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Resumen Introduccion Los programas de recuperacion precoz (rapid recovery, RP) en artroplastia total de rodilla pueden mejorar la funcionalidad a la vez que se reducen los costes. El objetivo del estudio es comparar los resultados de un programa de rehabilitacion precoz con nuestro protocolo habitual. Pacientes y metodos Se realizo un ensayo clinico aleatorizado (NCT03823573) en pacientes operados de artroplastia total de rodilla. El grupo intervencion (RP) recibio infiltracion periarticular con levobupivacaina e inicio deambulacion supervisada a las 4-6 h tras la intervencion. El grupo control (C) empleo drenaje y recibio un bloqueo femoral e inicio la deambulacion al retirar el drenaje. Los pacientes completaron un cuestionario Oxford Knee Score preoperatorio y a los 6 meses. La incidencia de trombosis venosa profunda asintomatica se analizo mediante ecodoppler. El seguimiento minimo fue de 6 meses. Resultados Fueron incluidos 175 pacientes (92 pacientes en el grupo C y 83 en el RP). No hubo diferencias en sexo, edad, tipo de protesis, descenso de hemoglobina, necesidad de transfusiones, balance articular activo al alta (C: 82,6°; RP: 85°) ni al finalizar el seguimiento (C: 105,1°; RP: 106,6°), mejoria del cuestionario (C: 17,5 puntos; RP: 19,3 puntos), satisfaccion del paciente o reatenciones hospitalarias (C: 7,6%; RP: 10,8%). Se observo significacion en el tiempo de isquemia (C: 81,29 min; RP: 85,35 min; p = 0,03), necesidad de rescate con opioides (C: 19,7%; RP: 38,6%; p = 0,007), estancia media (C: 3,84 dias; RP: 2,54 dias; p Conclusion El protocolo RP puede reducir la estancia hospitalaria sin aumentar las complicaciones ni las reatenciones.

Resumen Introduccion La practica en modelos experimentales es una opcion valida que mejora los resultados y acorta las curvas de aprendizaje de las tecnicas quirurgicas. Nuestro objetivo fue desarrollar un modelo en plastico, impreso en 3D para la docencia, el entrenamiento y la formacion en ureteroscopia flexible, analizando costes e idoneidad para la practica de esta tecnica quirurgica. Metodos Se elaboro un modelo impreso en 3D a partir de una tomografia axial computarizada de una via urinaria superior de un paciente real. La segmentacion se llevo a cabo mediante el software HorosTM y la impresion mediante una impresora FDM-Ultimaker. Se numero los calices renales para ser identificados, como en el plan de formacion de tratamiento endoscopico de litiasis, ejercicio 4, de la Asociacion Europea de Urologia. Se utilizaron: un ureteroscopio flexible desechable Innovex (Palex) y cestillas de nitinol (Coloplast). Resultados El tiempo de impresion fue de 19 h, con un coste total de 8,77 €. El modelo tridimensional permitio la introduccion del ureteroscopio flexible y la exploracion de los calices renales por parte de urologos tanto en formacion como en ejercicio actual de la especialidad sin dificultad. El modelo tambien permitio la utilizacion de cestillas y la movilizacion y extraccion de litiasis previamente colocadas. Conclusion Damos a conocer un modelo tridimensional valido para ejercicios de formacion en ureteroscopia flexible con unos costes razonables, que permitira adquirir la destreza y la confianza necesaria para iniciar el procedimiento en un escenario real.

Background: Chronic malnutrition is a condition that can have important negative impacts on subsequent physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The supplementation with small quantity lipid based nutrients (SQ-LNS) and the provision of cash transfers are promising interventions to prevent it but more operational research is needed to gain evidence on their effectiveness. Methods/Design: The Crescer project aims to evaluate the impact of a SQ-LNS intervention and a cash transfer intervention in the lineal growth of children less than 2 years old in Southern Angola. The three-arm parallel cluster randomised controlled trial is set in four comunas of Huila and Cunene provinces. Pregnant women are recruited, and treatment arms receive unconditional cash or SQ-LNS plus a food family ration for the first 1000 days, from pregnancy through the child reaching 24 months. A comparison group receives “standard of care” provided by the Crescer project to which all groups have the same access. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children’s age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children’s dietary diversity. Quantitative data are also collected on women’s empowerment, household food security, expenditure and relevant clinical and social events at base line, end line and intermediate time points. Discussion: The results of this trial will provide valuable information on the impact of a SQ LNS and an unconditional cash transfer intervention, carried out during the first 1000 days, in the children´s growth up to 2 years, and related outcomes. Trial registration: Clinical Trials NCT05571280. Registered 7 October 2022.

Very-high Energy (VHE) gamma-ray astroparticle physics is a relatively young field, and observations over the past decade have surprisingly revealed almost two hundred VHE emitters which appear to act as cosmic particle accelerators. These sources are an important component of the Universe, influencing the evolution of stars and galaxies. At the same time, they also act as a probe of physics in the most extreme environments known - such as in supernova explosions, and around or after the merging of black holes and neutron stars. However, the existing experiments have provided exciting glimpses, but often falling short of supplying the full answer. A deeper understanding of the TeV sky requires a significant improvement in sensitivity at TeV energies, a wider energy coverage from tens of GeV to hundreds of TeV and a much better angular and energy resolution with respect to the currently running facilities. The next generation gamma-ray observatory, the Cherenkov Telescope Array Observatory (CTAO), is the answer to this need. In this talk I will present this upcoming observatory from its design to the construction, and its potential science exploitation. CTAO will allow the entire astronomical community to explore a new discovery space that will likely lead to paradigm-changing breakthroughs. In particular, CTA has an unprecedented sensitivity to short (sub-minute) timescale phenomena, placing it as a key instrument in the future of multi-messenger and multi-wavelength time domain astronomy. I will conclude the talk presenting the first scientific results obtained by the LST-1, the prototype of one CTAO telescope type - the Large-Sized Telescope, that is currently under commission., PoS: Proceedings of Science, 395, ISSN:1824-8039, Proceedings of 37th International Cosmic Ray Conference (ICRC2021)

Accurate reference data to validate burned area (BA) products are crucial to obtaining reliable accuracy metrics for such products. However, the accuracy of reference data can be affected by numerous factors; hence, we can expect some degree of deviation with respect to real ground conditions. Since reference data are usually produced by semi-automatic methods, where human-based image interpretation is an important part of the process, in this study, we analyze the impact of the interpreter on the accuracy of the reference data. Here, we compare the accuracy metrics of the FireCCI51 BA product obtained from reference datasets that were produced by different analysts over 60 sites located in tropical regions of South America. Additionally, fire severity, tree cover percentage, and canopy height were selected as explanatory sources of discrepancies between interpreters’ reference BA classifications. We found significant differences between the FireCCI51 accuracy metrics obtained with the different reference datasets. The highest accuracies (highest Dice coefficient) were obtained with the reference dataset produced by the most experienced interpreter. The results indicated that fire severity is the main source of discrepancy between interpreters. Disagreement between interpreters was more likely to occur in areas with low fire severity. We conclude that the training and experience of the interpreter play a crucial role in guaranteeing the quality of the reference data.

Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery programme compared to our classic protocol.We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made 1 month after discharge. Minimum follow-up was of 6 months.A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, haemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford knee score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%). Significancy was found on time of ischaemia (C: 81.29min; RP: 85.35min; p=.03), need for morphine shots (C: 19.7%; RP: 38.6%; p=.007), hospital stay (C: 3.84 days; RP: 2.54 days, p.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; p.0001).Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

Rapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery program compared to our classic protocol.We performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal. All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made one month after discharge. Minimum follow-up was of 6 months.A total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, hemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford Knee Score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%). Significancy was found on time of ischemia (C: 81.29min; RP: 85.35min; P=0.03), need for morphine shots (C: 19.7%; RP: 38.6%; P=0.007), hospital stay (C: 3.84 days; RP: 2.54 days, P0.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; P0.0001).Rapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

Introduction In-hospital 3D printing is being implemented in orthopaedic departments worldwide, being used for additive manufacturing of fracture models (or even surgical guides) which are sterilized and used in the operating room. However, to save time and material, prints are nearly hollow, while 3D printers are placed in non-sterile rooms. The aim of our study is to evaluate whether common sterilization methods can sterilize the inside of the pieces, which would be of utmost importance in case a model breaks during a surgical intervention. Material and method A total of 24 cylinders were designed and printed with a 3D printer in Polylactic Acid (PLA) with an infill density of 12%. Manufacturing was paused when 60% of the print was reached and 20 of the cylinders were inoculated with 0.4 mL of a suspension of S epidermidis ATTCC 1228 in saline solution at turbidity 1 McFarland. Printing was resumed, being all the pieces completely sealed with the inoculum inside. Posteriorly, 4 groups were made according to the chosen sterilization method: Ethylene Oxide (EtO), Gas Plasma, Steam Heat or non-sterilized (positive control). Each group included 5 contaminated cylinders and 1 non-contaminated cylinder as a negative control. After sterilization, the inside of the cylinders was cultured during 7 days. Results We observed bacterial growth of just a few Forming Colony Units (FCU) in 4 out of 5 positive controls and in 2 out of 5 contaminated cylinders sterilized with Gas Plasma. We could not assess any bacterial growth in any of the EtO or Steam Heat samples or in any of the negative controls. Pieces sterilized under Steam Heat resulted completely deformed. Conclusions High temperatures reached during the procedure of additive manufacturing can decrease the bacterial load of the biomodels. However, there is a potential risk of contamination during the procedure. We recommend sterilization with EtO for in-hospital 3D-printed PLA hollow biomodels or guides. Otherwise, in case of using Gas Plasma, an infill of 100% should be applied.

Objectives We present the results of the prospective follow up of a sample of large head metal-metal total hip arthroplasty obtained after the safety alert regarding a higher incidence of revision of these implants. Material and methods All patients implanted with the Recap-M2a-Magnum cup between 2008 and 2011 were included. They were prospectively reviewed recording Harris Hip Score, clinical symptoms of chromium or cobalt intoxication. Serum levels of these ions were requested as well as X-rays and ultrasonography. An MRI was performed in the cases of positive ultrasonography. Results Twenty-six males with a mean age of 48.54 years [32–62, SD: 7.18] were included. An anterolateral approach and Bi-Metric (7) and F-40 (19) stems were used. Cephalic diameters ranged 42–52 (mode: 46) and the mean cup inclination was 39.35° [21–59°, SD: 9.78]. During follow-up (7.3 years [5.9–9.4; SD: .78]), 3 patients (11.5%) underwent revision (2 cases aseptic loosening, 1 pseudotumour). Mean time until revision was 5.4 years [3.1–8.0; SD: 2.48]. The accumulated survival probability was 88.5% (95% CI 76.3–100%). Harris Hip Score was 94.47 [66.5–100; SD: 8.94] and the patients showed no metallic intoxication symptoms. The levels of chromium were 1.88 μg/dl [0.6–3.9] and cobalt 1,74 μg/dl [0.5–5,6]. One pseudotumour was found in an asymptomatic patient, and small amounts of periarticular liquid were found in 5 patients (19.2%) Discussion and conclusions High revision rates are still found when follow up is extended due to aseptic loosening and pseudotumour formation. MRI might not be the most adequate test to study the complications of these prostheses.

Resumen Objetivos A raiz de las alertas sanitarias surgidas por la alta incidencia de recambios en la artroplastia de cadera metal-metal, se presentan los resultados obtenidos del seguimiento prospectivo de la serie de nuestro centro con cabezas de gran tamano. Material y metodos Se incluyeron todos los pacientes tratados con el cotilo Recap-M2a-Magnum, Biomet de 2008 a 2011. Se revisaron prospectivamente todos los pacientes registrando Harris Hip Score y sintomas de intoxicacion por cromo-cobalto y se solicitaron niveles sericos de estos iones, radiografia y ecografia. Se solicito resonancia magnetica en caso de ecografia positiva. Resultados Se incluyeron 26 varones de 48,54 anos de edad media [32-62, DE: 7,18]. Se utilizo un abordaje anterolateral y vastagos Bimetric (7) o F40 (19). La moda de los diametros cefalicos fue 46 [42-52]. La inclinacion media del cotilo fue 39,35° [21-59°, DE: 9,78]. Durante el seguimiento (7,3 anos [5,9-9,4 anos, DE: 0,78]), 3 pacientes (11,5%) precisaron revision (2 por movilizacion aseptica, un pseudotumor). El tiempo medio hasta la revision fue 5,4 anos [3,1-8,0, DE: 2,48]. La probabilidad acumulada de supervivencia fue del 88,5% (IC95% 76,3-100%). El Harris Hip Score fue de 94,47 [66,5-100, DE: 8,94] y los pacientes no mostraron ningun sintoma de intoxicacion metalica, con niveles de cromo 1,88 mcg/dl [0,6-3,9] y cobalto 1,74 mcg/dl [0,5-5,6]. Se encontro un pseudotumor en un paciente asintomatico y pequenas cantidades de liquido periprotesico en 5 pacientes (19,2%). Discusion y conclusiones Seguimos encontrando altas tasas de revision al extender el seguimiento de los pacientes debido a la movilizacion aseptica y la formacion de pseudotumores. La resonancia nuclear magnetica no parece la prueba mas adecuada para el estudio de las complicaciones de este tipo de protesis.

Resumen Objetivo Evaluar la eficacia del acido tranexamico topico en la artroplastia total de cadera no cementada desde el punto de vista del sangrado, las necesidades transfusionales y la estancia media, asi como describir las complicaciones derivadas de su uso respecto a un grupo control. Material y metodos Estudio prospectivo, aleatorizado, controlado y doble ciego que incluye todos los pacientes intervenidos de artroplastia total de cadera no cementada en nuestro centro entre junio de 2014 y julio de 2015. La perdida de sangre se estimo mediante la formula descrita por Nadler y Good. Resultados El analisis final incluyo 119 pacientes. El descenso de hemoglobina tras la cirugia fue menor en el grupo del acido tranexamico (3,28 ± 1,13 g/dL) que en el control (4,03 ± 1,27 g/dL, p = 0,001), asi como el volumen estimado de sangre perdida (1.216,75 ± 410,46 mL vs. 1.542,12 ± 498,97 mL, p Conclusiones El uso de acido tranexamico topico en la artroplastia total de cadera no cementada produce una disminucion en las necesidades transfusionales y el sangrado sin aumentar la incidencia de las complicaciones.

Objectives Our aim was to investigate whether patients presenting with fragility fractures of the proximal femur are receiving osteoporosis treatment and to assess the number of other fragility fractures they have sustained prior to admission. Methods All patients presenting to our institution with fragility fractures of the proximal femur within an 18-month period (January 2012–August 2013) were included. Patient demographics; fracture classification (AO/OTA); American Society of Anesthesiologists (ASA) grade; Abbreviated Mental Test Score (AMTS) on admission; type of operation; time to operation; peri -operative complications; length of hospital stay (LOS); walking status; osteoporotic medication; Dual-energy X-ray absorptiometry (DEXA) results; additional fragility fractures; and mortality were collected and analysed. Results A total of 1004 patients (278 male) met the inclusion criteria and were included into the study. The mean age was 82.01 years and mean LOS was 19.54 days. Fifty-four per cent of the patients were admitted from their own homes whereas 43% were capable to walk indoors without any aids before their injury. Mean time to surgery was 2.06 days (Median: 1.31, range: 0–26 days). Three hundred and six patients (30.5%) had at least another fragility fracture before the index episode (mean 1.40 fractures; SD: 0.71 fractures; range: 1–6 fractures). Only 16.4% were under complete osteoporosis treatment on admission, defined as receiving calcium with vitamin D and a bisphosphonate or an alternative agent. When we compared patients without a history of a previous fragility fracture (Group A) and patients with at least another previous fragility fracture (Group B), we found that patients in Group B had a significantly lower AMTS score, lower bone mineral density (BMD) as evident on the DEXA scan, an inferior mobility before admission and a higher incidence of extracapsular fractures (p On discharge, patients in Group B had a higher chance of receiving complete bone protection compared to group A (27.9% versus 41.7%; p Following discharge, 11.2% of the patients sustained an additional fragility fracture. The mean time from the index episode to the additional fracture was 0.65 years, whilst these injuries were more frequent in Group B (RR = 1.638; p Conclusion Patients presenting with a hip fracture are generally under-treated for osteoporosis. Post-operative assessment by a designated geriatrician and use of a standardised protocol is of paramount importance for reducing the risk of additional fragility fractures. Additionally, screening of the elderly population for identifying the patients who suffer from osteoporosis can potentially reduce the risk of sustaining a further fragility fracture.

Fisicoquimica es una asignatura cuyos contenidos se perciben como de escasa aplicacion en el futuro, por lo que gran parte de los alumnos dirigen sus esfuerzos hacia un aprendizaje superficial. El «aprendizaje basado en problemas» (ABP) constituye una estrategia metodologica que pretende estimular en los alumnos el deseo de saber y se plantea como medio para adquirir conocimientos y aplicarlos para solucionar un problema real o ficticio. El proposito de este articulo es describir los resultados de una experiencia en la que se empleo el ABP como complemento de la ensenanza tradicional en 3 cohortes de alumnos. Se contemplaron 2 instancias de evaluacion cualitativa y 3 de evaluacion cuantitativa. Los resultados mostraron una alta valoracion cualitativa, destacando su agrado por la estrecha integracion de contenidos teoricos y practicos. A su vez, los logros cuantitativos grupales fueron muy alentadores, aun cuando el desempeno individual de los miembros de los grupos no reflejo lo mismo. Concluyendo, la adopcion del ABP como complemento de la ensenanza tradicional es una inversion educativa que resulta fructifera al menos en el corto y mediano plazo, a pesar de la resistencia inicial de los estudiantes y del tiempo y esfuerzo que demanda a docentes y alumnos.

Distal radius fracture (DRF) is the most common upper extremity fracture. The incidence of complications after surgical treatment still remains high. The objective of our study was to assess functional and radiological results of DRF treated with volar locking plate.We conducted a retrospective study including DRF treated by open reduction and internal fixation with a volar locking plate during a period of 8 years (2010-2018). Data were collected from clinical records and included patient demographics, fracture characteristics, radiological parameters (radial inclination, palmar tilt, ulnar variance, articular step-off), range of motion (ROM), complications and reinterventions.A total of 170 patients (63.5% female) met the inclusion criteria with a mean age of 55.9 years [24.1-83.7; 13.76]. High energy injuries were more frequent in younger patients (25.56% vs 3.95%; p 0.0001). AO classification was: 2R3A: 23.5%, 2R3B: 24.1% and 2R3C: 52.4%. Time until surgery was 8.5 days, longer in extraarticular fractures (AO-2R3A: 12.22 days, AO-2R3B: 7.97 days, AO-2R3C: 7.04 days, p = 0.018). Younger patients had better radial inclination (excellent in 85.1% vs 59.21%, p = 0.001) and radial shortening (excellent in 100% vs 88.15%, p = 0.001). ROM was: flexion 63° [0-90°; 19.73], extension 57.67° [5-90°; 21.61], pronation 78.94° [40-90°] and supination 81.76° [38-90°; 8.87]. We found a weak correlation between ROM in flexion-extension and radial shortening (r = 0.218; p = 0.001) and articular step-off (r = -0.269; p = 0.002). We had 39 complications (21.18% of patients). 10.6% of patients needed a re-operation, being the most frequent hardware removal (6.5%) and tendinous disruptions repairs (2.4%). Reintervention rate was higher in younger patients (14.9% vs 5.3%; p = 0.042), complete articular fractures (AO-2R3A: 2.5%; AO-2R3B: 7.3%; AO-2R3C: 15.7%; p = 0.037) and high energy injuries (8.4% vs 22.2%; p = 0.044). Patients undergoing reintervention had a decreased flexion-extension (94.44° vs 123.83°, p = 0.007).Radial shortening and articular step-off seem the most important predictors for postoperative range of motion. Worse radiological outcomes are observed in complete articular fractures and those affecting elder population. Although radiological and functional results are good or excellent in most of cases, the incidence of complications and need for reintervention still remains noticeable. Re-operations were more frequent in younger patients, complete articular fractures and high energy injuries, and it worsened functional outcomes.

IntroductionPatient specific instrumentation is a novel aid the industry has been implementing in our hospitals during the last years. However, the cost of the process and the impossibility to discuss face to face with the manufacturer the needs of the particular cases may favor the in-hospital production of these devices.We present the design and manufacturing process of three patient-specific devices to treat complex common situations in orthopaedic surgery, such as intramedular tumor resections, long bone pseudarthrosis and malunions of articular fractures.Material and MethodsCT scans of the region of interest were performed to all the patients. Horos® software was used to isolate the affected bone region, whereas Meshmixer® software was used to create the patient specific guides. An Ultimaker 2+® 3D printer was used to print the guide, in a biocompatible material (SmartFil® Medical). The printing parameters included a nozzle of 0.6 mm and a layer height of 0.1 mm.There was one case of a low-grade chondrosarcoma in which we created a guide to resect enough cortical bone to make an extended curettage of the lesion. Phenol and PMMA were used as adjuvants after the curettage. We used the same guide to obtain an exact replica of allograft which was later placed in position.We had a femur diaphyseal atrophic pseudarthrosis in a patient with achondroplasia, in which the guide permitted the resection of the affected bone with a saw and posterior osteosynthesis with an anterior LCP plate.Finally, in an intraarticular malunion of a distal radius Die-Punch fracture we used the guide to make an osteotomy of the affected articular portion and correct the articular surface. Bone autograft was added prior to the osteosynthesis with a plate.ResultsMean design time was 6.3 hours. Mean printing time was 5.2 hours. The price of the filament used for each guide was under 10 USD. The mean time from the CT-Scan and the surgery being performed was 2.7 months. In all cases the patient specific guides fitted in the bone and permitted the planned resection/osteotomy.All the surgeries fulfilled their purpose.ConclusionsPatient specific guides are easy to design in a local setting with the aid of free software. Design time still needs dedication although it permits the manufacturing of the guides following surgeon needs. The use of self-designed and printed guides is safe and accurate, with a low cost for the institutions.

PurposeThe medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life.MethodsDesign and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50years old admitted in 48 hospitals in Spain.Outcomes: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture.Statistics: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range).ResultsA total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to -0.01 (-0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (-0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively.ConclusionsHip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture., This work has been sponsored by an unrestricted grant of AMGEN to the Hospital del Mar Institute of Medical Investigation (IMIM).

Introduction and objective Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution. Material and methods Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed. Results A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P Conclusions Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique.

Resumen Introduccion y objetivo La artrodiastasis consiste en la movilizacion de la cadera mediante la distraccion por medio de un fijador externo articulado. El objetivo de nuestro estudio es mostrar los resultados obtenidos en nuestro centro en el tratamiento de la enfermedad de Perthes de inicio tardio o de mal pronostico con esta tecnica quirurgica. Material y metodos Revision ambispectiva de todos los casos intervenidos en nuestro servicio de ortopedia infantil entre los anos 2010 y 2014 con los siguientes criterios de inclusion: pacientes mayores de 8 anos, con minima deformidad y pronostico desfavorable. Se evaluan movilidad, dolor, Trendelenburg, esfericidad radiologica y complicaciones. Resultados Se incluyeron 13 pacientes, 9 de ellos varones, con una edad media de 11,93 anos. Siete casos presentaron signos radiologicos de riesgo. La disminucion del dolor mediante EVA tras la cirugia fue cuantificada en 3,83 puntos (p Conclusiones La artrodiastasis constituye una tecnica minimamente invasiva y util en el tratamiento de Perthes de inicio tardio o de mal pronostico, mejorando la clinica y manteniendo la esfericidad cefalica, siendo recomendable el tratamiento de estos pacientes al inicio de la enfermedad. Sin embargo, no esta exenta de complicaciones, que pueden afectar a 8 de cada 10 pacientes tratados.

We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients >= 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis., Funded in part by CIBER on Frailty and Healthy Aging (CIBERFES), Instituto Carlos III, Spanish Ministry of Economy and Competitiveness, FEDER funds. Unrestricted research grant from Amgen S.A. Amgen did not have any role in study design, collection, analysis and interpretation of data, writing the report, and the decision to submit the report for publication.

Leopardus wiedii (margay) is the only arboreal Neotropical felid able to climb head-first down trees, due to its ability to rotate its tarsal joint 180°. A closely related, similar-sized species, L. geoffroyi (Geoffroy´s cat) exhibits more typical terrestrial habits and lacks the arboreal capabilities of L. wiedii. There is osteological evidence that supports a mechanical specialization of L. wiedii´s tarsal joint for inversion, but there have been no studies on the myology of this specialization. Based on comparative gross-anatomy dissections of zeugo- and autopodial muscles related to the ankle joint of one margay specimen and two Geoffroy´s cats, we identified myological specializations of L. wiedii that support its arboreal abilities. In addition, we documented both species hunting the same prey (domestic pigeon Columba livia, Aves: Columbidae) in captivity, to complement. We report differences in the origin, insertion and belly in 8 of the 10 dissected muscles. At least 3 of these interspecific variations can be associated with strengthening of the main muscles that command inversion/eversion movements of the tarsal joint and support the body weight in the head-down climbing position typical of L. wiedii. Frame-by-frame video reconstructions depict the sequence of movements in these species while hunting and highlight the advantages of the arboreal abilities of L. wiedii. Fil: Morales, Miriam Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Jujuy. Universidad Nacional de Jujuy. Centro de Investigaciones y Transferencia de Jujuy; Argentina. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; Argentina. Centro de estudios Territoriales y Ambientales y Sociales. Facultad de Ciencias Agrarias. Universidad Nacional de Jujuy. San Salvador de Jujuy; Argentina Fil: Moyano, Silvana Rocio. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; Argentina. Centro de estudios Territoriales y Ambientales y Sociales. Facultad de Ciencias Agrarias. Universidad Nacional de Jujuy. San Salvador de Jujuy; Argentina Fil: Ortiz, Agustina M.. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias; Argentina. Universidad Nacional de Jujuy. Instituto de Geología Minera; Argentina Fil: Ercoli, Marcos Darío. Universidad Nacional de Jujuy. Instituto de Geología Minera; Argentina. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; Argentina Fil: Aguado, Luis I.. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias; Argentina Fil: Cardozo, Sergio A.. Centro de estudios Territoriales y Ambientales y Sociales. Facultad de Ciencias Agrarias. Universidad Nacional de Jujuy. San Salvador de Jujuy; Argentina. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias; Argentina Fil: Giannini, Norberto P.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucuman. Unidad Ejecutora Lillo. Fundación Miguel Lillo. Unidad Ejecutora Lillo; Argentina. American Museum Of Natural History. New York; Estados Unidos

Introduction Several authors have suggested a correlation between the fracture patterns of proximal femur fractures and the degree of hip osteoarthritis (HOA), but the current evidence to support this are insufficient. The aim of our study was to demonstrate whether there is an association between the grade of HOA and fracture pattern observed, in patients presenting with a fragility fracture of the proximal femur. Materials and methods We contacted a retrospective review of all patients presenting to our institution with fragility fractures involving the proximal femur, between March 2012 and October 2013. Pathological fractures, high-energy injuries and patients with less than one year of follow-up were excluded from further analysis. Admission radiographs and severity of HOA were assessed according to Kellgren and Lawrence scale (minimal: Grades 1–2; severe: Grades 3–4). Fractures were classified according to AO/OTA classification. Results A total of 1003 patients (725 females; 1003 fractures) met the inclusion criteria, having a mean age of 81.5 (46–106 years). With regards to fracture classification, 417 (41.6%) fractures were classified as extracapsular and 586 (58.4%) as intracapsular. A total of 939 (93.9%) patients presented with minimal HOA, whilst 61 (6.1%) of the patients presented with severe HOA. Of the 61 patients presenting with severe HOA, 42 patients (68.9%) sustained a 31A-interthrocanteric fracture and 19 patients (31.1%) sustained a 31B-intracapsular fracture. Regarding the patients presenting with minimal HOA (832 patients in total), 323 patients (38.8%) sustained 31A-intertrochanteric fracture and 509 patients (61.2%) sustained a 31B-intracapsular fracture. Patients presenting with severe HOA were found to have a statistically significant chance to present with an extracapsular fracture (p Conclusions The degree of HOA is related to the fracture pattern in patients presenting following simple mechanical falls. More specifically, higher grades of HOA are associated with extracapsular fracture patterns, whereas lower grades of HOA are associated with intracapsular fracture patterns.

We present the results of the prospective follow up of a sample of large head metal-metal total hip arthroplasty obtained after the safety alert regarding a higher incidence of revision of these implants.All patients implanted with the Recap-M2a-Magnum cup between 2008 and 2011 were included. They were prospectively reviewed recording Harris Hip Score, clinical symptoms of chromium or cobalt intoxication. Serum levels of these ions were requested as well as X-Rays and ultrasonography. An MRI was performed in the cases of positive ultrasonography.Twenty-six males with a mean age of 48.54 years [32-62, SD: 7.18] were included. An anterolateral approach and Bi-Metric (7) and F-40 (19) stems were used. Cephalic diameters ranged 42-52 (mode: 46) and the mean cup inclination was 39.35° [21-59°, SD: 9.78]. During follow-up (7.3 years [5.9-9.4; SD: .78]), 3 patients (11.5%) underwent revision (2 cases aseptic loosening, 1 pseudotumour). Mean time until revision was 5.4 years [3.1-8.0; SD: 2.48]. The accumulated survival probability was 88.5% (95% CI 76.3-100%). Harris Hip Score was 94.47 [66.5-100; SD: 8.94] and the patients showed no metallic intoxication symptoms. The levels of chromium were 1.88 mcg/dl [0.6-3.9] and cobalt 1,74 mcg/dl [0.5-5,6]. One pseudotumour was found in an asymptomatic patient, and small amounts of periarticular liquid were found in 5 patients (19.2%) DISCUSSION AND CONCLUSIONS: High revision rates are still found when follow up is extended due to aseptic loosening and pseudotumour formation. MRI might not be the most adequate test to study the complications of these prostheses.

Resumen Objetivos Evaluacion del manejo quirurgico, evolucion y complicaciones de pacientes afectados por fractura pertrocanterea de cadera tratados mediante enclavado PFNA. Material y metodo Revision retrospectiva de 200 pacientes intervenidos entre abril de 2010 y febrero de 2012 de forma consecutiva. Se realiza evaluacion radiografica preoperatoria, postoperatoria y durante el seguimiento (reduccion de la fractura, posicion de la espiral, consolidacion o signos de colapso). La evaluacion clinica se realizo en funcion de la autonomia para la marcha. Se comparan los resultados obtenidos con estudio previo, sobre muestra de 700 pacientes y enclavado gamma 3 y TFN. Resultados La posicion de la espiral es centro-centro en el 64% de los pacientes, que disminuye al 53% en el grupo de las complicaciones mecanicas, siendo la distancia punta-vertice menor a 25 mm en el 91,5% de los casos. La estancia hospitalaria media se situa en 9,17 dias con una estancia media postintervencion de 5,95 dias. Las complicaciones (7,5%) fueron: 2 casos de cut out (1%), uno de cut through (0,5%), 4 casos de efecto telescopaje (2%), un fallo en el encerrojado distal (0,5%), 2 casos de molestias en la fascia lata (1%), un retardo en la consolidacion (0,5%), 2 seudoartrosis que condicionaron la rotura del dispositivo (1%), un caso de sangrado relativo al clavo (0,5%) y un caso de necrosis avascular (0,5%). Conclusiones El sistema de espiral cefalica PFNA parece reducir la incidencia de cut out y cut through en el hueso osteoporotico. La posicion de la espiral supone uno de los principales parametros relacionados con las complicaciones mecanicas.

Objective Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail. Materials and methods A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails. Results The blade position was center–center in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25 mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%). Conclusions The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications.

To evaluate the efficacy of topical tranexamic acid topical in cementless total hip arthroplasty from the point of view of bleeding, transfusion requirements and length of stay, and describe the complications of use compared to a control group.A prospective, randomised, double-blinded and controlled study including all patients undergoing cementless total hip arthroplasty in our centre between June 2014 and July 2015. Blood loss was estimated using the formula described by Nadler and Good.The final analysis included 119 patients. The decrease in haemoglobin after surgery was lower in the tranexamic acid group (3.28±1.13g/dL) than in the controls (4.03±1.27g/dL, P=.001) and estimated blood loss (1,216.75±410.46mL vs. 1,542.12±498.97mL, P.001), the percentage of transfused patients (35.9% vs. 19.3%, P.05) and the number of transfused red blood cell units per patient (0.37±0.77 vs. 0.98±1.77; P.05). There were no differences between groups in the occurrence of complications or length of stay.The use of topical tranexamic acid in cementless total hip arthroplasty results in a decrease in bleeding and transfusion requirements without increasing the incidence of complications.

Arthrodiastasis consists of the mobilisation of the hip while distracted by a hinged distractor. The aim of our study is to show the results of the treatment of late-onset Perthes disease with this technique in our institution.Ambispective review of all the cases that underwent this surgery in our Department of Paediatric Orthopaedics between 2010 and 2014 with the following inclusion criteria: patients over 8 years old, with minimal deformity, and poor prognosis. Mobility, pain, Trendelenburg sign, radiographic sphericity, and complications were assessed.A total of 13 patients (9 male, 4 female) were included. The mean age was 11.93 years. Radiographic risk signs were present in 7 cases. The mean decrease in pain measured with a visual analogue scale (VAS) after the surgery was 3.83 points (P.05). Cephalic sphericity was maintained in 11 cases during follow up (1.75 years). Complications were observed complications in 84.6% of the patients, with infection of the screw tract being the most frequent. All of them were easy to treat.Arthrodiastasis is a minimally invasive technique, useful in the treatment of late onset Perthes disease. It improves clinical results and maintains cephalic shape when applied in early stages. However, it is not free of complications, which can involve as many as 8 out of 10 patients treated with the technique.

The coeliac ganglion and the ovary are related by the superior ovarian nerve, which penetrates into the ovary by the hilium and innervates mainly the ovarian stroma. On the other hand, it is known that the gaseous neurotransmitter nitric oxide (NO) and the two isoforms of its synthesis enzyme, the nitric oxide synthetase (NOS), are present in the ovary. Both innervation and NO participate in ovarian steroidogenesis. Therefore, the purposes of this work were (a) to standardize an in vitro coeliac ganglion-superior ovarian nerve-ovary integrated system in prepubertal rats; (b) to determine the presence of NO in the ovary and analyze the ganglionic cholinergic effect on the ovarian release of androstenedione, progesterone and NO; and (c) to assess the steroids/NO relationship. The system was incubated in buffer solution for 120 min, with the ganglion and ovary located in different compartments and linked by the superior ovarian nerve. From the results obtained, it is concluded that the system is viable and functional. The presence of basal NO is stimulated by the cholinergic action, while the release of the steroids is inhibited, which might indicate that the ganglionic cholinergic effect is probably mediated by NO. To our knowledge, this work constitutes the first study of the relationship between the neural cholinergic action and NO on the ovarian steroidogenesis of prepubertal rats.

The coeliac ganglion neurons, whose axons constitute the superior ovarian nerve (SON), contain cholinergic receptors. The aim of this work was to study the effect of cholinergic agents added to the coeliac ganglion on the release of ovarian progesterone in the coeliac ganglion–SON–ovary in vitro system. We also analyzed the release of norepinephrine in the ovarian compartment and its possible relationship with the release of progesterone. After the addition of cholinergic agents in the ganglion compartment, progesterone release was determined by radioimmuneassay (RIA) and norepinephrine by catecholamine assay (HPLC). The release of progesterone and norepinephrine in the ovary compartment was studied during period of 180 min in pre-oestrus (PE), oestrus (E), dioestrus day 1 (D1) and dioestrus day 2 (D2) rats. The most relevant results concerning the action of acetylcholine were found on PE and dioestrus. On PE, the pre-ovulatory peak of progesterone, which is known to respond to the endocrine action, was not modified by neural effect of acetylcholine in our scheme. On the other hand, the progesterone peak occurs in the afternoon of D1, which has been described as independent of the gonadotrophic action but was inhibited by neural effect of acetylcholine in our experimental scheme. This action on D1 was accompanied by a decrease of norepinephrine release in the ovary compartment. We conclude that the action of cholinergic agents varies according to the oestrous cycle stage and constitutes one of the factors governing the secretory activity of the ovarian steroids, in this case, progesterone.

The neural pathway most related with ovarian steroidogenesis has been identified as the superior ovarian nerve (SON). This work constitutes the first study of the effects of early ovarian SON transection, which was performed in rats of 4 days of age (SON-t rats) to magnify the effects of the denervation. The rats were studied at the prepubertal (30 days), peripubertal (41 days) and adult cyclic in dioestrus (60 days) reproductive stages. The SON-t rats showed a delay of vaginal opening, a notable disruption of oestrous cyclicity, and a large number of corpora lutea. In all the stages, the circulating levels of FSH, prolactin and growth hormone were lower in SON-t rats than in controls, whereas LH did not vary. Serum androstenedione levels were higher in SON-t rats at 30 days and lower at 41 days, compared with control animals while no difference was observed at 60 days. Serum progesterone levels did not differ between control and SON-t, but serum oestradiol concentrations were higher in SON-t rats in all of the stages. At the peripubertal stage, there were fewer ovarian beta-adrenergic receptors in SON-t ovaries, associated with a rise in the ovarian content of norepinephrine, but no changes were observed in SON-t rats at 30 and 60 days with respect to the controls. The release of progesterone in vitro from luteal cell in SON-t rats at 60 days was reduced in basal condition and under ovine LH or FSH stimulation, when compared with control animals; while no difference was observed in presence of isoproterenol or androstenedione in the culture medium. In corpora lutea of SON-t rats at 60 days, no change was observed in the activity of 3beta-hydroxysteroid dehydrogenase (3beta-HSD), but the activity of 20alpha-hydroxysteroid dehydrogenase (20alpha-HSD) was reduced, suggesting abnormal luteolysis in spite of the large number of corpora lutea. The interruption of innervation at an early age by SON transection is very important in the regulation of ovarian development in prepubertal and cyclic rats. The functional changes observed in the ovary suggest a possible alteration in the hypothalamic-hypophyseal axis.

Strong evidence indicated that spermatic nerves are involved in the regulation of testosterone secretion. Our previous work showed that the inferior spermatic nerves play a more significant role than the superior ones in the regulation of testosterone secretion. However, it is unknown whether traditional neurotransmitters are involved in this regulation. In order to evaluate this point, the present experiments were carried out in an in vitro system where an isolated testis-spermatic nerve plexus preparation was incubated in two separate containers, one for the testis and the other for the nerve plexus and both interconnected by the inferior spermatic nerves. Both tissues were maintained in the same environmental conditions except for the neurotransmitter treatment, applied only to the nerve plexus. Acetylcholine can significantly inhibit the secretion of testosterone until the end of incubation. The present experiments suggest that the secretion of testosterone could be regulated, at least in part, by acetylcholine through the inferior spermatic nerves.

This study investigates the interaction between the effect of epinephrine intracerebroventricular (icv) injection and LH on the progesterone concentration in ovarian vein blood (Po) in vivo, and also, on the release of ovarian progesterone and androstenedione in vitro, in rats on dioestrus day 2. When 2 mg ovine LH were injected in vein (i.v.), Po increased reaching 120+/-12.2 and 151+/-17.5 ng ml(-1) at 22 and 25 min, respectively. Another group of rats was injected intracerebroventricular with 5 microgram epinephrine at time zero, and with 2 mg ovine LH i.v. 3 min later. This time Po decreased during the first 3 min, then increased, reaching 64+/-7.1 ng ml(-1) at 25 min, lower than the Po obtained 22 min after LH i.v. injection only (P

Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail.A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails.The blade position was centre-centre in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%).The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications.

The effect of androstenedione on luteal progesterone production was studied during luteolysis preceding parturition as well as that induced by the antiprogestin RU486 in late pregnant rats. Luteal cells from animals on days 19, 20 or 21 of pregnancy and incubated with 10 microM androstenedione increased progesterone production by 99, 136, and 277%, respectively. The animals receiving androstenedione (10 mg/rat s.c.) on day 19 of pregnancy showed an increase in serum progesterone levels, a decline in luteal 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) activity and an increase in corpus luteum weight without modifying 20 alpha-hydroxysteroid dehydrogenase (20 alpha-HSD) activity on day 21 of pregnancy. Androstenedione and testosterone but not dihydrotestosterone were able to prevent the decrease in serum progesterone concentration and corpus luteum weight observed 58 h after treatment with RU486 (2 mg/kg) on day 18 of pregnancy. However, the three androgens studied inhibited the luteal 3 beta-HSD activity but 20 alpha-HSD activity was not affected, when compared with animals receiving RU486 alone. The co-administration of androstenedione with the aromatase inhibitor 4-hydroxyandrostenedione or with the specific antioestrogen ICI 164,384 did not modify the effects induced by androstenedione in RU486-treated rats, indicating that the action of androstenedione on progesterone production and secretion at the time of luteolysis seems to occur through an androgenic mechanism and is not mediated by previous conversion of the androgens to oestrogens. In all experiments the high luteal 20 alpha-HSD activity, that characterizes a luteolytic process, was not modified by androgens. Androstenedione administered to adrenalectomized rats was also able to prevent the decrease in serum progesterone concentration observed in spontaneous or RU486-induced luteolysis. The administration of androstenedione to RU486-treated rats induced a decrease in luteal progesterone content concomitant with an increase in serum progesterone levels. These studies demonstrate that androgens during luteolysis, are able to stimulate luteal progesterone secretion, prevent the loss in corpora lutea weight and enhance the decrease in 3 beta-HSD activity, without affecting the increase in 20 alpha-HSD activity.

To determine if androstenedione, an aromatizable androgen, has a direct effect on luteal progesterone secretion, collagenase-dispersed luteal cells or whole corpora lutea from pregnant rats were incubated in the presence of the androgen. Luteal cells from 15-day pregnant rats responded to androstenedione in a dose-dependent manner, with an increase in progesterone output at doses of 1 and 10 microM, but with no effect at minor doses of the androgen. Luteal cells obtained from animals on day 4, 9, 15 or 19 of pregnancy and incubated with 10 microM of androstenedione, increased progesterone production by 243, 39, 84 and 146%, respectively. Androgens (androstenedione, testosterone or dihydrotestosterone) but no oestrogens (oestradiol or diethylstilboestrol) at a dose of 10 microM, stimulated progesterone production in incubated luteal cells obtained from 15-day pregnant rats. The time-course pattern of androstenedione-induced progesterone production was studied by superfusion experiments using corpora lutea from rats on day 15 of pregnancy. A significant progesterone output was observed when androstenedione, but not oestradiol, was perfused through the luteal tissue. Intrabursal ovarian administration of androstenedione (10 microM) to 19-day pregnant rats induced a significative increase in serum progesterone levels 8 and 24 h after treatment. These in vivo results confirm the stimulatory effect of androstendione on progesterone production obtained in incubated luteal cells from pregnant rats. This study reports a direct luteotrophic effect of androstenedione in rat corpus luteum, not mediated by previous conversion to oestrogens.

It is known that noradrenergic sympathetic nerve fibers connect the ovary and the spleen from the celiac ganglion. The modulation of the ovarian steroidogenesis in rats with polycystic ovary (PCO) by secretions of culture splenocytes from control (non PCO), PCO and PCO rats with superior ovarian nerve transection (PCO+SON-t) is investigated. Splenocytes from PCO rats increased progesterone (P) and decreasing estradiol (E) and androstenedione (A) release, a steroidogenic response different from that obtained with splenocytes of control rats. PCO also decreased the number of splenocyte beta-adrenergic receptors (betaR). SON transection reverted the effect of PCO on splenocytes betaR numbers and secretions of these splenocytes also reverted the stimulatory effect of PCO on P release, while norepinephrine (NE) treatment to PCO+SON-t splenocytes decreased their betaR number and their secretions restored the stimulation on progesterone release. Inversely, PCO+SON-t splenocyte secretions intensified the inhibition in estradiol with no effect on A. Treatment of PCO+SON-t splenocytes with NE or neuropeptide Y partially reverted the effects of PCO and SON-t The P and E-A response of PCO ovary might be differentially regulated by the splenocyte secretions through the neural connection involving ovary, SON, celiac ganglion and spleen and the neurotransmitter NE.

The paper makes a detailed description of the multimedia services being offered over the network of the RECIBA project (Experimental Network for Integrated Broadband Communications). The definition of the services as well as the most relevant aspects of each of them are discussed: the infrastructure required for the service provision, the type of multimedia information the user can handle, the quality of each type of information, etc. The RECIBA project covers two types of services: teleservices and bearer services. The article concentrates on the teleservices provided in RECIBA.

Most of the fibres that constitute the superior ovarian nerve (SON) originate at the neuronal bodies of the coeliac ganglion and innervate rat ovarian stroma cells. The purpose of this work was to study the part played by innervation on ovarian release of progesterone on day 15 and at the end of pregnancy in an integrated in vitro system known as the coeliac ganglion-SON-ovary system. We also investigated, in the same system, whether there is some kind of inter-relationship between the effect of adrenergic agents and LH on progesterone release on day 15 of pregnancy. The coeliac ganglion and the ovary were incubated in separate compartments, linked by the SON. The ovary was immersed in 2 ml buffer solution (ovarian compartment) and the coeliac ganglion was immersed in 2 ml of a different buffer solution (ganglion compartment). Under these conditions, the accumulation of progesterone in the ovarian compartment medium was used as an endpoint. Conditions were standardised on day 15 of pregnancy, when the decrease in the release of ovarian progesterone caused by non-specific stimulation on the ganglion with KCl (56 mM) demonstrated the functional integrity of the system. Neural influence was evaluated by the addition of adrenergic agents at a concentration of 10(-6)M to the coeliac ganglion. On day 15 of pregnancy, noradrenaline and propranolol increased progesterone release while phentolamine diminished it. The existence of ganglionic tone was assessed by analysing progesterone basal levels at different stages of pregnancy. The highest secretion of progesterone was found to take place on day 15, diminishing as pregnancy advanced. In addition, adrenergic neural participation was studied during the physiological luteolysis occurring at the end of pregnancy. Major findings were that noradrenaline increased ovarian accumulation of progesterone on day 19 and decreased it on day 20, while propranolol and phentolamine diminished progesterone release on both days. In additional studies, some neuroendocrine aspects were investigated at a peripheral level. The addition of LH only to the ovarian compartment did not affect progesterone secretion. However, when LH in the ovarian compartment was accompanied by noradrenaline, propranolol or phentolamine in the ganglion compartment, the release of progesterone decreased. It can be concluded that modifications of the neural state of the coeliac ganglion affect ovarian progesterone secretion and the physiology of pregnancy via the SON. The results may confirm that the coeliac ganglion-SON-ovary system provides a direct link between the autonomic nervous system and physiological events during pregnancy.

Solid-phase extraction (SPE) methods are easy, rapid, and reliable. Their growing popularity is in part due to their operational simplicity and cost reduction in sol- vents, and partly because they are easier to automate. Sphin- golipids are implicated in various cellular events such as growth, differentiation, and apoptosis. However, their sepa- ration by small SPE cartridges has attracted limited atten- tion. Here we describe an SPE procedure on aminopropyl cartridges that by sequential elution allows the separation of a lipid mixture into free ceramides, neutral glycosphin- golipids, neutral phospholipids (sphingomyelin), and a frac- tion containing the acidic phospholipids and phosphory- lated sphingoid bases, phosphoceramides and sulfatides. Individual components are obtained in high yield and purity. We applied the procedure to obtain data on separa- tion of ( 3 H)myristic acid-labeled sphingolipids from fish gills, and from human melanoma tumor tissue. Individual lipids in the SPE fractions were identified by chromatogra- phy on several high-performance thin-layer chromatography (HPTLC) systems. The chromatographic behavior of free sphingoid bases is also reported. —Bodennec, J., O. Koul, I. Aguado, G. Brichon, G. Zwingelstein, and J. Portoukalian. A procedure for fractionation of sphingolipid classes by solid- phase extraction on aminopropyl cartridges. J. Lipid Res. 2000. 41: 1524-1531.

The superior ovarian nerve (SON) arrives at the ovary through the suspensory ligament and innervates mainly the ovarian stroma. Most neurones from which the SON fibres originate are located in the complex coeliac and mesenteric ganglia. Taking into account that other ganglia have been shown to have alpha- and beta-adrenergic receptors, and that the coeliac ganglion receives adrenergic fibres from other sympathetic paravertebral and preaortic ganglia, we utilised adrenergic agonists and antagonists specific to the ganglion, to analyse the role of the alpha and beta receptors in ovarian physiology. To that end, it was necessary to develop and standardise an in vitro coeliac ganglion-SON-ovary (coeliac ganglion-SON-O) experimental system that would enable study of the release of steroids in the ovary in the absence of humoral factors. We investigated the effect of adrenergic agents on the liberation of progesterone in the different stages of the oestrous cycle.To this end we placed the coeliac ganglion and the ovary in different compartments, connected through the SON, to produce a system being studied as a whole. Combined neural and hormonal (luteinising hormone (LH)) effects were also examined. Non-specific stimulation with KCl in the ganglion compartment evoked different responses in terms of release of progesterone, depending on the physiological conditions of the cycle; this demonstrated the sensitivity and viability of the system. During pro-oestrus, stimulation of the ganglion compartment with adrenergic agents such as the agonist noradrenaline or the beta-adrenergic antagonist propranolol, did not modify the release of progesterone. In contrast, the alpha-adrenergic antagonist, phentolamine, induced a strong inhibitory response. During the oestrous stage, noradrenaline was inactive, but phentolamine and propranolol exerted a strong stimulus throughout the experiment. On dioestrus day 1 (D1), both noradrenaline and propranolol increased the release of ovarian progesterone, whereas phentolamine had the opposite effect. Finally, on dioestrus day 2 (D2), what was noteworthy was the pronounced inhibitory effect of noradrenaline, whereas phentolamine was inactive and propranolol showed its greatest stimulatory effect. In order to compare the combined neural and endocrine effects on the ovarian release of progesterone, the experiment was carried out during stages D1 and D2, when the corpora lutea are at their peak of activity. Adrenergic agents were added to the ganglion and LH in a final concentration of 50 ng/ml was added to the ovarian comparment. Different effects were observed indicating a differential response to these agents in stimulated and basal conditions. We conclude that the in vitro coeliac ganglion-SON-ovary system is a functional entity because it possesses its own autonomic tone. This is verified because different basal values of progesterone appear in the different stages of the oestrous cycle. In similar fashion, variations of progesterone induced via the neural pathway were observed under different experimental conditions. In contrast, on D2, noradrenaline added to the ganglion compartment had an inhibitory effect on the liberation of ovarian progesterone.This would indicate that, during this phase, noradrenaline may not be the neurotransmitter released in the ovarian compartment, but that other inhibitory molecules might participate in the observed effects. Finally, during D2, the neural input would condition the ovarian response to LH, facilitating the decrease in progesterone necessary to start a new cycle. The experimental scheme is, in our opinion, a valuable tool for the study of peripheral neural participation in ovarian physiology.