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espanolObjetivo: Evaluar la asociacion entre la fuerza de prension manual (FPM) y diversos parametros de condicion fisica y composicion corporal en mujeres supervivientes de cancer de mama. Metodo: Se realizo un estudio transversal con los datos basales del ensayo clinico EFICAN (Ejercicio FIsico para supervivientes de CANcer de mama). Participaron 60 mujeres supervivientes de cancer de mama que habian terminado los tratamientos centrales de la enfermedad en los 10 anos previos al comienzo del estudio, que no presentaban enfermedad pulmonar o cardiovascular, cancer de mama metastasico, ni tenian prevista una intervencion para reconstruccion mamaria en un plazo de 3 meses desde el comienzo del estudio. Se evaluo la fuerza de prension manual mediante dinamometria manual, la fuerza muscular isometrica pico mediante dinamometria electromecanica funcional, el fitness cardiorrespiratorio (VO2max) se estimo a traves del Siconolfi step test, la amplitud de movimiento (ADM) en flexion de hombro mediante goniometria digital, y la composicion corporal mediante bioimpedancia. Resultados: Se observo una asociacion positiva de la FPM con la masa muscular (r=0.423), y con la fuerza isometrica de miembro superior (r=0.523) e inferior (r=0.335), y una asociacion negativa de la FPM con el porcentaje de grasa corporal (r=-0.405). Sin embargo, no se encontro asociacion entre FPM y VO2max ni ADM del hombro (P>0.05). Conclusiones: Estos resultados sugieren que la FPM puede ser un buen indicador de fuerza muscular, asi como de composicion corporal en mujeres supervivientes de cancer de mama. Futuros estudios prospectivos deberan evaluar el valor predictivo de la FPM en esta poblacion. portuguesObjetivo: Avaliar a associacao entre a forca de preensao manual (FPM) e varios parâmetros de condicao fisica e composicao corporal em mulheres sobreviventes de cancro da mama. Metodo: Foi realizado um estudo transversal utilizando dados de base do ensaio clinico EFICAN (Physical Exercise for Breast Cancer Survivors). Participaram sessenta mulheres sobreviventes de cancro da mama que tinham concluido os tratamentos centrais da doenca nos 10 anos anteriores ao inicio do estudo, que nao tinham doencas pulmonares ou cardiovasculares, cancro da mama metastasico, ou que nao estavam programadas para se submeterem a reconstrucao da mama nos 3 meses seguintes ao inicio do estudo. A forca de preensao manual foi avaliada por dinamometria manual, o pico de forca muscular isometrica por meio de dinamometria electromecânica funcional, a capacidade cardiorrespiratoria (VO2max) foi estimada pelo Siconolfi step test, a amplitude de movimento (ADM) em flexao do ombro por meio de goniometria digital, e a composicao corporal por bioimpedância. Resultados: Observamos uma associacao positiva de FPM com massa muscular (r=0,423), e com forca isometrica de membro superior (r=0,523) e membro inferior (r=0,335), e uma associacao negativa de FPM com percentagem de gordura corporal (r=-0,405). Contudo, nao foi encontrada qualquer associacao entre FPM e VO2max ou ADM de ombro (P>0.05). Conclusoes: Estes resultados sugerem que a FPM pode ser um bom indicador da forca muscular, bem como da composicao corporal das mulheres sobreviventes de cancro da mama. Os futuros estudos prospectivos devem avaliar o valor preditivo do FPM nesta populacao. EnglishObjectives: This study evaluated the association between handgrip strength (HGS) and various parameters of physical fitness and body composition in female breast cancer survivors. Methods: A cross-sectional study was conducted with the baseline data from the EFICAN (Ejercicio FIsico para supervivientes de CANcer de mama) clinical trial. 60 female breast cancer survivors who had completed the core treatments of the disease in the 10 years prior to the study beginning, who didn’t have any cardiovascular or pulmonary disease, metastatic breast cancer or awaited breast cancer reconstruction in the following 3 months, participated. Handgrip strength was assessed using a digital dynamometer, peak isometric strength was determined using an electromechanical dynamometer, cardiorespiratory fitness (VO2max) was estimated through the Siconolfi step test, shoulder flexion mobility was assessed through digital goniometry and body composition was determined using a bioelectrical impedance device. Results: Positive associations between HGS and muscle mass (r=0.423), isometric upper-limb (r=0.523) and lower-limb (r=0.335) strength were found, and a negative association between HGS and fat mass percentage (r=-0.405) was also found. However, no associations between HGS and VO2max or shoulder flexion mobility were found (P>0.05). Conclusions: These results suggest that HGS may be a good indicator of muscular strength and body composition in female breast cancer survivors. Future prospective studies are needed to assess the predictive value of HGS in this population.

Total knee arthroplasty (TKA) is a common procedure in orthopeadic surgery. It has been estimated that the incidence of periprosthetic fractures after TKA ranged between 0.3 to 2.5%,but increases to 38% when considering revision TKA.Patient-related risk factors for TKA periprosthetic fracture (TKAPF) include osteoporosis, age, female gender, revision arthroplasty and osteolysis. The choice of the most appropriate fixation device of TKAPF is a matter of debate, considering that locking plates and retro-grade intramedullary are both associated with good outcomes in terms of fracture union and joint function. In case of prosthetic component instability, severe comminution or metaphyseal extension of the fracture that precludes fixation, failure of previous treatments, and severe malalign-ment of the TKA, revision TKA (RTKA) should be considered. Severe bone loss is another is-sue of concern, that might be addressed using both megaprosthesis or allograft-prosthesis composite. Considering the variability of the clinical scenario of TKAPF, a comprehensive approach based on both fracture fixation and/or revision arthroplashty is needed.

Purpose This study assessed the effects of 12-week supervised resistance training combined with home-based physical activity on physical fitness, cancer-related fatigue, depressive symptoms, health-related quality of life (HRQoL), and life satisfaction in female breast cancer survivors. Methods A parallel-group, outcome assessor-blinded, randomized controlled trial included 60 female breast cancer survivors who had completed their core treatments within the previous 10 years. Through computer-generated simple randomization, participants were assigned to resistance training (RTG; two sessions/week for 12 weeks plus instructions to undertake ≥ 10,000 steps/d) or control (CG; ≥ 10,000 steps/d only). Outcomes were evaluated at baseline and week 12. Muscular strength was assessed with electromechanical dynamometry. A standardized full-body muscular strength score was the primary outcome. Secondary outcomes included cardiorespiratory fitness, shoulder mobility, cancer-related fatigue, depressive symptoms, HRQoL, and life satisfaction. Results Thirty-two participants were assigned to RTG (29 achieved ≥ 75% attendance) and 28 to CG (all completed the trial). Intention-to-treat analyses revealed that the standardized full-body muscular strength score increased significantly in the RTG compared to the CG (0.718; 95% CI 0.361–1.074, P d = 1.04). This increase was consistent for the standardized scores of upper-body (0.727; 95% CI 0.294–1.160, P = 0.001, d = 0.87) and lower-body (0.709; 95% CI 0.324–1.094, P = 0.001, d = 0.96) strength. There was no effect on cardiorespiratory fitness, shoulder flexion, cancer-related fatigue, depressive symptoms, HRQoL, or life satisfaction. The sensitivity analyses confirmed these results. Conclusion and implication for cancer survivors. In female breast cancer survivors who had completed their core treatments within the past 10 years, adding two weekly sessions of supervised resistance training to a prescription of home-based physical activity for 12 weeks produced a large increase in upper-, lower-, and full-body muscular strength, while other fitness components and patient-reported outcomes did not improve. Trial registration number. ISRCTN14601208.

Severe bone loss is a critical issue in trauma and it requires complex techniques to preserve limb form and function. Regenerative medicine, using stem cells and molecular biology, might be useful to enhance bone healing in severe bone loss. Between 2017 and 2018, 4 patients showed severe bone loss. In all of them, the use of stem cells was added to fixation with a cortical graft. Fracture healing occurred in a range of 3 to 8 months. In our experience, the use of stem cells, in association with bone graft and stable fixation, was able to achieve bone healing even in case of severe bone loss.

Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.

Una obra orientada a plantear la pertinencia y convergencia de la integracion en America Latina despierta reacciones encontradas, pues para algunos, si los procesos de integracion se encuentran en crisis, ?que objeto tiene formular reflexiones sobre su convergencia? Todavia, diran algunos, esta bien evaluar su pertinencia, etapa necesaria, pues en un contexto complejo de crisis mundial, se debe tener claro que razones respaldan continuar en el siglo XXI con esfuerzos integracionistas. Pero es que, si la integracion es pertinente, se requiere que en la situacion de estancamiento y confusion en que se encuentran los distintos procesos de integracion, America Latina establezca un camino, una hoja de ruta, sobre como relanzar y profundizar la integracion, conociendo a donde llegar mediante una agenda de trabajo que indique en el corto, mediano y largo plazo, los temas fundamentales a desarrollar.

Introduction:Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence of a type of PFF with an atypical pattern (atypical PFF, APFF). The aim of the present study is to report 3 cases of APFF treated at a single centre.Methods:Clinical and radiographic records of PFF that occurred between January 2016 and August 2018 were retrospectively reviewed. All patients meeting the American Society for Bone and Mineral Research (ASBMR) criteria for definition of PFF were included. Management strategies for APFF and patient outcomes, including fracture healing and hip function (assessed by the Oxford Hip Score [OHS]) were collected.Results:3 patients in the study period were identified as APFF (1 incomplete, 2 complete). All patients were females with a mean age of 83.3 years. All patients were treated with lateral plating. The application of a contralateral strut allograft resulted in fracture healing in cases of complete fractures. Mean OHS at final follow-up was 34.3.Conclusions:Despite occurring around a hip stem like PFF, APFF had peculiar clinical and radiographic features, making them more similar to AFF. Therefore, the orthopaedic surgeon should also consider the natural history and healing problems associated with AFF prior in order to choose the most appropriate management for APFF.

Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6–23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: “joint depression” type and 1 case “tongue” type). Radiographic measurement (Böhler's and Gissane's angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler's angle was 12.3 ± 8.41° (95% CI 6.3–18.3°), whereas mean preoperative Gissane's angle was 123.66 ± 20.47° (95% CI 109.0–138.3°). At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5–24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9–82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty. Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6–23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: “joint depression” type and 1 case “tongue” type). Radiographic measurement (Böhler's and Gissane's angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler's angle was 12.3 ± 8.41° (95% CI 6.3–18.3°), whereas mean preoperative Gissane's angle was 123.66 ± 20.47° (95% CI 109.0–138.3°). At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5–24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9–82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty.

Background The number of people living with the side effects of breast cancer treatment (eg, loss of muscular mass and muscular strength, upper-limb mobility and disability, lymphedema, cardiac toxicity, and reduced quality of life) is increasing yearly. These consequences can be improved through exercise, specially combining resistance and aerobic training. Previous exercise trials have not been consistent in applying training principles and standardized reporting, and this partly explains the variability in obtained results. The aim of this study is to assess the effect of a 12-week supervised resistance exercise program combined with home-based aerobic exercise, compared with home-based aerobic exercise only, on muscular strength and several aspects of health-related quality of life in breast cancer survivors. To maximize transparency, replicability, and clinical applicability, the intervention is described following the consensus on exercise reporting template. Methods This study is a parallel-group randomized controlled trial in which 60 female breast cancer survivors, who have completed central treatments of the disease in the last 5 years, will be randomly assigned to either an experimental group that will perform a total of 24 progressive resistance training sessions for 12 weeks (ie, 2 weeks of individual training and 10 weeks of micro-group training) and will be requested to undertake 10,000 steps/d, or a control group that will be requested to undertake 10,000 steps/d, only. Outcomes will be evaluated at baseline and at week 12. Primary outcome measure is peak isometric muscular strength of the lower- and upper-body, assessed with several exercises through an electromechanical dynamometer. Secondary outcomes include cardiorespiratory fitness, upper-joint mobility and disability, health-related quality of life, cancer-related fatigue, depression, life satisfaction, and presence of lymphedema. Discussion This study aims to investigate the extent to which a 12-week supervised and progressive resistance exercise program, in addition to home-based aerobic physical activity, might improve muscular strength and health-related quality of life in breast cancer survivors. The comprehensive description of the intervention will likely contribute to enhancing exercise prescription in this population. Trial registration number ISRCTN14601208.

Introduction: The mechanism that leads to a given fracture pattern is not understood. Heredity could act in this field through the ABO system. We investigated the relationship between ABO blood system and hip fracture pattern in a population from Southern Italy. Methods: Hip fractures were identified through a registry evaluation of the activity of a level I Hospital, and subsequently classified in ‘intracapsular’ or ‘extracapsular’ according to their anatomical location. Information on these patients’ ABO blood type was collected and compared with general population data from the report on blood donors of the Salerno division of Italian Blood Volunteers Association (AVIS). Results: 590 hip fractures were included (414 extracapsular, 176 intracapsular) and compared with 709 blood donors. Fractured patients presented a blood group A more often and blood group O less often than the AVIS population ( p A vs. non-A = 0.0033; p O vs. non-O = 0.0024). None of the ABO blood groups were associated with fracture pattern ( p O vs. non-O = 0.5858, p A vs. non-A = 0.409; p B vs. non-B = 0.253; p AB vs. non-AB = 0.212). The rhesus factor was not associated the fracture pattern ( p = 0.34). Conclusions: The ABO blood type could play a role as a risk factor for proximal femoral fractures, but in our population its relevance in influencing the fracture pattern is unclear.

Para favorecer la compresión del concepto fuerzas intermoleculares, que presenta dificultades en su conceptualización como consecuencia de requerir el conocimiento de procesos a nivel molecular. Para ello, se plantea realizar tareas experimentales que posibilitan establecer relaciones entre los tipos de fuerzas involucradas con la estructura y las propiedades macroscópicas. La experiencia en laboratorio consiste en medir una propiedad macroscópica como la tensión superficial, para diferentes sustancias y relacionar estas medidas con las fuerzas de interacción y su naturaleza. Se evaluó el conocimiento adquirido utilizando el laboratorio didáctico propuesto, comparando con evaluaciones donde se había aplicado enseñanza teórica clásica. El laboratorio propuesto produjo notables mejoras con respecto a la forma clásica de enseñanza.

Una metodologia muy usada en la enseñanza de la química a nivel universitario incluye la diferenciación entre lo teórico y lo práctico. En las clases teóricas, el docente a cargo, a través de clases magistrales, desarrolla los contenidos conceptuales de la asignatura, mientras que las clases de problemas están destinadas a enseñar las aplicación de esos conceptos teóricos. El aprendizaje de las aplicaciones la realizan los alumnos mediante el desarrollo o puesta en marcha de actividades enfocadas hacia la concreción de la solución de los problemas-ejercicios. Así, los docentes proponen problemas numéricos y enseñan a los alumnos a resolverlos, constituyendo lo más importante hacer que estos últimos desarrollen destrezas suficientes para llegar exitosamente a la solución numérica esperada.

La presente investigación estima un índice de vulnerabilidad social intrínseca en función de las características socioeconómicas y laborales presentes en los hogares de la región Atlántica de Colombia, que permite evaluar su situación de susceptibilidad y predisposición a ser afectados por eventos adversos, independientemente del contexto de amenaza, constituyendo un aporte a la gestión y prevención de riesgos como un problema de desarrollo. Con base en la Gran Encuesta Integrada de Hogares de 2010, se observa una diferencia importante en la dimensión socioeconómica de la vulnerabilidad social intrínseca entre la población según su localización en cabeceras urbanas (cabeceras) o en áreas rurales dispersas (resto). Además, se encuentra que la consideración de la dimensión laboral en este índice evidencia diferencias sustantivas entre la situación de las jefaturas de hogar masculinas y femeninas, en detrimento de las últimas.