In vitro gastrointestinal digestion and simulated colonic fermentation of pistachio nuts determine bioaccesibility and biosynthesis of chronobiotics

Chronodisruption leads to obesity and other metabolic disorders that can be alleviated by food-derived potential chronobiotics, such as phytomelatonin (PMT), phenolic compounds (PCs) and dietary fiber rich pistachios. Pistachios with (PN + SC) or without (PN) the seed coat were investigated for their in vitro chronobiotic potential since they are one of the main reported PMT sources. Consequently we evaluated the bioaccessibility, permeability, and biosynthesis of pistachio chronobiotics, particularly PMT, during gastrointestinal and colonic fermentation. The maximum in vitro bioaccessibility and apparent permeability (efflux-prone) of PCs, flavonoids and PMT were sample-specific [∼1.3% (both), 27 and 3.4% (PN + SC)], but additional amounts (flavonoids > PCs > PMT) were released under simulated colonic conditions. Short-chain fatty acids (SCFAs; 38 mM; >50% butyrate, PN + SC > PN) and some metabolites (e.g., indole, benzaldehyde, phenolic acids, and aliphatic/aromatic hydrocarbons) were detected depending on the sample. The predominant pistachio butyrate production during in vitro colonic fermentation can improve chronodisruption and benefit obese individuals. Pistachio’s digestion increases the bioaccessibility and intestinal permeability of potential chronobiotics (PMT and PCs) and the biosynthesis of colonic metabolites (SCFAs, among others) also with chronobiotic potential

Closed reduction of fracture-dislocation of the sub-axial cervical spine with Gardner-Wells tongs. Technical note

Study design: Technical note. Purpose: To provide a technical description of the placement of Gardner-Wells tongs and the performance of awake cranio-cervical traction to reduce AO type C injuries of the sub-axial cervical spine with Gardner-Wells tongs. Methods: In this technical note, the authors present the indications, the contraindications, the pull-out of the pins, a detailed description of the technique for its proper placement, traction reduction technique, reduction maneuvers, complications and post-reduction care. Results: Awake reduction of AO type C injuries of the sub-axial cervical spine can be successfully performed using Gardner-Wells tongs. Conclusions: There is sufficient evidence to recommend the use of cranio-cervical traction in these vertebral injuries; however, we lack a detailed technical note to guide its proper placement

MULTIPLE VERTEBRAL FRACTURES AT THE “DR. MANUEL DUFOO” SPINE CLINIC

ABSTRACT Objective: To establish the frequency of presentation of multiple vertebral fractures and evaluate the relationship between the postsurgical condition and the initial neurological lesion, as well as to report the associated injuries in this group of patients. Methods: We conducted a review of patients with spinal trauma and a diagnosis of multiple vertebral fractures who were admitted to the “Dr. Manuel Dufoo Olvera” Spine Clinic of the Secretary of Health of Mexico City from January 1,2014 to June 30, 2017. The multiple fractures were classified as either contiguous or non-contiguous, according to the number of vertebral bodies and levels affected. The statistical analysis was conducted using formulas of descriptive statistics and the information was then tabulated and graphed to assess the relationship between the anatomical classification and the degree of neurological injury. Results: We observed 530 patients, of whom 47 met the criteria. Thirty-one (65.95%) of the cases corresponded to contiguous fractures and 16 cases (34.05%) to non-contiguous fractures. Fourteen patients (29.78%) with neurological integrity were classified as ASIA D, 20 patients (42.58%) with complete lesion as ASIA A, 7 seven patients (14.89%) as ASIA B, and 6 patients (12.76%) with partial injury as ASIA C. Conclusions: The correlation between the classification of vertebral injuries and the presence of neurological lesion did not show significant differences between contiguous and non-contiguous fractures. Level of Evidence II; Retrospective

Recomendaciones generales para mejorar la práctica de la ortopedia

Orthopedics is one of the specialties with more number of dissents received at CONAMED (National Medical Arbitration Commission of México). The cases related to this specialty were analyzed. Results: 28% of involved doctors didn�t have any board certification; deforming and degenerative were the main causes of application of service; the most frequent dissent reasons were delay of medical attention and delay or negation of diagnostics auxiliaries. The communication problems in the doctor-patient relationship reached 87.3% of the cases. The most outstanding deviation by frequency was a deficient diagnosis plan (40.9%). A group of prestigious specialist analyzed those results and emitted by Consensus these General Recommendations to improve the Practice of Orthopedics: 1) Have the board certification and re-certifications indispensable to exercise Orthopedics specialty, 2) Maintain appropriate medical communication with the patient and its responsible relative, 3) Assure the understanding and acceptance of the proposed diagnostic and therapeutic procedures, 4) Value the patient integrally, to structure diagnostic and establish treatments or opportune therapeutic measures, 5) Assure from the first contact the injured patient�s integral valuation, 6) Define and meditate with opportunity the handling for each case. They also emitted Specific Recommendations for the patient�s attention with Low Back Pain and with Sprain in extremities, because these were the most frequent sufferings found in the dissents.La Ortopedia es una de las especialidades con mayor número de inconformidades ante CONAMED. Se analizaron los casos relacionados a esta especialidad y se encontró que 28% de los médicos involucrados no contaban con ninguna certificación. Los padecimientos deformantes y degenerativos fueron las principales causas de solicitud de servicio. Los motivos de inconformidad más frecuentes fueron diferimiento de la atención, diferimiento y/o negación de auxiliares de diagnóstico. Los problemas de comunicación en la relación médico-paciente alcanzaron 87.3% de los casos. Se detectó que la desviación más relevante por frecuencia fue un protocolo de estudio deficiente (40.9%). Un grupo de prestigiados médicos especialistas analizó estos resultados y emitió por consenso las Recomendaciones Generales para mejorar la Práctica de la Ortopedia: 1) Contar con las certificación y recertificaciones indispensables para ejercer la especialidad de ortopedia, 2) Mantener comunicación médica adecuada con el paciente y su familiar responsable, 3) Asegurar la comprensión y la aceptación de los procedimientos diagnósticos y terapéuticos propuestos, 4) Valorar integralmente al paciente, estructurar diagnósticos y establecer tratamientos o medidas terapéuticas oportunas, 5) Asegurar desde el primer contacto la valoración integral del paciente lesionado, 6) Definir y reflexionar con oportunidad el manejo para cada caso. Emitieron también Recomendaciones Específicas para la atención del paciente con Lumbalgia y con Esguince en extremidades, pues estos fueron los padecimientos más frecuentes encontrados en las inconformidades