Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring.

Background: Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.

[Translated article] Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels.

Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our centre, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analysed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS: One hundred and one patients (25 women and 76 men), 55 years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10 years (between 5 and 17 years). The mean head diameter was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5 years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3 patients with HHS 100 who presented unacceptable elevation of cobalt >20µm/l (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10µm/l (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.

[Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment]. / Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama.

INTRODUCTION: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. METHODS: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test-retest reproducibility 15 days' interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. RESULTS: The internal consistency and the test-retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). CONCLUSION: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.

Bacteria associated with apical periodontitis promotes in vitro the differentiation of macrophages to osteoclasts.

OBJECTIVE: To analyze the possible in vitro effect of the cytokine RANKL and bacteria involved in apical periodontitis on the differentiation of macrophages into osteoclasts. MATERIAL AND METHODS: Bacteria were isolated (mainly E. faecium and E. faecalis) from the root canal of fifty patients with apical periodontitis, the possible effect of these bacteria on the phagocytic activity of the monocyte cell line THP-1 was analyzed by flow cytometry. Furthermore, the effect of these bacteria (alone or in combination with the cytokine RANKL) on the differentiation of THP-1 macrophages into osteoclasts was analyzed through the expression of the receptor RANK and the tartrate-resistant acid phosphatase TRAP. Finally, the release of different cytokines (IL-1ß, TNF-α, IL-6, IL-8, IL-10, and IL-12p70) by THP-1 cells induced to differentiate into osteoclasts was also analyzed. RESULTS: We observed a significant proportion of THP-1 cells were able to internalize E. faecium and E. faecalis. Furthermore, these bacteria were able to induce (alone or in combination with RANKL) a significant expression of RANK by THP-1 macrophages; accordingly, E. faecium and E. faecalis induced very significant levels of TRAP in these cells. Finally, during the differentiation of THP-1 macrophages induced by RANKL or bacteria, a significant release of the pro-inflammatory cytokines IL-6 and TNF-α was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Our data suggest that the causative agents of apical periodontitis can induce the differentiation of osteoclasts as well as the release of pro-inflammatory cytokines, phenomena that may have an important role in the bone damage observed in this condition.

Metal on metal total hip arthroplasty: Correlation between inclination of the acetabular and metal ion levels. / Artroplastias metal-metal en cadera: correlación entre el aumento de iones y el ángulo del componente acetabular.

Due to their low friction index, hip arthroplasties with metal-metal (M-M) friction torque have been an attractive option in young patients with high functional demand, currently they have suffered a decrease in their use due to the complications of some models and physiological reactions adverse reactions related to the elevation of metal ions in the blood. Our objective is to review the patients with M-M pair operated in our center, correlating the ion level with the position of the acetabular component and with the size of the head. MATERIAL AND METHODS: Retrospective review of 166 M-M hip prostheses operated between 2002 and 2011. Sixty five ruled out for different causes (death, loss of follow-up, no current ion control, no radiography or others), leaving a sample of 101 patients to be analyzed. Follow-up time, cup inclination angle, blood ion level, Harris Hip Score (HHS), and complications were recorded. RESULTS: One hundred and one patients (25 women and 76 men), 55years of average age (between 26 and 70), of these 8 were surface prostheses and 93 total prostheses. The mean follow-up time was 10years (between 5 and 17years). The mean head diameters was 46.25 (between 38 and 56). The mean inclination of the butts was 45.7° (between 26° and 71°). The correlation force between the verticality of the cup and the increase in ions is moderate r=0.31 for Cr and slight r=0.25 for Co. The correlation force between head size and ion increase is weak and inverse r=-0.14 for Cr and r=0.1 for Co. Five patients (4.9%) required revision (2 [1%] due to increased ions with pseudotumor). The mean time to revision was 6.5years in which the ions increased. The mean HHS was 94.01 (between 55.8 and 100). In the review of patients, we found 3 with a significant increase in ions who had not followed controls, all 3 had an HHS of 100. The angles of the acetabular components were 69°, 60° and 48° and the diameter of the head was 48.42 and 48mm, respectively. DISCUSSION AND CONCLUSIONS: M-M prostheses have been a valid option in patients with high functional demand. A bi-annual analytical follow-up is recommended, since in our case we have detected 3patients with HHS100 who presented unacceptable elevation of cobalt >20µm/L (according to SECCA) of the ions and 4 with very abnormal elevation of cobalt ≥10µm/L (according to SECCA), all of them with cup orientation angles >50°. With our review we can conclude that there is a moderate correlation between the verticality of the acetabular component and the increase in blood ions and that the follow-up of this patient with angles >50° is essential.

Bruxismo y su relación con otorrinolaringología: una revisión de la literatura

Resumen El bruxismo es una condición que se observa frecuentemente en los pacientes y estos a menudo consultan por sus consecuencias físicas, como pueden ser el desgaste o destrucción dentaria, el dolor orofacial, así como también por el deterioro de la calidad de vida tanto de ellos mismos como de las personas cercanas. En la última década han aumentado en forma importante las investigaciones en torno a esta condición, así como los consensos en cuanto a su definición, clasificación y manejo clínico. Los dentistas son quienes actualmente reconocen esta actividad parafuncional y manejan estos problemas, pero es importante que los profesionales de otras áreas de la salud, como médicos y en especial otorrinolaringólogos, puedan identificar los signos, síntomas y consecuencias del bruxismo, ayudando en la detección de esta condición. Así, el objetivo de esta revisión es establecer un estado del arte sobre bruxismo e incentivar la formación de equipos multidisciplinares que ayuden en el diagnóstico y la terapéutica de esta condición.

Abstract Bruxism is a condition that is frequently observed in patients, and they often consult for physical consequences, such as teeth wear or destruction, orofacial pain, as well as for the decrease of the quality of life, of both patients and their loved ones. In the last decade, research on this phenomenon has increased significantly, as well as the consensus in terms of definition, classification and clinical management. Dentists are those who at present recognize this parafunctional activity and manage these problems, but it is important that professionals from other health areas, such as medical doctors, and specially otolaryngologists, can identify signs, symptoms and consequences of bruxism, helping in the detection of this condition. Thus, the objective of this review is to establish a state of the art about bruxism and encourage the formation of multidisciplinary teams that help to in the diagnosis and better management of this condition.

[Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules]. / Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos.

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis.

Duplicación del apéndice vermiforme. Reporte de caso / Vermiform appendix duplication - case report

Dar a conocer una presentación inusual de una patología frecuente. Se presenta caso de paciente masculino de 27 años con cuadro clínico de apendicitis aguda. Se realiza apendicetomía abierta en la cual se identifican dos apéndices vermiformes. Se confirma el diagnóstico por medio de anatomía patología, una con apendicitis aguda perforada y otra con peri-apendicitis. Es importante el conocimiento de esta patología para que se pueda reconocer y evitar errores de juicio durante el procedimiento quirúrgico y futuras complicaciones para el paciente. (AU)

Report an unusual presentation of a common pathology. A case of a 27-year-old male with a clinical picture of acute appendicitis is presented. An open appendectomy is performed in which two vermiform appendages are identified. The diagnosis is confirmed by pathology, one with perforated acute appendicitis and the other with peri-appendicitis. Knowledge of this pathology is important so that errors of judgment can be recognized and avoided during the surgical procedure and future complications for the patient. (AU)

[Description of the use of inhaled rescue medication in an asthmatic population treated in the Primary Care clinics. UMI-ASMA Study]. / Descripción del uso de medicación inhalada de rescate en una población asmática atendida en el ámbito de Atención Primaria. Estudio UMI-ASMA.

OBJECTIVE: To describe the quantitative use of inhaled rescue medication in an asthmatic population treated in the Primary Care clinics, and secondly to determine its possible relationship as regards other variables associated with control. MATERIAL AND METHODS: An observational, descriptive study was conducted on a randomised sample of all the asthmatic patients with more than one year of onset, and coming from 17 Primary Care catchment areas. 1 year observation period. The data collected included sociodemographic variables and characteristics of the asthma, such as the use of short-acting beta-agonists (SABA) and level of control as regards its frequency of use, the use of inhaled control medication (ICM), number of hospital exacerbations, smoking habits, and availability of an action plan. The data were obtained from the clinical history and the computerised prescription modules. RESULTS: A total of 442 asthmatic patients were included (59.5% female), with a mean age of 45.4 years. The total number of SABA containers prescribed in one year per patient was between 0 and 25 containers, with a mean of 4.26 (SD=4.1). Only 46.6% showed a regular use of an ICM. The number of SABA containers prescribed to patients with an intermittent use of an ICM was significantly higher than those patients that used it regularly (P=.001). There was an association between the number of exacerbations and the number of SABA containers prescribed (Spearman correlation coefficient=0.474, P<.001), as such that the higher the number of containers prescribed there was also a higher number of hospitalised asthmatic exacerbations. CONCLUSIONS: A considerable number of asthmatics in the sample had elevated prescriptions for SABA inhalers and within the defined quantitative ranges of at least a partially or poor-controlled asthma. There is a positive relationship between the overuse of SABA and the intermittent use of the ICM, the same as with hospital exacerbations, smoking, and the lack of a written action plan..

Intussusceptive angiogenesis and its counterpart intussusceptive lymphangiogenesis.

Intussusceptive angiogenesis (IA) is currently considered an important alternative and complementary form of sprouting angiogenesis (SA). Conversely, intussusceptive lymphangiogenesis (IL) is in an initial phase of study. We compare their morphofunctional characteristics, since many can be shared by both processes. To that end, the following aspects are considered: A) The concept of IA and IL as the mechanism by which blood and lymphatic vessels split, expand and remodel through transluminal pillar formations (hallmarks of intussusception). B) Terminology and historical background, with particular reference to the group of Burri, including Djonov and Patan, who initiated and developed the vessel intussusceptive concept in blood vessels. C) Incidence in normal (e.g. in the sinuses of developing lymph nodes) and pathologic conditions, above all in vessel diseases, such as dilated veins in hemorrhoidal disease, intravascular papillary endothelial hyperplasia (IPEH), sinusoidal hemangioma, lobular capillary hemangioma, lymphangiomas/lymphatic malformations and vascular transformation of lymph nodes. D) Differences and complementarity between vessel sprouting and intussusception. E) Characteristics of the cover (endothelial cells) and core (connective tissue components) of pillars and requirements for pillar identification. F) Structures involved in pillar formation, including endothelial contacts of opposite vessel walls, interendothelial bridges, merged adjacent capillaries, vessel loops and spilt pillars. G) Structures resulting from pillars with intussusceptive microvascular growth, arborization, remodeling and segmentation (compartmentalization). H) Influence of intussusception in the morphogenesis of vessel tumors/ pseudotumors; and I) Hemodynamic and molecular control of vessel intussusception, including VEGF, PDGF BB, Hypoxia, Notch, Endoglobin and Nitric oxide.

[Idiopathic axillary web syndrome]. / Síndrome axillary web idiopático.

We report the case of a 67-year-old woman who developed a cord of subcutaneous tissue extending from the axilla into the medial arm, accompanied by axillary neuropathic pain, with no history of surgery or infection. The patient was instructed in home exercises, and the condition progressively improved. Four months later, a small cord was visible on abduction with mild axillary dysesthesia, which was less severe than at onset. Diagnosis of exclusion was idiopathic axillary web syndrome (AWS). This syndrome is widely recognized after surgical axillary lymph node removal to treat breast cancer, but the etiopathogenesis is still unknown. Published reports of AWS with no history of surgery are rare, but a few reports have described this entity after infection or intense exercise. There are currently no previous reports of idiopathic AWS. The anatomical and clinical presentation, and clinical course of AWS without prior surgery, are similar to those of postoperative AWS.

Estrés académico en estudiantes de la Universidad Mayor Real y Pontificia de San Francisco Xavier de Chuquisaca / Academic stress in students of the Universidad Mayor Real y Pontificia de San Francisco Xavier de Chuquisaca

El estrés es hoy en día, es una problemática a la que se está prestando una atención creciente. Sin embargo, el estrés académico no recibe la suficiente atención en el ámbito de la investigación. Es por eso que con la presente investigación se determinará el nivel de estrés académico en estudiantes de la Universidad Mayor Real y Pontificia de San Francisco Xavier de Chuquisaca, ya que al seguir una Carrera Universitaria se tiende a desarrollar algún nivel de estrés que puede desencadenar problemas emocionales, cognitivos y fisiológicos. En el estudio participaron 332 estudiantes de todas las Facultades y Carreras en general, a quienes se les aplicó el inventario SISCO de Barraza. Los resultados mostraron que la mayoría de los estudiantes presenta un estrés patológico que consta los niveles, mediano, alto y máximo que representan un 92,4% de los individuos y el porcentaje restante presentan un estrés fisiológico. De acuerdo a los resultados obtenidos concluimos que el estrés académico es un fenómeno de frecuencia elevada. Su carácter multidimensional presenta manifestaciones fisiológicas, conductuales y cognitivas, que están asociadas a variables como la edad y el sexo siendo estas las de mayor nivel de expresión. Es importante generar el interés de realizar futuras investigaciones en la que el estrés académico sea centro de atención.

Stress is today, it is a problem that is being given increasing attention. However, academic stress does not receive sufficient attention in the field of research. That is why with the present investigation the level of academic stress will be determined in students of the Universidad Mayor Real y Pont ificia de San Francisco Xavier de Chuquisaca, since following a University Degree there is a tendency to develop some level of stress that can cause problems Emotional, cognitive and physiological. The study involved 332 students from all faculties and careers in general, to whom the SISCO inventory of Barraza was applied. The results showed that the majority of the students present a pathological stress that consists of the medium, high and maximum levels that represent 92.4% of the individuals and the remaining percentage presents a physiological stress. In the study we conclude that academic stress is a phenomenon of high frequency. Its multidimensional character presents physiological, behavioral and cognitive manifestations, which are associated with variables such as age and sex, these being the highest level of expression. It is important to generate interest in conducting future research in which academic stress is the center of attention.

Enhancement of gemcitabine cytotoxicity in pancreatic adenocarcinoma through controlled release of nitric oxide.

Gemcitabine (GEM) is the first-line treatment for pancreatic adenocarcinoma (PAC) yet chemoresistance is common. Nitric oxide (NO) is the predominant species responsible for the cytotoxic action of macrophages against cancer cells yet localized delivery is difficult given the short half-life. We sought to study the effect of locally delivered NO on GEM mediated PAC cytotoxicity and the potential role of SMAD4 in this effect. We hypothesized that NO would enhance the cytotoxicity of GEM in a SMAD4 dependent manner. NO-Silica nanoparticles (NO-Si) were synthesized via a co-condensation of tetraethoxysilane with aminoalkoxysilane under high-pressure nitrous oxide. NO release was measured using chemiluminescence. A SMAD4 negative PAC cell line (SMAD4-) was made using retroviral knockdown of Panc1 PAC cells. Panc1 and SMAD4- cells were treated with gemcitabine (100 nm (hi) to 30 µm (lo)), 30 mg NOSi particles, or both (NOSihi or NOSilo) and cell viability assessed. NoSi reduced cell viability by 25.99% in Panc1 and 24.38% in SMAD4-. When combined with gemcitabine, further reductions were seen in a dose dependent manner for both cell lines. We have demonstrated the in-vitro dose dependent cytotoxic effects of NOSi. When combined with GEM there is a synergistic effect resulting in improved cytotoxicity seen in both Panc1 and SMAD4- PAC cells with a differential pattern of cell death seen at high concentrations of NO. These findings suggest not only that NO is useful chemosensitizing agent but that SMAD4- may play a role in its synergism with GEM.

Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification.

BACKGROUND: Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups. METHODS: We carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results. Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson's correlation was used. Student's T and Mann Whitney's U were used to compare 2 independent samples; multiple and linear regressions were carried out. RESULTS: The mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days. CONCLUSIONS: Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.

[Result of 12 years of non-surgical treatment of pectus carinatum]. / Resultado de 12 años de tratamiento no quirúrgico del pectus carinatum.

OBJECTIVE: To report our experience in the treatment of pectus carinatum by using the dynamic compression system. MATERIAL AND METHODS: Retrospective study during the period from January 2005 to September 2017. Patients with typical condrogladiolar pectus carinatum and correction pressure (PC) ≤ 14 PSI (pound square inch) were included. Exclusion criteria: patients with previous thoracic surgery, mixed malformations and chondromanubrial pectus carinatum. For the treatment, the Dynamic Thoracic Compressor System (FMF) with pressure meter in PSI was used. The PC, the treatment pressure (PT), the correction time (TC) and the maintenance time (TM), recurrences and complications were analyzed. A qualitative scale was measured in three grades: where A is excellent or very good, B is regular and C is bad. RESULTS: We treated 104 patients under 18 years of age. The PT was 2.26. The average of the TC was 8.8 months. The TM was on average 8 months. 36.5% of the patients finished the treatment, 36.5% still continue in treatment and 26.9% of the patients lost the follow-up due to desertion. The qualitative assessment was positive in 95.5% of our patients, and unfavourable in 4.5%. CONCLUSION: The non-surgical treatment of pectus carinatum is efficient, non-invasive and of low morbidity. Regarding the high dropout rate, we must analyze the variables to be modified to reduce it. This treatment should be considered as the first option to correct pectus carinatum in patients with flexible thorax.

OBJETIVO: Describir nuestra experiencia en el tratamiento del pectus carinatum mediante el uso del sistema de compresión dinámico. MATERIALES Y METODOS: Estudio retrospectivo durante el período de enero de 2005 a septiembre de 2017. Se incluyeron pacientes con pectus carinatum condrogladiolar típico y presión de corrección (PC) ≤ 14 PSI (pound per square inch). Criterios de exclusión: pacientes con cirugía torácica previa, malformaciones mixtas y condromanubriales. Para el tratamiento se utilizó el sistema compresor torácico dinámico (FMF) con medidor de presión en PSI. Se analizaron la PC, la presión de tratamiento (PT), el tiempo de corrección (TC) y el tiempo de mantenimiento (TM), recidivas y complicaciones. Se realizó una escala cualitativa medida en tres grados: donde A es excelente o muy bueno, B regular y C malo. RESULTADOS: Tratamos 104 pacientes menores de 18 años. La PT fue de 2,26. El promedio del TC fue de 8,8 meses. El TM fue en promedio de 8 meses. El 36,5% de los pacientes finalizaron el tratamiento, 36,5% aún continúan en tratamiento y 26,9% de los pacientes se perdió el seguimiento por deserción del mismo. La valoración cualitativa fue positiva en el 95,5% de nuestros pacientes, y desfavorable en el 4,5%. CONCLUSION: El tratamiento no quirúrgico del pectus carinatum es eficiente, no invasivo y de baja morbilidad. Respecto a la alta tasa de deserción, debemos analizar las variables a modificar para disminuirla. Este tratamiento debe ser considerado una opción de primera elección, para corregir el pectus carinatum en pacientes con tórax flexible.

Educación en salud, práctica de actividad física y alimentación en grandes urbes: perspectiva de los usuarios / Education in health, physical practice and food in big cities: perspective of the users

Resumen Introducción: La población que vive en grandes urbes cuenta con elementos culturales que difícilmente están incorporados en las intervenciones de educación para la salud. Objetivo: Identificar los elementos clave en el diseño de estrategias culturalmente competentes para mejorar las sesiones de educación en salud, práctica de actividad física y alimentación. Metodología: Estudio cualitativo, exploratorio y descriptivo realizado en la Ciudad de México. Se utilizó la técnica de grupos focales. El guion temático incluyó: a) causas de la enfermedad, prevención y tratamiento; b) elementos para prevenir la enfermedad: dieta y actividad física; c) motivaciones para participar en una intervención que prevenga las Enfermedades Crónicas no Transmisibles desde su contexto cultural; y d) barreras y facilitadores. Las entrevistas fueron grabadas, transcritas y analizadas de acuerdo con la teoría fundamentada. Resultados: Los resultados muestran que uno de los impedimentos de mayor peso es la falta de tiempo para acudir a sesiones de educación en salud, la práctica de actividad física, la preparación y consumo de alimentos saludables. Dentro de los grupos, obesidad y sobrepeso no se perciben como un factor importante para el desarrollo de Enfermedades crónicas no trasmisibles. Se propone incorporar elementos tanatológicos y logoterapéuticos en las intervenciones con el fin de dar sentido de vida a la salud. Conclusión: Se proponen estrategias que transiten de la promoción de la salud hacia el desarrollo humano, que integren elementos de manejo efectivo del tiempo, inteligencia emocional, aumento de la autoestima y estrategias familiares de colaboración.

Abstract Introduction: The population in the large cities has cultural elements that are hardly incorporated in health education interventions. Objective: To identify the key elements for designing culturally competent strategies necessary to improve health education sessions, physical activity and food intake for people at risk of chronic non-communicable diseases (NCD). Methodology: A qualitative, exploratory and descriptive study was performed in Mexico City. Focal group technique was used. Thematic script included topics such as: a) causes of the disease, its prevention and treatment; B) elements for disease prevention: diet and physical activity; C) motivations to participate in an intervention that prevents NCD in their own cultural context; and d) Elements that do not work in an intervention to prevent NCD. The interviews were recorded, transcribed and analyzed under the fundamental theory approach. Results: Data showed that one of the most important impediments is the lack of time to attend health education sessions, physical activity and healthy foods preparation and consumption. Within the groups, obesity and weight were not perceived as an important factor for the development of NCD. We proposed to incorporate thanatological and logotherapeutic elements in the interventions in order to give live meaning to people´s health. Conclusion: Strategies are proposed to move from health promotion to human development, integrating elements of effective management of time, emotional intelligence, increased self-esteem and family strategies of collaboration.

Intrathecal administration of autologous bone marrow stromal cells improves neuropathic pain in patients with spinal cord injury.

Neuropathic pain (NP) is highly disabling, responds poorly to pharmacological treatment, and represents a significant cause of decreased quality of life in patients suffering from spinal cord injury (SCI). In recent years, cell therapy with autologous mesenchymal stromal cells (MSCs) has been considered as a potential therapeutic weapon in this entity. Ten patients suffering chronic SCI received 100 million MSCs into subarachnoid space by lumbar puncture (month 1 of the study) and this procedure was repeated at months 4 and 7 until reaching a total doses of 300 million MSCs. Intensity of NP was measured by standard numerical rating scale (VAS) from 0 to 10, recording scores previous to the first MSCs administration and monthly, until month 10 of follow-up. Months 1, 4, 7 and 10 of the study were selected as time points in order to a statistical analysis by the nonparametric Wilcoxon rank test. Our results showed significant and progressive improvement in NP intensity after the first administration of MSCs (p: 0.003). This study supports the benefit of intrathecal administration of autologous MSCs for the treatment of NP in patients with SCI.

Morphofunctional basis of the different types of angiogenesis and formation of postnatal angiogenesis-related secondary structures.

We review the morpho-functional basis of the different types of angiogenesis and report our observations, including the formation of angiogenesis-related secondary structures. First of all, we consider the following issues: a) conceptual differences between angiogenesis and vasculogenesis, b) incidence of angiogenesis in pre- and postnatal life, c) regions of vascular tree with angiogenic capacity, d) cells (endothelial cells, pericytes, CD34+ adventitial stromal cells of the microvasculature and inflammatory cells) and extracellular matrix components involved in angiogenesis, e) events associated with angiogenesis, f) different types of angiogenesis, including sprouting and intussusceptive angiogenesis, and other angiogenic or vascularization forms arising from endothelial precursor cells (postnatal vasculogenesis), vasculogenesis mimicry, vessel co-option and piecemeal angiogenesis. Subsequently, we consider the specific morpho-functional characteristics of each type of angiogenesis. In sprouting angiogenesis, we grouped the events in three phases: a) activation phase, which includes vasodilation and increased permeability, EC, pericyte and CD34+ adventitial stromal cell activation, and recruitment and activation of inflammatory cells, b) sprouting phase, encompassing EC migration (concept and characteristics of endothelial tip cells, tip cell selection, lateral inhibition, localized filopodia formation, basal lamina degradation and extracellular changes facilitating EC migration), EC proliferation (concept of endothelial stalk cells), pericyte mobilization, proliferation, recruitment and changes in CD34+ adventitial stromal cells and inflammatory cells, tubulogenesis, formation of a new basal lamina, and vascular anastomosis with capillary loop formation, and c) vascular remodelling and stabilization phase (concept of phalanx cells). Subsequently, the concept, incidence, events and mechanisms are considered in the other forms of angiogenesis. Finally, we contribute the formation of postnatal angiogenesis-related secondary structures: a) intravascular structures through piecemeal angiogenesis, including intravascular papillae in vessel tumours and pseudotumours (intravascular papillary endothelial hyperplasia, vascular transformation of the sinus in lymph nodes, papillary intralymphatic angioendothelioma or Dabska tumour, retiform hemangioendothelioma, hemangiosarcoma and lymphangiosarcoma), vascular septa in hemorrhoidal veins and intravascular projections in some tumours; b) arterial intimal thickening; c) intravascular tumours and pseudotumours (e.g. intravenous pyogenic granulomas and intravascular myopericytoma); d) vascular glomeruloid proliferations; and e) pseudopalisading necrosis in glioblastoma multiform.

Adaptive Control in Passive rehabilitation routines using ELLTIO / Control Adaptable en rutinas de rehabilitación pasiva utilizando ELLTIO

ABSTRACT: The Exoskeleton for Lower Limb Training with Instrumented Orthosis (ELLTIO) is a mechatronic device that can be used to assist in passive kinesitherapy to increase human muscles strength and resistance [1]. This paper presents an alternative for passive rehabilitation process using an exoskeleton for knee and ankle. The main idea is assist a pro fessional physiotherapist in the design and performance of exercises routines for his patients using the prototype. The knee and ankle joint's movements are recorded and storage during the exercises to propose a similar computer generated trajectories which the exoskeleton on should follow. An adaptive controller is implemented to track the trajectories and adapt the user parameters.

RESUMEN: El exoesqueleto para el entrenamiento de miembros inferiores con órtesis instrumentada (ELLTIO) por sus siglas en ingles "Exoskeleton for Lower Limb Training with Instrumented Orthosis" es un dispositivo mecatrónico que se puede utilizar para ayudar en la fisioterapia pasiva para aumentar la fuerza y resistencia de los músculos humanos. En este trabajo se presenta una alternativa para el proceso de rehabilitación pasiva utilizando un exoesqueleto de rodilla y tobillo. La idea principal es ayudar a un fisioterapeuta profesional en el diseño y ejecución de rutinas de ejercicios para sus pacientes utilizando el prototipo. Los movimientos de la articulación de la rodilla y el tobillo se registran y se almacenan durante los ejercicios para proponer trayectorias similares generadas por computadora que el exoesqueleto debe seguir. Se implementa un controlador adaptativo para rastrear las trayectorias y adaptar los parámetros del usuario.

Evaluation of different fragment sizes and cryoprotectants for cryopreservation of feline testicular tissues.

This study aimed to evaluate tissue damage of feline testicles sectioned in two different sizes (0.3 or 0.5 cm3 ) and submitted to different cryoprotectants (propanediol or glycerol). Testicles obtained from 12 domestic cats were sectioned in 0.3 and 0.5 cm3 sized pieces and immediately evaluated by TBARS and semi-quantitatively by histomorphology. The remaining fragments were placed in cryotubes with 1 ml Egg yolk Tris Equex STM extender containing 3% glycerol or 3% propanediol and cryopreserved by fast-freezing technique. Frozen-thawed fragments were also evaluated by TBARS and histomorphology. Statistical analysis was performed using one-way ANOVA with Student-Newmann-Keuls post hoc test, with p < .05. Fresh and cryopreserved tissues generally exhibited a similar morphology concerning detachment of cells from the basement membrane and observation of nucleoli, with a great proportion scored as 0 (no alteration). When present, alterations were slight and the morphology was considered to be good (most classified in scores 1). Pyknosis was the main anomaly observed as score 2 in 54.6% and 58.4% of 0.3-cm3 fragments cryopreserved in propanediol and glycerol, respectively (16.7% scored 2 in fresh tissue). In TBARS evaluation, 0.5-cm3 fragments cryopreserved in glycerol produced less free radical compared to the 0.3 cm3 cryopreserved in glycerol or propanediol. Our results showed that glycerol was more efficient than propanediol to cryopreserve 0.5-cm3 fragments; this might be attributed to the fact that glycerol molecular weight is larger than propanediol and so its perfusion in the testicular tissue is slower.