Polyethylene Luxation in an Oxinium Fixed-bearing Unicompartmental Knee Replacement Leading to Metallosis: A Case Reports for an Early and a Late Presentation.

Introduction: Polyethylene (PE) subluxation is a rare complication after fixed-bearing unicompartmental knee replacement. We present two cases of PE luxation with a rapid onset of metallosis in a unicompartmental knee replacement made of Oxinium, one early presentation 3 months after surgery and the other case 6 years after. Case Report: Case 1: A 84-year-old male underwent a fixed-bearing medial unicompartmental knee replacement in his left knee. Standard surgery was carried out with robotic assistance. Three months after surgery, he felt acute pain in the anterior portion of his knee. Radiographs showed that the PE was luxated anteriorly and a radiopaque "cloud" that blurs the vision of the implants suggesting metallosis. In the revision surgery, abundant blackish liquid and metallic-like debris were deposited in the synovial tissue and capsule around the knee. The tibial and femoral components presented extensive wear areas, suggesting extensive metal-to-metal contact. Both components were removed, and a posterior stabilized total knee prosthesis was placed. Case 2: A 50-year-old male patient underwent a fixed-bearing medial unicompartmental knee replacement. After 6 years, he complained of insidious pain in the posteromedial side of his knee. During the physical examination, significant joint effusion, a loss of extension, and a limited flexion were observed, with flexion reaching only up to 80°. The patient did not report systemic symptoms associated with metallosis, and no signs of systemic involvement were found. Radiographs show similar findings than in case 1, but the radiopaque "cloud" was limited to the knee. In the revision surgery, both components were removed. The tibial and femur components had extensive wear, especially in the posterior-central portion. A posterior stabilized total knee prosthesis was used. Conclusion: Emphasis on careful engagement between the PE and the tibial component is a must, checking that no tissue or cement gets in the way of the anchoring system. Furthermore, prosthesis designs must look for models with a more friendly, engaging system to prevent early presentation. The radiographs assessing the height of the PE - especially in the posterior area - must be carried out. In the case of metallosis and PE luxation, we suggest performing a revision surgery with total knee arthroplasty; however, there is little evidence for a strong recommendation.

Searching for the Best Treatment for Ramp Lesions: A Systematic Review and Network Meta-Analysis.

Ramp lesions are a common occurrence in patients with anterior cruciate ligament (ACL) tears. These lesions can be difficult to diagnose due to their concealed nature, and their treatment is crucial due to the stabilizing function of the medial meniscocapsular region. The optimal treatment option for ramp lesions varies depending on the size and stability of the lesion. The purpose of this study was to evaluate the best treatment option for ramp lesions based on the stability of the lesion, including no treatment, biological treatment, and arthroscopic repair. We hypothesize that stable lesions have a favorable prognosis with techniques that do not require the use of meniscal sutures. In contrast, unstable lesions require appropriate fixation, either through an anterior or posteromedial portal. This study is a systematic review and meta-analysis with a level of evidence IV. The study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for a systematic review of clinical studies reporting outcomes of ramp lesion treatment. The PubMed/MEDLINE database was searched using Mesh and non-Mesh terms related to ramp lesions, medial meniscus ramp lesions, and meniscocapsular injuries. The inclusion criteria encompassed clinical studies in English or Spanish that reported the treatment of ramp meniscal lesions, with a follow-up of at least six months and inclusion of functional results, clinical stability tests, radiological evaluation, or arthroscopic second look. The analysis included 13 studies with 1614 patients. Five studies distinguished between stable and unstable ramp lesions using different criteria (displacement or size) for assessment. Of the stable lesions, 90 cases received no treatment, 64 cases were treated biologically (debridement, edge-curettage, or trephination), and 728 lesions were repaired. There were 221 repaired unstable lesions. All different methods of repair were registered. In stable lesions, three studies were included in a network meta-analysis. The best-estimated treatment for stable lesions was biological (SUCRA 0.9), followed by repair (SUCRA 0.6), and no treatment (SUCRA 0). In unstable lesions, seven studies using International Knee Documentation Committee Subjective Knee Form (IKDC) and 10 studies using Lysholm for functional outcomes showed significant improvement from preoperative to postoperative scores after repair, with no differences between repairing methods. We recommend simplifying the classification of ramp lesions as stable or unstable to determine treatment. Biological treatment is preferred for stable lesions rather than leaving them in situ. Unstable lesions, on the other hand, require repair, which has been associated with excellent functional outcomes and healing rates.

EFECTO DEL pH EN LAS TASAS DE BIOACUMULACIÓN DE METALES PESADOS EN LA MACROALGA Bostrychia calliptera (Rhodomelaceae, Ceramiales) / Effect of pH on the bioacumulation rates of heavy metals in macroalgae Bostrychia calliptera (Rhodomelaceae, Ceramiales)

RESUMEN Uno de los factores que más influye en las características químicas de un metal en solución es el nivel de acidez. El pH, por lo tanto, afecta la reactividad del ion y por ende su interacción con los puntos de unión de la pared celular de la planta. Este estudio evaluó el efecto del pH en la capacidad de bioacumulación de metales pesados en el alga roja Bostrychia calliptera (Rhodophyta, Rhodomelaceae). Se sometieron talos del alga a diferentes concentraciones de mercurio (Hg) y Plomo (Pb), desde 0,1 hasta 10 mg/L para Hg y desde 0,1 hasta 15 mg/L para Pb, durante periodos exposición de 0, 12, 24 y 96 horas, bajo diferentes niveles de pH. Las concentraciones de metal acumulado se determinaron por espectrofotometría de absorción atómica. Las mayores tasas de acumulación se encontraron en el alga expuesta a pH 8 (tanto para Hg como para Pb), el cual es un nivel de pH muy cercano al medido en el área de muestreo. La concentración de metal en el alga se incrementó de manera lineal hasta las 48 h de exposición, tiempo en el que se evidenció una mayor eficiencia de acumulación durante el primer intervalo del periodo del bioensayo. El presente estudio permitió identificar el uso potencial del alga B. calliptera como especie bioindicadora de metales pesados en ambientes estuarinos.

ABSTRACT One of the factors with a bigger influence on the chemical characteristics of metal in solution is the level of acidity. Solution pH affects the cell wall metal-binding sites and the metal ion chemistry in water. This study evaluated the effect of pH on the bioaccumulation capacity in the red algae B. calliptera (Rhodophyta, Rhodomelaceae) exposed to different pH ranges. Algae thalli were subjected to different concentrations ofmercury (Hg) and Lead (Pb), at concentrations from 0.1 to 10 mg/L for Hg and from 0.1 to 15 mg/L for Pb, respectively, during the following exposure times: 0, 12, 24 and 96 hours for each ion. Metal concentrations were determined by atomic absorption spectrophotometry according to standard APHA methods. The highest accumulation rates were found when the algae were exposed to pH 8 (for both Hg and Pb), which is a level very close to that measured in the study area. The metal concentration in the algae increased linearly until 48 hrs, a time where a greater accumulation efficiency was evident. The present study allowed to identify the potential use of the alga B. calliptera as a bioindicator species for heavy metals in estuarine environments.

Adaptación y validación de un cuestionario para evaluar contratransferencia en una sesión / Adaptation and validation of a questionnaire to asses countertransference in a session

Despite the clinical importance of the concept of countertransference there are few instruments to evaluate it; one of them is the Countertransference Questionnaire (CQ), which measures countertransference during a therapeutic process. The CQ is a self-report questionnaire, composed of a set of items that refer to a wide range of ideas, feelings and behaviors that therapists develop towards their patients. It is written in common language, without the use of technical terms, allowing the instrument to be used and compared by clinicians of any theoretical orientation. The following paper shows the translation to Spanish, an adapted version for its application in one interview or session, and its validation in a population of Chilean psychiatrists and psychologists in a sample of 333 completed questionnaires. Three versions of the questionnaire were created: Interviewer, Observer and Observer of the Interviewer. We conducted an exploratory factor analysis wich grouped the items on a total of seven factors with good or very good internal consistency (Cronbach’s alpha between 0.66 and 0.89) Results showed that the instrument is valid for its application in Chilean psychiatrists and psychologists.

A pesar de la importancia clínica del concepto de la contratransferencia hay pocos instrumentos para evaluarla, uno de ellos es el Countertransference Questionnaire que mide la contratransferencia durante un proceso terapéutico. Este cuestionario es de autoreporte, sus ítems se refieren a un amplio rango de ideas, sentimientos y conductas hacia sus pacientes expresados por los terapeutas. Está redactado en lenguaje cotidiano, sin términos técnicos, lo que permite que el instrumento pueda ser usado y comparado por clínicos de cualquier orientación teórica. En este artículo presentamos su traducción, adaptación para ser aplicado en una entrevista o sesión y la validación en una población de psiquiatras y psicólogos chilenos que realizamos con una muestra de 333 cuestionarios. Hicimos tres versiones del cuestionario: Entrevistador, Observador y Observador del entrevistador. Realizamos un análisis factorial exploratorio que agrupó los ítems en siete factores con consistencia interna buena o muy buena (alfa de Cronbach entre 0,66y 0,89). Los resultados arrojaron que este instrumento es válido para ser aplicado en psiquiatras y psicólogos chilenos.

Relationship of cortisol levels and genetic polymorphisms to antidepressant response to placebo and fluoxetine in patients with major depressive disorder: a prospective study.

BACKGROUND: Increased cortisol levels and genetic polymorphisms have been related to both major depressive disorder and antidepressant treatment outcome. The aim of this study is to evaluate the relationship between circadian salivary cortisol levels, cortisol suppression by dexamethasone and genetic polymorphisms in some HPA axis-related genes to the response to placebo and fluoxetine in depressed patients. METHODS: The diagnosis and severity of depression were performed using the Mini International Neuropsychiatric Interview (M.I.N.I.) and Hamilton depression scale (HAM-D17), respectively. Euthyroid patients were treated with placebo (one week) followed by fluoxetine (20 mg) (two months). Severity of depression was re-evaluated after placebo, three weeks and two months of fluoxetine treatments. Placebo response was defined as HAM-D17 score reductions of at least 25% and to < 15. Early response and response were reductions of at least 50% after three weeks and two months, and remission with ≤ 7 after two months. Plasma TSH, free-T4, circadian salivary cortisol levels and cortisol suppression by dexamethasone were evaluated. Seven genetic polymorphisms located in the Corticotrophin-releasing-hormone-receptor-1 (rs242939, rs242941, rs1876828), Corticotrophin-releasing-hormone-receptor-2 (rs2270007), Glucocorticoid-receptor (rs41423247), FK506-binding-protein-5 (rs1360780), and Arginine-vasopressin (rs3729965) genes were determined. Association analyses between response to placebo/fluoxetine and polymorphism were performed by chi-square or Fisher exact test. Cortisol levels were compared by t-test, ANOVA and the general linear model for repeated measures. RESULTS: 208 depressed patients were recruited, 187 of whom were euthyroid. Placebo responders, fluoxetine responders and remitters exhibited significantly lower circadian cortisol levels than those who did not respond (p-values of 0.014, 0.008 and 0.021 respectively). Patients who abandoned treatment before the third week also exhibited a trend to low cortisol levels (p = 0.057). The polymorphisms rs242939 (CRHR1) and rs2270007 (CRHR2) were not in Hardy-Weinberg equilibrium. Only the rs242939 polymorphism (CRHR1) exhibited association with early response (three weeks) to fluoxetine (p-value = 0.043). No other association between outcomes and polymorphisms was observed. CONCLUSIONS: These results support the clinical relevance of low salivary cortisol levels as a predictor of antidepressant response, either to placebo or to fluoxetine. Only one polymorphism in the CRHR1 gene was associated with the early response. Other factors may be involved in antidepressant response, although further studies are needed to identify them.

Ethanol production by Saccharomyces cerevisiae using lignocellulosic hydrolysate from Chrysanthemum waste degradation.

Ethanol production derived from Saccharomyces cerevisiae fermentation of a hydrolysate from floriculture waste degradation was studied. The hydrolysate was produced from Chrysanthemum (Dendranthema grandiflora) waste degradation by Pleurotus ostreatus and characterized to determine the presence of compounds that may inhibit fermentation. The products of hydrolysis confirmed by HPLC were cellobiose, glucose, xylose and mannose. The hydrolysate was fermented by S. cerevisiae, and concentrations of biomass, ethanol, and glucose were determined as a function of time. Results were compared to YGC modified medium (yeast extract, glucose and chloramphenicol) fermentation. Ethanol yield was 0.45 g g(-1), 88 % of the maximal theoretical value. Crysanthemum waste hydrolysate was suitable for ethanol production, containing glucose and mannose with adequate nutrients for S. cerevisiae fermentation and low fermentation inhibitor levels.

Prácticas y comportamientos sexuales de estudiantes de la Universidad de Manizales (Colombia) 2010 / Practices and sexual behaviors of students of the Universidad de Manizales 2010

El presente estudio pretende indagar sobre las prácticas y comportamientos sexuales en una población universitaria, ya que comportamientos positivos pueden desarrollar mejores habilidades para la prevención de conductas de alto riesgo, mayor satisfacción sexual y, por ende, vivir más plenamente. La presente investigación es de tipo transversal y en ella participaron estudiantes de todas las facultades de la Universidad de Manizales (Caldas, Colombia), que estaban cursando entre primero y noveno semestre. La muestra de esta investigación la constituyeron 267 personas sobre una población de 3600 estudiantes regulares; se obtuvo mediante un muestreo probabilístico estratificado por género y facultad. La edad media fue de 21.69 años; la mayor proporción fue de mujeres en un 58.8%; 1.5% eran homosexuales y un 5%, bisexuales, el método de anticoncepción más usado fueron los métodos de barrera en un 41.3%; el 15.2% habían tenido alguna infección de transmisión sexual. En lo que se refiere a las prácticas sexuales el 22.8% realizan todas las prácticas (masturbación, sexo oral, sexo anal, sexo vaginal); en cuanto al promedio de edad de inicio de relaciones sexuales fue de 16.09 años; están de acuerdo con la despenalización total del aborto en un 53.1%; el 73.2% adoptan una posición de aceptación y tolerancia hacia la homosexualidad. El estudio permitió ver la influencia de varias variables como género, familia, religión y formación educativa sobre el comportamiento y la práctica sexual responsable.

This study aims at investigating the practices and sexual behaviors in a university population since positive behaviors may develop best abilities for the prevention of high-risk behaviors, major sexual satisfaction and a more meaningful life. This was a cross-sectional study, which involved students from all programs of the Universidad de Manizales (Caldas, Colombia), who were between first and ninth semester. The sample of this study was 267 students of a population of 3600 regular students, which was obtained by probability sampling stratified by gender and program. The average age was 21.69, with a higher ratio of women (58.8%), 1.5% were homosexual and 5% bisexual; the most used contraception method was barrier methods (41.3%); 15.2% had had some kind of sexual transmission infection (STI). Regarding sexual practices 22.8% performed the different practices (masturbation, oral sex, anal sex, vaginal sex), and the average age of first sexual intercourse was 16.09; 53.1% agrees with abortion and 84% agreed with its total decriminalization; 73.2% have an acceptance and tolerance of homosexuality. The study allowed seeing the influence of several variables such as gender, family, religion and educational background on behavior and responsible sexual practice.