[Effectiveness of a multidimensional therapeutic program for aged people attending senior centers]. / Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile.

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

Cell Adhesion and Proliferation on Sulfonated and Non-Modified Chitosan Films.

Three types of chitosan-based films have been prepared and evaluated: a non-modified chitosan film bearing cationizable aliphatic amines and two films made of N-sulfopropyl chitosan derivatives bearing both aliphatic amines and negative sulfonate groups at different ratios. Cell adhesion and proliferation on chitosan films of C2C12 pre-myoblastic cells and B16 cells as tumoral model have been tested. A differential cell behavior has been observed on chitosan films due to their different surface modification. B16 cells have shown lower vinculin expression when cultured on sulfonated chitosan films. This study shows how the interaction among cells and material surface can be modulated by physicochemical characteristics of the biomaterial surface, altering tumoral cell adhesion and proliferation processes.

First evidence of neosaxitoxin as a long-acting pain blocker in bladder pain syndrome.

INTRODUCTION AND HYPOTHESIS: Neosaxitoxin is a phycotoxin whose molecular mechanism of action shows a reversible inhibition of voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of neosaxitoxin as a long-acting pain blocker in the treatment of bladder pain syndrome (BPS). METHODS: Five patients with a diagnosis of BPS received a total dose of 80 µg of neosaxitoxin in an isoosmotic solution of 0.9 % NaCl, pH 6.5. Infiltration was performed via cystoscopy under spinal anesthesia. Questionnaires were administered immediately before and 7, 30 and 90 days after the procedure to measure the patients' reported pain severity and quality of life. RESULTS: This study, for the first time, showed the effect of blocking the neuronal transmission of pain by local infiltration of neosaxitoxin into the bladder submucosa. All five patients successfully responded to the treatment. Furthermore, the analgesic effect lasted for the entire 90 days of follow-up without the need for a second infiltration, and no adverse reactions to neosaxitoxin were detected. CONCLUSIONS: Neosaxitoxin infiltration was shown to be a safe and effective intervention to control pain related to BPS. It was well tolerated by patients, who experienced extended pain relief and associated beneficial effects over a follow-up of 90 days. These results confirm the effectiveness of neosaxitoxin as a long-acting local pain blocker.

Evaluation of urinary biomarkers of oxidative/nitrosative stress in adolescents and adults with Down syndrome.

Urinary biomarkers of oxidative stress have been little studied in adults with Down syndrome (DS), usually no more than two biomarkers have been measured in the population studied and controversial results are reported in literature. Thus, we aimed to assess a set of oxidative and nitrosative stress biomarkers in urine samples of adolescents and adults with DS, with and without hypothyroidism, which comprise: 8-hydroxy-2'-deoxyguanosine (8-OHdG), isoprostane 15-F(2t)-IsoP, thiobarbituric acid-reacting substances (TBARS), advanced glycation end products (AGEs), dityrosine (diTyr), hydrogen peroxide (H(2)O(2)) and nitrite/nitrate (NOx). Fluorimetric and spectrophotometric assays were performed in DS (n=78), some of them taking levothyroxine for hypothyroidism (n=24), and in their healthy age-matched controls (n=65). We found that levels of AGEs, diTyr, H(2)O(2) and NOx are increased in DS patients in any or in all age groups, whereas Cr levels were lower in DS than in controls in all age groups. Besides, correlations with age in DS were positive for diTyr and negative for Cr, TBARS, 15-F(2t)-IsoP and NOx. We also found lower levels of Cr from 15 to 19years, higher levels of TBARS and AGEs from 20 to 40years and higher levels of diTyr from 15 to 40years in DS patients receiving levothyroxine than in DS without hypothyroidism diagnosed. We conclude that AGEs, diTyr, H(2)O(2) and NOx could be used as oxidative stress biomarkers in DS in contrast to 8-OHdG, 15-F(2t)-IsoP and TBARS, at least with the methods used. However, renal impairment could occur in DS and Cr adjustment may bias the results, particularly in hypothyroid patients.

Biomarkers of age effect on renal function in Down syndrome.

OBJECTIVE: To assess differences in kidney function between Down syndrome (DS) individuals and a control group related to aging. METHODS: Creatinine (Cr) and specific gravity (SG) were assessed by spectrophotometric and refractometric assays in urine samples of 103 individuals with DS and 82 age-matched controls. RESULTS: Significantly lower levels of Cr and SG were found in DS after puberty. Significant correlations were found between SG and age as well as between Cr and SG in DS and controls (p ≤ 0.05). CONCLUSIONS: Premature aging in kidneys of DS patients could lead to an impaired renal function.

Urinary biomarkers of oxidative/nitrosative stress in healthy smokers.

OBJECTIVE: To evaluate the effect of cigarette smoking on oxidative and nitrosative stress, we assessed urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), isoprostane 15-F(2t)-IsoP, thiobarbituric acid-reacting substances (TBARS), advanced glycation end-products (AGEs), dityrosine (diTyr), hydrogen peroxide, total nitrite and nitrate and trolox equivalent antioxidant capacity (TEAC) in healthy smokers. METHODS: Fluorimetric and spectrophotometric assays were performed in urine samples of 33 healthy smokers and 58 age-matched controls. RESULTS: Levels of 8-OHdG, 15-F(2t)-IsoP and AGES were found significantly higher in smokers than in controls (10.7 ng/mg Cr vs. 8.3 ng/mg Cr, 1.41 ng/mg Cr vs. 1.01 ng/mg Cr and 189 AFU/mg Cr vs. 143 AFU/mg Cr, respectively; P < 0.05 for all). Positive correlations were found between age and levels of AGEs and diTyr in smokers (r = 0.380, P < 0.035 and r = 0.418, P < 0.019, respectively) and also between age and AGEs, diTyr and TEAC in controls (r = 0.474, P < 0.001, r = 0.463, P < 0.001 and r = 0.576, P < 0.001, respectively), being this correlation negative for 8-OHdG in controls (r = -0.295, P = 0.041). Positive correlation between the number of cigarettes smoked per day and AGEs was also found (r = 0.355, P = 0.044). CONCLUSION: Urinary 8-OHdG, 15-F(2t)-IsoP and AGEs may represent a non-invasive quantitative index of oxidant stress in healthy smokers, being AGEs a possible indicator of tobacco toxin exposure. The increased oxidative stress in healthy smokers observed may be generated because of an excessive production of reactive oxygen species and not by exhaustion of antioxidant defenses.

There is direct relationship between bone bridge length and coracoclavicular fixation resistance to failure: Biomechanical study in a porcine model.

BACKGROUND: This study aims to evaluate the relation between coracoclavicular resistance to failure and the distance between clavicular tunnels. The hypothesis is that a greater clavicular bone bridge between tunnels achieves a stronger coracoclavicular fixation. METHODS: Descriptive Laboratory Study. Thirty-six (36) coracoclavicular models were constructed utilizing porcine metatarsals. Coracoclavicular stabilizations were performed using a subcoracoid loop fixation configuration through two clavicular tunnels, tied at the clavicle's superior cortex using a locking knot. Models were randomly assigned to 1 of 3 experimental groups of variable bone bridge length between clavicular tunnels: 5 mm, 10 mm, and 15 mm. Each group had 12 models. Fixation resistance was assessed through the ultimate failure point under an axial load to failure trial. Failure patterns were documented. A one-way ANOVA test was used, and a Tukey post hoc as needed (P < 0.05). FINDINGS: Mean strength per bone bridge length: 5 mm = 312 N (Range: 182-442 N); 10 mm = 430 N (Range: 368-595 N); 15 mm = 595 N (Range: 441-978 N). The 15 mm group had a significantly higher ultimate failure point than the other two groups: 5 mm (P < 0.001) and 10 mm (P < 0.001). All fixations systematically failed by a superior cortex clavicle fracture at the midpoint between tunnels. INTERPRETATION: A direct relationship between bone bridge length and coracoclavicular resistance to failure was demonstrated, being the 15 mm length a significantly higher strength construct in a tied loop model.

[Differences in biomechanical parameters during sit to stand transfer between elderly with and without history of frequent falls]. / Diferencias biomecánicas durante la transferencia de sedente a bípedo entre adultos mayores con y sin historia de caídas frecuentes.

INTRODUCTION: The phenomenon of frequent falls (FF) is a health problem in the older population, and is a reason why tools need to be designed for the objective assessment of the risk of FF. In this sense the use of biomechanical parameters could be of use in designing these. The aim of this work was to describe the biomechanical differences registered during a sit to stand transfer (STS) between subjects with and without a history of frequent falls. MATERIAL AND METHOD: A sample of sixty voluntary older adults were assessed, divided in two groups of thirty subjects. The first group was composed of older adults without history of frequent falls (WoHFF) and the other group with history of frequent falls (WHFF). In both groups the velocity of the mass centre, the anterior flexion of the trunk, the joint and support moments of the lower extremity and the time of execution during the TSB was assessed. RESULTS: The subjects WHFF generate a slower vertical velocity (P<0.001), lower slope (P<0.001), greater anterior trunk flexion (P<0.0001), lower support moment (P=0.001) and took longer in executing the STS (P=0.0001) than the group WoHFF. CONCLUSIONS: Differences exist in the biomechanical parameters registered during the STS between the elderly WHFF and WoHFF. The results indicate that the function of the hip extensor muscles could have an important role in the execution of the STS in subjects WHFF. The biomechanical parameters assessed during the STS should be considered as useful tools to distinguish between subjects WHFF and WoHFF, and should be considered in the design of tools to determine the risk of frequent falls.

Author Correction: Space lidar observations constrain longwave cloud feedback.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Evaluation of the copper(II) reduction assay using bathocuproinedisulfonic acid disodium salt for the total antioxidant capacity assessment: the CUPRAC-BCS assay.

There is heightened interest in determining antioxidant status of individuals in experimental and clinical studies investigating progression of diseases or diverse aspects of oxidative stress, among others. The aim of this study was to evaluate the copper(II) reduction assay with bathocuproinedisulfonic acid disodium salt as chelating agent (the CUPRAC-BCS assay) for the total antioxidant capacity (TAC) assessment in human plasma and urine. Samples from 20 individuals were determined with four spectrophotometric assays-CUPRAC-BCS, ferric reducing ability of plasma (FRAP), trolox equivalent antioxidant capacity (TEAC), and 1,1-diphenyl-2-picrylhydrazyl assay (DPPH)-to compare these methods. CUPRAC-BCS was significantly correlated with FRAP and TEAC for plasma and urine samples (r>0.5, P<0.05 for all) and with DPPH for urine samples (r=0.925, P<0.001) but not with DPPH for plasma samples (r=0.366, P=0.112). However, the four methods do not agree given that lines of equality and regression were not matched up. The imprecision of the method is less than 6%, the detection limit is 41.8 micromol trolox equivalents/L, it is linear up to 2 mM trolox, and ethylenediaminetetraacetic acid dihydrate disodium salt (EDTA) binds to Cu(II), avoiding the formation of Cu(I)-BCS complex. This study shows that CUPRAC-BCS is a simple, fast, inexpensive, and suitable method for TAC assessment in human urine and heparinized plasma samples.

[Differences in momentum development when standing up from a chair between elderly with and without frequent falls history]. / Diferencias en el desarrollo de momentum al levantarse desde una silla en adultos mayores con y sin historia de caídas frecuentes.

INTRODUCTION: The momentum of the upper body (UB) during transfer sit-to-stand (STS) could be sensitive to the deterioration of dynamic postural control, and also the risk of falls. The aim of this study is to quantify the differences in the momentum development on UB during the STS in a sample of fall and no-fall elderly subjects. MATERIAL AND MEHODS: The sample consisted of twenty three voluntary elderly subjects (n=23), six elderly adults with antecedents of frequent falls (more than two within a year period) and seventeen without histories of frequent falls. Through a motion analysis system we registered the kinematics of UB during STS, from which we calculated the momentum of UB. The determined analysis variables were: the maximum values of the vertical (P(V)M) and horizontal (P(H)M) lineal momenta, the minimum (L(Max)) and maximum (L(Min)) values of the angular momentum and maximum trunk flexion (thetaM(UB)). RESULTS: No difference was observed in P(H)M, L(Max) and L(Min) (P>0.05) between both groups. However, a significant difference was found for the variable P(V)M (P=0.03) and thetaM(UB) (P=0.03) between both groups. CONCLUSIONS: We can conclude that, for the sample studied, the frequent fall condition relates to a smaller capacity to develop vertical momentum and increase flexion of the upper body.

Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot.

BACKGROUND: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). METHODS: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. RESULTS: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. CONCLUSION: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.

Space lidar observations constrain longwave cloud feedback.

Some of the most challenging questions in atmospheric science relate to how clouds will respond as the climate warms. On centennial scales, the response of clouds could either weaken or enhance the warming due to greenhouse gas emissions. Here we use space lidar observations to quantify changes in cloud altitude, cover, and opacity over the oceans between 2008 and 2014, together with a climate model with a lidar simulator to also simulate these changes in the present-day climate and in a future, warmer climate. We find that the longwave cloud altitude feedback, found to be robustly positive in simulations since the early climate models and backed up by physical explanations, is not the dominant longwave feedback term in the observations, although it is in the model we have used. These results suggest that the enhanced longwave warming due to clouds might be overestimated in climate models. These results highlight the importance of developing a long-term active sensor satellite record to reduce uncertainties in cloud feedbacks and prediction of future climate.

Efectividad a mediano plazo de un programa multidimensional en personas mayores en centros diurnos en Chile / Effectiveness of a multidimensional therapeutic program for aged people attending senior centers

BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation (T.C. PTNS) versus extended release oxybutynin (E.R.O.) in patients with overactive bladder. MATERIALS AND METHODS: Seventy female patients were randomized to receive either 10mg E.R.O. daily or T.C. PTNS, using a TENS machine program with the 20Hz, 200 cycles/s, and normal stimulation setting for two 30-min sessions, each week for a 12-week period. Pre-treatment and after the 12-week intervention, each patient completed a 3-day voiding diary and a self-report quality of life questionnaire (OAB-q). Statistical analysis was performed using Stata V12.1. RESULTS: Sixty-four patients completed the treatment protocol. There were no significant differences between study groups in terms of age, body mass index, past hormone replacement therapy, smoking habits, menopause status, and parity. Prior to treatment, there were also no significant differences in the analysis of the 3-day voiding diary or in the OAB-q questionnaire results. Following the 12-week study, there was a statistically significant reduction in frequency of urination, urgency episodes, and urge incontinent episodes compared to pre-treatment values. However, there were no significant differences in these values between intervention groups after 12-weeks of therapy. There was a similar improvement in OAB-q scores in both treatment groups following therapy, and the T.C. PTNS group showed a statistically significant improvement over the E.R.O. in domain 2 of the OAB-q questionnaire. The other two domains showed similar improvement in both study groups. CONCLUSION: T.C. PTNS and E.R.O. demonstrated similar improvements in subjects with OAB in a 12-week study.

Biocompatibility assessment of spark plasma-sintered alumina-titanium cermets.

Alumina-titanium materials (cermets) of enhanced mechanical properties have been lately developed. In this work, physical properties such as electrical conductivity and the crystalline phases in the bulk material are evaluated. As these new cermets manufactured by spark plasma sintering may have potential application for hard tissue replacements, their biocompatibility needs to be evaluated. Thus, this research aims to study the cytocompatibility of a novel alumina-titanium (25 vol. % Ti) cermet compared to its pure counterpart, the spark plasma sintered alumina. The influence of the particular surface properties (chemical composition, roughness and wettability) on the pre-osteoblastic cell response is also analyzed. The material electrical resistance revealed that this cermet may be machined to any shape by electroerosion. The investigated specimens had a slightly undulated topography, with a roughness pattern that had similar morphology in all orientations (isotropic roughness) and a sub-micrometric average roughness. Differences in skewness that implied valley-like structures in the cermet and predominance of peaks in alumina were found. The cermet presented a higher surface hydrophilicity than alumina. Any cytotoxicity risk associated with the new materials or with the innovative manufacturing methodology was rejected. Proliferation and early-differentiation stages of osteoblasts were statistically improved on the composite. Thus, our results suggest that this new multifunctional cermet could improve current alumina-based biomedical devices for applications such as hip joint replacements.

Biomechanical evaluation of various suture configurations in side-to-side tenorrhaphy.

BACKGROUND: Side-to-side tenorrhaphy is increasingly used, but its mechanical performance has not been studied. METHODS: Two porcine flexor digitorum tendon segments of equal length (8 cm) and thickness (1 cm) were placed side by side. Eight tenorrhaphies (involving sixteen tendons) were performed with each of four suture techniques (running locked, simple eight, vertical mattress, and pulley suture). The resulting constructs underwent cyclic loading on a tensile testing machine, followed by monotonically increasing tensile load if failure during cyclic loading did not occur. Clamps secured the tendons on each side of the repair, and specimens were mounted vertically. Cyclic loading varied between 15 N and 35 N, with a distension rate of 1 mm/sec. Cyclic loading strength was determined by applying a force of 70 N. The cause of failure and tendon distension during loading were recorded. RESULTS: All failures occurred in the monotonic loading phase and resulted from tendon stripping. No suture or knot failure was observed. The mean loads resisted by the configurations ranged from 138 to 398 N. The mean load to failure, maximum load resisted prior to 1 cm of distension, and load resisted at 1 cm of distension were significantly lower for the vertical mattress suture group than for any of the other three groups (p < 0.031). CONCLUSIONS: All four groups sustained loads well above the physiologic loads expected to occur in tendons in the foot and ankle (e.g., in tendon transfer for tibialis posterior tendon insufficiency). None of the four side-to-side configurations distended appreciably during the cyclic loading phase. The vertical mattress suture configuration appeared to be weaker than the other configurations. CLINICAL RELEVANCE: For surgeons who advocate immediate loading or motion of a side-to-side tendon repair, a pulley, running locked, or simple eight suture technique appears to provide a larger safety margin compared with a vertical mattress suture technique.

Nacimiento anómalo de la arteria coronaria izquierda desde la arteria pulmonar, síndrome de ALCAPA. Primer reporte de caso en Uruguay / Anomalous origin of the left coronary artery from the pulmonary artery, ALCAPA syndrome. First case report in Uruguay / Nascimento anômalo da artéria coronária esquerda a partir da artéria pulmonar, síndrome de ALCAPA. Relato do primeiro caso no Uruguai

Resumen: El nacimiento anómalo de la arteria coronaria izquierda desde la arteria pulmonar (síndrome de ALCAPA) es una rara entidad con una mortalidad de 90% durante el primer año de vida. Este hecho hace que su presencia en el adulto sea excepcional. Presentamos el primer caso reportado en nuestro país en un adulto. Se trata de una paciente de 32 años en estudio por historia de ángor de esfuerzo en la que el ecocardiograma brindó elementos sugestivos de esta entidad que se confirmó con coronariografía. Se intervino quirúrgicamente de forma exitosa con técnica de Takeuchi.

Summary: The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare entity with a high infant mortality rate during first year of life reaching up to 90%. This fact makes this condition extremely uncommon among adults. We report for the first time in our country an adult presentation in a 32-year-old woman. This patient presented with a history of exertional angina and a transthoracic echocardiogram showed suggestive clues for the diagnosis of ALCAPA, then confirmed with coronary angiography. The patient underwent successfull surgical correction with Takeuchi technique.

Resumo: O nascimento anômalo da artéria coronária esquerda a partir da artéria pulmonar (síndrome de ALCAPA) é uma entidade rara com uma mortalidade de 90% durante o primeiro ano de vida. Este fato faz com que sua apresentação da idade adulta seja excepcional. Apresentamos o primeiro caso reportado dessa síndrome no nosso país. Se trata de uma paciente de 32 anos em estudo por uma historia de angina de esforço na qual o ecocardiograma brindou elementos sugestivos dessa entidade sendo confirmada posteriormente com angiografia coronaria. Se realizou uma intervenção cirúrgica exitosa com a técnica de Takeuchi.

Chitosan scaffolds containing calcium phosphate salts and rhBMP-2: in vitro and in vivo testing for bone tissue regeneration.

Numerous strategies that are currently used to regenerate bone depend on employing biocompatible materials exhibiting a scaffold structure. These scaffolds can be manufactured containing particular active compounds, such as hydroxyapatite precursors and/or different growth factors to enhance bone regeneration process. Herein, we have immobilized calcium phosphate salts (CPS) and bone morphogenetic protein 2 (BMP-2)--combined or alone--into chitosan scaffolds using ISISA process. We have analyzed whether the immobilized bone morphogenetic protein preserved its osteoinductive capability after manufacturing process as well as BMP-2 in vitro release kinetic. We have also studied both the in vitro and in vivo biocompatibility of the resulting scaffolds using a rabbit model. Results indicated that rhBMP-2 remained active in the scaffolds after the manufacturing process and that its release kinetic was different depending on the presence of CPS. In vitro and in vivo findings showed that cells grew more in scaffolds with both CPS and rhBMP-2 and that these scaffolds induced more bone formation in rabbit tibia. Thus chitosan scaffolds containing both CPS and rhBMP-2 were more osteoinductive than their counterparts alone indicating that could be useful for bone regeneration purposes, such as some applications in dentistry.

51. Endocarditis infecciosa primaria mural del ventrículo izquierdo

Historia clínica: paciente de 16 años, sexo masculino, sin antecedentes patológicos. Cuadro de dos semanas de evolución de fiebre hasta 41 ºC, sin otros fenómenos acompañantes. Del examen se destaca: hemorragias en astilla. Temperatura axilar 39 ºC. Cardiovascular: ritmo regular de 92 cpm, ruidos cardiacos normales, sin soplos. Resto del examen sin alteraciones. Pruebas complementarias: estudios paraclínicos: hemograma: hemoglobina 10 g/dl, leucocitos: 241.000/ml (neutrófilos: 90%), velocidad de eritrosedimentacion 120 s. Proteína C reactiva 214 mg/l. TAC tórax-abdómen-pelvis: infarto esplénico. Hemocultivos: Staphylococcus aureus meticilino resistente. ETT: masa hiperecogénica con movilidad independiente a nivel del ápex del VI, pediculada, plilobulada, de 22 por 10 mm. Evolución clínica: se realiza resección quirúrgica de la masa y tratamiento antibiótico con vancomicina y gentamicina, con buena evolución posoperatoria. El estudio patológico de la masa resecada fue compatible con una vegetación, y el cultivo de la misma desarrolló Staphylococcus aureus meticilino resistente. Diagnóstico: endocarditis infecciosa aguda primaria mural del ventrículo izquierdo. Discusión: presentamos un caso de endocarditis infecciosa primaria mural del ventrículo izquierdo en un paciente sin cardiopatía predisponente ni endocarditis valvular concomitante. Esta es una entidad infrecuente y existen pocos casos reportados. Habitualmente su diagnóstico es tardío, presentándose muchas veces con fenómenos embólicos al momento del diagnóstico. Son factores de riesgo la inmunodepresión, la adicción a drogas intravenosas y la cirugía reciente. La ecocardiografía precoz es una herramienta de suma importancia para su diagnóstico, ya sea transtorácica o transesofágica, mientras que el diagnóstico por resonancia nuclear magnética se realiza en aquellos casos en que la ecocardiografía no es concluyente. El germen más frecuentemente implicado es el Staphylococcus aureus. Dada la escasa evidencia, se plantea una conducta similar a la de la endocarditis infecciosa.