How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study.

OBJECTIVES: To assess the accuracy of patient-specific instruments (PSIs) versus standard manual technique and the precision of computer-assisted planning and PSI-guided osteotomies in pelvic tumour resection. METHODS: CT scans were obtained from five female cadaveric pelvises. Five osteotomies were designed using Mimics software: sacroiliac, biplanar supra-acetabular, two parallel iliopubic and ischial. For cases of the left hemipelvis, PSIs were designed to guide standard oscillating saw osteotomies and later manufactured using 3D printing. Osteotomies were performed using the standard manual technique in cases of the right hemipelvis. Post-resection CT scans were quantitatively analysed. Student's t-test and Mann-Whitney U test were used. RESULTS: Compared with the manual technique, PSI-guided osteotomies improved accuracy by a mean 9.6 mm (p < 0.008) in the sacroiliac osteotomies, 6.2 mm (p < 0.008) and 5.8 mm (p < 0.032) in the biplanar supra-acetabular, 3 mm (p < 0.016) in the ischial and 2.2 mm (p < 0.032) and 2.6 mm (p < 0.008) in the parallel iliopubic osteotomies, with a mean linear deviation of 4.9 mm (p < 0.001) for all osteotomies. Of the manual osteotomies, 53% (n = 16) had a linear deviation > 5 mm and 27% (n = 8) were > 10 mm. In the PSI cases, deviations were 10% (n = 3) and 0 % (n = 0), respectively. For angular deviation from pre-operative plans, we observed a mean improvement of 7.06° (p < 0.001) in pitch and 2.94° (p < 0.001) in roll, comparing PSI and the standard manual technique. CONCLUSION: In an experimental study, computer-assisted planning and PSIs improved accuracy in pelvic tumour resections, bringing osteotomy results closer to the parameters set in pre-operative planning, as compared with standard manual techniques.Cite this article: A. Sallent, M. Vicente, M. M. Reverté, A. Lopez, A. Rodríguez-Baeza, M. Pérez-Domínguez, R. Velez. How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study. Bone Joint Res 2017;6:577-583. DOI: 10.1302/2046-3758.610.BJR-2017-0094.R1.

Adaptación al castellano del inventario de duelo complicado / No disponible

Introducción: el proceso de duelo se puede complicar y prolongar en el tiempo, dando lugar a un duelo patológico o complicado, generando un sufrimiento añadido a la pérdida de un ser querido. Es necesario contar con instrumentos de evaluación que nos permitan diferenciar las reacciones normales de las que no lo son, para poder intervenir y facilitar el ajuste a la pérdida de los deudos. Objetivo: adaptar al castellano el Inventory of Complicated Grief -Inventario de Duelo Complicado- (IDC), cuestionario que permite diagnosticar el duelo patológico. Material y método: se realizó una adaptación transcultural del IDC, y se estimaron las propiedades psicométricas del instrumento mediante el análisis de la fiabilidad (consistencia interna y estabilidad en el tiempo), la validez factorial (análisis factorial tipo rotación varimax) y la validez convergente(correlación del IDC con las escalas de Beck de ansiedad y depresión y con el Inventario de experiencias en duelo) en una muestra de 87 deudos. Resultados: el análisis de consistencia interna mostró un alfa de Cronbach del IDC adaptado al castellano de 0,88, y una fiablidad test-retest de 0,81. Del análisis factorial del IDC adaptado al castellano resultaron 3 factores que explicaron el 50,2% de la varianza del IDC total, y la correlación del IDC con la escala de ansiedad fue 0,24 y 0,43 con la de depresión. ElIDC presenta correlaciones positivas con 9 subescalas del Inventario de duelo complicado que oscilan entre 0,21 y 0,31. Conclusiones: los resultados obtenidos muestran que el IDC adaptado al castellano presenta adecuadas propiedades psicométricas, similares a la versión original. El IDC es un instrumento sencillo que permitirá distinguirlas reacciones normales de duelo de las complicadas, lo que facilitará, en gran medida, la planificación de las intervenciones en los deudos en proceso de duelo (AU)

Introduction: the grieving process can become complicated and prolonged over time, leading to pathological or complicated mourning, and generating suffering added to the loss of a loved one. There is a need for assessment tools allowing to differentiate between normal reactions and maladaptive symptoms in order to intervene and facilitate adjustment to loss. Objective: the aim of this study was to develop a Spanish version of the Inventory of Complicated Grief, and to explore its psychometric properties. Material and method: we conducted a cross-cultural adaptation ofIDC, and studied the psychometric properties of the instrument by analyzing its reliability (internal consistency and stability over time), factorial validity (factor analysis varimax rotation rate), and convergent validity(correlation of IDC with Beck scales for anxiety and depression, and theGrief Experiences Inventory) in a sample of 87 conjugally bereaved relatives. Results: the analysis of the adapted IDC showed an internal consistency of 0.88 Cronbach alpha, and a test-retest reliability of 0.81. A factorial analysis of the adapted IDC provided 3 factors that explained 50.2% of the total variance of IDC. The correlation of IDC with the level of anxiety was 0.24, and 0.43 with depression. IDC presents positive correlations with 9 subscales of the Grief Experience Inventory, ranging from 0.21 to 0.31. Conclusions: data show that the Spanish adaptation has good psychometric properties, similar to the original version. IDC, as validated and adapted into Spanish, is a useful tool for the identification and follow-up of symptoms of complicated grief, and allows to schedule interventions to facilitate adaptation to loss (AU)

Control of oncologic pain in relief of suffering. Our experience.

BACKGROUND: Pain and suffering are not synonymous terms. The concept of suffering is wider than just physical pain. People can suffer for multiple causes, pain among them, but it is not the only reason since <>. If our main objective is the achievement of the well-being and the relief of pain, it will be necessary, according to Lazarus, Folkman, Chapman, Gravin, Bayés and Labrador, to reduce or eliminate the physical (cancer, pain and so on) and psychosocial harm (loneliness, culpability, etc.) perceived like a threat and to increase the perception of control about this situation. AIMS: The main objectives of our work were: First: to evaluate the efficacy of a tool that allows the identification of the symptoms perceived by the patient as a threat in order to reduce or suppress them and empower their resources at the same time; and secondly to evaluate the incidence of pain in the suffering. MATERIALS AND METHODS: Our tool includes the following groups of variables: subjective perception of the time course, emotional aspects, concerns and confrontation strategies, perception of adaptation and sense of life, perceived support and pain. This tool has been tested in 73 oncologic patients, 31 men and 42 women, mean aged 55, 41 (SD = 14, 54) visited at the Medical Oncology Service of La Paz Hospital. RESULTS: Mainly, people who refers great suffering are those with more pain (p < 0.05); while patients with less suffering and higher well-being are those that use strategies to face their situation (p < 0.05). Our tool reduces perceived threats and that reflects the need for a good control of pain and at the same time to empower the resources to relieve the suffering as much as possible. CONCLUSION: The referred tool seems to be effective in order to easy the intervention to relieve the suffering.

Beneficial effect of verapamil added to chronic ACE inhibitor treatment on renal function in hypertensive elderly patients.

This study analysed the effect of low doses of verapamil added to chronic treatment with angiotensin-converting enzyme (ACE) inhibitors on blood pressure and serum creatinine levels in eight elderly hypertensive patients who had a steady increase of serum creatinine while on ACE inhibitors. The study was performed in eight elderly hypertensive subjects, five men and three women (mean age 70+/-2 years; systolic blood pressure 173+/-4 mm Hg; diastolic blood pressure 99+/-1 mm Hg) and serum creatinine of 1.60+/-0.27 mg/dl before treatment. During an average of 25 weeks, ACE inhibitors significantly reduced both systolic and diastolic blood pressures, but serum creatinine levels were increased over basal levels (0,68+/-0,20 mg/dl, p < 0.05). During an average of 10 weeks, the addition of verapamil did not decrease blood pressure further, but serum creatinine levels were reduced to baseline. Our study suggests that the addition of verapamil to ACE inhibitors can reverse ACE-induced increase in creatinine levels in elderly hypertensive patients in whom this side effect is observed.

Protective effect of exogenous nitric oxide on the renal function and inflammatory response in a model of ischemia-reperfusion.

BACKGROUND: Tissue subjected to a period of ischemia undergoes morphological and functional damage that increases during the reperfusion phase. The aim of the present work was to assess the possible improvement induced by exogenous administration of nitric oxide (NO) on renal injury and inflammatory reaction in an experimental animal model of renal ischemia-reperfusion (I-R). METHODS: Ischemia was achieved by ligation of the left arteria and vein for 60 min, followed first by contralateral nephrectomy and then reestablishment of blood flow. Molsidomine, used as an NO donor, was administered by systemic injection 30 min before reperfusion. The effect of molsidomine was compared with the effect of hydralazine, a non-NO donor hypotensive agent. RESULTS: Treatment with molsidomine improved the renal dysfunction (increase in plasma creatinine and urea levels) caused by I-R. Moreover, molsidomine blunted the enhanced production of proinflammatory cytokines (tumor necrosis factor [TNF]-alpha and interleukin [IL] 1alpha), the increase in tissular levels of superoxide anions and oxygen free radical scavengers, and the neutrophilic infiltration observed in the ischemic kidney. One hundred percent survival was achieved in the group of animals treated with the NO donor, whereas the groups of animals undergoing I-R that did not receive molsidomine showed a 40% mortality from the second day after reperfusion. CONCLUSIONS: The present work demonstrated that systemic treatment with an NO donor before reperfusion improved renal function and diminished inflammatory responses in a kidney subjected to an I-R process.

Nitrite production does not always reflect nitric oxide synthesis by isolated glomeruli.

The goal of this paper was the measurement of nitric oxide (NO) production in isolated rat glomeruli using two different techniques. NO production was detected directly by a NO-specific electrode and the results were compared with data measured by the Griess reaction, an indirect index to evaluate NO production. The NO production, determined by both techniques, was dependent on the number of glomeruli. Pretreatment with Nw-nitro-L-arginine methyl ester, an inhibitor of the NO synthesis, reduced the NO concentration detected by the NO-sensor, but increased the NO2-concentration (when both results where compared with glomeruli without treatment). Preincubation with 1 mg/ml of Escherichia coli lipopolysaccharide significantly enhanced both NO and NO2-concentrations. Therefore, the present study provides direct evidence of NO generated in isolated glomeruli under physiological conditions and demonstrates that the measurement of NO2- by the Griess reaction, is not always an adequate technique to evaluate the actual NO production.

Effect of chronic NG-nitro-L-arginine methyl ester (L-NAME) on blood pressure and renal function in conscious uninephrectomized spontaneously hypertensive rats.

We have studied during 30 days the effect of a low dose of NG-nitro-L-arginine methyl ester (1 mg.kg-1.day-1 in drinking water) in the presence of D- or L-arginine (1 mg.kg-1.day-1 in drinking water) in comparison with D- or L-arginine alone on blood pressure and renal function in conscious uninephrectomized female spontaneously hypertensive rats. At the end of the study, there was a significant increase in systolic blood pressure in the NG-nitro-L-arginine methyl ester + D-arginine group (307 +/- 6 mmHg (1 mmHg = 133.3 Pa), n = 14, p < 0.05) in comparison with NG-nitro-L-arginine methyl ester + L-arginine (281 +/- 6 mmHg, n = 14), L-arginine (262 +/- 5 mmHg, n = 13), and D-arginine (258 +/- 7 mmHg, n = 12) groups. There were no changes in diuresis, proteinuria, or sodium and potassium excretion between differently treated animals during this study. These results suggest that in uninephrectomized female spontaneously hypertensive rats, after 1 month blockade of NO synthesis with a low dose of NG-nitro-L-arginine methyl ester, vasculature is under tonic control by NO and it is not correlated with renal dysfunction.

Comparative effects of calcium channel blockers and indomethacin on insulin secretion and blood pressure increase derived from alpha 1-adrenoceptor stimulation in the rabbit.

1. In conscious, fasted rabbits the intravenous infusion of the alpha 1-adrenoceptor agonist, amidephrine (3 and 10 micrograms kg-1 min-1) induced a dose related increase in insulin plasma levels. This effect was accompanied by a minor hypo- or hyperglycaemic response, depending on the dose of agonist infused. 2. A dose related increase in mean arterial pressure and reduction in heart rate were also found after amidephrine administration. 3. The insulin secretory response to amidephrine was not prevented in rabbits previously treated with atropine (5.26 micrograms kg-1 min-1). However, in the presence of muscarinic receptor blockade the bradycardic effect of amidephrine was either suppressed or attenuated. 4. Pretreatment with the calcium channel antagonist elgodipine (35 ng kg-1 min-1) or with indomethacin (0.66 mg kg-1 min-1) clearly blocked the effect of amidephrine on insulin secretion. 5. The haemodynamic changes induced by amidephrine were preserved in the presence of either verapamil (0.17 microgram kg-1 min-1) or indomethacin, whereas the hypertensive response was antagonized by elgodipine. 6. Our results suggest that the metabolic and haemodynamic changes mediated by amidephrine are two independent effects, insulin secretion requiring the presence of extracellular calcium and the synthesis of arachidonic acid metabolites.

Effects of the beta 3-adrenoceptor agonist BRL 37344 on lipomobilization and plasma glucose levels in conscious fasted rabbits.

The existence of a functional beta 3-adrenoceptor in conscious 24 h fasted rabbits was investigated by studying the effect of BRL 37344 (a beta 3-adrenoceptor agonist) in comparison with CGP 12177 (a beta 1- and beta 2-adrenoceptor antagonist, which also acts as a partial beta 3 agonist) and isoproterenol (a nonselective beta 1-, beta 2-, and beta 3-adrenoceptor agonist) on plasma nonesterified fatty acids (NEFA) and its possible relation with glucose metabolism. All drugs were intravenously infused at the same dose, 0.3 microgram.kg-1.min-1 (30 min), BRL 37344, CGP 12177, and isoproterenol significantly elevated plasma NEFA levels without increasing plasma glucose levels. Isoproterenol elevated plasma insulin and lactate levels, but BRL 37344 and CGP 12177 did not. Bupranolol (0.1 mg/kg, subcutaneously) blocked the BRL 37344 mediated effect on plasma NEFA levels. In the presence of CGP 20712A (1 mg/kg, subcutaneously), ICI 118551 (30 micrograms/kg, subcutaneously), or the mixture of both selective beta-antagonists, BRL 37344 also evoked an increase in plasma NEFA levels, but the response was less pronounced when compared with BRL 37344 alone. These data suggest that in conscious rabbits deprived of food for 24 h (i) BRL 37344 induces lipomobilization through beta 3-adrenoceptor stimuli, but the effect is less than by beta 1- and beta 2-adrenoceptor stimuli, and (ii) an excess of plasma NEFA evoked by BRL 37344 may not necessarily contribute to plasma glucose increases.

Increased severity of gentamicin nephrotoxicity in aging rats is mediated by a reduced glomerular nitric oxide production.

The present experiments have been performed to assess whether the increased severity of gentamicin-induced nephrotoxicity in old animals could be mediated by a decreased production of nitric oxide. Aging rats (12 months) treated with gentamicin showed higher plasma creatinine and a higher reduction in creatinine clearance. After gentamicin treatment, glomerular nitrite production was higher in young than in old animals, whereas no differences in cortical gentamicin concentration were observed between young and aging animals. The increased severity of gentamicin-induced acute renal failure in old animals could be based on a decreased glomerular NO production after gentamicin treatment.

The effect of LU-49938 (nexopamil) on the activation by serotonin of mesangial cells.

Intraglomerular platelet activation may release vasoactive agents such as serotonin (5-hydroxytryptamine, 5-HT) that may affect local hemodynamics and promote mesangial proliferation, eventually leading to glomerular sclerosis. The main purpose of this study is to analyze whether nexopamil, a verapamil derivative, with the property of blocking simultaneously calcium channels and 5-HT2 receptors, could modify the contractile and mitogenic effects of serotonin on cultured rat mesangial cells. Serotonin caused a concentration-dependent increase in [3H]thymidine incorporation into DNA, and mesangial cell proliferation. The effects of 5-HT on thymidine uptake and cell proliferation were blocked by the selective 5-HT2 receptor blocker ketanserin 10(-5) M. Nexopamil abolished in a concentration-dependent way the serotonin-induced [3H]thymidine incorporation into DNA, and the serotonin-induced increase in number of cells. Using 5-HT 10(-4) or 10(-5) M, nexopamil had significant effects at concentration above 10(-7) M. Serotonin induced a concentration- and time-dependent reduction of planar cell surface area. This effect was also completely blocked by ketanserin. Nexopamil partially blocked the serotonin-induced mesangial cell contraction, in a dose-dependent manner. All these data suggest that nexopamil inhibits both 5-HT-induced mesangial cell contraction and proliferation by blocking 5-HT2 receptors and the voltage-operated Ca2+ channels.

Effects of salbutamol and BRL 37344 on diastolic arterial blood pressure, plasma glucose and plasma lactate in rabbits.

The aim of this study was to investigate in rabbits the diastolic arterial blood pressure, plasma glucose and plasma lactate responses to salbutamol (a selective beta-2 adrenoceptor agonist) and BRL 37344 (a selective beta-3 adrenoceptor agonist) in comparison with CGP 12177 (a potent beta-1 and beta-2 adrenoceptor antagonist which also acts as a partial beta-3 agonist), isoprenaline (a non-selective beta-1, beta-2 and beta-3 adrenoceptor agonist) and adrenaline (a non-selective beta and alpha adrenoceptor agonist). All drugs were iv infused at the same dose: 0.3 microgram/kg/min (30 min). In sodium pentobarbitone (40 mg/kg)-anasthetized animals none of these compounds altered diastolic arterial blood pressure. BRL 37344 (0.1, 0.3, 1 microgram/kg/min) did not modify this parameter either. In conscious 24-h fasted rabbits, only adrenaline was able to increase plasma glucose levels. By contrast, under the same experimental conditions, salbutamol, isoprenaline and adrenaline, but not BRL 37344 or CGP 12177, induced a significant increase in plasma lactate levels. Finally, the salbutamol-mediated plasma lactate response was inhibited in the presence of clonidine (2 micrograms/kg/min, an alpha-2 adrenoceptor agonist), a drug considered to have opposite effects (stimulatory and inhibitory) on the adenylate cyclase system. In conclusion, these data suggest that only beta-2 adrenoceptor stimulation is able to increase plasma lactate levels, a response which is inhibited by alpha-2 adrenoceptor stimulation.