Total synthesis of (-)-isoavenaciolide

An enantioselective approach to (-)-isoavenaciolide was achieved starting from 1- undecyn-3-ol. The synthesis relied upon the preparation of a chiral 4-silyloxy-2-alkenylborane by hydroboration of a protected 2,3-allenol and subsequent stereoselective addition to 2- thiophenecarboxaldehyde

Cable fixation and early total hip arthroplasty in the treatment of acetabular fractures in elderly patients.

Eighteen patients with acetabular fractures, with a mean age of 76 years, were treated with cable fixation and acute total hip arthroplasty. Nine were T-shaped fractures, 4 associated transverse and posterior wall, 2 transverse, 2 posterior column and posterior wall, and 1 anterior and posterior hemitransverse fractures. One patient experienced 3 episodes of hip dislocation within 10 months after surgery. All the others had a good outcome at a mean follow-up time of 36 months. Radiographic assessment showed healing of the fracture and a satisfactory alignment of the cup without loosening. This option provides good primary fixation, stabilizes complex acetabular fractures in elderly patients, and permits early postoperative mobilization.

FM127: Systemic metal ion levels in patients with modular neck total hip arthroplasties: a prospective cohort study

There is increasing evidence that modular neck stems are prone to corrosion-related complications. Recent studies showed elevated metal ions levels and occasional pseudotumor formation in patients with such implants. The purpose of this study was to compare systemic metal-ion levels in patients after primary THA with modular neck stems to those of patients after non-modular implants. To our knowledge, this is the first cohort study including a control group, THA without CoCr heads and dry-assembled neck-stem connections. Methods: 50 patients after THA at a minimum follow-up of 1 year have been selected for the study. Patients with multiple prosthesis or other implants have been deselected. All received a cementless SPS stem from Symbios (Ti6Al4V). 40 patients have the modular neck (CoCr) version and 10 a monobloc version. All bearings were either ceramic-ceramic or ceramic-polyethylene to minimize other sources of CoCr ion release. In the modular group, the neck was chosen pre-operatively based on a 3D planning, allowing for a dry assembly of the stem and neck on the back table before implantation. A plasma system coupled to mass spectrometry was used for a complete elementary quantification in blood and serum separately. Clinical outcome was measured using the Oxford Hip Score. Results : Complete data sets of 29 patients (24 in the modular neck-group (10male, mean age 63y, 35-84y) and 5 in the monobloc-group (3 male, 69 y, 51-83y) are available to date. Mean Co blood levels were .95 ug/L (.14-12.4) in the modular group vs .27 ug/L (.10-.73) in the monobloc group (p=.2). Respective values for Cr were significantly higher in the modular group (.99 g/L; range .75-1.21) compared to those in the monobloc group (.74 g/L ;.62-.86; p=.001). No significant difference was found when comparing serum levels. 5/24 patients had Co levels above 1 g/L (12/24 for Cr), which is by some considered as a relevant elevation. The maximum Co level was measured in an asymptomatic patient. The Oxford Hip Scores were similar in both groups. Conclusion: Cr levels were significantly elevated in the modular neck group compared to those in the monobloc group. 1/24 patients with a modular prosthesis exhibited Co levels, which are beyond the threshold accepted even for metal-on-metal bearing couples. These results have contributed to our decision to abandon the use of modular neck stems. Routine follow-up including annual measurements of systemic CoCr concentrations should be considered.

Fatal intrahepatic hemorrhage after nadroparin use for total hip arthroplasty.

Low-molecular-weight heparins have become the predominant choice for deep venous thrombosis prophylaxis and treatment. However, their use may cause bleeding complications. Intrahepatic bleeding is exceptional and only very few cases have been described. The authors present a unique case of fatal intrahepatic hematoma complicating nadroparin use in a 65-year-old woman with a hepatic cyst who was admitted to hospital for unilateral total hip arthroplasty. At autopsy, hemoperitoneum (2,000 ml of blood and clots) was evident. A ruptured sub-capsular hematoma involving the right lobe of the liver was observed. The hemorrhage within the cyst induced by the nadroparin use was likely responsible for the subsequent hepatic hematoma, liver rupture, and death. This case highlights the need for pathologists and surgeons to be aware of the possibility of intrahepatic hematoma in patients who have received low-molecular-weight heparins, undergone major surgery and present postoperative hemodynamic instability, especially in those with preoperative diagnosis of hepatic cyst.

Total hip replacement with a collarless polished cemented anatomic stem: clinical and gait analysis results at ten years follow-up.

PURPOSE: The aim of this study was to determine outcomes of total hip replacement (THR) with the Lemania cemented femoral stem. METHODS: A total of 78 THR patients were followed and compared to 17 "fit", healthy, elderly and 72 "frail" elderly subjects without THR, using clinical outcome measures and a portable, in-field gait analysis device at five and ten years follow-up. RESULTS: Forty-one patients (53%), mean age 83.4 years, available at ten years follow-up, reported very good to excellent satisfaction. Mean Harris Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 81.2 and 10.5 points, respectively, with excellent radiological preservation of proximal femur bone stock. Spatial and temporal gait parameters were close to the fit group and better than the frail group. CONCLUSIONS: Lemania THR demonstrated very good, stable clinical and radiological results at ten years in an older patient group, comparable to other cemented systems for primary THR. Gait analysis confirmed good walking performance in a real-life environment.

Plantilla d'observació i avaluació de competències (POAC) : millora de la qualitat docent en l'avaluació psicològica

Els autors, un grup de professorat que imparteix docència al 3r curs de la Llicenciatura en Psicologia, reflexionen sobre el procés d’ensenyament- aprenentatge i les competències a assolir pels estudiants dins el marc de l’Espai Europeu d’Educació Superior. Considerant la rellevància de l’avaluació psicològica i de l’entrevista com a eina fonamental per a dur-la a terme, es centren en l’objectivació, definició i operacionalització de les competències necessàries per desenvolupar un procés diagnòstic de qualitat en el nou pla d’estudis. S’exposen diferents experiències pilot de treball amb grups reduïts d’estudiants. La reflexió sobre la tasca docent genera la creació de la Plantilla d’Observació i Avaluació de Competències (POAC 33), i de la seva versió abreujada (la POAC 14). Es clou l’article constatant que ambdós instruments es mostren útils i pràctics tan per a l’ensenyament de les competències com per a la seva avaluació.

Projecte Gutenberg : l'aplicació del mètode de treball per projectes per a l'edició d'un llibre

L’objectiu prioritari d’aquesta intervenció, presentada en el marc dels MQD (Mòduls de qualitat docent) del curs 2010-2011, titulada Projecte Gutenberg, ha estat la pràctica de realitzar uns treballs cooperatius amb un grup classe per tal d’assolir la competència bàsica de saber treballar en equip i de ser conscient de la responsabilitat que aquest treball requereix per part de cada alumne. La finalitat, però, d’aquest projecte ha estat també la publicació d’un opuscle (llibret amb ISBN) amb un total de deu articles a partir de cinc temàtiques diferents triades pels mateixos alumnes. Cada un d’aquests temes s’ha tractat des de dues perspectives diferents: una més global, des d’una visió social, i l’altra més concreta, des d’una visió educativa. Aquest projecte proposava tanmateix una activitat transversal programada duta a terme en el marc de la Trobada Internacional per la Pau celebrada a Barcelona i organitzada per la Comunitat de Sant Egidi, dels dies 3 al 5 d’octubre del 2010. El grup classe que ha participat d’aquest esdeveniment ha estat el de segon curs de Magisteri del Grau de Primària (EP, tarda). El projecte s’ha realitzat des del mòdul d’Humanitats Cristianisme i Cultura i des dels seminaris corresponents al mòdul 2, amb la col·laboració dels seus tutors/es durant el primer semestre del curs 2010-2011.

A genome-wide screen for interactions reveals a new locus on 4p15 modifying the effect of waist-to-hip ratio on total cholesterol.

Recent genome-wide association (GWA) studies described 95 loci controlling serum lipid levels. These common variants explain ∼25% of the heritability of the phenotypes. To date, no unbiased screen for gene-environment interactions for circulating lipids has been reported. We screened for variants that modify the relationship between known epidemiological risk factors and circulating lipid levels in a meta-analysis of genome-wide association (GWA) data from 18 population-based cohorts with European ancestry (maximum N = 32,225). We collected 8 further cohorts (N = 17,102) for replication, and rs6448771 on 4p15 demonstrated genome-wide significant interaction with waist-to-hip-ratio (WHR) on total cholesterol (TC) with a combined P-value of 4.79×10(-9). There were two potential candidate genes in the region, PCDH7 and CCKAR, with differential expression levels for rs6448771 genotypes in adipose tissue. The effect of WHR on TC was strongest for individuals carrying two copies of G allele, for whom a one standard deviation (sd) difference in WHR corresponds to 0.19 sd difference in TC concentration, while for A allele homozygous the difference was 0.12 sd. Our findings may open up possibilities for targeted intervention strategies for people characterized by specific genomic profiles. However, more refined measures of both body-fat distribution and metabolic measures are needed to understand how their joint dynamics are modified by the newly found locus.

Evolució de la qualitat vocal d’un grup d’infants amb sordesa pregona usuaris d’implant coclear

L’ús generalitzat dels implants coclears ha possibilitat l’accés al món sonor a moltes persones amb sordesa pregona, facilitant la seva competència comunicativa en llenguatge oral. Objectiu: Amb aquest article pretenem realitzar una revisió de la descripció que tradicionalment ha caracteritzat la veu dels infants amb sordesa. Posteriorment, analitzem l’evolució de la qualitat vocal obtinguda amb una mostra de 12 infants (8 nenes i 4 nens) amb sordesa pregona congènita i una mitjana d’edat de 6 anys i 1 mes, usuaris d’Implant Coclear (IC), als quals vam realitzar una avaluació inicial de la seva qualitat vocal i una avaluació final, dos anys més tard. Els resultats es comparen amb els obtinguts per un grup control d’infants oients. Resultats i conclusions: Els resultats mostren com els perfils obtinguts pels infants sords usuaris d’IC evolucionen molt favorablement, essent els valors obtinguts més similars als del grup control en l’avaluació final que en la inicial. Finalment, ens qüestionem la validesa d’utilitzar alguns paràmetres acústics com a indicadors de la qualitat vocal dels infants amb pèrdua auditiva i sense problemes laringis.

Total and segmental liver volume variations: implications for liver surgery.

BACKGROUND: Liver remnant volumes after major hepatic resection and graft volumes for liver transplantation correlate with surgical outcome. The relative contributions of the hepatic segments to total liver volume (TLV) are not well established. METHODS: TLV and hepatic segment volumes were measured with computed tomography (CT) in 102 patients without liver disease who underwent CT for conditions unrelated to the liver or biliary tree. RESULTS: TLV ranged from 911 to 2729 cm(3). On average, the right liver (segments V, VI, VII, and VIII) contributed approximately two thirds of TLV (997+/-279 cm(3)), and the left liver (segments II, III and IV) contributed approximately one third of TLV (493+/-127 cm(3)). Bisegment II+III (left lateral section) contributed about half the volume of the left liver (242+/-79 cm(3)), or 16% of TLV. Liver volumes varied significantly between patients--the right liver varied from 49% to 82% of TLV, the left liver, 17% to 49% of TLV, and bisegment II+III (left lateral section) 5% to 27% of TLV. Bisegment II+III contributed less than 20% of TLV in more than 75% of patients and the left liver contributed 25% or less of TLV in more than 10% of patients. DISCUSSION: There is clinically significant interpatient variation in hepatic volumes. Therefore, in the absence of appreciable hypertrophy, we recommend routine measurement of the future liver remnant before extended right hepatectomy (right trisectionectomy) and in selected patients before right hepatectomy if a small left liver is anticipated.

Avaluació dels efectes d'un tractament logopèdic en la qualitat de veu d'adults amb sordesa

La veu de les persones amb pèrdues auditives severes o profundes presenta diverses característiques acústiques que són reconegudes pels oients i que, sovint, se’ls assignen valoracions negatives.En aquest treball s’exposen els resultats d’una experiència d’entrenament vocal amb un grup de deu adults amb pèrdues auditives severes i pregones, portadores de diferents tipus de pròtesi. L’entrenament es va duu a terme durant un any amb una mitjana de 14 sessions individuals. Es va realitzar un registre de la veu en format digital previ i posterior dels participants que ha estat analitzada des de tres perspectives distintes: acústica, perceptiva i narrativa. Des del punt de vista acústic, les mostres han estat analitzades amb el programa MDVP de Kay Elemetrics. S’han utilitzat els paràmetres jitter (estabilitat de freqüència), shimmer (estabilitat d’intensitat) i NHR (relació soroll vs. harmònics). En segon lloc, les mostres s’han sotmès a la valoració de dos jurats d’escolta, un de logopedes experts en veu i un altre de no experts, format per estudiants universitaris no entrenats. Finalment, s’han analitzat els discursos dels participants sobre les característiques de la seva veu.El conjunt de resultats no és totalment coincident entre les distintes perspectives d’anàlisi. Totes tres coincideixen a reflectir la millora vocal en sis dels participants, però discrepen en els altres quatre.L’experiència obre les portes a noves investigacions sobre l’efectivitat dels tractaments de millora de la veu en les persones sordes.

Pediatric reference intervals for plasma free and total metanephrines established with a parametric approach: Relevance to the diagnosis of neuroblastoma.

BACKGROUND: Urine catecholamines, vanillylmandelic, and homovanillic acid are recognized biomarkers for the diagnosis and follow-up of neuroblastoma. Plasma free (f) and total (t) normetanephrine (NMN), metanephrine (MN) and methoxytyramine (MT) could represent a convenient alternative to those urine markers. The primary objective of this study was to establish pediatric centile charts for plasma metanephrines. Secondarily, we explored their diagnostic performance in 10 patients with neuroblastoma. PROCEDURE: We recruited 191 children (69 females) free of neuroendocrine disease to establish reference intervals for plasma metanephrines, reported as centile curves for a given age and sex based on a parametric method using fractional polynomials models. Urine markers and plasma metanephrines were measured in 10 children with neuroblastoma at diagnosis. Plasma total metanephrines were measured by HPLC with coulometric detection and plasma free metanephrines by tandem LC-MS. RESULTS: We observed a significant age-dependence for tNMN, fNMN, and fMN, and a gender and age-dependence for tMN, fNMN, and fMN. Free MT was below the lower limit of quantification in 94% of the children. All patients with neuroblastoma at diagnosis were above the 97.5th percentile for tMT, tNMN, fNMN, and fMT, whereas their fMN and tMN were mostly within the normal range. As expected, urine assays were inconstantly predictive of the disease. CONCLUSIONS: A continuous model incorporating all data for a given analyte represents an appealing alternative to arbitrary partitioning of reference intervals across age categories. Plasma metanephrines are promising biomarkers for neuroblastoma, and their performances need to be confirmed in a prospective study on a large cohort of patients. Pediatr Blood Cancer 2015;62:587-593. © 2015 Wiley Periodicals, Inc.

Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis.

We conducted this study to determine the relative influence of various mechanical and patient-related factors on the incidence of dislocation after primary total hip asthroplasty (THA). Of 2,023 THAs, 21 patients who had at least 1 dislocation were compared with a control group of 21 patients without dislocation, matched for age, gender, pathology, and year of surgery. Implant positioning, seniority of the surgeon, American Society of Anesthesiologists (ASA) score, and diminished motor coordination were recorded. Data analysis included univariate and multivariate methods. The dislocation risk was 6.9 times higher if total anteversion was not between 40 degrees and 60 degrees and 10 times higher in patients with high ASA scores. Surgeons should pay attention to total anteversion (cup and stem) of THA. The ASA score should be part of the preoperative assessment of the dislocation risk.

Qüestionari d'avaluació del curs de Formació Magistral (FMO): una eina per a la millora de la qualitat docent

Se ha elaborado un cuestionario que pretende recoger la opinión del alumnado de evaluación continuada (77% de los matriculados) de FMO, una asignatura obligatoria del 5º Curso del grado de Farmacia, sobre las distintas sesiones y actividades que conformaron el curso 2011-12, para realizar eventuales acciones de mejora de la docencia.