Actuación fisioterápica tras la valoración pericial de las lesiones de columna vertebral / Role of physiotherapy after legal assessment of spinal column injuries

Las valoraciones periciales realizadas en pacientes con lesiones vertebrales es de por sí sumamente difícil, exigiendo completos conocimientos de anatomía, funcional y patológica, y sus diferentes posibilidades diagnósticas. A pesar de que la principal causa del peritaje es el dolor, resulta coincidente con la causa primaria de derivación a fisioterapia por lesiones de columna vertebral traumáticas. Este trabajo pretende analizar la repercusión de la participación del fisioterapeuta tras la valoración pericial, bien en primera instancia, o bien como continuación de un primer ciclo iniciado antes de la peritación

Legal assessment over patients with spinal column injuries is by itself hardly difficult, and it requires full knowledge of functional and pathological anatomy, and its diverse diagnostic possibilities. Although the pain is the main item for assessment, it also goes with the first symptom for column injuries Physiotherapy referral. This study pretends to analyze the role of the physiotherapist intervention after first or secondary legal assessment

Análisis psicométrico del Cuestionario de Discapacidad del Dolor Lumbar de Oswestry / Psychometric analisys of the Oswestry Lower Back Pain Disability Questionnaire

La utilización de sistemas de medición y valoración de la discapacidad requieren la validación por los sistemas psicométricos más habituales. El presente estudio analiza la fiabilidad del denominado Cuestionario del Dolor Lumbar de Oswestry, instrumento de medición del grado de discapacidad de la lesión referida, utilizando una muestra de 26 pacientes, y analizando la consistencia interna de los ítems de los cuestionarios aplicados mediante el coeficiente a de Cronbach (Teoría Clásica de los Tests). Los resultados revelan la aproximación a los estudios ya publicados y ponen de manifiesto las posibilidades expresas de nuevas validaciones en muestras superiores, incluso por medio de otras teorías psicométricas

Use of measurement and assessment of disability requires the validity by most common psychometric tools. This study analyzes fiability of the Oswestry Lower Back Pain Disability Questionnaire, measurement tool of disability caused by the referred injury using a sample of 26 patients and analyzing the items' internal consistence of the completed questionnaires by the Cronbach a coefficient (Classical Theory of Tests). Results show the approach to published studies and evidence the clear possibilities of new validations with wieder samples, even using other psychometric theories

Incidence of salmonellae in captive and wild free-living raptorial birds in central Spain.

A total of 595 faecal samples from raptorial birds, either captive or free-living, residing in GREFA Wildlife Hospital were bacteriologically examined using various selective media and an Automated Diagnostic Assay System for Salmonella detection. Serotype and phage type of the strains identified as Salmonella was determined. In the captive group, of the 285 samples examined, 21 (7.36%) were positive for Salmonella. Serotyping revealed that most of the individuals were infected by Salmonella serotype Havana. This result suggested that there could be a source of contamination in the Hospital although it could not be established. In the wild free-living group, over 310 samples examined (4.19%) were positive for Salmonella. The Salmonella isolates showed a major variety of serotypes: Enteritidis, Adelaide, Brandenburg, Newport, Typhimurium, Hadar, Saintpaul and Virchow. Most of them are similar to those commonly described in isolates from human and domestic animals. These results indicate that wild birds could be involved in the dissemination of Salmonella in humans or domestic animals or vice versa.

Comparison of phenotypic and genotypic markers for characterization of an outbreak of Salmonella serotype Havana in captive raptors.

AIMS: To establish a typing method for tracing the epidemic relationship of 16 strains of Salmonella serotype Havana isolated from captive raptors showing no symptomatology and residing in a wildlife hospital in Spain. METHODS AND RESULTS: Antimicrobial susceptibility testing, ribotyping, pulsed field gel electrophoresis (PFGE) and amplified fragment length polymorphism (AFLP) methodology were applied. Ten unrelated strains of serotype Havana were included as a control group to provide a basis of for the efficiency of the different markers used. All outbreak-related strains were resistant to nalidixic acid and streptomycin and showed the same ripotype, pulsotype and AFLP pattern. CONCLUSIONS: This is the first time that AFLP analysis has been tested with serotype Havana isolates and it has demonstrated to be the most useful epidemiological tool for discriminating between unrelated and outbreak-related strains of this serotype. The results obtained suggest that all the Salmonella serotype Havana isolates represented a common outbreak strain whose origin of contamination could not be established although it is thought that it was the poultry meat used for raptors'diet. SIGNIFICANCE AND IMPACT OF THE STUDY: Our study suggests the importance of microbiological analysis of these products in order to prevent contamination and dissemination of Salmonellae in this kind of Hospital.

Effects of keratinocyte growth factor-2 (KGF-2) on wound healing in an ischaemia-impaired rabbit ear model and on scar formation.

Keratinocyte growth factor-2 (KGF-2), also described as fibroblast growth factor-10 (FGF-10), is a member of the fibroblast growth factor family. KGF-2 shares 57 per cent sequence homology to previously reported KGF-1 (FGF-7). In skin, both growth factors are expressed in the dermal compartment. KGF-1 and KGF-2 bind to the same receptor with high affinity, the KGFR isoform of FGFR2, which is exclusively expressed by epithelial cells. This study examines the in vivo function of topically applied KGF-2 on wound healing using an ischaemia-impaired rabbit dermal ulcer model, in young and aged animals. Histological analysis of the wounds showed that KGF-2 significantly promoted re-epithelialization in both young and old animals. Similar results have been observed with KGF-1 in this model. In addition, KGF-2 enhanced granulation tissue formation in both young and old rabbits, a biological effect not found with KGF-1, suggesting a possible indirect mechanism which enhances neo-granulation tissue formation. Immunohistological staining of day 7 wounds with proliferating cell nuclear antigen (PCNA) antibody demonstrated a significant increase of dermal cell proliferation in KGF-2-treated wounds compared with placebo wounds. These results suggest a mesenchymal-epithelial interaction that is mediated by a paracrine feedback loop of KGF-2. Because of the wound healing impairment observed with ageing, the wound healing response to KGF-2 was also studied in ischaemic wounds of aged animals. Administration of KGF-2 led to significant stimulation of epithelial growth and granulation tissue formation. The effects seen in the old animals were delayed compared with the young animals. Lastly, the effect of KGF-2 was examined in a rabbit model of scar formation. Quantification of scar elevation index showed no significant differences in scar formation when KGF-2 was compared with buffer placebo. Compared with other growth factors, including KGF-1 and TGF-beta which have previously been examined in these models, KGF-2 is the most effective and causes no obvious scarring.

In vivo characterization of keratinocyte growth factor-2 as a potential wound healing agent.

Human keratinocyte growth factor-2 exerts a proliferative effect on epithelial cells and mediates keratinocyte migration. It has also been shown to increase both deposition of granulation tissue and collagen and maturation of collagen. Because these properties should affect the healing trajectory of wounds, this study set out to investigate the effects of keratinocyte growth factor-2 on the healing of three different types of wounds. Human meshed skin grafts explanted to athymic "nude" rats, surgical incisions in Sprague-Dawley rats, and acute excisional rat wounds inoculated with Escherichia coli were used. Two concentrations of recombinant human keratinocyte growth factor-2 were compared to a vehicle control and keratinocyte growth factor-1. Keratinocyte growth factor-2 significantly accelerated the rate of epithelialization in the meshed skin graft model and effected a modestly more rapid gain in breaking strength of surgical incisions than keratinocyte growth factor-1 or the vehicle control treatment. Neither keratinocyte growth factors accelerated wound closure by contraction of the excisional wounds. Based on these data, keratinocyte growth factor-2 may be useful in accelerating healing in wounds healing mainly by the process of epithelialization such as venous stasis ulcers, partial thickness burn wounds, and skin graft donor sites. It might also accelerate the gain in incisional wound strength in acute surgical or traumatic wounds.

Keratinocyte growth factor-2 accelerates wound healing in incisional wounds.

BACKGROUND: Keratinocyte growth factor-2 (KGF-2) also described as fibroblast growth factor-10 (FGF-10) is a newly identified member of the fibroblast growth factor family. KGF-2 is 96% identical to the recently identified rat FGF-10 and specifically stimulates growth of normal human epidermal keratinocytes. The present study was undertaken to examine the effects of topically applied KGF-2 in an incisional wound healing model. KGF-2 treatment resulted in an improvement in incisional wound healing as characterized by an increase in breaking strength, collagen content, and epidermal thickness. METHODS: KGF-2 was topically applied to linear incisions made in the dorsal skin of Sprague-Dawley rats. Biomechanical testing was done using an Instron tensiometer for breaking and tensile strength determinations. Wound collagen content was determined using the Sircol collagen assay. Epidermal thickness measurements were conducted using Masson's trichrome-stained sections of the wound. RESULTS: A single topical application of KGF-2 at the time of wounding resulted in an increase in wound breaking and tensile strength at Day 5 after wounding. Breaking strength of KGF-2-treated wounds was significantly higher compared with the buffer control (1 microgram, 222.1 +/- 13.5 g, P = 0.0007; 4 microgram, 248.7 +/- 15.4 g, P = 0.0001; 10 microgram, 247.2 +/- 21.9 g, P = 0.001; buffer, 141.0 +/- 9.7 g). Epidermal thickness and wound collagen content were significantly increased following treatment with KGF-2. CONCLUSIONS: Based on our findings, KGF-2 is a potent stimulator of wound healing as demonstrated by increased mechanical strength accompanied by an increase in wound collagen content. KGF-2 could be an important cellular mediator responsible for the initiation and acceleration of wound healing and may enhance the healing of surgical wounds.

Gelatin/chondroitin 6-sulfate microspheres for the delivery of therapeutic proteins to the joint.

OBJECTIVE: To develop a biodegradable, inflammation-responsive microsphere system for the intraarticular delivery of therapeutic proteins. METHODS: Microspheres were synthesized by complex coacervation. Radiolabeled protein release and microsphere degradation were assessed by exposing the microspheres to human synovial fluids (SF) and recombinant gelatinase. Microsphere degradation was confirmed by scanning electron microscopy (SEM). Microsphere biocompatibility was evaluated in vitro by incubating the microspheres with human synoviocytes, and in vivo by injection into mouse joints. RESULTS: Optimal microsphere formulation was developed. Significant (up to 100%) release of encapsulated protein occurred in SF samples with measurable metalloprotease activity, while release was minimal in SF with negligible activity. Dissolution of microspheres exposed to gelatinase was confirmed by SEM. Microspheres were found to be noncytotoxic in vitro, and noninflammatory in vivo. CONCLUSION: Microsphere encapsulation is an inflammation-responsive and biocompatible system of protein delivery that holds promise for use in the delivery of therapeutic proteins to the joint.

Neuropeptide Y, neurokinin A and neurotensin in brain regions of Fawn Hooded "depressed", Wistar, and Sprague Dawley rats. Effects of electroconvulsive stimuli.

1. Concentrations of neuropeptide Y (NPY)-, neurokinin A (NKA)- and neurotensin (NT)-like immunoreactivity (-LI) were measured in brain tissues of Fawn Hooded (FH) (a model of depression), Wistar (W) (control for depression) and Sprague Dawley (SD) rats (control for strain) with the aim to explore possible associations between neuropeptides and models of depression. 2. In addition, peptides were determined after six electroconvulsive stimuli (ECS) or six sham ECS ("baseline") in order to investigate ECS mechanisms of action. 3. Baseline NPY-LI concentrations were markedly lower in the hippocampus of the "depressed" FH compared to the W and SD animals. 4. Baseline NKA-LI concentrations were higher in the occipital cortex and NT-LI concentrations in the occipital cortex, frontal cortex, and hypothalamus of the FH and W compared to the SD rats. 5. ECS increased NPY-LI in the hippocampus, frontal cortex and occipital cortex of all three strains. In the hippocampus, the increase was significantly larger in the FH compared to the W and SD rats. ECS also increased NKA-LI in the hippocampus. 6. In contrast, ECS decreased NT-LI in the occipital cortex of the FH and W animals. 7. The results indicate that NPY may play a role in depression and that changes in NPY and NKA probably constitute one of the mechanisms of ECT action. More speculatively, NT may also be involved in depression.

Effects of electroconvulsive stimuli and MK-801 on neuropeptide Y, neurokinin A, and calcitonin gene-related peptide in rat brain.

Rats were pretreated with 0.9% NaCl, or 0.1 or 1.0 mg/kg MK-801, an anticonvulsant and a psychotomimetic drug, and 60 minutes later given ECS or sham ECS. After six sessions the animals were sacrificed and neuropeptide Y (NPY-), neurokinin A (NKA-), and calcitonin gene-related peptide (CGRP-) like immunoreactivity (-LI) measured with radioimmunoassays. ECS increased NPY-LI in frontal cortex, striatum, occipital cortex and hippocampus, and NKA-LI in occipital cortex and hippocampus. MK-801 increased CGRP in a dose-response manner in frontal cortex, and NKA-LI in occipital cortex. Although the higher MK-801 dose reduced seizure duration by 50%, the ECS induced NPY-LI increase in striatum, occipital cortex and hippocampus, and NKA-LI in occipital cortex was not diminished. In contrast, there was a parallel decrease in seizures and NPY-LI and NKA-LI changes in frontal cortex and hippocampus, respectively. Investigation of neuropeptides in brain may contribute to understanding of the mechanisms of action of antidepressive and antipsychotic treatments and of psychotomimetic drugs.

Spontaneous osteoarthritis in Dunkin Hartley guinea pigs: histologic, radiologic, and biochemical changes.

Dunkin Hartley guinea pigs develop spontaneous, age-related osteoarthritis (OA) of the knee and other joints. Histologic changes are observed beginning at 3 months of age. Disease severity increases with age, and at 18 months moderate to severe OA is observed. A study was undertaken to assess the morphologic and biochemical changes of 22-month-old animals, and to compare them with values in 2-month-old guinea pigs. Biochemical indices characteristic of OA, from tibial cartilage, indicated an increase in proteoglycan content from 233 +/- 2 micrograms/mg (mean +/- SEM) at 2 months of age to 365 +/- 6 micrograms/mg at 22 months. Collagen concentration in cartilage decreased from 364 +/- 2 micrograms/mg at 2 months to 223 +/- 3 micrograms/mg at 22 months. Proteoglycan fragments found in synovial fluid measured 4.6 +/- 1 micrograms/ml at 2 months and increased to 37 +/- 2 micrograms/ml at 22 months. Radiographic changes observed at 22 months included marginal osteophytes of the tibia and femur, sclerosis of the subchondral bone of the tibial plateau, femoral condyle cysts, and calcification of the collateral ligaments. Histologic evaluation revealed severe OA, with a Mankin score of 10.7 +/- 0.5 in 22-month-old animals. In contrast, 2-month-old animals had no histologic or radiographically detectable lesions. The results of the study reported here indicate that the lesions observed in this model are similar to those of human OA. Spontaneous development of OA in guinea pigs is amenable to the study of the pathogenesis of OA and to the evaluation of potential disease-modifying agents.