Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial / Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery / Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera

Introduction: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methods: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. Results: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. Discussion: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.(AU)

Introducción: La artroplastia de cadera es el tratamiento de elección para las fracturas desplazadas del cuello de fémur en la población de edad avanzada. La luxación de la prótesis de cadera es una de las complicaciones potenciales tras la artroplastia de cadera, pero falta información actualizada sobre el efecto de la luxación en la supervivencia de los pacientes mayores con fractura de cadera tratados mediante hemiartroplastia de cadera. Nuestro objetivo es evaluar el efecto de la luxación de la prótesis de cadera (hemiartroplastia) como factor aislado, en la función de supervivencia de los pacientes. Materiales y métodos: Realizamos un estudio multicéntrico retrospectivo, que incluyó a 6.631 pacientes mayores de 65 años con fractura de cuello de fémur tratados quirúrgicamente mediante hemiartroplastia. Se realizaron cortes de seguimiento a los 30 días, 6 semanas, 90 días y un año del alta hospitalaria, determinando la tasa de luxación de cadera y la supervivencia de los pacientes. Resultados: La población femenina representó el 78,7%, y la edad media de la población fue de 85,2±6,7 años. La incidencia de luxación de la prótesis de cadera fue del 1,9% en los primeros 90 días tras el alta, lo que representa el 91,54% de las luxaciones primarias observadas anualmente. Se registró un aumento estadísticamente significativo de las tasas de mortalidad de los pacientes que presentaban al menos un evento de luxación de la prótesis de cadera (del 16,0 al 24,6% a los 90 días del alta, y del 29,5 al 44,7% al año), y también una disminución significativa de la función de supervivencia de los pacientes a los 90 días (p=0,016) y al año de seguimiento (p<0,001). Los eventos de luxación recurrente (26,15%) mostraron tasas de mortalidad aún más altas (hasta el 60,6%, p<0,001). El modelo multivariante de regresión de Cox determinó que la luxación de la prótesis de cadera es la única variable significativa (p=0,035) que afecta a la...(AU)

[Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera / Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

Introducción: La artroplastia de cadera es el tratamiento de elección para las fracturas desplazadas del cuello de fémur en la población de edad avanzada. La luxación de la prótesis de cadera es una de las complicaciones potenciales tras la artroplastia de cadera, pero falta información actualizada sobre el efecto de la luxación en la supervivencia de los pacientes mayores con fractura de cadera tratados mediante hemiartroplastia de cadera. Nuestro objetivo es evaluar el efecto de la luxación de la prótesis de cadera (hemiartroplastia) como factor aislado, en la función de supervivencia de los pacientes. Materiales y métodos: Realizamos un estudio multicéntrico retrospectivo, que incluyó a 6.631 pacientes mayores de 65 años con fractura de cuello de fémur tratados quirúrgicamente mediante hemiartroplastia. Se realizaron cortes de seguimiento a los 30 días, 6 semanas, 90 días y un año del alta hospitalaria, determinando la tasa de luxación de cadera y la supervivencia de los pacientes. Resultados: La población femenina representó el 78,7%, y la edad media de la población fue de 85,2±6,7 años. La incidencia de luxación de la prótesis de cadera fue del 1,9% en los primeros 90 días tras el alta, lo que representa el 91,54% de las luxaciones primarias observadas anualmente. Se registró un aumento estadísticamente significativo de las tasas de mortalidad de los pacientes que presentaban al menos un evento de luxación de la prótesis de cadera (del 16,0 al 24,6% a los 90 días del alta, y del 29,5 al 44,7% al año), y también una disminución significativa de la función de supervivencia de los pacientes a los 90 días (p=0,016) y al año de seguimiento (p<0,001). Los eventos de luxación recurrente (26,15%) mostraron tasas de mortalidad aún más altas (hasta el 60,6%, p<0,001). El modelo multivariante de regresión de Cox determinó que la luxación de la prótesis de cadera es la única variable significativa (p=0,035) que afecta a la...(AU)

Introduction: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methods: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. Results: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. Discussion: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.(AU)

Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care. / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial.

OBJECTIVE: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care.

OBJECTIVE: To analyse referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2 referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (p<0.001). Due to a large number of referrals, 2 scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2 scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. / [Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera.

INTRODUCTION: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS: The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery.

INTRODUCTION: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC).

Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.

Vertebral destruction due to abdominal aortic aneurysm.

INTRODUCTION: Low back pain is a common cause of medical consultation, and usually supposes a non-malignant prognostic. PRESENTATION OF CASE: We report an atypical appearance of low back pain associated to shock and pulsatile abdominal mass that made us diagnose an abdominal aortic aneurysm as reason of vertebral lysis and pain. DISCUSION: Surgical repair of contained AAA should be directed to secondary re-rupture prevention, with an approximate survival near to 100% at selected patients for elective surgery. Consequently, orthopedic surgery for back spine stabilization has to be elective in those cases when vertebral destruction is above 30% and clinic is directly related to spine instability. CONCLUSION: We should consider AAA as other cause of low back pain and routinely examine the abdomen and seek complementary imaging proves when risk factors for AAA are present.

Caracterización de células madre de núcleo pulposo de disco intervertebral cervical y comparación con células de médula ósea de los mismos pacientes / Characterization of stem cells from nucleus pulposus of cervical intervertebral disc and compared with bone marrow cells from the same patients

Objetivo: Evaluar la presencia de células mesenquimales en el núcleo pulposo de disco intervertebral cervical y caracterizarlas comparativamente con las obtenidas de médula ósea de los mismos sujetos. Pacientes y metodología: Hemos realizado un estudio descriptivo con 14 pacientes que precisaron cirugía de artrodesis cervical. Se analizó la presencia de células mesenquimales (CSM) en el núcleo pulposo (NP) del disco, comparándolas cualitativamente con las de médula ósea (MO) de los mismos pacientes. Se aislaron y expandieron CSM, tanto de NP como de MO. Se realizaron los estudios de diferenciación multilineal in vitro de las células mesenquimales de ambas fuentes, hacia osteoblasto y adipocito, y caracterización inmunofenotípica por citometría de flujo. Resultados: Las células de ambos orígenes se diferencian in vitro hacia ambos tipos celulares, si bien la diferenciación adipocítica de las células procedentes del disco fue menor que las procedentes de MO. Tampoco se han demostrado diferencias en los marcadores inmunofenotípicos. Las células de ambas fuentes poseen los marcadores inmunofenotípicos característicos de las células mesenquimales. Conclusión: El NP de disco vertebral cervical degenerado contiene células troncales mesenquimales. Estas células son similares a las células de MO, con la excepción de su capacidad disminuida de diferenciación adipogénica (AU)

Objective: To evaluate the presence of mesenchymal cells in the nucleus pulposus (NP) of cervical discs and characterize them in comparison ot those obtained from the bone marrow of the same subjects. Patients and methods: We have performed a descriptive study with 14 patients requiring cervical fusion surgery. The presence of mesenchymal stem cells (MSCs) were analyzed in the NP from the disk and compared qualitatively with the bone marrow (BM) of the same patients. MSC were isolated and expanded for both NP and MO. We performed in vitro differentiation studies of mesenchymal cells from both sources, into osteogenic and adipogenic lines, and flow cytometric immunophenotyping. Results: We got differentiation towards both cell types, although adipocyte differentiation of disc-derived cells was decreased compared to those from BM. There were no differences in immunophenotypic markers. Cells from both sources have immunophenotypic markers characteristic of mesenchymal cells. Conclusion: The NP of degenerated cervical disc contains mesenchymal stem cells. These cells are quite similar to BM cells, with the exception of a diminished adipogenic differentiation capacity (AU)

The epoxyketone-based proteasome inhibitors carfilzomib and orally bioavailable oprozomib have anti-resorptive and bone-anabolic activity in addition to anti-myeloma effects.

Proteasome inhibitors (PIs), namely bortezomib, have become a cornerstone therapy for multiple myeloma (MM), potently reducing tumor burden and inhibiting pathologic bone destruction. In clinical trials, carfilzomib, a next generation epoxyketone-based irreversible PI, has exhibited potent anti-myeloma efficacy and decreased side effects compared with bortezomib. Carfilzomib and its orally bioavailable analog oprozomib, effectively decreased MM cell viability following continual or transient treatment mimicking in vivo pharmacokinetics. Interactions between myeloma cells and the bone marrow (BM) microenvironment augment the number and activity of bone-resorbing osteoclasts (OCs) while inhibiting bone-forming osteoblasts (OBs), resulting in increased tumor growth and osteolytic lesions. At clinically relevant concentrations, carfilzomib and oprozomib directly inhibited OC formation and bone resorption in vitro, while enhancing osteogenic differentiation and matrix mineralization. Accordingly, carfilzomib and oprozomib increased trabecular bone volume, decreased bone resorption and enhanced bone formation in non-tumor bearing mice. Finally, in mouse models of disseminated MM, the epoxyketone-based PIs decreased murine 5TGM1 and human RPMI-8226 tumor burden and prevented bone loss. These data demonstrate that, in addition to anti-myeloma properties, carfilzomib and oprozomib effectively shift the bone microenvironment from a catabolic to an anabolic state and, similar to bortezomib, may decrease skeletal complications of MM.

Secular changes in Paget's disease: contrasting changes in the number of new referrals and in disease severity in two neighboring regions of Spain.

SUMMARY: We studied the changes in the number of new referrals with Paget's disease of bone (PDB) and severity of PDB in a high prevalence focus and its neighboring region. Referral of patients changed only in the high prevalence focus. The severity of PDB decreased in both regions. These results could suggest the effects of an environmental influence on disease activity. INTRODUCTION: The prevalence and severity of PDB have decreased in several countries over recent years. We previously reported a high radiological prevalence of PDB in Vitigudino. Here we sought to determine if secular changes in the number of new referrals and severity of PDB had occurred over recent years. METHODS: We studied 280 patients with clinically diagnosed PDB who were evaluated at a regional referral center for metabolic bone disease between 1986 and 2009. Changes in the number of new referrals were calculated by relating these data to the number of subjects at risk as determined by population registers. Trends in disease severity were analyzed with alkaline phosphatase (ALP) activity and disease extent on scan. RESULTS: Referrals from the Vitigudino region increased substantially between 1986 and 2003 but fell markedly between 2004 and 2009, although by this time there had been depopulation of the region due to emigration. No significant changes in the rates of referral occurred in the remainder of Salamanca. ALP activity and disease extent decreased in Salamanca, but only ALP activity decreased in Vitigudino. Referrals rate and severity of PDB in Vitigudino were greater than in the remainder of Salamanca. CONCLUSIONS: Referral of patients with clinically diagnosed PDB has remained stable for most of Salamanca during the past 24 years, but substantial changes have been observed in Vitigudino. In agreement with other reports, the severity of PDB has decreased in both regions consistent with the effects of an environmental influence on disease activity.

Resultados a largo plazo de la reparación por doble incisión de las roturas distales del bíceps braquial. Cómo evitar las complicaciones / Long term results of double-incision repair of distal brachial biceps ruptures. How to prevent complications

Objetivo: Revisar los resultados de la reinserción de la rotura distal del músculo bíceps braquial con la vía de doble incisión. Material y metodología: Con un seguimiento de cinco años valoramos once pacientes intervenidos mediante la técnica modificada de doble incisión de Morrey, utilizando arpones para su reinserción y una movilización precoz del codo. Todos eran varones, fumadores y trabajadores de esfuerzo, con una edad media de 51 años. En 8 casos la rotura fue tendinosa y en 3 se observaron desinserciones óseas. Analizamos los resultados midiendo la movilidad flexo-extensora del codo y prono-supinadora con goniómetro y la fuerza supinadora con un dinamómetro. Se analizaron radiografías de codo, se realizó el cuestionario DASH, el grado de satisfacción personal y el dolor. Resultados: No hemos visto ninguna complicación postoperatoria inmediata ni tardía. Los resultados fueron excelentes en el 94% de los casos y buenos en el 6%, no apareciendo ninguna rerrotura. Conclusión: una intervención precoz y una técnica meticulosa puede conseguir un resultado excelente en la reparación de la rotura distal del bíceps braquial (AU)

Objective: To review the results of reinsertion of distal rupture of the brachial biceps muscle with the doubleincision technique. Material and Methods: With a follow-up of five years, we assessed eleven patients operated on by the modified Morrey double-incision technique using harpoons for reinsertion and early mobilization of the elbow. All were male, smokers, and heavy exertion workers, with a mean age of 51 years. In 8 patients, rupture was of the tendon and 3 showed bone detachments. We analyzed the results measuring elbow flexion-extension and pronation-supination mobility with a goniometer and supination strength with a dynamometer. Elbow X-rays were analyzed, the DASH questionnaire was performed, and degree of personal satisfaction and pain were measured. Results: We did not observe any immediate or late postoperative complication. The results were excellent in 94% patients and good in 6%, and no rerupture occurred. Conclusion: Early intervention and meticulous technique can achieve an excellent result in repair of distal brachial biceps rupture (AU)

[Impact of Nd: YAG capsulotomy on quality of life in pseudophakic patients]. / Impacto de la capsulotomía Nd: YAG en la calidad de vida de pacientes pseudofáquicos.

OBJECTIVE: To determine whether visual acuity (VA) improvement in patients with posterior capsule opacification (PCO), accepted after the capsulotomy, is followed by positive changes in the perception of their quality of life. METHOD: A total of 130 patients with PCO were examined before and after capsulotomy. In addition to the ophthalmic examination, the EuroQol questionnaire was completed. We analyzed the influence of demographic characteristics on the outcome of the test. RESULTS: The mean binocular visual acuity (BVA) and the mean scores in the EuroQol dimensions and EQ-VAS improved significantly after capsulotomy. VA did not have the same effect on daily common tasks. After treatment, the problems in the usual activities dimension have seen the largest reduction. Mobility is still the dimension with more problems regarding patients after capsulotomy. CONCLUSIONS: Decreased VA induced by PCO is associated with difficulties performing daily living activities. Capsulotomy results in a gain in VA and functional ability of the majority of patients, improving the perception of their quality of life.

Impacto de la capsulotomía Nd: YAG en la calidad de vida de pacientes pseudofáquicos / Impact of Nd: YAG capsulotomy on quality of life in pseudophakic patients

Objetivo: Determinar si la mejoría de agudeza visual (AV) en los pacientes con opacificaciónde cápsula posterior del cristalino (OCP) que se acepta tras la capsulotomía, se traduce encambios positivos en la percepción de su calidad de vida.Método: Se evaluaron 130 pacientes con OCP antes y después de la capsulotomía. Ademásde la exploración oftalmológica se recogieron las respuestas del cuestionario EuroQol y seestudió la influencia de factores demográficos en el resultado del test.Resultados: La agudeza visual binocular (AVB) media y las puntuaciones medias de las cincodimensiones del cuestionario EuroQol y de la EVA mejoraron en el conjunto de pacientesde forma estadísticamente significativa tras la capsulotomía. No todas las tareas de la vidadiaria se afectan en el mismo grado por el estado de la AV. Las limitaciones en la dimensiónde actividades cotidianas son las que más disminuyen con el tratamiento. La dimensión enla que más dificultades continúan relatando los pacientes tras la capsulotomía es en la demovilidad.Conclusiones: La deficiencia visual ocasionada por la OCP conlleva dificultades para realizarlas actividades cotidianas. La capsulotomía supone un incremento en la AV y en lafuncionalidad de la mayoría de los pacientes, mejorando la percepción sobre su estado desalud(AU)

Objective: To determine whether visual acuity (VA) improvement in patients with posteriorcapsule opacification (PCO), accepted after the capsulotomy, is followed by positive changesin the perception of their quality of life.Method: A total of 130 patients with PCO were examined before and after capsulotomy. In addition to the ophthalmic examination, the EuroQol questionnaire was completed. We analyzed the influence of demographic characteristics on the outcome of the test. Results: The mean binocular visual acuity (BVA) and the mean scores in the EuroQol dimensionsand EQ-VAS improved significantly after capsulotomy. VA did not have the same effecton dailycommontasks. After treatment, the problems in the usual activities dimension haveseen the largest reduction. Mobility is still the dimension with more problems regardingpatients after capsulotomy.Conclusions: Decreased VA induced by PCO is associated with difficulties performing dailyliving activities. Capsulotomy results in a gain in VA and functional ability of the majorityof patients, improving the perception of their quality of life

[Long-term analysis of minimally invasive surgery in knee arthroplasty]. / Análisis a largo plazo de la cirugía mínimamente invasiva en la artroplastía de rodilla.

BACKGROUND: Knee arthroplasty is the treatment of choice for gonarthrosis. The development of minimally invasive surgery (MIS) requires assessing results based on the classical approaches and this is the purpose of our study. METHODS: Randomized, prospective study comparing two groups; one underwent MIS (45 patients) and the second one a classical approach (51 patients); both groups were comparable. The following variables were assessed in the immediate postoperative period and at 4 and 8 years: blood loss, pain according to the VAS, flexion and extension and quality of life measured with the SF-36. RESULTS: In the immediate postoperative period we observed statistically significant differences (p < 0.05) in favor of the MIS approach in pain, hospital stay and blood loss. However, this was not observed at 4 and 8 years concerning pain, quality of life and range of motion. We observed an improvement in the functional scale and quality of life compared with the preoperative status, without any differences when both groups were compared. CONCLUSIONS: The MIS technique results in a better immediate postoperative period, but no differences were seen in the choice of the approach 4 and 8 years after surgery.

Mesenchymal stem cells from multiple myeloma patients display distinct genomic profile as compared with those from normal donors.

It is an open question whether in multiple myeloma (MM) bone marrow stromal cells contain genomic alterations, which may contribute to the pathogenesis of the disease. We conducted an array-based comparative genomic hybridization (array-CGH) analysis to compare the extent of unbalanced genomic alterations in mesenchymal stem cells from 21 myeloma patients (MM-MSCs) and 12 normal donors (ND-MSCs) after in vitro culture expansion. Whereas ND-MSCs were devoid of genomic imbalances, several non-recurrent chromosomal gains and losses (>1 Mb size) were detected in MM-MSCs. Using real-time reverse transcription PCR, we found correlative deregulated expression for five genes encoded in regions for which genomic imbalances were detected using array-CGH. In addition, only MM-MSCs showed a specific pattern of 'hot-spot' regions with discrete (<1 Mb) genomic alterations, some of which were confirmed using fluorescence in situ hybridization (FISH). Within MM-MSC samples, unsupervised cluster analysis did not correlate with particular clinicobiological features of MM patients. We also explored whether cytogenetic abnormalities present in myelomatous plasma cells (PCs) were shared by matching MSCs from the same patients using FISH. All MM-MSCs were cytogenetically normal for the tested genomic alterations. Therefore we cannot support a common progenitor for myeloma PCs and MSCs.

Histomorphometric study of femoral heads in hip osteoarthritis and osteoporosis.

During the period from 2000 to 2003, ninety eight samples of femoral heads were collected. In these pieces, two zones were analyzed: a high-load zone (the hard core of the head) and a low-load zone (the round ligamentum teres zone). As control group, 6 femoral heads (3 of women and 3 of men), proceeding from autopsy in peoples without pathological antecedents and youngs, were studied. After the samples had been embedded in methylmethacrylate and stained, they were subjected to an histomorphometric study. By means of histomorphometry, trabecular bone volume (TBV) and osteoid substance (OSV) was determined. Statistically significant differences were found as for peripheral osteoid volume (low-load zone) (p=0.036) and trabecular bone volume, both peripheral and central. Both volumes decreased in osteoporotic samples and in those from women (p=0.000), in comparison with control group. Regarding the relationship between the high-load and low-load zone, significant data were obtained. The high-load zone had a greater trabecular bone volume than the low-load zone, regardless of the pathology and sex, but this increase was more pronounced in the arthrosic samples and in those from men. Additionally, this trabecular bone volume in the high-load zone decreased with increasing age of the donor (p=0.037), when the control group is compared. In sum, we observed a reduction in the formation of TBV and OSV in osteoporosis but also a decrease in the arthrosic, in samples from older subjects, in women, and in the low-load zone of the samples, when the control group is compared. These data suggest the coexistence of both pathologies, which is more pronounced in older subjects and women.