A Case Report of a Sacral Giant Cell Tumor Treated With Block Resection and Lumbo-Pelvic Fixation.

Giant cell tumors (GCT) are benign but locally aggressive neoplasms composed of osteoclast-like giant cells and fusiform to ovoid mononuclear stromal cells. GCT generally comprise 5-10% of all benign bone tumors; they appear most frequently between the second and third decades of life. These tumors are also distributed throughout the vertebral column. Approximately half of all spinal GTCs develop in the sacrum. Many cases remain clinically silent and are discovered incidentally during the study of minor trauma. Symptomatic tumors often mimic other common spinal pathologies. Imaging studies ideal for diagnosis are CT and MRI. The techniques used in the treatment of giant cell tumors are curettage or intralesional surgery, block resection, radiotherapy, and chemotherapy. Herein, we report on a 23-year-old female patient diagnosed with a tumoral mass in the anterior part of the sacrum, suggestive of GCT. The lesion was completely excised in two consecutive surgeries, and lumbopelvic fixation was performed with favorable immediate postoperative results. Careful surgical planning with a multi-disciplinary approach leading to block resection still remains the most viable option for the treatment of vertebral GCT.

[Proposal for a new information model about the surgical waiting list.] / Propuesta de un nuevo modelo de información sobre la lista de espera quirúrgica.

In these moments in which the pandemic seems to have granted a truce, hospitals are beginning to normalize their care activity and data on waiting lists have begun to regain their prominence as they are the object of attention by all interest groups: citizens, the media, politicians and health professionals themselves. An improvement is proposed in the treatment of the information on the surgical waiting list that is usually published based on the analysis of some relevant indicators of it. This proposal can contribute to a better understanding and interpretation of waiting list data at such an important time as the present.

En estos momentos en los que la pandemia parece haber concedido una tregua, los hospitales están comenzando a normalizar su actividad asistencial y los datos sobre listas de espera han empezado a recuperar su protagonismo al ser objeto de atención por parte de todos los grupos de interés: ciudadanos, medios de comunicación, políticos y los propios profesionales de la salud. Se propone una mejora en el tratamiento de la información sobre la lista de espera quirúrgica que suele publicarse fundamentado en el análisis de algunos indicadores relevantes de la misma. Dicha propuesta puede contribuir a entender e interpretar mejor los datos de lista de espera en un momento tan importante como el actual.

Comparison of Magnoliaceae Plastomes: Adding Neotropical Magnolia to the Discussion.

Chloroplast genomes are considered to be highly conserved. Nevertheless, differences in their sequences are an important source of phylogenetically informative data. Chloroplast genomes are increasingly applied in evolutionary studies of angiosperms, including Magnoliaceae. Recent studies have focused on resolving the previously debated classification of the family using a phylogenomic approach and chloroplast genome data. However, most Neotropical clades and recently described species have not yet been included in molecular studies. We performed sequencing, assembly, and annotation of 15 chloroplast genomes from Neotropical Magnoliaceae species. We compared the newly assembled chloroplast genomes with 22 chloroplast genomes from across the family, including representatives from each genus and section. Family-wide, the chloroplast genomes presented a length of about 160 kb. The gene content in all species was constant, with 145 genes. The intergenic regions showed a higher level of nucleotide diversity than the coding regions. Differences were higher among genera than within genera. The phylogenetic analysis in Magnolia showed two main clades and corroborated that the current infrageneric classification does not represent natural groups. Although chloroplast genomes are highly conserved in Magnoliaceae, the high level of diversity of the intergenic regions still resulted in an important source of phylogenetically informative data, even for closely related taxa.

Helicobacter pylori and its association with autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis and Sjögren syndrome.

Helicobacter pylori (H. pylori) is a gram-negative bacterium that adapts to the gastric mucosa and provokes symptoms associated with gastritis. Chronic H. pylori infection in patients with a genetic predisposition can trigger autoimmune diseases due to the immune interaction of cellular and humoral responses. Infections are a triggering factor for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren syndrome (SS), although the association between H. pylori and these diseases is unclear. Therefore, we reviewed this interaction and its clinical importance.

Clinical relevance of P-glycoprotein activity on peripheral blood mononuclear cells and polymorphonuclear neutrophils to methotrexate in systemic lupus erythematosus patients.

To elucidate the relationship between P-glycoprotein activity on peripheral blood leukocytes of systemic lupus erythematosus (SLE) patients with lupus arthritis and the clinical response to methotrexate. An observational study was made in patients with SLE according to ACR criteria 1997 who had arthralgia and arthritis and received methotrexate for ≥3 months. Methotrexate responders and non-responders were compared according to the Clinical Disease Activity Index. Mononuclear cells and polymorphonuclear neutrophils were isolated from SLE patients and P-glycoprotein expression was measured using the relative fluorescence index and percentage of positive cells. The chi-square test was used to compare P-glycoprotein activity between responders and non-responders. Thirty-two patients with a mean age of 45.4 ± 10.7 years were included: 34.4% had a response to methotrexate and 65.6% did not. Mean relative fluorescence units of both mononuclear cells and polymorphonuclear neutrophils were significantly lower in patients with a good response (7.0 ± 4.3 vs. 9.6 ± 3.8; p = 0.041 and 4.2 ± 3.5 vs. 7.6 ± 4.0; p = 0.004). The prevalence of low fluorescence levels (<6 relative fluorescence units), signifying higher P-glycoprotein activity of both mononuclear cells and polymorphonuclear neutrophils, was higher in methotrexate responders than in non-responders (27.3 vs. 4.8%; p = 0.10 and 81.8 vs. 23.8%; p = 0.003, respectively). In SLE patients with joint involvement treated with methotrexate, P-glycoprotein activity was higher in responders to methotrexate than in non-responders. Further studies are required to determine the mechanisms behind this finding and whether P-glycoprotein activity mediates alterations in methotrexate efficacy.

Mercado de trabajo versus formación inicial: competencias del pedagogo en el TFG / Mercado de trabalho versus formação inicial: competências do pedagogo no TCC / Workmarket vs initial training: educator skills in the final year project

Este trabajo presenta un análisis comparativo mediante un estudio descriptivo documental ex post facto entre las competencias que según la normativa deben adquirir los Graduados en Pedagogía de la Universidad de Málaga en el Trabajo deFin de Grado (TFG) con las competencias profesionales exigidas por el mercado laboral para conocer si existe o no desfase entre la oferta laboral y la demanda formativa de este alumnado. Los resultados ponen de manifiesto que el 57,87% de las competencias profesionales exigidas en el mercado laboral no se encuentran recogidas en las competencias formativas del TFG. Por otro lado, y atendiendo a los ámbitos profesionales, las principales competencias profesionales que se solicitan son competencias transversales, ausentes en la guía docente del TFG.

Neste trabalho apresenta-se uma análise comparativa tendo em conta um estudo descritivo documental ex post facto. São aqui comparadas as competências que, segundo as normativas, os alunos graduados em Pedagogia, da Universidade de Málaga, devem adquirir na unidade curricular do Trabalho de Conclusão de Curso (TCC), com as competências profissionais que lhes são exigidas no mercado laboral, de modo a verificar se existe ou não desfasamento entre a oferta laboral e a demanda formativa destes alunos. Os resultados revelam que 57,87% das competências profissionais exigidas no mercado laboral não estão incluídas nas competências formativas da unidade curricular do TCC. Por outro lado, e atendendo aos âmbitos profissionais, as principais competências profissionais que se solicitam no mercado laboral são competências transversais, ausentes na unidade curricular do TCC.

This paper presents a comparative analysis by means of a descriptive documentary study ex post facto between the skills that, according to the regulations, must be acquired by Graduates in Pedagogy at Universidad de Málaga in the Course Final Project (CFP) with the professional skills demanded by the labor market to know whether or not there is a gap between the labor supply and the training demand of the students. The results show that 57.87% of the professional skills demanded in the labor market are not included in the training skills of the CFP. On the other hand, and considering the professional fields, the main requested professional skills are transversal ones, which are absent in the teaching guide of the CFP.

Cirugía de 360º en el tratamiento de la espondilolistesis lumbosacra de alto grado: técnica por única vía posterior / Cirurgia de 360 graus no tratamento da espondilolistese lombossacral de alto grau: técnica por via posterior única / 360 degrees surgery in the treatment of high-grade lumbosacral spondylolisthesis: surgical technique only by posterior approach

OBJETIVO: El tratamiento de las espondilolistesis lumbosacras de altos grados (IV y espondiloptosis) incluye la reducción del desplazamiento si es posible, descompresión, y la fijación y artrodesis del segmento afectado. Esta patología provoca un grado de incapacidad grave en los pacientes así como deformidad en su postura lumbosacra, llevándolos a adoptar una marcha anodina, acompañada de retracción de isquiotibiales de forma crónica. Con el fin de ofrecer una mejoría clínica, reducir el tiempo quirúrgico y la tasa de morbilidad, se propone esta técnica quirúrgica que permite realizar todo por única vía posterior, como una alternativa en el tratamiento quirúrgico de estos pacientes. MÉTODOS: Los autores describen una técnica para descomprimir y fijar la columna lumbosacra, realizando una instrumentación transpedicular en L4 y S1, discectomía más TLIF (Caja intersomática para fusión lumbar) en L4-L5, laminectomía niveles L4-L5, L5-S1, S1-S2, artrodesis postero-anterior de S1 a L5 tunelizando a través de ambas vértebras y colocando injerto fibular (peroné). Los autores revisaron, retrospectivamente, 9 pacientes intervenidos con esta técnica, entre los años 2000 y 2010. A todos se les evaluó y controló durante 12 meses, en promedio, posteriores a su intervención quirúrgica. RESULTADOS: Los síntomas mecánicos y radiculares mejoraron en el seguimiento a corto y largo plazo. Los estudios radiológicos demostraron adecuada fusión ósea en todos los pacientes. No se observaron fallas relacionadas con la instrumentación. CONCLUSIONES: Los autores afirman que esta técnica es segura y eficiente por vía posterior para lograr la descompresión y la fijación in situ sin corrección sagital. El uso de esta técnica evita el uso de los abordajes por vía anterior o combinados, y disminuye el porcentaje de sangramiento, la tasa de morbilidad y los altos costos.

OBJETIVO: O tratamento da espondilolistese lombossacral de alto grau (grau IV e espondiloptose) inclui a redução do deslocamento, se possível, descompressão e fixação e artrodese do segmento afetado. Essa doença causa nível grave de incapacidade e deformidade postural na região lombossacral, levando os pacientes a adotar marcha anódina, acompanhada por retração crônica dos músculos isquiotibiais. Esta técnica realizada por acesso unicamente posterior visa proporcionar a melhora clínica, reduzir o tempo cirúrgico e a morbidade. MÉTODOS: Os autores descrevem uma técnica para descomprimir e fixar a coluna lombossacral por instrumentação transpedicular em L4 e S1, discectomia mais TLIF (artrodese transforaminal intersomática) em L4-L5, laminectomia nos níveis L4-L5, L5-S1, S1-S2, fusão póstero-anterior S1-L5 para tunelização através de ambos os corpos vertebrais e enxerto ósseo de fíbula. Os autores revisaram retrospectivamente nove pacientes submetidos a essa técnica entre 2000 e 2010. Todos os pacientes foram avaliados e acompanhados por 12 meses, em média, após a cirurgia. RESULTADOS: Os sintomas mecânicos e radiculares melhoraram no acompanhamento a curto e longo prazo. Estudos radiológicos mostraram fusão óssea adequada em todos os pacientes. Não houve falhas relacionadas com a instrumentação. CONCLUSÕES: Os autores afirmam que esta técnica é segura e eficiente para realizar descompressão posterior e fixação in situ sem correção sagital. A utilização desta técnica evita o acesso por via anterior ou combinado e reduz a hemorragia, a morbidade e os custos elevados.

OBJECTIVE: The treatment of high-grade lumbosacral spondylolisthesis (grade IV and spondyloptosis) includes the reduction of the displacement if possible, decompression, fixation and arthodesis of the affected level. This disease causes severe level of disability and a postural lumbosacral deformity, leading the patients to assume anodyne gait with a chronic contraction of the hamstrings. This technique performed solely by posterior approach aims to provide clinical improvement, reduce surgical time and morbidity. METHODS: The authors describe a technique to decompress and fix the lumbosacral spine by trans pedicular instrumentation in L4 and S1, discectomy and TLIF (Transforaminal Lumbar Interbody Fusion) in L4-L5, laminectomy at levels L4-L5, L5-S1, S1-S2, posterior-anterior fusion from S1 to L5 for tunneling through both vertebral bodies and a fibular bone graft.The authors retrospectively reviewed nine patients who underwent this technique between 2000 and 2010. All patients were assessed and followed for 12 months on average after surgery. RESULTS: The mechanical and radicular symptoms improved in the follow-up period in the short and long term. Radiological studies showed adequate bone fusion in all patients. There were no instrumentation-related failures. CONCLUSIONS: The authors claim that this technique is safe and effective for decompression and posterior fixation in situ without sagittal correction. This technique prevents access by the anterior or combined approaches and reduce bleeding, morbidity and high costs.

Fractura de odontoides tipo II: reporte de caso / Type II odontoid fracture: a case report

Las fracturas de Odontoides tipo II son relativamente frecuentes y su enfoque terapéutico sigue sometido a considerable debate por parte de los diferentes grupos especializados en columna tanto nacionales como internacionales. Se trata de una mujer joven quien sufrió un trauma cráneano cervical en un accidente de tránsito. Aunque no presentó compromiso neurológico, la cervicalgia persistente condujo al diagnóstico de una fractura tipo II de odontoides. Ante la refractariedad al tratamiento conservador la paciente fue llevada a cirugía, en la cual le fue practicada una fijación anterior de la apófisis odontoides. Las fracturas tipo II de odontoides pueden ser tratadas con un enfoque quirúrgico o médico, cada uno con ventajas y desventajas y en todo caso ninguno exento de morbilidad. El tratamiento quirúrgico está indicado ante la falla del enfoque conservador.

Modification of insulin, glucose and cholesterol levels in nonobese women undergoing liposuction: is liposuction metabolically safe?

An open autocontrolled clinical study was performed on 15 healthy nonobese women who underwent liposuction to establish how metabolic profiles are modified in the short-term postsurgical period. Preoperative glucose, insulin, and cholesterol levels were determined. Also, impedancometry was used to determinate body composition. After 3 postoperative weeks, the levels and determinations were again tested. The results demonstrated a significant difference in glucose, cholesterol, insulin secretion, and adiposity, but insulin levels, glucose-insulin relationship, and insulin sensitivity remained unaltered. From the results of this study, we consider liposuction to be a safe surgical procedure from a metabolic point of view because it improves the levels of cholesterol, glucose, and insulin secretion and at the same time decreases adiposity. Therefore, in the short term, liposuction can modify important markers for the development of type II diabetes mellitus and cardiovascular disease.

Accuracy of noninvasive estimates of respiratory muscle effort during spontaneous breathing in restrictive diseases.

Mean inspiratory pressure (Pi), estimated from the occlusion pressure at the mouth and the inspiratory time, is useful as a noninvasive estimate of respiratory muscle effort during spontaneous breathing in normal subjects and patients with chronic obstructive pulmonary disease. The aim of this study was to compare the Pi with respect to mean esophageal pressure (Pes) in patients with restrictive disorders. Eleven healthy volunteers, 12 patients with chest wall disease, 14 patients with usual interstitial pneumonia, and 17 patients with neuromuscular diseases were studied. Pi, Pes, and mean transdiaphragmatic pressure were simultaneously measured. Tension-time indexes of diaphragm (TTdi) and inspiratory muscles (TTmu) were also determined. In neuromuscular patients, significant correlations were found between Pi and Pes, Pi and transdiaphragmatic pressure, and TTmu and TTdi. A moderate agreement between Pi and Pes and between TTmu and TTdi was found. No significant correlation between these parameters was found in the other patient groups. These findings suggest that Pi is a good surrogate for the invasive measurement of respiratory muscle effort during spontaneous breathing in neuromuscular patients.