C. El segle de les grans barbàries

Conté: Un día cualquiera de agosto; Hace diez años, la URSS…; Termina una vergüenza de Europa; Del nacional arabismo al islamismo; El Imperio vuelve a tener enemigo; La caída del tirano; La Normandía a Iraq; Derrota y rehabilitación de Europa; La gran metáfora de la plaza Roja; Los derechos humanos y la realidad; El siglo de la guerra total (1); El siglo de la guerra total (y 2); Memoria del muro de Berlín

Postoperative subconjunctival mitomycin-C injection after non-penetrating glaucoma surgery.

PURPOSE: To evaluate subconjunctival mitomycin C (MMC) injection efficacy and safety in patients with failing glaucoma non-penetrating filtering blebs. METHODS: Twenty-eight eyes were consecutively recruited for this study. Only one eye for each patient was randomly selected. All the recruited patients had glaucoma and uncontrolled intraocular pressure after a non-penetrating filtering glaucoma surgery and/or a pathological aspect of the filtering bleb (i.e., vascularized and/or encysted). One or more MMC injections were performed under the conjunctiva closed to the bleb to improve filtration. Local effects and complications of subconjunctival MMC injections were analyzed. RESULTS: Out of the 28 patients, 21 (75%) had MMC also applied intraoperatively. The mean postoperative IOP before MMC injections was 17 +/- 6.6 mmHg. The final IOP after MMC injections was 13.9 +/- 2.9 mmHg after a mean follow-up of 6 months. A total of 67 subconjunctival MMC injections were performed with a mean of 2.9 (ranging from 1 to 5) injections per patient. The only complication found to be possibly related to MMC injections was two cases of corneal Dellen. CONCLUSION: From these preliminary results, subconjunctival MMC injections in selected cases appear to be not only safe but also effective in promoting further the postoperative IOP drop.

An intramedullary alignment guide lodging within the femoral canal during total knee arthroplasty: a case report.

The usual complications of total knee arthroplasty include thrombo-embolism, infection, and loosening. We report an unusual and potentially serious complication of an intramedullary guide lodging within the femoral canal during the procedure. Considering the risk of fracture and additional exposure, the guide was not removed and was cut in situ. The rest of the operation was completed successfully and the patient made an uneventfully recovery.

Body surface area and body weight predict total liver volume in Western adults.

Computed tomography (CT) is used increasingly to measure liver volume in patients undergoing evaluation for transplantation or resection. This study is designed to determine a formula predicting total liver volume (TLV) based on body surface area (BSA) or body weight in Western adults. TLV was measured in 292 patients from four Western centers. Liver volumes were calculated from helical computed tomographic scans obtained for conditions unrelated to the hepatobiliary system. BSA was calculated based on height and weight. Each center used a different established method of three-dimensional volume reconstruction. Using regression analysis, measurements were compared, and formulas correlating BSA or body weight to TLV were established. A linear regression formula to estimate TLV based on BSA was obtained: TLV = -794.41 + 1,267.28 x BSA (square meters; r(2) = 0.46; P <.0001). A formula based on patient weight also was derived: TLV = 191.80 + 18.51 x weight (kilograms; r(2) = 0.49; P <.0001). The newly derived TLV formula based on BSA was compared with previously reported formulas. The application of a formula obtained from healthy Japanese individuals underestimated TLV. Two formulas derived from autopsy data for Western populations were similar to the newly derived BSA formula, with a slight overestimation of TLV. In conclusion, hepatic three-dimensional volume reconstruction based on helical CT predicts TLV based on BSA or body weight. The new formulas derived from this correlation should contribute to the estimation of TLV before liver transplantation or major hepatic resection.

Origin of mineralizing fluids of the sediment-hosted Navachab gold mine, Namibia: Constraints from stable (O, H, C, S) isotopes

The Navachab gold mine in the Damara belt of central Namibia is characterized by a polymetallic Au-Bi-As-Cu-Ag ore assemblage, including pyrrhotite, chalcopyrite, sphalerite, arsenopyrite, bismuth, gold, bismuthinite, and bismuth tellurides. Gold is hosted by quartz sulfide veins and semimassive sulfide lenses that are developed in a near-vertical sequence of shelf-type metasedimentary rocks, including marble, calcsilicate rock, and biotite schist. The sequence has been intruded by abundant syntectonic lamprophyre, aplite, and pegmatite dikes, documenting widespread igneous activity coeval with mineralization. The majority of quartz from the veins has delta(18)O values of 14 to 15 per mil (V-SMOW). The total variations in delta(18)O values of the biotite schist and calcsilicate rock are relatively small (12-14 parts per thousand), whereas the marble records steep gradients in delta(18)O values (17-21 parts per thousand), the lowest values being recorded at the vein margins. Despite this, there is no correlation between delta(18)O and delta(13)C values and the carbonate content of the rocks, indicating that fluid-rock interaction alone cannot explain the isotopic gradients. In addition, the marble records increased delta(13)C values at the contact to the veins, possibly related to a change in the physicochemical conditions during fluid-rock interaction. Gold is interpreted to have precipitated in equilibrium with metamorphic find (delta(18)O 12-14 parts per thousand; delta D = -40 to -60 parts per thousand) at peak metamorphic conditions of ca. 550 degrees C and 2 kbars, consistent with isotopic fractionations between coexisting calcite, garnet, and clinopyroxene in the alteration halos. The most likely source of the mineralizing fluid was a midcrustal fluid in equilibrium with the Damaran metapelites that underwent prograde metamorphism at amphibolite- to granulite-facies grades. Although there is no isotopic evidence for the contribution of magmatic fluids, they may have been important in contributing to the overall hydraulic regime and high apparent geothermal gradients (ca. 80 degrees C/km(-1)) in the mine area.

Genetic Loci Associated with C-reactive Protein Levels and Risk of Coronary Heart Disease.

CONTEXT: Plasma levels of C-reactive protein (CRP) are independently associated with risk of coronary heart disease, but whether CRP is causally associated with coronary heart disease or merely a marker of underlying atherosclerosis is uncertain. OBJECTIVE: To investigate association of genetic loci with CRP levels and risk of coronary heart disease. DESIGN, SETTING, AND PARTICIPANTS: We first carried out a genome-wide association (n = 17,967) and replication study (n = 13,615) to identify genetic loci associated with plasma CRP concentrations. Data collection took place between 1989 and 2008 and genotyping between 2003 and 2008. We carried out a mendelian randomization study of the most closely associated single-nucleotide polymorphism (SNP) in the CRP locus and published data on other CRP variants involving a total of 28,112 cases and 100,823 controls, to investigate the association of CRP variants with coronary heart disease. We compared our finding with that predicted from meta-analysis of observational studies of CRP levels and risk of coronary heart disease. For the other loci associated with CRP levels, we selected the most closely associated SNP for testing against coronary heart disease among 14,365 cases and 32,069 controls. MAIN OUTCOME MEASURE: Risk of coronary heart disease. RESULTS: Polymorphisms in 5 genetic loci were strongly associated with CRP levels (% difference per minor allele): SNP rs6700896 in LEPR (-14.8%; 95% confidence interval [CI], -17.6% to -12.0%; P = 6.2 x 10(-22)), rs4537545 in IL6R (-11.5%; 95% CI, -14.4% to -8.5%; P = 1.3 x 10(-12)), rs7553007 in the CRP locus (-20.7%; 95% CI, -23.4% to -17.9%; P = 1.3 x 10(-38)), rs1183910 in HNF1A (-13.8%; 95% CI, -16.6% to -10.9%; P = 1.9 x 10(-18)), and rs4420638 in APOE-CI-CII (-21.8%; 95% CI, -25.3% to -18.1%; P = 8.1 x 10(-26)). Association of SNP rs7553007 in the CRP locus with coronary heart disease gave an odds ratio (OR) of 0.98 (95% CI, 0.94 to 1.01) per 20% lower CRP level. Our mendelian randomization study of variants in the CRP locus showed no association with coronary heart disease: OR, 1.00; 95% CI, 0.97 to 1.02; per 20% lower CRP level, compared with OR, 0.94; 95% CI, 0.94 to 0.95; predicted from meta-analysis of the observational studies of CRP levels and coronary heart disease (z score, -3.45; P < .001). SNPs rs6700896 in LEPR (OR, 1.06; 95% CI, 1.02 to 1.09; per minor allele), rs4537545 in IL6R (OR, 0.94; 95% CI, 0.91 to 0.97), and rs4420638 in the APOE-CI-CII cluster (OR, 1.16; 95% CI, 1.12 to 1.21) were all associated with risk of coronary heart disease. CONCLUSION: The lack of concordance between the effect on coronary heart disease risk of CRP genotypes and CRP levels argues against a causal association of CRP with coronary heart disease.

Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies.

Although cigarette smoking and alcohol consumption increase risk for head and neck cancers, there have been few attempts to model risks quantitatively and to formally evaluate cancer site-specific risks. The authors pooled data from 15 case-control studies and modeled the excess odds ratio (EOR) to assess risk by total exposure (pack-years and drink-years) and its modification by exposure rate (cigarettes/day and drinks/day). The smoking analysis included 1,761 laryngeal, 2,453 pharyngeal, and 1,990 oral cavity cancers, and the alcohol analysis included 2,551 laryngeal, 3,693 pharyngeal, and 3,116 oval cavity cancers, with over 8,000 controls. Above 15 cigarettes/day, the EOR/pack-year decreased with increasing cigarettes/day, suggesting that greater cigarettes/day for a shorter duration was less deleterious than fewer cigarettes/day for a longer duration. Estimates of EOR/pack-year were homogeneous across sites, while the effects of cigarettes/day varied, indicating that the greater laryngeal cancer risk derived from differential cigarettes/day effects and not pack-years. EOR/drink-year estimates increased through 10 drinks/day, suggesting that greater drinks/day for a shorter duration was more deleterious than fewer drinks/day for a longer duration. Above 10 drinks/day, data were limited. EOR/drink-year estimates varied by site, while drinks/day effects were homogeneous, indicating that the greater pharyngeal/oral cavity cancer risk with alcohol consumption derived from the differential effects of drink-years and not drinks/day.

Study of the combined radial post-feeding dispersion of the blowflies Chrysomya megacephala (Fabricius) and C. albiceps (Wiedemann) (Diptera, Calliphoridae)

Blowflies use discrete and ephemeral substrates to feed their larvae. After they run out of food, the larvae begin to disperse in order to find adequate places for pupation or additional food sources, a process named post-feeding larval dispersion. Some important aspects of this process were studied in a circular arena allowing the combined radial post-feeding dispersion from the center of the arena of C. albiceps and C. megacephala larvae. To determine the location of each pupa, the arena was divided in 72 identical sections starting from the center. The distance from the center, the depth and weight of each pupa were evaluated. Statistical tests were done to verify the relation between weight, depth and distance for pupation. From the total an average of 976 larvae released (488 for each species) were collected considering both experiments 456 C. megacephala pupae and 488 of C. albiceps. This demonstrates that C. albiceps probably preyed on 32 C. megacephala larvae during post-feeding dispersion. The study of this dispersion process can be used to estimate the postmortem interval (PMI) of human cadavers in legal medicine.

Revue des arthroplasties totales de la hanche et du genou infectées--à propos de 28 cas [Review of infected total arthroplasties of the hip and knee--apropos of 28 cases]

This study is a long-term analysis of a group of patients with infected arthroplasties of the hip or the knee. We identified 28 patients with an infected arthroplasty (22 hips, 6 knees) documented by bacterial culture or on direct examination. At the time of diagnosis and on follow-up (a mean of 46 months after treatment) we evaluated the clinical picture, the radiological appearances of the articulation and the biological parameters. 19/28 patients showed a typical clinical picture, whereas in 9 others the picture was more doubtful. The treatments were 14 two-stage replacements of the arthroplasties, 7 simple resections, 5 conservative treatments and 2 one-stage replacements. On follow-up, 25 patients were considered as cured of their infection and 3 as failures. From a functional viewpoint, 9 patients showed no limitation, whereas 19 were limited in the daily activity. Half of the patients had no pain. Radiology showed that 20/26 evaluated patients had no signs of recurrence. Paraclinical examinations are important in the diagnosis of persistent low grade infections, particularly the demonstration of bacteria by pre-surgical sampling (fine needle aspiration, culture from draining sinuses). In spite of the cure of infection, the functional and painful sequellae are often considerable. As a result of our experience, we recommend a two-stage surgical procedure. Only when the general condition of the patient is poor, or when the infection is not under control, would we envisage an alternative procedure (arthrodesis, girdelstone, conservative).

Les douze points-clés de la rééducation après une prothèse totale de genou [The 12 keypoints for rehabilitation after total knee arthroplasty].

The rehabilitation process after total knee arthroplasty (TKA) relies more and more on the family doctor. Many factors contribute to this development: the constantly increasing number of TKA performed, the reduced length of stay at the hospital and the rehabilitation process after TKA requiring care for 3 to 4 months. After this time, it is also of major importance to encourage patients to take up physical activities in order to limit the negative effects of sedentarity. The goal of this paper is to give family doctors an overview of the current knowledge in the area of rehabilitation after TKA for physicians.

Bioimpedance for oedema evaluation after total knee arthroplasty.

BACKGROUND AND PURPOSE: Electrical bioimpedance spectroscopy (BIS) allows the evaluation of limb extracellular fluid (R0) and total fluid (Rinf). BIS could facilitate post-surgical oedema evaluation after total knee arthroplasty (TKA), as it is easily performed and is non-invasive. However, neither its applicability in this context nor the influence of metallic implants on measurement has been evaluated. The aim of this study was to evaluate the influence of TKA implants on the BIS R0 and Rinf variables used for oedema evaluation. METHOD: This was a prospective non-randomized comparative clinical trial. One oedema-free group of patients with TKA was compared with a group presenting similar characteristics except for the arthroplasty, to assess the influence of the implant on BIS measurement in the absence of oedema. The TKA group included 15 patients who had undergone surgery more than a year previously, and the control group included 19 patients awaiting TKA surgery. Volume and perimeter measurements served as reference criterions. The lower limb percentage differences for BIS, knee perimeter and volume were calculated. The significance of differences between groups was calculated for all measurement methods, using the Mann-Whitney test. The setting was a Department of Orthopedic Surgery and Traumatology in a university hospital. RESULTS: The differences between groups were not significant for R0, Rinf, volume and perimeter. R0 showed the smallest mean difference in limb percentage difference between groups [means (SD): TKA 3.98 (8.09), controls 3.97 (5.16)]. CONCLUSIONS: The lower-leg percentage difference in the TKA group is comparable with that of healthy subjects. R0 can be used for oedema evaluation following TKA surgery, as there was no sign of alteration from the metallic implant. These findings indicate the potential for early oedema evaluation after TKA. More research is warranted to extensively validate the application of BIS for oedema evaluation after TKA. Copyright © 2012 John Wiley & Sons, Ltd.

A Implementação de um Sistema de Gestão da Qualidade: O Caso da C.M. Aveiro

Este relatório tem como objetivo compreender o nível de implementação de um Sistema de Gestão da Qualidade no município de Aveiro. O nosso trabalho empírico e os dados investigados permitiu-nos investigar se houve uma implementação fragmentada ou completa do Sistema de Gestão da Qualidade no município. A fim de entender esse processo foi necessário resumir o contexto histórico da adoção de medidas de qualidade no setor público Português, através de um breve levantamento das fases dessas reformas e dos seus processos de modernização, incluindo as iniciativas e a implementação dos princípios de gestão da qualidade total nos serviços públicos. Neste sentido, este estudo tem como objetivo compreender o impacto e a sustentabilidade da implementação de um Sistema de Gestão da Qualidade na Câmara Municipal de Aveiro. Estamos particularmente preocupados com os desafios e motivações associadas a este processo, de modo a inferir sobre os benefícios que o processo de certificação da qualidade trouxe ao município. Levando em consideração o cenário económico atual, tentou-se também investigar o possível efeito que a crise económica sobre o futuro deste processo de modernização no município. A partir dos dados coletados é possível concluir que houve uma implementação fragmentada do Sistema de Gestão da Qualidade no município de Aveiro. Embora exista a noção da importância da plena implementação Sistema no município, os custos associados a este processo e a situação económica do país e da autarquia representam as principais barreiras no sucesso da implementação plena do Sistema de Gestão da Qualidade no município.

Total curvature and total torsion of knotted polymers

Previous work on radius of gyration and average crossing number has demonstrated that polymers with fixed topology show a different scaling behavior with respect to these characteristics than polymers with unrestricted topology. Using numerical simulations, we show here that the difference in the scaling behavior between polymers with restricted and unrestricted topology also applies to the total curvature and total torsion. For each knot type, the equilibrium length with respect to a given spatial characteristic is the number of edges at which the value of the characteristic is the same as the average for all polygons. This number appears to be correlated to physical properties of macromolecules, for example gel mobility as measured by the separation between distinct knot types. We also find that, on average, closed polymers require slightly more total curvature and slightly less total torsion than open polymers with the corresponding number of monomers.

Culturas de cobertura, acúmulo de nitrogênio total no solo e produtividade de milho

A associação de preparos conservacionistas com culturas de cobertura é importante estratégia de melhoria da qualidade do solo. Quando leguminosas são utilizadas, verifica-se incremento na disponibilidade de nitrogênio (N) para a primeira cultura em sucessão (efeito imediato). Todavia, o uso de leguminosas por vários anos pode se refletir no incremento da capacidade do solo em suprir N (efeito residual). Com o objetivo de distinguir o efeito residual do efeito imediato do uso de culturas de cobertura foi realizada esta pesquisa. Utilizou-se um experimento de longa duração (1985 a 1995) instalado na Estação Experimental Agronômica da UFRGS, RS. O delineamento experimental foi o de blocos casualizados com parcelas subsubdivididas e três repetições. As parcelas principais incluíram três sistemas de preparo: convencional, reduzido e direto; as subparcelas abrangeram três sistemas de cultura: aveia/milho (A/M), aveia + ervilhaca/milho (A + E/M) e aveia + ervilhaca/milho+caupi (A + E/M + C) e as subsubparcelas doses de N. O solo da área experimental é um Podzólico Vermelho-Escuro. No ano desta pesquisa (1995), os sistemas de cultura utilizados foram aveia/milho, ervilhaca/milho e aveia + ervilhaca/milho. Visando avaliar o efeito residual do uso de culturas de cobertura, um segmento da parcela foi mantido descoberto durante o inverno que antecedeu o cultivo do milho. A associação de preparos conservacionistas (reduzido e direto) com o uso de leguminosas aumentou o estoque de N total na camada superficial do solo. O efeito residual das leguminosas no sistema A + E/M + C promoveu incrementos de 26 e 19% na quantidade de N absorvido e rendimento de grãos, respectivamente, em relação ao histórico de uso de A/M. Contudo, a presença de resíduos de ervilhaca ainda foi a principal responsável pelo fornecimento de N ao milho (efeito imediato).

Evaluación poblacional de Chondracanthus chamissoi (C. Agardh 1820) en las bahías de Pisco y Paracas, Otoño 2010.

Entre mayo y junio 2010, se desarrolló la evaluación poblacional de la macroalga Chondracanthus chamissoi “yuyo” de las praderas en las bahías de Pisco y Paracas. Las biomasas medias fluctuaron entre 2,2 y 67,0 g.m-2, con promedio de 43,6 g.m-2. Se estimó una biomasa total de 211,96 toneladas (±56,8%); de los cuales 179,74 t correspondieron a Atenas; 30,1 t a Puerto Nuevo y 2,1 t a Playa Lobería. El sustrato de fijación estuvo compuesto, principalmente, por piedras, conchuela y arena media. En las praderas de Atenas ocupó la mayor parte del área evaluada, en las praderas de Puerto Nuevo y Playa Lobería se encontraron reducidas, respecto al 2007. Se encontró ejemplares entre 1 y 25 cm de longitud. El peso total individual varió de 0,1 a 94,6 g. Se registró biodiversidad asociada conformada por moluscos. Las condiciones oceanográficas se registraron normales, lo que permite suponer que la disminución poblacional respondería a las actividades de extracción.