Ensayo clínico fase III para evaluar la eficacia y seguridad del uso de plasma rico en plaquetas frente a ácido hialurónico en coxartrosis / Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis

OBJETIVOS: Comparar la eficacia y seguridad de la infiltración de plasma rico en plaquetas preparado respecto a ácido hialurónico en pacientes con coxartrosis refractaria a tratamiento conservador. Así como correlacionar el impacto clínico entre las diferentes concentraciones celulares. MATERIALES Y MÉTODOS: Ensayo clínico fase III, doble-ciego, controlado, en el que se aleatorizaron a los pacientes en dos grupos de tratamiento (PRP o AH) con una única infiltración de cadera ecoguiada. El seguimiento fue de 12 meses, registrando escala de dolor (EVA) y escalas funcionales (HHS y WOMAC), analgesia consumida, respondedores (criterios OARSI) y efectos adversos. Se analizaron, en el grupo experimental, las concentraciones celulares en sangre periférica y en el PRP infiltrado. RESULTADOS: Se incluyeron un total de 74 pacientes. Ambos grupos de tratamiento presentaron mejoría en las escalas EVA, WOMAC, HHS y reducción del consumo de analgesia en el tiempo (p < 0,05). Únicamente encontramos diferencias significativas entre grupos al año de tratamiento en los valores de HHS (Grupo PRP 70,9 [3,7-58] grupo AH 60,2[43-74,2] p < 0,05). No se registraton efectos adversos en ninguno de los grupos. Encontramos correlación entre la concentración de plaquetas en pacientes respondedores (un mes postratamiento; no respondedores 449[438-578] x103 plaquetas/μl, respondedores 565 [481-666] x103 plaquetas/μl, p < 0,044). Se correlaciona la concentración de leucocitos con las escalas clínico-funcionales (EVA 6 meses, r=0,748, p < 0,013, subescala rigidez WOMAC 6 meses, r=0,748, p < 0,013). Los pacientes con estadios de coxartrosis iniciales (KL 1 y 2) tienen mayor probabilidad de responder al tratamiento con plasma rico en plaquetas (11,51 OR, IC 95% 2,34-50,65, p < 0,03). CONCLUSIONES: La infiltración única de PRP es eficaz en términos de mejoría funcional, reducción del dolor y disminución del consumo de analgesia en coxartrosis. Los sistemas de preparación abiertos, son un procedimiento seguro para la obtención de PRP. Se deben indicar las infiltraciones de cadera en estadios evolutivos iniciales. Se debe tener en cuenta la composición celular para garantizar una repuesta clínica positiva

AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/μl versus responders 565 [481-666] x103 platelets/μl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response

Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis. / Ensayo clínico fase III para evaluar la eficacia y seguridad del uso de plasma rico en plaquetas frente a ácido hialurónico en coxartrosis.

AIMS OF THE STUDY: To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS: This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS: Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/µl versus responders 565 [481-666] x103 platelets/µl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS: Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response.

Características de los neonatos trasladados al hospital de referencia regional en Asturias / Characteristics of the newborns transferred to the regional reference hospital in Asturias

INTRODUCCIÓN: La regionalización de la asistencia neonatal es un punto importante de la asistencia pediátrica de calidad. Los traslados interhospitalarios neonatales forman parte de esta regionalización. OBJETIVO: Analizar las características de los neonatos trasladados al hospital de referencia en Asturias. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo y descriptivo de los pacientes neonatales trasladados al Servicio de Neonatología del hospital regional de referencia, entre enero de 2017 y diciembre de 2018 en Asturias. RESULTADOS: Se incluyeron 136 pacientes (56 mujeres y 80 varones), lo que supone un traslado cada 5 días, el 1,8% de los neonatos nacidos en los hospitales emisores y el 14,4% de los ingresos en el hospital receptor. El 63,2% ingresaron en la unidad de cuidados intensivos y el 36,7% en la sala de cuidados intermedios, con un tiempo de ingreso medio de 9,5 días. El 20,7% eran prematuros. El peso medio al nacimiento fue de 2.983 g. La edad media al traslado fue de 5 días y el 46,3% de los traslados se realizaron durante las primeras 24 horas de vida. Las causas más frecuentes de traslado fueron: respiratorias (25%), neurológicas (14,7%), digestivas (13,2%) e infecciosas (12,5%). El 38% de los pacientes precisó soporte ventilatorio y el 1,4% falleció durante el ingreso. CONCLUSIONES: Los traslados neonatales interhospitalarios son relativamente frecuentes en nuestra región, siendo el distrés respiratorio y los problemas neurológicos las causas más comunes. El análisis de la regionalización de la asistencia neonatal resulta especialmente importante en regiones con escasa natalidad debido a la crisis demográfica

INTRODUCTION: Regionalization of neonatal care is an important point of quality in pediatric care. Neonatal interhospital transfers between regional hospitals and referral centers are part of this regionalization. OBJECTIVE: To analyze characteristics of newborns transferred from the different regional and private hospitals to theregional reference hospital in Asturias during 2017 and 2018. MATERIALS AND METHODS: An observational, descriptive and retrospective study was conducted, including all neonatal patients transferred fron other Asturian hospital to Neonatology Service of HUCA between January 2017 and December 2018, in Asturias. RESULTS: 136 patients were included (56 female and 80 male), which represents a transfer every 5 days, 1.8% of the 7,563 neonates born in the sending hospitals and 14.4% of the neonatal admissions in the receiving hospital. 63.2% of patients were admitted to the neonatal Intensive Care Unit and 36.7% to the neonatal Intermiediate care room with a mean admission time of 9.5 days. 20.7% were preterm newborns. The average born weight was 2,983 g. 20.6% were less than 2,500 g. Average age at transfer was 5 days, being the 46.3% made during first 24 hours of life. The most frequent causes of transfer were: respiratory (25%) neurological (14.7%), digestive (13.2%) and infectous (12.5%). 38% required ventilatory support and 1,4% died during admission. CONCLUSIONS: Neonatal inter-hospital transfers are relatively frequent in our region, with respiratory distress and neurological problems being the most common causes. The analysis of neonatal care regionalization is especially important in regions with low birth rates due to demographic crisis

Assessment of multi-step processes for an integral use of the biomass of the marine microalga Amphidinium carterae.

Sustainable dinoflagellate microalgae-based bioprocess designed to produce secondary metabolites (SMs) with interesting bioactivities are attracting increasing attention. However, dinoflagellates also produce other valuable bioproducts (e.g polyunsaturated fatty acids, carotenoids, etc.) that could be recovered and should therefore be taken into account in the bioprocess. In this study, biomass of the marine dinoflagellate microalga Amphidinium carterae was used to assess and optimise three different methods in order to obtain three families of high-value biochemical compounds present in the biomass. The existing processes encompassed a multi-step extraction process for carotenoids, fatty acids and APDs individually and are optimized for the integral valorization of raw A. carterae biomass, with SMs being the primary target compounds. Total process recovery yields were 97% for carotenoids, 80% for total fatty acids and 100% for an extract rich in APDs (not purified).

Análisis de las diferencias en la atención a la Salud Mental del Niño y Adolescente en España a través de los Planes Estratégicos de Salud Mental Autonómicos / Analysis of the disparities in Mental Health care of Children and Adolescents in Spain through the Autonomic Mental Health Strategic Plans

Introduccion: La Psiquiatría Infantil es una especialidad relativamente reciente. Es un área importante de trabajo ya que los datos reflejan que la tasa de prevalencia de trastornos mentales en niños y adolescentes se sitúa entre el 15 y el 20 % de la población infanto-juvenil a nivel mundial, o que el 80 % de los trastornos mentales de los adultos tuvieron comienzo antes de los 18 años. En toda España se puede ofrecer asistencia a niños y adolescentes, aunque ésta no se encuentra homogeneizada en todas las Comunidades Autónomas (CCAA). Adicionalmente, España es uno de los dos únicos países de la Unión Europea que no dispone de la especialidad de Psiquiatría del Niño y Adolescente. Al no existir a día de hoy una especialidad propia, el carácter de la atención ofrecida dependerá de la formación particular de cada profesional. Objetivo: Analizar la situación de la atención a la Salud Mental del Niño y Adolescente en España a través de los Planes Estratégicos de Salud Mental Autonómicos. Método: Se analizaron mediante lectura exhaustiva las líneas estratégicas de los 17 Planes Estratégicos de Salud Mental de todas las CCAA. Resultados: Se han encontrado desigualdades tanto en la vigencia y actualización de dichos planes, como en la estructura y oferta de recursos asistenciales y formativos. Conclusión: Hoy en día la especificidad en la atención a la Salud Mental del niño y adolescente se distribuye de forma desigual en España, dependerá de la CCAA en la que resida el niño o adolescente

Background: Child Psychiatry is a relatively recent specialty. It is an important field of work because the data show that the prevalence rate of Mental Disorders in children and adolescents is between 15 and 20 % of the infantile-juvenile population worldwide, and that 80 % of the Mental Disorders in adults began before the age of 18. Throughout Spain, assistance can be offered to children and adolescents, although it is not standardised in all the Autonomous Communities (CCAA). In addition, Spain is one of only two countries in the European Union that does not have the specialty of Child and Adolescent Psychiatry. As there is currently no specialty of its own, the nature of the care offered will depend on the particular training of each professional. Objective: To analyse the situation of mental health care for children and adolescents in Spain through the Autonomous Mental Health Strategic Plans. Methods: The strategic lines of the 17 Strategic Mental Health Plans of all the Autonomous Communities were analysed. Results: Inequalities were found in the validity and updating of these plans, as well as in the structure and supply of assistance and training resources. Conclusion: Today, the specificity of mental health care for children and adolescents is distributed unequally in Spain, depending on the Autonomous Community in which the child or adolescent resides

Maximizing carotenoid extraction from microalgae used as food additives and determined by liquid chromatography (HPLC).

Microalgae are an interesting source of natural pigments that have valuable applications. However, further research is necessary to develop processes that allow us to achieve high levels of carotenoid recovery while avoiding degradation. This work presents a comprehensive study on the recovery of carotenoids from several microalgae genera, optimizing carotenoid extraction using alkaline saponification at various temperatures and KOH concentrations. Results show that I. galbana requires a temperature of 60 °C and <10% KOH, N. gaditana and K. veneficum require 60 °C and no saponification, P. reticulatum requires 40 °C and 10% KOH, T. suecica and H. pluvialis require 25 °C and 40% KOH while C. sp. and S. almeriensis require 80 °C and 40% KOH. The influence of the solvent on carotenoid recovery was also studied. In general terms, an ethanol:hexane:water (77:17:6 v/v/v) mixture results in good yields.

Outdoor pilot-scale production of Nannochloropsis gaditana: influence of culture parameters and lipid production rates in tubular photobioreactors.

This work studied outdoor pilot scale production of Nannochloropsis gaditana in tubular photobioreactors. The growth and biomass composition of the strain were studied under different culture strategies: continuous-mode (varying nutrient supply and dilution rate) and two-stage cultures aiming lipid enhancement. Besides, parameters such as irradiance, specific nitrate input and dilution rate were used to obtain models predicting growth, lipid and fatty acids production rates. The range of optimum dilution rate was 0.31-0.351/day with maximum biomass, lipid and fatty acids productivities of 590, 110 and 66.8 mg/l day, respectively. Nitrate limitation led to an increase in lipid and fatty acids contents (from 20.5% to 38.0% and from 16.9% to 23.5%, respectively). Two-stage culture strategy provided similar fatty acids productivities (56.4 mg/l day) but the neutral lipids content was doubled.

A low-cost culture medium for the production of Nannochloropsis gaditana biomass optimized for aquaculture.

Nannochloropsis gaditana is a microalga with a high nutritional value and a protein and polyunsaturated fatty acid (PUFA) content that makes it interesting as a feed in aquaculture. To maximize its productivity and nutritional value in large-scale culture, a well-known commercial medium was optimized to the most favorable nutrient level using commercial fertilizers. Optimal growth conditions were obtained in the alternative fertilizer-based medium at a nitrogen concentration of 11.3 mM, a phosphorus concentration of 0.16 mM, and a micronutrient concentration of 30 µL L(-1). This alternative medium allowed to obtain a biomass concentration similar to that achieved when using the commercial formula but with a reduction in Cu, Fe, and Mo content of 71%, 89%, and 99%, respectively. A maximum biomass productivity of 0.51 g L(-1) d(-1) was obtained. The eicosapentaenoic acid and protein contents of the biomass were 2.84% and 44% of dry weight, respectively.

Marine microalgae selection and culture conditions optimization for biodiesel production.

Continuous cultures of Nannochloropsis gaditana, Tetraselmis chuii, Tetraselmis suecica and Phaeodactylum tricornutum were carried out at different dilution rates and culture media in order to check their influence on biomass productivity. N. gaditana attained maximum biomass productivity of 0.49 g/lday at a dilution rate of 0.421/day. The influence of nitrate concentration on biomass productivity was tested by continuous cultures of N. gaditana. At 8.0 mM nitrate and dilution rates ranging between 0.30 and 0.401/day, maximum biomass productivities were achieved. To enhance lipid accumulation, a two-stage culture strategy consisting in a first stage of nitrate-replete conditions followed by a nitrate-depleted phase was performed. The accumulated productivity was 51 mgFATTY ACIDS/l day. Results showed an important change in the fatty acids profile and an increase in the neutral lipids content, representing 73.1% of total lipids. Additionally, the combination of nitrogen depletion and light stress was proved to contribute to lipid enhancement.

Medium recycling for Nannochloropsis gaditana cultures for aquaculture.

Nannochloropsis gaditana is a good producer of proteins and valuable fatty acids for aquaculture. Recycling of culture medium is interesting for microalgae commercial production as it cuts costs and prevents environmental contamination. The recycled medium must be sterilized to prevent the buildup of unwanted metabolites and microorganisms. We tested several sterilization methods: filtration, ozonation, chlorination, addition of hydrogen peroxide and heating. Results showed that the most successful method is ozonation lowering the bacterial load to 1.910(3)CFUs/mL, which is 1000-fold and 10-fold lower than the supernatant obtained after harvesting and the initial filtered medium, respectively. Continuous cultures of N. gaditana were grown using this recirculated supernatant. A maximum biomass productivity of 0.8 g/L/d composed of ∼50% proteins and 40% lipids with more than 3%d.w. EPA was obtained making this biomass very interesting for aquaculture.

Conversion of CO2 into biomass by microalgae: how realistic a contribution may it be to significant CO2 removal?

Microalgae have been proposed as a CO(2) removal option to contribute to climate change avoidance and problems coming from the use of fossil fuels. However, even though microalgae can be used to fix CO(2) from air or flue gases, they do not permit long-term CO(2) storage because they are easily decomposed. On the other hand, microalgae can contribute to an enhancement in human sustainability by producing biofuels as an alternative to fossil fuels in addition to the production of other useful chemicals and commodities. Moreover, microalgae can contribute to enhancing the sustainability of waste treatment processes, reducing the energy consumed, and improving the recycling of nutrients contained within them. This paper reviews the potential contribution of these processes and the existing knowledge in these areas.

Utilization of Anabaena sp. in CO2 removal processes: modelling of biomass, exopolysaccharides productivities and CO2 fixation rate.

This paper focuses on modelling the growth rate and exopolysaccharides production of Anabaena sp. ATCC 33047, to be used in carbon dioxide removal and biofuels production. For this, the influence of dilution rate, irradiance and aeration rate on the biomass and exopolysaccharides productivity, as well as on the CO(2) fixation rate, have been studied. The productivity of the cultures was maximum at the highest irradiance and dilution rate assayed, resulting to 0.5 g(bio) l(-1) day(-1) and 0.2 g(eps) l(-1) day(-1), and the CO(2) fixation rate measured was 1.0 gCO(2) l(-1) day(-1). The results showed that although Anabaena sp. was partially photo-inhibited at irradiances higher than 1,300 µE m(-2) s(-1), its growth rate increases hyperbolically with the average irradiance inside the culture, and so does the specific exopolysaccharides production rate. The latter, on the other hand, decreases under high external irradiances, indicating that the exopolysaccharides metabolism hindered by photo-damage. Mathematical models that consider these phenomena have been proposed. Regarding aeration, the yield of the cultures decreased at rates over 0.5 v/v/min or when shear rates were higher than 60 s(-1), demonstrating the existence of thus existence of stress damage by aeration. The behaviour of the cultures has been verified outdoors in a pilot-scale airlift tubular photobioreactor. From this study it is concluded that Anabaena sp. is highly recommended to transform CO(2) into valuable products as has been proved capable of metabolizing carbon dioxide at rates of 1.2 gCO(2) l(-1) day(-1) outdoors. The adequacy of the proposed equations is demonstrated, resulting to a useful tool in the design and operation of photobioreactors using this strain.

Development of a process for efficient use of CO2 from flue gases in the production of photosynthetic microorganisms.

A new methodology to use efficiently flue gases as CO(2) source in the production of photosynthetic microorganisms is proposed. The CO(2) is absorbed in an aqueous phase that is then regenerated by microalgae. Carbonated solutions could absorb up to 80% of the CO(2) from diluted gas reaching total inorganic carbon (TIC) concentrations up to 2.0 g/L. The pH of the solution was maintained at 8.0-10.0 by the bicarbonate/carbonate buffer, so it is compatible with biological regeneration. The absorption process was modeled and the kinetic parameters were determined. Anabaena sp. demonstrated to tolerate pH (8.0-10.0) and TIC (up to 2.0 g/L) conditions imposed by the absorption step. Experiments of regeneration of the liquid phase demonstrated the feasibility of the overall process, converting CO(2) into organic matter. The developed process avoids heating to regenerate the liquid whereas maximizing the efficiency of CO(2) use, which is relevant to achieve the commercial production of biofuels from microalgae.

Utilization of the cyanobacteria Anabaena sp. ATCC 33047 in CO2 removal processes.

In this paper the utilization of the cyanobacteria Anabaena sp. in carbon dioxide removal processes is evaluated. For this, continuous cultures of this strain were performed at different dilution rates; alternatives for the recovery of the organic matter produced being also studied. A maximum CO(2) fixation rate of 1.45 g CO(2) L(-1) day(-1) was measured experimentally, but it can be increased up to 3.0 g CO(2) L(-1) day(-1) outdoors. The CO(2) is mainly transformed into exopolysaccharides, biomass representing one third of the total organic matter produced. Organic matter can be recovered by sedimentation with efficiencies higher than 90%, the velocity of sedimentation being 2.10(-4) s(-1). The major compounds were carbohydrates and proteins with productivities of 0.70 and 0.12 g L(-1) day(-1), respectively. The behaviour of the cultures of Anabaena sp. has been modelized, also the characteristics parameters requested to design separation units being reported. Finally, to valorizate the organic matter as biofertilizers and biofuels is proposed.

Lesión polipoidea colónica infrecuente / No disponible

No disponible

Síndrome diarreico y carcinoma de células renales / No disponible

No disponible

Sarcoma de Kaposi gástrico y Mycobacterium genavense / No disponible

No disponible