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e location, implant choice, or presence of metabolic abnormality. No complications were reported. Time to full weight bearing was not dependent on implant choice. However, restricted weight bearing beyond 8 weeks can lead to prolonged healing times. Fixation should be safe, effective and promote early weight bearing and mobilization.An entry point medial to the tip of the greater trochanter is considered optimal for antegrade femur nailing. The deforming forces in a subtrochanteric fracture often make it difficult to establish a perfect entry point during antegrade cephalomedullary nailing. To overcome this problem, we report a simple technique of making a retrograde entry portal for select difficult subtrochanteric fractures. The technique was used in 12 subtrochanteric fractures. Our indications were morbid obesity, revision nailing and atypical fractures. The technique involves creating a nail entry portal through the fracture from distal to proximal taking advantage of the abducted proximal fragment. Fracture reduction and nail insertion then proceeds in a standard manner. Additional reaming of the thick endosteal lateral cortex through the fracture was performed in atypical fractures. CID44216842 solubility dmso Satisfactory fracture reduction was achieved in all patients and 11 out of the 12 fractures united in the series. 1 patient developed an infected nonunion and was considered failure of treatment. The retrograde entry portal is a valuable alternative method that can be considered in nailing of difficult subtrochanteric fractures to establish an ideal entry point and nail trajectory.

In nephrotic syndrome, increased podocyturia accompanies pathologic proteinuria. The therapeutic regimen with enalapril, losartan and amiloride could reduce both variables.

Evaluate the anti-proteinuric effect of 2 non-immunological therapeutic regimens, the quantitative relationship between podocyturia and proteinuria.

We included children aged 4 to 12 years with corticoresistant nephrotic syndrome, using 2 different schemes group A, enalapril+losartan, and group B, enalapril+losartan+amiloride.

In group A, 17 patients completed the study, the initial mean proteinuria was 39mg/m

/h and mean proteinuria at the end was 24mg/m

/h, while in group B 14 patients were treated and the initial average proteinuria was 36mg/m

/h and the end average proteinuria was 13mg/m

/h. The paired T test showed significant differences in the decrease in proteinuria, for patients in group B without variation in podocyturia. The 2 factors associated with an increase in proteinuria were podocyturia and the time elapsed from the diagnosis of cortico-resistant nephrotic syndrome to the start of treatment anti-proteinuric.

The use of amiloride decreased proteinuria, without significantly modifying podocyturia; we did not observe a positive relationship between both variables.

The use of amiloride decreased proteinuria, without significantly modifying podocyturia; we did not observe a positive relationship between both variables.This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.Licensed independent practitioners in emergency clinical practice are tasked with differentiating acute cardiac presentations. Despite its similarity in clinical presentation to acute coronary syndrome, Takotsubo cardiomyopathy is a unique cardiac disorder characterized by a stress-induced ballooning of the myocardium. Also known as the broken heart syndrome, Takotsubo cardiomyopathy most frequently occurs after an overwhelming emotional or physical stressor. The subsequent impaired contractility of the heart places the patient at risk of complications, including acute heart failure, cardiogenic shock, thromboembolism, arrhythmias, and left ventricular outflow obstruction. Takotsubo cardiomyopathy is similar in presentation to other cardiac disorders; therefore, clinicians in emergency settings must be efficient and effective in their diagnosis of this disorder on the basis of its distinct criteria. The current article uses most recent evidence to describe the etiology, pathophysiology, diagnosis, and recommended treatment for Takotsubo cardiomyopathy to support licensed independent practitioners in emergency departments in improving patient outcomes and reducing morbidity.

To investigate the tensile and flexural strength of poured, subtractive, and additive manufactured denture base methacrylates bonded to soft and hard relining materials after hydrothermal cycling and microwave irradiation.

This study included a conventional (CB), subtractive (SB), and additive (AB) base material as well as a soft (SCR) and hard (HCR) chairside and one hard laboratory-side (HLR) relining material. Reference bodies of the base materials and bonded specimens to the relining materials were produced with a rectangular cross-section. The specimens were either pre-treated by water storage (50 h, 37 °C), hydrothermal cycling (5000 cycles, 5 °C and 55 °C, 30 s each), or microwave irradiation (6 cycles, 640 W, 3 min, wet). A tensile and four-point bending test were performed for a total of 504 specimens. Data were analysed using multivariate analysis of variance (MANOVA) with post-hoc Tukey tests (α = 0.05).

In comparison with the other reference groups SB showed marginally higher tensile and flexural strength (p < 0.047). Bond strength to SCR was affected neither by the base material nor by the pre-treatment (p > 0.085). HCR demonstrated twice the bond strength to AB compared with SB and CB (p ≤ 0.001). HLR showed the highest bond strength to CB (p ≤ 0.001). There was no difference between the specimens after hydrothermally cycling and microwave irradiation (p > 0.318).

The bond strength of hard relining materials to subtractive and additive manufactured denture bases differ compared with conventional pouring.

The bond strength of hard relining materials to subtractive and additive manufactured denture bases differ compared with conventional pouring.