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Background Polytrauma is a major clinical problem due to its impact on morbidity and mortality, especially among the younger population. Its pathophysiology is not completely elucidated, and the study of the involvement of certain cell populations with therapeutic potential, such as mesenchymal stromal cells (MSCs), is an area of growing interest, as mesenchymal cells have anti-inflammatory, immunoregulatory, and osteogenic potential. Methods In the present preliminary work, we have evaluated the characteristics of MSCs in terms of proliferation, immunophenotype, cell cycle, clonogenic capacity, and multilineage differentiation ability in a series of 18 patients with polytrauma and compared them to those from otherwise healthy patients undergoing elective spinal surgery. Results MSCs from polytrauma patients displayed higher proliferative potential with significantly higher cumulative population doublings, increased expression of some important cell adhesion molecules (CD105, CD166), and an early pre-osteogenic differentiation ability compared to those of the control group. Conclusions MSCs could potentially be of help in the repair process of polytrauma patients contribute to both cell-tissue repair and anti-inflammatory response. This potential should be further explored in larger studies.

1. Switching plant species visited by pollinators (partner flexibility) has been proposed as a behavioural mechanism able to attenuate the negative impacts of shifts in plant communities on pollination. However, it is unclear whether the magnitude of such response is generalizable or depends on the environmental context. Moreover, the ability of pollinators to exploit plants with dissimilar traits (trait flexibility) has been overlooked, even though it can affect the spectrum of new partners available. 2. To shed some light on this problem, we quantified partner and trait flexibility in five communities from four different environments, from Alpine to semi-arid. We evaluated whether the rate at which pollinators incorporated new plant species throughout the flowering season was similar across communities or context dependent. Then, we assessed whether pollinators changed the type of flowers visited and if such trait flexibility was related to their capacity to visit new plant species. Finally, we developed an agent-based model to explore whether diet flexibility can protect pollination when the plant community changes. To this end, we used scenarios of phenological decoupling. 3. In general, pollinators switched interaction partners to cope with the temporal replacement of plant species. Yet, the magnitude of such behaviour varied across communities, probably in response to differences in the number of floral resources available. Also, pollinators were able to visit plant species with dissimilar traits, though both components of diet flexibility (partner identity and traits) did not necessarily covary. Thus, to have a full picture of pollinators' diet flexibility, we need to consider the floral traits of partners. Finally, our theoretical model shows that diet flexibility can protect pollination after shifts in plant communities, but that such positive effects are limited by trait-matching between co-occurring species. 4. Synthesis. Overall, our study highlights the importance of incorporating plant traits when evaluating the ability of pollinators to find new interaction partners. Besides, our simulation results suggest that diet flexibility may not unequivocally protect pollination against changes in plant communities, especially if they entail shifts in the characteristics of the floral assemblage, and hence, the ability of pollinators to find new interaction partners can be compromised., We are thankful to Marcelo Aizen and Carolina Morales for their constructive comments in the initial ideas of this work. Field work from the Monte desert community was funded by CONICET (PIP 6564and 2781) and FONCYT (PICT 20805, 1471, 2010-2779 and 2014-3168). Work at Mediterranean alpine communities was supported by the project LIMITES (CGL2009-07229), MOUNTAINS (CGL2012-38427) and PHENOTYPES (PGC2018-099115-B-100) of the Spanish Ministry of Ministry of Economy and Competitiveness (MINECO). The study on Temperate montane communities was part of the research cooperation ‘Climatic Impacts on Ecosystems and Climatic Adaptation Strategies’ (FORKAST) funded by the Bavarian Ministry of Sciences, Research and the Arts, Germany. CLR was supported by a Juan de la Cierva Incorporación post-doctoral fellowship (Spanish Ministry of Science: IJC2019-041342-I).T.M.-L. was supported by CONICET (PICT-2018-01566). This work did not need field permits as we used databases already available.

Effect of oral anticoagulant and antiplatelet treatment in older patients requiring surgical treatment for hip fracture. The oral anticoagulant or high-dose antiplatelet treatments are significantly associated with an increase in the waiting time to surgery and the mean length of stay. Those treatments also showed a higher rate of some immediate postsurgical medical complications. Hip fracture patients following previous oral anticoagulant treatment have a higher 2-year mortality rate, but we could not demonstrate an effect on early mortality. To analyze the associations of oral anticoagulant and antiplatelet treatments in older patients requiring surgical treatment for hip fracture with mortality, length of stay, waiting time to surgery and postsurgical immediate complications. A prospective observational study, including surgically treated hip fracture patients aged 65 years and older. We analyzed admission status variables, and time to surgery, length of stay and immediate surgical and medical complications. We recorded a 2-year survival follow-up. Of the 237 patients studied, 32.5% received antiplatelet treatment and 17.7% received oral anticoagulant treatment. The overall 2-year mortality was 29.1%. The 2-year mortality rate reached the 33.8% for antiplatelet-treated patients (n.s.) and 45.2% for oral anticoagulated patients (p = 0.011). The length of stay increased significantly associated with the oral anticoagulant or high-dose antiplatelet treatment (p

To relate the Anterior Cruciate Ligament (ACL) innervation and histologic degeneration status to the knee osteoarthritis radiologic and functional status.Prospective observational study including 30 consecutive patients affected by primary knee osteoarthritis undergoing Total Knee Arthroplasty (TKA). All patients suffering secondary knee osteoarthritis, an antecedent of an infectious process, malignant process, autoimmune disorder, or previous knee surgery were excluded. We recorded biodemographic, clinical, and radiologic variables of all participants previous to the TKA procedure. ACL tissue was harvested during TKA standard procedure and the obtained sample was fixed in 4% formalin and paraffin-embedded. ACL cross-sections were stained by haematoxylin-eosin and Gallego staining for elastic and collagen fibers, and Sevier-Munger silver staining for nervous tissue.ACL samples histologic degeneration classification reported 15.4% normal, 23.1% slight, 26.9% mild, 11.5% moderate and 23.1% marked. We noted 46.2% large nervous fascicles, 15.4% medium fascicles, 3.8% small fascicles, and no nerve fibers were found in 34.6% ACL samples. No significant correlation was found between the histologic degeneration and the nervous fiber quantification (p0.05, in all cases). We noted a significant histologic degeneration inverse correlation with the VAS scale (p=0.016), and nervous fiber quantification correlation with Lequesne maximum distance walked punctuation (p=0.043). We also noted greater nervous fiber quantification with minor radiological knee osteoarthritis (Kellgren-Lawrence grade II).ACL degeneration and innervation deficit may play a role in primary knee osteoarthritis onset, but the lack of a defining relationship among the different parameters assessed justifies further research in greater populations.

Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties is increasing, so infections could also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee arthroplasty.This is a case-control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca. We included 66 TKA PJI patients and 66 control TKA patients. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed by logistic regression and attributable risk fraction assessed.Prolonged operative time ( 90') and tourniquet time ( 60') were the most relevant risk factors described (OR 40.77, AFE 0.97, p 0.001 and OR 37.14, AFE 0.97, p 0.001, respectively). The use of non-antibiotic-laded cement (OR 3.62), obesity (BMI 30, OR 8.86), diabetes (OR 2.33), high ASA grade (III-IV, OR 15.30), and blood transfusion requirement (OR 4.60) were also statistically significant risk factors for TKA PJI.Our study provides evidence concerning that operative time, tourniquet time, cement type, diabetes, obesity, ASA grade, and blood transfusion requirement as independently associated risk factors for TKA PJI. Modifiable risk factors were specifically relevant, so we should be able to reduce the infection rate.

Background: Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties has increased and will continue to increase so that the number of infections will also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee prosthesis in a Spanish population. Methods: This is a case-control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca during the period January 1 2010 until January 1, 2015. TKA PJI was detected in 66 patients. As controls, a similar number of patients from the same period who did not develop a periprosthetic infection were included. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed. Results: Diabetes, ASA grade, obesity and the use or not of antibiotic loaded cement were statistically significant related to the appearance of the infection. For the variables of surgical time and ischemia time, this relationship disappeared when the logistic regression was made. Conclusions: Our study provides evidence that diabetes, cement type, ASA and BMI were independently associated with increased risk of PJI for TKA patients in a Spanish population. We think that modifiable risk factors were specifically relevant and for that reason we can reduce the infection rate.

Background Posterolateral spinal fusion with autologous bone graft is considered the “gold standard” for lumbar degenerative disc disease (DDD) when surgical treatment is indicated. The potential role of mesenchymal stromal cells (MSCs) to replace the bone graft in this setting has not been fully addressed. Objective To analyze the safety, feasibility and potential clinical efficacy of the implantation of autologous MSCs embedded with tricalcium phosphate as a therapeutic alternative to bone graft in patients with DDD during posterolateral spine fusion. Study design Phase I/II single-arm prospective clinical trial. Methods Eleven patients with monosegmental DDD at L4–L5 or L5–S1 level were included. Autologous bone marrow-derived MSC were expanded in our Good Manufacturing Practice (GMP) Facility and implanted during spinal surgery embedded in a tricalcium phosphate carrier. Monitoring of patients included a postoperative period of 12 months with four visits (after the 1st, 3rd, 6th, and 12th month), with clinical and radiological assessment that included the visual analog scale (VAS), the Oswestry disability index (ODI), the Short-Form Health Survey (SF-36), the vertebral fusion grade observed through a simple Rx, and the evaluation of possible complications or adverse reactions. In addition, all patients were further followed up to 5 years for outcome. Results Median age of patients included was 44 years (range 30–58 years), and male/female ratio was (6/5) L4–L5 and L5–S1 DDD was present five and six patients, respectively. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell implantation. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 80% of patients achieved lumbar fusion at the end of the follow-up. No adverse effects related to the procedure were recorded. Conclusions The use of autologous MSCs for spine fusion in patients with monosegmental degenerative disc disease is feasible, safe, and potentially effective. Trial registration no. EudraCT: 2010–018335-17; code Identifier: NCT01513694 (clinicaltrials.gov). Electronic supplementary material The online version of this article (10.1186/s13287-019-1166-4) contains supplementary material, which is available to authorized users.

We present the case of a patient with a giant cell tumor of the thoracic wall that invaded the thoracic spine.A giant cell tumor that affects the spine and the thoracic wall is very rare but can grow to a large size. We report a case of giant cell tumor of the left chest wall extending to the thoracic spine in a 28-year-old man. Positron emission tomography (PET) showed a tumor of 11 × 4 × 13 cm in size and the histopathology specimen of the first surgical procedure diagnosed a giant cell tumor. The tumor was treated by oblique osteotomy guided with pedicle wires.A giant cell tumor was histologically confirmed following radical surgery. After 1 year of follow-up the patient was asymptomatic. There has been no recurrence of the tumor.The use of transpedicular Kirschner wires could be a good technical support for transpedicular oblique sagittal osteotomy.

Significant research efforts have been undertaken during the last decades to treat musculoskeletal disorders and improve patient’s mobility and quality of life. The goal is the return of function as quickly and completely as possible. Cellular therapy has been increasingly employed in this setting. The design of this study was focused on cell-based alternatives. The present study aimed at investigating the bone regeneration capacity of xenogeneic human bone marrow-derived mesenchymal stromal cell (hMSC) implantation with tricalcium phosphate (TCP) granules in an immunocompetent rabbit model of critical-size bone defects at the femoral condyles. Two experimental groups, TCP and hMSC + TCP, were compared. Combination of TCP and hMSC did not affect cell viability or osteogenic differentiation. We also observed significantly higher bone regeneration in vivo in the hMSC + TCP group, which also displayed better TCP osteointegration. Also, evidence of hMSC contribution to a better TCP osteointegration was noticed. Finally, no inflammatory reaction was detected, besides the xenotransplantation of human cells into an immunocompetent recipient. In summary, hMSC combined with TCP granules is a potential combination for bone regeneration purposes that provides better preclinical results compared to TCP alone.

Purpose To assess, with finite element analysis and an in vitro biomechanical study in cadaver, whether the implementation of an anterior interbody cage made of hedrocel with nitinol shape memory staples in compression increases the stiffness of the stand-alone interbody cage and to compare these constructs' stiffness to other constructs common in clinical practice. Methods A biomechanical study with a finite element analysis and cadaveric testing assessed the stiffness of different fixation modes for the L4-L5 functional spinal unit: intact spine, destabilized spine with discectomy, posterior pedicle-screw fixation, anterior stand-alone interbody cage, anterior interbody cage with bilateral pedicle screws and anterior interbody cage with two shape memory staples in compression. These modalities of vertebral fixation were compared in four loading modes (flexion, extension, lateral bending, and axial rotation). Results The L4-L5 spinal unit with an anterior interbody cage and two stapleswas stiffer than the stand-alone cage. The construct stiffness was similar to that of a model of posterior pedicular stabilization. The stiffness was lower than that of the anterior cage plus bilateral pedicle-screw fixation. Conclusion The use of an anterior interbody implant with shape memory staples in compression may be an alternative to isolated posterior fixation and to anterior isolated implants, with increased stiffness.

Producción Científica, Over the last decades, novel therapeutic tools for osteochondral regeneration have arisen from the combination of mesenchymal stromal cells (MSCs) and highly specialized smart biomaterials, such as hydrogel-forming elastin-like recombinamers (ELRs), which could serve as cell-carriers. Herein, we evaluate the delivery of xenogeneic human MSCs (hMSCs) within an injectable ELR-based hydrogel carrier for osteochondral regeneration in rabbits. First, a critical-size osteochondral defect was created in the femora of the animals and subsequently filled with the ELR-based hydrogel alone or with embedded hMSCs. Regeneration outcomes were evaluated after three months by gross assessment, magnetic resonance imaging and computed tomography, showing complete filling of the defect and the de novo formation of hyaline-like cartilage and subchondral bone in the hMSC-treated knees. Furthermore, histological sectioning and staining of every sample confirmed regeneration of the full cartilage thickness and early subchondral bone repair, which was more similar to the native cartilage in the case of the cell-loaded ELR-based hydrogel. Overall histological differences between the two groups were assessed semi-quantitatively using the Wakitani scale and found to be statistically significant (p, Ministerio de Economía, Industria y Competitividad (Project (MAT2016-78903-R, MAT2016-9 79435-R, MAT2013-42473-R, MAT2013-41723-R and MAT2012-38043), Junta de Castilla y León (programa de apoyo a proyectos de investigación – Ref. VA244U13, VA313U14 and GRS/516/A/10)

INTRODUCTIONThe scapula is one of the most common locations for chondrosarcomas. They may have a primary or secondary origin, and they can be due to a degeneration of benign lesions or be secondary to radiotherapy. The surgical treatment presents good survival rates, if safety margins are preserved.PRESENTATION OF CASEWe present the case of a chondrosarcoma of the scapula secondary to a radiodermatitis that required a modified total scapulectomy with a latissimus dorsi flap.DISCUSSION AND CONCLUSIONOperations that respect or try to preserve the function of the upper limb must be taken into consideration in tumors of the pectoral girdle.

Q fever is a common worldwide zoonosis that is often difficult to diagnose because of its variety and the fact that its clinical symptoms are highly unspecific. We present a rare case of chronic multifocal osteomyelitis caused by Coxiella burnetti in a 2-year-old girl, which has recurred on many occasions, although the patient is under treatment with the most widely accepted approaches from other studies. A systemic review of the little published literature on this patients shows that there is no universal consensus with regard to the most adequate treatment.

[ES] El objetivo de esta tesis es evaluar de forma comparativa la eficacia de la ingeniería tisular con un hidrogel proteico y células madre mesenquimales humanas en el tratamiento de un defecto osteocondral en un modelo de xenotransplante en un conejo. También se pretende estudiar la viabilidad del hidrogel como soporte para la terapia celular con células mesenquimales, evaluar los resultados radiológicos, comparando las rodillas tratadas con células madre mesenquimales humanas y sin ellas y evaluar los resultados histológicos, comparando las rodillas tratadas con células madre mesenquimales humanas y sin ellas., [EN] The objective of this thesis is evaluate comparatively the efficiency of tissue engineering with a hydrogel proteic and human mesenchymal stem cells in the treatment of an osteochondral defect in a xenograft model in a rabbit. It also aims to study the viability of the hydrogel as a support for mesenchymal cell therapy, evaluate the radiological results, comparing the knees treated with human mesenchymal stem cells and without them and evaluate the histological results, comparing the knees treated with human mesenchymal stem cells and without them.

Bone metastases are the most common cause of osteolytic lesions of bones in adults. Cancers most likely to metastasize to bone include breast, lung, kidney and prostate, while metastases are rare in colorectal cancer (although they cannot be dismissed). In this last case, metastases usually appear in advanced stages of the disease. Most of the metastatic lesions in women derive from breast cancer, and in the case of men, they derive from prostate cancer. Primary sarcomas of the bone do not usually metastasize to bone. Metastatic lesions are usually multiple, and they tend to appear on the axial skeleton and the proximal segments of the limbs. Their location, in decreasing order, is the following: dorso-lumbar spine, sacrum, pelvis, ribs, sternum, proximal third of the femur, proximal third of the humerus and cranium. Metastases affect the cancellous bone more, but they have a larger repercussion if they affect a cortical bone, because if load-bearing bones are involved, pathological fractures may appear. Colorectal carcinoma may generate metastasis on the cancellous and cortical bone. According to the statistics, three out of every four patients who die of cancer present a bone metastasis, and an estimated 90% of cancer patients die of metastasis. Therefore, this is one of the final causes of the high mortality rates associated to cancer, and there is a limited amount of therapeutic and clinical resources to deal with it. The most common locations for these metastases are: spinal column, pelvis, ribs and pectoral and pelvic girdles. Acral metastases are rare and for this reason they will be analyzed separately.

In the health sector, the EQ-5D has been widely used to evaluate health-related quality of life, mainly due to its simplicity, robustness and plasticity in calculating years of life adjusted for quality. However, its model has remained stable over time and knowledge of the influence of such biodemographical variables as age and gender has not been incorporated. This information, along with the well-known non-linear behavior of the VAS, which measures the self-concept of the ‘General State of Health’, forms the basis for a new model, which we present here from a sample of patients who were operated on for chronic low back pain. These are obtained using multiple regression analysis are consistent in terms of goodness-of-fit given that this new model is able to explain 91.3% of the self-concept of the ‘general state of health’. Above leads to an improvement of 21.6% compared to the available models more robust and meets most of the restrictions for this type of statistical modeling.

There are many causes for the paralysis of the external sciatic popliteal nerve , such as the intraneural ganglion cyst. In this case, we evaluate a 52-year-old woman with no relevant personal record, who was admitted with paresis of the right foot of 4 months of evolution associated with alterations in the sensitivity that rose up to the posterolateral region of the leg. The diagnosis was based on MR and cyst decompression and disconnection of the articular branch. Given the low incidence of these lesions, their origin is still subject to controversy. The most widely accepted theory is the unifying articular theory described by Spinner in the year 2003. Intraneural ganglion cysts must be included in the differential diagnosis of progressive paralysis of the sciatic nerve, lesions of the nerve root at L5 and nerve sheath tumours that start at the lateral compartment of the knee. The treatment of a fibular intraneural ganglion cyst must be surgical and the operation must be performed as soon as possible.