Disease activity assessment for juvenile idiopathic arthritis in transitional care.

OBJECTIVE: The indices to measure disease activity of chronic arthritis in adulthood and childhood are different. Therefore, assessing the status of the disease in young patients with juvenile idiopathic arthritis (JIA) can be tricky, especially when the transition to adult care is ongoing. The aim of our study was to assess the level of correlation between adult and juvenile scores in the measurement of disease activity in JIA patients during transitional care. METHODS: We estimated the disease activity by using the Juvenile Arthritis Disease Activity Score 71 (JADAS71), clinical JADAS, adult Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in JIA patients in transitional care. We enrolled patients older than 16 years at the time of the first transition visit, and disease activity was assessed at baseline and 12 months. Regression analyses were carried out to estimate the level of agreement among the different indices. RESULTS: We recruited 26 patients with JIA; 11 patients were polyarticular (42.3%) and 15 patients were oligoarticular (53.1%). The mean age at diagnosis was 7.7±3.9 years and the age at the first evaluation was 20.9±3.7 years. The correlation between JADAS71 and DAS28 was r2=0.69, r2=0.86 between JADAS71 and SDAI, and r2=0.81 between JADAS71 and CDAI. CONCLUSIONS: SDAI and JADAS71 showed the best correlation, but a few patients were not captured at the same level of disease activity. New prospective studies with a larger number of patients will be needed in this field.

Bishop Flap and Sigma Flap to Repair Surgical Defects in High-Tension Anatomical Regions. / Colgajo obispo y colgajo sigma para defectos quirúrgicos en zonas anatómicas de elevada tensión.

BACKGROUND: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion. RESULTS: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis. CONCLUSIONS: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid.

Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales / Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

[Translated article] Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face / Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face. / Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales.

BACKGROUND: Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. PATIENTS AND METHODS: Retrospective study of the use of 2 novel flap designs-the nautilus flap and the bullfighter crutch flap-to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects. RESULTS: Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. CONCLUSIONS: The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas.

[Translated article] Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face.

BACKGROUND: Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. PATIENTS AND METHODS: Retrospective study of the use of 2 novel flap designs-the nautilus flap and the bullfighter crutch flap-to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects. RESULTS: Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. CONCLUSIONS: The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas.

Does acclimation in distinct light conditions determine differences in the photosynthetic heat tolerance of coffee plants?

Worldwide coffee production is threatened by climate change, which highlights the importance of heat tolerance studies. Here we tested the hypothesis that photosynthetic heat tolerance in coffee varieties changes according to acclimation to distinct light conditions. Furthermore, we tested if heat tolerance is associated with the habitat of origin of the coffee species. We evaluated heat tolerance using chlorophyll fluorescence in varieties of Coffea arabica (Mundo Novo and Catuai Amarelo) and C. canephora (Conilon) grown in a common garden under two conditions: high (HS) and low (LS) sunlight. Leaf traits associated with leaf cooling were evaluated in plants grown in LS and HS and associations of heat tolerance with these traits were determined. The varieties tested had high photosynthetic heat tolerance, with temperatures above 54 °C leading to a 50% reduction in Fv /Fm (T50 ). The heat tolerance of each Coffea variety was unaffected by growth in distinct light conditions. Leaves of plants grown in LS were larger and had a lower fraction of the leaf area occupied by stomata (nast ). Heat tolerance was positively associated with leaf size and negatively with nast . C. canephora exhibited higher heat tolerance than C. arabica. The limited plasticity of heat tolerance in response to acclimation under distinct light conditions contradicts the prediction that plants acclimated to HS would have higher photosynthetic heat tolerance than those acclimated to LS. Our results on heat tolerance among Coffea species/varieties in HS and LS indicate the possibility of selection of varieties for better acclimation to ongoing climate changes.

Diaspore dispersal season influences root growth and seed traits, but not germination responses, of sympatric Piper species in a seasonal forest.

Seeds may differ in terms of dormancy, longevity, sensitivity to desiccation and dry mass, according to the timing (dry season/rainy season) of diaspore dispersal. In addition, seasonal variations in temperature and water availability can act as signals of the season during seed development, influencing germination responses and root growth. We evaluated the effects of temperature variations and water availability on germination parameters, root growth and seed traits of four coexisting Piper species in seasonal vegetation that differed in diaspore dispersal timing. Eight temperature treatments (15, 20, 23, 25, 28, 30, 35 °C, and alternate 30 °C-20 °C) and four induced water potentials (0, -0.3, -0.6 and -1.2 MPa) were used. The parameters germination onset, germination percentage (G%), mean germination time (MGT), root elongation, seed longevity during ex situ storage and dry mass of seeds were evaluated. Germination responses observed were independent of the diaspore dispersal timing, such as variations in germination onset, G% and MGT, both in temperature and water availability treatments. In contrast, root elongation, longevity and dry mass of seeds varied according to the time of diaspore dispersal. Our results corroborate the hypothesis that the timing of diaspore dispersal is an important factor in controlling the initial development of seedlings in seasonal vegetation, but not in germination responses. The predominance of negative effects of temperature increases and water deficit on root growth shows that the initial stages of plant development can be strongly impacted by these environmental factors.

Análisis de las interacciones farmacológicas y recomendaciones terapéuticas asociadas a la utilización de isavuconazol / Analysis of drug interactions and therapeutic recommendations associated with the use of isavuconazole

Objetivos: Identificar, describir las interacciones farmacológicas potenciales de isavuconazol, estudiar el impacto clínico de aquellas más relevantes y establecer recomendaciones terapéuticas para las encontradas en pacientes ingresados.Métodos: Estudio observacional descriptivo retrospectivo que incluyó todos los pacientes tratados con isavuconazol desde su comercialización hasta diciembre 2019.Se recogieron variables demográficas y fármacos concomitantes a isavuconazol durante más de 48 horas que recibió el paciente. Se revisaron los tratamientos con Lexicomp® para detectar interacciones potenciales, se analizó su mecanismo de acción y se relacionó con los fármacos implicados, estableciéndose recomendaciones terapéuticas.Para establecer el impacto clínico, se revisaron las historias clínicas de los pacientes con interacciones de mayor gravedad (D y X de Lexicomp®). En el caso de hallar alguna reacción adversa, se aplicó el algoritmo de Horn para establecer la probabilidad de que el efecto esté producido por la interacción farmacológica.Resultados: Se analizaron 84 ingresos en 59 pacientes. Se produjeron 209 interacciones potenciales en el 84,5% de los ingresos. La mayoría, 84,7% fueron de carácter moderado (categoría C), la más frecuente con tacrolimus. El principal mecanismo de acción fue el efecto inhibidor sobre el citocromo CYP3A4 de isavuconazol (82,8%). Se detectó una paciente con aumento de fosfatasa alcalina coincidente con el inicio concomitante de isavuconazol y claritromicina. Al aplicar el algoritmo de Horn, se consideró la interacción como posible.Conclusiones: Se detectaron interacciones farmacológicas potenciales graves en un porcentaje inferior al 10% de los ingresos y solo se detectó una posible reacción adversa asociada a esta interacción, no pudiéndose clasificar como definitiva. (AU)

Objetive: Identify, describe the potential pharmacological interactions of isavuconazole, study the clinical impact of the most relevant ones and establish therapeutic recommendations for those found in hospitalized patients.Methods: Retrospective descriptive observational study that included all patients treated with isavuconazole from its marketing until December 2019.Demographic variables and drugs concomitant to isavuconazole for more than 48 hours received by the patient were collected. The treatments with Lexicomp® were reviewed to detect possible interactions, its mechanism of action was analyzed and it was related to the drugs involved, establishing therapeutic recommendations.To establish the clinical impact, the medical records of the patients with more severe interactions (D and X for Lexicomp®) were reviewed. In the case of finding any adverse reaction, Horn’s algorithm was applied to establish the probability that the effect is produced by the pharmacological interaction.Results: 84 admissions in 59 patients were analyzed. There were 209 potential interactions in 84.5% of the admissions. The majority, 84.7%, were of a moderate nature (category C), the most frequent with tacrolimus. The main mechanism of action was the inhibitory effect on cytochrome CYP3A4 of isavuconazole (82.8%).A patient with an increase in alkaline phosphatase coinciding with the concomitant initiation of isavuconazole and clarithromycin was detected. When applying Horn’s algorithm, the interaction is considered as possible.Conclusions: Potential serious drug interactions were detected in less than 10% of admissions and only one possible adverse reaction associated with this interaction was detected, and it could not be classified as definitive. (AU)

Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?

OBJECTIVE: To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening. METHODS: In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region. RESULTS: All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations. CONCLUSION: RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery. KEY POINTS: • Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants. • Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life. • Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.

Efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico / Effectiveness and safety of ramucirumab in the treatment of gastric adenocarcinoma

Objetivos: Evaluar la efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico metastático (AGM) o adenocarcinoma de la unión gastroesofágica metastático (AUGEM) en un hospital de clase 5. Métodos: Estudio observacional retrospectivo en el que se incluyeron a todos los pacientes tratados con ramucirumab en el hospital. Se realizó un seguimiento a través de la historia clínica electrónica (HCE) de la que se recogieron edad, sexo, diagnóstico, estado funcional según ECOG y líneas previas de tratamiento. Como variables de efectividad se calcularon la supervivencia libre de progresión (SLP) y supervivencia global (SG). Como variables de seguridad se analizaron los efectos adversos recogidos en la HCE y se categorizaron por gravedad según CTCAE (v.5). Resultados: Se analizó un total de 40 pacientes (20% mujeres) con edad media al inicio del tratamiento de 62,5±12,4 años. Al inicio del tratamiento, el 67,5% de los pacientes tenían ECOG 1. El 78% de los tratamientos con ramucirumab fueron en segunda línea y el 22% en tercera. Respecto a la primera línea, el 100% de los esquemas estaban basados en platino y fluoropirimidinas.EL 90,1% de los pacientes fueron tratados con la combinación de paclitaxel 80 mg/m2 más ramucirumab 8 mg/kg; el resto se trató en monoterapia. Los pacientes recibieron de media 5,1±4,1 ciclos. La SLP fue de 4 (3,1-8,9) meses y la SG fue de 5,8 (4,6-13) meses.En cuanto a la seguridad, el 75,6% de los pacientes (n=31) presentó algún efecto adverso. El efecto adverso más observado fue astenia en el 48,8% de los pacientes (n=20). También se observó: hipertensión (17,1%), rash cutáneo (12,2%), alopecia (12,2%), neutropenia (9,7%), mucositis (9,7%) y náuseas (9,7%). Conclusiones: La SLP fue similar en este estudio a la obtenida en el ensayo clínico pivotal RAINBOW, aunque el valor de la SG obtenida fue de casi la mitad. La seguridad fue similar a la observada en el ensayo clínico mencionado. (AU)

Objetive: To assess the effectiveness and safety of ramucirumab in the treatment of metastatic gastric adenocarcinoma (MGA) or metastatic gastroesophageal junction adenocarcinoma (MGJA) in a class 5 hospital.Methods: Retrospective observational study in which all patients treated with ramucirumab in the hospital were included.A follow-up was carried out through the electronic medical history (HCE) from which age, sex, diagnosis, functional status according to ECOG and previous treatment lines were collected. As effectiveness variables, progression-free survival (PFS) and overall survival (OS) were calculated. As safety variables, the adverse effects recorded in the HCE were analyzed and categorized by severity according to CTCAE (v.5).Results: A total of 40 patients (20% women) with a mean age at the start of treatment of 62.5±12.4 years were analyzed. At the beginning of treatment, 67,5% of patients had ECOG 1.78% of the treatments with ramucirumab were in the second line and 22% in the third. Regarding the first line, 100% of the schemes were based on platinum and fluoropyrimidines.90.1% of the patients were treated with the combination of paclitaxel 80 mg/m2 plus ramucirumab 8 mg/kg; The rest was treated in monotherapy. Patients received on average 5.1±4.1 cycles. The PFS was 4 (3.1-8.9) months and the OS was 5.8 (4.6-13) months.Regarding safety, 75.6% of the patients (n=31) presented some adverse effect. The most observed adverse effect was asthenia in 48.8% of the patients (n=20). It was also observed: hypertension (17.1%), skin rash (12.2%), alopecia (12.2%), neutropenia (9.7%), mucositis (9.7%) and nausea (9.7%).Conclusions: The PFS was similar in this study to that obtained in the pivotal clinical trial RAINBOW, although the value of the OS obtained was almost half. Safety was similar to that observed in the clinical trial. (AU)