Role of Mitochondria in Inflammatory Bowel Diseases: A Systematic Review.

Mitochondria are key cellular organelles whose main function is maintaining cell bioenergetics by producing ATP through oxidative phosphorylation. However, mitochondria are involved in a much higher number of cellular processes. Mitochondria are the home of key metabolic pathways like the tricarboxylic acid cycle and ß-oxidation of fatty acids, as well as biosynthetic pathways of key products like nucleotides and amino acids, the control of the redox balance of the cell and detoxifying the cell from H2S and NH3. This plethora of critical functions within the cell is the reason mitochondrial function is involved in several complex disorders (apart from pure mitochondrial disorders), among them inflammatory bowel diseases (IBD). IBD are a group of chronic, inflammatory disorders of the gut, mainly composed of ulcerative colitis and Crohn's disease. In this review, we present the current knowledge regarding the impact of mitochondrial dysfunction in the context of IBD. The role of mitochondria in both intestinal mucosa and immune cell populations are discussed, as well as the role of mitochondrial function in mechanisms like mucosal repair, the microbiota- and brain-gut axes and the development of colitis-associated colorectal cancer.

Mitochondrial Stress Links Environmental Triggers with Pro-Inflammatory Signaling in Crohn's Disease.

Inflammatory Bowel Diseases (IBD) are a group of chronic, inflammatory disorders of the gut. The incidence and activity of IBD are determined by both genetic and environmental factors. Among these factors, polymorphisms in genes related to autophagy and the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) have been consistently associated with IBD. We show that NSAIDs induce mitochondrial stress and mitophagy in intestinal epithelial cells. In an altered mitophagy context simulating that observed in IBD patients, NSAID-induced mitochondrial stress leads to the release of mitochondrial components, which act as Danger Associated Molecular Patterns with pro-inflammatory potential. Furthermore, colonic organoids from Crohn's disease patients and healthy donors show activation of the mitochondrial Unfolded Protein Response (UPRmt) upon treatment with ibuprofen. Finally, colon biopsies from Crohn's disease patients in remission or with low-to-moderate activity also show expression of genes involved in UPRmt, while patients with severe activity show no increase compared to healthy donors. Our results suggest the involvement of mitochondria in the mechanisms triggering inflammation in IBD after NSAID use. Moreover, our results highlight the clinical relevance of mitochondrial stress and activation of the UPRmt pathway in the pathophysiology of Crohn's disease.

First account of microplastics in pelagic sporting dolphinfish from the eastern Mexican coast of Baja California Sur.

This study is a baseline data on the presence of MPs from the gastro-intestinal tracts (GITs) in Coryphaena hippurus Linnaeus, from eastern Baja California Sur, México. 878 MPs items (in %) of fibers (29%), fragments (68%) and films (1.3%) were detected from 51 GITs of Coryphaena hippurus. Transparent, white, blue and black were the prevalent colours. Morphological features observed through SEM analysis, the presence of heavily weathered MPs is due to the mechanical, microbiological and chemical weathering process. PP (29%), Nylon (29%), PS (17%), PE (11%), PET (6%) and HDPE (8%) presence indicates their source from regional anthropogenic stress. Trophic level transition is enforced by polymer derivative, permitting the sinking behavior of MPs and increased ingestion probability. Fishes were classified as slim despite their higher feeding capabilities and ingested MPs indicates a relationship with environmental contaminants. Current study emphasizes the health risk linked to biological aspects of MPs ingestion.

Inferring pollution records in sediment cores from transitional environments of Marquelia coast, Guerrero, Mexico.

The vertical distribution pattern and concentrations of elements (Fe, Al, Ca, Mg, Mn, Cr, Cu, Ni, Co, Pb, Zn, and As) in the estuarine and lagoon region of Marquelia coast, Guerrero, Mexico, were studied to comprehend the origin and pollutant phases of geochemical elements. Henceforth, two sediment core samples [C1 (127 cm) and C2 (110 cm)] were collected to assess the pollution status using geochemical indices, namely anthropogenic factor (AF), enrichment factor (EF), and geoaccumulation index (Igeo). Additionally, the elemental concentrations were compared with the sediment quality guidelines (SQGs) to examine the potential risks to biota. Among the two depositional environments, the sediments of lagoon Apozahualco exhibited higher concentrations of elements. The granulometry characteristics of sediment grains also attested that the concentration and mobilization of metals are largely governed by the fine-grained fractions. Major elemental concentration and grain size changes were identified at several depths (30-40, 60-70, and 90-100 cm) revealing the internal hydrodynamic condition. The overall assessment of geochemical indices revealed that the sediments were unpolluted to moderately polluted. The anthropogenic factor indicated that the upper portion of the sediments were affected by anthropogenic influences. The comparison of trace element concentration with SQGs denoted that Cr, Ni, and As could pose potential adverse effect to the organisms that live in and near the sedimentary environment. Factor analysis revealed the origin and behaviour of the studied elements during transportation and deposition processes in both the ecosystems (i.e. estuary and lagoon). The results of this study provided an in-depth understanding of variations in elemental concentration and pollution status of sediment profile in coastal transitional environments that would aid in sustainable management.

Seasonal tendencies of microplastics around coral reefs in selected Marine Protected National Parks of Gulf of California, Mexico.

This study focuses on the presence of MPs in the sediment beds around coral reefs of MPNPs in Baja California Sur, México. Based on seasonal sampling results, comparison of MPs from Cabo Pulmo (avg. 680.25 items/100 g-1 d.w) recorded higher values than Espiritu Santo Island (avg. 321.75 items/100 g-1 d.w) from backshore/foreshore regions. Fibrous MPs are the dominant morphotypes followed by fragments and spheres. SEM/EDS analysis revealed that the MPs are altered texturally in surface and is bioavailable to marine organisms independent of size/shape. FTIR analysis indicate different polymers (in %) in the form of PP (70), PET (65), HDPE (59), LDPE (50), PS (30), PC (18), PU (10) and RYN (10). Most of the MPs are secondary in origin resulting from man-made and tourist's activities controlled by wave transportation and tidal currents. Existence of MPs in sediment beds around the coral reefs signals the ways for future investigations.

Influence of age on molecular characteristics and rheological behavior of nopal mucilage.

Nopal mucilages are of interest due to a variety of potential applications, which include their use as thickeners and rheological modifiers. In this work, changes in molecular characteristics of nopal mucilages with their age and its influence on the rheological behavior of their solutions were analyzed by light scattering, high performance liquid chromatography, a colorimetric method, and linear viscoelastic rheometrical measurements. For this, mucilages obtained from cladodes from Opuntia ficus-indica with different ages, namely 20, 80, and 600 days, respectively, were extracted using water as solvent and then subjected to freeze-drying. The weight-average molecular weight (M w) of the mucilages was found to increase along with the age; meanwhile, the concentration of uronic acids increased and the galactose, rhamnose, and xylose contents decreased. Increasing M w with age resulted in enhanced viscoelastic behavior of solutions, namely, higher viscosity and elasticity at lower mucilage concentrations. Also, along with increasing M w, decrease in neutral sugar contents and increase of pectic compounds (uronic acids) and Ca+ cations in mucilages with age promoted formation of weak gels. Overall, the molecular weights and rheological behaviors reported in this work for nopal mucilages are comparable to those of widely used thickeners such as xanthan and guar gums, which suggest their use in similar applications regarding its age.

Seasonal evidences of microplastics in environmental matrices of a tourist dominated urban estuary in Gulf of Mexico, Mexico.

The study evaluated the spatial and seasonal variations of microplastic abundances in water, sediments, and commercial fishes of a semi-urban tourist impacted estuary in the Gulf of Mexico, Mexico. The prevalence of microplastics (MPs) elucidated diffuse sources namely long-range transport, domestic, agricultural, fishing, industrial and recreational activities and the local climatic conditions. Seasonally, the mean abundances of MPs in both water and sediments were high during Nortes (strong winds) followed by the dry and rainy seasons. Overall, black and blue colored MPs dominated the region and all the recovered plastics were fibers. The commercial fishes (n = 187) contained 881 MPs in their gastrointestinal tracts, suggesting that the food web of the estuary is highly prone to microplastic contamination. SEM images of extracted plastic fibers presented surface morphologies that are impacted by physical strains. Further, the elemental characterization of fibers using EDX displayed significant peaks of Al, As, Cl, Cr, Cu, Pb, and Zn that were used as additives during the production of plastics. The main types of polymers included low-density polyethylene, polyester, polypropylene, polycarbonate, rayon, polyvinyl chloride, polyacrylonitrile, polyamide, nylon and polyethylene terephthalate. MP abundances demonstrated in this study elucidate that estuaries are a major conduit for land-derived plastics to the ocean and the results will aid in implementing remedial/clean up actions of the estuary for better conservation of the ecosystem.

Occurrence, distribution and provenance of micro plastics: A large scale quantitative analysis of beach sediments from southeastern coast of South Africa.

Microplastics (MPs) existence, identification and source were investigated by studying a total of 2539 particles in 349 sediment samples from nine different tourist beaches [(Sodwana & Richard Bays; Ballito, Mtunzini, Tugela, Zinkwazi, Ballito (north & south) and Durban north & south)] of southeastern coast of South Africa. They are more abundant in the beaches of the Durban city, followed by the Sodwana & Richards Bays, Ballito and Mtunzini. The black particles prevailed over the blue, white, pink, brown, red and green MPs. Supremacy of MPs in the Durban city is mainly due to the longshore coastal Agulhas current in the South eastern side of African coast aiding the degradation of primary plastics coming both from continent and sea. SEM images provided the evidences of weathering/degrading process through grooves, cracks, deep fissures, sharp edges and layered degradation showing signs of oxidation due to long term exposure in the coastal environment. EDS results suggested presence of elements (i.e. C, -O, Si, Al, Fe, Ca, Mg, Na, K, S, Ti, Cu and Zn introduced during the production of plastics as additives. FTIR spectral matches identified from all samples infer polypropylene (PP) (62%), rayon (RY) (17.2%), polycarbonate (PC) (29.8%), nylon (NY) (18.92%), polyester (PES) (31.2%), polyacrylonitrile (PAN) (11.21%) and polystyrene (PS) as well as low (28.9%) & high (36.1%) polyethylene terephthalate (PET). Higher abundance of MPs in the beaches of South Africa in comparison with studies around the world emphasizes the need of dispersal monitoring and use of plastic materials/polymers.

Clinical impact of clonal hematopoiesis in patients with lymphoma undergoing ASCT: a national population-based cohort study.

Clonal hematopoiesis of indeterminate potential (CHIP) is suspected of being a risk factor for patients with cancer. This study aimed to assess the clinical consequences of CHIP in patients with lymphoma intended for high-dose chemotherapy and autologous stem-cell transplantation (ASCT) in a population-based setting. We identified 892 lymphoma patients who had undergone stem cell harvest at all transplant centers in Denmark. A total of 565 patients had an available harvest sample, which was analysed for CHIP by next-generation sequencing, and the median follow-up was 9.1 years. Of the patients who were intended for immediate ASCT, 25.5% (112/440) carried at least one CHIP mutation. In contrast to previous single-center studies CHIP was not associated with inferior overall survival (OS) in multivariate analyses. However, patients with mutations in genes of the DNA repair pathway (PPM1D, TP53, RAD21, BRCC3) had a significant inferior OS (HR after 1 year of follow-up 2.79, 95% confidence interval 1.71-4.56; p < 0.0001), which also was evident in multivariate analysis (p = 0.00067). These patients had also increased rates of therapy-related leukemia and admission to intensive care. Furthermore, in patients who did not undergo immediate ASCT, a significant inferior OS of individuals with DNA repair mutations was also identified (p = 0.003).

Mechanical and Thermal Behavior of Canola Protein Isolate Films As Improved by Cellulose Nanocrystals.

The effects of cellulose nanocrystals (CNCs) (12, 24, and 36% w/w) on the microstructure and mechanical and thermal properties of canola protein isolate films were evaluated. The incorporation of cellulose nanocrystals led to homogeneous films, and new Fourier transform infrared peaks appeared at 1055 cm-1, indicating the presence and the interaction of CNCs with proteins and glycerol. The addition of CNCs also improved the thermal stability of the films, since higher temperatures were required for their thermal decomposition. In addition, CNC addition resulted in an increase in tensile strength and a decrease in elongation at break values due to strong interactions between the OH groups in proteins, glycerol, and CNCs.

Heavy metals in the volcanic and peri-urban terrain watershed of the River Yautepec, Mexico.

Thirty-four water samples were collected all along the course of River Yautepec, Morelos State, Central Mexico, in three different zones based on the physical and anthropogenic setting. In situ measurements of physical characteristics (temperature, pH, conductivity, and turbidity) were also performed at each sampling station. Likewise, total/dissolved metal concentrations (Fe, Mn, Cr, Cu, Ni, Pb, Zn, Cd, As, and Pb) were determined using an atomic absorption spectrophotometer. Located in a peri-urban and volcanic zone of Central Mexico, the river system presented impacts of both natural and anthropogenic activities. Results revealed differences in pH values (6.7-8.23) in all the three zones probably due to the influences of volcanic ash and local geological formations, whereas conductivity levels (635-1098 µs/cm) were high indicating the effect of agricultural and industrial activities. The relative order of the concentrations of metals in both the total and dissolved fractions was observed to be in the following order: zone I, Fe > Zn > Mn > Cu > Pb > Ni > Cr > As > Cd > Hg; zone II, Fe > Zn > Pb > Ni > Mn > Cu > Cr > Cd > As > Hg; zone III, Fe > Pb > Zn > Mn > Ni > Cu > As > Cd > Cr > Hg. Calculated heavy metal evaluation index (HEI) values indicated less contamination. However, concentrations of Fe and Pb were observed to be higher than the permissible limits set forth by the Mexican government for human consumption. Henceforth, the prerequisite for maintaining and improving the health of a river system depends on continuous long-term monitoring of the dynamic ecosystem for sustainable management.

Microplastics in freshwater sediments of Atoyac River basin, Puebla City, Mexico.

Microplastics (MPs) are contaminants of emerging concern in aquatic environments. The abundance, distribution and characteristics (color, morphology, texture) of MPs from Atoyac River basin, a highly urbanized river system located in Central Mexico were investigated in this study. The sediment samples were collected from 29 different sites along the Atoyac River basin in four different zones: Zahuapan River, Atoyac River, Confluence zone and Valsequillo dam and processed for MPs extraction using ZnCl2 density separation method. The total number of MPs in Zahuapan River, Atoyac River, Confluence zone and Valsequillo dam was 1633.34 ±â€¯202.56, 1133.33 ±â€¯72.76, 833.33 ±â€¯80.79 and 900 ±â€¯346.12 items kg-1 respectively. It was found that the concentration of MPs is higher in the downstream section of the river (confluence zone: 833.33 ±â€¯80.79 & Valsequillo dam: 900 ±â€¯346.12 items kg-1), revealing significant impacts of dense population and industrial complex of Puebla City. Colored MPs were predominant accounting for 51% and white MPs for 49% of the total MPs. Films (25.9%) and fragments (22.2%) were the most abundant type followed by fibers (14.8%). Scanning electron microscope images revealed varying disintegration features and energy-dispersive X-ray spectra demonstrated the presence of different metal elements on the surface of MPs. The results highlighted the widespread distribution of MPs in the sediments of Atoyac River basin, Mexico.

Androgen receptor gene polymorphisms and maximal fat oxidation in healthy men. A longitudinal study.

INTRODUCTION: Androgens play a major role in fat oxidation; however, the effects of androgens depend, among other factors, on the intrinsic characteristics of the androgen receptor (AR). Lower repetitions of CAG and GGN polymorphism appear to have a protective effect on fat accumulation in the transition from adolescent to mid-twenties. Whether a similar protective effect is present later in life remains unknown. The aims of this study were: a) to evaluate if extreme CAG and GGN repeat polymorphisms of the androgen receptors influence body fat mass, its regional distribution, resting metabolic rate (RMR), maximal fat oxidation capacity (MFO) and serum leptin, free testosterone and osteocalcin in healthy adult men; and b) to determine the longitudinal effects on fat tissue accumulation after 6.4 years of follow-up. METHODS: CAG and GGN repeats length were measured in 319 healthy men (mean ± standard deviation [SD]: 28.3 ± 7.6 years). From these, we selected the subjects with extreme short (CAGS < or equal 19; n = 7) and long (CAGL > or equal 24; n = 10) CAG repeats, and the subjects with short (GGNS < or equal to 22; n = 9) and long (GGNL > or equal to 25; n = 10) GGN repeats. Body composition was assessed by DXA and serum levels of leptin, free testosterone and osteocalcin by ELISA. After 6.4 years of follow-up, DXA was repeated, and resting metabolic rate (RMR), MFO and VO2max determined by indirect calorimetry. RESULTS: CAGS and CAGL subjects had similar RMR and accumulated comparable amounts of fat tissue over 6.4 ± 1.0 years of follow-up. However, CAGL had higher MFO and total lean mass than CAGS (p < 0.05). Men with GGNS accumulated greater amount of total fat mass than men with GGNL, particularly in the trunk region seven years later. This concurred with a greater MFO in the GGNL group (p < 0.05), who accumulated less fat mass. Free testosterone was associated with MFO in absolute values (r = 0.45; p < 0.05) and MFO per kg of lower extremity lean mass per height squared (r = 0.35; p < 0.05). CONCLUSIONES: CAG and GGN repeat polymorphisms may influence muscle fat oxidation capacity and may have a role in the accumulation of fat over the years.

Androgen receptor gene polymorphisms and maximal fat oxidation in healthy men. A longitudinal study / Polimorfismo del gen del receptor de andrógenos y oxidación máxima de grasa en hombres sanos. Estudio longitudinal

Introduction: Androgens play a major role in fat oxidation; however, the effects of androgens depend, among other factors, on the intrinsic characteristics of the androgen receptor (AR). Lower repetitions of CAG and GGN polymorphism appear to have a protective effect on fat accumulation in the transition from adolescent to mid-twenties. Whether a similar protective effect is present later in life remains unknown. The aims of this study were: a) to evaluate if extreme CAG and GGN repeat polymorphisms of the androgen receptors influence body fat mass, its regional distribution, resting metabolic rate (RMR), maximal fat oxidation capacity (MFO) and serum leptin, free testosterone and osteocalcin in healthy adult men; and b) to determine the longitudinal effects on fat tissue accumulation after 6.4 years of follow-up. Methods: CAG and GGN repeats length were measured in 319 healthy men (mean ± standard deviation [SD]: 28.3 ± 7.6 years). From these, we selected the subjects with extreme short (CAGS ≤ 19; n = 7) and long (CAGL ≥ 24; n = 10) CAG repeats, and the subjects with short (GGNS ≤ 22; n = 9) and long (GGNL ≥ 25; n = 10) GGN repeats. Body composition was assessed by DXA and serum levels of leptin, free testosterone and osteocalcin by ELISA. After 6.4 years of follow-up, DXA was repeated, and resting metabolic rate (RMR), MFO and VO2max determined by indirect calorimetry. Results: CAGS and CAGL subjects had similar RMR and accumulated comparable amounts of fat tissue over 6.4 ± 1.0 years of follow-up. However, CAGL had higher MFO and total lean mass than CAGS (p < 0.05). Men with GGNS accumulated greater amount of total fat mass than men with GGNL, particularly in the trunk region seven years later. This concurred with a greater MFO in the GGNL group (p < 0.05), who accumulated less fat mass. Free testosterone was associated with MFO in absolute values (r = 0.45; p < 0.05) and MFO per kg of lower extremity lean mass per height squared (r = 0.35; p < 0.05). Conclusions: CAG and GGN repeat polymorphisms may influence muscle fat oxidation capacity and may have a role in the accumulation of fat over the years (AU)

Introducción: los andrógenos juegan un papel importante en la oxidación de grasas; sin embargo, el efecto de los andrógenos depende, entre otros factores, de las características intrínsecas del receptor de andrógenos (RA). Un menor número de repeticiones CAG y GGN del RA parecen tener un efecto protector sobre la acumulación de grasa en la transición de la adolescencia hasta la veintena. Se desconoce si adelante en la vida persiste un efecto protector similar. Los objetivos de este estudio fueron: a) evaluar si repeticiones extremas de los polimorfismos CAG y GGN del RA influyen sobre la masa grasa corporal, su distribución regional, la tasa metabólica en reposo (RMR), la máxima oxidación de grasas (MFO) y la concentración sérica de leptina, testosterona libre y osteocalcina en hombres sanos; y b) determinar los efectos longitudinales sobre la acumulación de grasa después de 6.4 años de seguimiento. Métodos: la longitud de las repeticiones de CAG y GGN fueron medidas en 319 hombres sanos (media ± desviación estándar [SD]: 28,3 ± 7,6 años). De estos, seleccionamos los sujetos con repeticiones del CAG extremas cortas (CAGS ≤ 19; n = 7) y largas (CAGL ≥ 24; n = 10), y los sujetos con repeticiones del GGN extremas cortas (GGNS ≤ 22; n = 9) y largas (GGNL ≥ 25; n = 10). Se evaluaron la composición corporal mediante DXA y los niveles séricos de leptina, testosterona libre y osteocalcina por ELISA. Tras 6.4 años de seguimiento el DXA fue repetido, y la tasa metabólica en reposo (RMR), máxima oxidación de grasas (MFO) y VO2max fueron determinados mediante calorimetría indirecta. Resultados: los grupos CAGS y CAGL fueron comparables en RMR y cantidad de tejido graso tras 6,4 ± 1,0 años de seguimiento. Sin embargo, el grupo CAGL tuvo mayor MFO y masa libre de grasa que el grupo CAGS (p < 0,05). Los hombres con GGNS acumularon mayor cantidad de masa grasa total que los hombres con GGNL, particularmente en la región del tronco siete años después. Esto concordó con un mayor MFO en el grupo GGNL (p < 0,05), que acumuló menos masa grasa. La testosterona libre se asoció con el MFO en valores absolutos (r = 0,45; p < 0,05) y con MFO expresado por kg de masa libre de grasa de las piernas al cuadrado (r = 0,35; p < 0,05). Conclusiones: las repeticiones del polimorfismo del CAG y GGN pueden influenciar la capacidad muscular de oxidación de grasas y pueden tener un rol en la acumulación de grasa con los años (AU)

Androgen receptor CAG and GGN repeat polymorphisms influence performance in boys and girls.

BACKGROUND: Shorter CAG and GGN androgen receptor (AR) repeat polymorphisms are associated with stronger androgen signaling, and therefore, could influence lean mass and exercise performance during growth. METHODS: Physical fitness and body composition were measured by standardized procedures and the length of CAG and GGN repeats was determined by PCR and fragment analysis in 152 boys (11.5±2.6 years; Tanner ≤5) and 116 girls (10.1±3.2 years; Tanner ≤5). Individuals were grouped as CAG short (CAGS) if harboring repeat lengths of ≤21 and CAG long (CAGL) if CAG >21. Moreover, subjects were grouped as GGN short (GGNS) if harboring repeat lengths of ≤23 and GGN long (GGNL) if GGN>23. RESULTS: No significant differences in anthropometrics and body composition were observed between either CAGS and CAGL groups and GGNS and GGNL groups. Boys harboring CAGS completed the 300-meter test faster than their CAGL counterparts. Moreover, girls from the GGNL group showed a significant higher VO2max than those in the GGNS group. CONCLUSIONS: In summary, carrying a short allele of the androgen receptor CAG repeat polymorphism is associated to higher anaerobic performance in boys, whereas long alleles of androgen receptor GGN polymorphisms are associated to higher aerobic capacity in girls.

Estudio comparativo de la escala Palliative Prognostic Score y la estimación de los médicos en la supervivencia de la enfermedad oncológica terminal / Comparative study between the Palliative Prognosis Score and the survival of terminal cancer patients estimated by the physicians

OBJETIVO: Valorar la experiencia en la práctica diaria de la escala Palliative Prognostic Score (PaP score) como predictora de supervivencia en enfermos oncológicos terminales y compararla con la impresión clínica de supervivencia de los pacientes por parte de los médicos.comparamos también con la supervivencia real de los pacientes y analizamos los datos que la escala nos aporta. Se analizaron también las características del grupo de pacientes estudiado. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo prospectivo de 100 pacientes consecutivos oncológicos en situación terminal que ingresaron en una unidad de hospitalización específica en cuidados paliativos. Se aplicó la escala PaP score en el momento del ingreso, medida por 2 médicos de la unidad con al menos 15 años de experiencia en este tipo de pacientes. Esta escala valora 6 variables de las que se consigue una puntuación que clasifica a los pacientes en 3 grupos distintos de probabilidad de supervivencia a un mes. Una de estas 6 variables fue la estimación de supervivencia del médico, que se analizó de forma independiente y se comparó con las predicciones de la escala. El programa que se empleó en la tabulación y análisis de datos fue la hoja de cálculo y programa estadístico IBM-SPSS versión 18. Se analizaron las medianas de supervivencia para cada estrato establecido por la escala PaP scorejunto a las supervivencias reales y predichas por los médicos, comparando ambas y calculando por regresión lineal el coeficiente de correlación de Spearman. No se compararon las diferencias en los promedios de valoración de los 2 médicos ya que este no fue el motivo del estudio. RESULTADOS: De los 100 pacientes analizados la escala nos clasificó 3 grupos probabilísticos de supervivencia; se analizó en cada grupo el porcentaje de cumplimiento de la escala. Grupo A con probabilidad alta de sobrevivir al mes, con un total de 13 pacientes y donde solo sobrevivieron el 53,8% de los casos. Grupo B con probabilidad intermedia de sobrevivir al mes, con un total de 32 pacientes donde el 90% de ellos no sobrevivieron al mes. Grupo C con probabilidad baja de sobrevivir al mes, con un total de 55 pacientes donde el 96,4% de los casos no sobrevivieron. Se compararon las medianas de supervivencia: estimadas por la escala (SE), estimadas por el médico (SM) las supervivencias reales de los pacientes (SR). En el grupo A con una SE de 33 días, la SR fue de 31,69 días y la SM fue de 79,48 días; en el grupo B con una SE de 13,5 días, la SR fue de 17,53 días y la SM fue de 48,36 días; y en el grupo C con una SE de 7 días, la SR fue de 10,36 días y la SM fue de 21,7 días. En el grupo A el médico sobrestima 2,5 veces por encima de la supervivencia real; en el grupo B sobrestima 2,75 y en el C, 2,09. El coeficiente de correlación de Spearman entre supervivencias reales y predichas por los médicos fue de 0,64, lo que indica una buena correlación, aunque con tendencia a sobrestimar. CONCLUSIONES: La escala PaP score cumplió aceptablemente las predicciones en los 3 grupos clasificados por la escala. La estimación de la supervivencia realizada por un médico experimentado tiene una aceptable correlación cuando se compara con la supervivencia real, aunque con tendencia a sobrestimar y las predicciones del médico son más acertadas cuanto peor es el pronóstico del paciente

OBJECTIVE: To examine the experience in the routine use of the Palliative Prognostic Score (PaP score) as a predictor of survival in terminal cancer patients and to compare it with the estimation of the patients' survival made by doctors, as well as comparing this with the actual survival of the PATIENTS: The survival data provided by the scale are also analyzed, together with the specific characteristics of the studied group. METHODS: A prospective study was conducted on 100 consecutive patients with advanced terminal cancer admitted to a Hospital Palliative Care Unit. The PaP score was applied by 2 physicians, with at least 15 years experience, when the patients were admitted. This scale assesses 6 variables that give a score that classifies patients into 3 different probabilistic groups of survival at one month. One of these 6 variables was the physician's estimation, which was analyzed and compared with the predictions of the scale. The data were collected in a database and analyzed using IBM-SPSS version 18. Medians of survival were analyzed for each group established by the PaP score, and were compared with the actual and physician's predictions. The Spearman correlation coefficient between survivals was calculated by linear regression. The differences between the evaluations made by the 2 doctors were not compared as this was not the reason for the study. RESULTS: Of the 100 patients analyzed, the scale distinguished 3 different probabilistic groups of survival, analyzing the percentage of compliance to the scale: Group A; high probability of surviving one month, with a total number of 13 PATIENTS: In this group only 53.8% of cases survived. Group B; intermediate probability of surviving one month, with a total number of 32 patients, where the 90% of patients did not survive for one month. Group C; with low probability of surviving one month, with a total number of 55 patients, where the 96.4% of the cases did not survive for one month. The median survival, estimated by the scale (SE), estimated by the physician (SM), and the actual survival of patients (SR) was calculated. In group A, with a SE of 33 days, the SR was 31.69 days, and SM was 79.48 days; in group B with a SE of 13.5 days, the SR was 17.53 days and the SM was 48.36 days, and in group C with a SE of 7 days, the SR was 10.36 days with an SM of 21.7 days. In group A, the doctors overestimated 2.5 times above the actual survival, while in group B and C it was overestimated 2.75 and 2.09 times, respectively. The Spearman correlation coefficient between the actual and predicted survival by physicians was 0.64, indicating a good correlation, although with a tendency to overestimate. CONCLUSIONS: PaP score scale predictions were acceptably fulfilled in all 3 groups classified by the scale. The survival estimated by an experienced physician had an acceptable correlation when compared with actual survival, although with a tendency to overestimate. When the prognosis was worse, the physician predictions were better

Incidence of and risk factors for femoral fractures in the gap between hip and knee implants.

PURPOSE: The purpose of this study was to analyse the incidence of interprosthetic femoral fractures and describe risk factors for them. METHODS: Between 2009 and 2015, we selected patients who were carrying two implants (hip and knee) in the same femur. We collected demographic and clinical data and performed a radiological evaluation to analyse the gap between implants-the femoral canal area and total femoral area-in the axial plane. We defined interprosthetic fracture as that corresponding to a Vancouver type C fracture and types 1 and 2 according to the Su classification. RESULTS: We studied 68 patients who had total knee arthroplasty (TKA), and 44 patients who had total hip arthroplasty (THA); 24 patients an intramedullary nail. We found six interprosthetic fractures (8.8 %), all in patients with a non-cemented THA. There was a tendency towards statistical difference (p = 0.08). Patients with an additional implant at the proximal femur were statistically less likely to have an interprosthetic fracture (p = 0.04). In radiological results, we found more interprosthetic fractures in patients who had an increased femoral canal area in the axial plane just distal to the tip of the hip implant. CONCLUSIONS: Identifying risk factors for this specific type of fracture may facilitate their prevention. Better implant stability and the presence of a gap between stems in a lower canal zone appear to hinder the occurrence of interprosthetic fractures.