Efecto de la adición de fracción vasculoestromal de grasa a la sutura de lesiones meniscales crónicas en zona avascular del menisco de cerdo

ResumenObjetivoLa adición directa de células troncales mesenquimales puede aumentar las posibilidades de curación de las lesiones meniscales en zona avascular. El objetivo de este estudio es averiguar si la aplicación postoperatoria de la fracción vasculoestromal (FVE) obtenida a partir de tejido adiposo puede tener un efecto en la vascularización y la proliferación celular en el menisco suturado.MétodosA 4 cerdos (8 rodillas) se les realizó una lesión longitudinal de 10mm en zona avascular del menisco medial de ambas rodillas. Dos meses más tarde se reparó la lesión de ambas rodillas con un punto simple. Al mismo tiempo se obtuvieron 50g de grasa abdominal de la que se consiguieron 2cm3 de FVE (donde se objetivó la presencia de aproximadamente 1-5×106células troncales mesenquimales) y se inyectaron en una de las 2 rodillas de cada cerdo 4h después de la cirugía (grupo FVE), siendo la otra rodilla el grupo de control. Los animales se sacrificaron 15 días después. Se evaluaron los siguientes parámetros histológicos en tinción con hematoxilina-eosina: grado de curación, neovascularización del tejido, proliferación de fibrocondrocitos alrededor de la lesión y presencia de repoblación condrocitaria.ResultadosLa tasa de curación (no curado/cicatrización parcial/curación completa) para el grupo de FVS fue 1/1/2, y para el grupo control fue de 2/2/0 (diferencias no significativas). El grado de neovascularización fue mayor en el grupo FVE (3,25 vs. 2). El grado de proliferación de fibrocondrocitos fue mayor en el grupo FVE (2,5 vs. 1,75). Aparecieron formaciones de condrocitos isogénicos en 2 meniscos del grupo FVE y en ninguno del grupo control.ConclusionesLa inyección intraarticular postoperatoria inmediata de FVE parece aumentar la neovascularización, la proliferación fibrocondrocítica y la repoblación de condrocitos a los 15 días después de la reparación de una lesión meniscal en cerdos.Nivel de evidenciaEstudio experimental.Relevancia clínicaSe plantea una manera de administración de células troncales que puede ser más sencilla de implementar en humanos que el cultivo celular.AbstractObjectiveThe addition of mesenchymal stem cells may increase the chance of healing of meniscal lesions in the avascular zone. The objective of this study is to find out if the postoperative application of the stromal vascular fraction (SVF) from adipose tissue can have an effect on vascularization and cell proliferation in the sutured meniscus.MethodsFour pigs (8 knees) underwent a longitudinal injury of 10mm in the avascular area of the medial meniscus in both knees. Two months later the injury was repaired on both knees with a simple suture. At the same time 50g of abdominal fat was removed and 2cm3 of SVF was purified (in which it was found to contain approximately 1-5×106mesenchymal stem cells). This was injected into one of the knees of each pig 4h after the surgery (SVF group), using the other knee as the control group. The animals were sacrificed after 15 days. The following histological parameters with hematoxylin-eosin staining were evaluated: degree of healing, neo-vascularization of tissue and the proliferation of fibro-chondrocytes around the lesion and the presence of new chondrocytes.ResultsThe healing rate (unhealed / partial healing / healed) for the SVF group was 1/1/2, and was 2-2-0 for control group (non-significant differences). The degree of neo-vascularization was higher in the SVF group (3.25 vs 2). The degree of fibro-chondrocytes proliferation was greater in the SVF group (2.5 vs 1.75). The formation of isogenic chondrocytes was observed in 2 menisci of the SVF group and none in the control group.ConclusionsThe postoperative intra-articular injection of SVF might increase the neovascularization, the proliferation of fibro-chondrocytes and the repopulation of chondrocytes 15 days after the repair of meniscal injury in pigs.Evidence levelExperimental study.Clinical relevanceA system for the use of stem cells is presented that might be easier to implement in humans that cell cultures

Comprehensive management of posterior shoulder instability: diagnosis, indications, and technique for arthroscopic bone block augmentation

Recurrent posterior glenohumeral instability is an entity that demands a high clinical suspicion and a detailed study for a correct approach and treatment. Its classification must consider its biomechanics, whether it is due to functional muscular imbalance or to structural changes, volition, and intentionality. Due to its varied clinical presentations and different structural alterations, ranging from capsule-labral lesions and bone defects to glenoid dysplasia and retroversion, the different treatment alternatives available have historically had a high incidence of failure. A detailed radiographic assessment, with both CT and MRI, with a precise assessment of glenoid and humeral bone defects and of glenoid morphology, is mandatory. Physiotherapy focused on periscapular muscle reeducation and external rotator strengthening is always the first line of treatment. When conservative treatment fails, surgical treatment must be guided by the structural lesions present, ranging from soft tissue repair to posterior bone block techniques to restore or increase the articular surface. Bone block procedures are indicated in cases of recurrent posterior instability after the failure of conservative treatment or soft tissue techniques, as well as symptomatic demonstrable nonintentional instability, presence of a posterior glenoid defect >10%, increased glenoid retroversion between 10 and 25 degrees, and posterior rim dysplasia. Bone block fixation techniques that avoid screws and metal allow for satisfactory initial clinical results in a safe and reproducible way. An algorithm for the approach and treatment of recurrent posterior glenohumeral instability is presented, as well as the author's preferred surgical technique for arthroscopic posterior bone block

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Search for anomalous production of events with three or more leptons in pp collisions at √s = 8TeV

Published by the American Physical Society under the terms of the Creative Commons Attribution 3.0 License. Further distribution of this work must maintain attribution to the author(s) and the published articles title, journal citation, and DOI.A search for physics beyond the standard model in events with at least three leptons is presented. The data sample, corresponding to an integrated luminosity of 19.5fb-1 of proton-proton collisions with center-of-mass energy s=8TeV, was collected by the CMS experiment at the LHC during 2012. The data are divided into exclusive categories based on the number of leptons and their flavor, the presence or absence of an opposite-sign, same-flavor lepton pair (OSSF), the invariant mass of the OSSF pair, the presence or absence of a tagged bottom-quark jet, the number of identified hadronically decaying τ leptons, and the magnitude of the missing transverse energy and of the scalar sum of jet transverse momenta. The numbers of observed events are found to be consistent with the expected numbers from standard model processes, and limits are placed on new-physics scenarios that yield multilepton final states. In particular, scenarios that predict Higgs boson production in the context of supersymmetric decay chains are examined. We also place a 95% confidence level upper limit of 1.3% on the branching fraction for the decay of a top quark to a charm quark and a Higgs boson (t→cH), which translates to a bound on the left- and right-handed top-charm flavor-violating Higgs Yukawa couplings, λtcH and λctH, respectively, of |λtcH|2+|λctH|2<0.21

Measurement of associated W plus charm production in pp collisions at √s=7 TeV

Peer reviewe

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació