[Bacterial coinfection in the critically-ill COVID-19 patient: incidence, impact and need for antimicrobial therapy]. / Coinfección bacteriana en el paciente COVID-19 crítico: incidencia, impacto y necesidad de tratamiento antibiótico.

OBJECTIVE: To assess the frequency of bacterial coinfection upon ICU admission in SARS-CoV-2 pneumonia patients, its microbiology, and impact on prognosis.The secondary objective was to identify risk factors for coinfection on admission. METHODS: Retrospective study, including patients with SARS-CoV-2 pneumonia admitted to the ICU.We defined bacterial coinfection by respiratory symptoms, radiological data, positive and clinically significant microbiological results in samples obtained in the first 48 h of admission and/or a determination of procalcitonin ≥ 0.5 ng/mL in the first 48 h.We evaluated demographic variables, comorbidities, SARS-CoV-2 infection data, severity scores, treatments received, need for respiratory support and outcomes (ICU and hospital mortality). RESULTS: A total of 182 patients were analyzed, 62 (34.1%) with bacterial coinfection.The most frequent microbiology was S. pneumoniae and M. pneumoniae. 96.1% of the patients received antibiotic therapy on admission, 98.9% corticosteroids, 27.5% tocilizumab, and 7.7% remdesivir.85.7% required invasive mechanical ventilation.The SOFA score (OR: 1.315, 95% CI1.116-1.548) and the delay in ICU admission (OR: 0.899, 95% CI 0.831-0.972) were related to the risk of coinfection. Bacterial coinfection increases the risk of death in hospital (OR 2.283; 95% CI 1.011.5.151; p=0.047). CONCLUSIONS: Bacterial coinfection is common in COVID patients admitted to the ICU and increases the risk of death. It is not possible to identify with certainty, at the time of admission, which patients do not benefit from antibiotic treatment.

[Resuscitation strategy for patients with sepsis and septic shock]. / Estrategia integral de reanimación del paciente con sepsis y shock séptico.

Fluid and vasopressor resuscitation is, along with antimicrobial therapy and control of the focus of infection, a basic issue of the treatment of sepsis and septic shock. There is currently no accepted protocol that we can follow for the resuscitation of these patients and the Surviving Sepsis Campaign proposes controversial measures and without sufficient evidence support to establish firm recommendations. We propose a resuscitation strategy adapted to the situation of each patient: in the patient in whom community sepsis is suspected, we consider that the early administration of 30mL/kg of crystalloids is effective and safe; in the patient with nosocomial sepsis, we must carry out a more in-depth evaluation before initiating aggressive resuscitation. In patients who do not respond to initial resuscitation, it is necessary to increase monitoring level and, depending on the hemodynamic profile, administer more fluids, a second vasopressor or inotropes.

COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome.

OBJECTIVE: To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). METHODS: Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. RESULTS: A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). CONCLUSIONS: Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse.

BACKGROUND: Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS: Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS: The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS: Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Enfermedad de Sinding-Larsen-Johansson: análisis de factores asociados / Sinding-Larsen-Johansson disease: analysis of the associated factors

Objetivo. Analizar los factores clínicos, etiológicos biomecánicos asociados a la enfermedad de Sinding-Larsen-Johansson (SLJ). Material y método. Estudio de casos-control valorando los siguientes parámetros: edad, sexo, tiempo de evolución clínica, lateralidad, nivel de actividad deportiva, grado radiológico, existencia de patela alta, existencia de retracción de isquiotibiales y aumento de la caída posterior de la tibia. Resultados. Presentamos 15 rodillas en 14 pacientes (un caso de afectación bilateral). El porcentaje de varones es del 85,7% y la edad media de afectación es de 10,86 años (d.t. 1,61). Todos ellos presentaban un nivel de actividad física y deportiva elevado con una duración de los síntomas muy variable (1-36 meses). Sin tendencia clara en cuanto a la lateralidad, la mayoría se incluyen en un grado radiológico tipo ii (53,3%). El análisis de los datos no muestra diferencias significativas (p>0,05) entre los grupos respecto al índice de Caton ni de Insall modificado. En la medición del ángulo poplíteo en las rodillas lesionadas, sí encontramos diferencias significativas (media: 32,50 d.t.:8,90) con respecto al grupo control (17,67; 8,21). La diferencia en la medición del ángulo de caída posterior en las rodillas lesionadas también ha resultado estadísticamente significativo (10,47; 2,82) con respecto a las rodillas de los casos control (8,33; 1,40). Conclusiones. Los pacientes con la enfermedad tienen un aumento de la pendiente tibial y retracción de isquiotibiales respecto al grupo control y esta diferencia es estadísticamente significativa (AU)

Aim. To analyse the clinical symptoms, aetiology and biomechanical aspects related to Sinding-Larsen-Johansson (SLJ) disease. Material and method. A case control study was conducted, analysing the following variables: age, gender, clinical follow up, side of body with the symptoms, sporting activity, radiological stage, presence of patella alta, presence of short hamstring tendons, and increased posterior tibial slope. Results. A total of 15 knees in 14 patients were studied; one case with bilateral disease. The large majority of cases were 85.7% were male, and the mean age was 10.86 (standard deviation 1.61). All of them practised sport and physical activity at a high level with a variable duration of symptoms (1-36 months). There was predominance in side. The majority were radiological grade II (53.3). The data analysis did not show any significant difference (P>.05) between the study groups regarding the Caton and modified Insall indexes. There was a significant difference in the popliteal angle measured in the affected knees (mean: 32.50, SD: 8.9) compared with the control group (mean: 17.67, SD: 8.21). The difference in the posterior slope angle in the affected knees was also statistically significant (mean: 10.47, SD: 2.82) compared with the control (mean: 8.33, SD: 1.4). Conclusions. According to our data, patients have short hamstring tendons and increased posterior tibial slope compared to the control group, and this difference is statistically significant (AU)

[Radial head and neck fractures in children]. / Fracturas pediátricas de cabeza y cuello de radio.

OBJECTIVE: To analyse cases of radial head and neck fractures in children and compare them with the literature. METHOD: Retrospective and descriptive study of 21 children with radial head and neck fractures. The following parameters were collected: demographics, comorbidity, classification, treatment, need for rehabilitation, lack of range of motion (ROM), time for recovery and complications. RESULTS: The series included 11 males, and the mean age was 8.3 years. The right side was affected in 14 patients. Twelve cases had an associated ipsilateral elbow injury. According to the Chambers classification, 15 cases belonged to group A, while in the Steele-Graham classification, 12 cases were in group I. Eleven patients were treated with immobilization only, 4 percutaneously, and 6 by open reduction and internal fixation (ORIF). Eleven of them needed rehabilitation and despite this, 8 did not achieve full mobility. The mean time to obtain the greatest ROM was 4.71 months. Eight patients had complications, with the most common being neuroapraxia and valgus deformity of the elbow. DISCUSSION AND CONCLUSIONS: Treatment of paediatric radius head and neck fractures must be step-wise, from immobilization only, manual and/or percutaneous reduction, to ORIF, whichever is less indicated. In this respect, both the transcapital needle and/or removal the radius head should be avoided. The most common complication is lack of supination, especially in cases treated by ORIF. The posterior interosseous neuroapraxia was the most common of the rest of complications.

[Bone mineral density in a population with severe infantile cerebral palsy]. / Densidad mineral ósea en la población con afectación severa por parálisis cerebral infantil.

OBJECTIVE: To determine the bone mineral density (BMD) values in children and adolescents with moderate and severe infantile cerebral palsy (ICP) in our catchment area, and compare these values with a healthy population. MATERIAL AND METHOD: A prognostic study of cases and controls for the assessment of BMD in patients from 2 to 18 years old with infantile cerebral palsy belonging to the Gross Motor Function Classification System (GMFCS) Groups IV and V. The BMD measurements were performed at distal femur level, dividing this region into 3 areas following the forearm protocol. RESULTS: The BMD for each of the three areas studied results in the final sample of 69 patients were much lower than the reference levels. There was a statistically significant difference (P<.05) between the BMD values in the two sub-groups studied. DISCUSSION: The greater the involvement, from a neurological point of view, in patients classified as Group V shows a very low BMD compared to patients of similar sex and age. The acquisition of bone capital in patients with ICP does not follow the normal pattern of the healthy population.

[Sinding-Larsen-Johansson disease: analysis of the associated factors]. / Enfermedad de Sinding-Larsen-Johansson: análisis de factores asociados.

AIM: To analyse the clinical symptoms, aetiology and biomechanical aspects related to Sinding-Larsen-Johansson (SLJ) disease. MATERIAL AND METHOD: A case control study was conducted, analysing the following variables: age, gender, clinical follow up, side of body with the symptoms, sporting activity, radiological stage, presence of patella alta, presence of short hamstring tendons, and increased posterior tibial slope. RESULTS: A total of 15 knees in 14 patients were studied; one case with bilateral disease. The large majority of cases were 85.7% were male, and the mean age was 10.86 (standard deviation 1.61). All of them practised sport and physical activity at a high level with a variable duration of symptoms (1-36 months). There was predominance in side. The majority were radiological grade II (53.3). The data analysis did not show any significant difference (P>.05) between the study groups regarding the Caton and modified Insall indexes. There was a significant difference in the popliteal angle measured in the affected knees (mean: 32.50, SD: 8.9) compared with the control group (mean: 17.67, SD: 8.21). The difference in the posterior slope angle in the affected knees was also statistically significant (mean: 10.47, SD: 2.82) compared with the control (mean: 8.33, SD: 1.4). CONCLUSIONS: According to our data, patients have short hamstring tendons and increased posterior tibial slope compared to the control group, and this difference is statistically significant.

Relationship between insulin resistance, inflammation and liver cell apoptosis in patients with severe obesity.

BACKGROUND: In obesity, insulin resistance appears frequently after activation of proinflammatory molecules. Caspase-generated cytokeratin-18 (CK-18) fragments are produced during the apoptosis of hepatic cells. The main objective in the present study is to investigate the relationship between insulin resistance and caspase-generated CK-18 fragments in patients with severe obesity. METHODS: Sixty-two patients selected for bariatric surgery were clinically studied (sex, age, weight, waist diameter, body mass index, arterial pressure and type 2 diabetes mellitus) and analytic parameters were measured in blood (glucose concentration, cholesterol, triglycerides, insulin, glycosylated hemoglobin, aspartate aminotransferase, alanine aminotransferase, high-sensitivity C-reactive protein, adiponectin, interleukin 6, interleukin 18 and CK-18 fragments). Patient group division was based on 70th percentile of insulin resistance as measured by homeostasis model assessment (HOMA) and also according to liver histology. RESULTS: Patients with greater insulin resistance (percentile > 70th) showed higher values of CK-18 fragments, interleukin 6 and transaminases. A positive correlation between the HOMA score, value of CK-18 fragments and triglyceride level was found. A correlation between CK-18 fragments with interleukin 6, triglycerides and transaminases was also observed. HOMA score and value of CK-18 fragments correlated with the degree of liver fibrosis. CONCLUSIONS: Greater degree of insulin resistance induces apoptosis of hepatic cells as measured by the serum levels of CK-18 fragments.

Incidence of adult form of autoimmune hepatitis in Valencia (Spain).

BACKGROUND AND STUDY AIMS: There is little information on the incidence of autoimmune hepatitis (AIH) because on many occasions the disease can progress asymptomatically, different diagnostic criteria have been proposed during the last 20 years, and many epidemiological studies are based on retrospective clinical series. The aim of this study was to determine the incidence of AIH in the province of Valencia, Spain, during the year 2003. PATIENTS AND METHODS: The Services of Gastroenterology of eight acute-care reference hospitals in the province of Valencia, Spain, covering 1,774,736 inhabitants over 14 years of age, participated in a prospective study. All newly diagnosed patients with AIH between January 1, 2003 and December 31, 2003 were eligible. The diagnosis was based on criteria of the International Autoimmune Hepatitis Group revised in 1999. RESULTS: There were 19 new cases of AIH, 18 females and 1 male [mean (SD) age of 54.3 (11.2) years, range 23-73]. Incidence peaked in the 45-54 year age group. Eighteen cases were classified as AIH type 1 and one case as AIH type 2. The incidence rate of AIH for the year 2003 in people older than 14 years of age was 1.07 new cases per 100,000 inhabitants, with 1.96 cases per 100,000 inhabitants in females and 0.12 cases per 100,000 inhabitants in males. CONCLUSIONS: The 2003 annual incidence of AIH in Valencia, Spain, was similar to that reported in other European countries. AIH occurred more frequently in women and in the 45-54 year age group, type 1 being the most common.

[A clinical study of adult autoimmune hepatitis in Valencia, Spain]. / Estudio clínico de la hepatitis autoinmune del adulto en Valencia.

OBJECTIVE: the clinical phenotype of autoimmune hepatitis (AIH) varies among geographical areas. The aim of this study is to determine the salient features of AIH in adult patients from the province of Valencia, Spain. MATERIAL AND METHODS: eighty-one patients with AIH attended to in eight acute-care hospitals between 1994 and 2003. New patients diagnosed with AIH during year 2003 were evaluated prospectively. Data from patients currently attending follow-up visits and diagnosed before 2003 were collected retrospectively. RESULTS: a total of 94% of patients were females. Forty-three percent were asymptomatic, 27% had acute hepatitis, and 30% had chronic hepatitis. Type 1 AIH was diagnosed in 90% of cases. Type 2 AIH was more frequent in younger patients, and presented with an acute pattern. One third of patients had cirrhosis at onset. Patients with cirrhosis were older than 60 years more frequently. Immunosuppressants were given to 57 patients, with complete or partial remission in 87.7%. There were no significant differences in response to immunosuppression according to presentation pattern or AIH subtype. CONCLUSIONS: AIH in Valencia was predominantly diagnosed in asymptomatic women. Most cases were type 1, and in 25% of patients another autoimmune disease coexisted. At the time of diagnosis one third of patients had cirrhosis, particularly those over 60 years.

[Waldenström macroglobulinemia associated with cutaneous lesions and type I cryoglobulinemia]. / Macroglobulinemia de Waldenström asociada a lesiones cutáneas y crioglobulinemia tipo I.

Waldenström macroglobulinemia is a blood dyscrasia characterized by monoclonal proliferation of B cells in the bone marrow, lymph nodes, and spleen. Patients with this disease show elevated serum levels and tissue deposition of monoclonal immunoglobulin (Ig) M produced by these aberrant cells. We present the case of a patient with Waldenström macroglobulinemia who suffered cutaneous lesions resulting from deposition of k light chains of IgM and clinical manifestations secondary to associated type I cryoglobulinemia. We discuss the different pathological cutaneous processes caused by IgM in Waldenström macroglobulinemia.

Rejuvenecimiento periorbitario no invasivo / Non-invasive periorbital rejuvenation

Cirujanos plásticos y médicos estéticos se esfuerzan por lograr resultados satisfactorios y estéticos que mejoren o suavicen el paso del tiempo a nivel facial, con un especial interés o énfasis en el área periorbitaria. Un gran número de pacientes consultan para mejorar esta zona, pero por diferentes motivos desean que los procedimientos que se les realicen sean poco invasivos y con resultados rápidos, permitiéndoles así incorporarse lo antes posible a sus actividades cotidianas. Es fundamental el conocimiento de las proporciones faciales y periorbitarias para lograr resultados naturales. El objetivo de la técnica que proponemos es lograr una bioestimulación local de la piel, restaurar los volúmenes y reducir las arrugas de expresión o dinámicas, consiguiendo así una apariencia relajada y juvenil en el paciente (AU)

Plastic surgeons and aesthetic doctors are making an effort to reach positive aesthetic results. Their aim is to soften the effects of age on facial features stressing in the periorbital area. Many patients come to improve their facial image on this area, but they are asking for non-invasive and fast procedures to keep on their daily life. It is indispensable the knowledge of facial and periorbital proportions to achieve a more naturaleffect. The aim of the technique exposed is to achieve a local bioestimulation on skin, to restore volumes and to reduce expression and dynamical wrinkles. The expected result is a relaxing, youthful appearance (AU)

Genetic variability in hepatitis C virus and its role in antiviral treatment response.

Hepatitis C virus (HCV) is a major health problem worldwide, infecting an estimated 170 million people. The high genetic variability of HCV contributes to the chronicity of hepatitis C. Here, we report results from a large-scale sequence analysis of 67 patients infected with HCV genotype 1, 23 with subtype 1a and 44 with subtype 1b. Two regions of the HCV genome were analysed in samples prior to combined therapy with alpha interferon plus ribavirin, one compressing the hypervariable regions (HVR1, HVR2 and HVR3) of the E2 glycoprotein and another one including the interferon-sensitive determining region (ISDR) and the V3 domain of the NS5A protein. Genetic diversity measures showed a clear tendency to higher genetic variability levels in nonresponder patients to antiviral treatment than in responder patients, although highly disperse values were present within each response group for both subtypes. A more detailed analysis of amino acid composition revealed the presence of several subtype-specific variants in a few positions, but no discriminating positions between responder and nonresponder patients were detected. Our results also revealed that most amino acid positions were highly conserved, especially for subtype 1a. We conclude that the outcome of the antiviral treatment might depend not only on the nature of one or a few independent positions, but more likely on the combination of several positions along the HCV genome. Moreover, the own host's ability to generate an appropriate systemic response, in combination with the action of antivirals, is also likely to be essential for treatment outcome.

Ear, nose and throat manifestations in pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are two clinical forms: mucosal (MPV) and mucocutaneous (MCPV). The frequency of ear, nose and throat (ENT) involvement in PV is not clearly defined. Only a few isolated individual cases have been reported. OBJECTIVES: The objective of our study was to determine the incidence of ENT involvement in patients with PV. PATIENTS: We studied prospectively all 16 patients diagnosed with PV and treated in the Department of Dermatology of the University Clinic of Navarra between 2001 and 2005. They were 10 cases of MPV and six cases of MCPV. All patients were evaluated for ENT manifestations by endoscopic examination. RESULTS: Of the 16 patients, 13 presented with throat symptoms (81%), 12 pharyngeal (75%) and seven laryngeal symptoms (44%). Fourteen patients (88%) had active PV lesions on endoscopic evaluation (eight patients had active lesions on both pharyngeal and laryngeal mucosa, four had PV lesions only on laryngeal mucosa and two had PV lesions on pharyngeal mucosa). Laryngeal lesions were most commonly present in MPV patients. The frequency of nasal symptoms (38%) was lower than active PV lesions (62%) found on ENT examination. Oral symptoms and oral active PV lesions were the most frequent findings (94%). Only three patients with MCPV showed erosions on the external auditory canal. CONCLUSIONS: As ENT endoscopy allows more extensive areas of mucosa to be examined than simple visual inspection, we recommend that it be included in the examination of all patients with PV. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided and, ultimately, response to treatment may be improved.

Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate.

BACKGROUND: Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM: To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS: Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS: The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION: If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

Uso de factores de crecimiento plaquetar unidos a injertos de grasa para lipofiling facial en ritidectomía / Use of fat grafts enriched with platelet growth factors for facial lipofiling in ritidectomy

Presentamos una serie de pacientes a los que hemos realizado infiltraciones de grasa enriquecida con Factores de Crecimiento Plaquetario (F.C.P.) como único procedimiento. Igualmente presentamos casos donde las infiltraciones van acompañadas con otros procedimientos (liftingtemporal, lifting cérvico-frontal, etc.). También usamos el plasma rico en F.C.P. en forma de coágulo para rellenar el surco de la cuenca orbitaria (“Tear Through”),y como mesoterapia facial enriquecida con nutrientes. El objetivo de este trabajo es presentar una revisión detallada de los pasos a seguir para la realización de éste procedimiento, que van desde la simple extracción de sangre para la posterior obtención de F.C.P. hasta la técnica de infiltración de grasa enriquecida con dichos factores a nivel facial. Con esta técnica de enriquecimiento de la grasa hemos logrado tener mejores resultados y con mayor permanencia. Evaluando los postoperatorios de pacientes sometidos a este procedimiento, hemos observado que el volumen infiltrado en áreas como la región malar, se mantiene entre un 90% a 95%. En otras áreas como labios y surcos nasogenianos (áreas de gran movilidad), solo permanece entre el 50% a 60% del volumen infiltrado (AU)

We present a serie of patients with facial fat infiltration enriched with platelet-derived growth factors, some of them associated to other surgical procedures (temporal lifting, cervico-frontal lifting, etc.) We explain how to use this platelet – rich plasma to fill the tear – through and as a facial mesotherapy. Our purpose is to present a detailled review of our method: since blood extraction to the last obtention of the platelet – derived growth factors and the use of this plasma combined with fat infiltration in the facial area. With this methodology we have got better and more permanent results. We have evaluated 90-95 % fat grafts survival in malar region. In other facial areas such as lips or nasogenian folds (big movement areas), we only report about 50 to 60% fat graft survival (AU)

[Experimental models used in research into genetic disorders that involve intellectual disability]. / Modelos experimentales utilizados en la investigación de trastornos genéticos que cursan con discapacidad intelectual.

INTRODUCTION: A basic principle of molecular and clinical medicine states that the function of the organs and the cells they are made up of is determined by the overall set of specific proteins. Therefore, the function of each organ depends on the molecules present in each cell, and hence it comes as no surprise to find that when tissue function is altered, different changes have taken place in the proteins. In the nervous system there are numerous examples of changes in proteins that correlate with functional alterations, either during normal or pathological development. DEVELOPMENT: In order to understand these relations, and to establish models in which to study the aetiopathogenesis of the disease, it is necessary to direct steady synthesis or to suppress synthesis in the brain of the protein that is potentially involved in the development of the disease. In consequence, it is possible to determine whether the presence or the absence of the protein is the direct or indirect cause of the effects; this is one of the main goals that must be achieved in order to enable researchers to define potential therapeutic targets in hereditary diseases. In order to manipulate the specific protein causing a pathology, we use experimental animal models as essential research tools, since they enable us to determine which mechanisms are altered and how the function of a particular protein affects the mechanisms being studied. CONCLUSIONS: Suppressing a gene or its over-expression in models using genetically modified mice will provide us with a means of modifying the genome and, eventually, the protein in the different tissues as well as in the nervous system in an attempt to imitate the genetic pathology that involves mental retardation. By controlling or suppressing the expression of a protein in the brain it becomes possible to remodel the functional profile of the tissue and study the consequences of molecular genetic manipulation, together with the biochemical, cytological and physiological processes, under normal basal conditions and under specific stimuli or conditions such as stress.