Resultados a largo plazo del tratamiento de las fracturas de rótula mediante hemipatelectomia

Han sido revisadas retrospectivamente 48 fracturas de rótula tratadas mediante hemipatelectomía, con un seguimiento medio de 14,6 años. Para la valoración se han seguido criterios clínicos, radiológicos, subjetivos y de potencia del aparato extensor. El rango de movilidad de la extremidad intervenida es del 89%, la potencia del aparato extensor de 83% y la medición de la circunferencia del muslo del 97%, tomando como referencia la extremidad no intervenida. Encontramos un 45% de resultados excelentes, 39,58% de buenos resultados, 10,41% de resultados regulares y 4,16% de malos resultados. Existe una relación estadísticamente significativa entre el tipo de fractura, la edad de los pacientes, la existencia de patología previa en la rodilla, las lesiones asociadas a la fractura rotuliana por el traumatismo y el resultado final obtenido. A la vista de estos resultados podemos concluir que la hemipatelectomía es una técnica eficaz y segura para el tratamiento de algunos tipos de fracturas de rótula.A retrospective stydy was made of 48 patellar fractures who were threated with a hemipatellectomy. The mean time of follow-up was 14,6 years. The results were assessed with use of clinical, radiological, subjective and isokinetic quadriceps strength-testing criteria. The mean active range of motion was 89%, the strength of quadriceps was 83% and the circumference of the thigh was 97% of these measurements in the contralateral extremity. The over-all results was rated as excellent in 45,83%, dood in 39,58%, fair in 10,41% and poor in 4,16%. There was a significant statistical correlation between the type of fracture, the previous patology in the knee, the associated lesions caused by trauma and the outcome. The results of this study indicate that hemipatellectomy can be an effective and secure treatment for selected patellar fractures

El Macizo Paleozoico de Santa María La Real de Nieva

Bibliogr.: p.154-156

Identification of MiRNAs as Viable Aggressiveness Biomarkers for Prostate Cancer

MiRNAs play a relevant role in PC (prostate cancer) by the regulation in the expression of several pathways’ AR (androgen receptor), cellular cycle, apoptosis, MET (mesenchymal epithelium transition), or metastasis. Here, we report the role of several miRNAs’ expression patterns, such as miR-miR-93-5p, miR-23c, miR-210-3p, miR-221-3p, miR-592, miR-141, miR-375, and miR-130b, with relevance in processes like cell proliferation and MET. Using Trizol® extraction protocol and TaqMan™ specific probes for amplification, we performed miRNAs’ analysis of 159 PC fresh tissues and 60 plasmas from peripheral blood samples. We had clinical data from all samples including PSA, Gleason, TNM, and D’Amico risk. Moreover, a bioinformatic analysis in TCGA (The Cancer Genome Atlas) was included to analyze the effect of the most relevant miRNAs according to aggressiveness in an extensive cohort (n = 531). We found that miR-210-3p, miR-23c, miR-592, and miR-93-5p are the most suitable biomarkers for PC aggressiveness and diagnosis, respectively. In fact, according with our results, miR93-5p seems the most promising non-invasive biomarker for PC. To sum up, miR-210-3p, miR-23c, miR-592, and miR93-5p miRNAs are suggested to be potential biomarkers for PC risk stratification that could be included in non-invasive strategies such as liquid biopsy in precision medicine for PC management.Regional Ministry of Health and Families of the Andalusian Government (ref: PI-0319-2018)FIBAO (Andalusian Public Foundation for Biomedical Research in Eastern Andalusia, “Alejandro Otero”

Exposure to Mixtures of Pollutants in Mexican Children from Marginalized Urban Areas

Background: Exposure to contaminant mixtures in developing countries is an important public health issue. Children are identified as the most susceptible group to adverse health effects due to the exposure. Objective: The aim of this study was to conduct a screening for mixture pollutants in Mexican children in urban marginalized communities. Methods: We analyzed children (aged 6–12 years old) who resided in four urban marginalized communities in San Luis Potosi, Mexico: i) Bellas Lomas (BEL), a site with vehicular traffic; ii) Tercera Chica (TC), a site with brick kilns; Iii) Rincon de San Jose (SJR), a site with a hazardous waste landfill; and (iv) Morales (MOR) a metallurgical zone with copper-arsenic and electrolytic zinc smelters. Polycyclic Aromatic Hydrocarbons (1-hydroxypyrene (1-OHP)), benzene (trans, trans-muconic acid (t,t-MA), manganese, arsenic and fluoride were quantified in urine and lead in blood samples. Findings: Our results indicate that median exposures to manganese were 4.4, 5.2, 5.8 and 6.3 μg/L for BEL, TC, SJR and MOR, respectively. For BEL, fluoride was present at a higher concentration with 2.3 mg/L followed by MOR, TC and SJR with 1.7, 1.5 and 1.2 mg/L respectively. The highest concentrations of arsenic that were found were 11 μg/L in MOR and lead concentration was reported between 4.2 and 6.8 μg/dL, in BEL, TC and MOR. 1-OHP and t,t-MA were higher in TC (0.23 μmol/mol creatinine (cr), 429.7 μg/g cr, respectively) followed by SJR (0.09 μmol/mol cr, 427.4 μg/g cr), MOR (0.03 μmol/mol cr, 258.6 μg/g cr) and BEL (0.06 μmol/mol cr, 220.6 μg/g cr). Conclusion: Considering the large number of people, especially children, exposed to multiple pollutants, it is important to design effective intervention programs that reduce exposure and the resultant risk in the numerous urban marginalized communities in Mexico

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study

Background: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). Methods: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxyterminal telopeptide of type I collagen (b-CTX) were analysed. Results: Patients with RCC who died or progressed had higher baseline b-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline b-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that b-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. Conclusion: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOLNovartis Oncology Spain for supporting this stud

Effect of Mineral Aggregates and Chemical Admixtures as Internal Curing Agents on the Mechanical Properties and Durability of High-Performance Concrete

Abstract: In the present work, the effect of mineral aggregates (pumice stone and expanded clay aggregates) and chemical admixtures (superplasticizers and shrinkage reducing additives) as an alternative internal curing technique was investigated, to improve the properties of highperformance concrete. In the fresh and hardened state, concretes with partial replacements of Portland cement (CPC30R and OPC40C) by pulverized fly ash in combination with the addition of mineral aggregates and chemical admixtures were studied. The physical, mechanical, and durability properties in terms of slump, density, porosity, compressive strength, and permeability to chloride ions were respectively determined. The microstructural analysis was carried out by scanning electronic microscopy. The results highlight the effect of the addition of expanded clay aggregate on the internal curing of the concrete, which allowed developing the maximum compressive strength at 28 days (61 MPa). Meanwhile, the replacement of fine aggregate by 20% of pumice stone allowed developing the maximum compressive strength (52 MPa) in an OPC-based concrete at 180 days. The effectiveness of internal curing to develop higher strength is attributed to control in the porosity and a high water release at a later age. Finally, the lowest permeability value at 90 days (945 C) was found by the substitutions of fine aggregate by 20% of pumice stone saturated with shrinkage reducing admixture into pores and OPC40C by 15% of pulverized fly ash. It might be due to impeded diffusion of chloride ions into cement paste in the vicinity of pulverized fly ash, where the pozzolanic reaction has occurred. The proposed internal curing technology can be considered a real alternative to achieve the expected performance of a high-performance concrete since a concrete with a compressive strength range from 45 to 67 MPa, density range from 2130 to 2310 kg/m3, and exceptional durability (< 2000 C) was effectively developed

Effect of mineral aggregates and chemical admixtures as internal curing agents on the mechanical properties and durability of highperformance concrete

In the present work, the effect of mineral aggregates (pumice stone and expanded clay aggregates) and chemical admixtures (superplasticizers and shrinkage reducing additives) as an alternative internal curing technique was investigated, to improve the properties of highperformance concrete. In the fresh and hardened state, concretes with partial replacements of Portland cement (CPC30R and OPC40C) by pulverized fly ash in combination with the addition of mineral aggregates and chemical admixtures were studied. The physical, mechanical, and durability properties in terms of slump, density, porosity, compressive strength, and permeability to chloride ions were respectively determined. The microstructural analysis was carried out by scanning electronic microscopy. The results highlight the effect of the addition of expanded clay aggregate on the internal curing of the concrete, which allowed developing the maximum compressive strength at 28 days (61 MPa). Meanwhile, the replacement of fine aggregate by 20% of pumice stone allowed developing the maximum compressive strength (52 MPa) in an OPC-based oncrete at 180 days. The effectiveness of internal curing to develop higher strength is attributed to control in the porosity and a high water release at a later age. Finally, the lowest permeability value at 90 days (945 C) was found by the substitutions of fine aggregate by 20% of pumice stone saturated with shrinkage reducing admixture into pores and OPC40C by 15% of pulverized fly ash. It might be due to impeded diffusion of chloride ions into cement paste in the vicinity of pulverized fly ash, where the pozzolanic reaction has occurred. The proposed internal curing technology can be considered a real alternative to achieve the expected performance of a high-performance concrete since a concrete with a compressive strength range from 45 to 67 MPa, density range from 2130 to 2310 kg/m3, and exceptional durability (< 2000 C) was effectively developed

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis