Oxidative Damage and Antioxidants as Markers for the Selection of Emersion Hardening Treatments in GreenshellTM Mussel Juveniles (Perna canaliculus).

Transport out of the water is one of the most challenging events for juvenile Perna canaliculus and can be a highly inefficient process, with many juveniles subsequently being lost following extended periods of emersion. Hardening techniques offer a possible method for reducing transport-related stress. In this study, different hardening treatments (short, long and intermittent sub-lethal emersion) were used to prepare ~1.2 mm P.canaliculus for transport (20 h) and subsequent reoxygenation stress during re-immersion (i.e., recovery). The oxidative stress responses, resettlement behaviour, respiration rates and survival of the mussels after transport and during recovery were all assessed. Short emersion (1 h) as a hardening treatment prior to transport did not cause major stress to the mussels, which maintained respiration at control levels, showed significantly stimulated antioxidant defences during recovery, showed greater resettlement behaviour and remained viable after 24 h of recovery. In comparison, the long and intermittent emersion treatments negatively impacted oxidative stress responses and affected the viability of the mussels after 24 h of recovery. This study showed that exposing juvenile P.canaliculus to a mild stress prior to transport may stimulate protective mechanisms, therefore eliciting a hardening response, but care must be taken to avoid overstressing the mussels. Improving the management of stress during the transport of juvenile mussels may be key to minimising mussel losses and increasing harvest production, and biomarkers associated with oxidative stress/antioxidant metabolism could be valuable tools to ensure emersion hardening does not overstress the mussels and reduce survival.

Microplastics in stomach contents of juvenile Patagonian blennies (Eleginops maclovinus).

Microplastics are one of the major environmental issues that need to be addressed because they are starting to impact food chains and are also affecting human populations. The size, colour, form, and abundance of microplastics in young blennies of the species Eleginops maclovinus were examined in the current study. While the stomach contents of 70 % of the studied individuals contained microplastics, 95 % of them included fibres. Individual size and the largest particle size that can be eaten, which ranges between 0.09 and 1.5 mm present no statistical correlation. The quantity of particles taken in by each individual does not change with size. The most present microfibers colours were blue and red. Sampled fibres were analysed with FT-IR and no natural fibres were detected, proving the synthetic origin of the detected particles. These findings suggest that protected coastlines create conditions that favour the encounter of microplastics increasing local wildlife exposure to microplastics, raising the danger of their ingestion with potential physiological, ecological, economical and human health consequences.

Effects of seawater temperature and acute Vibriosp. challenge on the haemolymph immune and metabolic responses of adult mussels (Perna canaliculus).

The New Zealand Greenshell™ mussel (Perna canaliculus) is an endemic bivalve species with cultural importance, that is harvested recreationally and commercially. However, production is currently hampered by increasing incidences of summer mortality in farmed and wild populations. While the causative factors for these mortality events are still unknown, it is believed that increasing seawater temperatures and pathogen loads are potentially at play. To improve our understanding of these processes, challenge experiments were conducted to investigate the combined effects of increased seawater temperature and Vibrio infection on the immune and metabolic responses of adult mussels. Biomarkers that measure the physiological response of mussels to multiple-stressors can be utilised to study resilience in a changing environment, and support efforts to strengthen biosecurity management. Mussels acclimated to two temperatures (16 °C and 24 °C) were injected with either autoclaved, filtered seawater (control) or Vibriosp. DO1 (infected). Then, haemolymph was sampled 24 h post-injection and analysed to quantify haemocyte immune responses (via flow-cytometry), antioxidant capacity (measured electrochemically) and metabolic responses (via gas chromatography-mass spectrometry) to bacterial infection. Both seawater temperature and injection type significantly influenced the immune and metabolite status of mussels. A lack of interaction effects between temperature and injection type indicated that the effects of Vibrio sp. 24 h post-infection were similar between seawater temperatures. Infected mussels had a higher proportion of dead haemocytes and lower overall haemocyte counts than uninfected controls. The proportion of haemocytes showing evidence of apoptosis was higher in mussels held at 24 °C compared with those held at 16 °C. The proportion of haemocytes producing reactive oxygen species did not differ between temperatures or injection treatments. Mussels held at 24 °C exhibited elevated levels of metabolites linked to the glycolysis pathway to support energy production. The saccharopin-lysine pathway metabolites were also increased in these mussels, indicating the role of lysine metabolism. A decrease in metabolic activity (decreases in BCAAs, GABA, urea cycle metabolites, oxidative stress metabolites) was largely seen in mussels injected with Vibrio sp. Itaconate increased as seen in previous studies, suggesting that antimicrobial activity may have been activated in infected mussels. This study highlights the complex nature of immune and metabolic responses in mussels exposed to multiple stressors and gives an insight into Vibrio sp. infection mechanisms at different seawater temperatures.

An investigation of gecko attachment on wet and rough substrates leads to the application of surface roughness power spectral density analysis.

The roughness and wettability of surfaces exploited by free-ranging geckos can be highly variable and attachment to these substrates is context dependent (e.g., presence or absence of surface water). Although previous studies focus on the effect of these variables on attachment independently, geckos encounter a variety of conditions in their natural environment simultaneously. Here, we measured maximum shear load of geckos in air and when their toes were submerged underwater on substrates that varied in both surface roughness and wettability. Gecko attachment was greater in water than in air on smooth and rough hydrophobic substrates, and attachment to rough hydrophilic substrates did not differ when tested in air or water. Attachment varied considerably with surface roughness and characterization revealed that routine measurements of root mean square height can misrepresent the complexity of roughness, especially when measured with single instruments. We used surface roughness power spectra to characterize substrate surface roughness and examined the relationship between gecko attachment performance across the power spectra. This comparison suggests that roughness wavelengths less than 70 nm predominantly dictate gecko attachment. This study highlights the complexity of attachment in natural conditions and the need for comprehensive surface characterization when studying biological adhesive system performance.

Luxación tibiofibular proximal diagnóstico y tratamiento / Proximal tibiofibular joint dislocation diagnosis and treatment

Resumen: Introducción: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. Caso clínico: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. Conclusión: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

Abstract: Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud «clank¼. He has been followed for three months with MRI, and remains asymptomatic with full functions. Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

[Proximal tibiofibular joint dislocation diagnosis and treatment]. / Luxación tibiofibular proximal diagnóstico y tratamiento.

INTRODUCTION: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. CASE REPORT: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud "clank". He has been followed for three months with MRI, and remains asymptomatic with full functions. CONCLUSION: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.

INTRODUCCIÓN: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. CASO CLÍNICO: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. CONCLUSIÓN: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.

Rituximab Prevents the Development of Experimental Autoimmune Encephalomyelitis (EAE): Comparison with Prophylactic, Therapeutic or Combinational Regimens.

OBJECTIVE: To investigate, in detail, the effects of rituximab (RTX), an off-label drug for treating multiple sclerosis (MS) disease on preventing and/or ameliorating experimental autoimmune encephalomyelitis (EAE). METHODS: Using bioinformatics analysis of publicly available transcriptomics data, we determined the accumulation of B cells, plasma cells and T cells in different compartments of multiple sclerosis patients (MS) and healthy individual brains. Based on these observations and on the literature search, we dosed RTX in EAE mice either orally, or injected intraperitoneally (IP). The latter route was used either prophylactically (asymptomatic stage; upon the induction of the disease), or therapeutically (acute stage; upon the appearance of the first sign of the disease). Further, we used RTX as a preventive drug either as a single agent or in combination with other routes of administration. RESULTS: Because no complete recovery was observed when RTX was used prophylactically or therapeutically, we devised another protocol of injecting this drug before the onset of the disease and designated this regiment as prevention. We demonstrated that the 20 µg/mouse prevention completely reduced the EAE clinical score, impaired infiltration of T and B cells into the perivascular space of mice brains, along with inhibiting the inflammation and demyelination. However, the 5 and 10 µg/mouse doses although reduced all aspects of inflammation in these mice, their effects were not as potent as the 20 µg/mouse RTX dose. Finally, we combined the 5 µg/mouse prevention treatment with either the prophylactic or therapeutic regimen and observed a robust effect. CONCLUSION: We observed that combinatorial regimens resulted in further reduction of inflammation, T and B cell extravasation into the brains of EAE mice and improved the re-myelination.

mTOR mutations in Smith-Kingsmore syndrome: Four additional patients and a review.

Smith-Kingsmore syndrome (SKS) OMIM #616638, also known as MINDS syndrome (ORPHA 457485), is a rare autosomal dominant disorder reported so far in 23 patients. SKS is characterized by intellectual disability, macrocephaly/hemi/megalencephaly, and seizures. It is also associated with a pattern of facial dysmorphology and other non-neurological features. Germline or mosaic mutations of the mTOR gene have been detected in all patients. The mTOR gene is a key regulator of cell growth, cell proliferation, protein synthesis and synaptic plasticity, and the mTOR pathway (PI3K-AKT-mTOR) is highly regulated and critical for cell survival and apoptosis. Mutations in different genes in this pathway result in known rare diseases implicated in hemi/megalencephaly with epilepsy, as the tuberous sclerosis complex caused by mutations in TSC1 and TSC2, or the PIK3CA-related overgrowth spectrum (PROS). We here present 4 new cases of SKS, review all clinical and molecular aspects of this disorder, as well as some characteristics of the patients with only brain mTOR somatic mutations.

Factores de riesgo relacionados a la falla de la sutura meniscal en niños y adolescentes / Risk factors related to meniscal suture failure in children and adolescents

Las lesiones meniscales en niños son cada día más frecuentes. La preservación meniscal es una prioridad en este grupo de pacientes, sin embargo, existen pocos artículos que muestran los resultados de suturas meniscales en niños. OBJETIVO: El objetivo de este estudio es identificar factores de riesgo de falla en pacientes sometidos a una sutura meniscal en niños menores de 18 años. MÉTODO: Estudio retrospectivo de 35 pacientes sometidos a una sutura meniscal, con una edad promedio de 16 años (13­18) y un seguimiento de 71 meses de media (16­115). Se evaluaron 6 variables: tipo, localización y tamaño de la lesión, edad, técnica quirúrgica y asociación a rotura de ligamento cruzado anterior (LCA). Los pacientes que presentaron falla de la sutura meniscal fueron identificados y sometidos a una regresión logística usando un modelo Stata V.14.0. RESULTADOS: 9 pacientes (24.3%) presentaron una falla en su cirugía durante el seguimiento. Lesiones iniciales mayores a 16 mm mostraron una tasa de re-rotura de un 73% independiente de la técnica quirúrgica. En lesiones menores a 16 mm, se obtuvo un 78% de reparaciones exitosas. No se encontró relación entre la re-rotura meniscal y lesión de LCA, tipo y localización de la lesión, técnica quirúrgica y edad de los pacientes. CONCLUSIÓN: Este estudio muestra que la reparación meniscal en niños tiene buenos resultados con una tasa de éxito promedio de un 75%. El riesgo de falla de sutura meniscal se correlacionó con el tamaño inicial de la lesión con un 73% de fallo en lesiones mayores a 16 mm independientemente del tipo de cirugía.

Meniscal tears are uncommon in the pediatric population, with an increasing number. Currently meniscal preservation is a priority when treating these injuries. However, only a few studies have reported the clinical outcomes of arthroscopic meniscal repair in children and its risk factors of failure. OBJECTIVE: Identify risk factors related to meniscal suture failure in patients under 18 years who underwent a meniscal repair. METHODS: Retrospective study of 35 patients with an average age of 16 years (13 - 18) who underwent arthroscopic meniscal repair with a mean follow up of 71.1 months (16­115). We evaluate 6 variables: type, location and size of meniscal tear, age, surgical technique and anterior cruciate ligament (ACL) association. Patients with re-rupture were identified and statistical analysis was performed through a logistic regression model using Stata V.14.0. RESULTS: 9 patients (24.3%) presented a suture failure during follow-up. Average time for re-rupture was 16 months (4­60 months). With an initial tear size of 16 mm or bigger, 73% of the meniscal repair will fail despite surgery technique. With an initial tear size smaller than 16 mm, 78% of will heal. No association was found between meniscal re-rupture and ACL rupture, type and location of tear, surgical technique and age. Conclusion: In our study meniscal repairs in pediatric population had good overall results with a global healing rate of 75.7%. The risk of suture failure was related to the initial size of meniscal tear: when meniscal tear is bigger than 16 mm, 73% of them will fail despite surgery.

Influence of substrate modulus on gecko adhesion.

The gecko adhesion system fascinates biologists and materials scientists alike for its strong, reversible, glue-free, dry adhesion. Understanding the adhesion system's performance on various surfaces can give clues as to gecko behaviour, as well as towards designing synthetic adhesive mimics. Geckos encounter a variety of surfaces in their natural habitats; tropical geckos, such as Gekko gecko, encounter hard, rough tree trunks as well as soft, flexible leaves. While gecko adhesion on hard surfaces has been extensively studied, little work has been done on soft surfaces. Here, we investigate for the first time the influence of macroscale and nanoscale substrate modulus on whole animal adhesion on two different substrates (cellulose acetate and polydimethylsiloxane) in air and find that across 5 orders of magnitude in macroscale modulus, there is no change in adhesion. On the nanoscale, however, gecko adhesion is shown to depend on substrate modulus. This suggests that low surface-layer modulus may inhibit the gecko adhesion system, independent of other influencing factors such as macroscale composite modulus and surface energy. Understanding the limits of gecko adhesion is vital for clarifying adhesive mechanisms and in the design of synthetic adhesives for soft substrates (including for biomedical applications and wearable electronics).

Delaying Frost Formation by Controlling Surface Chemistry of Carbon Nanotube-Coated Steel Surfaces.

Superhydrophobic surfaces are appealing as anti-icing surfaces, given their excellent water repellent performance. However, when water condenses on the surface due to high humidity, the water becomes pinned, and superhydrophobic surfaces fail to perform. Here we studied how the stability of the superhydrophobicity affected water condensation and frost formation. We created rough surfaces with the same surface structure, but with a variety of surface chemistries, and compared their antifrost properties as a function of intrinsic contact angle. Frost initiation was significantly delayed on surfaces with higher intrinsic contact angles. We coupled these macromeasurements with environmental scanning electron microscopy of water droplet initiation under high humidity conditions. These provide experimental evidence toward previous hypotheses that for a lower intrinsic-angle rough surface, Wenzel state is thermodynamically favorable, whereas the higher intrinsic-angle surface maintains a Cassie-Baxter state. Surfaces with a thermodynamically stable Cassie-Baxter state can then act both as antisteam and antifrost surfaces. This research could answer the persistent question of why superhydrophobic surfaces sometimes are not icephobic; anti-icing performance depends on the surface chemistry, which plays a critical role in the stability of the superhydrophobic surfaces.

The effect of temperature and humidity on adhesion of a gecko-inspired adhesive: implications for the natural system.

The adhesive system of geckos has inspired hundreds of synthetic adhesives. While this system has been used relentlessly as a source of inspiration, less work has been done in reverse, where synthetics are used to test questions and hypotheses about the natural system. Here we take such an approach. We tested shear adhesion of a mushroom-tipped synthetic gecko adhesive under conditions that produced perplexing results in the natural adhesive system. Synthetic samples were tested at two temperatures (12 °C and 32 °C) and four different humidity levels (30%, 55%, 70%, and 80% RH). Surprisingly, adhesive performance of the synthetic samples matched that of living geckos, suggesting that uncontrolled parameters in the natural system, such as surface chemistry and material changes, may not be as influential in whole-animal performance as previously thought. There was one difference, however, when comparing natural and synthetic adhesive performance. At 12 °C and 80% RH, adhesion of the synthetic structures was lower than expected based on the natural system's performance. Our approach highlights a unique opportunity for both biologists and material scientists, where new questions and hypotheses can be fueled by joint comparisons of the natural and synthetic systems, ultimately improving knowledge of both.

Reconstrucción del ligamento patelofemoral medial. Evaluación de los resultados clínicos del autoinjerto frente al aloinjerto / Reconstruction of the medial patellofemoral ligament: evaluation of the clinical results of autografts versus allografts

Objetivo. Evaluar los resultados clínicos en pacientes con inestabilidad femoropatelar sometidos a reconstrucción del ligamento patelofemoral medial (LPFM) con auto y aloinjerto. Pacientes y metodología. Evaluación clínica retrospectiva de 28 pacientes con inestabilidad femoropatelar sometidos a cirugía de reconstrucción LPFM; se analizaron un grupo de 13 pacientes (13 rodillas) en que se utilizó autoinjerto obtenido de los tendones isquiotibiales y otro grupo de 15 pacientes (16 rodillas) con aloinjerto. El grupo total correspondió a 13 hombres y 15 mujeres con edades entre 15-38 años. Se estudió la morbilidad asociada al injerto y técnica quirúrgica, se realizó evaluación clínica con escala de Kujala, pre y postoperatoria y se evaluaron sus complicaciones. El seguimiento fue mayor a 12 meses. Resultados. No encontramos episodios de reluxación ni complicaciones asociadas al injerto en ninguno de los grupos. El puntaje promedio postoperatorio de la escala de Kujala en el grupo de autoinjerto fue de 89,2 y en el grupo de aloinjerto fue de 92,6 (p > 0,05). En el grupo de autoinjertos un paciente fue reoperado por mala posición del material de osteosíntesis y en el grupo de aloinjertos un paciente presentó una fractura de rótula no desplazada provocada por los túneles óseos realizados y otro paciente requirió movilización bajo anestesia por déficit de flexión. Conclusión. No encontramos diferencias significativas entre ambos grupos y los resultados clínicos fueron similares (AU)

Objective. The purpose of the study was to evaluate the functional results after medial patellofemoral ligament (MPFL) reconstruction in patients using auto- and allograft. Patients and Methods. A retrospective study was conducted on 28 patients with recurrent patellar dislocation, with 13 patients (13 knees) undergoing MPFL reconstruction with hamstring autograft, and 15 patients (16 knees) with reconstruction surgery with allograft. The total group included 13 males and 15 females, with an age range of 15 to 38 years. The graft-related morbidity was studied and a clinical assessment was performed using the pre- and postoperative Kujala score. Associated complications were reported for each group. All the patients had more than 12 months of follow up. Results. No recurrent dislocations or graft related complications were reported in either group. The post-operative Kujala subjective knee score was 89.2 in the autograft group, and 92.6 in the allograft group (p > .05). One patient in the allograft group received a revision surgery due to poor positioning of anchors. Another patient in the allograft group had non-displaced patella fracture related to the bone tunnels and another patient had flexion deficit and needed mobilization under anesthesia. Conclusion. There were no significant differences between both groups, and the results were comparable (AU)

A founder EIF2AK4 mutation causes an aggressive form of pulmonary arterial hypertension in Iberian Gypsies.

Pulmonary arterial hypertension (PAH) is a pathological condition characterized by a persistent and progressive elevation of pulmonary vascular resistance with devastating consequences if untreated. In the past recent years, several genes have been related to PAH, however, the molecular defect remains unknown in a significant proportion of patients with familial PAH (∼20%). During the past few years, we have observed that PAH shows a particular behavior in Iberian Gypsies, with more aggressive course and frequently affecting multiple members of the same family. We studied five Gypsy families in whom at least one individual from each family developed a severe form of PAH and in whom no mutation had been identified in the common genes. We applied SNP-array-based homozygosity mapping in three families and obtained, among others, one of which included the gene EIF2AK4, recently reported in patients with PAH from group-1' pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH). Subsequently, we sequenced EIF2AK4 and found a homozygous mutation in all five families: c.3344C>T(p.P1115L). The majority of our patients required early lung transplantation. Hence, this mutation appeared with a more severe phenotype than previously reported for other EIF2AK4 mutations. The finding of this novel mutation is important for genetic counseling and calculation of population recurrence risks.

Reconstruction of the medial patellofemoral ligament: Evaluation of the clinical results of autografts versus allografts.

OBJECTIVE: The purpose of the study was to evaluate the functional results after medial patellofemoral ligament (MPFL) reconstruction in patients using auto- and allograft. PATIENTS AND METHODS: A retrospective study was conducted on 28 patients with recurrent patellar dislocation, with 13 patients (13 knees) undergoing MPFL reconstruction with hamstring autograft, and 15 patients (16 knees) with reconstruction surgery with allograft. The total group included 13 males and 15 females, with an age range of 15 to 38 years. The graft-related morbidity was studied and a clinical assessment was performed using the pre- and postoperative Kujala score. Associated complications were reported for each group. All the patients had more than 12 months of follow up. RESULTS: No recurrent dislocations or graft related complications were reported in either group. The post-operative Kujala subjective knee score was 89.2 in the autograft group, and 92.6 in the allograft group (p >.05). One patient in the allograft group received a revision surgery due to poor positioning of anchors. Another patient in the allograft group had non-displaced patella fracture related to the bone tunnels and another patient had flexion deficit and needed mobilization under anesthesia. CONCLUSION: There were no significant differences between both groups, and the results were comparable.

Fracturas múltiples de la columna cervical: Reporte de un caso / Multiple cervical spine fractures: Case report

Introducción: Las fracturas múltiples en la columna cervical son una entidad relativamente infrecuente, acerca de la cual la información disponible a nivel mundial es escasa. Existe una tendencia en los casos reportados a manejar dicha entidad de manera conservadora, con combinación de tracciones esqueléticas y diversas órtesis, con resultados variables. Existen pocos reportes de fracturas múltiples manejadas quirúrgicamente. Objetivo: Reportar un caso clínico de fractura múltiple cervical manejado quirúrgicamente en dos tiempos y su seguimiento, en el Centro de Atención a Lesionados Raquimedulares de la Ciudad de México, en el Hospital General "La Villa" de los SSDF. Material y métodos: Se presenta el caso clínico de un paciente masculino de 46 años de edad quien sufre accidente automovilístico con trauma raquimedular con fracturas de C2 a C6, ASIA C. Se decide su tratamiento quirúrgico a dos tiempos con instrumentación posterior y anterior sucesivamente. Se reporta el seguimiento clínico y radiológico a casi dos años de evolución. Resultados: A 19 meses de seguimiento el paciente se encuentra neurológicamente en ASIA D, con un leve déficit motor en el miembro torácico izquierdo. Reincorporado a su trabajo habitual y con movilidad aceptable en la columna cervical. Conclusiones: La evolución satisfactoria presentada por el paciente, tanto en su recuperación neurológica como en la reincorporación a sus labores cotidianas permite recomendar el manejo quirúrgico de fracturas múltiples, individualizando cada caso e interviniendo de acuerdo con la personalidad de cada fractura, con lo cual se puede esperar la obtención de resultados favorables.

Introduction: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atención a Lesionados Raquimedulares de la Ciudad de México), located at "La Villa" General Hospital, SSDF. Material and methods: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. Results: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. Conclusions: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.

Encuesta de percepción de competencias en médicos residentes de Ortopedia y Traumatología en un hospital de Yucatán, México / Competence perception survey among Residents of Orthopedics and Trauma in a hospital of Yucatán México

Antecedentes: El modelo por competencias plantea que lo más importante es poseer elementos para la solución de problemas, ya que una preparación en abstracto no cuenta con suficientes herramientas para solucionarlos. Para ello utiliza competencias centrales y auxiliares que están vinculadas a valores destacando las actitudes. Para explorar estas competencias se hizo el presente estudio. Material y métodos: Estudio transversal, observacional y descriptivo. Se aplicó una encuesta anónima con datos del perfil de médicos residentes de Ortopedia y Traumatología que contenía 14 preguntas que se aplicaron a residentes que cursan diferentes grados académicos. Resultados: En la encuesta participaron 24 residentes de los 35 registrados en el curso. En 100% de ellos aceptó responder la encuesta, 54% cursaban el segundo grado, 29% primer grado y 17% cuarto grado. El 75% manifestó desarrollo de competencias auxiliares, 13% no respondió, 8% desarrollaron competencias centrales y 4% lo ignora. Conclusiones: Se manifestaron tres factores principales que influyen negativamente para mejorar el saber hacer en Ortopedia. El más relevante es que los médicos residentes describen una mala actitud de los médicos adscritos, falta de disponibilidad para enseñar y la mala relación interpersonal entre ellos. Se debe crear conciencia en los especialistas en formación de Ortopedia, que poseer sólo conocimientos y habilidades no es suficiente para abordar integralmente los problemas de salud para cada paciente, ya que se debe motivar el desarrollo de mejores competencias, en especial las centrales.

Background: The competence model states that what is most important is to have the elements to solve problems since abstract training does not provide enough tools to solve them. Therefore, it uses key and auxiliary competences that are linked to values such as attitudes. This study was performed to explore these competences. Material and methods: This is a cross sectional, observational and descriptive trial. An anonymous survey with profile data of Orthopedics and Trauma residents was given, it contained 14 questions for residents of different academic levels. Results: 24 residents participated out of the 35 registered in the course. 100% agreed to answer the survey, 54% was in the second year, 29% in the first year and 17% in the fourth year. 75% expressed auxiliary competences, 13% did not respond, 8% developed key competences and 4% don't know. Conclusions: Three main factors that are a negative influence to improve the knowledge of orthopedics were expressed. The most relevant is that residents describe a bad attitude from attending physicians, lack of willingness to teach and poor interpersonal relationships. Awareness should be raised among orthopedics specialists so they understand that having the knowledge and skills is not enough to approach health issues in a comprehensive manner for each patient and the development of better competences should be fostered, especially key competences.

[Multiple cervical spine fractures. Case report]. / Fracturas múltiples de la columna cervical. Reporte de un caso.

INTRODUCTION: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atenci6n a Lesionados Raquimedulares de la Ciudad de Mexico), located at "La Villa" General Hospital, SSDF. MATERIAL AND METHODS: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. RESULTS: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. CONCLUSIONS: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.