Utilización de cotilos 3D en defectos acetabulares graves / Use of 3D cups in severe acetabular defects

Introducción: Ante el aumento de las artroplastias de cadera en el último siglo, los defectos acetabulares graves son eventos cada vez más frecuentes. Su tratamiento representa un verdadero desafío, debido al déficit y la pobre calidad ósea, habitual en estos pacientes. materiales y métodos: Se presentan 6 pacientes tratados entre 2016 y 2021. Cinco casos de disrupción pélvica por revisiones fallidas, clasificadas como tipo IIIB de Paprosky y una fractura transversal de acetábulo, posible opción de tratamiento en casos de pacientes osteoporóticos. Resultados: Los pacientes tratados con esta técnica multidisciplinaria fueron controlados durante un promedio de 20 meses, ninguno presentó complicaciones posoperatorias. Los resultados valorados con escalas analógicas son prometedores e invitan a establecer este procedimiento como el patrón de referencia. Conclusiones: La evaluación estricta es necesaria en los defectos acetabulares. La inclusión de ingeniería informática médica permite estudiar la necesidad de usar injerto de banco, fabricar implantes a medida de titanio/tantalio trabecular multiporos, lo que es ideal para lograr la osteointegración, sumado a la posibilidad de planificar la dirección y la longitud de los tornillos al hueso remanente, según su calidad. La cementación de un cotilo de doble movilidad dentro del implante a medida disminuye el riesgo de luxación y de sobrecarga de este último, al eliminar la fricción metal-metal. Nivel de Evidencia: IIIB

Introduction: Given the increase in hip arthroplasties in the last century, serious acetabular defects are increasingly frequent events. Their treatment represents a real challenge, due to the bone deficit and poor bone quality that these patients usually present. Materials and Methods: Six patients treated between 2016 and 2021 are presented. Five cases of pelvic discontinuity due to failed revisions, classified as Paprosky type IIIB, and one transverse fracture of the acetabulum, a possible treatment option in cases of osteoporotic patients. Results: The patients treated with this multidisciplinary technique were followed up for an average of 20 months, and none of them presented postoperative complications. The results evaluated by analogous scales are promising and invite us to establish this procedure as the gold standard. Conclusions: Strict evaluation is necessary for acetabular defects. The inclusion of medical IT makes it possible to study the need to use bank grafting and to manufacture custom-made multiporous trabecular titanium/tantalum implants, which is ideal for achieving osseointegration, added to the possibility of planning the direction and length of the screws to the remaining bone, according to its quality. The cementation of a dual mobility cup inside the customized implant reduces the risk of dislocation and overload of the latter, by eliminating metal-metal friction. Level of Evidence: IIIB

[Utilization study in real clinical practice of ceftolozane/tazobactam vs aminoglycosides and/or colistin in the treatment of multirresistant or extremely resistant Pseudomonas aeruginosa]. / Estudio de utilización en práctica clínica real de ceftolozano/tazobactam frente a aminoglucósidos y/o colistina en el tratamiento de Pseudomonas aeruginosa.

OBJECTIVE: Comparative "real life" data on the effectiveness and safety of ceftolozane/tazobactam (C/T) versus other regimens (aminoglycosides/colistin/combination), in the treatment of multi-resistant (MDR) and extremely resistant (XDR) Pseudomonas aeruginosa (PA), are needed to establish positions. METHODS: Observational, retrospective study of patients with microbiological confirmation of MDR and XDR PA from July 2016 up to December 2018 in a tertiary hospital. Variables: age, sex, comorbidities, risk factors for multidrug resistance, variables related to infection, source of infection, microorganism and type of sample, antibiotic treatment, clinical cure, microbiological cure, recurrence, mortality on admission and 30 days post-discharge. Patients were classified according to received antibiotic treatment, C/T or aminoglycosides/colistin/combination. RESULTS: A total of 405 patients with PA MDR and XDR infection (73.1% men, mean age 63 ± 15 years) were studied. An 87.1% of PA XDR and a 12.9% MDR were observed. All patients received C/T as targeted therapy and in the aminoglycosides/colistin/combination group were 73.5%. Patients in the C/T group present worse prognostic factors: septic shock (30.0%) and catheterization (90.0%) (p<0.05). There were not statistically significant differences in microbiological cure (p=0.412), recurrence (p=0.880) and clinical cure (p=0.566). There were not statistically significant differences in mortality at admission (p=0.352) or at 30 days after discharge (p=0.231). A 17.2% of the patients with aminoglycosides/colistin/combination had acute kidney injury according to RIFLE criteria and 4.3% with C/T. CONCLUSIONS: The data obtained suggest that there have been no differences in effectiveness (clinical or microbiological cure) in favour of C/T, although, in the period studied, it was used in most cases in multitreated patients with a worse prognosis. Randomized and prospective studies would be needed to establish an adequate positioning.

Effect of graphite and graphene oxide on thorium carbide microstructural and thermal properties.

Thorium carbide to be tested as target material for the production of 225Ac with the ISOL method, was produced via carbothermal reduction of ThO2 nanoparticles by graphite and graphene oxide, respectively. The use of graphene oxide (GO) as carbon source resulted in a reduced reactivity compared to graphite, confirmed by the presence of unreacted ThO2 mainly in the core of the samples. The reacted ThO2 or ThC2-GO showed a faster reactivity in air, mainly observed as ThC2 amorphization. The specific surface area of the ThC2-GO samples was almost doubled compared to ThC2-graphite samples. The effect of these microstructural features was analysed in terms of thermal diffusivity and calculated thermal conductivity that were both reduced in ThC2-GO samples, however the difference with ThC2-graphite samples decreased at increasing temperature. The present study shows that the use of unreduced GO inhibits the solid-state reaction between ThO2 and C; on the other hand, the high reactivity of the ThC2 so produced is expected to be beneficial for the 225Ac production with the ISOL method, affording a high release efficiency. It is expected that the use of reduced GO could represent a good solution for highly efficient ThC2 targets.

Medial closing-wedge distal femoral varus osteotomy: Symptoms and functional impact in cases of associated patellofemoral osteoarthritis. A two-year follow-up prospective pilot study.

PURPOSE: To date, indications for distal femoral varus osteotomy (FVO) in cases of associated patellofemoral osteoarthritis (PFO) have yet to be clarified. The purpose of this prospective study is to assess the short-term symptoms, functional and radiological impact of a medial closing-wedge femoral varus osteotomy on the patellofemoral joint in patients with valgus deformities who are afflicted with lateral tibiofemoral osteoarthritis (LTFO) associated with PFO. METHODS: Fourteen patients (15 knees) received a medial closing-wedge femoral varus osteotomy. The functional impact of an FVO on the patellofemoral joint was assessed based on the KOOS-PF (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral Subscale), the Kujala score and the patellofemoral symptoms. Realignment of the patella was measured by the Merchant's patellofemoral congruence angle. The pre- and post-operative symptoms and functional scores were compiled prospectively and compared two years after the surgery. RESULTS: The Kujala patellofemoral functional scores and the KOOS-PF showed considerable improvement with a differential of +37.5 points ± 20.4 and +42.7 points ± 19.3 (p < .01) respectively. The average Merchant's congruence angle went from 8.8° laterally to 3.6° medially, resulting in medialization of the patella, with a significant difference (p < .01). Based on the specific clinical analysis of the patellar joint, preoperative J-sign was identified in 26.7% of patients (n = 4) and was not found during postoperative examination (p = .1). Preoperative apprehension test was identified in 33.3% of patients (n = 5) against 13.3% (n = 2) after surgery (p = .39). Preoperative pain extension test was identified in 40% of patients (n = 6) against 20% during postoperative clinical analysis (p = .43). DISCUSSION: Although the threshold of significance for patellofemoral symptoms was not reached, the medial closing-wedge femoral varus osteotomy induces a significant medialization of the patella (Merchant's congruence angle) and improves short-term functional results even with co-existing patellofemoral osteoarthritis. Due to the lack of specificity of the patellofemoral scores, patellofemoral osteoarthritis improvement is difficult to determine on its own, but does not represent a contraindication to FVO. LEVEL OF EVIDENCE: III. Prospective clinical study.

Morphological and functional effects of graphene on the synthesis of uranium carbide for isotopes production targets.

The development of tailored targets for the production of radioactive isotopes represents an active field in nuclear research. Radioactive beams find applications in nuclear medicine, in astrophysics, matter physics and materials science. In this work, we study the use of graphene both as carbon source for UO2 carbothermal reduction to produce UCx targets, and also as functional properties booster. At fixed composition, the UCx target grain size, porosity and thermal conductivity represent the three main points that affect the target production efficiency. UCx was synthesized using both graphite and graphene as the source of carbon and the target properties in terms of composition, grain size, porosity, thermal diffusivity and thermal conductivity were studied. The main output of this work is related to the remarkable enhancement achieved in thermal conductivity, which can profitably improve thermal dissipation during operational stages of UCx targets.

Bejel in Cuba: molecular identification of Treponema pallidum subsp. endemicum in patients diagnosed with venereal syphilis.

OBJECTIVES: Bejel, caused by Treponema pallidum subsp. endemicum (TEN), was until now considered as a non-venereal disease endemic in areas with hot and dry climates. This study has identified TEN in clinical samples from Cuban patients previously diagnosed with syphilis. METHODS: We performed sequencing-based molecular typing on 92 samples from Cuban individuals diagnosed with syphilis. Moreover, to differentiate T. pallidum subspecies, multi-locus sequence analysis (MLSA) was designed and was applied to suspicious samples. RESULTS: Nine samples, from six patients, had a nucleotide sequence similarity (at all typing loci) to the Bosnia A genome, which is the infectious agent of bejel. Additionally, MLSA clearly supported a TEN classification for the treponemal samples. Clinical and epidemiological data from the six patients also suggested sexual transmission of bejel as well as the endemicity of this rare treponematosis in Cuba. CONCLUSIONS: Molecular identification of Treponema pallidum subsp. endemicum, the agent of bejel, in Cuban patients diagnosed with syphilis indicates the clear limitations of a diagnosis based exclusively on serology, geographical occurrence, clinical symptoms and anamnestic data. This finding has important implications for Global Public Health Systems, including paradigm changes regarding the location of endemic outbreaks, clinical aspects and transmission of this neglected disease.

Arthroscopic suture repair of acute quadriceps tendon ruptures.

Acute quadriceps tendon ruptures disrupt the continuity of the extensor mechanism and must be treated surgically. Tendon reattachment with suture anchors has recently been shown to be biomechanically superior to reattachment through transosseous tunnels. In this context, arthroscopy is an interesting alternative. It can limit postoperative wound healing and infectious complications, while ensuring functional outcomes that are equivalent to standard techniques. The goal of this technical note is to describe an original, reproducible method for arthroscopic reattachment of the quadriceps tendon with suture anchors. Four patients were operated using this technique in a pilot study. No wound healing, infectious complications or re-tears were observed. At 6 months' postoperative, the mean subjective IKDC score was 85.8/100.

Síndrome hemolítico urémico típico: comunicación del primer caso producido porEscherichia coli O26:H11 en España / Mitral valve replacement in infants less than 6 months-old

No disponible

Resultados de la encuesta de tabaquismo en el Hospital de Alcañiz / Results of the smoking habit survey in the Hospital de Alcañiz

Introducción. En el hospital de Alcañiz y dentro de las iniciativas para el control de consumo de tabaco, hemos realizado una encuesta de prevalencia y opinión de tabaquismo en todos los servicios del hospital. Material y métodos. Hemos realizado una encuesta en formato cuestionario escrito dirigida a todos los trabajadores del hospital, tanto sanitarios como no sanitarios. La encuesta, voluntaria y anónima, fue entregada y recogida en los diferentes servicios del hospital por un responsable designado por el grupo de trabajo. Resultados. Participaron 283 encuestados, la mayoría, 221 (78,1%), mujeres. La prevalencia de tabaquismo activo fue de 78 (27,6%) trabajadores. El colectivo que más fumadores activos presentó fue enfermería, con un 37,4%, siendo el equipo de informática los que contaban con más personal nunca fumador 75%. El 71,7% de los fumadores reconocieron fumar en el horario de trabajo aunque solamente 2 (0,3%) lo hacían dentro del recinto hospitalario. Más de un 70% de los trabajadores estuvieron de acuerdo en la utilidad del proyecto Hospital de Alcañiz sin humo, así como en que tanto padres como profesionales sanitarios y no sanitarios debían dar ejemplo no fumando. Conclusión. La prevalencia de tabaquismo en centros sanitarios es elevada por lo que se debe seguir trabajando e implementando medidas en contra del tabaquismo (AU)

Introduction. In the hospital of Alcañiz and within the initiative to control smoking, we have conducted a survey on the prevalence and opinion regarding the smoking habit in all the hospital departments. Material and methods. We have carried out a survey in form of a written questionnaire addressed to all the hospital worker, both health care and non-health care workers. The voluntary and anonymous survey was distributed and collected in the different hospital departments by a responsible person designated by the work group. Results. A total of 283 persons surveyed participated, most, 221 (78.1%) being women. Active smoking prevalence was 78 (27.6%) workers. The most active smoking group present was nursing with 37.4%, the computer technology team being the group having the greatest amount of personnel who had never smoked 75%. A total of 71.7% of the smokers admitted having smoked during the work hour although only 2 (0.3%) did so within the hospital premises. More than 70% of the workers agreed with the utility of the smoke-free Hospital de Alcañiz project and that parents as well as health care and non-health care professionals should lead by example by not smoking. Conclusion. Prevalence of smoking the health care centers is elevated so that work must continue and measures implemented against the smoking habit (AU)

[Use of benzodiazepines in prolonged seizures and status epilepticus in the community]. / Uso benzodiacepinas en crisis prolongadas y estado epiléptico en la comunidad.

Prolonged seizures and status epilepticus are common neurological medical emergencies. Early and appropriate treatment is essential to reduce morbidity and mortality. Most seizures occur in the community, so parents and caregivers must be prepared for their management. Benzodiazepines (BZD) are the first-line drugs used, with rectal diazepam (DZPr) being the most commonly used in pre-hospital treatment in Spain. In September 2011, the European Medicines Agency (EMA) authorized the use of oromucosal midazolam (MDZb) for the treatment of prolonged acute convulsive seizures in patients aged 3 months to <18 years. MDZb has a rapid onset, short duration of effect, and avoids first-pass hepatic metabolism. MDZb has shown to be at least as or more effective than DZPr to stop the seizures. Buccal administration is easier and more socially accepted, especially in adolescents and adults. It is a safe drug with similar effects to other BZD; MDZb improves the overall cost-effectiveness of seizures management.

Uso benzodiacepinas en crisis prolongadas y estado epiléptico en la comunidad / Use of benzodiazepines in prolonged seizures and status epilepticus in the community

Las crisis prolongadas y el estado epiléptico son emergencias médicas neurológicas frecuentes y su tratamiento adecuado y precoz es fundamental para reducir su morbi-mortalidad. La mayoría de las crisis se inician en un medio extrahospitalario, lo que obliga a familiares y cuidadores a estar preparados en las medidas de actuación iniciales ante una crisis convulsiva. En su manejo, las benzodiacepinas (BZD) son los fármacos de primera línea, siendo el uso de diazepam rectal (DZPr) el más extendido en el ámbito prehospitalario en España. La Agencia Europea del Medicamento (EMA) autorizó en septiembre del 2011 el empleo de midazolam bucal (MDZb) para el manejo de las crisis epilépticas repetidas en pacientes entre los 3 meses y 18 años. Es un fármaco de acción rápida por evitar la metabolización hepática y con efecto de corta duración. MDZb ha demostrado al menos igual o mayor eficacia que el DZPr y la vía de administración bucal es más sencilla y mejor aceptada socialmente, sobre todo en adolescentes y adultos. Es un fármaco seguro, con efectos adversos similares a otras BZD. Estudios de farmacoeconomía demuestran un buen coste-efectividad global en el manejo de las crisis frente al DZPr, reduciendo traslados en ambulancia e ingresos hospitalarios

Prolonged seizures and status epilepticus are common neurological medical emergencies. Early and appropriate treatment is essential to reduce morbidity and mortality. Most seizures occur in the community, so parents and caregivers must be prepared for their management. Benzodiazepines (BZD) are the first-line drugs used, with rectal diazepam (DZPr) being the most commonly used in pre-hospital treatment in Spain. In September 2011, the European Medicines Agency (EMA) authorized the use of oromucosal midazolam (MDZb) for the treatment of prolonged acute convulsive seizures in patients aged 3 months to < 18 years. MDZb has a rapid onset, short duration of effect, and avoids first-pass hepatic metabolism. MDZb has shown to be at least as or more effective than DZPr to stop the seizures. Buccal administration is easier and more socially accepted, especially in adolescents and adults. It is a safe drug with similar effects to other BZD; MDZb improves the overall cost-effectiveness of seizures management

Experimental validation of a novel compact focusing scheme for future energy-frontier linear lepton colliders.

A novel scheme for the focusing of high-energy leptons in future linear colliders was proposed in 2001 [P. Raimondi and A. Seryi, Phys. Rev. Lett. 86, 3779 (2001)]. This scheme has many advantageous properties over previously studied focusing schemes, including being significantly shorter for a given energy and having a significantly better energy bandwidth. Experimental results from the ATF2 accelerator at KEK are presented that validate the operating principle of such a scheme by demonstrating the demagnification of a 1.3 GeV electron beam down to below 65 nm in height using an energy-scaled version of the compact focusing optics designed for the ILC collider.

Aislamiento y caracterización de las células madre mesenquimales de la pulpa dentaria humana / Isolation and characterization of stem cells mesenchymal of human dental pulp

Las células madre mesenquimales de la pulpa dentaria han surgido como una herramienta promisoria en la medicina regenerativa. El objetivo de la presente investigación es establecer el cultivo de las células madre mesenquimales de la pulpa dentaria humana. Estas fueron aisladas de terceros molares retenidos de pacientes entre 15 y 24 años, con técnica de disgregación enzimática y cultivadas en medio DMEM-F12, suplementado con 15% de SFB , 100 ?M L-ácido ascórbico 2-fosfato, 2 mM L-glutamina, 100 U/mL de penicilina, 100 µg/mL de estreptomicina y 2 µg/mL de anfotericina B . Las células fueron observadas diariamente bajo microscopio. Pruebas inmunohistoquímicas mostraron en las poblaciones de células aisladas la existencia de células mesenquimales STRO-1+, marcador de células madre mesenquimales, también expresaron CD146+ y no expresaron CD45-, marcador de células hematopoyéticas. Las células aisladas mostraron capacidad de autorrenovación y eficiencia de formación de colonias. En el presente estudio, en las poblaciones de células aisladas se identificaron células con características de células madre mesenquimales, como su capacidad de adherirse a las placas plásticas en cultivo, formar colonias altamente proliferativas, su morfología fusiforme y la expresión consistente de marcadores de superficie que caracteriza células madre mesenquimales adultas de pulpa dentaria. Sin embargo, faltaría determinar su capacidad de diferenciación para cumplir con los criterios básicos para definirlas como células madre

Mesenchymal stem cells dental pulp-derived have emerged as a promising tool in regenerative medicine. The objective of the present investigation is to establish the culture of mesenchymal stem cells of dental pulp human. The dental pulp mesenchymal cells were isolated from impacted third molars of patients between 15-24 year-old. The dental pulp tissue was extracted, enzymatic digestion technique and culture in medium DMEM-F12, supplemented with 15% de SFB , 100 ?M L-ascorbic acid 2- phosphate, 2 mM L-glutamine, 100 U/mL de penicillin, 100 µg/mL de streptomycin y 2 µg/mL de amphotericin B. Cells were observed daily under microscope. Immunocytochemistry tests showed cells STRO-1+ mesenchymal stem cell marker. These cells also expressed CD146+ and no expressed CD45- hematopoietic stem cell marker. The isolated cells showed self-renewal capabilities and colony-forming efficiency. In this study, isolated cell populations were identified cells with mesenchymal stem cell characteristics, such as its ability to adhere to plastic culture plates, highly proliferative colony forming, fusiform morphology and consistent expression of surface markers characterized adult mesenchymal stem cells from dental pulp. However, missing differentiating their ability to meet the basic criteria to define them as stem cells

Isolated lesser trochanter fracture in adults: an early indicator of tumor infiltration.

We report on a case of isolated lesser trochanter fracture, without associated trauma, secondary to pulmonary adenocarcinoma metastasis. Treatment consisted in resection-reconstruction by megaprosthesis. This form of isolated fracture is rare, and results from infiltration of the trochanteric area by a malignant tumoral process, which is usually metastatic.

Reduced proportion of decidual DC-SIGN+ cells in human spontaneous abortion.

Recent studies showed that some functions of decidual dendritic cells appear to be essential for pregnancy. In humans, decidual dendritic cells are identifiable by their expression of DC-SIGN. We compared the subpopulations of human decidual DC-SIGN+ cells from first-trimester normal pregnancies and spontaneous abortions by flow cytometry. In normal decidua, DC-SIGN+ cells expressed antigens associated with immature myeloid dendritic cells. In samples from spontaneous abortions, we detected decidual DC-SIGN+ cells with an antigen phenotype equivalent to that of DC-SIGN+ cells from normal pregnancies, but at a significantly lower proportion (P < 0.01). Our results support the hypothesis that dendritic cells play a role in normal or pathological human pregnancy outcomes.

Pregnancy influences the hematological profile of Carthusian broodmares.

In order to investigate the effect of pregnancy on equine hematological profile, venous blood samples were taken from 44 Carthusian broodmares every two weeks during pregnancy, divided into three periods: I (conception to 110 days), II (111-220 days) and III (222 days to delivery). Routine hematological analysis was performed. Packed cell volume (PCV) increased in period II probably as a consequence of the climatic conditions or as a result of physical stress of lactation during period I. After that, a reduction in PCV was found but this was not matched with a similar decrease in total serum proteins. Platelets presented the same evolution as PCV. Neutrophils and eosinophils decreased in period II, probably because of increased hormone concentrations. In conclusion, pregnancy influences the hematological profile of the Carthusian broodmare and these reference values can aid the diagnosis of diseases during pregnancy.