Myelopexy: A novel technique in posttraumatic syringomyelia / Mielopexia: una técnica novedosa para la siringomielia postraumática

Posttraumatic syringomyelia (PTS) is a well-reported phenomenon that usually takes place in the long-term course of patients following spinal cord injury. Different surgical procedures have been described: spinal cordectomy is usually a last option technique, but might be an excellent choice in patients with severe spinal cord injuries. We present a young patient with complete spinal cord injury after spine trauma, who developed posttraumatic syringomyelia with progressive motor deterioration twelve years after fixation. We performed a novel surgical technique (myelopexy) with excellent resolution of syringomyelia, sparing the negative implications of complete cord transection. Some artistic illustrations made by one of the corresponding authors are included, to better understanding of operative details (AU)

La siringomielia postraumática (SPT) es un fenómeno bien documentado, que suele ocurrir en la recuperación a largo plazo de los pacientes después de una lesión de la médula espinal. Se han descrito diferentes procedimientos quirúrgicos: la cordectomía de la médula espinal es generalmente una técnica que se considera como última opción, pero podría ser una excelente elección para pacientes con lesiones graves en dicha zona. Presentamos el caso de un paciente joven con una lesión completa de la médula espinal después de un traumatismo de la columna vertebral, que desarrolló una siringomielia postraumática con un deterioro motor progresivo 12 años después de la fijación. Aplicamos una novedosa técnica quirúrgica (mielopexia) con una excelente resolución de la siringomielia, evitando las implicaciones negativas de la transección completa de la médula. Se incluyen algunas ilustraciones realizadas por uno de los autores para una mejor comprensión de los detalles de la intervención quirúrgica (AU)

Efectividad del trabajo de resistencia y de cicloergómetro a alta velocidad sobre la bradicinesia en la enfermedad de Parkinson: revisión sistemática / Effectiveness of endurance exercises and high-speed cycling on bradykinesia in Parkinson's disease: A systematic review

Antecedentes y objetivo Los ejercicios de resistencia y de cicloergómetro a alta intensidad se han utilizado en los últimos años para tratar la bradicinesia en la enfermedad de Parkinson (EP). El objetivo es determinar la efectividad del ejercicio de resistencia y de cicloergómetro a alta intensidad para disminuir la bradicinesia en pacientes con EP. Sujetos y métodos Se realizó una búsqueda hasta el año 2020 en las bases de datos PubMed, Web of Science, Medline, Cochrane Library, Google Scholar y ScienceDirect. Para evaluar la calidad metodológica y validez interna de los estudios se utilizó la escala PEDro. Resultados Se incluyeron 10 estudios en nuestra revisión. Cinco estudios llevaron a cabo un trabajo con cicloergómetro de alta intensidad cuya duración fue de una a cinco semanas, mejorando la bradicinesia cuatro de ellos, siendo tres de manera significativa. Cuatro estudios realizaron un trabajo con resistencia (desde nueve semanas hasta 24 meses) mejorando todos la bradicinesia, siendo significativos tres de ellos. Un estudio realizó un trabajo de resistencia y cicloergómetro demostrando mejorar la bradicinesia tras 12 semanas de tratamiento. Conclusión Aunque los dos tratamientos son beneficiosos para mejorar la bradicinesia en EP con severidades leves-moderadas, en un periodo mínimo de una semana, el tratamiento con cicloergómetro a alta velocidad tiene mejoras significativas, mientras que el trabajo con resistencia lo hace a partir de nueve semanas, siendo necesarios más estudios con mejores evidencias (AU)

Background and objective Endurance and high-intensity stationary cycling exercises have been used in recent years to treat bradykinesia in Parkinson's disease (PD). The aim is to determine the effectiveness of endurance and high-intensity stationary cycling in reducing bradykinesia in people with PD. Subjects and methods A search was conducted up to 2020 in the PubMed, Web of Science, Medline, Cochrane Library, Google Scholar and ScienceDirect databases. The PEDro scale was used to assess the methodological quality and internal validity of the studies. Results 10 studies were included in our review. Five studies carried out high intensity stationary cycling workouts with a duration of 1 to 5 weeks, 4 of them showed improved bradykinesia, 3 of them significantly. Four studies carried out endurance exercises (from 9 weeks to 24 months) all cases of bradykinesia improved, 3 significantly. One study looked at endurance exercises and stationary cycling showing, an improvement in bradykinesia after 12 weeks of treatment. Conclusion Although both treatments are beneficial for improving bradykinesia in PD of mild-moderate severity, in a minimum period of one week, treatment with high-speed stationary cycling shows significant improvements, while endurance exercises do so from 9 weeks onwards. Further studies with better evidence are needed (AU)

Results of a self-management program added to standard physical therapy in chronic neck pain.

OBJECTIVE: To evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain. METHODS: Fifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up. RESULTS: There were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032). CONCLUSIONS: An individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone. PRACTICAL IMPLICATIONS: This study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.

Efectividad de la terapia acuática en pacientes con accidente cerebrovascular: una revisión sistemática / Effectiveness of aquatic therapy in stroke patients: A systematic review

Antecedentes y objetivos: A pesar del avance científico existe una gran cantidad de pacientes con discapacidad tras sufrir un accidente cerebrovascular. Desde la fisioterapia y la terapia acuática se han llevado a cabo diferentes investigaciones. El objetivo de este estudio fue revisar de forma sistemática la efectividad de la terapia acuática en el tratamiento del paciente con accidente cerebrovascular. Métodos: Se llevaron a cabo búsquedas en las bases de datos PubMed, Scopus y Web Of Science sobre terapia acuática y su efectividad. Se seleccionaron ensayos clínicos aleatorizados sin limitación en el tiempo y publicados en inglés o español. Se evaluó la calidad de los artículos seleccionados con la escala Physiotherapy Evidence Database. Resultados: Trece ensayos clínicos aleatorizados cumplieron los criterios de selección. Se incluyeron un total de 336 participantes, de los cuales un 64% habían sufrido un incidente isquémico. Ciento noventa y siete participantes se encontraban en fase crónica. Las intervenciones se llevaron a cabo en una piscina terapéutica en 11 de los estudios y en una piscina de natación en 2. Se evaluaron los efectos de las intervenciones sobre: equilibrio, marcha, función cardiorrespiratoria, fuerza muscular, función muscular, tono muscular, funcionalidad y calidad de vida. Conclusión: La terapia acuática es efectiva en el tratamiento de pacientes con accidente cerebrovascular en todas las variables analizadas

Background and objectives: Despite scientific advances there are a great number of patients with disability after suffering stroke. Previous studies have investigated the effects of physiotherapy and aquatic therapy. The objective of this study was to systematically review the effectiveness of aquatic therapy in the treatment of stroke patients. Methods: The searches were performed in PubMed, Scopus, and Web of Science, and the topic was aquatic therapy and its effectiveness on stroke patients. Randomised controlled trials were selected without limitation over time, and published in English or Spanish. The quality of the selected articles was evaluated using the Physiotherapy Evidence Database scale. Results: A total of 13 randomised controlled trials met the selection criteria. A total of 336 participants were included, of whom 64% had suffered an ischaemic event, with 197 participants in the chronic phase. The interventions were carried out in therapeutic pool in 11 of the studies, with 2 using swimming pool. The effects of interventions were assessed on: balance, gait, cardiorespiratory function, muscle strength, muscle function, muscle tone, functionality, and an evaluation of the quality of life. Conclusion: Aquatic therapy is effective in the treatment of stroke patients in all the variables analysed

Relación entre el perfil clínico y la tensión neural en personas con dolor cervical crónico / Relationship between clinical profile and neural tension in people with chronic neck pain

Introducción y objetivos: El dolor cervical crónico (DCC) confluye con una gran variedad de signos y síntomas, tales como la tensión neural y las alteraciones conductuales. Este estudio pretende evaluar la relación entre la tensión neural y el perfil clínico de los pacientes con DCC. Materiales y métodos: Se llevó a cabo un estudio observacional de corte transversal. Se incluyeron 25 pacientes con DCC y 25 personas sin dolor. Se evaluó el perfil clínico incluyendo las variables físicas (dolor, discapacidad), y las variables psicológicas y/o comportamentales (ansiedad, depresión, calidad de vida, miedo al movimiento y conductas de miedo-evitación). La tensión neural se midió a través de pruebas de neurodinamia. Resultados: Los sujetos con DCC presentaron una alteración significativa de la tensión neural, en comparación con las personas sin dolor. Se halló una correlación significativa entre los test de neurodinamia y las conductas y creencias sobre el dolor, así como su interferencia en la vida diaria. Adicionalmente se mostró una relación significativa entre las creencias y actitudes sobre el dolor y la intensidad e interferencia del mismo, la discapacidad y el estado de salud percibido. Conclusiones: Los pacientes con DCC muestran peores resultados que el grupo sin dolor en los test de neurodinamia del miembro superior. La neurodinamia se relaciona con las variables psicológicas y comportamentales medidas

Introduction and objectives: Chronic neck pain includes a wide variety of signs and symptoms, such as neural tension and behavioural changes. The aim of this study was to evaluate the relationship between neural tension and the clinical profile of patients with chronic neck pain. Materials and methods: We carried out a cross-sectional observational study. We included 25 patients with chronic neck pain and 25 without pain. The clinical profile was evaluated including physical variables (pain, disability), and psychological and / or behavioural variables (anxiety, depression, quality of life, fear of movement and fear-avoidance behaviours). Neural tension was measured through neurodynamic tests. Results: The subjects with chronic neck pain had worse neural tension results compared with the controls. A significant correlation was found between the neurodynamic tests and the psychological and behavioural variables. Additionally, there was a significant relationship between beliefs and attitudes about pain and daily life interference, disability and perceived health status. Conclusions: The patients with chronic neck pain had worse results than the painless group in the upper limb neurodynamic tests. Neurodynamics related to the psychological and behavioural variables

De Novo Anti-HLA Antibodies After Heart Transplantation Are Associated With Adverse Events in the Long-term Follow-up of Cardiac Transplant Recipients.

BACKGROUND AND OBJECTIVES: Long-term morbidity and mortality after heart transplantation (HTx) remain very high. Several reports have suggested that anti-HLA antibodies (anti-HLA-AB) detected after HTx might be associated with poor survival, but the implication of isolated anti-HLA-AB is still under debate. The aim of the study was to analyze the incidence of de novo anti-HLA-AB and whether they are associated with adverse events after HTx. METHODS: This retrospective study analyzed the presence of anti-HLA-AB assessed by fluorimetry (Luminex) and quantified by a single-antigen bead assay in 119 HTx patients. Mortality, graft dysfunction, antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV) were recorded. Cardiovascular mortality of patients with and without anti-HLA-AB was compared according Kaplan-Meier curves. Cox regression analyses were performed to identify predictors for global mortality and for a combined endpoint (cardiovascular mortality, AMR, and CAV). Mean age of recipients and donors was 49 ± 15 and 38 ± 14 years, 70% were men, 29% were urgent transplants, and mean ischemic time was 195 ± 56 minutes. RESULTS: Anti-HLA-AB were detected in 23 patients (19%). These patients had higher rates of AMR (39% vs 1%; P < .05) and cardiovascular mortality (17% vs 2%; P < .05). By multivariate analysis, anti-HLA-AB were the only predictor of the combined endpoint (hazard ratio 3.1; confidence interval 1.3 to 7.5; P = .01). Kaplan-Meier curves showed the worse cardiovascular survival of patients with anti-HLA-AB (72% vs 97%; P = .003). CONCLUSIONS: Presence of anti-HLA-AB identifies a group of HTx patients with worse prognosis. Better understanding of the immunologic relevance of anti-HLA-AB is expected to improve long-term survival after HTx.

Mitochondrial DNA damage is associated with damage accrual and disease duration in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the extent of mitochondrial DNA (mtDNA) damage in systemic lupus erythematosus (SLE) patients compared to healthy subjects and to determine the factors associated with mtDNA damage among SLE patients. METHODS: A cross-sectional study was performed in 86 SLE patients (per American College of Rheumatology classification criteria) and 86 healthy individuals matched for age and gender. Peripheral blood mononuclear cells (PBMCs) were collected from subjects to assess the relative amounts of mtDNA damage. Quantitative polymerase chain reaction assay was used to measure the frequency of mtDNA lesions and mtDNA abundance. Socioeconomic-demographic features, clinical manifestations, pharmacologic treatment, disease activity, and damage accrual were determined. Statistical analyses were performed using t test, pairwise correlation, and Pearson's chi-square test (or Fisher's exact test) as appropriate. RESULTS: Among SLE patients, 93.0% were women. The mean (SD) age was 38.0 (10.4) years and the mean (SD) disease duration was 8.7 (7.5) years. SLE patients exhibited increased levels of mtDNA damage as shown by higher levels of mtDNA lesions and decreased mtDNA abundance as compared to healthy individuals. There was a negative correlation between disease damage and mtDNA abundance and a positive correlation between mtDNA lesions and disease duration. No association was found between disease activity and mtDNA damage. CONCLUSION: PBMCs from SLE patients exhibited more mtDNA damage compared to healthy subjects. Higher levels of mtDNA damage were observed among SLE patients with major organ involvement and damage accrual. These results suggest that mtDNA damage have a potential role in the pathogenesis of SLE.

Hipertensión pulmonar secundaria a estenosis múltiples del árbol arterial pulmonar / Pulmonary hypertension, secondary to multiple stenosis of the pulmonary artery branch

Las estenosis de arterias pulmonares es una causa de hipertensión pulmonar y se asocia generalmente a malformaciones cardíacas congénitas. Se diagnostican habitualmente en las primeras etapas de la vida. Puede estar provocado por el síndrome de rubeola congénita, dentro de la clásica triada compuesta por cataratas, hipoacusia y malformaciones cardiovasculares. Presentamos un adulto, asintomático durante la infancia, que comienza con disnea progresiva, detectándose múltiples estenosis en el árbol vascular pulmonar secundario a infección por el virus de la rubeola durante la gestación que fue tratado con angioplastia (dilatación con balón)

Stenosis of the pulmonary arteries is a cause of pulmonary hypertension and is generally associated with congenital car-diac malformations. It is usually diagnosed during the initial states of life. It may be caused by congenital rubella syndro-me, within a classic triad that includes cataracts, deafness and cardiovascular malformations. We present the case of an adult who was asymptomatic during childhood. The patient began having progressive dyspnea; multiple stenosis of the pulmo-nary artery tree was detected, secondary to a rubella viral in-fection during pregnancy. The stenosis was treated with angio-plasty (dilatation with balloon)

Long-term membranous glomerulonephritis as the presenting manifestation of systemic lupus erythematosus in a patient with human immunodeficiency virus infection.

The coexistence of human immunodeficiency virus (HIV) infection and systemic lupus erythematosus (SLE) is unusual, but the occurrence of SLE after HIV infection is even less common. Both conditions share similar clinical features including constitutional symptoms, facial rash, oral ulcers, alopecia, arthralgias, arthritis, seizures, cytopenias, glomerulonephritis, and antinuclear and antiphospholipid antibodies. This clinical overlap makes the diagnosis of SLE in a patient with pre-existing HIV infection difficult. Furthermore, immune complex glomerulonephritis with features resembling lupus nephritis has been described in HIV-positive patients. We present the case of a 45-year-old Hispanic woman with long-standing HIV infection who developed membranous glomerulonephritis with histological features of lupus nephritis. Five years after onset of renal disease she developed clinically evident SLE.

Steroid use in heart transplant patients in Spain in the current era: a multicenter survey.

OBJECTIVE: Steroid withdrawal (SW) from maintenance therapy in heart transplant patients is still a controversial subject. We designed a questionnaire to ascertain the attitudes and procedures of a number of Spanish heart transplant units (16) regarding the use/withdrawal of steroids as part of the immunosuppressive maintenance therapy. MATERIALS AND METHODS: We sent an 11-item questionnaire to the clinical director in charge of each unit. The questionnaire was completed and returned by 14 units. RESULTS: In 21.5% of the centers SW was performed in all patients, while 78.5% of the centers only performed SW in selected patients. In 57% of units SW was performed at 12 months posttransplantation and between 6 and 12 months in the rest. Fewer than 20% of patients were steroid-free in 46% of units while in 23% of units this proportion was >50%. In 11 units, the minimum prednisone dose administered was

Prevalencia de patología disfuncional masticatoria en una muestra de pacientes de la clínica odontológica universitaria / Prevalence of disfuncional masticatorry pathology in a patients sample of the university dental clinic

El objetivo de este trabajo es valorar los signos y síntomas más frecuentes relativos a la patología temporomandibular en una muestra de pacientes. Para ello se estudian las respuestas a un cuestionario y los resultados obtenidos en un protocolo de exploración aplicado a 63 pacientes visitados en la clínica odontológica universitaria de la Facultad de Odontología de la Universidad de Barcelona. La semiología más prevalente Dallada incluye la que se asocia al apretamiento diurno de los dientes, seguida de clics, apretamiento nocturno de los dientes los desgastes oclusales cuya repercusión física parece afectar con mayor or frecuencia al disco u menisco articular (AU)

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Randomized trial of tamoxifen versus aminoglutethimide and versus combined tamoxifen and aminoglutethimide in advanced postmenopausal breast cancer.

In a randomized trial, 105 postmenopausal women with advanced carcinoma of the breast received tamoxifen or aminoglutethimide or combined tamoxifen and aminoglutethimide. No differences were found in the rate of responses and duration of responses between the treatment groups. Toxicity was significantly greater (p less than 0.01) in patients who received aminoglutethimide.