Modelo tridimensional para la corrección de fractura vertebrales evitando la artrodesis segmentaria

Actualmente solo existen estudios cadavéricos que demuestren la reducción anatómica vertebral, no existiendo referencias clínicas con las técnicas actuales de su consecución. Hipótesis de Trabajo: 1. Capacidad de reducción anatómica vertebral mediante aplicación de fuerzas en sentido cráneo-caudal que reducen el platillo vertebral e implementar el efecto de la ligamentotaxis. 2. Aplicación de un mapeo3D para analizar las pruebas de imagen. 3. Seguridad-Eficacia. Material-Métodos: Estudio prospectivo de 27 pacientes, 15 hombres, 12 mujeres, fractura vertebral tipo A. Procedimiento quirúrgico miniinvasivo de reducción-fijación vertebral. Resultados: Reducción superior al 90% de la anatomía de referencia, incrementos de altura del platillo vertebral y cortical vertebral estadísticamente significativos en todos los parámetros analizados. Conclusiones: La reducción vertebral anatómica postfractura es realizable. Precisa: 1. Fractura aguda-móvil. 2. Correcta clasificación de la fractura preoperatoria. 3. Planificación quirúrgica. 4. Abordaje especifico según tipo de fractura.Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapi

Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries

Producción CientíficaThe worldwide increasing wealth and increased life expectancy of humans has led to an increase in the number of medical procedures and surgeries. Surgeries are complex medical procedures which contribute to a significant share of the total environmental impact of the healthcare system. Among other important sources of environmental impacts from surgeries, material consumption due to required instrumentation accounts for up to 65 % of greenhouse gas emissions from surgeries. This study investigates how a disposable and a reusable surgery instrument sets for lumbar fusion surgeries contribute to the environmental impact and which system is more advantageous for the environment. For lumbar fusion surgeries, reusable and disposable instrumentation and implant sets are commercially available. Both sets are capable to support a one level lumbar fusion surgery. The reusable set is comprehensive and fully opened before the surgery, while the disposable system comes in a modular box system, and the boxes are opened on demand during the surgery. To compare the environmental impact of these different configurations, a comparative Life Cycle Assessment (LCA) was performed to assess the overall environmental impacts of both alternatives. One of the key findings is that the selected cleaning and sterilization process for reusable instruments is responsible for up to 90 % of the greenhouse gas emissions and decides which system is advantageous from an environmental perspective. Reducing the number of instruments to be cleaned and sterilized for a surgery should be the focus for future surgery instruments development from an environmental perspective

The immunomodulatory function of vitamin D, with particular reference to SARS-CoV-2

Producción CientíficaVaccines are the only way to reduce the morbidity associated to SARS-CoV-2 infection. The appearance of new mutations urges us to increase the effectiveness of vaccines as a complementary alternative. In this context, the use of adjuvant strategies has improved the effectiveness of different vaccines against virus infections such as dengue, influenza, and common cold. Recent reports on patients infected by COVID-19 reveal that low levels of circulating vitamin D correlate with a severe respiratory insufficiency. The immunomodulatory activity of this micronutrient attenuates the synthesis of pro-inflammatory cytokines and at the same time, increases antibody production. Therefore, the present review proposes the use of vitamin D as adjuvant micronutrient to increase the efficacy of vaccines against SARS-CoV-2 infection

L-Arginine and beetroot extract supplementation in the prevention of sarcopenia

Producción CientíficaAging is associated with a significant decline in neuromuscular function, leading to a reduction in muscle mass and strength. The aim of the present report was to evaluate the effect of supplementation with nitric oxide precursors (l-arginine and beetroot extract) in muscular function during a training period of 6 weeks in elderly men and women. The study (double-blind, placebo-controlled) involved 66 subjects randomly divided into three groups: placebo, arginine-supplemented and beetroot extract-supplemented. At the end of this period, no changes in anthropometric parameters were observed. Regarding other circulating parameters, urea levels were significantly (p < 0.05) lower in women of the beetroot-supplemented group (31.6 ± 5.9 mg/dL) compared to placebo (41.3 ± 8.5 mg/dL) after 6 weeks of training. In addition, the circulating creatine kinase activity, as an index of muscle functionality, was significantly (p < 0.05) higher in women of the arginine- (214.1 ± 162.2 mIU/L) compared to the beetroot-supplemented group (84.4 ± 36.8 mIU/L) at the end of intervention. No significant effects were noticed with l-arginine or beetroot extract supplementation regarding strength, endurance and SPPB index. Only beetroot extract supplementation improved physical fitness significantly (p < 0.05) in the sprint exercise in men after 6 weeks (2.33 ± 0.59 s) compared to the baseline (2.72 ± 0.41 s). In conclusion, beetroot seems to be more efficient during short-term training while supplementing, preserving muscle functionality in women (decreased levels of circulating creatine kinase) and with modest effects in men.Caja Rural de Soria e Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) - (Grant 190290

Relationship between strength and professional quality of life of nurses working hospital emergency departments

Producción CientíficaOptimal quality of professional life can allow coping with stressful situations and avoiding fatigue. This is instrumental in jobs undergoing very demanding situations, such as nurses working in Emergency Departments. In this study, we investigated the relationship between functional and physiological indicators and the quality of professional life in nurses of Emergency Departments of two public hospitals. Fifty-nine professionals participated in the study. Cortisol (an indicator of stress) and post-test lactate (an indicator of fatigue) were analyzed in saliva and in the blood, respectively, at the beginning and at the end of the morning shift. The CVP-35 survey (Spanish version of the QPL-35 questionnaire) was used to assess the quality of professional life. Post-dynamometry circulating lactate levels increased significantly; meanwhile, salivary cortisol decreased in participants at the end of the working shift. Regarding dynamometry, no significant changes were observed. CVP-35/QPL-35 scores did not show significant changes in participants from both hospitals in all dimensions analyzed. In conclusion, nurses participating in the study displayed adaptation to stress accompanied by an acceptable level of professional quality of life. However, certain fatigue appears at the end of the working day. Altogether, results suggest that a better organization must be implemented at work, improving ergonomic, safe, and healthy conditions

Effects of vitamin D in post-exercise muscle recovery. A systematic review and meta-analysis

Producción CientíficaVitamin D is a key micronutrient modulating function and health in skeletal muscle. Therefore, we sought to systematically review the role of vitamin D in muscle recovery. A search in different databases (PubMed/MEDLINE, WOS, Google Scholar, and Scopus) was carried out following PRISMA® and PICOS. The search period was from inception to April 2020. Changes in post-exercise muscle damage were quantified comparing experimental group vs. placebo in each study by using number of participants, standardized mean difference (SMD), and standard error of the SMD. Hedges’s g was used to calculate the SMDs for each study group and biased by the inverse of variance that allows calculating an overall effect and the 95% confidence interval (CI). The net vitamin D supplementation effect was calculated by subtracting the placebo SMD from SMD of the experimental group. The DerSimonian and Laird method was used as a random effect model, taking into account that the effect of vitamin D on muscular damage may vary according to the dose administered and additional moderators. Six studies were selected. In conclusion, regarding circulating levels of muscle biomarkers and additional limitations of the studies, it cannot be concluded that vitamin D supplementation exerts an effect in post-exercise muscle recovery. Likely, the anti-inflammatory action of vitamin D is quicker than the recovery of tissue structure and function. This aspect is pending verification in future research.Instituto de Salud Carlos III - Fondo Europeo de Desarrollo Regional (CB12/03/30038

L-citrulline supplementation and exercise in the management of sarcopenia

Producción CientíficaSarcopenia is a process associated to aging. Persistent inflammation and oxidative stress in muscle favour muscle wasting and decreased ability to perform physical activity. Controlled exercise can optimize blood flux and moderate the production of reactive oxygen species. Therefore, supplements that can work as a vasodilators and control oxidative stress, might be beneficial for active elders. In this context, we have tested citrulline supplementation in a group of 44 participants aged from 60–73 years that followed a physical activity program adapted to their age and capacities. Volunteers were divided in two groups: placebo (n = 22) and citrullline supplemented (n = 22). Different physical tests and blood extractions were performed at the beginning and at the end of intervention (six weeks). Strength and endurance showed a tendency to increase in the citrulline supplemented group, with no significant differences respect to placebo. However, walking speed in the citrulline supplemented group improved significantly compared to placebo. Markers of muscle damage as well as circulating levels of testosterone, cortisol and vitamin D showed no significant changes, but a tendency to improve at the end of intervention in the supplemented group compared to placebo. Additional studies are necessary to confirm the effect of citrulline supplementation in sarcopenia delay.Caja Rural de Soria - Instituto de Investigación Sanitaria y Biomédica de Alicante (grant number 190290

Influence of HLA Matching on the Efficacy of Allogeneic Mesenchymal Stromal Cell Therapies for Osteoarthritis and Degenerative Disc Disease

Producción CientíficaThe necessity for more effective therapies for chronic osteoarticular diseases has led to the development of treatments based on mesenchymal stem cells (MSCs), the natural precursors of musculoskeletal tissue. Treatments with autologous MSCs yielded excellent results, with nearly 70% improvement of pain and disability in osteoarthritis and degenerative disc disease. Using allogeneic MSCs is logistically more convenient and would widen the pool of eligible patients, but potential immune rejection should be considered. In this context, MSCs are purportedly immune evasive and better tolerated than other cell types. Methods We used samples collected during the performance of 2 randomized clinical trials using allogeneic bone marrow MSCs for treatment of osteoarthritis (NCT01586312) and degenerative disc disease (NCT01860417). Serum samples were used to determine anti-HLA antibodies, whereas either blood or MSC samples were used for HLA typing of recipients and donors, respectively. Algofunctional indexes were used as indicators of clinical evolution, and the correlation between the number of donor-host HLA mismatches and the efficacy of treatment was determined. Results Immune response was weak and transient, with reactivity decaying during the first year. Consistently, better donor-recipient HLA matching did not enhance efficacy. Conclusions This lack of reactivity is presumably due to the cooperation of 2 factors, (1) downregulation of the host immune responses by the transplanted MSCs and (2) effective insulation of these cells inside the articular cavity or the intervertebral disc, respectively. Interestingly, better HLA matching did not enhance efficacy. These observations have medical relevance as they support the clinical use of allogeneic cells, at least as a single-dose administration. Multiple-dose applications will require further research to exclude possible sensitization.Red de Terapia Celular of the Instituto de Salud Carlos III (RD16/0011/0003) and Centro en Red de Medicina Regenerativa de Castilla y Leó

Atraumatic acromioclavicular joint dislocation: A case report treated with excision of the distal clavicle margin and button slide system with allograft tendon reinforcement at coracoclavicular and acromioclavicular joint

Producción CientíficaAlthough acromioclavicular joint (ACJ) dislocation is a common injury following trauma involving the shoulder, it is rare in the absence of trauma. In this manuscript, we describe a case of ACJ in a 15-year-old girl who presented a painful dislocation with spontaneous shortening of the right acromioclavicular joint that forced her to temporarily abandon her sports career. After failure of conservative physiotherapy treatment, surgical intervention was proposed by performing an arthroscopic-assisted button slide combined with augmented hamstring allograft reconstruction. After the intervention and the subsequent recovery period, the athlete was able to return to her semi-professional training. The follow-up of the patient is 5.5 years post-surgery. The result obtained could help in planning the treatment of future cases

Optical and Infrared Photometry of the Type Ia Supernovae 1991T, 1991bg, 1999ek, 2001bt, 2001cn, 2001cz, and 2002bo

We present optical and/or infrared photometry of the Type Ia supernovae SN 1991T, SN 1991bg, SN 1999ek, SN 2001bt, SN 2001cn, SN 2001cz, and SN 2002bo. All but one of these supernovae have decline rate parameters Delta m_15(B) close to the median value of 1.1 for the whole class of Type Ia supernovae. The addition of these supernovae to the relationship between the near-infrared absolute magnitudes and Delta m_15(B) strengthens the previous relationships we have found, in that the maximum light absolute magnitudes are essentially independent of the decline rate parameter. (SN 1991bg, the prototype of the subclass of fast declining Type Ia supernovae, is a special case.) The dispersion in the Hubble diagram in JHK is only ~0.15 mag. The near-infrared properties of Type Ia supernovae continue to be excellent measures of the luminosity distances to the supernova host galaxies, due to the need for only small corrections from the epoch of observation to maximum light, low dispersion in absolute magnitudes at maximum light, and the minimal reddening effects in the near-infrared.Comment: Astron. J., 128, 3034 (Dec. 2004). This version with updated author list, addresses, acknowledgments, reference