Economic evaluation of high tibial osteotomy: Closing wedge is more cost-effective than open wedge technique when analysing the KOOS-12 improvement.

PURPOSE: The purpose of this study was to compare the cost-effectiveness of two techniques for performing a knee valgus osteotomy: opening wedge high tibial osteotomy (OW-HTO) vs closing wedge high tibial osteotomy (CW-HTO). METHODS: In this economic evaluation study, a cost-effectiveness analysis from the perspective of the Spanish public healthcare system was performed, comparing OW-HTO with CW-HTO. All patients with medial knee osteoarthritis who underwent one of these procedures between 2018 and 2020 in our institution were included. The cost analysis included operating room, implant, graft and hospital admission costs. Functional outcomes (KOOS-12, Tegner activity scale, pain and satisfaction) and radiological outcomes (hip-knee-ankle angle, medial proximal tibial angle, tibial slope and patellar height) were analysed. The cost-effectiveness ratio was obtained by calculating the cost of improving the minimal clinically important difference (MCID) of KOOS-12 for each procedure. All costs are expressed in 2020 euros. RESULTS: Fifty-one patients met the inclusion criteria (27 OW-HTO and 24 CW-HTO). Good to excellent functional outcomes, significant pain reduction (>6 points) and high patient satisfaction (>9/10) were observed in both groups. Both techniques yielded excellent radiological outcomes. N.s. differences in functional or radiological outcomes improvements between both procedures were found. However, the OW-HTO group presented a higher total cost than the CW-HTO group (4612.1 ± 765.6€ vs. 1827.1 ± 701.9€; p < 0.001). The cost-effectiveness ratio was 818.1 ± 46.8 €/MCID for the CW-HTO procedure and 2414.3 ± 115.2 €/MCID for the OW-HTO procedure (p = 0.025). CONCLUSION: The CW-HTO procedure presented a cost-effectiveness ratio almost three times lower than the OW-HTO procedure. Both techniques allowed to achieve of good to excellent functional outcomes, significant pain reduction and high patient satisfaction while correcting the varus limb malalignment and the metaphyseal tibial varus in patients with medial compartment osteoarthritis. LEVEL OF EVIDENCE: Level III; economic study.

An Unusual Cause of Right Heart Dysfunction and High Output Heart Failure in a Young Woman.

A 35-year-old female presented to our emergency department with clinical signs of acute heart failure. Clinical workup identified severe right heart (RH) dilation and dysfunction with a crossing membrane structure in the right atrium. Right heart catheterization confirmed high output heart failure (HOHF), pulmonary hypertension (PH), and left-to-right blood shunting followed by the documentation of multiple liver and pulmonary arteriovenous malformations (AVMs). Hereditary Hemorrhagic Telangiectasia (HHT) diagnosis was made according to clinical criteria and was established as the cause of HOHF because of chronic volume overload from systemic to pulmonary shunts. With this illustrative case, we aim to discuss the broad spectrum of clinical manifestations of HHT and the unusual phenotype of HOHF secondary to HHT. This case also highlights the broad diagnosis of atrial echocardiographic abnormalities and cardiac structural distortion secondary to high output that can be misleading at imaging evaluation.

Improving Properties of Starch-Based Adhesives with Carboxylic Acids and Enzymatically Polymerized Lignosulfonates.

A novel strategy for improving wet resistance and bonding properties of starch-based adhesives using enzymatically polymerized lignosulfonates and carboxylic acids as additives was developed. Therefore, lignosulfonates were polymerized by laccase to a molecular weight of 750 kDa. Incorporation of low concentrations (up to 1% of the starch weight) of 1,2,3,4-butanetetracarboxylic acid (BTCA) led to further improvement on the properties of the adhesives, while addition of greater amounts of BTCA led to a decrease in the properties measured due to large viscosity increases. Great improvements in wet-resistance from 22 to 60 min and bonding times (from 30 to 20 s) were observed for an adhesive containing 8% enzymatically polymerized lignin and 1% BTCA. On the other hand, the addition of citric acid (CA) deteriorated the properties of the adhesives, especially when lignosulfonate was present. In conclusion, this study shows that the addition of the appropriate amount of enzymatically polymerized lignosulfonates together with carboxylic acids (namely BTCA) to starch-based adhesives is a robust strategy for improving their wet resistance and bonding times.

Annual Nitrogen Balance from Dairy Barns, Comparison between Cubicle and Compost-Bedded Pack Housing Systems in the Northeast of Spain.

The aim of this study was to determine N recovery and irreversible losses (i.e., through NH3-N volatilization) from manure in two different housing systems throughout a year using an N mass balance approach. Dietary, milk, and manure N were monitored together with outside temperatures in six dairy barns during six months, comprising two different seasons. Three barns were designed as conventional free stalls (cubicle, CUB) and the other three barns as compost-bedded packs (CB). All the barns were located in the Ebro's valley, in the northeast of Spain. Mass N balance was performed simultaneously in the six barns, during two three-month periods (Season I and II) and sampling at a 15-day interval. Results of ANOVA analysis showed that annual N retained in manure (kg/head per year) from cows housed in CUB barns was significantly higher than in manure from cows housed in CB (133.5 vs. 70.9, p < 0.001), while the opposite was observed for N losses (26.9 vs. 84.8, for CUB and CB barn, respectively; p < 0.005). The annual mean proportion of irreversible N loss from manure in relation to N intake was much lower in barns using conventional free-stall cubicles than the mean ratio registered in bedded pack systems barns.

Clinical and Echocardiographic Findings in an Aged Population of Cavalier King Charles Spaniels.

Myxomatous mitral valve disease (MMVD) is the most common cardiac disease in dogs. It varies from dogs without clinical signs to those developing left-sided congestive heart failure, leading to death. Cavalier King Charles Spaniels (CKCSs) are particularly susceptible to MMVD. We hypothesised that within the elderly CKCS population, there is a sub-cohort of MMVD-affected dogs that do not have cardiac remodelling. The objectives of the present study were (i) to determine the prevalence and the degree of cardiac remodelling associated with MMVD; and (ii) assess the effect of age, gender, and body weight on echocardiographic status in a population of aged CKCSs. A total of 126 CKCSs ≥ 8 years old were prospectively included. They all had a physical and echocardiographic examination. A systolic murmur was detected in 89% of dogs; the presence of clinical signs was reported in 19% of them; and echocardiographic evidence of MMVD was described in 100%. Despite the high prevalence, 44.4% of the dogs were clear of echocardiographic signs of cardiac remodelling. Age was significantly associated with the presence and severity of cardiac remodelling and mitral valve prolapse. Our results showed that a proportion of elderly CKCS with confirmed MMVD did not undergo advanced stages of this pathology.

The Impact of Producing Type and Dietary Crude Protein on Animal Performances and Microbiota Together with Greenhouse Gases Emissions in Growing Pigs.

In order to reduce dietary nitrogen and achieve an efficient protein deposition as well as decrease N wastage, we challenged the nutrient utilization efficiency of two different producing types in front of a dietary crude protein (CP) restriction and studied the role of the microbiota in such an adaptation process. Therefore, 32 pure castrated male Duroc (DU) and 32 entire male hybrid (F2) piglets were raised in a three-phase feeding regime. At each phase, two iso caloric diets differing in CP content, also known as normal protein (NP) and low protein (LP), were fed to the animals. LP diets had a fixed restriction (2%) in CP content in regards to NP ones throughout the phases of the experiment. At the end of third phase, fecal samples were collected for microbiota analysis purposes and greenhouse gases emissions, together with ammonia, were tested. No changes were found in average daily feed intake (ADFI) of animals of two producing types (Duroc vs. F2) or those consumed different experimental diets (NP vs. LP) throughout the course of study. However, at the end of each experimental phase the average body weight (BW) of hybrid animals were higher compared to Duroc pigs, whereas a reverse trend was observed for average daily gain (ADG), where Duroc pigs showed greater values with respect to hybrid ones. Despite, greater CH4 and ammonia emissions in Duroc pigs with respect to F2, no significant differences were found in contaminant gases emissions between diets. Moreover, LP diets did not alter the microbial community structure, in terms of diversity, although some genera were affected by the dietary challenge. Results suggest that the impact of reducing 2% of CP content was limited for reduction in contaminant gases emissions and highlight the hypothesis that moderate change in the dietary protein levels can be overcome by long-term adaptation of the gut microbiota. Overall, the influence of the producing type on performance and digestive microbiota composition was more pronounced than the dietary effect. However, both producing types responded differently to CP restriction. The use of fecal microbiota as biomarker for predicting feed efficiency has a great potential that should be completed with robust predictive models to achieve consistent and valid results.

Observational Study of Total Knee Arthroplasty in Aseptic Revision Surgery: Clinical Results.

OBJECTIVE: To review the long-term clinical results after revision surgery and the relationship between the different clinical variables involved with a failed total knee arthroplasty (TKA) and its evolution to provide a better understanding of the current treatment methods. METHODS: The present study involved 89 subjects with a failed knee arthroplasty that ended up requiring revision surgery and component replacement between 2011 and 2015. The study included patients with pain remaining after TKA and indication from the knee unit surgeon to review the implant, without presenting with thromboembolic or neurological changes that could bias the results. The demographic data, surgical information, type of implant, and causes of failure were analyzed. The patients subjected to replacement surgery were specifically asked to fill out clinical and satisfaction questionnaires (Lysholm and KOOS). The mean follow-up was 5.6 years (range, 3-11 years) and the analysis was divided into early revision (<5 years) and late revision (>5 years). The R statistical package version 3.2.5 for Windows was used, with significance less than 0.05 Cohort observational study. RESULTS: The results indicated that implant revisions accounted for 5.57% of total primary implants, with a mean survival of 6 years for primary prosthesis failure. The mean revision surgery result on the Lysholm knee scoring scale was 68.73 out of 100 points. A better score was obtained for revisions undertaken on TKA with over 5 years' survival and there were no significant differences in terms of the type of implant used. The causes of TKA failure were aseptic loosening (77.38%), instability (9.52%), and painful prosthesis (13.10%). The results were statistically significant when isolated revisions were performed on one component. Rating worse on most of the questionnaire subscales. CONCLUSION: The clinical results were better in primary implant replacements with at least 5 years' survival. The replacement of only one of the components (tibial or femoral) provided worse clinical results than total replacement.

A comparative study of the neuromuscular response during a dynamic activity after anterior cruciate ligament reconstruction.

BACKGROUND: Injury to the anterior cruciate ligament (ACL) not only causes mechanical instability but also produces proprioceptive deficit with an altered neuromuscular response. After ACL reconstruction, patients in general continue to complain of a feeling of knee instability. The objective of our study was to assess patient proprioception and its evolution over time by measuring the muscle latency time during a dynamic activity. METHODS: Twenty-five patients with an ACL tear following sports injuries were included in a prospective, comparative, matched controlled study. The study group consisted of the injured knees in those patients, while the control group consisted of the contralateral non-injured knee in the same patients. The neuromuscular response in five leg muscles (vastus medialis, vastus lateralis, rectus femoris, semitendinosus and biceps femoris) was measured during a dynamic activity through the muscle latency time via the use of electromyography. RESULTS: The comparison of the reaction time in the vastus medialis showed that time in the injured knee was longer at pre-op, but it reduced over time reaching a value at 6 months post-op that was close to the reaction time in the non-injured knee group. In the rectus femoris, biceps femoris and semitendinosus muscles, the reaction times in the injured knee group were similar to those in the non-injured knee group at pre-op and post-op visits. CONCLUSION: Before ACL surgery, the muscle latency time of the vastus medialis was significantly longer in the injured knee group than in the non-injured knee group. 'Muscle reflex reaction' as a response during a dynamic task improved in the ACL reconstructed patients at 6 months post-op. LEVEL OF EVIDENCE: Prospective, comparative, matched controlled study.

Experiencia e historia crítica de la locura en Michel Foucault / Experience and critical history of madness in Michel Foucault

El presente artículo argumenta que, si bien es complicado establecer continuidades en la obra de Michel Foucault, hay al menos dos cuestiones, una teórica y otra temática, que pueden ser consideradas como constantes a lo largo de su trayectoria. Así, si bien se consideran adecuadas las lecturas de la obra de Foucault que desde lo metodológico dividen su trayectoria en dos (arqueología y genealogía), o mejor aún, las perspectivas temáticas que dividen su obra en tres (saber, poder y subjetividad), se comparte lo propuesto por Luca Paltrinieri en cuanto a que es más útil comprender su producción intelectual en función de una serie de transformaciones clave en torno al concepto de experiencia. Tomando en cuenta esta consideración, el artículo aborda las consecuencias de dichas transformaciones con el objetivo de brindar un panorama esquemático de las contribuciones teóricas y analíticas de Michel Foucault para una historia crítica de la psiquiatría

The present article argues that, although it is difficult to find continuities in the work of Michel Foucault, there are at least two questions, one theoretical and one thematic, that can be considered constant throughout his career. Thus, although the interpretations of Foucault’s work that divide his trajectory into two periods (archeology and genealogy), or better, into three thematic perspectives (knowledge, power and subjectivity), are considered adequate, we share Luca Paltrinieri’s proposal according to which it is more useful to understand his intellectual production in terms of a series of key transformations in the concept of experience. Taking this consideration into account, the article addresses the consequences of these transformations with the aim of providing a schematic overview of the theoretical and analytical contributions of Michel Foucault for a critical history of psychiatry

Multi-Robot Coalitions Formation with Deadlines: Complexity Analysis and Solutions.

Multi-robot task allocation is one of the main problems to address in order to design a multi-robot system, very especially when robots form coalitions that must carry out tasks before a deadline. A lot of factors affect the performance of these systems and among them, this paper is focused on the physical interference effect, produced when two or more robots want to access the same point simultaneously. To our best knowledge, this paper presents the first formal description of multi-robot task allocation that includes a model of interference. Thanks to this description, the complexity of the allocation problem is analyzed. Moreover, the main contribution of this paper is to provide the conditions under which the optimal solution of the aforementioned allocation problem can be obtained solving an integer linear problem. The optimal results are compared to previous allocation algorithms already proposed by the first two authors of this paper and with a new method proposed in this paper. The results obtained show how the new task allocation algorithms reach up more than an 80% of the median of the optimal solution, outperforming previous auction algorithms with a huge reduction of the execution time.

High-Resolution Underwater Mapping Using Side-Scan Sonar.

The goal of this study is to generate high-resolution sea floor maps using a Side-Scan Sonar(SSS). This is achieved by explicitly taking into account the SSS operation as follows. First, the raw sensor data is corrected by means of a physics-based SSS model. Second, the data is projected to the sea-floor. The errors involved in this projection are thoroughfully analysed. Third, a probabilistic SSS model is defined and used to estimate the probability of each sea-floor region to be observed. This probabilistic information is then used to weight the contribution of each SSS measurement to the map. Because of these models, arbitrary map resolutions can be achieved, even beyond the sensor resolution. Finally, a geometric map building method is presented and combined with the probabilistic approach. The resulting map is composed of two layers. The echo intensity layer holds the most likely echo intensities at each point in the sea-floor. The probabilistic layer contains information about how confident can the user or the higher control layers be about the echo intensity layer data. Experimental results have been conducted in a large subsea region.

Trajectory-based visual localization in underwater surveying missions.

We present a new vision-based localization system applied to an autonomous underwater vehicle (AUV) with limited sensing and computation capabilities. The traditional EKF-SLAM approaches are usually expensive in terms of execution time; the approach presented in this paper strengthens this method by adopting a trajectory-based schema that reduces the computational requirements. The pose of the vehicle is estimated using an extended Kalman filter (EKF), which predicts the vehicle motion by means of a visual odometer and corrects these predictions using the data associations (loop closures) between the current frame and the previous ones. One of the most important steps in this procedure is the image registration method, as it reinforces the data association and, thus, makes it possible to close loops reliably. Since the use of standard EKFs entail linearization errors that can distort the vehicle pose estimations, the approach has also been tested using an iterated Kalman filter (IEKF). Experiments have been conducted using a real underwater vehicle in controlled scenarios and in shallow sea waters, showing an excellent performance with very small errors, both in the vehicle pose and in the overall trajectory estimates.

The uspIC: performing scan matching localization using an imaging sonar.

This paper presents a novel approach to localize an underwater mobile robot based on scan matching using a Mechanically Scanned Imaging Sonar (MSIS). When used to perform scan matching, this sensor presents some problems such as significant uncertainty in the measurements or large scan times, which lead to a motion induced distortion. This paper presents the uspIC, which deals with these problems by adopting a probabilistic scan matching strategy and by defining a method to strongly alleviate the motion induced distortion. Experimental results evaluating our approach and comparing it to previously existing methods are provided.

Sonar sensor models and their application to mobile robot localization.

This paper presents a novel approach to mobile robot localization using sonar sensors. This approach is based on the use of particle filters. Each particle is augmented with local environment information which is updated during the mission execution. An experimental characterization of the sonar sensors used is provided in the paper. A probabilistic measurement model that takes into account the sonar uncertainties is defined according to the experimental characterization. The experimental results quantitatively evaluate the presented approach and provide a comparison with other localization strategies based on both the sonar and the laser. Some qualitative results are also provided for visual inspection.

Tratamiento quirúrgico de la luxación recidivante del hombro con la técnica de Bankart / Surgical treatment for recurrent dislocation of the shoulder with the Bankart procedure

El éxito del tratamiento de la inestabilidad anterior del hombro requiere un equilibrio entre el restaurar una estabilidad de la articulación y su normal movilidad. Escoger el tratamiento puede personalizarse en función de las caracteristicas del paciente como su trabajo habitual, actividad deportiva, así como el grado de inestabilidad del hombro. A pesar de las diferentes ideas, la existencia de la lesión de Bankart es sin lugar a duda la mas importante en estas inestabilidades. El tratamiento debe permitir reconocer y resolver la inestabilidad durante el acto operatorio. Gran cantidad de técnicas han sido propuestas para el tratamiento de la inestabilidad anterior del hombro, sin embargo, la estabilización abierta sigue siendo la que mejor opción especialmente en las inestabilidades severas y deportistas. Presentamos un estudio retrospectivo de 33 pacientes que presentaban una inestabilidad anterior escápalo- humeral producida por un traumatismo deportivo. El diagnóstico se realizó mediante la anamnesis y exploración física acompañada de radiología simple y resonancia magnética. Todos los pacientes ful:ron intervenidos mediante la técnica de Bankart a cielo abierto, utilizando los anc1ajes metálicos para la reparación del complejo cápsulo-labrum, y la cápsula fue suturada de manera que la parte infero-externa fue suturada en la porción medial superior, a modo de retensado capsular. Se trataban de 33 pacientes, 29 varones y 4 mujeres, con una edad media de 24 años. Seguimiento medio de los pacientes fue de 31 meses. El resultado final según la escala de Rowe fue excelente o bueno en 31 pacientes (93,9%) regular en 1 caso (3,03%) y malo en un caso. La movilidad fue completa en 28 pacientes pero hubo 5 casos que presentaron una disminución de la rotación externa, con una media de perdida de 8°Todos los pacientes volvieron a su actividad deportiva al finalizar el tratamiento. Hubo un caso de recidiva de la luxación y un caso en el que se comprobó una subluxación, en ambos casos dejaron la práctica deportiva

Successful treatment of anterior instability of the shoulder requires a balance between restoringjoint stability and minimizing loss of glenohumeral motion. The choice of treatment should be individualized on the basis ofthe patient's occupation and level of participation in sports, as well as on the degree of instability of the shoulder. Despite discussions to the contrary, there is no single "essential lesion," as proposed by Bankart, that is responsible for recurrent anterior shoulder instability, although the Bankart lesion is by far the most important. The choice of operative treatment must be tailored to correct the abnormality that is identified at the time of surgery. A variety of techniques have been developed for the treatment of anterior shoulder instability; however, open stabilization remains the standard, especially for severe instabilities, revision procedures, and for athletes who participate in contact sports. We present a retrospective study of 33 patients with traumatic anterior instability of the shoulder produced by sport injury. The diagnostic was made with the medical exploration and XR and MR. All patients underwent surgerywith the open Bankart technique using sutures supported on bone anchors with metal hooks. The series consisted 29 men and 4 women with a mean age of 24 years. The mean postoperative followup was 23.4 months evaluated on the Rowe scale. The results were excellent or good in 31 patients, fair in 1, and poor in 1. Complete mobility was recovered in 28 patients, but external rotation was limited in 5 patients, with a mean loss of 8°. AII patients carne back sport finished the treatment There were l case of recurrent dislocation and another case of subluxation, Both 2 cases leave de sport practical

La luxacion transescafoperilunar en el deporte: a proposito de tres casos / The transscaphoid perilunate dislocation in the sport: about three cases

Las fracturas luxaciones transescafoperilunares constituyen untipo de lesiones poco frecuentes en la traumatología y menos aún en el ámbito deportivo. Normalmente se producen en caídas con apoyo de la mano estando la muñeca en hiperextensión. Su baja incidencia hace que exista cierta controversia en cuanto al tipo de tratamiento que precisan. Para algunos autores es mejor la reducción a cielo cerrado y no realizar osteosintesis de la fractura, mientras que para otros autores es imprescindible la reducción a cielo abierto con osteosintesis interna. Nosotros presentamos tres casos tratados en nuestro servicio producidos por accidentes deportivos. En todos ellos realizamos una reducción a cielo abierto acompañada de osteosintesis interna, en dos casos mediante agujas de Kirschner y en un casos con la colocación de un tornillo de compresión de Herber (AU)

La luxación esternoclavicular en accidente deportivo: a proposito de un caso / Posterior sternoclavicular dislocation in sport: one case

La luxación posterior esternoclavicular es una entidad poco frecuente en el ámbito deportivo, y que puede ocasionar lesiones importantes a nivel de los grandes vasos y de las estructuras del mediastino superior. Su diagnóstico es difícil debido a su baja frecuencia de incidencia así como la poca ayuda que nos da la radiografía antero-posterior. Por esta razón es de gran ayuda tanto la meticulosa exploración física como el uso de la tomografía axial computerizada. En el presente trabajo presentamos una luxación posterior esternoclavicular producida tras accidente deportivo de judo, y al mismo tiempo revisamos la bibliografía existente sobre estas lesiones (AU)