Prognostic Value of Measurable Residual Disease in Patients with AML Undergoing HSCT: A Multicenter Study.

Allogeneic hematopoietic stem cell transplantation (HSCT) represents the best therapeutic option for many patients with acute myeloid leukemia (AML). However, relapse remains the main cause of mortality after transplantation. The detection of measurable residual disease (MRD) by multiparameter flow cytometry (MFC) in AML, before and after HSCT, has been described as a powerful predictor of outcome. Nevertheless, multicenter and standardized studies are lacking. A retrospective analysis was performed, including 295 AML patients undergoing HSCT in 4 centers that worked according to recommendations from the Euroflow consortium. Among patients in complete remission (CR), MRD levels prior to transplantation significantly influenced outcomes, with overall (OS) and leukemia free survival (LFS) at 2 years of 76.7% and 67.6% for MRD-negative patients, 68.5% and 49.7% for MRD-low patients (MRD < 0.1), and 50.5% and 36.6% for MRD-high patients (MRD ≥ 0.1) (p < 0.001), respectively. MRD level did influence the outcome, irrespective of the conditioning regimen. In our patient cohort, positive MRD on day +100 after transplantation was associated with an extremely poor prognosis, with a cumulative incidence of relapse of 93.3%. In conclusion, our multicenter study confirms the prognostic value of MRD performed in accordance with standardized recommendations.

Efficacy of aquatic therapy for neck pain: a systematic review.

This study systematically reviews the current state of aquatic treatment of neck pain and assesses the scientific evidence of its benefits. The databases PubMed, Scopus, Web of Science and PEDro were searched for relevant reports published from January 1, 2008, to November 7, 2017, using the keywords "neck pain" in addition to "balneotherapy", "spa treatment", "spa", "thalassotherapy", "hydrotherapy", "aquatic therapy" or "aquatic". Inclusion criteria were full-text articles published in journals included in Journal Citation Reports in English and Spanish describing human studies. Case studies, letters to the editor and meeting presentations or other contributions were excluded. Of 367 articles identified, only 13 fulfilled the inclusion criteria: 5 randomized trials, 1 single blind controlled study, 2 pilot studies, 2 observational retrospective studies, 1 prospective study, 1 clinical study and 1 not specified. Participants were 658 subjects with chronic neck pain. Main symptoms and signs treated were neck pain, disability, cervical disc herniation and compromised quality of life. Evidence that aquatic treatment improves quality of life in affected individuals was good in four studies, fair in eight and weak in one. Treatment of neck pain using different waters and techniques reduced pain and disability, and improved functional capacity, quality of life, joint mobility, balance, relaxation and mood.

Efficacy of aquatic therapy for multiple sclerosis: a systematic review.

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory, progressive, disabling autoimmune disease affecting the central nervous system. Symptoms and signs of MS vary widely and patients may lose their ability to walk. To date the benefits of aquatic therapy often used for rehabilitation in MS patients have not been reviewed. The aim of this study was to systematically review the current state of aquatic treatment for persons with MS (hydrotherapy, aquatic therapy, aquatic exercises, spa therapy) and to evaluate the scientific evidence supporting the benefits of this therapeutic option. EVIDENCE ACQUISITION: The databases PubMed, Scopus, WoS and PEDro were searched to identify relevant reports published from January 1, 2011 to April 30, 2016. EVIDENCE SYNTHESIS: Of 306 articles identified, only 10 fulfilled the inclusion criteria: 5 randomized controlled, 2 simple randomized quasi-experimental, 1 semi-experimental, 1 blind controlled pilot and 1 pilot. CONCLUSIONS: Evidence that aquatic treatment improves quality of life in affected patients was very good in two studies, good in four, fair in two and weak in two.

Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial.

BACKGROUND: Extracorporeal shockwave treatment (ESWT) and ultrasound-guided percutaneous lavage (UGPL) are two effective ways of treating rotator cuff calcific tendinopathy (RCCT). AIM: The aim of the present study was to compare the effectiveness of these techniques in the treatment of RCCT. DESIGN: Prospective, randomized, controlled trial. SETTING: Patients treated in our sports medicine and rehabilitation center (Centro Médico Deyre, Madrid. Spain) between January 2007 and December 2013. METHODS: This randomized study compares the results achieved with these techniques over one year following their use to treat the above condition. Eighty patients received ESWT and 121 received UGPL. A visual analogue scale was used to measure pain, and ultrasound to determine the extent of calcification, at 3, 6, and 12 months after treatment. RESULTS: Pain and the amount of calcification were significantly reduced by both techniques at 3, 6 and 12 months (P<0.001 for each), but significantly more so by UGPL (P<0.001). CONCLUSIONS: Both techniques are valid for the treatment of RCCT, although UGPL is associated with a greater reduction of calcification and greater reduction in pain. CLINICAL REHABILITATION IMPACT: The results obtained applying UGPL, the low cost and the lack of complications should therefore make the treatment of choice in centers that are appropriately equipped and staffed.

Effect of therapeutic horseback riding on balance and gait of people with multiple sclerosis.

BACKGROUND: Exercise therapy is an important part of symptomatic and supportive treatment in patients with multiple sclerosis (PwMS). According to the literature, equine-assisted therapies--such as therapeutic horseback riding (THR) and hippotherapy (HT)--are exercise therapies that can have positive physical effects on coordination, muscle tone, postural alignment, stiffness/flexibility, endurance and strength, correcting abnormal movement patterns and improving gait and balance. While HT is known to have a positive effect on balance in PwMS, data about THR are limited. OBJECTIVE: The aim of the present work was to determine the effect of THR on the balance and gait of ambulatory PwMS. METHODS: Twenty-seven PwMS were included in the study. Patients were divided into two groups: 12 underwent THR and 15 traditional physiotherapy (for both groups, two series of 10 weekly sessions were performed). Before and after the study period, the following outcome measures were applied: Extended Disability Status Scale (EDSS), Barthel Index, Tinetti Performance-Oriented Mobility Assessment (POMA). In addition, patients of the THR group underwent a gait analysis to assess spatiotemporal gait parameters and ground reaction forces. RESULTS: The THR group showed a significant improvement in POMA scores (p<0.005) and two gait parameters: stride time (p<0.04) and ground reaction forces (p<0.01). No statistically significant change was found in the control group. CONCLUSION: The results of the study show that THR can improve balance and gait of ambulatory PwMS. Findings are preliminary, but promising and in line with the recent literature.

Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.

BACKGROUND: Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007. METHODS: Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions. RESULTS: After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall. CONCLUSIONS: The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.

Interdisciplinary team working in physical and rehabilitation medicine.

Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.

Effects of training status on fibers of the musculus vastus lateralis in professional road cyclists.

OBJECTIVE: To evaluate possible changes occurring in muscle fibers related to the training status of professional road cyclists. DESIGN: A comparative study was performed on two groups of male road cyclists: ten 21-yr-old cyclists with a history of 3 yr of sport competition (RC21) and ten 25-yr-old cyclists with a history of 7 yr of competition (RC25). The control group was formed by two subgroups of five nontrained, sedentary volunteers who were matched for age with the study subjects (NT21 and NT25). Biopsies of the vastus lateralis muscle were obtained to determine the fiber variables: percentage, cross-sectional area, mitochondrial volume, and capillary density. RESULTS: Control group variables were within the normal range. According to their training status, cyclists showed an increased percentage of type I and IIC fibers (RC25 > RC21 > NT) and decreased percentage of type IIA (RC25 < RC21 < NT) and IIB fibers (RC25 = RC21 < NT), an increased cross-sectional area of all fiber types after 3 yr of training (RC25 = RC21 > NT) except IIB fibers (RC25 > RC21), an increased mitochondrial volume in all fiber types (RC25 > RC21 > NT) except type IIA fibers (RC25 > RC21 = NT21), and an increased capillary density (RC25 > RC21 > NT). CONCLUSIONS: Findings indicate a progressive increase in the muscle fiber types that are mostly implicated in endurance sports, accompanied by phenotypic changes in the fiber population of lesser participation.

Neumonía necrotizante y sepsis en el síndrome de dificultad respiratoria del adulto / Necrotizing pneumonia and sepsis of adult respiratory distress syndrome

Se estudian 91 pacientes con criterios diagnósticos de síndrome de dificultad respiratoria del adulto.La mortalidad total grupo fue de 51%. La incidencia de sepsis fue del 69%. La neumonía necrotizante se presentó en 32% y se manifestó con mayor frecuencia en pacientes que permanecieron intubados y sometidos a ventilación mecánica por tiempo prolongado. En este grupo la mortalidad se elevó al 66%. Los gérmenes aislados mas frecuentes fueron seudomona, enterobacter, klebsiella y acinetobacter

Insulinomas: hemorragia interna como consecuencia de la invasión y ruptura de la arteria esplénica por un insulinoma; presentación de un caso / Insulinomas: internal hemorrhage as consequence of invasion and rupture of splenic artery by an insulinoma; presentation of a case

Nos referimos a un caso de insulinoma. Se hacen consideraciones generales acerca de la historia, etiopatogenia, clínica, diagnóstico y tratamiento de esta patología. Presentamos el caso de un paciente que fue llevado de urgencia a quirófano, por abdomen agudo, con diagnóstico de obstrucción intestinal. Hallazgos operatorios: Hemorragia profusa que ocupaba la cavidad abdominal (3.000 ml.); tumor pancreático que invadía la arteria esplénica provocando erosión y ruptura parcial de la misma. Se practicó resección parcial del páncreas (cuerpo y cola) y esplenectomía. La autopsia reveló edema pulmonar severo, dilatación de las cavidades cardíacas, tumor de la cabeza del páncreas y ruptura de la arteria esplénica. El estudio histológico del tumor reveló que se trataba de un insulinoma maligno