National epidemiologic trends (2008-2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery.

PURPOSE: It is unknown whether the trend of rising incisional hernia (IH) repair (IHR) incidence and costs until 2011 currently persists. We aimed to evaluate how the IHR procedure incidence, cost and patient risk-profile have changed over the last decade relative to all abdominal surgeries (AS). METHODS: Repeated cross-sectional analysis of 38,512,737 patients undergoing inpatient 4AS including IHR within the 2008-2018 National Inpatient Sample. Yearly incidence (procedures/1,000,000 people [PMP]), hospital costs, surgical and patient characteristics were compared between IHR and AS using generalized linear and multinomial regression. RESULTS: Between 2008-2018, 3.1% of AS were IHR (1,200,568/38,512,737). There was a steeper decrease in the incidence of AS (356.5 PMP/year) compared to IHR procedures (12.0 PMP/year) which resulted in the IHR burden relative to AS (2008-2018: 12,576.3 to 9,113.4 PMP; trend difference P < 0.01). National costs averaged $47.9 and 1.7 billion/year for AS and IHR, respectively. From 2008-2018, procedure costs increased significantly for AS (68.2%) and IHR (74.6%; trends P < 0.01). Open IHR downtrended (42.2%), whereas laparoscopic (511.1%) and robotic (19,301%) uptrended significantly (trends P < 0.01). For both AS and IHR, the proportion of older (65-85y), Black and Hispanic, publicly-insured, and low-income patients, with higher comorbidity burden, undergoing elective procedures at small- and medium-sized hospitals uptrended significantly (all P < 0.01). CONCLUSION: IH persists as a healthcare burden as demonstrated by the increased proportion of IHR relative to all AS, disproportionate presence of high-risk patients that undergo these procedures, and increased costs. Targeted efforts for IH prevention have the potential of decreasing $17 M/year in costs for every 1% reduction.

A Short-Term Resistance Training Circuit Improved Antioxidants in Sedentary Adults with Down Syndrome.

Previous studies have found aerobic training improved oxidative damage in people with Down syndrome (DS). However, there is a lack of information regarding the influence of resistance training on redox imbalance in this population. Accordingly, this study was conducted to determine the effect of resistance training (RT) on antioxidant defence system in sedentary adults with DS. Thirty-six male adults with DS were recruited through different community support groups. Eighteen were randomly assigned to perform a circuit RT program with 6 stations, 3 days/week for 12 weeks. Plasma total antioxidant status (TAS), reduced glutathione (GHS), ascorbate, serum α-tocopherol, and erythrocyte glutathione reductase activity were assessed. Plasma malondialdehyde (MDA) and carbonyl groups (CG) were assessed as markers of oxidative damage. Muscle strength was also measured. Dynamic torque of knee extensors and flexors as well as maximal handgrip strength was significantly improved after the completion of the training program. Plasma levels of TAS and erythrocyte glutathione reductase (GR) activity were significantly increased. Conversely, MDA and CG levels were significantly reduced. It was concluded RT improved antioxidant defence system and reduced oxidative damage in adults with DS. Further, long-term studies are required to determine whether the increased antioxidant system may improve clinical outcomes of adults with DS.

[Rates of surgical wound infection in hip arthroplasty (2007-2015)]. / Tasas de infección de herida quirúrgica en artroplastia de cadera (2007-2015).

OBJECTIVE: To estimate the incidence of surgical site infection in the hip replacement procedure during nine years of follow-up in a local public hospital. MATERIAL AND METHODS: A prospective study conducted between 2007 and 2015, using the Clinical Indicators of Continuous Quality Improvement (INCLIMECC) tool. All primary hip prostheses and revisions were studied. The definitions, criteria and categories for surgical site infection were those estimated for the risk index of the National Nosocomial Infections Surveillance of Centres for Disease Control and Prevention. Crude and adjusted rates were calculated by risk index. RESULTS: A total of 999 interventions were included. The overall infection rate was 1.5% (95%CI: 0.75-2.25). Surgical prophylaxis was prescribed in 98.3% of the cases, and was adequate in 70.7%, with the main cause of inadequacy being its prolonged duration in 71.3%. The infection rate was 53%, being better than the rates published for Spanish hospitals INCLIMECC in the period 1997-2012. But they were 19% higher than those published for the USA according to the National Healthcare Safety Network, and 50% higher than expected according to data published for Europe by the European Centre for Disease Prevention and Control. DISCUSSION: The infection rate in the present study is better than those described in the Spanish literature, but it is higher than those published for Europe and North America. Strategies for surveillance and control of infections associated with health care allow the evaluation of trends and the impact of prevention measures.

Home-based treadmill training improved seminal quality in adults with type 2 diabetes.

OBJECTIVE: This was the first study conducted to determine the influence of home-based treadmill training on seminal quality in adults with type 2 diabetes. MATERIAL AND METHODS: Sixty sedentary adults with type 2 diabetes volunteered for the current study. Thirty were randomly allocated to the intervention group and performed a a 14-week, home-based, treadmill training program, 3 sessions per week, consisting of a warm-up (10-15min), 40min treadmill exercise at a work intensity of 55-70% of peak heart rate (increasing by 2.5% each two weeks) measured during a maximal treadmill test, and cooling-down (5-10min). The control group included 30, age and BMI matched adults with type 2 diabetes who did not take part in any training program. Seminal quality analysis included semen volume, sperm concentration, motility and normal morphologic features. Furthermore, total antioxidant status (TAS) as well as glutathione peroxidase (GPX) activity were assessed in seminal plasma. This protocol was approved by an Institutional Ethics Committee. RESULTS: The home-based treadmill training significantly increased sperm concentration as well as percentages of total sperm motility and normal spermatozoa. Furthermore, TAS and GPX activity were increased after the completion of the training program. No significant changes in any of the measured variables were found in the control group. CONCLUSIONS: Home-based treadmill training improved seminal quality in adults with type 2 diabetes. A secondary finding was that seminal antioxidant defense system was significantly increased after being exercised.

Exercise reduced inflammation: but for how long after training?

BACKGROUND: Previous studies have reported that obese people with trisomy 21 suffer from low-grade systemic inflammation. A recent study has found that aerobic training reduced inflammation in obese women with Down syndrome. To the best of our knowledge, the study reported in this paper is the first to determine for how long these effects were maintained after completion of the programme. METHODS: Twenty premenopausal obese women (18-30 years old) with Down syndrome volunteered for this study. Eleven were randomly assigned to the intervention group and performed a 10-week aerobic training programme, 3 sessions per week, consisting of warming-up followed by treadmill exercise (30-40 min) at a work intensity of 55-65% of peak heart rate and a cooling-down period. The control group included 9, age, sex and BMI matched women with Down syndrome that did not perform any training programme. Fat mass percentage and distribution were measured. Plasma level of IL-6 and high-sensitive C-reactive protein (hs-CRP) were monitored. Time-course changes for these outcomes were assessed at pre- and post-intervention. Further, they were re-evaluated at 1, 3 and 6 months after completion of the programme. RESULTS: Three months after completion of the programme, plasma levels of IL-6 and hs-CRP were significantly increased. Up to 6 months later, both fat mass percentage and waist circumference (WC) were significantly increased. Furthermore, physical fitness was also impaired in the intervention group. No changes were observed in the control group. CONCLUSION: A 3-month detraining period significantly impaired chronic inflammation in obese women with DS.

Aerobic training improved low-grade inflammation in obese women with intellectual disability.

BACKGROUND: Obesity is a major health problem in people with intellectual disabilities. It is also widely accepted that low-grade systemic inflammation associated to obesity plays a key role in the pathogenic mechanism of several disorders. Fortunately, physical activity has shown to improve inflammation in people with metabolic syndrome and type 2 diabetes. Accordingly, we assessed the influence of aerobic training on pro-inflammatory cytokines and acute phase proteins in women with Down syndrome. METHODS: To achieve this outcome, 20 premenopausal obese young women with Down syndrome volunteered for this study. Eleven were randomly assigned to the intervention group and performed a 10-week aerobic training programme, three sessions per week, consisting of a warm-up then a 30- to 40-min treadmill exercise at a work intensity of 55-65% of peak heart rate followed by a cooling-down period. The control group included nine age-, sex- and body mass index-matched women with Down syndrome. Fat mass percentage and fat distribution were measured. Plasmatic levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6 and fibrinogen were assessed by commercial enzyme-linked immunosorbent assay kits. C-reactive protein (CRP) was assessed by nephelometry. RESULTS: Plasmatic levels of TNF-α (11.7 ± 1.6 vs. 9.2 ± 1.3 pg/ml; P = 0.022), IL-6 (8.2 ± 1.1 vs. 6.1 ± 0.9 pg/ml; P = 0.014) and high sensitive CRP (0.62 ± 0.11 vs. 0.53 ± 0.09 mg/dl; P = 0.009) were significantly reduced in the intervention group. Further, significant correlations between plasmatic and anthropometric parameters were found. CONCLUSION: A 10-week training programme reduced pro-inflammatory cytokines and acute phase proteins in obese young women with Down syndrome. Long-term, well-conducted studies are still required to determine whether correction of this low-grade inflammation improves clinical outcomes of women with trisomy 21.

Correlaciones entre marcadores de grasa abdominal obtenidos por densitometría y técnicas antropométricas convencionales en mujeres postmenopausicas con síndrome metabólico / Correlations between markers of abdominal fat obtained by dxa and anthropometric conventional techniques in postmenopausal women with metabolic syndrome

El presente estudio pretende identificar correlaciones estadísticamente significativas entre parámetros de masa grasa abdominal obtenidos por densitometría (DXA) y otros de tipo cineantropométrico (índices de distribución de masa grasa) y bioquímico (perfil lipídico) en mujeres postmenopausicas con síndrome metabólico. Se diseño un estudio de cohortes histórico que incluyó a un total de 1326 mujeres post-menopausicas con edad > 45 años que se habían sometido rutinariamente a DXA para conocer su densidad mineral ósea entre Enero de 2006 y Enero de 2011. Se utilizó un DXA tipo Lunar DPX-L para determinar la masa grasa abdominal en las regiones de interés L1-L4 y L3-L4. Además del DXA, se obtuvo de cada participante la correspondiente anamnesis, bioquímica, tensión arterial e índices de distribución de masa grasa mediante técnicas antropométricas convencionales. Se utilizó la clasificación NCEP-ATP-III para el diagnóstico de síndrome metabólico. Este protocolo fue aprobado por un Comité de Ética Institucional. La mayor fuerza de asociación se estableció entre el porcentaje de masa grasa L1-L4 obtenido por DXA y el perímetro de la cintura (r= 0,77; p= 0,0016) además de con colesterol-HDL (r= -0,58; p= 0,0290). Finalmente se concluye que el perímetro de la cintura y los niveles de colesterol-HDL podrían recomendarse como predictores del comportamiento de la masa grasa abdominal de regiones de interés L1-L4 y L3-L4 obtenidas por DXA en mujeres postmenopausicas con síndrome metabólico.

The current study was conducted to identify potential correlations between abdominal fat mass obtained by DXA and several parameters obtained by anthropometric conventional techniques as well as lipid profile in postmenopausal women with MS. This historical cohort study included a total of 1326 postmenopausal women aged > 45 years old who had routinely undergone DXA to measure their bone mineral density between January 2006 and January 2011. The regions of interest envisaged in our study by using DXA were the lumbar regions L1-L4 and L4-L5. At the same time, they underwent a complete medical examination including personal medical history assessment, biochemical blood analysis, blood pressure measurements and anthropometrical evaluation. Metabolic syndrome was diagnosed attending to the criteria established by National Cholesterol Education Program Adult Treatment Panel III (NECP-ATP-III). This protocol was approved by an Institutional Ethics Committee. Several significant correlations were found between DXA and indices of body fat distribution as well as lipid profile. The strongest correlations were found between fat mass L1-L4 and waist circumference (r= 0.77; p= 0.0016) and levels of HDL-cholesterol (r= -0.58; p= 0.0290). It was concluded that waist circumference and HDL-cholesterol may be recommended to predict fat mass in regions of interest L1-L4 and L3-L4 in postmenopausal women with MS.

Autotrasplante de células madre adultas en miembros inferiores con isquemia crítica / Adult stem cell autotransplantation in chronic critical limb ischemia

INTRODUCCIÓN. Recientemente se ha hecho evidente el potencial terapéutico de las células madre adultas en el tratamiento de arteriopatías periféricas, pues la implantación en los miembros isquémicos de células mononucleares procedentes de la médula ósea (CMN-MO) o de la sangre periférica (CMN-SP) puede mejorar la vascularization del tejido. MATERIAL Y MÉTODO. Se trataron 30 pacientes con isquemia critica de un miembro inferior, en los que no existía ninguna posibilidad de revascularización por métodos tradicionales. En 13 se implantaron CMN-MO autólogas en el miembro isquémico y en 17 se utilizaron CMN-SP. Los pacientes se monitorearon durante 24 semanas con el índice de presiones tobillo-brazo (ITB) en reposo, la distancia de marcha sin claudicación y la evaluación de la escala del dolor de reposo. RESULTADOS. Veintiún pacientes tenían indicación de amputación mayor del miembro afectado y en catorce (67%) de ellos se logró evitar. Tanto en los pacientes en que se emplearon CMN-MO como en los que recibieron CMN-SP hubo mejoría significativa del ITB en el miembro en que se hizo la implantación celular. El dolor de reposo mejoró significativamente en ambos grupos a las 4 semanas y a las 24 semanas había desaparecido. La distancia de marcha sin claudicación mejoró progresivamente en los dos grupos. En ningún caso se observaron efectos adversos secundarios al tratamiento. CONCLUSIONES. Los métodos de implantación de CMN-MO y de CMN-SP autólogas en pacientes con isquemia crítica de miembros inferiores resultaron procedimientos eficaces y sin complicaciones, lo que estimula a la continuación de los estudios clínicos en este campo (AU)

INTRODUCTION. Recently the therapeutic potential of adult stem cells in the treatment of peripheral arterial diseases has become increasingly evident, since implantation of bone marrow mononuclear cells (BM-MNC) or peripheral blood mononuclear cells (PB-MNC) into ischemic limbs can improve tissue vascularization. PATIENTS AND METHODS. Thirty patients with severe unilateral lower limb ischemia, with no option for standard revascularization therapies, were treated. Autologous BM-MNC were implanted into the ischemic limb in 13 cases and 17 received PBMNC. The patients were monitored during 24 weeks with resting ankle-brachial pressure index (ABI), pain-free walking distance and rest pain scale evaluation. RESULTS. Twenty one patients had been specifically advised to undergo major limb amputation that was avoided in 14 (67%). ABI significantly improved in the treated limb in both groups. Rest pain significantly improved in both groups at week 4 and at 24 weeks patients were completely pain-free. Pain free walking distance progressively improved in both groups. No related adverse effects were observed in any patient throughout the therapeutic procedure. CONCLUSIONS. The methods of autologous BM-MNC and PB-MNC implantation in patients with critical lower limb ischemia showed to be effective procedures without related complications. These results encourage to continue clinical studies in this field (AU)

Prevalencia y duración de la lactancia materna en Asturias / Prevalence and duration of breastfeeding in Asturias, Spain

Objetivo: Estimar la prevalencia y duración de la lactancia materna en Asturias y describir los factores asociados. Métodos: Estudio transversal. La población fueron todos los niños nacidos en los hospitales públicos de Asturias que tenían entre 0 y 8 meses de edad en el momento del estudio (4.326). Se obtuvo una muestra aleatoria estratificada de 453 niños. Los datos se obtuvieron por entrevista telefónica con cuestionario a las madres, preguntando si el día del estudio el niño tomaba el pecho. Se interrogaba además sobre datos sociodemográficos y de atención prenatal y perinatal. La estimación de la curva de prevalencia de lactancia según la edad del niño se realizó mediante regresión logística univariante, y el análisis de los factores asociados mediante regresión logística múltiple. Se estimaron como indicadores de duración el índice de discontinuidad (ID) y el índice de lactancia acumulada (ILA). Resultados: Se efectuaron 418 entrevistas. La prevalencia de lactancia materna exclusiva (LME) al inicio fue del 51,4 por ciento (intervalo de confianza [IC] del 95 por ciento: 46,6-56,2) decayendo al 14,9 por ciento a los 90 días y al 8,7 por ciento a los 120 días. Los ID fueron del 28,6 por ciento a los 30 días y del 71,0 por ciento a los 90 días. La prevalencia de LME se relacionó en el ajuste multivariado con la localidad de residencia: residir en una localidad rural o semiurbana aumentaba la probabilidad de lactar ( odds ratio [OR] = 5,69 y OR = 3,55, respectivamente) respecto al medio urbano. También se encontró relación positiva con que la madre tuviera estudios universitarios (OR = 3,90; IC del 95 por ciento: 1,778,58) y el haber sido atendida por la matrona durante el embarazo (OR = 2,13; IC del 95 por ciento: 1,04-4,38); se detectó relación inversa entre la LME y que el niño hubiera recibido suplementos en las primeras horas de vida (OR = 0,43; IC del 95 por ciento: 0,20-0,95).Conclusiones: La prevalencia de lactancia materna es muy inferior a la recomendada por la Organizacion Mundial de la Salud, especialmente su duración. En el hábitat no urbano se mantienen patrones más adecuados de lactancia (AU)

[Cost-benefit analysis of fluoridating the public water supply of the city of Málaga]. / Análisis coste-beneficio de la fluoración de las aguas de abastecimiento público de la ciudad de Málaga.

The aim of the present study was to assess the cost-benefit of the program of fluoridation of the public water supply in the city of Málaga. Marginal benefits and the rate cost/benefit were the two parameters used to evaluate the cost-benefit. We have considered all the information available about similar experiences performed in other countries and about the particular aspects of the city in which this program was going to be set up. The cost of fluoridation per inhabitant per year and the effects of the cost of fluoridation on the price of the water supplied were also estimated. The program for the fluoridation of the public water supply in Málaga is profitable from the first year, as for each peseta spent we will benefit 2.10 pesetas. After 20 years of public water fluoridation the net benefit of this program will reach between 519 and 5,300 millions pesetas.

[Influence of combined oral contraceptives on prolactin blood levels (author's transl)].

PIP: The authors studied the effects of the use of combined pills on serum prolactin (PRL) levels. Serum PRL levels were determined by radioimmunoassay in 9 women using combined pills for at least 6 months. Each woman was sampled 6 times during the month of study. The authors conclude that combined pills increase PRL serum levels in a much higher proportion than the spontaneous incidence of hyperprolactinemia and suggest that this effect is strongly related to the length of pill use. (author's modified)^ieng

Influencia dos anticoncepcionais orais combinados no nivel sanguineo de prolactina. / Influence of combined oral contraceptives on prolactin blood levels

Os autores estudam os efeitos do uso de pilulas anticoncepcionais combinadas no nivel sanguineo de prolactina (PRL). Em nove mulheres usando pilulas anticoncepcionais combinadas por seis meses ou mais determinou-se a prolactinemia por radioimunoensaio, em seis amostras colhidas durante o mes do estudo. Os autores concluem que os anticoncepcionais orais combinados elevam a prolactinemia numa proporcao bem maior que a incidencia espontanea de hiperprolactinemia e sugerem que o tempo de uso e importante na producao deste efeito