Comportamiento Biológico de Implantes Tendinosos Autógenos Intraarticulares. Interfase con los distintos medios receptores

En el presente trabajo se ha efectuado un estudio experimental de la respuesta biológica de implantes intraarticulares de tendones autógenos insertados en canales óseos. Se ha seguido, mediante microscopía óptica y electrónica, la revascularización de los implantes, los cambios tendinosos intrínsecos y, fundamentalmente, la interfase establecida entre la estructura tendinosa y los distintos medios del lecho receptor. En las zonas bañadas por líquido sinovial se produce "sinovialización", con presencia de sinoviocitos A (aspecto macrofágico) y B (aspecto fibroblástico). En las zonas que delimitan con cartílago aparece una hendidura, cuya superficie tendinosa es también sinovializada. En la interfase hueso-tendón se pueden diferenciar zonas de aposición lateral y termino-terminales. Las primeras muestran fenómenos de remodelación (presencia de abundantes osteoblastos y osteoclastos) y dispositivos arciformes de las fibras colágenas que "anclan" el tendón a trabéculas óseas. En las zonas término-terminales se establece continuidad entre la colágena del tendón y del hueso. En las regiones en que el tendón se relaciona con el tejido adiposo de la médula ósea, se produce también continuidad entre fibras colágenas pertenecientes a ambos componentes.The authors presented an experimental work in rabbits. They rewiewed the revascularization an morfology ("Sinovialization" and "Ligamentation") of tendon autograft used to replace the anterior cruciate ligament (18 rabbits studied) by histological techniques

Comportamiento Biológico de Aloinjertos Tendinosos Intraarticulares.

En el presente trabajo, los autores han efectuado un estudio experimental de la respuesta biológica de aloinjertos tendinosos, implantados en el interior de la articulación de la rodilla. Se ha seguido mediante microscopía óptica y micoscopía electrónica, la revascularización de los implantes y los cambios tendinosos intrínsecos, tanto en la serie de aloinjertos en "fresco", como de aloinjertos congelados. En los aloinjertos en fresco, predomina la intensa respuesta inflamatoria -inmunitaria, siendo la respuesta reparadora de escasos signos de orientación del tejido fibroso definitivo. En la serie de injertos congelados, los fenómenos inflamatorios son escasos, predominando la angiogénesis.In this paper, the authors have studied the biological respons e of tendinous allografts, implanted inside the kne e articulation, in a experimental study. The revascularization of the grafts, and the intrinsic tendinous change s in both series, frozen and no frozen allografts, is studied with optical and electron microscopy. In the no frozen allografts, is more important the intensive inflamatory inmunitary response, with few signs of orientation of the definitive fibrous tissue. In the serie of frozen allografts, the inflamatory response is limited with predominanc e of the angiogénesis process

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Long-term survival of mechanically ventilated patients with severe COVID-19 : an observational cohort study

Altres ajuts: Fundación para la Investigación Biomédica del Hospital Universitario de Getafe (0010604).Background: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality. Methods: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality. Results: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460). Conclusion: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments. Trial registration: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered)