Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años / Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up

Objetivo: Valorar los resultados de la artroscopia de cadera (CAC) como tratamiento del choque femoroacetabular (CFA) con seguimiento mínimo de 10 años, y determinar las variables predictoras de reintervención quirúrgica. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante CAC entre enero de 2010 y diciembre de 2011. Las lesiones del reborde acetabular se evaluaron según la clasificación ALAD. Se realizó valoración clínica y radiológica. La supervivencia de la técnica quirúrgica se calculó con la prueba de Kaplan-Meier y la prueba de regresión de Cox. Resultados: Se incluyeron en el estudio 74 pacientes con un seguimiento medio de 132 meses. La puntuación media en las escalas de valoración mejoró significativamente al final del seguimiento. Diecisiete pacientes (23,9%) fueron reintervenidos. El odds ratio de reintervención en un paciente mayor de 40 años fue de 8,08; en un paciente Tönnis 2-3 de 7,57; y en un paciente con lesión cartilaginosa ALAD 2-3 de 4,25. La supervivencia de la CAC en el CFA a 10 años fue del 77,8%, con un 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis de 1 o menor (p<0,001). La variable predictora asociada a la necesidad de reintervención quirúrgica fue la degeneración articular radiológica preoperatoria (p=0,02). Conclusiones: La supervivencia de la CAC en el tratamiento del CFA a 10 años fue del 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis 1 o menor. La edad, la lesión cartilaginosa y la degeneración articular incrementarían el riesgo de reintervención quirúrgica.(AU)

Purpose: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. Methods: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. Results: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). Conclusion: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.(AU)

[Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up / Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años

Objetivo: Valorar los resultados de la artroscopia de cadera (CAC) como tratamiento del choque femoroacetabular (CFA) con seguimiento mínimo de 10 años, y determinar las variables predictoras de reintervención quirúrgica. Material y métodos: Estudio retrospectivo de una base de datos prospectiva de pacientes intervenidos mediante CAC entre enero de 2010 y diciembre de 2011. Las lesiones del reborde acetabular se evaluaron según la clasificación ALAD. Se realizó valoración clínica y radiológica. La supervivencia de la técnica quirúrgica se calculó con la prueba de Kaplan-Meier y la prueba de regresión de Cox. Resultados: Se incluyeron en el estudio 74 pacientes con un seguimiento medio de 132 meses. La puntuación media en las escalas de valoración mejoró significativamente al final del seguimiento. Diecisiete pacientes (23,9%) fueron reintervenidos. El odds ratio de reintervención en un paciente mayor de 40 años fue de 8,08; en un paciente Tönnis 2-3 de 7,57; y en un paciente con lesión cartilaginosa ALAD 2-3 de 4,25. La supervivencia de la CAC en el CFA a 10 años fue del 77,8%, con un 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis de 1 o menor (p<0,001). La variable predictora asociada a la necesidad de reintervención quirúrgica fue la degeneración articular radiológica preoperatoria (p=0,02). Conclusiones: La supervivencia de la CAC en el tratamiento del CFA a 10 años fue del 45,4% en los pacientes con grado de Tönnis mayor de 1 frente al 85,2% en los pacientes con grado de Tönnis 1 o menor. La edad, la lesión cartilaginosa y la degeneración articular incrementarían el riesgo de reintervención quirúrgica.(AU)

Purpose: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. Methods: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan–Meier and a multivariate Cox proportional hazards model. Results: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). Conclusion: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.(AU)

[Translated article] Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (p=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (p<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

Hip arthroscopy for femoroacetabular impingement with 10-year minimum follow-up. / Artroscopia de cadera como tratamiento del choque femoroacetabular con seguimiento mínimo de 10 años.

PURPOSE: To determine outcomes after hip arthroscopy (HA) for femoroacetabular impingement (FAI) at a minimun 10-year follow up and identified risk factors for revision surgery. METHODS: Retrospective study of a prospective database of patients undergoing HA between January 2010 and December 2011. Rim chondral injuries were evaluated using the acetabular labral articular disruptions system (ALAD). Clinical and radiological data was obtained. Cumulative survival was estimated by Kaplan-Meier and a multivariate Cox proportional hazards model. RESULTS: Seventy-four patients were included in the study. Mean follow-up was 132 months. There was statistically significant improvement from preoperative PROs at latest follow-up. Seventeen patients (23.9%) underwent revision surgery. Odds ratio for revision surgery was 8.08 in a patient above 40 years old, 7.57 in a patient Tönnis greater than 1, and 4.25 in a patient ALAD 2-3. Cumulative survivorship rate at 10 years was 77.8%, with a 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Risk factor for revision surgery was preoperative degree of osteoarthrosis (P=.02). CONCLUSION: Cumulative survivorship rate at 10 years was 45.4% for patients with Tönnis grade greater than 1 in front of 85.2% for patients with Tönnis grade of 1 or less (P<.001). Age, chondral injuries, and degree of osteoarthrosis would increase the risk for revision surgery.

SARC-F and SARC-CalF Scores as Mortality Risk Factors in Older Men with Cancer: A Longitudinal Study from Peru.

OBJECTIVES: We aimed to evaluate the role of SARC-F and SARC-CalF scores as risk factors for mortality in adults over 60 years of age with cancer of the Centro Médico Naval (CEMENA) in Callao, Peru during 2012-2015. METHODS: We performed a secondary analysis of data from a prospective cohort carried out from September 2012 to February 2013 in the Geriatrics Department of CEMENA. The outcome variable was mortality at two years of follow-up, while the exposure variable was the risk of sarcopenia assessed using the SARC-F and SARC-CalF scales. We carried out Cox proportional-hazards models to assess the role of SARC-F and SARC-CalF scores as risk factors for mortality. We estimated crude (cHR) and adjusted (aHR) hazard ratios (HR) with their respective 95% confidence intervals (95%CI). Likewise, we calculated the area under the curve (AUC) of both exposure variables in relation to mortality. RESULTS: We analyzed data from 922 elderly men with cancer; 43.1% (n=397) were between 60 and 70 years old. 21.5% (n=198) and 45.7% (n=421) were at risk of sarcopenia according to SARC-F and SARC-CalF, respectively, while the incidence of mortality was 22.9% (n=211). In the adjusted Cox regression model, we found that the risk of sarcopenia measured by SARC-F (aHR=2.51; 95%CI: 1.40-2.77) and SARC-CalF (aHR=2.04; 95%CI: 1.55-4.02) was associated with a higher risk of death in older men with cancer. In the diagnostic performance analysis, we found that the AUC for mortality prediction was 0.71 (95%CI: 0.68-0.75) for SARC-F and 0.80 (95%CI: 0.78-0.82) for SARC-CalF. CONCLUSIONS: The risk of sarcopenia evaluated by SARC-F and SARC-CalF scores was associated with an increased risk of mortality in older men with cancer. Both scales proved to be useful and accessible instruments for the identification of groups at risk of mortality.

Psychological readiness to return to sports after anterior cruciate ligament reconstruction in amateur sport. / Preparación psicológica para la reincorporación deportiva tras cirugía reconstructiva del ligamento cruzado anterior en el deportista aficionado.

INTRODUCTION: Return to sports (RTS) is maybe the main expectation for the patient after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to analyze the psychological readiness to RTS in a cohort of amateur sports after ACLR. MATERIAL AND METHODS: Retrospective study of a prospective database of patients treated with ACLR performed between January and December 2017. Psychological readiness to RTS after ACLR was evaluated with the short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. RESULTS: A total of 43 patients met the inclusion criteria. The mean age of the patients was 24.7 years. The mean follow-up was 32.5 months. All patients practiced any type of sports at final follow-up. The mean ACL-RSI score was 71.5. Fear of reinjury was mentioned by 14 patients (32.5%). Twenty-four patients (55.8%) pointed out that they did not practice sport at the pre-injury level. The mean ACL-RSI score was statistically significant lower in this group of patients (59.7 vs 87.3; P<.001). CONCLUSIONS: Fear of reinjury keeps after ACLR. Patients that they did not practice sport at the pre-injury level show lower scores in ACL-RSI for RTS.

Abnormalities in Cortical GABAergic Interneurons of the Primary Motor Cortex Caused by Lis1 (Pafah1b1) Mutation Produce a Non-drastic Functional Phenotype.

LIS1 (PAFAH1B1) plays a major role in the developing cerebral cortex, and haploinsufficient mutations cause human lissencephaly type 1. We have studied morphological and functional properties of the cerebral cortex of mutant mice harboring a deletion in the first exon of the mouse Lis1 (Pafah1b1) gene, which encodes for the LisH domain. The Lis1/sLis1 animals had an overall unaltered cortical structure but showed an abnormal distribution of cortical GABAergic interneurons (those expressing calbindin, calretinin, or parvalbumin), which mainly accumulated in the deep neocortical layers. Interestingly, the study of the oscillatory activity revealed an apparent inability of the cortical circuits to produce correct activity patterns. Moreover, the fast spiking (FS) inhibitory GABAergic interneurons exhibited several abnormalities regarding the size of the action potentials, the threshold for spike firing, the time course of the action potential after-hyperpolarization (AHP), the firing frequency, and the frequency and peak amplitude of spontaneous excitatory postsynaptic currents (sEPSC's). These morphological and functional alterations in the cortical inhibitory system characterize the Lis1/sLis1 mouse as a model of mild lissencephaly, showing a phenotype less drastic than the typical phenotype attributed to classical lissencephaly. Therefore, the results described in the present manuscript corroborate the idea that mutations in some regions of the Lis1 gene can produce phenotypes more similar to those typically described in schizophrenic and autistic patients and animal models.

Preparación psicológica para la reincorporación deportiva tras cirugía reconstructiva del ligamento cruzado anterior en el deportista aficionado / Psychological readiness to return to sports after anterior cruciate ligament reconstruction in amateur sport

Introducción: La reincorporación deportiva es posiblemente el objetivo principal para el paciente tras la cirugía reconstructiva de ligamento cruzado anterior (LCA). El propósito del presente estudio fue determinar la preparación psicológica para la reincorporación deportiva de una cohorte de deportistas aficionados tratados mediante cirugía reconstructiva de LCA. Material y método: Estudio retrospectivo de una base de datos prospectiva de pacientes con rotura de LCA intervenidos entre enero y diciembre de 2017. La preparación psicológica del paciente para la reincorporación deportiva se valoró al final del seguimiento según la versión corta de la escala Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). Resultados: Se incluyeron en el estudio 43 pacientes con una edad media de 24,7 años. El seguimiento medio de los pacientes fue de 32,5 meses. Todos los pacientes practicaban algún tipo de actividad deportiva al final del seguimiento. La puntuación media en la escala ACL-RSI fue de 71,5 puntos. El miedo a lesionarse nuevamente al practicar deporte persistía en 14 pacientes (32,5%). Veinticuatro pacientes (55,8%) indicaron que no practicaban deporte al mismo nivel que antes de la lesión ligamentosa. La puntuación media en la escala ACL-RSI fue significativamente menor en este grupo de pacientes (59,7 vs. 87,3; p<0,001). Conclusiones: El miedo a lesionarse nuevamente persiste tras la cirugía reconstructiva de LCA. Los pacientes que no practicaban deporte al mismo nivel que antes de la lesión ligamentosa presentaban menores puntuaciones en la escala ACL-RSI de preparación psicológica para la reincorporación deportiva.(AU)

Introduction: Return to sports (RTS) is maybe the main expectation for the patient after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to analyze the psychological readiness to RTS in a cohort of amateur sports after ACLR. Material and methods: Retrospective study of a prospective database of patients treated with ACLR performed between January and December 2017. Psychological readiness to RTS after ACLR was evaluated with the short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. Results: A total of 43 patients met the inclusion criteria. The mean age of the patients was 24.7 years. The mean follow-up was 32.5 months. All patients practiced any type of sports at final follow-up. The mean ACL-RSI score was 71.5. Fear of reinjury was mentioned by 14 patients (32.5%). Twenty-four patients (55.8%) pointed out that they did not practice sport at the pre-injury level. The mean ACL-RSI score was statistically significant lower in this group of patients (59.7 vs 87.3; P<.001). Conclusions: Fear of reinjury keeps after ACLR. Patients that they did not practice sport at the pre-injury level show lower scores in ACL-RSI for RTS.(AU)

Psychological readiness to return to sports after anterior cruciate ligament reconstruction in amateur sport / Preparación psicológica para la reincorporación deportiva tras cirugía reconstructiva del ligamento cruzado anterior en el deportista aficionado

Introduction: Return to sports (RTS) is maybe the main expectation for the patient after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to analyze the psychological readiness to RTS in a cohort of amateur sports after ACLR. Material and methods: Retrospective study of a prospective database of patients treated with ACLR performed between January and December 2017. Psychological readiness to RTS after ACLR was evaluated with the short version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. Results: A total of 43 patients met the inclusion criteria. The mean age of the patients was 24.7 years. The mean follow-up was 32.5 months. All patients practiced any type of sports at final follow-up. The mean ACL-RSI score was 71.5. Fear of reinjury was mentioned by 14 patients (32.5%). Twenty-four patients (55.8%) pointed out that they did not practice sport at the pre-injury level. The mean ACL-RSI score was statistically significant lower in this group of patients (59.7 vs 87.3; P<.001). Conclusions: Fear of reinjury keeps after ACLR. Patients that they did not practice sport at the pre-injury level show lower scores in ACL-RSI for RTS.(AU)

Introducción: La reincorporación deportiva es posiblemente el objetivo principal para el paciente tras la cirugía reconstructiva de ligamento cruzado anterior (LCA). El propósito del presente estudio fue determinar la preparación psicológica para la reincorporación deportiva de una cohorte de deportistas aficionados tratados mediante cirugía reconstructiva de LCA. Material y método: Estudio retrospectivo de una base de datos prospectiva de pacientes con rotura de LCA intervenidos entre enero y diciembre de 2017. La preparación psicológica del paciente para la reincorporación deportiva se valoró al final del seguimiento según la versión corta de la escala Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). Resultados: Se incluyeron en el estudio 43 pacientes con una edad media de 24,7 años. El seguimiento medio de los pacientes fue de 32,5 meses. Todos los pacientes practicaban algún tipo de actividad deportiva al final del seguimiento. La puntuación media en la escala ACL-RSI fue de 71,5 puntos. El miedo a lesionarse nuevamente al practicar deporte persistía en 14 pacientes (32,5%). Veinticuatro pacientes (55,8%) indicaron que no practicaban deporte al mismo nivel que antes de la lesión ligamentosa. La puntuación media en la escala ACL-RSI fue significativamente menor en este grupo de pacientes (59,7 vs. 87,3; p<0,001). Conclusiones: El miedo a lesionarse nuevamente persiste tras la cirugía reconstructiva de LCA. Los pacientes que no practicaban deporte al mismo nivel que antes de la lesión ligamentosa presentaban menores puntuaciones en la escala ACL-RSI de preparación psicológica para la reincorporación deportiva.(AU)

Shock wave and mesenchymal stem cells as treatment in the acute phase of spinal cord injury: A pilot study / Ondas de choque y células madre mesenquimales como tratamiento en la fase aguda de la lesión medular: un estudio piloto

Introduction: Spinal cord injury (SCI) is a complex pathology with thousands of patients worldwide. During the acute early phase, neural tissue shows some regenerative properties that disappear at the chronic phase. Shock Waves and Stem Cells have been proposed as a possible therapy. Methods: Here, we analyse Shock Waves’ immediate effect over spinal cord genetic response in the injured and healthy spinal cord and the effect of Shock Waves and combined Shock Waves plus Stem Cells distally grafted to treat the first month after spinal cord injury. Results: The immediate application of shock waves increases VEGF (Vascular Endothelial Growth Factor) but reduces the BDNF (Brain-Derived Growth Factor) RNA (Ribonucleic acid) response. Shock wave therapy increases GFAP (Glial fibrillary acidic protein) positive cells and vascularity during the treatment's acute phase. Conclusion: Shock wave treatment seems to be enough to produce benefits in the acute phase of spinal cord injury, with no accumulative positive effects when mesenchymal stem cell graft is applied together.(AU)

Introducción: La lesión medular es una afección compleja con miles de pacientes repartidos a lo largo del mundo. Durante la fase aguda temprana de la lesión, el tejido neural muestras ciertas propiedades regenerativas que desaparecen durante la fase crónica. Las ondas de choque y las células madre han sido propuestas como posibles terapias. Metodología: En este estudio analizamos el efecto inmediato de una sesión de ondas de choque sobre la médula espinal, tanto sana como lesionada, y si su efecto es sumatorio al que produce un tratamiento de células madre mesenquimales inyectadas distalmente, como se ha observado en estudios previos. Resultados: Se observa un efecto inmediato con las ondas de choque que promueve un incremento del efecto trófico vascular endotelial, y una disminución del factor trófico derivado del cerebro. La terapia prolongada con ondas de choque en la fase aguda incrementa la presencia de astrocitos y la vascularización local. No parece haber efecto sumatorio con el tratamiento de células madre, produciéndose efectos similares con o sin las células madre mesenquimales. Conclusiones: Las ondas de choque parecen tener un efecto positivo durante la fase aguda de una lesión medular por compresión, sin que el tratamiento distal de células madre mesenquimales parezca implicar un efecto sumatorio.(AU)

Shock wave and mesenchymal stem cells as treatment in the acute phase of spinal cord injury: A pilot study.

INTRODUCTION: Spinal cord injury (SCI) is a complex pathology with thousands of patients worldwide. During the acute early phase, neural tissue shows some regenerative properties that disappear at the chronic phase. Shock Waves and Stem Cells have been proposed as a possible therapy. METHODS: Here, we analyse Shock Waves' immediate effect over spinal cord genetic response in the injured and healthy spinal cord and the effect of Shock Waves and combined Shock Waves plus Stem Cells distally grafted to treat the first month after spinal cord injury. RESULTS: The immediate application of shock waves increases VEGF (Vascular Endothelial Growth Factor) but reduces the BDNF (Brain-Derived Growth Factor) RNA (Ribonucleic acid) response. Shock wave therapy increases GFAP (Glial fibrillary acidic protein) positive cells and vascularity during the treatment's acute phase. CONCLUSION: Shock wave treatment seems to be enough to produce benefits in the acute phase of spinal cord injury, with no accumulative positive effects when mesenchymal stem cell graft is applied together.

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

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Frailty and Vulnerability as Predictors of Chemotherapy Toxicity in Older Adults: A Longitudinal Study in Peru.

BACKGROUND: Multiple markers are used to assess frailty and vulnerability, conditions associated with the development of chemotherapy toxicity (CTT). However, there is still no consensus on which condition has stronger association with this adverse effect of chemotherapy in the elderly. OBJECTIVES: To evaluate the association between frailty and vulnerability with the development of CTT in oncogeriatric patients. DESIGN, SETTING, AND PARTICIPANTS: Through a retrospective cohort, a secondary database of 496 male oncogeriatric military patients treated at the Geriatrics Service of the Naval Medical Centre of Peru during 2013-2015 was analyzed. MEASUREMENTS: With prior informed consent, the presence of frailty, assessed by Fried Phenotype; and vulnerability, assessed by the Vulnerable Elders Survey-13 (VES-13) and G-8, was determined. The follow-up of patients in chemotherapy was performed every 8 weeks, to determine the development of CTT (according to the Common Terminology Criteria for Adverse Events v4.0). In addition, we included sociodemographic characteristics, medical background information and functional assessment variables. The data collected was encoded and imported into STATA v14.0 statistical package for analysis. Multivariate analysis was performed using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). RESULTS: The average age was 79.2 ± 4.3 years. 129 (26.01%) developed CTT during follow-up. Similarly, 129 older adults (26.01%) were positive for frailty according to Fried phenotype; 101 (20.36%) were positive for vulnerability with VES-13, and 112 (22.58%) with G-8. In the adjusted Cox model, by type of cancer and adverse effects, a statistically significant association was found between the 3 scales evaluated and the development of CTT, with the Fried Phenotype as the scale with the strongest association (HR=2.01; 95%CI: 1.04-4.90). CONCLUSIONS: The frailty and vulnerability in the elderly are conditions associated with the development of CTT. The Fried phenotype was the scale with the most significant association with the outcome studied.

ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells).

INTRODUCTION: Goblet cell carcinoma (GCC) is an appendicular neoplasia representing less than 5% of all appendicular tumors, found in 0.3-0.9% of the appendectomies, 35-58% of all appendicular neoplasms, and less than 14% of malign appendix tumors. The most frequent clinical presentation is abdominal pain associated with a picture of acute appendicitis. MATERIALS AND METHODS: We present 3 clinical cases of appendix GCC, 2 subjected to cytoreductory surgery plus intraperitoneal hyperthermic chemotherapy and a third, who is currently receiving neoadjuvant treatment with a good response to chemotherapy and who will be offered the same treatment as the first two patients. Given the unpredictable behavior of these tumors, the use of molecular markers could help us to predict their behavior and prognosis. In this context, the TP73 gene would make an interesting putative marker. ∆Np73 has been described as overexpressed in a great variety of tumor types including colon cancer and this up-regulation is associated with a poor prognosis. To evidence its role in this malignancy, we evaluate here the status of ∆Np73 in the primary tumor and normal counterpart tissues, in the metastatic implants and in healthy areas of the peritoneum from the appendicular GCC patients. In addition, we checked the expression levels of this p73 variant in the tumor and normal tissue of 26 patients with colon cancer. RESULTS: Remarkably, 2 patients showed significant ∆Np73 down-regulation in both the primary tumor and the implants. Case 1 presented a fourfold decrease of levels in the primary tumor and 20-fold decrease in the implants. Case 2 showed a seven- and fourfold down-regulation in the primary tumor and implants, respectively. However, Case 3 showed an up-regulation of 53- and threefold in the primary tumor and implants, respectively. CONCLUSION: Goblet cell carcinoma of the appendix is very rate. It tends to seed throughout the peritoneum, making aggressive surgical cytoreduction and chemotherapy viable treatment options. Investigation into the molecular basis of these tumors may improve the diagnosis, prognosis and therapeutic decisions regarding these patients. ∆Np73 seems a good candidate for further analysis in longer series.

Las enfermedades cardio-cerebro-vasculares en Medellín - Colombia, entre 2000- 2013: ¿un referente para las políticas públicas en salud? / Cardio-cerebrovascular diseases in Medellin - Colombia between 2000 and 2013: ¿a reference for public policy in health?

Introducción: Las políticas públicas son asuntos clave de la gestión gubernamental y su estudio es importante cuando se analiza el impacto que tienen frente a problemas relevantes que se reflejan en el perfil epidemiológico. Objetivo: Analizar la importancia que las enfermedades cardio-cerebro-vasculares tuvieron en la formulación de las políticas públicas en salud en Medellín entre 2000-2013. Materiales y métodos: Enfoque cualitativo con estrategia metodológica de análisis documental de corte hermenéutico. Se tomaron como base los acuerdos aprobados por el Concejo de Medellín y se seleccionaron aquellos, que tienen relación directa o indirecta con estas enfermedades, asimismo se revisaron planes de desarrollo contextualizados en lineamientos de políticas nacionales e internacionales. Resultados: Se encuentra un acuerdo que se refiere explícitamente a estas enfermedades. La mayoría son políticas orientadas, a grupos específicos o problemáticas relacionadas con promoción de la salud y prevención de las enfermedades cardio-cerebro-vasculares. El seguimiento y evaluación son fases menos tenidas en cuenta en el ciclo de las políticas públicas. Conclusiones: Los resultados sugieren la necesidad de una concepción amplia de la salud que oriente la formulación de las políticas locales e impacte un problema tan complejo e importante para el municipio, como lo son estas enfermedades.

Introduction: Public policy is a key element to government administration and its study is important when analyzing the impact it has on relevant issues evidenced in the epidemiological profile. Objective: To analyze the importance of cardio-cerebrovascular diseases in the development of public policy in health in Medellin between 2000 and 2013. Materials and methods: A qualitative approach with hermeneutic documentary analysis was done. The agreements approved by the Medellin council were taken as a base, from which those directly or indirectly related with these diseases were selected. Plans of action based on national and international policy guidelines were also reviewed. Results: An agreement that explicitly referred to these diseases was found. Most policy is oriented toward specific groups or issues related to health promotion and the prevention of cardio-cerebrovascular diseases. Follow-up and evaluation are the most overlooked stages of the public policy cycle. Conclusions: These results suggest the need for a broader definition of health that foments local policy development and impacts such a complex and important issue for the city by taking into account these diseases.

Déficit de carnitina palmitoil transferasa II: peculiaridades en su diagnóstico / Rhabdomyolysis due to carnitine palmitoyl transferase II deficiency

Introducción: El déficit de carnitina palmitoil transferasa II (CPT-II) es la miopatía metabólica más frecuente causante de crisis recurrentes de rabdomiólisis en la infancia, especialmente después del ejercicio. Caso clínico: Niño de 13 años que consulta por dolor muscular y orinas oscuras tras haber realizado ejercicio físico intenso. Como antecedentes personales destaca un episodio hace un año de similares características. Los hallazgos analíticos más relevantes fueron: CPK 283.400 UI/L [38-190], AST 4.178 UI/L [5-35], ALT 768 UI/L [5-26], LDH 4.100 UI/L [135-225] y mioglobinuria 17.446 µg/24 horas, con resto de parámetros analíticos dentro de la normalidad. Se realiza estudio metabólico en sangre y orina incluyendo: ácidos orgánicos, carnitina, acilcarnitinas, piruvato y lactato sin hallazgos patológicos. Ante la alta sospecha clínica y a pesar de la normalidad del estudio metabólico, se solicita estudio del gen de la CPT-II, encontrando la mutación c338C>T en homocigosis en dicho gen, lo cual confirma el diagnóstico. Conclusiones: El déficit de CPT-II es la causa más frecuente de rabdomiólisis recurrente en la infancia dentro de las miopatías metabólicas. Para su diagnóstico es fundamental una alta sospecha clínica. Los estudios que confirman el diagnóstico son el análisis genético o la medición de la actividad enzimática en músculo, a pesar de un estudio metabólico normal. Las medidas higiénico-dietéticas, evitando los periodos de ayuno y siguiendo una dieta rica en hidratos de carbono de absorción lenta permiten a estos niños llevar a cabo una vida normal

Introduction: Carnitine palmitoyl transferase II deficiency (CPT-II) is the most common inherited cause of recurrent episodes of rhabdomyolysis in childhood, especially after exertion. Case report: 13 year-old child with dark urine and myalgia after prolonged exercise. His medical history included a similar event a year ago. The main laboratory findings were: CPK 283,400 IU / L [38-190], AST 4,178 IU / L [5-35], ALT 768 IU / L. [5-26], LDH 4100 IU / L [135-225] and myoglobinuria 17,446 µg / 24 hours. Metabolic study in plasma and urine was performed including: organic acids, carnitine, acylcarnitines, pyruvate and lactate without abnormal findings. Given the high clinical suspicion and despite normal metabolic study, study of gene CPT-II is requested showing c338C>T homozygous mutation which confirms the diagnosis. Conclusions: CPT-II deficiency is the most common cause of recurrent episodes of rhabdomyolysis in childhood. High clinical suspicion is the main factor in the diagnostic process. Genetic analysis or enzyme activity measurement in muscle will confirm the diagnosis despite normal metabolic studies in plasma and urine. Treatment consists of nutritional modifications including avoidance of fasting and a high slow burning carbohydrates diet

Mesenchymal stromal-cell transplants induce oligodendrocyte progenitor migration and remyelination in a chronic demyelination model.

Demyelinating disorders such as leukodystrophies and multiple sclerosis are neurodegenerative diseases characterized by the progressive loss of myelin that may lead toward a chronic demyelination of the brain's white matter, impairing normal axonal conduction velocity and ultimately causing neurodegeneration. Current treatments modifying the pathological mechanisms are capable of ameliorating the disease; however, frequently, these therapies are not sufficient to repress the progressive demyelination into a chronic condition and permanent loss of function. To this end, we analyzed the effect that bone marrow-derived mesenchymal stromal cell (BM-MSC) grafts exert in a chronically demyelinated mouse brain. As a result, oligodendrocyte progenitors were recruited surrounding the graft due to the expression of various trophic signals by the grafted MSCs. Although there was no significant reaction in the non-grafted side, in the grafted regions oligodendrocyte progenitors were detected. These progenitors were derived from the nearby tissue as well as from the neurogenic niches, including the subependymal zone and dentate gyrus. Once near the graft site, the cells matured to myelinating oligodendrocytes. Finally, electrophysiological studies demonstrated that axonal conduction velocity was significantly increased in the grafted side of the fimbria. In conclusion, we demonstrate here that in chronic demyelinated white matter, BM-MSC transplantation activates oligodendrocyte progenitors and induces remyelination in the tissue surrounding the stem cell graft.

Polarity and timing-dependent effects of transcranial direct current stimulation in explicit motor learning.

Transcranial direct current stimulation (tDCS) is attracting increasing interest as a therapeutic tool for neurorehabilitation, particularly after stroke, because of its potential to modulate local excitability and therefore promote functional plasticity. Previous studies suggest that timing is important in determining the behavioural effects of brain stimulation. Regulatory metaplastic mechanisms exist to modulate the effects of a stimulation intervention in a manner dependent on prior cortical excitability, thereby preventing destabilization of existing cortical networks. The importance of such timing dependence has not yet been fully explored for tDCS. Here, we describe the results of a series of behavioural experiments in healthy controls to determine the importance of the relative timing of tDCS for motor performance. Application of tDCS during an explicit sequence-learning task led to modulation of behaviour in a polarity specific manner: relative to sham stimulation, anodal tDCS was associated with faster learning and cathodal tDCS with slower learning. Application of tDCS prior to performance of the sequence-learning task led to slower learning after both anodal and cathodal tDCS. By contrast, regardless of the polarity of stimulation, tDCS had no significant effect on performance of a simple reaction time task. These results are consistent with the idea that anodal tDCS interacts with subsequent motor learning in a metaplastic manner and suggest that anodal stimulation modulates cortical excitability in a manner similar to motor learning.