The Effect of the Overexpression or Addition of IGF1 and FGF2 in Human Chondrocytes Included in a Fibrin Matrix and Cultivated in a Dynamic Environment.

Hyaline cartilage is a highly specialized tissue. When injured, its repair capacity is low, which results in the massive destruction of the articular surface. Using tissue engineering and genetic engineering techniques, it is possible to provide a suitable microenvironment providing chondrocyte growth factors involved in the development of hyaline cartilage proteins, as well as cell proliferation and differentiation. Our aim was to stimulate the synthesis of an extracellular matrix via the chondrocytes included in a fibrin matrix through the addition or overexpression of IGF1 and/or FGF2, while maintaining a constant agitation of the culture medium. Collagen type II and glycosaminoglycans increased during the entire incubation time. In contrast, collagen type I decreased its expression under the same culture conditions, transfecting or supplementing growth factors to chondrocytes. However, chondrocytes that were not transfected or supplemented showed a general increase in the proteins analyzed in this study. The presence of IGF1 and FGF2 increased the protein synthesis of the hyaline cartilage, regardless of which one was the source of growth factors. Continuous agitation using the spinner flask allows for the adequate nutrition of chondrocytes included in the fibrin matrix. However, they require growth factors to up-regulate or down-regulate collagenous proteins.

Efficacy of an oral collagen therapy compared with intra-articular therapies (hyaluronic acid and platelet-rich plasma) to treat knee osteoarthritis / Eficacia de una terapia oral de colágeno comparada con terapias intraarticulares (ácido hialurónico y plasma rico en plaquetas) en el manejo de la osteoartritis de rodilla

Introducción: la osteoartritis es una enfermedad crónica y progresiva que afecta a más del 30 % de las personas mayores de 60 años. Actualmente, se reconoce la osteoartritis como una enfermedad multifactorial. Se emplean varios tratamientos conservadores en el manejo de la osteoartritis de rodilla (AINE, analgésicos y terapias intraarticulares). Se realizó un ensayo clínico aleatorizado para determinar si una terapia a base de 10 g de colágeno hidrolizado y 100 mg de fucoidano (Hydroidan pro, Acten, Suiza) era más efectiva que las terapias intraarticulares. Métodos: se dividió a los pacientes en 3 grupos. El primero recibió 23 g de ACTEN® cada día durante 3 meses. Los otros grupos recibieron una única inyección intraarticular de ácido hialurónico (5 ml) o plasma rico en plaquetas (3 ml). Se emplearon las escalas WOMAC, SF-12 y VAS para valorar el dolor al inicio, 4, 12 y 24 semanas después. Resultados: se incluyó a 108 pacientes con osteoartritis de rodilla de grado II-III que participaron en un estudio de seguimiento de 24 semanas de duración. La edad media fue de 57 años (53-65). Los 3 grupos rebajaron la puntuación en el grupo WOMAC (p < 0,001). El grupo que recibió colágeno y fucoidano obtuvo puntuaciones más bajas en las escalas WOMAC y VAS que los grupos que recibieron ácido hialurónico y plasma rico en plaquetas a las 24 semanas (p < 0,001). Conclusiones: el colágeno y el fucoidano tomado por vía oral, a diario, y durante 12 semanas parecen cosechar mejores resultados en las escalas WOMAC y VAS que las terapias intraarticulares a base de ácido hialurónico o plasma rico en plaquetas. Se debería de intentarse combinar terapias orales e intraarticulares para determinar su perfil de eficacia.(AU)

Introduction: osteoarthritis is a chronic and progressive disease. It affects over 30 % of people older than 60. Osteoarthri-tis is currently recognized as a multifactorial disease. Various conservative treatments are used in the management of kneeosteoarthritis (NSAIDs, analgesics, and intra-articular therapy). We conducted a randomized clinical trial to determine if a10 g therapy of hydrolyzed collagen along with 100 mg fucoidan (Hydroidan pro, Acten, Switzerland) is more effective thanintra-articular therapies.Methods: we divided patients into 3 groups. The first group received 23 g of ACTEN®, daily, for 3 months. The other groupsreceived a single intra-articular injection of hyaluronic acid (5 ml) or platelet-rich plasma (3 ml). We used the WOMAC scale,the SF-12 scale, and the VAS for pain at baseline, and 4, 12, and 24 weeks later.Results: we enrolled 108 patients with grade II-III knee osteoarthritis who underwent a 24-week follow-up study. The meanage was 57 years (53-65). The three groups showed low scores in the WOMAC group (p < 0.001). The collagen with fucoid-an group had lower WOMAC and VAS scores compared with the hyaluronic acid and platelet-rich plasma groups at 24weeks (p < 0.001).Conclusions: collagen along with fucoidan taken orally, daily, for 12 weeks seem to have better results in the WOMACand VAS scales compared with intra-articular therapies such as hyaluronic acid or platelet-rich plasma. Combined oral andintra-articular therapies should be tried to determine their efficacy profile.(AU)

Switchable Explosives: Performance Tuning of Fluid-Activated High Explosive Architectures.

We present our discovery of switchable high explosives (HEs) as a new class of energetic material that cannot detonate unless filled with a fluid. The performance of fluid-filled additive-manufactured HE lattices is herein evaluated by analysis of detonation velocity and Gurney energy. The Gurney energy of the unfilled lattice was 98% lower than that of the equivalent water-filled lattice and changing the fluid mechanical properties allowed tuning of the Gurney energy and detonation velocity by 8.5% and 13.4%, respectively. These results provide, for the first time since the development of HEs, a method to completely remove the hazard of unplanned detonations during storage and transport.

Perception of Medical Professionalism among Medical Residents in Spain.

BACKGROUND: Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. RESULTS: A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). CONCLUSIONS: The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.

Treatment of Chondral Knee Lesions with Autologous Chondrocytes Embedded in a Fibrin Scaffold. Clinical and Functional Assessment.

Objective The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries. Methods We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm 2 in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1-6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results. Results Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state ( p < 0.05). They were also able to carry out their sporting activities more easily than prior to surgery ( p < 0.05). Conclusion The seeding of chondrocytes in fibrin may provide a favorable micro-environment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.

Una aproximación a las prácticas y contextos alimentarios de estudiantes de escuelas secundarias de General Roca: reflexiones en torno al desayuno / An approach to the food practices and contexts of students of secondary schools in general roca: reflections on breakfast

Entendiendo a la alimentación humana como un hecho complejo, que une lo biológico y nutricional con lo social y cultural de manera indisoluble, este estudio tiene por objetivo describir prácticas y contextos alimentarios de adolescentes de la ciudad de General Roca, Río Negro, mostrando la potencialidad del paisaje alimentario como instrumento para caracterizar los desayunos. Participaron 31 estudiantes pertenecientes al ciclo básico de tres escuelas secundarias de la ciudad, dos del sector público y una de gestión privada, quienes registraron con imágenes todos los episodios alimentarios de un día de semana y un día de fin de semana. Las socializaron utilizando la red social Instagram, acompañadas cada una de un posteo aclaratorio. Se constituyó un banco de imágenes que luego permitió la aproximación de un paisaje alimentario y al análisis de prácticas alimentarias. El encuadre se hizo desde un punto de vista micro: a nivel doméstico, sobre la comida, los platos y la mesa, incluyendo episodios dentro de la escuela. Se analizaron aspectos implicados en las dimensiones biológica/nutricional y sociocultural. De manera preliminar, se conformó un paisaje de los desayunos. Se infirió un desayuno caracterizado por la escasa variedad de alimentos y nutrientes, a base de alimentos ultraprocesados, de baja densidad nutricional, pobre en proteína, fibra y micronutrientes. Los contextos en que se realizó el desayuno muestran que en general fue en el hogar, preparado por ellos mismos y sin compañía. Concluimos que a través de las imágenes de los perfiles fue posible describir el desayuno desde la dimensión biológica/nutricional y sociocultural. La idea de paisaje alimentario permite incorporar para su estudio otros aspectos vinculados a la alimentación, ampliando las posibilidades de intervención en el desarrollo de educación alimentaria, situando a los estudiantes en un lugar más activo para pensar su propia alimentación, que luego pueda traducirse en elecciones alimentarias más beneficiosas.

Understanding human nutrition as a complex fact, joining the biological/nutritional with the social/cultural aspects in an indissoluble way, this study aims at describing practices and food contexts of students of secondary schools in General Roca city showing the potential of foodscape as an instrument to characterize breakfasts. Thirty-one students belonging to the basic cycle of three secondary schools in the city participated, two state ones and one private, that registered with images all the eating episodes of one day of the week and one of the weekend. They were socialized using Instagram, each accompanied by an explanatory post. An image bank was created that later allowed the approximation to a foodscape and the analysis of food practices. The framing was done from a micro point of view: at a domestic level, about food, dishes and the table, including episodes inside the school. Aspects involved in biological/nutritional and sociocultural dimensions were analyzed. In a preliminary way, a foodscape of breakfasts was formed. What was inferred was a breakfast characterized by a limited variety of foods and nutrients, processed foods of low nutritional density, poor in protein, fiber and micronutrients. The contexts were generally their own homes, and breakfasts were prepared by themselves and without company. We concluded that through the images of the profiles it was possible to describe breakfast from biological/nutritional and socialcultural dimensions. The idea of a foodscape allows the incorporation of other aspects related to food for study, expanding the possibilities of intervention in the development of food education, putting students in a more active place to think about their own food, which can then be translated into more beneficial food choices.

Treatment of Chondral Knee Lesions with Autologous Chondrocytes Embedded in a Fibrin Scaffold. Clinical and Functional Assessment / Tratamento de lesões condrais no joelho com condrócitos autólogos embebidos em arcabouço de fibrina. Avaliação clínica e funcional

Abstract Objective The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries. Methods We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm2 in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1-6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results. Results Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state (p < 0.05). They were also able to carry out their sporting activities more easily than prior to surgery (p < 0.05). Conclusion The seeding of chondrocytes in fibrin may provide a favorable microenvironment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.

Resumo Objetivo O objetivo do nosso estudo é analisar os resultados clínicos e funcionais do tratamento de lesões nas articulações do joelho com condrócitos autólogos embebidos em arcabouço de fibrina. Métodos O estudo foi realizado com 56 pacientes (36 homens e 20 mulheres) com idade média de 36 anos; 6 indivíduos eram atletas profissionais. Os pacientes apresentavam lesões únicas, condrais ou osteocondrais (43 condrais, nove osteocondrais, 2 casos de osteocondrite dissecante e duas fraturas osteocondrais) no joelho, com 2 a 10 cm2 de tamanho e ≤ 10 mm de profundidade, sem sinais de osteoartrite. As lesões estavam localizadas na patela (8), no côndilo femoral medial (40), no côndilo femoral lateral (7) e na tróclea (1). O período médio de acompanhamento foi de 3 anos (faixa de 1-6 anos). A evolução clínica foi avaliada pelos escores de Cincinnati e Knee Injury and Osteoarthritis Outcome (KOOS), 6 e 12 meses após a cirurgia. O teste t de Student pareado foi utilizado para comparação dos achados pré e pós-operatórios. Resultados Os pacientes retomaram suas atividades diárias 6 meses após o implante. Os escores avaliados demonstraram a melhora em comparação ao estado pré-cirúrgico (p < 0,05). Além disso, os pacientes conseguiram realizar suas atividades esportivas com mais facilidade do que antes da cirurgia (p < 0,05). Conclusão A cultura de condrócitos em fibrina pode proporcionar um microambiente favorável para a síntese de matriz extracelular e melhorar a condição clínica e a atividade dos pacientes 1 ano após a cirurgia

Bixaceae of the Paraná State, Brazil / Bixaceae do Estado do Paraná, Brasil

This study provides a floristic survey of the Bixaceae from Paraná State. The family is represented in the area by two species: Cochlospermum regium (Mart. ex Schrank) Pilg., native from the remnants of the Cerrado biome, and Bixa orellana L., which has an uncertain origin but occurs sub-spontaneously in Paraná State. Descriptions, an identification key, photographs, and comments on the taxonomy of these species are provided.

Este trabalho apresenta o tratamento florístico de Bixaceae para o Estado do Paraná. A família está representada por duas espécies: Cochlospermum regium (Mart. ex Schrank) Pilg., nativa dos remanescentes de Cerrado; e Bixa orellana L., de origem incerta, mas subespontânea no Estado do Paraná. São apresentadas descrições, uma chave de identificação para as espécies, pranchas fotográficas e comentários taxonômicos.

Anomalías congénitas de los embera-chamí en los resguardos indígenas de riosucio, caldas, colombia, de 2007 a 2012

Introducción: Tal como sucede a nivel mundial, en Colombia las malformaciones congénitas son causas importantes de mortalidad infantil, enfermedad crónica y discapacidad. Las poblaciones indígenas de Colombia no cuentan con estudios definidos a este respecto, por lo cual la presente investigación se desarrolla en la zona indígena. Objetivo general: Caracterizar las anomalías congénitas de los indígenas Embera- Chamí residentes en los resguardos del municipio de Riosucio, Caldas, entre los años 2007 y 2012. Métodos: Estudio descriptivo, retrospectivo, aplicado a 125 nacidos vivos con anomalías congénitas. Se aplicó el formato especializado de Instituto Nacional de Salud (INS) de Colombia y para el análisis de variables se utilizó el paquete estadístico SPSS. Resultados: De 3.382 nacimientos el 3,7% (125) presentó anomalías congénitas. Se encuentra una asociación entre la edad de la madre y la presencia de anomalías congénitas. En el 87,2% de los casos fueron con edad gestacional de término. Las anomalías más frecuentes fueron: displasia de cadera, criptorquidia, malformaciones cardiovasculares, pie equino e hidrocefalia. Conclusiones: Se encuentra una incidencia de anomalías congénitas en la población indígena de los Embera-Chamí de Riosucio, Caldas, mayor que para el promedio de la población general en Colombia.

Introduction: As it happens worldwide, in Colombia, congenital malformations are important causes of child mortality, chronic disease and disabilities. Given that indigenous populations in Colombia do not count with specific research about this topic, this work is developed in an indigenous area. Objective: To characterize congenital abnormalities in Embera-Chamí indigenous people who live in the reservations of Riosucio, Caldas, between 2007 and 2012. Method: Descriptive and retrospective study applied on 125 newborns who had congenital malformations. We used the specialized format from Colombia's National Health Institute and we used SPSS to analyze the variables. Results: Out of 3.382 births, a 3.7% (125) had congenital malformations. We associated the age of the mother with the presence of said malformations. 87.2% of cases had term gestational age. Most frequent malformations were: hip dysplasia, cryptorchidism, cardiovascular malformations, clubfoot and hydrocephaly. Conclusions: There is a higher incidence of congenital malformations in the Embera-Chamí people, compared to the average of general population in Colombia.

Introdução: assim como acontece em outros países, na Colômbia, as más-formações congênitas são causas importantes de mortalidade infantil, doença crônica e deficiência. As populações indígenas colombianas não contam com estudos definidos sobre isso, portanto esta pesquisa é desenvolvida na zona indígena. Objetivo geral: caracterizar as anomalias congênitas dos indígenas Embera-Chamí residentes nas reservas do município de Riosucio, Caldas, entre 2007 e 2012. Métodos: estudo descritivo, retrospectivo, aplicado a 125 nascidos vivos com anomalias congênitas. Foi aplicado o formulário especializado do Instituto Nacional de Saúde da Colômbia; para a análise de variáveis, foi utilizado o pacote estatístico SPSS. Resultados: de 3.382 nascimentos, 3,7% (125) apresentaram anomalias congênitas. Verifica-se uma associação entre a idade da mãe e a presença de anomalias congênitas. Em 87,2% dos casos foram com idade gestacional de termo. As anomalias mais frequentes foram: displasia do quadril, criptorquidia, más-formações cardiovasculares, pé equino e hidrocefalia. Conclusoes: constata-se uma incidência de anomalias congênitas na população indígena dos Embera-Chamí de Riosucio, Caldas, maior que para a média da população geral na Colômbia.

Reproducibility of the measurement of central corneal thickness in healthy subjects obtained with the optical low coherence reflectometry pachymeter and comparison with the ultrasonic pachymetry.

BACKGROUND: Corneal pachymetry is widely used for refractive surgery and follow up in keratoconus, accurate measurement is essential for a safe surgery. OBJECTIVE: To assess intraobserver reliability of central corneal thickness (CCT) measurements using optical low-coherence reflectometry (OLCR) technology and its agreement with ultrasonic pachymeter (US). METHOD: Randomized and prospective comparative evaluation of diagnostic technology. One randomly healthy eye of subjects was scanned three times with both devices. Intraobserver within-subject standard deviation (Sw), coefficient of variation (CVw) and intraclass correlation coefficient (ICC) were obtained for reliability analysis; for study agreement, data were analyzed using the paired-sample t test and the Bland-Altman LoA method. The mean of three scans of each equipment was used to assess the LoA. RESULTS: The study enrolled 30 eyes of 30 subjects with average age of 28.70 ± 8.06 years. For repeatability, the Sw were 3.41 and 5.96 µ, the intraobserver CVw was 2 and 4% and ICC 0.991 and 0.988, for OLCR and US respectively. The mean CCT difference between OLCR and US was 8.90 ± 9.03 µ (95% confidence interval: 5.52-2.27 µ), and the LoA was 35.40 µ. CONCLUSIONS: OLCR technology provided reliable intraobserver CCT measurements. Both pachymetry measurements may be used interchangeably with minimum calibration adjustment.

ANTECEDENTES: La paquimetría corneal es ampliamente utilizada para la cirugía refractiva y el seguimiento de pacientes con queratocono. La medición exacta es esencial para una cirugía refractiva segura. OBJETIVO: Evaluar la reproducibilidad intraobservador en la medición del grosor corneal central (GCC) utilizando reflectometría óptica de baja coherencia (OLCR) y su concordancia con la paquimetría ultrasónica. MÉTODO: Estudio prospectivo, comparativo y aleatorizado de una tecnología diagnóstica. Se midió de forma aleatorizada un ojo de cada sujeto en tres ocasiones con ambos equipos. Para el análisis de fiabilidad se obtuvieron la desviación estándar (DE) intrasujeto, el coeficiente de variación (CV) y el coeficiente de correlación intraclase (CCI). Para el estudio de concordancia se analizaron los datos usando una prueba t pareada simple, además de los límites de acuerdo de Bland-Altman (LA). Para la evaluación de los LA se utilizó el promedio de las tres mediciones de cada equipo. RESULTADOS: El estudio incluyó 30 ojos de 30 sujetos con una edad promedio de 28.70 ± 8.06 años. Para la repetibilidad, la DE intrasujeto fue de 3.41 y 5.96µ, el CV del 2 y el 4%, y el CCI de 0.991 y 0.988, para el OLCR y el paquímetro ultrasónico, respectivamente. La diferencia del GCC promedio entre el OLCR y el paquímetro ultrasónico fue de 8.90 ± 9.03µ (intervalo de confianza del 95%: 5.52-2.27µ), y el LA fue de 35.40µ. CONCLUSIONES: La tecnología de OLCR proporciona medidas del GCC intraobservador fiables. Ambas mediciones paquimétricas pueden usarse de forma intercambiable con mínimos ajustes de calibración.

Anomalías congénitas de los embera-chamí en las reservas indígenas de Riosucio, Caldas, Colombia, de 2007 a 2012 / Congenital anomalies of the Embera-Chamí in the indigenous reservations of Riosucio, Caldas, Colombia, from 2007 to 2012 / Anomalias congénitas dos Embera-Chamí nas reservas indígenas de Riosucio, Caldas, Colômbia, de 2007 a 2012

Introducción: Tal como sucede a nivel mundial, en Colombia las malformaciones congénitas son causas importantes de mortalidad infantil, enfermedad crónica y discapacidad. Las poblaciones indígenas de Colombia no cuentan con estudios definidos a este respecto, por lo cual la presente investigación se desarrolla en la zona indígena. Objetivo general: Caracterizar las anomalías congénitas de los indígenas Embera-Chamí residentes en los resguardos del municipio de Riosucio, Caldas, entre los años 2007 y 2012. Métodos: Estudio descriptivo, retrospectivo, aplicado a 125 nacidos vivos con anomalías congénitas. Se aplicó el formato especializado de Instituto Nacional de Salud (INS) de Colombia y para el análisis de variables se utilizó el paquete estadístico SPSS. Resultados: De 3.382 nacimientos el 3,7 % (125) presentó anomalías congénitas. Se encuentra una asociación entre la edad de la madre y la presencia de anomalías congénitas. En el 87,2 % de los casos fueron con edad gestacional de término. Las anomalías más frecuentes fueron: displasia de cadera, criptorquidia, malformaciones cardiovasculares, pie equino e hidrocefalia. Conclusiones: Se encuentra una incidencia de anomalías congénitas en la población indígena de los Embera-Chamí de Riosucio, Caldas, mayor que para el promedio de la población general en Colombia.

Introduction: As is the case worldwide, in Colombia congenital malformations are important causes of infant mortality, chronic disease and disability. The indigenous populations of Colombia do not have defined studies in this regard, so the present research is developed in the indigenous area. General objective: To characterize congenital anomalies in Embera-Chamí indigenous people living in the reservations of the municipality of Riosucio, Caldas, between 2007 and 2012. Methods: Descriptive, retrospective study, applied to 125 live births with congenital anomalies. The specialized format of the National Institute of Health (INS) of Colombia was applied and the SPSS statistical package was used for the analysis of variables. Results: Out of 3,382 births, 3.7% (125) presented congenital anomalies. An association was found between the mother's age and the presence of congenital anomalies. In 87.2 % of the cases, the gestational age was at term. The most frequent anomalies were: hip dysplasia, cryptorchidism, cardiovascular malformations, clubfoot and hydrocephalus. Conclusions: An incidence of congenital anomalies is found in the indigenous population of the Embera-Chamí of Riosucio, Caldas, higher than for the average of the general population in Colombia.

Introduction: As is the case worldwide, in Colombia congenital malformations are important causes of infant mortality, chronic disease and disability. The indigenous populations of Colombia do not have defined studies in this regard, so the present research is developed in the indigenous area. General objective: To characterize congenital anomalies in Embera-Chamí indigenous people living in the reservations of the municipality of Riosucio, Caldas, between 2007 and 2012. Methods: Descriptive, retrospective study, applied to 125 live births with congenital anomalies. The specialized format of the National Institute of Health (INS) of Colombia was applied and the SPSS statistical package was used for the analysis of variables. Results: Out of 3,382 births, 3.7% (125) presented congenital anomalies. An association was found between the mother's age and the presence of congenital anomalies. In 87.2 % of the cases, the gestational age was at term. The most frequent anomalies were: hip dysplasia, cryptorchidism, cardiovascular malformations, clubfoot and hydrocephalus. Conclusions: An incidence of congenital anomalies is found in the indigenous population of the Embera-Chamí of Riosucio, Caldas, higher than for the average of the general population in Colombia.

Reproducibility of the measurement of central corneal thickness in healthy subjects obtained with the optical low coherence reflectometry pachymeter and comparison with the ultrasonic pachymetry. / Evaluación de la reproducibilidad en la medición del grosor corneal central con el paquímetro de reflectometría óptica de baja coherencia y comparación con el paquímetro ultrasónico en sujetos sanos

Background: Corneal pachymetry is widely used for refractive surgery and follow up in keratoconus, accurate measurement is essential for a safe surgery. Objective: To assess intraobserver reliability of central corneal thickness (CCT) measurements using optical low-coherence reflectometry (OLCR) technology and its agreement with ultrasonic pachymeter (US). Method: Randomized and prospective comparative evaluation of diagnostic technology. One randomly healthy eye of subjects was scanned three times with both devices. Intraobserver within-subject standard deviation (Sw), coefficient of variation (CVw) and intraclass correlation coefficient (ICC) were obtained for reliability analysis; for study agreement, data were analyzed using the paired-sample t test and the Bland-Altman LoA method. The mean of three scans of each equipment was used to assess the LoA. Results: The study enrolled 30 eyes of 30 subjects with average age of 28.70 ± 8.06 years. For repeatability, the Sw were 3.41 and 5.96 µ, the intraobserver CVw was 2 and 4% and ICC 0.991 and 0.988, for OLCR and US respectively. The mean CCT difference between OLCR and US was 8.90 ± 9.03 µ (95% confidence interval: 5.52-2.27 µ), and the LoA was 35.40 µ. Conclusions: OLCR technology provided reliable intraobserver CCT measurements. Both pachymetry measurements may be used interchangeably with minimum calibration adjustment.

Antecedentes: La paquimetría corneal es ampliamente utilizada para la cirugía refractiva y el seguimiento de pacientes con queratocono. La medición exacta es esencial para una cirugía refractiva segura. Objetivo: Evaluar la reproducibilidad intraobservador en la medición del grosor corneal central (GCC) utilizando reflectometría óptica de baja coherencia (OLCR) y su concordancia con la paquimetría ultrasónica. Método: Estudio prospectivo, comparativo y aleatorizado de una tecnología diagnóstica. Se midió de forma aleatorizada un ojo de cada sujeto en tres ocasiones con ambos equipos. Para el análisis de fiabilidad se obtuvieron la desviación estándar (DE) intrasujeto, el coeficiente de variación (CV) y el coeficiente de correlación intraclase (CCI). Para el estudio de concordancia se analizaron los datos usando una prueba t pareada simple, además de los límites de acuerdo de Bland-Altman (LA). Para la evaluación de los LA se utilizó el promedio de las tres mediciones de cada equipo. Resultados: El estudio incluyó 30 ojos de 30 sujetos con una edad promedio de 28.70 ± 8.06 años. Para la repetibilidad, la DE intrasujeto fue de 3.41 y 5.96 µ, el CV del 2 y el 4%, y el CCI de 0.991 y 0.988, para el OLCR y el paquímetro ultrasónico, respectivamente. La diferencia del GCC promedio entre el OLCR y el paquímetro ultrasónico fue de 8.90 ± 9.03 µ (intervalo de confianza del 95%: 5.52-2.27 µ), y el LA fue de 35.40 µ. Conclusiones: La tecnología de OLCR proporciona medidas del GCC intraobservador fiables. Ambas mediciones paquimétricas pueden usarse de forma intercambiable con mínimos ajustes de calibración.

Osteogenesis induced by a three-dimensional bioimplant composed of demineralised bone matrix, collagen, hydroxyapatite, and bone marrow-derived cells in massive bone defects: An experimental study.

Treatment of massive bone defects is one of the most difficult problems to solve in orthopedics. At present, there is no consensus on the best way to resolve these problems. The aim of our study was to evaluate the effect of a three-dimensional bioimplant over massive bone defects, and to analyse if it improves the speed and quality of integration in recipient bone compared to allograft treatment. Fifteen female lambs with massive bone defects, surgically created in their tibias, were randomly divided into three groups of five lambs each: Group I -treated with the bioimplant; Group 2 -treated with the bioimplant plus nucleated cells of autologous bone marrow; Group 3 -treated with a frozen allograft. Radiographs were taken post-treatment at weeks 1, 6, and 12. Animals were euthanized to obtain the studied bone segment for morphological analyses. TREATMENT: with bioimplants vs. bioimplant plus bone marrow nucleated cells (BMNCs) showed a notorious osteogenic effect, but with greater osteoid synthesis and cellularity in the latter. These results suggest that combined treatment with bioimplants and BMNCs have an additive effect on massive bone defects in lambs. These experimental results could be applied to repair damaged human bone.

[Trends in asthma prevalence and its symptoms in Mexican late adolescents over a 7-year period]. / Tendencia de la prevalencia de asma y sus síntomas en los adolescentes tardíos mexicanos en un periodo de siete años.

BACKGROUND: Late adolescents with asthma are rarely studied, since generally they are not included in children or adult groups; in addition, studies assessing asthma trends are scarce in Mexico, and their results might differ from findings in developed countries. OBJECTIVE: To determine the trends in asthma prevalence and its symptoms in late adolescents over a period of 7 years. METHODS: The prevalence of asthma and its symptoms were compared in two cross-sectional population-based cohorts, one from 2009 and the other from 2016. RESULTS: The presence of wheezing sometime in life and during the previous year was significantly increased between 2009 and 2016 (12.8 % versus 20.1 % and 7.3 % versus 10.3 %, p < 0.001 and 0.002, respectively). The prevalence of asthma went from 7.8 % in 2009 to 12.7 % in 2016 (p < 0.0001). In addition, the prevalence of allergic rhinitis (4.5 % versus 9.0 %) and atopic dermatitis (3.8 % versus 5.2 %) also showed marked increases (p < 0.0001 and 0.051, respectively). CONCLUSIONS: The prevalence of asthma and some of its symptoms in late adolescents substantially increased in a 7-year period.

Antecedentes: Los adolescentes tardíos con asma pocas veces son investigados, dado que generalmente no se incluyen en los grupos de niños ni adultos, además, en México, los estudios que evalúan la tendencia del asma son escasos y sus resultados pudieran diferir de los hallazgos en los países desarrollados Objetivo: Determinar la tendencia de la prevalencia del asma y sus síntomas en adolescentes tardíos en un periodo de siete años. Métodos: Se compararon las prevalencias de asma y sus síntomas de dos cortes transversales con base poblacional, uno en 2009 y otro en 2016. Resultados: La presencia de sibilancias alguna vez en la vida y durante el año previo se incrementó significativamente entre 2009 y 2016 (12.8 % versus 20.1 % y 7.3 % versus 10.3 %; p < 0.0001 y 0.002, respectivamente). La prevalencia del asma pasó de 7.8 % en 2009 a 12.7 % en 2016 (p < 0.0001). Adicionalmente, las prevalencias de rinitis alérgica (4.5 % versus 9.0 %) y dermatitis atópica (3.8 % versus 5.2 %) también sufrieron incrementos notorios (p < 0.0001 y 0.051 respectivamente). Conclusión: La prevalencia de asma y algunos de sus síntomas en adolescentes tardíos se incrementaron sustancialmente en los siete años previos.

[Interosseous electrostimulation in a model of lengthening with external fixation]. / Electroestimulación interósea en un modelo de elongación con fijación externa.

BACKGROUND: A fracture repair involves complex cellular processes. However, despite optimal treatment, some fractures heal slowly or do not repair. These complications support the need for innovative therapies. Electromagnetic stimulation is a non-invasive technology that could have a direct impact on many cellular pathways. OBJECTIVE: To demonstrate the effectiveness of electro-stimulation by alternating current applied during bone elongation to accelerate the consolidation process for 30 days in an animal model. MATERIALS AND METHODS: A device with closed circuit and graduated voltage was designed and kept in contact with the external fixator. Group A was elongated without electro-stimulation and group B was electro-stimulated since the beginning of the distraction. Radiographs were taken at 15 and 30 days post-surgical. Haematoxylin and eosin staining and Masson's trichrome stain were performed. RESULTS: No significant difference were observed in bone density of group A (4.05±3.24, P=0.163). In group B there was a significant difference (61.06±20.17, P=0.03) in bone density. Group A maintained a fibrous tissue repair, with areas of cartilage and bone matrix. Group B had more organised tissue in the stages of bone repair. CONCLUSION: Because there is a significant difference in the growth and callus formation at 15 and 30 days between groups, electro-stimulation could be considered as an adjuvant during bone elongation.

Aspectos a considerar en una actualización de la normativa nacional en materia de legionelosis / Considerations on Updating the Spanish Legislation on Legionelosis

Objetivo. En España, el vigente Real Decreto 865/2003 establece una serie de medidas destinadas a la prevención de la legionelosis que inciden especialmente en el mantenimiento de las instalaciones de riesgo relacionadas con la proliferación y transmisión de Legionella. Este trabajo pretende revisar determinados aspectos estructurales, de mantenimiento, operacionales y documentales que, desde el punto de vista del Control Oficial, podrían ser incluidos en una futura nueva norma que pudiera ser más efectiva, si cabe, en la prevención y control de la legionelosis en las instalaciones de riesgo. Materiales y Métodos. Se ha utilizado la normativa nacional vigente en materia de la legionelosis, documentación técnica de apoyo, otras normativas de aplicación en países de la Unión Europea, así como servicios en línea de información científica (ISI Web of Knowledge) y bases de datos de bibliografía médica (MEDLINE PubMed). Resultados y Discusión. Tras más de una década en vigor, es necesario que ciertos aspectos técnicos de las instalaciones de riesgo en la transmisión de la legionelosis sean revisados y adecuados al co-nocimiento actual y a la experiencia adquirida. Entre ellos se encuentran la clasificación de riesgo de las instalaciones, aspectos técnicos y operacionales de los sistemas de agua fría de consumo humano y caliente sanitaria, de los equipos de enfriamiento evaporativos, de los sistemas de agua climatizada y de los procedimientos de toma de muestras. Por último, se discute sobre la inclusión de técnicas analíticas basadas en la Biología Molecular (qPCR) como método oficial en la determinación de Legionella. Conclusiones. Una posible nueva normativa sobre prevención y control de la legionelosis debe contemplar una clasificación de las instalaciones en función del riesgo, que recoja las de reciente aparición que han sido asociadas a brotes. También deberá contar con anexos sobre las medidas preventivas para cada una de ellas, que desarrollen protocolos de toma de muestras específicos y modelos para la evaluación de riesgos adecuados que tengan en cuenta establecimientos especialmente sensibles, debería estudiarse la inclusión de las técnicas analíticas moleculares como métodos oficiales o complementarios a los oficiales. Esta actualización permitirá una actuación más rápida y eficaz ante la identificación de casos y la asociación de los mismos a las instalaciones de riesgo implicadas

Objective. In Spain, Royal Decree 865/2003 establishes actions aimed at the prevention of legionellosis on the maintenance of systems related to the proliferation and transmission of the disease. This work aims to review certain structural, operational, of maintenance and documentary aspects which, from the point of view of Official Control, could be included in a future new legal regulation that might be more effective in preventing the emergence and proliferation of Legionella in the risk systems. Materials y Methods. To carry out this work Spanish legislation on Legionella, technical support documentation, other regulations from countries of EU and online services of scientific information (ISI Web of Knowledge) and databases of medical literature (MEDLINE PubMed) were used. Results and Discussion. After more a decade, it is necessary that certain technical aspects of risk systems in the transmission of legionellosis are reviewed and adapted to current knowledge and experience. These include the risk classification of the systems, technical and operational aspects of cold drinking and hot water systems, evaporative cooling equipment, spa pools and sampling procedures. Finally, the inclusion of molecular analytical techniques based qPCR as official methods in determining Legionella is discussed. Conclusions. A new legal regulation on the prevention and control of legionellosis should include a classification risk-based of the systems that collect emerging that have been associated with outbreaks. It must have annexes on preventive action to each of them, specific sampling procedures and models to assess appropriate risk that take into account sensitive establishments. Last it should be considered including molecular analytical techniques such as official or complementary methods. This update will allow a faster and more effective performance at identifying cases and associating them to risk systems

Human bone morphogenetic protein 2-transduced mesenchymal stem cells improve bone regeneration in a model of mandible distraction surgery.

BACKGROUND: Bone morphogenetic proteins (BMPs) are actively involved in ossification, and BMP-2 participates throughout the entire process. Gene therapy for bone regeneration using adenovirus-expressing BMPs has been successful in small mammals, but it has not been satisfactory in large mammals. METHODS: We generated a 3-component implant (3C graft) comprising autologous mesenchymal stem cells (MSCs), ex vivo transduced with an adenovirus vector-expressing BMP-2 and embedded in a demineralized human bone matrix (DBM). RESULTS: In vitro studies demonstrated vector-induced osteogenesis; osteoblast population and mineralization of the extracellular matrix were greater in the vector-transduced cultures than in the controls (nontransduced MSCs stimulated with osteogenic media were used as positive controls, and nontransduced MSCs served as a negative control). The 3-component grafts were used to fill osteotomies created by bone distraction surgery in mongrel dogs. Control groups comprised dogs with bone distraction alone and dogs with nontransduced MSC grafts. The radiography follow-up, performed 10 weeks after distraction, demonstrated a remarkable reduction in the consolidation period compared with controls. Postmortem mandibles submitted for anatomic and histologic analyses showed improved remodeling and bone maturation in the 3C-grafted dogs. Inflammatory infiltrates were not observed in any of the treated areas, and no liver toxicity was detected. CONCLUSIONS: We demonstrated acceleration of osteogenesis in a dog model for bone distraction by using an implant of BMP-2 modified MSCs. These results are helpful for future clinical trials of mandible bone distraction.

Knee chondral lesions treated with autologous chondrocyte transplantation in a tridimensional matrix: clinical evaluation at 1-year follow-up.

BACKGROUND: Despite the many studies on chondral injury repair, no outcomes have been evaluated with the Western Ontario and McMaster (WOMAC) Universities osteoarthritis index, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Oxford Knee Score, all of which are specific for evaluating the presence of osteoarthritis. MATERIALS AND METHODS: We evaluated the clinical progress of patients following autologous chondrocyte implantation (ACI) performed by our Bone and Tissue Bank using a technique in which cells, instead of being introduced to the articular defect in a liquid form, are implanted into a tridimensional matrix of semisolid collagen (Condrograft((R))). A total of 22 patients underwent the procedure, 15 of whom were available for a 1-year follow-up that included clinical evaluation by WOMAC score before and after surgery and KOOS and the Oxford Knee Score after surgery. RESULTS: The results were improved WOMAC score from 56.4 before surgery to 16.2 after surgery (P < 0.002), average KOOS score of 83.6, and average Oxford Knee Score of 18.8. CONCLUSIONS: These results indicate that our tridimensional matrix technique effectively improved patients' quality of life, at least in the short term, and delayed any subsequent procedure. Long-term assessment is necessary to determine the true value of this technique.