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To provide family physicians with an approach to office management of gait disorders in the elderly.Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly.Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific "cautious" gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders.Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment.

Proteins which bind methylated lysines (“readers” of the histone code) are important components in the epigenetic regulation of gene expression and can also modulate other proteins that contain methyl-lysine such as p53 and Rb. Recognition of methyl-lysine marks by MBT domains leads to compaction of chromatin and a repressed transcriptional state. Antagonists of MBT domains would serve as probes to interrogate the functional role of these proteins and initiate the chemical biology of methyl-lysine readers as a target class. Small molecule MBT antagonists were designed based on the structure of histone peptide-MBT complexes and their interaction with MBT domains determined using a chemiluminescent assay and ITC. The ligands discovered antagonize native histone peptide binding, exhibiting 5-fold stronger binding affinity to L3MBTL1 than its preferred histone peptide. The first co-crystal structure of a small molecule bound to L3MBTL1 was determined and provides new insights into binding requirements for further ligand design.

Urease plays a central role in the pathogenesis of Helicobacter pylori in humans. Maturation of this nickel metalloenzyme in bacteria requires the participation of the accessory proteins UreD (termed UreH in H. pylori), UreF, and UreG, which form sequential complexes with the urease apoprotein as well as UreE, a metallochaperone. Here, we describe the crystal structure of C-terminal truncated UreF from H. pylori (residues 1-233), the first UreF structure to be determined, at 1.55 A resolution using SAD methods. UreF forms a dimer in vitro and adopts an all-helical fold congruent with secondary structure prediction. On the basis of evolutionary conservation analysis, the structure reveals a probable binding surface for interaction with other urease components as well as key conserved residues of potential functional relevance.

Entre marzo de 1999 y octubre de 2001 en la unidad de Cirugía Endoscópica del Servicio de Cirugía II en el Hospital Universitario de Caracas, se realizó un estudio con el objetivo primordial de describir la técnica quirúrgica para safenectomía endoscópica en pacientes con insuficiencia de safena magna. Se evaluó además, el tiempo operatorio, las complicaciones posoperatorias y la conformidad del paciente con la técnica realizada, comparando el uso de anestesia troncular versus epidural. El promedio de tiempo quirúrgico fue de 62,5 minutos para el grupo A y de 87 para el B. El 83 % de los pacientes tuvo un dolor posoperatorio clasificado como bajo en el grupo A y 90 % en el B. Se convirtió un paciente a cirugía abierta (5,88 %). Hubo dos casos de linforragia (12,5 %) ambos en el grupo A y obesos y tres equimosis (uno distal en el A y dos proximales en el B), no hubo infecciones y el 90 % de los pacientes se mostraron conformes con el procedimiento. La safenectomía endoscópica con anestesia troncular es un excelente procedimiento para el tratamiento quirúrgico de los pacientes con insuficiencia de safena magna seleccionados, bien tolerada y con bajo índice de complicaciones. A study was done between March 1999 and October 2001 at the Endoscopic Surgery Unit of the Surgery Service II, University Hospital of Caracas, with the objective to describe the surgical technique for Endoscopic Saphenectomy in patients with saphena magna insufficiency. The operative time, postoperative complications, and patient’s satisfaction with the technique was also evaluated, comparing nerve block versus epidural anesthesia. The average operative time was 62.5 minutes for group A and 87 minutes for group B. The 83 % of patients had low postoperative pain in the group A and 90 % in group B. One patient was converted to open surgery (5.88 %). Two cases of lympha discharge (12.5 %) both in group A and obese patients; and three equimosis (one distal in group A and two proximal in group B) occurred; there were not infections and 90 % of patients were satisfied with the procedure. The endoscopic saphenectomy with nerve block anesthesia is an excellent procedure for the surgical treatment of selected patients with saphena magna insufficiency, well tolerated and with low complications rate.

In a heterogeneous computing environment, computers have to use a suitable transfer syntax to communicate with each other because of the differences in data representations in each computer. The need to translate the data from one format to another, which can be under-stood by all computers, takes over 90% of the processing power used for protocol processings. Application specific architectures in a heterogeneous system may not be efficient in performing protocol processing functions and there is a need for a stand alone protocol processing system. In a gigabit networking environment, the processing power required for protocol processing is beyond that of a single processor and a multiprocessor approach is needed. Three different multiprocessor architectures with increasing complexities for protocol processing are described in this thesis. These designs make use of the properties of locality of processing and prefetching techniques. Both simulations and analytical methods are used to evaluate the performance. The results indicated that by putting instructions and packet data close to the processors, a significant increase in processing throughput can be obtained as compared to previously published designs. In our best scenario, we obtained a throughput of up to560MBits/s. With further optimizations, it is expected that the throughput can be extended to a gigabit rate. The study also revealed that a bus based architecture is sufficient in handling the OSI protocol processing requirement for a network rate of over 560MBits/s. It was observed that the use of fast processors alone without matching fast memory is inadequate in providing a feasible solution. The sequential nature of protocol definition could be changed to include more parallelism and to further improve the scalability of the protocol processing system.