Severe Allergy as a Chronic Inflammatory Condition From a Systems Biology Perspective.

Persistent and unresolved inflammation is a common underlying factor observed in several and seemingly unrelated human diseases, including cardiovascular and neurodegenerative diseases. Particularly, in atopic conditions, acute inflammatory responses such as those triggered by insect venom, food or drug allergies possess also a life-threatening potential. However, respiratory allergies predominantly exhibit late immune responses associated with chronic inflammation, that can eventually progress into a severe phenotype displaying similar features as those observed in other chronic inflammatory diseases, as is the case of uncontrolled severe asthma. This review aims to explore the different facets and systems involved in chronic allergic inflammation, including processes such as tissue remodelling and immune cell dysregulation, as well as genetic, metabolic and microbiota alterations, which are common to other inflammatory conditions. Our goal here was to deepen on the understanding of an entangled disease as is chronic allergic inflammation and expose potential avenues for the development of better diagnostic and intervention strategies.

Current status of precision medicine in pediatric oncology in Spain: a consensus report by the Spanish Society of Paediatric Haematology and Oncology (SEHOP)

The study analyzes the current status of personalized medicine in pediatric oncology in Spain. It gathers national data on the tumor molecular studies and genomic sequencing carried out at diagnosis and at relapse, the centers that perform these studies, the technology used and the interpretation and clinical applicability of the results. Current challenges and future directions to achieve a coordinated national personalized medicine strategy in pediatric oncology are also discussed. Next generation sequencing-based (NGS) gene panels are the technology used in the majority of centers and financial limitations are the main reason for not incorporating these studies into routine care. Nowadays, the application of precision medicine in pediatric oncology is a reality in a great number of Spanish centers. However, its implementation is uneven and lacks standardization of protocols; therefore, national coordination to overcome the inequalities is required. Collaborative work within the Personalized Medicine Group of SEHOP is an adequate framework for encouraging a step forward in the effort to move precision medicine into the national healthcare system.

First-degree relationships and genotyping errors deciphered by a high-density SNP array in a Duroc × Iberian pig cross.

BACKGROUND: Two individuals with a first-degree relationship share about 50 percent of their alleles. Parent-offspring relationships cannot be homozygous for alternative alleles (genetic exclusion). METHODS: Applying the concept of genetic exclusion to HD arrays typed in animals for experimental purposes or genomic selection allows estimation of the rate of rejection of first-degree relationships as the rate at which two individuals typed for a large number of Single Nucleotide Polymorphisms (SNPs) do not share at least one allele. An Expectation-Maximization algorithm is applied to estimate parentage. In addition, genotyping errors are estimated in true parent-offspring relationships. Samples from nine candidate Duroc sires and 55 Iberian dams producing 214 Duroc × Iberian barrows were typed for the HD porcine Affymetrix array. RESULTS: We were able to establish paternity and maternity of 75 and 85 piglets, respectively. Rate of rejection in true parent-offspring relationships was estimated as 0.000735. This is a lower bound of the genotyping error since rate of rejection depends on allele frequencies. After accounting for allele frequencies, our estimate of the genotyping error is 0.6%. A total of 7,744 SNPs were rejected in five or more true parent-offspring relationships facilitating identification of "problematic" SNPs with inconsistent inheritance in multiple parent-offspring relationships. CONCLUSIONS: This study shows that animal experiments and routine genotyping in genomic selection allow to establish or to verify first-degree relationships as well as to estimate genotyping errors for each batch of animals or experiment.

Current status of precision medicine in pediatric oncology in Spain: a consensus report by the Spanish Society of Paediatric Haematology and Oncology (SEHOP).

The study analyzes the current status of personalized medicine in pediatric oncology in Spain. It gathers national data on the tumor molecular studies and genomic sequencing carried out at diagnosis and at relapse, the centers that perform these studies, the technology used and the interpretation and clinical applicability of the results. Current challenges and future directions to achieve a coordinated national personalized medicine strategy in pediatric oncology are also discussed. Next generation sequencing-based (NGS) gene panels are the technology used in the majority of centers and financial limitations are the main reason for not incorporating these studies into routine care. Nowadays, the application of precision medicine in pediatric oncology is a reality in a great number of Spanish centers. However, its implementation is uneven and lacks standardization of protocols; therefore, national coordination to overcome the inequalities is required. Collaborative work within the Personalized Medicine Group of SEHOP is an adequate framework for encouraging a step forward in the effort to move precision medicine into the national healthcare system.

Epithelial Barrier: Protector and Trigger of Allergic Disorders.

The epithelial barrier has classically been considered as the only first line of defense against irritants, pathogens, and allergens. However, it is now known to play an essential role in the immune response to exogenous agents. In fact, recent reports postulate the epithelial barrier hypothesis as a possible explanation for the increasing incidence and severity of allergic diseases. The epithelial barrier preserves the isolation of internal tissues from potential external threats. Moreover, a coordinated interaction between epithelial and immune cells ensures the unique immune response taking place in mucosal tissues, which is reported to be dysregulated in allergic diseases. We and others have demonstrated that in severe allergic phenotypes, the epithelial barrier undergoes several histological modifications, with increased infiltration of immune cells, leading to dysfunction. This is common in atopic dermatitis, asthma, and food allergy. However, the precise role of the epithelial barrier in mucosal biology during progression of allergic diseases is not well understood. In this review, we aim to compile recent knowledge regarding the histological structure and immunological function of the epithelial barrier and to shed light on the role of this compartment in the onset and progression of allergic diseases.

Epithelial Barrier: Protector and Trigger of Allergic Disorders

The epithelial barrier has classically been considered as the only first line of defense against irritants, pathogens, and allergens. However,it is now known to play an essential role in the immune response to exogenous agents. In fact, recent reports postulate the epithelialbarrier hypothesis as a possible explanation for the increasing incidence and severity of allergic diseases.The epithelial barrier preserves the isolation of internal tissues from potential external threats. Moreover, a coordinated interaction betweenepithelial and immune cells ensures the unique immune response taking place in mucosal tissues, which is reported to be dysregulatedin allergic diseases.We and others have demonstrated that in severe allergic phenotypes, the epithelial barrier undergoes several histological modifications,with increased infiltration of immune cells, leading to dysfunction. This is common in atopic dermatitis, asthma, and food allergy. However,the precise role of the epithelial barrier in mucosal biology during progression of allergic diseases is not well understood.In this review, we aim to compile recent knowledge regarding the histological structure and immunological function of the epithelialbarrier and to shed light on the role of this compartment in the onset and progression of allergic diseases (AU)

La barrera epitelial se ha considerado clásicamente sólo como la primera línea de defensa contra los irritantes, patógenos y alérgenos,pero ahora sabemos que el epitelio también desempeña un papel esencial en la respuesta inmunológica frente los agentes exógenos.De hecho, informes recientes postulan la hipótesis de la barrera epitelial como una posible explicación de la creciente incidencia y lagravedad de las enfermedades alérgicas.La barrera epitelial preserva el aislamiento de los tejidos internos de las posibles amenazas exteriores. Se sabe que las células epiteliales,además de un papel meramente protector, también tienen una función esencial en el desarrollo de la respuesta inmune en las mucosas,favoreciendo un ambiente tolerogénico. Sin embargo, en enfermedades alérgicas, estas características se ven afectadas como demuestrauna repuesta exagerada ante antígenos inocuos. De hecho, en los fenotipos alérgicos graves, la barrera epitelial experimenta variasmodificaciones histológicas que se asocian con pérdida de integridad y aumento de los infiltrados celulares, lo que conduce a una disfunciónde la misma. Este proceso es común en la dermatitis atópica, el asma y/o la alergia alimentaria. Aunque todavía no se conoce bien lafunción exacta de la barrera epitelial en la biología de la mucosa durante las enfermedades alérgicas.En esta revisión, pretendemos recopilar los conocimientos recientes sobre la estructura histológica y la función inmunológica de la barreraepitelial, y arrojar luz sobre el papel de este compartimento en la aparición y la progresión de las enfermedades alérgicas (AU)

Sequential chemotherapy regimen of induction with panitumumab and paclitaxel followed by radiotherapy and panitumumab in patients with locally advanced head and neck cancer unfit for platinum derivatives. The phase II, PANTERA/TTCC-2010-06 study

Background Sequential treatment of Panitumumab (Pb) plus Paclitaxel (Px) as induction treatment (IT) followed by concurrent bioradiotherapy (Bio–RT) with Pb may be an alternative for locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) in patients ineligible for high-dose cisplatin therapy. Methods Phase II, single-arm, multicentre study, with two-stage design, in patients ≥ 18 years with stage III–IVa–b LA-SCCHN unfit for platinum. Patients received Px + Pb (9 weeks) as IT followed by Bio–RT + Pb. Primary endpoint: overall response rate (ORR) after IT, defined as: more than 70% of patients achieving complete response (CR) or partial response (PR) to IT. Secondary end-points: progression-free survival, organ preservation rate, safety profile. Results Study ended prematurely (51 patients) due to slow recruitment. ORR: 66.7% (95% CI: 53.7–79.6), 8 (15.7%) CR and 26 (51.0%) PR. 39 patients (76%) completed radiotherapy (RT). Pb and/or Px-related adverse events (AEs) grade 3–4: 56.9% during IT and 63.4% during the concomitant phase, of which most common were skin toxicity (33.3%). Five deaths occurred during treatment, two of them (3.9%) were Pb and/or Px-related. Conclusions Although underpowered, ORR was higher than the pre-specified boundary for considering the treatment active. Although Px + Pb as IT provides some benefit, the safety profile is worse than expected. To consider Pb + Px as IT as an alternative for platinum-unsuitable LA-SCCHN, further research/investigation would be needed (AU)

Sequential chemotherapy regimen of induction with panitumumab and paclitaxel followed by radiotherapy and panitumumab in patients with locally advanced head and neck cancer unfit for platinum derivatives. The phase II, PANTERA/TTCC-2010-06 study.

BACKGROUND: Sequential treatment of Panitumumab (Pb) plus Paclitaxel (Px) as induction treatment (IT) followed by concurrent bioradiotherapy (Bio-RT) with Pb may be an alternative for locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) in patients ineligible for high-dose cisplatin therapy. METHODS: Phase II, single-arm, multicentre study, with two-stage design, in patients ≥ 18 years with stage III-IVa-b LA-SCCHN unfit for platinum. Patients received Px + Pb (9 weeks) as IT followed by Bio-RT + Pb. Primary endpoint: overall response rate (ORR) after IT, defined as: more than 70% of patients achieving complete response (CR) or partial response (PR) to IT. Secondary end-points: progression-free survival, organ preservation rate, safety profile. RESULTS: Study ended prematurely (51 patients) due to slow recruitment. ORR: 66.7% (95% CI: 53.7-79.6), 8 (15.7%) CR and 26 (51.0%) PR. 39 patients (76%) completed radiotherapy (RT). Pb and/or Px-related adverse events (AEs) grade 3-4: 56.9% during IT and 63.4% during the concomitant phase, of which most common were skin toxicity (33.3%). Five deaths occurred during treatment, two of them (3.9%) were Pb and/or Px-related. CONCLUSIONS: Although underpowered, ORR was higher than the pre-specified boundary for considering the treatment active. Although Px + Pb as IT provides some benefit, the safety profile is worse than expected. To consider Pb + Px as IT as an alternative for platinum-unsuitable LA-SCCHN, further research/investigation would be needed.

[Informed consent for anaesthesia: Presential or non-presential information?] / Consentimiento informado de anestesia: ¿información presencial o no presencial?

INTRODUCTION: The anaesthesia informed consent (AIC) is a process of communication between a clinician and a patient that results in the patient agreeing to undergo a specific anaesthetic procedure after understanding all the information needed to make a free, voluntary and conscious decision. This information is traditionally given during a face-to-face pre-operative visit. OBJECTIVE: To evaluate patient perceptions when they receive the information about AIC, face-to-face or by phone. PATIENTS AND METHODS: A single centre, randomised, double-blind, parallel-group pilot clinical trial was conducted on patients > 18 years of age undergoing major ambulatory surgery procedures with a surgical complexity that did not require a face-to-face pre-operative visit. Patients were randomly assigned to be informed by telephone (experimental group) or in a face- to-face visit (control group). Fifteen days after the surgery a questionnaire was used to gather patient perceptions in understanding the anaesthetic procedure and risks, autonomy (to ask for explanations), as well as and satisfaction. RESULTS: Of the 160 patients that gave their consent, 142 were interviewed: 70 from the experimental group and 72 from the control group. Both groups were comparable in age, gender, anaesthetic risk, and surgical complexity. The percentage of patients that understood the information provided on the anaesthetic technique was 71% and 81%, respectively (P=.429); on its risks: 67% and 69% (P=.951); autonomy: 56% and 74% (P=.036) and satisfaction rate: 46% and 46% (P=.835). CONCLUSION: There is no difference between the groups in the level of understanding of the information that the patient perceives and the level of satisfaction. Nevertheless, almost half of them did not remember to have been given the possibility to clear-up doubts.

Increasing Incidence of Pediatric Eosinophilic Esophagitis in the Southwest of Madrid, Spain.

OBJECTIVES: The incidence of eosinophilic esophagitis is unknown in our area. The aim of our study was to determine the incidence of eosinophilic esophagitis and its possible association with the most frequent absolute annual pollen counts. METHODS: A descriptive retrospective multicenter observational study was designed to calculate the incidence of eosinophilic esophagitis in children aged under 15 years in the southwest region of Madrid, Spain in 2002-2013 (data were provided by the Statistics Institute of Madrid). We collected data on age, sex, clinical presentation, and date of endoscopic diagnosis. Relative risk (RR) was estimated (Stata v.11) using negative binomial regression models to assess the association between incidence and pollen counts (provided by Subiza Clinic). RESULTS: The study population comprised 254 patients (192 male [75.6%], aged 0.5-14.99 years). The clinical presentation was esophageal impaction in 23.6%, dysphagia in 22%, gastroesophageal reflux-like symptoms in 44.9%, and other findings in 9.4%. The annual incidence from 2002 to 2013 per 100 000 children aged <15 years per year was, respectively, 0.81, 1.5, 0.37, 3.17, 3.07, 4.36, 6.87, 7.19, 8.38, 9.05, 9.14, and 9.68. The incidence of eosinophilic esophagitis increased by an average of 19% annually (RR, 1.19; 95%CI, 1.14-1.25; P<.001). In the overall analysis, the relationship between incidence and absolute annual and monthly counts during the pollen seasons of the respective pollen types was analyzed only for Platanus species, which had an RR >1 (1.17 and 1.06, respectively) (P<.05). CONCLUSION: The incidence of diagnosis of pediatric eosinophilic esophagitis increased by an average of 19% annually. No significant association was found between incidence and pollen counts, except for a weak association with Platanus species.

Increasing incidence of pediatric eosinophilic esophagitis in the Southwest of Madrid, Spain

Objectives: The incidence of eosinophilic esophagitis is unknown in our area. The aim of our study was to determine the incidence of eosinophilic esophagitis and its possible association with the most frequent absolute annual pollen counts. Methods: A descriptive retrospective multicenter observational study was designed to calculate the incidence of eosinophilic esophagitis in children aged under 15 years in the southwest region of Madrid, Spain in 2002-2013 (data were provided by the Statistics Institute of Madrid). We collected data on age, sex, clinical presentation, and date of endoscopic diagnosis. Relative risk (RR) was estimated (Stata v.11) using negative binomial regression models to assess the association between incidence and pollen counts (provided by Subiza Clinic). Results: The study population comprised 254 patients (192 male [75.6%], aged 0.5-14.99 years). The clinical presentation was esophageal impaction in 23.6%, dysphagia in 22%, gastroesophageal reflux-like symptoms in 44.9%, and other findings in 9.4%. The annual incidence from 2002 to 2013 per 100 000 children aged <15 years per year was, respectively, 0.81, 1.5, 0.37, 3.17, 3.07, 4.36, 6.87, 7.19, 8.38, 9.05, 9.14, and 9.68. The incidence of eosinophilic esophagitis increased by an average of 19% annually (RR, 1.19; 95%CI, 1.14-1.25; P<.001). In the overall analysis, the relationship between incidence and absolute annual and monthly counts during the pollen seasons of the respective pollen types was analyzed only for Platanus species, which had an RR >1 (1.17 and 1.06, respectively) (P<.05). Conclusion: The incidence of diagnosis of pediatric eosinophilic esophagitis increased by an average of 19% annually. No significant association was found between incidence and pollen counts, except for a weak association with Platanus species

Objetivo: La incidencia de esofagitis eosinofílica es desconocida en nuestra área. El objetivo de nuestro estudio es determinar la incidencia de diagnóstico de esofagitis eosinofílica y su posible asociación con los recuentos absolutos anuales de los pólenes más frecuentes. Métodos: Se diseñó un estudio descriptivo multicéntrico retrospectivo para el cálculo de la incidencia de esofagitis eosinofílica en niños menores de 15 años en el suroeste de la Comunidad de Madrid entre 2002-2013 (datos poblacionales obtenidos del Instituto de Estadística de la Comunidad de Madrid). Se recoge de cada paciente: edad, sexo, presentación clínica y fecha de diagnóstico endoscópico. Se estimó la asociación entre la incidencia y los recuentos polínicos (aportados por la Clínica Subiza) mediante cálculo del riesgo relativo usando modelos de regresión binomial negativa (Stata v.11).Resultados: Se incluyeron 254 pacientes, 75,6% varones (n=192), de edades comprendidas entre 0,5-14,99 años. La presentación clínica fue: impactación esofágica 23,6%, disfagia 22%, síntomas sugerentes de reflujo gastroesofágico 44,9% y otros 9,4%. Las incidencias anuales desde 2002 a 2013 (nº casos/100.000 niños menores de 15 años/año) fueron respectivamente: 0,81; 1,5; 0,37; 3,17; 3,07; 4,36; 6,87; 7,19; 8,38; 9,05; 9,14 y 9,68. La incidencia de esofagitis eosinofílica se incrementó en una media anual de 19% (RR 1,19, 95% IC: 1,14-1,25, p <0,001). En nuestro estudio únicamente existió asociación (RR>1) entre la incidencia y los recuentos polínicos absolutos de Platanus spp anuales y durante los meses de máxima polinización (1,17 and 1,06, respectivamente) (p <0,05).Conclusión: La incidencia de diagnóstico de esofagitis eosinofílica en la edad pediátrica se ha incrementado en una media anual de un 19%. No se encontró una asociación estadísticamente significativa entre la incidencia y los recuentos polínicos, excepto con el Platanus spp aunque ésta fue débil

Urinary Clara Cell Protein in Kidney Transplant Patients: A Preliminary Study.

OBJECTIVE: The aim of this exploratory study was to analyze the urinary excretion of Clara cell protein (CC16), a new marker of proximal tubular dysfunction (PTD), in kidney transplantation (KT). MATERIALS AND METHODS: Urinary concentrations of CC16, ß2-microglobulin (ß2m), and N-acetyl-glucosaminidase (NAG) were measured in 50 KT patients (72% men; mean age 50.4 ± 12.4 years; diabetes in 24%; duration of KT 4.3 ± 3.1 years) and 10 healthy controls (6 men; mean age 33.6 ± 13.4 years). RESULTS: Urinary levels of ß2m, NAG, and CC16 were significantly higher in KT patients than in controls: ß2m: 0.77 (interquartile range [IQ] 0.22 to 4.62) g/g vs 0.069 (IQ 0.05 to 0.10) g/g; NAG: 3.16 (IQ 2.09 to 5.33) U/g vs 1.73 (IQ 1.25 to 2.07) U/g; CC16: 26.01 (IQ 8.62 to 123.3) g/g vs 2.51 (IQ 0.83 to 7.18) g/g (P < .001). Elevated levels of ß2m, NAG, and CC16 were found in 81%, 28%, and 71% of KT patients, respectively. Urinary levels of ß2m, NAG, and CC16 significantly increase as glomerular filtration rate (GFR) decreases. Interestingly, in patients with GFR >60 mL/min, we still found high levels of ß2m, NAG, and CC16 in 77%, 13%, and 52%, respectively. Diabetic subjects had significant higher levels of the 3 markers compared with nondiabetic subjects, without differences in albumin excretion or GFR. CC16 showed a positive correlation with urinary albumin (r = 0.42, P < .001), NAG (r = 0.352, P < .05), and ß2m (r = 0.75, P < .001). CONCLUSION: PTD is highly prevalent in KT patients. This is the first study that analyzes CC16 in KT patients, showing that the urinary excretion of this protein is significantly increased in this population. Further studies are needed to examine the clinical value of CC16 in KT patients.

Alimentación complementaria: qué, cuándo y cómo / Complementary feeding: what, when and how

Las recomendaciones de introducción de la alimentación complementaria han variado paralelamente al incremento de la incidencia de enfermedad celíaca, alergias e intolerancias alimentarias y de obesidad infantojuvenil, base de muchas enfermedades crónicas del adulto. Existen controversias sobre cuándo es el momento idóneo de inicio, qué alimento es el más adecuado y cuál es la forma de presentar esos alimentos al lactante para mejorar el comportamiento alimentario. No existen guías específicas para lactantes con alto riesgo alérgico o prematuros. El baby-led weaning se ha propuesto como una manera relajada para incorporar al lactante al patrón familiar de alimentación. La evidencia actual apoya que la respuesta a todas estas preguntas se encuentra en el grado de maduración y necesidades específicas de cada lactante; sin embargo, la controversia está servida (AU)

The recommendations of introduction of complementary feeding have varied in parallel with the increasing incidence of celiac disease, food allergies and intolerances and childhood obesity basis of many chronic diseases in adults. There is controversy about when is the right time to start, what kind of food is the best and what is the way to introduce these foods to infants to improve eating behaviour. There are not specific guidelines for risk populations such as infants at high-risk of allergy or premature. The baby-led weaning has been proposed as a relaxing way to incorporate the infant to family feeding patterns. Current evidence supports the answer to all these questions lies in the degree of maturity and specific needs of each infant, however, the controversy is served (AU)

Sensibilidad y especificidad del examen físico para el diagnóstico de apendicitis / Sensitivity an specificity of physical exam for the diagnosis of appendicitis

La apendicitis aguda es la emergencia quirúrgica más común en todo el mundo. En nuestra sala de emergencias, la discriminación inicial para el diagnóstico de la apendicitis se realiza basada únicamente en el examen físico del paciente. El objetivo del estudio es determinar la precisión del examen físico estandarizado para el diagnóstico de apendicitis aguda en el servicio de emergencia del Hospital General San Juan de Dios Diseño, lugar y partcipantes: todos los pacientes mayores de 12 años prospectvamente evaluados de abril a junio 2015 en el servicio de emergencia,cuyo motvo de consulta fue dolor abdominal y sospecha de apendicits. Se documentó la impresión clínica del examinador en base a la anamnesis y elexamen fsico estandarizado, la histopatología de los pacientes operados y el seguimiento a las 48h y a los 30 días de todos los pacientes.Resultados: se evaluaron 85 pacientes. El 61% de los pacientes fueron clasifcados por el investgador sin cuadro clínico de apendicits aguda. La sensibilidaddel examen fsico estandarizado para el diagnóstco de apendicits es de 75%, la especifcidad de 93%, el valor predictvo positvo de 92%, el valorpredictvo negatvo de 79%. El porcentaje de falsos positvos es de 3% y el porcentaje de falsos negatvos es del 12%.Conclusiones: el examen fsico estandarizado no es lo sufcientemente sensible para hacer el diagnóstco de apendicits aguda, por lo que es necesarioagregar estudios complementarios, así como considerar un período de observación intrahospitalaria antes de dar egreso a los pacientes basados únicamenteen el examen fisico.(AU)

Acute appendicits is the most common surgical emergency visit worldwide. In our emergency department, the inital evaluaton for thediagnosis of appendicits is made based solely on the physical examinaton. The aim of the study is to determine the accuracy of standardized physicalexaminaton for the diagnosis of acute appendicits in the emergency department of San Juan de Dios General Hospital.Design, Setng, and Partcipants: All patents over 12 evaluated from April to June 2015 in the emergency department, whose main complaint wasabdominal pain and suspected appendicits. Clinical diagnosis, histopathology and follow-up at 48h and 30 days for all patents were collected.Results: A total of 85 patents were studied, 61% were negatve for appendicits by clinical diagnosis. Standardized physical examinaton for the diagnosisof appendicits has 75% sensitvity, 93%specifcity, 92%positve predictve value, 79% negatve predictve value. The false positve rate is 3% andfalse negatve rate is 12%.Conclusions: the standardized physical examinaton is not sensitve enough for the diagnosis of acute appendicits. It is necessary to consider addingfurther studies as well as an observaton period before hospital discharge.

Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico / Treatment of juvenile scoliosis: increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth

Objetivo. Evaluar el crecimiento longitudinal del tórax y el control de la deformidad en una serie de pacientes con escoliosis juvenil tratados con barras de crecimiento aumentando los intervalos de tiempo entre alargamientos más de seis meses. Material y métodos. Estudio retrospectivo de ocho pacientes midiendo las siguientes variables: el ángulo de Cobb, la traslación vertebral apical, el balance coronal, la longitud torácica T1-L1, la cifosis torácica T5-T12, el ángulo de cifosis de unión proximal (CUP) y la lordosis lumbar. Se registraron las complicaciones. Resultados. Se evaluaron cinco escoliosis idiopáticas y tres casos de sindrómica (media de edad 9,4 ± 1,5 años). Se realizó una cirugía inicial y un promedio de dos retensados por paciente. El tiempo medio entre retensados fue de 15,7 meses. La corrección coronal final de la curva principal fue del 58%. La longitud torácica (T1-L1) preoperatoria fue de 20,8 cm, postoperatoria de 24,4 cm, y final de 26 cm. Al final del seguimiento el crecimiento medio del tórax fue de 5,2 cm. La cifosis preoperatoria (T5-T12) fue 33,5°, y final 32,1°. El cambio en el ángulo CUP fue de 2,5° en el seguimiento final. La mayoría de las complicaciones estuvieron relacionadas con la instrumentación. Se encontraron dos infecciones superficiales de la herida. Conclusión. En pacientes con escoliosis juvenil en formas «menos graves» tratados mediante barras de crecimiento, es posible espaciar los alargamientos más de un año y con ello disminuir el número de cirugías y al mismo tiempo controlar la deformidad y permitir el crecimiento longitudinal torácico (AU)

Objective. Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. Material and methods. Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. Results. Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. Conclusion. For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth (AU)

Neumonía grave por Pneumocystis jiroveci en paciente con enfermedad de Crohn y tratamiento con adalimumab / Pneumocystis jiroveci pneumonia in a Crohn’s disease patient treated with adalimumab

No disponible

[Treatment of juvenile scoliosis: Increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth]. / Tratamiento de la escoliosis juvenil: aumentar el tiempo entre alargamientos con la técnica de barras de crecimiento no debe comprometer necesariamente el crecimiento torácico.

OBJECTIVE: Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. MATERIAL AND METHODS: Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. RESULTS: Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. CONCLUSION: For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.

Addition of cholesterol-loaded cyclodextrins to the thawing extender: effects on boar sperm quality.

The aim of the present study was to evaluate the effect that the addition of cholesterol-loaded cyclodextrins (CLC) to the thawing extender has on the quality of frozen-thawed boar sperm. Pooled semen (n = 5) from three boars was used for the experiments. The semen was cryopreserved with an egg-yolk-based extender, it was diluted after thawing in Beltsville thawing solution (BTS) supplemented with different concentrations of CLC (0, 12.5, 25, 50 or 100 mg/500 × 10(6) sperm), and these samples were incubated at 37°C for 150 min. The following parameters of sperm quality were evaluated 30 and 150 min after incubation: sperm with intact plasma membrane (SIPM; %), sperm with normal acrosomal ridge (NAR; %), total motile sperm (TMS; %), progressively motile sperm (PMS; %) and kinetic parameters. Both SIPM and NAR increased (p < 0.05) when the thawing extender was supplemented with 12.5, 25 and 50 mg CLC/500 × 10(6) sperm. Nevertheless, motility decreased (p < 0.05) when the concentration of CLC exceeded 12.5 mg CLC/500 × 10(6) sperm. In conclusion, our results suggest that the supplementation of thawing extenders with CLC improves sperm viability and reduces acrosome damage after freezing/thawing.

Factores de riesgo de deterioro de calidad de vida en pacientes traumáticos críticos. Valoración a los 6 y 12 meses del alta de la unidad de cuidados intensivos / Risk factors for the deterioration of quality of life in critical trauma patients. Assessment at 6 and 12 months after discharge from the intensive care unit

OBJETIVO: Evaluar los factores que influyen en el deterioro de la calidad de vida relacionada con la salud (CVRS) de pacientes traumatizados ingresados en una UCI. DISEÑO: Estudio prospectivo observacional. ÁMBITO: UCI polivalente de un hospital universitario de segundo nivel con servicio de neurocirugía 24 h. PACIENTES: Pacientes traumatizados ingresados en la UCI durante un periodo de 2 años. Evaluación de CVRS previa, a los 6 y 12 meses del alta. Variables de interés Se recogen variables demográficas, tipo y gravedad de lesiones (AIS), nivel de gravedad (APACHE II, ISS, TRISS), estancia, procedimientos, mortalidad y CVRS según los cuestionarios SF-36 y EQ-5D.ResultadosSe completó el seguimiento en 110 pacientes que mostraron un deterioro significativo de su CVRS en todas las dimensiones evaluadas. Según el SF-36 se deterioró más el rol físico a los 12 meses, aunque el componente mental disminuyó más que el componente físico a los 6 meses. La EVA del EQ-5D bajó a los 6 meses hasta 55 (19) y aumentó a los 12 meses hasta 66 (17). En el análisis de regresión logística múltiple las variables relacionadas con peor CVRS fueron: la edad > 45 años, un TRISS > 10, peor calidad de vida previa y tener una lesión grave de las extremidades. CONCLUSIONES: Los pacientes muestran un deterioro marcado de su CVRS a los 6 meses con mejoría a los 12 meses, aunque sin llegar a igualar su estado previo. Los factores que determinan peor calidad de vida son la edad, la gravedad, la CVRS previa y las lesiones graves de las extremidades

OBJECTIVE: To evaluate factors influencing the deterioration of health-related quality of life (HRQoL) in trauma patients admitted to an ICU. DESIGN: A prospective observational study was carried out. SETTING: The combined medical/surgical ICU in a university secondary hospital with 24-hour neurosurgery service. Patients Trauma patients admitted to the ICU during a two-year period. HRQoL assessment prior to admission to the ICU, and at 6 and 12 months after discharge. MAIN VARIABLES: Demographic variables, type and severity of injury (AIS), severity (APACHE II, ISS, TRISS), length of stay, procedures, mortality and HRQoL according to the SF-36 and EQ-5D. RESULTS: We completed the monitoring of 110 patients that showed significant impairment of their HRQoL in all the dimensions assessed. According to the SF-36, physical role was more deteriorated at 12 months, but the mental component decreased more than the physical component after 6 months. The VAS scale of the EQ-5D decreased to 55 at 6 months (19) and increased to 66 at 12 months (17). In the multiple logistic regression analysis, the variables associated with poorer HRQoL were age > 45 years, TRISS > 10, previous porer quality of life, and serious injuries in the extremities. CONCLUSIONS: Patients showed marked deterioration of their HRQoL at 6 months, followed by overall improvement at 12 months, though without reaching their previous state. The factors that determine poorer quality of life include age, severity, previous HRQoL, and severe injuries in the extremities

[Risk factors for the deterioration of quality of life in critical trauma patients. Assessment at 6 and 12 months after discharge from the intensive care unit]. / Factores de riesgo de deterioro de calidad de vida en pacientes traumáticos críticos. Valoración a los 6 y 12 meses del alta de la unidad de cuidados intensivos.

OBJECTIVE: To evaluate factors influencing the deterioration of health-related quality of life (HRQoL) in trauma patients admitted to an ICU. DESIGN: A prospective observational study was carried out. SETTING: The combined medical/surgical ICU in a university secondary hospital with 24-hour neurosurgery service. PATIENTS: Trauma patients admitted to the ICU during a two-year period. HRQoL assessment prior to admission to the ICU, and at 6 and 12 months after discharge. MAIN VARIABLES: Demographic variables, type and severity of injury (AIS), severity (APACHE II, ISS, TRISS), length of stay, procedures, mortality and HRQoL according to the SF-36 and EQ-5D. RESULTS: We completed the monitoring of 110 patients that showed significant impairment of their HRQoL in all the dimensions assessed. According to the SF-36, physical role was more deteriorated at 12 months, but the mental component decreased more than the physical component after 6 months. The VAS scale of the EQ-5D decreased to 55 at 6 months (19) and increased to 66 at 12 months (17). In the multiple logistic regression analysis, the variables associated with poorer HRQoL were age > 45 years, TRISS > 10, previous porer quality of life, and serious injuries in the extremities. CONCLUSIONS: Patients showed marked deterioration of their HRQoL at 6 months, followed by overall improvement at 12 months, though without reaching their previous state. The factors that determine poorer quality of life include age, severity, previous HRQoL, and severe injuries in the extremities.