Eficacia y seguridad a largo plazo del polimetilmetacrilato (PMMA) en pacientes osteoporóticos tratados mediante vertebroplastia percutánea / Long-term efficacy and safety of polymethylmethacrylate (PMMA) in osteoporotic patients treated by percutaneous vertebroplasty

OBJETIVO: Actualmente, existen pocos datos sobre la influencia a largo plazo del polimetilmetacrilato (PMMA) en la integridad de los cuerpos vertebrales tras la vertebroplastia percutánea (VP). Resulta de interés investigar la posible relación entre esta técnica y la aparición con el tiempo de fenómenos de osteólisis o la fragmentación del cemento en las vértebras intervenidas. El objetivo de este trabajo fue investigar si, a largo plazo, existe una pérdida de efectividad y/o seguridad de la VP con PMMA. MATERIAL Y MÉTODOS: Se analizaron radiografías de pacientes intervenidos correspondientes al post-operatorio inmediato y al estudio radiológico más reciente (VP hace más de 15 años). Con ambos estudios radiológicos, describimos: la altura del cuerpo vertebral, la angulación de platillos y la presencia de osteólisis alrededor del cemento en el tiempo. RESULTADOS: Un total de 7 pacientes intervenidos mediante VP con PMMA hace 15 o más años accedieron a realizarse una nueva radiografía en nuestro Centro. Tras el análisis de sus imágenes post-operatorias (inmediatas y a 15 ó más años de la cirugía), no se observó en ninguna de las vértebras intervenidas pérdida de altura del cuerpo vertebral cementado, diferencias de angulación en los platillos, presencia de osteólisis alrededor del cemento o fragmentación del PMMA inyectado. CONCLUSIÓN: El PMMA inyectado en el cuerpo vertebral mantiene una situación estable en el tiempo (más de 15 años). No se observan cambios en la interfaz hueso-PMMA, osteólisis y/o cambios en la altura de los cuerpos vertebrales en los casos analizados

OBJETIVE: Currently, there are limited data on the long-term influence of polymethylmethacrylate (PMMA) on the integrity of vertebral bodies after percutaneous vertebroplasty (PVP). Interesting investigation is being carried out into the possible relationship between this technique and the appearance over time of osteolytic phenomena or cement fragmentation in the intervened vertebrae. The objective of our study was to investigate whether there is a loss of effectiveness and/or safety of PVP with PMMA in the long term. MATERIAL AND METHOD: X-rays were analyzed of intervened patients corresponding to the immediate post-operative and the most recent radiological study (PVP more than 15 years previous). With both radiological studies, we describe: the height of the vertebral body, the angulation of lamellar plates and osteolytic presence around the cement over time. RESULTS: A total of 7 patients operated by PVP with PMMA 15 or more years earlier agreed to have a new radiograph in our center. After the analysis of their post-operative images (immediate and 15 or more years after surgery), no loss of height of the cemented vertebral body, differences in angulation in the lamellar plates, presence of osteolysis around the vertebrae was observed in any of the involved vertebrae cement or fragmentation of the injected PMMA. CONCLUSIONS: PMMA injected into the vertebral body remains stable over time (more than 15 years). There are no changes in the bone-PMMA interface, osteolysis and/or changes in the height of the vertebral bodies in the cases analyzed

A subgroup of lupus patients with nephritis, innate T cell activation and low vitamin D is identified by the enhancement of circulating MHC class I-related chain A.

The major histocompatibility complex (MHC) class I-related chain A (MICA) is induced upon stress, and labels malfunctioning cells for their recognition by cytotoxic lymphocytes. Alterations in this recognition and also abnormal natural killer (NK) functions have been found in systemic lupus erythematosus (SLE). MICA can be shed from cells, subsequently acting as a soluble decoy receptor (sMICA). Our purpose was to study circulating sMICA levels in relationship with the activation of innate pathways in PBMC in a cohort of lupus patients. NK cells were characterized by flow cytometry. Gene expression of Toll-like receptors (TLR), interferon (IFN)-I sensitive genes and MICA were separately analyzed in monocytes, T cells and B cells. Serum sMICA was measured with enzyme-linked immunosorbent assay (ELISA). In our cohort, NK cell counts dropped in relationship with disease activity. sMICA showed an inverse trend with NK cell counts, as well as a significant association with activity indices, but not with complement decrease. Levels of sMICA associated to proteinuria and active nephritis. A multivariate regression model revealed anti-nuclear antibody (ANA) titres, the up-regulation of TLR-4 in T cells and lower vitamin D as predictors of sMICA enhancement. Interestingly, vitamin D showed an inverse association with proteinuria and a strong correlation with T cell MICA mRNA levels. According to our data, circulating sMICA identifies a subgroup of lupus patients with low vitamin D, innate activation of T cells and nephritis. We propose that lymphocyte shedding could account for the enhancement of sMICA and reflect an immune evasion mechanism driving disease activation in lupus.

Sleep disordered breathing and nocturnal hypoxemia are very prevalent in a lung cancer screening population and may condition lung cancer screening findings: results of the prospective Sleep Apnea In Lung Cancer Screening (SAILS) study.

OBJECTIVE: Obstructive sleep apnea (OSA) can influence the appearance and proliferation of some tumors. The Sleep Apnea In Lung Cancer Screening (SAILS) study (NCT02764866) evaluated the prevalence of OSA and nocturnal hypoxemia in a high-risk population enrolled in a lung cancer screening program. METHODS: This was a prospective study of the prevalence of OSA in a lung cancer screening program. Subjects met the National Lung Screening Trial (NLST) age and smoking criteria (age 55-75 years; pack-years >30). Participants in the study were offered annual screening with low-dose computed tomography (LDCT) and pulmonary function testing, as well as home sleep apnea testing (HSAT) and a sleep-specific questionnaire. Sleep study-related variables, symptoms, and epidemiologic data were recorded. RESULTS: HSAT was offered to 279 subjects enrolled in our lung cancer screening program. HSAT results were available for 236 participants (mean age 63.6 years; mean tobacco exposure: 45 pack-years), of whom 59% were male and 53% were active smokers. Emphysema (74%) and chronic obstructive pulmonary disease (COPD) (62%) were common and in most cases mild in severity. OSA, including moderate to severe disease, was very common in this patient population. AHI distributions were as follows: AHI <5 (22.5%); 5-15 (36.4%); 15-30 (23.3%); and >30 (17.8%). Nocturnal hypoxemia (T90) (p = 0.003), diffusing capacity for carbon monoxide (DLCO) (p = 0.01), tobacco exposure (p = 0.024), and COPD (p = 0.023) were associated with OSA severity. Positive screening findings (nodules ≥6 mm) were associated with nocturnal hypoxemia on multivariate analysis adjusted for confounders (OR = 2.6, 95% CI = 1.12-6.09, p = 0.027). CONCLUSION: Moderate to severe OSA is very prevalent in patients enrolled in a lung cancer screening program. Nocturnal hypoxemia more than doubles the risk of positive screening findings.

Hiperparatiroidismo secundario al déficit de vitamina D / Secondary hyperparathyroidism due to vitamin D deficiency

Introducción: Cada vez está más demostrado el papel de la vitamina D en múltiples patologías, una de ellas el desarrollo de un hiperparatiroidismo secundario al déficit de vitamina D. Los métodos de laboratorio de cuantificación de vitamina D en suero no estaban bien estandarizados hasta ahora, por lo que no podía establecerse con certeza a partir de qué niveles de vitamina D se producían determinadas anomalías como la elevación de la PTH. Nuestro estudio pretende determinar por debajo de qué niveles de vitamina D nos encontraremos con niveles de PTH anormalmente elevados, realizando la determinación de vitamina D en el laboratorio con una técnica debidamente estandarizada y fiable. Métodos: El estudio descriptivo y retrospectivo se realizó con pacientes mayores de 18 años en los que se hicieron simultáneamente determinaciones de PTH, 25(OH) vitamina D (25OHD) y que además tuvieran valores normales de calcio, filtrado glomerular y fósforo. Para la determinación de vitamina D se utilizó un método de electroquimioluminiscencia estandarizado con respecto a la técnica de gases-masas. Por el programa estadístico Stava versión 11 se calculó el valor de 25OHD para el que la PTH se elevaba por encima de 70 pg/ml con la mayor sensibilidad y especificidad. Resultados: Se incluyeron 4.083 pacientes, de los que 2.858 eran mujeres (70%) y 1.225 (30%) varones. La edad media de la población estudiada fue 60,60 años (desviación estándar, 15,29). El 74% de la población tenía una PTH en suero por debajo de 70 pg/ml (valores considerados normales) y el 26% mayor de 70 pg/ml. Al construir la curva de ROC de los niveles de 25OHD, en función de valores de PTH por debajo o por encima de 70 pg/ml, el área bajo la curva fue 0,5962 (p<0,0001). El punto de corte teniendo en cuenta conjuntamente la sensibilidad y la especificidad que determinaban los valores de vitamina D para predecir los valores de PTH por encima de 70 pg/ml fue 24 ng/ml. De los pacientes con PTH normal, el 71% tenían valores de vitamina D normales, mientras que, de los pacientes con PTH elevada (mayor de 70 pg/ml), casi la mitad presentaban una vitamina D menor de 24 ng/ml, porcentaje que aumentaba según se iba elevando la PTH. Conclusiones: El valor de 25OHD que muestra una mejor especificidad y sensibilidad para predecir valores anormalmente elevados de PTH es 24 ng/ml, valor superior al presentado en trabajos anteriores (alrededor de 18 ng/ml). Con los resultados de este estudio, realizado con un método debidamente calibrado, se puede decir que el 44,9% de pacientes con valores de vitamina D menores de 24 ng/ml presenta niveles de PTH anormalmente elevados, con una función renal normal y valores de calcio y fósforo normales. Este porcentaje es menor entre los 18 y 40 años (24%) y llega al 49% por encima de los 60 años. Estos pacientes podrían tratarse con vitamina D para evitar un posible hiperparatiroidismo secundario al déficit de dicha vitamina. Es importante tener en cuenta que el método de determinación de vitamina D utilizado debe estar debidamente estandarizado con respecto al método de gases-masas (AU)

Introduction: Vitamin D is increasingly recognized as playing a significant role in combatting many diseases. One is the development of secondary hyperthyroidism due vitamin D deficiency. To date, laboratory quantification methods of serum vitamin D were not well standardized. It could not be established with certainty from which levels of vitamin D certains abnormalities take place, like an elevation of PTH. The present study was aimed at determining below what vitamin D levels we will find abnormally high levels of PTH, carrying out the vitamin D determination in the laboratory with a standardized, reliable technique. Methods: This descriptive, retrospective study was conducted with patients over 18 years in which determinations were made simultaneously with PTH, 25 (OH) vitamin D (25OHD) and which also have normal values of calcium, glomerular filtration rate and phosphorus. For determining vitamin D, standardized electrochemiluminescence method was used with gas chromatography- mass spectrometry method. Using the Stava version 11 statistical program, the 25OHD was calculated where PTH value was above 70 pg/ml with greater sensitivity and specificity. Results: In all, 4,083 patients were included, of whom 2,858 were women (70%) and 1,225 (30%) males. The mean age of the study population was 60.60 years (standard deviation, 15.29). 74% of the population had a serum PTH under 70 pg/ml (normal values) and 26% had a serum PTH higher tan 70 ng/ml. By constructing the ROC curve levels of 25OHD, depending on PTH values below or above 70 pg/ml, the area under the curve was 0.5962 (p<0.0001). The cut having jointly account the sensitivity and specificity that determined vitamin D levels to predict PTH values above 70 pg/ml was 24 ng/ml. Of the patients with normal PTH, 71% presented normal vitamin D values, while patients with elevated PTH (Greater than 70 pg/ml), almost half had a vitamin D below 24 ng / ml, which increased as the PTH percentage was elevated. Conclusions: The 25OHD value that presents better specificity and sensitivity to predict abnormally high PTH is 24 ng/ml, which is higher than the level reported in previous work, (about 18 ng/ml) value. The results of this study, carried out with an appropriately calibrated method, showed that 44.9% of patients with vitamin D values of less than 24 ng/ml PTH had abnormally high levels, with a normal value of calcium and phosphorus and normal renal function. This percentage is less in those individuals between 18 and 40 years (24%) and reaches 49% beyond 60 years. These patients could be treated with vitamin D to prevent possible secondary hyperparathyroidism due to vitamin deficiency. It is noteworthy that the method of determining vitamin D used must be properly standardized with respect to gas chromatography-tandem mass spectrometry method (AU)

Comparación entre dos inmunoensayos automatizados por quimioluminiscencia para la cuantificación de 25(OH) vitamina D / Comparison between two automated chemiluminescence immunoassays for quantifying 25 (OH) vitamin D

Introducción: La cuantificación de 25(OH) vitamina D total en sangre es el marcador más preciso del estado de vitamina D en un individuo. La técnica patrón-oro para su medición es la cromatografía líquida/ espectrometría de masas en tándem (LC-MS/MS), aunque actualmente los laboratorios clínicos utilizan de rutina técnicas de quimioluminiscencia. El objetivo del estudio fue comparar las concentraciones de 25(OH) vitamina D obtenidas mediante dos métodos automatizados comerciales y estudiar la correlación de dichos métodos con la técnica de referencia LC-MS/MS. Material y método: Se cuantificaron los niveles de 25(OH) vitamina D en 1.000 muestras de suero del laboratorio de Bioquímica de la Fundación Jiménez Díaz mediante 2 métodos automatizados comerciales por detección de quimioluminiscencia: ADVIA CENTAURO® (SIEMENS) y LUMIPULSE® G1200 (FUJIREBIO). Entre todas las muestras analizadas, las 50 más discordantes entre sí se enviaron para ser evaluadas por la técnica de referencia LC-MS/MS. Resultados: Los resultados obtenidos indican que existe una buena correlación entre los dos métodos: CCI=0,923 (0,914-0,932), siendo los valores de LUMIPULSE® G1200 un 10% superiores a los de CENTAURO ®. Con respecto a las 50 muestras seleccionadas, podemos observar que existe una buena correlación entre los dos inmunoensayos con la técnica LC-MS/MS, aunque ambos métodos infraestiman considerablemente los resultados de 25(OH) vitamina D con respecto al patrón-oro. Discusión: Aunque ambas técnicas son adecuadas para su utilización, habría que plantearse si la «epidemia» mundial de hipovitaminosis D se debe a la metodología de análisis utilizada. Esta variabilidad entre inmunoensayos se solucionaría estandarizando las diferentes técnicas comerciales con los materiales de referencia elaborados por el NIST (AU)

Introduction: Quantifying total blood 25 (OH) vitamin D is the most accurate marker of an individual’s vitamin D status. The gold standard technique for measurement is liquid chromatography tandem mass spectrometry (LC-MS/MS), although currently clinical laboratories tend to use chemiluminescence techniques. The objective of this study was to compare 25 (OH) vitamin D concentrations obtained by two commercially-produced automated methods and study the correlation of these methods with the LC-MS/MS reference technique. Material and methods: The 25(OH) vitamin D levels were quantified in 1,000 serum samples from the Jimenez Diaz Biochemistry Foundation Laboratory using 2 automated methods for chemiluminescence detection: ADVIA CENTAURO® (SIEMENS) and LUMIPULSE® G1200 (Fujirebio). Among all the samples tested, the 50 most discordant to each other were sent to be evaluated by LC-MS/MS reference technique. Results: The results indicate that there is good correlation between the two methods: CCI=0.923 (0.914-0.932), with the G1200 LUMIPULSE® values 10% being higher than CENTAURO®. Regarding the 50 samples selected, we can see that there is a good correlation between the two immunoassays with LC-MS/MS, although both methods significantly underestimate 25 (OH) vitamin D results with respect to the gold standard. Discussion: Although both techniques are suitable for use, it is worth considering whether the worldwide vitamin D deficiency epidemic is due to the analysis methodology used. This variability between immunoassays could be solved by standardizing the different commercial techniques in line with NIST produced reference materials (AU)

Changes in Exhaled Nitric Oxide After Inhalation Challenge With Occupational Agents

Background and objective: The use of fractional exhaled nitric oxide (FeNO) concentration has been proposed as a surrogate marker for monitoring airway response to specific inhalation challenge (SIC). We investigated the usefulness of FeNO measurements for monitoring airway response to SIC with occupational agents. Material and methods: Workers with suspected occupational asthma were recruited to undergo SIC with occupational agents and subsequently FeNO testing at baseline and 24 hours. Results: Sixty-eight patients were evaluated, 45 of whom had a positive SIC. SIC-positive patients showed a significant increase in FeNO 24 hours postchallenge, with an increase ratio of 1.25 (95% CI, 1.05-1.48; P=.01); no increase was seen in patients with a negative SIC (P=.08). The predictive capacity of variations in FeNO showed that for each unit increase in FeNO, the probability of a positive SIC rose by 4%. A baseline FeNO value of 25 ppb predicted a positive SIC with 60% sensitivity and 80% specifi city. The increase in %FeNO cutoff point providing maximal sensitivity and specificity for predicting a positive SIC was 41% (sensitivity 50%, specificity 95%). Conclusions: We demonstrated that asthmatic reactions induced by occupational agents during SICs are associated with a consistent increase in FeNO. However, the predictive diagnostic capacity of FeNO measurements is low. While FeNO may aid in the interpretation of SIC in some cases, it cannot be used as a general surrogate marker to predict or to assess SICs with occupational agents (AU)

Antecedentes y objetivo: Se ha sugerido la medición del oxido nítrico exhalado (FeNO) como un marcador en la monitorización de la respuesta de las vías respiratorias a provocaciones específicas bronquiales (SIC). Hemos investigado la utilidad de la medición del FeNO en la monitorización de la respuesta de la vía respiratoria a SIC con agentes ocupacionales. Materiales and métodos: Se han reclutado trabajadores con sospecha de asma ocupacional sometidos a SIC y a los que se les determino FeNO antes y a las 24 horas del SIC. Resultados: Un total de 68 fueron evaluados, 45 de ellos tuvieron un SIC positivo. En los pacientes SIC-positivos el FeNO aumento de forma significativa 24 horas tras el SIC con un incremento en el cociente de 1.25 (IC 1.05-1.48,p=0.01), pero no en el grupo de SIC-negativo (p=0.08). La capacidad predictiva de la variación del FeNO mostro que por cada unidad de incremento en FENO, el riesgo de tener un SIC positivo se incremento un 4%. Un valor de FeNO basal de 25 ppb predijo un SIC positivo con una sensibilidad del 60% y una especificidad del 80%. El punto de corte que dio la máxima sensibilidad y especificidad de incremento del %FeNO para predecir un SIC positivo fue del 41% (sensibilidad 50%, especificidad 95%). Conclusiones: Se ha demostrado que las reacciones asmáticas inducidas por agentes ocupacionales durante SICs se asocian a un consistente aumento del FeNO. Sin embargo, su capacidad predictiva es baja. Aunque esta medición puede ayudar a interpretar los SICs, en algunos casos, no se puede generalizar su uso como marcador indirecto para predecir o valorar los SICs con agentes ocupacionales (AU)

Changes in exhaled nitric oxide after inhalation challenge with occupational agents.

BACKGROUND AND OBJECTIVE: The use of fractional exhaled nitric oxide (FeNO) concentration has been proposed as a surrogate marker for monitoring airway response to specific inhalation challenge (SIC). We investigated the usefulness of FeNO measurements for monitoring airway response to SIC with occupational agents. Materialandmethods: Workers with suspected occupational asthma were recruited to undergo SIC with occupational agents and subsequently FeNO testing at baseline and 24 hours. RESULTS: Sixty-eight patients were evaluated, 45 of whom had a positive SIC. SIC-positive patients showed a significant increase in FeNO 24 hours postchallenge, with an increase ratio of 1.25 (95% CI, 1.05-1.48; P=.01); no increase was seen in patients with a negative SIC (P=.08). The predictive capacity of variations in FeNO showed that for each unit increase in FeNO, the probability of a positive SIC rose by 4%. A baseline FeNO value of 25 ppb predicted a positive SIC with 60% sensitivity and 80% specificity. The increase in %FeNO cutoff point providing maximal sensitivity and specificity for predicting a positive SIC was 41% (sensitivity 50%, specificity 95%). CONCLUSIONS: We demonstrated that asthmatic reactions induced by occupational agents during SICs are associated with a consistent increase in FeNO. However, the predictive diagnostic capacity of FeNO measurements is low. While FeNO may aid in the interpretation of SIC in some cases, it cannot be used as a general surrogate marker to predict or to assess SICs with occupational agents.

DLC coatings for UHMWPE: relationship between bacterial adherence and surface properties.

Development of intrinsically antibacterial surfaces is of key importance in the context of prostheses used in orthopedic surgery. This work presents a thorough study of several plasma-based coatings that may be used with this functionality: diamond-like carbon (DLC), fluorine-doped DLC (F-DLC), and a high-fluorine-content-carbon-fluor polymer (CF(X)). The coatings were obtained by a radio-frequency plasma-assisted deposition on ultra high molecular weight polyethylene (UHMWPE) samples and physicochemical properties of the coated surfaces were correlated with their antibacterial performance against collection and clinical Staphylococcus aureus and Staphylococcus epidermidis strains. The fluorine content and the relative amount of C-C and C-F bonds were controlled by X-ray photoelectron spectroscopy, and hydrophobicity and surface tension by contact angle measurements. Surface roughness was studied by Atomic Force Microscopy. Additional nanoidentation studies were performed for DLC and F-DLC coatings. Unpaired t test and regression linear models evaluated the adherence of S. aureus and S. epidermidis on raw and coated UHMWPE samples. Comparing with UHMWPE, DLC/UHMWPE was the least adherent surface with independence of the bacterial species, finding significant reductions (p ≤ 0.001) for nine staphylococci strains. Bacterial adherence was also significantly reduced in F-DLC/ UHMWPE and CFx/UHMWPE for six strains.

How molecular diagnosis can change allergen-specific immunotherapy prescription in a complex pollen area.

BACKGROUND: The identification of disease-eliciting allergens is a prerequisite for accurate prescription of allergen-specific immunotherapy (SIT). The aim of this study was to determine whether molecular diagnosis (MD) may change indication and allergen prescription of SIT. METHODS: A total of 141 patients with allergic rhinoconjunctivitis and/or asthma sensitized to pollen with or without concomitant food allergy were included. Skin prick testing with a panel of aeroallergens and a microarray-based panel of allergens (ISAC(®); Phadia, Sweden) was performed in all patients. Prior to learning the results of molecular diagnosis, three of the authors reached a consensus on the indication of SIT and use of allergens following EAACI recommendations, basing their judgment on clinical history and skin prick test results before and after obtaining the ISAC results. The agreement coefficient (kappa index) was used to analyze the results. RESULTS: Fifty-nine percent of the patients were women with a mean age of 31 ± 13.63. Agreement in SIT indication before and after ISAC(®) results was found in only 62 (46%) patients (kappa = 0.1057 ± 0.0413). Concerning allergens used in the most common prescriptions before and after MD results, we obtained the following results: κ = 0.117 ± 0.0825 for grass; κ = 0.1624 ± 0.0639 for olive; κ = 0.0505 ± 0.0548 for olive and grass; κ = 0.1711 ± 0.0471 for grass and cypress; κ = 0.1897 ± 0.0493 for grass and London plane; κ = 1 ± 0.0842 for olive and cypress, and κ = 0.3586 ± 0.0798 for other combinations. CONCLUSIONS: There was very low agreement concerning indication and use of allergens for SIT before and after performing MD. This discrepancy emphasizes the usefulness of MD, at least in areas of complex sensitization to pollen, in determining correct indication of SIT.