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Purpose To describe the prognostic value of pulmonary artery (PA) trunk enlargement on the admission of in-hospital patients with severe COVID-19 infection by unenhanced CT image. Materials and methods In-hospital patients confirmed COVID-19 from January 18, 2020, to March 7, 2020, were retrospectively enrolled. PA trunk diameters on admission and death events were collected to calculate the optimum cutoff using a receiver operating characteristic curve. According to the cutoff, the subjects on admission were divided into two groups. Then the in-hospital various parameters were compared between the two groups to assess the predictive value of PA trunk diameter. Results In the 180 enrolled in-hospital patients (46.99 ± 14.95 years; 93 (51.7%) female, 14 patients (7.8%) died during their hospitalization. The optimum cutoff PA trunk diameter to predict in-hospital mortality was > 29 mm with a sensitivity of 92.59% and a specificity of 91.11%. Kaplan–Meier survival curves for PA trunk diameter on admission showed that a PA trunk diameter > 29 mm was a significant predictor of subsequent death (log-rank 29 mm was 28 days). Conclusion PA trunk enlargement can be a useful predictive factor for distinguishing between mild and severe COVID-19 disease progression.

Polymorphisms in the PER3 gene have been associated with several human disease phenotypes, including sleep disorders and cancer. In particular, the long allele of a variable number of tandem repeat (VNTR) polymorphism has been previously linked to an increased risk of breast cancer. Here we carried out a combined germline and somatic genetic analysis of the role of the PER3VNRT polymorphism in breast cancer. The combined data from 8284 individuals showed a non-significant trend towards increased breast cancer risk in the 5-repeat allele homozygous carriers (OR = 1.17, 95% CI: 0.97–1.42). We observed allelic imbalance at the PER3 locus in matched blood and tumor DNA samples, showing a significant retention of the long variant (risk) allele in tumor samples, and a preferential loss of the short repetition allele (p = 0.0005). Gene co-expression analysis in healthy and tumoral breast tissue samples uncovered significant associations between PER3 expression levels with those from genes which belong to several cancer-associated pathways. Finally, relapse-free survival (RFS) analysis showed that low expression levels of PER3 were linked to a significant lower RSF in luminal A (p = 3 × 10−12) but not in the rest of breast cancer subtypes.

Objective The purpose of this study was to assess the effectiveness of a single session of global postural reeducation (GPR) in postural sway in young adult university students who use data visualization screens. Methods A randomized controlled trial with 2 parallel groups was performed. Sixty-four subjects were randomized in the experimental group (12 men and 20 women) who underwent the GPR session, and a control group (13 men and 19 women) that did not receive any intervention was included. Center of pressure (COP) was assessed using a stabilometric platform, with eyes open and eyes closed before, immediately after, 48 hours after, and 7 days after intervention in both groups. Results In the interaction of time and gender, statistically significant differences were found for the area covered by COP (P = .020) and for the standard deviation (SD) in the mediolateral axis (P = .035). Considering the complete interaction time, gender, and group, statistically significant differences were found (P = .015) for the anteroposterior rate covered by COP and the SD in the anteroposterior axis (P = .033). In eyes closed condition, the intersubject analysis showed statistically significant differences for the interaction between group and gender for the variable mediolateral SD (P = .043). Considering the interaction of time with group, statistically significant differences were found for full length covered by COP (P = .017). Conclusions Changes in postural sway were observed after a single GPR session, mainly at 48 hours, with different behaviors between men and women.

Streptococcus iniae and S. agalactiae are both economically important Gram positive bacterial pathogens affecting the globally farmed tilapia (Oreochromis spp.). Historically, control of these bacteria in tilapia culture has included biosecurity, therapeutants and vaccination strategies. Genetic gains in performance traits have been realized for Nile tilapia (Oreochromis niloticus) and interest in breeding for disease resistance has recently received attention. The goal of this study was three fold: 1) to verify previous results demonstrating heritability of S. iniae resistance in Nile tilapia families using increased numbers of fish per family; 2) to determine if realized genetic gain in resistance and/or susceptibility to S. iniae can be obtained following positive assortative mating between parents with high or low estimated breeding values (EBV); and 3) to determine if resistance to S. iniae and S. agalactiae capsular type Ib is genetically correlated. A total of 144 and 130 full sib families were challenged intraperitoneally with S. iniae and intramuscularly with S. agalactiae Ib, respectively. Cumulative mortality at test end was 46% for S. iniae and 68% for S. agalactiae. There was a high additive genetic component found for survival in fish injected with S. iniae (estimated heritability 0.52 ± 0.12) and with S. agalactiae (estimated heritability 0.38 ± 0.11). The S. iniae challenge results confirmed additive genetic variation in resistance of Nile tilapia to S. iniae. We also demonstrated via assortative mating that genetic gain for survival to S. iniae is possible. The genetic correlation between resistance to S. iniae and S. agalactiae Ib was not significantly different from zero (rg = − 0.30 ± 0.19). The lack of correlation suggests if resistance to both Streptococcus sp. is desired, selection for both traits must be simultaneous. Selection of fish to improve survival to Streptococcus sp. may require a thorough understanding of the type of pathogen prevalent in the region so that custom genetic material may be tailored to meet the needs of the individual farm and/or region.

Introducción: la lesión renal aguda es una complicación frecuente en pacientes con COVID-19 y su aparición es un potencial indicador de disfunción multiorgánica y de gravedad de la enfermedad. Objetivo: desarrollar, mediante un consenso de expertos, recomendaciones para la prevención, el diagnóstico y el manejo de la lesión renal aguda en pacientes con infección por SARS-CoV-2/COVID-19 con base en la evidencia disponible. Materiales y métodos: a partir de una rápida revisión sistemática en las bases de datos EMBASE y PubMed y en los portales de algunas sociedades científicas, se formularon recomendaciones preliminares, las cuales fueron consultadas a un colectivo experto a través de una herramienta en línea. Se definió acuerdo respecto a las recomendaciones cuando se obtuvo aprobación en al menos el 70 %. La calidad de la evidencia se evalúo de acuerdo con el tipo de documento incluido y la fuerza de las recomendaciones se clasificó como fuerte o débil. Resultados: la consulta al colectivo de expertos tuvo lugar entre el 24 y 29 de mayo de 2020. El rango de acuerdo osciló entre 75,5 % y 100 % y 50 expertos clínicos declararon su conflicto de interés. Se lograron establecer recomendaciones para prevenir, diagnosticar y manejar la lesión renal aguda en pacientes con infección por SARS CoV2/COVID-19. Conclusiones: aunque la información disponible de buena calidad respecto a lesión renal aguda en paciente con COVID-19 es escasa, las recomendaciones aquí presentadas permitirán orientar la toma de decisiones clínicas y estratégicas alrededor de pacientes con esta complicación; de igual forma se garantizará un cuidado centrado en las personas y con altos estándares de calidad, y la generación de políticas de seguridad, salud y bienestar para los equipos multidisciplinarios de atención

Resumen Introduccion Los meningiomas son los tumores primarios mas frecuentes del sistema nervioso central y son de consulta frecuente en neurooncologia. Metodos Se realizo una revision bibliografica extensa y actualizada con el objetivo de favorecer el mejor abordaje de esta patologia. Resultados Los meningiomas son tumores extraaxiales originados a partir de las celulas de la aracnoides y representan el 36,4% de los tumores primarios intracraneanos. Los meningiomas pueden ser incidentales, pequenos y de lento crecimiento, o masas extensas y/o de crecimiento progresivo. La primera alteracion genetica descripta fue la perdida del cromosoma 22; en los ultimos anos se han descripto diversas mutaciones geneticas, tales como las mutaciones del promotor de transcriptasa reversa de la telomerasa (TERT), implicadas en la progresion maligna. Las neuroimagenes suelen tener caracteristicas distintivas en la tomografia computarizada y la resonancia magnetica. Por anatomia patologica se los clasifica en grados i , ii y iii de la Organizacion Mundial de la Salud y existen diversos subtipos con diferentes caracteristicas, evolucion y pronostico. La neurocirugia y el grado de reseccion son el pilar del tratamiento y el predictor de progresion. En pacientes seleccionados se podria considerar la embolizacion prequirurgica. La radioterapia puede ser adyuvante o como tratamiento unico en los irresecables; al igual que en los grados ii y anaplasicos. En relacion con la terapia farmacologica, solo bevacizumab, sunitinib y vatalinib han mostrado una potencial actividad clinica. Conclusiones Describimos en detalle las caracteristicas mas relevantes, la evaluacion y las opciones terapeuticas disponibles para pacientes con meningiomas.

The goal of this work was to find out if the information about hiv/aids published in five Mexican newspapers denoted any kind of stigmatization. The content analysis resulted in the presence of neutral vocabulary. The disease wasn’t linked to the topic of death and alarmist information was not used.

The aim of this study was to evaluate the tips and the surface conditions of two types of needles with different quality and their possible alterations after performing different needling on human beings. A total of 160 needles from AguPunt brand were examined. Surface conditions (lumps and scratches) and tip of the needles after needling procedures in humans were tested using a JEOL JSM-6360LV microscopy device. Additionally, a group of physiotherapists assessed the use of both types of needles in clinical practice using a self-reported questionnaire. Both types of needles, after performing different needling on human beings, kept the needle tips well preserved although the dry needle (Type B) suffered very little deformation even touching the bone of the scapula 10 times versus acupuncture needle (Type A), which were deformed slightly. The surface conditions revealed irregularities and scratches in both types of needles but the tips of Type A suffered more damage after different procedures (Odds ratio = 0.04,95% CI:0.01–0.13, p

Stereotypic cell migrations in the developing brain are fundamental for the proper patterning of brain regions and formation of neural networks. In this work, we uncovered in the developing rat, a population of neurons expressing tyrosine hydroxylase (TH) that migrates posteriorly from the alar plate of the midbrain, in neurophilic interaction with axons of the mesencephalic nucleus of the trigeminal nerve. A fraction of this population was also shown to traverse the mid-hindbrain boundary, reaching the vicinity of the locus coeruleus (LC) in rhombomere 1 (r1). This migratory population, however, does not have a noradrenergic (NA) phenotype and, in keeping with its midbrain origin, expresses Otx2 which is down regulated upon migration into the hindbrain. The interaction with the trigeminal mesencephalic axons is necessary for the arrangement and distribution of migratory cells as these aspects are dramatically altered in whole embryo cultures upon disruption of trigeminal axon projection by interfering with DCC function. Moreover, in mouse embryos in an equivalent developmental stage, we detected a cell population that also migrates caudally within the midbrain apposed to mesencephalic trigeminal axons but that does not express TH; a fraction of this population expresses calbindin instead. Overall, our work identified TH-expressing neurons from the rat midbrain alar plate that migrate tangentially over long distances within the midbrain and into the hindbrain by means of a close interaction with trigeminal mesencephalic axons. A different migratory population in this region and also in mouse embryos revealed diversity among the cells that follow this descending migratory pathway.

Background Head and neck squamous cell carcinoma shows high prevalence of lymph node metastasis at diagnosis, and despite the advances in treatment, the overall 5-year survival is still under 50%. Chemokine receptors have a role in the development and progression of cancer, but their effect in head and neck carcinoma remains poorly characterised. This study aimed to assess the prognostic value of CCR1, CCR3, CCR4, CCR5, CCR7 and CXCR4 in head and neck squamous cell carcinomas. Methods Immunohistochemical expression of chemokine receptors was evaluated in a retrospective cohort of 76 cases of head and neck squamous cell carcinoma. Clinicopathological associations were analysed using the chi-square test, survival curves were analysed according to the Kaplan-Meier method, and the Cox proportional hazard model was applied for multivariate survival analysis. Results The chemokine receptors were highly expressed in primary carcinomas, except for CCR1 and CCR3. Significant associations were detected, including the associations between CCR5 expression and lymph node metastasis (N stage, P = .03), advanced clinical stage (P = .003), poor differentiation of tumours (P = .05) and recurrence (P = .01). The high expression of CCR5 was also associated with shortened disease-free survival (HR: 2.85, 95% CI: 1.09-8.14, P = .05), but the association did not withstand the Cox multivariate survival analysis. At univariate analysis, high expression of CCR7 was associated with disease-free survival and low levels of CXCR4 were significantly associated with both disease-specific and disease-free survival. Conclusions These findings show that chemokine receptors may have an important role in head and neck squamous cell carcinoma progression, regional lymph node metastasis and recurrence.

A set of astrocytic process associated with altered myelinated axons is described in the forebrain of normal adult rodents with confocal, electron microscopy, and 3D reconstructions. Each process consists of a protuberance that contains secretory organelles including numerous lysosomes which polarize and open next to disrupted myelinated axons. Because of the distinctive asymmetric organelle distribution and ubiquity throughout the forebrain neuropil, this enlargement is named paraxial process (PAP). The myelin envelope contiguous to the PAP displays focal disruption or disintegration. In routine electron microscopy clusters of large, confluent, lysosomes proved to be an effective landmark for PAP identification. In 3D assemblies lysosomes organize a series of interconnected saccules that open up to the plasmalemma next to the disrupted myelin envelope(s). Activity for acid hydrolases was visualized in lysosomes, and extracellularly at the PAP-myelin interface and/or between the glial and neuronal outer aspects. Organelles in astrocytic processes involved in digesting pyknotic cells and debris resemble those encountered in PAPs supporting a likewise lytic function of the later. Conversely, processes entangling tripartite synapses and glomeruli were devoid of lysosomes. Both oligodendrocytic and microglial processes were not associated with altered myelin envelopes. The possible roles of the PAP in myelin remodeling in the context of the oligodendrocyte-astrocyte interactions and in the astrocyte's secretory pathways are discussed.

Background: medical attention to the obstetric patient with disseminated intravascular coagulation requires intensive care services to reduce the mortality this condition may bring about.Objective: to characterize the obstetric patients with disseminated intravascular coagulation admitted to the intensive care unit of “Dr. Ernesto Guevara de la Serna” General Teaching Hospital, from January 1st 2006 to December 31st 2015.Methods: a retrospective, longitudinal and descriptive study was carried out, in a sample of 28 obstetric and puerperal patients admitted to the intensive care unit and during the period herein mentioned.Results: according to the etiological diagnosis, the highest incidence was caused by hypertensive disorders with 35,7 %, followed by hemorrhagic shock with 21,42 % and sepsis as well as abortive procedures with 14,3 %. The most frequent complications were found in the multi-organic failure, septic shock and acute respiratory infection with 53,6 % in each case, followed by left ventricular dysfunction (39,3 %) and hepatic dysfunction (35,7 %). 96,43 % of the patients remained admitted for more than 72 hours, with a mortality of 53,6 %. There were comorbidities in all those who died for 100 %, while they were only present in 23,08 % of those who survived.Conclusions: a characterization of the obstetric patients admitted to the intensive care unit with disseminated intravascular coagulation was made. Most of the patients stayed in the unit for more than 72 hours and presented an important number of comorbidities.

The purpose of this study was to evaluate and compare disability, quality of life and satisfaction outcomes between young people and elderly who were operated on for degenerative lumbar disease. A database of 263 patients undergoing lumbar surgery for degenerative conditions was collected. There were 74 patients who were 65 years old or above and 189 who were below 65 who had complete preoperative and 2-year postoperative HRQOL data measures: ODI, SF-36 and COMI. There were no significant differences in the outcomes between the two age groups (p > 0.05). An improvement from baseline in all quality of life measures in the two age groups was observed. A median improvement of 6.0 points was found in the ODI in the younger patients versus 12.0 in older ones. A median improvement in the SF36 physical component score of 6.95 was seen in the younger group while improvement was reported at 6.36 points in patients over 65. The SF36 mental component score improved by 4.48 points and 4.96 points, respectively. COMI improved a median of 1.2 points in both groups. In terms of satisfaction, 66.9 % of the younger patients were pleased or very pleased whereas this was found to be 59.7 % for the older group. Older patients can see substantial clinical improvement after degenerative lumbar disease surgery similar to that obtained in younger patients in terms of quality of life and satisfaction. The improvement in terms of the disability is greater for older patients. Thus, age should not be a contraindication for this procedure.

Summary Background Recent data suggest that varicella zoster virus (VZV)-associated complications of the central nervous system (CNS) are more common and diverse than previously thought. The main purpose of this article is to describe the clinical characteristics and the outcome of patients suffering from meningitis and encephalitis caused by VZV reactivation. Methods A retrospective case study of adult patients (≥16 years old) diagnosed with a VZV reactivation in the CNS was performed. The cases were identified by a qualitative PCR DNA assay of the cerebrospinal fluid (CSF) at the Regional Hospital of Lugano between January 1, 2003 and July 31, 2010. Results Eleven out of 519 CSF samples (2.1%), submitted from patients with a clinical diagnosis of viral meningitis or encephalitis, were positive for VZV. A vesiculo-pustular skin eruption was observed in only five patients (45%). In six cases (55%), a systemic inflammatory syndrome was absent. The clinical outcome was favorable in eight patients (73%). Only one out of 11 patients (9%) died. The four patients with encephalitis had a less favorable prognosis: one patient recovered without residual neurological sequelae; two had a chronic neuropsychological handicap, speech difficulties, facial nerve palsy, and focal seizures; one patient died. We estimated an annual incidence rate of VZV infection of the CNS of 1.02/100 000 inhabitants for southern Switzerland. Conclusions Screening of CSF for VZV by PCR is recommended for all patients with encephalitis and for those with viral meningitis of unclear origin in order to better target antiviral treatment.

Resumen El tratamiento quirurgico de los tumores gliales del sistema nervioso central es un marcador pronostico y uno de los pilares respecto del tiempo libre de progresion y sobrevida del paciente. Sin embargo, el riesgo de secuelas neurologicas posquirurgicas aumenta con el grado de reseccion y localizacion del tumor. Basandonos en las caracteristicas de las neuroimagenes tumorales y posquirurgicas, confeccionamos esta guia para la planificacion prequirurgica, incluyendo algunos comentarios del acto quirurgico y el seguimiento posquirurgico, con el objetivo de clasificar y definir porcentajes de reseccion adecuadamente.

Purpose: The aim of this work was to evaluate the effect of PPAR agonists on the differentiation and metabolic features of porcine mesenchymal stem cells induced to the adipogenic or myogenic lineages. Methods: Bone marrow MSCs from neonate pigs were isolated and identified by cell proliferation, cell surface markers or the gene expression of stem cells (CD44, CD90, CD105 or Oct4 and Nanog, respectively). Cells were differentiated into adipose or muscle cells and treated with the PPAR agonists; adipogenic and myogenic differentiation was promoted by adding these compounds. The expression of PPARγ (an adipose marker) and MyoD1 and MyHC (muscle markers), metabolic changes and expression levels of metabolic enzymes involved in glycolysis, lipogenesis, lipolysis and the pentose phosphate pathway were tested by qPCR. Results: MSCs from neonate pigs exhibited high proliferation and were positive for CD44, CD90 and CD105 markers and Oct4 and Nanog expression. The treatment that promoted the highest expression of PPARγ was 50 µM of conjugated linoleic acid (CLA) c9 t11 (6.44 ± 0.69-fold, p ≤ 0.0001) in the adipose differentiation, and upregulation of HX2, ACCAα, ATGL, LPL and G6DP (p ≤ 0.0001) and downregulation of PFK and ACCAβ (p ≤ 0.0001) were found. For muscle differentiation, the best treatment was 50 µM of CLA c10 t12 (59.72 ± 4.72-fold, p ≤ 0.0001), and metabolic changes were upregulation of PFK, ACCAβ, G6DP, CPT1 and PPARβ/δ (p ≤ 0.0001), but no effect was observed with HX2 and ACCAα (p ≥ 0.05). Conclusions: Our results suggest that differentiated cells exhibit a typical cell lineage metabolism and higher efficiencies both in anabolism and catabolism.

Background Socioeconomic disadvantage is associated with an increased risk of adverse diabetes outcomes. In Switzerland, a country with theoretical universal healthcare coverage, people without health insurance face barriers in accessing to and in receiving standard quality care. The Geneva University Hospitals (HUG) have implemented policies aiming at reducing these gaps. We compared quality of diabetes care and ambulatory healthcare services utilization among insured and uninsured diabetic patients. Methods This retrospective study linked health and administrative data of type 2 diabetic outpatients with at least one HbA1c test performed in 2012–2013 at HUG. Quality of care evaluation relied on processes (annual serum HbA1c, cholesterol and microalbuminuria tesing) and outcomes (HbA1c) assessment. Healthcare utilization was assessed by the number of ambulatory clinical and laboratory visits. Results were stratified by disease course (newly diagnosed versus prevalent diabetes). Results Of the 198 patients included, 80 (40.4 %) were uninsured. Both groups underwent annual testing of HbA1c, cholesterol, kidney function and microalbuminuria at comparably high rates and numbers of ambulatory visits did not significantly differ. After adjustments for age and sex, there were no significant differences in serum HbA1c between groups both in those with prevalent or with newly diagnosed diabetes. Initial medical intervention entailed comparable glycaemic improvement after 6 months in incident diabetes among insured and uninsured patients. Conclusions This study did not find any difference in quality of diabetes care between insured and uninsured patients in a public hospital enforcing health-equity policies for access to and for delivery of standard diabetes care. It highlights the frontline role of public hospitals in contributing to care delivery equity even in countries with theoretical universal healthcare coverage.

Hypopigmentation is a characteristic of several diseases associated with vesicle traffic defects, like the Hermansky-Pudlak, Chediak-Higashi, and Griscelli syndromes. Hypopigmentation is also a characteristic of the zebrafish mutant vps18(hi2499A), which is affected in the gene vps18, a component of the homotypic fusion and protein sorting complex that is involved in tethering during vesicular traffic. Vps18, as part of this complex, participates in the formation of early endosomes, late endosomes, and lysosomes. Here, we show that Vps18 is also involved in the formation of melanosomes. In the zebrafish mutant vps18(hi2499A) the retroviral insertion located at exon 4 of vps18, leads to the formation of two abnormal splicing variants lacking the coding sequence for the clathrin repeat and the RING finger conserved domains. A deficiency of Vps18 in zebrafish larvae results in hepatomegaly and skin hypopigmentation. We also observed a drastic reduction in the number of melanosomes in the eye's retinal pigmented epithelium along with the accumulation of immature melanosomes. A significant reduction in the vps18(hi2499A) larvae visual system capacity was found using the optokinetic response assay. We propose that the insertional mutant vps18(hi2499A) can be used as a model for studying hypopigmentation diseases in which vesicle traffic problems exist.

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.

OBJECTIVES: Although chemokines seem to be important in certain inflammatory disorders, little is known about the role of these proteins in chronic hepatitis C. METHODS: Expression of selected CXC and CC chemokines and their receptors was assessed by immunohistochemistry and flow cytometry in chronic hepatitis C. Tissue samples from normal liver and that of sustained responders were also evaluated. A comparative analysis between the histological grading and the intrahepatic expression level of chemokines was performed. RESULTS: The majority of liver-derived T lymphocytes expressed CXCR3 and CCR5 chemokine receptors, representing high enrichment over levels of CXCR3+ and CCR5+ T cells in blood from chronic hepatitis C. An intense intrahepatic expression of their respective ligands, the CXC chemokine Mig, and RANTES, was detected in the same patients studied, being restricted to the sinusoidal endothelium and to hepatocytes, respectively. A statistically significant association between the intrahepatic chemokine expression level and the inflammatory activity of chronic hepatitis C was found. Of note was the marked expression of both CXCR3 and its ligand Mig on endothelial cells from portal neovessels in chronic hepatitis C. CONCLUSIONS: Intrahepatic chemokine signaling could play a key role regulating significant pathological events during chronic hepatitis C, opening new avenues for therapeutic interventions based on chemokine activities.

Introduction: Fat grafting can be used to place fat in the face, hands, breasts, buttocks, calves, and genitals for cosmetic purposes. The procedure is also used to reconstruct some congenital abnormalities (such as hemifacial atrophy) or to correct selected traumatic facial defects; it may also be used in combination with other surgical procedures (facelifts) or as part of a facial rejuvenation program. We present a review of the steps for fat grafting performed at our center. We have experienced excellent cosmetic results using these techniques. Method and Materials: Of the 867 patients, 367 underwent facial fat transplant; 153 underwent bilateral augmentation mammaplasty by injection (BAMBI); 67 underwent fat injections to the buttock, calves, and other areas of the body; and 280 received fat grafts to the genitalia. Two hundred seventeen patients were men and 63 were women. The operations were performed as ambulatory procedures. Local anesthesia and intravenous (IV) sedation (midazolam plus fentanyl) were used. For all of our patients, we used a modification of the classic Klein formula. All of our patients were operated on under IV sedation. Results: Fat survival was approximately 70% at the end of 1 year. Of the 367 patients undergoing facial fat transplant, 65% were satisfied with the results, and 35% were not satisfied and required a touch-up procedure. Of the 153 undergoing BAMBI, 72% were satisfied with the results, and 28% were not satisfied and required touch-up procedures. Of the 67 patients undergoing fat transplant to the buttocks, calves, and other areas, 76% were satisfied, and 24% were not satisfied and required additional fat grafting. Of the 217 men undergoing genital fat transplant, 82% were satisfied with the results, and 18% were not satisfied. Of the 63 women undergoing genital fat transplant, 86% were satisfied with the results, and 14% were not satisfied. Absorption, infection, and embolism are the most common complications mentioned in the cases of fat injection. Out of 867 total fat transplant operations, absorption occurred after 1 procedure in an average of 30% of cases. In 5 cases, we saw some degree of infection, which was rapidly treated with antibiotics. We did not see any cases of fat embolism. We saw 2 cases of cysts in the dorsum of the hands and 2 in the breasts; these cysts were easily treated with triamcinolone injections. Discussion: When administered properly, autologous fat transplantation is an acceptable procedure resulting in highly satisfied patients. This satisfaction is mostly due to the fact that this process utilizes the patients' own tissue instead of a prosthetic or synthetic implant. Rejection or allergic reaction is not possible with autologous tissue.

Cervicocephalic screw medialization is a rare complication after intertrochanteric fracture synthesis with a Gamma3-type intramedullary nail. Only 6 cases of intrapelvic penetration by Gamma3 lag screw have been described. We now describe 2 additional cases and a review of the literature.

To evaluate the influence of epidemiological factors on the outcomes of surgery for degenerative lumbar disease in terms of quality of life, disability and chronic pain.A total of 263 patients who received surgery for degenerative lumbar disease (2005-2008) were included in the study. The epidemiological data collected were age, gender, employment status, and co-morbidity. The SF-36, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), and VAS score for lumbar and sciatic pain were measure before and 2 years after surgery. The correlation between epidemiological data and questionnaire results, as well as any independent prognostic factors, were assessed in the data analysis.The mean age of the patients was 54.0 years (22-86), and 131 were female (49.8%). There were 42 (16%) lost to follow-up. Statistically significant correlations (P.05) were observed between age, gender, co-morbidity, permanent sick leave, and pre-operative pain with changes in the ODI, COMI, physical and SF-36 mental scales, and lumbar and sciatic VAS. Linear regression analysis showed permanent sick leave and age as predictive factors of disability (β=14.146; 95% CI: 9.09 - 29.58; P.01 and β=0.334; 95% CI: 0.40 - 0.98, P.05, respectively), and change in quality of life (β=-8.568; 95% CI: -14.88 - -2.26; p.01 and β=-0.228, IC 95% CI: -0.40 - -0.06, P.05, respectively).Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery.

Introduction. Outcome evaluation is an important aspect of the treatment of patients with degenerative lumbar disease. We evaluated the usefulness of the Core Outcome Measures Index (COMI) in assessing people affected by degenerative lumbar disease in daily clinical practice.Methods. We evaluated 221 patients who had completed preoperatively and 2 years after surgery VAS pain, Short Form-36 (SF-36), Oswestry Disability Index (ODI) and COMI. We calculated the change of scores and its sensitivity to change. The internal consistency of the COMI items and the correlation between the COMI scores and the scores of the other measurements were assessed.Results. Statistically significant differences were observed between the mean scores of the preoperative and 2 years questionnaires for nearly all measurements. COMI showed a good internal consistency, except for the preoperative pain subscale. The sensitivity to change was high for the total COMI and its pain and well-being subscales and moderate for the rest. The COMI demonstrated strong correlation with the other measurements.Conclusions. The COMI is a useful tool for assessing the patient-based outcome in the studied population. Given its simplicity, good correlation with the SF-36 and ODI and its good sensitivity to change, it could replace more cumbersome instruments in daily clinical practice.

Background and aims: Type 2 diabetes mellitus (DM) has a high prevalence in aging obese postmenopausal women. It is not clear whether or not diabetes produces an increase in bone mineral density or an increase in fracture rates. Objective: The main objective of this study was to investigate whether type 2 DM produces a higher prevalence of vertebral, hip and non-vertebral fractures in obese postmenopausal Caucasian women. A secondary objective was to study the influence of DM in quantitative ultrasound measurements of the heel (QUS) and bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA), in both lumbar spine (L2–L4) and proximal femur. Method: This study was a prospective cohort of 111 patients with type 2 DM and 91 control individuals (CTR) over age 65 and obese, recruited from 16 centers in Spain. Main Outcome Measures: Lateral dorsal and lumbar X-rays were performed to assess vertebral fractures. Hip and non-vertebral fractures were noted from medical records, written reports or X-ray studies. QUS measurements were made of the calcaneus and BMD measurements of the lumbar spine (L2–L4) and proximal femur. Results: Patients had higher BMD in the lumbar spine (L2–L4) than controls (0.979 g/cm2 vs 0.927 g/cm2, p=0.035), but we found no statistically significant differences in the proximal femur. QUS measurements showed similar values in both groups: BUA (69.3 dB/Mhz vs 66.7 dB/Mhz, p=0.291), SOS (1537 m/sg vs 1532 m/sg, p=0.249) and QUI (87.5 vs 83.7, p=0.153). No statistically significant differences were found in any case. There was no association between vertebral, hip and non-vertebral fractures and DM. The crude odds ratio, without adjusting was 1.045 (CI 957o 0.531; 2.059), and the adjusted odds ratio was 0.927 (CI 95% 0.461; 1.863). Conclusions: In obese postmenopausal Caucasian women, type 2 DM produces an increase in BMD of the lumbar spine without changes in BMD of the proximal femur or in QUS measurements of the heel. The prevalence of vertebral, hip and non-vertebral fractures did not increase in type 2 DM.

article i nfo Article history: The effects of ketoconazole and miconazole uptake on K + transport and the internal pH of Saccharomyces cerevisiae were studied. The uptake of both drugs was very fast, linear with concentration and not dependent on glucose, indicating entrance by diffusion and concentrating inside. Low (5.0 μM) to intermediate concentrations (40 μM) of both drugs produced a glucose-dependent K + efflux; higher ones also produced a small influx of protons, probably through a K + /H + exchanger, resulting in a decrease of the internal pH of the cells and the efflux of material absorbing at 260 nm and phosphate. The cell membrane was not permeabilized. The K + efflux with miconazole was dependent directly on the medium pH. This efflux results in an increased membrane potential, responsible for an increased Ca 2+ uptake and other effects. These effects were not observed with two triazolic antifungals. A decrease of the Zeta (ζ) potential was observed at low concentrations of miconazole. Although the main effect of these antifungals is the inhibition of ergosterol synthesis, K + efflux is an important additional effect to be considered in their therapeutic use. Under certain conditions, the use of single mutants of several transporters involved in the movements of K + allowed to identify the participation of several antiporters in the efflux of the cation.