Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures.

OBJECTIVE: Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The aim of this study was to determine the best indication and therapeutic technique for subtrochanteric fractures and unifying criteria when choosing the most suitable type of nail. MATERIALS AND METHODS: To analyze the influence of the material and the type of distal locking of intramedullary nails (static or dynamic), a femur model with a fracture in the subtrochanteric region stabilized with a long Gamma intramedullary nail was applied using finite element method (FEM) simulation. RESULTS: The mechanical study shows that titanium nails allow for greater micromobility at the fracture site, which could act as a stimulus for the formation of callus and consolidation of the fracture. In the mechanical study, the type of distal locking mainly affects mobility at the fracture site and stress in the cortical bone around the distal screws, without in any case exceeding values that may compromise the viability of the assembly or that may result in detrimental effects (in terms of mobility at the fracture site) for the consolidation process. CONCLUSION: Subtrochanteric fractures treated with titanium nail and static distal locking is safe and does not hinder consolidation.

Pathological findings and husbandry management in captive Chrysaora spp. medusae affected by umbrellar ulcerative lesions.

During a 12 month period, a group of 14 medusa-stage jellies of the genus Chrysaora, including Pacific sea nettle (Chrysaora fuscescens, n = 11) and Japanese sea nettle (Chrysaora pacifica, n = 3), that were maintained in a public aquarium developed progressive ulcerative umbrellar lesions. In 6 cases (42.9%), ulceration was deep, transmural, and perforated through the mesoglea and subumbrella. In 6 cases (42.9%), ciliated protozoa histomorphologically consistent with scuticociliates were observed in the mesoglea and gastrovascular cavity. In 2 cases (14.3%), commensal dinoflagellates (zooxanthellae) were in the mesoglea and in the cytoplasm of the scuticociliates. During this period, water quality parameters including temperature [°C], pH, oxidation-reduction potential (ORP) [mV], salinity [psu], dissolved oxygen [%], ammonia (NH3), and nitrite(NO2) levels were monitored daily or weekly. The main water quality abnormalities were increased NO2 and pH levels above recommended reference ranges for C. fuscescens and elevated temperature above recommended reference ranges for C. pacifica tank. After correction of water quality parameters, apparent improvement of jellies was observed. In this case, environmental factors were considered the most likely predisposing factors for the development of ulcerative lesions, and ciliated protozoa were considered secondary rather than primary pathogens.

Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport.

On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert's experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

Perfil clínico y pronóstico de las miocardiopatías causadas por mutaciones en el gen de la troponina T / Clinical and prognostic profiles of cardiomyopathies caused by mutations in the troponin T gene

Introducción y objetivos: Las mutaciones en el gen de la troponina T (TNNT2) se han asociado en pequeños estudios al desarrollo de miocardiopatía hipertrófica caracterizada por alto riesgo de muerte súbita e hipertrofia leve. Se describe el curso clínico de los pacientes portadores de mutaciones en este gen. Métodos: Se analizaron las características clínicas y el pronóstico de los sujetos con mutaciones en el gen TNNT2 atendidos en una unidad de cardiopatías familiares. Resultados: A partir de 180 familias con miocardiopatías estudiadas genéticamente, se identificó a 21 (11,7%) con mutaciones en TNNT2: 10 familias Arg92Gln, 5 Arg286His, 3 Arg278Cys, 1 Arg92Trp, 1 Arg94His y 1 Ile221Thr. A través de la evaluación familiar se identificó a 33 portadores genéticos adicionales. El estudio incluyó a 54 portadores genéticos: el 56% varones con una media de edad de 41 ± 17 años; 33 miocardiopatías hipertróficas, 9 dilatadas y 1 no compactada, con grosor máximo de 18,5 ± 6 mm; con disfunción ventricular el 30% y antecedentes de muerte súbita el 62%. En el seguimiento 4 fallecieron y 14 (33%) recibieron un desfibrilador (8 probandos, 6 familiares). La supervivencia media fue de 54 años. Los portadores de Arg92Gln tuvieron desarrollo precoz, alta penetrancia, alto riesgo de muerte súbita, alta tasa de implante de desfibrilador y alta frecuencia de fenotipo mixto. Conclusiones: Las mutaciones en el gen TNNT2 fueron más frecuentes en esta serie. Su perfil clínico y pronóstico depende de la mutación hallada. Los portadores de la mutación Arg92Gln desarrollaron miocardiopatía hipertrófica o dilatada y tuvieron un pronóstico significativamente peor que con otras mutaciones en TNNT2 u otros genes sarcoméricos (AU)

Introduction and aims: Mutations in the troponin T gene (TTNT2) have been associated in small studies with the development of hypertrophic cardiomyopathy characterized by a high risk of sudden death and mild hypertrophy. We describe the clinical course of patients carrying mutations in this gene. Methods: We analyzed the clinical characteristics and prognosis of patients with mutations in theTNNT2 gene who were seen in an inherited cardiac disease unit. Results: Of 180 families with genetically studied cardiomyopathies, 21 families (11.7%) were identified as having mutations in TNNT2: 10 families had Arg92Gln, 5 had Arg286His, 3 had Arg278Cys, 1 had Arg92Trp, 1 had Arg94His, and 1 had Ile221Thr. Thirty-three additional genetic carriers were identified through family assessment. The study included 54 genetic carriers: 56% were male, and the mean average age was 41 ± 17 years. There were 33 cases of hypertrophic cardiomyopathy, 9 of dilated cardiomyopathy, and 1 of noncompaction cardiomyopathy, and maximal myocardial thickness was 18.5 ± 6 mm. Ventricular dysfunction was present in 30% of individuals and a history of sudden death in 62%. During follow-up, 4 patients died and 14 (33%) received a defibrillator (8 probands, 6 relatives). Mean survival was 54 years. Carriers of Arg92Gln had early disease development, high penetrance, a high risk of sudden death, a high rate of defibrillator implantation, and a high frequency of mixed phenotype. Conclusions: Mutations in the TNNT2 gene were more common in this series than in previous studies. The clinical and prognostic profiles depended on the mutation present. Carriers of the Arg92Gln mutation developed hypertrophic or dilated cardiomyopathy and had a significantly worse prognosis than those with other mutations in TNNT2 or other sarcomeric genes (AU)

TRAUMATIC (FOREIGN BODY) PERICARDITIS IN A TOCO TOUCAN (RAMPHASTOS TOCO).

An approximately 10-yr-old, captive-born female toco toucan ( Ramphastos toco ) was presented due to an acute onset of depression and apathy. On visual and physical examination, it showed an abnormal posture and dehydration, respectively. Serum biochemistry revealed hyperuricemia (39.4 mg/dl) and elevated glutamic oxaloacetic transaminase (GOT; 1,050 U/L). Radiographs demonstrated an enlargement of the cardiac silhouette. The bird died 7 days after presentation, despite treatment with enrofloxacin, allopurinol, a preparation of hepatorenal protectors, and complex B vitamins with dextrose. Necropsy revealed severe fibrinohemorrhagic pericarditis with a 15 mm long and 2.5 mm diameter, rigid foreign body in the pericardial exudate. Microscopically, this foreign body was of vegetal origin.

Clinical and Prognostic Profiles of Cardiomyopathies Caused by Mutations in the Troponin T Gene.

INTRODUCTION AND AIMS: Mutations in the troponin T gene (TTNT2) have been associated in small studies with the development of hypertrophic cardiomyopathy characterized by a high risk of sudden death and mild hypertrophy. We describe the clinical course of patients carrying mutations in this gene. METHODS: We analyzed the clinical characteristics and prognosis of patients with mutations in the TNNT2 gene who were seen in an inherited cardiac disease unit. RESULTS: Of 180 families with genetically studied cardiomyopathies, 21 families (11.7%) were identified as having mutations in TNNT2: 10 families had Arg92Gln, 5 had Arg286His, 3 had Arg278Cys, 1 had Arg92Trp, 1 had Arg94His, and 1 had Ile221Thr. Thirty-three additional genetic carriers were identified through family assessment. The study included 54 genetic carriers: 56% were male, and the mean average age was 41 ± 17 years. There were 33 cases of hypertrophic cardiomyopathy, 9 of dilated cardiomyopathy, and 1 of noncompaction cardiomyopathy, and maximal myocardial thickness was 18.5 ± 6mm. Ventricular dysfunction was present in 30% of individuals and a history of sudden death in 62%. During follow-up, 4 patients died and 14 (33%) received a defibrillator (8 probands, 6 relatives). Mean survival was 54 years. Carriers of Arg92Gln had early disease development, high penetrance, a high risk of sudden death, a high rate of defibrillator implantation, and a high frequency of mixed phenotype. CONCLUSIONS: Mutations in the TNNT2 gene were more common in this series than in previous studies. The clinical and prognostic profiles depended on the mutation present. Carriers of the Arg92Gln mutation developed hypertrophic or dilated cardiomyopathy and had a significantly worse prognosis than those with other mutations in TNNT2 or other sarcomeric genes.

Spanish Consensus Statement: The Treatment of Muscle Tears in Sport.

On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms-without inhibiting these from the early stages of the recovery period-all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain.

Multivariate models to predict human adipose tissue PCB concentrations in Southern Spain.

The use of Polychlorinated biphenyls (PCBs) has been severely restricted due to their high toxicity and persistency in the environment. However, the presence of PCBs in human tissues nowadays is still been reported worldwide. Background exposure predictors of the human PCB body burden require more precise understanding. In the present study, PCB congeners 138, 153, and 180 were quantified in adult adipose tissue samples (n=387) from Granada Province (Southern Spain) and data on potential predictors of PCB concentrations were gathered by questionnaire. Chemical analysis of the selected congeners was done by gas chromatography and mass spectrometry, and multivariate analyses were performed stratifying by gender. PCB residues were quantified in 92% (PCB 153), 90% (PCB 180), and 86% (PCB 138) of the population. Geometric mean concentrations were 161.65+/-4.41 ng/g lipid for PCB 153, 111.62+/-6.27 ng/g lipid for PCB 180, and 38.41+/-8.61 ng/g lipid for PCB 138. Multivariate models explained 30-36% of the variability in PCB concentrations. Age and body mass index (BMI) predicted exposure in both males and females and were positively correlated with the concentration of the three PCB congeners. Occupation and diet predicted exposure in the males, whereas only dietary predictors were observed in the females. Further in-depth studies are required to investigate the influence of dietary habits on the bioaccumulation of PCBs and to evaluate the impact of policies aimed at reducing human exposure.

Socio-economic level, farming activities and risk of cancer in small areas of Southern Spain.

An ecological design was used to study the relationship between cancer incidence and both socioeconomic and environmental features in Southern Spain. Twenty-four sites and 26,380 cases diagnosed in 1985--1996 were analysed. Generalised Additive Models were used for data analysis. Except for lip cancer, the urban areas showed an increase in cancer risk for all sites. The relative risks among urban and rural municipalities ranges between 1.09 for skin non-melanoma (95% CI: 1.00-1.18) and 1.64 for cervix cancer (95% CI: 1.28-2.12). The relative risk among areas with high and low unemployment was 1.29 for stomach cancer (95% CI: 1.07-1.57), 1.45 for oral cavity cancer (95% CI: 1.10-1.93) and 1.77 for oesophagus cancer (95% CI: 1.02-3.05). Areas with highest unemployment showed the lowest incidence of melanoma. Risk for leukaemia, gall bladder, breast and prostate cancer showed a significant decreases by approximately 28% in the municipalities with the highest illiteracy score. A high percentage of land under cultivation was related to uterine tumours, larynx, rectum, lung, skin non-melanoma and brain cancers. For these sites, the risk had a significant increase by between 23% (skin non-melanoma) and 70% (rectum). Areas with high intensive farming showed a significant increase in cancer risk for lip, oral cavity, larynx, oesophagus, colon, lung, and bladder cancer. The relative risks ranges between 1.16 for colon cancer (95% CI: 1.04-1.29) and 1.47 for oesophagus cancer (95% CI: 1.15-1.87). The results of this study reveal how important socio-economic and environmental factors are for the analysis of cancer incidence in small areas of Southern Spain.

Dehydroepiandrosterone sulfate and growth axis hormones in patients after surgery.

We selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin-like growth factor-1 (GH/IGF-1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA-S), ACTH, cortisol, human GH (hGH), IGF-1, and IGF-1 binding protein-3 (IGFBP-3) preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group. The results were analyzed by gender because DHEA and GH/IGF-1 are known to present sexual dimorphism. There were no significant differences between the preoperative and control results for any of the parameters studied. We found a significant reduction in the concentrations of DHEA-S and IGF-1 on days 2 and 7 after surgery versus the preoperative values. We conclude that the decrease in DHEA-S in patients after surgery is a result of surgical trauma and does not precede surgical stress. The decrease in hormone levels observed in patients with chronic disease may therefore be a result, not a cause, of disease, as some have claimed. Further studies with a later endpoint would be of interest to assess any subsequent return of DHEA-S levels to baseline measurements.

Evaluacion de las diferencias entre el tiempode reaccion ojo-mano y ojo-balón entre jugadores de futbol del Valencia CF / Evaluation of the eye-hand and eye-ball reaction time differences among footballers of the Valencia CF

Es sabido que la información de tipo visual juega un papel fundamental en la práctica deportiva. Una de las habilidades visuales más importante es el tiempo de reacción visual, el cual se define como el mínimo tiempo necesario entre la aparición de un estímulo y la ejecución de una respuesta ha dicho estímulo. Por ello, y dada la importancia de esta habilidad, este estudio pretende evaluar el tiempo de reacción ojo-mano y ojo-balón entre jugadores y no jugadores de fútbol, y a su vez diferenciar entre jugadores de campo y porteros de fútbol. La primera parte del estudio consistió en realizar un screening visual sobre 75 jugadores de fútbol pertenecientes al Valencia CF, y 60 no-jugadores, todos ellos con edades comprendidas entre los 9 y los 20 años. En la segunda parte, se estimó el tiempo de reacción ojo-mano y ojo-balón para todos los sujetos sometidos a estudio. El screening visual consistió de una refracción completa y de una evaluación ocular tanto del segmento anterior como posterior con el fin de detecar cualquier error refractivo o anormalidad ocular que pudiese afectar al sistema visual. Ambos tiempos de reacción fueron evaluados mediante un sistema de creación de estímulos por ordenador, en el que se presentaron estímulos con una configuración central de un test de color rojo sobre un fondo verde, ambos contrastados en luminancia. El tiempo de reacción motor para cada observador se computó como el promedio de cuatro series de 50 presentaciones en cada tipo de tiempo de reacción. Los valores promedios del tiempo de reacción ojo-mano y ojo-balón fueron analizados en relación a cada categoría entre jugadores y no-jugadores. Los resultados obtenidos pusieron de manifiesto que. primero, existen diferencias significativas entre los tiempos de reacción ojo-mano y ojo-balón entre los jugadores de fútbol y los no jugadores (p<0.05), y segundo, que las variaciones obtenidas entre porteros y jugadores de campo fueron estadísticamente significativas (p<0.05).Por tanto, se ha demostrado que los tiempos de reacción de jugadores de fútbol son mejores que los de los no jugadores. Adicionalmente, las variaciones obtenidas entre los dos tipos de tiempos de reacción entre jugadores y porteros se achaca al diferente ejercicio que se realiza en cada una de las extremidades del cuerpo (AU)

La vision en el futbol: estudio de diferentes habilidades visuales / Football soccer vision: study of different visual skills

Por todos es conocida la importancia que adquiere en la actualidad la práctica del deporte, no sólo por ser un fenómeno de masas, sino como una saludable práctica en el tiempo de ocio. Es conocida la importancia de las habilidades visuales requeridas para un deportista de competición, ya que su rendimiento tiene que ser el máximo física, técnica y también visualmente. Sin embargo, estas características no son tan necesarias en un deportista base. Debido al importante papel jugado por la información visual en la práctica deportiva, ya que alrededor del 85 por ciento de la información requerida por un deportista proviene del sistema visual, hemos llevado a cabo en este trabajo un estudio sobre el importante papel que posee la visión en el mundo del deporte, en particular en el deporte del fútbol, uno de los deportes más importantes en nuestro país y en el mundo entero. Hemos desarrollado un estudio de determinadas funciones y habilidades visuales relacionadas con el mundo del fútbol sobre 53 jugadores pertenecientes a diferentes categorías del Valencia CF, con edades comprendidas entre los 9-20 años, que compiten a nivel nacional. Con el fin de comparar los resultados obtenidos en estos jugadores, realizamos el mismo estudio sobre 75 sujetos pertenecientes a una población normal, los cuales no practicaban de una manera habitual el fútbol. Después de haber realizado un examen optométrico a todos los jugadores, las funciones y habilidades que sometimos a estudio fueron: agudeza visual estática y dinámica, motilidad ocular, visión estereoscópica, memoria visual, localización visual, visión del color, sensibilidad al contraste y campos visuales. Los resultados obtenidos mostraron que los jugadores tenían mejor agudeza visual estática y dinámica que los no jugadores (p=0.02 y p=0.03 para la agudeza estática y dinámica respectivamente). La motilidad ocular fue normal para todos los sujetos estudiados. Se encontraron diferencias significativas entre jugadores y no jugadores con el test DEM (p=0.015 y p=0.045 para el tiempo ajustado vertical y horizontal respectivamente). Los resultados obtenidos con el test de estereopsis, memoria visual, visualización y localización visual fueron estadísticamente significativos. La función de sensibilidad al contraste entre jugadores y no jugadores nos indica que no existen diferencias significativas (p>0.05). No encontramos ninguna alteración en el campo visual en ninguno de los sujetos sometidos a estudio. En este estudio hemos encontrado diferencias significativas en las habilidades visuales entre jugadores y no jugadores, excepto para la función de sensibilidad al contraste. Los jugadores de fútbol poseen unas determinadas funciones y habilidades visuales superiores a la población normal, las cuales podrían mejorar mediante entrenamiento visual. Como conclusión podemos decir que el estudio de las habilidades visuales es un factor muy importante para la mejora en el rendimiento deportivo (AU)

El trabajo intermitente de alta intensidad: experiencia de campo / High intensity discontinuous work: a field experience

El ejercicio intermitente de alta intensidad es una modalidad de trabajo utilizada muy frecuentemente en el entrenamiento del fútbol. El presente estudio tiene como objetivo la valoración de la influencia de las variables; tiempo de recuperación, tiempo de trabajo y modelo de trabajo en la programación de un entrenamiento, teniendo en cuenta la carga lactácida producida en cada una de las variables. Se han protocolizado 6 tipos diferentes de entrenamiento intermitente de alta intensidad, con la característica común de que la distancia recorrida al final de cada entrenamiento era prácticamente la misma. Del equipo Juvenil, se eligieron 14 futbolistas, que realizaron todos 6 tipos de trabajo en días diferentes. Tras cada entrenamiento se obtuvo el lactato producido a los 3, 5 y 8 minutos, y se tuvo solo en cuenta el pico de lactato. Se apreció que una variación en los tiempos de recuperación de 20" a 40" para un mismo trabajo produce variaciones en la producción de lactato del 30,4 por ciento y del 27,l por ciento en dos tipos diferentes de entrenamiento. La variación en los tiempos de trabajo, produjo una diferencia porcentual del 45,9 por ciento cuando la distancia de las repeticiones era de 40 metros sobre 20 metros para un tiempo de recuperación constante de 20", y del 42,4 por ciento cuando el tiempo de recuperación era de 40". También se analizaron las variaciones en el modelo de trabajo utilizado apreciando una diferencia porcentual en la producción de lactatos a favor del lineal del 22 por ciento respecto sobre uno de ida y vuelta (AU)