Switching from onabotulinum toxin A to abobotulinum toxin A for treating detrusor overactivity in spinal cord injured patient, does it really work?

AIM: To assess the efficacy of switching to Abobotulinumtoxin A (ATA) intradetrusor injections (IDI) after failure of Onabotulinumtoxin A (OTA) IDI for the treatment of neurogenic detrusor overactivity in patients with spinal cord injury (SCI). MATERIALS AND METHODS: A single-centre retrospective chart review study. All SCI patients who started OTA IDI after 2011 and had an ATA IDI switch were included. The primary outcome was the clinical and urodynamic efficacy of the switch to ATA IIDs at the last follow-up. Secondary outcomes were initial efficacy, duration of ATA treatment, and patient outcome including the occurrence of augmentation enterocystoplasty at last follow-up. RESULTS: Sixty-two patients were included. Eighteen patients (28.9%) were initially responders to ATA IDI. Nine patients (14.5%) remained responders at last follow-up after a median of 17 months (AE 8.8-29). Thirty-two patients (51.6%) had had or were awaiting augmentation enterocystoplasty with a follow-up time of 18.5 months (IQR 8-27). Eleven patients (17.7%) were on ATA IDI with low efficacy. Seven patients (11.3%) were switched back to OTA and 3 patients (4.8%) changed their voiding pattern. CONCLUSION: Switching from OTA to ATA toxin for IDI in the treatment of detrusor overactivity after spinal cord injury have long-term efficacy for a limited number of patients but may delay the need for surgery.

[Should we interfere with the interleukin-6 receptor during COVID-19: What do we know?] / Inhibiteurs du récepteur de l'IL-6 dans le traitement de la COVID-19 : que savons-nous ?

COVID-19 is a viral infection with predominant respiratory tropism. In its most severe forms, the initial viral aggression leads to acute respiratory failure due to damage secondary to an exacerbated inflammatory response provoked by the activation of innate, followed by adaptive immunity. The inflammatory response may entail respiratory distress syndrome, if not multivisceral failure and death. IL-6 receptor inhibitors (Tocilizumab and Sarilumab) have been proposed as treatments. Numerous studies have provided new information, which remains heterogeneous and difficult to interpret. This review is aimed at clarifying the potential role of IL-6 receptor inhibitors in severe forms of COVID-19.

Granulosa cells provide elimination of apoptotic oocytes through unconventional autophagy-assisted phagocytosis.

STUDY QUESTION: Do human granulosa cells (GCs) ingest and destroy apoptotic oocytes? SUMMARY ANSWER: Somatic GCs ingest and destroy apoptotic oocytes and other apoptotic substrates through unconventional autophagy-assisted phagocytosis. WHAT IS KNOWN ALREADY: Most (99%) ovarian germ cells undergo apoptosis through follicular atresia. The mode of cleaning of atretic follicles from the ovary is unclear. Ovarian GCs share striking similarities with testicular Sertoli cells with respect to their origin and function. Somatic Sertoli cells are responsible for the elimination of apoptotic spermatogenic cells through unconventional autophagy-assisted phagocytosis. STUDY DESIGN, SIZE, DURATION: Human GCs were tested for the ability to ingest and destroy the apoptotic oocytes and other apoptotic substrates. A systemic study of the main phagocytosis steps has been performed at different time points after loading of apoptotic substrates into the GC. PARTICIPANTS/MATERIALS, SETTING, METHODS: Primary cultures of GC retrieved following controlled ovarian stimulation of five women for IVF/ICSI and a human granulosa KGN cell line were incubated with different apoptotic substrates: oocytes which underwent spontaneous apoptosis during the cultivation of immature germ cells for IVF/ICSI; apoptotic KGN cells; and apoptotic membranes from rat retinas. Cultured GC were analyzed for the presence of specific molecular markers characteristic of different steps of phagocytic and autophagy machineries by immunocytochemistry, confocal microscopy, transmission electron microscopy and western blotting, before and after loading with apoptotic substrates. MAIN RESULTS AND THE ROLE OF CHANCE: Incubation of human GC with apoptotic substrates resulted in their translocation in cell cytoplasm, concomitant with activation of the phagocytosis receptor c-mer proto-oncogene tyrosine kinase MERTK (P < 0.001), clumping of motor molecule myosin II, recruitment of autophagy proteins: autophagy-related protein 5 (ATG5), autophagy-related protein 6 (Beclin1) and the rise of a membrane form of microtubule-associated protein 1 light chain 3 (LC3-II) protein. Ingestion of apoptotic substrates was accompanied by increased expression of the lysosomal protease Cathepsin D (P < 0.001), and a rise of lysosomes in the GCs, as assessed by different techniques. The level of autophagy adaptor, sequestosome 1/p62 (p62) protein remained unchanged. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: The number of patients described here is limited. Also the dependence of phagocytosis on reproductive hormone status of patients should be analyzed. WIDER IMPLICATIONS OF THE FINDINGS: Removal of apoptotic oocytes by surrounding GC seems likely to be a physiological mechanism involved in follicular atresia. Proper functioning of this mechanism may be a new strategy for the treatment of ovarian dysfunctions associated with an imbalance in content of germ cells in the ovaries, such as premature ovarian failure and polycystic ovary syndrome. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by Rennes Metropole (AIS 2015) and Agence de BioMédecine. This work was supported by funding from Université de Rennes1, Institut National de la Santé et de la Recherche Médicale (INSERM) and CHU de Rennes. A.B. is funded in part by the program Actions Concertées Interpasteuriennes (ACIP) and a research grant from the European Society of Pediatric Endocrinology. This work is supported by the Agence Nationale de la Recherche Grants ANR-17-CE14-0038 and ANR-10-LABX-73. The authors declare no competing interests.

Transrectal high-intensity focused ultrasound (HIFU) for management of rectosigmoid deep infiltrating endometriosis: results of Phase-I clinical trial.

OBJECTIVES: Deep infiltrating endometriosis (DIE) of the rectosigmoid is associated with painful symptoms. When medical treatment is ineffective, surgical resection remains the standard treatment, despite significant risk of adverse events. High-intensity focused ultrasound (HIFU) is a minimally invasive ablative procedure. Focal One® is a transrectal HIFU (TR-HIFU) device used in prostate cancer treatment. The primary objective of this study was to confirm the feasibility of treatment with TR-HIFU in patients presenting with posterior DIE with rectosigmoid involvement. We also assessed its safety and clinical efficacy in this context. METHODS: This was a non-controlled, prospective, Phase-I clinical trial in a French University Hospital which is a multidisciplinary center for management of endometriosis. Included were patients older than 25 years, without plans to conceive within 6 months, who presented with a single lesion of posterior DIE, with rectosigmoid invasion, after failure of hormonal therapy. All lesions were assessed preoperatively using transvaginal sonography and magnetic resonance imaging. Patients completed questionnaires on gynecological and intestinal symptoms (similar to a visual analog scale (VAS)), and on quality of life (Medical Outcomes Study 36-item short-form survey (SF-36) and, for the second half of patients recruited, symptom scoring system for constipation (KESS), female sexual function index (FSFI) and endometriosis health profile short-version score (EHP-5)), before, and at 1, 3 and 6 months after, TR-HIFU treatment with a Focal One real-time ultrasound-guided HIFU device. RESULTS: Twenty-three consecutive patients were included in the study between September 2015 and October 2019. All 23 lesions were visualized, giving a detection rate of 100%. Twenty lesions were treated ('feasibility rate', 87.0%): in 13 the whole lesion was treated and in seven the lesion was treated partially. The mean duration of the TR-HIFU procedure was 55.6 min. We observed a significant improvement in VAS score at 6 months, with differences relative to preoperative scores as follows, for: dysmenorrhea (-3.6, P = 0.004), dyspareunia (-2.4, P = 0.006), diarrhea (-3.0, P = 0.006), constipation (-3.0, P = 0.002), dyschezia (-3.2, P = 0.003), false urge to defecate (-3.3, P = 0.007), posterior pelvic pain (-3.8, P = 0.002) and asthenia (-3.8, P = 0.002). There was also a significant improvement in the SF-36 score, with an increase at 6 months relative to the preoperative score in both the physical component summary (+ 9.3%, P = 0.002) and mental component summary (+ 10.9%, P = 0.017). No major complications occurred during or after any procedure. CONCLUSIONS: TR-HIFU therapy for posterior DIE is feasible. If its efficacy and safety are confirmed, it could be a minimally invasive alternative to surgery for the treatment of rectosigmoid endometriosis. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Bladder cancer in neurogenic patients: A retrospective study of management and follow-up]. / Cancers de vessie chez les patients neurologiques : étude rétrospective de prise en charge et de suivi.

INTRODUCTION: The prevalence of bladder cancer (BC) in neurological patients seems to be similar to that of the general population. However, they are more aggressive with a higher rate of muscle-invasive forms and squamous cells carcinomas. The aim of the current study was to report etiologies, management and outcomes of BC in neurological population. MATERIAL AND METHOD: Were enrolled all neurological patients with a BC diagnosed between 2004 and 2017. The following data were retrospectively reported: age, gender, duration of the disease, mode of discovery, histological type, treatment and outcomes. RESULTS: In total, 27 patients were included: 11 spinal cord injuries, 7 Parkinson's disease, 5 multiple sclerosis, 3 head trauma, 3 brain strokes, 2 cerebral palsies and 1 spina bifida. The histological subtypes were as follows: 22 transitional cells carcinomas, 4 squamous cell carcinomas (SCC), one mucinous adenocarcinoma, one sarcomatoid and one neuroendocrine with 19 high-grade tumors and 15 muscle-invasive bladder cancer. Seven patients (26%) were diagnosed before 15 years history of neurogenic bladder. The mean follow-up was 14 months (1-210 months). Eight deaths were observed, with 5 related to bladder cancer. In our study, smoking habits, voiding mode, lithiasis or infection histories were not related with a more aggressive pattern, such as SCC. CONCLUSION: The high rate of muscle-invasive bladder cancer and aggressive patterns justify neuro-urological follow-up, even before 15 years of neurogenic bladder. LEVEL OF EVIDENCE: 4.

Reproducibility of length measurements of the lower limb by using EOS™.

BACKGROUND: Lower-limb discrepancy following total hip arthroplasty is the third-most common reason for patient dissatisfaction in orthopaedic surgery. Therefore, accurate planning and evaluation methods are mandatory. The main aim of this study was to evaluate the reliability of the EOS™ system by establishing and comparing the reproducibility of lower-limb automatic and manual 3D measurements. We hypothesized that the reproducibility of the lower-limb measurements is similar regardless of the method used and with an agreement higher than 0.95 for the length parameters. MATERIALS AND METHODS: This study utilized an EOS radiological database of 112 patients. Two independent observers performed two rounds of lower-limb measurements twice, either in manual 3D or automatic 3D mode. The intra- and inter-observer reproducibility was evaluated by the calculation of the intra-class coefficient for each measurement method. The methods were then compared. RESULTS: The intra- and inter-observer reproducibility for length measurements found with the manual and automatic 3D methods was always > 0.98. There was no significant difference in the reproducibility between the two measurement modes, with the exception of the offset, hip-knee-shaft, and neck-shaft angles. CONCLUSION: Our results indicate a very good reproducibility of EOS™ length measurement, regardless of the method used. Automated 3D mode is preferred for the collection of angular and offset measurements. Furthermore, manual mode measurements are not affected by surgical history. Level of evidence IV.

Genetically tailored magnetosomes used as MRI probe for molecular imaging of brain tumor.

We investigate here the potential of single step production of genetically engineered magnetosomes, bacterial biogenic iron-oxide nanoparticles embedded in a lipid vesicle, as a new tailorable magnetic resonance molecular imaging probe. We demonstrate in vitro the specific binding and the significant internalization into U87 cells of magnetosomes decorated with RGD peptide. After injection at the tail vein of glioblastoma-bearing mice, we evidence in the first 2 h the rapid accumulation of both unlabeled and functionalized magnetosomes inside the tumor by Enhanced Permeability and Retention effects. 24 h after the injection, a specific enhancement of the tumor contrast is observed on MR images only for RGD-labeled magnetosomes. Post mortem acquisition of histological data confirms MRI results with more magnetosomes found into the tumor treated with functionalized magnetosomes. This work establishes the first proof-of-concept of a successful bio-integrated production of molecular imaging probe for MRI.

Gold-iron oxide dimers for magnetic hyperthermia: the key role of chloride ions in the synthesis to boost the heating efficiency.

With the aim of producing Au-Fe x O y dimers with outstanding heating performances under magnetic hyperthermia conditions applicable to human patients, here we report two synthesis routes, a two-pot and a one-pot method. The addition of chloride ions and the absence of 1,2-hexadecanediol (HDDOL), a commonly used chemical in this synthesis, are the key factors that enable us to produce dimers at low temperature with crystalline iron oxide domains in the size range between 18-39 nm that is ideal for magnetic hyperthermia. In the case of two-pot synthesis, in which no chloride ions are initially present in the reaction pot, dimers are obtained only at 300 °C. In order to lower the reaction temperature to 200 °C and to tune the size of the iron oxide domain, the addition of chloride ions becomes the crucial parameter. In the one-pot method, the presence of chloride ions from the start of the synthesis (as counter ions of the gold salt precursor) enables a prompt formation of dimers directly at 200 °C. In this case, the reaction time is the main parameter used to tune the iron oxide size. A record value of specific absorption rates (SARs) up to 1300 W gFe-1 at 330 kHz and 24 kA m-1 was measured for dimers with an iron oxide domain of 24 nm in size.

Influence of experience on intra- and inter-observer reproducibility of the Crowe, Hartofilakidis and modified Cochin classifications.

INTRODUCTION: A previous study demonstrated that the reproducibility of the Crowe (Cr), the Hartofilakidis (Ha) and the modified Cochin (Co) classifications were comparable. However, there were differences with a trend that suggested the influence of experience. Therefore, we performed a prospective study to investigate whether experience influenced the reproducibility of the commonly used developmental dysplasia of the hip (DDH) classifications. HYPOTHESIS: The hypothesis was that the intra- and inter-observer reproducibility scores would be higher in the senior group than the junior group, and particularly for the modified Co classification. METHODS: Four seniors and four residents classified 104 A/P pelvic radiographs (200 hips) two times using the Cr, Ha and Co classification systems. RESULTS: For intra-observer reproducibility, the average weighted concordance coefficients [95% confidence intervals] were for the senior and the junior groups: 92.2 [88.6-95.7] and 92.6 [87.9-97.2] for Cr, 92.1 [88.7-94.6] and 92.0 [87.7-96.3] for Ha, 94.2 [91.8-96.6] and 94.1 [91.5-96.6] for Co. The average weighted Kappa (95% confidence intervals) were 0.8 [0.71-0.88] and 0.79 [0.68-0.89] for Cr, 0.77 [0.74-0.81] and 0.75 [0.62-0.88] for Ha, 0.82 [0.76-0.89] and 0.80 [0.74-0.87] for Co. The junior inter-observer reproducibility multi-rater Kappa (list A:list B) were 0.57:0.50 (Cr), 0.47:0.53 (Ha), 0.42:0.42 (Co). Senior multi-rater Kappa were 0.53:0.49 (Cr), 0.40:0.34 (Ha), 0.40:0.43 (Co). CONCLUSIONS: Contrary to our hypothesis, the experience of the observer did not affect the intra- and inter-observer reproducibility of the three classification systems.

1º Congreso AADYND: Categoría Premio Congreso / Gasto energético y hemodiálisis crónica / Valoración nutricional cualitativa de los menús y diseño de la carta de restaurantes / Ferias Municipales: Viabilidad como canal de comercialización / Prueba piloto para conocer aceptabilidad, preferencia y saciedad de colaciones dulces con baja densidad energética y alto aporte proteico en mujeres perimenopáusicas / Rol de la infección por Helicobacter pylori en la regulación hormonal del apetito y el índice de masa corporal / Incursionando nuevas áreas de trabajo: "El licenciado en nutrición en una unidad de cuidados intensivos neonatales" / Diseño y proyección de audiovisuales animados como estrategia comunicativa / Proceso de mejora de las bases y condiciones para la concesión del servicio de confitería de la Facultad de Ciencias de la Salud (FCS). Universidad Nacional de Salta (UNSa) / Consumo de frutas en estudiantes universitarios

Introducción: Existen controversias sobre el comportamiento del gasto energético en reposo (GER) en pacientes en hemodiálisis (HD), algunos autores señalan que la HD aumenta el GER, mientras que otros no hallaron diferencias significativas. Objetivos: Determinar si el GER en pacientes en HD es superior al de individuos que no dializan. Determinar si el GER en pacientes en HD es mayor durante el momento de diálisis en comparación al momento que no dializan. Materiales y método: Para el objetivo 1, diseño comparativo a muestras independientes, observacional, prospectivo, transversal; para el objetivo 2, comparativo a muestras relacionadas, observacional, prospectivo, longitudinal. La muestra quedó conformada por 30 individuos en HD crónica y 30 controles apareados por edad, sexo, actividad física y estado nutricional. Se midió el GER utilizando un calorímetro indirecto móvil. Para el análisis estadístico se aplicaron test de diferencias (p < 0,05). Resultados: El GER de los individuos en HD no fue significativamente mayor al del grupo control (test de medias 56,8kcal, IC -76,6/190,2, p=0,1955; test de medianas 49,9kcal, IC -84,9/189,9, p=0,2142; test de signos 56,6%, IC 37,4/74,5, p=0,292). En los individuos en HD, el GER aumentó significativamente durante la sesión (test de medias 173kcal, IC -83,6/262,4, p=0,00022; test de medianas 170kcal, IC 85/255, p=0,00024; test de signos 83,33%, IC 65,3/94,3, p=0,00016). Al subdividir este grupo según presencia o ausencia de diabetes, se mantuvo el incremento del GER durante la diálisis. (test de medias 210kcal, IC 75,1/344,9, p 0,0044; test de medianas 212,5kcal, IC 65/340, p 0,0028; test de signos 85,71%, IC 42,1/99,6, p 0,06). Conclusiones: El GER de pacientes en HD no está incrementado con respecto a individuos sanos. En el paciente en HD crónica el GER aumenta durante el procedimiento dialítico en comparación al día que no asiste a diálisis.

Introducción: La carta de menú del restaurante, aparece como el elemento de comunicación más fuerte y a veces el único que se establece entre el restaurante y el consumidor. La tendencia creciente de comer fuera de casa convierte a los restaurantes en establecimientos cruciales para la promoción de un patrón alimentario saludable para toda la población. Una oferta alimentaria variada y equilibrada desde el punto de vista nutricional es el camino adecuado para mejorar la calidad de los menús, y con ello llevar mensajes nutricionales para mejorar la salud poblacional. Objetivos: Analizar el valor nutricional cualitativo de los menús y el diseño de la carta en los restaurantes de la ciudad de Mar del Plata en el año 2014. Materiales y método: La selección de restaurantes se llevó a cabo al azar por estratificación en zonas geográficas. Se realizó un análisis de valoración nutricional cualitativa de los menús con los datos recolectados. Simultáneamente, se analizó el diseño de las cartas de menús a través de una grilla de observación planteada específicamente para tal fin. Es un estudio descriptivo; no experimental y de tipo transversal. Resultados: Del menú se analizó un total de 258 entradas, 1186 platos principales, 137 guarniciones y 198 postres. La mayoría de las entradas y los platos principales ofrecidos están compuestos por proteínas animales, representado el 84% y el 70%, respectivamente. El promedio por restaurante es de 28 platos principales con papas fritas de guarnición. El diseño de la carta en su mayoría es sencillo y claro, sin elementos de comunicación visual llamativos. Conclusiones: Los menús analizados presentan un desequilibrio en su valor nutricional, con un exceso en proteína animal y poca oferta de platos con carbohidratos bajos.

Introducción: La perimenopausia se asocia con mayor probabilidad de padecer trastornos de la alimentación, destacándose la compulsión glucídica, que lleva a consumir fundamentalmente alimentos con alto contenido de carbohidratos entre comidas. Objetivos: evaluar aceptabilidad, preferencia y saciedad de colaciones dulces de baja densidad energética (DE) y alto aporte proteico en muestra de mujeres adultas perimenopáusicas. Materiales y método: A partir de receta estándar de merengues, se desarrollaron tres variantes con disminución de DE y sacarosa (Muestra A y C se reemplazó sacarosa por azúcar light y sucralosa en diferentes proporciones; Muestra B se disminuyó sacarosa y se agregó sucralosa). Se realizó ensayo de aceptabilidad y preferencia en 75 evaluadoras no entrenadas y prueba de saciedad a 27 evaluadoras no entrenadas, utilizando encuesta autoadministrada y escala hedónica de Likert de 9 puntos. Análisis estadístico: medidas de tendencia central, ANOVA, prueba de Friedman y Software "Statgraphics Centurion XVII" para pruebas de aceptabilidad. Resultados: Se desarrollaron merengues para las tres muestras de 1 g. cada uno, con disminución del 31% en la DE y 1,03 mg. de triptófano por unidad. La muestra B (se disminuyó la sacarosa al 88,7% y se agregó sucralosa en 11,3%), fue la de mayor preferencia y aceptabilidad por sus características sensoriales. Sobre esta muestra se aplicó el test de saciedad (libre demanda), obteniendo una media de ingesta de 10 unidades (Rango: 3-15). El 22,2% de las mujeres consumió 3 a 8 merengues; 51,8% 9 a 12 merengues y 25,9% más de 12 merengues. Se pudo observar que las mujeres estaban plenamente saciadas a los primeros 30 minutos, manifestando que a los 120 minutos tuvieron apetito. Conclusiones: La colación más aceptada y preferida fue la que mantuvo sacarosa y una proporción fue sustituida por edulcorante no calórico. El test de saciedad demostró que la colación seleccionada logró saciedad a corto plazo.

Introducción: Helicobacter pylori coloniza la mucosa gástrica y se asocia con el desarrollo de patologías gastrointestinales, pudiendo afectar la secreción de hormonas moduladoras del apetito. Objetivo: Evaluar la asociación entre la colonización gástrica por H. pylori, las concentraciones séricas de grelina y leptina y el índice de masa corporal (IMC) en pacientes con sintomatología digestiva. Materiales y método: Se llevó a cabo un estudio transversal que incluyó 163 pacientes dispépticos (18 - 70 años) derivados al Hospital de Gastroenterología "Dr. Carlos Bonorino Udaondo". Se realizó una encuesta sociodemográfica, recordatorio de 24 horas y se midió circunferencia de cintura (CC), peso y talla para el cálculo del IMC. La presencia de H. pylori se diagnosticó mediante 13C-Test del Aire Espirado (13C-UBT). Las concentraciones séricas de grelina y leptina se determinaron mediante enzimoinmunoensayo. Para el análisis estadístico se utilizaron los Tests de χ2, Mann-Whitney, correlación de Spearman y regresión lineal (SPSS19.0). Resultados: La prevalencia de la infección por H. pylori fue de 53,4% (IC95%;45,7-65,8%). La ingesta promedio de energía, carbohidratos, proteínas y lípidos no se asoció a la infección. Las prevalencias de sobrepeso/ obesidad y adiposidad central no difirieron significativamente entre H. pylori positivos y negativos (p=0.09 y p=0.87, respectivamente). La mediana de la concentración de grelina fue 306.5 pg/mL (RIC;230.0- 385.5) en H. pylori positivos y 358.3 pg/mL (RIC;253.8-547.8) en negativos. La infección se asoció con menores concentraciones séricas de grelina (p=0.016) aún ajustando por IMC y género (p=0.019), no habiéndose encontrado asociación entre los valores de leptina y la infección (p=0,76). Los niveles de grelina sérica se correlacionaron negativamente con el IMC (r=-0,25; p=0,0013), mientras que la correlación leptina-IMC fue positiva (r=0,56; p<0,00001) en la población total. Conclusiones: La colonización por H. pylori en pacientes con sintomatología digestiva se asoció con menores concentraciones séricas de grelina, enfatizando su rol en la regulación hormonal del apetito.

Introducción: La alimentación del recién nacido de pretérmino (RNPT) es un gran desafío. La administración óptima de nutrientes requiere de una infraestructura organizada y profesionales de distintas áreas que trabajen en forma conjunta. A partir de la necesidad de cumplir con estándares de calidad respecto del estado nutricional de pacientes neonatales, la Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital Universitario Austral (HUA) sugirió la incorporación de un licenciado en nutrición para colaborar en diferentes aspectos del cuidado nutricional de los mismos. Objetivos: Promover la inserción del licenciado en nutrición como parte del equipo colaborador del cuidado nutricional del neonato. Evaluar posibles herramientas que el licenciado en nutrición pudiera aportar dentro de una UCIN. Materiales y método: Se trabajó con monitoreo continuo de pacientes ingresados en la UCIN del HUA de Pilar durante el periodo de diciembre 2012 hasta la actualidad. Se diseñó una planilla para cargar datos de los pacientes que ingresan a la Unidad obtenidos de la historia clínica informatizada de la institución (Pectra Digital Gate®). Resultados: A partir de los datos recolectados se obtuvo información sobre: días de recuperación del peso de nacimiento; número de días para cubrir requerimientos propuestos; número de días que recibe NPT; aumento de peso de los últimos 7 días; monitoreo de soporte nutricional indicado y recibido; porcentaje de leche materna vs fórmula recibida. Se colaboró en el diseño de planillas de fraccionamiento de leches, protocolos de inicio de alimentación del recién nacido de bajo peso al nacer y uso de fortificadores de la leche materna; se optimizó el registro de la alimentación enteral y parenteral recibida en la historia clínica; se realizó asesoramiento de productos y búsqueda bibliográfica para la incorporación de nuevas fórmulas dentro del Vademécum de la institución. Conclusión: La existencia de protocolos básicos actualizados, cálculo de los requerimientos energéticos en función de la situación clínica y el estado nutricional, monitoreo de la alimentación enteral y parenteral, cumplimento del objetivo calórico, son algunos indicadores que pueden utilizarse como herramienta para medir la calidad de la actividad asistencial. El asesoramiento y monitoreo del cuidado nutricional del neonato son parte de las funciones que los nutricionistas pueden cumplir dentro de dichas unidades. La inclusión en la enseñanza de grado y postgrado del cuidado nutricional de este grupo es de vital importancia dentro del aprendizaje continuo del licenciado en nutrición.

Introducción: El proyecto se enmarca en el Programa de Ciudadanía Porteña, programa de asistencia alimentaria implementado por el Ministerio de Desarrollo Social de la Ciudad de Buenos Aires, basado en transferencia directa de ingresos a familias en situación de vulnerabilidad Objetivos: Realizar educación alimentaria nutricional en 3 mensajes: lactancia materna, alimentación complementaria e hidratación a usuarios del programa en salas de espera de las sedes en que realizan trámites. Materiales y método: Se diseñaron y proyectaron 3 animaciones audiovisuales de corta duración, cada una con contenidos de cada mensaje principal de los objetivos. Se entregaron 3 folletos para complementar la información del video. Se realizaron 148 encuestas directas a los beneficiarios que asistieron a las sedes del programa para evaluar la incorporación de los mensajes. Resultados: Se analizaron las encuestas por mensaje. Lactancia materna: 98% vio el video; 81,6 % recordó el tema principal; el beneficio de defensas fue el mayor con el 33%; 28% leyó el folleto; 42% opinó es bueno amamantar hasta los 2 años y más. Alimentación complementaria: 87% vio el video; 47,5% respondió como tema principal: Primeras comidas del bebé; 24% y el 17% según sede leyeron el folleto; 60% respondió como tema del folleto: Qué alimentos dar a los bebés por edades; 31% opinó en comenzar la alimentación complementaria antes de los 6 meses. Hidratación y consumo: 76% vio el video; 86% respondió correctamente el tema principal del video; 44% respondió como principal beneficio del agua saca la sed; 6% tomó el folleto. Conclusiones: Los mensajes fueron comprendidos satisfactoriamente. La implementación de la animación es un recurso práctico y moderno que facilita la incorporación de los mensajes. Su proyección repetitiva permite llegar a mayor cantidad de beneficiarios, el material gráfico tuvo menor recepción.

Introducción: El pliego de condiciones para la concesión de un servicio de confitería establece la calidad requerida. Por tal motivo es esencial especificar adecuadamente las condiciones del servicio que se espera recibir para brindar satisfacción a los usuarios y partes interesadas.Objetivos: Analizar el proceso y el pliego de bases y condiciones para la concesión del servicio de confitería de la FCS de la UNSa. Proponer mejoras para orientar las actividades futuras en relación a la compra, selección, preparación distribución y control del servicio. Materiales y Método: Se realizó una encuesta de satisfacción para conocer la calidad percibida por los usuarios de la confitería de la FCS. Se analizaron el proceso y los subprocesos de concesión del servicio, el pliego de condiciones mediante el cual se rige la actual concesión. Se aplicó el diagrama de Espina de Pescado para determinar la causa raíz el problema. Resultados: Los clientes manifestaron insatisfacción en relación a la variedad de preparaciones y la omisión de alimentos saludables como vegetales, pescados, lácteos descremados, jugos de frutas, cereales integrales. Problema raíz: pliego de condiciones incompleto y poco detallado. Conclusiones: El plan de mejoras en relación al pliego de bases y condiciones requiere tener en cuenta aspectos tales como: calidad de la materia prima, plan de menú, tipo y cantidad de comidas, ingredientes, formas de preparación, características físico químicas de las preparaciones saludables, porción estándar, presentación y tipos de vajilla.

Introducción: La importancia del consumo de frutas es vital debido a sus propiedades nutritivas, por su aporte de vitaminas, minerales, fibra y agua. Las Guías Alimentarias para la Población Argentina (GAPA) recomiendan el consumo diario de 2 a 3 frutas. Objetivos: Estimar la prevalencia de consumo inadecuado de frutas y determinar la prevalencia de dicho consumo por exceso o déficit, en estudiantes. Estimar la prevalencia de los motivos por los cuales no se consumen frutas en estudiantes. Materiales y método: Diseño descriptivo, observacional y transversal. La muestra quedó conformada por 486 estudiantes universitarios y terciarios. Se midió el consumo de frutas a través de una encuesta diseñada para tal fin. El análisis estadístico se realizó mediante el paquete VCCstat V.Beta 2.0. Resultados: El 23,5% de la muestra pertenecía a alguna carrera de ciencias de la salud. El 74% (IC95% 69,9-77,9) de los estudiantes no cumplió con la recomendación diaria de las GAPA. De este porcentaje, un 96,4% (IC95% 93,8-98) no llegó a consumir al menos dos frutas diarias, mientras que solo un 3,6% (IC95% 1,9-6,1) de los encuestados superó dicha recomendación. Se encontró un 34,6% (IC95%30,3-38,9) de estudiantes con consumo nulo. Entre los motivos de este hallazgo, un 72% (IC95% 64,5-78,6) lo adjudicó a la "falta de hábito". Entre los motivos restantes se destacan "no me gusta" con el 10,7% (IC95%6,4-16,4) y "falta de practicidad" con el 9,5% (IC95%,5-15). Conclusión: La mayoría de los estudiantes consume menos cantidad de frutas que la recomendada. Debido a la falta de hábito, un gran porcentaje de estudiantes no incorpora frutas en su alimentación diaria.

Can computer-assisted surgery help restore leg length and offset during THA? A continuous series of 321 cases.

INTRODUCTION: Total hip arthroplasty (THA) can bring about complications - particularly leg length differences - that are becoming increasingly litigious. Computer-assisted orthopedic surgery (CAOS) can help optimize the procedure, but its ability to effectively restore leg length is controversial. As a consequence, we carried out a study to determine: (1) its contribution to meeting leg length and offset objectives, (2) its reliability, by evaluating the correlation between radiological and navigation data, (3) its safety, by evaluating navigation-specific and non-specific complications. HYPOTHESIS: CAOS will help to restore leg length within ± 5 mm in more than 80% of cases. MATERIAL AND METHODS: A series of 321 continuous cases of cementless THA implanted through the posterolateral approach using CAOS was analyzed retrospectively. With a minimum 1 year follow-up, we evaluated whether the leg length and offset goals were achieved, how well the navigation and radiology data were correlated and whether navigation-specific and non-specific complications occurred. Based on our hypothesis that 80% of patients would have less than 5 mm leg length difference and the null hypothesis (PA = P0) with an alpha of 0.05, 200 observations were required to achieve a power of 90%. RESULTS: The leg length and offset objectives were achieved in 83.3% and 88% of cases, respectively. Twenty-two patients required a heel wedge to compensate for leg length differences. The correlation between the radiology and surgical navigation data was satisfactory - the Pearson coefficient was 0.79 for length and 0.74 for offset. Intraoperative and postoperative complications or adverse events were found in 14.6% of cases; these were specific to CAOS in 12.1% of cases and non-specific in 2.5% of cases. CONCLUSION: This study shows the relevance of CAOS for achieving preoperative leg length objectives, with good correlation between navigation and radiology data, and without major complications. LEVEL OF EVIDENCE: IV - retrospective study.

Comparison of the reliability of leg length and offset data generated by three hip replacement CAOS systems using EOS™ imaging.

INTRODUCTION: Computer-assisted orthopaedic surgery (CAOS) theoretically will help to optimise total hip arthroplasty (THA) results. Although CAOS systems have become more sophisticated, they are not widely used, partially because of their suspect reliability. To assess reliability of these systems, we carried out a study with multiple objectives in mind: (1) establish and compare the accuracy of the leg length (LL) measurement from three CAOS systems; (2) analyse the correlation of LL and offset data generated by these CAOS systems with those of the EOS™ imaging system; (3) determine if the goals of leg length restoration with ±2 and ±5 mm were achieved; (4) evaluate why certain cases fails. HYPOTHESIS: The three CAOS systems have the same accuracy for LL, and their error is less than or equal to 0.6mm. MATERIAL AND METHODS: We retrospectively studied 106 cases of primary THA where preoperative and postoperative measures of leg length had been performed with an EOS™ imaging system. The cases were placed in three groups, depending on which CAOS system had been used: group A (Amplivision™, amplitude), group B (Hip Express™, Brainlab), group P (THS™, Praxim). The accuracy of the leg length data was calculated by finding the difference between the data from each CAOS system and the gold-standard EOS measurements. RESULTS: The leg length accuracy was -0.846 [-5 to 9], -0.675 [-9 to 18] and 0.542 mm [-5 to 13], respectively for groups A, B and P. The accuracy was significantly lower in group A than B (P=0.044) and group P (P=0.038). The Pearson correlation coefficient for CAOS and EOS measurements was 0.189, 0.701 and 0.891 for leg length and 0.668, 0.202 and 0.680 for offset, for groups A, B and P, respectively. No difference between groups were observed relative to the leg length objectives being achieved within ±2 mm (P=0.61) and ±5 mm (P=0.314). There were no differences in terms of the number of CAOS failures: three in group A, one in group B and three in group P (P=0.06). CONCLUSION: The Praxim™ and Brainlab™ CAOS systems had similar accuracy for leg length measurements, and both were better than the Amplitude™ system. Only the Praxim™ had an error of less than 0.6mm. All the CAOS systems had values less than 1mm, which is considered excellent. LEVEL OF EVIDENCE: Level IV, retrospective study.

Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink.

BACKGROUND: Previous studies have demonstrated that patients with psoriasis have higher rates of comorbidities compared to the general population. Despite the clinical and economic burden of psoriatic disease, there have been few large-scale observational studies focused on this condition. OBJECTIVE: To assess rates of cardiovascular, autoimmune, infectious and other conditions in patients with psoriasis or psoriatic arthritis (PSA). METHODS: The data for this retrospective study were obtained from the Clinical Practice Research Datalink (CRPD). Cohorts of patients with psoriasis (n = 27,672; mild, n = 22,174, severe, n = 5498) and PSA (n = 1952) were generated based on the diagnosis made by general practitioner or specialist recorded in CPRD between 2006 and 2010. Frequencies of comorbidities at baseline and incidence rate ratios (IRR) of medical conditions occurring during follow-up were calculated and compared between groups. Cox proportional hazard models were employed to compare hazard ratios (HR) of comorbidities across the same subpopulations previously described. RESULTS: Significant differences in the unadjusted risk of cardiovascular disease, hyperlipidaemia, diabetes, skin cancer and autoimmune diseases were observed between patients with differing severity of psoriasis or between PSA and psoriasis patients. The adjusted HR analyses confirmed patients with severe psoriasis had significantly higher rates of several conditions including diabetes (1.23; 95% CI: 1.01-1.51) and rheumatoid arthritis (2.88; 95% CI: 2.25-3.67) compared to patients with mild psoriasis. Patients with PSA had significantly higher adjusted rates of hypertension (1.30; 95% CI: 1.01-1.68), rheumatoid arthritis (6.93; 95% CI: 5.45-8.80) and ankylosing spondylitis (6.98; 95% CI: 2.37-20.58) compared to those with severe psoriasis. CONCLUSION: Patients with mild psoriasis are less affected by comorbid conditions than those with severe psoriasis, and patients with psoriasis are less affected by comorbidities than those with PSA. Given the differences observed across severities of psoriasis and between psoriasis and PSA, each patient subgroup should be taken into consideration in clinical practice and future research.

Does prior conservative surgery affect survivorship and functional outcome in total hip arthroplasty for congenital dislocation of the hip? A case-control study in 159 hips.

INTRODUCTION: The results of total hip arthroplasty (THA) in congenital dislocation of the hip (CDH) are well known, but such is not the case for the impact of prior conservative surgery on THA function and survivorship. The present study compared THA in CDH with prior conservative bone surgery (BS group) versus no prior bone surgery (NBS group), to (1) assess the impact of prior conservative surgery on function and survivorship after THA, and (2) determine whether a particular type of conservative surgery affected function or survivorship. HYPOTHESIS: Prior conservative surgery for CDH does not affect function or survivorship of subsequent THA. PATIENTS AND METHODS: A multicenter retrospective case-control study analyzed 430 THAs in CDH patients (332 patients: 269 female, 63 male; mean age, 56 years [range, 17-80 years]) at a mean 13.2±5.4 years' follow-up (range, 1-29 years). The BS group included 159 hips (37%) (64 pelvic, 81 femoral and 14 combined pelvic and femoral osteotomies), and the NBS group 271 (63%). Groups were comparable for gender, age at surgery, Devane activity score, preoperative Postel Merle d'Aubigné (PMA) functional score and CDH radiographic type following Crowe. RESULTS: At follow-up, PMA scores were comparable: BS, 16.8±1.4 (11-18); NBS, 16.9±1.5 (7-18). Fifteen-year survivorship censored for implant revision for whatever reason did not significantly differ: BS, 87% (95% CI: 83-91%); NBS, 89% (95% CI: 86-92%). Ten-year survivorship on the same criterion did not significantly differ according to type of prior surgery: hip shelf arthroplasty, 97% (95% CI: 95-99%); Chiari osteotomy, 100%; femoral osteotomy, 95% (95% CI: 92-98%); and Milch osteotomy 96% (95% CI: 93-99%). DISCUSSION/CONCLUSION: Conservative surgery for CDH does not impair the functional results or survivorship of subsequent THA. LEVEL OF EVIDENCE: III, case-control study.

Comparison of the inter- and intra-observer reproducibility of the Crowe, Hartofilakidis and modified Cochin classification systems for the diagnosis of developmental dysplasia of the hip.

INTRODUCTION: Developmental dysplasia of the hip (DDH) leads to multiple treatment challenges during adulthood. Surgical treatment is mainly based on radiographic evaluation of the anatomical alterations. Several classification systems have been described in the published English scientific literature, but the French Cochin classification has not been used very much. Its primary advantage lies in its ability to intricately describe the DDH alterations with a large number of grades. We hypothesized that the inter- and intra-observer reproducibility of the SOFCOT-modified Cochin classification system was equal to that of the Crowe and Hartofilakidis classifications. MATERIAL AND METHODS: Five French orthopaedic surgeons who were DDH experts classified 94 A/P pelvis radiographs (179 hips) using the Crowe (Cr), Hartofilikadis (Ha) and modified Cochin (Co) systems. This evaluation was repeated a second time one month later. The intra-observer reproducibility was determined with weighted Kappa and concordance coefficients. The inter-observer reproducibility was performed by calculating the multirater Kappa coefficient on each of the two data series. RESULTS: For the intra-observer reliability, the average weighed concordance coefficients (95% CI) were 88.62-94.52 for Cr, 89.43-93.80 for Ha and 92.14-95.71 for Co. The average weighed Kappa coefficients (95% CI) were 0.70-0.85 for Cr, 0.67-0.82 for Ha and 0.75-0.83 for Co. For the inter-observer reliability, the Kappa for each assessment round was 0.57 and 0.48 for Cr, 0.43 and 0.44 for Ha, and 0.43 and 0.37 for Co. DISCUSSION: The intra- and inter-observer reliability for the modified Cochin classification system is the same as the one for the Crowe and Hartofilakidis classifications. The theoretical advantage of this classification system should be confirmed by comparing the findings with intra-operative anatomical observations. LEVEL OF PROOF, TYPE OF STUDY: IV.

Rotational femoral osteotomies using an endomedullary saw.

INTRODUCTION: The goal of this retrospective study is to analyze a series of ten patients (11 osteotomies) who underwent closed femoral rotational osteotomy using an endomedullary saw; stabilization was achieved by a locked centromedullary nail. We report the indications, technical aspects, clinical and radiological results as well as intercurrent complications with this surgical technique. HYPOTHESIS: Femoral endomedullary osteotomy is a safe procedure to correct malrotations. PATIENTS AND METHODS: Eleven femoral rotational osteotomies using an endomedullary saw were performed on ten patients, between January 1999 and July 2007. The indications were post-traumatic rotational malunions or congenital rotational deformities. The angular deformity averaged 33.5 degrees (24 degrees -52 degrees ). They were divided into internal rotation (ten cases) or external rotation (one case). One patient required a bilateral rotational osteotomy because of a congenital femoral malrotation combined to bilateral trochlear dysplasia. Rotational correction was, in two patients, simultaneously associated with a closed lengthening osteotomy. Clinical and radiological follow-up averaged 4 years and 9 months (26-104 months). The angular corrections obtained by these rotation osteotomies were calculated by CAT scans. RESULTS: Ten out of eleven osteotomies allowed a correction within a 4 degrees range in relation to the physiological femoral neck anteversion values (or to the contralateral side in the case of a healthy opposite lower extremity). There was no bone, joint, skin, or soft tissues infection, no pseudoarthrosis and no delayed outgrowth. We observed a transient neurological complication in the area of the pudendal nerve, during a combined rotational-lengthening osteotomy, as well as a bilateral femoral fracture during the bilateral rotational osteotomy. In all patients, consolidation occurred within a 3- to 5-month delay. The subjective results showed that eight out of nine patients (one was lost to follow-up) were satisfied or very satisfied with their operation, their functional recovery and the aesthetic aspects of their scars. DISCUSSION: Closed rotational osteotomies in adults represent a reliable, effective, safe and reproducible procedure for the correction of femoral torsion problems, whether they are post-traumatic or congenital. These results can be obtained only by respecting the indications and by applying a rigorously planned technique, including expertise in centromedullary nailing. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic study.

The island hemisoleus flap on distal vascular pedicle: anatomical bases and clinical applications.

The coverage of skin defects of the ankle and of the distal fourth of the leg remains a difficult problem despite progress in reconstructive surgery. The aim of our study was to establish an arterial map of the lateral head of the soleus muscle, to compare it with the existing data in order to investigate the possibility of raising a fibular artery-based pedicle island reverse flow flap. It has the theoretical advantage over its medial counterpart of sparing the main arterial axis of the leg and foot. The anatomical study was undertaken on 15 fresh cadavers, 8 left and 7 right randomly chosen lower extremities from different subjects. For each calf, the following measurements were obtained: fibular length from the fibular head to the tip of the lateral malleolus; length of the lateral head of the soleus from its most proximal insertion point on the fibula to the most proximal part of the ending of the muscle belly on the Achilles tendon; width of the lateral head of the soleus; distance between the origin of the fibular artery and the tip of the fibular head; number and height of the pedicles for the lateral soleus, taking as reference their origin from the fibular artery. The mean dimensions of the muscle belly of the lateral soleus were 218 mm in length (between 160 and 270) and 73 mm in width (58-95). In all the examined lower extremities, we found a main pedicle for the lateral soleus emerging from the fibular artery; and in all cases the blood supply of the proximal part of the muscle was of a segmental distribution by way of multiple branches originating from the fibular artery. Then the flaps were raised with a distal pivot point represented by the perforating branch of the fibular artery. In all the cases, the flap would have covered an ankle or a dorsal foot defect up to the metatarsal heads.

[Transmaxillary approach to the skull base: surgical anatomy and guidelines]. / Voie d'abord transmaxillaire de la base du crâne : anatomie chirurgicale et repères.

BACKGROUND: A surgical and anatomic approach to the skull base using the transmaxillary route is presented. This route is well-known and used for a long time for sinus conditions. METHOD: This study was performed on injected cadavers. This study describes step by step this approach in microsurgical conditions following a vital lead: the infraorbital nerve. RESULTS: Anatomical landmarks are located in order to avoid complications. These complications are on one hand, hemorrhages by vascular lesions and on the other, definitive nerve palsy. CONCLUSION: Several skull base approaches exist, transfacial routes produce cosmetic damages. This route preserves the functional anatomy of the nose because it preserves the integrity of the lateral wall of the nasal cavity.