Summary The corticoperiosteal flap from the medial femoral condyle (CP) has proved to be highly reliable in the management of persistent, recurrent nonunion. However, much of the related literature ...has focussed on the flap aspects of the procedure and not so much on bone work-up. We present a series of 25 patients with nonunions and small bone gaps irresponsive to conventional therapy that were successfully treated with a CP with/without the addition of non-vascularised bone graft from the iliac crest. Different technical options of bone reconstruction are possible and discussed: CP plus non-structural bone chips, CP plus structural bi/tricortical struts or CP plus vascularised cancellous bone from the femoral condyle. A stable internal fixation was performed in all cases. Clinical and radiological evidence of healing was obtained in all the patients. Donor-site complications were few and transient (suture intolerance, seroma and numbness in the saphenous territory). No fracture of the femur, knee instability or stiffness has been observed. The corticoperiosteal flap from the femoral condyle is an excellent source of vascularisation and osteogenic stimulus to the nonunion site and highly effective in the management of persistent nonunions and small bone gaps. When needed, a structural corticocancellous strut from the iliac crest (along with a stable internal fixation) provides the greatest stability and the possibility of a prompt rehabilitation and functional recovery. The corticoperiosteal flap has succeeded in revascularising these highly demanding grafts and in allowing a 100% union rate.
Since its invention in 2004, graphene has attracted considerable interest worldwide. Advances in the use of graphene in materials science and engineering require important increases in the quality of ...the final product for integration in photonic and electronic devices. To meet this demand, which will become increasingly strict in the future, analytical techniques capable of differentiating between the starting materials and graphene need to be developed. The interest in the use of laser-induced breakdown spectroscopy (LIBS) for this application rests on the rapid progress experienced by this technology for identification of carbon-based materials of close chemical composition. The potential of LIBS has been explored here by a careful investigation of the spectral properties of both multi-layer and few-layer graphene, graphite and graphene oxide. Results reveal significant differences in the specific optical emission responses of these materials, expressly reflected on the behavior of CN and C2 molecular emissions. These differences result from the particularities of the materials, such as the number of carbon layers and the carbon hybridization in the bonding structure, together with the post-ablation evolution of the concerned plasma plume. In short, this interconnection between ablation and emission events generated from each material allows its characterization and its differentiation from other materials with highly similar chemical composition.
•The emitting behavior of nano-sized carbon lattices has been evaluated.•Laser fluence change impacts equally on optical emissions from pure carbon lattices.•Temporal profiles of molecular emissions reveal differences between carbon lattices.•Variable stacking of nano-carbon layers leads to difference in molecular emissions.
Chronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by ...scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation.
Twenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of 111InIn-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression.
Of the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them.
Scintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.
El estreñimiento crónico es una patología frecuente en la práctica clínica. Ante una falta de respuesta al tratamiento, se recomienda evaluar la función gastrointestinal. Esta puede ser realizada mediante gammagrafía, aunque su uso no es generalizado. El objetivo del estudio fue valorar la utilidad de la gammagrafía de tránsito gastrointestinal en pacientes con estreñimiento crónico.
Se valoraron 20 pacientes (13 niños) remitidos para estudio gammagráfico por estreñimiento crónico refractario al tratamiento, siringomielia, rectocele o migraña abdominal. Todos fueron sometidos a valoración clínica, determinación analítica, estudio de imagen radiológica y/o biopsia rectal. Se realizó un protocolo de estudio completo, incluyendo gammagrafía de vaciamiento gástrico, tránsito de intestino delgado y colónico. Para ello, se administró una dosis de 111InIn-DTPA diluida en agua (37MBq) junto con comida estandarizada. Siguiendo guías internacionales, se definieron áreas de interés en estómago, íleon terminal y diferentes regiones del intestino grueso para calcular el centro geométrico como medida de progresión.
De los 13 pacientes en edad pediátrica, 10 presentaron patrones gammagráficos anormales, modificando el tratamiento en 8 de ellos. La mayoría de los niños no mostraron alteraciones en las exploraciones radiológicas. En pacientes adultos, el resultado de la prueba conllevó el cambio del manejo terapéutico en todos ellos.
El estudio gammagráfico proporcionó información útil en el estudio del estreñimiento crónico, influyendo en el diagnóstico y manejo terapéutico del paciente. La información fisiológica y cuantitativa que proporciona permite la determinación global y regional del tránsito gastrointestinal.
The audio-to-score framework consists of two separate stages:
preprocessing
and
alignment
. The
alignment
is commonly solved through offline dynamic time warping (DTW), which is a method to find the ...path over the distortion matrix with the minimum cost to determine the relation between the performance and the musical score times. In this work we propose a parallel online DTW solution based on a client–server architecture. The current version of the application has been implemented for multi-core architectures (
×
86,
×
64 and ARM), thus covering either powerful systems or mobile devices. An extensive experimentation has been conducted to validate the software. The experiments also show that our framework allows to achieve a good score alignment within the real-time window using parallel computing techniques.
New dinuclear cyclometallated palladium complexes of general formula {Pd(μ-NCO)(CˆN)} 2 (CˆN = 2-benzoylpyridine (bzpy) I; NCO = saccharinate (sacc) a, Phthalimidate (phthal) b or ...4,5-dichlorophthalimidate (DiClphthal) c have been synthesized by a simple acid-base reaction involving the di-μ-hydroxo-precursor {Pd(μ-OH)(bzpy)}2 recently reported. Analogous to Ic, complex IIc with CˆN = 2-phenylpyridine (phpy) II has also been prepared, meaning the first examples reported to date of complexes including 4,5-dichlorophthalimidate as ligand coordinating a metal centre. The reaction of bridged imidato precursors against triphenylphosphine to form the mononuclear N-bonded imidato derivatives of general formula Pd(CˆN)(N-imidate)(PPh3) IaP, IbP, IcP and IIcP has been achieved under mild conditions. The new complexes were characterized by partial elemental analyses and spectroscopic methods. Structural characterization by X-ray diffraction of Ib and IIcP, the first crystal structure of a complex containing 4,5-diClphthal that has been deposited to date on the Cambridge Structural Database, have confirmed the proposed formulae.
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•A new route to prepare scarce 2- benzoylpyridine palladacycles is presented.•The basicity of {Pd(μ-OH)(bzpy)}2 is exploited reacting with cyclic imides.•Bridge splitting with PPh3 of dinuclear μ-NCO- imidates thus prepared is explored.•First crystal structure reported to date of a 4,5-dichlorophthalimidate complex.
Sacral chordoma is a rare entity with high local recurrence rates when complete resection is not achieved. To date, there are no series available in literature combining surgery and intraoperative ...radiotherapy (IORT).
The objective of this study was to report the experience of our center in the management of sacral chordoma combining radical resection with both external radiotherapy and IORT.
This is a retrospective case series.
The patient sample included 15 patients with sacral chordoma resected in our center from 1998 to 2015.
The outcome measures were overall survival (OS), disease-free survival (DFS), and rates of local and distant recurrences.
We retrospectively reviewed the records of all the patients with sacral chordoma resected in our center from 1998 to December 2015. Overall survival, DFS, and rates of local and distant recurrences were calculated. Results between patients treated with or without IORT were compared.
A total of 15 patients were identified: 8 men and 7 women. The median age was 59 years (range 28–77). Intraoperative radiotherapy was applied in nine patients and six were treated with surgical resection without IORT. In 13 patients, we performed the treatment of the primary tumor, and in two patients, we performed the treatment of recurrence disease. A posterior approach was used in four patients. Wide surgical margins (zero residue) were achieved in six patients, marginal margins (microscopic residue) were achieved in seven patients, and there were no patients with intralesional (R2) margins. At a median follow-up of 38 months (range 11–209 months), the 5-year OS in the IORT group was 100% versus 53% in the group of non-IORT (p=.05). The median DFS in the IORT group was 85 months, and that in the non-IORT group was 41 months. In the group without IORT, two patients died and nobody died during the follow-up in the group treated with IORT. High–sacrectomy treated patients had a median survival of 41 months, and low–sacrectomy treated patients had a median survival of 90 months. Disease-free survival in patients without gluteal involvement was 100% at 5 years, and that in patients with gluteal involvement was 40%. All patients with a recurrence in our study had gluteal involvement.
Multidisciplinary management of sacral chordoma seems to improve local control. The use of IORT, in our experience, is associated with an increase in OS and DFS. The level of resection and gluteal involvement seems to affect survival. The posterior approach is useful in selected cases. Multicenter studies should be performed to confirm the utility of IORT.
To evaluate the reproducibility in the measurement of ocular biometric parameters using a new swept-source optical coherence tomographer and its comparability with an optical low coherence ...reflectometry biometer.
An observational, descriptive, cross-sectional study.
45 right eyes of 45 patients diagnosed with cataract were included. Three successive biometric measurements with Anterion and one with Lenstar LS900 were performed on each patient. The following variables were collected: axial length (AXL), anterior chamber depth (ACD), flat K (K1), steep K (K2), central corneal thickness (CCT), lens thickness (LT) and white-to-white distance (WTW). The intrasubject standard deviation (Sw) and the coefficient of Pearson “R” were calculated in order to assess the repeatability. The intraclass correlation coefficient (ICC) and the concordance correlation coefficient (CCC) were obtained to evaluate the comparability between devices. A Bland-Altman plot was performed for each variable.
The coefficient of Pearson was excellent and statistically significant in the evaluation of the repeatability in all the variables. The highest values were 0.987 (AXL), 0.983 (CCT) and 0.942 (ACD). There were no statically significant differences between repeated measurements with Anterion in all the parameters. The ICC and CCC were excellent in the evaluation of AXL, CCT and ACD, and were also good in regard to K1, K2, LT and WTW.
Performing biometry with the SS-OCT Anterion is a reliable and reproducible procedure, and it is comparable with the Lenstar LS900.
Evaluar la reproducibilidad en la medición de los parámetros biométricos utilizando un nuevo biómetro por tomografía de coherencia óptica con fuente de barrido y su comparabilidad con un biómetro por reflectometría óptica de baja coherencia.
Estudio observacional, descriptivo, de corte transversal.
Se incluyeron 45 ojos derechos de 45 pacientes, a los que se realizó tres mediciones consecutivas con el biómetro Anterion y una con el biómetro Lenstar LS900. Se recogieron las siguientes variables: longitud axial (AXL), profundidad de cámara anterior (ACD), K plana (K1), K curva (K2), grosor corneal central (CCT), grosor del cristalino (LT) y distancia blanco-blanco (WTW). Para evaluar la repetibilidad se calculó el coeficiente de Pearson “R” y la desviación estándar intrasujeto (Sw). Para evaluar la comparabilidad entre los biómetros se utilizó el coeficiente de correlación de concordancia (CCC) y el coeficiente de correlación intraclase (CCI). Además, se realizaron gráficos de Bland-Altman para cada variable.
El coeficiente de Pearson fue excelente y estadísticamente significativo en la evaluación de la repetibilidad para todas las variables. Los valores más altos fueron 0.987 (AXL), 0.983 (CCT) y 0.942 (ACD). No hubo diferencias estadísticamente significativas entre las repetidas mediciones con Anterion para todas las variables. Los valores de CCC y CCI fueron excelentes en la evaluación de las variables AXL, CCT y ACD, y fueron altos para las variables K1, K2, LT y WTW.
La realización de una biometría óptica ocular con el biómetro SS-OCT Anterion es un procedimiento reproducible y comparable con el biómetro Lenstar LS900.
•Therapies for treatment-resistant depression need to be improved.•Lifestyle modification might be effective against treatment-resistant depression.•Insufficient patient recruitment probably ...prevented confirmation in this study.•Our program improved life quality and decreased use of antidepressants.•The COVID-19 pandemic made it difficult to perform more thorough evaluations.
The high prevalence of depression is partly attributable to the poor response of patients to first-line antidepressants. Multimodal programs that promote a healthy lifestyle are successful in treating depression when used as a complementary therapy, but their medium- and long-term benefits have not been demonstrated for patients with treatment-resistant depression (TRD). The main aim of this study was to compare the effectiveness of a lifestyle modification program (LMP) with mindfulness-based cognitive therapy (MBCT) and a placebo-control (written suggestions for lifestyle changes) in Spanish patients with TRD.
This controlled clinical trial randomized 94 patients with TRD into 3 arms. The primary outcome was the Beck Depression Inventory-II (BDI-II) score at baseline, 2, 6 and 12 months. The secondary outcomes were changes in scores that evaluated quality-of-life, adherence to the Mediterranean diet, physical activity, and social support.
Relative to the placebo group, the LMP and MBCT groups had significantly better quality of life (p = 0.017; p = 0.027), and the LMP group had significantly better adherence to the Mediterranean diet (p<0.001) and reduced use of antidepressants (p = 0.036). However, the three groups showed no significant differences in BDI-II score.
Only about half of the planned 180 patients were recruited, in part due to the COVID-19 pandemic.
There was no evidence that the LMP treatment significantly reduced symptoms of depression relative to the other groups during the COVID-19 lockdown.
This paper reports world averages of measurements of b-hadron, c-hadron, and τ-lepton properties obtained by the Heavy Flavour Averaging Group using results available through September 2018. In rare ...cases, significant results obtained several months later are also used. For the averaging, common input parameters used in the various analyses are adjusted (rescaled) to common values, and known correlations are taken into account. The averages include branching fractions, lifetimes, neutral meson mixing parameters, CP violation parameters, parameters of semileptonic decays, and Cabibbo–Kobayashi–Maskawa matrix elements.
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