Comparative study of biomodels manufactured using 3D printing techniques for surgical planning and medical training.

OBJECTIVES: To obtain 3D printed bone models with a haptic sensation similar to that of the real bone, which will help the surgeon to learn and improve based on practice. METHODS: From computed tomography, 3 digital anatomical models of the human proximal femur were created and, by modifying the printing parameters, both cortical and trabecular tissues were simulated, which were combined in a different cortico-cancellous interface depending on the bone segment. The 3 equivalent models obtained were compared with a commercial Sawbone synthetic model and subjected to a series of blind surgical practice trials performed by 5 TOC specialists from a hospital, each of them with different degrees of expertise. A statistical analysis of the qualitative data collected based on the Wilcoxon test, the Spearman correlation matrix, and the Validity Ratio Coefficient was performed. RESULTS: The deviations observed in the dimensional study are less than 0.2 millimeter, which confirms the validity of the 3DP-FFF technology to geometrically recreate personalized biomodels with high anatomical precision. CONCLUSIONS: The reproductions obtained have given rise to a reliable method that professionals can refine to plan operations with the consequent reduction of time and risks for the patient, as well as for medical training.

Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach

IntroductionTraditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option.MethodsA systematic review of the literature was conducted in PubMed (Jan 2000–Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included.Results7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant.ConclusionSurgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.

Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach.

INTRODUCTION: Traditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option. METHODS: A systematic review of the literature was conducted in PubMed (Jan 2000-Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included. RESULTS: 7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant. CONCLUSION: Surgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.

Destino ambiental y efectos ecológicos de los tres herbicidas más utilizados en Colombia / Environmental fate and ecological effects of the three most commonly used herbicides in Colombia / Destino ambiental e efeitos ecológicos dos três herbicidas mais comumente usados na Colômbia

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Abstract Knowledge of the environmental and transport fate of pesticides is integral to characterizing environmental exposures. Agencies such as the Environmental Protection Agency (EPA) 27 integrate the characterization of an exposure with ecological effects to determine the risks of pesticide use. The three most widely used herbicides in Colombia are glyphosate, propanil, and glufosinate ammonium. Although glyphosate had, since the early 1970's, been considered an environmentally friendly herbicide, the weight of the evidence of studies beginning in the 1990s show that inadvertent applications in wetlands can be fatal to the larvae of amphibians. Although glyphosate formulations are typically considered moderately toxic (LC50 = 1-10 ppm) for most aquatic organisms, for many amphibian species they are highly toxic (LC50 ˂ 1 ppm). This concern is compounded by the fact that Colombia has an incredibly high diversity of amphibians (746 species). In addition, chronic exposures of some amphibian species to sublethal concentrations, which are more likely found in the environment, have been shown to cause decreased survival, intersex gonads, tail damage, prolongation of time to metamorphosis, and liver lipidosis. In Colombia, aerial applications of Glyphos-Cosmo-Flux have been used since 1997 to fumigate illicit coca crops. As of 2019, the International Union for Conservation of Nature (IUCN) Red List had 285 species of amphibians in Colombia considered threatened. We found that 132 of the endangered (EN) and critically endangered (CR) amphibian species were present in 11 of the 32 Colombian departments with illegal coca plantations. Therefore, studies are needed to evaluate the impact of the coca eradication program on the amphibian population of the country. Propanil is the main herbicide used in rice fields. Despite its rapid environmental degradation ((1 day in aerobic conditions), studies on the impact of propanil have found that at projected application rates (4.5 kg/ha), within 48 hours after application, it reduces dissolved oxygen to levels critically important for survival of fish. At very low concentrations of 50 ppb or less of propanil, this effect correlates with lower phytoplankton production rather than higher community respiration. Despite being mild to moderately toxic at acute exposures, chronic exposure data also show that concentrations greater than 9 ppb affect the growth, reproduction, and development of fish and invertebrates. With respect to glufosinate ammonium, although it is highly likely to contaminate surface (runoff) and groundwater due to its physicochemical properties, data suggest that it is practically non-toxic to aquatic and terrestrial species. The acute hazard ratios were well below the level of concern, and therefore the EPA determined that the acute risk to non-target terrestrial and aquatic organisms is very low.

Resumo O conhecimento do destino ambiental e de transporte dos pesticidas é parte integrante da caracterização das exposições ambientais. Agências como a Agência de Proteção Ambiental (EPA) 27 integram a caracterização de uma exposição com efeitos ecológicos para determinar os riscos do uso de pesticidas. Os três herbicidas mais usados na Colômbia são glifosato, propanil e glufosinato de amônio. Embora o glifosato tenha sido considerado um herbicida ambientalmente correto desde o início da década de 1970, foi evidenciado por estudos iniciados na década de 1990 que aplicações inadvertidas em pântanos podem ser fatais para larvas de anfíbios. Embora as formulações de glifosato sejam tipicamente consideradas moderadamente tóxicas (CL50 = 1-10 ppm) para a maioria dos organismos aquáticos, para muitas espécies de anfíbios elas são altamente tóxicas (CL50 ˂ 1 ppm). Essa preocupação é agravada pelo fato de que a Colômbia tem uma diversidade incrivelmente alta de anfíbios (791 espécies). Além disso, foi demonstrado que exposições crônicas de algumas espécies de anfíbios a concentrações subletais, que são mais prováveis no ambiente, causam diminuição da sobrevivência, gônadas intersex, dano na cauda, prolongamento do tempo até a metamorfose e lipidose hepática. Na Colômbia, aplicações aéreas de Glyphos-Cosmo-Flux têm sido usadas desde 1997 para fumigar plantações ilícitas de coca. Em 2019, a Lista Vermelha da União Internacional para a Conservação da Natureza (IUCN) tinha 285 espécies de anfíbios na Colômbia consideradas ameaçadas. Descobrimos que 132 das espécies de anfíbios em perigo (EN) e criticamente em perigo (CR) estavam presentes em 11 dos 32 departamentos colombianos onde há mais plantações ilegais de coca. Portanto, são necessários estudos para avaliar o impacto do programa de erradicação da coca na população de anfíbios do país. O propanil é o principal herbicida usado nos campos de arroz. Apesar de sua rápida degradação ambiental ((1 dia em condições aeróbicas), estudos sobre o impacto do propanil descobriram que nas taxas de aplicação projetadas (4,5 kg / ha), ele reduz o oxigênio dissolvido a níveis criticamente importantes para a sobrevivência dos peixes em 48 horas. após a aplicação. Este efeito se correlaciona com a produção de fitoplâncton mais baixa, em vez de maior respiração da comunidade em concentrações muito baixas de 50 ppb ou menos de propanil. Apesar de ser leve a moderadamente tóxico em exposições agudas, os dados de exposição crônica também mostram que concentrações maiores que 9 ppb afetam o crescimento, a reprodução e o desenvolvimento de peixes e invertebrados. Com relação ao glufosinato de amônio, embora tenha grande probabilidade de contaminar a superfície (escoamento) e as águas subterrâneas devido às suas propriedades físico-químicas, os dados sugerem que é praticamente atóxico para as espécies aquáticas e terrestres. As razões de risco agudo estavam bem abaixo do nível de preocupação e, portanto, a EPA determinou que o risco agudo para organismos terrestres e aquáticos não visados é muito baixo.

Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. / Papel del cirujano ortopédico y traumatólogo en la impresión 3D: aplicaciones actuales y aspectos legales para una medicina personalizada.

3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of orthopaedic surgery and traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering. This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.

Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación / Surgical treatment of periprosthetic humerus fractures and algorithm

INTRODUCCIÓN: Las fracturas periprotésicas de húmero son infrecuentes y su manejo, difícil. La bibliografía es limitada y no existe consenso sobre su tratamiento. MATERIAL Y MÉTODO: Hemos realizado un estudio observacional retrospectivo de 10pacientes con fractura periprotésica de húmero con un seguimiento de 25,1 meses (6-87). Valoramos los resultados clínicos, radiológicos y funcionales, como las complicaciones. Utilizamos el cuestionario Quick-DASH y UCLA Shoulder Score (UCLASS). Realizamos una búsqueda sistemática para comparar la serie presentada y los protocolos de tratamiento publicados. RESULTADOS: Diez pacientes con una media de edad de 69,4 años (37-91) fueron intervenidos quirúrgicamente: 8 mediante reducción abierta y fijación interna (RAFI), en otro se realizó un recambio protésico colocando una nueva prótesis con un vástago más largo, y en el último se retiró la prótesis y se realizó una osteosíntesis con un clavo endomedular. Nueve de 10 pacientes consolidaron en un tiempo de 6,2 meses (rango 5-12); el restante sufrió una nueva fractura 5 meses después, siendo reintervenido, realizándole una nueva osteosíntesis, con aporte de aloinjerto óseo, que consolidó a los 8meses de la última fractura. En relación con la situación previa a la fractura, los pacientes tenían como promedio un descenso notable de la función, que era de 10,66 puntos en el test de UCLASS y un ascenso de 27,3 puntos en el cuestionario Quick-DASH. CONCLUSIONES: Nuestra serie tiene similitudes con las publicadas en relación con los aspectos demográficos, las complicaciones y el tiempo de consolidación. Sin embargo, en otros aspectos, como el dolor y los resultados funcionales, encontramos gran variabilidad

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10 cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23 months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10 patients with an average age of 69.4 years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5 months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66 points, and an increase of 27.3 points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients

Oral administration of Lactobacillus fermentum CRL1446 improves biomarkers of metabolic syndrome in mice fed a high-fat diet supplemented with wheat bran.

This work aimed to evaluate the effect of oral administration of probiotic Lactobacillus (L.) fermentum CRL1446, with feruloyl esterase (FE) activity, on metabolic biomarkers and intestinal microbiota of mice with high fat diet-induced Metabolic Syndrome (MS) and supplemented with wheat bran as a source of esterified ferulic acid. Six-week-old male Swiss albino mice developed the components of MS when fed with high fat diet supplemented with wheat bran (HFD + WB) for 14 weeks. Positive impact of L. fermentum CRL1446 administration on these animals was reflected in a decrease in body weight gain and adiposity index compared to the animals that did not receive the probiotic strain. In addition, a decrease in plasma leptin levels, improvement of inflammatory profile, reduction of fatty infiltration in hepatocytes and modification of lipid profile (increased HDL-cholesterol and decreased LDL-cholesterol and triglyceride levels) were observed. On the other hand, L. fermentum CRL1446 reduced fasting glucose and insulin levels, improving the HOMA index in mice with MS. Postprandial glucose levels were also reduced in the oral glucose tolerance test. Consumption of L. fermentum CRL1446 with HFD + WB (HFD + WB-Lf mice group) had a great impact on host metabolism, modulating intestinal microbiota, with an increase in Bacteroidetes and a decrease in Firmicutes abundance being observed. Increased intestinal FE activity, improved oxidative status and increased abundance of 3-hydroxyphenylpropionic acid and butyric acid concentration in colonic content, were also demonstrated in HFD + WB-Lf mice. Results obtained suggest that supplementation with L. fermentum CRL1446 enhances beneficial effects of a bran diet, attenuating the risk factors associated with MS.

Análisis de la mortalidad tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal / Analysis of mortality after surgical treatment of periprosthetic distal femur fractures

INTRODUCCIÓN: Está aumentando la incidencia de las fracturas periprotésicas de rodilla debido al incremento en el número de artroplastias totales de rodilla realizadas, junto al envejecimiento poblacional. Encontramos escasos estudios que analicen en nuestro medio la mortalidad a largo plazo tras la intervención quirúrgica. Nuestro objetivo fue evaluar la mortalidad y la supervivencia tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal en nuestro medio. MATERIAL Y MÉTODOS: Realizamos un estudio observacional retrospectivo de una serie consecutiva de 97 pacientes intervenidos quirúrgicamente en nuestro centro por fractura periprotésica de rodilla entre los años 2007 y 2015, con un seguimiento mínimo de 12 meses. Se analizaron estadísticamente diversas variables sociodemográficas, clínicas y quirúrgicas. Se realizó una consulta al índice nacional de defunciones del Ministerio de Sanidad para el análisis de mortalidad y se analizó la supervivencia utilizando el método Kaplan-Meier. RESULTADOS: Revisamos un total de 97 pacientes con edad media de 75años, de los cuales 86 fueron mujeres y 11 fueron hombres. El 50,5% de los pacientes presentaban alguna comorbilidad. La demora media hasta la intervención fue de 3,1 días. Respecto al tratamiento, 45 pacientes fueron intervenidos mediante osteosíntesis con placa (49,5%), 40 de ellos con clavo intramedular (41,2%) y en 9 se realizó una revisión de la artroplastia (9,3%). Se registraron un total de 30 defunciones durante el seguimiento, con una mortalidad acumulada al año, a los 3años y a los 10 años del 7,2, del 17,5 y del 30,9%, respectivamente, aumentando progresivamente en mayores de 75 años. No hubo diferencias significativas en las tasas de mortalidad respecto al método de osteosíntesis. La principal complicación fue la seudoartrosis (6,2%). CONCLUSIONES: Las fracturas periprotésicas de rodilla se asocian a altas tasas de complicaciones y de mortalidad, siendo la edad del paciente y la propia lesión factores no modificables que pueden influir en la mortalidad tras la cirugía, mientras que otras variables, como el tipo de intervención o la demora quirúrgica, no mostraron diferencias en las tasas de mortalidad en nuestro estudio

INTRODUCTION: The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. MATERIAL AND METHOD: We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12 months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. RESULTS: We reviewed a total of 97 patients with an average age of 75 years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1 days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75 years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). CONCLUSIONS: Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study

Analysis of mortality after surgical treatment of periprosthetic distal femur fractures. / Análisis de la mortalidad tras el tratamiento quirúrgico de las fracturas periprotésicas de fémur distal.

INTRODUCTION: The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment. MATERIAL AND METHOD: We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method. RESULTS: We reviewed a total of 97 patients with an average age of 75years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%). CONCLUSIONS: Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study.

Surgical treatment of periprosthetic humerus fractures and algorithm. / Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación.

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10patients with an average age of 69.4years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66points, and an increase of 27.3points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients.

Fracturas de astrágalo. Resultados funcionales en pacientes politraumatizados / Talus fractures. Functional results for polytraumatized patients

Las fracturas de astrágalo son lesiones poco frecuentes (0,1-0,9%) y con un alto índice de complicaciones. Una de las situaciones en las que puede darse una fractura de astrágalo es en el contexto de un politraumatismo, lo que puede comprometer aún más el pronóstico funcional. El objetivo del presente trabajo ha sido analizar los resultados funcionales en los pacientes con fracturas de astrágalo según se produjeran en el contexto de un politraumatismo o no. Estudio observacional sobre una cohorte retrospectiva de 24 pacientes intervenidos por fractura de astrágalo en nuestro centro (2008-2016). Se agruparon según fuesen politraumatizados (ISS>16) o no (ISS≤16). Revisión de variables sociodemográficas, radiográficas, funcionales (escala EVA de dolor y FADI -Foot and Ankle Disability Index-) y la aparición de complicaciones como artrosis o necrosis avascular. Revisión de 25 fracturas de astrágalo en 24 pacientes con una edad media de 38 años (19-75) y un seguimiento medio de 4,2 años (0,5-9). Según el ISS un 44% de pacientes (11) fueron politraumatizados y un 56% (14) no. Respecto a los resultados funcionales entre politraumatizados y no politraumatizados, la puntuación media según la escala FADI fue de 62 puntos y de 76,9 respectivamente y según la escala EVA fue de 5,8 y 4,3 puntos respectivamente. Respecto a las complicaciones, en el grupo de politraumatizados se presentaron en un 64% de los pacientes y en los no politraumatizados en un 43%. Un 36% de los pacientes politraumatizados tuvieron signos clínicos y radiológicos de artrosis subastragalina y un 27% fueron intervenidos mediante una artrodesis frente al 35% y al 27% del grupo de no politraumatizados, Respecto a la necrosis avascular del astrágalo, se registro un 27% frente a un 0% de los no politraumatizados

Talar fractures are uncommon lesions (0.1-0.9%) and have a high rate of complications. One of the situations in which a fracture of the talus can occur is in the context of polytrauma which may further compromise the functional prognosis. The aim of this study was to analyze the functional results in patients with talar fractures whether or not they occurred in the context of polytrauma. Observational study on a retrospective cohort of 24 patients operated in our centre (2008-2016). They were grouped according to whether they were polytraumatized (ISS>16) or not (ISS≤16). Review of sociodemographic, radiographic, functional variables (VAS pain scale and FADI -Foot and Ankle Disability Index-) and the onset of complications such as arthrosis, arthrodesis or avascular necrosis. Review of 25 talar fractures in 24 patients with a mean age of 38 years (19-75) and a mean follow-up of 4.2 years (0.5-9). According to the ISS, 44% of patients (11) were polytraumatized and 56% (14) were not. The average score according to the FADI scale was 62 points for the polytraumatized patients and 76.9 for the non-polytraumatized patients. The pain according to the VAS scale was 5.8 points in the group of polytraumatized patients and 4.3 in the non-polytraumatized patient group. Regarding complications, 64% of the polytraumatized patients and 43% of the non-traumatized patients had a complication. 36% of the polytraumatized patients had clinical and radiological signs of subtalar arthrosis compared to 35% of the non-traumatized patients, of whom 27% underwent arthrodesis compared to 28% of the non-traumatized patients. 27% of the polytraumatized patients were diagnosed with avascular necrosis as opposed to 0% of the non-polytraumatized patients

Planificación preparatoria digital en artroplastia total de cadera / Digital preoperative planning in total hip artroplasty

La planificación preoperatoria de la artroplastia total de cadera es una fase fundamental para disminuir la incidencia de complicaciones y conseguir resultados clínicos consistentes y reproducibles. Gracias a la planificación preoperatoria, el cirujano puede identificar las dificultades quirúrgicas del paciente sobre las cuales es necesario actuar, permite anticipar instrumental o implantes específicos, facilita la comunicación y docencia entre compañeros y proporciona cobertura legal. La introducción de la radiología digital ha supuesto un verdadero avance en la evaluación radiográfica de los pacientes. Encontramos numerosas ventajas asistenciales, docentes e investigadoras. Para realizar correctamente las técnicas de planificación preoperatoria en Cirugía Ortopédica y Traumatología, así como para realizar diversas mediciones o colocar plantillas digitales, es necesario el uso de un software específico y conocer la magnificación de la radiografía. Para establecer la magnificación de la radiografía existen diversos sistemas de calibración como el uso de marcadores o la magnificación fija según la región anatómica a estudio. En este trabajo realizamos una revisión del estado actual de la planificación preoperatoria digital en la artroplastia de cadera, las ventajas que su realización de forma adecuada proporciona al cirujano y los recursos técnicos que son necesarios para poder realizarla de forma habitual en un servicio de Cirugía Ortopédica y Traumatología

Preoperative planning of total hip arthroplasty is an essential step in order to reduce the incidence of complications and achieving consistent and reproducible clinical outcomes. Thanks to preoperative planning, the surgeon can identify surgical difficulties of the patient, anticipate specific implants or techniques, facilitates communication between surgical team and provides legal coverage. The introduction of digital radiology has been a real advance in the radiographic evaluation of patients. We find many clinical, educational and researchers benefits. It is necessary the use of a specific software and know the magnification of the digital radiograph to correctly perform preoperative techniques as well to perform measurements or place digital templates. To establish the magnification of the radiograph there are several calibration methods such as the use of markers or fixed magnification according to the anatomical region under study. In this paper, we perform a review of the current state of digital preoperative planning in hip arthroplasty, the advantages that its adequate realization provides to the surgeon and the technical resources that are necessary perform it regularly in a department of Orthopedic Surgery and Traumatology

Talus fractures. Functional results for polytraumatized patients. / Fracturas de astrágalo. Resultados funcionales en pacientes politraumatizados.

Talar fractures are uncommon lesions (0.1-0.9%) and have a high rate of complications. One of the situations in which a fracture of the talus can occur is in the context of polytrauma which may further compromise the functional prognosis. The aim of this study was to analyze the functional results in patients with talar fractures whether or not they occurred in the context of polytrauma. Observational study on a retrospective cohort of 24 patients operated in our centre (2008-2016). They were grouped according to whether they were polytraumatized (ISS>16) or not (ISS≤16). Review of sociodemographic, radiographic, functional variables (VAS pain scale and FADI -Foot and Ankle Disability Index-) and the onset of complications such as arthrosis, arthrodesis or avascular necrosis. Review of 25 talar fractures in 24 patients with a mean age of 38 years (19-75) and a mean follow-up of 4.2 years (0.5-9). According to the ISS, 44% of patients (11) were polytraumatized and 56% (14) were not. The average score according to the FADI scale was 62 points for the polytraumatized patients and 76.9 for the non-polytraumatized patients. The pain according to the VAS scale was 5.8 points in the group of polytraumatized patients and 4.3 in the non-polytraumatized patient group. Regarding complications, 64% of the polytraumatized patients and 43% of the non-traumatized patients had a complication. 36% of the polytraumatized patients had clinical and radiological signs of subtalar arthrosis compared to 35% of the non-traumatized patients, of whom 27% underwent arthrodesis compared to 28% of the non-traumatized patients. 27% of the polytraumatized patients were diagnosed with avascular necrosis as opposed to 0% of the non-polytraumatized patients.

Microencapsulated feruloyl esterase-producing lactobacilli ameliorate lipid profile and glycaemia in high fat diet-induced obese mice.

The effect of oral administration of spray-dried microcapsules of feruloyl esterase (FE) producing Lactobacillus fermentum CRL1446 (Lf) and Lactobacillus johnsonii CRL1231 (Lj) on high fat diet-induced obese mice was investigated to evaluate whether these strains could be used as a biotherapeutic for obesity. Swiss albino mice were divided into a normal diet fed group receiving empty microcapsules (control), a high fat diet plus empty microcapsules (HFD group), HFD plus microcapsules with Lf (HFD-Lf group) and HDF plus microcapsules with Lj (HFD-Lj group). Microcapsules containing Lf or Lj at a dose of ~107 cells/day/mouse were given orally for 7 weeks. Body weight gain, adiposity index, plasma leptin, lipid profiles, glycaemia, insulinemia, oral glucose tolerance, intestinal FE, glutathione peroxidase and glutathione reductase (GR) activities were determined. Administration of lactobacilli (HFD-Lf and HFD-Lj groups) improved metabolic parameters (triglyceride, total cholesterol, low-density lipoprotein cholesterol levels) and cardiovascular risk indicators (37-46% decrease of atherogenic index), and reduced body weight gain (29-38%), adiposity index (42-62%), plasma leptin levels, liver weight and fat deposition in liver. Intestinal FE activities significantly increased in HFD-Lf (62%) and HFD-Lj group (48%), thus improving hepatic GR activity (42% increment) compared to HFD group. Moreover, L. johnsonii increased HDL-cholesterol and L. fermentum reduced blood glucose to levels similar to the control. These FE-producing lactobacilli have the potential to improve biomarkers involved in obesity by increasing intestinal FE activity.

Characterization of cytokine gene expression in uterine cytobrush samples of non-endometritic versus endometritic postpartum dairy cows.

To better understand uterine inflammation in postpartum dairy cows we collected sequential cytobrush samples at 29-35 and at 49-55 d in milk (DIM). Based on the uterine cytology, cows were classified as Non-endometritic (n = 23; <18% neutrophils) or Endometritic (n = 12; ≥18% neutrophils) at 29-35 DIM and Non-endometritic (n = 17; <10% neutrophils) or Endometritic (n = 9; ≥10% neutrophils) at 49-55 DIM. Cows defined as Sham Controls (n = 6) were examined by vaginoscopy at 29-35 DIM and identified as Non-endometritic (<10% neutrophils) at 49-55 DIM. Cytokine gene expression in cytobrush samples was assessed using qRT-PCR. Sham Controls did not differ significantly (P > 0.17) from Non-endometritic cows at 49-55 DIM and these data were combined (n = 23). Uterine cytology-based classification using the aforementioned thresholds effectively separated cows into groups with Endometritic cows having significantly higher expression of pro-inflammatory (interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-17A CSF-1; P < 0.01) and regulatory (IL-1RA and IL-10; P < 0.03) cytokines, relative to Non-endometritic cows. Furthermore, Non-endometritic cows showed a significant decline (P < 0.03) in the expression of pro-inflammatory (IL-1α, IL-6, IL-8) and regulatory (IL-10) cytokine genes as the postpartum period progressed; whereas Endometritic cows exhibited a sustained elevation in transcript abundance throughout the sample period for both pro-inflammatory and regulatory cytokine genes. Expression of transforming growth factor (TGF) genes was more complex with TGF-ß3 expression significantly (P < 0.01) lower at 29-35 DIM and TGF-ß1 gene expression significantly (P < 0.03) increased at 49-55 DIM in Endometritic versus Non-endometritic cows. Expression of TGF-ß2 gene was 2.7-fold higher (P < 0.01) at 29-35 DIM in cows that remained Endometritic when compared to cows recovering by 49-55 DIM. Some Non-endometritic cows (n = 4) at 29-35 DIM were reclassified as Endometritic at 49-55 DIM. The sampling procedures at 29-35 DIM did not alter either the cellular response (P > 0.43) or cytokine gene expression (P > 0.17) at 49-55 DIM. In conclusion, normal uterine involution is characterized by a progressive decline in pro-inflammatory and regulatory cytokine gene expression, while cows with endometritis show a dysregulated inflammatory process characterized by a sustained elevation in pro-inflammatory and regulatory cytokine gene expression. This analysis also shows that decreased TGF-ß2 gene expression at 29-35 DIM may be an indicator of recovery from endometritis.

Fibroma no osificante / Non-ossifying fibroma

No disponible

Treatment of posttraumatic bone defects of the forearm with vascularized fibular grafts. Follow up after fourteen years.

BACKGROUND: Among several techniques proposed for the reconstruction of posttraumatic bone defects of the forearm, that of free vascularised fibular graft (FVFG) is one of the most widely used. PATIENTS AND METHOD: We study the long-term outcomes of 14 patients who underwent FVFG between 1994 and 2009, with a minimum follow up of 8 years and a maximum of 23 years (mean: 13.9 years). Demographic, clinical and radiological variables were collected retrospectively. The DASH scale was used for clinical assessment. RESULTS: Fourteen patients were operated on by the same surgeon, applying FVFG for the reconstruction of posttraumatic bone defects of the forearm (three septic non-union of the ulna or radius, five radius fractures, two ulna fractures and four fractures of both bones). The maximum length of the defect was 11 cm and the minimum length was 6 cm. In four cases, reconstruction of the two bones was achieved using the double barrel technique, and in another four cases, an osteoseptocutaneous flap was used. Fixation was performed with 3.5 mm reconstruction plates in thirteen cases and with 3.5 mm screws in one case. Consolidation was obtained in 12 cases (85.7%) after an average time of 4.2 months (range: 2-6.5 months). In one case, consolidation of the proximal ulnar fracture site was not achieved, and in another, following the failure of reconstruction attempts, an arthrodesis was performed. At the end of the follow-up period, the patients had an average DASH score of 17.1 points (range 1.8-68.1). CONCLUSIONS: FVFG is a valid option for the reconstruction of posttraumatic bone defects of the forearm. Its use via the double barrel method or as an osteocutaneous composite graft enables the simultaneous reconstruction of both forearm bones and associated soft tissue injuries. Long-term follow-up of patients who have undergone this technique confirms its satisfactory functional and radiological results.

Melatonin expression in periodontitis and obesity: An experimental in-vivo investigation.

BACKGROUND AND OBJECTIVE: Melatonin deficiency has been associated with obesity and systemic inflammation. This study aims to evaluate whether melatonin could interfere with the mechanisms of co-morbidity linking obesity and periodontitis. MATERIAL AND METHODS: Twenty-eight male Wistar rats were randomly divided in 4 groups: control group (Con) (fed with standard diet); high-fat diet group (HFD) (fed with a diet containing 35.2% fat); Con group with induced periodontitis (Con-Perio) and HFD group with induced periodontitis (HFD-Perio). To induce periodontitis, the method of oral gavages with Porphyromonas gingivalis ATCC W83K1 and Fusobacterium nucleatum DMSZ 20482 was used. Circulating melatonin levels were analyzed by multiplex immunoassays. Periodontitis was assessed by alveolar bone loss (micro-computed tomography and histology) and by surrogate inflammatory outcomes (periodontal pocket depth, modified gingival index and plaque dental index). RESULTS: Plasma melatonin levels were significantly decreased (P < .05) in the obese rats with periodontitis when compared with controls or with either obese or periodontitis rats. Alveolar bone loss increased 27.71% (2.28 µm) in HFD-Perio group compared with the Con group. The histological analysis showed marked periodontal tissue destruction with osteoclast activity, particularly in the HFD-Perio group. A significant negative correlation (P < .05) was found between periodontal pocket depth, modified gingival index and circulating melatonin levels. CONCLUSION: Obese and periodontitis demonstrated significantly lower melatonin concentrations when compared with controls, but in obese rats with periodontitis these concentrations were even significantly lower when compared with either periodontitis or obese rats. These results may indicate that melatonin deficiency could be a key mechanism explaining the co-morbidity effect in the association between obesity and periodontitis.

Resultados de la implementación del reporte de sospecha de reacciones adversas a medicamentos por pacientes: revisión estructurada / Results of the implementation of the report of suspicion of adverse drug reactions by patients: structured review

Resumen Objetivo: Identificar la contribución del reporte de reacciones adversas a medicamentos por pacientes, así como las barreras y facilitadores asociados con esta estrategia. Metodología: Revisión estructurada en PubMed/MedLine de artículos en inglés y/o español, hasta el 30/05/2017, con los términos: Pharmacovigilance reporting AND patient report. Resultados: Se obtuvieron 16 artículos con información relacionada con el objeto de estudio y se incluyeron tres artículos más considerados como relevantes. Se identificaron las principales barreras y facilitadores del paciente para reportar la sospecha de reacciones adversas a medicamentos, los efectos del reporte y las características del mismo. De igual forma, se describieron las diferencias y similitudes entre el reporte por profesionales de la salud y pacientes. Conclusiones: La implementación del informe por pacientes disminuye el sub-reporte en farmacovigilancia. Además, permite la participación activa y la integración de las experiencias del paciente con las reacciones adversas a los medicamentos.

Abstract Objective: To identify the contribution of the report of suspected adverse drug reactions by patients, as well as the barriers and facilitators associated with this strategy. Methodology: Structured review based on PubMed / MedLine articles in English and Spanish, until 05/30/2017, using the keywords: Pharmacovigilance reporting AND patient report. Results: 16 articles were identified with information related to the object of study and three more were included taking into account their relevance. Main barriers and facilitators of patients for reporting suspected adverse drug reactions, the effects of the report and its characteristics, were identified. Besides, similarities and disparities between reports from health professionals and patients were described. Conclusions: The implementation of the report by patients decreases sub-reporting in pharmacovigilance. In addition, it allows the active participation and integration of patients' experiences about adverse drug reactions.