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Objectives: The primary objective of the present study is to compare the radiographic outcomes and complications of two different techniques for lateral closing-wedge osteotomy in pediatric patients with cubitus varus., Methods: We retrospectively identified patients treated at five tertiary care institutions: 17 underwent the Kirschner-wire (KW) technique, and 15 patients were treated with the mini external fixator (MEF) technique. Demographic data, previous treatment, pre- and postoperative carrying angle (CA), complications and additional procedures were recorded. Radiographic evaluation included assessment of the humerus-elbow-wrist angle (HEW), and the lateral prominence index (LPI)., Results: Patients treated with both KW and MEF achieved significant improvements in clinical alignment (mean pre-op CA -16 ± 6.1 degrees to mean post-op 8.9 ± 5.3 degrees, P < 0.001). There were no differences in final radiographic alignment or radiographic union time; however, time to achieve full elbow motion was faster in the MEF group (13.6 versus 34.3 weeks, P = 0.4547). Two patients (11.8%) in the KW group experienced complications, including one superficial infection and one failed correction that required unplanned revision surgery. Eleven patients in the MEF group underwent a planned second surgical procedure for hardware removal., Conclusions: Both fixation techniques are effective at correcting cubitus varus in the pediatric population. The MEF technique may have the advantage of shorter recovery of elbow range of motion but may require sedation for hardware removal. The KW technique may present a slightly higher complication rate., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Tension band plates (TPBs) are frequently used in guided growth (CG) surgeries. Recently, the concept of removing the metaphyseal screw only to stop the growth modulating effect rather than completely removing the implant, has gained popularity. Although this strategy would have certain potential advantages, the associated risks are unknown. The aim of this study is to report the experience of three institutions with this strategy., Methods: A database was compiled with the demographic information of patients treated by guided growth using TBPs between January 2014 and January 2019 at three institutions. The cases where only the metaphyseal screw was removed were identified. The records were reviewed to analyze the indications, demographic data, characteristics of the procedure, complications and need for additional procedures., Results: We reviewed 28 partial hardware removals, performed in 10 patients (all male). Initial surgery was indicated for angular deformity (N = 6), and leg-length discrepancy (N = 4). The average age at the time of surgery was 9.5 ± 2.9 years (range 4 to 13 years). Three procedures were performed on the distal femur, 3 on the proximal tibia, 2 on the distal tibia, and 20 combined. The average follow-up was 23.3 ± 11 months (range 12 to 52 months). We observed recurrence of deformities in 7 of 28 (22%) limbs that required re-insertion of the metaphyseal screw. Two patients presented complications from the procedure: soft tissue irritation (N = 1) and angular deformity (N = 1). Both patients required unplanned surgery., Discussion: Partial hardware removal in guided growth surgery could favor the presentation of complications. The benefits of this strategy must be considered against the possible undesired effects generated by its application., Study Design: Therapeutic study (Level IV)., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity., Methods: We conducted a retrospective analysis of patients treated with distal femoral physeal bar resection, fat graft interposition, and growth modulation with a tension-band plate. Data recorded included patient demographics, growth arrest cause, physeal bar size, time-to-surgery, details of the operative procedure, and complications. The mechanical axis zones, tibiofemoral angle, and the anatomic lateral distal femoral angle were assessed on 51-inch anteroposterior standing radiographs., Results: Five patients (3 male individuals) with valgus (n=4) and varus deformities (n=1) due to physeal arrests of the distal femur were analyzed. The cause of the physeal arrest was trauma (n=3) and infection (n=2). The average age at the time of surgery was 6.6 years (range: 2 to 11 y). Average size of the physeal bar was 413.4 mm, which represented 16.8% of the total distal femoral physis (range: 12% to 26%). Four of the 5 patients had a total correction of the deformity in 14.3 months (range: 9 to 22 mo). One patient required correction by osteotomy and external fixation. Postoperatively, 1 patient presented no improvement, and 4 had restoration of the longitudinal bone growth and alignment. Two patients had rebound valgus: one is being observed and another has undergone a repeat guided growth procedure., Conclusions: Distal femoral physeal bar resection combined with tension-band hemiepiphysiodesis provides a viable option for the correction of angular deformities associated with physeal arrest. Longer follow-up is required to evaluate future growth of the distal femoral physis after this combined procedure., Level of Evidence: Level IV-therapeutic study.

Background: During 24-hour on-call shifts medical residents are exposed to diverse circumstances such as sleep deprivation and stress., Objective: Our aim is to assess the effect of 24-hour on-call shifts on medical residents' headache-related disability., Methods: The Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test (HIT-6), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to medical residents who had never performed on-call shifts at baseline and 6 months after beginning 24-hour on-call shifts. Scores were compared., Results: About 66 medical residents completed this study. About 21.2% (n = 14) had history of migraine, 42.4% (n = 28) had a history of tension-type headache (TTH) and 12.1% (n = 8) had a history of both migraine and TTH. Among medical residents with migraine, the median MIDAS score was significantly higher after starting 24-hour on-call shifts than at a baseline (4.0 vs 8.0; Wilcoxon, P = .001), meaning that, on average, disability increased from little or no disability, to moderate disability. No difference in HIT-6 scores was found. The median score of PSQI and HADS was higher at 6 months (PSQI: 7.0 vs 8.0; P = .003), (HADS: 5.0 vs 8.0; P < .001) for the general group., Conclusions: In medical residents with migraine, migraine-related disability increased after starting 24-hour on-call shifts. We also found a worsening in depression and anxiety symptoms and self-reported sleep quality in medical residents with and without headache history., (© 2020 American Headache Society.)

Introduction: Formal therapeutic interventions based on music have been used in rehabilitation to stimulate the brain functions involved in movement., Objective: The objective of this study was to conduct a systematic review and meta-analysis following the PRISMA recommendations on the effectiveness of music therapy in improving the functionality of the upper limb in patients with hemiparesis secondary to stroke., Methods: A search of the Pubmed, clinicaltrials.gov and Cochrane databases was performed in September 2018. The articles included in this review had to meet the following criteria: randomised controlled trials with therapeutic interventions that evaluated improvement in manual dexterity, measured with the box and block test in patients older than 18 years with a residual deficit secondary to an ischaemic or haemorrhagic stroke in the previous months., Results: Of 371 studies analysed, six were included in the study and subsequent meta-analysis with a total of 149 patients. The musical interventions improved the functionality of the parietal limb in patients with stroke compared with that in controls who received conventional treatment. This effect was statistically significant in the meta-analysis, with a difference in the standardised mean in the box and block test of 0.40 (95% CI 0.09 - 0.72)., Conclusions: Musical interventions could be beneficial for the functional recovery of the upper extremity. These results are encouraging but a greater number of clinical trials are required to confirm these findings before their subsequent implementation in clinical practice., (Copyright © 2019 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate levels of spirituality and hope in patients with diabetic foot ulcers (DFUs) according to sociodemographic factors., Design: This was a primary, prospective, descriptive, analytical, and clinical study. Questionnaires assessing sociodemographic and clinical characteristics of the patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all participants., Setting: University-affiliated skilled nursing center and outpatient wound care clinic in Pouso Alegre, Brazil., Patients: Fifty adult patients with DFUs participated in the study. Patients with ischemic diabetic foot and mixed ulcers were excluded from the study., Main Results: On average, patients with DFUs had low levels of spirituality (mean SSRS score, 12.6) and low hope for cure (mean HHI, 16.5). Patients younger than 60 years reported significantly lower levels of spirituality (mean SSRS scores, 11.0), and those older than 70 years had significantly lower hope for cure (mean HHI, 12.5) than other age groups (P = .040). Level of spirituality was significantly lower among women (P = .015) and those living with an ulcer for more than 2 years, who also reported significantly lower hope for cure (P = .029) compared with patients having an ulcer for less than 2 years., Conclusion: On average, patients with DFUs, especially women and older adults, had a low sense of hope and spirituality. Except for gender, age, and ulcer duration, other sociodemographic and ulcer characteristics had no significant effect on the study population's spirituality and hope.

Several molecular tools have been used to clarify the basis of plant-bacteria interaction; however, the mechanism behind the association is still unclear. In this study, we used a proteomic approach to investigate the root proteome of Zea mays (cv. DKB240) inoculated with Herbaspirillum seropedicae strain SmR1 grown in vitro and harvested 7 days after inoculation. Eighteen differentially accumulated proteins were observed in root samples, ten of which were identified by MALDI-TOF mass spectrometry peptide mass fingerprint. Among the identified proteins, we observed three proteins present exclusively in inoculated root samples and six upregulated proteins and one downregulated protein relative to control. Differentially expressed maize proteins were identified as hypothetical protein ZEAMMB73&#95;483204, hypothetical protein ZEAMMB73&#95;269466, and tubulin beta-7 chain. The following were identified as H. seropedicae proteins: peroxiredoxin protein, EF-Tu elongation factor protein, cation transport ATPase, NADPH:quinone oxidoreductase, dinitrogenase reductase, and type III secretion ATP synthase. Our results presented the first evidence of type III secretion ATP synthase expression during H. seropedicae-maize root interaction.

Introduction: Delirium is a condition with a high prevalence in hospitalised patients (10%-30%), and it has important prognostic implications. There are few prospective studies of the incidence of delirium in Spain, and most of these were carried out in surgical wards or intensive care units. Our objective is to calculate the incidence of delirium in a neurological department and describe characteristics of affected patients., Methods: Longitudinal descriptive study including all patients admitted to the neurology department in an 8-week period. The CAM score for diagnosing delirium was recorded on the first, second and fifth day of hospitalisation and we recorded demographic data, medical history, analytical data (including inflammatory markers), use of anticholinergic treatments, cognitive and functional state at admission, reason for admission, length of stay, and other events during hospitalisation., Results: We studied 115 patients and found an incidence of delirium of 16.52%. There was a significant correlation between delirium and age, cognitive state at admission according to the Pfeiffer test, functional situation at admission according to the Canadian Neurological Scale, kidney failure, history of stroke, anticholinergic treatment, erythrocyte sedimentation rate, and C-reactive protein. These patients were also hospitalised for longer periods of time., Conclusions: These results confirm a high incidence of delirium in our geographical area. Although additional studies with larger samples are needed, we would like to emphasise the importance of several risk factors which may enable early detection of patients who are at risk for developing delirium during hospitalisation. This would permit preventive action and early treatment for these patients., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Extrafloral nectar (EFN) plays an important role as plant indirect defence through the attraction of defending ants. Like all rewards produced in the context of a mutualism, however, EFN is in danger of being exploited by non-ant consumers that do not defend the plant against herbivores. Here we asked whether plants, by investing more in EFN, can improve their indirect defence, or rather increase the risk of losing this investment to EFN thieves. We used the obligate plant-ant Acacia-Pseudomyrmex system and examined experimentally in the field during the dry and the rainy seasons how variations in EFN secretion are related to (i) ant activity, to (ii) the ant-mediated defence against herbivores and (iii) the exploitation of EFN by non-ant consumers. Extrafloral investment enhanced ant recruitment and was positively related to the ant mediated defence against herbivores. The ant-mediated protection from exploiters also increased in proportion to the nectar sugar concentration. Although the daily peak of EFN production coincided with the highest activity of EFN thieves, Pseudomyrmex ferrugineus ants protected this resource effectively from exploiters. Nevertheless, the defensive effects by ants differed among seasons. During the dry season, plants grew slower and secreted more EFN than in the rainy season, and thus, experienced a higher level of ant-mediated indirect defence. Our results show that an increased plant investment in an indirect defence trait can improve the resulting defensive service against both herbivores and exploiters. EFN secretion by obligate ant-plants represents a defensive trait for which the level of investment correlates positively with the beneficial effects obtained.

Ant-plant interactions represent a diversity of strategies, from exploitative to mutualistic, and how these strategies evolve is poorly understood. Here, we link physiological, ecological, and phylogenetic approaches to study the evolution and coexistence of strategies in the Acacia-Pseudomyrmex system. Host plant species represented 2 different strategies. High-reward hosts produced significantly more extrafloral nectar (EFN), food bodies, and nesting space than low-reward hosts, even when being inhabited by the same species of ant mutualist. High-reward hosts were more effectively defended against herbivores and exploited to a lower extent by nondefending ants than low-reward hosts. At the phenotypic level, secretion of EFN and ant activity were positively correlated and a mutualistic ant species induced nectar secretion, whereas a nondefending exploiter did not. All of these mechanisms contribute to the stable association of high-reward hosts with defending ant species. However, exploiter ants are less dependent on the host-derived rewards and can colonize considerable proportions of the low-reward hosts. Mapping these strategies onto phylogenetic trees demonstrated that the low-reward hosts represent the derived clade within a monophyletic group of obligate ant plants and that the observed exploiter ant species evolved their strategy without having a mutualistic ancestor. We conclude that both types of host strategies coexist because of variable net outcomes of different investment-payoff regimes and that the effects of exploiters on the outcome of mutualisms can, thus, increase the diversity within the taxa involved.

Background/aims: Podocytes are critical in maintaining the filtration barrier of the glomerulus and are dependent on the slit diaphragm. We hypothesized that disturbances of podocyte biology contribute to proteinuria in women with preeclampsia (PE)., Methods: A human podocyte cell line was stimulated with serum from women with PE (patients) and healthy pregnant women (controls); the main changes in 3 important podocyte proteins: podocin, CD2AP and actin were established by immunofluorescence and Western blot; we also searched for changes in cell plasticity by measuring the resistance of cultured podocytes., Results: Different distributions of CD2AP, podocin and actin were observed in the podocytes stimulated with patient sera compared to podocytes stimulated with control sera. We also found that the mean resistance value of podocytes cultured with serum from women with PE was significantly lower than podocytes cultured with serum from controls. There was no difference in the protein expression level of podocin and CD2AP between patients and controls., Conclusions: We present evidence that there are differences in podocytes when stimulated with sera from women with PE compared to those stimulated with healthy pregnancy sera. This is the first time that podocyte alterations have been directly related to PE; these descriptive findings could be considered as an interesting beginning for further studies relating podocytes and PE., (Copyright 2008 S. Karger AG, Basel.)

Plants respond to local herbivory or pathogen infection with phenotypic changes, which reduce the danger of future attack. This so-called induced resistance is usually not restricted to the attacked plant organ but is also expressed in distant, so far undamaged parts of the plant. Signaling compounds such as jasmonic acid and salicylic acid have been discovered that move within the plant via the xylem or the phloem and elicit the resistance, thus acting as plant hormones. We now found that volatiles released in response to herbivore damage are required to elicit extrafloral nectar secretion in other parts of the same plant. Extrafloral nectar attracts ants and other carnivorous arthropods and serves as an effective indirect defense against herbivores. So called green leaf volatiles are released within minutes in response to tissue damage and were among the compounds that induced nectar secretion in yet undamaged parts of the damaged plant, but also in neighboring plants. Being gaseous and transported via the air, green leaf volatiles can serve a rapid within-plant communication, which moves much faster from one plant organ to the other than any plant-internal compound.

Plants respond to herbivore attack with the release of volatile organic compounds (VOCs), which can attract predatory arthropods and/or repel herbivores and thus serve as a means of defense against herbivores. Such VOCs might also be perceived by neighboring plants to adjust their defensive phenotype according to the present risk of attack. We exposed lima bean plants at their natural growing site to volatiles of beetle-damaged conspecific shoots. This reduced herbivore damage and increased the growth rate of the exposed plants. To investigate whether VOCs also can serve in signaling processes within the same individual plant we focused on undamaged "receiver" leaves that were either exposed or not exposed to VOCs released by induced "emitter" leaves. Extrafloral nectar secretion by receiver leaves increased when they were exposed to VOCs of induced emitters of neighboring plants or of the same shoot, yet not when VOCs were removed from the system. Extrafloral nectar attracts predatory arthropods and represents an induced defense mechanism. The volatiles also primed extrafloral nectar secretion to show an augmented response to subsequent damage. Herbivore-induced VOCs elicit a defensive response in undamaged plants (or parts of plants) under natural conditions, and they function as external signal for within-plant communication, thus serving also a physiological role in the systemic response of a plant to local damage.