Valor del seguimiento densitométrico en la evaluación de una prótesis total de cadera

En este estudio se ha revisado la evolución clínica, radiográfica y densitométrica de 30 Prótesis Totales de Cadera modelo Bihapro, con recubrimiento de Hidroxiapatita. Se han presentado complicaciones clínicas en 3 casos (10%). La evolución ha sido de incremento de la densidad alrededor de la prótesis en el 97% de los casos. El aumento medio de densidad fue de 1 a 1,3 (cociente hueso periprotésico/hueso normal) en el cotilo y de 1,4 a 1,5 en la zona metafisaria (áreas 1 y 7 de Gruen) del fémur. Los resultados clínicos, radiográficos y densitométricos (Sistema CADIA) han sido coincidentes en el 97% de los casos.In this study we have reviewed the clinical, radiographical and densitometric follow-up of 30 Bihapro® total hip hydroxyapatite-coated arthroplasties. There were complications in 3 cases (10%). Densitometric results showed an increase of bone density around the prosthesis in 97% of cases. The average increase in bone denstiy (periprosthetic/normal bone ratio) varied from 1 to 1.3 in the acetabulum and from 1.4 to 1.5 in the metaphysial area of the femur (Gruen's zones 1 and 7). Clinical, radiographical and densitometric results (CADIA System) exhibited a foot correlation in 97% of cases

Artroplastia total de cadera bihapro® primeros resultados

Se analizan en este trabajo 150 artroplastias totales implantadas en tres hospitales con un seguimiento de 3 a 15 meses. En todos los casos se utilizó el modelo Bihapro® fabricado en aleación de Titanio y vástago recubierto de hidroxiapatita en su porción proximal. La edad de los pacientes osciló entre los 29 y 76 años con una media de 61. Aunque el periodo de revisión es corto, los autores señalan por una parte la buena evolución clínica con escasa presencia de dolor en el muslo y por otra, en cuanto a los hallazgos radiográficos, la excelente integración ósea acetabular con áreas de osteocondensación y trabéculas en la zona metafísaria femoral.In this report we review 150 total hip arthroplasties performed in three hospitals with a follow-up of 3 to 15 months. In all cases were used the Bihapro® model made of Titanium alloy with a hidroxiapatite coated femoral component in its proximal region. The age of the patients varies from 29 to 76 years, with an average of 61 years. Although the follow-up period is short the authors show both a good clinical evolution with little thigh pain and an excelent acetabular bone integration with areas of osteocondensation and trabeculae in the femoral metaphyseal area

Psiquiatría ambulatoria de la Seguridad Social en Asturias.

La situación creada por las autonomías en el Estado español ha planteado al movimiento obrero la necesidad de aportar sus planteamientos y soluciones a diversos problemas con un rigor técnico que se superponga a los planteamientos ideológicos. Esta necesidad es más aguda aún en aquellos terrenos como el de la salud mental, en la que la ausencia de planteamientos tecnocráticos y la miseria asistencial actual deja todo por hace

Psiquiatría ambulatoria de la Seguridad Social en Asturias.

La situación creada por las autonomías en el Estado español ha planteado al movimiento obrero la necesidad de aportar sus planteamientos y soluciones a diversos problemas con un rigor técnico que se superponga a los planteamientos ideológicos. Esta necesidad es más aguda aún en aquellos terrenos como el de la salud mental, en la que la ausencia de planteamientos tecnocráticos y la miseria asistencial actual deja todo por hace

RET signalling provides tumorigenic mechanism and tissue specificity for AIP-related somatotrophinomas

International audienceIt is unclear how loss-of-function germline mutations in the widely-expressed co-chaperone AIP , result in young-onset growth hormone secreting pituitary tumours. The RET receptor, uniquely co-expressed in somatotrophs with PIT1, induces apoptosis when unliganded, while RET supports cell survival when it is bound to its ligand. We demonstrate that at the plasma membrane, AIP is required to form a complex with monomeric-intracellular-RET, caspase-3 and PKCδ resulting in PIT1/CDKN2A-ARF/p53-apoptosis pathway activation. AIP-deficiency blocks RET/caspase-3/PKCδ activation preventing PIT1 accumulation and apoptosis. The presence or lack of the inhibitory effect on RET-induced apoptosis separated pathogenic AIP variants from non-pathogenic ones. We used virogenomics in neonatal rats to demonstrate the effect of mutant AIP protein on the RET apoptotic pathway in vivo. In adult male rats altered AIP induces elevated IGF-1 and gigantism, with pituitary hyperplasia through blocking the RET-apoptotic pathway. In females, pituitary hyperplasia is induced but IGF-1 rise and gigantism are blunted by puberty. Somatotroph adenomas from pituitary-specific Aip -knockout mice overexpress the RET-ligand GDNF, therefore, upregulating the survival pathway. Somatotroph adenomas from patients with or without AIP mutation abundantly express GDNF, but AIP -mutated tissues have less CDKN2A-ARF expression. Our findings explain the tissue-specific mechanism of AIP-induced somatotrophinomas and provide a previously unknown tumorigenic mechanism, opening treatment avenues for AIP -related tumours

Unmasking a new prognostic marker and therapeutic target from the GDNF-RET/PIT1/p14ARF/p53 pathway in acromegaly

Most of acromegaly is caused by a sporadic somatotropinoma and a couple of novel gene mutations responsible for somatotropinoma have recently been reported. To determine the cause of sporadic somatotropinoma in Japanese patients, we analyzed 61 consecutive Japanese patients with somatotropinoma without apparent family history. Comprehensive genetic analysis revealed that 31 patients harbored guanine nucleotide-binding protein, alpha stimulating (GNAS) mutations (50.8%) and three patients harbored aryl hydrocarbon receptor interacting protein (AIP) mutations (4.9%). No patients had G protein-coupled receptor 101 (GPR101) mutations. The patients in this cohort study were categorized into three groups of AIP, GNAS, and others and compared the clinical characteristics. The AIP group exhibited significantly younger age at diagnosis, larger tumor, and higher nadir GH during oral glucose tolerance test. In all patients with AIP mutation, macro- and invasive tumor was detected and repetitive surgery or postoperative medical therapy was needed. One case showed a refractory response to postoperative somatostatin analogue (SSA) but after the addition of cabergoline as combined therapy, serum IGF-I levels were controlled. The other case showed a modest response to SSA and the switching to cabergoline monotherapy was also effective. These data suggest that although resistance to SSA has been reported in patients with AIP mutations, the response to dopamine agonist (DA) may be retained. In conclusion, the cause of sporadic somatotropinoma in Japanese patients was comparable with the previous reports in Caucasians, patients with AIP mutations showed unique clinical characteristics, and DA may be a therapeutic option for patients with AIP mutations

Threshold Values for the Information to the General Public about the Poaceae and Urticaceae Pollen Types in the Towns of Cartagena, Lorca and Murcia (REAREMUR) 2010-2016

The incidence of pollinosis in developed countries has been on the rise for the past few decades. It is an illness that leads to a large number of missed work and school days. Therefore, in addition to the direct costs associated therewith, it also causes significant indirect costs. Avoidance to exposure is the most effective preventive measure. With aerobiological data for homogeneous geographical areas, sick people can both take preventive measures and optimize the period of usage of drugs and thus improve the quality of their life. Aerobiological networks have to decide how to provide this information. In the case of information intended for the general public, it is more useful to give it as concentration ranges adjusted to categories of low, medium and high/very high threshold values than as specific numerical values, which might not achieve the desired goal.In this paper we have analyzed the data generated by the Aerobiological Network of the Region of Murcia, Spain, from aerobiological databases in the 2010-2016 period. Based on the analysis of the 90, 95, 97 and 99 percentiles of the time series, we have proposed threshold values —in four levels (low, medium, high and very high), for the Poaceae and Urticaceae pollen types in the towns of Cartagena, Lorca and Murcia— that enhance the information supplied by said Aerobiological Network and are aimed at allowing allergic people to take avoidance and pharmacological treatment measures.</p

Valores limite para informação à população dos tipos polínicos Poaceae e Urticaceae nas cidades deCartagena, Lorca e Múrcia (REAREMUR) 2010-2016

The incidence of pollinosis in developed countries has been on the rise for the past few decades. It is an illness that leads to a large number of missed work and school days. Therefore, in addition to the direct costs associated therewith, it also causes significant indirect costs. Avoidance to exposure is the most effective preventive measure. With aerobiological data for homogeneous geographical areas, sick people can both take preventive measures and optimize the period of usage of drugs and thus improve the quality of their life. Aerobiological networks have to decide how to provide this information. In the case of information intended for the general public, it is more useful to give it as concentration ranges adjusted to categories of low, medium and high/very high threshold values than as specific numerical values, which might not achieve the desired goal.In this paper we have analyzed the data generated by the Aerobiological Network of the Region of Murcia, Spain, from aerobiological databases in the 2010-2016 period. Based on the analysis of the 90, 95, 97 and 99 percentiles of the time series, we have proposed threshold values —in four levels (low, medium, high and very high), for the Poaceae and Urticaceae pollen types in the towns of Cartagena, Lorca and Murcia— that enhance the information supplied by said Aerobiological Network and are aimed at allowing allergic people to take avoidance and pharmacological treatment measures.La prevalencia de la polinosis está aumentando en los países desarrollados en las últimas décadas, siendo una enfermedad que ocasiona un gran número de días de pérdida de actividad laboral o de asistencia a la escuela, por lo que, además de los costes directos ligados a la enfermedad, ocasiona importantes costes indirectos. La evitación de la exposición es la medida preventiva más eficaz. El disponer de datos aerobiológicos para áreas geográficas homogéneas permite a los enfermos, tanto poner en marcha medidas preventivas, como optimizar el periodo de uso de medicamentos y mejorar la calidad de vida. Las redes aerobiológicas deben decidir el modo en que suministra la información. En el caso de información destinada a la población general, es más útil difundirla como intervalos de concentraciones ajustados a categorías de valores umbrales bajos, medios, altos o muy altos, que a un dato numérico concreto que puede no alcanzar el objetivo perseguido.En este trabajo hemos analizado esta información para los datos generados en la Red Aerobiológica de la Región de Murcia y a partir de las bases de datos aerobiológicas del periodo 2010-2016 hemos propuesto, basado en el análisis de los percentiles 90, 95, 97 y 99 de la serie temporal, unos valores umbrales, en cuatro escalones, bajo, medio, alto y muy alto para los tipos polínicos Poaceae y Urticaceae en la ciudades de Cartagena, Murcia y Lorca, que mejoran la información suministrada por la Red Aerobiológica de la Región de Murcia encaminada a que los pacientes alérgicos emprendan las medidas de evitación y el tratamiento farmacológico.A prevalência da polinose tem vindo a aumentar nos países desenvolvidos nas últimas décadas, sendo uma doença que ocasiona um grande número de dias de absentismo laboral ou escolar, pelo que, além dos custos diretos associados à doença, determina consideráveis custos indiretos. Evitar a exposição é a medida preventiva mais eficaz. Dispor de dados aerobiológicos para áreas geográficas homogéneas permite aos doentes quer adotar medidas preventivas, quer otimizar o período do uso de medicamentos, melhorando a sua qualidade de vida. As redes aerobiológicas devem decidir a forma como disponibilizam a informação. No caso de informação destinada à população em geral é mais útil difundi-la como intervalos de concentrações ajustados a categorias de valores limite baixos, médios, altos ou muito altos, considerando que um dado numérico concreto pode não atingir o objetivo pretendido.Neste trabalho foi analisada esta informação para os dados gerados na Rede Aerobiológica da Região de Múrcia, já a partir das bases de dados aerobiológicas no período 2010-2016. Baseados na análise dos percentis 90, 95, 97 e 99 da série temporal, foram propostos valores limites, em quatro escalões (baixo, médio, alto e muito alto), para os tipos polínicos Poaceae e Urticaceae, nas cidades de Cartagena, Múcia e Lorca, visando melhorar a informação disponibilizada pela Rede Aerobiológica da Região de Múrcia, destinada a que os pacientes alérgicos empreendam medidas de redução da exposição e o tratamento farmacológico

The syndrome of central hypothyroidism and macroorchidism: IGSF1 controls TRHR and FSHB expression by differential modulation of pituitary TGFβ and Activin pathways

IGSF1 (Immunoglobulin Superfamily 1) gene defects cause central hypothyroidism and macroorchidism. However, the pathogenic mechanisms of the disease remain unclear. Based on a patient with a full deletion of IGSF1 clinically followed from neonate to adulthood, we investigated a common pituitary origin for hypothyroidism and macroorchidism, and the role of IGSF1 as regulator of pituitary hormone secretion. The patient showed congenital central hypothyroidism with reduced TSH biopotency, over-secretion of FSH at neonatal minipuberty and macroorchidism from 3 years of age. His markedly elevated inhibin B was unable to inhibit FSH secretion, indicating a status of pituitary inhibin B resistance. We show here that IGSF1 is expressed both in thyrotropes and gonadotropes of the pituitary and in Leydig and germ cells in the testes, but at very low levels in Sertoli cells. Furthermore, IGSF1 stimulates transcription of the thyrotropin-releasing hormone receptor (TRHR) by negative modulation of the TGFβ1-Smad signaling pathway, and enhances the synthesis and biopotency of TSH, the hormone secreted by thyrotropes. By contrast, IGSF1 strongly down-regulates the activin-Smad pathway, leading to reduced expression of FSHB, the hormone secreted by gonadotropes. In conclusion, two relevant molecular mechanisms linked to central hypothyroidism and macroorchidism in IGSF1 deficiency are identified, revealing IGSF1 as an important regulator of TGFβ/Activin pathways in the pituitary