Evaluación antropométrica biomédica y diseño mecánico conceptual de un sistema robótico para la rehabilitación pasiva de miembros inferiores en pacientes post-accidente cerebrovascular / Biomedical anthropometric evaluation and conceptual mechanical design of robotic system for lower limbs passive-rehabilitation on post-stroke patients

RESUMEN Antecedentes: El accidente cerebrovascular (ACV) es una de las principales causas de discapacidad permanente, ya que puede provocar lesiones cerebrales graves con secuelas físicas significativas, limitando la capacidad de realizar actividades diarias. Objetivo: Esta investigación tuvo como objetivo diseñar un sistema robótico de movimiento pasivo-continuo para la rehabilitación de miembros inferiores en pacientes adultos con ACV, mejorando así las probabilidades de recuperación de su movilidad de marcha. Metodología: Se llevó a cabo el modelado y simulación del sistema robótico mediante Diseño Asistido por Computadora (CAD), utilizando el software de ingeniería Autodesk Inventor Professional 2023. Resultados: Se obtuvieron las posiciones iniciales y finales del sistema robótico, así como la simulación de movimiento pasivo-continuo. Conclusiones: La toma de medidas precisas de un paciente maximiza la posibilidad de implementar un prototipo funcional que contribuya en el proceso de rehabilitación.

ABSTRACT Background: Cerebrovascular accident (CVA) is one of the main causes of permanent disability, as it can cause serious brain injuries with significant physical consequences, limiting the ability to perform daily activities. Objective: This research aimed to design a robotic system of passive-continuous movement for the rehabilitation of lower limbs in adult patients with stroke, thus improving the chances of recovery of their walking mobility. Methodology: Modeling and simulation of the robotic system using Computer Aided Design (CAD), using the engineering software Autodesk Inventor Professional 2023. Results: The initial and final positions of the robotic system were obtained, as well as the simulation of passive-continuous movement. Conclusions: Taking precise measurements of a patient maximizes the possibility of implementing a functional prototype that contributes to the rehabilitation process.

Retinoic acid signaling in mouse retina endothelial cells is required for early angiogenic growth.

The development of the retinal vasculature is essential to maintain health of the tissue, but the developmental mechanisms are not completely understood. The aim of this study was to investigate the cell-autonomous role of retinoic acid signaling in endothelial cells during retina vascular development. Using a temporal and cell-specific mouse model to disrupt retinoic acid signaling in endothelial cells in the postnatal retina (Pdgfbicre/+dnRAR403fl/fl mutants), we discovered that angiogenesis in the retina is significantly decreased with a reduction in retina vascularization, endothelial tip cell number and filipodia, and endothelial 'crowding' of stalk cells. Interestingly, by P15, the vasculature can overcome the early angiogenic defect and fully vascularized the retina. At P60, the vasculature is intact with no evidence of retina cell death or altered blood retinal barrier integrity. Further, we identified that the angiogenic defect seen in mutants at P6 correlates with decreased Vegfr3 expression in endothelial cells. Collectively, our work identified a previously unappreciated function for endothelial retinoic acid signaling in early retinal angiogenesis.

Association between falls and cardiovascular diseases in the geriatric population.

Objective: To determine the association of cardiovascular diseases with falls in the geriatric population. Methods: Original, Transversal and analytical study. Elderly patients who attend the external consultation of the Geriatrics service, older than 65 years, with falls history, perform comprehensive geriatric assessment to indentify causes of falls in the period from March 2018 to June 2019. We perform measures of central tendency, chi-square test X2 for qualitative variables, we performed linear regression model. Results: A total of 669 patients were included, the analysis shows association with frailty [OR 1.65 (95% CI 1.37-3.77), p <0.05], Heart Failure [OR 1.02, (95% CI, 0.68 - 1.54), p < 0.05 ], the logistic regression analysis with the variables (Fragility, SAH, es: DM2, AMI, Stroke, AF, postural hypotensive syncope, Hypothyroidism, Dyslipidemia, and HF) shows that the probability of falling is 57%. Conclusion: Cardiovascular diseases have a high prevalence in the population studied and increase the risk of falls. Individually analyzed cardiovascular diseases do not show an association with the syndrome of falls in the elderly, except for frailty, which proved to be an independent factor that increases the risk of falls with an OR 1.65. When analyzing them together, the risk of falling increases up to 57%. It is necessary to correctly identify and treat cardiovascular diseases in the elderly.

Objetivo: Determinar la asociación de las caídas con las enfermedades cardiovasculares en la población geriátrica. Métodos: Estudio original, transversal y analítico. Se incluyó a los pacientes que acuden a la consulta externa del Servicio de Geriatría, mayores de 65 años, con antecedentes de caídas, se realizó una evaluación geriátrica integral para identificar las causas de las caídas en el periodo de marzo de 2018 a junio de 2019. Realizamos medidas de tendencia central, chi cuadrada (prueba c2) para variables cualitativas, realizamos modelo de regresión lineal. Resultados: Se incluyeron un total de 669 pacientes. El análisis muestra asociación con fragilidad (odds ratio [OR]: 1.65; intervalo de confianza del 95% [IC 95%]: 1.37-3.77); p < 0.05]), insuficiencia cardiaca (OR: 1.02; IC 95%: 0.68-1.54); p < 0.05). El análisis de regresión logística con las variables fragilidad, HAS, DM2, IAM, EVC, FA, síncope por hipotensión ortostática, hipotiroidismo, dislipidemia e insuficiencia cardiaca (IC) muestra que la probabilidad de caídas es del 57%. Conclusión: Las enfermedades cardiovasculares tienen una alta prevalencia en la población estudiada y aumentan el riesgo de caídas. Las enfermedades cardiovasculares analizadas individualmente no muestran una asociación con el síndrome de caídas en los ancianos, a excepción de la fragilidad, que resultó ser un factor independiente que aumenta el riesgo de caídas con una OR de 1.65. Al analizarlas juntas, el riesgo de caídas se incrementa en un 57%. Es necesario identificar y tratar correctamente las enfermedades cardiovasculares en los ancianos.

Association between falls and cardiovascular diseases in the geriatric population / Asociación entre caídas y enfermedades cardiovasculares en los ancianos

Abstract Objective: To determine the association of cardiovascular diseases with falls in the geriatric population. Methods: Original, Transversal and analytical study. Elderly patients who attend the external consultation of the Geriatrics service, older than 65 years, with falls history, perform comprehensive geriatric assessment to indentify causes of falls in the period from March 2018 to June 2019. We perform measures of central tendency, chi-square test X2 for qualitative variables, we performed linear regression model. Results: A total of 669 patients were included, the analysis shows association with frailty [OR 1.65 (95% CI 1.37-3.77), p <0.05], Heart Failure [OR 1.02, (95% CI, 0.68 - 1.54), p < 0.05 ], the logistic regression analysis with the variables (Fragility, SAH, es: DM2, AMI, Stroke, AF, postural hypotensive syncope, Hypothyroidism, Dyslipidemia, and HF) shows that the probability of falling is 57%. Conclusion: Cardiovascular diseases have a high prevalence in the population studied and increase the risk of falls. Individually analyzed cardiovascular diseases do not show an association with the syndrome of falls in the elderly, except for frailty, which proved to be an independent factor that increases the risk of falls with an OR 1.65. When analyzing them together, the risk of falling increases up to 57%. It is necessary to correctly identify and treat cardiovascular diseases in the elderly.

Resumen Objetivo: Determinar la asociación de las caídas con las enfermedades cardiovasculares en la población geriátrica. Métodos: Estudio original, transversal y analítico. Se incluyó a los pacientes que acuden a la consulta externa del Servicio de Geriatría, mayores de 65 años, con antecedentes de caídas, se realizó una evaluación geriátrica integral para identificar las causas de las caídas en el periodo de marzo de 2018 a junio de 2019. Realizamos medidas de tendencia central, chi cuadrada (prueba c2) para variables cualitativas, realizamos modelo de regresión lineal. Resultados: Se incluyeron un total de 669 pacientes. El análisis muestra asociación con fragilidad (odds ratio [OR]: 1.65; intervalo de confianza del 95% [IC 95%]: 1.37-3.77); p < 0.05]), insuficiencia cardiaca (OR: 1.02; IC 95%: 0.68-1.54); p < 0.05). El análisis de regresión logística con las variables fragilidad, HAS, DM2, IAM, EVC, FA, síncope por hipotensión ortostática, hipotiroidismo, dislipidemia e insuficiencia cardiaca (IC) muestra que la probabilidad de caídas es del 57%. Conclusión: Las enfermedades cardiovasculares tienen una alta prevalencia en la población estudiada y aumentan el riesgo de caídas. Las enfermedades cardiovasculares analizadas individualmente no muestran una asociación con el síndrome de caídas en los ancianos, a excepción de la fragilidad, que resultó ser un factor independiente que aumenta el riesgo de caídas con una OR de 1.65. Al analizarlas juntas, el riesgo de caídas se incrementa en un 57%. Es necesario identificar y tratar correctamente las enfermedades cardiovasculares en los ancianos.

Asociación de disfunción tiroidea subclínica con el síndrome de fragilidad en pacientes adultos mayores / Relation of subclinical thyroid dysfunction to frailty syndrome in older patients

Resumen OBJETIVO: Evaluar la asociación entre disfunción tiroidea subclínica y síndrome de fragilidad en pacientes adultos mayores. MATERIAL Y MÉTODO: Estudio de casos y controles efectuado de enero de 2016 a junio de 2017 en adultos mayores con síndrome de fragilidad (casos) y sin síndrome de fragilidad (controles). El diagnóstico de síndrome de fragilidad se estableció con los criterios de Fried. Se compararon las concentraciones séricas de TSH y T4 libre en pacientes robustos, prefrágiles y frágiles. También se determinó la razón de momios (OR) para fragilidad en pacientes con hipotiroidismo subclínico e hipertiroidismo subclínico. RESULTADOS: La edad promedio de los casos (n = 100) y controles (n = 104) fue de 83.2 y 78.1 años, respectivamente (p ≤ 0.01). Las concentraciones de TSH en sujetos frágiles en comparación con pacientes robustos fueron 3.1 vs 2.7 ng/mL (p = 0.5) y las concentraciones séricas de T4 libre fueron 1.26 y 1.32 ng/dL, respectivamente (p = 0.315). El OR para fragilidad en pacientes con hipotiroidismo subclínico fue de 1.21 (IC95% 0.39-3.80, p = 0.740) y en pacientes con hipertiroidismo subclínico fue OR = 0.74 (IC95% 0.14-3.75, p = 0.714). CONCLUSIONES: No existen diferencias significativas en las concentraciones séricas de TSH ni T4 libre entre pacientes frágiles y robustos. El hipotiroidismo y el hipertiroidismo subclínico no se asociaron con mayor riesgo de síndrome de fragilidad.

Abstract OBJECTIVE: To evaluate the association between subclinical thyroid dysfunction and frailty syndrome in elderly patients. MATERIAL AND METHOD: A case-control study was carried out from January 2016 to June 2017 in older adults with frailty syndrome (cases) and without frailty syndrome (controls). The diagnosis of frailty syndrome was made according to the Fried criteria. The serum levels of TSH and free-T4 were compared in robust, pre-frailty and frailty patients. Also, the odds ratio (OR) for frailty was determined in patients with subclinical hypothyroidism and subclinical hyperthyroidism. RESULTS: The mean age of the cases (n = 100) and controls (n = 104) was 83.2 and 78.1 years, respectively (p ≤ 0.01). The TSH levels in fragile and robust were 3.1 and 2.7 ng/ mL (p = 0.594) and the serum levels of free T4 were 1.26 and 1.32 ng/dL, respectively (p = 0.315). The OR for fragility in patients with subclinical hypothyroidism was 1.21 (CI95% 0.39-3.80, p = 0.740) and in patients with subclinical hyperthyroidism it was of 0.74 (CI95% 0.14-3.75, p = 0.714). CONCLUSIONS: There are no significant differences in serum levels of TSH or free T4 between fragile and robust patients. Subclinical hyperthyroidism and hypothyroidism were not associated with an increased risk of frailty syndrome.

Comorbilidad en pacientes mayores de 65 años con demencia / Comorbidity in patients older than 65 years with dementia

Resumen: ANTECEDENTES La demencia se define como la evidencia de un declive cognitivo significativo comparado con el nivel previo de rendimiento en uno o más dominios cognitivos. OBJETIVO Analizar la comorbilidad en pacientes mayores de 65 años de edad, ambulatorios, con demencia. MATERIAL Y MÉTODO Estudio transversal efectuado en pacientes mayores de 65 años de edad del servicio de Geriatría del Hospital Regional del ISSSTE en León, Guanajuato. La información se tomó de noviembre de 2016 a junio de 2017; se compararon las variables sociodemográficas y la comorbilidad entre ancianos con y sin demencia. RESULTADOS Se analizaron 324 pacientes, 206 (63.6%) eran mujeres, con edad media de 81.2 ± 6 años, escolaridad media de 5.2 ± 4.0 años y 45 (46.8%) estaban casados. Se documentaron 96 (42.4%) sujetos con demencia, de los que hubo mayor proporción de mujeres: 52 (54.1%) vs 91 (40.2%), p< 0.05. El evento vascular cerebral fue la única comorbilidad que mostró diferencia estadísticamente significativa con 22 (22.9%) vs 24 (10.6%), p < 0.01. Los factores asociados con demencia fueron el sexo femenino (OR 1.79; IC95%: 1.05-3.05; p < 0.05) y el evento vascular cerebral (OR 3.4; IC95%: 1.52-7.59; p < 0.01). CONCLUSIÓN La demencia suele ser más común en mujeres ancianas. Se asocia principalmente con eventos vasculares cerebrales, sin establecerse relación específica con el resto de las enfermedades analizadas.

Abstract BACKGROUND Dementia is defined as the evidence of a significant cognitive decline compared to the previous level of performance in one or more cognitive domains. OBJECTIVE To analyze the comorbidity in ambulatory patients older than 65 years with dementia. MATERIAL AND METHOD A cross-sectional study was done in patients older than 65 years, taking the information from November 2016 to June 2017. Socio-demographic variables and comorbidity among elderly people with and without dementia were compared. RESULTS 324 patients were analyzed, 206 (63.6%) women, mean age 81.2 ± 6 years, average schooling of 5.2 ± 4.0 years, 45 (46.87%) were married. The 96 (42.4%) subjects with dementia had a higher proportion of women: 52 (54.16%) vs 91 (40.26%), p < 0.05. Cerebral vascular event was the only one of the comorbidities that showed a statistically significant difference with 22 (22.9%) vs 24 (10.6%), p < 0.01. The factors associated with dementia were female sex (OR 1.79; 95% CI: 1.05-3.05; p < 0.05) and cerebral vascular event (OR 3.4; 95% CI: 1.52-7.59; p < 0.01). CONCLUSION Dementia is usually more common in older women. It is associated mainly with cerebral vascular events, without establishing a specific comorbidity relationship with the rest of the diseases analyzed.

Recombinant drugs-on-a-chip: The usage of capillary electrophoresis and trends in miniaturized systems - A review.

We present here a critical review covering conventional analytical tools of recombinant drug analysis and discuss their evolution towards miniaturized systems foreseeing a possible unique recombinant drug-on-a-chip device. Recombinant protein drugs and/or pro-drug analysis require sensitive and reproducible analytical techniques for quality control to ensure safety and efficacy of drugs according to regulatory agencies. The versatility of miniaturized systems combined with their low-cost could become a major trend in recombinant drugs and bioprocess analysis. Miniaturized systems are capable of performing conventional analytical and proteomic tasks, allowing for interfaces with other powerful techniques, such as mass spectrometry. Microdevices can be applied during the different stages of recombinant drug processing, such as gene isolation, DNA amplification, cell culture, protein expression, protein separation, and analysis. In addition, organs-on-chips have appeared as a viable alternative to testing biodrug pharmacokinetics and pharmacodynamics, demonstrating the capabilities of the miniaturized systems. The integration of individual established microfluidic operations and analytical tools in a single device is a challenge to be overcome to achieve a unique recombinant drug-on-a-chip device.

Antiviral factors and type I/III interferon expression associated with regulatory factors in the oral epithelial cells from HIV-1-serodiscordant couples.

Individuals who remain HIV-seronegative despite repeated unprotected exposure to the virus are defined as exposed seronegative (ESN) individuals. Innate and adaptive immunity, as well as genetic factors, provide ESNs with important advantages that allow for low infection susceptibility. The majority of HIV-1-infected individuals undergo antiretroviral therapy, which can decrease the level of HIV-1 exposure in ESNs. We analyzed type I interferon (IFN)-related antiviral and regulatory factors in peripheral blood mononuclear cells (PBMCs) and oral epithelial cells from serodiscordant couples. Our findings revealed that ESNs did not induce the expression of antiviral factors (APOBEC-3G, TRIM5-α, SAMDH1, STING, TBk1) or regulatory factors (Trex, Foxo3, Socs3, IL-10) in PBMCs, unlike their HIV-1-infected partners. In contrast, ESNs upregulated APOBEC-3G and type I/III IFNs (IFNs-α,-ß/-λ) in oral mucosal epithelial cells similar to their HIV-infected partners. The serodiscordant groups exhibited an increased expression of type I IFN-induced regulators, such as Trex and Foxo3, in oral epithelial cells. TLR7, TLR8 and TLR9 were expressed in oral epithelial cells of both ESNs and HIV-1-infected subjects. These findings revealed evidence of antiviral factors, type I/III interferon and regulatory factor expression only in the oral mucosal compartment of ESNs, while HIV-1-infected partners systemically and oral mucosal expressed the antiviral profile.

Knotless choledochorraphy with barbed suture, safe and feasible.

PURPOSE: To describe the safety and feasibility of a running continuous unidirectional barbed suture (V-Loc, Covidien, Mansfield, MA) for primary common bile duct closure while performing laparoscopic common bile duct exploration (LCBDE). INTRODUCTION: LCBDE is nowadays the best approach for treating complex common bile duct lithiasis or cases where the endoscopic retrograde cholangiopancreatography has failed. It is clear that the primary closure of the common bile duct must be preferred over the T-tube drainage. The actual technical aspects offer room for improvement. We present our experience with barbed suture, for which recently, various fields of surgery have become interested in and which now has a series of studies that support it for several uses. METHODS: Between July 2012 and July 2014, 54 consecutive patients with bile duct stones underwent LCBDE by a single surgeon. Perioperative outcomes and 30-day complications were recorded. RESULTS: Upon the completion of the exploration, 50 patients had primary common bile duct closure using knotless unidirectional barbed 3-0 V-Loc 90 suture, and 4 patients were excluded. All of the sutures were performed without knot tying. The procedure in all patients was successfully performed with no intraoperative complications. There were no bile leaks in the 50 patients or other postoperative complications such as infection, need for reintervention or death. CONCLUSION: The use of unidirectional knotless barbed suture (V-Loc 90) is safe, feasible and effective on LCBDE for primary common bile duct closure. The biliary leak rate is acceptably low and comparable to the rate reported in the literature. This report is our initial experience that needs further clinical trials.

Increased frequency of circulating Tc22/Th22 cells and polyfunctional CD38(-) T cells in HIV-exposed uninfected subjects.

Some individuals are resistant to HIV-1 infection despite repeated exposure to the virus, suggesting the presence of a complex antiviral response. Innate factors like IL-22 exert gut mucosal protection and polyfunctional T cells have been associated with low progression in HIV infection; therefore, we evaluated the frequencies of CD4+ and CD8+ T cell-secreting cytokines, including Tc22/Th22 cells and polyfunctional T cells in HIV-1-exposed uninfected individuals (EUs), their HIV-1-infected partners and healthy controls. EUs exhibited an increased frequency of p15 Gag CD4+ IL-22+ secreting T cells, whereas HIV-infected partners demonstrated a high frequency of CD4+ IL-17+ T cells in response to p24. Similar responses of Th22 and Tc22 cells to Gag peptides and Staphylococcal enterotoxin B (SEB) stimulation were detected in the serodiscordant couples. However, polyfunctionality in HIV subjects was associated with an HIV Gag response of CD38+ T cells, whereas polyfunctionality for EUs was induced upon SEB stimulation by CD38- T cells. EUs demonstrated the presence of Tc22/Th22 cells and polyfunctional CD38- T cells with a low activation profile. These data suggest that SEB-induced polyfunctional CD4+ and CD8+ T cells together with Tc22/Th22 cells in EU individuals can provide an immunological advantage in the response to pathogens such as HIV-1.

Increased frequency of circulating Tc22/Th22 cells and polyfunctional CD38(-) T cells in HIV-exposed uninfected subjects

Some individuals are resistant to HIV-1 infection despite repeated exposure to the virus, suggesting the presence of a complex antiviral response. Innate factors like IL-22 exert gut mucosal protection and polyfunctional T cells have been associated with low progression in HIV infection; therefore, we evaluated the frequencies of CD4+ and CD8+ T cell-secreting cytokines, including Tc22/Th22 cells and polyfunctional T cells in HIV-1-exposed uninfected individuals (EUs), their HIV-1-infected partners and healthy controls. EUs exhibited an increased frequency of p15 Gag CD4+ IL-22+ secreting T cells, whereas HIV-infected partners demonstrated a high frequency of CD4+ IL-17+ T cells in response to p24. Similar responses of Th22 and Tc22 cells to Gag peptides and Staphylococcal enterotoxin B (SEB) stimulation were detected in the serodiscordant couples. However, polyfunctionality in HIV subjects was associated with an HIV Gag response of CD38+ T cells, whereas polyfunctionality for EUs was induced upon SEB stimulation by CD38- T cells. EUs demonstrated the presence of Tc22/Th22 cells and polyfunctional CD38- T cells with a low activation profile. These data suggest that SEB-induced polyfunctional CD4+ and CD8+ T cells together with Tc22/Th22 cells in EU individuals can provide an immunological advantage in the response to pathogens such as HIV-1

Luxación traumática de cadera. Resultados a mediano plazo / Traumatic dislocation of the hip. Long term results

La luxación traumática de la cadera se considera una urgencia, debida a traumatismos de alta energía y sus complicaciones dejan limitaciones importantes en la extremidad, por lo que la valoración clínica y radiología así como el tratamiento oportuno son muy importantes para disminuir las secuelas que dejan este padecimiento. En este estudio se establece la epidemiología de la luxación traumática de la cadera en el Hospital General de Xoco así como los mecanismos de lesión y si existe alguna relación entre el diagnóstico, tratamiento y las complicaciones, evaluando la función de la cadera a mediano plazo. Se incluyen 57 pacientes a los que se les hizo el seguimiento durante un año posterior al trauma encontrándose que sí existe relación directa entre el tiempo de inicio de la marcha para la presencia de complicaciones que dejan limitación