Relative femoral neck lengthening improves pain and hip function in proximal femoral deformities with a high-riding trochanter

BACKGROUND Complex proximal femoral deformities, including an elevated greater trochanter, short femoral neck, and aspherical head-neck junction, often result in pain and impaired hip function resulting from intra-/extraarticular impingement. Relative femoral neck lengthening may address these deformities, but mid-term results of this approach have not been widely reported. QUESTIONS/PURPOSES Do patients who have undergone relative femoral neck lengthening show (1) less hip pain and greater function; (2) improved radiographic parameters; (3) significant complications requiring subsequent surgery; and (4) progression of osteoarthrosis (OA) or conversion to total hip arthroplasty (THA) at mid-term followup? METHODS We retrospectively reviewed 40 patients (41 hips) with isolated relative femoral neck lengthening between 1998 and 2006 with sequelae of Legg-Calvé-Perthes disease (38 hips [93%]), slipped capital femoral epiphysis (two hips [5%]), and postseptic arthritis (one hip [2%]). During this time, the general indications for this procedure included a high-riding greater trochanter with a short femoral neck with abductor weakness and symptomatic intra-/extraarticular impingement. Mean patient followup was 8 years (range, 5-13 years), and complete followup was available in 38 patients (39 hips [95%]). We evaluated pain and function with the impingement test, limp, abductor force, Merle d'Aubigné-Postel score, and range of motion. Radiographic parameters included trochanteric height, alpha angle, and progression of OA. Subsequent surgeries, complications, and conversion to THA were summarized. RESULTS The proportion of positive anterior impingement tests decreased from 93% (38 of 41 hips) preoperatively to 49% (17 of 35 hips) at latest followup (p = 0.002); the proportion of limp decreased from 76% (31 of 41 hips) to 9% (three of 35 hips; p < 0.001); the proportion of normal abductor strength increased from 17% (seven of 41 hips) to 91% (32 of 35 hips; p < 0.001); mean Merle d'Aubigné-Postel score increased from 14 ± 1.7 (range, 9-17) to 17 ± 1.5 (range, 13-18; p < 0.001); mean internal rotation increased to 25° ± 15° (range, 0°-60°; p = 0.045), external rotation to 32° ± 14° (range, 5°-70°; p = 0.013), and abduction to 37° ± 13° (range, 10°-50°; p = 0.004). Eighty percent of hips (33 of 41 hips) showed normal trochanteric height; alpha angle improved to 42° ± 10° (range, 27°-90°). Two hips (5%) had subsequent surgeries as a result of lack of containment; four of 41 hips (10%) had complications resulting in reoperation. Fourteen of 35 hips (40%) showed progression of OA; four of 40 hips (10%) converted to THA. CONCLUSIONS Relative femoral neck lengthening in hips with combined intra- and extraarticular impingement results in reduced pain, improved function, and improved radiographic parameters of the proximal femur. Although lack of long-term complications is gratifying, progression of OA was not prevented and remains an area for future research.

Exaggerated pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale.

BACKGROUND There is considerable interindividual variability in pulmonary artery pressure among high-altitude (HA) dwellers, but the underlying mechanism is not known. At low altitude, a patent foramen ovale (PFO) is present in about 25% of the general population. Its prevalence is increased in clinical conditions associated with pulmonary hypertension and arterial hypoxemia, and it is thought to aggravate these problems. METHODS We searched for a PFO (transesophageal echocardiography) in healthy HA dwellers (n = 22) and patients with chronic mountain sickness (n = 35) at 3,600 m above sea level and studied its effects (transthoracic echocardiography) on right ventricular (RV) function, pulmonary artery pressure, and vascular resistance at rest and during mild exercise (50 W), an intervention designed to further increase pulmonary artery pressure. RESULTS The prevalence of PFO (32%) was similar to that reported in low-altitude populations and was not different in participants with and without chronic mountain sickness. Its presence was associated with RV enlargement at rest and an exaggerated increase in right-ventricular-to-right-atrial pressure gradient (25 ± 7 mm Hg vs 15 ± 9 mm Hg, P < .001) and a blunted increase in fractional area change of the right ventricle (3% [-1%, 5%] vs 7% [3%, 16%], P = .008) during mild exercise. CONCLUSIONS These findings show, we believe for the first time, that although the prevalence of PFO is not increased in HA dwellers, its presence appears to facilitate pulmonary vasoconstriction and RV dysfunction during a mild physical effort frequently associated with daily activity. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov.

Sleep disordered breathing and vascular function in patients with chronic mountain sickness and healthy high-altitude dwellers.

Background Chronic mountain sickness (CMS) is often associated with vascular dysfunction, but the underlying mechanism is unknown. Sleep disordered breathing (SDB) frequently occurs at high altitude. At low altitude SDB causes vascular dysfunction. Moreover, in SDB, transient elevations of right-sided cardiac pressure may cause right-to-left shunting in the presence of a patent foramen ovale (PFO) and, in turn, further aggravate hypoxemia and pulmonary hypertension. We speculated that compared to healthy high-altitude dwellers, in patients with CMS, SDB and nocturnal hypoxemia are more pronounced and related to vascular dysfunction. Methods We performed overnight sleep recordings, and measured systemic and pulmonary-artery pressure in 23 patients with CMS (mean±SD age 52.8±9.8 y) and 12 healthy controls (47.8±7.8 y) at 3600 m. In a subgroup of 15 subjects with SDB, we searched for PFO with transesophagal echocardiography. Results The major new findings were that in CMS patients, a) SDB and nocturnal hypoxemia was more severe (P<0.01) than in controls (apnea/hypopnea index, AHI, 38.9±25.5 vs. 14.3±7.8[nb/h]; SaO2, 80.2±3.6 vs. 86.8±1.7[%], CMS vs. controls), and b) AHI was directly correlated with systemic blood pressure (r=0.5216, P=0.001) and pulmonary-artery pressure (r=0.4497, P=0.024). PFO was associated with more severe SDB (AHI 48.8±24.7 vs. 14.8±7.3[nb/h], P=0.013, PFO vs. no PFO) and hypoxemia. Conclusion SDB and nocturnal hypoxemia are more severe in CMS patients than in controls and are associated with systemic and pulmonary vascular dysfunction. The presence of a PFO appeared to further aggravate SDB. Closure of PFO may improve SDB, hypoxemia and vascular dysfunction in CMS patients. Clinical Trials Gov Registration NCT01182792.

The Impact of Property Condition Disclosure Laws on Housing Prices: Evidence from an Event Study using Propensity Scores

We examine the impact of seller's Property Condition Disclosure Law on the residential real estate values. A disclosure law may address the information asymmetry in housing transactions shifting of risk from buyers and brokers to the sellers and raising housing prices as a result. We combine propensity score techniques from the treatment effects literature with a traditional event study approach. We assemble a unique set of economic and institutional attributes for a quarterly panel of 291 US Metropolitan Statistical Areas (MSAs) and 50 US States spanning 21 years from 1984 to 2004 is used to exploit the MSA level variation in house prices. The study finds that the average seller may be able to fetch a higher price (about three to four percent) for the house if she furnishes a state-mandated seller.s property condition disclosure statement to the buyer. When we compare the results from parametric and semi-parametric event analyses, we find that the semi-parametric or the propensity score analysis generals moderately larger estimated effects of the law on housing prices.

The Role Of IL-8-Mediated Src Family Kinase Activation In Tumor-Tumor And Tumor-Stromal Interactions In Metastasis Of Prostate Cancer

Men with localized prostate cancer (PCa) have a 100% five-year survival rate, but this rate drops to 33% for men with metastatic disease. A better understanding of the metastatic process is needed to develop better therapies for PCa. Aberrant activation of protein tyrosine kinases, including Src Family Kinases (SFKs) contribute to metastasis through numerous functions, one of which leads to increased expression of cytokines, such as IL-8. However, the relationship between Src activity and IL-8 regulation is not completely understood. In cell line models, I determined that IL-8 activates Src and in turn Src activates IL-8 demonstrating a feed forward loop contributing to the migration and invasion of PCa cells. However, IL-8 is also produced by tumor-associated stromal cells. In bone marrow derived stromal cells (HS5), I demonstrated a feed forward loop occurs as was observed in tumor cells. HS5 conditioned media increased Src activity in PCa cells. By silencing IL-8 in HS5 cells, Src activity was decreased to control levels in PCa cells as was migration and invasion. Thus, stromal cells producing IL-8 contribute to metastatic properties of PCa by a paracrine mechanism. To examine the effect of stromal cells on tumor growth and metastatic potential of PCa in vivo, I mixed HS5 and PCa cells and co-injected them intraprostatically. I determined that tumor growth and metastases were increased. By silencing IL-8 in HS5 cells and co-injecting them with PCa cells intraprostatically, tumor growth and metastases were still increased relative to injection of PCa cells alone, but decreased relative to co-injections with PCa cells and HS5 cells. These studies demonstrated: (1) a feed forward loop in both tumor and stromal cells, whereby IL-8 activates Src, derepressing IL-8 expression in PCa cells in vitro; (2) stromal produced IL-8 activates Src and contributes to the migration and invasion of PCa cells in vitro; and (3) stromal produced IL-8 is responsible, in part, for increases in PCa tumor growth and metastatic potential. Together, these studies demonstrated that IL-8-mediated Src activity increases the metastatic potential of PCa and therapeutic agents interfering with the IL-8/SFK signaling axis may be useful for prevention and treatment of metastases.

Immobilisation dose rates and photogrammetry based mass calculations for southern elephant seals during expedition JUB2010

Immobilization and anaesthesia of adult male southern elephant seals (Mirounga leonina) is potentially risky for animals and scientists. A tiletamine/zolazepam injection is considered the most appropriate drug combination for field application in this species. Since appropriate dosages are difficult to assess due to uncertainties in weight estimation, we used photogrammetry-derived weight estimates to ensure precise post hoc calculations of dosages. We report on 15 intramuscular tiletamine/zolazepam immobilizations of post-moult males of the upper weight class at King George Island/Isla 25 de Mayo, in April 2010. Initial injections were made using blowpipe syringes. Mean tiletamine/zolazepam combined dosages of 0.71 mg/kg (SD ± 0.16) ranged between 0.46 and 1.01 mg/kg. In four cases, ketamine was added in dosages between 0.96 and 2.61 mg/kg. Mean induction period was 23 min (± 15), and the mean duration of the procedures from first injection to release of the animals required 96 min (± 51). Four seals exhibited periods of apnoea, and one case of an extended, repetitive, and potentially critical apnoea (> 25 and 8 min) required intervention in order to successfully re-initiate spontaneous respiration. All procedures resulted in proper immobilizations allowing for the deployment of the satellite tags on the seals' heads. The fact that even substantial deviations between the initial weight estimates and the photogrammetry-derived weight estimates had no apparent effect on the course of the immobilization underlines the drugs' wide safety margin in this species.

La música electrónica : siglo XX : influencia del desarrollo tecnológico en la creación musical

Fil: Antón, Susana. Universidad Nacional de Cuyo. Facultad de Artes y Diseño

Horizontal profiles of longwave and shortwave radiation components over sea ice near Barrow, Alaska during the 2011 melt

An integrated instrument package for measuring and understanding the surface radiation budget of sea ice is presented, along with results from its first deployment. The setup simultaneously measures broadband fluxes of upwelling and downwelling terrestrial and solar radiation (four components separately), spectral fluxes of incident and reflected solar radiation, and supporting data such as air temperature and humidity, surface temperature, and location (GPS), in addition to photographing the sky and observed surface during each measurement. The instruments are mounted on a small sled, allowing measurements of the radiation budget to be made at many locations in the study area to see the effect of small-scale surface processes on the large-scale radiation budget. Such observations have many applications, from calibration and validation of remote sensing products to improving our understanding of surface processes that affect atmosphere-snow-ice interactions and drive feedbacks, ultimately leading to the potential to improve climate modelling of ice-covered regions of the ocean. The photographs, spectral data, and other observations allow for improved analysis of the broadband data. An example of this is shown by using the observations made during a partly cloudy day, which show erratic variations due to passing clouds, and creating a careful estimate of what the radiation budget along the observed line would have been under uniform sky conditions, clear or overcast. Other data from the setup's first deployment, in June 2011 on fast ice near Point Barrow, Alaska, are also shown; these illustrate the rapid changes of the radiation budget during a cold period that led to refreezing and new snow well into the melt season.

La cura por amor

Inscripto en el marco de la investigación 'Vicisitudes del lazo amoroso en la época (en el gran La Plata)' que se esta llevando a cabo desde la cátedra de psicología clínica de adultos y gerontes de la facultad de psicología, UNLP, el presente trabajo se propone indagar sobre el efecto de cura que produce un nuevo encuentro amoroso en aquellos sujetos cuya decepción o ruptura amorosa es lo que los condujo inicialmente al encuentro con un analista. En estos casos, la angustia motiva la demanda. Es frecuente escuchar que ese afecto, que no engaña, los invade y los 'invalida' en lo cotidiano; de ella quieren deshacerse. Este trabajo se centrara en lo trabajado con aquellos pacientes que se presentan sufriendo por la ausencia del partenaire con quien creían mantener un perfecto y verdadero amor desde hacia muchos años; ilusión que estaba acompañada por otra: la completud, la complementariedad -hasta ahora- era posible. Gran parte de las sesiones transcurren recordando lo vivido en esa relación, muchos interrogantes sin respuestas o algunas respuestas desde lo imaginario, reproches, autorreproches. Hasta aquí es lo esperable escuchar en este tipo de presentaciones: la libido permanece ligada a ese objeto perdido, a ese partenaire que eligió no elegirlo. El sujeto amaba a ese objeto y no esperaba otra cosa que ser correspondido y por ello, como señala Freud, ha resignado el interés por el mundo exterior, excepto a aquello que tiene que ver con su amor. El énfasis estará puesto en el hecho que de repente nos encontramos con un giro inesperado en el tratamiento de esos pacientes. La contingencia propia de un nuevo encuentro amoroso los sorprendió y se presentan 'curados de esa angustia' que emergió por la pérdida de aquel amor: 'un amor que cura o cura analítica', hablamos de curación por amor, que como señala Freud en introducción del narcisismo (Freud, 1914, p.97). 'el paciente por regla general prefiere a la analítica' Un nuevo encuentro amoroso precipita la salida del análisis pues de la angustia ya no se habla, se habla del amor. Punto de suspensión, del análisis en este caso, que el amor posibilita y con ello 'la ilusión de que algo no sólo se articula sino que se inscribe, se inscribe en el destino de cada uno, por lo cual durante un tiempo, tiempo de suspensión, lo que sería la relación sexual encuentra en el ser que habla su huella y su vía de espejismo. El desplazamiento de la negación, del cesa de no escribirse al no cesa de inscribirse, de contingencia a necesidad, este es el punto de suspensión del que se ata todo amor' (Lacan, 2010, p. 175). Freud nos advierte sobre la relación entre el amor y la curación: 'un fuerte egoísmo preserva de enfermar, pero al final uno tiene que empezar a amar para no caer enfermo, y por fuerza enfermara si a consecuencia de una frustración no puede amar' (Freud, 1914, p. 82,). Objetivos: explorar como influye el encuentro amoroso con un partenaire, un 'nuevo amor' en el análisis del paciente. Metodología: para este trabajo, se utilizara el material obtenido a partir de las entrevistas con pacientes que llegan sufriendo por temas relacionados con los avatares del amor y su ausencia. Dicho material, será recolectado con la utilización del método clínico y analizado desde una perspectiva lacaniana, tomando como eje algunas puntualizaciones de la noción de amor en lacan que aparecen en el seminario VII, VIII, XI Y XX entre otros; sin dejar de tener en cuenta la referencia freudiana que se extraen de introducción al narcisismo, duelo y melancolía; pulsiones y sus destinos

Las bibliotecas populares en la Argentina entre 1870 y 1875 : La construcción de una política bibliotecaria

El artículo trata sobre la institución de las bibliotecas populares en la Argentina entre 1870 y 1875. Mediante el estudio de diversos documentos, se analizan los siguientes aspectos y sus mutuas relaciones: a. las vinculaciones entre la sociedad civil y el Estado implícitas en el dispositivo legal de fomento a las bibliotecas; b. las responsabilidades asumidas por oficina gubernamental a cargo la política bibliotecaria y la manera en que se construyó un saber especializado en la materia; c. el papel preponderante del Boletín de las bibliotecas populares como instancia de articulación entre las asociaciones y el Estado; d. los resultados cuantitativos obtenidos en la fase fundacional. En el cierre del trabajo se valoran los resultados expuestos en función de la significación histórica que tiene este período como inauguración de una manera concebir la expansión de las bibliotecas de acceso público

Modelo de evaluación para sitios Web de bibliotecas universitarias

Este trabajo se propone el diseño de una grilla exhaustiva de características específicas de naturaleza formal, informativa y ergonómica para hacer que un sitio Web de bibliotecas universitarias sea de calidad, accesible y garantice el acceso a la información. Para ello, se efectúa un relevamiento de la bibliografía que analiza el tema y se elabora un modelo que pondera dichas características seleccionadas. Las conclusiones demuestran que es posible diseñar un modelo específico de atributos, estableciendo cuáles son los que mejor representan la calidad de una biblioteca universitaria en el entorno Web