El boro, elemento nutricional esencial en la funcionalidad ósea

En las dos últimas décadas, se ha descubierto que un oligoelemento como es el boro, es un elemento nutricional esencial en la fisiología animal y humana. De entre las diversas funciones que tiene, es su papel dentro del metabolismo mineral y óseo la más importante. Se ha demostrado como, suplementos dietéticos de boro pueden compensar las alteraciones estructurales y metabólicas óseas que se producen con déficits de elementos tan importantes como el calcio, la vitamina D o el magnesio. Además puede aumentar o imitar ciertas acciones estrogénicas. Debido a esta capacidad demostrada de reequilibrar el metabolismo óseo, el boro podría ser un importante elemento en la prevención y tratamiento de enfermedades óseas como es la osteoporosis.In the last two decades, it has been discovered that a trace element as Boron is an essential micronutrient element in animal and human physiology. Between their different functions is the mineral and bone metabolism role, the most important one. It has been demonstrate that supplemental dietary Boron may balance bone structural and metabolic disturbances produced by deficit of other important elements as Calcium, Vitamin D or Magnesium. Besides, it may enhance or mimic certain estrogenic actions. Boron may be an important element in osteoporosis prevention and treatment, due to this capacity to balance bone metabolism

Ejercicio y masa ósea

La actividad física es imprescindible para alcanzar una correcta arquitectura y masa ósea, ya que a nivel tisular, las cargas mecánicas locales desencadenan un proceso de adaptación encaminado a la contención de esas cargas. Por lo tanto, la práctica deportiva generará un aumento del estrés titular óseo, provocando la activación de los procesos de formación y modelado óseo. Los ejercicios con elevadas intensidades de carga son los que generan mayor masa ósea. Pero no todas las circunstancias de la práctica deportiva producen un incremento de la masa ósea. El ejercicio extenuante puede producir una disminución de los niveles de esteroides sexuales en adolescentes, aumenta la acidosis tisular y aumentan los niveles de glucocorticoides. Estando todos estos factores asociados a una disminución de la masa ósea.Physical activity is essential to develop a correct architecture and bone mass by jeans of the adaptation process of the tissues to hold the forces produced during exercise activities. Therefore, sports practice will produce higher bone tissue stress increasing the formation and remodelling of bone. Weight-bearing exercises produce the higher increase of bone mass, but not all circumstances of sport practice generate such increase of bone mass. Teenagers by various possible mechanism like sexual steroids, with an increase of tisular acidosis and glucocorticoids levels

Reparación de fibrocartílago meniscal

Las características tisulares y vasculares del fibrocartílago meniscal dificultan la reparación de sus lesiones, de forma semejante a lo que ocurre en el cartílago articular. Aunque Annandale en 1885 (1) ya realizó una sutura meniscal con éxito, ha tenido que pasar casi un siglo para considerar la reparación del menisco como tratamiento de elección, cuando es posible. Los experimentos clásicos de King de 1936 (2) en el perro, demostraron que las lesiones localizadas en la zona central libre del menisco no cicatrizaban nunca, pero en las lesiones periféricas del menisco, en la zona vascular, era posible, con un importante protagonismo de la sinovial. Otros autores como Palmer (1938) (3) demostraron la utilidad de la reparación

Roturas espontáneas del tendón cuadricipital

La rotura espontánea del tendón cuadricipital es una patología asociada a enfermedades crónicas metabólicas. La rotura suele ser unilateral y en raras ocasiones bilateral. Presentamos dos casos de rotura bilateral de tendón cuadricipital en dos pacientes con insuficiencia renal crónica y revisión de la literatura. El diagnóstico se hace fundamentalmente por la clínica de dolor súbito, seguido de incapacidad para la extensión de la rodilla y defecto palpable por encima de la paleta. El estudio radiológico sólo aporta datos valorables en un caso. La ecografía confirmó la lesión en ambos casos, pero informó mal de la extensión de la lesión. Ambos casos se resolvieron con tratamiento quirúrgico.Spontaneous quadriceps tendon rupture has been reported most often in association with metabolic chronic diseases. Rupture is accustomed to be unilateral and in rare bilateral occasions. Two cases report with a bilateral ruptures, both of them are associated with chronic renal failure, and review of the literature are presented. Diagnosis is made fundamentally for the clinic of sudden pain, consecutive from inability for the extension of the knee and palpable defect through the patella. X-ray study only contributes ratable data in case. Sonography confirmed the lesion in both cases, but in informed wrong of the extension of the lesion. Both cases were solved with surgical treatment

Fractura avulsión aislada del ligamento cruzado posterior de la rodilla

La fractura avulsión aislada del ligamento cruzado posterior es una lesión infrecuente, que en ocasiones puede estar enmascarada por otras lesiones asociadas, y que desencadena un cuadro de inestabilidad de rodilla si no se trata adecuadamente. El tratamiento quirúrgico es el de elección en la mayoría de los casos. Presentamos 14 casos tratados en nuestro servicio, 3 de ellos conservadoramente y el resto mediante reducción abierta y fijación con tornillo, con buenos resultados funcionales.Isolated avulsion fracture of the posterior cruciate ligament is a rare injury which can be masked by associated injuries, leaving an unstable knee if not properly treated. Surgery is the elective treatment in many cases. Fourteen cases were managed, three of them nonoperative, and the others with open reduction and internal fixation with screw. Good functional results were obtained

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit