Tibio-talar arthrodesis with long anterograde nail after complex open fracture-dislocation of the ankle : P17

Introduction: Posttraumatic painful osteoarthritis of the ankle joint after fracture-dislocation often has to be treated with arthrodesis. In the presence of major soft tissue lesions and important bone loss the technique to achieve arthrodesis has to be well chosen in order to prevent hardware failure, infection of bulky implants or non-union. Methods: We present the case of a 53 year-old biker suffering of a fracture-dislocation of the ankle associated with a mayor degloving injury of the heel. After initial immobilization of the lesion by external fixation in Spain the patient was transferred to our hospital for further treatment. The degloving injury of the heel with MRSA infection was initially treated by repeated débridement, changing of the configuration of the Ex Fix and antibiotic therapy with favourable outcome. Because of the bony lesions reconstruction of the ankle-joint was juged not to be an option and arthrodesis was planned. Due to bad soft-tissue situation standard open fixtion with plate and/or screws was not wanted but an option for intramedullary nailing was taken. However the use of a standard retrograde arthrodesis nail comes with two problems: 1) Risk of infection of the heel-part of the calaneus/nail in an unstable soft tissue situation with protruding nail. And 2) talo-calcaneal arthrodesis of an initially healthy subtalar joint. Given the situation of an unstable plantar/heel flap it was decided to perform anklearthrodesis by means of an anterograde nail with static fixation in the talus and in the proximal tibia. Results:This operation was performed with minimal opening at the ankle-site in order to remove the remaining cartilage and improve direct bone to bone contact. Arthrodesis was achieved by means of an anterograde T2 Stryker tibial nail.One year after the anterograde nailing the patient walks without pain for up to 4 hours with a heel of good quality and arthrodesis is achieved. Conclusion: Tibiotalar arthrodesis in the presence of mayor soft tissue lesions and bone loss can be successfully achieved with antegrade nailing.

Descripció de la tipologia d'usuaris derivats al servei de Teràpia Ocupacional Domiciliària a la comarca d'Osona: estudi descriptiu preliminar

Introducció Aquest treball, aborda l'atenció domiciliaria a les persones amb dependència des de la perspectiva de la teràpia ocupacional a la comarca d’Osona. Conèixer aquesta tipologia de persones i la seva problemàtica, ha de servir per adaptar les infraestructures d’aquests serveis a fi de donar millor resposta a les seves necessitats. Objectiu Descriure la tipologia d'usuaris que es deriven al servei de Teràpia Ocupacional Domiciliària a la comarca d'Osona Metodologia S'ha realitzat un estudi descriptiu preliminar d'una mostra (n=65) de usuaris de la base de dades del Banc D'ajudes Tècniques (BAT Osona) del Consell Comarcal d'Osona. En aquest estudi s'han analitzat les variables de sexe, edat, nivell funcional, diagnòstic, situació familiar, agents derivadors, motius de derivació i problemàtica principal detectada. Resultats S'indica un perfil femení de la mostra (72,09%), amb una mitjana d'edat de 74,41 anys. A nivell funcional, la mitjana de puntuació ha estat de 65 punts en l'Ìndex de Barthel, en persones amb patologia osteoarticular en el 18,60% dels casos. La situació familiar situa un perfil compartit de persones que viuen en família (41,86%) o soles (39,53%). En les derivacions al servei, el 58,13% dels casos es fa des dels Ajuntaments i per dificultats en el quarto de bany (46,51%). La problemàtica més detectada en aquests domicilis és la dificultat per l'accés a la banyera (67,40%). Conclusió Aquests resultats ens indiquen una clara tipologia de persones que s’han d’atendre i unes problemàtiques en la seva vivenda que provoquen serioses dificultats de desenvolupament funciona. Es precís, en futures investigacions acotar encara més aquets perfils i problemàtiques a fi de precisar les estratègies d’intervenció i optimitzar millor aquest tipus de recursos.

Chirurgie viscérate chez le patient greffé ou en attente d'une transplantation [Visceral surgery in organ transplant recipients or in patients awaiting transplantation]

Patients receiving immunosuppression are at higher risk for gastrointestinal complications: mortality is high if they are not diagnosed and treated rapidly. Systematic screening for cholelithiasis or diverticular disease, and prophylactic surgery, are not recommended systematically anymore. Patients awaiting a transplant with abdominal symptoms should be investigated without delay and surgery, if indicated and whenever possible based on the anaesthetic evaluation, should be performed. In the transplant population, a high degree of suspicion must be raised in case of any abdominal symptom. Radiological investigations and surgery without delay are often the only ways to preserve the function of the graft and optimize the patient's survival.

Mentoría para fomentar el éxito socioeducativo de jóvenes peruanos residentes en Barcelona

El programa de mentoría propuesto, toma como punto de partida la actual situación académica y social de jóvenes peruanos residentes en Barcelona y cercanías. Diversos estudios señalan la existencia de un alto índice de abandono escolar en Catalunya, así como un bajo rendimiento escolar que afecta principalmente a estudiantes extranjeros. El objetivo general es fomentar y optimizar la adecuada escolarización de jóvenes peruanos de entre 12 y 20 años. A través de procesos de mentoría y voluntariado se pretenden mejorar sus competencias escolares y sociales favoreciendo la creación de modelos de referencia positivos para los jóvenes en riesgo, así como espacios de aprendizaje, intercambio y acercamiento que fomenten la integración y la cohesión social entre las comunidades extranjera y autóctona. Para la realización del programa se prevé optimizar los recursos ya existentes, como los puntos de información juvenil y los centros de Asesoramiento Académica para jóvenes (CAAJ) y por otro lado se cuenta con la colaboración del Consulado General del Perú en Barcelona y de la escuela Virolai de Barcelona

Multiway Array Decomposition Analysis of EEGs in Alzheimer’s Disease

Methods for the extraction of features from physiological datasets are growing needs as clinical investigations of Alzheimer’s disease (AD) in large and heterogeneous population increase. General tools allowing diagnostic regardless of recording sites, such as different hospitals, are essential and if combined to inexpensive non-invasive methods could critically improve mass screening of subjects with AD. In this study, we applied three state of the art multiway array decomposition (MAD) methods to extract features from electroencephalograms (EEGs) of AD patients obtained from multiple sites. In comparison to MAD, spectral-spatial average filter (SSFs) of control and AD subjects were used as well as a common blind source separation method, algorithm for multiple unknown signal extraction (AMUSE). We trained a feed-forward multilayer perceptron (MLP) to validate and optimize AD classification from two independent databases. Using a third EEG dataset, we demonstrated that features extracted from MAD outperformed features obtained from SSFs AMUSE in terms of root mean squared error (RMSE) and reaching up to 100% of accuracy in test condition. We propose that MAD maybe a useful tool to extract features for AD diagnosis offering great generalization across multi-site databases and opening doors to the discovery of new characterization of the disease.

Disseny d'un sistema de control del consum d'aigua automàtic

Avui en dia s’ha convertit en una necessitat tenir cura del medi ambient i optimitzar els recursos naturals. En el camp per estalviar energia s’han fet grans progressos i disposem d’un gran ventall de dispositius que ens ajuden i ens faciliten l’optimització del consum d’energia. Però és una realitat que en l’estalvi del consum d’aigua el progrés ha estat molt menor i es limita molt a donar consells i repartir dosificadors d’aigua. Qui no ha vist carrers o jardins o cases inundades amb milers de litres d’aigua? Aquesta realitat m’ha portat a dissenyar i desenvolupar un prototip que em permeti tenir un millor control del consum d’aigua. El prototip, a trets principals, consta d’un sensor, una electrovàlvula i una placa Arduino Atmega. El sensor ens permet mesurar els litres consumits durant un cert període de temps. Passat aquest temps de mostreig es compara els litres consumits amb el consum habitual, en aquell període de temps. En cas de sobrepassar el volum programat es tancarà l’electrovàlvula de forma automàtica i rebrem un SMS al telèfon. L’activació de l’alarma es pot ajustar que sigui al igualar-se els dos valors, litres programats i litres consumits. També es pot programar el percentatge que cal sobrepassar de litres consumits per activar l’alarma, com el temps de mostreig. El fet de poder programar tots aquests valors ens permet fer un ajust ideal per a la instal·lació que es vol tenir controlada. A més, el prototip es pot utilitzar per enviar a la companyia d’aigua el valor del comptador de forma automàtica. D’aquesta forma la companyia d’aigua també optimitza recursos estalviant-se el desplaçament de personal a la instal·lació per fer la lectura corresponent. El prototip està basat amb un Arduino Atmega que ens permet el processament de les dades programades i capturades pel sensor. També s’ha incorporat una pantalla TFT Touch 2’8”, que permet visualitzar i programar els valors d’una forma molt més intuïtiva. Per enviar els SMS s’utilitza una placa d’Arduino Cel·lular Shield - SM5100B, a la qual només cal afegir una targeta SIM. A priori, el prototip té un elevat cost al fabricar una sola unitat i pot semblar poc útil. Però ens pot estalviar alguna sorpresa en les factures d’aigua si tenim una fuita i no ens n’adonem fins a veure el rebut de la companyia. Si es fabriqués a grans quantitats es podria abaratir el preu i fer-lo encara més engrescador.

Screening of the inhibitory effect of xenobiotics on alcohol metabolism using S9 rat liver fractions.

The purpose of this work was to develop and optimize a simple and suitable method to detect the potential inhibitory effect of drugs and medicines on alcohol dehydrogenase (ADH) activity in order to evaluate the possible interactions between medicines and alcohol metabolism. Commonly used medicines that are often involved in court litigations related with driving under the influence of alcohol were selected. Alprazolam, flunitrazepam and tramadol were tested as drugs with no known effect on ADH activity. Cimetidine, reported previously as having inhibitory effect on ADH, and 4-methylpyrazole (4-MP), a well known ADH inhibitor, were tested as positive controls. Apart from 4-MP, tramadol was identified as having the higher inhibitory effect with an IC50 of 44.7×10(-3)mM, followed by cimetidine (IC50 of 122.9×10(-3)mM). Alprazolam and flunitrazepam also reduced liver ADH activity but to a smaller extent (inhibition of 11.8±5.0% for alprazolam 1.0mM and 34.5±7.1% for flunitrazepam 0.04mM). Apart from cimetidine, this is the first report describing the inhibitory effect of these drugs on ethanol metabolism. The results also show the suitability of the method to screen for inhibitory effect of drugs on ethanol metabolism helping to identify drugs for which further study is justified.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Pla de gestió de senglars (Sus scrofa) en zones altament antropitzades. Parc Natural de la Serra de Collserola

By studying documents that define the species, as management experiences in Spain and the rest of the world, we have designed a new management plan. This Plan incorporates guidelines for cooperation and networking, as the newest techniques and technologies in the field of wildlife management. During this project, has highlighted the need for a protocol to monitor the effects caused by the animals, in order to define and optimize the actions and resources to use.

Early prediction of response to sunitinib after imatinib failure by 18F-fluorodeoxyglucose positron emission tomography in patients with gastrointestinal stromal tumor.

PURPOSE: Positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) was used to evaluate treatment response in patients with gastrointestinal stromal tumors (GIST) after administration of sunitinib, a multitargeted tyrosine kinase inhibitor, after imatinib failure. PATIENTS AND METHODS: Tumor metabolism was assessed with FDG-PET before and after the first 4 weeks of sunitinib therapy in 23 patients who received one to 12 cycles of sunitinib therapy (4 weeks of 50 mg/d, 2 weeks off). Treatment response was expressed as the percent change in maximal standardized uptake values (SUV). The primary end point of time to tumor progression was compared with early PET results on the basis of traditional Response Evaluation Criteria in Solid Tumors (RECIST) criteria. RESULTS: Progression-free survival (PFS) was correlated with early FDG-PET metabolic response (P < .0001). Using -25% and +25% thresholds for SUV variations from baseline, early FDG-PET response was stratified in metabolic partial response, metabolically stable disease, or metabolically progressive disease; median PFS rates were 29, 16, and 4 weeks, respectively. Similarly, when a single FDG-PET positive/negative was considered after 4 weeks of sunitinib, the median PFS was 29 weeks for SUVs less than 8 g/mL versus 4 weeks for SUVs of 8 g/mL or greater (P < .0001). None of the patients with metabolically progressive disease subsequently responded according to RECIST criteria. Multivariate analysis showed shorter PFS in patients who had higher residual SUVs (P < .0001), primary resistance to imatinib (P = .024), or nongastric GIST (P = .002), regardless of the mutational status of the KIT and PDGFRA genes. CONCLUSION: Week 4 FDG-PET is useful for early assessment of treatment response and for the prediction of clinical outcome. Thus, it offers opportunities to individualize and optimize patient therapy.

Testing of Vacuum Drum Filter

Tämän diplomityön tavoitteena oli testata ja optimoida erään alipainerumpusuodattimen toimivuutta, ja lisäksi maksimoida tuottavuus ja vertailla erilaisten pesumenetelmientehokkuutta. Testilietteiden ¿ rautarikasteen ja täyteainepastan ¿ karakterisointi oli myös tärkeää. Kirjallisuusosassa tarkasteltiin lyhyesti neste-kiintoaine-erotuksen teoriaa, erityisesti alipainesuodatusta ja alipainerumpusuodattimia. Lisäksi käsiteltiin kapillaarisuodatuksen toimintaperiaatteita sekä selvitettiin kaivosteollisuuden veden talteenottokeinoja, kiintoainejäämien käsittelymenetelmiä ja Chilen kaivosteollisuuden nykytilaa. Työn kokeellinen osa suoritettiin käyttämällä raskaita ja kiintoainepitoisuuksiltaan korkeita lietteitä, eli rautarikastetta ja täyteainepastaa. Kokeet suoritettiin erityisellä alipainerumpusuodattimella, joka oli muokattu perinteisestäpäältä syötettävästä alipainerumpusuodattimesta. Kokeissa tutkittiin pyörimisnopeuden ja erilaisten pesumenetelmien vaikutusta kakun kosteuteen ja suodatuskapasiteettiin. Koelietteiden karakterisointi suoritettiin analysoimalla partikkelikokojakauma, kiintoainepitoisuus, metallipitoisuus ja koostumus. Kokeiden perusteella havaittiin, että rummun pyörimisnopeudella ja lietteen kiintoainepitoisuudella on merkittävä vaikutus suodatuskapasiteettiin ja kakun kosteuspitoisuuteen. Havaittiin myös, että kakun kosteuspitoisuuksissa ja rummun suodatuskapasiteeteissa oli eroja, kun verrattiin eri suodatinväliaineen pesumenetelmiä. Täten oikean pesumenetelmän valinta on tärkeää, ja sillä pystytään lisäämään suodatinväliaineen käyttöikää.

Saccharomyces cerevisiae as a model organism: a comparative study

Background: Model organisms are used for research because they provide a framework on which to develop and optimize methods that facilitate and standardize analysis. Such organisms should be representative of the living beings for which they are to serve as proxy. However, in practice, a model organism is often selected ad hoc, and without considering its representativeness, because a systematic and rational method to include this consideration in the selection process is still lacking. Methodology/Principal Findings: In this work we propose such a method and apply it in a pilot study of strengths and limitations of Saccharomyces cerevisiae as a model organism. The method relies on the functional classification of proteins into different biological pathways and processes and on full proteome comparisons between the putative model organism and other organisms for which we would like to extrapolate results. Here we compare S. cerevisiae to 704 other organisms from various phyla. For each organism, our results identify the pathways and processes for which S. cerevisiae is predicted to be a good model to extrapolate from. We find that animals in general and Homo sapiens in particular are some of the non-fungal organisms for which S. cerevisiae is likely to be a good model in which to study a significant fraction of common biological processes. We validate our approach by correctly predicting which organisms are phenotypically more distant from S. cerevisiae with respect to several different biological processes. Conclusions/Significance: The method we propose could be used to choose appropriate substitute model organisms for the study of biological processes in other species that are harder to study. For example, one could identify appropriate models to study either pathologies in humans or specific biological processes in species with a long development time, such as plants.

Optimizing the Testing Process in Module Testing – Functional Testing Interface

Today's business environment has become increasingly unexpected and fast changing because of the global competition. This new environment requires the companies to organize their control differently, e.g. by logistic process thinking. Logistic process thinking in software engineering applies the principles of production process to immaterial products. Processes must be optimized, so that every phase adds value to the customer, and the lead times can be cut shorter to meet the new customer requirements. The purpose of this thesis is to examine and optimize the testing processes of software engineering concentrating on module testing, functional testing and their interface. The concept of logistic process thinking is introduced through production process, value added model and process management. Also theory of testing based on literature is presented, concentrating on module testing and functional testing. The testing processes of the Case Company are presented together with the project models in which they are implemented. The real life practices in module testing and functional testing and their interface are examined through interviews. These practices are analyzed against the processes and the testing theory, through which ideas for optimizing the testing process are introduced. The project world of the Case Company is also introduced together with two example testing projects in different life cycle phases. The examples give a view of how much effort of the project is put in different types of testing.

Hepatocyte nuclear factor 4alpha transactivates the mitochondrial alanine aminotransferase gene in the kidney of Sparus aurata

Alanine aminotransferase (ALT) plays an important role in amino acid metabolism and gluconeogenesis. The preference of carnivorous fish for protein amino acids instead of carbohydrates as a source of energy lead us to study the transcriptional regulation of the mitochondrial ALT (mALT) gene and to characterize the enzyme kinetics and modulation of mALT expression in the kidney of gilthead sea bream (Sparus aurata) under different nutritional and hormonal conditions. 5′-Deletion analysis of mALT promoter in transiently transfected HEK293 cells, site-directed mutagenesis and electrophoretic mobility shift assays allowed us to identify HNF4α as a new factor involved in the transcriptional regulation of mALT expression. Quantitative RT-PCR assays showed that starvation and the administration of streptozotocin (STZ) decreased HNF4α levels in the kidney of S. aurata, leading to the downregulation of mALT transcription. Analysis of the tissue distribution showed that kidney, liver, and intestine were the tissues with higher mALT and HNF4α expression. Kinetic analysis indicates that mALT enzyme is more efficient in catalyzing the conversion of L-alanine to pyruvate than the reverse reaction. From these results, we conclude that HNF4α transactivates the mALT promoter and that the low levels of mALT expression found in the kidney of starved and STZ-treated fish result from a decreased expression of HNF4α. Our findings suggest that the mALT isoenzyme plays a major role in oxidazing dietary amino acids, and points to ALT as a target for a biotechnological action to spare protein and optimize the use of dietary nutrients for fish culture.

Anthropomorphic model observer performance in three-dimensional detection task for low-contrast computed tomography.

X-ray medical imaging is increasingly becoming three-dimensional (3-D). The dose to the population and its management are of special concern in computed tomography (CT). Task-based methods with model observers to assess the dose-image quality trade-off are promising tools, but they still need to be validated for real volumetric images. The purpose of the present work is to evaluate anthropomorphic model observers in 3-D detection tasks for low-contrast CT images. We scanned a low-contrast phantom containing four types of signals at three dose levels and used two reconstruction algorithms. We implemented a multislice model observer based on the channelized Hotelling observer (msCHO) with anthropomorphic channels and investigated different internal noise methods. We found a good correlation for all tested model observers. These results suggest that the msCHO can be used as a relevant task-based method to evaluate low-contrast detection for CT and optimize scan protocols to lower dose in an efficient way.