A Network Meta-Analysis on the Surgical Management of Thoracolumbar Burst Fractures: Anterior, Posterior, and Combined.

Background: Thoracolumbar burst fractures (BFs) are traumatic lesions instigated by compression forces. Canal compression and compromise may lead to neurological deficits. Optimal surgical management is yet to be fully defined since various approaches such as anterior, posterior, or combined exist. This study aims to determine the operative performance of these three treatment modalities. Methods: In accordance with the PRISMA guidelines, a systematic review was performed, identifying studies comparing anterior, posterior, and/or combined surgical approaches in patients with thoracolumbar BFs. To analyze available evidence, a Bayesian network meta-analysis framework was utilized. Results: In this study, 16 studies were included. The shortest operative times and lowest operative blood losses were found for a posterior approach. The length of stay (LoS) was shorter with the posterior approach compared with the other two modalities. Return to work, postoperative kyphotic angle (PKA), and complications all favored the posterior approach. The visual analog scale score was similar between groups. Conclusions: This study suggests that the posterior approach has significant advantages in terms of operative time, blood loss, LoS, PKA, return to work, and complication rates when compared to the other approaches. Treatment should remain an individualized process, and before choosing an approach, factors such as patient characteristics, surgeon experience, and hospital settings should be considered.

Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches.

Background: A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the preferred treatment, but whether the optimal approach is either an anterior or a posterior approach remains unclear. This study aims to determine whether either method provides an advantage. Methods: Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing anterior versus posterior surgical approaches in patients with thoracolumbar BFs. Data were analyzed using Review Manager 5.3. Seven studies were included. Results: An operative time of 87.97 min (53.91, 122.03; p<0.0001) and blood loss of 497.04 mL (281.8, 712.28; p<0.0001) were lower in the posterior approach. Length of hospital stay, complications, reintervention rate, neurological outcomes, postoperative kyphotic angle, and costs were similar between both groups. Conclusions: Surgical intervention is usually selected to rehabilitate patients with BFs. The data obtained from this study suggest that a posterior approach represents a viable alternative to an anterior approach, with various advantages such as a shorter operative time and decreased bleeding.

Object shape affects hand grip function for heavy objects in younger and older adults.

Hand-grip function while lifting objects is essential for performing everyday tasks. The Box and Block Test (BBT) has been used to assess hand-grip function and dexterity, but only light objects have been used. The purpose of this study was to investigate the effects of block surface, shape, age, and sex on hand dexterity during the movement of heavy blocks in the BBT. Forty healthy participants comprised of a younger group of 10 males (M = 22.50 years, SD = 2.01) and 10 females (M = 22.20 years, SD = 2.66) between 20 and 30-years-old, and an older group of 10 males (M = 55.80 years, SD = 3.19) and 10 females (M = 55.90 years, SD = 2.56) between 50 and 60-years-old, performed the BBT using steel objects of different shapes (cylindrical and cubic) and different surfaces (plain steel, black spray-painted steel, and yellow non-slip spray-painted steel). The results indicated that repetition and shape had significant effects on the BBT score. Previous researchers have found that surface textures, age, and sex influenced hand dexterity for light objects, but these effects were not discovered in the current study. These findings suggest that shape should take priority over age, sex, and surface texture when designing tools to improve user handling. Practitioner Summary: Hand-grip function is critically important when performing daily grip tasks such as picking up a writing utensil, using a toothbrush, or twisting a hand tool. The shape should be considered during the design process of tools and equipment used in industry so that handling can be made for the user. Abbreviations: BBT: box and block test; COF: coefficient of friction; BPS: blocks per second.

Dysbindin Deficiency Modifies the Expression of GABA Neuron and Ion Permeation Transcripts in the Developing Hippocampus.

The neurodevelopmental factor dysbindin is required for synapse function and GABA interneuron development. Dysbindin protein levels are reduced in the hippocampus of schizophrenia patients. Mouse dysbindin genetic defects and other mouse models of neurodevelopmental disorders share defective GABAergic neurotransmission and, in several instances, a loss of parvalbumin-positive interneuron phenotypes. This suggests that mechanisms downstream of dysbindin deficiency, such as those affecting GABA interneurons, could inform pathways contributing to or ameliorating diverse neurodevelopmental disorders. Here we define the transcriptome of developing wild type and dysbindin null Bloc1s8sdy/sdy mouse hippocampus in order to identify mechanisms downstream dysbindin defects. The dysbindin mutant transcriptome revealed previously reported GABA parvalbumin interneuron defects. However, the Bloc1s8sdy/sdy transcriptome additionally uncovered changes in the expression of molecules controlling cellular excitability such as the cation-chloride cotransporters NKCC1, KCC2, and NCKX2 as well as the potassium channel subunits Kcne2 and Kcnj13. Our results suggest that dysbindin deficiency phenotypes, such as GABAergic defects, are modulated by the expression of molecules controlling the magnitude and cadence of neuronal excitability.

Aspergilosis traqueobronquial invasiva en un paciente con púrpura trombocitopénica trombótica tratada con Anti-CD20 / Invasive tracheobronchial aspergillosis in a patient with thrombotic thrombocytopenic purpura (TTP) and immunosuppressed due to the use of steroids and anti-CD20

La aspergilosis invasiva es una complicación que se presenta con mayor frecuencia en pacientes con inmunosupresión. La aspergilosis traqueobronquial es una complicación muy rara con mínimas manifestaciones clínicas. Se informa de una paciente de 53 años con diagnóstico de púrpura trombocitopénica trombótica (PTT) con inmunosupresión por el uso de esteroides y anti CD-20, que presentó hemoptisis en 2 ocasiones; la segunda fue masiva y ocasionó la muerte. Previo al segundo evento de la hemoptisis se logró realizar broncoscopía, que mostró pseudomembranas y ulceración del epitelio bronquial. En el postmortem se logró documentar la presencia de Aspergillus tanto en la biopsia como en el cultivo. Es de gran importancia la sospecha y un reconocimiento temprano de esta patología en pacientes con inmunosupresión por su alta mortalidad.

Invasive aspergillosis is a complication most commonly developed in immunosuppressed patients. Tracheobronquial aspergillosis is an extremely rare complication with minimal clinical expression. We present the case of a 53-year-old female patient diagnosed with thrombotic thrombocytopenic purpura (TTP) and immunosuppressed due to the use of steroids and anti-CD20, who presented hemoptisis twice; being the second one massive leading to death. Before the second event of hemoptisis, bronchoscopy was performed, which showed pseudomembranes and ulceration of the bronchial epithelium. In the post-mortem examination, the presence of Aspergillus was evidenced by both biopsy and culture. The presumption and early diagnosis of this condition are paramount for immunosuppressed patients due to its high mortality.

The contribution of ergonomics to risk analysis in the design process: the case of a future control room.

The aim of this paper is to highlight how ergonomics contributes to risk analysis and risk management in a design project for a new reactor, the French EPR (European Pressurized Reactor). An iterative ergonomics design process has been conducted over the last 10 years through a Human Factors Engineering program at the French energy company EDF. A parallel has been drawn between a risk management process and this ergonomics process based on International Organization for Standardization (ISO) publications such as ISO/IEC Guide 73, ISO Guide 51, etc. The contribution of ergonomics to risk analysis is illustrated by an example: the automatic diagnosis, which is a very important technical device for safety. Five main types of risk have been identified via ergonomic analyses during the different design stages. Counter-measures have been implemented and their efficacy tested within the scope of new campaigns to assess human factors. However, the management of risks in such a design project requires the participation both of the different design entities involved in the project and of other experts in aspects of risk management, such as human reliability. The organization of collaborative participation remains a challenge to be addressed.

From needs to requirements for computer systems: the added value of ergonomics in needs analysis.

It is widely recognised that ergonomists must contribute during needs analysis. However, few studies have investigated the specific contributions of ergonomists at this stage of the design process. In this study, this contribution is studied through the requirement document produced by the design team. For each requirement, the source (i.e. who formulated the requirement), justification (why the requirement is needed), type (functional, interaction, operational, physical, organizational), and scope (entire system or part thereof) were analysed. Results indicate that the various actors are complementary and work collectively to define the various dimensions of the system. With end-users, the ergonomist worked on the global aspects of the system: function, conditions of use and organizational dimension. Alone, he defined the global interaction of the system. The various functions derived from the global function were defined in collaboration with engineers. However, while engineers contributed to defining how these functions would work, as well as their technical conditions of use, the ergonomist focused on their purpose, and, with end-users, on their organizational aspects. Finally, results suggest that neither the ergonomist's specific knowledge in ergonomics, nor work analysis were sufficient to derive his requirements; both are mandatory.

Utilization of physician health care services in Mexico by U.S. Hispanic border residents.

One of the most controversial topics in the U.S. is the issue of accessibility to health services by U.S. residents. This issue is most critical to U.S. Hispanic residents living along the U.S.-Mexico border who have been identified as having low health standards and low socio-economic conditions when compared to the rest of the state and the country. The availability of lower cost health services across the U.S. border in Mexico is, therefore, perceived as a viable economic alternative source of health care. This study is derived from a health needs assessment survey of 1,100 households residing in Laredo, Texas, the largest land port along the 2,000-miles long U.S.-Mexico border. The major result of this study indicates that about 41.2 percent of the Laredo U.S. Hispanic residents are utilizing cross border physician health care services in Mexico.

Citologia nasal en fumadores, fumadores pasivos y no fumadores / Nasal cytology in smokers, passive smokers and non-smokers

El objetivo del estudio fue investigar la citopatología nasal en pacientes fumadores, fumadores pasivos y no fumadores. Se estudiaron 60 pacientes divididos en grupos de 20 cada uno. En el 95 por ciento de los fumadores (Grupo 1) se encontró algún tipo de metaplasia o displasia; en los fumadores pasivos (Grupo 2) solo en el 55 por ciento se encontró alteración citológica y solo en el 15 por ciento de los no fumadores (Grupo 3). El estudio concluye que el riesgo de tener cambios citológicos en los fumadores pasivos es de aproximadamente la mitad en relación a los fumadores. La citología nasal es un método barato, sencillo y muy adecuado para el diagnóstico de los cambios histológicos de la mucosa nasal