Medida por consenso del estado de la innovación en medicina física y rehabilitación / Consensus measurement of innovation in physical medicine and rehabilitation

Objetivo: Valorar el estado actual y el potencial de innovación del colectivo de profesionales de la especialidad médica de medicina física y rehabilitación (MFRHB) en España. Método: Se aplicaron 3técnicas consecutivas mediante herramientas digitales para el consenso entre profesionales: primero de forma síncrona a un colectivo de 17 profesionales, después se extendió a un colectivo de 169 que participaron de forma asíncrona y la tercera técnica se realizó de forma síncrona con 25 médicos especialistas en MFRHB. Resultados: Se dispuso del análisis consensuado por los propios profesionales sobre el potencial de innovación del colectivo realizado en octubre y noviembre del 2020: situación de partida, puntos fuertes y puntos débiles, así como sus prioridades en innovación. Conclusiones: Los médicos especialistas en MFRHB consideran que la innovación podría mejorar el coste efectividad de los servicios y podría aumentar su eficiencia clínica; también consideran que para innovar necesitan una relación estrecha con la industria.(AU)

Objective: To measure by consensus the level of innovation and its potential within the physical medicine and rehabilitation (PM&R) medical specialists. method: Three consecutive techniques are applied using digital tools for consensus among professionals, first synchronously to a group of 17 professionals; posteriorly extended to a group of 169 professionals who participate asynchronously and the third technique is done synchronously with 25 physiatrists. Results: The analysis of the consensus done by the PM&R physicians on the innovation potential of the group during October and November 2020 shows: starting situation, strengths and weaknesses, as well as their innovation priorities. Conclusions: PM&R physicians believe that innovation could improve the cost-effectiveness of their departments, and could increase their clinical efficiency, also that to innovate they need a close relationship with the industry.(AU)

[Consensus measurement of innovation in physical medicine and rehabilitation]. / Medida por consenso del estado de la innovación en medicina física y rehabilitación.

OBJECTIVE: To measure by consensus the level of innovation and its potential within the physical medicine and rehabilitation (PM&R) medical specialists. METHOD: Three consecutive techniques are applied using digital tools for consensus among professionals, first synchronously to a group of 17 professionals; posteriorly extended to a group of 169 professionals who participate asynchronously and the third technique is done synchronously with 25 physiatrists. RESULTS: The analysis of the consensus done by the PM&R physicians on the innovation potential of the group during October and November 2020 shows: starting situation, strengths and weaknesses, as well as their innovation priorities. CONCLUSIONS: PM&R physicians believe that innovation could improve the cost-effectiveness of their departments, and could increase their clinical efficiency, also that to innovate they need a close relationship with the industry.

La atención al paciente con patología linfática y lipedema en la pandemia COVID-19. Recomendaciones del Grupo Español de Linfología (GEL) / Management of patients with lymphatic diseases and lipoedema during the COVID-19 pandemic. Recommendations of the Spanish Group of Lymphology

La pandemia de COVID-19 es un desafío para el manejo de las patologías no COVID como la enfermedad linfática y el lipedema. La telemedicina puede evitar la propagación del coronavirus. Se necesita un sistema que nos ayude a determinar la prioridad clínica y la selección de la asistencia presencial o telemática para cada paciente y la forma de realizarlas durante la pandemia. El Grupo Español de Linfología ha realizado un documento de consenso con recomendaciones basadas en la bibliografía y experiencia clínica, como guía de práctica clínica en el manejo de anomalías linfáticas y lipedema durante la pandemia de COVID-19. Estas recomendaciones deben adaptarse a las características del paciente, las condiciones locales de los centros y las decisiones de los profesionales de la salud. Es un documento de criterios mínimos, sujeto a modificaciones según evolucione la pandemia, los conocimientos científicos y las instrucciones de las autoridades sanitarias

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities

[Management of patients with lymphatic diseases and lipoedema during the COVID-19 pandemic. Recommendations of the Spanish Group of Lymphology]. / La atención al paciente con patología linfática y lipedema en la pandemia COVID-19. Recomendaciones del Grupo Español de Linfología (GEL).

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.

Combination of fluorescence microscopy and nanomotion detection to characterize bacteria.

Antibiotic-resistant pathogens are a major health concern in everyday clinical practice. Because their detection by conventional microbial techniques requires minimally 24 h, some of us have recently introduced a nanomechanical sensor, which can reveal motion at the nanoscale. By monitoring the fluctuations of the sensor, this technique can evidence the presence of bacteria and their susceptibility to antibiotics in less than 1 h. Their amplitude correlates to the metabolism of the bacteria and is a powerful tool to characterize these microorganisms at low densities. This technique is new and calls for an effort to optimize its protocol and determine its limits. Indeed, many questions remain unanswered, such as the detection limits or the correlation between the bacterial distribution on the sensor and the detection's output. In this work, we couple fluorescence microscopy to the nanomotion investigation to determine the optimal experimental protocols and to highlight the effect of the different bacterial distributions on the sensor.

Aproximación al linfedema / Approach to lymphedema

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Linfedema primario / Primary lymphedema

El linfedema primario se origina por una alteración intrínseca del sistema linfático, que en función de la edad de aparición se clasifica en 3 grupos: congénito, precoz y tardío. El linfedema primario, sobre todo en las formas congénitas como la enfermedad de Milroy, se ha relacionado con alteraciones genéticas, encontrándose en muchos casos distintas mutaciones (VEGFR3, FOXC2, SOX 18 y HGF/MET). La valoración es fundamentalmente clínica, siendo necesaria la realización de pruebas complementarias que descarten otros procesos que cursen con edema. La linfogammagrafía es la prueba diagnóstica principal para su confirmación. Las formas hereditarias requieren una correcta historia familiar, debiendo ser valoradas en consultas específicas de consejo genético (AU)

Primary lymphedema is caused by an intrinsic abnormality of the lymphatic system. Based on the onset age, it is classified into three groups: congenital, precox and tarda. Primary lymphedema, especially in congenital forms as Milroy disease, has been linked to genetic alterations, different mutations being described in many cases: VEGFR3, FOXC2, SOX 18 and HGF/MET. Clinical assessment is the key stone in diagnosis, additional tests being necessary to rule out other kinds of edema. Lymphoscintigraphy is the gold standard confirmatory test. In hereditary forms, a careful family history is necessary, so specific genetic counseling must be provided (AU)

Vendaje en el linfedema / Multilayer lymphedema bandaging

El vendaje multicapa es un paso clave dentro de la terapia física compleja (TFC). Su objetivo es mantener el efecto descongestivo obtenido tras la realización del drenaje linfático manual. Utilizamos vendas de diferentes tipos con las que obtenemos bajas presiones de reposo y altas de trabajo. La correcta aplicación del vendaje multicapa es segura y eficaz, requiere un estricto adiestramiento y representa una parte indispensable de la terapia de contención junto con la prenda de compresión (AU)

Multilayer lymphoedema bandaging (MLLB) is a key element of decongestive lymphatic therapy. Its objective is to maintain the swelling reduction achieved through manual lymphatic drainage. MLLB uses inelastic bandages that have low extensibility and that produce high working pressures and lower resting pressures. The MLLB correct application is safe and efficient. It requires strict training and is an indispensable part of the compressive therapy together with compression garments (AU)

Tratamiento con prendas de presión / Treatment with compression garments

Las prendas de contención son el pilar del tratamiento del linfedema. Tienen su indicación tras la reducción del edema, como tratamiento de mantenimiento. También se pueden utilizar tanto como prevención de la aparición del linfedema como de sus complicaciones. La prenda ejerce una compresión directamente proporcional a la tensión del tejido e inversamente proporcional al tamaño del miembro. Depende del material y de la técnica de tricotado empleada, siendo mayor la presión a nivel distal que a nivel proximal. El tejido puede ser circular o plano, y la prenda será estándar o hecha a medida. El tiempo de uso diario no está claro. Es importante la educación del paciente para el uso constante y mantenido de la prenda de contención. Varios ensayos clínicos randomizados sugieren que la terapia compresiva es efectiva, y se alcanzan mejores resultados en fases iniciales con el vendaje multicapa, seguido de la prenda. No existen evidencias de diferencias en cuanto a la eficacia obtenida con la terapia combinada frente a la prenda de presión sola. Estrategia de búsqueda: Revisión bibliográfica en PubMed, Tripdatabase y Cochrane Library (AU)

Compression garments are the basis of lymphoedema treatment. They are indicated after reduction of the edema as maintenance therapy. They can also be used to prevent the appearance of lymphoedema and its complications. The garment exerts compression directly proportional to the tissue tension and inversely proportional to the limb size. It depends on the material and knitting technique used, with greater pressure on the distal level than on the proximal one. The tissue may be circular or flat and the garment standard or custom made. The time of daily use is unclear. The education of the patient is important regarding the continued and constant use of the garment. Several randomized clinical trials have suggested that compression therapy is effective, and that the best results are achieved in the initial stages with multilayer bandaging followed by the garment. No evidence exists regarding differences between combination therapy and compression alone. Search strategy: PubMed, Tripdatabase and Cochrane Library were searched (AU)

Toxoplasma gondii: comparison of human CD34+ and monocyte-derived dendritic cells after parasite infection.

Human dendritic cells (DC) obtained in vitro from CD34(+) progenitors (CD34-DC) or blood monocytes (mo-DC) are different DC which may be used in a model of T. gondii infection. We compared the survival, infection rate and cell surface receptor expression of both DC types after living T. gondii tachyzoite infection. CD34-DC appeared less resistant to the parasite than mo-DC. At 48h post-infection, chemokine receptors responsible for DC homing and migration were absent in mo-DC, while down regulation of CCR6 and up regulation of CCR7 was observed in CD34-DC. This result, suggesting migration ability of CD34-DC, was confirmed by in vitro migration experiments against different chemokines. Tachyzoite supernatant, used as chemokine, attracted immature CD34-DC as observed by MIP3alpha, while MIP3beta, as expected, attracted mature CD34-DC. Under similar conditions, no significant difference was noticed between mature or immature mo-DC. These data indicated that CD34-DC represent an alternative model that allows migration assay of infected DC by T. gondii.

A deficiency in RFX3 causes hydrocephalus associated with abnormal differentiation of ependymal cells.

Ciliated ependymal cells play central functions in the control of cerebrospinal fluid homeostasis in the mammalian brain, and defects in their differentiation or ciliated properties can lead to hydrocephalus. Regulatory factor X (RFX) transcription factors regulate genes required for ciliogenesis in the nematode, drosophila and mammals. We show here that Rfx3-deficient mice suffer from hydrocephalus without stenosis of the aqueduct of Sylvius. RFX3 is expressed strongly in the ciliated ependymal cells of the subcommissural organ (SCO), choroid plexuses (CP) and ventricular walls during embryonic and postnatal development. Ultrastructural analysis revealed that the hydrocephalus is associated with a general defect in CP differentiation and with severe agenesis of the SCO. The specialized ependymal cells of the CP show an altered epithelial organization, and the SCO cells lose their characteristic ultrastructural features and adopt aspects more typical of classical ependymal cells. These differentiation defects are associated with changes in the number of cilia, although no obvious ultrastructural defects of these cilia can be observed in adult mice. Moreover, agenesis of the SCO is associated with downregulation of SCO-spondin expression as early as E14.5 of embryonic development. These results demonstrate that RFX3 is necessary for ciliated ependymal cell differentiation in the mouse.