OsteoMac: A new player on the bone biology scene.

The knowledge of bone biology has undergone major advances in recent decades. In bone, resorbing osteoclasts have classically been described as tissue-resident macrophages, however, it is currently known that a new subtype of macrophages, called OsteoMacs, are specialised bone-resident macrophages, which, depending on certain conditions, may play an important role not only in bone homeostasis, but also in promoting pro-anabolic functions or in creating an inflammatory environment. There is growing evidence that these osteal macrophages may influence the development of bone-loss diseases. It is essential to understand the biological bases underlying bone physiological processes to search for new therapeutic targets for bone-loss diseases, such as osteoporosis, rheumatoid arthritis, or even periodontal disease. This narrative review provides an update on the origin, characterisation, and possible roles of osteoMacs in bone biology. Finally, the potential clinical applications of this new cell in bone-loss disorders are discussed.

Burnout syndrome assessment among Spanish oral surgery consultants: A two populations comparative pilot study

Background: The professional Burnout Syndrome (BOS) or Burnout is considered a professional disease made up of three interrelated dimensions (emotional exhaustion, depersonalization and lack of personal fulfillment). BOS has been documented to most severely affect the healthcare professions, especially dentists. On the other hand, its appearance has been documented at an early age, during dental training. However, there are no studies that analyze its incidence in professionals dedicated to Oral Surgery and Implantology, determining the age of onset and related factors. Material and Methods: The modified Maslach questionnaire was carried out anonymously among the professors and students of the Master of Oral Surgery and Implantology at the Complutense University of Madrid. A total of 36 participants were enrolled in this study and the results of the modified Maslach Questionnaire were established into four groups [1st year (n=6), 2nd year (n=6), 3rd year (n=6) postgraduate students and clinical teachers (n=18)]. The following variables were recorded: Age, sex, years of experience, weekly hours of work, dedication on weekends and scope of work. The statistical analysis performed included Pearson's correlation, analysis of variance, Student's t-test, F-Anova, Chi-Square and Gamma correlation. Statistical Significance of the tests was established of p≤0.05. Results: 36 questionnaires were analyzed, of which 22.2% (n = 8) presented BOS, and 77.8% (n = 28) a medium risk of suffering it. The mean values and standard deviation ​​of emotional exhaustion (7.50 ± 2.43; 9.83 ± 4.12; 15.83 ± 6.21; 30.22 ± 7.86), depersonalization (5.50 ± 1.23; 50 ± 3.27; 11.33 ± 1.75; 17.56 ± 4.13), low personal fulfillment (39.67 ± 3.72; 39.33 ± 2.34; 43.17 ± 3, 55; 37.33 ± 5.51) and professional burnout (54.33 ± 2.66; 61.67 ± 2.88; 70.33 ± 5.43; 85.11 ± 9.05) in the four groups respectively. A significant association was found in the appearance of emotional exhaustion and depersonalization, years of experience, weekly work hours and the work environment. Conclusions: BOS is a disease that can appear from 30 years of age, after 5 years of professional experience and when there is a clinical consultation of 40 hours a week. Oral Surgery and Implantology seems to be a risk activity for the manifestation of depersonalization.(AU)

Differences in platelet-rich plasma composition influence bone healing.

AIM: Platelet-rich plasma (PRP) is an autologous blood-derived material that has been used to enhance bone regeneration. Clinical studies, however, reported inconsistent outcomes. This study aimed to assess the effect of changes in leucocyte and PRP (L-PRP) composition on bone defect healing. MATERIALS AND METHODS: L-PRPs were prepared using different centrifugation methods and their regenerative potential was assessed in an in-vivo rat model. Bilateral critical-size tibial bone defects were created and filled with single-spin L-PRP, double-spin L-PRP, or filtered L-PRP. Empty defects and defects treated with collagen scaffolds served as controls. Rats were euthanized after 2 weeks, and their tibias were collected and analysed using micro-CT and histology. RESULTS: Double-spin L-PRP contained higher concentrations of platelets than single-spin L-PRP and filtered L-PRP. Filtration of single-spin L-PRP resulted in lower concentrations of minerals and metabolites. In vivo, double-spin L-PRP improved bone healing by significantly reducing the size of bone defects (1.08 ± 0.2 mm3 ) compared to single-spin L-PRP (1.42 ± 0.27 mm3 ) or filtered L-PRP (1.38 ± 0.28 mm3 ). There were fewer mast cells, lymphocytes, and macrophages in defects treated with double-spin L-PRP than in those treated with single-spin or filtered L-PRP. CONCLUSION: The preparation method of L-PRP affects their composition and potential to regenerate bone.

Chorea gravidarum associated with systemic lupus erythematosus and antiphospholipid syndrome: case report.

Las manifestaciones neuropsiquiátricas en los pacientes con lupus eritematoso sistémico (LES) y síndrome antifosfolípido (SAF) secundario son muy frecuentes. En ambos casos, la fisiopatología se correlaciona con vasculopatía asociada a anticuerpos antifosfolípido y neurotoxicidad por anticuerpos y citocinas. La corea es el único trastorno del movimiento incluido en los 19 síndromes neuropsiquiátricos del LES según el American College of Rheumatology, con presentación inusual (prevalencia del 2%), y puede ocurrir como primera manifestación de la enfermedad. Se describe el caso de una paciente de 17 años con corea desencadenada durante el embarazo como manifestación inicial de LES y SAF.Neuropsychiatric symptoms of systemic lupus erythematosus (SLE) and secondary antiphospholipid syndrome (APS) are very common. In both cases, pathophysiology is correlated to vasculopathy associated to antiphospholipid antibodies as well as neurotoxicity mediated by antibodies and cytokines. Chorea, instead, is the only movement disorder included in the 19 SLE's neuropsychiatric syndromes described by the American College of Rheumatology. Nevertheless, its presence is unusual with a prevalence of about 2%, and could appear as an early manifestation of the disease. The case of a 17-year-old pregnant woman in whom chorea was an early manifestation of SLE and APS.

Acute myocardial infarction, as a rare manifestation in granulomatosis with polyangiitis.

La granulomatosis con poliangeítis es una vasculitis de pequeños vasos asociada a la presencia de anticuerpos anticitoplasma de neutrófilos, con manifestaciones cardíacas que son poco frecuentes, como pericarditis, miocarditis, arteritis coronaria y enfermedad valvular. Reportamos el caso de un paciente de 49 años con reciente diagnóstico de granulomatosis con poliangeítis, quien presentó infarto agudo del miocardio. Se consideró la actividad de la enfermedad como causa del infarto. Las manifestaciones clínicas cardiovasculares en la granulomatosis con poliangeítis son relevantes por ser marcadores de mal pronóstico.Granulomatosis with polyangiitis is a small vessel vasculitis associated to anti-neutrophil cytoplasmic antibodies, in which the cardiac manifestations are not common, as pericarditis, cardiomyopathy, coronary artery disease and vascular disease. We report a clinical case of a 49-year-old man with a recent diagnosis of granulomatosis with polyangiitis, he presented myocardial infarction. Disease activity was considered the cause of myocardial infarction. Cardiovascular clinical manifestations in granulomatosis with polyangiitis are relevant because are markers of poor prognosis.

Enfermedad de Poncet: manifestación inusual de tuberculosis / Poncets disease: unusual manifestation of tuberculosis

Resumen LA enfermedad de Poncet es una poliartritis aséptica reactiva poco frecuente que ocurre durante cualquier etapa de una infección activa pulmonar o extrapulmonar por Mycobacterium tuberculosis. Existen apenas 200 casos descritos en la bibliografía y hasta el momento permanece como diagnóstico de exclusión sin patogenia bien definida. Suele responder rápida y satisfactoriamente al tratamiento antituberculoso sin dejar secuelas. Este artículo revisa la epidemiología, patogenia, manifestación clínica, diagnóstico, tratamiento y pronóstico de la enfermedad de Poncet.

Abstract Poncet's disease is a rarely reported aseptic reactive polyarthritis associated to active pulmonary or extrapulmonary infection caused by Mycobacterium tuberculosis. There are no more than 200 cases reported in the literature and still remains as a diagnosis of exclusion with unknown pathogenesis. It quickly and remarkably resolves with antituberculous drugs, has usually a good prognosis and does not turn into chronic arthritis. This article reviews the epidemiology, pathogenesis, clinical presentation, diagnosis, treatment options and prognosis of Poncet's disease.

Serum creatinine during physiological perinatal dehydration may estimate individual nephron endowment.

It is well known that the nephron endowment of healthy subjects is highly variable and that individual nephron mass has potentially important implications both in health and disease. However, nephron count is technically impossible in living subjects. Based on the observation of an increase in serum creatinine (sCr) in otherwise healthy newborns with solitary kidney during the physiological perinatal dehydration, we hypothesized that perinatal sCr might be helpful in identifying healthy subjects with a reduced nephron mass. In the framework of a study on blood pressure in babies (NeoNeph), sCr of normal Caucasian neonates was determined 48-96 h after birth and their association with a family history of arterial hypertension (AH) was analyzed. SCr was determined in 182 normal newborns (90 males) at a mean of 61 ± 8 h after birth (range 46-82). Newborns with paternal AH had a higher mean sCr (0.97 + 0.28 mg/dL) then newborns without paternal AH (0.73 + 0.28 mg/dL; p = 0.006). No differences in mean sCr were found in relation with mother or grandparent's history of AH. CONCLUSION: The association between parental AH and high sCr during perinatal dehydration supports the hypothesis that the latter is a promising tool for identifying normal subjects with a reduced nephron mass with potential important implications in prevention and in understanding the individual outcome of renal and extrarenal diseases (including AH). What is Known: • Nephron endowment of healthy subjects is highly variable and individual nephron mass has potentially important implications both in health and disease however nephron count is not feasible in living subjects. What is New: • Serum creatinine during perinatal dehydration is a possible biomarker for identifying normal subjects with a reduced nephron mass.

Cor triatriatum dexter associated with atrial septal defect: Management in a complex clinical case.

The coexistence of an atrial septal defect and a prominent eustachian valve is a rare congenital anomaly, rarely reported in literature. Differentiation between a giant eustachian valve and cor triatriatum dexter can be difficult. A case of a large atrial septal defect associated with cor triatriatum dexter diagnosed by echocardiography in an asymptomatic woman is reported. A watchful waiting strategy was adopted.

Differences between office and ambulatory blood pressures in children and adolescents attending a hospital hypertension clinic.

BACKGROUND AND OBJECTIVES: Information on ambulatory blood pressure monitoring (ABPM) in children is scarce. While in adults office BP (OBP) is higher than ABP and the difference increases as OBP increases, information in children suggests that at this young age ABP is no lower and often higher than OBP. This study was aimed at describing OBP-ABP differences in a cohort of children of different ages and BPs, and investigating whether OBP-ABP differences are dependent on age or OBP level. METHODS: We retrospectively compared OBP and 24-h, daytime and night-time ABP in 433 children and adolescents aged 4-18 years, referred to our hospital clinic. RESULTS: OBP was found to be significantly lower than 24-h and daytime ABP in the low age tertile (4-10 years) but not in the medium and high tertiles. OBP was also lower than ABP in normotensive patients (n = 182), but higher than ABP in untreated hypertensive patients (n = 92) despite similar ages. Continuous analyses showed a weak correlation of OBP-ABP differences with age, and a much stronger correlation with OBP so that 24-h ABP was higher than OBP at OBP values less than 117/73 mmHg and lower than OBP at higher OBP values. Logistic regression analysis indicates that also in children OBP accounts for most of the OBP-ABP difference. CONCLUSION: There is a common relation both in children and adults between OBP and ABP. It is only because high OBP is common in the elderly, and the lowest OBP is usually found in young children that large positive OBP-ABP differences have been associated with old age, and negative differences with childhood. OBP-ABP differences, often defined as white-coat effect, can have different directions and are likely to be largely due to regression to the mean.

Tratamiento con rituximab para la trombocitopenia secundaria a lupus eritematoso sistémico / Treatment with rituximab for thrombocytopenia due to systemic lupus erythematosus

En algunos casos la trombocitopenia secundaria a lupus eritematoso sistémico (LES) no responde al tratamiento convencional. En los últimos años se ha reportado que el rituximab es una alternativa para estos pacientes. Objetivo Evaluar la respuesta de la trombocitopenia (T) secundaria a LES con el uso de rituximab y determinar el tiempo que se mantiene el efecto libre de recaída. Material y métodos Se revisaron los expedientes de los pacientes con diagnóstico de LES con T que recibieron tratamiento con rituximab (2g) para conocer la proporción de pacientes que lograron remisión completa (RC): definida como una cuenta plaquetaria >100.000/mm3; remisión parcial (RP): cuenta plaquetaria entre 50.000 y 100.000/mm3 y los no respondedores (NR); así como el tiempo que se mantiene el paciente sin recaída. Resultados Se aplicaron 16 tratamientos en 13 pacientes, en una paciente 3 y en otra 2 ciclos. Fueron 12 mujeres y 1 hombre con edad media de 28±9 años y tiempo medio de duración del LES de 68±44 meses, con una cuenta media plaquetaria de 38.000±29.000. En 14 tratamientos (87%) se logró RC después de 5±2 semanas y 2 pacientes (12.5%) fueron NR. Una de ellas murió por hemorragia masiva. El tiempo medio de respuesta sin recaída fue de 15,6±6 meses. Tres pacientes perdieron el seguimiento y 3 murieron de infecciones. Conclusiones El rituximab es una alternativa de tratamiento en pacientes con T secundaria a LES (AU)

Some patients with thrombocytopenia due SLE fail to respond to conventional therapies. Rituximab has been reported to be an alternative for patient treatment. Objective To evaluate the response of thrombocytopenia due to Systemic Lupus Erythematosus to the use of Rituximab and patient relapse time at our hospital. Patients and methods We analyzed patients with SLE than received a 2 gram rituximab treatment for thrombocytopenia. We analyzed the rate of patients that achieved complete remission (CR), defined as a platelet count over 100mil/mm3, partial remission (PR) described as platelets within 50–100mil/mm3 and no response (NR) if platelets remained unchanged and the time the remission was sustained.Results16 treatments were applied to 13 patients, aged 28±9 years of age and SLE mean duration time of 68±44 months with a mean platelet count of 38±29mil. In 14 treatments (87%) remission was achieved after 5±2 weeks where 2 patients (12.5%) were non respondent. One of them died due to a massive hemorrhage. The mean response time without relapse was 15.6±6 months. Follow up of three patients was not possible and 3 other died due to infections. Conclusions Rituximab is an alternative for treatment of thrombocytopenia due to Systemic Lupus Erythematosus (AU)

[Treatment with rituximab for thrombocytopenia due to systemic lupus erythematosus]. / Tratamiento con rituximab para la trombocitopenia secundaria a lupus eritematoso sistémico.

UNLABELLED: Some patients with thrombocytopenia due SLE fail to respond to conventional therapies. Rituximab has been reported to be an alternative for patient treatment. OBJECTIVE: To evaluate the response of thrombocytopenia due to Systemic Lupus Erythematosus to the use of Rituximab and patient relapse time at our hospital. PATIENTS AND METHODS: We analyzed patients with SLE than received a 2 gram rituximab treatment for thrombocytopenia. We analyzed the rate of patients that achieved complete remission (CR), defined as a platelet count over 100mil/mm(3), partial remission (PR) described as platelets within 50-100mil/mm(3) and no response (NR) if platelets remained unchanged and the time the remission was sustained. RESULTS: 16 treatments were applied to 13 patients, aged 28±9 years of age and SLE mean duration time of 68±44 months with a mean platelet count of 38±29mil. In 14 treatments (87%) remission was achieved after 5±2 weeks where 2 patients (12.5%) were non respondent. One of them died due to a massive hemorrhage. The mean response time without relapse was 15.6±6 months. Follow up of three patients was not possible and 3 other died due to infections. CONCLUSIONS: Rituximab is an alternative for treatment of thrombocytopenia due to Systemic Lupus Erythematosus.

Reemplazo total de rodilla. Experiencia de quince años en un servicio de reumatologia / Total knee replacement. Experience of 15 years in a rheumatology service

Se analizó la experiencia obtenida en 45 pacientes del Servicio de Reumatología a quienes se les colocaron 58 prótesis totales de rodilla durante el período 1980-1995. La enfermedad más frecuente fue la artritis reumatoide en el 73 por ciento de los casos con promedio de 5 años de permanencia de la prótesis. La frecuencia de complicaciones fue 11 por ciento, predominando las infecciones con 7 por ciento (IC 95 por ciento 0-44 13.56). Los resultados obtenidos corresponden a lo mencionado en la literatura; sin embargo, llamó la atención la frecuencia de las complicaciones infecciosas, por lo que se recomiendan algunas medidas encaminadas a disminuirlas