5 years DKMS Chile: approach, results and impact of the first unrelated stem cell donor center in Chile.

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is performed worldwide to treat blood cancer and other life-threatening blood disorders. As successful transplantation requires an HLA-compatible donor, unrelated donor centers and registries have been established worldwide to identify donors for patients without a family match. Ethnic minorities are underrepresented in large donor registries. Matching probabilities are higher when donors and patients share the same ethnic background, making it desirable to increase the diversity of the global donor pool by recruiting donors in new regions. Here, we report the establishment and the first 5 years of operation of the first unrelated stem cell donor center in Chile, a high-income country in South America with a population of over 19 million. Methods: We used online and in-person donor recruitment practices through patient appeals and donor drives in companies, universities, the armed forces, and public services. After confirmatory typing donors were subjected to medical work-up and cleared for donation. Results: We recruited almost 170,000 donors in 5 years. There were 1,488 requests received for confirmatory typing and donor availability checks, of which 333 resulted in medical work-up, leading to 194 stem cell collections. Products were shipped to Chile (48.5%) and abroad. Even when the COVID-19 pandemic challenged our activities, the number of donors recruited and shipped stem cell products remained steady. In Chile there was an almost 8-fold increase in unrelated donor transplantation activity from 16 procedures in 2016-2018 to 124 procedures in 2019-2021, mainly for pediatric patients following the center's establishment. We estimate that 49.6% of Chilean patients would find at least one matched unrelated donor in the global DKMS donor pool. Discussion: Establishing a DKMS donor center in Chile has significantly increased donor availability for Chilean patients and contributed to an increase of unrelated donor stem cell transplant activity.

A computational framework for testing hypotheses of the minimal mechanical requirements for cell aggregation using early annual killifish embryogenesis as a model.

Introduction: Deciphering the biological and physical requirements for the outset of multicellularity is limited to few experimental models. The early embryonic development of annual killifish represents an almost unique opportunity to investigate de novo cellular aggregation in a vertebrate model. As an adaptation to seasonal drought, annual killifish employs a unique developmental pattern in which embryogenesis occurs only after undifferentiated embryonic cells have completed epiboly and dispersed in low density on the egg surface. Therefore, the first stage of embryogenesis requires the congregation of embryonic cells at one pole of the egg to form a single aggregate that later gives rise to the embryo proper. This unique process presents an opportunity to dissect the self-organizing principles involved in early organization of embryonic stem cells. Indeed, the physical and biological processes required to form the aggregate of embryonic cells are currently unknown. Methods: Here, we developed an in silico, agent-based biophysical model that allows testing how cell-specific and environmental properties could determine the aggregation dynamics of early Killifish embryogenesis. In a forward engineering approach, we then proceeded to test two hypotheses for cell aggregation (cell-autonomous and a simple taxis model) as a proof of concept of modeling feasibility. In a first approach (cell autonomous system), we considered how intrinsic biophysical properties of the cells such as motility, polarity, density, and the interplay between cell adhesion and contact inhibition of locomotion drive cell aggregation into self-organized clusters. Second, we included guidance of cell migration through a simple taxis mechanism to resemble the activity of an organizing center found in several developmental models. Results: Our numerical simulations showed that random migration combined with low cell-cell adhesion is sufficient to maintain cells in dispersion and that aggregation can indeed arise spontaneously under a limited set of conditions, but, without environmental guidance, the dynamics and resulting structures do not recapitulate in vivo observations. Discussion: Thus, an environmental guidance cue seems to be required for correct execution of early aggregation in early killifish development. However, the nature of this cue (e.g., chemical or mechanical) can only be determined experimentally. Our model provides a predictive tool that could be used to better characterize the process and, importantly, to design informed experimental strategies.

Los inicios de la bacteriología en Buenos Aires en el siglo XIX: transformaciones institucionales y políticas sanitarias / [The beginnings of bacteriology in Buenos Aires in the 19th century: institutional transformations and health policies]

En este trabajo se analiza el comienzo de la incorporación de la bacteriología a la política sanitaria en Buenos Aires durante las décadas de 1880 y 1890, y las transformaciones que este proceso implicó en el plano institucional y de la intervención estatal. En particular, indagamos en estos cambios a través de la creación y los primeros años de funcionamiento de dos espacios orientados a la producción y enseñanza de conocimientos bacteriológicos: el Laboratorio Bacte-riológico de la Asistencia Pública y la Sección Bacteriológica de la Oficina Sanitaria Argentina. A través del estudio de las trayectorias de los creadores y primeros integrantes de ambos espacios, un grupo de la élite médica agrupada en el Círculo Médico Argentino, y de los conocimientos que circularon al interior de ambas instituciones, reconstruimos el inicio del desarrollo de la bacteriología en Argentina y el modo en que se incorporó a las agendas gubernamentales. (AU)

Towards Instant Calibration in Myoelectric Prosthetic Hands: A Highly Data-Efficient Controller Based on the Wasserstein Distance.

Prosthetic hand control research typically focuses on developing increasingly complex controllers to achieve diminishing returns in pattern recognition of muscle activity signals, making models less suitable for user calibration. Some works have investigated transfer learning to alleviate this, but such approaches increase model size dramatically-thus reducing their suitability for implementation on real prostheses. In this work, we propose a novel, non-parametric controller that uses the Wasserstein distance to compare the distribution of incoming signals to those of a set of reference distributions, with the intended action classified as the closest distribution. This controller requires only a single capture of data per reference distribution, making calibration almost instantaneous. Preliminary experiments building a reference library show that, in theory, users are able to produce up to 9 distinguishable muscle activity patterns. However, in practice, variation when repeating actions reduces this. Controller accuracy results show that 10 non-disabled and 1 disabled participant were able to use the controller with a maximum of two recalibrations to perform 6 actions at an average accuracy of 89.9% and 86.7% respectively. Practical experiments show that the controller allows users to complete all tasks of the Jebsen-Taylor Hand Function Test, although the task of picking and placing small common objects required on average more time than the protocol's maximum time.

Helminth fauna and histopathology associated with parasitic infections in Phrynops geoffroanus (Schweigger, 1812) (Testudines, Chelidae) in a Brazilian river subjected to anthropogenic activities.

The objective of this study was to determine the structure of the helminth fauna and identify the macroscopic and histopathological alterations associated with parasitic infections in Phrynops geoffroanus. Freshwater turtles of both sexes were captured during the dry and rainy seasons in four municipalities along the Capibaribe River. The study included 63 animals, of which 79.37% (50/63) were parasitized by one or more helminths. In total, 933 helminths of seven taxa were recovered: Serpinema monospiculatus, Spiroxys figueiredoi, Nematophila grandis, Polystomoides brasiliensis, Cheloniodiplostomum testudinis, Telorchis birabeni, and Prionosomoides scalaris. Monogeneans and digenetic trematodes were more sensitive to environmental pressures, since the prevalences varied significantly between areas. Nematodes proved to be more resistant to environmental pressure and caused severe injuries to their hosts: nodules in the stomach and small intestine, adhesions in the liver capsule, and pulmonary emphysema. Parasitic granulomas were recorded at the infection sites and in the lungs and liver, the latter caused by migration of S. figueiredoi larvae. This is the first record of P. brasiliensis, N. grandis, C. testudinis, and T. birabeni parasitizing P. geoffroanus in the state of Pernambuco. Histopathology proved to be an important tool for studies on the impact of parasites at the individual, population, and ecosystem levels. Considering the use of the Capibaribe River for public water supply, fishing, and other activities, within the One Health perspective, this study demonstrates that the anthropogenic impact affects parasites and their hosts, in addition to the human population that uses this ecosystem.

La revolución seroterápica´ en Buenos Aires. Tensiones y articulaciones políticas y profesionales en torno a la investigación científica y la producción de sueros (1894-1904) / The “serotherapic revolution” in buenos aires. Political and profesionals tensions and joints around a scientific research and serum production (1894-1904)

Este trabajo analiza la recepción de la seroterapia en Argentina a fines del siglo XIX. Nuestro argumento es que la incorporación de la seroterapia y el desarrollo de agentes terapéuticos supuso una serie de cambios significativos en el campo sanitario en tres dimensiones: a) en las políticas sanitarias, por la incorporación de la función de investigación y producción de agentes terapéuticos por parte de la principal autoridad sanitaria (en relación estrecha con la Escuela de Medicina de Buenos Aires); b) en la práctica profesional, por los cambios que introdujo el trabajo experimental en la relación médico-paciente; y c) en la configuración social del campo médico sanitario, donde a partir de una serie de disputas y conflictos se consolidó el liderazgo de un grupo de médicos ligados a la bacteriología. De este modo, esta nueva terapéutica fue un dinamizador de la actividad y tuvo una incidencia importante en la trayectoria de diferentes actores sociales y espacios institucionales ligados a la salud en el Buenos Aires de fines del siglo XIX.(AU)

This work analyzes the reception of serotherapy in Argentina at the end of the 19th century. Our argument is that the incorporation of serotherapy and the development of therapeutic agents represented a significant changes in the health field in three dimensions: a) in health policies, by the incorporation of the research and production function of therapeutic agents by the main health authority (closely related to the Buenos Aires School of Medicine); b) in professional practice, due to the changes that experimental work introduced in the doctor-patient relationship; and c) in the social configuration of the health field, where a group of physicians consolidated from its leadership through a series of disputes and conflicts. In this way, this new therapy was a catalyst for activity and had an important impact on the trajectory of different social actors and institutional spaces linked to health towards the end of the 19th century.(AU)

Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico / Total hip arthroplasty in protrusio acetabuli: ten tips to improve surgical outcomes

Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.

Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.

Results of standardized treatment of elbow fracture dislocations as per their injury pattern: a retrospective cohort of 89 patients.

BACKGROUND: Elbow fracture dislocations represent difficult injuries to treat, with a high percentage of complications. Classically, they are divided into posterolateral, posteromedial and transulnar pattern. It is essential to distinguish them to guide intraoperative treatment to achieve an anatomic and stable reduction that allows early mobility. METHODS: A retrospective study of 89 adult patients diagnosed with elbow fracture dislocations who underwent a standardized surgery between 2013 and 2018 with a minimum follow-up of 12 months. Demographic data, characteristics of the injury, and associated procedures were collected. Patients were evaluated with functional scores (Mayo elbow performance score/Broberg and Morrey score) and ranges of movement at the end of the follow-up. RESULTS: The mean age was 41 ± 12 years, mostly men (82%), with an average follow-up of 29 months. We present 42 patients with posterolateral fracture dislocation (47%), 21 posteromedial (24%) and 26 transulnar (29%). The average range of motion at the end of follow-up was -12 ± 11° extension, 124 ± 20° flexion, 76 ± 16° pronation, and 73 ± 20° supination, with a Mayo elbow performance score of 88.7 ± 12 points and 87.2 ± 12 points in the Broberg and Morrey scale. Reoperation rate was 23%, with no infection or heterotopic ossification cases. Transulnar fracture dislocations have significantly worse extension and supination. As per the functional result (Mayo elbow performance score/Broberg and Morrey scale), there are no significant differences between the different patterns. CONCLUSION: Proper injury pattern recognition and a standardized surgical management lead to a stable joint and good results in range of motion. Functional results are encouraging at least at short term, despite the high reoperations rate.

Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up.

Background: Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Results: Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5° ± 14.8° (range, 70°-140°) and the mean extension was -5.9° ± 7.0° (range, -20°-0°). Mean pronation and supination were 85.8° ± 11.9° (range, 45°-90°) and 86.9° ± 14.3° (range, 20°-90°), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P = 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P = 0.05), articular angle (22.5° vs. 27.7°, P = 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P = 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7° vs. 6.4°, P = 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P = 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P = 0.0219). Conclusion: The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.

Transferencia artroscópica del trapecio inferior en pacientes con rotura irreparable del manguito rotador posterosuperior. Resultados preliminares de ocho pacientes / Arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears. Preliminary outcomes in eight patients

Introducción: El objetivo de este trabajo es evaluar resultados clínicos y funcionales de pacientes con una rotura irreparable del manguito rotador posterosuperior, sometidos a una transferencia artroscópica del trapecio inferior. Materiales y métodos: estudio de una cohorte retrospectiva de pacientes con roturas irreparables del manguito rotador, en quienes se realizó una transferencia del trapecio inferior asistida por artroscopía. Se evaluó la evolución clínica mediante la ganancia del rango de movilidad del hombro y la disminución del dolor. Del mismo modo, se evaluó la evolución funcional usando el índice de Constant-Murley y la valoración subjetiva del hombro (SSV, por sus siglas en inglés). Resultados: se incluyeron ocho pacientes, con un seguimiento promedio de veintidós meses. Obtuvimos una ganancia estadísticamente significativa de rotación externa de 32°, disminución de 5 puntos en la escala del dolor, aumento de 31 puntos en el score de Constant y un aumento de 38% del SSV. Se registró un aumento de 12° de elevación, sin embargo, este no fue estadísticamente significativo. Dos pacientes presentaron un seroma en el sitio de la cosecha del trapecio, que se resolvió con manejo conservador. Conclusión: la transferencia del trapecio inferior con asistencia artroscópica, en pacientes con rotura irreparable del manguito rotador posterosuperior, es una técnica segura que mejora significativamente la rotación externa y los índices funcionales en este grupo de pacientes. Tipo de estudio: Serie de casos IV

Introduction: The purpose of this study is to compare clinical and functional outcomes of patients with irreparable posterosuperior rotator cuff tears treated by arthroscopic assisted lower trapezius transfer. Materials and methods: retrospective cohort design of patients with irreparable rotator cuff tear, treated by arthroscopy-assisted lower trapezius transfer. The clinical evolution was evaluated according to the gain in the range of shoulder movement and the decrease of pain. Functional outcomes were evaluated using the Constant-Murley score and the subjective shoulder value (SSV). Results: eight patients were included, with average follow-up of twenty-two months. We obtained a statistically significant gain in active external rotation of 32°, 5-point decrease in the pain scale (VAS), a 31-point increase in the Constant score, and a 38% increase in SSV. There was a 12° increase in active forward elevation, however this was not statistically significant. Two patients had a seroma at the trapezius harvest site, which resolved with conservative treatment. Conclusion: arthroscopically assisted lower trapezius transfer in patients with irreparable posterosuperior rotator cuff tears were a safe technique that significantly improves external rotation and functional scores in patients. Type of study: Case series IV

Hip fractures in the elderly Chilean population: a projection for 2030.

Using national databases, we projected the magnitude of hip fractures among the elderly Chilean population by 2030. Hip fractures will increase by 27.5% from 2018 to 9862 cases (95% CI = 8760 to 10,965). The most substantial growth is expected to occur in patients older than 80 years of age. INTRODUCTION: There is scarce information regarding the magnitude of hip fractures that will be observed in Latin American countries in the near future. The aim of this study is to project the volume of hip fractures in the elderly Chilean population by the year 2030. METHODS: The database of the Chilean Department of Statistics and Health Information, which includes all hospital discharges within Chile, was employed to evaluate the volume of hip fractures observed from 2012 to 2018 in the elderly population (≥ 65 years old). The annual incidence was determined by combining the volume of fractures with census data. Linear regression analysis was performed to determine the projected volume of hip fractures for 2030. RESULTS: For 2030, hip fractures among the elderly population are projected to grow 27.5% (R2 = 0.92) to 9862 cases (95% CI = 8760 to 10,965). In the group from 65 to 79 years old, hip fractures are expected to grow 21.6% (R2 = 0.87) to 3046 cases (95% CI = 2686 to 3405). In patients ≥ 80 years of age, hip fractures are expected to grow 30.1% (R2 = 0.9) to 6817 cases (95% CI = 5889 to 7744). CONCLUSIONS: A substantial growth in the volume of hip fractures is expected for the next decade among the elderly Chilean population, especially in patients ≥ 80 years of age. A national healthcare strategy should consider efforts to mitigate the impact of the future burden related to patients' care.

Tabaquismo entre las internas de un centro penitenciario para mujeres / Smoking among prisoners of a penitentiary center for women

Introducción: El tabaquismo es una de las principales causas de enfermedad y muerte en el mundo, y su consumo puede aumentar ante situaciones de estrés. Objetivos: Caracterizar el tabaquismo dentro de la cárcel de mujeres Casa del Buen Pastor. Materiales y métodos: Estudio observacional, descriptivo, de corte transversal con una encuesta anónima utilizando el método de múltiple opción de respuestas. Resultados: Declararon ser fumadoras 73 de las 101 internas encuestadas, y la gran mayoría de ellas quiere dejar de fumar. Conclusión: Hay una alta prevalencia de tabaquismo entre las mujeres en prisión, y su mayoritario deseo de cesación es una oportunidad que debe aprovecharse para apoyarlas con medidas adecuadas para lograrlo.

Introduction: Smoking is one of the main causes of disease and death in the world, and its consumption may increase in situations of stress. Objectives: To characterize smoking within the Casa del Buen Pastor women's prison. Materials and methods: Observational, descriptive, cross-sectional study with an anonymous survey using the method of multiple choice of answers. Results: 73 of the 101 inmates surveyed declared themselves to be smokers, and the vast majority of them want to quit smoking. Conclusion: There is a high prevalence of smoking among women in prison, and their majority desire for cessation is an opportunity that should be used to support them with appropriate measures to achieve it.

Intento de validación al español del instrumento FertiSTAT en población universitaria joven de Chile, 2018 / Spanish validation try of the FertiSTAT instrument in young university chilean population, 2018

INTRODUCCIÓN: Infertilidad es una enfermedad del sistema reproductivo. Su prevalencia ha aumentado, por diversos factores de riesgo. Actualmente no existe un sistema estandarizado en Chile para pesquisar dichos factores tempranamente, por lo que un instrumento con dicho fin sería útil. La encuesta inglesa FertiSTAT, cumple dicho rol desde 2010. El objetivo fue validarla al idioma español. MATERIAL Y MÉTODO: Estudio cuantitativo, transversal, que utilizó a la población estudiantil femenina, de 18 a 44 años, de la Universidad de Concepción 2018, mediante un muestreo presencial, no probabilístico, secuencial en dependencias de la Universidad. El instrumento FertiSTAT, fue revisada por experto y traducida al español de forma independiente. Al ser 19 preguntas en total, fueron necesarios 38 sujetos para prueba piloto y 190 sujetos para validación mediante pruebas psicométricas, realizadas mediante programa IBM-SPSS Statistic 22. Aprobado por comité de ética de la facultad de medicina de la Universidad de Concepción. RESULTADOS: Promedio de edad fue de 20.9 años. Respecto a las pruebas psicométricas: Alfa de Cronbach 0.213. Se obtuvieron correlaciones positivas significativas de baja intensidad. El análisis factorial concluyó en 8 dominios para explicar el 66.39% del grupo. DISCUSIÓN: El instrumento es poco confiable, con mayor número de dominios que el original. Dicho resultado se podría deber a un método no adecuado con preguntas mal estructuradas, errores en los sujetos de investigación e investigadores y una selección de muestra no adecuada. Sería útil revalidar en consultas preconcepcionales o policlínicos de fertilidad. Aun así, se logró traducir un instrumento al español que pesquisa factores de riesgo de infertilidad

INTRODUCTION: Infertility is a disease of the reproductive system. Its prevalence has increased, due to several risk factors. Currently, there is no standardized method in Chile to early identify these factors, so an instrument for this purpose would be useful. The English FertiSTAT survey fulfills this role since 2010. The objective was to validate it to Spanish language. MATERIAL AND METHOD: Quantitative, cross-sectional study that used the female student population, from 18 to 44 years old, from University of Concepción 2018, through a face-to-face, non-probabilistic, sequential sampling at the University's facilities. The FertiSTAT tool was reviewed by an expert and translated into Spanish by an interpreter; both independently. There were 19 questions in total, 38 subjects were needed for pilot test and 190 subjects for validation through psychometric tests, done through the IBM-SPSS Statistic 22 program. Ethics committee approval by the ethic committee of medicine faculty of the Universidad de Concepción. RESULTS: Average age was 20.9 years. About the psychometric tests: Cronbach Alpha; 0.213. Positive correlations were obtained of low intensity. The factorial analysis obtained 8 domains that explain 66.39% of the group. DISCUSSION: The tool is unreliable, with more domains than the original. This result could be due to a poor method with bad structured questions, mistakes in the research subjects and researchers, and an inadequate sample selection. It would be useful to re-validate in pre-conception or fertility polyclinics. At the end, it achieved a Spanish translated tool, which looks for infertility risk factors.

Distance-based kinematics of the five-oblique-axis thumb model with intersecting axes at the metacarpophalangeal joint.

This paper proposes a novel and simple method to compute all possible solutions of the inverse kinematics problem of the five-oblique-axis thumb model with intersecting axes at the metacarpophalangeal joint. This thumb model is one of the suggested results by a magnetic-resonance-imaging-based study that, in contrast to those based on cadaver fingers or on the tracking of the surface of the fingers, takes into account muscle and ligament behaviors and avoids inaccuracies resulting from the movement of the skin with respect to the bones. The proposed distance-based inverse kinematics method eliminates the use of arbitrary reference frames as is usually required by standard approaches; this is relevant because the numerical conditioning of the resulting system of equations with such traditional approaches depends on the selected reference frames. Moreover, contrary to other parametrizations (e.g., Denavit-Hartenberg parameters), the suggested distance-based parameters for the thumb have a natural, human-understandable geometric meaning that makes them easier to be determined from any posture. These characteristics make the proposed approach of interest for those working in, for instance, measuring and modeling the movement of the human hand, developing rehabilitation devices such as orthoses and prostheses, or designing anthropomorphic robotic hands.

Revisión bibliográfica: obesidad infanto juvenil y cirugía bariátrica / Literature review: juvenile obesity and bariatric surgery

La prevalencia de sobrepeso y obesidad en pacientes pediátricos ha aumentado significativamente en las últimas décadas, lo que se asocia a complicaciones a corto y largo plazo lo que conlleva un deterioro en la calidad de vida y aumento de la morbimortalidad asociada principalmente a enfermedades cardiovasculares. El manejo inicial de un paciente con exceso de peso se basa fundamentalmente en dieta y la realización periódica de actividad física. Sin embargo, en los casos de obesidad severa las modificaciones de estilo de vida son insuficientes para la disminución de peso, existiendo en la mayoría de los casos una reganancia de peso. En estos casos la cirugía bariátrica es una opción terapéutica y complementaria al tratamiento médico. Existen diversas técnicas quirúrgicas que alteran anatómicamente y/o funcionalmente el tracto gastrointestinal usado para el tratamiento de la obesidad. Estos procedimientos actúan mediante la restricción de la capacidad del estómago, interferencia con la progresión de la comida, o la desviación de los contenidos ingeridos de una región del tracto gastrointestinal a otra. En la actualidad, los procedimientos más utilizados para los adolescentes incluyen el bypass gástrico en Y de Roux, la banda gástrica ajustable, y por último la gastrectomía en manga, no existiendo estudios que evalúen las complicaciones a largo plazo. Las indicaciones de cirugía bariátrica en adolescentes se basan en el grado de obesidad, la presencia de comorbilidades y el fracaso de tratamiento médico multidisciplinario, entre otras.

The prevalence of overweight and obesity in pediatric patients has sharply increased in recent decades, that is associated with short and long term complications that imply a worsening in the quality of life and increased morbidity and mortality mainly associated with cardiovascular disease. The initial management of a patient with overweight is primarily based on diet and regular physical activity. However, in cases of severe obesity, changes in lifestyle are insufficient for weight reduction, existing in most cases weight gain. In these cases, bariatric surgery is a complementary therapeutic option to medical treatment. There are several surgical techniques that modify the anatomy and/or function of the gastrointestinal tract used in the treatment of obesity. These methods act by restricting stomach capacity, interfering with the progression of food, or deviation of ingested in a region of the gastrointestinal tract to other content. Currently, the most widely used procedures in obese teenagers include gastric bypass Roux, adjustable gastric banding, and finally sleeve gastrectomy. There are not studies evaluating long-term complications. Indications for bariatric surgery in adolescents are based on the degree of obesity, the presence of comorbidities and the failure of multidisciplinary medical treatment, among others.

Análisis de las lesiones en gimnastas de competición en tumbling / Analysis of injuries in competition tumbling gymnasts

El propósito de este estudio ha sido identificar y analizar las lesiones más comunes en gimnastas de tumbling en base a las características del entrenamiento, así como las áreas potenciales sobre las que se podrían aplicar medidas de prevención. Se ha llevado a cabo un estudio descriptivo retrospectivo mediante un cuestionario-entrevista a 18 gimnastas de categorías junior y senior (edad 22,6 años ± 5,4 años; peso corporal 65,94 ± 6,28 Kg; y altura 1,69 ± 0,05 cm). Las variables objeto de estudio fueron el tiempo de práctica y las lesiones sufridas por los gimnastas (localización, tipología, severidad, mecanismo de producción y el momento en el que se producen). Se registraron un total de 50 lesiones, (94%) durante el entrenamiento. Las lesiones más numerosas fueron ligamentosas (44%) y musculares (32%). Por localización, el 72% ocurrieron en los miembros inferiores. Los esguinces representaron un 24%, seguido de las contracturas (12%) y roturas (16%). El (40%) de las lesiones fueron moderadas. Respecto a los mecanismos lesionales, resaltar la sobrecarga en el volumen de trabajo (35%) y lesión por repetición técnica defectuosa (27,50%). La fase de la sesión con mayor incidencia lesional fue el trabajo de las series de competición (54%); y a nivel técnico los elementos dobles y con giros en el eje longitudinal (38,22%). Se halló una correlación positiva (p ≤0,05) entre el número de lesiones y la carga semanal de entrenamiento. Los resultados indican la necesidad de establecer metodologías preventivas, sobre todo para las articulaciones del tren inferior: tobillo y rodilla, al suponer el mayor porcentaje de lesiones. Se recomienda el trabajo propioceptivo como método preventivo para los esguinces y el fortalecimiento muscular asociado a la preparación física específica de los músculos estabilizadores de la rodilla, a través de cargas secuenciales que permitan soportar altos volúmenes de entrenamiento (AU)

The purpose of this study has been to identify and analyze the most common injuries in tumbling gymnasts based on the characteristics of training, as well as the potential areas in which prevention measures could be applied. This is a retrospective study through a questionnaire-interview given to 18 gymnasts (age 22.6 ± 5.4 years; body weight 65.94 ± 6.28 Kg; and height 1.69 ± 0.05 cm). The variables studied were the number of years of practice and the injuries suffered by the gymnasts (location, typology, severity, production mechanism and the moment in which they occurred). A total of 50 injuries was registered, (94%) were recorded during training. The most numerous injuries were ligamentous (44%) and muscle injuries (32%). By location, 72% occurred in lower limbs. Sprains were 24%, followed by contractures (12%) and tears (16%). 40% of the injuries suffered were moderately serious. Regarding the injury mechanisms, we would highlight the work volume overload (35%) and injury by a repetitive defective technique (27.50%). The time of the session with most injury load was the complete series training (54%); and a technical level the doubles somersault with twists in the longitudinal axis (38.22%) produced most injuries. A positive correlation (p ≤0.05) was found between the number of injuries and the weekly training load. Results indicate the need for preventive measures, overall to the lower body joints, ankle and knee. The propioceptive training is recommended as preventive method to avoid sprains, and the muscle strengthening associated with a specific physical preparation on knee stabilizing muscles by sequential charges, allowing high training loads (AU)

Trasplante alogénico de precursores hematopoyéticos de sangre de cordón umbilical de donante no emparentado: primera experiencia, en tres casos, con donantes del banco público chileno de células de cordón / Allogenic hematopoietic stem cell transplantation with unrelated cord blood: Report of three cases from the Chilean cord blood bank

Public cord blood banks are a source of hematopoietic stem cells for patients with hematological diseases who lack a family donor and need allogeneic transplantation. In June 2007 we started a cord blood bank with units donated in three maternity wards in Santiago, Chile. We report the first three transplants done with cord blood units form this bank. Cord blood units were obtained by intrauterine collection at delivery. They were depleted of plasma and red cells and frozen in liquid nitrogen. Tests for total nucleated cells, CD34 cell content, viral serology, bacterial cultures and HLA A, B and DRB1 were done. Six hundred cord blood units were stored by March 2012. Three patients received allogeneic transplant with cord blood from our bank, two with high risk lymphoblastic leukemia and one with severe congenital anemia. They received conditioning regimens according to their disease and usual supportive care for unrelated donor transplantation until full hematopoietic and immune reconstitution was achieved. The three patients had early engraftment of neutrophils and platelets. The child corrected his anemia and the leukemia patients remain in complete remission. The post-transplant course was complicated with Epstein Barr virus, cytomegalovirus and BK virus infection. Two patients are fully functional 24 and 33 months after transplant, the third is still receiving immunosuppression.

[Allogenic hematopoietic stem cell transplantation with unrelated cord blood: report of three cases from the Chilean cord blood bank]. / Trasplante alogénico de precursores hematopoyéticos de sangre de cordón umbilical de donante no emparentado: primera experiencia, en tres casos, con donantes del banco público chileno de células de cordón.

Public cord blood banks are a source of hematopoietic stem cells for patients with hematological diseases who lack a family donor and need allogeneic transplantation. In June 2007 we started a cord blood bank with units donated in three maternity wards in Santiago, Chile. We report the first three transplants done with cord blood units form this bank. Cord blood units were obtained by intrauterine collection at delivery. They were depleted of plasma and red cells and frozen in liquid nitrogen. Tests for total nucleated cells, CD34 cell content, viral serology, bacterial cultures and HLA A, B and DRB1 were done. Six hundred cord blood units were stored by March 2012. Three patients received allogeneic transplant with cord blood from our bank, two with high risk lymphoblastic leukemia and one with severe congenital anemia. They received conditioning regimens according to their disease and usual supportive care for unrelated donor transplantation until full hematopoietic and immune reconstitution was achieved. The three patients had early engraftment of neutrophils and platelets. The child corrected his anemia and the leukemia patients remain in complete remission. The post-transplant course was complicated with Epstein Barr virus, cytomegalovirus and BK virus infection. Two patients are fully functional 24 and 33 months after transplant, the third is still receiving immunosuppression.

Hematopoietic stem cell transplantation: clinical use and perspectives.

Hematopoietic stem cell transplantation is the accepted therapy of choice for a variety of malignant and non-malignant diseases in children and adults. Initially developed as rescue therapy for a patient with cancer after high doses of chemotherapy and radiation as well as the correction of severe deficiencies in the hematopoietic system, it has evolved into an adoptive immune therapy for malignancies and autoimmune disorders. The procedure has helped to obtain key information about the bone marrow environment, the biology of hematopoietic stem cells and histocompatibility. The development of this new discipline has allowed numerous groups working around the world to cure patients of diseases previously considered lethal. Together with the ever growing list of volunteer donors and umbilical cord blood banks, this has resulted in life saving therapy for thousands of patients yearly. We present an overview of the procedure from its cradle to the most novel applications, as well as the results of the HSC transplant program developed at our institution since 1989.