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1.
Ecotoxicol Environ Saf ; 272: 116015, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38290314

RESUMO

Graphene oxide (GOx) is a nanomaterial with demonstrated capacity to remove metals from water. However, its effects on organic pollutants and metal(loid)s present in polluted soils when used for remediation purposes have not been extensively addressed. Likewise, few studies describe the effects of GOx on edaphic properties and soil biology. In this context, here we assessed the potential of GOx for remediating polluted soil focusing also on different unexplored effects of GOx in soil. To achieve this, we treated soil contaminated with concurrent inorganic (As and metals) and organic pollution (TPH and PAHs), using GOx alone and in combination with nutrients (N and P sources). In both cases increased availability of As and Zn was observed after 90 days, whereas Cu and Hg availability was reduced and the availability of Pb and the concentration of organic pollutants were not significantly affected. The application of GOx on the soil induced a significant and rapid change (within 1 week) in microbial populations, leading to a transient reduction in biodiversity, consistent with the alteration of several soil properties. Concurrently, the combination with nutrients exhibited a distinct behaviour, manifesting a more pronounced and persistent shift in microbial populations without a decrease in biodiversity. On the basis of these findings, GOx emerges as a versatile amendment for soil remediation approaches.


Assuntos
Poluentes Ambientais , Grafite , Metais Pesados , Microbiota , Poluentes do Solo , Solo/química , Poluentes do Solo/análise , Metais , Metais Pesados/análise
2.
Fish Shellfish Immunol Rep ; 5: 100121, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-37964807

RESUMO

Chronic stress deteriorates the immune function of fish, thereby increasing their vulnerability to infections. However, the molecular and cellular mechanisms underlying stress-mediated immunosuppression and infection susceptibility in fish remain largely unknown. Understanding these mechanisms will contribute to improving fish welfare and their farm production. Herein, we review the challenges of sturgeon aquaculture in subtropical countries, where current climate change has giving rise to significant temperature increments during summer. This leads to the exposure of fish to stressful conditions during these months. Chronic heat stress deserves attention considering the rapid warming rate of the planet. It is already affecting wild fish populations, with disastrous consequences for sturgeons, which are one of the most endangered fish species in the world. In this context, we discuss the most recent advances through the studies on the effects of chronic heat stress on the innate immune components of sturgeons. To this end, we summarise the findings of studies focusing on the aquaculture of Russian sturgeons and observations made on other Acipenser species. Special attention is given to acute-phase proteins, as they might be valuable biomarkers of heat stress and infection, with applicability in monitoring the fish health status in farms.

4.
Sci Rep ; 13(1): 7168, 2023 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-37137963

RESUMO

Adjuvant trastuzumab in HER2+ breast cancer reduces recurrence and mortality, and has been the standard treatment since 2006. The objective was to analyze health outcomes in the real world. Observational, retrospective study of patients with HER2+ breast cancer, stages I-III, treated with adjuvant trastuzumab in the past 15 years in only one center and for the first time in Spain. Survival was analyzed according to the number of cycles and cardiotoxicity. Two hundred and seventy-five HER2positive patients (18.60%) out of 1479 received adjuvant (73%) or neoadjuvant/adjuvant (26%) trastuzumab, concomitantly (90%) or sequentially (10%) with chemotherapy. The probability of overall and disease-free survival (OS and DFS) at 5 years was 0.93 (95% CI 0.89-0.96), and 0.88 (95% CI 0.83-0.92). The number of cases with a significant and asymptomatic decrease in ventricular ejection fraction and heart failure were 54 (19.64%) and 12 (4.36%), respectively. Sixty-eight patients (24.70%) received 16 or fewer cycles, especially those older than 65 (OR 0.371, 95% CI 0.152-0.903; p = 0.029) and with cardiotoxicity (OR 15.02, 95% CI 7.437-30.335; p < 0.001). The risk of cardiotoxicity was associated with having received radiotherapy (OR 0.0362, 95% CI 0.139-0.938; p = 0.037). Arterial hypertension (HR 0.361, 95% CI 0.151-0.863, p = 0.022), neoadjuvant treatment (HR 0.314, 95% CI 0.132-0.750, p = 0.009) and cardiotoxicity (HR 2.755, 95% CI 1.235-6.143, p = 0.013) maintained significant association with OS. Only neoadjuvant treatment maintained a significant association with DFS (HR 0.437, 95% CI 0.213-0.899, p = 0.024). The effectiveness of neoadjuvant and adjuvant trastuzumab can be considered comparable to those of clinical trials. In the real world, factors such as age, hypertension, radiotherapy, neoadjuvant treatment, and cardiotoxicity should be taken into consideration to optimize outcomes.


Assuntos
Neoplasias da Mama , Hipertensão , Humanos , Feminino , Trastuzumab/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/etiologia , Cardiotoxicidade/tratamento farmacológico , Estudos Retrospectivos , Receptor ErbB-2/genética , Anticorpos Monoclonais Humanizados/uso terapêutico , Intervalo Livre de Doença , Adjuvantes Imunológicos/uso terapêutico , Hipertensão/tratamento farmacológico , Quimioterapia Adjuvante , Terapia Neoadjuvante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
5.
J Mater Sci ; 58(12): 5456-5476, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36969327

RESUMO

The use of polymers capable of being degraded by the action of microorganisms and/or enzymes without causing harmful effects is a strategy in waste management and environmental care. In this work, bio-nanocomposites based on thermoplastic starch (TPS) were synthesized by reactive extrusion using a twin-screw extruder. Two strategies were evaluated to reduce the disadvantages of TPS for packaging applications. First, starch was chemically modified producing the reaction of native starch with chemical reagents that introduce new functional groups to reduce the water adsorption. And two, nano-fillers were incorporated into TPS in order to enhance the mechanical and barrier properties, driving to materials with improved performance/cost ratio. The synergistic strategies of chemical modification and incorporation of modified nanoclays were also effective to reduce the dependence of properties of TPS with the environment humidity and the evolution thereof over time, which influences the performance during the service life of the product. Supplementary Information: The online version contains supplementary material available at 10.1007/s10853-023-08354-1.

7.
Neurologia (Engl Ed) ; 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36216226

RESUMO

INTRODUCTION: The variant c.1414-1G>T in the GRN gene has previously been reported as probably pathogenic in subjects of Hispanic origin in the American continent. METHODS: We report 5 families of Spanish origin carrying this variant, including the clinical, neuroimaging, and laboratory findings. RESULTS: Phenotypes were strikingly different, including cases presenting with behavioral variant frontotemporal dementia, semantic variant primary progressive aphasia, rapidly progressive motor neuron disease (pathologically documented), and tremor-dominant parkinsonism. Retinal degeneration has been found in homozygous carriers only. Ex vivo splicing assays confirmed that the mutation c.1414-1G>T affects the splicing of the exon, causing a loss of 20 amino acids in exon 11. CONCLUSIONS: We conclude that variant c.1414-1G>T of the GRN gene is pathogenic, can lead to a variety of clinical presentations and to gene dosage effect, and probably has a Spanish founder effect.

8.
Med. infant ; 29(3): 190-193, Septiembre 2022. tab
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1399567

RESUMO

Introducción: a partir de la pandemia por Covid19 se reportó variabilidad en la incidencia de las infecciones asociadas al cuidado de la salud (IACS). Con el objetivo de describir y comparar las tasas de IACS en la Unidad de Quemados de un hospital pediátrico de tercer nivel, antes y después del inicio de la pandemia se llevó a cabo este estudio. Material y métodos: estudio de cohorte, retrospectivo, descriptivo, de vigilancia epidemiológica. Se registraron todos los eventos de IACS en la Unidad de Quemados desde el 01/07/2018 hasta el 31/06/2021. Se compararon las tasas de las IACS entre el período I (PI) previo a la pandemia (07/2018-12/2019) y el período II (PII) posterior al inicio de la misma (01/2020- 06/2021). Resultados: se registraron 74 episodios de IACS, en un total de 8232 pacientes-día. Se registró una tasa global de IACS similar en ambos períodos, 10,08 ‰ pacientes-día (PI) vs 7,34 ‰ pacientes-día (PII), sin encontrarse diferencias estadísticamente significativas en las tasas de bacteriemia asociada a catéter venoso central (BSI-CVC) 3,32 ‰ días uso de CVC (PI) vs 3,20 ‰ (PII), neumonía asociada a ARM 1.43 ‰ días de uso de ARM (PI) vs un 2.02 ‰ (PII), ni infección urinaria asociada a sonda vesical (SV) 7,36 ‰ días de uso de SV (PI) vs 3,64 ‰ (PII). Conclusiones: no se observaron diferencias estadísticamente significativas en las tasas de IACS entre ambos períodos, lo cual podría justificarse con el estricto protocolo en control de infecciones implementado previo al inicio de la pandemia (AU)


Introduction: since the start of the Covid19 pandemic, variability in the incidence of healthcare-associated infections (HAIs) has been reported. This study was conducted to describe and compare the rates of HAIs in the burn unit of a tertiary pediatric hospital before and after the onset of the pandemic. Material and methods: a retrospective, descriptive, epidemiological surveillance cohort study was conducted. All HAI events in the burn unit from 01/07/2018 to 31/06/2021 were recorded. HAI rates between the pre-pandemic period I (PI) (07/2018- 12/2019) and post-pandemic period II (PII) (01/2020-06/2021) were compared. Results: 74 episodes of HAI were recorded in a total of 8232 patient-days. There was a similar overall rate of HAIs in both periods, 10.08 ‰ patient-days (PI) vs 7.34 ‰ patient-days (PII), with no statistically significant differences found in the rates of central venous catheter-related bloodstream infections (CVC-BSI) 3.32 ‰ days CVC use (PI) vs 3.20 ‰ (PII), ventilator-associated pneumonia 1. 43 ‰ days MV use (PI) vs a 2.02 ‰ (PII), or catheter-associated urinary tract infection 7.36 ‰ days catheter use (PI) vs 3.64 ‰ (PII). Conclusions: no statistically significant differences were observed in the rates of HAIs between both periods, which may be explained by the strict infection control protocol implemented prior to the onset of the pandemic (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Unidades de Queimados/estatística & dados numéricos , Queimaduras/complicações , Queimaduras/epidemiologia , Infecção Hospitalar/epidemiologia , Controle de Infecções , Monitoramento Epidemiológico , COVID-19/epidemiologia , Estudos Retrospectivos , Estudos de Coortes
10.
J Environ Manage ; 297: 113427, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34346399

RESUMO

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is widely used due to it selective action, and preferential control of dicotyledonous weeds affecting cereal crops. Physiological responses of sensitive dicotyledonous plants to 2,4-D include growth retardation, senescence, and cell death. Due to soil and water contamination by agricultural practices, 2,4-D constitutes a potential risk to non-target plant species. In this work, the potential advantage of using organic modified bentonite (Bent) to adsorb 2,4-D and therefore mitigate damage produced by this herbicide on sensitive not-target vegetable species was investigated. Dodecylamine (DDA) was used as an organic modifier to change the hydrophilic nature of Bent into an organophilic matrix. The adsorption performances of 2,4-D by Bent-DDA were analyzed. The maximum adsorptions of 2,4-D (22.1 mg/L) from aqueous solution containing 1.0 or 2.5 mg/mL Bent-DDA were 40 and 80 %, respectively. The physical interaction of Bent-DDA with 2,4-D was characterized by Wide Angle X-ray Scattering (WAXS) and thermogravimetric analysis (TGA). The biological functionality of Bent-DDA matrix as 2,4-D adsorbent was tested in a bioassay in the Arabidopsis thaliana plant model system. The primary root growth of Arabidopsis seedlings is strongly inhibited by low concentrations of 2,4-D. Arabidopsis seedlings submitted to Bent-DDA pre-treated herbicide aqueous solution showed similar root growth than 2,4-D non-treated seedlings. Finally, the ability of Bent-DDA to prevent 2,4-D phytotoxicity was exploratory investigated in lettuce plants. Lettuce plants pre-treated with 20 µg/mL Bent-DDA showed reduced sensitivity to 2,4-D including an increment on chlorophyll content and biomass compared with non-treated plants. Our findings revealed a promising scenario for the application of Bent-DDA as an effective adsorbent of 2,4-D at productive scale.


Assuntos
Bentonita , Herbicidas , Ácido 2,4-Diclorofenoxiacético/toxicidade , Herbicidas/toxicidade , Plantas Daninhas , Plântula
11.
J Environ Manage ; 297: 113326, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34314966

RESUMO

Greenhouse cultivation in the Mediterranean region has undoubtedly enhanced the economic growth and has generated social benefits by making an efficient use of resources. However, these production systems caused undesirable environmental impacts. In order to move towards cleaner production in greenhouse areas, this study has assessed the potential environmental benefits and trade-offs of the integration of an on-farm reverse osmosis system powered by photovoltaic solar energy to recycle the drainage effluents from greenhouses. To that end, we compare the environmental footprint of a greenhouse tomato crop using this technology in a hydroponic system (HS), versus the conventional sanded soil 'enarenado' (CS) with free-drainage to soil. Additionally, for comparison, three independent irrigation sources (desalinated seawater with low electrical conductivity and two different mixes of underground and desalinated water, with moderate and high electrical conductivity, respectively) were evaluated. The use of desalinated seawater can help reduce the overexploitation of aquifers, although if the desalination process is not done with clean energy it also comes with a negative impact on the carbon footprint. Life Cycle Assessment (LCA) was used to analyse and evaluate six environmental impact indicators associated with these production systems and water treatments. In addition, a sensitivity analysis was conducted to explore the potential environmental benefits of increasing the use of renewable energy for desalinated water production, whilst also curbing the common over-fertilisation malpractice reported in the study area. Based on our findings, the HS with leachate treatment technology showed, compared to the CS system, a significant reduction in the eutrophication (72 %), although it did inevitably increase the depletion of fossil fuels (43 %) global warming (37 %) and acidification (32 %) impacts, due to the need for additional infrastructure and equipment. Among the inputs considered for the cultivation systems, the greenhouse structure, and the production of fertilisers and electricity for fertigation represented the highest environmental burdens. When comparing the three irrigation treatments, it was observed that the partial substitution of desalinated seawater by brackish groundwater substantially mitigated (27 %) the global warming footprint. The sensitivity analysis revealed that a significant reduction in the environmental impact is feasible.


Assuntos
Solanum lycopersicum , Energia Solar , Hidroponia , Osmose , Água do Mar
13.
Artigo em Espanhol | CUMED | ID: cum-79471

RESUMO

RESUMEN:Fundamento: incorporar las tecnologías digitales al proceso de enseñanza-aprendizaje en la educación superior constituye una necesidad creciente.Objetivo: describir el desarrollo y utilización del software educativo “Compendio de rehabilitación en afecciones más frecuentes del sistema osteomioarticular en el nivel primario de salud”, en el Policlínico Universitario “Dr. Rudesindo Antonio García del Rijo”, del municipio Sancti Spíritus,durante el curso 2018-2019.Métodos: se diseñó un software educativo en forma de hipertexto, en una investigación cualicuantitativa,descriptiva y transversal en educación médica. La investigación en general constó de dos etapas: creación y utilización del software. En la parte cuantitativa del estudio la muestra fue de 25 estudiantes y seis docentes del curso referido en el objetivo. Se realizaron dos talleres para describir el compendio. Para evaluar el impacto del software se utilizó el criterio de especialistas y el nivel de satisfacción de docentes y estudiantes.Resultados: se creó un software educativo en forma de hipertexto, portable, utilizable sin necesidad de conexión a red. Con diseño sencillo y atractivo. Los especialistas consultados estuvieron en total acuerdo, o en acuerdo, con el contenido, diseño instruccional y los aspectos informáticos del compendio. Solo un estudiante manifestó insatisfacción. Abarcador y didáctico fue la característica más declarada por docentes y estudiantes.Conclusiones: se elaboró el software educativo en forma de compendio, con gran aceptación por especialistas, docentes y estudiantes.[AU]


Assuntos
Software , Aprendizagem , Reabilitação
14.
Colloids Surf B Biointerfaces ; 202: 111710, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33765626

RESUMO

The development of versatile carriers to deliver chemotherapeutic agents to specific targets with establishing drug release kinetics and minimum undesirable side effects is becoming a promising relevant tool in the medical field. Magnetic hybrid nanostructured lipid carriers (NLC) were prepared by incorporation of 1,8-cineole (CN, a monoterpene with antiproliferative properties) and maghemite nanoparticles (MNPs) into a hybrid matrix composed of myristyl myristate coated with chitosan. Hybrid NLC characterized by DLS and TEM confirmed the presence of positively charged spherical nanoparticles of around 250 nm diameter and +10.2 mV of Z-potential. CN encapsulation into the lipid core was greater than 75 % and effectively released in 24 h. Modification of the crystalline structure of nanoparticles after incorporation of CN and MNPs was observed by XRD, DSC, and TGA analyses. Superparamagnetic NLC behavior was verified by recording the magnetization using a vibrating scanning magnetometer. NLC resulted in more cytotoxic than free CN in HepG2 and A549 cell lines. Particularly, viability inhibition of HepG2 and A549 cells was increased from 35 % to 55 % and from 38 % to 61 %, respectively, when 8 mM CN was incorporated into the lipid NPs at 24 h. Green fluorescent-labeled NLC with DIOC18 showed an enhanced cellular uptake with chitosan-coated NLC. Besides, no cytotoxicity of the formulations in normal WI-38 cells was observed, suggesting that the developed hybrid NLC system is a safe and good potential candidate for the selective delivery and potentiation of anticancer drugs.


Assuntos
Antineoplásicos , Nanopartículas , Nanoestruturas , Antineoplásicos/farmacologia , Portadores de Fármacos , Eucaliptol , Lipídeos , Fenômenos Magnéticos , Tamanho da Partícula
16.
Agric Syst ; 190: 103098, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-36567886

RESUMO

CONTEXT: In Latin America, the so-called informal sector associated with family farming and the agroecology movements were instrumental at coping with and adapting to the COVID-19 challenges. OBJECTIVE: To assess the nature and extent of the early initiatives (first three months) deployed by this informal sector to cope with and adapt to the impacts of the COVID-19 pandemic on food production and consumption in several countries of the region. METHODS: We used key used informant consultation (n = 168), an online survey (n = 125) and the detailed characterisation of regional case studies (n = 4). Textual data was analysed and categorised using Reinert's method, combined with similarity analysis. RESULTS AND CONCLUSIONS: 65% of the initiatives were 'local' in terms of geographic reach, 30% of them started within the first month after the pandemic and most of them were urban or urban-rural, whereas only 29% of them were exclusively rural. The analysis of the textual information captured through the survey revealed four major types of initiatives that were deployed or adapted in response to COVID-19:1.Direct producer-to-consumer food sales, generally existing before the COVID-19 crisis but adapted/strengthened to cope with it;2.Short value chains that linked rural and urban organisations and individuals supported by national or local governments, readapted through new health and safety protocols;3.Newly developed support and training programs on sustainable food production for self-consumption or local commerce, in rural, urban or peri-urban settings;4.Food assistance and aid initiatives focusing on vulnerable populations, relying on solidarity networks associated with the agroecological movement. SIGNIFICANCE: The pandemic highlighted the key role played by local food systems and value chains and the need to strengthening them through public policies, as a way to build food resilience in times of crisis.

17.
Artigo em Espanhol | CUMED | ID: cum-79435

RESUMO

Fundamento:el cáncer colorrectal es la neoplasia maligna más frecuente que se puede presentar en el sistema digestivo. Se ha observado un incremento gradual en América Latina, Cuba presenta indicadores de salud similares a las naciones desarrolladas, el cáncer colorrectal constituye la tercera causa de muerte entre las enfermedades malignas.Objetivo:proporcionar una recopilación teórica y actualizada de investigaciones relacionadas con la sobrevida en adultos mayores con cáncer colorrectal.Métodos:se realizó una revisión bibliográfica con el método de análisis bibliográfico sin restricciones de idioma, se consultaron las bases de datos Lilacs, Medline, PubMed y SciELO. Se utilizaron como palabras claves: sobrevida, cáncer colorrectal, adulto mayor.Resultados:el cáncer colorrectal puede cursar asintomático, la sintomatología y los signos también dependerán de la localización del tumor. En su mayoría, se detecta en la etapa sintomática, un 50 % de estos pacientes de diagnóstico tardío se encuentran en un estadio avanzado del tumor. La sobrevida de los adultos mayores con cáncer colorrectal depende también de su forma de presentación y calidad de vida.Conclusiones:la sobrevida en adultos mayores con cáncer colorrectal está influenciada por la edad del paciente, estadio en el momento del diagnóstico, forma de presentación de la enfermedad nosológica, abordaje quirúrgico, estilo y calidad de vida antes y después de ser diagnosticado.[AU]


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/diagnóstico , Sobrevida , Idoso , Qualidade de Vida
18.
AAPS PharmSciTech ; 21(7): 278, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33033939

RESUMO

People with weakened immune systems are at risk of developing candidiasis which is a fungal infection caused by several species of Candida genus. In this work, polymeric nanoparticles containing miconazole nitrate and the anesthetic lidocaine clorhydrate were developed. Miconazole was chosen as a typical drug to treat buccopharyngeal candidiasis whereas lidocaine may be useful in the management of the pain burning, and pruritus caused by the infection. Nanoparticles were synthesized using chitosan and gelatin at different ratios ranging from 10:90 to 90:10. The nano-systems presented nanometric size (between 80 and 300 nm in water; with polydispersion index ranging from 0.120 to 0.596), and positive Z potential (between 20.11 and 37.12 mV). The determined encapsulation efficiency ranges from 65 to 99% or 34 to 91% for miconazole nitrate and lidocaine clorhydrate, respectively. X-ray diffraction and DSC analysis suggested that both drugs were in amorphous state in the nanoparticles. Finally, the systems fitted best the Korsmeyer-Peppas model showing that the release from the nanoparticles was through diffusion allowing a sustained release of both drugs and prolonged the activity of miconazole nitrate over time against Candida albicans for at least 24 h.


Assuntos
Candida albicans/isolamento & purificação , Candidíase/tratamento farmacológico , Lidocaína/administração & dosagem , Miconazol/administração & dosagem , Nanopartículas/química , Polímeros/química , Antifúngicos/administração & dosagem , Antifúngicos/química , Varredura Diferencial de Calorimetria , Quitosana , Humanos , Lidocaína/química , Miconazol/química , Nanopartículas/administração & dosagem , Difração de Raios X
19.
Mon Not R Astron Soc ; 497(2): 2066-2077, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32778847

RESUMO

We present multiwavelength light curves and polarimetric data of the Flat Spectrum Radio Quasar 3C 273 over 8 yr. The wavelength range of our data set extends from radio to gamma-rays. We found that the optical emission in this source is dominated by the accretion disc during the entire time-frame of study. We additionally find that in contrast with the observed behaviour in other blazars, 3C 273 does not show a correlation between the gamma-ray spectral index and the gamma-ray luminosity. Finally, we identified an anticorrelation between the 15 GHz and V-band light curves for the time-range JD 245 = 4860-5760, which we speculate is the consequence of the inner part of the accretion disc falling into the black hole, followed by the ejection of a component into the jet.

20.
Acta Ortop Mex ; 34(6): 433-440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-34020526

RESUMO

There are various approaches and surgical techniques with the objective of nerve root decompression, restrict mobility, and fusion of the listhesis. Among the techniques, posterior interbody fusion combines direct and indirect root decompression with the fusion between vertebral bodies, placing an autologous bone graft between transverse apophysis and vertebral bodies. Transforaminal lumbar and posterior interbody fusion, on the same way, look to decompress and fuse but with a different approach to the spine. The anterior approach for interbody fusion provides a better fusion rate. Lateral lumbar interbody fusion is considered less invasive, with an anterolateral transpsoas approach. The lumbar fusion technique in degenerative spondylolisthesis must be individualized. Non-fusion decompression is considered a less invasive procedure. Various studies suggest that decompression has better results when fusion is added. Surgery had several potential benefits and greater improvement in those patients who fail conservative management. An optimal technique is not conclusively identified.


El tratamiento de la espondilolistesis degenerativa lumbar es específico para cada etapa de la enfermedad y el manejo quirúrgico no debe de ser la primera elección en la mayoría de los casos. El manejo conservador está basado en el uso de antiinflamatorios no esteroideos, control de peso y rehabilitación. En caso de falla después de cuatro a seis semanas, el siguiente paso es la infiltración facetaria. En caso de dolor persistente, alteraciones neurológicas o claudicación neurogénica el siguiente paso es la cirugía. Existen varios abordajes y técnicas quirúrgicas con el objetivo de descomprimir las raíces nerviosas, restringir la movilidad y fusionar la listesis. Entre las técnicas quirúrgicas, la fusión posterior combina la descompresión directa e indirecta con artrodesis entre los cuerpos vertebrales, colocando injerto entre las apófisis transversas y los cuerpos vertebrales. La artrodesis intersomática transforaminal y posterior buscan de la misma manera la descompresión y fusión, pero con un abordaje distinto. El abordaje anterior para artrodesis intersomática provee la mejor tasa de fusión. La artrodesis intersomática lateral se considera un procedimiento menos invasivo, con un abordaje anterolateral transpsoas. La técnica de artrodesis lumbar en la espondilolistesis debe ser individualizada. La descompresión sin artrodesis se considera un procedimiento menos invasivo; varios estudios sugieren que la descompresión tiene mejores resultados cuando se agrega una artrodesis. La cirugía tiene múltiples beneficios posibles en pacientes en quienes el tratamiento conservador ha fallado. No se ha identificado una técnica óptima de tratamiento.


Assuntos
Fusão Vertebral , Espondilolistese , Descompressão Cirúrgica , Humanos , Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Resultado do Tratamento
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