Efectividad del uso de seating de posicionamiento en niños con parálisis cerebral discinética: revisión sistemática / Effectiveness of the use of seating devices in children with dyskinetic cerebral palsy: a systematic reviewx

Introduction: To assess the effectiveness of seating devices during the sitting position on postural stability and upper limb functionality in users with dyskinetic type cerebral palsy. Method: A systematic review that included randomized, quasi-randomized, cohort, and pre-post intervention clinical trials with evaluation before and after the intervention. This review included studies of chil-dren with a diagnosis of cerebral palsy, mainly of the dyskinetic type, with ages between 2 and 10 years old. The databases of CINAHL Plus, Cochrane (Central), EMBASE (Via Ovid), Virtual Health Library, OT Seeker, Medline (Via PubMed) and OpenGrey were used. Results: Two studies met the inclusion criteria; however, the analysis was carried out qualitatively due to the methodological quality for these, with presence of a high risk of bias. The study by Cimolin described greater trunk stability and smooth upper extremity movements with the use of a dynamically configured seat. Nwaobi described better upper extre-mity functionality in a seat inclined at 0º and 30º, not referring to trunk stability. Conclusion: From the review of the results it is concluded that there is not enough scientific evidence to determine that the use of seating devices favors the postural control and the functionality of upper extremities in children with cerebral dyskinesia type cerebral palsy.

Introducción: Evaluar la eficacia del posicionamiento sedente en la estabilidad postural y funcionalidad de extremidades superiores, en ni-ños con parálisis cerebral discinética, comparando el uso y el no uso de seating de posicionamiento. Método: Revisión siste-mática incluyendo ensayos clínicos de tipo aleatorio, cuasialeatorizado, de cohorte y casos con evaluación antes y después de la intervención. Se incluyó niños con parálisis cerebral discinético, entre 2 y 10 años de edad. Se utilizó bases de datos de CI-NAHL Plus, Cochrane (Central), EMBASE (Vía Ovid), Biblioteca Virtual de la Salud, OT Seeker, Medline (Via PubMed) y Open Grey. Resultados: Dos estudios cumplieron criterios de inclusión, aunque el análisis se realizó de forma cualitativa por la calidad metodológica de estos. Cimolin detectó mayor estabilidad de tronco y suavidad en los movimientos de extremidades superiores con el uso de un asiento de configuración dinámica. Nwaobi describió mejor funcionalidad de extremidad superior en un asiento inclinado a 0º y 30º, no haciendo referencia a la estabilidad de tronco. Conclusión: De la revisión de los resulta-dos, se concluye que no existe evidencia científica suficiente que determine que el uso de seating favorezca o no el control postural y la funcionalidad de extremidades superiores en niños y jóvenes con parálisis cerebral de tipo discinética.

Posttransplant oxygen inhalation improves the outcome of subcutaneous islet transplantation: A promising clinical alternative to the conventional intrahepatic site.

Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-basic fibroblast growth factor. Administration of 50% oxygen increased oxygen tension in the subcutaneous site to 140 mm Hg, compared to 45 mm Hg under ambient air. In vitro, islets cultured under 140 mm Hg oxygen showed reduced central necrosis and increased insulin release, compared to those maintained in 45 mm Hg oxygen. Six hundred syngeneic islets subcutaneously transplanted into the prevascularized graft bed reversed diabetes when combined with postoperative 50% oxygen inhalation for 3 days, a number comparable to that required for intrahepatic transplantation; in the absence of oxygen treatment, diabetes was not reversed. Thus, we show oxygen inhalation to be a simple and promising approach to successfully establishing subcutaneous islet transplantation.

SFPQ associates to LSD1 and regulates the migration of newborn pyramidal neurons in the developing cerebral cortex.

The development of the cerebral cortex requires the coordination of multiple processes ranging from the proliferation of progenitors to the migration and establishment of connectivity of the newborn neurons. Epigenetic regulation carried out by the COREST/LSD1 complex has been identified as a mechanism that regulates the development of pyramidal neurons of the cerebral cortex. We now identify the association of the multifunctional RNA-binding protein SFPQ to LSD1 during the development of the cerebral cortex. In vivo reduction of SFPQ dosage by in utero electroporation of a shRNA results in impaired radial migration of newborn pyramidal neurons, in a similar way to that observed when COREST or LSD1 expressions are decreased. Diminished SFPQ expression also associates to decreased proliferation of progenitor cells, while it does not affect the acquisition of neuronal fate. These results are compatible with the idea that SFPQ, plays an important role regulating proliferation and migration during the development of the cerebral cortex.

[Anterior knee pain in knee arthroplasty with or without a patellar component]. / Dolor anterior de rodilla en pacientes operados de artroplastía de rodilla con o sin remplazo del componente patelar.

INTRODUCTION: The appearance of patellofemoral pain after a knee arthroplasty, particularly in rheumatic diseases, resulted in the incorporation of the substitution of the patellar component in all designs. The replacement of the patella became a standard part of knee arthroplasty, but the controversy over whether to restore it or not continues among orthopedists that perform knee arthroplasties. OBJECTIVE: To analyze the incidence of anterior knee pain in patients who underwent primary knee arthroplasty with or without replacement of the patellar component. MATERIAL AND METHODS: Observational, retrospective, descriptive and transversal study from January 2011 to December 2013. RESULTS: A total of 54 patients were included, 12 men (with an average age of 63 years) and 42 women (with an average age of 71 years), totaling 64 knees that were surgically intervened. CONCLUSION: This study found no significant difference in anterior knee pain and in the function of the patellofemoral joint and the knee in the groups of patients who were tested with the different scales.

La aparición de dolor patelofemoral postoperatorio en la artroplastía de rodilla, sobre todo en pacientes reumáticos, resultó en la incorporación de la sustitución del componente patelar en la mayoría de los diseños. Esta se convirtió en una parte estándar de la artroplastía total de rodilla; la controversia sobre si restituir o no el componente patelar continúa siendo debatida por los cirujanos ortopedistas que realizan artroplastías de rodilla.

Dolor anterior de rodilla en pacientes operados de artroplastía de rodilla con o sin remplazo del componente patelar / Anterior knee pain in knee arthroplasty with or without a patellar component

Resumen: Introducción: La aparición de dolor patelofemoral postoperatorio en la artroplastía de rodilla, sobre todo en pacientes reumáticos, resultó en la incorporación de la sustitución del componente patelar en la mayoría de los diseños. Esta se convirtió en una parte estándar de la artroplastía total de rodilla; la controversia sobre si restituir o no el componente patelar continúa siendo debatida por los cirujanos ortopedistas que realizan artroplastías de rodilla. Objetivo: Realizar un análisis de la incidencia de dolor anterior de rodilla en pacientes sometidos a artroplastía primaria de rodilla con o sin remplazo del componente patelar. Material y métodos: Estudio observacional, retrospectivo, descriptivo y transversal de Enero de 2011 a Diciembre de 2013. Resultados: 54 individuos, 12 hombres (con un promedio de edad de 63 años) y 42 mujeres (con un promedio de edad de 71 años), que dieron un total de 64 rodillas intervenidas quirúrgicamente. Conclusión: No se encontró diferencia significativa en cuanto al dolor anterior de rodilla, en la función de la articulación patelofemoral y de la rodilla en los grupos de sujetos que fueron analizados con las diferentes escalas.

Abstract: Introduction: The appearance of patellofemoral pain after a knee arthroplasty, particularly in rheumatic diseases, resulted in the incorporation of the substitution of the patellar component in all designs. The replacement of the patella became a standard part of knee arthroplasty, but the controversy over whether to restore it or not continues among orthopedists that perform knee arthroplasties. Objective: To analyze the incidence of anterior knee pain in patients who underwent primary knee arthroplasty with or without replacement of the patellar component. Material and methods: Observational, retrospective, descriptive and transversal study from January 2011 to December 2013. Results: A total of 54 patients were included, 12 men (with an average age of 63 years) and 42 women (with an average age of 71 years), totaling 64 knees that were surgically intervened. Conclusion: This study found no significant difference in anterior knee pain and in the function of the patellofemoral joint and the knee in the groups of patients who were tested with the different scales.

Spanish adaptation of the Quality of Life Index-Spinal Cord Injury version.

STUDY DESIGN: A cross-sectional, validation study. OBJECTIVES: To (a) develop the Spanish version of the Quality of Life Index-Spinal Cord Injury version (SV-QLI/SCI) and (b) assess its psychometric characteristics among permanent wheelchair users and specifically among those with SCI. SETTING: Associations of wheelchair users in Mallorca (Spain). METHODS: Two forward and backward translations of the QLI/SCI into Spanish were carried out separately. Seventy-seven subjects were randomly selected among the members of the associations. They completed the SV-QLI/SCI and validated instruments to measure depression and spinal pain upon recruitment and 14 days later. Assessments included comprehensibility, reproducibility, floor and ceiling effects and correlations between quality of life, pain and depression (Spearman's correlation coefficient). Analyses were repeated excluding data from subjects without SCI. RESULTS: Three items of the SV-QLI/SCI required rephrasing. Reproducibility was 'almost perfect' for the entire questionnaire and its 'Health and functioning' subscale, 'substantial' for the 'Social and economic' and 'Family' subscales and 'moderate' for the 'Psychological/spiritual' subscale. Floor effect was not observed, and only for the 'Family' subscale >3% of the subjects reached the maximum possible score. The correlation between quality of life and depression was the strongest (r=-0.628). Results were virtually identical in the subsample with SCI. CONCLUSION: These results support the use of the SV-QLI/SCI among Spanish-speaking wheelchair users.

[Intravenous infusion of adult adipose tissue stem cells for repairing spinal cord ischaemic lesions. An experimental study on animals]. / Infusión intravenosa de células madre adultas procedentes del tejido adiposo para la reparación de lesiones medulares isquémicas. Estudio experimental en conejos.

OBJECTIVE: To assess if a peripheral intravenous infusion of adipose tissue stem cells (ATSC), after an ischemic spinal cord injury can promote selective cell migration and cell survival in the damaged neural tissue. ANIMALS AND METHOD: An ischaemic spinal cord injury was provoked by trapping the abdominal aorta for 20 minutes in 11 male New Zealand rabbits (2.5±0.5kg). They were randomised into two groups: one group (n=5) received an intravenous transfusion of 10±2×10(6) ATSC at 24 hours from the injury, and the control group (n=6) were only given the vehicle. The functional status was assessed, using the Tarlov scale at 24h, and 7 and 14 days. The animals were sacrificed at 14 days and a histological and immunohistochemical study was performed. RESULTS: Complete paraplegia was achieved in both groups. There were no significant differences as regards neurological recovery, which was nil in both cases. In the histological and immunohistochemical study, it was tested to see if there was any bromodeoxyuridine-marked ATSC in the area of the lesion, but there was only a small amount. CONCLUSION: ATSC are able to migrate and survive in the injured spinal cord after aortic ischaemia after they have been administered intravenously. Intravenous infusion is a harmless procedure with no side effect. No neurological recovery was achieved.

The extremophile Acidithiobacillus ferrooxidans possesses a c-di-GMP signalling pathway that could play a significant role during bioleaching of minerals.

AIMS: The primary goal of this study was to characterize the existence of a functional c-di-GMP pathway in the bioleaching bacterium Acidithiobacillus ferrooxidans. METHODS AND RESULTS: A bioinformatic search revealed that the genome sequence of At. ferrooxidans ATCC 23270 codes for several proteins involved in the c-di-GMP pathway, including diguanylate cyclases (DGC), phosphodiesterases and PilZ effector proteins. Overexpression in Escherichia coli demonstrated that four At. ferrooxidans genes code for proteins containing GGDEF/EAL domains with functional DGC activity. MS/MS analysis allowed the identification of c-di-GMP in nucleotide preparations obtained from At. ferrooxidans cells. In addition, c-di-GMP levels in cells grown on the surface of solid energetic substrates such as sulfur prills or pyrite were higher than those measured in ferrous iron planktonic cells. CONCLUSIONS: At. ferrooxidans possesses a functional c-di-GMP pathway that could play a key role in At. ferrooxidans biofilm formation during bioleaching processes. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first global study about the c-di-GMP pathway in an acidophilic bacterium of great interest for the biomining industry. It opens a new way to explore the regulation of biofilm formation by biomining micro-organisms during the bioleaching process.

Idiopathic osteonecrosis of the medial tibial plateau.

Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients-two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.

[Multiple disc herniation after chiropractic manipulation]. / Herniación discal múltiple tras manipulación quiropráctica cervical.

We present a case of multiple cervical spine disc herniation in a previously healthy patient following chiropractic manipulation. The aim of this paper is to review the medical literature about the complications following spinal manipulation to emphasize the potential risks of this widely extended therapeutic procedure, performed in many cases by non-qualified personnel without medical training.

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

[Cauda equina syndrome due to giant disc herniation]. / Síndrome de cauda equina por hernia discal gigante.

In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. To identify and confirm this syndrome by MR, Ismanoatory. Early surgical decompression must be achieved. Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later.

[Congenital synostoses of the tarsus. Concept, classification, diagnosis and therapeutic approach]. / Sinostosis congénitas del tarso. Concepto, clasificación, diagnóstico y planteamiento terapéutico.

The incidence of congenital tarsal coalition is about 1%. It is recognized as the main etiology of painful, rigid flatfoot in the pediatric population. Talonavicular (50%) and talocalcaneal (40%) coalition are the most common presentation. We must suspect a tarsal coalition in a child with mechanical pain and shoes deformity. Rigid and painful planovalgus deformity are found in physical exam which led to describe in the pass this entity as peroneal spastic flatfoot. Lateral and oblique (35 degrees-45 degrees) radiographs must be practice to observe the coalition. The presence of a beak in the head of the talus or a half moon condensation image as the result of the superposition of the talus over the calcaneus are commonly described. CT-scan is also useful to delineate the size of the coalition and its location. Resection of the bar is the surgical treatment of choice. Excision of the coalition and interposition of fat or a graft must be tried in young patients in order to preserve foot biomechanical properties and to avoid long term problems associated with arthrodesis. Triple arthrodesis or subtalar arthrodesis must be used in older patients with degenerative signs in radiographs or in those cases of multiple coalition or if resection has failed.

Femoral anteversion osteotomy for the treatment of hip dislocation in Down syndrome: long-term evolution.

We propose a femoral desrotational osteotomy to antevert the femoral head associated with plication of the anterior and superior capsule for treatment in the early stages of hip dislocation in Down syndrome. Eight patients (10 hips) with Down syndrome and hip dislocation were reviewed. Five children (seven hips) were operated. We used the proposed surgical technique in three patients (four hips). The average follow-up was 11 years (range, 5-16 years). No infections or complications were observed. In our short experience, this is the recommended procedure in the early stages of hip dislocation in Down syndrome.

Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee.

We describe three cases of postoperative haemorrhage, two after total hip and one after total knee replacement, treated by percutaneous embolisation. After diagnostic angiography, this is the preferred method for the treatment of postoperative haemorrhage due to the formation of a false aneurysm, after hip or knee arthroplasty. This procedure, carried out under local anaesthesia, has a low rate of complications and avoids the uncertainty of further surgical exploration.

[Cervical spondylodiscitis]. / Espondilodiscitis cervicales.

Eighty patients were treated for spondylodiscitis with the cervical spine involved in nine cases. Conservative treatment was applied in seven cases with Minerva jacket and antibiotics, and surgical treatment was applied in severe, rapidly, progressive, complicated cases and in patients with involvement of nervous system (two cases). The good and satisfactory results in both group were similar. These results show that when the indications are properly established, both conservative and operative methods have satisfactory results.

Utilización de pools de suero o de saliva, en la determinación de anticuerpos al VIH-1/2 por técnicas rápidas y convencionales de E.L.I.S.A / Utilization of serum or saliva pools in determination of VIH-1/2 amtibodies for rapid and conventional technic of E.L.I.S.A.

Con objeto de evaluar la utilidad del empleo de muestas combinadas (pools) de suero 'o de saliva en el diagnóstico de la infección con los virus de la Inmunodeficiencia Humana, se estudiaron 500 personas, 100 infectadas con el V.I.H.-1 y 400 clínicamente sanas. A todas ellas se les tomaron simultáneamente muestras de sangre y de saliva. Se formaron 100 pools de muestras de sangre, y 100 pools de saliva, mezclando 200 microlitros ya fuera de suero o de saliva de una persona seropositiva y 4 seronegativas. Cada muestra individual y cada pool se analizaron con las técnicas de E.L.I.S.A. convencional y rápida (Abbott HIV-1/HIV-2 EIA y TEST PACK). Todas las muestras repetidamente positivas se confirmaron con la técnica de Western Blot (Cambridge Biotech HIV). Cada pool tanto de suero como de saliva fue estudiado de la misma manera. Los resultados obtenidos mostraron un 100 por ciento de correlación tanto en las muestras consideradas inidividualmente como en las combinadas; la especificidad, sensibilidad y valor predictivo no se vieron afectadas con el empleo de muestas combinadas (pools) ya fueran de suero o de saliva.