Survey for Caregivers of People with Autism Spectrum in Chile: Access to Health and Education Services, Satisfaction, Quality of Life And Stigma [Encuesta para Cuidadores de Personas del Espectro Autista en Chile. Acceso a Servicios de Salud y Educación, Satisfacción, Calidad de Vida y Estigma]

People on the Autism Spectrum (AS) face multiple health, education, social, and economic problems. There is limited available information in Chile. \ Objective: To describe the access and satisfaction with health and education services, family and economic impact, stigma, and quality of life of people with AS and their families in Chile. Subjects and Method: Parents/caregivers of AS persons completed the Caregiver Needs Survey, developed by Autism Speaks, which includes demographic information, characteristics of AS persons (previously published), use of health and education services, parents/caregivers\u27 perceptions of satisfaction, impact, stigma, and quality of life. Results: 291 caregivers (86% mothers) of 291 AS persons participated, 89% were male, aged 1-40 years (X:10.4 SD:6.1). Limited and unspecific access to health services is reported. 77% are regularly attending a standard or special school system. Families pay for over 60% of therapies/medical care and over 40% of specific educational support, and 25% report difficulties in accessing services. The family income is affected by resignation (35%) or reduced working hours (46%). Stigma is associated with possible discrimination and feelings of helplessness. The main priorities mentioned for a better quality of life are support for inclusive schooling, better adjustment at home, and improved socialization. Conclusions: This survey provides relevant information about the needs, barriers, and challenges of AS people in Chile and highlights the difficulties in accessing health services and the severe impact on family income. Feelings of stigma, discrimination, and helplessness are reported. Collaborative strategies are needed to improve the quality and access to services and to reduce the economic and mental health burden on the family. - Introducción: Las personas del Espectro Autista (EA) enfrentan múltiples necesidades de salud, educación, problemas sociales y económicos. La información disponible en Chile es insuficiente. Objetivo: Conocer el acceso y satisfacción con servicios de salud y educación, el impacto familiar y económico, estigma y calidad de vida de personas EA y sus familias en Chile. Sujetos y Método: Padres/cuidadores de perso nas EA respondieron la Encuesta de Necesidades de Cuidadores, desarrollada por Autism Speaks, que comprende: información demográfica, características de las personas EA (publicado previamente), utilización de servicios de salud y educación, percepciones de padres/cuidadores en satisfacción, im pacto, estigma y calidad de vida (que presenta esta publicación). Resultados: Participaron 291 cuida dores (86% madres), de 291 personas EA, 89% varones, de 1-40 años (X:10,4 DE:6,1). Se reporta un acceso insuficiente y poco específico a servicios de salud. Un 77% asiste regularmente a algún sistema escolar regular o especial. Las familias financian sobre 60% de terapias/atención médica y sobre 40% de apoyos educacionales específicos; un 25% refiere dificultades de acceso a servicios. La economía familiar se afecta por renuncia (35%) o reducción de jornadas laborales de los cuidadores (46%). El estigma se asocia a posible discriminación y sentimientos de impotencia. Las principales prioridades mencionadas para una mejor calidad de vida son apoyos para escolaridad inclusiva, mejor adaptación en el hogar y mejorar la socialización. Conclusiones: Esta encuesta aporta información relevante acerca de las necesidades, barreras y desafíos de las personas EA en Chile. Destacan las dificultades de acceso a servicios de salud y el severo impacto sobre el ingreso económico familiar. Existe estigma, discriminación e impotencia. Se requiere elaborar estrategias colaborativas para mejorar la calidad y acceso a servicios y reducir la carga económica y de salud mental familiar

Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics

"Published online: 24 October 2017"PURPOSE: Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD). METHODS: Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task. RESULTS: The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001). CONCLUSIONS: Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively. LEVEL OF EVIDENCE: Level II, prospective cohort study.The authors gratefully acknowledge the funding support from the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST-EEXOT)info:eu-repo/semantics/publishedVersio

Attenuation of atherogenic apo B-48-dependent hyperlipidemia and high density lipoprotein remodeling induced by vitamin C and E combination and their beneficial effect on lethal ischemic heart disease in mice

Abstract Background and aims Atherosclerotic cardiovascular disease is highly prevalent and its underlying pathogenesis involves dyslipidemia including pro-atherogenic high density lipoprotein (HDL) remodeling. Vitamins C and E have been proposed as atheroprotective agents for cardiovascular disease management. However, their effects and benefits on high density lipoprotein function and remodeling are unknown. In this study, we evaluated the role of vitamin C and E on non HDL lipoproteins as well as HDL function and remodeling, along with their effects on inflammation/oxidation biomarkers and atherosclerosis in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. Methods and results Mice were pre-treated for 5 weeks before and during atherogenic diet feeding with vitamin C and E added to water and diet, respectively. Compared to a control group, combined vitamin C and E administration reduced serum total cholesterol and triglyceride levels by decreasing apo B-48-containing lipoproteins, remodeled HDL particles by reducing phospholipid as well as increasing PON1 and apo D content, and diminished PLTP activity and levels. Vitamin supplementation improved HDL antioxidant function and lowered serum TNF-α levels. Vitamin C and E combination attenuated atherogenesis and increased lifespan in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice. Conclusions Vitamin C and E administration showed significant lipid metabolism regulating effects, including HDL remodeling and decreased levels of apoB-containing lipoproteins, in mice. In addition, this vitamin supplementation generated a cardioprotective effect in a murine model of severe and lethal atherosclerotic ischemic heart disease

Medición de presiones relativas en aorta torácica y arteria pulmonar de voluntarios sanos y pacientes con Tetralogía de Fallot reparada utilizando la secuencia 4D Flow de resonancia magnética cardíaca Relative pressure measurement in thoracic aorta and pulmonary artery in healthy volunteers and patients with Tetralogy of Fallot repaired by 4D Flow cardiovascular MRI

Objetivo. Utilizar 4D Flow y las ecuaciones de Navier-Stokes para obtener mapas de presiones relativas (PR) en la Aorta y Arteria Pulmonar (AP) de voluntarios y pacientes con Tetralogía de Fallot reparada (TOFr). Métodos. En 10 voluntarios y 6 pacientes con TOFr se adquirió la secuencia 4D flow del corazón y sus principales vasos. La raíz de la Aorta Ascendente se utilizó como referencia para calcular las PR a esta zona en cinco puntos distintos. Además, se midió la PR de la AP derecha e izquierda respecto a la AP. Resultados. Los pacientes con TOFr tuvieron diferencias de PR entre los valores máximos y mínimos más grandes que los voluntarios en la AP (p<0,05). Adicionalmente, las PR de la aorta tuvieron una excelente correlación con datos publicados utilizando 4D flow y mediante cateterización. Conclusiones. 4D Flow podría constituir una nueva herramienta diagnóstica, no invasiva, ni operador dependiente, en el manejo de patologías CV.<br>Objective. To validate the utility of 4D Blood Flow and Navier-Stokes equations to create relative pressure (RP) maps in the aorta and pulmonary artery (PA) in healthy volunteers and patients with repaired tetralogy of Fallot (TOF). Methods. A 4D flow sequence of whole heart and its major vessels was acquired in 10 healthy volunteers and 6 patients with repaired TOF. The root of the ascending aorta was used as the reference point to calculate RP along five different points of this area. In addition, relative pressure of both right and left PA was measured as correlated to absolute pressure. Results. Patients with repaired TOF showed greater pulmonary artery (PA) relative pressure differences between maximum and minimum values when compared to volunteers (p <0.05). Additionally, aortic relative pressures had an excellent correlation with published data, whether using 4D flow or by catheterization. Conclusions. 4D Flow MRI may represent a new non-invasive and non operator-dependent diagnostic tool in CV disease management