Fracturas proximales de fémur. Osteosíntesis con tornillo-placa deslizante versus clavo gamma

Presentamos un estudio retrospectivo de noventa fracturas del fémur proximal tratados con clavo GAMMA o tornillo-placa dinámico de cadera (DHS). No encontramos diferencias en la duración de la intervención, pérdida hemática, ni estancia hospitalaria. Sin embargo, la serie con clavo GAMMA inició el apoyo más temprano, aunque en la revisión al final del seguimiento no había diferencias significativas en cuanto a la función de la cadera. El fracaso de la síntesis ocurrió en cuatro casos con el DHS, pero las complicaciones intraoperatorias fueron más frecuentes con el clavo GAMMA, principalmente elevada incidencia de fracturas de la diáfisis femoral, asociado en parte al diseño del implante. Recomendamos el empleo del clavo GAMMA sólo para las fracturas inestables del fémur proximal.We report a prospective study of ninety fractures of proximal femur treated by either the GAMMA nail or the dynamic hip screw (DHS). We found no difference in operating time, blood loss or stay in the hospital. However, the GAMMA nail group had a earlier full weight-bearing, but there was no significant difference in hip function at final review. There was failure of proximal fixation in four cases with the DHS. More intra-operative complications were recorded in the GAMMA nail group, mainly a high incidence of femoral shaft fracture which we relate in part to the design of the implant. We only recommend the use of the GAMMA nail for unstable intertrochanteric fractures of the proximal femur

Primary alpha-tertiary amine synthesis via alpha-C-H functionalization

A quinone-mediated general synthetic platform for the construction of primary a-tertiary amines from abundant primary a-branched amine starting materials is described. This procedure pivots on the efficient in situ generation of reactive ketimine intermediates and subsequent reaction with carboncentered nucleophiles such as organomagnesium and organolithium reagents, and TMSCN, creating quaternary centers. Furthermore, extension to reverse polarity photoredox catalysis enables reactivity with electrophiles, via a nucleophilic a-amino radical intermediate. This efficient, broadly applicable and scalable amine-to-amine synthetic platform was successfully applied to library and API synthesis and in the functionalization of drug molecules

Impact of adherence on growth response during the first 2 years of growth hormone treatment

Purpose Adherence to growth hormone (GH) treatment impacts clinical outcomes. The aim of this study is to assess the impact of adherence to rhGH treatment (2 years) on auxological outcomes. Methods Multicentric, retrospective observational study in rhGH-naive GHD/SGA children treated with Saizen (R) during >= 2 years. Growth response was assessed by evaluating the change in height standard deviation score (Delta H SDS) and the index of responsiveness (IoR). Adherence was monitored using EasyPod (TM) Connect device. Results A total of 110 patients (3 Spanish centers) were evaluable (GHD n = 76, SGA n = 34). Adherence was 95.6 and 93.9% (year 1, 2). SGA and GHD children showed an increase of 0.6 cm/year and 1.1 cm/year for each 10% adherence modification. Lower adherence was observed in patients with lower pretreatment height velocity (HV) and in patients whose parents had a lower level of education. A positive correlation between index of responsiveness (IoR) during the first and second years with HV SDS during the second year and between IoR2 and adherence (year 1, 2) was observed. The frequency of patients with HV > 1 SD was higher (p = 0.025) among patients with adherence >90%. The best model to predict the height gain(cm) reaching an adjusted R squared of 0.489 involved percentage of adherence, Tanner stage, pretreatment HV, dose of rhGH, and whether the treatment was initiated before or after puberty. Conclusions Adherence during the first 2 years of response was very high >90% and showed a negative association with age, pretreatment HV and treatment duration and a positive correlation with the level of parent education

Boletín de la Sociedad de Pediatría de Aragón, La Rioja y Soria

[No abstract available

Effects of locally applied Insulin-like Growth Factor-I on osseointegration

The aim of this study was to assess the effect of local application of IGF-I on osseointegration of dental implants placed in osteoporotic bones. 16 rabbits were randomly distributed into two groups: eight animals were ovariectomized and fed a low-calcium diet for six weeks, in order to induce experimental osteoporosis, and the others were sham-operated and fed a standard diet. A titanium implant was inserted into the tibiae in both groups. In half of the rabbits, 4 ?g of IGF-I was applied into the ostectomy, prior to the implant insertion. A total of 32 implants were placed. Animals were sacrificed two weeks after surgery and decalcified samples were processed for Bone-To-Implant Contact (BIC) and Bone Area Density (BAD) measurements. Analysis of variance (ANOVA) was used for statistical evaluation. P<0.05 was considered to be significant. Ovariectomy induced statistically significant lower BAD values (p=0.008) and a tendency towards lower BIC values when compared osteoporotic and healthy groups. The administration of 4 ?g of IGF-I did not produce statistically significant differences neither on BIC nor on BAD values, neither in the osteoporotic animals nor in healthy. Within the limitations of this experimental study, local administration of 4 ?g of IGF-I was not able to induce any changes in the osseointegration process two weeks after surgery, neither in healthy rabbits nor in the osteoporotic group

The significance of cheese sampling in the determination of histamine concentration: Distribution pattern of histamine in ripened cheeses

Cheeses are becoming a major safety and public health concern: cheeses available in supermarkets occasionally contain high histamine concentrations that can have negative effects on consumer health. In this study, we have attempted to assess the histamine distribution pattern in ripened cheeses, with the purpose of establishing a correct cheese sampling strategy for the quantification of histamine. To this aim, histamine was determined in four distinct areas of twelve long-ripened hard cheeses: the external and internal rind, along with the outer and inner core of the wedge. The concentrations measured were remarkably different: histamine accumulated in the central core, whereas the lowest amount was found in the peripheral rind. To explain this heterogenous distribution, histamine producers were determined in the four areas by identifying the hdc sequences obtained from cheese samples. Non-starter bacteria were identified as main histamine producers; however, these microbiota were homogeneously distributed throughout the wedge. Nevertheless, the analysis of psychochemical properties of the different areas revealed an observable trend: histamine tended to accumulate in the saltier, more humid, and less oxidized areas in a wedge. Overall, this study highlights the significance of a correct sampling strategy when histamine is quantified in cheese

Increasing Therapy Related Myeloid Neoplasms in Multiple Myeloma

© 2018 Stichting European Society for Clinical Investigation Journal Foundation. This document is made available under the CC-BY-NC 4.0 license http://creativecommons.org/licenses/by-nc /4.0/ This document is the submitted version of a published work that appeared in final form in European Journal of Clinical Investigation.Background: Despite the longer survival achieved in multiple myeloma (MM) patients due to new therapy strategies, a concern is emerging regarding an increased risk of secondary primary malignancies (SPMs) and how to characterize those patients at risk. We performed a retrospective study covering a 28‐year follow‐ up period (1991‐2018) in a tertiary single institution. Material and Methods: Data of 403 MM patients were recorded and compared with the epidemiologic register of the population area covered by our centre, calculating the standardize incidence ratio (SIR) for the different types of SPMs diagnosed in the MM cohort. Fine and Gray regression models were used to identify risk factors for SPMs. Results: Out of the 403 MM patients, 23 (5.7%) developed SPMs: 13 therapyrelated myeloid (TRM) malignancies (10 of them (77%) myelodysplastic syndrome (MDS), 1 acute lymphoid leukaemia and 9 solid neoplasms. In the MM cohort, the relative risk of MDS was significantly higher than in the general population. Survival of patients with TRM malignancies was poor with a median of 4 months from the diagnosis, and most of them showed complex karyotype. Within the MM subset, multivariable analysis showed a higher risk of TRM malignancies in patients that previously received prolonged treatment with lenalidomide (>18 months). Conclusions: Though the improvement in MM outcome during the last decades is an unprecedented achievement, it has been accompanied by the rise in TRM malignancies with complex cytogenetic profile and poor prognosis that are in the need of an improved biologic and therapeutic approach

Hipopituitarismo. Una causa poco frecuente de retraso psicomotor

Sr. Editor: El hipopituitarismo es un síndrome clínico, resultante de la secreción insuficiente o ausencia completa de secreción de una o varias hormonas hipofisarias anteriores. Aunque típicamente el diagnóstico se suele realizar en período neonatal, en ocasiones, su primera manifestación puede ser un retraso psicomotor en loa lactantes, por lo que el diagnóstico precoz puede prevenir el deterioro neurocognitivo, evitando la aparición de secuelas neurológicas. Se presentan 2 casos de hipopituitarismo, diagnosticados a raíz de la presencia de retraso psicomotor en periodo de lactante: Caso 1 Recién nacida mujer a término, controlada por aumento craneal del diámetro biparietal y ventriculomegalia de ventrículos laterales con colpocefalia, sin signos de hipertensión intracraneal. Con 20 meses persiste ausencia de bipedestación y lenguaje; estudio analítico neurometabólico, carga viral de citomegalovirus, electroencefalograma, potenciales evocados auditivos, fondo de ojo, cariotipo y cribado neonatal normal. A los 21 meses presenta longitud de 70, 3 cm (–4, 8 DE) y peso de 6, 9 kg (–3, 71 DE), baja velocidad de crecimiento y estudio analítico hormonal compatible con déficit de hormona de crecimiento (GH), con el resto de estudios, incluido el tiroideo, normal. En el estudio genético arrays-CGH se detecta una deleción 1q25.2, asociado a haploinsuficiencia del gen LHX4..

Estudio de carcinoma medular de tiroides a partir de un caso índice

El carcinoma de tiroides es un tumor infrecuente; constituye menos del 1% de las neoplasias malignas en la población general y el 0, 5%-3% en la edad pediátrica. Existen cuatro tipos: papilar (80%-90% de los casos), folicular (5%-10%), medular (5%) y anaplásico (2%-3%). En el tipo medular, el 80% son esporádicos, y un 20% se asocia a un síndrome hereditario que se divide, fundamentalmente, en tres grupos: neoplasia endócrina múltiple 1, neoplasia endócrina múltiple 2 y carcinoma medular de tiroides familiar. Las formas hereditarias se producen por una mutación en el protooncogén RET, localizado en el brazo largo del cromosoma 10. Se presenta un caso de carcinoma medular de tiroides detectado a raíz de un estudio genético familiar con el propósito de resaltar la importancia del diagnóstico precoz y la intervención de equipos multidisciplinares expertos en esta patología para su manejo y seguimiento. Thyroid cancer is an uncommon type of cancer, accounting less than 1% of all cancers in adults, and 0.5-3% of all cancers in children. There are four different types: papillary carcinoma (80-90% of cases), follicular (5-10%), medullary (5%) and anaplastic cell (2-3%). Eighty per cent of cases of medullary thyroid cancer are sporadic, but 20% are associated with an inherited syndrome that is divided into three groups: multiple endocrine neoplasia type 1, multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma. The inherited forms are caused by a disruption in the RET oncogene, which is located in the long arm of chromosome 10. A hereditary case of medullary thyroid carcinoma is presented. It was detected because of a familial genetic study. The purpose of the paper is emphasize the importance of the early diagnosis and the intervention of multidisciplinary teams of experts

The GW Vir instability strip in the light of new observations of PG 1159 stars. Discovery of pulsations in the central star of Abell 72 and variability of RX J0122.9-7521

We present the results of new time series photometric observations of 29 pre-white dwarf stars of PG 1159 spectral type, carried out in the years 2014-2022. For the majority of stars, a median noise level in Fourier amplitude spectra of 0.5-1.0 mmag was achieved. This allowed the detection of pulsations in the central star of planetary nebula Abell 72, consistent with g-modes excited in GW Vir stars, and variability in RX J0122.9-7521 that could be due to pulsations, binarity or rotation. For the remaining stars from the sample that were not observed to vary, we placed upper limits for variability. After combination with literature data, our results place the fraction of pulsating PG 1159 stars within the GW Vir instability strip at 36%. An updated list of all known PG 1159 stars is provided, containing astrometric measurements from the recent Gaia DR3 data, as well as information on physical parameters, variability, and nitrogen content. Those data are used to calculate luminosities for all PG 1159 stars to place the whole sample on the theoretical Hertzsprung-Russell diagram for the first time in that way. The pulsating stars are discussed as a group, and arguments are given that the traditional separation of GW Vir pulsators in "DOV" and "PNNV" stars is misleading and should not be used.Comment: Accepted for publication in ApJ