Prediction of ovarian response in IVF/ICSI cycles.

OBJECTIVE: Our study aims to evaluate the various correlations between demographic, biochemical, ultrasound, and ovarian stimulation parameters with the percentage of mature oocytes in conventional stimulation for IVF/ICSI cycles in order to develop a predictive model to improve our understanding of the oocyte maturation process. METHODS: This is a retrospective cohort study; patients underwent conventional antagonist ovarian stimulation protocols for fresh IVF/ICSI cycles. A total of 256 IVF/ICSI cycles were included. Age, antral follicle count (AFC), baseline serum follicle-stimulating hormone (FSH) levels, baseline serum luteinizing hormone (LH) levels, baseline serum estradiol (E2) levels, peak estradiol, P4 on hCG day, the body mass index (BMI), and stimulation length were measured. The variables were tested for correlations with the number of retrieved oocytes (#RO) and the number of mature oocytes (#MO). A backward stepwise regression was performed to identify the variables that correlated more strongly with percentage of mature oocytes (%MO). RESULTS: A predictive equation was obtained with the variables that were not excluded in the model. % MO = 72.700 - 0.910 (Age) + 0.979 (BMI) + 1.209 (Baseline serum LH) - 0.647 (Progesterone on human Chorionic Gonadotropin day). CONCLUSIONS: We concluded that age, the BMI, baseline serum LH, and progesterone level on hCG day may predict %MO. Prospective studies are required to validate this predictive equation.

Dysferlin quantification in monocytes for rapid screening for dysferlinopathies.

INTRODUCTION: In this study, we determined normal levels of dysferlin expression in CD14+ monocytes by flow cytometry (FC) as a screening tool for dysferlinopathies. METHODS: Monocytes from 183 healthy individuals and 29 patients were immunolabeled, run on an FACScalibur flow cytometer, and analyzed by FlowJo software. RESULTS: The relative quantity of dysferlin was expressed as mean fluorescence intensity (MFI). Performance of this diagnostic test was assessed by calculating likelihood ratios at different MFI cut-off points, which allowed definition of 4 disease classification groups in a simplified algorithm. CONCLUSION: The MFI value may differentiate patients with dysferlinopathy from healthy individuals; it may be a useful marker for screening purposes. Muscle Nerve 54: 1064-1071, 2016.

Relation of alcohol/tobacco use with metastasis, hormonal (estrogen and progesterone) receptor status and c-erbB2 protein in mammary ductal carcinoma.

BACKGROUND: An association between alcohol/tobacco use and risk of metastasis in breast cancer has been clearly shown. MATERIALS AND METHODS: The present study explored, in 48 samples of tissue from mammary ductal carcinoma (taken from Mexican women with an average age of 58.2±10.9 years), the association of risk of metastasis with the status of hormonal receptors and the c-erbB2 protein (by immunohistochemistry) as well as clinical, histopathological and sociodemographic factors. RESULTS: Of 48 patients, 41.6% (20/48) presented with metastasis, 43.8% were positive for the estrogen receptor (RE+), 31.3% for the progesterone receptor (RP+) and 47.7% for c-erbB2 (c-erbB2+). The following combinations were found: RE+/RP+/c-erbB2+ 8.3%, RE+/RP+ 22.9%, RE+/RP- 20.8%, RE-/RP+ 8.3%, RE-/RP-/c-erbB2- 22.9% and RE-/RP- 47.8%. There were 12 patients who used alcohol/tobacco, of which 91.6% did not present metastasis and 81.9% were RE-/RP-. Compared to the RE-/RP-/c-erbB2+, the RE+/RP+/c-erbB2+ group had a 15-fold greater risk for metastasis (95%CI, 0.9-228.8, p=0.05). The carriers of the double negative hormonal receptors had a 4.7 fold greater probability of being (or having been) smokers or drinkers (95%CI, 1.0-20.4, p = 0.03). CONCLUSIONS: There was a clear protective effect of using alcohol and/or tobacco, in the cases included in the present study of mammary ductal carcinoma, associated with double negative hormonal receptors. However, this association could be due to a protective factor not measured (Neyman bias) or to a bias inherent in the rate of hospitalization (Berkson fallacy). This question should be explored in a broad prospective longitudinal study.

[Quality of life in patients with bone tumors, a comparison between different treatments]. / Calidad de vida en pacientes con tumores oseos, una comparacion entre diferentes tratamientos.

INTRODUCTION. Previously, amputation was the only treatment option for patients with malignant bone tumors. Due to technological, medical and surgical advances, the number of survivors and years of survival has been increasing, and thus, the interest in evaluating the impact of this disease on quality of life. OBJECTIVE. To evaluate the health related quality of life reported by patients with bone tumors undergoing different treatments (no surgery/amputation/salvage). MATERIAL AND METHODS. Patients (n = 85) with bone tumors over the age of 18, both sexes, from the Instituto Nacional de Rehabilitación of Mexico City were included, divided into three groups according to type of treatment. The study design was cross-sectional, descriptive of a nonrandom sample. Quality of life was assessed with the Inventory of Quality of Life and Health (InCaViSa). Data were analyzed using descriptive statistics, comparisons between patients with different treatments were evaluated with multivariate analysis of covariance and Sidak post hoc tests. RESULTS. Statistically significant differences were detected in six of the twelve areas of quality of life that are assessed by the scale: physical functioning, isolation, body perception, treatment attitude leisure time and daily life. Health related quality of life in the study group is best for those patients who received amputation compared with the other treatments, while patients limb salvage procedures are those with greater impairment.

Análisis molecular por PCR múltiple anidada para virus de la familia herpes en la parálisis facial periférica idiopática / Molecular analysis by multiplex nested PCR for herpes virus family in idiopathic peripheral facial paralysis

En el Instituto Nacional de Rehabilitación, la parálisis facial periférica idiopática (PFPI) ocupa uno de los diez primeros lugares de atención. Su etiología aún es desconocida; sin embargo, se han identificado los virus de la familia herpes (HSV) como posibles agentes causales. Objetivo: Detectar el ADN de virus HSV-1 y HVS-2, citomegalovirus (CMV) y varicela zóster (VZV) en pacientes con PFPI y correlacionar su presencia con la presentación clínica de la enfermedad. Métodos: Se extrajo el ADN de la fracción leucocitaria de 62 muestras de pacientes con PFPI. La amplificación del ADN viral se realizó por PCR múltiple anidada con oligonucleótidos específicos para cada virus. La determinación de IgG e IgMse realizó por el método de ELISA. Resultados: La PCR mostró 22 (35.5%) casos positivos para HSV-1,1(1.6%) para HSV-2, 1 (1.6%) para VZV, 3 (4.8%) para CMV. La seroprevalencia mostró que 55 (88.7%) casos presentaron niveles altos de IgG para HSV-1 y 2, 2 (3.22%) para IgG-VZV y 5 (8.1%) para IgMCMV. Tanto los casos positivos como los negativos para HSV-1 no establecieron diferencias significativas con la edad, sexo, lateralidad, síntomas, grado de parálisis facial y la temporada en la que se presentó la parálisis. Conclusión: El virus más frecuente encontrado en nuestros pacientes fue el HSV-1 lo que sugiere una fuerte asociación entre la presencia de HSV-1 y la aparición de PFPI...

Effects of a stabilization exercise program in functionality and pain in patients with degenerative spondylolisthesis.

OBJECTIVE: To determine the effects of stabilization exercises on pain and function in patients with degenerative spondylolisthesis. STUDY DESIGN: Nonrandomized clinical trial, with 6 months of follow up. METHODS: Twenty patients over 50 years of age with degenerative spondylolisthesis underwent a 6-month, home-based training program of stabilization exercises. We applied functional and pain scales (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), and conducted an isokinetic trunk test. Statistical analysis included a T test for quantitative variables, a chi-squared test for qualitative data, and Pearson correlations. The significance alfa level was 0.05. RESULTS: Both pain and Oswestry Index scores were significantly decreased. Initial and final VAS "back pain" results were 63.50 ± 18.05 mm and 43.4 ± 22.09 (p=0.007) respectively. Initial and final VAS "sciatic pain" results were 53.65 ± 29.03 mm and 36.65 ± 27.21 (p=0.035) respectively. Oswestry Index at the beginning of the study was 30.35 ± 15.6%, decreasing to a final 20.15 ± 13.6% (p=0.007). The results of VAS and ODI scores correlated significantly with improvement in the isokinetic test. CONCLUSION: Lumbar stabilization exercises could be an effective treatment option in controlling pain and improving function in patients with degenerative spondylolisthesis. Further investigation with randomized controlled trials is necessary to obtain confirmation of these results.

Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint.

OBJECTIVE: To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis (RA). METHODS: One hundred three consecutive patients with RA and 103 age- and sex-matched healthy individuals were enrolled. Clinical evaluation and blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, osteophytes, erosions, and intraarticular power Doppler (PD) was recorded. Interobserver agreement was calculated. RESULTS: A total of 412 SC joints were evaluated: 206 from patients with RA and 206 from healthy controls. In the RA group, 39 joints (19%) were found to be clinically involved (pain/swelling), in contrast to only 4 (1.9%) in the control group (P = 0.0001). In the RA group, US abnormalities were recorded in 89 SC joints (43%) compared with 36 (17%) in the healthy control group (P = 0.0001), comprising osteophytes in 59 (29%) versus 25 (12%; P = 0.0001), synovitis in 31 (15%) versus 5 (2%; P = 0.0001), erosions in 23 (11%) versus none (P = 0.0001), and intraarticular PD in 5 (2%) versus none (P = 0.03). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. CONCLUSION: In patients with RA, US detected a higher number of involved SC joints than with clinical assessment. Our results indicate that both gray-scale and PD US findings were more prevalent in patients with RA than in healthy controls. US synovitis and synovial hyperperfusion correlated with the DAS28, suggesting that SC joints actively participate in the systemic inflammatory process of RA.

[Quantitative analysis of worn and torn particles in periprosthetic tissue of hip and knee with scanning electron microscopy]. / Análisis de partículas de desgaste en tejido periprotésico de cadera y rodilla con microscopia electrónica de barrido.

BACKGROUND: Arthroplasty is successful because biocompatible material is available, but its lifespan decreases due to inadequate fixation, mechanical wear and tear, or biological loss caused by osteolysis. This last is a tissue response to wear particles of the implanted material localized in the bone--prosthesis interface. We undertook this study to present the morphological analysis and characterization of the metal wear particles (MWP) in the periprosthetic tissue of patients with prosthetic loosening. METHODS: Interface tissue was studied in 63 patients with prosthetic loosening and was processed with the conventional histological technique, and tissues with wear and tear particles were subjected to chemical element determination by energydispersive X-ray analysis. RESULTS: Composition of the prosthesis placed in patients contained Cr-Co (30.2%), stainless steel (34.9%), Cr-Co/stainless steel (12.7%) and Ti (22.4%). Cellular response caused by wear and tear particles was classified according to three types. MWP were identified in only 19 membranes. Particle presence or absence was not significantly associated with clinical characteristics of the patient and worn and torn methacrylate or polyethylene particles. Periprosthetic membranes that showed MWP were the ones of older patients with a longer average time of graft use and those with severe necrosis. CONCLUSIONS: No patients experienced infection at the same time with MWP probably because they were treated for prosthetic septic loosening; consequently, it is less probable that they were recruited in a cross-sectional study such as the present one.

Bell's palsy. A prospective, longitudinal, descriptive, and observational analysis of prognosis factors for recovery in Mexican patients.

OBJECTIVE: To determine the prognosis factors in Mexican patients with Bell's palsy. DESIGN: We designed a prospective, longitudinal, descriptive, and observational analysis. Two hundred and fifty one patients diagnosed with Bell's palsy at the National Institute of Rehabilitation were included. We studied the sociodemographic characteristics, seasonal occurrence, sidedness, symptoms, and therapeutic options to determine the prognostic factors for their recovery. RESULTS: Thirty-nine percent of patients had a complete recovery and 41.5% had an incomplete recovery. Marital status, gender, etiology, symptoms, sidedness, House-Brackmann grade, and treatments did not represent significant prognostic factors for recovery. Age > 40 years (OR = 2.4, IC 95% 1.3-4.3, p = 0.002) and lack of physical therapy (OR = 6.4, IC 95% 1.4-29.6, p = 0.006) were significant prognostic factors for incomplete recovery. Familial palsy resulted to be a protective prognostic factor against an incomplete recovery (OR = 0.54, IC 95% 0.28-1.01, p = 0.039). This protection factor was only significant in female patients (OR = 0.41, p = 0.22) but not in male patients (OR = 1.0, p = 0.61). CONCLUSIONS: The proportion of cases with incomplete recovery was high. The age > 40 years and lack of physical therapy were the only significant prognostic factors for an incomplete recovery.

Effectiveness of calcitonin in intermittent claudication treatment of patients with lumbar spinal stenosis: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: Analyze the level of evidence in the effectiveness of calcitonin on the treatment of neurogenic claudication in patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: One of the most disabling features of lumbar spinal stenosis is neurogenic claudication. There have been proposed different drug therapies for it. The recommendation for calcitonin use in these patients has been sustained on autocontrolled clinical trial (Streifler et al, Neurol Neurosurg Psychiatry 1989;52:543-4), which only included 6 patients. MATERIAL AND METHOD: We performed a search on electronic databases that included Medline and Embase; we recovered 10 original articles, of which only 4 fulfilled the RCT criteria. These articles were reviewed independent and blinded way by 6 previously capacitated reviewers to extract data and score a quality of them by the criteria of Cochrane Handbook (1996) with maximum score of 1.00 and minimum score of 0.33. RESULTS: Score quality vary in the 4 articles: Porter and Millar, Spine 1988;13:1061-4 (score, 0.68), Eskola et al, Calcif Tissue Int 1992;50:400-3 (score, 0.88), Podichetty et al, Spine 2004;29:2343-9 (score, 0.88), and Tafazal et al, Eur Spine J 2007;16:207-12 (score, 0.92). Due to the great heterogenicity observed (sample sizes, selection criteria, doses, frequency, and duration of calcitonin, and outcome measurements), we were unable to perform a meta-analysis. Only one of these studies (Porter and Millar, Spine 1988;13:1061-4; score, 0.68) found favorable results for the use of calcitonin compared with placebo; of the 3 remaining trials none found significative evidence between drug therapy and placebo. CONCLUSION: The present data suggest that calcitonin administration in the treatment for neurogenic claudication has no benefit in patients with lumbar spinal stenosis.

[Description of a novel arthroscopic surgical technique for radio-ulnar instability in a cadaveric model]. / Descripción de una nueva técnica artroscópica para la inestabilidad radiocubital distal en modelos de cadáveres humanos.

INTRODUCTION: The distal radioulnar joint is subjected to two resultant loads. Axial load caused by grip and the transversal load due to the possibility of lifting weight against gravity. Therefore, instability of this joint leaves as a consequence a great functional incapacity. For this reason, numerous techniques have been described for its treatment such as Dr. Scheker's technique, a reconstruction technique based on a logical, anatomical, biological, mechanical, and functional solution. METHODS: We performed a descriptive study based in seven cadaveric models and fourteen wrists using a normal minimally invasive arthroscopic technique. The first step of the technique consisted in reproducing instability of the joint by means of a direct lesion of the dorsal fascicle of the triangular fibrocartilage complex. After this procedure, the reconstruction of the distal dorsal radioulnar ligament was carried out with a graft of palmaris longus tendon passed through the drilled tunnels in the distal methaphysis of the radio and ulna. Tunnels were performed under arthroscopic direct vision. The graft was inserted through the tunnels and then, fixed with a 2 mm. Endo-button system and a biodegradable screw of 5 mm. We measured range of motion before and after the surgery. The anterior-posterior translation test was applied on the models to measure instability of distal dorsal radioulnar joint, before, and after the surgical procedure. We performed descriptive statistics with SPPS 10.0 software. RESULTS: The technique was performed in fourteen wrists, with a mean surgical time of 104 minutes (80-164 min). The mean range of motion in flexion was 90.1 degrees before surgery and 90 degrees after surgery. Mean range of motion in extension was 86 degrees before and 88 degrees after the procedure. This finding was significant statistically with a value of p 0.008; the rest of measurements did not reach statistic significance. Stability was achieved in 12 models and 2 had a doubtful anterior-posterior translation test. DISCUSSION: The post-surgery extension was modified by the position and traction of the extremity in the cadaveric models. Two wrists remain unstable, by a technical defect while tensioning the graft at moment of fixation. CONCLUSION: Arthroscopic reconstruction for the distal dorsal radioulnar instability with a tendon graft is a technically reproducible technique. We recovered stability of the joint, and conserved range of motion in a cadaveric study.

[Meniscal repair in patients with chronic lesions]. / Reparación meniscal en pacientes con lesiones crónicas.

OBJECTIVE: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions. METHODS: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed. RESULTS: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 +/- 8.2 years (20-45). Mean time from lesion to surgery was 25.24 +/- 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings. CONCLUSIONS: Short-term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used.

[Epidemiology of bone and soft-part tumors of the foot and knee]. / Epidemiología de tumores óseos y partes blandas del pie y tobillo.

DESIGN: Report of cases. OBJECTIVE: Review of the cases in a period of 10 years with bone and soft tumors in foot and ankle, to knowing epidemilogical, clinic and patologic anatomy parameters to describe the behavior. MATERIALS AND METHODS: Review of 166 cases from 1991 to 2000 and been analyze with descriptive statistic, association measurment for inside stratum, with odds ratio, hipótesis test with chi square for qualitative date and t to Student for quantitative date. RESULTS: 166 patients within 2 years to 78 years old, 81 with bone tumors and 79 with soft tumors, mostly benign, the most frequent was in the soft tissue ganglion and oseal benign exostosis in bone, 6 different malignant tumors, the principal affected zone were the toes, as a difference to literature, the most affected age group was 10 to 20 years followed to the 30 to 40 years old, we report 42 different patological diagnostics results to soft tissue and osseous tissue. CONCLUSION: clinical features is not a useful parameter to differentiate between malign or benign tumors and does not allow to establish the biological behavior, we propose the diagnostic algorithm that includes the intentional clinical probe, comparative X-ray in three projections with soft technique, in suspicion to malignant lesion may require CT scan, MRI, osseous scan and finally biopsy which will improve the final outcome.

[Correlation of age, IGF-1 serum levels, muscular mass index and their influence as determinants of isokinetic variables in patients with osteoporosis]. / Correlación de edad, niveles séricos de IGF-1 e índice de mas muscular, y su influencia como determinantes de las variables isocinéticas en pacientes con osteoporosis.

INTRODUCTION: Bone and skeletal muscle mass loss is related to age. Mechanisms by which they interact have not been well established. OBJECTIVE: To establish a relationship of age with serum levels of IGF-1, skeletal muscle and appendicular muscle mass index, and their influence in isokinetic parameters in osteoporotic female patients. MATERIAL AND METHODS: Pearson correlation coefficient and linear regression analyses were used. RESULTS: There were 38 patients with a mean age of 65.16 years (range: 50-84 years), mean appendicular skeletal mass index (ASMI) of 6.3 kg/m2 (range: 4.3-8.3) and mean skeletal mass index (SMI) of 12.4 kg/m2 (range: 9.6-15.7), mean serum IGF-1 levels of 82.97 ng/ml (range: 22-177). Linear regression predicted hip mineral bone density by SMI (p = 0.19) and age (p = 0.017, r = 0.50). Some isokinetic parameters had a positive correlation for work with age. Knee acceleration time had a positive correlation with age. CONCLUSIONS: Osteoporosis and sarcopenia may have related pathophysiologic mechanisms. Growth factor study must include the influence of sex hormones. Some isokinetic parameters are determined by the predominant muscle fiber, skeletal mass index and age.

Factores de riesgo y manejo de la infección en la artroplastía total de rodilla / Risk factors and treatment for infection in total knee replacement

Objetivo. Con el presente estudio se trata de establecer los factores de riesgo para la artroplastía total de la rodilla, su frecuencia de infección y la eficacia del tratamiento para las complicaciones. Material y métodos. Estudio retrospectivo extraído de un total de 447 casos de prótesis total de rodilla (PTR) operados en un periodo de 10 años. Se diseñaron dos grupos comparativos, uno con 19 casos infectados y otro con 237 no infectados, tomados al azar, para un total de 256, con edad promedio de 68 años. Resultados. La edad promedio en mujeres con infección fue de 71 años (no infectadas 60 años, p = 0.002). Para mujeres infectadas con AR fue de 78 años (no infectadas con AR 54 años, p = 0.0001). No hubo diferencia entre mujeres que tenían enfermedades coexistentes, independientemente de artrosis o AR. En hombres con infección, la edad promedio fue 56.9 años para AR y 72.6 para artrosis (p = 0.0001). En todos los casos se resolvió mediante diversos procedimientos, como recambio del componente rotuliano en uno, recambio total en dos, desbridamiento y colgajos en cinco y artrodesis en 10. Conclusión. Los principales riesgos de infección parecen ser, la existencia en la 8a década de la vida para mujeres, independientemente de sufrir o no AR así como la presencia de AR en hombres menos viejos. La sola edad en varones, y la artrosis o las enfermedades coexistentes indistintamente del sexo no parecen ser por sí solas, factores de riesgo significativo.

Metodología de los estudios de meta-ánalisis en la investigación clínica / Meta-analysis methodology in clinical investigation

Frecuentemente la información médica sobre determinado aspecto clínico, es tan poco clara y contradictoria, que en ocasiones el profesional de la salud no tiene el tiempo o la orientación para poder analizarla en su totalidad, y poder así aprovecharla en su real magnitud. Para eso se ha desarrollado un proceso de análisis de esos conocimientos, llamándosele metaanálisis; éste es un estudio sistemático, cualitativo y cuantitativo de un grupo de informes o artículos de investigación, generalmente enfocado al análisis de un aspecto clínico. En este artículo de revisión, nosotros mostramos como se diseña, se ejecuta y reporta un metaanálisis, así como sus limitaciones y perspectivas.

Complicaciones paterales en la artroplastia total de rodilla: un estudio de metanálisis / Patellar complications in total knee arthroplasty: a meta-analysis study

Con el propósito de estimar las verdaderas diferencias entre diversos autores respecto a los porcentajes de complicaciones patelares (con o sin prótesis patelar) en la artroplastia total de rodilla (ATR), se realizó un estudio de metanálisis midiendo los tamaños del efecto (ES), las tasas de reducción del riesgo y el número de pacientes a tratar (NNT). En general, se demuestra que los estudios con muestras pequeñas introducen errores aletorios elevados y, estrictamente, no deberían ser considerados para estimar los tamaños del efecto al comparar los grupos tratados (ATR con prótesis patelar) contra los controles (ATR sin prótesis patelar). Se concluye que, al hacer las comparaciones correctas, los porcentajes de complicaciones son significativamente menores en la ATR con prótesis patelar y que las diferencias en los porcentajes de complicaciones, reportadas a partir de estudios con casuística relativamente grande, entre estos autores, son producto de los diferentes grados de dominio de las técnicas quirúrgicas empleadas. Se finaliza recomendando el uso de los estudios de metanálisis en ortopedia