Lavado articular en el tratamiento de la artrosis de la rodilla: descripción de una nueva técnica y valoración de la eficacia y tolerancia de la misma

El Lavado Articular (LA) es una medida terapéutica utilizada para el tratamiento de la patología articular, sobre articulaciones accesibles y desarrollada fundamentalmente en la patología de rodilla. El efecto del LA ha sido estudiado en pocas indicaciones concretas: artritis séptica, artritis reumatoide, condrocalcinosis y artrosis. Los objetivos de esta tesis son: 1) Valorar la eficacia del LA en pacientes con patología osteoarticular de rodilla (artrosis, condrocalcinosis y artritis). 2) Comparar la eficacia de dos combinaciones terapéuticas postlavado (Ácido hialurónico y corticoides) frente al LA sólo, en tres situaciones patológicas: Artrosis, Artritis y Condrocalcinosis. 3)Valorar la tolerancia de la técnica y sus complicaciones durante la realización y periódicamente hasta un año después del LA. 4)Cuantificar el coste del procedimiento emplead

JURASSIC PALEONTOLOGICAL HERITAGE OF MURCIA (BETIC CORDILLERA, SOUTH-EASTERN SPAIN)

Jurassic rocks of the External and Internal Zones of the Betic Cordillera are widespread in the province of Murcia. Four areas are considered of special interest for stratigraphical and paleontological analysis: a) Sierra Quípar and b) Sierras Lúgar-Corque (External Subbetic), c) Sierra Ricote (Median Subbetic) and d) Sierra Espuña (Malaguide Complex). The first two contain Jurassic sections including Sinemurian-Tithonian deposits, and major stratigraphic discontinuities, containing significant cephalopod concentrations of taphonomic and taxonomic interest, occuring in the Lower-Upper Pliensbachian, Lower/Middle Jurassic and Middle/Upper Jurassic boundaries. These areas are also relevant for biostratigraphical analysis of the Middle-Upper Jurassic interval. In the Sierra de Ricote, the Mahoma section is of especial interest for the study of Lías/Dogger transition. Casa Chimeneas section constitutes the best Subbetic site for the analysis of the Lower/Upper Bajocian boundary. In the La Bermeja-Casas de Vite area, the Bajocian-Tithonian interval is well-represented, including a parastratotype of the Radiolarite Jarropa Formation. Finally, the Malvariche section in Sierra Espuña represents the best Jurassic succession of Internal Zones of the Betic Cordillera and could be considered as a reference section for this Betic Domain. In this paper a heritage evaluation has been carried out for these classical jurassic sections with the object of protecting these sites according to the legal framework prevailing in the province of Murcia

Modelos didácticos para el autoaprendizaje

Definir el exacto papel del profesor en el proceso de enseñanza-aprendizaje constituye un objetivo esencial en la estrategia docente de dicho proceso educativo. El trabajo realizado identifica y describe dos modelos didácticos (el autoaprendizaje por identificación inducida y el autoaprendizaje por coordinación lógica) implantados como modelos educativos en la enseñanza, en los que se define el papel del profesor en los ámbitos cognitivos y técnicos que se deben impulsar, al objeto de que el alumno alcance por sí mismo sus objetivos docentes.To define the specific role that the professor and teacher play in the teaching-learning process is one of the main goals of the educational strategy of the teaching-learning process. In this work, we have identified and described two different didactic models (self-learning by inducted identification and self-learning by logic coordination) that were implanted as educational models. Then, we define the role that the teacher plays in the cognitive and technical areas that must be implemented in order to help the student to reach his educational objectives.Financiado por: PID 08/2

NKG2D-CAR memory T cells target pediatric T-cell acute lymphoblastic leukemia in vitro and n vivo but fail to eliminate leukemiai nitiating cells

[Introduction]: Refractory/relapsed pediatric acute leukemia are still clinically challenging and new therapeutic strategies are needed. Interactions between Natural Killer Group 2D (NKG2D) receptor, expressed in cytotoxic immune cells, and its ligands (NKG2DL), which are upregulated in leukemic blasts, are important for anti-leukemia immunosurveillance. Nevertheless, leukemia cells may develop immunoescape strategies as NKG2DL shedding and/or downregulation. [Methods]: In this report, we analyzed the anti-leukemia activity of NKG2D chimeric antigen receptor (CAR) redirected memory (CD45RA-) T cells in vitro and in a murine model of T-cell acute lymphoblastic leukemia (T-ALL). We also explored in vitro how soluble NKG2DL (sNKG2DL) affected NKG2D-CAR T cells’ cytotoxicity and the impact of NKG2D-CAR T cells on Jurkat cells gene expression and in vivo functionality. [Results]: In vitro, we found NKG2D-CAR T cells targeted leukemia cells and showed resistance to the immunosuppressive effects exerted by sNKG2DL. In vivo, NKG2D-CAR T cells controlled T cell leukemia burden and increased survival of the treated mice but failed to cure the animals. After CAR T cell treatment, Jurkat cells upregulated genes related to proliferation, survival and stemness, and in vivo, they exhibited functional properties of leukemia initiating cells. [Discussion]: The data here presented suggest, that, in combination with other therapeutic approaches, NKG2D-CAR T cells could be a novel treatment for pediatric T-ALL.This work was supported by a grant from the Instituto de Salud Carlos III to LF PI21/01049, the II and V awards from UNOENTRECIENMIL Foundation, and a grant from CRIS FOUNDATION to Beat Cancer as part of the projects “Cell therapy based on NKG2D-CAR for pediatric leukemia” and “NKG2D-CAR as treatment for pediatric patients suffering from acute leukemia and juvenile myelomonocytic leukemia”. AF, MI-N, AN-Z and CF have been supported by Personnel research grants from CRIS Foundation to beat cancer. CM has been supported by Personnel PhD student grants from the Instituto de Salud Carlos III (ISCIII), PFIS (FI19/00176). MVG is funded by grant PID2021-123795OB-I00 from the Spanish Ministry of Science and Innovation [Ministerio de Ciencia e Innovación (MCIN)/Agencia Estatal de Investigación (AEI) / 10.13039/501100011033 and European Regional Development Fund (ERDF)-A way of making Europe] and belongs to cancer-Hub CSIC. MI lab is funded by grant PID2020-114148RB-I00 from the Spanish Ministry of Science and Innovation MCIN/AEI/10.13039/501100011033,which was in part granted with FEDER funding (EC)

NKG2D-CAR memory T cells target pediatric T-cell acute lymphoblastic leukemia in vitro and in vivo but fail to eliminate leukemia initiating cells

Introduction Refractory/relapsed pediatric acute leukemia are still clinically challenging and new therapeutic strategies are needed. Interactions between Natural Killer Group 2D (NKG2D) receptor, expressed in cytotoxic immune cells, and its ligands (NKG2DL), which are upregulated in leukemic blasts, are important for anti-leukemia immunosurveillance. Nevertheless, leukemia cells may develop immunoescape strategies as NKG2DL shedding and/or downregulation. Methods In this report, we analyzed the anti-leukemia activity of NKG2D chimeric antigen receptor (CAR) redirected memory (CD45RA ⁻ ) T cells in vitro and in a murine model of T-cell acute lymphoblastic leukemia (T-ALL). We also explored in vitro how soluble NKG2DL (sNKG2DL) affected NKG2D-CAR T cells’ cytotoxicity and the impact of NKG2D-CAR T cells on Jurkat cells gene expression and in vivo functionality. Results In vitro , we found NKG2D-CAR T cells targeted leukemia cells and showed resistance to the immunosuppressive effects exerted by sNKG2DL. In vivo , NKG2D-CAR T cells controlled T cell leukemia burden and increased survival of the treated mice but failed to cure the animals. After CAR T cell treatment, Jurkat cells upregulated genes related to proliferation, survival and stemness, and in vivo , they exhibited functional properties of leukemia initiating cells. Discussion The data here presented suggest, that, in combination with other therapeutic approaches, NKG2D-CAR T cells could be a novel treatment for pediatric T-ALL

Modelos didácticos para el autoaprendizaje

Definir el exacto papel del profesor en el proceso de enseñanza-aprendizaje constituye un objetivo esencial en la estrategia docente de dicho proceso educativo. El trabajo realizado identifica y describe dos modelos didácticos (el autoaprendizaje por identificación inducida y el autoaprendizaje por coordinación lógica) implantados como modelos educativos en la enseñanza, en los que se define el papel del profesor en los ámbitos cognitivos y técnicos que se deben impulsar, al objeto de que el alumno alcance por sí mismo sus objetivos docentes.To define the specific role that the professor and teacher play in the teaching-learning process is one of the main goals of the educational strategy of the teaching-learning process. In this work, we have identified and described two different didactic models (self-learning by inducted identification and self-learning by logic coordination) that were implanted as educational models. Then, we define the role that the teacher plays in the cognitive and technical areas that must be implemented in order to help the student to reach his educational objectives.Financiado por: PID 08/2

Community Acquired Spondylodiscitis caused by Escherichia Coli; Case Report and Literature Review

Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes

Local adaptation of recommendation-based materials for shared decision-making and management of comorbidity in rheumatoid arthritis

Objectives: To describe local adaptations of materials derived from evidence-based recommendations in a training programme in rheumatoid arthritis (RA). Methods: The eRA (evolving the management of rheumatoid arthritis) programme generated shared decision-making practises and a checklist for managing comorbidity in RA, among others, at the international level. Unmet needs in RA management were first identified and prioritised. Then educational materials were designed and developed to address these gaps. These materials were evaluated in detailed and discussed in small regional groups by practicing rheumatologists. Voting, open discussions and recommendations were extracted from the meetings. Results: Thirty-five Spanish rheumatologists discussed a comorbidity checklist and a shared decision-making tool. The results of the local meetings were synthesised as (1) a judicious commitment to check agreed comorbidities, and (2) a list of barriers and facilitators for the implementation of shared decision making in the local settings. With regards to ways to implement the agreed list and periodicity, two issues stand-out: (1) patient education and (2) the need of easy access to information and the use of local organisational systems in place. With respect to shared decision-making, issues raised included messages for self-awareness, challenges, and practical facilitators. Conclusions: Discussion, adaptation, and planning are needed before implementing any evidence-based recommendation and materials if we want to achieve a successful implementation. Further studies should demonstrate whether this initiative was successful in achieving the goals of improved patient care. Our experience could be used as a guidance or example for implementation elsewhere.Sin financiación4.862 JCR (2021) Q2, 15/34 Rheumatology1.123 SJR (2021) Q1, 15/61 RheumatologyNo data IDR 2020UE

Recomendaciones sobre el uso de metrotexato parenteral en reumatología

Sin financiaciónNo data JCR 20180.363 SJR (2018) Q3, 38/66 RheumatologyNo data IDR 2018UE

Recommendations for the use of parenteral methotrexate in rheumatology

Desarrollar recomendaciones sobre el uso de metrotexato (MTX) parenteral en pacientes con enfermedades reumáticas, fundamentalmente en la artritis reumatoide, basadas en la mejor evidencia y experiencia. Métodos Se seleccionó un grupo de 21 expertos reumatólogos en el manejo de MTX. El coordinador generó 13 preguntas sobre el uso de MTX parenteral (perfiles de indicación, eficacia, seguridad, costo-eficacia y biodisponibilidad) para ser contestadas mediante una revisión sistemática de la literatura. Con base en las preguntas se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda (en Medline, EMBASE y la Cochrane Library). Tres revisores seleccionaron los artículos resultantes de la búsqueda. Se generaron tablas de evidencia. Paralelamente se evaluaron abstracts de congresos de la European League Against Rheumatism (EULAR) y del American College of Rheumatology (ACR). Con toda esta evidencia el coordinador generó 13 recomendaciones preliminares que se evaluaron, discutieron y votaron en una reunión del grupo nominal con los expertos. Para cada recomendación se estableció el nivel de evidencia y grado de recomendación, y el grado de acuerdo mediante un Delphi. Se definió acuerdo si al menos el 80% de los participantes contestaron sí a la recomendación (sí o no). Resultados La mayoría de la evidencia proviene de la artritis reumatoide. De las 13 recomendaciones preliminares se aceptaron 11 recomendaciones sobre el uso de MTX parenteral en reumatología. Dos no se llegaron a votar y se decidió no incluirlas, pero se comentan en el texto final. Conclusiones Este documento pretende resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones con el uso de MTX parenteral.To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience. Methods A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). Results Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text. Conclusions The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.Sin financiaciónNo data JCR 20180.363 SJR (2018) Q3, 38/66 RheumatologyNo data IDR 2018UE