Infección protésica de cadera : recambio en dos tiempos en una serie de 50 casos

Chronic infection in hip replacement is an important complication with a complex treatment, that is solved by adequate antibiotic therapy together with single-stage exchange or two-stage exchange. We present a descriptiveand retrospective study of a series of 50 consecutive patients operated on in our center with a diagnosis of chronic infection of the hip prosthesis between 2007 and 2018 with a two-stage exchange.At a mean follow-up of 52 months, the overall implant survival was 89%, with a 91% infection cure rate. The most frequent microorganism isolated was Staphylococcus epidermidis. The mean score achieved on the HHS was 82,4 points and 1.67 points on the visual analogue scale. We obtained better functional results (p=0,021) in those patients who had a preformed antibiotic-loaded spacer in the first surgical stage.As complications, we recorded four cases of prosthetic reinfection (8,7%), three cases of dislocation (6,5%), and one case of postsurgical hematoma (4,6%).No case of neurovascular injury or component loosening was recorded.According to the showed results, we consider that two-stage revision procedure, although it is a demanding surgery, is an effective method for the treatment of periprosthetic hip infection, with high implant survival and erradication of the infection

Circulating clonotypic B cells in multiple myeloma and monoclonal gammopathy of undetermined significance

This is an open-access paper.The B-cell compartment in which multiple myeloma stem cells reside remains unclear. We investigated the potential presence of mature, surface-membrane immunoglobulin-positive B lymphocytes clonally related to the tumor bone marrow plasma cells among different subsets of peripheral blood B cells from ten patients (7 with multiple myeloma and 3 with monoclonal gammopathies of undetermined significance). The presence of clonotypic immunoglobulin heavy chain gene rearrangements was determined in multiple highly-purified fractions of peripheral blood B-lymphocytes including surface-membrane IgM+ CD27- naïve B-lymphocytes, plus surface-membrane IgG+, IgA+ and IgM+ memory CD27+ B cells, and normal circulating plasma cells, in addition to (mono)clonal plasma cells, by a highly-specific and sensitive allele-specific oligonucleotide polymerase chain reaction directed to the CDR3 sequence of the rearranged IGH gene of tumor plasma cells from individual patients. Our results showed systematic absence of clonotypic rearrangements in all the different B-cell subsets analyzed, including M-compo-nent isotype-matched memory B-lymphocytes, at frequencies <0.03 cells/mL (range: 0.0003-0.08 cells/mL); the only exception were the myeloma plasma cells detected and purified from the peripheral blood of four of the seven myeloma patients. These results indicate that circulating B cells from patients with multiple myeloma and monoclonal gammopathies of undetermined significance are usually devoid of clonotypic B cells while the presence of immunophenotypically aberrant myeloma plasma cells in peripheral blood of myeloma patients is a relatively frequent finding.This work was supported by grants from European Union FP6 STREP MSCNet (N. E06005FF), Cooperative Research Thematic Network on Cancer (RTICs; RTICC RD06/0020/0035-FEDER, RD06/0020/0006, RD12/0036/0048, RD12/0036/0069 and G03/136), Instituto de Salud Carlos III/Subdirección General de Investigación Sanitaria Ministerio de Sanidad y Consumo (FIS: PI060339; 02/0905; 01/0089/01-02;PS09/01897, and PI06/0824-FEDER), Asociacion Española Contra el Cancer AECC (GCB120981SAN) and Gerencia Regional de Salud de Castilla y León; Ayuda de Excelencia de Castilla y León, Consejería de Educación (EDU/894/2009, GR37) Junta de Castilla y León, Valladolid, Spain. LST received a CAPES/Ministério da Educação scholarship from the Brazilian Government.Peer Reviewe

Intermodal exchange stations in the city of Madrid

The City of Madrid is putting into operation Intermodal Exchange Stations (IESs) to make connections between urban and suburban transportation modes easier for users of public transportation. The purpose of this article is to evaluate the actual effects that the implementation of IESs in the City of Madrid has on the affected stakeholders: users, public transportation operators, infrastructure managers, the government, the abutters and other citizens. We develop a methodology intended to help assess the welfare gains and losses for each stakeholder. Then we apply this methodology to the case study of the Avenida de América IES in the city of Madrid. We found that it is indeed possible to arrive at win–win solutions for the funding of urban transportation infrastructure, as long as the cost-benefit ratio of the project is high enough. Commuters save travel time. Bus companies diminish their costs of operation. The abutters gain in quality of life. The private operator of the infrastructure makes a fair profit. And the government is able to promote these infrastructure facilities without spending more of its scarce budgetary resources

Tratamiento de oligometástasis mediante cirugía oncológica con intención curativa

Oligometastasis is a clinical condition characterized by the presence of one to five metastases in a controlled or potentially controllable neoplasm, which can be treated at a local level through ablative therapy. Material and methods. We report the case of a 49 years old male who is diagnosed of a renal cell carcinoma, and presents metastases in the left humerus and the right radius. Two-stage surgery is carried out with the placement of tumor prosthesis in the humerus and reconstruction by using the fibula and osteosynthesis with a plate in the radius. Results. In the course of two years of monitoring, the patient is now disease free at both a local and systemic levels with a good clinical, functional and radiological condition. Conclusions. The management of patients with metastatic cancer has changed. Patients affected by oligometastasis can be treated with oncology surgery with a curative intention, increasing the chances of survival and even achieving the recovery of the patient

Effect of Biodiversity Changes in Disease Risk: Exploring Disease Emergence in a Plant-Virus System

The effect of biodiversity on the ability of parasites to infect their host and cause disease (i.e. disease risk) is a major question in pathology, which is central to understand the emergence of infectious diseases, and to develop strategies for their management. Two hypotheses, which can be considered as extremes of a continuum, relate biodiversity to disease risk: One states that biodiversity is positively correlated with disease risk (Amplification Effect), and the second predicts a negative correlation between biodiversity and disease risk (Dilution Effect). Which of them applies better to different host-parasite systems is still a source of debate, due to limited experimental or empirical data. This is especially the case for viral diseases of plants. To address this subject, we have monitored for three years the prevalence of several viruses, and virus-associated symptoms, in populations of wild pepper (chiltepin) under different levels of human management. For each population, we also measured the habitat species diversity, host plant genetic diversity and host plant density. Results indicate that disease and infection risk increased with the level of human management, which was associated with decreased species diversity and host genetic diversity, and with increased host plant density. Importantly, species diversity of the habitat was the primary predictor of disease risk for wild chiltepin populations. This changed in managed populations where host genetic diversity was the primary predictor. Host density was generally a poorer predictor of disease and infection risk. These results support the dilution effect hypothesis, and underline the relevance of different ecological factors in determining disease/infection risk in host plant populations under different levels of anthropic influence. These results are relevant for managing plant diseases and for establishing conservation policies for endangered plant species

Preclinical Evaluation of an Imidazole-Linked Heterocycle for Alzheimer’s Disease

Humanity is facing a vast prevalence of neurodegenerative diseases, with Alzheimer’s disease (AD) being the most dominant, without efficacious drugs, and with only a few therapeutic targets identified. In this scenario, we aim to find molecular entities that modulate imidazoline I2 receptors (I2-IRs) that have been pointed out as relevant targets in AD. In this work, we explored structural modifications of well-established I2-IR ligands, giving access to derivatives with an imidazole-linked heterocycle as a common key feature. We report the synthesis, the affinity in human I2-IRs, the brain penetration capabilities, the in silico ADMET studies, and the three-dimensional quantitative structure-activity relationship (3D-QSAR) studies of this new bunch of I2-IR ligands. Selected compounds showed neuroprotective properties and beneficial effects in an in vitro model of Parkinson’s disease, rescued the human dopaminergic cell line SH-SY5Y from death after treatment with 6-hydroxydopamine, and showed crucial anti-inflammatory effects in a cellular model of neuroinflammation. After a preliminary pharmacokinetic study, we explored the action of our representative 2-(benzo[b]thiophen-2-yl)-1H-imidazole LSL33 in a mouse model of AD (5xFAD). Oral administration of LSL33 at 2 mg/Kg for 4 weeks ameliorated 5XFAD cognitive impairment and synaptic plasticity, as well as reduced neuroinflammation markers. In summary, this new I2-IR ligand that promoted beneficial effects in a well-established AD mouse model should be considered a promising therapeutic strategy for neurodegeneration

GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain

Breast cancer (BC) is the most common cancer in women in Spain. During the COVID-19 pandemic caused by the SARSCoV-2 virus, patients with BC still require timely treatment and follow-up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in-hospital visit to minimize pandemic-associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the lack of evidence about COVID-19 infection, these recommendations are mainly based on expert opinion, medical organizations’ and societies’ recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing