Artritis séptica de rodilla por Streptococcus agalactiae: presentación de un caso y revisión de la literatura

Se describe un caso de artritis séptica de rodilla en un paciente diabético de 69 años. En el momento de la presentación se hallaba sometido a curas locales de una úlcera crónica en el mismo miembro y a antibioterapia oral inespecífica por supuesta infección urinaria. En el cultivo del líquido sinovial se identificó un Streptococcus agalactiae (Estreptococo del grupo B). La infección no remitió con antibioterapia intravenosa electiva e irrigación-aspiración articular repetidas, requiriendo desbridamiento quirúrgico y sinovectomía. A pesar de instaurarse un programa de rehabilitación intensiva la rodilla evolucionó a la rigidez. Se revisa la literatura al respecto, destacando la asociación de artritis por estreptococos del grupo B con pacientes diabéticos portadores de úlceras cutáneas crónicas, así como la potencial gravedad de estas infecciones.This report describes a case of knee septic arthritis in a 69-year-old diabetic patient. At the time of admission he was receiving local treatment for a chronic skin ulcer in the same extremity and inespecific oral antibiotherapy because of an urinary tract infection. Synovial fluid cultures showed a Streptococcus agalactiae (group B streptococcus). The infection had no response to specific parenteral antibiotherapy and repeated joint irrigations-aspirations, and therefore surgical desbridement and synovectomy was required. Despite of an intensive rehabilitation program, the affected knee developed ankylosis. In a review of literature, it is remarkable the association between group B streptococcal arthritis and chronic skin ulcers in diabetic patients and the potential severity of these infections

Analysis of a spatial Lotka-Volterra model with a finite range predator-prey interaction

We perform an analysis of a recent spatial version of the classical Lotka-Volterra model, where a finite scale controls individuals' interaction. We study the behavior of the predator-prey dynamics in physical spaces higher than one, showing how spatial patterns can emerge for some values of the interaction range and of the diffusion parameter.Comment: 7 pages, 7 figure

Oncologist’s knowledge and implementation of guidelines for breakthrough cancer pain in Spain: CONOCE study

[Purpose]: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP.[Methods]: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline.[Results]: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines.[Conclusion]: Despite oncologist’s clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.This study was funded by Kyowa Kirin Farmacéutica S. L.U. through Fundación ECO

Hydrogymnastics training program on physical fitness in elderly women

Se evaluó un programa de entrenamiento de hidrogimnasia sobre las capacidades físicas en 26 adultas mayores (grupo experimental n=16, grupo control n=10), determinadas mediante el protocolo senior fitness test, la hidrogimnasia fue 5 veces por semana por 12 semanas, con ejercicios aeróbicos del 50%-60% de la FCmáx. Se utilizó ANOVA 2x2, indicando interacción significativa (p=0.052) entre grupos y mediciones en la prueba de resistencia a la fuerza en extremidades inferiores, la prueba de agilidad de 2.4 metros tuvo interacción significativa (p≤0.01) entre grupos y mediciones, las pruebas de capacidad aeróbica step test de 2 minutos (p=0.02) y caminar 6 minutos indicaron interacción significativa entre grupos y mediciones (p=0.50); Se infiere que la hidrogimnasia en las adultas mayores participantes es eficaz en la mejora de las capacidades físicas principalmente aeróbicas, de resistencia a la fuerza y agilidad de miembros inferioresThe aim of this study was to evaluate the effect of a hydrogymnastics training program on physical fitness in 26 elderly women (experimental group n=16, control group n=10). The physical fitness was determined by the senior fitness test protocol, the hydrogymnastics consisted in aerobic exercise at 50%-60% of maximum heart rate, 5 times a week in a period of 12 weeks. ANOVA 2x2 as statistical test was used, indicating statistically significant interaction (p=0.052) between groups and measurements on test strength endurance in the legs by squatting on chair in 30 s, agility test 2.4 meters was significant interaction (p≤0.01) between groups and measures, testing aerobic capacity test step 2 minutes (p=0.02) and six minutes walk indicated significant interaction between groups and measurements (p=0.50), the results shown that hydrogymnastics in the elderly women participants was effective improving endurance, strength and agility mainly in leg

EWS-FLI1-mediated suppression of the RAS-antagonist Sprouty 1 (SPRY1) confers aggressiveness to Ewing sarcoma

Ewing sarcoma is characterized by chromosomal translocations fusing the EWS gene with various members of the ETS family of transcription factors, most commonly FLI1. EWS-FLI1 is an aberrant transcription factor driving Ewing sarcoma tumorigenesis by either transcriptionally inducing or repressing specific target genes. Herein, we showed that Sprouty 1 (SPRY1), which is a physiological negative feedback inhibitor downstream of fibroblast growth factor (FGF) receptors (FGFRs) and other RAS-activating receptors, is an EWS-FLI1 repressed gene. EWS-FLI1 knockdown specifically increased the expression of SPRY1, while other Sprouty family members remained unaffected. Analysis of SPRY1 expression in a panel of Ewing sarcoma cells showed that SPRY1 was not expressed in Ewing sarcoma cell lines, suggesting that it could act as a tumor suppressor gene in these cells. In agreement, induction of SPRY1 in three different Ewing sarcoma cell lines functionally impaired proliferation, clonogenic growth and migration. In addition, SPRY1 expression inhibited extracellular signal-related kinase/mitogen-activated protein kinase (MAPK) signaling induced by serum and basic FGF (bFGF). Moreover, treatment of Ewing sarcoma cells with the potent FGFR inhibitor PD-173074 reduced bFGF-induced proliferation, colony formation and in vivo tumor growth in a dose-dependent manner, thus mimicking SPRY1 activity in Ewing sarcoma cells. Although the expression of SPRY1 was low when compared with other tumors, SPRY1 was variably expressed in primary Ewing sarcoma tumors and higher expression levels were significantly associated with improved outcome in a large patient cohort. Taken together, our data indicate that EWS-FLI1-mediated repression of SPRY1 leads to unrestrained bFGF-induced cell proliferation, suggesting that targeting the FGFR/MAPK pathway can constitute a promising therapeutic approach for this devastating disease.FC-A, LG-G, JCL, AS, PG-M, SEL-P, SM and JA are supported by Asociación Pablo Ugarte and Miguelañez SA, ASION-La Hucha de Tomás, Fundación La Sonrisa de Alex and Instituto de Salud Carlos III (PI12/00816 and Spanish Cancer Network RTICC RD12/0036/0027). TGPG is supported by a grant from ‘Verein zur Förderung von Wissenschaft und Forschung an der Medizinischen Fakultät der LMU München (WiFoMed)’, the Daimler and Benz Foundation in cooperation with the Reinhard Frank Foundation, by LMU Munich’s Institutional Strategy LMUexcellent within the framework of the German Excellence Initiative, the ‘Mehr LEBEN für krebskranke Kinder—Bettina-Bräu-Stiftung’, the Walter Schulz Foundation, the Fritz Thyssen Foundation (FTH-40.15.0.030MN) and by the German Cancer Aid (DKH-111886 and DKH-70112257). The ‘Genetics and Biology of Cancers’ team (TGPG, DS and OD) is supported by grants from the Ligue Nationale Contre Le Cancer (Equipe labellisée). This work was also supported by the European PROVABES, ASSET and EEC FP7 grants. We also thank the following associations for their invaluable support: the Société Française des Cancers de l’Enfant, Courir pour Mathieu, Dans les pas du Géant, Olivier Chape, Les Bagouzamanon, Enfants et Santé and les Amis de Claire. We thank Dr S Navarro (University of Valencia, Valencia, Spain) and Dr TJ Triche (Children’s Hospital Los Angeles, Los Angeles, USA) for providing us with Ewing sarcoma cell lines A4573 and TTC-466, respectively.S

Classical and semi-classical energy conditions

The standard energy conditions of classical general relativity are (mostly) linear in the stress-energy tensor, and have clear physical interpretations in terms of geodesic focussing, but suffer the significant drawback that they are often violated by semi-classical quantum effects. In contrast, it is possible to develop non-standard energy conditions that are intrinsically non-linear in the stress-energy tensor, and which exhibit much better well-controlled behaviour when semi-classical quantum effects are introduced, at the cost of a less direct applicability to geodesic focussing. In this article we will first review the standard energy conditions and their various limitations. (Including the connection to the Hawking--Ellis type I, II, III, and IV classification of stress-energy tensors). We shall then turn to the averaged, nonlinear, and semi-classical energy conditions, and see how much can be done once semi-classical quantum effects are included.Comment: V1: 25 pages. Draft chapter, on which the related chapter of the book "Wormholes, Warp Drives and Energy Conditions" (to be published by Springer), will be based. V2: typos fixed. V3: small typo fixe