Ecografía de los troncos supraaórticos / Ultrasonography of supra-aortic trunks

La ecografía es un recurso del que disponemos de primera mano los médicos de familia y al que cada vez más frecuentemente recurrimos, hasta el punto de formar ya parte de nuestra exploración física. Es una técnica diagnóstica de fácil acceso, asequible, versátil y no invasiva que emplea los ultrasonidos para definir las estructuras anatómicas de nuestro cuerpo sin necesidad de radiación y que se realiza en tiempo real, pudiendo permitir una exploración dinámica. Pese a todo lo mencionado, la ecografía vascular y, en concreto, la de los troncos supraaórticos no está tan extendida en nuestro ámbito, pese a su importante papel en el ámbito de la prevención cardiovascular, fundamental en la atención primaria. Por este motivo en este artículo se pretende llevar a cabo una breve y clara descripción de la técnica con el objetivo de extender su uso en la práctica cotidiana (AU)

Ultrasound is a resource that family doctors have first-hand and that we use more and more frequently, to the point of becoming part of our physical examination. It is an easily accessible, affordable, versatile and non-invasive diagnostic technique that uses ultrasound to define the anatomical structures of our body without radiation and is performed in real time, allowing a dynamic exploration. Despite all the above, vascular ultrasound and, specifically, the supra-aortic trunks ultrasound is not as widespread in our setting, despite its important role in the field of cardiovascular prevention, which is essential in primary care. For this reason, this article aims to carry out a brief-and-clear description of the technique with the aim of extending its use in daily practice (AU)

[Ultrasonography of supra-aortic trunks]. / Ecografía de los troncos supraaórticos.

Ultrasound is a resource that family doctors have first-hand and that we use more and more frequently, to the point of becoming part of our physical examination. It is an easily accessible, affordable, versatile and non-invasive diagnostic technique that uses ultrasound to define the anatomical structures of our body without radiation and is performed in real time, allowing a dynamic exploration. Despite all the above, vascular ultrasound and, specifically, the supra-aortic trunks ultrasound is not as widespread in our setting, despite its important role in the field of cardiovascular prevention, which is essential in primary care. For this reason, this article aims to carry out a brief-and-clear description of the technique with the aim of extending its use in daily practice.

Selective estrogen receptor modulators (SERMs): new alternatives for osteoarthritis?

The dramatic rise in the prevalence rate of osteoarthritis (OA) after the menopause and the presence of estrogen receptors in joint tissues suggest that estrogen may help protect against the development of OA. Trials of estrogen therapy have produced inconclusive results, however, partly because of flaws in study design and partly because of the complexity of the mechanisms underlying estrogen's effects on joint tissues. Initial studies of the use of selective estrogen receptor modulators (SERMs) have reported beneficial effects in OA. These agents may exert both a direct effect upon joint cartilage and indirect effects on subchondral bone, synovium, muscle, tendons and ligaments. SERMs may be particularly beneficial for postmenopausal patients with osteoporotic OA, a phenotype defined by decreased bone density, associated with high remodeling in subchondral bone. More research is needed, though, before SERMs can become a therapeutic option for OA.

Effects of PTH [1-34] on synoviopathy in an experimental model of osteoarthritis preceded by osteoporosis.

PURPOSE: Synoviopathy contributes to cartilage degradation in osteoarthritis (OA). Intermittent parathyroid hormone (PTH) [1-34] administration inhibits terminal differentiation of human chondrocytes and prevents cartilage damage. We aimed to determine whether PTH [1-34] could modify synovial changes in experimental OA preceded by osteoporosis (OP). METHODS: Twenty osteoporosis (OP) rabbits underwent knee surgery to induce OA. They were administered either saline vehicle or PTH for 10 weeks. Ten healthy rabbits were used as controls. Following sacrifice, synovial changes were assessed by Krenn synovitis score, immunohistochemistry for macrophages (RAM-11), B and T lymphocytes, type I collagen, parathyroid hormone 1 receptor (PTH1R), and anti-proliferating cell nuclear antigen (PCNA). Synovial mRNA levels of Col1A1, IL-1ß, cyclooxygenase 2 (COX-2), matrix-degrading metalloproteinases (MMP-9, MMP-13), and monocyte chemotactic protein-1 (MCP-1), as well as protein expression of PTH1R were also determined. Cartilage damage was analyzed by Mankin score. RESULTS: OPOA + vehicle rabbits showed an increase in synovitis score vs controls (P = 0.003), mainly due to synovial hyperplasia and fibrosis, while PTH reduced these changes (P = 0.017). Mankin and Krenn scores were well correlated in all groups (r = 0.629, P = 0.012). Immunostaining for RAM-11 and B lymphocytes was increased (P ≤ 0.05), whereas PTH1R protein levels tended to be higher in OPOA + vehicle animals vs controls. PTH did not modify RAM-11 staining or PTH1R levels; however, it restored PTH1R localization to the vicinity of synovial vessels. PTH also decreased type I collagen, MCP-1, and MMP-13 expression (P < 0.05), as well as PCNA staining compared to vehicle-treated OPOA rabbits. CONCLUSIONS: In our model of OA aggravated by previous OP, synoviopathy correlated well with cartilage damage. Intermittent PTH [1-34] administration ameliorated both hyperplasia and fibrosis.

Células progenitoras del endotelio: su posible potencial en la terapia celular de la retina isquémica / Endothelial progenitor cells: their possible potential in cell therapy for ischemic retina

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