Assessment of the effects of dredging on metal levels in port waters using DGT passive samplers and spot sampling.

Aiming at assessing the effect of dredging activities on the levels of metals in Bilbao Port (northern Spain), dissolved and labile metal concentrations in the water were concurrently measured, before, during, and after dredging activities by spot sampling and Diffusive Gradients in Thin-films (DGTs) passive samplers, respectively. Most of the dissolved metal results were below the quantification limits (Cd, <0.06-0.26 µg/L; Co, <5 µg/L; Cu, <5-15 µg/L; Fe, <10-48 µg/L; Mn, <10-22 µg/L; Ni, <2.6-7 µg/L; Pb, <0.39-0.8 µg/L; Zn, <9-24 µg/L). In contrast, DGT results for all sampling times and stations were obtained (Cd, 0.02-0.12 µg/L; Co, 0.08-0.15 µg/L; Cu, 0.5-2.8 µg/L; Fe, 1.0-3.6 µg/L; Mn, 4.7-23.5 µg/L; Ni, 0.5-0.9 µg/L; Pb, 0.15-0.28 µg/L; Zn, 2.6-7.2 µg/L), enabling to determine those metals affected by dredging. Only labile-Pb concentration surpassed momentarily the DGT-Environmental Quality Standard, enabling to rule out biological effects on biota. DGTs are a promising technique for facilitating decision-making during dredging operations.

Forearm lengthening and prosthetic management in children with transverse congenital forearm deficiency.

In cases of transverse congenital forearm deficiency, achieving a good prosthesis fit during childhood remains a challenge. Ulnar lengthening is a treatment option for improving the prosthesis fit. The objective of this study was to evaluate surgical ulnar lengthening and the subsequent prosthesis fit. We reviewed four cases of ulnar lengthening in children with transverse congenital forearm deficiency. The procedure was evaluated in terms of the duration of lengthening, increase in ulnar length and healing index. The elbow range of motion, functional outcome (Prosthetic Upper Extremity Functional Index, PUFI) and time spent using the prosthesis per day were evaluated. The mean age at the time of the lengthening procedure was 3.5 years, the mean duration of lengthening was 58.3 days, the mean length gain was 21 mm, and the mean healing index was 70.1 days/cm. Elbow range of motion was restricted in one patient (100°-140°) and full in the other three patients. Based on the PUFI, 88.4% of activities were performed without the prosthesis. Children only used their prosthesis to perform specific tasks. Given the high complication rate and the lack of prosthesis use during daily activities, the main indication for forearm lengthening is a very short forearm that prevents prosthesis fitting. This procedure should be performed later in life - in adolescence.

Effect of Calcium-phosphate Desensitizers on Staining Susceptibility of Acid-eroded Enamel.

OBJECTIVE: To investigate the effect of calcium-phosphate-based desensitizers, Teethmate AP paste (TMAP) and Teethmate Desensitizer (TMD) (Kuraray Noritake Dental, Tokyo, Japan), on the prevention of staining on acid-eroded enamel. METHODS AND MATERIALS: Forty polished enamel samples (4×4×1 mm) from bovine incisors were randomly divided into five groups (n=8). After immersion in 50 mL of 0.5% citric acid (pH 2.5) for 15 minutes to form acid-eroded surfaces, the surfaces were subjected to different treatments with TMAP, TMD, and NaF (0.21% means 950 ppm) for five minutes. Another eroded group was not treated with desensitizer. For the control group, the samples were not eroded or treated. All the samples were stored in artificial saliva (AS) at pH 7.2 for 24 hours at 37°C. The TMAP, TMD, or NaF was reapplied at eight and 16 hours during the 24 hours of storage time. The surface roughness (Sa) was evaluated following ISO 25178 for surface texture using confocal laser scanning microscopy (VK-X 150 series, Keyence, Osaka, Japan) before acid erosion, after acid erosion, and after 24 hours of incubation in AS. Afterward, the color difference was measured with a dental colorimeter (Shade Eye NCC, Shofu, Kyoto, Japan) before and after staining with tea solution. RESULTS: One-way repeated measures analysis of variance showed that acid erosion significantly increased Sa (p<0.001). TMAP- and TMD-treated groups exhibited lower Sa values than the NaF group and the no-desensitizer treatment group. The greatest staining was observed in the NaF group and the no-desensitizer group, while the TMAP and TMD groups significantly decreased the formation of stains. CONCLUSIONS: Acid-eroded enamel increased surface roughness and tended to absorb more stains. However, the application of TMAP and TMD moderated the roughness and thus prevented the formation of extrinsic stains.

Baja tasa de eventos adversos en hemodiálisis domiciliaria / Low rate of adverse events in home hemodialysis

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Obstrucción proximal del implante XEN: diagnóstico y tratamiento / Proximal obstruction of a XEN gel stent: Diagnosis and treatment

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Epitaxial Growth of SrTiO3 Films on Cube-Textured Cu-Clad Substrates by PLD at Low Temperature Under Reducing Atmosphere.

The growth of epitaxial {001}<100> SrTiO3 (STO) on low-cost cube-textured Cu-based clad substrate at low temperature was carried out by means of pulsed laser deposition (PLD). STO film was deposited in one step under a reducing atmosphere (5% H2 and 95% Ar mixture) to prevent the oxidation of the metal surface. The optimization of PLD parameters leads to a sharpest biaxial texture at a temperature as low as 500 °C and a thickness of 500 nm with a (100) STO layer. The upper limit of highly textured STO thickness was also investigated. The maximum thickness which retains the best quality {001}<100> texture is 800 nm, since the texture is preserved not only through the layer but also on the surface. Atomic force microscopy (AFM) and scanning electron microscopy (SEM) measurements showed that STO films are continuous, dense, and smooth with very low roughness (between 5 and 7 nm). This paper describes the development of STO layer by means of PLD in absence of oxygen throughout the process, suggesting an alternative and effective method for growing highly {001}<100> textured STO layer on low-cost metal substrates.

Three-Dimensional Analysis of Enamel Crack Behavior Using Optical Coherence Tomography.

The aim of this study was to nondestructively analyze enamel crack behavior on different areas of teeth using 3D swept source-optical coherence tomography (SS-OCT). Ten freshly extracted human teeth of each type on each arch ( n = 80 teeth) were inspected for enamel crack patterns on functional, contact and nonfunctional, or noncontact areas using 3D SS-OCT. The predominant crack pattern for each location on each specimen was noted and analyzed. The OCT observations were validated by direct observations of sectioned specimens under confocal laser scanning microscopy (CLSM). Cracks appeared as bright lines with SS-OCT, with 3 crack patterns identified: Type I - superficial horizontal cracks; Type II - vertically (occluso-gingival) oriented cracks; and Type III - hybrid or complicated cracks, a combination of a Type I and Type III cracks, which may or may not be confluent with each other. Type II cracks were predominant on noncontacting surfaces of incisors and canines and nonfunctional cusps of posterior teeth. Type I and III cracks were predominant on the contacting surfaces of incisors, cusps of canines, and functional cusps of posterior teeth. Cracks originating from the dental-enamel junction and enamel tufts, crack deflections, and the initiation of new cracks within the enamel (internal cracks) were observed as bright areas. CLSM observations corroborated the SS-OCT findings. We found that crack pattern, tooth type, and the location of the crack on the tooth exhibited a strong correlation. We show that the use of 3D SS-OCT permits for the nondestructive 3D imaging and analysis of enamel crack behavior in whole human teeth in vitro. 3D SS-OCT possesses potential for use in clinical studies for the analysis of enamel crack behavior.

EphrinB2 repression through ZEB2 mediates tumour invasion and anti-angiogenic resistance.

Diffuse invasion of the surrounding brain parenchyma is a major obstacle in the treatment of gliomas with various therapeutics, including anti-angiogenic agents. Here we identify the epi-/genetic and microenvironmental downregulation of ephrinB2 as a crucial step that promotes tumour invasion by abrogation of repulsive signals. We demonstrate that ephrinB2 is downregulated in human gliomas as a consequence of promoter hypermethylation and gene deletion. Consistently, genetic deletion of ephrinB2 in a murine high-grade glioma model increases invasion. Importantly, ephrinB2 gene silencing is complemented by a hypoxia-induced transcriptional repression. Mechanistically, hypoxia-inducible factor (HIF)-1α induces the EMT repressor ZEB2, which directly downregulates ephrinB2 through promoter binding to enhance tumour invasiveness. This mechanism is activated following anti-angiogenic treatment of gliomas and is efficiently blocked by disrupting ZEB2 activity. Taken together, our results identify ZEB2 as an attractive therapeutic target to inhibit tumour invasion and counteract tumour resistance mechanisms induced by anti-angiogenic treatment strategies.

Does inter-tibiofibular graft still have a role in the treatment of lower-limb non-union?

INTRODUCTION: Tibial non-union is a complication that poses a real challenge for surgeons. Several forms of treatment, depending on the type of non-union, have been described. The present study sought to assess results for treatment of tibial non-union by inter-tibiofibular graft (ITFG). MATERIAL AND METHOD: An exhaustive cohort study was performed on the files of 33 patients: 25 male, 8 female; mean age, 44years. Twenty cases involved high-energy trauma. Twenty-four were open fractures. Twenty-two concerned diaphyseal fracture, 10 of which were complex segmental. Eleven concerned distal fracture, including 4 complete articular fractures. There were 17 cases of septic non-union. There were no cases of severe bone defect. ITFG was performed at a mean 8.7 months post-trauma, as first-line treatment in 30 cases and in second line in 3. RESULTS: Thirty-one patients showed bone consolidation, at a mean 7.2 months. The 2 failures resulted from technical error. Trauma kinetics emerged as a risk factor for failure. DISCUSSION: ITFG remains a useful treatment option in tibial non-union, whether infected or not. The present results are comparable with those of the literature. Although the present series comprised only tight non-union, a study of the literature showed that ITFG can treat bone defects up to 4 or 5cm. Functional results showed tibiotalar joint stiffening, due more to immobilization and non-weight-bearing than to syndesmosis. ITFG thus remains relevant to the treatment of tibial non-union. LEVEL OF EVIDENCE: IV, retrospective study.

Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia.

BACKGROUND: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. METHODS: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). RESULTS: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. CONCLUSIONS: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC.

Hemodiálisis domiciliaria: un derecho y un deber / Home haemodialysis: a right and a duty

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Application of Toxicity Identification Evaluation (TIE) procedures for the characterization and management of dredged harbor sediments.

This study refers to the performance of Phase I Toxicity Identification Evaluation (TIE) procedures to identify the contaminants (i.e. organic compounds, metals and ammonia) exerting toxicity in marine sediments from the Pasaia harbor (Oiartzun estuary, northern Spain). The effectiveness of the manipulations to reduce toxicity was proved with the marine amphipod survival test (whole-sediment) and the sea urchin embryo-larval assay (elutriates). By means of TIEs it was concluded that organic compounds were the major contaminants exerting toxicity, although toxic effects by metals was also demonstrated. Additionally, the combination of Phase I treatments allowed to investigate the toxicity changes associated to the mobility of contaminants during dredging activities. Therefore, the performance of TIE procedures as another line of evidence in the decision-making process is recommended. They show a great potential to be implemented at different steps of the characterization and management of dredged harbor sediments.

Integrative sediment assessment at Atlantic Spanish harbours by means of chemical and ecotoxicological tools.

This study refers to the integrative assessment of sediment quality in three harbour areas at the Spanish Atlantic Coast: Vigo (Northwestern Spain), Bilbao and Pasajes (Northern Spain). At each site, two lines of evidence have been considered: chemical analyses (metal, PAH and PCB concentrations in sediments and ammonia concentration in bioassays) and toxicity tests (Microtox®, Corophium sp. marine amphipod and Paracentrotus lividus sea urchin larvae). Chemical and ecotoxicological results have been integrated by means of a tabular matrix and a multivariate factorial analysis (FA). Highly toxic samples have been characterised in Vigo and Pasajes harbours while Bilbao samples present toxicity levels ranging from non-toxic to moderately toxic. High toxicity is associated with high levels of contaminants whereas confounding factors (ammonia, organic matter and mud) have been identified to be the main cause of low to moderate toxicity. Based on the obtained results, it can be concluded that deriving potential toxicity of sediments based on comparison with Sediment Quality Guidelines (SQGs) is in agreement to toxicity results in areas presenting high levels of contaminants. However, at lower levels of toxicity (low to moderate), the mismatch between the potential toxicity (SQG approach) and the toxicity measured by bioassays is greater, as the former only accounts for chemical concentrations, without considering the interaction between contaminants and the effect of confounding factors. Contrarily, the multivariate analysis seems to be a robust tool for the integration and interpretation of different lines of evidence in areas affected by different sources of contamination.

Use of an iliac crest growth plate for the development of a neo-articulation for congenital transverse deficiencies at the wrist.

PURPOSE: Terminal congenital transverse deficiencies of the wrist and hand are rare malformations. They are usually treated with prosthetic devices. We describe here a surgical technique to create a neo-articulation that could provide mobility distal to the forearm and help children with terminal transverse deficiencies use orthotic devices. METHODS: This procedure involved an autologous, nonvascularized graft from the immature iliac crest. The graft was placed with its cartilaginous side facing the radial and ulnar articular surfaces. We studied the clinical, radiological, and functional outcomes of this technique in 2 pediatric cases 5 and 14 years after this procedure. RESULTS: The x-rays showed a mobile graft distally in the forearm. Magnetic resonance imaging showed a space between the graft and the radius and an intermediate signal on either side of the space highly suggestive of articular cartilage. These various elements were organized into a neo-articulation between the forearm and the graft. The functional ability at follow-up was greater compared with the absence of a graft. CONCLUSIONS: The results of basic research work on cartilage and chondrocytes may help explain the presence of persistent cartilaginous tissue on the articulated part of the graft. The good functional outcome provided by our surgical procedure may translate into reduced need for prosthesis acceptance. Our surgical procedure does not restore limb length, but does add a new functional ability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Contact mechanics at nanometric scale using nanoindentation technique for brittle and ductile materials.

In the last years, Nanoindentation or Instrumented Indentation Technique has become a powerful tool to study the mechanical properties at micro/nanometric scale (commonly known as hardness, elastic modulus and the stress-strain curve). In this review, the different contact mechanisms (elastic and elasto-plastic) are discussed, the recent patents for each mechanism (elastic and elasto-plastic) are summarized in detail, and the basic equations employed to know the mechanical behaviour for brittle and ductile materials are described.

Evaluation of diffusive gradients in thin-films (DGTs) as a monitoring tool for the assessment of the chemical status of transitional waters within the Water Framework Directive.

In this contribution, the potential use of diffusive gradients in thin-films (DGTs) for the chemical evaluation of transitional water bodies within the Water Framework Directive (WFD) has been studied. The water metal concentration has been evaluated in 13 estuaries in the southeastern Bay of Biscay. The DGTs were deployed in triplicate at two stations in each estuary, delimiting the tidal influence. The DGT results were in the ranges of 2-1570 ng L(-1) for cadmium, 66-515 ng L(-1) for copper, 30-3650 ng L(-1) for nickel and 0.8-95.5 µg L(-1) for zinc. The DGTs provided reliable average labile metal concentrations in highly dynamic systems that were comparable with DGT measurements in coastal and estuarine waters worldwide. In addition, it was possible to discriminate those estuaries more susceptible to environmental impacts, being consistent with the historical contamination of each estuary. Based on the obtained results, a sampling strategy for the monitoring of transitional water bodies using DGTs is proposed.

[Blepharoplasty: to suture or to use cyanoacrylate?]. / Blefaroplastia: ¿suturar o usar cianocrilato?

OBJECTIVE: To study the safety and surgical time required when using the tissue adhesive 2-ethyl-cyanoacrylate compared with conventional suture in upper lid blepharoplasty. METHOD: A retrospective study was performed on 40 eyes of 20 patients who underwent bilateral upper lid blepharoplasty. In 7 patients, continuous non-absorbable suture (6-0 nylon monofilament Ethilon(®), Ethicon Inc., Somerville, NJ) was used for closure of the incision and in 13 patients 2-ethyl-cyanoacrylate (Epiglue(®), Meyer -Haake, Germany) was used. The variables studied were intraoperative time required to close the incision, the cost of the material used and the incidence of infections and suture dehiscence. RESULTS: The average time taken to close the incision was 6.069 minutes with cyanoacrylate and 11.914 minutes with conventional suture (P<.05). The price of surgical material used was practically similar. No cases of infection or wound dehiscence were found. CONCLUSION: The closure of the incision in upper lid blepharoplasty using 2-ethyl-cyanoacrylate is a safe, effective, and faster, but not less expensive method than conventional suture.