Therapy free of cells vs human mesenchymal stem cells from umbilical cord stroma to treat the inflammation in OA.

Osteoarthritis (OA) is closely linked to the increase in the number of senescent cells in joint tissues, and the senescence-associated secretory phenotype (SASP) is implicated in cartilage degradation. In the last decade, extracellular vesicles (EV) in combination with the use of miRNAs to modify post-transcriptional expressions of multiple genes have shown their utility in new therapies to treat inflammatory diseases. This work delves into the anti-inflammatory effect of extracellular vesicles derived from mesenchymal stem cells (MSC) previously modified to inhibit the expression of miR-21. We compare the efficacy of two treatments, MSC with their miR-21 inhibited through lentiviral transfection and their EV, against inflammation in a new OA animal model. The modified MSC and their EV were intraperitoneally injected in an OA animal model twice. One month after treatment, we checked which therapy was the most effective to reduce inflammation compared with animals untreated. Treated OA model sera were analyzed for cytokines and chemokines. Subsequently, different organs were analyzed to validate the results obtained. EV were the most effective treatment to reduce chemokines and cytokines in serum of OA animals as well as SASP, in their organs checked by proteomic and genomic techniques, compared with MSC alone in a statistically significant way. In conclusion, MSC-miR-21--derived EV showed a higher therapeutic potential in comparison with MSCs-miR-21-. They ameliorate the systemic inflammation through inactivation of ERK1/2 pathway in OA in vivo model. Workflow of the realization of the animal model of OA by injecting cells into the joint cavity of the left knee of the animals, which produces an increase in serum cytokines and chemokines in the animals in addition to the increase in SASP and markers of inflammation. Inhibition of miR-21 in MSCs, from the stroma of the human umbilical cord, by lentivirus and extraction of their EVs by ultracentrifugation. Finally, application of MSC therapy with its miR-21 inhibited or its EVs produces a decrease in serum cytokines and chemokines in the treated animals, in addition to an increase in SASP and markers of inflammation. The cell-free therapy being the one that produces a greater decrease in the parameters studied.

Action Mechanisms of Small Extracellular Vesicles in Inflammaging.

The accumulation process of proinflammatory components in the body due to aging influences intercellular communication and is known as inflammaging. This biological mechanism relates the development of inflammation to the aging process. Recently, it has been reported that small extracellular vesicles (sEVs) are mediators in the transmission of paracrine senescence involved in inflammatory aging. For this reason, their components, as well as mechanisms of action of sEVs, are relevant to develop a new therapy called senodrugs (senolytics and senomorphic) that regulates the intercellular communication of inflammaging. In this review, we include the most recent and relevant studies on the role of sEVs in the inflammatory aging process and in age-related diseases such as cancer and type 2 diabetes.

Acellular nerve graft enriched with mesenchymal stem cells in the transfer of the phrenic nerve to the musculocutaneous nerve in a C5-C6 brachial plexus avulsion in a rat model.

INTRODUCTION: Phrenic nerve transfer has been shown to achieve good nerve regeneration in brachial plexus avulsion. Acellular nerve allografts (ANAs) showed inferior results to autografts, which is why its use with mesenchymal stem cells (MSCs) is currently being studied. The aim is to study the effect of BM-MSCs associated with ANAs in a rat model of phrenic nerve transfer to the musculocutaneous nerve in a C5-C6 avulsion. MATERIAL AND METHODS: 42 Wistar-Lewis rats underwent a C5-C6 lesion in the right forelimb by excising a 3 mm segment from both roots, followed by a phrenic nerve transfer to the musculocutaneous nerve associated with the interposition of a three types of nerve graft (randomly distributed): control (autograft) group (n = 12), ANAs group (n = 12), and ANAs + BM-MSCs group (n = 18) After 12 weeks, amplitude and latency of the NAP and the compound motor action potential (CMAP) were measured. Biceps muscles were studied by histological analysis and nerve grafts by electron microscopy and fluorescence analysis. RESULTS: Statistically significant reductions were found in latency of the CMAP between groups control (2.48 ± 0.47 ms) and experimental (ANAs: 4.38 ± 0.78 ms, ANAs + BM-MSCs: 4.08 ± 0.85 ms) and increases in the amplitude of the CMAP between groups control (0.04388 ± 0.02 V) and ANAs + BM-MSCs (0.02275 ± 0.02 V), as well as in the thickness of the myelin sheath between groups control (0.81 ± 0.07 µm) and experimental (ANAs: 0.72 ± 0.08 µm, ANAs + BM-MSCs: 0.72 ± 0.07 µm) and in the area of the myelin sheath between groups control (13.09 ± 2.67 µm2 ) and ANAs (10.01 ± 2.97 µm2 ) (p < .05). No statistically significant differences have been found between groups ANAs and ANAs + BM-MSCs. CONCLUSIONS: This study presents a model for the study of lesions of the upper trunk and validates the autologous graft as the gold standard.

Factores relacionados con el riesgo de reintervención en pacientes operados de reducción cerrada de fractura de huesos propios / Factors related to the risk of reoperation in patients operated on for closed reduction of nasal bone fractures

INTRODUCCIÓN Y OBJETIVO: La fractura de huesos nasales es la fractura facial más frecuente. En relación a la cirugía, la técnica habitualmente empleada ante ella es la reducción cerrada bajo anestesia local o general. Presentamos nuestra experiencia en pacientes intervenidos de fractura de huesos nasales y valoramos el riesgo de reintervención en relación al tipo de técnica anestésica empleada. MATERIAL Y MÉTODO: Recopilamos datos de manera retrospectiva de pacientes intervenidos de reducción cerrada de fractura nasal en nuestro centro entre diciembre de 2014 y junio de 2019. Estudiamos la variable cualitativa analizada (la reintervención) con el test exacto de Fisher y las variables cuantitativas analizadas (días desde el traumatismo hasta cirugía y grados de desviación nasal) con el test U de Mann-Whitney. RESULTADOS: Incluimos 128 pacientes (91 hombres y 37 mujeres). La causa de fractura más frecuente fue la agresión, seguida por el traumatismo por caída y los deportes. Las fracturas por agresión se produjeron con mayor frecuencia los sábados y domingos entre las 3 y las 5 horas de la madrugada. Las fracturas por caída los lunes y martes a la 1 del mediodía. En 99 casos la cirugía se llevó a cabo en las primeras 24 horas, y en 29 pasado ese tiempo. Con respecto a la técnica anestésica, 9 pacientes fueron intervenidos bajo anestesia local, 24 bajo sedación y 95 bajo anestesia general. Tres de los intervenidos con anestesia local y 4 con anestesia general precisaron reintervención por mal resultado tras la primera cirugía. Ninguno de los pacientes intervenidos con sedación fue reintervenido. CONCLUSIONES: En nuestra experiencia, la reducción de la fractura nasal bajo sedación tiene buenos resultados, por lo que consideramos que es una buena alternativa en los casos de fractura nasal quirúrgica para reducir los efectos adversos de la anestesia general

BACKGROUND AND OBJECTIVE: Nasal bone fracture is the most frequent facial fracture. In relation to surgery, the most frequently employed technique is closed reduction under local or under general anesthesia. We present our experience with patients who underwent nasal bone fracture surgery and the risk of reintervention in relation to the type of anesthetic technique used. METHODS: Data were collected retrospectively of patients who underwent closed reduction of nasal fracture in our center between December 2014 and June 2019. Qualitative variable analyzed (reintervention) were studied with Fisher's exact test and the quantitative variables analyzed (days from trauma to surgery and degrees of nasal deviation) with the Mann-Whitney U test. RESULTS: One hundred and twenty-eight patients (91 men and 37 women) were included in the study. The most frequent cause of fracture was aggression, followed by falls and sports. Aggression fractures occurred most frequently on Saturdays and Sundays between 3 and 5 a.m. Fall fractures occurred most frequently on Mondays and Tuesdays at 1 p.m. In 99 cases the surgery was performed in the first 24 hours, while in 29 cases it was performed after that time. Regarding the anesthetic technique, 9 patients were operated under local anesthesia, 24 under sedation and 95 under general anesthesia. Three of the patients operated with local anesthesia and 4 with general anesthesia required reoperation because of poor results after the first surgery. None of the patients operated with sedation were reoperated. CONCLUSIONS: In our experience, nasal fracture reduction under sedation has good results making it a good alternative in cases of surgical nasal fracture reducing the deleterious effects of general anesthesia

Respuesta: Respuesta a: Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes / Reply: Response to: A Comparative study of doppler ultrasound against temporal artery biopsy in the diagnosis of giant cell arteritis

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Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes / A comparative study of doppler ultrasound against temporal artery biopsy in the diagnosis of giant cell arteritis

INTRODUCCIÓN: La arteritis de células gigantes (ACG) es una vasculitis que afecta a arterias de mediano y gran calibre. La biopsia de la arteria temporal es la técnica diagnóstica de elección. Atendiendo a la demanda asistencial que supone, pretendemos evaluar la utilidad de la ecografía Doppler en los pacientes con sospecha de ACG, su sensibilidad y especificidad como prueba diagnóstica y si puede suplir a la biopsia. MATERIALES Y MÉTODOS: Se ha realizado un estudio prospectivo de 57 pacientes entre febrero de 2015 y julio de 2016, que han sido diagnosticados con exploración mediante ecografía Doppler y biopsia de arteria temporal. RESULTADOS: Fueron incluidos 57 pacientes, de los cuales 3 fallecieron durante el seguimiento y una paciente fue excluida del estudio al negarse a la biopsia. Otros 21 pacientes fueron diagnosticados de ACG por un especialista reumatólogo tras un mínimo de 6 meses de seguimiento. Presentaron ecografía positiva 22 pacientes, de los cuales 8 fueron diagnosticados de ACG y 4 de polimialgia reumática. En nuestro estudio, la sensibilidad de la ecografía es del 42,6% y la especificidad es del 65,7%. Otros 19 pacientes presentaron biopsia positiva: todos ellos fueron diagnosticados de ACG. La biopsia presentó una sensibilidad de un 73,7% y una especificidad de un 100%. CONCLUSIONES: Según nuestro estudio, la utilidad de la ecografía es limitada y son necesarias nuevas investigaciones para determinar su papel en esta entidad

BACKGROUND: Giant cell arteritis (GCA) is a vasculitis that affects medium- and large-sized arteries. Temporal artery biopsy is the gold standard for diagnosis. In view of the high demand for temporal biopsies, the purpose of this study is to evaluate the usefulness of Doppler ultrasonography in patients with suspected giant cell arteritis, to determine its sensitivity and specificity as a diagnostic test and to determine whether it would be possible to substitute biopsy for ultrasonography. MATERIALS AND METHODS: A prospective study was undertaken including 57 patients from February 2015 to July 2016, who have undergone both ultrasonography and temporal biopsy. RESULTS: A total of 57 patients were included, 3of whom died during the follow-up, and a patient was excluded from the study when she refused to have the biopsy. Another 21 patients were diagnosed with GCA by a rheumatologist after a minimum of 6 months of follow-up and 22 patients had positive ultrasonography, 8 of whom were diagnosed with GCA and 4 with polymyalgia rheumatica. In our study, the sensitivity of ultrasonography was 42.6%, and the specificity was 65.7%. A total of 19 patients had a positive biopsy, all of them were diagnosed with GCA. In our study, the sensitivity of the biopsy was 73.7% and the specificity was 100%. CONCLUSIONS: In view of the data from our study, the usefulness of ultrasonography is questionable, and research about the role of ultrasonography in this disease should be further studied

A Comparative Study of Doppler Ultrasound against Temporal Artery Biopsy in the Diagnosis of Giant Cell Arteritis. / Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes.

BACKGROUND: Giant cell arteritis (GCA) is a vasculitis that affects medium- and large-sized arteries. Temporal artery biopsy is the gold standard for diagnosis. In view of the high demand for temporal biopsies, the purpose of this study is to evaluate the usefulness of Doppler ultrasonography in patients with suspected giant cell arteritis, to determine its sensitivity and specificity as a diagnostic test and to determine whether it would be possible to substitute biopsy for ultrasonography. MATERIALS AND METHODS: A prospective study was undertaken including 57 patients from February 2015 to July 2016, who have undergone both ultrasonography and temporal biopsy. RESULTS: A total of 57 patients were included, 3of whom died during the follow-up, and a patient was excluded from the study when she refused to have the biopsy. Another 21 patients were diagnosed with GCA by a rheumatologist after a minimum of 6 months of follow-up and 22 patients had positive ultrasonography, 8 of whom were diagnosed with GCA and 4 with polymyalgia rheumatica. In our study, the sensitivity of ultrasonography was 42.6%, and the specificity was 65.7%. A total of 19 patients had a positive biopsy, all of them were diagnosed with GCA. In our study, the sensitivity of the biopsy was 73.7% and the specificity was 100%. CONCLUSIONS: In view of the data from our study, the usefulness of ultrasonography is questionable, and research about the role of ultrasonography in this disease should be further studied.

Seguridad oncológica del lipofilling como técnica de reconstrucción mamaria secundaria / Oncologic safety of autologous fat grafting as a secondary breast reconstructive technique

Objetivos: El objetivo de este estudio es comparar de manera retrospectiva aquellas pacientes en las se emplearon lipoinjertos para su reconstrucción mamaria con aquellas en las que no. Materiales y métodos: Fueron incluidas 104 pacientes sometidas a cirugía oncológica y reconstructiva tras cáncer de mama entre enero de 2012 y diciembre de 2016. El estudio se centra en las complicaciones y recurrencias de la enfermedad. Resultados: En 25 de estas 104 pacientes se emplearon lipoinjertos para su reconstrucción, mientras que en las restantes 79 no se empleó esta técnica. Tras la cirugía de lipofilling, 3 pacientes presentaron complicaciones; en un caso consistió en un hematoma posquirúrgico y en los otros dos casos en la aparición de un nódulo, evidenciando la presencia de necrosis grasa en uno y recidiva tumoral en el otro. Hubo un caso de recidiva locorregional en cada uno de los grupos. En cuanto a las metástasis a distancia, no hubo ningún caso en el grupo de lipofilling, mientras que hubo 6 casos en el grupo control. Conclusiones: El lipofilling como opción reconstructiva tras cáncer de mama parece una técnica con una baja tasa de complicaciones. Sin embargo, es necesario realizar otros estudios que confirmen su seguridad oncológica

Objectives: The objective of this study was to retrospectively compare patients whose breast reconstruction surgery included fat grafts with those whose reconstruction did not. Material and methods: A total of 104 patients undergoing oncological and reconstructive surgery after breast cancer between January 2012 and December 2016 were included. The study focused on the complications and recurrences of the disease. Results: Fat grafts were used in the reconstructive surgery of 25 of the 104 patients, and not in the remaining 79 patients. After lipofilling surgery, 3 patients developed complications, consisting of a post-surgical hematoma in 1 patient and the appearance of a nodule in 2, showing the presence of fat necrosis in one and tumour relapse in the other. There was one case of locoregional recurrence in each of the groups. There were no cases of distant metastases in the lipofilling group, while there were 6 cases in the control group. Conclusions: Lipofilling as a reconstructive option after breast cancer seems to have a low complication rate. However, more studies are needed to confirm its oncological safety

The addition of albumin improves Schwann cells viability in nerve cryopreservation.

The purpose of the current study was to establish a valid protocol for nerve cryopreservation, and to evaluate if the addition of albumin supposed any advantage in the procedure. We compared a traditional cryopreservation method that uses dimethyl sulfoxide (DMSO) as cryoprotectant, to an alternative method that uses DMSO and albumin. Six Wistar Lewis rats were used to obtain twelve 20 mm fragments of sciatic nerve. In the first group, six fragments were cryopreserved in 199 media with 10% DMSO, with a temperature decreasing rate of 1 °C per minute. In the second group, six fragments were cryopreserved adding 4% human albumin. The unfreezing process consisted of sequential washings with saline in the first group, and saline and 20% albumin in the second group at 37 °C until the crioprotectant was removed. Structural evaluation was performed through histological analysis and electronic microscopy. The viability was assessed with the calcein-AM (CAM) and 4',6-diamino-2-fenilindol (DAPI) staining. Histological results showed a correct preservation of peripheral nerve architecture and no significant differences were found between the two groups. However, Schwann cells viability showed in the CAM-DAPI staining was significantly superior in the albumin group. The viability of Schwann cells was significantly increased when albumin was added to the nerve cryopreservation protocol. However, no significant structural differences were found between groups. Further studies need to be performed to assess the cryopreserved nerve functionality using this new method.

Experiencia en el desbridamiento con Nexobrid(R) y cura húmeda con Prontosan(R) wound gel en el paciente quemado / Experience with Nexobrid(R) debridement and Prontosan(R) wound healling gel moist in the treatment of burn patients

Introducción y Objetivo. El desbridamiento tangencial y autoinjerto ha sido el tratamiento de elección de las quemaduras profundas. Actualmente, la disponibilidad de técnicas no quirúrgicas, como el desbridamiento enzimático con Nexobrid(R), introduce un cambio de concepto permitiendo mayor selectividad en la eliminación de la escara y optimizar la preservación de la dermis sana, menor cicatrización patológica, mejor resultado estético, y sobre todo menor agresión al paciente. Prontosan(R)Wound Gel es un hidrogel con propiedades antibacterianas para mantener cura húmeda, y no interfiere en la epitelización. Presentamos nuestra experiencia en desbridamiento enzimático y aplicación de cura húmeda con estos productos en quemaduras de segundo grado profundo y/o tercer grado faciales, en manos, extremidades inferiores y tronco. Material y Método. Incluimos todos los pacientes quemados de segundo grado profundo y/o tercer grado de cualquier extensión tratados con Nexobrid(R) para Unidad de Quemados entre diciembre de 2015 y febrero de 2017. Realizamos desbridamiento enzimático en las primeras 24 horas aplicándolo en un máximo del 15% de superficie corporal, seguido de cura con Prontosán(R) y oclusión con apósito hidrocoloide. Cobertura de quemaduras profundas que no curaron espontáneamente en quirófano, con injertos laminares. Las variables recogidas fueron: edad, sexo, agente causal, extensión, localización y profundidad, tiempo de hospitalización, localización, superficie corporal y profundidad de la quemadura en la zona en la que se aplicó Nexobrid®, eficacia del desbridamiento enzimático, necesidad de desbridamiento quirúrgico, necesidad de injerto, tiempo hasta epitelización y complicaciones. Resultados.Analizamos 17 pacientes con SCQ del 3 al 55%. Valoramos visualmente el desbridamiento enzimático inicial como completo en todos ellos. Solo 5 pacientes precisaron injertos laminares. En los que no precisaron desbridamiento quirúrgico, la epitelización se produjo a los 15 días como promedio. Estudio histopatológico en 3 pacientes: desbridamiento completo de la quemadura en 1 y parcial en 2, con abundante infiltrado inflamatorio linfocítico perivascular postratamiento. Los hallazgos histopatológicos se correlacionaron con la eficacia del desbridamiento valorado clínicamente en 1 de los 3 casos, y con el diagnóstico clínico de la quemadura en los 3 casos. Ningún caso precisó cirugía de secuelas tras un seguimiento medio de 7 meses. Conclusiones. Nexobrid(R) en combinación con Prontosan(R) Wound Gel en nuestra experiencia preliminar parece una alternativa viable en el tratamiento de quemaduras en cara, extremidad superior, extremidad inferior y tronco

Background and Objective. Tangential debridement and autograft have been the gold standard surgical treatment of deep burns. Nowadays, the availability of non surgical enzymatic debridement techniques, such as Nexobrid(R) has introduced a new concept in the treatment of burn patients, allowing an increase in the selectivity for the scar removal leading to the preservation of healthy dermis, reducing scarring, improving cosmetic outcome, and even more, minimizing aggression to the patient. Prontosan(R) Wound Gel is a hydrogel with antibacterial properties that can be used to keep wound bed moist, without interfering epithelialization. We present our experience with these combined products in deep dermal and/or subdermal burns affecting face, upper and lower extremities, perineal and trunk. Methods. All patients with deep dermal and/or subdermal burns treated with Nexobrid(R) in our Burn Unit between December 2015 and February 2017 were included. Enzymatic debridement was performed within the first 24 hours, applied up to 15% of body surface. After that, Prontosan(R) was applied and Varihesive(R) was used as a sealed dressing. Whenever grafting was necessary, it was performed in operating room adding split thickness grafts. Variables collected were: age, sex, agent, extension, location and depth of the burn, period of hospitalization, location, extension and depth of the burn in the area where Nexobrid ® was applied, efficacy of enzymatic debridement, needing for surgical debridement, needing of grafting, time to epithelialization and complications. Results. Seventeen patients with 3 to 55% burn body surface were included. Initial enzymatic debridement was complete in all patients. Only 5 patients needed split thickness grafting. Complete epithelialization was achieved on an average of 15 days. Histopathology studies were performed on 3 patients. Histopathology findings correlated to the clinical efficacy of the debridement in 1 out of the 3 cases, and to the clinical diagnosis of the burn in the 3 cases. After 7 months follow up, no patients required surgery for correction of sequelae. Conclusions. In our preliminary experience, combines use of Nexobrid(R) and Prontosan (R)Wound Gel seems a feasible alternative in the treatment of facial, upper and lower extremities and trunk burns

Láser de dióxido de carbono fraccionado asociado a corticoide tópico para el tratamiento del prurito en las secuelas cicatriciales del paciente quemado / Fractional carbon dioxide laser associated with topic corticosteroid for the treatment of scar pruritus in burn patients

El prurito en los pacientes quemados supone una secuela frecuente que puede ser incapacitante y difícilmente controlable mediante tratamiento médico. Presentamos el caso de un paciente con prurito grave resistente a tratamiento médico y los resultados tras el tratamiento con láser ablativo y liberación de corticoide local asistida por láser. Se trata de un paciente con quemaduras graves en el 70% de superficie corporal, con prurito refractario a tratamiento médico y lesiones por rascado que precisaron de sedorrelajacion e intubación orotraqueal, y en el que realizamos una sola sesión de tratamiento con láser CO2 fraccionado tras la que se aplicó cura oclusiva con triamcinolona acetonido disuelta en suero (20 mg/ml). La evaluación del resultado se realizó mediante valoración del prurito (escala Burn Itch Questionnaire) y del resultado clínico y estético de la cicatriz (escalas Vancouver Scar Scale y Patient and Observer Scar Assessment Scale). Logramos un buen control del prurito y de las lesiones por rascado sin complicaciones asociadas. La liberación de fármacos asistida por láser fue la base del nuestro tratamiento, en el que el láser ablativo crea canales de comunicación transepidermicos que favorecen la entrada del corticoide a la dermis y el efecto inmediato del mismo. Esta modalidad de tratamiento y este nuevo concepto clínico se presentan como una alternativa terapéutica importante en el tratamiento del prurito refractario en el paciente quemado (AU)

Itch is a frequent sequelae in burns that might be disabling and hardly managed with medical treatment. We present a case of a burn patient with medical refractory pruritus and the result after treatment, consisting of laser assisted corticosteroid delivery. He was a severe burn patient with 70% total body surface area burned, with medical refractory pruritus and secondary skin lesions resulting from scratching, needing of sedation and intubation to control. One session of fractional carbon dioxide laser was performed, covering the treated area with an occlusive dressing soaked in triamcinolone acetonide dissolved with saline (20 mg/ml). Results were evaluated by using Burn Itch Questionnaire to assess the pruritus, and both Vancouver Scar Scale and Patient and Observer Scar Assessment Scale to assess the scar aesthetic result. We were able to control itch and stop scratching skin lesions, without any complication associated to the procedure. Laser assisted drug delivery was the mainstay concept of our patient treatment, where the ablative laser creates transepidermal channels that allow the corticosteroid to reach the dermis, and therefore the immediate effect of the drug. Both, this modality of treatment and new clinical concept are becoming an increasingly important tool for refractory pruritus management in burns (AU)

EHTIC study: Evaluation of a new hemostatic agent based on tissue factor in skin grafting procedures.

BACKGROUND: Excessive bleeding is a major concern in scar debridement and grafting procedures. TT-173 is a new topical hemostatic agent based on recombinant human tissue factor that has shown promising results in patients who underwent tooth extraction. EHTIC study sought to evaluate the efficacy and safety of TT-173 to reduce the bleeding in donor sites of skin grafting procedures. METHODS: EHTIC study was a phase II, randomized, parallel, double blind, placebo controlled trial. Patients received TT-173 (n=38) or placebo (n=33) sprayed over donor site after graft harvest. Time to hemostasis and incidence of adverse events were recorded. Systemic absorption of the product and its immunogenicity were also measured during the follow up of the subjects. RESULTS: Treatment with TT-173 significantly reduced the bleeding time from 7 to 3min (Log-Rank p<0.0001). Moreover, bleeding stopped within the 10min of evaluation period in all the patients that received TT-173. In contrast, 24.24% of patients from placebo group required additional measures to arrest hemorrhage (Fisher p=0.0013). Product related adverse events, systemic absorption into blood stream, interferences with the healing of the donor site or immunogenic reaction against TT-173 were not observed. CONCLUSION: The new hemostatic agent TT-173 has proven efficacious and safe to reduce the bleeding from donor site. This study paves the way for further investigation of the product as topical hemostatic treatment in plastic surgery and other surgical indications.

Intraneural Venous Malformations of the Median Nerve.

Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.

Burn patients during the Summer Solstice festivities: A retrospective analysis in a hospital burn unit from 2005 to 2015.

AIM: San Juan (Summer Solstice) is an annual festival celebrated in many parts of Spain on June 24 by lighting bonfires on beaches and in open air. The aim of this study is to analyse the patient profile of those sustaining burns the night before San Juan. MATERIAL AND METHODS: The data of 179 patients who sustained burns on June 23 and 24 between 2005 and 2015 were collected retrospectively. RESULTS: The average age of the patients involved in this study was 27.33 years, with males constituting a higher proportion. Hands were the most affected area of the body, and the average burn area was 3.39%. No statistically significant relationship was found between the tidal times and the number of patients with burns, although the latter increased at low tide (p=0.177). CONCLUSIONS: The results of this study can guide prevention campaigns during these festivities in the future.