Fracturas peritrocantéricas tratadas con el clavo proximal de fémur: Técnica y resultados

El Clavo Proximal de Fémur (PFN: Proximal Femoral Nail) es un sistema de osteosíntesis desarrollado por la AO/ASIF para el tratamiento quirúrgico de las fracturas de la región trocantérea del fémur y que se basa en los principios del enclavado endomedular a cielo cerrado. Se presenta un estudio prospectivo sobre 175 fracturas de cadera tratadas con P.F.N. en nuestro servicio, con un seguimiento mínimo exigido de 1 año. El 74,3% de los casos correspondieron a mujeres y el resto a hombres. La edad media fue de 81,87 años. Las fracturas se han clasificado según la AO, siendo el subtipo más frecuentemente registrado el A2. Se realizaron controles clínicos y radiológicos a los 1, 3, 6 y 12 meses. El sistema ha permitido la movilización y la deambulación precoz en la mayoría de nuestros pacientes, al igual que la consolidación de las fracturas en un tiempo aceptable (12 semanas de media). Se analizan los resultados y las diversas complicaciones registradas, así como la capacidad de recuperación de la capacidad funcional previa. El PFN se revela como un buen sistema de osteosíntesis para las fracturas de la región trocantérea del fémur, permitiendo una carga precoz que favorece la consolidación ósea. La técnica quirúrgica no es compleja, la tasa de complicaciones técnicas registradas es aceptable y los resultados globales obtenidos son equiparables e incluso superiores, en determinados aspectos, a los obtenidos con otros sistemas de osteosíntesis disponibles en el mercado para el tratamiento de este tipo de fracturas.The PFN ("proximal femoral nail") is an osteosynthesis system developed by the AO/ASIF group for the surgical treatment of fractures of the trochanteric region of the femur, which is based on the principles of closed endomedullary nailing. A prospective study of 175 hip fractures treated with the PFN is presented, with a minimum follow-up of 1 year. 74,3% of the patients were female, the rest male. The average age was 81,87 years. Fractures were classified according to the AO system, the most common sub-type recorded being the A2. Clinical and radiographic evaluations were performed at 1, 3, 6 and 12 months. The system allowed early mobilisation and walking in the majority of our patients, along with fracture consolidation in an acceptable time period (12 weeks on average). The results and the various complications recorded are analysed. The ability to recover previous walking ability was also studied. The PFN emerges as a good system of osteosynthesis for fractures of the trochanteric region of the femur, allowing early weight-bearing which favours bone consolidation. The surgical technique is not complex, the number of complications recorded is acceptable and the overall results obtained are comparable and even superior to those obtained with other osteosynthesis systems available on the market for treatment of this type of fracture

Molecular and cellular responses of the pathogenic fungus Lomentospora prolificans to the antifungal drug voriconazole

The filamentous fungus Lomentospora (Scedosporium) prolificans is an emerging opportunistic pathogen associated with fatal infections in patients with disturbed immune function. Unfortunately, conventional therapies are hardly of any use against this fungus due to its intrinsic resistance. Therefore, we performed an integrated study of the L. prolificans responses to the first option to treat these mycoses, namely voriconazole, with the aim of unveiling mechanisms involved in the resistance to this compound. To do that, we used a wide range of techniques, including fluorescence and electron microscopy to study morphological alterations, ion chromatography to measure changes in cell-wall carbohydrate composition, and proteomics-based techniques to identify the proteins differentially expressed under the presence of the drug. Significantly, we showed drastic changes occurring in cell shape after voriconazole exposure, L. prolificans hyphae being shorter and wider than under control conditions. Interestingly, we proved that the architecture and carbohydrate composition of the cell wall had been modified in the presence of the drug. Specifically, L. prolificans constructed a more complex organelle with a higher presence of glucans and mannans. In addition to this, we identified several differentially expressed proteins, including Srp1 and heat shock protein 70 (Hsp70), as the most overexpressed under voriconazole-induced stress conditions. The mechanisms described in this study, which may be directly related to L. prolificans antifungal resistance or tolerance, could be used as targets to improve existing therapies or to develop new ones in order to successfully eliminate these mycoses.This work has been supported by grants (GIU15/36 and UFI11/25) from the UPV/EHU. AP was supported by a predoctoral fellowship from the UPV/EHU, and IB and AA were supported by predoctoral fellowships from the Basque Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Indicadores de innovación y productividad en unidades de producción agrícola familiar: sur de México

Innovation is an opportunity to improve productivity and to achieve the development of marginalized communities. The objective of this study was to analyze the effect of innovation and productivity factors on the development of family farms (FFs) from marginalized localities in southern Mexico, under the systems approach. The study was non-experimental trans-sectional with a mixed approach and random stratified sampling. The indicator that interacted most with others was the farmer’s profile, defined by the type of crop in the FF that was independent of the locality, through the Kruskal-Wallis test (c2, 0.05) and Spearman’s correlation coefficient. Results show that FFs with greenhouse tomato innovate the most and generate greater economic satisfaction to the human factor, because of the productive system they implement. The interaction of factors implies the inexistence of knowledge that is strictly from the communities, since innovating and improving production requires a combination of influences, a type of crop and its aim, with the active participation of the farmer.La innovación es una oportunidad para mejorar la productividad y lograr el desarrollo de comunidades margi­nadas. El objetivo fue analizar el efecto de factores de innovación y productividad en el desarrollo de unidades de producción agrícola familiar (UPAF) de localidades marginadas del sur de México, bajo el enfoque de sistemas. La investigación fue de tipo no experimental trans-seccional con enfoque mixto, y muestreo estratificado aleatorio. El indicador que más interactuó con otros, fue el perfil del productor, definido por el tipo de cultivo de la UPAF que resultó independiente de la localidad, por medio de la prueba de Kruskal-Wallis (c2, 0.05) y el coeficiente de correlación de Spearman. Resultando las UPAF con jitomate en invernadero, las que más inno­van y generan mayor satisfacción económica al factor humano, por el sistema productivo que implementan. La interacción de factores implica la inexistencia de conocimiento que sea estrictamente de las comunidades. Ya que innovar y mejorar productivamente requiere una combinación de influencias, un tipo de cultivo y el fin del mismo, con la participación activa del productor

Cyclophilin and enolase are the most prevalent conidial antigens of Lomentospora prolificans recognized by healthy human salivary IgA and cross-react with Aspergillus fumigatus

Purpose: The study of the immunocompetent airways immune response may provide important information to improve the therapeutic efficacy against Lomentospora (Scedosporium) prolificans. So, this study aimed to identify the most prevalent conidial antigens of this multiresistant fungus recognized by healthy human salivary immunoglobulin A, and to study their expression and cross-reactivity with other fungal species. Experimental design: Twenty saliva from immunocompetent donors were used to detect and identify the immunoreactive proteins by 2D immunoblotting and LC-MS/MS. Moreover, anti-Aspergillus antibodies were purified to study their cross-reactivity. Results: Ten proteins of L. prolificans conidia showed reactivity with more than 50% of the saliva samples. Among them, cyclophilin and enolase were the most prevalent antigens recognized by 85 and 80% of the samples, respectively. These enzymes were also identified on the cell wall surface of L. prolificans and on the immunomes of Scedosporium apiospermum and Scedosporium aurantiacum. Additionally, they showed cross-reactivity with the most common pathogenic filamentous fungus Aspergillus fumigatus. Conclusion and clinical relevance: These results show that the immunocompetent immune response might offer a pan-fungal recognition of conserved antigens such as enolase and cyclophilins, making them potential candidates for study as therapeutic targets.This work has been partially supported by several grants (EHUA13/14, UFI11/25, GIU15/36) from the University of the Basque Country (UPV/EHU). I. B. and A. A. were supported by a fellowship from the Basque Government, and Aize Pellon was supported by a fellowship from the UPV/EHU

The Experience With Health Care of Patients With Inflammatory Arthritis: A Cross-sectional Survey Using the Instrument to Evaluate the Experience of Patients With Chronic Diseases

[Abstract] Background: Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care-related factors. Methods: Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care-related characteristics that may affect patients' experience. Results: A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions: This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care

The Host Immune Response to Scedosporium/Lomentospora

Infections caused by the opportunistic pathogens Scedosporium/Lomentospora are on the rise. This causes problems in the clinic due to the difficulty in diagnosing and treating them. This review collates information published on immune response against these fungi, since an understanding of the mechanisms involved is of great interest in developing more effective strategies against them. Scedosporium/Lomentospora cell wall components, including peptidorhamnomannans (PRMs), α-glucans and glucosylceramides, are important immune response activators following their recognition by TLR2, TLR4 and Dectin-1 and through receptors that are yet unknown. After recognition, cytokine synthesis and antifungal activity of different phagocytes and epithelial cells is species-specific, highlighting the poor response by microglial cells against L. prolificans. Moreover, a great number of Scedosporium/Lomentospora antigens have been identified, most notably catalase, PRM and Hsp70 for their potential medical applicability. Against host immune response, these fungi contain evasion mechanisms, inducing host non-protective response, masking fungal molecular patterns, destructing host defense proteins and decreasing oxidative killing. In conclusion, although many advances have been made, many aspects remain to be elucidated and more research is necessary to shed light on the immune response to Scedosporium/Lomentospora.This research was funded by the Basque Government, grant number IT1362-19. L.M.-S., M.A., and L.A.-F. were funded by the Basque Government

Modeling and Simulation of Temperature and Relative Humidity Inside a Growth Chamber

Modeling and simulation of internal variables such as temperature and relative humidity are relevant for designing future climate control systems. In this paper, a mathematical model is proposed to predict the internal variables temperature and relative humidity (RH) of a growth chamber (GCH). Both variables are incorporated in a set of first-order differential equations, considering an energy-mass balance. The results of the model are compared and assessed in terms of the coefficients of determination (R2) and the root mean squared error (RMSE). The R2 and RMSE computed were R2 = 0.96, R2 = 0.94, RMSE = 0.98 C, and RMSE = 1.08 C, respectively, for the temperature during two consecutive weeks; and R2 = 0.83, R2 = 0.81, RMSE = 5.45%RH, and RMSE = 5.48%RH, respectively, for the relative humidity during the same period. Thanks to the passive systems used to control internal conditions, the growth chamber gives average differences between inside and outside of +0.34 C for temperature, and +15.7%RH for humidity without any climate control system. Operating, the GCH proposed in this paper produces 3.5 kg of wet hydroponic green forage (HGF) for each kilogram of seed (corn or barley) harvested on average

ELISA Test for the Serological Detection of Scedosporium/Lomentospora in Cystic Fibrosis Patients

The detection and diagnosis of the opportunistic fungi Scedosporium spp. and Lomentospora prolificans still relies mainly on low-sensitive culture-based methods. This fact is especially worrying in Cystic Fibrosis (CF) patients in whom these fungal species are frequently isolated and may increase the risk of suffering from an infection or other health problems. Therefore, with the purpose of developing a serologic detection method for Scedosporium/Lomentospora, four different Scedosporium boydii protein extracts (whole cell protein extract, secretome, total cell surface and conidial surface associated proteins) were studied by ELISA to select the most useful for IgG detection in sera from CF patients. The four extracts were able to discriminate the Scedosporium/Lomentospora-infected from Aspergillus-infected and non-infected patients. However, the whole cell protein extract was the one selected, as it was the one with the highest output in terms of protein concentration per ml of fungal culture used, and its discriminatory capacity was the best. The ELISA test developed was then assayed with 212 sera from CF patients and it showed to be able to detect Scedosporium spp. and Lomentospora prolificans with very high sensitivity and specificity, 86%-100% and 93%-99%, respectively, depending on the cut-off value chosen (four values were proposed A(450nm)= 0.5837, A(450nm)= 0.6042, A(450nm)= 0.6404, and A(450nm)= 0.7099). Thus, although more research is needed to reach a standardized method, this ELISA platform offers a rapid, low-cost and easy solution to detect these elusive fungi through minimally invasive sampling, allowing the monitoring of the humoral response to fungal presenceThis research was funded by the Basque Government, grant number IT1362-19. IB, LM-S, and LA-F received a predoctoral fellowship from the Basque Government. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the result

The monoclonal antibody Ca37, developed against Candida albicans alcohol dehydrogenase, inhibits the yeast in vitro and in vivo

Candida albicans is a commensal yeast able to cause life threatening invasive infections particularly in immunocompromised patients. Despite the availability of antifungal treatments, mortality rates are still unacceptably high and drug resistance is increasing. We, therefore, generated the Ca37 monoclonal antibody against the C. albicans alcohol dehydrogenase (Adh) 1. Our data showed that Ca37 was able to detect C. albicans cells, and it bound to Adh1 in yeast and Adh2 in hyphae among the cell wall-associated proteins. Moreover, Ca37 was able to inhibit candidal growth following 18h incubation time and reduced the minimal inhibitory concentration of amphotericin B or fluconazole when used in combination with those antifungals. In addition, the antibody prolonged the survival of C. albicans infected-Galleria mellonella larvae, when C. albicans was exposed to antibody prior to inoculating G. mellonella or by direct application as a therapeutic agent on infected larvae. In conclusion, the Ca37 monoclonal antibody proved to be effective against C. albicans, both in vitro and in vivo, and to act together with antifungal drugs, suggesting Adh proteins could be interesting therapeutic targets against this pathogen.Technical and human support provided by the Proteomics Core Facility-SGIker at the UPV/EHU is gratefully acknowledged. We thank the member of the Chartered of Linguists, No 022913 for improving the English in the manuscript. This work was supported by Basque Government (Grant IT1362-19). AA, IB and LMS have received a predoctoral Grant from Basque Government and LAF from UPV/EH

Blood donations and transfusions during the COVID-19 pandemic in Spain: Impact according to autonomous communities and hospitals

Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (−11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March–10 May). The reduction in the consumption of RBCs was significant in the period from 1–15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs