Gastric GDF15 levels are regulated by age, sex, and nutritional status in rodents and humans.

AIM: Growth differentiation factor 15 (GDF15) is a stress response cytokine that has been proposed as a relevant metabolic hormone. Descriptive studies have shown that plasma GDF15 levels are regulated by short term changes in nutritional status, such as fasting, or in obesity. However, few data exist regarding how GDF15 levels are regulated in peripheral tissues. The aim of the present work was to study the variations on gastric levels of GDF15 and its precursor under different physiological conditions, such as short-term changes in nutritional status or overfeeding achieved by HFD. Moreover, we also address the sex- and age-dependent alterations in GDF15 physiology. METHODS: The levels of gastric and plasma GDF15 and its precursor were measured in lean and obese mice, rats and humans by western blot, RT-PCR, ELISA, immunohistochemistry and by an in vitro organ culture system. RESULTS: Our results show a robust regulation of gastric GDF15 production by fasting in rodents. In obesity an increase in GDF15 secretion from the stomach is reflected with an increase in circulating levels of GDF15 in rats and humans. Moreover, gastric GDF15 levels increase with age in both rats and humans. Finally, gastric GDF15 levels display sexual dimorphism, which could explain the difference in circulating GFD15 levels between males and females, observed in both humans and rodents. CONCLUSIONS: Our results provide clear evidence that gastric GDF15 is a critical contributor of circulating GDF15 levels and can explain some of the metabolic effects induced by GDF15.

The Chilean socio-ethno-genomic cline.

Studies of the current Chilean population performed using classical genetic markers have established that the Chilean population originated primarily from the admixture of European people, particularly Spaniards, and Amerindians. A socioeconomic-ethno-genetic cline was established soon after the conquest. Spaniards born in Spain or Chile occupied the highest Socioeconomic Strata, while Amerindians belonged to the lowest. The intermediate strata consisted of people with different degrees of ethnic admixture; the larger the European admixture, the higher the Socioeconomic Level. The present study of molecular genomic markers sought to calculate the percentage of Amerindian admixture and revealed a finer distribution of this cline, as well as differences between two Amerindian groups: Aymara and Mapuche. The use of two socioeconomic classifications - Class and Socioeconomic Level - reveals important differences. Furthermore, Self-reported Ethnicity (self-assignment to an ethnic group) and Self-reported Ancestry (self-recognition of Amerindian ancestors) show variations and differing relationships between socioeconomic classifications and genomic Amerindian Admixture. These data constitute a valuable input for the formulation of public healthcare policy and show that the notions of Ethnicity, Socioeconomic Strata and Class should always be a consideration in policy development.

Trends of maxillofacial trauma: An update from the prospective register of a multicenter study in emergency services of Chile.

BACKGROUND: Determine the behavior of the maxillofacial trauma of adults treated in 3 tertiary care centers in the central zone of Chile. MATERIAL AND METHODS: descriptive, cross-sectional, multicenter study, based on the prospective records of maxillofacial trauma cases attended between May 2016 and April 2017 by dental and maxillofacial clinical teams of Adult Emergency Units of hospitals Dr. Sótero del Río (metropolitan region), Carlos Van Buren and Dr. Gustavo Fricke (region V). Age, sex, date of occurrence, type of trauma according to ICD-10, etiology, legal medical prognosis and associated injuries were recorded, stratifying by sex and age. Chi square and unpaired Wilcoxon tests were used to compare by groups. RESULTS: 2.485 cases and 3.285 injuries were investigated. The male: female ratio was 1.7: 1 with age under 30 predominant, followed by older adults. Variability was observed in the yearly, weekly and daily presentation. The highest frequencies were in January and September, weekends and at night. The main etiologies were violence (42.3%), falls (13.1%) and road traffic crashes (12.9%) with differences by age and sex (p <0.05). 31,9% of the injuries occurred in hard tissue, being fractures in nasal bones predominant (S02.2). CONCLUSIONS: the profile of the maxillofacial trauma in Chile seems to be mixed by age, affecting young people and the elderly. The male sex predominates; the main cause, which varies by age group, is violence. Their surveillance is possible from hospital emergency records.

Tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal / Surgical treatment of deep pelvic endometriosis with colorectal involvement

INTRODUCCIÓN: En la endometriosis el compromiso intestinal afecta hasta al 12% de las pacientes, comprometiendo al recto y a la unión rectosigmoidea en el 90% de los casos. OBJETIVO: Describir la experiencia del equipo de Coloproctología y Ginecología de Clínica Alemana de Santiago en el tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal. MATERIAL Y MÉTODOS: Estudio retrospectivo a partir de la base de datos de pacientes con endometriosis tratados entre enero del año 2015 y abril de 2018. Los criterios de inclusión fueron pacientes con clínica de endometriosis pélvica profunda, que tuviesen compromiso colorrectal y hayan sido tratados con shaving rectal, resección discoide o resección segmentaria. Se revisaron fichas clínicas electrónicas, protocolos operatorios y biopsias definitivas. RESULTADOS: Se reclutaron 25 pacientes con una mediana de edad de 35 años. El síntoma principal de consulta fue dismenorrea y el síntoma digestivo más frecuente fue disquecia. En 8 pacientes se realizó un shaving rectal, en 7 una sigmoidectomía, en 9 una resección discoide y en 1 paciente una tiflectomía. La complicación posoperatoria reportada fue la hemorragia digestiva baja en 4 pacientes (Clavien-Dindo I y IIIa). Con una mediana de seguimiento de 13 meses, a la fecha 3 pacientes se les ha diagnosticado algún tipo de recidiva. CONCLUSIÓN: Es importante que la cirugía a realizar, garantice una morbilidad y recurrencia baja. Los resultados en nuestro centro son alentadores, lo que nos hace creer que el tratamiento quirúrgico podría ser una buena alternativa en la endometriosis pélvica profunda con compromiso colorrectal.

INTRODUCTION: In endometriosis, intestinal involvement affects up to 12% of patients, compromising the rectum and the rectosigmoid junction in 90% of cases. AIM: Describe the experience of the Coloproctolgy and Gynecology Team of the Clínica Alemana de Santiago in the surgical treatment of deep pelvic endometriosis with colorectal involvement. MATERIAL AND METHODS: Retrospective study based on the database of patients with endometriosis treated between January 2015 and April 2018. The inclusion criteria were patients with deep pelvic endometriosis clinic, who had colorectal involvement and who had been treated with rectal shaving, discoid resection or segmental resection. Electronic clinical records, operative protocols and definitive biopsies were reviewed. RESULTS: Twenty-five patients with a median age of 35 years were recruited. The main symptom of consultation was dysmenorrhoea and the most frequent digestive symptom was dyschezia. In 8 patients a rectal shaving was performed, in 7 a sigmoidectomy, in 9 a discoid resection and in 1 patient a tiflectomy. The only reported post-operative complication was low gastrointestinal bleeding in 4 of the 25 patients (Clavien-Dindo I and IIIa). A median follow-up of 13 months was achieved, to date 3 patients have been diagnosed with some type of recurrence. CONCLUSION: It is important that the surgery to be performed guarantees low morbidity and recurrence. The results in our center are encouraging, which makes us believe that surgical treatment could be a good alternative in deep pelvic endometriosis with colorectal involvement.

Respuesta del tumor primario a la quimioterapia en cáncer colorrectal etapa IV con metástasis hepáticas sincrónicas: serie de casos / Response of the primary tumor to chemotherapy in stage IV colorectal cancer with synchronous liver metastases: serie of cases

Resumen Introducción: El cáncer colorrectal se ha convertido en el tercer cáncer a nivel mundial en cuanto a incidencia y cuarto en mortalidad. Al diagnóstico, aproximadamente el 25% de los pacientes tendrán metástasis hepáticas. Con tratamiento adecuado el pronóstico de los pacientes etapa IV alcanza una sobrevida de 40% a 5 años. Con nuestro trabajo queremos evaluar la respuesta del tumor primario de colon desde el punto de vista imagenológico y anatomopatológico en pacientes con cáncer colorrectal con metástasis hepáticas tratados con quimioterapia y que luego fueron a resección del colon. Materiales y Método: Se trata un estudio retrospectivo y descriptivo, de pacientes con cáncer colorrectal con metástasis hepáticas. Los criterios de inclusión fueron que presentaran cáncer de colon o recto superior, con metástasis hepáticas sincrónicas, recibieran al menos 4 ciclos de quimioterapia neoadyuvante y que posteriormente fueran a resección del tumor primario. Resultados: Se reclutaron 9 pacientes, 4 hombres y 5 mujeres. Todos recibieron 4 o más ciclos de quimioterapia previo a la cirugía del tumor primario. De ellos, 8 tuvieron control imagenológico posquimioterapia. Según criterios RECIST, 3 pacientes presentaron respuesta completa, 1 paciente respuesta parcial y 4 enfermedad estable. El estudio anatomopatológico del colon resecado mostró desaparición tumoral macroscópica en 2 pacientes y microscópica en 1 paciente. Conclusiones: La regresión patológica completa en nuestros casos tratados con quimioterapia neoadyuvante es un hecho poco frecuente. Esto nos permite indicar la resección del sitio del tumor colorrectal en todos estos casos.

Introduction: Colorectal cancer has become the third cancer worldwide in terms of incidence and fourth in mortality. At diagnosis approximately 25% of patients will have liver metastases. With adequate treatment, the prognosis of stage IV patients reaches a survival of 40% at 5 years. We want to evaluate the response of the primary tumor of the colon from imaging and anatomopathological point of view in patients with colorectal cancer with liver metastases treated with chemotherapy and who then went to colon resection. Materials and Method: It is a retrospective and descriptive study of patients with stage IV colorectal cancer. The inclusion criteria were that they had cancer of the colon or upper rectum, with synchronous liver metastases, who have received at least 4 cycles of neoadjuvant chemotherapy and that subsequently went to resection of the primary tumor. Results: We recruited 9 patients, 4 men and 5 women. All received 4 or more cycles of chemotherapy prior to primary surgery. Of these, 8 had imaging control after chemotherapy. According to RECIST criteria, 3 patients presented complete response, 1 patient partial response and 4 stable disease. The anatomopathological study of the resected colon showed a macroscopic tumor disappearance in 2 patients, and microscopic in 1 patient. Conclusions: The complete pathological regression in our cases treated with neoadjuvant chemotherapy is a rare occurrence. This allows us to indicate the resection of the colorectal tumor site in all these cases.

Resultados del uso de stent metálico autoexpandible como terapia puente en cáncer de colon izquierdo obstructivo / Results of the use of self-expanding stent as a bridge therapy in obstructive left colon cancer

Resumen Objetivo: Analizar los resultados del uso de stent como terapia puente para cirugía en cáncer de colon izquierdo obstructivo en nuestro centro. Material y Método: Se realizó un análisis retrospectivo de pacientes con cáncer de colon izquierdo obstructivo sometidos a la instalación de stent metálicos como terapia puente para una cirugía definitiva, entre enero de 2008 y diciembre de 2016. Se analizaron datos demográficos, éxito del procedimiento, complicaciones, vía de abordaje quirúrgico, anatomía patológica y seguimiento. Resultados: Se analizaron 10 pacientes. El procedimiento fue técnica y clínicamente exitoso en los 10 pacientes, sin complicaciones. Todos fueron a cirugía resectiva, logrando anastomosis primaria en 9 pacientes. En 3 se realizó un abordaje laparoscópico. Se logró una mediana de linfonodos de 41 en la pieza quirúrgica. Con una mediana de seguimiento de 34 meses, 2 presentan recidiva a distancia siendo pacientes con etapas más avanzadas al diagnóstico de su enfermedad. Discusión: El stent como terapia de puente a una cirugía electiva, permite obtener una baja tasa de colostomías, baja morbilidad, ofrecer cirugía laparoscópica y una óptima cirugía oncológica. Conclusión: El uso del stent como terapia puente en el cáncer de colon izquierdo obstructivo aparece como una buena alternativa para resolver esta patología en pacientes de mayor riesgo quirúrgico.

Objetive: To analyze the results of the use of stent as bridge therapy for surgery in obstructive left colon cancer in our center. Material and Method: We performed a retrospective analysis of patients with obstructive left colon cancer undergoing metallic stenting as a bridge therapy for definitive surgery bet- ween January 2008 and December 2016. Demographic data, procedural success, complications, surgical approach, pathological anatomy and follow-up were analyzed. Results: Ten patients. The procedure was technically and clinically successful in all 10 patients, with no complications in any of them. All patients went to resective surgery, achieving primary anastomosis in 9 of them. In 3 of them, a laparoscopic approach was performed. A median of lymph nodes of 41 it was obtained in the surgical specimen. With a median follow-up of 34 months, 2 presented distant recurrence, which were patients diagnosed at a more advanced stage of their disease. Discussion: The stent as bridge therapy to an elective surgery, allows to obtain a low rate of colostomies, low morbidity, offer a laparoscopic surgery and an optimal cancer surgery. Conclusion: The use of the stent as a bridge therapy in obstructive left colon cancer appears as a good alternative to solve this pathology in patients of greater surgical risk.

Sperm Release From the Oviductal Epithelium Depends on Ca(2+) Influx Upon Activation of CB1 and TRPV1 by Anandamide.

The oviduct acts as a functional sperm reservoir in many mammalian species. Both binding and release of spermatozoa from the oviductal epithelium are mainly modulated by sperm capacitation. Several molecules from oviductal fluid are involved in the regulation of sperm function. Anandamide is a lipid mediator involved in reproductive physiology. Previously, we demonstrated that anandamide, through activation of the cannabinoid receptor type 1 (CB1), promotes sperm release from bovine oviductal epithelial cells, and through CB1 and the transient receptor potential vanilloid 1 (TRPV1), induces sperm capacitation. Herein we investigate co-activation between CB1 and TRPV1, and Ca(2+) influx as part of the mechanism of action of anandamide during sperm release from oviductal cells. Our results indicate that in the absence of Ca(2+) anandamide failed to release spermatozoa from oviductal epithelial cells. Additionally, sperm release promoted by cannabinoid and vanilloid agonists was abolished when the spermatozoa were preloaded with BAPTA-AM, a Ca(2+) chelator. We also determined Ca(2+) levels in spermatozoa preloaded with FURA2-AM co-cultured with oviductal cells and incubated with different cannabinoid and vanilloid agonists. The incubation with different agonists induced Ca(2+) influx, which was abolished by CB1 or TRPV1 antagonists. Our results also suggest that a phospholypase C (PLC) might mediate the activation of CB1 and TRPV1 in sperm release from the bovine oviduct. Therefore, our findings indicate that anandamide, through CB1 and TRPV1 activation, is involved in sperm release from the oviductal reservoir. An increase of sperm Ca(2+) levels and the PLC activation might be involved in anandamide signaling pathway.

Morbilidad global asociada a ileostomías en asa temporales / Morbidity associated to ileostomies

Introduction: The main indications for a loop ileostomy are to protect a distal anastomosis or to management of an anastomotic leak. However, it is a procedure with complications arising from its confection, function or closure. There are sparse local data on this topic. Objective: To describe the global morbidity from loop ileostomies. Method: Patients who underwent a loop ileostomy between January 2009 and January 2012 were retrospectively included. Demographics, indications, complications from the making, function and closure of the ileostomy was recorded. Results: The series consists of 64 patients. The total percentage of complications was 40.3 percent. Complications arising from the confection, function and closure were 4.7 percent, 18.7 percent and 16.9 percent respectively. Two patients were readmitted for dehydration with a total of 4 readmissions. Four patients were reoperated for morbidity of ileostomy closure, two intestinal obstructions, one leak and one enterotomy. Conclusion: In this study, loop ileostomy complications are present in a substantial proportion of patients. It should be take in consideration at the moment of making it.

Introducción: Las principales indicaciones de ileostomías en asa son proteger una anastomosis distal de alto riesgo o el manejo de una complicación séptica derivada de una filtración. Sin embargo, es un procedimiento que no está exento de complicaciones derivadas de la confección, función o cierre. En este contexto, existen escasas publicaciones que incluyen la morbilidad sumatoria. Objetivo: Describir la morbilidad global derivada de las ileostomías en asa. Método: Se incluyó en forma retrospectiva los pacientes a quienes se les practicó una ileostomía en asa de protección de una anastomosis distal entre enero de 2009 y enero de 2012. Se registraron datos demográficos, indicaciones y complicaciones derivadas de la confección, función y cierre de la ostomía. Resultados: La serie consta de 64 pacientes. Un 40,3 por ciento de los pacientes tuvieron una o más complicaciones. Complicaciones derivadas de la confección, función y cierre de la ileostomía fueron 4,7 por ciento, 18,7 por ciento y 16,9 por ciento respectivamente. Se rehospitalizaron por deshidratación 2 pacientes con un total de 4 rehospitalizaciones. Se reoperaron 4 pacientes por morbilidad del cierre de la ileostomía, 2 por obstrucción intestinal, 1 filtración y 1 enterotomía inadvertida. Conclusión: Las ileostomías en asa presentan complicaciones en un importante porcentaje de los pacientes, lo que debe ser tomado en cuenta al decidir su confección.

Population Dynamics of Anastrepha ludens (Loew) (Diptera: Tephritidae) on Citrus Areas in Southern Tamaulipas, Mexico.

An analysis of adult population fluctuation of Anastrepha ludens (Loew) was performed in southern Tamaulipas, Mexico from 2008 to 2011. The aim was to analyze population dynamics of A. ludens and its relationships with climatic factors in the citrus region of Llera, Tamaulipas, Mexico. Population densities were weekly examined to identify variation through the year and study period. Four periods were identified according to population size, amplitude, host availability and season of the year. The correlation between population density vs. rainfall and temperature (average, minimum and maximum) was determined by linear and multiple regression analyses. Simple linear regression analysis showed that population density with minimum temperature and rainfall was the most consistent correlation, whereas in multiple regression analysis, rainfall and maximum temperature showed more consistency. A seasonal association between the availability of commercial host, climatic variation, and population peaks of A. ludens was determined. This study may have practical implications for the design of specific control strategies, monitoring, and infestation prevention based on different phases of the pest through the year. This strategy, along with the area-wide approach implemented by the Plant Protection Service may lead to an optimization of material, financial and human resources.

In vivo postprandial bioavailability of interesterified-lipids in sodium-caseinate or chitosan based O/W emulsions.

Recent studies have shown that it should be possible to control lipid bioavailability through food structural approaches. Nevertheless, the gastrointestinal-tract physiological conditions must also be considered. To get a better understanding of this phenomenon, we evaluated the effect of emulsification, as well as the use of sodium caseinate or chitosan, on the postprandial bioavailability of interesterified-lipids in O/W emulsions after oral gastric feeding Sprague-Dawley rats. We verified that emulsification may increase lipid absorption, as determined after feeding sodium-caseinate emulsions. However, this result could not be generalised. Interesterified-lipids that were emulsified with chitosan were equally absorbed as those contained in non-emulsified interesterified-lipids/distilled-water blends.

The effect of interesterification on the bioavailability of fatty acids in structured lipids.

Fatty acid (FA) profile is a critical factor in the nutritional properties of fats, but, stereochemistry may also play a fundamental role in the rate and extent to which FAs are absorbed and become available. To better understand this phenomenon, we evaluated the bioavailability of FAs in linseed-oil and palm-stearin blends compared to their interesterified mix, using a sn-1,3 stereospecific lipase, to determine if there was any difference in terms of FA availability when using this technology. Test meals were fed through an intragastric feeding tube on Sprague-Dawley male rats after 18 h fasting. Postprandial blood samples were collected after meal or physiological serum (control) administration and the FA profile of plasma lipids was determined. Results showed that modification of the melting profile through interesterification, without altering the bioavailability determined by sn-2 stereochemistry, could delay lipid absorption at the beginning, but had no effect on total lipid absorption.

La Oficina de Farmacia: una herramienta para conocer el grado de adherencia a la dieta mediterránea de la población / No disponible

Objetivos: Evaluar el grado de adherencia a la dieta mediterránea y el IMC de individuos mayores de 40 años a través de las Oficinas de Farmacia y ver la influencia que tienen la edad, status socioeconómico y estado civil sobre el mismo. Métodos: 291 personas (130 hombres y 161 mujeres) distribuidos por intervalo de edad, en tres etapas de transición madura: 40-50 años (inicial), 50-60 años (media) y 60- 70 años (avanzada). Los datos fueron recolectados en unas oficinas de farmacia por medio de tres encuestas: aspectos sociodemograficos, variables antropométricas y valoración de la adherencia. Resultados: De acuerdo al IMC, el 62,4% de las personas encuestadas se clasificaron en situación de sobrepeso y el 37,6% en situación de normopeso. Las personas entre 40-50 años presentaban un valor medio de adherencia al patrón de dieta mediterránea de 7,8 (IC95%:7,7-7,9); los de 50-60 años de 8,3 (IC95%: 8,1-8,5) y los de 60-70 años de 11,4 (IC95%: 11,7-11,1). Conclusiones: No existen diferencias estadísticas significativas entre las condiciones socioeconómicas y estado civil en cuanto al IMC y grado de adherencia al patrón de dieta mediterránea. No sucede lo mismo en cuanto a la edad, entre 40-60 años no alcanzan las recomendaciones de consumo de la mayoría de los alimentos que constituyen la base de la alimentación mediterránea. El mayor grado de adherencia está en la población entre 60-70 años. El farmacéutico mediante unas sencillas encuestas puede detectar estas desviaciones y dar los consejos nutricionales adecuados para restablecer el patrón mediterráneo(AU)

Aim: To assess Mediterranean diet adherence and BMI in people over 40 years of age using a community pharmacy, and the influences of age, socioeconomic status and marital status. Methods: 291 people (130 men and 161 women) distributed in three age group: 40-50 years, 50-60 years and 60-70 years. The data were collected in several community pharmacies through three questionnaires about sociodemographic factors, anthropometric measurements and adherence to Mediterranean diet. Results: According to BMI, 62.4% of people were overweight and 37.6% normal weight. The mean Mediterranean diet adherence levels were 7.8 (95% CI :7,7-7,9) in the 40-50 year range, 8.3 (95% CI : 8,1-8,5) in the 50-60 year range and 11,4 (95% CI : 11,7-11,1) in the 60-70 year range. Conclusions: There are no statistically significant differences between socioeconomic status and marital status regarding BMI or Mediterranean diet adherence. However, this is not the case when the age variable is taken into account, as people in the 40-60 year range do not follow the recommendations of food consumption for the Mediterranean diet. The highest level of adherence is in people aged 60-70 years. Using simple questionnaires community pharmacists could reveal this low adherence and give adequate nutritional advice to reinforce Mediterranean diet adherence(AU)

Artroscopía y artrosis de cadera: dónde están los límite ? / Arthroscopy and hip osteoarthritis: where are the limits ?

La artroscopía de cadera es una técnica quirúrgica con un significativo crecimiento en el campo de la cirugía ortopédica en los últimos diez años. En el caso del pinzamiento femoroacetabular (PFA), con sus consecuentes lesiones labrales y condrales, el tratamiento artroscópico ha demostrado ser una alternativa exitosa, tanto en el alivio sintomático y mejoría funcional, como en la corrección de la alteración morfológica característica de esta patología. Sin embargo, en pacientes que se presentan con avanzado daño articular y artrosis de cadera secundaria al PFA,la artroscopía tiene resultados inferiores. El objetivo de este trabajo es presentar algunas herramientas clínicas e imagenológicas útiles, para distinguir entre los pacientes que son candidatos adecuados para un tratamiento artroscópico del PFA de aquellos que no lo son, debido a la presencia de daño articular avanzado.(AU)

Artroscopía y artrosis de cadera: dónde están los límite ? / Arthroscopy and hip osteoarthritis: where are the limits ?

La artroscopía de cadera es una técnica quirúrgica con un significativo crecimiento en el campo de la cirugía ortopédica en los últimos diez años. En el caso del pinzamiento femoroacetabular (PFA), con sus consecuentes lesiones labrales y condrales, el tratamiento artroscópico ha demostrado ser una alternativa exitosa, tanto en el alivio sintomático y mejoría funcional, como en la corrección de la alteración morfológica característica de esta patología. Sin embargo, en pacientes que se presentan con avanzado daño articular y artrosis de cadera secundaria al PFA,la artroscopía tiene resultados inferiores. El objetivo de este trabajo es presentar algunas herramientas clínicas e imagenológicas útiles, para distinguir entre los pacientes que son candidatos adecuados para un tratamiento artroscópico del PFA de aquellos que no lo son, debido a la presencia de daño articular avanzado.

Characterization of a novel immobilized biocatalyst obtained by matrix-assisted refolding of recombinant polyhydroxyoctanoate depolymerase from Pseudomonas putida KT2442 isolated from inclusion bodies.

Purification and matrix-assisted refolding of recombinant His-tagged polyhydroxyalkanoate (PhaZ) depolymerase from Pseudomonas putida KT2442 was carried out. His-tagged enzyme was overproduced as inclusion bodies in recombinant E. coli M15 (pREP4, pPAZ3), which were denatured by 8 M urea, immobilized on Ni(2+)-nitrilotriacetate-agarose matrix, and refolded by gradual removal of the chaotropic agent. The refolded enzyme could not be eluted with 1 M imidazole buffer, leading to an immobilized biocatalyst where PhaZ depolymerase was homogeneously distributed in the agarose support as shown by confocal scanning microscopy. Polyhydroxyoctanoate could not be hydrolyzed by this novel immobilized biocatalyst, whereas the attached enzyme was active in the hydrolysis of p-nitrophenyl alkanoate esters, which differed in their alkyl chain length. Taking advantage of the observed esterase activity on p-nitrophenylacetate, functional characterization of immobilized PhaZ depolymerase was carried out. The immobilized enzyme was more stable than its soluble counterpart and showed optimal hydrolytic activity at 37°C and 50 mM phosphate buffer pH 8.0. Kinetic parameters were obtained with both p-nitrophenylacetate and p-nitrophenyloctanoate, which had not been described so far for the soluble enzyme, representing an attractive and alternative chromogenic assay for the study of this paradigmatic enzyme.

Tratamiento quirúrgico de fractura de cabeza femoral mediante luxación controlada de cadera: resultados a mediano plazo / Surgical treatment through controlled hip dislocation for femoral head fractures: mid term results

Femoral head fractures associated to hip dislocations are uncommon lesions. Most reports present only short-term results. Objectives: To show functional outcome after a mid term follow up of patients with Pipkin II femoral head fractures treated operatively. Materials and Methods: A retrospective and descriptive evaluation of a 4 consecutive case series (four men, mean age of 36.5 years) treated operatively with an 89-month average follow up (range form 72-108 month). Controlled femoral head dislocation was performed in all patients and two 2.4 mm screws were used for fixation. At final follow up, the Harris Hip Score (HHS) and complications were assessed. Results: No immediate or late complications were reported. The mean HHS was of 95 points (range from 89 to 100 points).No signs of postraumatic arthritis or femoral head osteonecrosis were seen at the last radiographic assessment. Conclusion: in this series of patients with Pipkin II femoral head fractures mid-term functional results are good and no postraumatic arthritis or femoral head osteonecrosis were observed at final follow-up.

Las fracturas de cabeza femoral, asociada a luxación de cadera, corresponden a lesiones infrecuentes. La mayoría de los estudios reportan resultados a corto plazo. Objetivo: Describir el resultado funcional de pacientes con fractura Pipkin II operados con seguimiento a mediano plazo. Material y Métodos: Evaluación retrospectiva y descriptiva de una serie consecutiva de 4 pacientes (cuatro hombres, mediana de edad 36,5 años) operados con un seguimiento de mediana de 89 meses (72-108 meses). En todos los casos se realizó luxación controlada de la cabeza femoral y se utilizaron 2 tornillos de 2,4 mm. Se evaluaron complicaciones y Harris Hip Score (HHS) al último control clínico. Resultados: No se presentaron complicaciones tempranas ni tardías. El HHS promedio fue de 95 puntos (89-100 puntos). La última evaluación radiográfica no demostró signos de artrosis postraumática ni signos de necrosis avascular de cabeza femoral. Conclusión: En este grupo de pacientes con fractura de Pipkin tipo II los resultados funcionales a mediano plazo son buenos, no registrándose en el seguimiento artrosis de cadera postraumática ni necrosis avascular de la cabeza femoral.

Cirugía de revisión acetabular utilizando un cotilo modular con superficie de metal trabecular de tantalio: resultados a corto plazo / Acetabular revision surgery using a modular acetabular cup coated with trabecular metal of tantalum: short term results

Objectives: To evaluate short-term clinical results of patients performed acetabular revision surgery using a Trabecular Tantalum coated modular acetabular cups. Materials and Methods: This is a retrospective and descriptive analysis of a serie of 32 consecutive patients (34 hips) with acetabular revision surgery (23 women, 9 men, mean age 70.7 years), mean follow-up 32 month (12-60). The Paprosky and the AAOS acetabular defects classifications were assessed. According to Paprosky acetabular defects classification, there were eleven type I, two IIA, three IIB, nine IIC, seven IIIA and two IIIB. According to AAOS acetabular defects classification there were thirteen patients with type 1, nine patients with type 2, ten type 3 and two type 4. The percentage of own acetabular bone in contact with the new cup was recorded for each patient at the time of surgery and was 45 percent (range from 20 to 80 percent), with 23 patients presenting less than 50 percent of bone contact (mean 35 percent). Postoperatively, osseous integration was radiographically assessed. Functional results were evaluated according to the Harris Hip Score (HSS). The complications related to the implant were also recorded. Results: In all radiographic assessments performed at 3, 6 and 12 month postoperatively an integrated cup without signs of migration or osteolysis was observed. Four patients (11.8 percent) presented recurrent hip dislocation that required a revision surgery without further cup revision. The final clinical assessment was performed at a mean of 26 month after surgery (12-60) with a mean HHS of 91.8 points. Conclusion: Trabecular tantalum coated modular acetabular cups in acetabular revision surgery shows good short term clinical results even with acetabular defects greater than 50 percent. No cup loosening was observed in these series.

Objetivo: Evaluar los resultados clínicos a corto plazo de pacientes sometidos a cirugía de revisión acetabular utilizando cotilos modulares con superficie de metal trabecular de tantalio. Material y Métodos: Estudio retrospectivo-descriptivo de una serie consecutiva de 32 pacientes (34 caderas) sometidos a cirugía de revisión acetabular (23 mujeres, 9 hombres, edad promedio 70,7 años), seguimiento promedio 32 meses (12-60). Se clasifican los defectos acetabulares de acuerdo ala clasificación de Paprosky y de la AAOS. Según la clasificación de Paprosky de los defectos acetabulares, 11 pacientes tenían categoría I, 2 categoría IIA, 3 categoría IIB, 9 categoría IIC, 7 categoría IIIA y 2 categoría IIIB. Según la clasificación de la AAOS, 13 pacientes correspondieron a nivel 1, 9 pacientes a nivel 2, 10 a nivel 3 y 2 a nivel 4. Se registra el porcentaje de hueso propio acetabular en contacto con el nuevo cotilo de cada paciente que fue en promedio 45 por ciento (20-80 por ciento), presentándose en 23 caderas un porcentaje < 50 por ciento, el cual fue en promedio 35 por ciento. En el postoperatorio se evalúa la integración ósea mediante radiografías de pelvis. Se evalúan los resultados funcionales mediante el HHS (Harris Hip Score) y las complicaciones postoperatorias relacionadas con el implante. Resultados: En todas las radiografías postoperatorias realizadas a los 3, 6 y 12 meses se evidenciaba el cotilo integrado, sin signos de migración ni osteolisis. Cuatro pacientes (11,8 por ciento) presentaron luxaciones recidivantes de cadera, las cuales requirieron de una cirugía de revisión sin recambio del cotilo. La última evaluación clínica fue en promedio 26 meses tras la cirugía (12-60 meses) constatándose un HHS promedio de 91,8 puntos. Conclusión: El uso de cotilos modulares con revestimiento de metal trabecular de tantalio en cirugías de revisión acetabular presenta buenos resultados clínicos a corto plazo incluso en defectos óseos acetabulares superiores...

Detección de lesiones premalignas y malignas en población de la isla Robinson Crusoe, archipiélago Juan Fernández / Malignant and premalignant lesions in Juan Fernández Archipelago

Numerosos estudios demuestran que el cáncer de piel ha aumentado su incidencia en las últimas décadas a nivel nacional. El Archipiélago Juan Fernández, se encuentra a 674 km. del continente. Se estudió el 44,5 por ciento de sus habitantes (334 personas), no encontrándose lesiones malignas, pero con una tasa de incidencia de lesiones premalignas de 7,5 por ciento, destacando un alto porcentaje de hombres (68 por ciento) de edad avanzada (84 por ciento) y de actividad laboral pescadores (82,3 por ciento). Se concluye que existe una tasa importante de lesiones premalignas correlacionadas con los principales factores de riesgo para desarrollar un cáncer de piel.

Several studies show that skin cancer has increased its incidence en recent decades at national level. Juan Fernández Archipielago, is 674 km from the continent. 44,5 percent of the inhabitants (334 people) were studied and no malignant lesions were found, but a 7,5 percent incidence rate of premalignant lesions was observed showing a higher percentage of males (84 percent) and fishermen (82,3 percent). It is concluded that there is a significant rate of premalignant lesions correlated with the principal risk factors to develop skin cancer.

Rol de la cirugía artroscópica en pacientes mayores de 50 años con artrosis de rodilla / Treatment of knee osteoarthritis in patients older than 50 years old: role of arthroscopic surgery

Objective: To describe the functional outcomes in patients with knee osteoarthritis older than 50 years, treated with arthroscopic surgery. Methods: Retrospective study in 100 patients with knee osteoarthritis who underwent knee arthroscopy. Inclusion criteria: 50 years or more, knee osteoarthritis and Ahlbãck classification I-III. Exclusion criteria: Ahlbãck IV, deformities, joint inflammatory disease. There were 50 males and 50 females with an average age of 60.1 years (50-83). Lysholm and IKDC (International Knee Documentation Committee) postoperative scores were performed in all the cases. Associated lesions and procedures were also registered. Statistical analysis was performed by using a T Test for independent samples. Results: Average follow up 35.9 +/- 15.2 months. Postoperative average scores were: Lysholm 86.9 +/- 15.5 and IKDC 79.4 +/- 24.7 points. Associated lesions: chondral injuries: 48 percent condrales and meniscal tears:36 percent. Patients with meniscal lesions had 70 percent of good and excellent Lysholm results versus 84.6 percent of patients with chondral lesions (p = 0.035). Conclusion: Patients with knee arthroscopic surgery for mild to moderate knee osteoarthritis and associated lesions show good and excellent functional results in a mediumto long term follow up.

Objetivo: Describir resultados clínicos en pacientes mayores de 50 años con artrosis de rodilla tratados con artroscopía, evaluando lesiones asociadas y tratamiento. Métodos: Estudio retrospectivo de una serie consecutiva de 100 pacientes sometidos a una artroscopía de rodilla por diagnóstico de artrosis. Los criterios de inclusión fueron: pacientes > 50 años, diagnóstico clínico e imagenológico de artrosis y clasificación Ahlbãck I-III. Los criterios de exclusión fueron: Ahlbãck IV, mal alineamiento de extremidades inferiores y enfermedades inflamatorias articulares. Fueron 50 hombres y 50 mujeres, con edad promedio 60,1 años (50-83). Evaluamos con puntajes Lysholm e International Knee Documentation Committee (IKDC) postoperatorios. Documentamos lesiones asociadas encontradas y procedimientos realizados. Se utilizó T Test para muestras independientes. Resultados: Seguimiento promedio de 35,9 +/- 15,2 meses. Puntajes postoperatorios promedio: Lysholm 86,9 +/- 15,5 e IKDC 79,4 +/- 24,7 puntos. Las lesiones asociadas más frecuentes fueron: condrales (48 por ciento) y meniscales (36 por ciento) inestables. El 70 por ciento de los casos con lesiones meniscales refirieron buenos y excelentes resultados según Lysholm versus 84,6 por ciento de casos con lesiones condrales inestables (p = 0,035). Conclusión: Pacientes con artrosis asociada a lesiones condrales o meniscales refirieron buenos y excelentes resultados al seguimiento clínico a mediano-largo plazo luego de ser sometidos a un aseo artroscópico y estabilización de lesiones tanto meniscales como condrales.

Tratamiento quirúrgico de fracturas transversas más pared posterior de acetábulo / Surgical treatment of transverse and posterior acetabular wall fractures

Objective: Describe our experience in the surgical treatment of transverse with posterior wall fractures of the acetabulum, the elements that help in the choice of the approach and functional and radiological results of this type of injury. Methods: We retrospectively evaluated 9 patients (9 fractures) with transverse and posterior wall fractures operated between August 2008 and September 2010. Six patients were men and 3 women with an average age of 40.4 years. We reviewed the surgical protocols, the perioperative data and the pre and post operative radiological images. We registered the complications and the functional results with the Merle D’Aubigne and Postel score. Results: All cases were considered secondary to high energy mechanisms. Five patients had posterior dislocation of the hip and 4 had central dislocation. Eight patients had associated injuries. In the early postoperative period there were no complications. One patient had posttraumatic osteoarthritis and required total hip arthroplasty. The average of Merle d’Aubigne score was 16.1 points. Conclusion: Surgical treatment for this type of injury had good results in this group of patients.

Objetivo: Describir nuestra experiencia en el tratamiento quirúrgico de las fracturas transversas más pared posterior de acetábulo, los elementos que ayudan en la elección del abordaje y los resultados funcionales y radiológicos de este tipo de lesiones. Material y Métodos: Estudio retrospectivo y descriptivo de una serie consecutiva de 9 pacientes (9 fracturas) operados de una fractura transversa más pared posterior de acetábulo entre agosto de 2008 y septiembre de 2010. Seis hombres y 3 mujeres con una mediana de edad de 40,4 años se operaron en este período. Se revisaron los protocolos operatorios, las fi chas clínicas y las imágenes pre y postoperatorias. Se evaluaron las complicaciones tempranas y tardías y los resultados funcionales de acuerdo a la escala de Merle D’Aubigne y Postel a un seguimiento promedio de 17 meses. Resultados: Todos los casos se consideraron secundarios a mecanismos de alta energía. Cinco pacientes presentaron luxación posterior de cadera y 4 presentaron luxación central. Ocho pacientes presentaron lesiones asociadas. En el postoperatorio temprano no se presentaron complicaciones. Un paciente presentó artrosis post traumática y requirió artroplastía total de cadera. El puntaje promedio de Merle d’Aubigne fue de 16,1 puntos. Conclusión: El tratamiento quirúrgico para este tipo de lesiones tiene buenos resultados en el corto plazo en este grupo de pacientes.