88%) and three patients died (5.66%). Conclusions: The management of periprosthetic femoral fractures is a complex and challenging issue. Osteosynthesis treatment is a successful method that requires the application of current principles of minimally invasive techniques that, together with stable proximal fixation, improve the chances of success. Level of Evidence: IV

Factores de riesgo de inestabilidad en el reemplazo total de cadera por fractura medial de cadera / Instability risk factors in total hip arthroplasty for femoral neck fracture

Introducción: Una de las complicaciones más importantes de la artroplastia total de cadera en el tratamiento de las fracturas es la luxación, con una tasa del 10%, cinco veces mayor que la de la artroplastia total de cadera por osteoartrosis. El objetivo de este estudio fue conocer nuestra incidencia de luxación en pacientes sometidos a artroplastia total de cadera por fractura del cuello femoral y evaluar la causa de la luxación. Materiales y Métodos: Estudio retrospectivo en 110 pacientes sometidos a artroplastia total de cadera por fractura medial de cadera (edad promedio 69 años; 71% mujeres). Se evaluaron el tipo de fijación de la prótesis, el tamaño de la cabeza, el offset y el abordaje quirúrgico. Se midieron los ángulos de inclinación y de anteversión acetabulares y se registraron las comorbilidades. Resultados: El 72% de las cirugías fueron por vía posterolateral. La vía anterolateral se asoció con una copa 7° más vertical (p = 0,001). El 65,4% de las cabezas eran de 32 mm. El 15% (3/20) de las cabezas chicas (22 y 28 mm) y el 1% (1/90) de las grandes se luxaron (p = 0,0027). No se luxó ninguna cabeza de 36 mm. Las comorbilidades neurológicas más frecuentes fueron depresión, Parkinson y Alzheimer. Conclusiones: Las cabezas de pequeño diámetro junto con el mal posicionamiento de la prótesis y las enfermedades neurocognitivas se asocian a una inestabilidad mayor. El uso de cabezas de 36 mm y la correcta orientación de los componentes son suficientes para asegurar la estabilidad. Nivel de Evidencia: III

Introduction: One of the most relevant complications of total hip arthroplasty (THA) in the treatment of fractures is a dislocation rate of 10%, which is 5 times higher than that of THA for osteoarthritis. Our objective was to determine the dislocation rate in patients treated with THA due to femoral neck fracture and to evaluate the cause of dislocation. Materials and Methods: We carried out a retrospective study on 110 THAs in patients with femoral neck fractures (the average age was 69 years, and 71% were women). The type of fixation of the prosthesis, the size of the head, the offset, and the surgical approach were evaluated. The angle of acetabular inclination and anteversion and the comorbidities were measured. Results: 72% of surgeries were performed through the posterolateral approach. The anterolateral approach is associated with a 7° more vertical cup (p=0.001). 65.4% of the heads were 32 mm. 15% of the small heads (22 and 28mm) (3/20) and only 1% of the large heads (1/90) dislocated (p=0.0027). No 36-mm heads were dislocated. Depression, Parkinson's, and Alzheimer's disease were the most frequent neurological comorbidities. Conclusions: Small-diameter heads, in combination with poor positioning of the prosthesis and neurocognitive diseases, are associated with greater instability. Using prosthetic heads with a diameter of 36 mm and a correct orientation of the components is sufficient to ensure stability. Level of Evidence: III

Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients.

BACKGROUND: Schizophrenia is a severe mental disorder that often manifests within the first three decades of life. Its prognosis is uncertain and may result in a prolonged treatment that could extend throughout the entire lifespan of the patient. Antipsychotic drugs are characterized by a high interindividual variability when considering therapeutic effect and emergence of adverse effects. Such interindividual variability is thought to be associated primarily with pharmacokinetic matters. OBJECTIVE: The objective of this study was to evaluate the economic impact of the application of the 5-Step Precision Medicine model (5SPM), an approach based on the pharmacogenetic analysis of the primary genes involved in the metabolism of the therapy for each patient, restructuring treatment as necessary. PATIENTS AND METHODS: One hundred eighty-eight psychiatry patients were analysed for single nucleotide polymorphisms on genes CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5 and ABCB1. Information on patients' diagnosis, pharmacotherapy, and hospitalizations was collected. RESULTS: We achieved a cost-benefit ratio of 3.31-3.59 with a reduction of direct cost (hospitalizations plus pharmacotherapy) with a reduction of total cost in 67% of the patients who underwent the clinical intervention. CONCLUSION: A rational Precision Medicine-based approach to psychiatric patients could result in a reduction on number of drugs required to control exacerbations, and the underlying pathologies, reducing the risk of adverse effects and improving adherence to treatment, leading to a potential decrease in direct costs. This methodology has been shown to be cost-dominant and, being based on a pharmacogenetic analysis, it has a lifelong nature, as the data obtained can be applied to other medical disciplines.

Factores asociados con la mortalidad en pacientes traumáticos con puntuación de 3 en la escala de coma de Glasgow y midriasis bilateral arreactiva / Factors associated with death due to trauma in patients with a Glasgow Coma Scale score of 3 and bilateral fixed dilated pupils

Objetivo. Comparar los pacientes traumáticos con una puntuación de 3 en la escala de coma de Glasgow (Glasgow Coma Scale, GCS) en función de la reactividad pupilar e investigar los factores asociados a la mortalidad hospitalaria en los pacientes con GCS 3 y midriasis bilateral arreactiva.Método. Estudio observacional, prospectivo y multicéntrico. Se incluyeron todos los pacientes traumáticos recogidos con GCS 3 ingresados en las unidades de cuidados intensivos (UCI) participantes desde marzo 2015 hasta diciembre 2019. Se realizó un análisis de regresión logística para el estudio de los factores asociados a la mortalidad hospitalaria en pacientes con GCS 3 puntos y midriasis bilateral arreactiva.Resultados. De los 933 pacientes con GCS 3 puntos, 454 (48,7%) presentaron pupilas simétricas y reactivas, 201 (21,5%) anisocoria arreactiva y 278 (29,8%) midriasis bilateral arreactiva. La mortalidad hospitalaria fue elevada en los 3 grupos: 32,5% con pupilas normales, 54,6% con anisocoria arreactiva y 91,0% con midriasis bilateral arreactiva. La edad, la puntación de 3 o más en el Abbreviated Injury Scale (cabeza) y el shock o shock refractario se aso-ciaron de forma significativa con la mortalidad hospitalaria, siendo la lesión difusa tipo I y II y la lesión masa evacuada factores protectores en los pacientes con 3 puntos en la GCS y midriasis bilateral arreactiva. De los 26 pacientes que sobrevivieron con GCS 3 y midriasis bilateral arreactiva, 12 (46,1%) tuvieron un GCS de 14-15 al alta hospitalaria.Conclusiones. La mortalidad hospitalaria de los pacientes traumáticos con 3 puntos en la GCS y midriasis bilateral arreactiva fue del 91%. La edad, la puntación de 3 o más en el Abbreviated Injury Scale (cabeza) y el shock o shock refractario se asociaron de forma significativa con la mortalidad hospitalaria, siendo la lesión difusa tipo I y II, y la lesión masa evacuada factores protectores en este grupo de pacientes. (AU)

Objectives. To compare patients with a Glasgow Coma Scale (GCS) score of 3 stratified according to pupillary reaction and to explore factors associated with in-hospital death in those with bilateral fixed dilated pupils.Methods. Prospective, observational, multicenter study. We included all patients with trauma and GCS scores of 3 admitted to the intensive care unit from March 2015 to December 2019. Factors associated with in-hospital mortality in the patients with bilateral dilated pupils were explored using multiple regression analysis.Results. Of the 933 patients included, 454 (48.7%) had responsive pupils, 201 (21.5%) had a single fixed dilated pupil, and 278 (29.8%) had bilateral dilation. Hospital mortality was high in all 3 groups: 32.5% in those with normal responsive pupils, 54.6% in those with a single unreactive pupil, and 91.0% in those with bilateral dilation. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. Twelve of the 26 patients (46.1%) with bilateral dilated pupils and GCS scores of 3 had GCS scores of 14 or 15 on discharge from the hospital.Conclusions. The in-hospital mortality was 91% in this study of trauma patients with GCS scores of 3 and bilateral dilated pupils. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. (AU)

GraXRS-Dependent Resistance of Staphylococcus aureus to Human Osteoarthritic Synovial Fluid.

Osteoarthritis is the most prevalent joint disease in the United States, with many patients requiring surgical replacement of the affected joint. The number of joint arthroplasty procedures performed each year is increasing, and infection is a leading cause of implant failure. Staphylococcus aureus is the most frequently isolated organism associated with periprosthetic joint infections of the knee or hip, and due to the emergence of antibiotic-resistant strains, treatment options are limited. Here, we show that synovial fluid from osteoarthritic patients is iron restrictive toward S. aureus and, for strains representing the clonal lineages USA100, USA200, USA400, and USA600, bactericidal. Remarkably, community-associated methicillin-resistant S. aureus (CA-MRSA) strain USA300-LAC was highly resistant to synovial fluid killing but could be sensitized to killing by mutation of the GraXRS regulatory system and GraXRS-regulated mprF gene or by small-molecule inhibition of GraR. Thus, we propose the GraXRS-VraFG regulatory system and mprF as targets for future therapeutics for treatment of S. aureus bone and joint infections.IMPORTANCE Osteoarthritis, a degenerative disease that results in the breakdown of joint cartilage and underlying bone, is the most prevalent joint disease in the United States. Surgical intervention, including total joint replacement, is a clinically effective procedure that can help to restore the patient's quality of life. Unfortunately, joint replacement procedures come with a risk of infection that is estimated to occur in 1 to 2% of cases, and periprosthetic joint infection (PJI) is a leading cause of implant failure, requiring revision surgery. Staphylococcus aureus is well known for its ability to cause PJIs and was found to be the most frequently isolated organism from PJIs of the knee or hip. Antibiotic-resistant strains can often limit treatment options. In this study, we demonstrate that the MRSA strain LAC can resist killing and grow in human synovial fluid from osteoarthritic knees. Furthermore, we show that the GraXRS regulatory system is required for the displayed synovial fluid resistance. We further demonstrate that a small-molecule inhibitor of GraR sensitizes LAC to synovial fluid, validating the Gra system as a therapeutic target for the treatment of PJIs in humans.

Factors associated with death due to trauma in patients with a Glasgow Coma Scale score of 3 and bilateral fixed dilated pupils. / Factores asociados con la mortalidad en pacientes traumáticos con puntuación de 3 en la escala de coma de Glasgow y midriasis bilateral arreactiva.

OBJECTIVES: To compare patients with a Glasgow Coma Scale (GCS) score of 3 stratified according to pupillary reaction and to explore factors associated with in-hospital death in those with bilateral fixed dilated pupils. MATERIAL AND METHODS: Prospective, observational, multicenter study. We included all patients with trauma and GCS scores of 3 admitted to the intensive care unit from March 2015 to December 2019. Factors associated with in-hospital mortality in the patients with bilateral dilated pupils were explored using multiple regression analysis. RESULTS: Of the 933 patients included, 454 (48.7%) had responsive pupils, 201 (21.5%) had a single fixed dilated pupil, and 278 (29.8%) had bilateral dilation. Hospital mortality was high in all 3 groups: 32.5% in those with normal responsive pupils, 54.6% in those with a single unreactive pupil, and 91.0% in those with bilateral dilation. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils. Twelve of the 26 patients (46.1%) with bilateral dilated pupils and GCS scores of 3 had GCS scores of 14 or 15 on discharge from the hospital. CONCLUSION: The in-hospital mortality was 91% in this study of trauma patients with GCS scores of 3 and bilateral dilated pupils. Factors significantly associated with in-hospital death were age, a score of 3 or more on the Abbreviated Injury Scale for the head, and shock or refractory shock. Types I or II diffuse lesions and evacuated mass lesions were protective in patients with GCS scores of 3 and bilateral dilated pupils.

OBJETIVO: Comparar los pacientes traumáticos con una puntuación de 3 en la escala de coma de Glasgow (Glasgow Coma Scale, GCS) en función de la reactividad pupilar e investigar los factores asociados a la mortalidad hospitalaria en los pacientes con GCS 3 y midriasis bilateral arreactiva. METODO: Estudio observacional, prospectivo y multicéntrico. Se incluyeron todos los pacientes traumáticos recogidos con GCS 3 ingresados en las unidades de cuidados intensivos (UCI) participantes desde marzo 2015 hasta diciembre 2019. Se realizó un análisis de regresión logística para el estudio de los factores asociados a la mortalidad hospitalaria en pacientes con GCS 3 puntos y midriasis bilateral arreactiva. RESULTADOS: De los 933 pacientes con GCS 3 puntos, 454 (48,7%) presentaron pupilas simétricas y reactivas, 201 (21,5%) anisocoria arreactiva y 278 (29,8%) midriasis bilateral arreactiva. La mortalidad hospitalaria fue elevada en los 3 grupos: 32,5% con pupilas normales, 54,6% con anisocoria arreactiva y 91,0% con midriasis bilateral arreactiva. La edad, la puntación de 3 o más en el Abbreviated Injury Scale (cabeza) y el shock o shock refractario se asociaron de forma significativa con la mortalidad hospitalaria, siendo la lesión difusa tipo I y II y la lesión masa evacuada factores protectores en los pacientes con 3 puntos en la GCS y midriasis bilateral arreactiva. De los 26 pacientes que sobrevivieron con GCS 3 y midriasis bilateral arreactiva, 12 (46,1%) tuvieron un GCS de 14-15 al alta hospitalaria. CONCLUSIONES: La mortalidad hospitalaria de los pacientes traumáticos con 3 puntos en la GCS y midriasis bilateral arreactiva fue del 91%. La edad, la puntación de 3 o más en el Abbreviated Injury Scale (cabeza) y el shock o shock refractario se asociaron de forma significativa con la mortalidad hospitalaria, siendo la lesión difusa tipo I y II, y la lesión masa evacuada factores protectores en este grupo de pacientes.

Vástagos estriados cónicos modulares en revisión de artroplastia total de cadera. Estudio multicéntrico. Resultados y complicaciones a mediano plazo / Modular fluted tapered stems in revision total hip arthroplasty. Multicenter study. Medium-term results and complication rate

Introducción: Debido al crecimiento exponencial del número de artroplastias de cadera, se espera una mayor cantidad de re-visiones en las próximas décadas. Los vástagos cónicos estriados modulares se han vuelto populares en la última década por sus resultados favorables. El objetivo de este estudio es evaluar los resultados, las complicaciones y la tasa de supervivencia de estos vástagos en las revisiones de cadera, con un seguimiento a mediano plazo. materiales y métodos: Estudio multicéntrico, retrospectivo. Se incluyeron 182 pacientes a quienes se les realizó una cirugía de revisión de cadera entre 2007 y 2017. Se colo-caron 185 vástagos cónicos estriados de fijación distal. El déficit de stock óseo femoral se clasificó según Paprosky y Burnett; y las facturas periprotésicas, según la clasificación de Vancouver. Se evaluó a los pacientes clínicamente con el Harris Hip Score (HHS) y con radiografías a los 3 meses y anualmente para evaluar la estabilidad del vástago, la subsidencia y el aflojamiento, así como la consolidación de la osteotomía. Resultados: Seguimiento medio 55.18 meses. El HHS posoperatorio tuvo una media de 80,28 (DE = 12,8, IC95% 78,5-82,97). No hubo complicaciones posoperatorias en el 75,4% de los pacientes. Las complicaciones más frecuentes fueron inestabilidad (7,6%) y subsidencia del implante (11,5%). Al final del seguimiento, el 95,05% de los pacientes tenía un implante estable. Conclusiones: Los vástagos cónicos estriados modulares de fijación distal proporcionan una solución confiable, reproducible y duradera para el manejo de revisiones de componentes femorales a medio plazo. Nivel de Evidencia: IV

Background: The number of arthroplasties performed every year is increasing; therefore, a greater number of revisions is expected in the coming decades. Modular fluted tapered stems have become the gold standard for their results in different series of patients. The objective of this article is to evaluate the results, complications and the survival rate of these stems in hip revisions with a medium-term follow-up. Materials and Methods: Retrospective, multicenter analysis. One hundred eighty-two patients who had undergone hip revision surgery between 2007 and 2017 were included. One hundred eighty-five modular fluted tapered stems were placed. Femoral bone stock defects were classified according to Paprosky and Burnett; and periprosthetic femur fractures according to Vancouver classification. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically 3 months after surgery and every year to assess stem stability, subsidence and loosening, as well as osteotomy healing. Results: Average follow-up was 55.18 months. Postoperative HHS had an average of 80.28 (SD = 12.8, 95% CI = [78.5, 82.97]). There were no postoperative complications in 75.4% of the patients. The most frequent complications were instability in 7.6% and implant subsidence in 11.5%. At the end of the follow-up, 95.05% of the patients had a stable implant. Conclusion: Modular fluted tapered stems provide a reliable, reproducible solution for the management of femoral component revisions at medium-term. Level of Evidence: IV

Estudio prospectivo comparativo del manejo de la analgesia preventiva en pacientes sometidos a artroplastia total de rodilla primaria / Comparative prospective study of the management of preventive analgesia in patients undergoing primary total knee arthroplasty

Introducción: La analgesia preventiva es aquella que se administra horas o días antes de una artroplastia total de rodilla con el fin de reducir el dolor posoperatorio. El objetivo de este estudio fue comparar y analizar la eficacia clínica de la analgesia preventiva en los pacientes sometidos a un reemplazo total de rodilla. materiales y métodos: Noventa y seis pacientes, divididos en dos grupos de 48 pacientes, fueron evaluados prospectivamente y comparados entre noviembre de 2018 y marzo de 2019. El grupo A recibió analgesia preoperatoria con una combinación de etoricoxib, tramadol y paracetamol, por vía oral, 2 horas antes de la cirugía. El grupo B de control no recibió analgesia. El dolor posoperatorio de los pacientes se evaluó de acuerdo con sus propios registros en una escala analógica visual a las 12, 24, 48, 72 h y una semana después de la cirugía. Resultados: Se observó una diferencia significativa a las 24 h entre ambos grupos, el dolor fue significativamente menor en el grupo A (p = 0,001), a las 48 h la diferencia fue estadísticamente menor que a las 24 h (p = 0,016). También se observó que el grupo de control requirió más cantidad de rescates, aunque la diferencia solo fue significativa a las 24 h (p = 0,047). Conclusión: La combinación de etoricoxib, tramadol y paracetamol es eficaz, segura, económica y fácil de administrar, y la tasa de efectos adversos de la analgesia es baja; por lo tanto, representa un esquema adecuado para el manejo de la analgesia preventiva. Nivel de Evidencia: IIb

Background and Objective: Preventive analgesia is one that is administered hours or days before a total knee arthroplasty in or-der to reduce postoperative pain. The objective of this study was to compare and analyze the clinical efficacy of the use of preven-tive analgesia in patients undergoing total knee replacement. materials and methods: Ninety-six patients, divided into two groups of 48 patients, were evaluated prospectively and comparatively between November 2018 and March 2019. Group A received preoperative analgesia with a combination of etoricoxib, tramadol, and paracetamol, orally, 2 hours before surgery. Control group B, did not receive anything. The postoperative pain of the patients was evaluated according to their own records on a visual analog scale at 12, 24, 48, 72 hours and one week after surgery. Results: A significant difference was observed at 24 hours between both groups, pain was significantly less for group A (p = 0.001), at 48 hours the difference was statistically lower than at 24 hours (p = 0.016). It was also observed that the control group required a greater number of rescues, although the difference was only significant at 24 hours (p = 0.047). Conclusion: The combination of etoricoxib, tramadol and paracetamol represents an effective, safe, economical, easy to administer form with a low rate of analgesia adverse effects; which represents an adequate scheme for the management of preventive analgesia.Key words: Knee arthrosplasty; pain; preemptive analgesia. Level of evidence: IIb

Influencia de la fusión espinal en la orientación del implante acetabular / Influence of spinal fusion on acetabular implant orientation

Introducción: Las enfermedades degenerativas de la cadera y la columna vertebral son causas comunes de discapacidad y dolor y los síntomas suelen superponerse. Cuando algún parámetro se altera, otro debe modificarse para evitar el choque femoroacetabular y una posible luxación. Se piensa que la fijación lumbar afectaría la adaptación de la unidad espino-pélvica en las diferentes posturas. El objetivo de este estudio fue analizar el comportamiento espino-pélvico en pacientes con artroplastia total de cadera y artrodesis lumbar. Materiales y Métodos: Se realizó un estudio no aleatorizado, retrospectivo, de casos y controles en pacientes con artroplastia total de cadera evaluados con radiografía lumbopélvica de frente y de perfil en posición erecta y en sedestación, divididos en dos grupos: con artrodesis lumbar o sin ella. Se midieron parámetros espino-pélvicos y femoroacetabulares. Resultados: La muestra tenía 50 pacientes: 25 en cada grupo. Quince tenían artroplastia total de cadera bilateral y el nivel de fijación lumbar más frecuente era L5-S1. No hubo diferencia estadísticamente significativa en la edad y el sexo entre ambos grupos. Los pacientes con artrodesis lumbar necesitaron más flexión de cadera para sentarse, sin un aumento significativo asociado en la tasa de luxación. Conclusiones: La composición ideal de los componentes aún es difícil de alcanzar. La reconsideración de las "zonas seguras" de los componentes ha comenzado a alejarse de los valores del plano coronal de Lewinnek. Se ha propuesto un nuevo enfoque en las zonas seguras del plano sagital más apropiadas y precisas en pacientes seleccionados con enfermedad espino-pélvica grave. Nivel de Evidencia: III

Introduction: Degenerative diseases of the hip and spine are common causes of disability and pain, and the symptoms usually overlap. When a parameter is altered, another one should be modified to avoid femoroacetabular impingement and a potential dislocation. It is believed that lumbar fixation would affect the adaptation of the spinopelvic unit in different postures. This article aims to analyze the spinopelvic behavior in patients with Total Hip Arthroplasty (THA) and lumbar arthrodesis. Materials and Methods: A non-randomized retrospective study of cases and controls was carried out in patients with THA, who were assessed using anterior and lateral X-ray views in functional sitting and standing postures, divided into two groups depending on the presence or absence of lumbar arthrodesis. Spinopelvic parameters as well as femoroacetabular parameters were measured. Results: A sample of 50 patients was selected, 25 in each group. In total, 15 patients had bilateral THA, and the most common level of lumbar fixation was L5-S1. There was no statistically significant difference in gender and age between both groups. Lumbar arthrodesis patients required more hip flexion to sit, without being associated with a significant increase in the rate of dislocation. Conclusion: The ideal composition of the components is still difficult to achieve. The review of the "safe zones" of the components has started to depart from the values of the body plane proposed by Lewinnek. A new approach has been proposed to the safe zones of the sagittal plane, which are more appropriate and accurate in selected patients with severe spinopelvic pathology. Level of Evidence: IIII

Application of a Pharmacogenetics-Based Precision Medicine Model (5SPM) to Psychotic Patients That Presented Poor Response to Neuroleptic Therapy.

Antipsychotics are the keystone of the treatment of severe and prolonged mental disorders. However, there are many risks associated with these drugs and not all patients undergo full therapeutic profit from them. The application of the 5 Step Precision Medicine model(5SPM), based on the analysis of the pharmacogenetic profile of each patient, could be a helpful tool to solve many of the problematics traditionally associated with the neuroleptic treatment. In order to solve this question, a cohort of psychotic patients that showed poor clinical evolution was analyzed. After evaluating the relationship between the prescribed treatment and pharmacogenetic profile of each patient, a great number of pharmacological interactions and pharmacogenetical conflicts were found. After reconsidering the treatment of the conflictive cases, patients showed a substantial reduction on mean daily doses and polytherapy cases, which may cause less risk of adverse effects, greater adherence, and a reduction on economic costs.

Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI).

INTRODUCTION: Acute kidney injury (AKI) constitutes a common complication after severe trauma. Our objective was to analyse the associated risk factors and outcomes of AKI in a large, multicentre sample of trauma ICU patients. MATERIALS AND METHODS: Observational, prospective and multicentre nationwide registry (RETRAUCI). We included all patients admitted to the participating ICUs from November 2013 to May 2017. We analysed the impact of AKI evaluated by the Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) definition. Comparison of groups was performed using Wilcoxon test, Chi-Square Test or Fisher's exact test as appropriate. A multiple logistic regression analysis was performed to analyse associated factors to the development of AKI. Logistic regression was used to calculate AKI-related mortality. A P value<0.05 was considered significant. RESULTS: During the study period, 5882 trauma patients were admitted. Complete data were available for 5740 patients. Among them, 871 had AKI (15.17%), distributed by RIFLE R 458 (7.98%), RIFLE I 234 (4.08%) and RIFLE F 179 (3.12%). Associated risk factors were: age (OR 3.05), haemodynamic instability (OR 2.90 to OR 8.34 depending on the severity of hypotension), coagulopathy (OR 1.82), rhabdomyolysis (OR 4.67) and AIS abdomen (OR 1.54). AKI was associated with mortality (crude OR 1.93 (1.59-2.36)), even after adjusting by potential confounders (adjusted OR 1.40 (1.13-1.73)). CONCLUSION: In our large sample of trauma ICU patients we found an incidence of AKI of 15%, which was associated with an increased mortality.

Tratamiento conservador versus tratamiento quirúrgico de fracturas de estiloides cubital en el contexto de fracturas del radio distal / Conservative vs. surgical management of ulnar styloid fractures associated with distal radius fractures

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volar bloqueada. Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II). Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH y el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024). Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. Nivel de Evidencia: III

Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. Level of Evidence: III