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Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation.

Background: Intraoperative monitoring of parathyroid hormone (IOPTH) is a reliable method of predicting the cure of primary hyperparathyroidism (PHPT). The aim of this study is to assess whether common clinical variables (CCV) frequently encountered in patients with PHPT may affect the magnitude of PTH drop or the likelihood of patients meeting the intraoperative cure criterion. Design: Patients who were surgically cured from PHPT caused by single gland disease (SGD) and had full IOPTH protocol (4 measurements) were stratified according to age, gland weight, renal function, vitamin D status and severity of hypercalcemia. The percentage of IOPTH drop and the frequency of patients who had true positive IOPTH test results were compared among groups. Results: 762 patients had surgery for PHPT, of whom 746 were (98%) cured. Of these 746 patients, 511 who had SGD and a full IOPTH protocol were included in this study. The median IOPTH drop was significantly higher among younger patients, those with severe hypercalcaemia at 5, 10, 15 min after gland excision, giant glands (at 5-min only), patients with vitamin D deficiency (at 10, 15 min), and those with normal renal function (at 15 min only). The likelihood of the patients meeting the intraoperative cure criterion was not significantly affected among the groups except in patients with mild hypercalcaemia, who were significantly less likely to have 50% IOPTH drop than those with severe hypercalcaemia at all time points. The frequency of mildly hypercalcaemic patients who met cure criterion was significantly improved by extending measurement to 15 min. Conclusions: IOPTH monitoring has the ability to mitigate the variability of IOPTH kinetics associated with most clinical variables. Mildly hypercalcemic patients in particular may benefit from waiting for 15-min measurement before any surgical decision is made.

Crop diversification practices (CDPs) are alternative strategies aimed to achieve sustainable cropping systems and food production overcoming the agro-environmental impacts of conventional cropping systems such as monoculture. Thus, this paper aims to improve the knowledge of implementing CDPs in different European pedoclimatic regions by assessing the economic performance at the farm level. CDPs are compared with conventional cropping systems and clustered in terms of their gross margin (GM) results and variations. Farm-level assessment shows that CDPs provide positive economic results, representing an adaptive management strategy for ecological transition, without compromising economic sustainability. Particularly, the main findings show that (1) the impact of diversification depends more on crop type than on the selected CDPs, (2) most farms exhibited a low GM with low economic impact, and (3) there is a great likelihood that the CDPs facilitate the buildup of more resilient farming systems.

Durante el periodo inicial del confinamiento por la COVID-19 se tomaron una serie de medidas de restricción que modificaron el día a día de la población. En este estudio se buscó conocer el impacto de este periodo en la salud física y mental de niños y jóvenes con discapacidad originada en la infancia, y de sus familias, y describir los cambios que se produjeron en el acceso a la educación y a los servicios de salud.

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Las crisis epilépticas son un motivo de ingreso frecuente en urgencias y requieren una actuación diagnóstico-terapéutica precoz y precisa. Nuestro objetivo fue describir las características clínico-evolutivas de una serie de pacientes con crisis epilépticas atendidos en urgencias.

The primary austenitic solidification mode of Twinning Induced Plasticity (TWIP) steel weld joints is one of the most important issues limiting its weldability. In order to gain knowledge on this topic, a comprehensive study was carried out through numerical simulation of diffusive-convective phenomena of fluid flow and heat transfer of the melted material in the weld pool of TWIP steel weld joints. Weldments were performed using different heat inputs and constraint conditions. The predictions of convective motion, thermal history and cooling rates estimated by finite element (FE) and finite volume (FV) simulations were correlated with chemical species segregation (Mn, C, Al and Si) and the solidification mode in the fusion zone. The microstructural characterization of weld joints and the numerical results provided a full analysis of the weld pool solidification process. Results revealed a relationship between both the dendrite size and Mn segregation with the estimated velocity field of liquid material in the melted zone. Moreover, the presence of δ-ferrite was experimentally detected in some weld joints and associated with the convective movement of melted material and chemical segregation. The cellular dendritic growth mode found in some weld joints contributed to the formation of δ-ferrite and promoted the transition of the solidification mode from austenitic to ferritic-austenitic. As well δ-ferrite allowed to mitigate hot-cracking and interrupted the Mn-enriched liquid film migration towards the heat-affected zone, avoiding the formation of liquation cracks. The presence of δ-ferrite phase maintained a high mechanical strength providing improved elongation regarding the welded material mechanical properties.

El uso de tratamientos no farmacológicos en pacientes con cefalea, como la punción seca (PS), está asociado a una baja morbimortalidad y a un bajo coste sanitario. Algunos han demostrado utilidad en la práctica clínica. El objetivo de esta revisión fue analizar el grado de evidencia de la efectividad de la PS en la cefalea.

Leukaemia accounts for around 3% of all cancer types diagnosed in adults, and is the most common type of cancer in children of paediatric age (typically ranging from 0 to 14 years). There is increasing interest in the use of mathematical models in oncology to draw inferences and make predictions, providing a complementary picture to experimental biomedical models. In this paper we recapitulate the state of the art of mathematical modelling of leukaemia growth dynamics, in time and response to treatment. We intend to describe the mathematical methodologies, the biological aspects taken into account in the modelling, and the conclusions of each study. This review is intended to provide researchers in the field with solid background material, in order to achieve further breakthroughs in the promising field of mathematical biology.

A personal narrative is presented which explores the author's experience of keeping her faith in God while facing struggles in her journey from leaving her home country Colombia with her 12-year old son to migrating to the U.S. and seeking asylum.

Background: The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the ‘gold standard’. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. Methods: An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. Results: All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78–94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53–76]; p< 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64–96) versus US and sestamibi (57% [95% CI 34–77]; p= 0.016). For adenomas < 1.0 g (n= 36; 48%), the accuracy of CT was 81% (95% CI 64–91) compared with 62% (95% CI 44–77) for US and sestamibi (p= 0.04). The correct preoperative diagnosis of multiglandular disease (n= 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14–73]) and US and CT (50% [95% CI 20–80]) (p> 0.99). Conclusion: The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.

We characterize the good weights for some weighted weak-type iterated and bilinear modified Hardy inequalities to hold.

The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.

Las espondiloartritis (EspA) incluyen las EspA axiales y las EspA periféricas, pero existen otras como la artritis reactiva (ARe), las artritis asociadas a enfermedad inflamatoria intestinal (EII) o el síndrome de sinovitis, acné, pustulosis, hiperhidrosis, osteitis (SAPHO) que son habituales en las consultas de reumatología, aunque menos frecuentes que la espondilitis anquilosante (EA) o la artritis psoriásica (APs). Se pueden presentar tanto con clínica axial como periférica y tanto con manifestaciones extraarticulares como oftalmológicas o cutáneas. La forma de presentación más frecuente de la ARe es la oligoartritis de miembros inferiores, siendo más infrecuente la afectación axial; mientras que en la artropatía asociada a EII puede aparecer clínica a cualquier nivel. En el síndrome de SAPHO predomina la clínica axial. El diagnóstico se basa principalmente en la clínica y los hallazgos radiológicos, sin que existan criterios unánimes de diagnóstico. Para la clínica articular está indicada como primera línea el tratamiento con antiinflamatorios no esteroideos, aunque con restricciones en el caso de la artropatía asociada a EII, pudiéndose usar también corticoides sistémicos (no en afectación axial) o locales. En caso de fallo, estaría indicado el tratamiento con fármacos modificadores de la enfermedad como sulfasalazina y, si fuese necesario, con fármacos biológicos (sobre todo anti-factor de necrosis tumoral —anti-TNF—) que se han usado en estas patologías con diversas respuestas.

Se define como oligoartritis a la inflamación de 2 a 4 articulaciones. Puede ser la presentación clínica de una gran variedad de procesos, principalmente inflamatorios, pero también infecciosos y de otros orígenes. La oligoartritis puede progresar desde una monoartritis a formas poliarticulares en la evolución, por lo que las causas pueden ser comunes con esas entidades. Para el diagnóstico diferencial es importante llevar a cabo una anamnesis y una exploración física adecuadas, así como apoyarse en diferentes pruebas complementarias. Resulta fundamental el análisis del líquido sinovial y, con frecuencia, precisa de la realización de otras pruebas analíticas o radiológicas.

Los sistemas de Vigilancia de Parálisis Flácida Aguda (PFA) y Enterovirus (EV) son clave para lograr la erradicación de la poliomielitis en todo el mundo. Entre otras, permiten detectar la reintroducción de poliovirus (PV) desde zonas endémicas.

In this research work, the optimal parameters of post welding heat treatment (PWHT) for 12Cr–1Mo Steel in the welding condition are determined. The PWHT aims to decrease δ-ferrite percentage in the interface of the heat-affected zone (HAZ) and partially melted zone (PMZ). The parameters of post welding heat treatment (time, temperature, and cooling media) are determined through statistical analysis of a full factorial design. These considered δ-ferrite percentage in the HAZ-PMZ interface as the response variable, as well as microhardness in the critical welding regions. Subsequently, a predictive equation of δ-ferrite percentage in the HAZ-PMZ interface was obtained after the post welding heat treatment using non-linear regression coefficients given by full factorial design. The interaction between time and cooling media was essential to improve the PWHT. Also, a high temperature in the PWHT produced a total decrease of δ-ferrite. These mechanisms were associated with the dissolution of forming elements of the primary δ -ferrite, such as Cr and Mo. The PWHT optimal parameters to eliminate δ-ferrite were the temperature of 860 °C with the following combinations of treatment time and cooling media: 1 h-air and 2 h-oil.

AbstractIt is estimated that 80% of the world population trusts traditional medicine. A large number of Americans use infusions of Bocconia frutescensL. leaves to treat cough and gastrointestinal disorders. However, phytochemical studies reveal that this plant contains alkaloids and other potentially harmful substances. This study aimed to evaluate the teratogenic effects of B. frutescensL. in an experimental model. Pregnant Wistar rats were administered lyophilized B. frutescensL. extract at 300 mg/kg/day or vehicle by orogastric route during the organogenesis period (gestation days 7–13), and external and internal congenital malformations were analyzed on the progeny on gestational day 20. Bocconia frutescensL. produced a significant increase in the number of different malformations, relative to the control group. We conclude that the consumption of B. frutescensL. during pregnancy at a dose equivalent to that consumed by humans increases the risk of teratogenic effects.

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Los tratamientos tópicos e intralesionales (IL) pueden ser considerados como de primera línea en pacientes con hidradenitis supurativa (HS), sin embargo, la evidencia que apoya su uso es limitada. El objetivo de nuestra revisión es evaluar la eficacia y la seguridad de los tratamientos tópicos e IL en pacientes con HS.

Introduction Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation.

Mostrar nuestra experiencia con el uso del abordaje de Stoppa sobre fracturas del acetábulo con afectación de la lámina cuadrilátera.

La cardiopatía isquémica representa la primera causa de mortalidad en los países desarrollados y, dentro de ella, el infarto agudo de miocardio con elevación del segmento ST (IAMCEST) es una de las patologías con una tasa de mortalidad más elevada en sus primeras fases, de ahí la importancia de realizar un correcto diagnóstico, según los criterios de la 4ª definición del IAM. Actualmente, la realización del intervencionismo coronario percutáneo primario ha demostrado mayor eficacia de reperfusión coronaria frente al tratamiento farmacológico, pero para ello es necesario disponer de los recursos necesarios. La aplicación adecuada de la estrategia de reperfusión, en paralelo, con los nuevos tratamientos antiagregantes y/o anticoagulantes, han permitido un ligero descenso de la mortalidad dentro del síndrome coronario agudo, en comparación con los IAM sin elevación del segmento ST.

Demodex folliculorumy Demodex brevisson ectoparásitos que habitan en la piel de los seres humanos. Han sido relacionados con alteraciones en la superficie ocular, tales como disfunción de glándulas de Meibomio, blefaritis, chalazión, etc. La demodicosis ocular se caracteriza por la presencia patognomónica de caspa cilíndrica en la base de las pestañas y diversos síntomas como picazón, lagrimeo e hiperemia, entre otros. Se realizó una revisión bibliográfica del rol de Demodexspp. en la enfermedad ocular, incluyéndose publicaciones científicas entre los años 2005-2018. Se registró una asociación importante de prevalencia e incidencia de Demodexspp. en enfermedades oculares. D. folliculorumse encontró con mayor frecuencia que D. brevisen la infestación ocular, incrementándose la prevalencia o incidencia de infestación por ambas especies con la edad del paciente. Se sugiere que en pacientes con blefaritis, u otra enfermedad infecciosa de la superficie ocular no resuelta con tratamiento antibacteriano, debería plantearse la búsqueda de Demodexspp.

This study investigates the moderating influence of R&D intensity on the relationships between family management and firm performance in private firms. The results confirm that R&D intensity reinforces the negative effect of family management on firm performance. More specifically, we obtain that R&D intensity is a statistically significant moderator for those firms having large levels of R&D investment relative to one's industry peers. Likewise, we find that only when taking into account the total effect of R&D, including internal and external R&D, does its interaction with family management has a detrimental effect on firm performance.

This study investigates the moderating influence of R&D intensity on the relationships between family management and firm performance in private firms. The results confirm that R&D intensity reinforces the negative effect of family management on firm performance. More specifically, we obtain that R&D intensity is a statistically significant moderator for those firms having large levels of R&D investment relative to one's industry peers. Likewise, we find that only when taking into account the total effect of R&D, including internal and external R&D, does its interaction with family management has a detrimental effect on firm performance.

An important stage in the process of manufacturing diaphragms for steam turbines is the application of the seal welding in bands and blades. The geometry of the assembly, the weld constraint and thermal deformation lead to a complex distribution of residual stresses, which reduce the service life of the component. In this research work the expansion-contraction phenomenon was studied, as well as the residual stress distribution in the seal welding of a 12Cr-1Mo steel band-blade assembly. The One-Way Fluid Structure Interaction approach was considered in the numerical solution of the mathematical model through Finite Volume (FV) and Finite Element (FE) methods. Microstructural analysis and experimental tests were carried out to measure the thermal history and postwelding mechanical properties. The results indicated that the complex distribution of the transversal residual stresses generated by temperature gradients in the assembly are responsible for the expansion-contraction phenomenon occurring during the welding process. The volumetric expansion of the 12Cr-1Mo steel by phase change was a localized phenomenon. The microstructural study related to the FE analysis of the residual stresses suggest the possibility of dismissing a post-weld heat treatment during the manufacture of these components.

Evaluar el efecto de las dosis altas de corticoides en pacientes ingresados por exacerbación de una enfermedad pulmonar obstructiva crónica (EPOC).

La anemia es una entidad clínica que se detecta frecuentemente en la evaluación preoperatoria, especialmente en pacientes de edad avanzada. Se asocia a un aumento de la morbimortalidad perioperatoria, así como a una mayor probabilidad de transfusión de sangre alogénica (TSA), con los riesgos que ello implica.