Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study.

OBJECTIVE: To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS: Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS: At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS: This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE: A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.

A hybrid artificial intelligence model leverages multi-centric clinical data to improve fetal heart rate pregnancy prediction across time-lapse systems.

STUDY QUESTION: Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER: Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY: Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION: A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS: Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE: The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P < 0.001; Mann-Whitney test), and for fresh transfers (P < 0.001; Mann-Whitney test). LIMITATIONS, REASONS FOR CAUTION: Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S): Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for 'Devices and processes for machine learning prediction of in vitro fertilization' (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: N/A.

Environmental and economic impacts of combining backfill materials for novel circular narrow trenches.

Over the last few years, several policies and new technological solutions have targeted the construction sector with the aim of reducing the sector's impacts on the environment. Among the different technological advances proposed, the reuse of materials in construction has been reported as a promising solution for an increase in sustainability and circularity. In particular, a type of cities' undergrounds assets for which materials' reuse is being explored are trenches for protecting services (i.e., water and gas transport pipelines, and optic fibre and other telecommunications services). Nonetheless, the economic and environmental benefits and impact of this type of system is still insufficiently quantified. In this research study, the economic and environmental impacts of four scenarios of trenches were assessed by using Life Cycle Costing (LCC) and Life Cycle Assessment (LCA). The four alternatives analysed consisted of: (1) the classical solution; (2) the classical solution with the reuse of soil; (3) the control low-strength material, and (4) the eco-trench. The results allowed concluding that in the eco-trench system, for which all material is reused, the environmental and economic impacts could be reduced by more than 80% and 50%, respectively. A parametric study for which the dimensions of the trenches were varied, permitted to reinforce these results and to quantify the impact's change along with the width and depth of the trench. Overall, this study provides a comprehensive view of the high-impact potential of reusing material for the construction of trenches in cities. The outcomes allow also remarking that the eco-trench system could be an attractive and advantageous solution for urban infrastructure stakeholders, both from an economic and environmental perspective.

Periodontal health in a population with Parkinson's disease in Spain: a cross-sectional study.

BACKGROUND: The aim of this research is to evaluate the periodontal health of patients with Parkinson Disease (PD) in a Spanish cohort. MATERIAL AND METHODS: A cross-sectional study was performed on 104 patients with PD (mean age: 66.19+9.3 years) and 106 controls (mean age: 59.26+14.11 years). A pre-designed clinical protocol was implemented, which included a standardized epidemiological index for periodontal disease (CPITN), clinical attachment loss (CAL), tooth-loss, full mouth plaque index (FMPI), and oral hygienic habits. Univariate descriptions and comparative analysis were performed. RESULTS: The majority of PD patients presented good oral hygienic habits. There were no significant differences in relation to CPITN, periodontitis, gingival recessions and tooth loss. However, moderate/severe CAL (p=0.027) and FMPI (p=0.003) was higher in the PD group. CONCLUSIONS: There were no differences on periodontitis and tooth loss between both groups. The higher number of advanced CAL and presence of biofilm in the PD group could be related to the difficulties to perform an effective tooth brushing due to this neurological disorder.

Facts and controversies regarding oral health in Parkinson's disease: A case-control study in Spanish patients.

BACKGROUND: Parkinson's disease (PD) is one of the leading neurological disorders, affecting more than 6 million people worldwide. These patients present motor and non-motor symptoms, including oral pathology. The objective of this research is to determine the oral health of patients diagnosed with PD, in order to stablish a specific preventive oral health programme. MATERIAL AND METHODS: Case-control study on 104 PD and 106 control patients. The pre-designed clinical protocol included a complete oral examination on general aspects, standardised epidemiological index for caries, periodontal disease and edentulism, analysis of oral hygiene, presence of mucous/ salivary/ functional disorder, and dental treatments. RESULTS: A higher number of PD patients consumed daily sweets (p<0.004) and antidepressant drugs (p<0.004). Patients with PD practised less interdental hygiene (p<0.023). The mean plaque index was higher in PD (p<0.003). Drooling (p<0.001), xerostomia (p<0.001), hyposialia (p<0.001), dysphagia (p<0.001), hypogeusia/dysgeusia (p<0.025) and chewing difficulty (p<0.006) were more common in PD. CONCLUSIONS: Oral disorders are frequent in PD. A good knowledge of these alterations will allow us design a specific preventive protocol. Some oral alterations may be a sign of diagnostic alert or progression of PD.

Equine non-invasive time-lapse imaging and blastocyst development.

In this study we examined the timeline of mitotic events of invitro-produced equine embryos that progressed to blastocyst stage using non-invasive time-lapse microscopy (TLM). Intracytoplasmic sperm injection (ICSI) embryos were cultured using a self-contained imaging incubator system (Miri®TL; Esco Technologies) that captured brightfield images at 5-min intervals that were then generated into video for retrospective analysis. For all embryos that progressed to the blastocyst stage, the initial event of extrusion of acellular debris preceded all first cleavages and occurred at mean (±s.e.m.) time of 20.0±1.1h after ICSI, whereas 19 of 24 embryos that did not reach the blastocyst stage demonstrated debris extrusion that occurred at 23.8±1.1h, on average 4h longer for this initial premitotic event (P<0.05). Embryos that failed to reach the blastocyst stage demonstrated a 4-h delay compared with those that reached the blastocyst stage to reach the 2-cell stage (P<0.05). All embryos that reached the blastocyst stage expressed pulsation of the blastocyst with visible expansion and contraction at approximate 10-min intervals, or five to six times per hour. Using a logit probability method, we determined that 2- and 8-cell stage embryos could reasonably predict which embryos progressed to the blastocyst stage. Together, the results indicate that TLM for equine embryo development is a dynamic tool with promise for predicting successful embryo development.

APTANI: a computational tool to select aptamers through sequence-structure motif analysis of HT-SELEX data.

MOTIVATION: Aptamers are synthetic nucleic acid molecules that can bind biological targets in virtue of both their sequence and three-dimensional structure. Aptamers are selected using SELEX, Systematic Evolution of Ligands by EXponential enrichment, a technique that exploits aptamer-target binding affinity. The SELEX procedure, coupled with high-throughput sequencing (HT-SELEX), creates billions of random sequences capable of binding different epitopes on specific targets. Since this technique produces enormous amounts of data, computational analysis represents a critical step to screen and select the most biologically relevant sequences. RESULTS: Here, we present APTANI, a computational tool to identify target-specific aptamers from HT-SELEX data and secondary structure information. APTANI builds on AptaMotif algorithm, originally implemented to analyze SELEX data; extends the applicability of AptaMotif to HT-SELEX data and introduces new functionalities, as the possibility to identify binding motifs, to cluster aptamer families or to compare output results from different HT-SELEX cycles. Tabular and graphical representations facilitate the downstream biological interpretation of results. AVAILABILITY AND IMPLEMENTATION: APTANI is available at http://aptani.unimore.it. CONTACT: silvio.bicciato@unimore.it SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Effect of bovine ABCG2 Y581S polymorphism on concentrations in milk of enrofloxacin and its active metabolite ciprofloxacin.

The ATP-binding cassette transporter G2 (ABCG2) is involved in the secretion of several drugs into milk. The bovine Y581S ABCG2 polymorphism increases the secretion into milk of the fluoroquinolone danofloxacin in Holstein cows. Danofloxacin and enrofloxacin are the fluoroquinolones most widely used in veterinary medicine. Both enrofloxacin (ENRO) and its active metabolite ciprofloxacin (CIPRO) reach milk at relatively high concentrations. The aim of this work was to study the effect of the bovine Y581S ABCG2 polymorphism on in vitro transport as well as on concentrations in plasma and in milk of ENRO and CIPRO. Experiments using cells overexpressing bovine ABCG2 showed the effects of ABCG2 on the transport of CIPRO, demonstrating more efficient in vitro transport of this antimicrobial by the S581 variant as compared with the Y581 variant. Animal studies administering 2.5mg/kg of ENRO subcutaneously to Y/Y 581 and Y/S 581 cows revealed that concentrations in plasma of ENRO and CIPRO were significantly lower in Y/S animals. Regardless of the genotype, the antimicrobial profile in milk after the administration of ENRO was predominantly of CIPRO. With respect to the genotype effects on the amounts of drugs present in milk, AUC0-24 values were more than 1.2 times higher in Y/S cows for ENRO and 2.2 times for CIPRO, indicating a greater capacity of Y581S to transfer these drugs into milk. These results emphasize the clinical relevance of this polymorphism as a factor affecting the concentrations in plasma and in milk of drugs of importance in veterinary medicine.

Short communication: The gain-of-function Y581S polymorphism of the ABCG2 transporter increases secretion into milk of danofloxacin at the therapeutic dose for mastitis treatment.

The ATP-binding cassette transporter ABCG2 restricts the exposure of certain drugs and natural compounds in different tissues and organs. Its expression in the mammary gland is induced during lactation and is responsible for the active secretion of many compounds into milk, including antimicrobial agents. This particular function of ABCG2 may affect drug efficacy against mastitis and the potential presence of drug residues in the milk. Previous in vitro and in vivo studies showed increased transport of several compounds, including fluoroquinolones, by the bovine ABCG2 Y581S polymorphism. Our main purpose was to study the potential effect of this bovine ABCG2 polymorphism on the secretion into milk of the antimicrobial danofloxacin administered at the therapeutic dose of 6mg/kg used for mastitis treatment. In addition, the effect of this polymorphism on the relative mRNA and protein levels of ABCG2 by quantitative real-time PCR and Western blot were studied. Danofloxacin 18% (6mg/kg) was administered to 6 Y/Y homozygous and 5 Y/S heterozygous cows. Danofloxacin levels in milk and milk-to-plasma concentration ratios were almost 1.5- and 2-fold higher, respectively, in Y/S cows compared with the Y/Y cows, showing a higher capacity of this variant to transport danofloxacin into milk. Furthermore, the higher activity of this polymorphism is not linked to higher ABCG2 mRNA or protein levels. These results demonstrate the relevant effect of the Y581S polymorphism of the bovine ABCG2 transporter in the secretion into milk of danofloxacin after administration of 6mg/kg, with potentially important consequences for mastitis treatment and for milk residue handling.

[Treatment of lung lesions by stereotactic body radiation therapy after computed tomography guided placement of a Visicoil(®) marker: initial experience]. / Tratamiento de lesiones pulmonares mediante radioterapia estereotáxica extracraneal tras colocación guiada por tomografía computarizada de marcador Visicoil(®): experiencia inicial.

OBJECTIVE: To describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. MATERIAL AND METHOD: A series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analysed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation. The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumour to be controlled and to decrease the radiation volume, giving high doses with precision to the tumour, and minimal to the surrounding healthy tissue. RESULTS: The only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a grade 1 asthenia in 1 patient, a grade 2 pneumonitis in one patient and a grade 1 pneumonitis in the remainder. CONCLUSIONS: The CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumour to be increased, and reduces the volume of healthy lung treated, with few secondary effects.

Minimally invasive otoplasty: technical details and long-term results.

BACKGROUND: Aesthetic correction of the ears requires thorough diagnosis and subsequent treatment of the affected areas. The authors' technique addresses every deformity that might need correction through separate incisions, minimal scars, and conservative dissection without the use of permanent sutures. Correction of the eventual discrepancy between cartilage height and the skin envelope is particularly observed and addressed by means of scaphal reduction. The technical details, long-term results, and complications are evaluated in this article. METHODS: A retrospective review of 100 otoplasties performed between 2005 and 2009 by a single surgeon was conducted. Charts were reviewed and data were collected on the type of deformity corrected, the complications, and the outcome. RESULTS: Minimally invasive otoplasty was performed for 100 patients, primarily women (n=71), with an average age of 23.2 years. In 96 cases, bilateral correction was performed using a combination of concho-mastoid sutures (81%), scapha reduction (76%), antihelical folding (70%), conchal reduction (53%), or earlobe correction (19%). Three patients experienced partial recurrence and needed further correction. Partial upper pole necrosis developed in one patient after undue tension was applied to his dressing, and further correction was needed. Three patients experienced mild partial skin discoloration and epidermolysis that lasted no more than 10 days. Most of the patients were very satisfied (84%) or satisfied (15%) with the procedure after an average follow-up period of 12.4 months. CONCLUSIONS: Restoration of facial harmony through aesthetic correction of the ears is a highly satisfying procedure for both patients and surgeons. Since 1988, the author's unit has pursued and improved a technique that could provide shorter recovery times, minimal morbidity, and predictable results for a population consisting primarily of adults. This minimally invasive technique can achieve these goals with excellent long-term aesthetic outcomes.

Misidentification of two Brazilian triatomes, Triatoma arthurneivai and Triatoma wygodzinskyi, revealed by geometric morphometrics.

Triatoma arthurneivai Lent & Martins and Triatoma wygodzinskyi Lent (Hemiptera: Reduviidae) are two Brazilian species found in the sylvatic environment. Several authors may have misidentified T. arthurneivai and consequently published erroneous information. This work reports the use of geometric morphometric analysis on wings in order to differentiate T. arthurneivai and T. wygodzinskyi, and thus to detect possible misidentifications. Triatomines collected from the field in the states of Minas Gerais and São Paulo, and from laboratory colonies, were used. Analyses show a clear differentiation between specimens of T. arthurneivai and T. wygodzinskyi. This indicates that T. arthurneivai populations from São Paulo state were misidentified and should be considered as T. wygodzinskyi. This study also suggests that T. arthurneivai is an endemic species from Serra do Cipó, Minas Gerais state.

Treatment results of a modified Eden-Hybinette technique for anterior shoulder instability.

INTRODUCTION: Glenohumeral instability occurs in active-age patients with high recurrence rates in previously described treatments. The objective of the study was to analyze the functional and radiographic results of the patients that underwent a modified Eden-Hybinette technique. MATERIAL AND METHODS: From January 2017 to December 2019, 14 patients with post-traumatic anterior glenohumeral instability with glenoid bone loss higher or equal to 15% with or without Hill-Sachs lesion were included, qe used the modified Eden-Hybinette technique and outcomes were evaluated with WOSI and ROWE scales pre and post-procedure at 6, 12, and 24 months follow-up, a CT scan was performed at 6 weeks to evaluate the integration of the graft. RESULTS: Five women (35%) and nine men (65%) with a mean age of 39.1 (± 14) years were included. Ten involved the right shoulder (71.4%) and four the left one (28.5%). The results of WOSI and ROWE scales were statistically significant (p 0.05) in postsurgical evaluations as in all periods analyzed in contrast to a pre-surgical standing point; components of the WOSI test were also viewed separately (Sports, Lifestyle, Emotion, and Physical Symptoms) to assess if any of those separately could've altered or significantly influenced the total score obtained, but we found statistical significance (p 0.05) in all parameters. There was no recurrence or complications until the last follow-up. CONCLUSIONS: The modified Eden-Hybinette technique offers good short-term functional results. It is a safe technique. Further studies are necessary to determine the effectiveness and possible long-term results and complications.

INTRODUCCIÓN: La inestabilidad glenohumeral ocurre en pacientes en edad activa con altas tasas de recurrencia en tratamientos descritos anteriormente. El objetivo del estudio fue analizar los resultados funcionales y radiográficos de los pacientes sometidos a una técnica de Eden-Hybinette modificada. MATERIAL Y MÉTODOS: De enero de 2017 a diciembre de 2019, se incluyeron 14 pacientes con inestabilidad glenohumeral anterior postraumática con pérdida ósea glenoidea mayor o igual a 15% con o sin lesión de Hill-Sachs, se utilizó la técnica modificada de Eden-Hybinette y se evaluaron los resultados con las escalas WOSI y ROWE pre- y postprocedimiento a los 6, 12 y 24 meses de seguimiento, se realizó una tomografía computarizada a las seis semanas para evaluar la integración del injerto. RESULTADOS: Evaluamos cinco mujeres (35%) y nueve hombres (65%) con una edad media de 39.1 (± 14) años. Diez involucraron el hombro derecho (71.4%) y cuatro el izquierdo (28.5%). Los resultados de las escalas WOSI y ROWE fueron estadísticamente significativos (p 0.05) en las evaluaciones postquirúrgicas como en todos los períodos analizados en contraste con el prequirúrgico. Los componentes de la prueba WOSI también se vieron por separado (deportes, estilo de vida, emoción y síntomas físicos) para evaluar si alguno de ellos por separado podría haber alterado o influido en la puntuación total obtenida, pero encontramos significancia estadística (p 0.05) en todos los parámetros. No hubo recurrencia ni complicaciones hasta el último seguimiento. CONCLUSIONES: La técnica Eden-Hybinette modificada ofrece buenos resultados funcionales a corto plazo. Es una técnica segura. Se necesitan estudios adicionales para determinar la efectividad y los posibles resultados y complicaciones a largo plazo.

[Comparative study between enoxaparin and salicylic acetyl acid in antithrombotic prophylaxis for patients undergoing total knee arthroplasty]. / Estudio comparativo entre enoxaparina y ácido acetilsalicílico en profilaxis antitrombótica para pacientes sometidos a artroplastía total de rodilla.

INTRODUCTION: There is still controversy regarding thrombo-prophylaxis for the reduction of thromboembolic disease in major orthopedic surgery. OBJECTIVE: To answer the following question: is there a difference in the effectiveness and safety in the antithrombotic management of patients with a traditional regimen of enoxaparin against acetyl salicylic acid? MATERIAL AND METHODS: The surgeries were performed by 3 surgeons; the sample was randomized and the patients were subjected to the study criteria. We evaluated efficacy and safety as well as the need for readmission and secondary variables such as infection, acute myocardial infarction (AMI), cerebral vascular disease and death with a follow-up of 90 days. RESULTS: The total sample was 402 patients; 214 in the enoxaparin group and 188 in the aspirin group. There were 5 cases (1.24%) with thromboembolic disease, 3 (1.4%) enoxaparin and 2 (1.06%) aspirin without significant difference (p = 0.23). In terms of safety, major bleeding was zero in both groups, with minor bleeding in 7 patients (1.74%), 4 (1.86%) were from the enoxaparin group and 3 (1.59%) from the aspirin group without significant differences (p = 0.82). Secondary outcomes showed 5 (1.24%) superficial surgical wound infections and one AMI in the first 30 days of the procedure in the enoxaparin group. CONCLUSION: Aspirin as monotherapy is safe, effective in antithrombotic prophylaxis in patients operated on total knee arthroplasty.

INTRODUCCIÓN: Aún existe controversia en cuanto a la tromboprofilaxis para la disminución de la enfermedad tromboembólica en la cirugía ortopédica mayor. OBJETIVO: Responder la siguiente pregunta: ¿existe diferencia en la efectividad y seguridad en el manejo antitrombótico de pacientes con un régimen tradicional de enoxaparina contra ácido acetilsalicílico? MATERIAL Y MÉTODOS: Las cirugías se llevaron a cabo por tres cirujanos, se aleatorizó la muestra y los pacientes fueron sometidos a los criterios del estudio. Evaluamos eficacia y seguridad así como la necesidad de reingreso y variables secundarias como infección, infarto agudo de miocardio, enfermedad vascular cerebral y muerte con un seguimiento de 90 días. RESULTADOS: El total de la muestra fue de 402 pacientes, 214 en el grupo de enoxaparina y 188 en el de aspirina. Se presentaron cinco casos (1.24%) con enfermedad tromboembólica, tres (1.4%) enoxaparina y dos (1.06%) aspirina sin diferencia significativa (p = 0.23). En cuanto a seguridad, el sangrado mayor fue cero en ambos grupos, presentándose sangrado menor en siete pacientes (1.74%), cuatro (1.86%) fueron del grupo enoxaparina y tres (1.59%) del grupo aspirina sin diferencias significativas (p = 0.82). Los resultados secundarios mostraron cinco (1.24%) infecciones de herida quirúrgica superficiales y un IAM en los primeros 30 días del procedimiento en el grupo de enoxaparina. CONCLUSIÓN: La aspirina como monoterapia es segura y eficaz en profilaxis antitrombótica en pacientes operados de artroplastía total de rodilla.

Chondrogenic potential of subpopulations of cells expressing mesenchymal stem cell markers derived from human synovial membranes.

In this study we analyzed the chondrogenic potential of subpopulations of mesenchymal stem cells (MSCs) derived from human synovial membranes enriched for CD73, CD106, and CD271 markers. Subpopulations of human synovial membrane MSCs enriched for CD73, CD106, and CD271 markers were isolated using a cytometry sorter and characterized by flow cytometry for MSC markers. The expression of Sox9, Nanog, and Runx2 genes by these cells was measured by reverse transcriptase-polymerase chain reaction. The chondrogenesis of each subpopulation was assessed by culturing the cells in a defined medium to produce spontaneous spheroid formation and differentiation towards chondrocyte-like cells. The examination of the spheroids by histological and immunohistochemical analyses for collagen type II (COL2), aggrecan, collagen type I (COL1), metalloprotease 13 (MMP13), and collagen type X (COLX) levels were performed to assess their chondrogenesis capacity. The adipogenesis and osteogenesis potential of each subpopulation was determined using commercial media; the resulting cells were stained with oil red O or red alizarin to test the degree of differentiation. The subpopulations had different profiles of cells positive for the MSC markers CD44, CD69, CD73, CD90, and CD105 and showed different expression levels of the genes Sox9, Nanog, and Runx2 involved in chondrogenesis, undifferentiation, and osteoblastogenesis, respectively. Immunohistochemical analysis demonstrated that COL1, COL2, COLX, MMP13, and aggrecan were expressed in the spheroids as soon as 14 days of culture. The CD271(+) subpopulation expressed the highest levels of COL2 staining compared to the other subpopulations. CD105 and Runx2 were shown by immunohistochemistry and genetic analysis to have significantly higher expression CD271(+) subpopulation than the other subpopulations. Spheroids formed from CD271-enriched and CD73-enriched MSCs from normal human synovial membranes mimic the native cartilage extracellular matrix more closely than CD106(+) MSCs and are possible candidates for use in cartilage tissue engineering. Both cell types have potential for promoting the differentiation of MSCs into chondrocytes, presenting new possibilities for achieving intrinsic cartilage repair.

[Simulation as a tool to facilitate change in healthcare organisations]. / La simulación como herramienta para facilitar el cambio en las organizaciones sanitarias.

OBJECTIVE: To describe the use of simulation as a tool to support the strategic management of change in the Cantabrian Regional Health Service in Spain. METHODS: A working group was created to: 1) define the strategic areas of innovation and change; 2) establish criteria for the selection of proposals that can be addressed with simulation; 3) analyse and select the proposals; 4) design and implement the simulation programs, and 5) evaluate results. RESULTS: The constantly changing needs of the regional health system enabled 6 strategic areas to be identified during 2017-208: 1) efficient use of resources; 2) implementation of health plans of interest in the community; 3) patient safety improvement; 4) management of health personnel; 5) development of new professional skills, and 6) selection and implementation of new technology. CONCLUSIONS: Clinical simulation is a useful tool to promote innovation strategies in healthcare, facilitating the adaptation of professionals and patients to change.

Polyornithine-based polyplexes to boost effective gene silencing in CNS disorders.

Gene silencing therapies have successfully suppressed the translation of target proteins, a strategy that holds great promise for the treatment of central nervous system (CNS) disorders. Advances in the current knowledge on multimolecular delivery vehicles are concentrated on overcoming the difficulties in delivery of small interfering (si)RNA to target tissues, which include anatomical accessibility, slow diffusion, safety concerns, and the requirement for specific cell uptake within the unique environment of the CNS. The present work addressed these challenges through the implementation of polyornithine derivatives in the construction of polyplexes used as non-viral siRNA delivery vectors. Physicochemical and biological characterization revealed biodegradability and biocompatibility of our polyornithine-based system and the ability to silence gene expression in primary oligodendrocyte progenitor cells (OPCs) effectively. In summary, the well-defined properties and neurological compatibility of this polypeptide-based platform highlight its potential utility in the treatment of CNS disorders.

Differentiation of synovial CD-105(+) human mesenchymal stem cells into chondrocyte-like cells through spheroid formation.

Mesenchymal stem cells (MSCs) have the capacity to differentiate into several cell lineages, some of which can generate bone, cartilage, or adipose tissue. The presence of MSCs in the synovial membrane was recently reported. Data from comparative studies of MSCs derived from various mesenchymal tissues suggest that MSCs from synovial membranes have a superior chondrogenesis capacity. Previous chondrogenic differentiation studies have used the total population of MSCs, including cells with several MSC markers, such as CD44, CD90, CD105, or CD73. However the chondrogenic capacity of an individual population of MSCs has not been examined. Our aim was to study the chondrogenic capacity of the cellular MSC subset, CD105(+), derived from synovial membrane tissues of patients with osteoarthritis (OA) and normal donors. The tissues were digested with a cocktail of collagenase/dispase and the isolated MSCs were seeded into plates. The subpopulation of CD105(+)-MSCs was separated using a magnetic separator. The MSCs were then differentiated towards chondrocyte-like cells using a specific medium to promote spheroid formation. Spheroids were collected after 14, 28, and 46 days in chondrogenic medium and stained with hematoxylin, eosin, Safranin O or Alcian blue to evaluate the extracellular matrix. Immunohistochemistry was performed to study collagen types I (COLI) and II (COLII) and aggrecan expression. Phenotypic characterization of the isolated CD105(+)-MSCs shows that these cells are also positive for CD90 and CD44, but negatives for CD34 and CD45. In addition, this cellular subset expressed Sox-9. Spheroids appeared after 7 days in culture in the presence of chondrogenic medium. Our studies show no differences between MSCs obtained from OA and normal synovial membranes during chondrogenesis. The morphological analysis of spheroids revealed characteristics typical of chondrocyte cells. The intensity of Safranin O, Alcian blue and aggrecan staining was positive and constant throughout the culture period. However, the intensity of COL2 staining was higher at 28 days (84.29 +/- 0.1 U) than at 46 days (61.28 +/- 01 U), while COL1 staining was not detected in any samples analyzed. These results were confirmed by reverse transcriptase-polymerase chain reaction assays. We conclude that the cellular subset of CD105(+)-MSCs has chondrogenic capacity. The study also show the similar chondrogenic capacity of CD105(+)-MSCs cultured from normal and OA synovial membranes.

The association between the geographic distribution of Triatoma pseudomaculata and Triatoma wygodzinskyi (Hemiptera: Reduviidae) with environmental variables recorded by remote sensors.

In this study, predictive models of geographic distribution patterns of Triatoma pseudomaculata (Tps) and T. wygodzinskyi (Twy) were carried out. They were based on biophysical variables estimated from information provided by the satellite remote sensors AVHRR (Advanced Very High Resolution Radiometer) and MODIS (MODerate-resolution Imaging Spectroradiometer). Our goal was to analyze the potential geographic distribution of Tps and Twy and to assess the performance of three predictive models (one for each species and one for both species together) based on temperature, vapour pressure deficit, vegetation and altitude. The geographic distribution analysis shows that all models performed well (>85.7% of overall correct classification of presence and absence point data). The MODIS-based models showed lower correct classifications than the AVHRR-based models. The results strongly suggest that environmental information provided by remote sensors can be successfully used in studies on the geographic distribution of poorly understood Chagas disease vector species.