Phenogenetic profile and agronomic contribution of Azospirillum argentinense Az39T, a reference strain for the South American inoculant industry.

Azospirillum sp. is a plant growth-promoting rhizobacteria largely recognized for its potential to increase the yield of different important crops. In this work, we present a thorough genomic and phenotypic analysis of A. argentinense Az39T to provide new insights into the beneficial mechanisms of this microorganism. Phenotypic analyses revealed the following in vitro abilities: growth at 20-38 °C (optimum, 28 °C), pH 6.0-8.0 (optimum, pH 6.8), and in the presence of 1% (w/v) NaCl; production of variable amounts of PHB as intracellular granules; nitrogen fixation under microaerophilic conditions; IAA synthesis in the presence of L-tryptophan. Through biochemical (API 20NE) and carbon utilization profiling (Biolog) assays, we proved that A. argentinense Az39T is able to use 15 substrates and metabolize 19 different carbon substrates. Lipid composition indicated a predominance of medium and long-chain saturated fatty acids. A total of 6 replicons classified as one main chromosome, three chromids, and two plasmids, according to their tRNA and core essential genes contents, were identified. Az39T genome includes genes associated with multiple plant growth-promoting (PGP) traits such as nitrogen fixation and production of auxins, cytokinin, abscisic acid, ethylene, and polyamines. In addition, Az39T genome harbor genetic elements associated with physiological features that facilitate its survival in the soil and competence for rhizospheric colonization; this includes motility, secretion system, and quorum sensing genetic determinants. A metadata analysis of Az39T agronomic performance in the pampas region, Argentina, demonstrated significant grain yield increases in wheat and maize, proving its potential to provide better growth conditions for dryland cereals. In conclusion, our data provide a detailed insight into the metabolic profile of A. argentinense Az39T, the strain most widely used to formulate non-legume inoculants in Argentina, and allow a better understanding of the mechanisms behind its field performance.

SISTEMA DE GESTIÓN PARA LA INFORMACIÓN DE LOS CANALES ENDÉMICOS

Introducción: los departamentos de Vigilancia Epidemiológica y Análisis en Cuba se encargan de analizar la evolución y tendencias de los brotes o epidemias que inciden en una población. Para detectar la aparición se utilizan métodos y herramientas estadísticos que ayudan a la toma de decisiones; sin embargo, existen limitaciones en el manejo de la información para obtener los pronósticos. Objetivo: describir un sistema de gestión para la información de canales endémicos con la aplicación de herramientas Web para el manejo de información estadística de pronósticos. Métodos: el universo de estudio, está conformado por los 10 especialistas del departamento de Vigilancia Epidemiológica y Análisis de Sancti Spíritus. Se utilizó la observación, la entrevista y la encuesta para obtener información de los profesionales dedicados a esta actividad. El método de Bortman se utilizó para el cálculo de los canales endémicos, el método sistémico en la determinación de las herramientas para el desarrollo del software, la metodología XP en la modelación, definición de las etapas de desarrollo del sistema de gestión y la Norma ISO/IEC 9126 para evaluar la calidad. Resultados: desarrollo de un sistema de gestión para la información de canales endémicos con la aplicación de herramientas Web. Conclusión: se describió el desarrollo de un sistema de gestión como una solución adecuada para mejorar el proceso de elaboración de los canales endémicos. Lo que repercute en un mejor control de enfermedades y la toma de decisiones ante la aparición de posibles epidemias.[AU]

Paving the way towards an effective treatment for multiple sclerosis: advances in cell therapy.

Multiple sclerosis (MS) is a leading cause of chronic neurological disability in young to middle-aged adults, affecting ~2.5 million people worldwide. Currently, most therapeutics for MS are systemic immunosuppressive or immunomodulatory drugs, but these drugs are unable to halt or reverse the disease and have the potential to cause serious adverse events. Hence, there is an urgent need for the development of next-generation treatments that, alone or in combination, stop the undesired autoimmune response and contribute to the restoration of homeostasis. This review analyzes current MS treatments as well as different cell-based therapies that have been proposed to restore homeostasis in MS patients (tolerogenic dendritic cells, regulatory T cells, mesenchymal stem cells, and vaccination with T cells). Data collected from preclinical studies performed in the experimental autoimmune encephalomyelitis (EAE) model of MS in animals, in vitro cultures of cells from MS patients and the initial results of phase I/II clinical trials are analyzed to better understand which parameters are relevant for obtaining an efficient cell-based therapy for MS.

Utilidad de la ecografía diafragmática para predecir el éxito en la extubación / Usefulness of diaphragmatic ultrasound in predicting extubation success

Objetivo Evaluar la exactitud diagnóstica de la ecografía diafragmática para predecir el éxito en la extubación. Diseño Estudio de exactitud diagnóstica. Ámbito Unidad de Cuidado Intensivo Médico de un hospital académico de la ciudad de Bogotá (Colombia). Pacientes o participantes Muestra consecutiva de pacientes mayores de 18 años con ventilación mecánica invasiva durante más de 48h. Intervenciones Evaluación ecográfica diafragmática al finalizar la prueba de ventilación espontánea. Variables de interés principales Se evaluó la excursión diafragmática (ED, cm), el tiempo de inspiración (TPIAdia, s), la velocidad de contracción del diafragma (ED/TPIAdia, cm/s), el tiempo total (Ttot, s) y la fracción de engrosamiento (TFdi, %). Resultados Se incluyeron 84 pacientes, el 79,8% (n=67) con extubación exitosa y el 20,2% (n=17) con extubación fallida. La variable con mejor capacidad discriminatoria para predecir éxito en la extubación fue la velocidad de contracción, con un AUC-ROC de 0,70 (p=0,008). Conclusiones La velocidad de contracción diafragmática mostró una capacidad discriminatoria aceptable. La ultrasonografía podría formar parte de un abordaje multifactorial en el proceso de extubación. (AU)

Objective To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. Design A diagnostic accuracy study was carried out. Scope Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). Patients or participants A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. Interventions Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. Main variables of interest Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). Results A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). Conclusions Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process. (AU)

[Usefulness of diaphragmatic ultrasound in predicting extubation success]. / Utilidad de la ecografía diafragmática para predecir el éxito en la extubación.

OBJECTIVE: To evaluate the diagnostic accuracy of diaphragmatic ultrasound in predicting extubation success. DESIGN: A diagnostic accuracy study was carried out. SCOPE: Intensive Care Unit of an Academic hospital in the city of Bogotá (Colombia). PATIENTS OR PARTICIPANTS: A consecutive sample of patients >18 years of age subjected to invasive mechanical ventilation for >48h. INTERVENTIONS: Diaphragmatic ultrasound evaluation at the end of spontaneous ventilation testing. MAIN VARIABLES OF INTEREST: Diaphragmatic excursion (DE, cm), inspiration time (TPIAdia, s), diaphragm contraction speed (DE/TPIAdia, cm/s) and total time (Ttot, s) were evaluated, together with thickening fraction (TFdi, %). RESULTS: A total of 84 patients were included, 79.8% (n=67) with successful extubation and 20.2% (n=17) with failed extubation. The variable with the best discriminatory capacity in predicting extubation success was diaphragm contraction speed, with AUC-ROC 0.70 (p=0.008). CONCLUSIONS: Diaphragm contraction speed exhibited acceptable discriminatory capacity. Ultrasound could be part of a multifactorial approach in the extubation process.

Comprehensive flow cytometric reference intervals of leukocyte subsets from six study centers across Europe.

A group of European FOCIS Centers of Excellence adapted panels of the Human Immunophenotyping Consortium (HIPC) for whole blood analysis. Using four core panels [T/regulatory T cell/B/natural killer (T/Treg /B/NK) and myeloid cells] the main leukocyte populations were analyzed in a clinical-diagnostic setting in a harmonized manner across different platforms. As a first step, the consortium presents here the absolute and relative frequencies of the leukocyte subpopulations in the peripheral blood of more than 300 healthy volunteers across six different European centers.

Egocentric and allocentric spatial memory in healthy aging: performance on real-world tasks.

Although normal aging has been related to several cognitive difficulties, other processes have been studied less, such as spatial memory. Our aim was to compare egocentric and allocentric memory in an elderly population using ecological tasks. Twenty-eight cognitively unimpaired participants performed Egocentric and Allocentric Spatial Memory Tasks, as well as Spatial Span from CANTAB, Benton's Judge of Line Orientation test (JoLO), and Montreal Cognitive Assessment test (MoCA). The results revealed that younger participants showed better performance than older participants on both the Egocentric and Allocentric Spatial Memory Tasks, although only the Egocentric test was able to discriminate between younger, middle, and older elderly participants. Learning effect was found in Allocentric Spatial Memory Task in younger and older groups, but not in the middle group. Allocentric and egocentric performance was not related to other visuospatial neuropsychological scores and gender did not influence performance in any task. Egocentric and Allocentric Spatial Memory Tasks may be useful tools in early screening for cognitive decline, as they are able to detect age differences in the cognitive unimpaired elderly population.

Usefulness and correlation with clinical response of serum ustekinumab levels measured at 6 weeks versus 12 weeks.

BACKGROUND: Monitoring serum drug levels has been proposed as a useful tool for improving and personalizing the management of psoriasis. However, in the case of ustekinumab the usefulness of such monitoring was not demonstrated when drug levels were measured at week 12. OBJECTIVES: To evaluate the correlation of serum ustekinumab levels measured at weeks 6 and 12 with clinical response. METHODS: In a prospective cohort study, we enrolled patients with psoriasis treated with ustekinumab 45 mg every 12 weeks for at least 24 weeks. We measured serum ustekinumab levels at weeks 6 and 12 in each patient. Using the absolute PASI score, response to treatment was defined as optimal (≤1), excellent (≤3), appropriate (>3 and ≤5), or inappropriate (>5). RESULTS: About 54 serum samples from 27 patients were analyzed. No correlation was found between serum drug levels and absolute PASI at week 12. At week 6, an inverse linear correlation was found (p = .0001). Moreover, serum levels at week 6 were higher in patients with optimal, excellent and appropriate responses than in patients with an inappropriate response. CONCLUSIONS: Assessment of ustekinumab serum levels at week 6 could provide useful information in routine clinical practice.

Egocentric and allocentric spatial memory in healthy aging: performance on real-world tasks

Although normal aging has been related to several cognitive difficulties, other processes have been studied less, such as spatial memory. Our aim was to compare egocentric and allocentric memory in an elderly population using ecological tasks. Twenty-eight cognitively unimpaired participants performed Egocentric and Allocentric Spatial Memory Tasks, as well as Spatial Span from CANTAB, Benton's Judge of Line Orientation test (JoLO), and Montreal Cognitive Assessment test (MoCA). The results revealed that younger participants showed better performance than older participants on both the Egocentric and Allocentric Spatial Memory Tasks, although only the Egocentric test was able to discriminate between younger, middle, and older elderly participants. Learning effect was found in Allocentric Spatial Memory Task in younger and older groups, but not in the middle group. Allocentric and egocentric performance was not related to other visuospatial neuropsychological scores and gender did not influence performance in any task. Egocentric and Allocentric Spatial Memory Tasks may be useful tools in early screening for cognitive decline, as they are able to detect age differences in the cognitive unimpaired elderly population.

Un caso pediátrico infrecuente de hiperplasia nodular focal estudiado con 99mTc-mebrofenin / A unusual pediatric case of focal nodular hyperplasia studied with 99mTc-mebrofenin

No disponible

Effect of Sonic Resin Composite Delivery on Void Formation Assessed by Micro-computed Tomography.

OBJECTIVES: The aim of this study was to quantify the internal void volume formation in commercially available, resin composites inserted using conventional or sonic insertion methods, and analyzed using three-dimensional (3D) micro-computed tomography (µCT). METHODS AND MATERIALS: Four resin composites were evaluated: one conventional (Herculite, Ultra, Kerr Corporation, Orange, CA, USA), one flowable bulk fill (SureFil SDR Flow, Dentsply International, York, PA, USA), and two packable bulk fill (SonicFill, Kerr Corporation, and Tetric EvoCeram Bulk Fill, Ivoclar Vivadent Inc, Schaan, Liechtenstein). Eight groups were evaluated according to each resin composite type and insertion method (conventional or sonic; n=5). Forty ABS 3D-printed cylindrical molds, 5.0 mm in diameter and 4.0 mm in depth, were fabricated. For the conventional resin composite, the mold was filled incrementally (two layers), while for bulk-fill resin composites, insertion was performed in a single increment. The sonic insertion method was performed using a specific handpiece (SonicFill Handpiece, Kerr Corporation). Resin composites were light cured using a multipeak light-emitting diode light-curing unit (VALO, Ultradent Products Inc, South Jordan, UT, USA) in its regular mode. Samples were evaluated by µCT, and data were imported into software (Amira, version 5.5.2, VSG, Burlington, MA, USA) for 3D reconstruction, from which the percentage of void volume was calculated. Data were analyzed using two-way analysis of variance and Tukey post hoc test at a preset alpha of 0.05. RESULTS: The conventional insertion method resulted in reduced porosity, compared with sonic insertion, for SureFil SDR Flow and Tetric EvoCeram bulk fill. The sonic insertion method did not demonstrate any influence on void formation for Herculite Ultra or SonicFill. CONCLUSION: Results suggest that the sonic insertion method might increase void formation during resin composite delivery, depending on restorative material brand.

Correlation between trough serum levels of adalimumab and absolute PASI score in a series of patients with psoriasis.

BACKGROUND: The possibility of monitoring serum drug levels has opened the door to optimising biologic therapy. To consolidate this advance, it is imperative to demonstrate an adequate correlation between serum drug levels and clinical course. OBJECTIVES: To investigate whether a correlation exists between adalimumab levels and clinical response measured as absolute PASI. METHODS: In a prospective cohort study, we enrolled 51 patients with psoriasis treated with adalimumab for at least 16 s. Patients received approved doses of adalimumab, but after 52 s the dosing interval could be modified according to clinical criteria. Excellent response was defined as PASI ≤3, appropriate response as PASI >3 and ≤5 and inappropriate response as PASI> 5. Correlations were calculated using Spearman's correlation test. RESULTS: A total of 92 serum samples from 51 patients were analysed. Significant differences were found in serum trough levels between patients achieving an excellent response (6.46 µg/mL), versus an appropriate (2.5 µg/mL) and an inappropriate response (2 µg/mL). The therapeutic range for adalimumab serum levels was from 3.30 to 7.30 µg/mL. CONCLUSIONS: We found an adequate correlation between drug serum levels and PASI scores. Monitoring of absolute PASI and serum levels can provide a personalised and cost-effective evaluation.

Capacidad diagnóstica de los biomarcadores salivales interleucinas 6 y 8 para el diagnóstico de carcinoma de células escamosas de cavidad oral / Diagnostic capability of the salivary biomarkers interleukin 6 and 8 for diagnosis of oral squamous cell carcinoma

Introducción: El cáncer oral ocupa el sexto lugar entre los distintos tipos de cáncer y más del 90% corresponden al carcinoma de células escamosas de cavidad oral (CCECO). A pesar de los avances diagnósticos y terapéuticos, la tasa de supervivencia es baja debido a su diagnóstico tardío. Se han descrito técnicas alternativas al tradicional método de biopsia e histopatología, entre ellas, el uso de biomarcadores salivales. Las interleucinas-6 (IL-6) y la interleucina-8 (IL-8) se sugieren como potenciales biomarcadores salivales para la detección precoz del cáncer. La presente revisión bibliográfica evaluó la capacidad diagnóstica de la IL-6 e IL- 8 en el diagnóstico precoz de CCECO. Revisión: Los biomarcadores salivales constituyen un método sencillo, no invasivo y de bajo costo para la detección precoz de CCECO. Se pueden utilizar en todas las etapas del cáncer, desde etapas precancerosas hasta metástasis. Existen diversos tipos de biomarcadores, dentro del grupo de las citoquinas, la IL-6 e IL-8 son citoquinas proinflamatorias que favorecen la carcinogénesis al promover la proliferación, generación de radicales libres, la supervivencia celular y la angiogénesis. Su capacidad diagnóstica para la detección de CCECO se basa en que incrementan significativamente su concentración salival en presencia de la patología. Además poseen alta sensibilidad y especificidad para diagnosticar este cáncer. Conclusiones: Los biomarcadores salivales, IL-6 e IL-8, se consideran alternativas no invasivas de gran capacidad diagnóstica para el diagnóstico precoz de CCECO debido al incremento significativo de su concentración y altos valores de sensibilidad y especificidad (AU)

Introduction: Oral cancer is in the sixth place of the different types of cancer and more than 90% are oral squamous cell carcinoma (CCECO). Despite diagnostic and therapeutic advances, the survival rate is low due to late diagnosis. Alternative techniques have been described to replace the traditional biopsy and histopathology, including the use of salivary biomarkers. Interleukin-6 (IL-6) and interleukin-8 (IL-8) are suggested as potential salivary biomarkers for early cancer detection. This literature review evaluated the diagnostic capability of IL-6 and IL-8 in early diagnosis of CCECO. Review: Salivary biomarkers are simple, non-invasive and inexpensive for early detection of CCECO. They can be used in all stages of cancer from precancerous stages to metastasis. There are diverse types of biomarkers, within the group of cytokines the markers IL-6 and IL-8 are pro-inflammatory cytokines that facilitate carcinogenesis by promoting proliferation, generation of free radicals, cell survival and angiogenesis. Their diagnostic capability for the detection of CCECO is based on significant increases in their concentration in the presence of the pathology. They also have high sensitivity and specificity for diagnosing this cancer. Conclusions: As salivary biomarkers, IL-6 and IL-8, are considered as non-invasive alternatives of high diagnostic capability for early diagnosis of CCECO due to the significant increases in their concentration and high levels of sensitivity and specificity (AU)

Thoracolumbar fractures without neurological impairment: A review of diagnosis and treatment.

An appropriate protocol and unified management of thoracolumbar fractures without neurological impairment has not been well defined.This review attempts to elucidate some controversies regarding diagnostic tools, the ability to define the most appropriate treatment of classification systems and the evidence for conservative and surgical methods based on the recent literature. Cite this article: Vilà-Canet G, García de Frutos A, Covaro A, Ubierna MT, Caceres E. Thoracolumbar fractures without neurological impairment: a review of diagnosis and treatment. EFORT Open Rev 2016;1:332-338. DOI: 10.1302/2058-5241.1.000029.

Do surgical expectations change depending on first time surgery or reoperation? A prospective cohort study in lumbar spine surgery.

PURPOSE: To assess whether patients undergoing lumbar spine surgery for the first time (Group 1) had different expectations from those undergoing lumbar spine surgery for a failed previous procedure (Group 2). METHODS: A prospective study that included 77 patients. A set of self-reported questionnaires was pre-operatively administered including VAS, Oswestry Disability Index (ODI), Zung Depression Scale and the NASS lumbar spine questionnaire (expectations scale). RESULTS: Fifty-six patients in Group 1 and 21 patients in Group 2. Both groups had high expectations with regard to the surgical procedure (n.s.). Depressed patients, despite being more disabled than non-depressed according to ODI (p 0.001), had similar expectations than non-depressed patients (n.s.). CONCLUSION: Patients' expectations remained very high despite having had a failed previous surgery for the same procedure.

Similar biological effect of high-dose oral versus intravenous methylprednisolone in multiple sclerosis relapses.

UNLABELLED: Our aim was to investigate differences in immune mechanisms in multiple sclerosis (MS) relapse, after high-dose oral methylprednisolone (oMP) or intravenous methylprednisolone (ivMP). We measured serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and IFN-γ) in 39 of 49 MS patients with moderate-severe relapse, whom were treated with ivMP or oMP in a placebo-controlled, non-inferiority clinical trial. We assessed these cytokine levels at baseline and at 1 and 4 weeks post-treatment. The cytokine levels between oMP and ivMP were similar at any time. Proinflammatory cytokines (IL-6 and IFN-γ) were significantly decreased in both groups at week 1 (p = 0.05 / p = 0.03) and at week 4 (p = 0.04 / p = 0.05). This study provides further confirmatory evidence that oMP is not inferior to ivMP. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT00753792.

Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente / Morbidity and mortality of surgically treated proximal humerus fractures

Introducción. El objetivo de este estudio es analizar los factores que se correlacionan con la mortalidad y la capacidad para realizar actividades de la vida diaria (AVD) en las fracturas de húmero proximal tratadas quirúrgicamente. Métodos. Se estudiaron retrospectivamente a 94 pacientes con fractura de húmero proximal intervenidas quirúrgicamente con un seguimiento medio de 8 años (2-12 años). De la muestra, se estudió el tipo de fractura, el tratamiento aplicado y sus comorbilidades. Se correlacionan los parámetros con la mortalidad y el nivel de las actividades de la vida diaria. Resultados. Se localizaron a 72 pacientes, de los cuales el 18,6% habían fallecido. Un 85,4% de los pacientes presentan comorbilidades. El 79,5% de los pacientes eran totalmente independientes para las actividades de la vida diaria. No encontramos correlación entre la mortalidad, el tipo de fractura y el tratamiento aplicado. No se encontró relación significativa entre las AVD y las comorbilidades con el tipo de fractura, pero sí que se encontró una reducción significativa de la función de las actividades de la vida diaria en pacientes tratados con hemiartroplastia y en pacientes con trastornos neurológicos. Conclusiones. Encontramos una mortalidad del 18,6% en los pacientes con fractura de húmero proximal tratada quirúrgicamente. La mayoría de los pacientes intervenidos son totalmente independientes para las actividades de la vida diaria, con un seguimiento a largo plazo (AU)

Background. The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. Methods. A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. Results. A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. Conclusions. There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up (AU)

[Morbidity and mortality of surgically treated proximal humerus fractures]. / Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente.

BACKGROUND: The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. METHODS: A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. RESULTS: A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. CONCLUSIONS: There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up.

¿Pueden influir las variables epidemiológicas el resultado a los 2 años de una cirugía por enfermedad lumbar degenerativa en términos de calidad de vida, discapacidad y dolor postoperatorio? / Can epidemiological factors affect the 2-year outcomes after surgery for degenerative lumbar disease in terms of quality of life, disability and post-surgical pain?

Objetivo: Evaluar si los factores epidemiológicos afectan a los resultados de la cirugía por enfermedad lumbar degenerativa en términos de calidad de vida, discapacidad y dolor crónico. Material y método: Doscientos sesenta y tres pacientes intervenidos por afección lumbar degenerativa fueron incluidos en el estudio (2005-2008). Variables epidemiológicas: edad, género, situación laboral y comorbilidad. Se completaron en el preoperatorio y 2 años tras la cirugía el Medical Outcomes Study Short Form-36 version 2, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI) y EVA para dolor lumbar y ciático. En el análisis de los datos, se evaluó la correlación entre variables epidemiológicas y el cambio en los resultados de los cuestionarios, así como, la existencia de factores pronósticos independientes. Resultados: Edad media 54,00 años (22-86); 131 mujeres (49,8%); 42 pérdidas de seguimiento (16%). Se observaron correlaciones significativas (p < 0,05) entre la edad, el género, la comorbilidad, la incapacidad laboral permanente y el dolor preoperatorio con el cambio del ODI, el COMI, los componentes de salud física y mental y las EVA de lumbar y ciático. El análisis de regresión lineal muestra a las ILP y la edad como variables predictoras del cambio de la discapacidad (β = 14,146; IC del 95%, 9,09-29,58; p < 0,01, y β = 0,334; IC del 95%, 0,40-0,98, p < 0,05, respectivamente) y de la calidad de vida (β = −8,568; IC del 95%, −14,88, −2,26; p < 0,01 y β = −0,228, IC del 95%, −0,40, −0,06, p < 0,05, respectivamente). Conclusión: Según nuestros resultados, hemos de considerar al aumento de la edad y la incapacidad laboral permanente como factores epidemiológicos predictores negativos de los resultados tras cirugía por patología lumbar degenerativa (AU)

Purpose: To evaluate the influence of epidemiological factors on the outcomes of surgery for degenerative lumbar disease in terms of quality of life, disability and chronic pain. Material and method: A total of 263 patients who received surgery for degenerative lumbar disease (2005-2008) were included in the study. The epidemiological data collected were age, gender, employment status, and co-morbidity. The SF-36, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), and VAS score for lumbar and sciatic pain were measure before and 2 years after surgery. The correlation between epidemiological data and questionnaire results, as well as any independent prognostic factors, were assessed in the data analysis. Results: The mean age of the patients was 54.0 years (22-86), and 131 were female (49.8%). There were 42 (16%) lost to follow-up. Statistically significant correlations (P < 0.05) were observed between age, gender, co-morbidity, permanent sick leave, and pre-operative pain with changes in the ODI, COMI, physical and SF-36 mental scales, and lumbar and sciatic VAS. Linear regression analysis showed permanent sick leave and age as predictive factors of disability (β = 14.146; 95% CI : 9.09-29.58; P < 0.01 and β = 0.334; 95% CI: 0.40-0.98, P < 0.05, respectively), and change in quality of life (β = −8.568; 95% CI: −14.88 to −2.26; P < 0.01 and β = −0.228, 95% CI: −0.40 to −0.06, P < 0.05, respectively). Conclusion: Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery (AU)