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Micro/nanofibers are structures that nowadays have a wide range of cutting-edge applications including energy generation and storage devices, smart textiles, cell growth, and tissue engineering. These fibrous materials are mostly produced from polymer solutions spun, under laminar flow conditions, into nanofibers by external forces. However, the turbulent interaction of gas-liquid interfaces offers an innovative approach for the high-throughput production of nanofibers. Here, we present Flow Blurring (FB), a solely pneumatic approach for the massive production of liquid threads of polymer solutions, which relies on a micro-mixing mechanism that triggers a turbulent motion capable of fragmenting a viscous flow. The as-ejected threads are subsequently processed thermally, on-line in a single-step, thus producing micro/nanofibers that form mats. The method operates with relatively large liquid flow rates, equivalent of a high production rate, and is thus suitable for industrial production of engineered nanomaterials. In this work, we used solutions of poly(vinyl alcohol) (PVA) to study its ejection and fragmentation dynamics through computational fluid dynamics (CFD) simulations. In addition, the physics underlying the regulation of the liquid flow rate in FB atomizers are proposed. Fibers with typical diameters in the range 400-800 nm were produced by online heating of the liquid threads. Liquid ejection experiments were performed under different operating conditions thus verifying the capability of the method for synthesizing submicrometer-sized fibers with high uniformity and production rates suitable for scaling up., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Introduction and Objectives: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures., Material and Method: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ 2 test were used to evaluate the significance of the different factors, with the condition of P<.05., Results: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail., Conclusions: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending., (Copyright © 2023 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Controlled ejection of liquids at capillary scales is a ubiquitous phenomenon associated with significant advances in, for instance, molecular biology or material synthesis. In this work, we introduce a high-throughput approach, which relies on a micromixing mechanism to eject and fragment viscous liquids, for production of microfibers from poly(vinyl alcohol) solutions. First, filaments were generated pneumatically with a so-called flow-blurring atomizer and using liquid flow rates of up to ∼1 L/min. Subsequently, the filaments were ionized online by corona discharge and consecutively manipulated with an electric field created by disc electrodes. Such charging of the filaments and the effect of the electric field allowed for their ultrafast elongation and diameter reduction from 150 μm down to fibers of 500 nm, which after collection exhibited fabric-like texture. The approach presented herein is a general procedure with potential for scalability that, upon proper adaptation, may be extended to various polymeric materials., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Fractures of the distal femur affect three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. Main indications of intramedullary nailing are for supracondylar fractures type A or type C of the AO classification. The main objective of the present work is to analyze, by means of FE simulation, the influence of retrograde nail length, considering different blocking configurations and fracture gaps, on the biomechanical behavior of supracondylar fractures of A type. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by the retrograde nail at a distal fracture with different fracture gaps: 0.5 mm, 3 mm y 20 mm, respectively. Besides, for each gap, three nail lengths were studied with a general extent (320 mm, 280 mm and 240 mm), considering two transversal screws (M/L) at the distal part and different screw combinations above the fracture. The study was focused on the immediately post-operative stage, without any biological healing process. In view of the obtained results, it has been demonstrated new possibilities of blocking configuration in addition to the usual ones, which allows establishing recommendations for nail design and clinical practice, avoiding excessive stress concentrations both in screws, with the problem of rupture and loss of blocking, and in the contact of nail tip with cortical bone, with the problem of a new stress fracture., Competing Interests: Declaration of Competing Interest The authors have no professional or financial conflicts of interest to discloser., (Copyright © 2021. Published by Elsevier Ltd.)

Polymer filaments constitute precursor materials of so-called fiber mats, ubiquitous structures across cutting-edge technological fields. Thus, approaches that contribute to large-scale production of fibers are desired from an industrial perspective. Here, we use a robust liquid atomization device operated at relatively high flow rates, ~20 mL/min, as facilitating technology for production of multiple polymer filaments. The method relies on a turbulent, energetically efficient micro-mixing mechanism taking place in the interior of the device. The micro-mixing is triggered by radial implosion of a gas current into a liquid feeding tube, thus resulting in breakup of the liquid surface. We used poly(ethylene oxide) solutions of varying concentrations as test liquids to study their fragmentation and ejection dynamics employing ultra-high speed imaging equipment. Taking an energy cascade approach, a scaling law for filament diameter was proposed based on gas pressure, liquid flow rate and viscosity. We find that a filament dimensionless diameter, Df*, scales as a non-dimensional liquid flow rate Q* to the 1/5. The study aims to elucidate the underlying physics of liquid ejection for further applications in material production.

Cytosolic protein delivery remains elusive. The inability of most proteins to cross the cellular membrane is a huge hurdle. Here we explore the unique photothermal properties of gold nanorods (AuNRs) to trigger cytosolic delivery of proteins. Both partners, protein and AuNRs, are modified with a protease-resistant cell-penetrating peptide with nuclear targeting properties to induce internalization. Once internalized, spatiotemporal control of protein release is achieved by near-infrared laser irradiation in the safe second biological window. Importantly, catalytic amounts of AuNRs are sufficient to trigger cytosolic protein delivery. To the best of our knowledge, this is the first time that AuNRs with their maximum of absorption in the second biological window are used to deliver proteins into the intracellular space. This strategy represents a powerful tool for the cytosolic delivery of virtually any class of protein., (© 2020 Wiley-VCH GmbH.)

Background Mutations in the LMNA gene, encoding LMNA (lamin A/C), causes distinct disorders, including dilated cardiomyopathies, collectively referred to as laminopathies. The genes (coding and noncoding) and regulatory pathways controlled by LMNA in the heart are not completely defined. Methods and Results We analyzed cardiac transcriptome from wild-type, loss-of-function ( Lmna -/- ), and gain-of-function ( Lmna -/- injected with adeno-associated virus serotype 9 expressing LMNA) mice with normal cardiac function. Deletion of Lmna ( Lmna -/- ) led to differential expression of 2193 coding and 629 long noncoding RNA genes in the heart (q<0.05). Re-expression of LMNA in the Lmna -/- mouse heart, completely rescued 501 coding and 208 non-coding and partially rescued 1862 coding and 607 lncRNA genes. Pathway analysis of differentially expressed genes predicted activation of transcriptional regulators lysine-specific demethylase 5A, lysine-specific demethylase 5B, tumor protein 53, and suppression of retinoblastoma 1, paired-like homeodomain 2, and melanocyte-inducing transcription factor, which were completely or partially rescued upon reexpression of LMNA. Furthermore, lysine-specific demethylase 5A and 5B protein levels were increased in the Lmna -/- hearts and were partially rescued upon LMNA reexpression. Analysis of biological function for rescued genes identified activation of tumor necrosis factor-α, epithelial to mesenchymal transition, and suppression of the oxidative phosphorylation pathway upon Lmna deletion and their restoration upon LMNA reintroduction in the heart. Restoration of the gene expression and transcriptional regulators in the heart was associated with improved cardiac function and increased survival of the Lmna -/- mice. Conclusions The findings identify LMNA-regulated cardiac genes and their upstream transcriptional regulators in the heart and implicate lysine-specific demethylase 5A and B as epigenetic regulators of a subset of the dysregulated genes in laminopathies.

Objective: To describe the frequency and clinical characteristics of patients referred to a tertiary neuromuscular clinic as having amyotrophic lateral sclerosis (ALS) but who were re-diagnosed as having an ALS mimic syndrome, and to identify the reasons that led to the revision of the diagnosis., Methods: We reviewed the final diagnosis of all patients prospectively registered in the Sant Pau-MND register from 1 January 2004 to 31 December 2015. A detailed clinical evaluation and a clinically-guided electrophysiological study were performed at first evaluation., Results: Twenty of 314 (6.4%) patients included were re-diagnosed as having a condition other than ALS, in 18 cases already at first evaluation. An alternative specific diagnosis was identified in 17 of those 20, consisting of a wide range of conditions. The main finding leading to an alternative diagnosis was the result of the electrophysiological study. Fifty per cent did not fulfil the El Escorial revised criteria (EECr) for ALS. The most common clinical phenotype at onset in patients with ALS mimic syndromes was progressive muscular atrophy (PMA)., Conclusions: Misdiagnosing ALS is still a common problem. Early identification of ALS mimic syndromes is possible based on atypical clinical features and a clinically-guided electrophysiological study. Patients should be attended in specialised centres. The application of EECr helps to identify ALS misdiagnoses.

In this work, a "bio-electronic nose" for vapour phase detection of odorant molecules based on surface acoustic wave (SAW) resonators is presented. The biosensor system is composed of an array of five SAW resonators coated with three types of odorant-binding proteins (OBPs): the wild-type OBP from bovine (wtbOBP), a double-mutant of the OBP from bovine (dmbOBP), and the wild-type OBP from pig (wtpOBP). High resolution deposition of OBPs onto the active area of SAW resonators was implemented through laser-induced forward transfer (LIFT). The resonant frequency shifts of the SAW resonators after the deposition of the biomolecules confirmed the immobilisation of the proteins onto the Al/Au inter-digital transducers (IDTs). In addition, a low increase of insertion losses with a limited degradation of Q-factors is reported. The "bio-electronic nose" fabricated by LIFT is tested in nitrogen upon exposure to separated concentrations of R-(-)-1-octen-3-ol (octenol) and R-(-)-carvone (carvone) vapours. The "bio-electronic nose" showed low detection limits for the tested compounds (i.e. 0.48 ppm for the detection of octenol, and 0.74 ppm for the detection of carvone). In addition, the bio-sensing system was able to discriminate the octenol molecules from the carvone molecules, making it pertinent for the assessment of food contamination by moulds, or for the evaluation of indoor air quality in buildings., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Our objective was to determine the incidence and clinical-epidemiological characteristics of an ALS cohort patient in Catalonia (Spain). We conducted a population based registry for a three-year period (1999-2001) in Catalonia (6,361,365 inhabitants) using several sources of information. The original El Escorial diagnostic criteria (1994) for ALS were applied for the classification of patients. New cases diagnosed between 1 January 1999 and 31 December 2001 were 215 (118 males and 97 females), with an annual crude incidence rate of 1.4/100,000 (95% CI 1.3-1.8). This rate showed a peak age between 75 and 79 years. The incidence rate was 1.6 (95% CI 1.5-2.2) in males and 1.2 (95% CI 1.1-1.7) in females. Prevalence at the end of the period was 5.4/100,000 of the total population. Median age at onset was 64.3 years. Onset of symptoms was bulbar or generalized in 38% of cases. Mean disease duration at diagnosis was 11.0 months. Median time of survival from onset was 30.8 months. In conclusion, ALS incidence in Catalonia is within the range of other countries across Europe with different geographic, environmental and socioeconomic situations. However, as in other studies conducted in the Mediterranean area, Catalonia incidence is in the lower range of rates in Europe.

We report the results of treatment with Rituximab in six severe, non-responder MG patients. We treated three AChR+MG and three MuSK+MG patients, representing 2% and 20% of the respective groups of our series. Patients were assessed according to the Myasthenia Gravis Foundation of America (MGFA) recommendations. Antibody titers to AChR and MuSK, Ig levels, and IgG subclasses, were tested before treatment and during a follow-up of 9-22 months. All patients, one class V and five class IVB, improved dramatically, with no side effects. Antibody titers declined in all patients (p=0.006). The decline was significantly better in MuSK+MG patients at 9 months (p=0.046) and correlated with a more sustained clinical improvement. We did not find any significant changes in IgG4 that could explain the different outcome observed between these two groups.

Objectives: To describe the frequency and bibliographic characteristics of letters to the editor in the journal, Cirugía Española published between 2000 and 2007 and to compare the differences in the periods between 2000-2003 and 2004-2007., Materials and Method: A descriptive and cross-sectional study, using the letters to the editor published in Spanish surgery between 2000 and 2007, as observation units. The variables considered were: the number of letters according to the volume and year of publication, substantive content of the paper, text length, graphics resources use, number of signatories and their professional profile, institutions of the authors, by origin and number of Autonomous Communities and number of bibliographical references. To meet the second objective, we compared letters from the period 2000-2003 with the period 2004-2007 against the rest of variables considered as a result. We used descriptive statistics and statistical analysis for comparison of distributions (chi2), with a level of significance of p < 0.05, using the SPSS software (Version 15.0)., Results: We identified 312 documents classified as letters. Between 2002 and 2005 their number was small. Often referring to clinical cases 187 (59.9%) and related letters, 98 (31.4%). Of those, 81.1% met the standard length of the text and only 6 letters (1.9%) was the use of graphics exceeded. In 122 letters (39.1%) the permitted number of authors was exceeded. They were mostly contributed by surgeons, 238 cases (76.3%), usually a single hospital, with 294 letters (94.2%) mainly from, Catalonia, Andalusia, Madrid and Valencia. Only 58.1% of the letters complied with the permitted number of references. More related letters were published in the last period (59 letters; 42.1%) than during the years 2000-2003 (39 letters; 22.7%) (chi2 = 14.79; p < 0.001). The correct length of the text improved in the second period, 136 (97.1%), compared to the first 117 (68%) (chi2 = 42.67; p < 0.001. The graphics resources were used properly in both periods. The number of signatories ranged between 1 and 5 in 51.2% of cases in the first period compared to 72.9% in the second (chi2 = 15.25; p < 0.001. In both periods analysed the professional profile of the signatories was similar. More than one institution was involved in 10% of the letters in the final period, compared to 2.3% in the first year period (chi2 = 8.36; p = 0.004). The adequacy of the number of permitted references was higher in the final period (87.1%) than in the initial (34.9%) (chi2 = 86.72; p < 0.001)., Conclusions: The letters in Cirugía Española journal have regained their previous frequency after a period of stagnation between 2002 and 2005. In the final period of the study there was a marked improvement compared to the first one in most indicators studied.

Objective: To study lung function abnormalities and health-related quality of life (HRQL) in a group of patients diagnosed with generalized myasthenia gravis, and to analyze the relationship between these 2 sets of variables., Patients and Methods: In a prospective study of 20 patients diagnosed with generalized myasthenia gravis, the following parameters were measured: spirometry, static lung volumes, breathing pattern, maximal respiratory pressures, and maximum voluntary ventilation. HRQL was assessed using the 36-item short form general health questionnaire (SF-36)., Results: The mean (SD) age of the patients was 64 (11) years. Patients were classified into 2 groups depending on whether they had IIa (12 patients) or IIb (8 patients) type disease. A small decrease in total lung capacity (86%) and slight reductions in maximal inspiratory pressure (88%) and maximum voluntary ventilation (63% in group IIb) were observed. The HRQL domains most affected were those related to physical activity and self-perceived health status in all groups, although women were more affected. The scores relating to vitality and physical activity were found to be significantly associated with forced vital capacity and lung volumes. Tidal volume was associated with maximal inspiratory and expiratory pressures, inspiratory capacity, and maximum voluntary ventilation. The respiratory rate to tidal volume ratio was inversely associated with the first three of these variables., Conclusions: A very slight restrictive pattern and a reduction in inspiratory muscle strength were observed. The HRQL domains most affected were those related to physical activity and the patients' self-perceived health status. The weakness of the respiratory muscles contributes to the abnormalities observed in lung function and to the deterioration of health-related quality of life.

Study Objective: To assess the effect of interval-based inspiratory muscle training (IMT) combined with breathing retraining (BR) in patients with generalized myasthenia gravis (MG) in a partial home program., Design: A randomized controlled trial with blinding of outcome assessment., Setting: A secondary-care respiratory clinic., Patients: Twenty-seven patients with generalized MG were randomized to a control group or a training group., Interventions: The training group underwent interval-based IMT associated with BR (diaphragmatic breathing [DB] and pursed-lips breathing [PLB]) three times a week for 8 weeks. The sessions included 10 min each of DB, interval-based IMT, and PLB. Interval-based IMT consisted of training series interspersed with recovery time. The threshold load was increased from 20 to 60% of maximal inspiratory pressure (P(Imax)) over the 8 weeks., Measurements and Results: Lung function, respiratory pattern, respiratory muscle strength, respiratory endurance, and thoracic mobility were measured before and after the 8 weeks. The training group improved significantly compared to control group in P(Imax) (p = 0.001), maximal expiratory pressure (P(Emax)) [p = 0.01], respiratory rate (RR)/tidal volume (V(T)) ratio (p = 0.05), and upper chest wall expansion (p = 0.02) and reduction (p = 0.04). Significant differences were seen in the training group compared to baseline P(Imax) (p = 0.001), P(Emax) (p = 0.01), maximal voluntary ventilation (p = 0.02), RR/V(T) ratio (p = 0.003), Vt (p = 0.02), RR (p = 0.01), total time of RR (p = 0.01), and upper chest wall expansion (p = 0.005) and reduction (p = 0.005). No significant improvement was seen in lower chest wall or lung function., Conclusions: The partial home program of interval-based IMT associated with BR is feasible and effective in patients with generalized MG. Improvements in respiratory muscle strength, chest wall mobility, respiratory pattern, and respiratory endurance were observed.

Background and Objective: Recently, the presence of antibodies to a muscle-specific tyrosine kinase (MuSK) has been reported in some patients with seronegative generalized myasthenia gravis. Our objective was to describe a group of patients who were positive for anti-MuSK antibodies., Patients and Method: Detection of antibodies using a radioimmunoassay was performed in the serum of 26 patients with generalized myasthenia gravis. We identified 9 patients with anti-MuSK antibodies (MuSK+). Clinical and therapeutic data from these patients were reviewed., Results: Eight of nine patients were women aged between 20 and 40 years. Clinically, all of them showed prevalent bulbar signs, initially or during the progression of the disease. 77% of patients showed ocular involvement and 44% had symptoms of fatigability involving limbs. None of them improved upon thymectomy. Response to acetylcholinesterase inhibitors was variable. All of them responded to immunotherapy, although 30% required polytherapy., Conclusions: The study of anti-MuSK antibodies defines a subgroup of patients, 34,61% in our series, with seronegative generalized myasthenia. This group is characterized by an homogenous clinical presentation with prevalent bulbar symptoms. The knowledge of the immunopathogenic mechanisms of anti-MuSK antibodies will allow a better understanding of both the variable response to acetylcholinesterase inhibitors and the absence of response to thymectomy in these patients.

Laser induced forward transfer (LIFT) is a laser direct write technique that appears to be specially adequate for the production of biosensors, since it permits to deposit patterns of biomolecules with high spatial resolution. In the LIFT technique, a laser pulse is focused on a thin film of the material to be transferred through a transparent support, and under the action of the laser pulse, a small fraction of the film is transferred to a receptor substrate that is placed parallel to the film-support system. In the case of biomolecules transfer, the thin film consists in a liquid solution containing the biomolecules. In this work, microarrays of two different cDNAs have been both spotted by LIFT and pin microspotting onto a poly-L-lysine treated glass slide. Once transferred, all the microarrays have been submitted to hybridization with the complementary strands of the spotted cDNAs, each one tagged with a different fluorochrome. Comparative fluorescence scanner analyses have revealed that the microarrays transferred through LIFT are equivalent to those transferred through pin microspotting in terms of signal intensity and gene discrimination capacity, and that the action of the laser pulse does not result in significant damage of the transferred DNA.

Pseudowollastonite (psW) coatings on titanium alloys substrates were prepared by laser ablation and immersed in simulated body fluid (SBF) for different periods in order to investigate the nucleation and growth of hydroxyapatite (HA)-like formation on their surface. The structure of the coatings before soaking was analysed by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The interfacial reactions product was examined by thin-film XRD, SEM and transmission electron microscopy at low and high resolution level, both fitted with energy-dispersive X-ray spectroscopy. Additional changes in ionic concentration, using inductively couple plasma atomic emission spectroscopy, were determined as well as pH right at the psW-coatings/SBF interface using an ion-sensitive field effect transistor. The solution composition changes, increasing the Ca(2+) and Si(4+) concentration and pH as a function of the soaking time while HPO(4)(2-) decreased. The results obtained showed that the coating surfaces were covered by HA-like, which indicated that the psW-coating possesses good bioactivity and also suggested that the mechanism of HA-like layer formation in SBF was similar to that showed in in vitro test by other silica-based materials.

The term hemobilia is used to describe the presence of blood in the biliary tract. We report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. We review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. In our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. The clinical condition was resolved by means of a cholecystectomy. The patient had an uneventful recovery.

Pseudowollastonite (alpha-CaSiO3) is a bioactive ceramic material that induces direct bone growth. A process to obtain pseudowollastonite coatings that may be applied to implants is described and evaluated in this work. The coatings were first deposited on titanium alloy by laser ablation with a pulsed Nd:YAG laser tripled in frequency. After deposition, they were submitted to a soft laser treatment with a continuous wave Nd:YAG infrared laser. Coatings were characterised by X-ray diffractometry, Raman spectroscopy, scanning electron microscopy and energy dispersive spectroscopy before and after the laser treatment. As-deposited coatings are composed of pseudowollastonite and amorphous material. They have a porous structure of gathered grains and poor cohesion. After the laser treatment the coatings crystallinity and cohesion are improved. The laser treatment also makes the coatings dense and well adhered to the substrate. Therefore, this two-step process has been demonstrated as a valuable method to coat titanium implants with pseudowollastonite.

Calcium phosphate coatings were deposited by pulsed laser ablation with a radiation of 355 nm from a Nd:YAG laser. All the coatings were obtained at the same conditions, but deposition was stopped after different number of pulses to get coatings with different thickness. The influence of thickness in the structural and mechanical properties of the coatings was investigated. Coatings structure was characterised by scanning electron microscopy, grazing incidence X-ray diffractometry and Raman spectroscopy. The mechanical properties were evaluated by scratch test. The morphology of the coatings is dominated by the presence of droplets. The coatings are composed mainly of hydroxyapatite, alpha tricalcium phosphate and amorphous calcium phosphate. Thinner coatings withstand higher loads of failure in the scratch test.

Diabetic polyneuropathy is the most common subgroup of diabetic neuropathy, but its nature is controversial as it might be demyelinating and/or axonal. We have tried to determine whether diabetic polyneuropathy is electrophysiologically axonal, demyelinating, or both. We have studied the sural and peroneal nerves and the electromyographies of leg muscles in 50 healthy subjects (average age 67.2 years, range 45 to 84 years), in 50 diabetic patients (average age 66.34 years, range 44 to 82 years) showing no symptoms and/or signs of polyneuropathy (DP1), and in 50 diabetic patients (average age 67.10 years, range 49 to 87 years) showing symptoms and/or signs of polyneuropathy (DP2). The amplitude (AMP) of sural and peroneal nerves in healthy and DP1 subjects was similar. Conduction velocity (CV) of sural and peroneal nerves was slower in DP1 subjects than in healthy subjects. DP2 subjects showed AMP and CV values significantly lower than those in DP1 subjects, and signs of acute and chronic denervation/reinervation were found in the leg muscles. We believe that this result indicates that diabetic patients have two types of polyneuropathies: a demyelinating disease that could appear in diabetic patients with and without symptoms of polyneuropathy, and an axonal loss that is responsible for most of the symptoms.

Background: The present work is an audit of post-cesarean section morbidity in HIV-positive women in the tertiary teaching hospital La Fé, Valencia, Spain., Study Design: Retrospective case-control study., Subjects: Forty-five HIV-positive pregnant women and 90 appropriately matched controls, delivered by cesarean section in the same hospital and managed using a uniform protocol., Main Outcome Measures: The duration of stay in hospital after cesarean section, the need for postoperative antibiotics and the incidence of major and minor puerperal complications. Baseline characteristics of HIV-positive women were also analyzed in relation to the morbidity after surgery., Statistical Analysis: Chi-square analysis for categorical data and parametric and non-parametric tests for numerical data, where appropriate., Results: Most HIV-positive women (86.7%) had a complicated recovery after surgery. A longer duration of stay in hospital (p<0.0005) and a greater incidence of major (p<0.003) and minor (p<0.00001) postoperative complications were observed in the HIV-positive group compared to the control group. HIV-positive women with > or =500 CD4 lymphocytes/mm3 had less post-cesarean section morbidity, Conclusions: A greater post-cesarean section morbidity was found in HIV-positive women compared to the control women. Immunological status of HIV-positive women may be important in predicting puerperal morbidity after surgery.

Objectives: In order to establish the focal compression in the elbow, a study of 318 patients with clinical manifestations of ulnar neuropathy was carried out. We divided the patients in three groups: I) those who presented mechanical anomalies with background of fracture, elbow valgus...; II) those who did not present mechanical anomalies, but they have been in bed long time or they have been operated...; III) those who did not have evident cause for the compression., Material and Method: Antidromic sensory conduction and segmentary motor conduction of the ulnar nerve were studied, and segmental motor conduction along the elbow with interval of 2 centimetres (technique of Kanakamedala)., Results: 83.6% of the 318 ulnar neuropathy had the focal compression in the ulnar sulcus. 8.2% had the focal compression distal to the ulnar sulcus. 0.94% had double focal compression. In 7.2% was not possible to determinate the focal compression. In group I, the focal compression was in the ulnar sulcus in 93.8% of the cases. In group II, the focal compression was in the ulnar sulcus in 94.3% of the cases. In group III, the focal compression was in the ulnar sulcus in 55.8% of the cases, and distal to the ulnar sulcus in 29.1% of the cases., Conclusion: It is possible to localize the focal compression of the ulnar neuropathy in the elbow, with high level of probability, with the nerve conductions. This allows the surgeon to be orientated about therapeutical attitude.

A dissolution test was performed with pulsed laser (Nd: YAG, 355 nm)-deposited calcium phosphate coatings composed of hydroxyapatite (HA) and alpha-tricalcium phosphate (alpha-TCP) in different proportions, as a result of the use of different deposition rates. During immersion in a Ca2+-free Hank's solution, the dissolution kinetics were determined while other structural and compositional properties of the coatings were derived. It was possible to infer that the alpha-TCP is distributed uniformly and that the coating is of a non-columnar compact grain structure. The mass ratio of the phases for each coating was also determined and was related to the X-ray diffraction intensities. When incomplete, the hydroxylation level of the HA in the coatings is completed after immersion.

Objective: To compare the overall effect on the general public before and after the primary care reform, its economic outcome and professional satisfaction, following the model of the European Foundation for Quality Management., Design: A descriptive analysis of results at reformed primary care centres compared with results at non-reformed centres in the same city., Setting: The study was conducted at Sant Boi de Llobregat, a town of 77,591 inhabitants in Baix Llobregat county (Barcelona). 32.7% of the population was covered by two reformed centres. The rest was covered by one single non-reformed primary care centre., Measurements and Results: Clinical audits and data on pharmaceutical prescription quality were used to find attendance. For economic results, the formula of attribution of cost/inhabitant and cost/inhabitant seen, including the costs of labour, structure, referral, further tests and pharmacy, were used. The satisfaction of the outside customer (user) was measured by a population survey. Internal customer satisfaction was measured by a survey of the professionals. Results were compared with those for 1997. The study showed that the reformed primary care sector's results, measured in terms of professional satisfaction, user-outside customer, attendance, economic results and social impact, were better than the non-reformed sector's. Inside and outside customers' satisfaction was higher in the reformed network. The cost per inhabitant in the reformed network was 31,874 pesetas, against 25,177 in the non-reformed network. The cost per inhabitant seen was 34,482 and 44,603, respectively., Conclusions: The reform creates efficient resource management and greater satisfaction of the general public and professionals, when an indicator sensitive to the real use of services is used.

The case of a 58-year-old male who, after 47 months of treatment with cervical radiotherapy for labial carcinoma, developed brachial plexopathy and six months later cervical myelopathy is herewith presented. Involvement of both the brachial plexus and the spinal cord in the same patient secondary to radiotherapy is exceptional.

A neurophysiological study of 921 hands with clinical manifestations of carpal tunnel syndrome (CTS), 88 of normal individuals and 588 of patients with disorders not related with median neuropathy was carried out to establish the diagnostic sensibility 130 non-operated on patients with slight CTS were controlled one year later. The same was achieved with 105 surgically treated patients in order to establish the electrophysiological changes related to therapeutic methods. Antidromic sensory conduction and segmentary motor conduction of the median nerve were studied along with the difference between median and ulnar sensory latencies. Only 84 of the 921 hands (5.2%) showed normal electrophysiological findings and 469 (50.9%) minimal changes. 343 hands (37.2%) showed signs suggestive of axonal degeneration in sensory fibers and 147 (16%) in motor ones. Of the 130 slight CTS not surgically treated, clinical manifestations persisted for one year in 118, 17 of which have normal electrophysiological parameters. Twenty six (20%) of these 130 hands got worse. Of the 105 CTS surgically treated hands, 58 continued with symptoms one year later in spite of the electrophysiological improvement in 88.6% of them. Among 588 patients hands without CTS symptoms, only 0.8% had electrophysiological signs suggesting CTS. A high yield of the electrophysiological diagnosis of the CTS is shown. Symptoms frequently persist in patients without definite nerve compression.

Survival in patients with amyotrophic lateral sclerosis is highly variable. In a prospective study of 71 patients, we analyzed the influence of several clinical factors on survival: age of onset, sex, initial involvement (bulbar, upper extremities or lower extremities) and familial history. Mean time of evolution was 2.6 years, with 25% survival 5 years after onset. Patients under 45 years old had better survival than those over 45 (5.8 and 2.2 years, respectively, p < 0.002). The prognosis for women was worse (2.07 and 3.6 years for women and men, respectively, p < 0.001), probably because age of onset was later in women (61 versus 53 years, respectively, p < 0.006). Neither first symptom or familial history of the disease affected prognosis. We conclude that age at onset is a decisive prognostic factor that is inversely related to survival. In the design of clinical trials in which survival is a variable, the treatment and control groups should be matched for age.

Several aspects of amyotrophic lateral sclerosis are reviewed, with special emphasis on arguments based on etiological and pathogenic theories currently in vogue: free radicals, glutamate-induced toxic excitation, trophic factors, autoimmunity and axon transport. Each of these theories has inspired therapeutic trials, some of which are already completed and others are still in progress. More than one neurodegenerative mechanism may be involved in amyotrophic lateral sclerosis, meaning that it might be necessary to combine several drugs in future trials.

Much interest has focused on the role of glutamate-mediated excitotoxicity in the etiopathogenesis of amyotrophic lateral sclerosis (ALS). We therefore conducted a phase I study of high-dose dextromethorphan (DM) in ALS. DM is a selective, noncompetitive antagonist of the N-methyl-D-aspartate subtype of the glutamate receptor. Thirteen patients were given DM in an escalating dose fashion, to a target of 10 mg/kg/day or the maximum tolerable dose, and then maintained on this dose for up to 6 months. Total daily doses ranged from 4.8 to 10 mg/kg (median, 7 mg/kg). Side effects were dose limiting in most patients. The most common side effects were light-headedness, slurred speech, and fatigue. Detailed pharmacokinetic and neuropsychology studies were performed. This study demonstrates the feasibility of long-term administration of high-dose DM in ALS, as well as in other conditions associated with glutamate excitotoxicity.