Platelet lysate for the treatment of osteoarthritis: a systematic review of preclinical and clinical studies.

Intra-articular injection-based therapy is often used aside conservative treatment and lifestyle modifications to manage knee osteoarthritis (KO) patients. Conventional injections contain steroids and hyaluronic acid, while more recently multipotential adult stem cell, platelet-rich plasma (PRP), and platelet lysate (PL) injections have been used to promote cartilage regeneration or repair. The aim of the current study is to analyse current evidence on PL injections for the treatment of KO and to determine if these are effective and how these perform compared to other injection regimens. The databases of Scopus, Embase, PubMed, Web of Science, and Cochrane Library were searched on 30 June 2023. Risk of bias was assessed using the SYRCLE tool for animal studies and Cochrane RoB 2 as well as ROBINS-I tool for human studies. Studies were included if these were in English, any year, and regarded animals with osteoarthritis (OA) or human adult patients with OA. In vitro trials and non-adult human studies were excluded. Results on OA symptom stage and severity, and pain were recorded. The research retrieved three human studies (n = 48, n = 25, n = 58) and four animal studies: one rabbit, two studies, and one rat study. PL was found to decrease KO symptoms at follow-up ≤ 1 year with respect to baseline levels and when compared to hyaluronic acid or platelet-rich plasma. Symptoms returned 6 months-1 year after the final administration, with studies showing peak efficacy at approximately 6 months. Animal studies showed clinical improvements, reduction of lameness, and partial effect on the cartilage regeneration of the seven studies, two had a high risk of bias, four were associated to some concerns, and one had low risk. A major source of bias in these studies was the use of questionnaires and scoring that could be subject to interpretation. Overall, PL was well-tolerated and showed efficacy comparable to PRP; when pain control was assessed, it showed similar efficacy compared to hyaluronic acid. These findings may support its use in clinical trials to confirm these initial findings; future research should also focus on the comparison with other non-surgical treatments, on a more detail of the potential regenerative properties, and to optimise the treatment schedule.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

[Benefit of therapeutic drug monitoring of immunosuppressants and immunomodulators in the management of autoimmune diseases]. / Intérêt des dosages pharmacologiques d'immunosuppresseurs et immunomodulateurs dans la prise en charge des maladies autoimmunes.

The pharmacokinetics of drugs, such as immunosuppressants, justify the need of measuring their blood concentrations in order to adjust their dosage. Therapeutic Drug Monitoring (TDM) of ciclosporin, tacrolimus and mycophenolate mofetil has shown its benefit particularly in the management of renal transplantees, in order to prevent graft rejection. When prescribed in autoimmune diseases, their pharmacokinetic variability and the variability of clinical response would justify TDM in practice. TDM may be useful in systemic lupus, for hydroxychloroquine, in order to monitor patient compliance. Despite insufficient data in the literature, for mycophenolate mofetil, TDM would permit to maintain clinical remission in adults and children with lupus nephritis, as well as in mucosal pemphigoid and idiopathic nephrotic syndrome in children. Studies are still necessary to validate the thresholds and TDM conditions. For azathioprine, TPMT phenotyping is recommended before prescription. For methotrexate, tacrolimus and ciclosporin, data are still sparse on the benefit of TDM, although it may improve tolerance to tacrolimus in lupus. Finally, for infliximab, in case of loss of response in maintenance, TDM may be proposed in parallel with detection of anti-drug antibodies.

High-dimensional profiling reveals Tc17 cell enrichment in active Crohn's disease and identifies a potentially targetable signature.

The immune-pathology in Crohn's disease is linked to dysregulated CD4+ T cell responses biased towards pathogenic TH17 cells. However, the role of CD8+ T cells able to produce IL-17 (Tc17 cells) remains unclear. Here we characterize the peripheral blood and intestinal tissue of Crohn's disease patients (n = 61) with flow and mass cytometry and reveal a strong increase of Tc17 cells in active disease, mainly due to induction of conventional T cells. Mass cytometry shows that Tc17 cells express a distinct immune signature (CD6high, CD39, CD69, PD-1, CD27low) which was validated in an independent patient cohort. This signature stratifies patients into groups with distinct flare-free survival associated with differential CD6 expression. Targeting of CD6 in vitro reduces IL-17, IFN-γ and TNF production. These results identify a distinct Tc17 cell population in Crohn's disease with proinflammatory features linked to disease activity. The Tc17 signature informs clinical outcomes and may guide personalized treatment decisions.

Acute symptomatic seizures and epilepsy after mechanical thrombectomy. A prospective long-term follow-up study.

INTRODUCTION: New treatments for acute ischaemic stroke, such as mechanical thrombectomy, can achieve reperfusion of large ischaemic tissue. Some studies have suggested that reperfusion therapies can increase the risk of suffering acute symptomatic seizure (ASS) and poststroke epilepsy (PSE). The aim of the study was to determine the incidence of ASS and PSE in patients undergoing thrombectomy, and related factors. PATIENTS AND METHODS: This was a retrospective single-centre study including patients with ischaemic stroke and NIHSS> 8 treated with thrombectomy with a follow-up ≥5 years. We evaluated several epidemiological, radiological, clinical and electroencephalographic variables. RESULTS: Of the 344 included patients, 21 (6.1%) presented ASS, 53 (15.40%) died in the acute phase, and 13 (4.46%) died during the first year. The degree of reperfusion (p 0.029), advanced age (p 0.035), and haemorrhagic transformation (p 0.038) increased the risk of suffering ASS, with degree of reperfusion being an independent factor, OR 2.02 (1.21-4.64). The incidence of PSE was 4.12% in the first year, 3.72% in the second, and 1.61% in the fifth. The accumulated incidence at 5 years was 8.93%. Related risk factor for suffering PSE was ASS (p < 0.001), yielding an OR value of 2.00 (1.28-3.145). CONCLUSIONS: Thrombectomy doesn´t increase the risk of ASS. A higher percentage of reperfusion, advanced age, and haemorrhagic transformation are associated with an increased risk of ASS. ASS is a risk factor for suffering PSE. In terms of mortality, having suffered ASS and/or PSE does not increase acute or long-term mortality.

Xantogranuloma juvenil: una entidad con amplio espectro clínico / Juvenile Xanthogranuloma: An Entity With a Wide Clinical Spectrum

El xantogranuloma juvenil es un trastorno benigno poco frecuente, que pertenece al amplio grupo de las histiocitosis de células no Langerhans. Se presenta con uno o más nódulos eritematosos o amarillentos, ubicados preferentemente en la cabeza y el cuello. La mayoría de los casos se inician durante el primer año de vida, incluyendo lesiones congénitas. La afectación extracutánea es rara, sugiriéndose tradicionalmente en la literatura estudiar el compromiso ocular. El diagnóstico del xantogranuloma juvenil es fundamentalmente clínico, sin embargo, en ocasiones se requiere confirmarlo con biopsia de piel. Las lesiones cutáneas son autolimitadas, por lo que suelen no requerir tratamiento. En la presente revisión se describen los distintos aspectos clínicos y terapéuticos de esta enfermedad, resaltando la evidencia respecto al estudio diagnóstico del compromiso extracutáneo

Juvenile xanthogranulomas (JXGs) are rare, benign lesions that belong to the large group of non-Langerhans cell histiocytoses. JXG presents with 1 or more erythematous or yellowish nodules that are usually located on the head or neck. Most JXG lesions are congenital or appear during the first year of life. Extracutaneous involvement is rare, but the literature traditionally suggests investigating the possibility of ocular compromise. JXG is mainly a clinical diagnosis, but a skin biopsy may sometimes be needed for confirmation. JXGs on the skin are self-limiting and usually do not require treatment. This review describes the clinical and therapeutic aspects of JXG, emphasizing available evidence and the diagnosis of extracutaneous involvement

Coulomb logarithm accuracy in a Yukawa potential.

We present a complete theory of the scattering of a particle in a Yukawa potential when the screening length is much larger than the classical impact parameter for 90^{∘} deflection and than the de Broglie length. The classical limit, the quantum limit, and the intermediate case are investigated, enabling an accurate determination of the argument of the Coulomb logarithm in the general case. The connection with previously published results is made.

Estimulación magnética transcraneal y fisioterapia en la rehabilitación motora de la enfermedad vascular cerebral. Revisión sistemática / Transcranial magnetic stimulation and physiotherapy on motor stroke rehabilitation. Systematic review

OBJETIVO: Realizar una revisión sistemática actualizada y crítica sobre los estudios clínicos que han utilizado la combinación de estimulación magnética transcraneal repetitiva (EMTr) con fisioterapia en pacientes con secuelas de enfermedad vascular cerebral (EVC) para conocer si existen efectos sinérgicos de ambas terapias sobre la función motora. ESTRATEGIA DE BÚSQUEDA Y SELECCIÓN DE ESTUDIOS: Revisión sistemática de estudios clínicos con grupo control. La búsqueda se realizó en las siguientes bases de datos: PubMed, MedLine, DynaMed, EBSCO, Science Direct y Latindex, de 2009 a 2019. Se encontró un total de 184 artículos, y basado en los criterios de inclusión se seleccionó un total de 10 estudios que combinaron fisioterapia con EMTr. SÍNTESIS DE RESULTADOS: Existen pocos estudios en donde se haya combinado la aplicación de EMTr con fisioterapia para la recuperación motora en EVC. Se encontraron diversos puntos de variabilidad en el diseño de los estudios, lo cual dificulta su comparación: número de participantes, tipo de fisioterapia aplicada, parámetros de estimulación, variables de desenlace, etc. Seis estudios demostraron efectos sinérgicos de la EMT + fisioterapia en la función motora en EVC. CONCLUSIONES: Se observaron múltiples puntos de variabilidad metodológica que pueden afectar la comparación entre los estudios. La evidencia disponible parece sugerir un efecto sinérgico de la combinación de EMTr + fisioterapia en la función motora en EVC

OBJECTIVE: To perform an updated and critical systematic review of the clinical studies that have used the combination of repetitive Transcranial Magnetic Stimulation (rTMS) and physiotherapy in patients with sequelae of stroke to establish whether there are synergistic effects of both therapies on motor function SEARCH STRATEGY AND STUDY SELECTION: Systematic review of clinical studies with control group. The search was carried out in the following databases: PubMed, MedLine, DynaMed, EBSCO, Science Direct and Latindex from 2009 to 2019. A total of 184 articles were found and, based on the inclusion criteria, a total of 10 studies were selected who combined physiotherapy with rTMS. SYNTHESIS OF RESULTS: There are few studies where rTMS has been combined with physiotherapy for motor recovery in stroke. Several points of variability were found in the design of the studies, which makes comparison difficult: number of participants, type of physiotherapy applied, stimulation parameters, outcome variables, etc. Six studies showed a synergistic effect of rTMS + physiotherapy on motor function in stroke. CONCLUSIONS: There are several points of methodological variability between studies but the available evidence suggests a possible synergistic effect of rTMS+physiotherapy

Uso de la espironolactona en dermatología: acné, hidradenitis supurativa, alopecia femenina e hirsutismo / Spironolactone in Dermatology: Uses in Acne, Hidradenitis Suppurativa, Female Pattern Baldness, and Hirsutism

La espironolactona es un diurético ahorrador de potasio con efecto antiandrogénico, de bajo coste y con un buen perfil de seguridad. Hemos observado en nuestra experiencia que es un fármaco infrautilizado en dermatología, pese a que existe evidencia de su uso en diversas patologías dermatológicas, especialmente en el acné femenino (nivel de evidencia II-III, fuerza de recomendación B), donde podría disminuir el uso de antibióticos y probablemente de isotretinoína. Otras enfermedades en las cuales puede ser útil son la hidrosadenitis supurativa y la alopecia androgenética femenina. Discutimos las indicaciones de la espironolactona, su dosificación en la práctica dermatológica, las precauciones que deben tener en cuenta y sus efectos secundarios. Además, presentamos nueva evidencia que avala su uso en dermatología sin necesidad de indicar pruebas complementarias en mujeres jóvenes y enfatiza su seguridad a largo plazo. Consideramos que la espironolactona debería estar entre los agentes comúnmente utilizados en la práctica clínica habitual

Spironolactone is an economical potassium-sparing diuretic with an anti-androgenic effect and a good safety profile. Our experience suggests that this diuretic is underexploited in dermatology even though there is evidence supporting its use in several skin conditions. When prescribed for acne in female patients (level 1-2 evidence; strength of recommendation, B), for example, it can reduce the need for antibiotics and possibly isotretinoin. Other diseases in which spironolactone is potentially useful are hidradenitis suppurativa and female androgenetic alopecia. We discuss the indications for spironolactone, dosing in dermatology, precautions to consider, and adverse effects. We also review new evidence that stresses the safety of long-term therapy and supports the use of this drug without the need for complementary testing in young women. We think that spironolactone merits a place among the medications commonly used in routine clinical practice

Poroqueratosis. Revisión de su etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento / Porokeratosis: A Review of Its Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment

Las poroqueratosis son un grupo heterogéneo e infrecuente de dermatosis adquiridas o heredadas de etiología desconocida, caracterizadas por un trastorno de la queratinización secundario a una expansión clonal anormal de los queratinocitos. Se han descrito múltiples mutaciones genéticas potencialmente implicadas. Histológicamente, se caracterizan por la presencia de la lamela cornoide. Su presentación clínica es variable con formas localizadas, diseminadas e incluso eruptivas. Las poroqueratosis se han asociado con inmunosupresión, radiación ultravioleta, enfermedades sistémicas, infecciosas y neoplásicas. Muchos autores las consideran como entidades premalignas dada su potencial degeneración neoplásica a carcinoma escamoso o basocelular. Por ello, el seguimiento a largo plazo es uno de los pilares de su tratamiento, el que suele ser complejo y a menudo insatisfactorio. En la presente revisión se discuten los últimos avances en su etiopatogenia, diagnóstico y terapéutica, y se propone un algoritmo de tratamiento

Porokeratosis comprises a group of heterogeneous and uncommon acquired or congenital skin diseases of unknown origin characterized by a keratinization disorder resulting from abnormal clonal expansion of keratinocytes. Numerous genetic mutations are thought to be involved. These conditions are characterized histologically by the presence of a cornoid lamella. Clinical manifestations are variable, with localized, disseminated, and even eruptive forms. Porokeratosis has been associated with immunosuppression, ultraviolet radiation, and systemic, infectious, and neoplastic diseases. Many authors consider it to be a premalignant condition because of the potential for malignant transformation to squamous cell or basal cell carcinoma. Therefore, long-term follow-up is a key component of treatment, which is usually complex and often unsatisfactory. We review the latest advances in our understanding of the pathogenesis, diagnosis, and treatment and propose a treatment algorithm

Juvenile Xanthogranuloma: An Entity With a Wide Clinical Spectrum. / Xantogranuloma juvenil: una entidad con amplio espectro clínico.

Juvenile xanthogranulomas (JXGs) are rare, benign lesions that belong to the large group of non-Langerhans cell histiocytoses. JXG presents with 1 or more erythematous or yellowish nodules that are usually located on the head or neck. Most JXG lesions are congenital or appear during the first year of life. Extracutaneous involvement is rare, but the literature traditionally suggests investigating the possibility of ocular compromise. JXG is mainly a clinical diagnosis, but a skin biopsy may sometimes be needed for confirmation. JXGs on the skin are self-limiting and usually do not require treatment. This review describes the clinical and therapeutic aspects of JXG, emphasizing available evidence and the diagnosis of extracutaneous involvement.

Efectividad de la ventilación de los diversos dispositivos extraglóticos durante las maniobras de reanimación. Revisión sistemática / Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review

INTRODUCCIÓN: El uso de dispositivos extraglóticos se ha difundido ampliamente en urgencias pre e intrahospitalarias debido a la facilidad de inserción y la reducción de las interrupciones en las maniobras de reanimación cardiopulmonar. Sin embargo, la mayoría de estos estudios no especifica si dichos dispositivos aseguran una ventilación adecuada durante la reanimación cardiopulmonar. Esta revisión sistemática tiene como objetivo principal determinar si existe evidencia que demuestre que los dispositivos extraglóticos permiten una ventilación efectiva durante la reanimación. MÉTODOS: Se han utilizado las bases de datos de MEDLINE y COCHRANE para buscar estudios elegibles publicados en inglés hasta el 30 de noviembre de 2018. Los estudios considerados elegibles fueron todos aquellos que han evaluado objetivamente el volumen tidal durante las maniobras de reanimación, en diversos dispositivos extraglóticos y en pacientes mayores de 18 años. RESULTADOS: Se identificaron 3.734 artículos, de los cuales 252 eran duplicados. Solo uno evaluó objetivamente la ventilación durante las maniobras de reanimación y presentó datos relevantes para esta revisión. En este ensayo de 470 pacientes, se realizó una espirometría en 51 pacientes. Solo el 4,48% de los pacientes sobrevivieron hasta el alta hospitalaria, sin embargo, no se evaluó la relación con la efectividad de la ventilación. CONCLUSIÓN: No existe evidencia científica que demuestre que los dispositivos extraglóticos proporcionan una ventilación efectiva durante las maniobras de reanimación. La evaluación mediante espirometría, impedancia torácica y ultrasonido podría ayudar a discernir la eficacia ventilatoria de los dispositivos extraglóticos durante la reanimación cardiopulmonar y aclarar si este factor está contribuyendo de manera negativa en las dificultades experimentadas para revertir el paro cardiorrespiratorio en los pacientes

INTRODUCTION: Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS: The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS: A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION: There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest

Spironolactone in Dermatology: Uses in Acne, Hidradenitis Suppurativa, Female Pattern Baldness, and Hirsutism. / Uso de la espironolactona en dermatología: acné, hidradenitis supurativa, alopecia femenina e hirsutismo.

Spironolactone is an economical potassium-sparing diuretic with an anti-androgenic effect and a good safety profile. Our experience suggests that this diuretic is underexploited in dermatology even though there is evidence supporting its use in several skin conditions. When prescribed for acne in female patients (level 1-2 evidence; strength of recommendation, B), for example, it can reduce the need for antibiotics and possibly isotretinoin. Other diseases in which spironolactone is potentially useful are hidradenitis suppurativa and female androgenetic alopecia. We discuss the indications for spironolactone, dosing in dermatology, precautions to consider, and adverse effects. We also review new evidence that stresses the safety of long-term therapy and supports the use of this drug without the need for complementary testing in young women. We think that spironolactone merits a place among the medications commonly used in routine clinical practice.

Porokeratosis: A Review of Its Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment. / Poroqueratosis. Revisión de su etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento.

Porokeratosis comprises a group of heterogeneous and uncommon acquired or congenital skin diseases of unknown origin characterized by a keratinization disorder resulting from abnormal clonal expansion of keratinocytes. Numerous genetic mutations are thought to be involved. These conditions are characterized histologically by the presence of a cornoid lamella. Clinical manifestations are variable, with localized, disseminated, and even eruptive forms. Porokeratosis has been associated with immunosuppression, ultraviolet radiation, and systemic, infectious, and neoplastic diseases. Many authors consider it to be a premalignant condition because of the potential for malignant transformation to squamous cell or basal cell carcinoma. Therefore, long-term follow-up is a key component of treatment, which is usually complex and often unsatisfactory. We review the latest advances in our understanding of the pathogenesis, diagnosis, and treatment and propose a treatment algorithm.

Minimizing the impact of sample preparation on analytical results: In-tube solid-phase microextraction coupled on-line to nano-liquid chromatography for the monitoring of tribenuron methyl in environmental waters.

The degradation kinetics and residual levels of the sulfonylurea herbicide tribenuron-methyl (TBM) in different environmental waters were studied using in tube-solid phase microextraction (IT-SPME) coupled on-line to nano-liquid chromatography (nanoLC) and UV diode array detection (DAD). This approach combines the high extraction efficiency of IT-SPME using polymeric coatings reinforced with metal oxide nanoparticles and the high sensitivity attainable by nanoLC, making possible the determination of TBM at low ppb levels (limit of detection, 0.25 ppb) without altering the sample matrix. The present study demonstrated that the preservation of the sample properties is essential to ensure accurate results at these concentration levels due to the high tendency of TBM to hydrolyze, particularly under the acidic conditions involved in most protocols used for sample treatment. The approach used in the present study was applied to evaluate the degradation of this herbicide under different conditions (UV radiation, pH), as well as to study the evolution of its concentration in different environmental waters, namely sea, river, ditch and transition waters. When the samples were exposed to identical conditions, significant differences in the degradation rate of TBM were found depending on the water matrix. The results obtained indicate that this herbicide can persist from several days to weeks depending on the type of water.