[Publications on spine surgery in Mexico: a bibliometric study]. / Estudio bibliométrico de las publicaciones en cirugía de columna en México.

INTRODUCTION: bibliometric analysis is a useful way of assessing the past, present and future publications related to a given area in a qualitative and quantitative way. OBJECTIVE: to determine characteristics of national authors productivity in the field of spine surgery research across the time. MATERIAL AND METHODS: an online research was performed using the Elsevier´s database Scopus in October, 2021. All studies were assessed for the following parameters: year, title, access, language, journal, type of article, focus of research, objective of research, cites, authors and institutions. RESULTS: a total of 404 publications were identified between 1973 and 2021. Between 1991-2000 decade to 2011-2021 decade the number of published articles tended to increase by 68.28 times. The largest number of articles was from South-Central Region (66.16%), followed by Western (15.03%) and Northwest (8.27%). The highest h-index was found for USA journals (102). The highest number of articles was published in Coluna/Columna (15.53%), followed by Cirugía y Cirujanos (10.52%) and Acta Ortopédica Mexicana (8.52%). Instituto Nacional de Rehabilitación published the largest number of articles (17.57%), followed by Centro Médico Nacional de Occidente del IMSS (6.67%) and Centro Médico ABC (5.44%). CONCLUSIONS: the number of articles published in the field of spine surgery in Mexico has increased rapidly in the past 15 years. In terms of quality, publications written in English are the most cited. The geographical distribution of research in Mexico is centralized, the largest number of publications was from South-Central Region of Mexico.

INTRODUCCIÓN: el análisis bi­bliométrico es una forma útil de evaluar el pasado, el pre­sente y el futuro de las publicaciones relacionadas con un área determinada de forma cualitativa y cuantitativa. OBJETIVO: determinar las características de la productividad nacional en investigación escrita por autores mexicanos en el campo de cirugía de columna a través del tiempo. MATERIAL Y MÉTODOS: se realizó una búsqueda exhaustiva en línea en Octubre de 2021 utilizando la base de datos Scopus desarrollada por Elsevier. La información de las publicaciones recolectadas fue la siguiente: año, título, acceso, idioma, revista, tipo de artículo, tema, objetivo, citas, autores e instituciones de afiliación. RESULTADOS: se identificó un total de 404 publicaciones entre 1973 y 2021. El número de publicaciones entre la década 1991-2000 y 2011-2021 incrementó 68.28 veces. La mayoría de las publicaciones se realizaron en instituciones de la región centro-sur de México (66.16%), seguida de la región occidente (15.03%) y noreste (8.27%). El índice H más alto encontrado fue de revistas de origen estadounidense (102). La mayor parte de las publicaciones se realizó en la revista Coluna/Columna (15.53%), seguida de Cirugía y Cirujanos (10.52%) y de Acta Ortopédica Mexicana (8.52%). La institución con la más alta productividad fue el Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra" (17.57%), seguida del Centro Médico Nacional de Occidente del IMSS (6.67%) y del Centro Médico ABC (5.44%). CONCLUSIONES: el número de artículos publicados en el campo de cirugía de columna ha incrementado rápidamente en los últimos 15 años. Las publicaciones escritas en inglés son las más citadas. La distribución geográfica de la investigación en este campo en México está centralizada, realizándose la mayor parte de las publicaciones en la región centro-sur del país (66.16%).

Vertebral fracture assessment (VFA) for monitoring vertebral reshaping in children and adolescents with osteogenesis imperfecta treated with intravenous neridronate.

PURPOSE: The study was aimed at monitoring vertebral bodies changes with the use of Vertebral Fracture Assessment (VFA) in children and adolescents affected by osteogenesis imperfecta (OI) during treatment with intravenous neridronate. METHODS: 60 children and adolescents (35 males and 25 females; age 1-16 years) with OI type I, III and IV were included in the study. Intravenous neridronate was administered at the dose of 2 mg/kg every 3 months in all patients. Lumbar spine (LS) bone mineral density (BMD) and VFA by dual X-ray absorptiometry (DXA) were assessed every 6 months up to 24 months during treatment. VFA with vertebral morphometry (MXA) was used to calculate the three indices of vertebral deformity: wedging, concavity and crushing. Serum calcium, phosphate, parathyroid hormone (PTH), 25-hydroxy-vitamin D [25(OH)D], total alkaline phosphatase (ALP), bone alkaline phosphatase (BALP) and urinary C-terminal telopeptide of type 1 collagen (CTx) were measured at any time point. RESULTS: Mean LS BMD values significantly increased at 24 months compared to baseline (p < 0.0001); the corresponding Z-score values were -1.28 ± 1.23 at 24 months vs -2.46 ± 1.25 at baseline; corresponding mean Bone Mineral Apparent Density (BMAD) values were 0.335 ± 0.206 vs 0.464 ± 0.216. Mean serum levels of ALP, BALP and CTx significantly decreased from baseline to 24 months. By MXA, we observed a significant 19.1% reduction of the mean wedging index of vertebral reshaping at 12 months, and 38.4% at 24 months (p < 0.0001) and of the mean concavity index (16.3% at 12 months and 35.9% at 24 months; p < 0.0001). Vertebral reshaping was achieved for 66/88 (75%) wedge fractures and 59/70 (84%) concave fractures, but there were 4 incident mild fractures. Finally, VF rate was reduced at 24 months compared to baseline: 37/710 (5.2%) vs 158/710 (22.2%). CONCLUSION: Our study demonstrates the utility of VFA as a safe and alternative methodology in the follow-up of children and adolescents with OI.

Ultrastructure study of skin fibroblasts in patients with Ehlers-Danlos Syndrome (EDS): preliminary results.

AIM OF THE STUDY: To investigate, in vivo and in vitro, the fibroblast-to-myofibroblast transition in patients with hypermobile Ehlers-Danlos Syndrome (EDS). To analyze the dermis of patients with classical form of EDS (cEDS) and with hEDS, to identify qualitative and/or quantitative differences in ECM component and ultrastructural changes in collagen. MATERIALS AND METHODS: Seven subjects, aged over 18, two with cEDS and five with hEDS underwent two skin biopsy. One sample was prepared for transmission electron microscopy (TEM), the other for immunofluorescence. The diameter of collagen fibers was measured with TEM. Fibrils were analyzed in four patients: the two with cEDS and two with hEDS. For each patient, the diameter of n=250 collagen fibrils was measured. αSMA was used as specific marker for myofibroblast to highlight their presence in vivo in the skin of patients with hEDS. RESULT: IF observation could not assess an increased expression of αSMA in hEDS patients, which showed no statistical difference compared to classic form patients. The major result from the analysis of TEM images is the clear difference in ECM composition between the two forms of EDS: ECM in hEDS is optically more dense and more prominently composed of elastic fibers. CONCLUSION: Our study provides the following important evidence: 1) the absence in vivo of dermal fibroblasts in patients with hEDS, demonstrated by αSMA negativity; 2) the presence of statistically significant changes in the diameter of collagen fibrils between the classic and the hypermobile forms.

The geographic mosaic of Ecuadorian Y-chromosome ancestry.

Ecuadorians originated from a complex mixture of Native American indigenous people with Europeans and Africans. We analyzed Y-chromosome STRs (Y-STRs) in a sample of 415 Ecuadorians (145 using the AmpFlSTR® Yfiler™ system [Life Technologies, USA] and 270 using the PowerPlex®Y23 system [Promega Corp., USA]; hereafter Yfiler and PPY23, respectively) representing three main ecological continental regions of the country, namely Amazon rainforest, Andes, and Pacific coast. Diversity values are high in the three regions, and the PPY23 exhibits higher discrimination power than the Yfiler set. While summary statistics, AMOVA, and RST distances show low to moderate levels of population stratification, inferred ancestry derived from Y-STRs reveal clear patterns of geographic variation. The major ancestry in Ecuadorian males is European (61%), followed by an important Native American component (34%); whereas the African ancestry (5%) is mainly concentrated in the Northwest corner of the country. We conclude that classical procedures for measuring population stratification do not have the desirable sensitivity. Statistical inference of ancestry from Y-STRS is a satisfactory alternative for revealing patterns of spatial variation that would pass unnoticed when using popular statistical summary indices.

Clinical and biochemical response to neridronate treatment in a patient with osteoporosis-pseudoglioma syndrome (OPPG).

Osteoporosis-pseudoglioma syndrome (OPPG) is a rare autosomal recessive syndrome characterized by juvenile-onset osteoporosis and ocular abnormalities due to a low-density lipoprotein receptor-related protein 5 (LRP5) gene mutation. Treatment with bisphosphonates, particularly with pamidronate and risedronate, has been reported to be of some efficacy in this condition. We report on a patient with OPPG due to an LRP5 gene mutation, who showed an encouraging response after a 36-month period of neridronate therapy. We report a case of a patient treated with bisphosphonates. Bisphosphonates should be administered in OPPG patients as a first-line therapy during early childhood.

Serum creatine kinase isoenzymes in children with osteogenesis imperfecta.

This study evaluates serum creatine kinase isoenzyme activity in children with osteogenesis imperfecta to determine its usefulness as a biochemical marker during treatment with bisphosphonate. The changes of creatine kinase (CK) isoenzyme activity during and after discontinuation therapy were observed. These results could be useful in addressing over-treatment risk prevention. INTRODUCTION: The brain isoenzyme of creatine kinase (CKbb) is highly expressed in mature osteoclasts during osteoclastogenesis, thus plays an important role in bone resorption. We previously identified high serum CKbb levels in 18 children with osteogenesis imperfect (OI) type 1 treated for 1 year with bisphosphonate (neridronate). In the present study, serum CK isoenzymes were evaluated in the same children with continuous versus discontinued neridronate treatment over a further 2-year follow-up period. METHODS: This study included 18 children with OI type 1, 12 with continued (group A) and 6 with ceased (group B) neridronate treatment. Auxological data, serum biochemical markers of bone metabolism, bone mineral density z-score, and serum total CK and isoenzyme activities were determined in both groups. RESULTS: Serum CKbb was progressively and significantly increased in group A (p < 0.004) but rapidly decreased to undetectable levels in group B. In both groups, the cardiac muscle creatine kinase isoenzyme (CKmb) showed a marked decrease, while serum C-terminal telopeptide (CTx) levels were almost unchanged. CONCLUSIONS: This study provides evidence of the cumulative effect of neridronate administration in increasing serum CKbb levels and the reversible effect after its discontinuation. This approach could be employed for verifying the usefulness of serum CKbb as a biochemical marker in patients receiving prolonged bisphosphonate treatment. Moreover, the decreased serum CKmb levels suggest a systemic effect of these drugs.

Estimation of genetic and phenotypic parameters for production traits in Holstein and Jersey from Colombia / Estimación de parámetros genéticos y fenotípicos para características de producción en ganado Holstein y Jersey Colombiano

Objective. Determine the genetic and phenotypic parameters for milk yield, fat percentage, protein percentage and somatic cell score. Materials and methods. 18134 lactation records were used to Holstein and 1377 lactations for Jersey in different herds. The (co) variance components and genetic parameters were estimated using the software Multiple Trait Derivative-Free Restricted Maximum Likelihood MTDFREML. Results. The Holstein and Jersey heritability's (and standard error) for milk yield were: 0.16 (0.082) and 0.15 (0.306), 0.30 (0.079) and 0.37 (0.319) for protein percentage, 0.32 (0.076) and 0.46 (0.313) for fat percentage and for somatic cell score were: 0.01 (0.054) and 0.01 (0.233), respectively. The largest genetic correlations were found between the percentage of fat and percentage of protein, with values of 0.82 (0.126) and 0.98 (0.852) for Holstein and Jersey respectively. The lowest correlations were between fat percentage and somatic cell score with -0.01 (1.147) and -0.01 (1. 734). Phenotypic correlations were generally found low and repeatability showed a significant effect of permanent environment on milk production per lactation. Conclusions. It is important to emphasize the development of research to help guide breeding programs in the tropics, using selection indices of multi-traits.

Objetivos. Determinar los parámetros genéticos y fenotípicos para producción de leche, porcentaje de grasa, porcentaje de proteína y puntaje de células somáticas. Materiales y métodos. Se utilizó información de 18134 lactancias para Holstein y 1377 para Jersey de diferentes hatos del departamento de Antioquia (Colombia). La determinación de los componentes de varianza, covarianza y los parámetros genéticos se realizó mediante el método de máxima verosimilitud restricta libre de derivadas usando el programa MTDFREML. Resultados. La heredabilidad y el error estándar en Holstein y Jersey para producción de leche fueron 0.16 (0.082) y 0.15 (0.306), para porcentaje de proteína 0.30 (0.079) y 0.37 (0.319), para el porcentaje de grasa de 0.32 (0.076) y 0.46 (0.313) y para el puntaje de células somáticas fue de 0.01 (0.054) y 0.01 (0.233), respectivamente. Las mayores correlaciones genéticas encontradas fueron entre porcentaje de grasa y porcentaje de proteína, con valores de 0.82 (0.126) y 0.98 (0.852) para Holstein y Jersey, respectivamente. La menores correlaciones fueron obtenidas entre porcentaje de grasa y puntaje de células somáticas con valores de -0.01 (1.147) y -0.01 (1.734), respectivamente. Las correlaciones fenotípicas encontradas por lo general fueron bajas y la repetibilidad evidenció un efecto importante del ambiente permanente sobre la producción de leche por lactancia. Conclusiones. El presente trabajo encuentra algunas diferencias con los reportes de parámetros genéticos en otros países, lo que resalta la importancia del desarrollo de trabajos de investigación que permitan orientar los programas de mejoramiento genético en el trópico.

Estimation and comparison of conventional and genomic breeding values in Holstein cattle of Antioquia, Colombia / Estimación y comparación de valores de cría convencionales y genómicos en ganado Holstein de Antioquia, Colombia

Objective. To estimate and compare breeding values (EBV) using the conventional method (BLUP) and genomic breeding values (MEBV and GEBV) estimated through bayes C method for milk yield and milk quality traits in dairy cattle in Antioquia, Colombia. Materials and methods. Two methods were used to estimate breeding values: BLUP to estimate conventional breeding value (EBV) and bayes C to estimate genomic values (MEBV and GEBV). The traits evaluated were: milk yield (PL), protein percentage (PPRO), fat percentage (PGRA) and score somatic cell (SCS). The methods (BLUP and bayes C) were compared using Person correlation (r p), Spearman rank correlation (r s) and linear regression coefficient (b). Results. The Pearson and Spearman correlations among EBVs and genomic values (MEBV and GEBV) (r pMEBV;EBV and r sGEBV;EBV) were greater than 0.93 and the linear regression coefficients of EBVs on genomic values (MEBV and GEBV) (bMEBV;EBV, and bGEBV;EBV) ranged between 0.954 and 1.051 in all traits evaluated. Conclusions. The predictions of genomic values (MEBV and GEBV), using bayes C method were consistent with the predictions of the EBVs estimate through the conventional method (BLUP) in conditions of high Colombian tropic, allowing to obtain high associations between the breeding values.

Objetivo. Estimar y comparar valores genéticos (EBV) usando el método convencional (BLUP) y valores genómicos (MEBV y GEBV) mediante el método bayes C en características de producción y calidad de la leche en ganado Holstein de Antioquia, Colombia. Materiales y métodos. Fueron empleados dos métodos para estimar valores genéticos: BLUP para estimar valores genéticos (EBV) y Bayes C para estimar valores genómicos (MEBV y GEBV). Las características evaluadas fueron: producción de leche (PL), porcentaje de proteína (PPRO), porcentaje de grasa (PGRA) y puntaje de células somáticas (SCS). Los métodos BLUP y bayes C fueron comparadas usando correlación de Pearson (r p), correlación por rangos de Spearman (r s) y regresión lineal (b). Resultados. Las correlaciones de Pearson y Spearman entre los EBVs y los valores genómicos (MEBV y GEBV) (r pMEBV;EBV y r sGEBV;EBV) fueron mayores de 0.93 y los coeficientes de regresión entre los EBVs y los valores genómicos (MEBV y GEBV) (bMEBV;EBV, y bGEBV;EBV) oscilaron entre 0.954 y 1.051 en todas las características evaluadas. Conclusiones. La predicción de valores genómicos (MEBV y GEBV) usando el método Bayes C fue consistente con los EBVs estimados mediante el método BLUP en condiciones del trópico alto colombiano, permitiendo obtener altas asociaciones entre los valores genéticos.

Pursuit-and-Evasion Reaction-Diffusion Waves in Microreactors with Tailored Geometry.

Out-of-equilibrium chemical systems may self-organize into structures displaying spatiotemporal order, such as traveling waves and Turing patterns. Because of its predictable chemistry, DNA has recently appeared as an interesting candidate to engineer these spatiotemporal structures. However, in addition to the intrinsic chemical parameters, initial and boundary conditions have a major impact on the final structure. Here we take advantage of microfluidics to design controlled reactors and investigate pursuit-and-evasion chemical waves generated by a DNA-based reaction network with Predator-Prey dynamics. We first propose two complementary microfabrication strategies to either control the initial condition or the two-dimensional geometry of the reactor where the waves develop. We subsequently use them to investigate the effect of curvature in wave propagation. We finally show that DNA-based waves can compute the optimal path within a maze. We thus suggest that coupling configurable microfluidics to programmable DNA-based dissipative reaction networks is a powerful route to investigate spatiotemporal order formation in chemistry.

Reliability of vertebral fractures assessment (VFA) in children with osteogenesis imperfecta.

The aim of this study is to evaluate the diagnostic accuracy of vertebral fractures assessment (VFA) in comparison with conventional radiography in identifying vertebral fractures in children and adolescents affected by OI. On 58 patients (33 males, 25 females; age range 1-18 years; 41 children and 17 adolescents) with osteogenesis imperfecta (OI type I, n = 44, OI type III, n = 4; OI type IV, n = 10), lateral spine images by radiographs and by dual-energy X-ray absorptiometry (DXA) were acquired. For vertebral fracture diagnosis, plain radiographs were used as "gold standard" and VFA and morphometric X-ray absorptiometry (MXA) were performed. The visualized vertebrae were 738 (97.9%) by radiographs and 685 (90.9%) by DXA of a total of 754 vertebrae from T4 to L4. VFA and MXA identified, respectively, 129 (74%) and 116 (66%) of the 175 vertebral fractures detected by radiographs. Radiographs identified 36 patients with vertebral fractures, VFA 35 and MXA 41 (6 false positives). On a per vertebra basis, radiographs and VFA had elevated agreement (93.9%; k score 0.81, 95% CI 0.76-0.86), that resulted slightly lower for MXA (90.6%; k score 0.72, 95% CI 0.65-0.78). VFA and MXA demonstrated high sensitivity (95.6 and 94.1 %, respectively) while specificity was 100% for VFA and 90.6% for MXA on a per patient basis; the agreement was excellent for VFA (98.3%; k score 0.96, 95% CI 0.89-1.03) and good for MXA (87.9%; k score 0.73, 95% CI 0.55-0.91). The diagnostic performance parameters resulted better for VFA (sensitivity 95.6%; specificity 100%; PPV 100%; NPV 97.2%), than for MXA (sensitivity 94.1%; specificity 85.4%; PPV 72.7%; NPV 97.2%). The results of our study demonstrate the reliability of VFA for diagnosis of vertebral fractures in children with OI suggesting its use as a more safe and practical alternative to conventional radiography.

Application of cattle slurry containing Mycobacterium avium subsp. paratuberculosis (MAP) to grassland soil and its effect on the relationship between MAP and free-living amoeba.

Slurry from dairy farms is commonly used to fertilize crops and pastures. This mixture of manure, urine and water can harbor multiple microbial pathogens among which Mycobacterium avium subsp. paratuberculosis (MAP) is a major concern. Persistence of MAP in soil and infection of soil Acanthamoeba was evaluated by culture, real-time IS900 PCR, and by staining of amoeba with acid-fast and vital stains comparing soils irrigated with MAP-spiked or control dairy farm slurry. MAP DNA was detected in soil for the 8 month study duration. MAP was detected by PCR from more soil samples for plots receiving MAP-spiked slurry (n=61/66) than from soils receiving control slurry (n=10/66 samples). Vital stains verified that intracellular MAP in amoeba was viable. More MAP was found in amoeba at the end of the study than immediately after slurry application. There was no relationship between MAP presence in soil and in amoeba over time. Infection of amoeba by MAP provides a protected niche for the persistence and even possibly the replication of MAP in soils. As others have suggested, MAP-infected amoeba may act like a "Trojan horse" providing a means for persistence in soils and potentially a source of infection for grazing animals.

Association of gene BoLA DRB32 with production traits in a dairy herd of Antioquia, Colombia / Asociación del gen BoLA DRB32 con características productivas en un hato lechero de Antioquia, Colombiaá

Objective. To determine the associations of BoLA DRB3.2 alleles present in Holstein and BON x Holstein cattle to production and milk quality traits in a dairy herd of Antioquia, Colombia. Materials and methods. Ninety-one cows, 66 Holstein and 25 BxH, were genotyped for the BoLA DRB3.2 gene, through PCR-RFLP technique. Furthermore, the association of the alleles of the gene BoLA DRB3.2 with milk yield (PL305), fat yield (PG305), protein yield (PP305) fat percentage (PGRA) and protein percentage (PPRO) were determined, using a general linear model. Results. Twenty-seven BoLA DRB3.2 alleles were identified; the most frequent alleles in Holstein were: BoLA DRB3.2*23, 22, and 24 with frequencies of: 0.159, 0.129, and 0.106, respectively and the most frequent alleles in BxH were: BoLA DRB3.2*23, 24 and 20 with frequencies of: 0.20, 0.140, and 0.120, respectively. Associations of BoLA DRB3.2 alleles with production and milk quality traits were also determined. In Holstein cows the BoLA DRB3.2*36 allele was associated with low PL305 (p≤0.01), high PGRA in multiparous cows (p≤0.05) and high PG305 in primiparous cows (p≤0.01). The BoLA DRB3.2*33 allele was associated with increased in the PPRO in multiparous cows (p≤0.01). In BXH cows only the BoLA DRB3*19 allele was associated with high PGRA (p≤0.05). Conclusions. The gene BoLA DRB3.2 shows high polymorphism in both groups; Holstein and BxH and some of its allelic variants were associated with production and milk quality traits.

Objetivo. Determinar la asociación de los alelos BoLA DRB3.2 presentes en vacas Holstein y BONxHolstein con características productivas y de calidad composicional de la leche en un hato lechero de Antioquia, Colombia. Materiales y métodos. Fueron genotipificados 91 animales; 66 Holstein y 25 BONxHolstein (BxH) para el gen BoLA DRB3.2, mediante la técnica PCR-RFLP. También, se determinó la asociación de los alelos del gen BoLA DRB3.2 con producción de leche (PL305), producción de grasa (PG305), producción de proteína (PP305), porcentaje de grasa (PGRA) y porcentaje de proteína (PPRO); usando un modelo lineal generalizado. Resultados. Fueron identificados 27 alelos BoLA DRB3.2; los más frecuentes en Holstein fueron: BoLA DRB3.2*23, 22 y 24 con frecuencias de 0.159, 0.129 y 0.106 respectivamente y los más frecuentes para BxH fueron: BoLA DRB3.2*23, 24, 20 con frecuencias de 0.20, 0.140 y 0.120 respectivamente. También fueron determinadas asociaciones de los alelos BoLA DRB3.2 con características productivas y de calidad composicional de la leche. En vacas Holstein el alelo BoLA DRB3.2*36 fue asociado con baja PL305 (p≤0.01), alto PGRA en vacas multíparas (p≤0.05) y alta PG305 en vacas primíparas (p≤0.01). El alelo BoLA DRB3.2*33 fue asociado con alto PPRO en vacas multíparas (p≤0.01). En vacas BxH sólo el alelo BoLA DRB3.2*19 estuvo asociado con aumento en el PGRA (p≤0.05). Conclusiones. El gen BoLA DRB3.2 presentó un alto polimorfismo en ambos grupos genéticos; Holstein y BxH y algunas de sus variantes alélicas fueron asociadas significativamente con características productivas y características de calidad composicional de la leche.

Enfermedad por modelantes: problemática actual en México y presentación de casos / Actual status of adyuvant disease in México and some case examples

La enfermedad por modelantes o por adyuvantes es una patología frecuente en nuestro medio que conlleva un abordaje complejo por la diversidad de los materiales aplicados y la profundidad de los planos anatómicos en que son infiltrados. Además del tratamiento médico se han propuesto diversos tratamientos quirúrgicos que incluyen resección amplia con reconstrucción, ya sea mediante colgajos locales o microquirúrgicos. En nuestro hospital recibimos pacientes con complicaciones derivadas de la inyección de sustancias modelantes de diferente origen entre las cuales destacan: aceite vegetal, animal o mineral y polimetilmetacrilato, situación que nos convierte en centro de referencia. La revisión que presentamos fue realizada entre 2008 y 2011 e incluye a los pacientes que recibieron tratamiento en el Hospital General de México a causa de esta patología. Presentamos también algunos casos seleccionados. Se atendieron en el periodo de 3 años 177 pacientes con edades entre los 17 y 73 años, 128 mujeres y 49 varones, que presentaban infiltraciones en glúteos (53.6 %), mamas (29.39 %) piernas (9.03 %), cara (5.09 %) y cadera (2.89 %). El material más frecuente fue aceite mineral, seguido de aceite vegetal, aunque la mayoría de los pacientes desconocían cuál era. El promedio en tiempo para el inicio de la sintomatología tras la infiltración fue de 8.8 años. El 11.86 % de los pacientes presentaba área cruenta en el momento de la consulta, y al 23.72 % se les realizó algún procedimiento quirúrgico, destacando colgajos de perforantes lumbares para glúteos, mastectomía más reconstrucción con colgajo dorsal ancho o TRAM más implantes o sin ellos. En 135 casos únicamente fue necesario tratamiento médico. Hubo 2 casos de defunción tras sepsis por Pseudomonas aureginosa. Los estudios de imagen utilizados para cuantificar el grado de extensión fueron el ultrasonido y la resonancia magnética nuclear. El abordaje de estos pacientes es un reto ya que no hay un tratamiento satisfactorio para todos los casos. Quirúrgicamente, es eficaz la resección en bloque del material extraño pero puede condicionar deformidades y ser necesario el uso de colgajos y/o injertos para la reconstrucción de los defectos resultantes. El uso de sistemas de presión subatmosférica amplia y optimiza el armamento terapéutico disponible para estos casos

Management of modeling disease, produced by the infiltration of strange substances is complicated, because of the different sites where the material can be infiltrated, in addition of the depth of the infiltration. They have been proposed various types of surgical procedures which include wide resection and reconstruction with local flaps or microsurgical procedures. Because our hospital is a referral center, we receive patients with complications from the injection of different substances, among which they figure vegetable oil, animal and mineral oils, and polymethylmethacrylate. This review was made from 2008 to 2011 and includes all the patients that held its treatment at the General Hospital of Mexico because of this disease. We are also presenting some representative cases. We reviewed a total of 177 patients in 3 years which have been attended by complications secondary to the infiltration of strange substances with an age range of 17 to 73 years, 128 female and 49 male. According to the anatomical region the infiltrated areas were buttocks (53.6 %), breast (29.39 %) legs (9.03 %), face (5.09 %) and hips (2.89 %). The most frequent substance was mineral oil, followed by vegetal oil, but most of the patients didn't know it. The average time to present symptoms since initial infiltration was 8.8 years. In 11.86 % there was cutaneous loss and 23.72 % needed surgical treatment with lumbar perforator flap for buttocks and mastectomy and reconstruction with dorsal or TRAM flaps with or without implants. In 135 cases only was necessary medical treatment. There were 2 deaths due to sepsis caused by Pseudomonas aeruginosaThe imaging study used to quantify the degree of extension were ultrasound and MRI. To conclude, we believe that the management of these patients becomes a medical challenge and there is not yet a satisfactory treatment. In surgical treatment, complete resection of the foreign material is effective, unless it is a mutilating procedure that occasionally required the use of flaps or grafts for reconstruction. The use of sub-atmospheric pressure systems optimize and accelerate the treatment of this kind of patients

Tratamiento endoscópico de cálculos ureterales: experiencia en una serie de 102 casos / Endoscopic treatment of ureteral stones: experience in a series of 102 cases

INTRODUCCIÓN: La ureterolitectomía endoscópica (URS) es una técnica validada para el manejo de cálculos ureterales, ya que tiene alto poder resolutivo y es poco invasiva. El desarrollo de instrumentos flexibles ha facilitado el manejo endoscópico de los cálculos en uréter medio y proximal. El objetivo de este trabajo es describir la experiencia de nuestro centro en URS. Material y metodos: Análisis retrospectivo de las URS realizadas en nuestro centro entre Diciembre 2009 y Mayo 2012. Se consignaron las características del cálculo, el método de fragmentación, la efectividad del procedimiento y las complicaciones. Se utilizaron los ureteroscopios semirrígido Wolf (6,0-9,5 Fr) y flexible Karl Storz Flex X2. Resultados: Se revisaron 102 ureteroscopías, 85 con ureteroscopio semirrígido y 17 con flexible. Los cálculos tuvieron un promedio de 5,7 mm y 642 UH. El 89,4 por ciento de los cálculos resueltos mediante URS semirrígida se localizaban en uréter distal y 52,9 por ciento de los resueltos con URS flexible en uréter proximal. Se realizó litotripsia con láser Holmium en un 25,9 por ciento y 70,6 por ciento de los casos con URS semirrígida y flexible, respectivamente. Se utilizó litotripsia pneumática en un 4,7 por ciento de los casos de URS semirrígida. En URS semirrígida y flexible, la tasa de stone-free + fragmentos < 2 mm fue de 89,4 por ciento y 88,2 por ciento, respectivamente. Sólo hubo una complicación en nuestra serie (infección urinaria febril en 1 caso con URS flexible). La mediana de hospitalización fue de 1 día (rango 1-5 días). Conclusion: Nuestros resultados reafirman a la URS como una técnica eficaz, segura y poco invasiva para el tratamiento de los cálculos ureterales.

INTRODUCTION: The endoscopic ureterolithotomy (URS) is a validated technique for the management of ureteral calculi, which is highly resolutive and minimally invasive. The development of flexible instruments has facilitated the endoscopic management of stones in the mid and proximal segments of the ureter. The aim of this paper is to describe the experience of our center in endoscopic ureterolithotomy. Material and methods: Retrospective analysis of URS performed at our center between December 2009 and May 2012. We recorded the characteristics of the stones, the fragmentation method, the effectiveness of the procedure and complications. The Wolf semi-rigid (6.0 to 9.5 Fr) and the flexible Karl Storz Flex X2 ureteroscopes were used. RESULTS: We reviewed 102 URS, 85 with semi-rigid and 17 with flexible ureteroscope. The calculi were 5.7 mm and 642 HU in average. 89.4 percent of the stones treated with a semi-rigid URS were localized in the distal ureter and 52.9 percent of the calculi treated with a flexible URS were in the proximal ureter. Holmium laser lithotripsy was performed in 25.9 percent and 70.6 percent of the cases of semi-rigid and flexible URS, respectively. Pneumatic lithotripsy was used in 4.7 percent of the semi-rigid URS. In semi-rigid and flexible URS, the rate of stone-free + fragments < 2 mm was 89.4 percent and 88.2 percent, respectively. There was only one complication in our series (febrile urinary tract infection in 1 case of flexible URS). The median length of stay was 1 day (range 1-5 days). CONCLUSION: Our results confirm that URS is an effective, safe and minimally invasive treatment for ureteral calculi.

PTTG2 silencing results in induction of epithelial-to-mesenchymal transition and apoptosis.

Human securin, also known as human pituitary tumor-transforming gene 1 (pttg1), plays a key role in cell-cycle regulation. Two homologous genes, pttg2 and pttg3, have been identified although very little is known about their physiological function. In this study, we aimed at the characterization of these two pttg1 homologs. Real-time PCR analysis using specific probes demonstrated that Pttg2 is expressed at very low levels in various cell lines and tissues whereas Pttg3 was largely undetectable. We focused on the study of Pttg2 and found that, unlike PTTG1, PTTG2 lacks transactivation activity and does not bind to separase, making improbable a role in the control of sister chromatids separation. To further investigate the biological role of pttg2, we used short hairpin RNA inhibition of Pttg2 and found that cells with reduced Pttg2 levels assumed a rounded morphology compatible with a defect in cell adhesion and died by apoptosis in a p53- and p21-dependent manner. Using microarray technology, we generated a gene expression profile of Pttg2-depleted cells versus wild-type cells and found that knockdown of PTTG2 results in concomitant downregulation of E-cadherin and elevated vimentin levels, consistent with EMT induction. The observation of aberrant cellular behaviors in Pttg2-silenced cells reveals functions for pttg2 in cell adhesion and provides insights into a potential role in cell invasion.

Rhegmatogenous retinal detachment treatment guidelines.

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.

Guías de tratamiento del desprendimiento de retina rhegmatógeno / Rhegmatogenous retinal detachment treatment guidelines

El objetivo de esta guía es describir unas directrices generales del proceso seguido por el cirujano oftalmólogo desde el diagnóstico del desprendimiento de retina, pasando por su evaluación preoperatoria, hasta su tratamiento, complicaciones intra y postoperatorias, fracaso o recidiva del desprendimiento de retina rhegmatógeno, y las posibles alternativas terapéuticas en cada caso. También describiremos el tratamiento del desprendimiento de retina traumático por su importancia y peculiaridades. Se sugieren líneas de tratamiento o profilaxis para las diferentes situaciones del desprendimiento de retina en base a la variables encontradas, a la experiencia de los cirujanos oftalmólogos de la comisión que las ha redactado, y a la revisión bibliográfica con los distintos niveles de evidencia, pero no pretende establecer criterios de obligado cumplimiento, sobre todo considerando que el desprendimiento de retina tiene amplias posibilidades de tratamiento, y que la experiencia del cirujano en una u otra técnica va a ser fundamental en la obtención del mejor resultado quirúrgico. Como guías que son, solamente pretenden asesorar al cirujano en la práctica diaria, dejando en sus manos y en su experiencia la mejor opción terapéutica(AU)

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons’ experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience(AU)

Spinal elastofibroma: a case report.

Elastofibroma is a benign fibroproliferative tumor of unknown origin and pathogenesis. It usually appears in the subscapular or infrascapular area. It is extremely rare in the spinal area, and it is most common in middle-aged women. In most cases, it is asymptomatic. Its diagnosis is based on nuclear MRI, where it presents a homogeneous lesion, similar to the skeletal muscle, hyperintense in T1-weighted sequences and hypointense in T2-weighted sequences. This finding is confirmed with anatomical pathology tests, where it appears as a nonencapsulated lesion made up of wide collagen bands from connective tissue mixed with fat and muscle tissue. The treatment of choice is surgical removal of the lesion. We present a clinical case of elastofibroma, a benign and rare pathology with few described cases in the literature, in a patient with a previous dorsal lesion.