Diagnostic et traitement de la rupture du tendon d'Achille [Diagnosis and treatment of the ruptured Achilles tendon].

The treatment of the recently ruptured Achilles tendon can be conservative or surgical. The conservative treatment may be carried out using either a static cast immobilisation or using a dynamic brace and an early functional rehabilitation. The surgical technique can be either open or mini-invasive. Neglected and ancient ruptures may need to be treated surgically by a tendinoplasty. There is an ongoing discussion about how to manage the recently ruptured Achilles tendon, especially since recent descriptions of conservative-functional treatment procedures and mini-invasive surgical techniques. We present the choice of the different treatment options and the clinical reasoning to identify the best adapted treatment for the individual patient. The ideal treatment option depends on the functional demand and the medical condition of the patient.

Dimensions of national culture and the accounting environment -The Spanish case-

Gray (1988) has put forward a hypothesis on how a national accountingenvironment might reflect the cultural dimensions identified by Hofstede (1980, 1983). A number of studies have tested Gray's hypothesis, including one by Pourjalali and Meek (1995) which identified a match between changes in cultural dimensions and the accounting environment in Iran following the revolution. In this paper we replicate this work in the context of Spain following the death of Franco in 1975 and the emergence of a democratic constitution in 1978. Specifically, we: 1) Consider Gray's hypothesis built on Hofstede's cultural dimensions and review some empirical tests of the hypotheses.2) Building on the work of Hofstede and Gray, we: put forward some hypotheses on how we would expect cultural dimensions to change in Spain with the transition to democracy.3) Review developments in accounting in Spain following the transition to democracy, in order to identify how well these fit with our hypotheses.

Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study.

OBJECTIVE: The primary aim of the study was to evaluate whether rheumatoid arthritis (RA) patients considered to be in remission according to clinical criteria sets still had persisting ultrasound (US) synovitis. We further intended to evaluate the capacity of our US score to discriminate between the patients with a clinically active disease versus those in remission. METHODS: This is an observational study nested within the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) rheumatoid arthritis cohort. A validated US score (SONAR score) based on a semi-quantitative B-mode and Doppler (PwD) score as part of the regular clinical workup by rheumatologists in different clinical settings was used. To define clinically relevant synovitis, the same score was applied to 38 healthy controls and the 90st percentile was used as cut-off for 'relevant' synovitis. RESULTS: Three hundred and seven patients had at least one US examination and concomitant clinical information on disease activity. More than a third of patients in both DAS28 and ACR/EULAR remission showed significant gray scale synovitis (P=0.01 and 0.0002, respectively) and PwD activity (P=0.005 and 0.0005, respectively) when compared to controls. The capacity of US to discriminate between the two clinical remission groups and patients with active disease was only moderate. CONCLUSION: This observational study confirms that many patients considered to be in clinical remission according the DAS and the ACR/EULAR definitions still have residual synovitis on US. The prognostic significance of US synovitis and the exact place of US in patients reaching clinical remission need to be further evaluated.

Adaptive dynamics and the implementation problem with complete information

This paper studies the equilibrating process of several implementationmechanisms using naive adaptive dynamics. We show that the dynamics convergeand are stable, for the canonical mechanism of implementation in Nash equilibrium.In this way we cast some doubt on the criticism of ``complexity'' commonlyused against this mechanism. For mechanisms that use more refined equilibrium concepts,the dynamics converge but are not stable. Some papers in the literatureon implementation with refined equilibrium concepts have claimed that themechanisms they propose are ``simple'' and implement ``everything'' (incontrast with the canonical mechanism). The fact that some of these ``simple''mechanisms have unstable equilibria suggests that these statements shouldbe interpreted with some caution.

Evaluación poblacional de Gari solida (Gray, 1828) en bahía Independencia-Pisco, junio 2010

En junio 2010, se efectuó la evaluación poblacional de almeja Gari solida en los principales bancos naturales de bahía Independencia: El Ancla, Pan de Azúcar y La Pampa para determinar su distribución, concentración, estructura por tamaños y magnitud poblacional. Los resultados evidenciaron una disminución de la biomasa y población, respecto a agosto del 2008, en 44,9% y 56,2%, respectivamente. La densidad por unidad de muestreo fluctuó entre 1 y 47 ind.m-2, las mayores densidades medias se encontraron en Pan de Azúcar (5,06 ind.m-2), La Pampa (2,42 ind.m-2) y menor densidad en El Ancla (0,57 ind.m-2). La biomasa total se calculó en 336,96 t (± 19,9%) y la población en 8,48 millones de individuos (± 19,85%), el 22,1% de la biomasa correspondió a ejemplares con tamaño mínimo de extracción (TME ≥75 mm). Las tallas de 792 ejemplares analizados fluctuaron entre 4 y 95 mm de longitud valvar, con moda en 65 mm y media en 57,5 mm. El rendimiento promedio del pie con respecto al peso total fue de 1: 9,5.

Microvascular burden and Alzheimer-type lesions across the age spectrum.

The occurrence of microvascular and small macrovascular lesions and Alzheimer's disease (AD)-related pathology in the aging human brain is a well-described phenomenon. Although there is a wide consensus about the relationship between macroscopic vascular lesions and incident dementia, the cognitive consequences of the progressive accumulation of these small vascular lesions in the human brain are still a matter of debate. Among the vast group of small vessel-related forms of ischemic brain injuries, the present review discusses the cognitive impact of cortical microinfarcts, subcortical gray matter and deep white matter lacunes, periventricular and diffuse white matter demyelinations, and focal or diffuse gliosis in old age. A special focus will be on the sub-types of microvascular lesions not detected by currently available neuroimaging studies in routine clinical settings. After providing a critical overview of in vivo data on white matter demyelinations and lacunes, we summarize the clinicopathological studies performed by our center in large cohorts of individuals with microvascular lesions and concomitant AD-related pathology across two age ranges (the younger old, 65-85 years old, versus the oldest old, nonagenarians and centenarians). In conjunction with other autopsy datasets, these observations fully support the idea that cortical microinfarcts are the only consistent determinant of cognitive decline across the entire spectrum from pure vascular cases to cases with combined vascular and AD lesion burden.

Low income, community poverty and risk of end stage renal disease

BACKGROUND: The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. METHODS: Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. RESULTS: There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years (105 py) in high poverty outlier counties and were 76.3 /105 py in affluent outlier counties, p trend = 0.06. In unadjusted competing risk models, persons residing in high poverty outlier counties had higher incidence of ESRD (which was not statistically significant) when compared to those persons residing in counties with neither high poverty nor affluence [hazard ratio (HR) 1.54, 95% Confidence Interval (CI) 0.75-3.20]. This association was markedly attenuated following adjustment for socio-demographic factors (age, sex, race, education, and income); HR 0.96, 95% CI 0.46-2.00. However, in the same adjusted model, income was independently associated with risk of ESRD [HR 3.75, 95% CI 1.62-8.64, comparing the < $20,000 income group to the > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. CONCLUSIONS: In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level.

Correlations between trabecular bone score, measured using anteroposterior dual-energy x-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae.

Developing a novel technique for the efficient, noninvasive clinical evaluation of bone microarchitecture remains both crucial and challenging. The trabecular bone score (TBS) is a new gray-level texture measurement that is applicable to dual-energy X-ray absorptiometry (DXA) images. Significant correlations between TBS and standard 3-dimensional (3D) parameters of bone microarchitecture have been obtained using a numerical simulation approach. The main objective of this study was to empirically evaluate such correlations in anteroposterior spine DXA images. Thirty dried human cadaver vertebrae were evaluated. Micro-computed tomography acquisitions of the bone pieces were obtained at an isotropic resolution of 93μm. Standard parameters of bone microarchitecture were evaluated in a defined region within the vertebral body, excluding cortical bone. The bone pieces were measured on a Prodigy DXA system (GE Medical-Lunar, Madison, WI), using a custom-made positioning device and experimental setup. Significant correlations were detected between TBS and 3D parameters of bone microarchitecture, mostly independent of any correlation between TBS and bone mineral density (BMD). The greatest correlation was between TBS and connectivity density, with TBS explaining roughly 67.2% of the variance. Based on multivariate linear regression modeling, we have established a model to allow for the interpretation of the relationship between TBS and 3D bone microarchitecture parameters. This model indicates that TBS adds greater value and power of differentiation between samples with similar BMDs but different bone microarchitectures. It has been shown that it is possible to estimate bone microarchitecture status derived from DXA imaging using TBS.

Plaque characteristics and arterial remodeling in coronary and peripheral arterial systems.

BACKGROUND: Few studies have examined plaque characteristics among multiple arterial beds in vivo. The purpose of this study was to compare the plaque morphology and arterial remodeling between coronary and peripheral arteries using gray-scale and radiofrequency intravascular ultrasound (IVUS) at clinical presentation. METHODS AND RESULTS: IVUS imaging was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac arteries). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P = NS) and VH-TCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; P = 0.02) were observed in all arteries. Compared with coronary arteries, VH-FA was less frequently observed in renal (P < 0.001) and iliac arteries (P < 0.006). Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary (84% vs. 25%, P < 0.001), carotid (72% vs. 20%, P = 0.001), and renal arteries (42% vs. 4%, P = 0.001) compared with those with intermediate/negative remodeling. There was positive relationship between remodeling index and percent necrotic area in all four arteries. CONCLUSIONS: Atherosclerotic plaque phenotypes were heterogeneous among four different arteries; renal and iliac arteries had more stable phenotypes compared with coronary artery. In contrast, the associations of remodeling pattern with plaque phenotype and composition were similar among the various arterial beds.

Dynamic properties of human brain structure: learning-related changes in cortical areas and associated fiber connections.

Recent findings in neuroscience suggest that adult brain structure changes in response to environmental alterations and skill learning. Whereas much is known about structural changes after intensive practice for several months, little is known about the effects of single practice sessions on macroscopic brain structure and about progressive (dynamic) morphological alterations relative to improved task proficiency during learning for several weeks. Using T1-weighted and diffusion tensor imaging in humans, we demonstrate significant gray matter volume increases in frontal and parietal brain areas following only two sessions of practice in a complex whole-body balancing task. Gray matter volume increase in the prefrontal cortex correlated positively with subject's performance improvements during a 6 week learning period. Furthermore, we found that microstructural changes of fractional anisotropy in corresponding white matter regions followed the same temporal dynamic in relation to task performance. The results make clear how marginal alterations in our ever changing environment affect adult brain structure and elucidate the interrelated reorganization in cortical areas and associated fiber connections in correlation with improvements in task performance.

Mirror me : the effect of the voting advice application smartvote on voting preferences and behavior of Swiss voters

Voting Advice Applications (VAAs) have become a central component of election campaigns worldwide. Through matching political preferences of voters to parties and candidates, the web application grants voters a look into their political mirror and reveals the most suitable political choices to them in terms of policy congruence. Both the dense and concise information on the electoral offer and the comparative nature of the application make VAAs an unprecedented information source for electoral decision making. In times where electoral choices are found to be highly individualized and driven by political issue positions, an ever increasing number of voters turn to VAAs before casting their ballots. With VAAs in high demand, the question of their effects on voters has become a pressing research topic. In various countries, survey research has been used to proclaim an impact of VAAs on electoral behavior, yet practically all studies fail to provide the scientific evidence that would allow for making such claims. In this thesis, I set out to systematically establish the causal link between VAA use and electoral behavior, using various data sources and appropriate statistical techniques in doing so. The focus lies on the Swiss VAA smartvote, introduced in the forefront of the 2003 Swiss federal elections and meanwhile an integral part of the national election campaign, smartvote has produced over a million voting recommendations in the last Swiss federal elections to an active electorate of two million, potentially guiding a vast amount of voters in their choices on the ballot. In order to determine the effect of the VAA on electoral behavior, I analyze both voting preferences and choice among Swiss voters during two consecutive election periods. First, I introduce statistical techniques to adequately examine VAA effects in observational studies and use them to demonstrate that voters who used smartvote prior to the 2007 Swiss federal elections were significantly more likely to swing vote in the elections than non- users. Second, I analyze preference voting during the same election and show that the smartvote voting recommendation inclines politically knowledgeable voters to modify their ballots and cast candidate specific preference votes. Third, to further tackle the indication that smartvote use affects the preference structure of voters, I employ an experimental research design to demonstrate that voters who use the application tend to strengthen their vote propensities for their most preferred party and adapt their overall party preferences in a way that they consider more than one party as eligible vote options after engaging with the application. Finally, vote choice is examined for the 2011 Swiss federal election, showing once more that the VAA initiated a change of party choice among voters. In sum, this thesis presents empirical evidence for the transformative effect of the Swiss VAA smartvote on the electoral behavior.

Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing.

OBJECTIVE: To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing. SUBJECTS AND METHODS: Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast. RESULTS: Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting. CONCLUSION: Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.

Genesis and classification of Oxisols in a highland toposequence of the upper Jequitinhonha Valley (MG)

The Brazilian System of Soil Classification (SiBCS) is a taxonomic system, open and in permanent construction, as new knowledge on Brazilian soils is obtained. The objective of this study was to characterize the chemical, physical, morphological, micro-morphological and mineralogical properties of four pedons of Oxisols in a highland toposequence in the upper Jequitinhonha Valley, emphasizing aspects of their genesis, classification and landscape development. The pedons occupy the following slope positions: summit - Red Oxisol (LV), mid slope (upper third) - Yellow-Red Oxisol (LVA), lower slope (middle third)- Yellow Oxisol (LA) and bottom of the valley (lowest third) - "Gray Oxisol" ("LAC"). These pedons were described and sampled for characterization in chemical and physical routine analyses. The total Fe, Al and Mn contents were determined by sulfuric attack and the Fe, Al and Mn oxides in dithionite-citrate-bicarbonate and oxalate extraction. The mineralogy of silicate clays was identified by X ray diffraction and the Fe oxides were detected by differential X ray diffraction. Total Ti, Ga and Zr contents were determined by X ray fluorescence spectrometry. The "LAC" is gray-colored and contains significant fragments of structure units in the form of a dense paste, characteristic of a gleysoil, in the horizons A and BA. All pedons are very clayey, dystrophic and have low contents of available P and a pH of around 5. The soil color was related to the Fe oxide content, which decreased along the slope. The decrease of crystalline and low- crystalline Fe along the slope confirmed the loss of Fe from the "LAC". Total Si increased along the slope and total Al remained constant. The clay fraction in all pedons was dominated by kaolinite and gibbsite. Hematite and goethite were identified in LV, low-intensity hematite and goethite in LVA, goethite in LA. In the "LAC", no hematite peaks and goethite were detected by differential X ray diffraction. The micro-morphology indicated prevalence of granular microstructure and porosity with complex stacking patterns.. The soil properties in the toposequence converged to a single soil class, the Oxisols, derived from the same source material. The landscape evolution and genesis of Oxisols of the highlands in the upper Jequitinhonha Valley are related to the evolution of the drainage system and the activity of excavating fauna.

Genetic association tests: a method for the joint analysis of family and case-control data.

With the trend in molecular epidemiology towards both genome-wide association studies and complex modelling, the need for large sample sizes to detect small effects and to allow for the estimation of many parameters within a model continues to increase. Unfortunately, most methods of association analysis have been restricted to either a family-based or a case-control design, resulting in the lack of synthesis of data from multiple studies. Transmission disequilibrium-type methods for detecting linkage disequilibrium from family data were developed as an effective way of preventing the detection of association due to population stratification. Because these methods condition on parental genotype, however, they have precluded the joint analysis of family and case-control data, although methods for case-control data may not protect against population stratification and do not allow for familial correlations. We present here an extension of a family-based association analysis method for continuous traits that will simultaneously test for, and if necessary control for, population stratification. We further extend this method to analyse binary traits (and therefore family and case-control data together) and accurately to estimate genetic effects in the population, even when using an ascertained family sample. Finally, we present the power of this binary extension for both family-only and joint family and case-control data, and demonstrate the accuracy of the association parameter and variance components in an ascertained family sample.

Highlands of the upper Jequitinhonha valley, Brazil: I - characterization and classification

In the upper Jequitinhonha valley, state of Minas Gerais, Brazi, there are large plane areas known as "chapadas", which are separated by areas dissected by tributaries of the Jequitinhonha and Araçuaí rivers. These dissected areas have a surface drainage system with tree, shrub, and grass vegetation, more commonly known as "veredas", i.e., palm swamps. The main purpose of this study was to characterize soil physical, chemical and morphological properties of a representative toposequence in the watershed of the Vereda Lagoa do Leandro, a swamp near Minas Novas, MG, on "chapadas", the highlands of the Alto Jequitinhonha region Different soil types are observed in the landscape: at the top - Typic Haplustox (LVA), in the middle slope - Xanthic Haplustox (LA), at the footslope - Xanthic Haplustox, gray color, here called "Gray Haplustox" ("LAC") and, at the bottom of the palm swamp - Typic Albaquult (GXbd). These soils were first morphologically described; samples of disturbed and undisturbed soils were collected from all horizons and subhorizons, to evaluate their essential physical and chemical properties, by means of standard determination of Fe, Al, Mn, Ti and Si oxides after sulfuric extraction. The contents of Fe, Al and Mn, extracted with dithionite-citrate-bicarbonate and oxalate treatments, were also determined. In the well-drained soils of the slope positions, the typical morphological, physical and chemical properties of Oxisols were found. The GXbd sample, from the bottom of the palm swamp, is grayish and has high texture gradient (B/A) and massive structure. The reduction of the proportion of crystalline iron compounds and the low crystallinity along the slope confirmed the loss of iron during pedogenesis, which is reflected in the current soil color. The Si and Al contents were lowest in the "LAC" soil. There was a decrease of the Fe2O3/TiO2 ratio downhill, indicating progressive drainage restriction along the toposequence. The genesis and all physical and chemical properties of the soils at the footslope and the bottom of the palm swamp of the "chapadas" of the Alto Jequitinhonha region are strongly influenced by the occurrence of ground water on the surface or near the surface all year long, at present and/or in the past. Total concentrations of iron oxides, Fe d and Fe o in soils of the toposequence studied are related to the past and/or present soil colors and drainage conditions.