Escoliosis experimental por lesión vascular metamérica a nivel lumbar

Se ha realizado un estudio experimental en 25 híbridos de conejo californiano con conejo blanco gigante neozelandés de 37 ± 3 días, lesionando la vascularización metamé- rica que irriga las vértebras lumbares con el propósito de alterar indirectamente el desarrollo de los cartílagos neurocentrales (CNC). La lesión vascular se produjo por la destrucción unilateral a dos o tres niveles de los vasos metaméricos de las vértebras L3 a L5. Las columnas vertebrales fueron disecadas, realizándose estudios radiológicos, macroscópicos e histológicos. Se obtuvieron curvas escolióticas (13 ±4°) de convexidad hacia el lado contrario al intervenido, con rotación de los cuerpos vertebrales (12 ± 5o ) hacia la concavidad de la curva, y rectificación de la cifosis lumbar fisiológica de los conejos (5 ±7°). El ascpecto macroscópico de las curvas era similar al que se observa en la escoliosis idiopática humana. Estos hallazgos apoyan la idea de que una alteración del desarrollo del CNC por déficit vascular, de forma unilateral, es capaz de inducir la aparición de una escoliosis.We have damaged the vascular supply to the right neurocentral cartilage (NCC) to 25 growing rabbits, in order to induce scoliosis. The employed technique was the section of the right metameric artery and vein at two or three levels in the lumbar region (L3 to L5). The spine was studied histologically macroscopically and radiologically. We got slight curves (13 ±4°) with the convexity towards the opposite side to the operated zone, and with rotation (12 ±5°) and lordosis (5 ± 7°). These lesions are similar to human idiopathic scoliosis and may be explained because of the NCC's physiological properties. Those findings support the idea that any mechanic, metabolic or endocrine alteration that cause damage to the NCC or to its vascularization, unilaterally, will induced a scoliosis development

Prevalence of metabolic syndrome in Murcia Region, a southern European Mediterranean area with low cardiovascular risk and high obesity

<p>Abstract</p> <p>Background</p> <p>Metabolic syndrome (MS) is associated with subsequent appearance of diabetes and cardiovascular disease. As compared to other Spanish regions, Murcia (southern Spain) registers increased obesity as well as cardiovascular morbidity and mortality. The aim of this study was to assess the prevalence of MS and its components, awareness of obesity as a health risk and associated lifestyles.</p> <p>Methods</p> <p>A population-based, cross-sectional study was conducted in 2003, covering a sample of 1555 individuals 20 years and over. MS was defined according to the Revised National Cholesterol Education Program Adult Treatment Panel III (R-ATPIII), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Both low (94/80) and high (102/88) waist circumference (WC) thresholds were considered.</p> <p>Results</p> <p>Prevalence of MS was 27.2% (95%CI: 25.2-29.2), 32.2% (95%CI: 30.1-34.3) and 33.2% (95%CI: 31.2-35.3) according to the R-ATPIII, IDF and JIS94/80 respectively. It increased with age until reaching 52.6% (R-ATPIII) or 60.3% (JIS94/80) among persons aged 70 years and over, and was higher in persons with little or no formal education (51.7% R-ATPIII, 57.3% JIS94/80). The most common risk factors were hypertension (46.6%) and central obesity (40.7% and 66.1% according to high and low WC cut-off points respectively). Although most persons were aware that obesity increased health risks, regular exercise was very unusual (13.0% centrally obese, 27.2% non-centrally obese). Adherence to dietary recommendations was similar among centrally obese and non-centrally obese subjects.</p> <p>Conclusions</p> <p>Prevalence of MS is high in our population, is comparable to that found in northern Europe and varies with the definition used. Adherence to preventive recommendations and to adequate weight promotion is very low. In the absence of a specific treatment for MS, integrated intervention based on a sustained increase in physical activity and changes in diet should be reinforced.</p

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Neuroanatomía a través de casos clínicos

Este proyecto ha sido desarrollado en el Departamento de Anatomía y Embriología Humana de la Universitat de València por los profesores Amparo Ruiz Torner que ha ejercido la coordinación, Vicent Teruel Martí, Alfonso A. Valverde Navarro, Ana Cervera Ferri y Joana Martínez Ricós Nuestro objetivo ha sido ofrecer un contexto aplicado de la Neuroanatomía, asignatura básica que se cursa en el segundo año del Grado en Medicina, de una forma amena, entretenida y asequible para el estudiante. Con el fin de facilitar al estudiante el estudio de la asignatura desarrollamos este proyecto que consta de tres grandes apartados: 1. Una exposición de repaso elemental de los diferentes conceptos funcionales y de las estructuras responsables de los mismos a tener en cuenta en la exploración neurológica. 2. La presentación del caso clínico y del contexto en que se desarrolla con el fin de que el estudiante pueda establecer el nivel en el que se localizaría la lesión. 3. El acceso del estudiante a un desarrollo temático completo que le permitiría alcanzar el objetivo pretendido. El estudiante puede abordar la asignatura iniciándola por cualquiera de los tres apartados de los que consta el proyecto

Implementation of Antibiotic Discovery by Student Crowdsourcing in the Valencian Community Through a Service Learning Strategy

© 2020 Maicas, Fouz, Figàs-Segura, Zueco, Rico, Navarro, Carbó, Segura-García and Biosca.Antibiotic misuse is a public health problem due to the appearance of resistant strains in almost all human pathogens, making infectious diseases more difficult to treat. The search for solutions requires the development of new antimicrobials as well as novel strategies, including increasing social awareness of the problem. The Small World Initiative (SWI) and the Tiny Earth (TE) network are citizen science programs pursuing the discovery of new antibiotics from soil samples and the promotion of scientific culture. Both programs aim to bring scientific culture and microbiological research closer to pre-university students through a crowdsourcing strategy and a Service Learning (SL) educational approach, with a 2-fold objective: to encourage students to pursue careers in science and to involve them in the discovery of soil microorganisms producing new antimicrobials. SWI and TE projects were put into practice in Spain under the common name MicroMundo. MicroMundo@Valencia was implemented at the Universitat de València (UV) during the academic years 2017–2018 and 2018–2019. It trained 140 university students to disseminate this initiative into 23 high/secondary schools, and one primary school, involving about 900 people (teachers and students) as researchers. A total of 7,002 bacterial isolates were obtained from 366 soil samples and tested for antibiosis at UV and high/secondary school centers. About 1 or 7% of them produced inhibition halos for the Escherichia coli or Bacillus cereus target strains, respectively. Geolocation of sampling sites by an application developed ad hoc and Kriging analysis also allowed detection of soil foci of antibiotic-producing bacteria. Evaluation of the project by university, high/secondary, and primary school students revealed their strong positive perception and their increased interest in science, as a consequence of acquiring new scientific and pedagogical concepts and skills that they were able to pass on to other classmates, younger students, or relatives. To further expand the dissemination of the project in the Valencian Community, diverse extramural activities deemed to include a gender perspective and aimed at different age groups, were also carried out, obtaining very satisfactory results, increasing sensitivity and awareness to the global antibiotic crisis.We acknowledge funding from the Universitat de València: Equality Unit Projects (2018–2020), Language Policy Service (INNOV-17/18-SPL_330 and UV-INNOV-18/19-SPL_330), and Staff Development and Educational Innovation Service (SFPIE_RMD17_588566, SFPIE_GER17-588199, SFPIE_RMD18_ 839102, SFPIE_GER18-844761, SFPIE_RMD18_954062, SFPIE_ PID19-1096784, and SFPIE_PID19_1096021)

Surgical anatomy applied to transperitoneal approaches of the abdominal aorta and visceral trunks. Dynamic article

Access to the abdominal aorta and its visceral trunks is possible through several approaches. Dissections of five cadavers performed during three National Surgical Anatomy courses applied to Aorta, Hepatobiliopancreatic and Digestive Surgery. Videos and pictures were taken throughout the dissections and showed different abdominal aorta approaches. Abdominal aorta and visceral trunks approaches: longitudinal inframesocolic access, supraceliac clamping, celiac trunk dissection, superior mesenteric artery approaches (retroperitoneal after Kocher menoeuvre, supramesocolic or inframesocolic), Cattell-Braasch manoeuvre and mattox manoeuvre: retrorenal and prerenal. Correct knowledge of the intraabdominal anatomy is necessary to perform all the abdominal aorta surgical approaches. Cadaveric dissection could help to achieve this objective. Cardiovascular and digestive surgeons need to know the possible strategies in order to choose the one which is best suited for each patient

Proyecto Small World Initiative-Tiny Earth en la Universitat de València

Trabajo presentado en las II Jornades d'Aprenentatge-Servei Universitari (ApS), celebradas en Valencia el 17 de octubre de 2018Peer reviewe