Comparing optic nerve head parameters in two Spanish dog breeds using digital planimetry.

The optic discs of dogs exhibit considerable size, shape, and colour variations, depending on the degree of myelination. This variability makes the interpretation of lesions difficult, owing to the lack of reference patterns. This study aimed to compare optic nerve head (ONH) parameters determined by digital planimetry (DP) in two pure-bred dogs, Spanish Greyhound (SG) and Spanish Water Dog (SWD). The vertical and horizontal diameters, area, circularity, and the proportion of the ONH at the tapetal or non-tapetal zone (top height and bottom height) were calculated using image treatment software and compared between breeds. Significant between-breed differences were detected for all parameters, with SWD exhibiting greater height, width, area, top height, and lower circularity of the ONH than SG. Linear regression revealed that age significantly influenced mean disc height (R2 = 0.310; p = 0.0001), mean disc width (R2 = 0.280; p = 0.0001), mean disc area (R2 = 0.281; p = 0.0001), and circularity (R2 = 0.243; p = 0.0001). The multiple regression model significantly predicted mean disc height, width, and area [(S) (R2 = 0.715; p = 0.001), (R2 = 0.742; p = 0.001), and (S) (R2 = 0.736; p = 0.001), respectively], based on age and breed. Excellent concordance was observed between the measurements of experienced and novice researchers, and there were no differences between the parameters measured by the researcher and those obtained by the software. Planimetric ONH measurements can be easily performed by novice operators using a portable fundus camera and digital computer software. These results may be of considerable clinical value, but further studies are required because of the great variability of the ONH in dogs.

Two-dimensional square and hexagonal oxide quasicrystal approximants in SrTiO3 films grown on Pt(111)/Al2O3(0001).

The formation of two-dimensional oxide dodecagonal quasicrystals as well as related complex approximant phases was recently reported in thin films derived from BaTiO3 or SrTiO3 perovskites deposited on (111)-oriented Pt single crystals. Here, we use an all-thin-film approach in which the single crystal is replaced by a 10 nm thick Pt(111) buffer layer grown by molecular beam epitaxy on an Al2O3(0001) substrate. An ultra-thin film of SrTiO3 was subsequently deposited by pulsed laser deposition. The film stacking and structure are fully characterized by diffraction and microscopy techniques. We report the discovery of two new complex phases obtained by reduction of this system through high temperature annealing under ultrahigh vacuum conditions. The formation of a new large square approximant with a lattice parameter equal to 44.4 Å is evidenced by low-energy electron diffraction and scanning tunneling microscopy (STM). Additionally, a new 2D hexagonal approximant phase with a lattice parameter of 28 Å has been observed depending on the preparation conditions. Both phases can be described by two different tilings constructed with the same basic square, triangle and rhombus tiles possessing a common edge length of about 6.7 Å. Using the tiling built from high resolution STM images, we propose an atomic model for each approximant which accounts for the experimental observations. Indeed, the STM images simulated using these models are found to be in excellent agreement with the experimental ones, the bright protrusions being attributed to the topmost Sr atoms. In addition our theoretical approach shows that the adhesion of the oxide layer is rather strong (-0.30 eV Å-2). This is attributed to charge transfer, from the most electropositive elements (Sr and Ti) to the most electronegative ones (Pt and O), and to hybridization with Pt-states. Density of states calculations indicate differences in the electronic structure of the two approximants, suggesting different chemical and physical properties. This all-thin-film approach may be useful to explore the formation of complex two-dimensional oxide phases in other metal-oxide combinations.

Target plasma factor levels for personalized treatment in haemophilia: a Delphi consensus statement.

BACKGROUND: Prophylactic replacement with factor concentrate is the optimal treatment for persons with severe haemophilia to avoid or minimize bleeding. This ultimately prevents or reduces joint disease and improves life expectancy and quality of life towards values matching those in the normal population. However, uncertainty still exists around the optimal regimens to be prescribed for prophylaxis. An increasing number of treating physicians and patients are showing interest in patient-tailored approaches to prophylaxis, which aim to harmonize the prophylaxis regimen with the patients' bleeding phenotype, levels of physical activity and a variety of other variables. METHODS: A modified Delphi technique was adopted to generate consensus. The expert panel met in person to set the objectives, be trained on the Delphi technique and agree on the desired level of consensus. Three iterations were used to identify the targets, the scenarios and their combinations. RESULTS: Twenty-eight scenarios and eight target levels were identified and used to issue recommendations. The panel reached the desired level of consensus on positive or negative recommendations. Areas where consensus was not reached were identified and proposed as areas for future research. Prospective assessment of the validity of most of the proposed targets is recommended. CONCLUSIONS: We have generated, by expert consensus, target plasma levels of factor concentrate to be used to tailor treatment for persons with haemophilia.

Ecotoxicological characterisation of sediments from stormwater retention basins.

Retention-detention basins are important structures for managing stormwater. However, their long-term operation raises the problem of managing the sediments they accumulate. Potential uses for such sediments have been envisaged, but each sediment must be characterised beforehand to verify its harmlessness. In this paper we address this issue through the development of a battery of bioassays specifically adapted to such sediments. We tested the method on samples taken from four retention basins in the region of Lyon (France). This battery focuses on the toxic effects linked to both the solid phase (ostracod and Microtox(®) solid-phase tests) and the liquid-phase (interstitial water) of sediments (rotifer and Microtox(®) liquid-phase tests). The results obtained permit the sorting of sediments presenting little toxicity, and which could therefore be potentially exploitable, from those from more polluted areas presenting higher toxicity that limits their use.

A method for evaluating the evolution of clogging: application to the Pampulha Campus infiltration system (Brazil).

In order to evaluate the hydraulic performance of stormwater infiltration trenches, a study was undertaken to assess clogging and its distribution between the bottom and the sides. The method used was based on the calibration of the hydraulic resistance event by event according to Bouwer's model and applied to a demonstration trench in Belo-Horizonte monitored in the framework of the European Project Switch. The calibration was performed by minimizing the distance between measured and modeled infiltration flow rates and by using continuous measurements of rainfall, inflow, water temperature and depth in the trench. The study showed that the methodology and particularly Bouwer's model was able to produce satisfactory results. It revealed a significant clogging evolution within a year, with global resistance increasing by a factor of 9. A significant difference between the bottom and the sides was observed; the bottom being more rapidly prone to clogging. Sudden fluctuations of the hydraulic resistance of the bottom were found that could be explained by very high concentrations of total suspended solids from inflows (about 2,000 mg/L). Clogging of the sides evolves over the time but with a very low rate.

Prophylaxis in 10 patients with severe haemophilia A and inhibitor: different approaches for different clinical situations.

The effect of bypassing agents is not as predictable as replacement therapy with the deficient factor in inhibitor patients. Consequently, these patients have more levels of arthropathy than patients without inhibitors. Prophylaxis for inhibitor patients has gained attention over the last decade and some papers have reported that bypassing agents could work in the prevention of arthropathy. However, there is a lack data to support any specific agent or regimen or even to recommend their use in different clinical conditions. We report ten patients with haemophilia A and inhibitors treated prophylacticaly with bypassing agents (5 with FEIBA and 5 with NovoSeven). The variable conditioning the choice of one agent or the other was the intention to initiate of immune tolerance induction therapy (ITI) in the future. In 8/10 patients (4 in FEIBA group and 4 in rFVIIa group) there was a decrease of bleeding episodes while 9/10 maintained or increased their joint range of motion (ROM). In the rFVIIa prophylaxis group, prophylaxis can be considered primary since all of them had had less than one joint bleed before prophylaxis. Economic analysis showed that prophylaxis is an expensive treatment. In our experience both agents seem to be safe and effective in reducing the number of bleeds in patients with inhibitors. The anamnestic response provoked by FEIBA could be an issue while awaiting a decline in titres before ITI can be initiated and so rFVIIa may be the best option for prophylaxis in patients with inhibitors who have not yet begun ITI.

Orthopaedic management of haemophilia arthropathy of the ankle.

Joint bleeding, or haemarthrosis, is the most common type of bleeding episode experienced by individuals with haemophilia A and B. This leads to changes within the joints, including synovial proliferation, which results in further bleeding and chronic synovitis. Blood in the joint can also directly damage the cartilage, and with repeated bleeding, there is progressive destruction of both cartilage and bone. The end result is known as haemophilic arthropathy. The joints most commonly affected are the knees, elbows and ankles, although any synovial joint may be involved. In the ankle, both the tibiotalar and subtalar joints may be affected and joint bleeding and arthropathy can lead to a number of deformities. Haemophilic arthropathy can be prevented through regular factor replacement prophylaxis and implementing physiotherapy. However, when necessary, there are multiple surgical and non-surgical options available. In early ankle arthropathy with absent or minimal joint changes, both radioisotopic and chemical synoviorthesis can be used to reduce the hypertrophied synovium. These procedures can decrease the frequency of bleeding episodes, minimizing the risk of articular cartilage damage. Achilles tendon lengthening can be performed, in isolation or in combination with other surgical measures, to correct Achilles tendon contractures. Both arthroscopic and open synovectomies are available as a means to remove the friable villous layer of the synovium and are often indicated when bleeding episodes cannot be properly controlled by factor replacement therapy or synoviorthesis. In the later stages of ankle arthropathy, other surgical options may be considered. Debridement may be indicated when there are loose pieces of cartilage or anterior osteophytes, and can help to improve the joint function, even in the presence of articular cartilage damage. Supramalleolar tibial osteotomy may be indicated in patients with a valgus deformity of the hindfoot without degenerative radiographic findings. Joint fusion, or arthrodesis, is the treatment of choice in the advanced stages of ankle arthropathy although total ankle replacement is currently available. Early ankle replacement components were associated with a poor outcome, but as implant designs have improved, there have been successful outcomes achieved. As the ankle is a commonly affected joint in many individuals with haemophilia, it is important to add to the knowledge base to validate indications and timing of surgical and non-surgical interventions in ankle arthropathy.

Seguridad del tratamiento antibiótico intravenoso domiciliario en pacientes adultos con fibrosis quística / Safety of home intravenous antibiotic treatment in adult patients with cystic fibrosis

Objetivo: Estudio descriptivo en el que se valoran los ciclos de tratamiento antibiótico domiciliario (TAIVD) que se han originado en una Unidad de FQ de adultos de 55 pacientes en un periodo de 5 años. Se analizaron las características de los pacientes, tipo de antibioterapia, acceso venoso utilizado, así como los dispositivos de administración, complicaciones surgidas y resolución de las mismas. Pacientes y métodos: Se incluyeron en el estudio los pacientes con FQ que recibieron TAIVD a lo largo del periodo enero 2002-diciembre 2006. Se recogieron las siguientes variables de los enfermos: edad, sexo, colonización bacteriana dela vía aérea y función pulmonar en fase estable. Resultados: 29 enfermos: 14 varones y 15 mujeres. Recibieron un total de 98 ciclos de antibioterapia intravenosa. La edad media fue de 25,31 (6,83) años. El 62% estaban colonizados por Pseudomonas aeruginosa. Los antibióticos más utilizados fueron ceftazidima y tobramicina. Los pacientes permanecieron una media de 3,62 (4,13) días ingresados en el hospital y 12,27 (4,16) en domicilio. En todos los casos se utilizó la vía periférica, salvo en 3 ciclos en que se usó catéter central de inserción periférica para la administración de los antibióticos. En el 37% de los casos se perdió el acceso venoso y en el 19,2% se produjo flebitis. La canalización de la nueva vía periférica se realizó en el 60,4% por la enfermera de la Unidad de FQ correspondiente, en un 23,25% por el hospital más cercano y en un 12,6% por el Centro de Salud. En 3 casos se presentaron reacciones cutáneas y en 4, alteraciones gastrointestinales secundarias al antibiótico. Conclusiones: La TAIVD es una modalidad terapéutica que, ajustándose a unos criterios de inclusión y exclusión predeterminados, presenta escasas complicaciones y permite reducir el número de estancias hospitalarias. Previsiblemente el uso de la TAIVD se incremente en los próximos años debido a la mayor expectativa de vida de estos enfermos y a que la terapia domiciliaria es la elegida por la población adulta con FQ (AU)

Objectives: A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in CF Units of fifty five patients in period of six years. Different patient features were recorded, antibiotherapy, intravenous access, complications and their resolutions. We accessed the improvement of the pulmonary function, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at the end of the treatment. Patients and Methods: For a five years period (January 2002-December 2006) the patients with CF who received HIVAT and fulfilled the previously fixed criteria were included. The next clinic variables were collected: age, sex, bacterial colonization of respiratory tree, pancreatic function and pulmonary function in steady phase. Results: 29 patients, 14 male and 15 female, were given 98 courses of HIAT. Mean age was 25.31 (6.83) years. 62% of the patients were colonized by Pseudomonas aeruginosa. The most frequently used antibiotics were ceftazidime and tobramycin. Courses of treatment lasted a mean of 3,62 (4,13) days inpatient and 12.27 (4.16) at home. The most of the course were used the intravenous cannula, but in three courses used insertion of peripheral central catheter. The intravenous access was replaced, in the 60.4% of the cases, by the nurse of the CF Unit, in the 23,25% in the emergency room of the nearest hospital and in 12,6% in primary care centre. Three occasions skin reactions were reported and four cases gastrointestinal disorders secondary to antibiotic. The parameters of pulmonary function improved significatively after HIVAT. Conclusions: The HIVAT is a therapeutic option that, following predetermined inclusion criteria, has a low complication rate and permit reduction hospitalization. Probably, HIVAT will be an increasing therapeutic option due to the rise of life expectancy and to that the domiciliary therapy is the chosen one by the adult population with CF (AU)

Fractures of the coracoid process: presentation of seven cases and review of the literature.

Coracoid process fracture is a rare and uncommon clinical entity. Seven cases of the base of the coracoid process are presented. This fracture was isolated in one case, being in the other six cases combined with injuries, either to acromioclavicular dislocation or to fracture of the superior glenoid cavity disorder. One of these patients had associated fractures of the clavicle and the coracoid process. The treatment was conservative in all cases. Results were satisfactory and therefore nonoperative management is advocated.

[Unusual bone tumor in a hemophiliac patient. Diagnosis using aspiration biopsy of the lesion]. / Tumor óseo inusual en paciente hemofílico. Diagnóstico mediante punción aspirado de la lesión.

Bone tumors due to repeated haemorrhages in haemophiliacs (haemophilic pseudotumours) usually are no diagnostic trouble. However, when x-ray findings are not conclusive, the differential diagnosis with malignant tumours may be difficult as bleeding complications hinder invasive diagnostic procedures. A fifteen year-old patient with severe haemophilia A is presented, who had a tumor in his left fibula with no previous traumatism. X-ray and CT scan images showed a broken cortical substance with reactive sclerosis and no alteration of the soft tissues. In order to establish the diagnosis and choose the adequate surgical management, aspiration with thin needle was performed through the cortical hole, under visual control with CT scan. A benign lesion was found upon study of the aspirate. No haemorrhagic or infectious complications developed after tumor dissection and filling with heterologous lyophilized bone. The final diagnosis was "giant cell reparative granuloma", an uncommon lesion in the fibula not previously reported in haemophiliacs. It was concluded that aspiration, when appropriately applied, may be a useful diagnostic procedure which should be borne in mind for the diagnosis of bone tumors in haemophiliacs.

Tarsometatarsal fractures and dislocations.

A total of 32 cases of tarsometatarsal fracture dislocations, treated during a 15-year period, have been retrospectively reviewed. Results were assessed in 29 patients with a mean age of 33.8 years and a mean follow-up of 6.3 years. On the basis of Quénu and Küss' classification, five patients had homolateral dislocations, three had divergent dislocations, and 21 had partial dislocations (seven medial partial and 14 lateral partial). Treatment included closed manipulative reduction, occasionally followed by Kirschner (K)-wire fixation. If closed reduction was not achieved, open reduction was performed. Results were assessed according to Hardcastle's scoring system. On that basis, 20 good, 5 fair, and 3 poor results were obtained and there was one early amputation. Good results were associated with an accurate reduction. Open treatment is advocated if minor displacement persists. Routine K-wire fixation is advised for all cases.

Geriatria: Medicina, envejecimiento, salud / Geriatría: Medicine, aging, health

Contiene una descripción de los métodos de diagnóstico y tratamiento para las enfermedades comunes de la tercera edad. Analiza los factores que influyen en la salud de los ancianos y su recuperación. Presenta los lineamientos básicos para una atención adecuada tanto física como mental...