Traumatismo de la fisis distal de la tibia: tratamiento y resultados

Hemos realizado un estudio retrospectivo de 206 fracturas fisiarias distales de tibia. Se excluyeron las lesiones fisiarias aisladas de peroné y los arrancamientos óseos de tibia o peroné sin afectación de la placa fisiaria. Se recopilaron variables de 199 casos relativas al diagnóstico, tratamiento y evolución. La clasificación utilizada fue la de Salter y Harris para los traumatismos fisiarios. El tiempo de seguimiento medio fue de 7,73 meses (rango de 1,36 a 126 meses). Se trataba de 115 varones y 84 hembras. El tipo más frecuente fue el II (n=82, 41,2%). La media de edad fue de 12,1 ± 2,6 años. La causa más frecuente fue el accidente casual. Se realizó tratamiento conservador en 121 casos (60,8%). Los resultados se valoraron en función de las complicaciones aparecidas. En 169 casos (90,7%) el resultado fue satisfactorio, encontrando sólo 17 casos (9,3%) de malos resultados por presentar desalineación de los ejes (de 5 o más grados) y/o acortamiento (de 1 cm o más). Se presentó malposición en 9 casos (12%) en el tipo II, 4 casos (10,8%) en el tipo III, 1 caso (4%) en el tipo IV y 3 casos (100%) en el tipo V. La relación entre el grado de reducción obtenido y aparición de malposición sólo presentó diferencias significativas en los casos aparecidos del tipo II. La aparición de alteraciones de crecimiento en los tipos III y IV suele tener poca trascendencia clínica por ocurrir en pacientes con cartílagos en fase avanzada de cierre, no así en el tipo II donde pueden estar asociadas lesiones de tipo V, aconsejando realizar reducciones mediante maniobras cuidadosas para intentar evitar alteraciones.This is a retrospective study of 206 physeal fractures of the distal tibia. Isolated physeal injuries to the fibula and dislocations of the tibia or fibula without involvement of the growth plate were excluded. Variables from 199 cases relative to the diagnosis, treatment and evolution were recorded. The Salter-Harris classification was used for physeal fractures. The mean follow-up period was 7.73 months (range: 1.36 to 126 months), and 115 male and 84 female patients were treated. The most frequented type of fracture was type II (n=82, 41.2%). The mean age of the patients was 12.1 ± 2.6 years. The most frequented cause of injury was accident. In 121 cases (60.8%) the injury was treated conservatively. The results were evaluated in terms of subsequent complications. In 169 cases (90.7%) the results were satisfactory, and in only 17 cases (9.3%) the results were poor as a consequence of misalignment of the axes (5 or more degrees) and/or shortening (1 cm or more). Misalignment was found in 9 cases (12%) of type II, 4 cases (10.8%) of type III, 1 case (4%) of type IV and 3 cases (100%) of type V. The correlation between the degree of reduction obtained and the appearance of misalignment was statistically significant only in the cases of type II fracture. The appearance of growth disturbance in type III and type IV fractures is usually of minor clinical importance because it occurs in patients whose cartilage is at an advanced stage of closure, unlike type II fractures, which may be associated with type V injuries. In these cases reduction must be performed with special care in order to avoid growth disturbance

Exploring the Immunogenicity of Noncanonical HLA-I Tumor Ligands Identified through Proteogenomics

Purpose: Tumor antigens are central to antitumor immunity. Recent evidence suggests that peptides from noncanonical (nonC) aberrantly translated proteins can be presented on HLA-I by tumor cells. Here, we investigated the immunogenicity of nonC tumor HLA-I ligands (nonC-TL) to better understand their contribution to cancer immunosurveillance and their therapeutic applicability. Experimental Design: Peptides presented on HLA-I were iden-tified in 9 patient-derived tumor cell lines from melanoma, gyneco-logic, and head and neck cancer through proteogenomics. A total of 507 candidate tumor antigens, including nonC-TL, neoantigens, cancer-germline, or melanocyte differentiation antigens, were tested for T-cell recognition of preexisting responses in patients with cancer. Donor peripheral blood lymphocytes (PBL) were in vitro sensitized against 170 selected nonC-TL to isolate antigen-specific T-cell recep-tors (TCR) and evaluate their therapeutic potential.Rudolf Virchow Center, Center for Integrative and Transla- tional Bioimaging, Julius-Maximilians-University Wueurorzburg, Wueurorzburg, German

Adult Prevalence of Epilepsy in Spain: EPIBERIA, a Population-Based Study

Background. This study assesses the lifetime and active prevalence of epilepsy in Spain in people older than 18 years. Methods. EPIBERIA is a population-based epidemiological study of epilepsy prevalence using data from three representative Spanish regions (health districts in Zaragoza, Almería, and Seville) between 2012 and 2013. The study consisted of two phases: screening and confirmation. Participants completed a previously validated questionnaire (EPIBERIA questionnaire) over the telephone. Results. A total of 1741 valid questionnaires were obtained, including 261 (14.99%) raising a suspicion of epilepsy. Of these suspected cases, 216 (82.75%) agreed to participate in phase 2. Of the phase 2 participants, 22 met the International League Against Epilepsy’s diagnostic criteria for epilepsy. The estimated lifetime prevalence, adjusted by age and sex per 1,000 people, was 14.87 (95% CI: 9.8–21.9). Active prevalence was 5.79 (95% CI: 2.8–10.6). No significant age, sex, or regional differences in prevalence were detected. Conclusions. EPIBERIA provides the most accurate estimate of epilepsy prevalence in the Mediterranean region based on its original methodology and its adherence to ILAE recommendations. We highlight that the lifetime prevalence and inactive epilepsy prevalence figures observed here were compared to other epidemiological studies

Characterizing the invasive tumor front of aggressive uterine adenocarcinoma and leiomyosarcoma

The invasive tumor front (the tumor-host interface) is vitally important in malignant cell progression and metastasis. Tumor cell interactions with resident and infiltrating host cells and with the surrounding extracellular matrix and secreted factors ultimately determine the fate of the tumor. Herein we focus on the invasive tumor front, making an in-depth characterization of reticular fiber scaffolding, infiltrating immune cells, gene expression, and epigenetic profiles of classified aggressive primary uterine adenocarcinomas (24 patients) and leiomyosarcomas (11 patients). Sections of formalin-fixed samples before and after microdissection were scanned and studied. Reticular fiber architecture and immune cell infiltration were analyzed by automatized algorithms in colocalized regions of interest. Despite morphometric resemblance between reticular fibers and high presence of macrophages, we found some variance in other immune cell populations and distinctive gene expression and cell adhesion-related methylation signatures. Although no evident overall differences in immune response were detected at the gene expression and methylation level, impaired antimicrobial humoral response might be involved in uterine leiomyosarcoma spread. Similarities found at the invasive tumor front of uterine adenocarcinomas and leiomyosarcomas could facilitate the use of common biomarkers and therapies. Furthermore, molecular and architectural characterization of the invasive front of uterine malignancies may provide additional prognostic information beyond established prognostic factors

The Variant rs1867277 in FOXE1 Gene Confers Thyroid Cancer Susceptibility through the Recruitment of USF1/USF2 Transcription Factors

In order to identify genetic factors related to thyroid cancer susceptibility, we adopted a candidate gene approach. We studied tag- and putative functional SNPs in genes involved in thyroid cell differentiation and proliferation, and in genes found to be differentially expressed in thyroid carcinoma. A total of 768 SNPs in 97 genes were genotyped in a Spanish series of 615 cases and 525 controls, the former comprising the largest collection of patients with this pathology from a single population studied to date. SNPs in an LD block spanning the entire FOXE1 gene showed the strongest evidence of association with papillary thyroid carcinoma susceptibility. This association was validated in a second stage of the study that included an independent Italian series of 482 patients and 532 controls. The strongest association results were observed for rs1867277 (OR[per-allele] = 1.49; 95%CI = 1.30–1.70; P = 5.9×10−9). Functional assays of rs1867277 (NM_004473.3:c.−283G>A) within the FOXE1 5′ UTR suggested that this variant affects FOXE1 transcription. DNA-binding assays demonstrated that, exclusively, the sequence containing the A allele recruited the USF1/USF2 transcription factors, while both alleles formed a complex in which DREAM/CREB/αCREM participated. Transfection studies showed an allele-dependent transcriptional regulation of FOXE1. We propose a FOXE1 regulation model dependent on the rs1867277 genotype, indicating that this SNP is a causal variant in thyroid cancer susceptibility. Our results constitute the first functional explanation for an association identified by a GWAS and thereby elucidate a mechanism of thyroid cancer susceptibility. They also attest to the efficacy of candidate gene approaches in the GWAS era

Amyloid PET as a marker of normal-appearing white matter early damage in multiple sclerosis: correlation with CSF β-amyloid levels and brain volumes

PURPOSE The disease course of multiple sclerosis (MS) is unpredictable, and reliable prognostic biomarkers are needed. Positron emission tomography (PET) with β-amyloid tracers is a promising tool for evaluating white matter (WM) damage and repair. Our aim was to investigate amyloid uptake in damaged (DWM) and normal-appearing WM (NAWM) of MS patients, and to evaluate possible correlations between cerebrospinal fluid (CSF) β-amyloid (Aβ) levels, amyloid tracer uptake, and brain volumes. METHODS Twelve MS patients were recruited and divided according to their disease activity into active and non-active groups. All participants underwent neurological examination, neuropsychological testing, lumbar puncture, brain magnetic resonance (MRI) imaging, and F-florbetapir PET. Aβ levels were determined in CSF samples from all patients. MRI and PET images were co-registered, and mean standardized uptake values (SUV) were calculated for each patient in the NAWM and in the DWM. To calculate brain volumes, brain segmentation was performed using statistical parametric mapping software. Nonparametric statistical analyses for between-group comparisons and regression analyses were conducted. RESULTS We found a lower SUV in DWM compared to NAWM (p < 0.001) in all patients. Decreased NAWM-SUV was observed in the active compared to non-active group (p < 0.05). Considering only active patients, NAWM volume correlated with NAWM-SUV (p = 0.01). Interestingly, CSF Aβ concentration was a predictor of both NAWM-SUV (r = 0.79; p = 0.01) and NAWM volume (r = 0.81, p = 0.01). CONCLUSIONS The correlation between CSF Aβ levels and NAWM-SUV suggests that the predictive role of β-amyloid may be linked to early myelin damage and may reflect disease activity and clinical progression

Primary progressive aphasia: a clinical approach

This work was supported by the Alzheimer’s Society (AS-PG-16-007), the National Institute for Health Research University College London Hospitals Biomedical Research Centre and the UCL Leonard Wolfson Experimental Neurology Centre (PR/ylr/18575). Individual authors were supported by the Leonard Wolfson Foundation (Clinical Research Fellowship to CRM), the National Institute for Health Research (NIHR Doctoral Training Fellowship to AV), the National Brain Appeal–Frontotemporal Dementia Research Fund (CNC) and the Medical Research Council (PhD Studentships to CJDH and RLB, MRC Research Training Fellowship to PDF, MRC Clinician Scientist to JDR). MNR and NCF are NIHR Senior Investigators. SJC is supported by Grants from ESRC-NIHR (ES/L001810/1), EPSRC (EP/M006093/1) and Wellcome Trust (200783). JDW was supported by a Wellcome Trust Senior Research Fellowship in Clinical Science (091673/Z/10/Z)

Estudio piloto de un nuevo método de estimulación aritmética empleando el ábaco en ancianos sanos y con trastorno cognitivo

Resumen: Introducción: El objetivo del estudio fue evaluar la aplicabilidad de un método de estimulación cognitiva basado en la aritmética mediante el uso del ábaco en población anciana sana y con deterioro cognitivo. Métodos: Estudio observacional, prospectivo, realizado en 2 centros, en que se evaluó la aplicabilidad de una versión desarrollada para población anciana de un programa de estimulación cognitiva aritmético. El objetivo principal del estudio fue valorar la usabilidad, la satisfacción y el cumplimiento del programa de estimulación en población sana, pacientes con deterioro cognitivo leve amnésico y enfermedad de Alzheimer. Asimismo, como objetivos secundarios, se evaluaron la satisfacción del familiar, la sobrecarga del cuidador y la cognición y la conducta de los pacientes. Resultados: La usabilidad, la satisfacción y el grado de participación fueron elevados. Se observaron cambios significativos en Mini-mental State Examination (23,1 ± 4,8 antes de la intervención vs. 24,9 ± 4,2 después, p = 0,002), mientras que no se observaron diferencias significativas en TMT-A y B, escala de depresión geriátrica de Yesavage y la escala de sobrecarga del cuidador de Zarit. Conclusiones: El estudio indica que la estimulación cognitiva aritmética mediante ábaco es aplicable a los sujetos ancianos, con y sin deterioro cognitivo. Se necesitan futuros estudios que evalúen la eficacia del tratamiento. Abstract: Background: This study explores the applicability of a cognitive stimulation method based on abacus arithmetic in elderly people with and without cognitive impairment. Methods: This observational and prospective pilot study was performed in 2 hospitals. The study assessed the applicability of a programme of arithmetic training developed for use in the elderly population. The primary endpoint was an evaluation of the stimulation programme, in terms of usability, satisfaction, and participation, in healthy elderly controls and elderly patients with mild cognitive impairment or Alzheimer disease. Secondary endpoints were family satisfaction, caregiver burden, and the behaviour and cognition of patients. Results: Usability, satisfaction, and degree of participation were high. The Mini-Mental State Examination showed significant changes (23.1 ± 4.8 before the intervention vs 24.9 ± 4.2 afterwards, P=.002); there were no changes on the Trail Making Test parts A and B, Yesavage Geriatric Depression scale, and Zarit caregiver burden scale. Conclusions: The study suggests that cognitive stimulation with abacus arithmetic may be used in elderly people with and without cognitive impairment. Further studies will be needed to evaluate the efficacy of this kind of programmes. Palabras clave: Estimulación cognitiva, Terapias no farmacológicas, Ábaco, Demencia, Enfermedad de Alzheimer, Keywords: Cognitive stimulation, Non-pharmacological therapies, Abacus, Dementia, Alzheimer diseas

A pilot study of a new method of cognitive stimulation using abacus arithmetic in healthy and cognitively impaired elderly subjects

Background: This study explores the applicability of a cognitive stimulation method based on abacus arithmetic in elderly people with and without cognitive impairment. Methods: This observational and prospective pilot study was performed in 2 hospitals. The study assessed the applicability of a programme of arithmetic training developed for use in the elderly population. The primary endpoint was an evaluation of the stimulation programme, in terms of usability, satisfaction, and participation in healthy elderly controls and elderly patients with mild cognitive impairment or Alzheimer disease. Secondary endpoints were family satisfaction, caregiver burden, and the behaviour and cognition of patients. Results: Usability, satisfaction, and degree of participation were high. The Mini-Mental State Examination showed significant changes (23.1 ± 4.8 before the intervention vs 24.9 ± 4.2 afterwards, P = .002); there were no changes on the Trail Making Test parts A and B, Yesavage Geriatric Depression scale, and Zarit caregiver burden scale. Conclusions: The study suggests that cognitive stimulation with abacus arithmetic may be used in elderly people with and without cognitive impairment. Further studies will be needed to evaluate the efficacy of this kind of programmes. Resumen: Introducción: El objetivo del estudio fue evaluar la aplicabilidad de un método de estimulación cognitiva basado en la aritmética mediante el uso del ábaco en población anciana sana y con deterioro cognitivo. Métodos: Estudio observacional, prospectivo, realizado en 2 centros, en que se evaluó la aplicabilidad de una versión desarrollada para población anciana de un programa de estimulación cognitiva aritmética. El objetivo principal del estudio fue valorar la usabilidad, la satisfacción y el cumplimiento del programa de estimulación en población sana, pacientes con deterioro cognitivo leve amnésico y enfermedad de Alzheimer. Asimismo, como objetivos secundarios, se evaluaron la satisfacción del familiar, la sobrecarga del cuidador y la cognición y la conducta de los pacientes. Resultados: La usabilidad, la satisfacción y el grado de participación fueron elevados. Se observaron cambios significativos en Mini-mental State Examination (23,1 ± 4,8 antes de la intervención vs. 24,9 ± 4,2 después, p = 0,002), mientras que no se observaron diferencias significativas en TMT-A y B, escala de depresión geriátrica de Yesavage y la escala de sobrecarga del cuidador de Zarit. Conclusiones: El estudio indica que la estimulación cognitiva aritmética mediante ábaco es aplicable a los sujetos ancianos, con y sin deterioro cognitivo. Se necesitan futuros estudios que evalúen la eficacia del tratamiento. Keywords: Cognitive stimulation, Non-pharmacological therapies, Abacus, Dementia, Alzheimer disease, Palabras clave: Estimulación cognitiva, Terapias no farmacológicas, Ábaco, Demencia, Enfermedad de Alzheime