Bio-inspired hydrogel composed of hyaluronic acid and alginate as a potential bioink for 3D bioprinting of articular cartilage engineering constructs

Bioprinting is a promising tool to fabricate well-organized cell-laden constructs for repair and regener- ation of articular cartilage. The selection of a suitable bioink, in terms of composition and mechanical properties, is crucial for the development of viable cartilage substitutes. In this study, we focused on the use of one of the main cartilage components, hyaluronic acid (HA), to design and formulate a new bioink for cartilage tissue 3D bioprinting. Major characteristics required for this application such as printabil- ity, biocompatibility, and biodegradability were analyzed. To produce cartilage constructs with optimal mechanical properties, HA-based bioink was co-printed with polylactic acid (PLA). HA-based bioink was found to improve cell functionality by an increase in the expression of chondrogenic gene markers and specific matrix deposition and, therefore, tissue formation. These results indicate that it is a promising bioink candidate for cartilage tissue engineering based in 3D bioprinting.This work was partially supported by MINECO MAT2016-78778-R and PCIN-2015-051 projects (Spain), European Regional Development Fund (ERDF), by the Consejería de Economía, Conocimiento, Empresas y Universidad de la Junta de Andalucía and European Regional Development Fund (ERDF), ref. SOMM17/6109/UGR and by the Ministerio de Economía, Industria y Competitividad ( FEDER funds, project RTC-2016-5451-1 ) (to JA.M and P.G-M)

Knee Viscosupplementation: Cost-Effectiveness Analysis between Stabilized Hyaluronic Acid in a Single Injection versus Five Injections of Standard Hyaluronic Acid

Given the wide difference in price per vial between various presentations of hyaluronic acid, this study seeks to compare the effectiveness and treatment cost of stabilized hyaluronic acid (NASHA) in a single injection with standard preparations of hyaluronic acid (HA) in five injections in osteoarthritis (OA) of the knee. Fifty-four patients with knee osteoarthritis (Kellgren–Lawrence Grade II and III) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score greater than 7, with a homogeneous distribution of age, sex, BMI, and duration of disease, were included in this study. Patients were randomized into two groups: Group I was treated with NASHA (Durolane®) and Group II with HA (Go-ON®). Patient’s evolution was followed up at the 1st, 2nd, 4th, 8th, 12th, and 26th week after treatment. A statistically significant improvement in WOMAC score was observed for patients treated with NASHA versus those who received HA at Week 26. In addition, the need for analgesia was significantly reduced at Week 26 in the NASHA-treated group. Finally, the economic analysis showed an increased cost of overall treatment with HA injections. Our data support the use of the NASHA class of products in the treatment of knee OA

Riesgo social como factor de riesgo para la no adherencia farmacológica en pacientes con DM2 mayores de 65 años

Aims: The aim of this study was to establish the influence of social risk and itsrelation on therapeutic adherence to pharmacological treatment of diabetes mellitus type 2 (DM2) in people older than 65 years. Method: A cross-sectional descriptive study based on the electronic clinical records of primary care in people over 65 years of age with DM2 of north area of Madrid (n = 26703). Multivariate logistic regression analysis was performed for Non-Adherence to Treatment (Non-AdhT) and for poor control of DM2, disaggregated by sex. Results: A 33,7% had poor control of DM2 and 3.1% Non-AdhT. In regression models for poor DM2 control, the Non-AdhT increased (OR: 1.64; 95% CI: 1.07-2.51). In both sexes, social risk causes a greater lack of adherence, in women (5.7% vs. 1.9%, p = 0.000), men (7.5% vs. 2.3%, p = 0.000). In the regression models for non-AdhT, it was increased to have a social risk (OR: 2.92, 95% CI: 1.61-5.30) in women; social risk (OR = 3.52, 95% CI 1.90-6.52) was associated with non-adherence also in men. Discussion: In those older than 65 years with DM2, although the No AdhT is low, the prevalence of poor control is high. For Non-AdhT, social risk is a risk factor for both sexes, but having depression increases Non-AdhT in women, and anxiety symptoms in men. No AdhT raises the risk of poor control of DM2, especially in women; as well as not dieting and being overweight/obese.Objetivos: Establecer la influencia del riesgo social en la adherencia terapéutica al tratamiento farmacológico de la diabetes mellitus 2 (DM2) en mayores de 65 años. Método: Estudio descriptivo transversal a partir de las historias clínicas electrónicas de Atención Primaria en personas mayores de 65 años con DM2 de la Dirección Asistencial Norte de Madrid (n=26703). Se realizó análisis multivariante de regresión logística para la No Adherencia al Tratamiento (No AdhT) y para mal control de DM2, desagregado por sexo. Resultados: Un 33,7% tenían mal control de la DM2 y un 3,1% No AdhT. En modelos de regresión para el mal control de la DM2, lo aumentaba la No AdhT (OR: 1,64; IC95%: 1,07-2,51)). En ambos sexos, el riesgo social provoca una mayor falta de adherencia, en mujeres (5.7% vs. 1.9%, p = 0.000), hombres (7.5% vs. 2.3%, p = 0,000). En los modelos de regresión para la no AdhT, la aumentaba tener riesgo social (OR: 2.92, IC 95%: 1.61-5.30) en mujeres; riesgo social (OR = 3.52, IC 95% 1.90-6.52) se asoció con la no adherencia también en hombres. Conclusiones: En los mayores de 65 años con DM2, aunque el No AdhT es bajo, la prevalencia de control deficiente es alta. Para la no AdhT, el riesgo social se presenta como factor de riesgo para ambos sexos, pero tener depresión aumenta la no  AdhT en las mujeres y los síntomas de ansiedad en los hombres. Sin AdhT aumenta el riesgo de un control deficiente de DM2, especialmente en mujeres; además de no hacer dieta y tener sobrepeso/obesidad

Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System

Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga’s Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades

La gestión del conocimiento en el medio empresarial colombiano

Magíster en AdministraciónMaestrí

Efficacy of IV tranexamic acid versus autologous blood salvage systems in controlling blood loss following knee arthroplasty.

The purpose of this study is evaluate and compare efficacy of tranexamic acid (TXA) versus autologous blood salvage systems in blood loss management following primary total knee arthroplasty (TKA). Observational, prospective, randomized study performed between April 2016 and June 2017. 120 consecutive patients who underwent TKA were divided into three groups: Group A, with one drain and a blood salvage system; Group B, with two drains and a blood salvage system; and Group C, with IV TXA and one drain without a blood salvage system. Principal outcomes included hemoglobin (Hb) and hematocrit (Htc) decreases 24 hours after surgery and need for transfusion. We found statistically-significant differences between Group C versus A and B (P=0.002, P=0.004) and among the groups individually: C vs A (P=0.012) and C vs B (P=0.003) in hemoglobin levels; C vs A (P=0.022) and C vs B (P=0.007) in hematocrit levels. There were no significant differences between A and B. Three patients in A (50%) and 3 in B (50%) needed transfusions. No patients in C required transfusion, but this was not statistically significant (P=0.206). TXA significantly reduces decreases in hemoglobin and hematocrit levels following TKA compared to blood salvage drains

Periprosthetic femoral fractures treated with intramedullary nail knee retrograde, and plate osteosynthesis: comparison of results in the medium to long term

INTRODUCTION: The femoral periprosthetic fracture of the knee is one of the most feared complications because of its repercussions. Incidence are more and more likely due to the increase of total implanted arthroplasty of the knee, due to the increasing lifespan among the general population. The objective of this study is to analyze some of the perioperative aspects of the treatment of these fractures, comparing the use of osteosynthesis with plates and the retrograde nailing in those patients with femoral periprosthetic knee fractures with a stable implant. MATERIAL AND METODS: The study retrospectively examines 18 cases treated consecutively in our hospital (3 men and 15 women, average age of 72.7 years) between the years of 2000 and 2009. All fractures were located in the distal femur and on a stable implant. Eight were treated through retrograde nailing (Group I) and ten with plates (Group II). The cases are analyzed through the tests of the University of Mann-Withney and the exact Fischer test, with significant values of p≤0.05, the variables of median hospital stay, necessity of transfusion indicated with values of hemoglobin less than 8 mg/ml, preoperative radiological alignment and postoperative alignment of the total knee prosthesis (TKR), measured following the anatomical tibiofemoral axis, time of consolidation and incidence of localized complications in both groups. RESULTS: We did not find any statistically significant differences between the two groups in any of the variables analyzed. Localized complications are more frequent in Group I (62.5 percent of patients) than in Group II (10 percent of patients). The need for transfusion is greater in Group II (40 percent) than in Group I (12.5 percent). CONCLUSIONS: The type of implant used in treatment of femoral periprosthetic knee fracture does not significantly influence perioperative factors. The treatment for this type of fractures should be individually chosen in relation to the type of fracture, characteristics of the patient and stability and prosthesis model of the primary knee.YesINTRODUCCIÓN: La fractura periprotésica femoral de rodilla constituye una de las complicaciones mas temidas por sus repercusiones. Su incidencia aumenta debido tanto al mayor número de artroplastias totales de rodilla (ATR) implantadas como al aumento de la esperanza de vida de la población. El objetivo del estudio es analizar algunos aspectos perioperatorios del tratamiento de estas fracturas comparando el uso de osteosíntesis con placas y el enclavado retrógrado en los pacientes con fracturas femorales periprotésicas de rodilla con implante estable. MATERIAL Y MÉTODOS: Se estudian retrospectivamente 18 casos tratados consecutivamente en nuestro hospital (3 hombres y 15 mujeres; edad media, 72.7 años) entre los años 2000 y 2009. Todas las fracturas asentaban en fémur distal y sobre implante estable. Fueron tratados mediante enclavado retrógrado 8 (Grupo I) y 10 con placas (Grupo II). Se analizan mediante el test de la U de Mann-Withney y el test exacto de Fisher, con valores significativos de p£0.05, las variables: estancia media hospitalaria, necesidad de transfusión indicada con cifras de hemoglobina menor a 8mg/ml, alineación radiológica preoperatoria y postoperatoria de la ATR, medida según el eje anatómico tibiofemoral, tiempo de consolidación e incidencia de complicaciones locales en ambos grupos. RESULTADOS: No hemos encontrado diferencias estadísticamente significativas entre ambos grupos para ninguna de las variables analizadas. Las complicaciones locales son más frecuentes en el Grupo I (75% pacientes) que en el Grupo II (50% pacientes). La necesidad de transfusión es mayor en el Grupo II (40%) que en el Grupo I (12.5%). CONClUSIONES: El tipo de implante utilizado en el tratamiento de las fracturas femorales periprotésicas no influye de forma significativa en los aspectos Perioperatorios. El tratamiento para este tipo de fracturas debe ser elegido de forma individualizada en función de tipo de fractura, características del paciente y estabilidad y modelo de prótesis de rodilla primaria

Development of a Biomimetic Hydrogel Based on Predifferentiated Mesenchymal Stem-Cell-Derived ECM for Cartilage Tissue Engineering

The use of decellularized extracellular matrix (dECM) as a biomaterial has been an important step forward for the development of functional tissue constructs. In addition to tissues and organs, cell cultures are gaining a lot of attention as an alternative source of dECM. In this work, a novel biomimetic hydrogel is developed based on dECM obtained from mesenchymal stem cells (mdECM) for cartilage tissue engineering. To this end, cells are seeded under specific culture conditions to generate an early chondrogenic extracellular matrix (ECM) providing cues and elements necessary for cartilage development. The composition is determined by quantitative, histological, and mass spectrometry techniques. Moreover, the decellularization process is evaluated by measuring the DNA content and compositional analyses, and the hydrogel is formulated at different concentrations (3% and 6% w/v). Results show that mdECM derived hydrogels possess excellent biocompatibility and suitable physicochemical and mechanical properties for their injectability. Furthermore, it is evidenced that this hydrogel is able to induce chondrogenesis of mesenchymal stem cells (MSCs) without supplemental factors and, furthermore, to form hyaline cartilage-like tissue after in vivo implantation. These findings demonstrate for the first time the potential of this hydrogel based on mdECM for applications in cartilage repair and regeneration.Spanish Ministry of Education, Culture and Sports BOE-A-2014-13539Ministerio de Economía, Industria y Competitividad (ERDF funds) RTC-2016-5451-1Instituto de Salud Carlos III FMM-AP17196-2019Consejería de Economía, Conocimiento, Empresas y Universidad de la Junta de Andalucía (ERDF funds) B-CTS-230-UGR18 PY18-2470 SOMM17-6109 P18-FR-2465Instituto de Salud Carlos III, ERDF funds DTS19/0014

Dispositivo para la fijación del injerto en mosaicoplastia de tracción

Número de publicación: 2 541 867Número de solicitud: 201301204La invención describe un dispositivo (1) para el taladrado y fijación del injerto (100) osteocondral en la técnica quirúrgica de mosaicoplastia de tracción, comprendiendo el dispositivo (1): un primer cuerpo (2) que tiene un primer orificio (3) cilíndrico pasante para recibir un injerto (100); Y un segundo cuerpo (4) contiguo al primer cuerpo (2) y que tiene un segundo orificio (5) cilíndrico pasante para recibir una broca (25) o una varilla (27), donde el primer orificio (3) tiene un diámetro mayor que el segundo orificio (5), y donde el primer orificio (3) y el segundo orificio (5) son coaxiales entre sí.Universidad de GranadaUniversidad de MálagaServicio Andaluz de Salu