Shoulder arthroplasty for patients with juvenile idiopathic arthritis.

Between 1986 and 1997, 13 shoulders in adult patients who had severe polyarticular juvenile idiopathic arthritis were treated with primary arthroplasty. Eleven shoulders were evaluated retrospectively by an independent observer with a mean follow-up of 9 years. Patient evaluation included pain Visual Analogue Scale, range of motion, Disabilities of the Arm, Shoulder and Hand score, and Short-Form 36. Patients' pain decreased significantly after surgery (mean 6.7). Forward elevation improved on average by 41.1 degrees and external rotation by 39.1 degrees , without evidence of shoulder instability. Final Short-Form 36 scores and Disabilities of the Arm, Shoulder and Hand results (mean, 44.7) were poor, but all patients rated themselves satisfied with the procedure. Shoulder arthroplasty provided pain relief for end-stage shoulder involvement in adult juvenile idiopathic arthritis. Improvement in external rotation in this severely affected group appears to have a beneficial effect on functional outcome.

The genus Aloe L. (Xanthorrhoeaceae) in Djibouti

The Horn of Africa is rich in succulent plants, yet the flora in some parts of the region remains under-explored, owing largely to political instability and inaccessibility. The Republic of Djibouti is a relatively small, politically stable country where botanical studies continue to identify new species records and new taxa. Here, we focus on the genus Aloe L. (Xanthorrhoeaceae subfamily Asphodeloideae) in Djibouti. Recent field surveys resulted in five new species records for the country (A. rigens Reynolds & Bally, A. macrocarpa Tod., A. eumassawana Carter, Gilbert & Sebsebe, A. ericahenriettae McCoy and A. djiboutiensis McCoy), in addition to the three taxa included in treatment for the Flora of Djibouti (Aloe trichosantha A.Berger, A. aff. trichosantha and A. mcloughlinii Christian). We present notes on the determination distribution and habitats of the nine Aloe species recorded in Djibouti.

Test of four colon cancer risk-scores in formalin fixed paraffin embedded microarray gene expression data.

BACKGROUND: Prognosis prediction for resected primary colon cancer is based on the T-stage Node Metastasis (TNM) staging system. We investigated if four well-documented gene expression risk scores can improve patient stratification. METHODS: Microarray-based versions of risk-scores were applied to a large independent cohort of 688 stage II/III tumors from the PETACC-3 trial. Prognostic value for relapse-free survival (RFS), survival after relapse (SAR), and overall survival (OS) was assessed by regression analysis. To assess improvement over a reference, prognostic model was assessed with the area under curve (AUC) of receiver operating characteristic (ROC) curves. All statistical tests were two-sided, except the AUC increase. RESULTS: All four risk scores (RSs) showed a statistically significant association (single-test, P < .0167) with OS or RFS in univariate models, but with HRs below 1.38 per interquartile range. Three scores were predictors of shorter RFS, one of shorter SAR. Each RS could only marginally improve an RFS or OS model with the known factors T-stage, N-stage, and microsatellite instability (MSI) status (AUC gains < 0.025 units). The pairwise interscore discordance was never high (maximal Spearman correlation = 0.563) A combined score showed a trend to higher prognostic value and higher AUC increase for OS (HR = 1.74, 95% confidence interval [CI] = 1.44 to 2.10, P < .001, AUC from 0.6918 to 0.7321) and RFS (HR = 1.56, 95% CI = 1.33 to 1.84, P < .001, AUC from 0.6723 to 0.6945) than any single score. CONCLUSIONS: The four tested gene expression-based risk scores provide prognostic information but contribute only marginally to improving models based on established risk factors. A combination of the risk scores might provide more robust information. Predictors of RFS and SAR might need to be different.

Constant fluctuating asymmetry but not directional asymmetry along the geographic distribution of Drosophila antonietae (Diptera, Drosophilidae)

ABSTRACT The population dynamics of a species tends to change from the core to the periphery of its distribution. Therefore, one could expect peripheral populations to be subject to a higher level of stress than more central populations (the center–periphery hypothesis) and consequently should present a higher level of fluctuating asymmetry. To test these predictions we study asymmetry in wing shape of five populations of Drosophila antonietae collected throughout the distribution of the species using fluctuating asymmetry as a proxy for developmental instability. More specifically, we addressed the following questions: (1) what types of asymmetry occur in populations of D. antonietae? (2) Does the level of fluctuating asymmetry vary among populations? (3) Does peripheral populations have a higher fluctuating asymmetry level than central populations? We used 12 anatomical landmarks to quantify patterns of asymmetry in wing shape in five populations of D. antonietae within the framework of geometric morphometrics. Net asymmetry – a composite measure of directional asymmetry + fluctuating asymmetry – varied significantly among populations. However, once net asymmetry of each population is decomposed into directional asymmetry and fluctuating asymmetry, most of the variation in asymmetry was explained by directional asymmetry alone, suggesting that populations of D. antonietae have the same magnitude of fluctuating asymmetry throughout the geographical distribution of the species. We hypothesize that larval development in rotting cladodes might play an important role in explaining our results. In addition, our study underscores the importance of understanding the interplay between the biology of a species and its geographical patterns of asymmetry.

Morfogénesis del valle de Sant Miquel de Campmajor

A series of circumstances which converge in a little valley in the province of Girona, result in a peculiar type of morphogenetic evolution and a quite singular mechanical instability of its buttons. Very recent tectonic movements as well as dissolution phenomena of its subsoil due to pressurized underground water have played an important role in the morphogenesis. Such conditions have resulted in a fast morphological evolution which a progressive lowering of the valley floor as well as peculiar morphological features which favour the existence of numerous pits caused by sudden collapses distributed in altitude and time

GUINEA-BISSAU: The Role of Local and International NGOs in Environmental Preservation and Sustainability of the Bijagos Archipelago

Bijagos Archipelago in Guinea-Bissau is at present subject to numerous external impacts that affect its centuries old balance. Since 1975 Guinean society has been using its natural resources in an uncontrolled way over the territory and especially in the coastal area. The archipelago has been increasingly raising interest, most of which is incompatible with the guarantee for a long-term sustainable development. It has also displayed a general impoverishment as far as resource preservation is concerned, due to internal demographic pressure of a population that has doubled since 1981 and to external pressure related to neighboring migrations and consequent depletion of non-renewable resources. This article aims to analyze the actions of local and international NGOs in the preservation and sustainability of the Bijagos Archipelago. We seek through an interdisciplinary approach to analyze the phenomena that are configured within the strategies of NGOs, on the assumption that these issues are articulated in the field of geography and sociology, as well as in politics and international cooperation. It is proposed new challenges to environmental issues, especially in a current situation shaken by constant instability internal and external policies.

Venous cannula performance assessment in a realistic caval tree model.

OBJECTIVES: A new caval tree system was designed for realistic in vitro simulation. The objective of our study was to assess cannula performance for virtually wall-less versus standard percutaneous thin-walled venous cannulas in a setting of venous collapse in case of negative pressure. METHODS: For a collapsible caval model, a very flexible plastic material was selected, and a model with nine afferent veins was designed according to the anatomy of the vena cava. A flow bench was built including a lower reservoir holding the caval tree, built by taking into account the main afferent vessels and their flow provided by a reservoir 6 cm above. A cannula was inserted in this caval tree and connected to a centrifugal pump that, in turn, was connected to a reservoir positioned 83 cm above the second lower reservoir (after-load = 60 mmHg). Using the same pre-load, the simulated venous drainage for cardiopulmonary bypass was realized using a 24 F wall-less cannula (Smartcanula) and 25 F percutaneous cannula (Biomedicus), and stepwise increased augmentation (1500 RPM, 2000 and 2500 RPM) of venous drainage. RESULTS: For the thin wall and the wall-less cannulas, 36 pairs of flow and pressure measurements were realized for three different RPM values. The mean Q-values at 1500, 2000 and 2500 RPM were: 3.98 ± 0.01, 6.27 ± 0.02 and 9.81 ± 0.02 l/min for the wall-less cannula (P <0.0001), versus 2.74 ± 0.02, 3.06 ± 0.05, 6.78 ± 0.02 l/min for the thin-wall cannula (P <0.0001). The corresponding inlet pressure values were: -8.88 ± 0.01, -23.69 ± 0.81 and -70.22 ± 0.18 mmHg for the wall-less cannula (P <0.0001), versus -36.69 ± 1.88, -80.85 ± 1.71 and -101.83 ± 0.45 mmHg for the thin-wall cannula (P <0.0001). The thin-wall cannula showed mean Q-values 37% less and mean P values 26% more when compared with the wall-less cannula (P <0.0001). CONCLUSIONS: Our in vitro water test was able to mimic a negative pressure situation, where the wall-less cannula design performs better compared with the traditional thin-wall cannula.

A sex-specific marker reveals male heterogamety in European tree frogs.

Most amphibians examined so far show undifferentiated sex chromosomes. The heterogametic sex's identity, usually revealed through indirect means, often varies among closely related species or even populations (as do sex-linkage groups), suggesting great evolutionary instability of the sex-determining genes. Here we take advantage of a sex-specific marker that amplifies in several related species of European tree frogs (Hyla arborea group) to disclose a homogeneous pattern of male heterogamety. Besides relevance for evolutionary studies of sex determination in amphibians, our results have potential for addressing practical issues in conservation biology because sex reversal by anthropogenic endocrine disruptors is considered one possible cause of amphibian decline.

Características geológicas y geotécnicas de los lodos de flotación de la Sierra Minera de Cartagena-La Unión (SE España)

We present the results of a geological and geotechnical characterization of the metallurgic waste from the Sierra Minera de Cartagena-La Union. We have studied eight tailings dams from which we collected and analysed 42 samples of metallurgic waste. We measured grainsize distribution, the specific gravity of solid particles, plasticity index, permeability, both in situ and in the laboratory, direct shear characteristicsand moisture content. According to size distribution the tailings can be classified as sandy silt. Their plasticity index ranges from medium to nil. The internal friction angle varies between 28 and 42 degrees. Cohesion is between 0 and 2.2 t/m2. The specific gravity of the solid particles ranges widely from 1.8 to 4 g/cm3. The saturated hydraulic conductivity values vary between 1.3x 10-5 and 3.2x 10-9 m/s.The water content measured in situ shows that the degree of saturation remains relatively high despite low rainfall and high evaporation rates. Several tailings dams have failed. The leading causes of tailings-dam failure are: 1) slope instability; 2) overflow; 3) erosion; and 4) subsidence or collapse. The main factor leading to dam failure is that the tailings stored in the ponds are highly saturated

Traumatic rupture of both peroneal longus and brevis tendons.

Injuries of peroneal tendons are rare. Diagnosis of traumatic rupture is often late and presents as chronic ankle instability. A case of a complete traumatic rupture of both peroneal longus and brevis tendons with acute clinical and radiological diagnosis is presented. Surgical repair was performed by direct end-to-end suture on the 4th day after trauma, with excellent functional outcome at 1-year follow-up.

Pain assessment in PICU and NICU: Have we got it right?

Pain assessment in critically ill infants and nonverbal children remains a challenge for health professionals. Despite the numerous pain observational measures that have been developed or adapted for infants and children with impaired communication, pain prevalence in paediatric and neonatal intensive care unit remains too high. As pain assessment has been recognised as a pre-requisite for appropriate pain management, much effort was put in the validation or the adaptation of pain measures with little emphasis on implementation of these instruments into practice. Only a few studies demonstrated the benefit of using standardised protocols for the management of pain to guide practice with variable effects. When standardised protocols are undeniably useful in practice, they do not replace health professionals' clinical reasoning necessary to care for individuals. The diversity of the PICU population makes that pain scores need to be interpreted within its clinical context. This session will present pain assessment as a complex transaction that describes structured clinical reasoning from expert nurses that goes beyond the "silver" standard of hetero-evaluation of pain in non-communicative children. Besides pain scores, several patients and nurses factors play a major role in making decisions about analgesia and/or sedation. Patient's clinical instability, change in patient's clinical status, source for observed agitated behaviour, patient's known reactions to analgesia and sedation and anticipation of risks are factors that should be taken into account when implementing pain assessment and management guidelines in PICU and NICU.

Effect of tibial tray inclination on the femoro-tibial contact pattern of a mobile total knee arthroplasty

Introduction: The posterior inclination of the tibial component is an important factor that can affect the success of total knee arthroplasty. It can reduce the posterior impingement and thus increase the range of flexion, but it may also induce instability in flexion, anterior impingement between the polyethylene of postero-stabilizing knee prosthesis, and anterior conflict with the cortical bone and the stem. Although the problem is identified, there is still a debate on the ideal inclination angle and the surgical technique to avoid an excessive posterior inclination. The aim of this study was to predict the effect of a posterior inclination of the tibial component on the contact pattern on the tibial insert, using a numerical musculoskeletal model of the knee joint. Methods: A 3D finite element model of the knee joint was developed to simulate an active and loaded squat movement after total knee arthroplasty. Flexion was actively controlled by the quadriceps muscle and muscle activations were estimated from EMG data and were synchronized by a feedback algorithm. Two inclinations of the tibial tray were considered: a posterior inclination of 0° or 10°. During the entire range of flexion, the following quantities were calculated: the tibiofemoral and patello-femoral contact force, and the contact pattern on polyethylene insert. The antero-posterior displacement of the contact pattern was also measured. Abaqus 6.7 was used for all analyses. Results: The tibio-femoral and patello-femoral contact forces increased during flexion and reached respectively 4 and 7 BW (bodyweight) at 90° of flexion. They were slightly affected by the inclination of the tibial tray. Without posterior inclination, the contact pattern on the tibial insert remained centered. The contact pressure was lower than 5 MPa below 60° of flexion, but exceeded 20 MPa at 90° of flexion. The posterior inclination displaced the contact point posteriorly by 2 to 4 mm. Conclusion: The inclination of the tibial tray displaced the contactpattern towards the posterior border of the tibial insert. However, even for 10° of inclination, the contact center remained far from the posterior border (12 mm). There was no instability predicted for this movement.

Bilan préopératoire pour la chirurgie cardio-vasculaire en urgence [Preoperative assessment in emergency cardiovascular surgery].

In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways

Precarious Work: Agenda and Implications for Corporate Social Responsibility

Precarious work, in contrast to regular, permanent wage work, is commonly associated to insecure and unstable, and often poor quality jobs. The concept of precarious work relates either to a socioeconomic group which allows one to refer it to a "class in itself," or as - pursued more recently - to the precarization process which results in a growing fragmentation of societal structures. Common to both conceptions is that they refer to the exposition of workers to employment instability, limited access to legal and union protection, socially irresponsible and discriminating employment practices, and social and economic vulnerability in general. The present contribution provides an overview of some key issues and future directions of research on precarious work relevant to CSR researchers, policy-makers, and social scientists.