20 research outputs found
Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy
Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment. Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum follow-up of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C). Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P < .001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C. Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount
Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II)
Background: Mesenchymal stromal cells (MSCs) are a promising option to treat knee osteoarthritis (OA). Their safety
and usefulness have been reported in several short-term clinical trials but less information is available on the longterm efects of MSC in patients with osteoarthritis. We have evaluated patients included in our previous randomized
clinical trial (CMM-ART, NCT02123368) to determine their long-term clinical efect.
Materials: A phase I/II multicenter randomized clinical trial with active control was conducted between 2012 and
2014. Thirty patients diagnosed with knee OA were randomly assigned to Control group, intraarticularly administered
hyaluronic acid alone, or to two treatment groups, hyaluronic acid together with 10Ă106
or 100Ă106
cultured autolâ
ogous bone marrow-derived MSCs (BM-MSCs), and followed up for 12 months. After a follow up of 4 years adverse
efects and clinical evolution, assessed using VAS and WOMAC scorings are reported.
Results: No adverse efects were reported after BM-MSCs administration or during the follow-up. BM-MSCs-adminisâ
tered patients improved according to VAS, median value (IQR) for Control, Low-dose and High-dose groups changed
from 5 (3, 7), 7 (5, 8) and 6 (4, 8) to 7 (6, 7), 2 (2, 5) and 3 (3, 4), respectively at the end of follow up (Low-dose vs Control
group, p=0.01; High-dose vs Control group, p=0.004). Patients receiving BM-MSCs also improved clinically accordâ
ing to WOMAC. Control group showed an increase median value of 4 points (â11;10) while Low-dose and Highdose groups exhibited values of â18 (â28;â9) and â10 (â21;â3) points, respectively (Low-dose vs Control group
p=0.043). No clinical diferences between the BM-MSCs receiving groups were found.
Conclusions: Single intraarticular injection of in vitro expanded autologous BM-MSCs is a safe and feasible proceâ
dure that results in long-term clinical and functional improvement of knee OA
Preneoplastic somatic mutations including MYD88(L265P) in lymphoplasmacytic lymphoma
Normal cell counterparts of solid and myeloid tumors accumulate mutations years before disease onset; whether this occurs in B lymphocytes before lymphoma remains uncertain. We sequenced multiple stages of the B lineage in elderly individuals and patients with lymphoplasmacytic lymphoma, a singular disease for studying lymphomagenesis because of the high prevalence of mutated MYD88. We observed similar accumulation of random mutations in B lineages from both cohorts and unexpectedly found MYD88(L265P) in normal precursor and mature B lymphocytes from patients with lymphoma. We uncovered genetic and transcriptional pathways driving malignant transformation and leveraged these to model lymphoplasmacytic lymphoma in mice, based on mutated MYD88 in B cell precursors and BCL2 overexpression. Thus, MYD88(L265P) is a preneoplastic event, which challenges the current understanding of lymphomagenesis and may have implications for early detection of B cell lymphomas
Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II)
InyecciĂłn intraarticular de cĂ©lulas madre mesenquimales autĂłlogas derivadas de mĂ©dula Ăłsea en el tratamiento de la artrosis de rodilla: Ensayo clĂnico multicĂ©ntrico aleatorizado (Fase I/II)
El objetivo principal de este ensayo clĂnico es determinar la seguridad y viabilidad del tratamiento de la artrosis de rodilla mediante la administraciĂłn intraarticular de BM-MSCs autĂłlogas junto con ĂĄcido hialurĂłnico (AH). Como objetivo secundario queremos determinar la eficacia terapĂ©utica del tratamiento intraarticular con BM-MSCs autĂłlogas en combinaciĂłn con AH en
pacientes con artrosis de rodilla, mediante la utilizaciĂłn de dos dosis celulares diferentes y comparĂĄndolo con el tratamiento aislado de AH. La determinaciĂłn de la eficacia se realizarĂĄ utilizando como variables principales del estudio: 1) Escalas clĂnicas de dolor y funcionalidad. 2) ValoraciĂłn radiolĂłgica utilizando radiologĂa simple y resonancia magnĂ©tica. Las tĂ©cnicas y escalas se detallan en la metodologĂa del ensayo
Hip Preservation Surgery in Osteoarthritis Prevention: Potential Benefits of the Radiographic Angular Correction
Objective: The aim of the study is to describe the morphology associated with the development of osteoarthritis (OA) in three different age groups. These data will contribute to defining the morphology associated with early and late hip OA. Methods: We studied 400 hips in 377 patients who had undergone primary THA due to idiopathic OA. Three groups were compared: group 1 (n = 147), younger patients, aged up to 60 years; group 2 (n = 155), patients aged between 61 and 74 years; and group 3 (n = 98), aged 75 or over. Five independent researchers measured the hip angles and the mean values were used to build a database. Results: No differences between groups in sex distribution and BMI were detected. Less coverage of the head (extrusion index), higher Tönnis angle, lower Wiberg and alpha angles characterized early OA hips. These differences increased with age, being greater between group 2 and group 3 (p < 0.01). However, significant differences were still present in the comparison between group 1 and group 2 (p < 0.01)). No differences were detected between group 2 and group 3. Conclusion: Elevated acetabular angle, head extrusion and decreased Wiberg angle characterize hip osteoarthritis at younger ages and should be the focus of hip preservation surgery in terms of osteoarthritis prevention. Pincer-type FAI (higher Wiberg and lower Tönnis angle) and higher alpha angle (CAM) are correlated with the development of later OA. These results shed doubt on applying the hip preservation surgery concept in terms of osteoarthritis prevention in FAI, especially in Pincer-type FAI patients
Do we really improve life quality after total knee arthroplasty in patients with Parkinsonâs disease?
Introduction The knee in Parkinsonâs disease (PD) patients is a problematic joint due to pain, stifness and gait instability.
The aim of this study is to evaluate the functional outcome and degree of pain relief achieved after total knee arthroplasty
(TKA) in PD patients.
Materials and methods This is a retrospective review of 26 PD patients (32 knees) with osteoarthritis who underwent a TKA
between 1994 and 2013. Comorbidities, anesthetic procedures and complications were recorded. Patient functional status
was assessed with the Knee Society Function Score (KFS) and the Knee Society Score (KSS). PD stage was classifed with
the Hoehn and Yahr Scale.
Results The mean follow-up was 3.5 years (range 2â9). The mean age was 71 years (range 61â83) with a mean time since PD
diagnosis of 11.8 years (range 4â24). PD severity on the Hoehn and Yahr Scale was 1.5 points before surgery and 2 points
postoperatively. Pain on the visual analogic scale improved from 8 points preoperatively to 5 points at 1-year follow-up;
function improved from 32 (range 20â45) to 71 (range 50â81) and from 34 (range 28â52) to 59 (range 25â76) on the KSS
and KFS, respectively. The mean postoperative hospital stay was 9.8 days (range 5â21). Confusion and fexion contracture
were the most frequent perioperative complications.
Conclusion TKA successfully provided pain relief in PD patients. However, the functional outcome is related to disease
progression and, therefore, variable. Perioperative complications are difcult to avoid and manage
Clinical Value of NGS Genomic Studies for Clinical Management of Pediatric and Young Adult Bone Sarcomas
Genomic techniques enable diagnosis and management of children and young adults with sarcomas by identifying high-risk patients and those who may benefit from targeted therapy or participation in clinical trials. Objective: to analyze the performance of an NGS gene panel for the clinical management of pediatric sarcoma patients. We studied 53 pediatric and young adult patients diagnosed with sarcoma, from two Spanish centers. Genomic data were obtained using the Oncomine Childhood Cancer Research Assay, and categorized according to their diagnostic, predictive, or prognostic value. In 44 (83%) of the 53 patients, at least one genetic alteration was identified. In 80% of these patients, the diagnosis was obtained (n = 11) or changed (n = 9), and thus genomic data affected therapy. The most frequent initial misdiagnosis was Ewingâs sarcoma, instead of myxoid liposarcoma (FUS-DDDIT3), rhabdoid soft tissue tumor (SMARCB1), or angiomatoid fibrous histiocytoma (EWSR1-CREB1). In our series, two patients had a genetic alteration with an FDA-approved targeted therapy, and 30% had at least one potentially actionable alteration. NGS-based genomic studies are useful and feasible in diagnosis and clinical management of pediatric sarcomas. Genomic characterization of these rare and heterogeneous tumors also helps in the search for prognostic biomarkers and therapeutic opportunities
Anisotropic cryostructured collagen scaffolds for efficient delivery of RhBMPâ2 and enhanced bone regeneration
In the treatment of bone non-unions, an alternative to bone autografts is the use of bone morphogenetic proteins (BMPs), e.g., BMPâ2, BMPâ7, with powerful osteoinductive and osteogenic properties. In clinical settings, these osteogenic factors are applied using absorbable collagen sponges for local controlled delivery. Major side effects of this strategy are derived from the supraphysiological doses of BMPs needed, which may induce ectopic bone formation, chronic inflammation, and excessive bone resorption. In order to increase the efficiency of the delivered BMPs, we designed cryostructured collagen scaffolds functionalized with hydroxyapatite, mimicking the structure of cortical bone (aligned porosity, anisotropic) or trabecular bone (random distributed porosity, isotropic). We hypothesize that an anisotropic structure would enhance the osteoconductive properties of the scaffolds by increasing the regenerative performance of the provided rhBMPâ2. In vitro, both scaffolds presented similar mechanical properties, rhBMPâ2 retention and delivery capacity, as well as scaffold degradation time. In vivo, anisotropic scaffolds demonstrated better bone regeneration capabilities in a rat femoral critical-size defect model by increasing the defect bridging. In conclusion, anisotropic cryostructured collagen scaffolds improve bone regeneration by increasing the efficiency of rhBMPâ2 mediated bone healing