Integrative Medicine

Danshensu Ameliorates Cardiac Ischaemia Reperfusion Injury through Activating Sirt1/FoxO1/Rab7 Signal Pathway Abstract Objective: To explore the specific molecular mechanisms of Danshensu (DSS) in the treatment of ischemia reperfusion injury (IRI). Methods: IRI model was established with isolated rat hearts by performing global ischaemia for 30 min, and then followed by 60 min reperfusion. Also, H9C2 cells were subjected to 4-h hypoxia followed by 3-h reoxygenation. Then 10 μmol/L DSS were added in the reperfusion/reoxygenation step to intervene IRI. Cardiac function, structural change and apoptosis were respectively tested by Langendorff System, hematoxylin and eosin (HE) and terminal-deoxynucleotidyl transferase mediated nick endabeling (TUNEL) stainings. Then lactate dehydrogenase (LDH), reactive oxygen species (ROS), superoxide gasififi cation enzyme (SOD) and glutathione peroxidase (GSH-PX) were detected by enzyme-linked immunosorbent assay (ELISA). Sirt1/FoxO1/Rab7 Signal Pathway was monitored at both protein and mRNA levels. Results: The results showed that IRI not only greatly attenuated cardiac function (LVDP and ±dp/dtmax, P<0.01, P<0.05) and increased the level of the marker enzymes (cardiac troponin T, LDH, P<0.01) from the coronary effluents, but also markedly induced changes in the structure of cardiomyocytes and contributed to apoptosis, which were mediated by boosted endogenous ROS. However, after treatment with DSS all above indexes were improved, which was related to activating Sirt1/FoxO1/Rab7 signal pathway accompanied with the enhancement of antioxidant defense system, such as superoxide gasififi cation enzyme and glutathione peroxidase. Conclusion: DSS is able to protect hearts from IRI, which may be attributable to inhibiting excessive ROS through Sirt1/FoxO1/Rab7 signaling.

Effects and Mechanism of Action of Artemisinin on Mitochondria of Plasmodium berghei Abstract Objective To study the antimalarial effects and mechanisms of artemisinin (Qinghaosu in Chinese, QHS) on mitochondria in mice infected with Plasmodium berghei. Methods A total of 108 C57 mice infected with Plasmodium berghei were randomly divided into 3 groups by weight: the control group, 200 and 400 mg/kg QHS groups. The two QHS treatment groups were further divided into 4 sub-groups with 12 animals each time according to the treatment time, 0.5, 1, 2, and 4 h. Normal saline was intragastrically (i.g.) administered to the control group. The other two groups received different doses of QHS by i.g. administration. Animals were treated once with QHS for different detection time as follows: 0.5, 1, 2, and 4 h. The mitochondrial energy metabolism, oxidative damage, membrane potential, and membrane permeability and other indexes were detected. Results After administration of 200 and 400 mg/kg QHS, adenosine triphosphate (ATP) levels in Plasmodium and its mitochondria were reduced (P<0.05), the levels of reactive oxygen species (ROS) and malondialdehyde (MDA) were increased (P<0.05), and the activity of superoxide dismutase (SOD) was also increased (P<0.05). At the same time, the membrane potential of the mitochondria was reduced and the degree to which the membrane permeability transition pore was opened was irreversibly increased (P<0.05). Conclusions Mitochondria in Plasmodium were the targets of QHS, which can adversely affect mitochondrial energy metabolism, oxidative damage, membrane potential, and membrane opening, and ultimately exert an antimalarial effect.

Tongxinluo Ameliorates Myocardial Ischemia-Reperfusion Injury Mainly via Activating Parkin-Mediated Mitophagy and Downregulating Ubiquitin-Proteasome System Abstract Objective To investigate the protective effects and mechanism of Chinese herbal compound Tongxinluo Capsule (通心络胶囊, TXL) on the Parkin-mediated mitophagy and the ubiquitin-proteasome system in a rat model of myocardial ischemia-reperfusion injury (MIRI). Methods Seventy adult male Sprague-Dawley rats were randomly divided into 7 groups: sham group, MIRI group, low- and high-dose TXL (0.5 and 1 g·kg-1·d-1, respectively) groups, atorvastatin (ATV) group (7.2 g·kg-1·d-1), chloroquine (CQ) group (10 g·kg-1·d-1), and highdose TXL + CQ group. After pharmacological administration for 7 days, rats underwent left anterior descending artery ligation surgery to establish the MIRI models with 50 min ischemia followed by 4 h reperfusion. Blood was taken for cardiac troponin I (cTnI) detection and hearts were harvested for infarct staining and apoptosis detection. The autophagy or mitophagy proteins and ubiquitinated proteins were detected by Western blotting. Results Compared with the sham group, the MIRI group exhibited a larger infarcted area (27.13%±0.01%, P<0.01), a higher apoptotic index (34.33%±2.03% vs.1.81%±0.03%, P<0.01), and higher cTnI expression (14.18±1.01 vs. 7.96±0.32, P<0.01). The mitochondrial integrity was damaged in the MIRI group, while TXL and ATV alleviated the damage of MIRI. More autophagosomes were observed in the high-dose TXL group than in the MIRI group (7.00±0.58 vs. 4.33±1.15, P<0.05). More amounts of PTEN-induced putative kinase protein 1 (PINK1) and Parkin translocated onto the mitochondria were detected in the high-dose TXL group than in the MIRI group (P<0.05). The ubiquitin response was signifificantly downregulated in the high-dose TXL group relative to the MIRI group (P<0.05). CQ administration abolished the activation of autophagy flux and the PINK1/ Parkin pathway induced by high-dose of TXL. Conclusions TXL ameliorates MIRI via activating Parkin-mediated mitophagy in rats. The downregulation of the ubiquitin-proteasome system is also involved.

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis Abstract Objective: To evaluate the effectiveness and safety of oral Chinese herbal medicines (CHMs) on post-percutaneous coronary intervention (PCI) patients with depressive disorder in coronary heart disease (CHD). Methods:A literature search was conducted through databases including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2018. Randomized controlled trials (RCTs) comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 software was used to synthesize the results. Results: A total of 16 RCTs enrolling 1,443 participants were included in this systematic review. When compared with antidepressants alone, CHMs showed similar benefits with less side effects [risk ratio=0.54, 95% confidence interval (CI) 0.43 to 0.69, 582 patients]; meanwhile, the combination therapy may have more advantages than antidepressants alone [mean difference (MD)=–1.03, 95%CI–1.81 to–0.25, 267 patients). When identified with placebo, CHMs seem to have more advantages in relieving depressive symptoms (MD=–19.00, 95%CI–20.02 to–17.98, 189 patients). However, when compared with basic treatment of post- PCI, CHMs showed different results in two trials. In terms of post-PCI related clinical symptoms, CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms. However, the heterogeneity in this review was generally high, it may be caused by different interventions used in each trial and the low quality of the trials. Conclusions: In total, CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.

Comparative Studies of Two Major Sets of Tibetan Medical Paintings: A Historical Perspective Abstract Tibetan medicine, one of the time-honored medical systems in the world, has increasingly been receiving attention the world over. Tibetan medical paintings (TMP, tib. Sman thang) has become one of the focal points in the studies of this medical system. To date, there are many atlases and publications on TMP, which are principally based on the two major sets of TMP series existing today in the world, the Lhasa set and the Buryat set. It has been found that the Buryat set is based on the Lhasa set, which was brought in late 19th to the first half of the 20th century from Tibet to Buryatia, Russia. A careful investigation on the basic structure of the two sets reveals that there are many differences between the two sets of paintings, including the total number of the paintings involved, of which some are missing in one set, the details of the captions of some of the paintings, the existence of the 80th painting and its supervisor, and the overall order of the entire set, etc. The details of the differences are elaborated and discussed, and the prospective of developing the research to arrive at a standard and perfect TMP set in the future is also analyzed and anticipated.

Effect of Shexiang Baoxin Pill (麝香保心丸) in Alleviating Early Hypertensive Renal Injury in Rats Abstract Objective To investigate the effect of Shexiang Baoxin Pill (麝香保心丸, SBP) on early hypertensive renal injury in rats and to explore the possible mechanism. Methods Twelve-week-old spontaneous hypertensive rats (SHRs) with high-salt diet (dietary containing 8% NaCl) were randomized into the SBP group [40 mg/(kg·d)], losartan potassium group [20 mg/(kg·d)] and saline group by stratified random sampling method, 12 in each group. Blood pressure and urea albumin creatinine ratio were measured. After 10 weeks, the expression levels of serum creatinine (Scr), hypersensitive C-reactive protein (hs-CRP), interleukin (IL)-1 β, IL-6, tumor necrosis factor α (TNF-α), and transforming growth factor β (TGF-β) in serum were assessed. Kidney pathology periodate-schiff staining was performed. Semi-quantitative count of macrophage infiltration was determined by immunochemistry of CD68 staining. Real-time quantitative polymerase chain reaction and Western blot were performed to examine the mRNA and protein expressions of Toll-like receptor 4 (TLR4), nuclear factor κB (NF-κB), monocyte chemokine peptide (MCP-1), inducible nitric oxide synthase (iNOS), and arginase-1 (Arg-1). Results SBP did not affect the mortality of SHR (P<0.05). SBP significantly reduced the level of elevated blood pressure of SHRs, but the effect was less significantly than that of losartan potassium. SBP decreased urine protein (P<0.01) and the expression levels of IL-1 β, IL-6, TNF-α, and TGF-β in serum. The 22-week-old SHRs showed mild proliferation of glomerular endothelial cells, glomerular ischemic lesions, inflammatory cell infiltration in renal tubular interstitium and arteriosclerosis. Both SBP and losartan potassium had alleviated renal pathological change, and significantly reduced the infiltration of macrophage (P<0.05, P<0.01). SBP and losartan potassium decreased the expressions of TLR4, NF-κB, MCP-1, iNOS, and Arg-1. Conclusion SBP significantly modified the early hypertensive renal injury by reducing inflammation, and the effect was similar to losartan potassium.

Changes of Intestinal Microecology in Patients with Primary Sjogren's Syndrome after Therapy of Yangyin Yiqi Huoxue Recipe (养阴益气活血方) Abstract Objective To explore the change of intestinal microecology in patients with primary Sjogren's syndrome (pSS) and correlation with disease activity, and also discuss the therapy effect of Yangyin Yiqi Huoxue Recipe (养阴益气活血方, YYHD). Methods Sixteen pSS patients were enrolled in the present study, who received 3-month treatment of YYHR, 200 mL orally twice daily. Their pre-and post-test ESSDAI scores, erythrocyte sedimentation rate (ESR) and serum immunoglobulin G (IgG) levels were measured respectively. The 16SrDNA metagenomic sequencing was used to detect and analyze the abundance and diversity of intestinal bacteria flora and the proportion of bacteria at the levels of phylum, family, and genus, in comparision with those of 6 healthy subjects in the control group. Results The abundance and diversity of intestinal bacteria flora in pSS patients were lower than those of healthy subjects (P<0.05). After the treatment with YYHD, patients' ESSDAI score and levels of IgG and ESR have decreased significantly (P<0.05). At the phylum level, the proportions of Actinobacteria, Firmicutes, Fusobacteria and Proteobacteria have reduced sharply, while the proportions of Bacteroidetes, Teneriquetes and Candidate-division-TM7 have increased significantly by treatment (all P<0.05). At the classification level, such treatment has caused a significant decrease in the proportions of Bacteroidaceae, Ruminococcaceae, Veillonellaceae, and Enterobacteriacea (all P<0.05), but a significant increase in the proportion of Lachnospiraceae (P<0.05). At the genus level, the treatment has significantly decreased the proportions of Bifidobacterium, Bacteroides, Escherichia-Shigella, Faecalibacterium and Prevotella (all P<0.05), but significantly increased the proportion of Clostridia (P<0.05), close to the levels of healthy subjects (P>0.05). Conclusions There exists an imbalance of intestinal microecology in pSS patients, which can be improved through the treatment with YYHD. Besides, such treatment can also improve the disease activity and adjust the diversity of intestinal bacteria flora, the composition and the abundance of intestinal flora.

Anticancer Effects of Constituents of Herbs Targeting Osteosarcoma Abstract Osteosarcoma is a rare primary malignancy of bone that is prone to early metastasis. Resection surgery and chemotherapeutic regimens are current standard treatments for osteosarcoma. However, the long-term survival rate of patients with osteosarcoma is low due to a high risk of metastasis. Hence, a new approach is urgently needed to improve the treatment of osteosarcoma. Compared with chemotherapy, natural active constituents isolated from herbs exhibit less adverse effects and better anti-tumor effects. This study aimed to summarize the anticancer effects of constituents of herbs on the progression and metastasis of osteosarcoma cells. It showed that many constituents of herbs inhibited osteosarcoma by targeting proliferation, matrix metalloproteinases, integrin and cadherin, and angiogenesis. The findings might be beneficial for the development of new drugs and treatment strategies.

Is Acupressure Useful for Alleviating Hyperventilation Syndrome?

Embolic effects of Bletilla striata microspheres in renal artery and transplanted VX2 liver tumor model in rabbits Abstract Objectives To evaluate the characteristics of Bletilla striata microspheres (BSMs) and its effects as an embolic agent in a rabbit model. Methods BSMs were prepared with an emulsification-cool condensation-chemical cross-linking method. The characteristics of BSMs in vitro were observed. Embolization experiments were performed in renal artery of rabbit and in a rabbit liver VX2 carcinoma model. Seventy-two New Zealand rabbits were divided into 2 groups, and the right renal artery was embolized with BSMs (200 μm in diameter) in the experimental group and with polyvinyl alcohol (PVA) of the same size in the control group. The pathological findings were examined with hematoxylin-eosin and Masson stainings. Liver and renal functions were tested before and after embolization. VX2 tumor was transplanted in 15 New Zealand rabbits, which were randomly divided into 3 groups (n=5). Group A were treated with saline, group B with a mixture of doxorubicin and lipiodol, and group C with hepatic arterial infusion of BSMs (200 μm in diameter). Tumor growth rate was evaluated by magnetic resonance imaging scan. Apoptosis-related factors (bax, bcl-2) and tumor vascular endothelial cell growth factor (VEGF) were evaluated through immunohistochemical staining. Results The characteristics of BSMs in vitro were in full compliance with the requirements for use in interventional procedures. In the renal artery embolization experiment, after BSMs intervention, it was more difficult to form collateral circulation than that with PVAs, and the kidney manifested atrophy and calcification. There were no significant difference of liver and renal functions in rabbits between groups. In the liver VX2 carcinoma embolization experiment, compared with group A, the growth rate of VX2 liver tumor and Bcl-2 levels was reduced, while apoptosis index, Bax, and VEGF were increased in group B (P<0.05). There were no significant difference between groups B and C (P>0.05). Conclusions The characteristics of BSMs in vitro and in vivo meet the requirements for its use as an embolic agent in interventional approaches.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Philosophical Studies

Prioritizing Platonism Abstract Some see concrete foundationalism as providing the central task for sparse ontology, that of identifying which concreta ground other concreta but aren't themselves grounded by concreta. There is, however, potentially much more to sparse ontology. The thesis of abstract foundationalism, if true, provides an additional task: identifying which abstracta ground other abstracta but aren't themselves grounded by abstracta. We focus on two abstract foundationalist theses—abstract atomism and abstract monism—that correspond to the concrete foundationalist theses of priority atomism and priority monism. We show that a consequence of an attractive package of views is that abstract reality has a particular mereological structure, one capable of underwriting both theses. We argue that, of abstract foundationalist theses formulated in mereological terms, abstract atomism is the most plausible.

Naïve realism: a simple approach Abstract Naïve realism is often characterized, by its proponents and detractors alike, as the view that for a subject to undergo a perceptual experience is for her to stand in a simple two-place acquaintance relation toward an object. However, two of the leading defenders of naïve realism, John Campbell and Bill Brewer, have thought it necessary to complicate this picture, claiming that a third relatum is needed to account for various possible differences between distinct visual experiences of the same object (for example, differences that result from changes in the object's spatial orientation relative to the subject, or from changes in the intensity with which the subject focuses her attention on the object). This, I argue, is a mistake. Once it is acknowledged that a subject's visual experience acquaints her with more than just a single object, all of the relevant facts can be explained from within the simpler naïve realist framework.

Moral pickles, moral dilemmas, and the obligation preface paradox Abstract This paper introduces and defends a new position regarding the question of whether it is possible to have conflicting moral obligations. In doing so, it focuses on what I call a moral pickle. By "moral pickle" I mean a set of actions such that you ought to perform each and cannot perform all. Typically, when people discuss conflicting moral obligations, they focus on the notion of a moral dilemma, which is a type of moral pickle involving two conflicting actions. In other words, a moral dilemma is a pair of actions such that you ought to perform each and cannot perform both. As of yet, there is no debate about the possibility of moral pickles over and above the possibility of moral dilemmas. But as I show, there is good reason to think that moral pickles are possible and moral dilemmas are not.

Against epistemic partiality in friendship: value-reflecting reasons Abstract It has been alleged that the demands of friendship conflict with the norms of epistemology—in particular, that there are cases in which the moral demands of friendship would require one to give a friend the benefit of the doubt, and thereby come to believe something in violation of ordinary epistemic standards on justified or responsible belief (Baker in Pac Philos Q 68:1–13, 1987; Keller in Philos Pap 33(3):329–351, 2004; Stroud in Ethics 116(3):498–524, 2006; Hazlett in A luxury of the understanding: on the value of true belief, Oxford University Press, Oxford, 2013). The burden of this paper is to explain these appearances away. I contend that the impression of epistemic partiality in friendship dissipates once we acknowledge the sorts of practical and epistemic reasons that are generated by our values: value-reflecting reasons. The present proposal has several virtues: it requires fewer substantial commitments than other proposals seeking to resist the case for epistemic partiality (in particular, it eschews both Pragmatic Encroachment and Epistemic Permissivism); it is independently motivated, as it cites a phenomenon—value-reflecting reasons—we have independent reasons to accept; it provides a single, unified account of how various features of friendship bear on belief-formation; and makes clear how it is the very value we place on friendship itself that ensures against epistemic partiality.

Weak speech reports Abstract Indirect speech reports can be true even if they attribute to the speaker the saying of something weaker than what she in fact expressed, yet not all weakenings of what the speaker expressed yield true reports. For example, if Anna utters 'Bob and Carla passed the exam', we can accurately report her as having said that Carla passed the exam, but we can not accurately report her as having said that either it rains or it does not, or that either Carla passed the exam or pandas are cute. This paper offers an analysis of speech reports that distinguishes weakenings of what the speaker expressed that yield true reports from weakenings that do not. According to this analysis, speech reports are not only sensitive to the informational content of what the speaker expressed, but also to the possibilities a speaker raises in making an utterance. As I argue, this analysis has significant advantages over its most promising competitors, including views based on work by Barwise and Perry (J Philos 78(11): 668–691, 1981), views appealing to recent work on the notion of content parthood by Fine (J Philos Log 45(2):199–226, 2016) and Yablo (Aboutness. Princeton University Press, Princeton, 2014), and Richard's (Mind Lang 13(4): 605–616, 1998) proposal appealing to structured propositions.

Second best epistemology: fallibility and normativity Abstract The Fallibility Norm—the claim that we ought to take our fallibility into account when managing our beliefs—appears to conflict with several other compelling epistemic norms. To shed light on these apparent conflicts, I distinguish two kinds of norms: norms of perfection and norms of compensation. Roughly, norms of perfection tell us how agents ought to behave if they're to be perfect; norms of compensation tell us how imperfect agents ought to behave in order to compensate for their imperfections. I argue that the Fallibility Norm is a norm of compensation, and that thinking of it like this helps us make progress in debates surrounding disagreement, higher-order evidence, and coherence.

Against reductive ethical naturalism Abstract This paper raises an objection to two important arguments for reductive ethical naturalism. Reductive ethical naturalism is the view that ethical properties reduce to the properties countenanced by the natural and social sciences. The main arguments for reductionism in the literature hold that ethical properties reduce to natural properties by supervening on them, either because supervenience is alleged to guarantee identity via mutual entailment, or because non-reductive supervenience relations render the supervenient properties superfluous. After carefully characterizing naturalism and reductionism, we will present, explain, and raise objections against each of the main reductionist arguments: (a) that supervenience does not support the claim that ethical properties and their subvenient natural properties are mutually entailing; (b) that reductive views undermine the claim that ethical properties yield resemblance; and (c) that supervenience does not entail that non-descriptive ethical properties are superfluous in the most fundamental sense.

The epistemic significance of political disagreement Abstract The degree of doxastic revision required in response to evidence of disagreement is typically thought to be a function of our beliefs about (1) our interlocutor's familiarity with the relevant evidence and arguments, and their intellectual capacities and virtues, relative to our own, or (2) the expected probability of our interlocutor being correct, conditional on our disagreeing. While these two factors are typically used interchangeably, I show that they have an inverse correlation in cases of disagreement about politically divisive propositions. This presents us with a puzzle about the epistemic impact of disagreement in these cases. The most significant disagreements on (1) are the least significant disagreements on (2), and vice versa. I show that assessing the epistemic status of an interlocutor by reference to either (1) or (2) has uncomfortable consequences in these cases. I then argue that this puzzle cannot be escaped by claiming that we usually have dispute-independent reason to reject the significance of politically charged disagreement altogether.

Imprecise lexical superiority and the (slightly less) Repugnant Conclusion Abstract Recently, Derek Parfit has offered a novel solution to the "Repugnant Conclusion" that compared with the existence of many people whose quality of life would be very high, there is some much larger number of people whose existence would be better but whose lives would be barely worth living. On this solution, qualitative differences between two populations will often entail that the populations are merely "imprecisely" comparable. According to Parfit, this fact allows us to avoid the Repugnant Conclusion without violating the transitivity of better than. In this paper, I argue that Parfit's view nevertheless implies two objectionable conclusions. The first is an alternative version of the Repugnant Conclusion that, Parfit suggests, may not be all that repugnant. The second is a revised version of the first that is nearly identical to the Repugnant Conclusion. I conclude that Parfit's view offers no escape from repugnance.

Saying and believing: the norm commonality assumption Abstract One very popular assumption in the epistemological literature is that belief and assertion are governed by one and the same epistemic norm. This paper challenges this claim. Extant arguments in defence of the view are scrutinized and found to rest on value-theoretic inaccuracies. First, the belief-assertion parallel is shown to lack the needed normative strength. Second, I argue that the claim that assertion inherits the norm of belief in virtue of being an expression thereof rests on a failed instance of deontic transmission. Third, the inheritance argument from the norm for action is proven guilty of deontic equivocation. Last but not least, it is argued that, on a functionalist normative picture, assertion and belief are governed by different epistemic norms, in virtue of serving different epistemic functions.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Integrative Medicine

Danshensu Ameliorates Cardiac Ischaemia Reperfusion Injury through Activating Sirt1/FoxO1/Rab7 Signal Pathway Abstract Objective: To explore the specific molecular mechanisms of Danshensu (DSS) in the treatment of ischemia reperfusion injury (IRI). Methods: IRI model was established with isolated rat hearts by performing global ischaemia for 30 min, and then followed by 60 min reperfusion. Also, H9C2 cells were subjected to 4-h hypoxia followed by 3-h reoxygenation. Then 10 μmol/L DSS were added in the reperfusion/reoxygenation step to intervene IRI. Cardiac function, structural change and apoptosis were respectively tested by Langendorff System, hematoxylin and eosin (HE) and terminal-deoxynucleotidyl transferase mediated nick endabeling (TUNEL) stainings. Then lactate dehydrogenase (LDH), reactive oxygen species (ROS), superoxide gasififi cation enzyme (SOD) and glutathione peroxidase (GSH-PX) were detected by enzyme-linked immunosorbent assay (ELISA). Sirt1/FoxO1/Rab7 Signal Pathway was monitored at both protein and mRNA levels. Results: The results showed that IRI not only greatly attenuated cardiac function (LVDP and ±dp/dtmax, P<0.01, P<0.05) and increased the level of the marker enzymes (cardiac troponin T, LDH, P<0.01) from the coronary effluents, but also markedly induced changes in the structure of cardiomyocytes and contributed to apoptosis, which were mediated by boosted endogenous ROS. However, after treatment with DSS all above indexes were improved, which was related to activating Sirt1/FoxO1/Rab7 signal pathway accompanied with the enhancement of antioxidant defense system, such as superoxide gasififi cation enzyme and glutathione peroxidase. Conclusion: DSS is able to protect hearts from IRI, which may be attributable to inhibiting excessive ROS through Sirt1/FoxO1/Rab7 signaling.

Effects and Mechanism of Action of Artemisinin on Mitochondria of Plasmodium berghei Abstract Objective To study the antimalarial effects and mechanisms of artemisinin (Qinghaosu in Chinese, QHS) on mitochondria in mice infected with Plasmodium berghei. Methods A total of 108 C57 mice infected with Plasmodium berghei were randomly divided into 3 groups by weight: the control group, 200 and 400 mg/kg QHS groups. The two QHS treatment groups were further divided into 4 sub-groups with 12 animals each time according to the treatment time, 0.5, 1, 2, and 4 h. Normal saline was intragastrically (i.g.) administered to the control group. The other two groups received different doses of QHS by i.g. administration. Animals were treated once with QHS for different detection time as follows: 0.5, 1, 2, and 4 h. The mitochondrial energy metabolism, oxidative damage, membrane potential, and membrane permeability and other indexes were detected. Results After administration of 200 and 400 mg/kg QHS, adenosine triphosphate (ATP) levels in Plasmodium and its mitochondria were reduced (P<0.05), the levels of reactive oxygen species (ROS) and malondialdehyde (MDA) were increased (P<0.05), and the activity of superoxide dismutase (SOD) was also increased (P<0.05). At the same time, the membrane potential of the mitochondria was reduced and the degree to which the membrane permeability transition pore was opened was irreversibly increased (P<0.05). Conclusions Mitochondria in Plasmodium were the targets of QHS, which can adversely affect mitochondrial energy metabolism, oxidative damage, membrane potential, and membrane opening, and ultimately exert an antimalarial effect.

Tongxinluo Ameliorates Myocardial Ischemia-Reperfusion Injury Mainly via Activating Parkin-Mediated Mitophagy and Downregulating Ubiquitin-Proteasome System Abstract Objective To investigate the protective effects and mechanism of Chinese herbal compound Tongxinluo Capsule (通心络胶囊, TXL) on the Parkin-mediated mitophagy and the ubiquitin-proteasome system in a rat model of myocardial ischemia-reperfusion injury (MIRI). Methods Seventy adult male Sprague-Dawley rats were randomly divided into 7 groups: sham group, MIRI group, low- and high-dose TXL (0.5 and 1 g·kg-1·d-1, respectively) groups, atorvastatin (ATV) group (7.2 g·kg-1·d-1), chloroquine (CQ) group (10 g·kg-1·d-1), and highdose TXL + CQ group. After pharmacological administration for 7 days, rats underwent left anterior descending artery ligation surgery to establish the MIRI models with 50 min ischemia followed by 4 h reperfusion. Blood was taken for cardiac troponin I (cTnI) detection and hearts were harvested for infarct staining and apoptosis detection. The autophagy or mitophagy proteins and ubiquitinated proteins were detected by Western blotting. Results Compared with the sham group, the MIRI group exhibited a larger infarcted area (27.13%±0.01%, P<0.01), a higher apoptotic index (34.33%±2.03% vs.1.81%±0.03%, P<0.01), and higher cTnI expression (14.18±1.01 vs. 7.96±0.32, P<0.01). The mitochondrial integrity was damaged in the MIRI group, while TXL and ATV alleviated the damage of MIRI. More autophagosomes were observed in the high-dose TXL group than in the MIRI group (7.00±0.58 vs. 4.33±1.15, P<0.05). More amounts of PTEN-induced putative kinase protein 1 (PINK1) and Parkin translocated onto the mitochondria were detected in the high-dose TXL group than in the MIRI group (P<0.05). The ubiquitin response was signifificantly downregulated in the high-dose TXL group relative to the MIRI group (P<0.05). CQ administration abolished the activation of autophagy flux and the PINK1/ Parkin pathway induced by high-dose of TXL. Conclusions TXL ameliorates MIRI via activating Parkin-mediated mitophagy in rats. The downregulation of the ubiquitin-proteasome system is also involved.

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis Abstract Objective: To evaluate the effectiveness and safety of oral Chinese herbal medicines (CHMs) on post-percutaneous coronary intervention (PCI) patients with depressive disorder in coronary heart disease (CHD). Methods:A literature search was conducted through databases including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2018. Randomized controlled trials (RCTs) comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 software was used to synthesize the results. Results: A total of 16 RCTs enrolling 1,443 participants were included in this systematic review. When compared with antidepressants alone, CHMs showed similar benefits with less side effects [risk ratio=0.54, 95% confidence interval (CI) 0.43 to 0.69, 582 patients]; meanwhile, the combination therapy may have more advantages than antidepressants alone [mean difference (MD)=–1.03, 95%CI–1.81 to–0.25, 267 patients). When identified with placebo, CHMs seem to have more advantages in relieving depressive symptoms (MD=–19.00, 95%CI–20.02 to–17.98, 189 patients). However, when compared with basic treatment of post- PCI, CHMs showed different results in two trials. In terms of post-PCI related clinical symptoms, CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms. However, the heterogeneity in this review was generally high, it may be caused by different interventions used in each trial and the low quality of the trials. Conclusions: In total, CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.

Comparative Studies of Two Major Sets of Tibetan Medical Paintings: A Historical Perspective Abstract Tibetan medicine, one of the time-honored medical systems in the world, has increasingly been receiving attention the world over. Tibetan medical paintings (TMP, tib. Sman thang) has become one of the focal points in the studies of this medical system. To date, there are many atlases and publications on TMP, which are principally based on the two major sets of TMP series existing today in the world, the Lhasa set and the Buryat set. It has been found that the Buryat set is based on the Lhasa set, which was brought in late 19th to the first half of the 20th century from Tibet to Buryatia, Russia. A careful investigation on the basic structure of the two sets reveals that there are many differences between the two sets of paintings, including the total number of the paintings involved, of which some are missing in one set, the details of the captions of some of the paintings, the existence of the 80th painting and its supervisor, and the overall order of the entire set, etc. The details of the differences are elaborated and discussed, and the prospective of developing the research to arrive at a standard and perfect TMP set in the future is also analyzed and anticipated.

Effect of Shexiang Baoxin Pill (麝香保心丸) in Alleviating Early Hypertensive Renal Injury in Rats Abstract Objective To investigate the effect of Shexiang Baoxin Pill (麝香保心丸, SBP) on early hypertensive renal injury in rats and to explore the possible mechanism. Methods Twelve-week-old spontaneous hypertensive rats (SHRs) with high-salt diet (dietary containing 8% NaCl) were randomized into the SBP group [40 mg/(kg·d)], losartan potassium group [20 mg/(kg·d)] and saline group by stratified random sampling method, 12 in each group. Blood pressure and urea albumin creatinine ratio were measured. After 10 weeks, the expression levels of serum creatinine (Scr), hypersensitive C-reactive protein (hs-CRP), interleukin (IL)-1 β, IL-6, tumor necrosis factor α (TNF-α), and transforming growth factor β (TGF-β) in serum were assessed. Kidney pathology periodate-schiff staining was performed. Semi-quantitative count of macrophage infiltration was determined by immunochemistry of CD68 staining. Real-time quantitative polymerase chain reaction and Western blot were performed to examine the mRNA and protein expressions of Toll-like receptor 4 (TLR4), nuclear factor κB (NF-κB), monocyte chemokine peptide (MCP-1), inducible nitric oxide synthase (iNOS), and arginase-1 (Arg-1). Results SBP did not affect the mortality of SHR (P<0.05). SBP significantly reduced the level of elevated blood pressure of SHRs, but the effect was less significantly than that of losartan potassium. SBP decreased urine protein (P<0.01) and the expression levels of IL-1 β, IL-6, TNF-α, and TGF-β in serum. The 22-week-old SHRs showed mild proliferation of glomerular endothelial cells, glomerular ischemic lesions, inflammatory cell infiltration in renal tubular interstitium and arteriosclerosis. Both SBP and losartan potassium had alleviated renal pathological change, and significantly reduced the infiltration of macrophage (P<0.05, P<0.01). SBP and losartan potassium decreased the expressions of TLR4, NF-κB, MCP-1, iNOS, and Arg-1. Conclusion SBP significantly modified the early hypertensive renal injury by reducing inflammation, and the effect was similar to losartan potassium.

Changes of Intestinal Microecology in Patients with Primary Sjogren's Syndrome after Therapy of Yangyin Yiqi Huoxue Recipe (养阴益气活血方) Abstract Objective To explore the change of intestinal microecology in patients with primary Sjogren's syndrome (pSS) and correlation with disease activity, and also discuss the therapy effect of Yangyin Yiqi Huoxue Recipe (养阴益气活血方, YYHD). Methods Sixteen pSS patients were enrolled in the present study, who received 3-month treatment of YYHR, 200 mL orally twice daily. Their pre-and post-test ESSDAI scores, erythrocyte sedimentation rate (ESR) and serum immunoglobulin G (IgG) levels were measured respectively. The 16SrDNA metagenomic sequencing was used to detect and analyze the abundance and diversity of intestinal bacteria flora and the proportion of bacteria at the levels of phylum, family, and genus, in comparision with those of 6 healthy subjects in the control group. Results The abundance and diversity of intestinal bacteria flora in pSS patients were lower than those of healthy subjects (P<0.05). After the treatment with YYHD, patients' ESSDAI score and levels of IgG and ESR have decreased significantly (P<0.05). At the phylum level, the proportions of Actinobacteria, Firmicutes, Fusobacteria and Proteobacteria have reduced sharply, while the proportions of Bacteroidetes, Teneriquetes and Candidate-division-TM7 have increased significantly by treatment (all P<0.05). At the classification level, such treatment has caused a significant decrease in the proportions of Bacteroidaceae, Ruminococcaceae, Veillonellaceae, and Enterobacteriacea (all P<0.05), but a significant increase in the proportion of Lachnospiraceae (P<0.05). At the genus level, the treatment has significantly decreased the proportions of Bifidobacterium, Bacteroides, Escherichia-Shigella, Faecalibacterium and Prevotella (all P<0.05), but significantly increased the proportion of Clostridia (P<0.05), close to the levels of healthy subjects (P>0.05). Conclusions There exists an imbalance of intestinal microecology in pSS patients, which can be improved through the treatment with YYHD. Besides, such treatment can also improve the disease activity and adjust the diversity of intestinal bacteria flora, the composition and the abundance of intestinal flora.

Anticancer Effects of Constituents of Herbs Targeting Osteosarcoma Abstract Osteosarcoma is a rare primary malignancy of bone that is prone to early metastasis. Resection surgery and chemotherapeutic regimens are current standard treatments for osteosarcoma. However, the long-term survival rate of patients with osteosarcoma is low due to a high risk of metastasis. Hence, a new approach is urgently needed to improve the treatment of osteosarcoma. Compared with chemotherapy, natural active constituents isolated from herbs exhibit less adverse effects and better anti-tumor effects. This study aimed to summarize the anticancer effects of constituents of herbs on the progression and metastasis of osteosarcoma cells. It showed that many constituents of herbs inhibited osteosarcoma by targeting proliferation, matrix metalloproteinases, integrin and cadherin, and angiogenesis. The findings might be beneficial for the development of new drugs and treatment strategies.

Is Acupressure Useful for Alleviating Hyperventilation Syndrome?

Embolic effects of Bletilla striata microspheres in renal artery and transplanted VX2 liver tumor model in rabbits Abstract Objectives To evaluate the characteristics of Bletilla striata microspheres (BSMs) and its effects as an embolic agent in a rabbit model. Methods BSMs were prepared with an emulsification-cool condensation-chemical cross-linking method. The characteristics of BSMs in vitro were observed. Embolization experiments were performed in renal artery of rabbit and in a rabbit liver VX2 carcinoma model. Seventy-two New Zealand rabbits were divided into 2 groups, and the right renal artery was embolized with BSMs (200 μm in diameter) in the experimental group and with polyvinyl alcohol (PVA) of the same size in the control group. The pathological findings were examined with hematoxylin-eosin and Masson stainings. Liver and renal functions were tested before and after embolization. VX2 tumor was transplanted in 15 New Zealand rabbits, which were randomly divided into 3 groups (n=5). Group A were treated with saline, group B with a mixture of doxorubicin and lipiodol, and group C with hepatic arterial infusion of BSMs (200 μm in diameter). Tumor growth rate was evaluated by magnetic resonance imaging scan. Apoptosis-related factors (bax, bcl-2) and tumor vascular endothelial cell growth factor (VEGF) were evaluated through immunohistochemical staining. Results The characteristics of BSMs in vitro were in full compliance with the requirements for use in interventional procedures. In the renal artery embolization experiment, after BSMs intervention, it was more difficult to form collateral circulation than that with PVAs, and the kidney manifested atrophy and calcification. There were no significant difference of liver and renal functions in rabbits between groups. In the liver VX2 carcinoma embolization experiment, compared with group A, the growth rate of VX2 liver tumor and Bcl-2 levels was reduced, while apoptosis index, Bax, and VEGF were increased in group B (P<0.05). There were no significant difference between groups B and C (P>0.05). Conclusions The characteristics of BSMs in vitro and in vivo meet the requirements for its use as an embolic agent in interventional approaches.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Medicina Interna

Irma Elizabeth Gonzalez Curiel

LOS PÉPTIDOS ANTIMICROBIANOS Y SUS BENEFICIOS EN EL TRATAMIENTO DE LAS ÚLCERAS DE PIE DIÁBETICO

En la presente revisión se analiza, sobre la base de los estudios realizados tanto in vivocomo in vitro el posible uso de péptidos antimicrobianos y sus inductores en el tratamiento de úlceras de pie diabético.

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Vivian Molina

TRATAMIENTO DE LA ISQUEMIA CEREBRAL GLOBAL EN JERBOS DE MONGOLIA

El tratamiento con dosis orales únicas de las combinaciones policosanol (100 mg/kg) más aspirina (60 mg/kg) y policosanol (100 mg/kg) más atorvastatina (20 mg/kg) redujo marcada y significativamente la isquemia cerebral global en jerbos de Mongolia, con una eficacia muy similar entre ellos, pero ligeramente superior a la obtenida con la monoterapia con aspirina. Además, ambas combinaciones presentaron efectos antioxidantes, a diferencia de la monoterapia con aspirina, lo que les proporciona un beneficio adicional.

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Cristina Chirico

EL AMPARO ECONÓMICO PARA MEJORAR EL TRATAMIENTO DE LA TUBERCULOSIS

El objetivo de nuestro estudio es analizar las diferencias de los datos clínicos y epidemiológicos entre pacientes con y sin inclusión en el régimen de amparo, y si el subsidio fue un factor de éxito en el tratamiento.

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Fernando Ricardo Racca Velásquez

PAQUIMENINGITIS HIPERTRÓFICA POSINFECCIOSA: PRESENTACIÓN DE CASO CLÍNICO

La paquimeningitis hipertrófica es una entidad infrecuente que puede ser idiopática o secundaria, y dado que incluso un diagnóstico acertado y un correcto tratamiento pueden dejar secuelas neurológicas graves o incluso producir la muerte, presentamos este caso en el que consideramos que la causa fue una meningitis que no recibió tratamiento adecuado al inicio de los síntomas y que tuvo una respuesta satisfactoria al tratamiento con corticoides inicialmente en altas dosis.

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Glaucio De Moraes Paula

FATORES ASSOCIADOS A DISPLASIA BRONCOPULMONAR EM RECÉM-NASCIDOS EGRESSOS (EN LOS RECIÉN NACIDOS) DE GESTAÇÃO COM AMNIORREXE PREMATURA NO PRÉ-TERMO (EN EL PRETÉRMINO)

O (El) estudo teve por objetivo identificar fatores obstétricos e neonatais associados à ocorrência da (a la aparición de) displasia broncopulmonar

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Cirugía Ortopédica y Traumatología

¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®? Publication date: Available online 22 June 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): M. Luque-Valenzuela, A.J. Sánchez-Aguilera, A. Martín-Vivaldi-Jiménez, R. Jódar-Graus, N. Prados-Olleta Resumen Introducción Las fracturas de tobillo representan un 10% del total de fracturas. La mayor parte requieren tratamiento quirúrgico, que conlleva un importante riesgo de complicaciones de la herida. El objetivo de este estudio ha sido determinar si los apósitos impregnados con plata (Aquacel Ag Extra®) reducen la tasa de complicaciones de la herida quirúrgica tras el tratamiento de las fracturas de tobillo en comparación con el uso de gasas estériles. Métodos De forma prospectiva se han reunido 233 pacientes con fracturas de tobillo subsidiarias de tratamiento quirúrgico. Desde el inicio del estudio en julio de 2017 hasta febrero de 2018, los traumatólogos participantes en el estudio cambiaron el uso de la gasa estéril estándar para cubrir la herida quirúrgica tras su cierre por Aquacel Ag Extra®, manteniendo el resto del protocolo pre- y posquirúrgico igual. Se comparan la tasa de complicaciones cutáneas en ambos grupos, tras un seguimiento de 3 meses. Resultados El análisis estadístico no reflejó diferencias significativas entre ambos grupos. Conclusiones Se necesitan ensayos clínicos aleatorizados para demostrar las ventajas teóricas de los apósitos impregnados con plata y su indicación en Traumatología. Abstract Introduction Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. Methods We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. Results The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. Conclusions The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Estudio de cohortes comparativo del abordaje Superpath con abordaje convencional posterior en cirugía protésica primaria de cadera no cementada: curva de aprendizaje y resultados a corto plazo Publication date: Available online 17 June 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): J. Más Martínez, J. Sanz-Reig, M. Morales-Santías, D. Bustamante Suarez de Puga, C. Verdu Roman, E. Martinez Gimenez Resumen Antecedentes y objetivo En la actualidad no existe un consenso sobre cuál es el mejor abordaje de cadera para implantar una prótesis. Sin embargo, sí existe una tendencia a reducir al máximo la lesión sobre los tejidos periarticulares, lo cual puede influir en los resultados a corto plazo. El abordaje Superpath permite el acceso a la articulación manteniendo la integridad de los rotadores externos. El objetivo de nuestro estudio fue comparar los resultados a corto plazo del abordaje Superpath con el abordaje convencional posterior. Materiales y métodos Estudio prospectivo de cohorte de 30 pacientes intervenidos mediante abordaje Superpath pareados por sexo, edad, índice de masa corporal y valoración clínica, con 60 pacientes intervenidos mediante abordaje convencional posterior. La valoración clínica se realizó mediante la escala de Harris, Merle d'Aubigné, Womac para el dolor y la función, SF-12 físico y mental, HOS-AVD e IHOT-12. Radiológicamente se determinó el ángulo de inclinación acetabular, alineación del vástago femoral e integración de los implantes. Resultados No hubo diferencias significativas entre ambas cohortes con respecto a las variables preoperatorias. El tiempo quirúrgico, el descenso medio de Hb y Hto y la pérdida sanguínea fue mayor en la cohorte Superpath. La estancia hospitalaria fue similar. Los cuestionarios de valoración clínica mostraron incrementos significativos entre los valores preoperatorios y a los 12 meses en ambas cohortes. El cuestionario IHOT-12 a los 3 meses, el cuestionario SF-12 físico y el cuestionario SF-12 mental a los 12 meses, mostró mayores puntuaciones en la cohorte Superpath, siendo las diferencias significativas. Radiológicamente no se detectaron diferencias entre ambas cohortes. Conclusiones La curva de aprendizaje del abordaje Superpath presenta unos resultados clínicos y radiológicos similares al abordaje posterior durante el primer año tras la prótesis total de cadera. A destacar la necesidad de un mayor tiempo quirúrgico y un mayor sangrado en los pacientes. Abstract Background and objectives There is no current consensus on the most suitable hip approach. However, there is a trend to reduce damage to soft tissue, which may have an influence on early outcomes. The SuperPath approach accesses the capsule maintaining integrity of the external rotators. The purpose of this study was to compare the SuperPath approach with the conventional posterior approach, in terms of early outcomes and radiological results. Material and methods A cohort of 30 patients operated using the SuperPath approach was prospectively matched for age, gender, body mass index and hip function with 60 patients operated using a conventional posterior approach. Clinical evaluation was performed by the Harris score, Merle d'Aubigné score, reduced Western Ontario and McMasters Universities (WOMAC), Short-Form 12 (SF12), IHOT-ADV and IHOT-12 questionnaires. Radiological evaluation was also performed. Results Preoperatively, no significant differences were detected between cohorts. Skin-to-skin operation time and blood loss was higher in the SuperPath cohort. Length of stay was similar between cohorts. Clinical evaluation improved significantly from the preoperative values to the 1-year follow-up. At 3 months the SuperPath cohort showed better results for IHOT-12, and at 12 months for SF. Radiologically, there were no differences between cohorts. Conclusion This prospective randomized study reveals that the learning curve for the SuperPath approach provides similar outcomes to the conventional posterior approach within the first year after surgery. The Superpath approach was associated with longer skin-to-skin operation time, and greater blood loss.

Influencia de la instrumentación sobre el tiempo quirúrgico para implantar una prótesis total de rodilla Publication date: Available online 7 June 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): V.J. León-Muñoz, A.J. Lisón-Almagro, M. López-López Resumen Objetivo Demostrar si existe diferencia en el tiempo que se prolonga la cirugía para implantar una prótesis de rodilla atendiendo al sistema de instrumentación empleado. Material y método Análisis retrospectivo de la duración de 243 intervenciones (tiempo piel-piel y tiempo de isquemia) realizadas por el mismo cirujano. Setenta y dos casos intervenidos con instrumental convencional, 68 asistidos por navegador (computer assisted surgery) y 103 con bloques de corte personalizados (personalized instrumentation system [PSI]). Resultados IC piel-piel 87,85 min (DE 11,86). IC isquemia 94,44 min (DE 11,49). Computer assisted surgery piel-piel 123,46 min (DE 11,27). Computer assisted surgery isquemia 129,63 min (DE 11,37). PSI piel-piel 78,69 min (DE 13,06). PSI isquemia 84,63 (DE 12,06). Existe una diferencia significativa favorable a PSI respecto a los otros sistemas de instrumentación (p 0,000). Conclusiones En nuestro estudio, el consumo de tiempo para la implantación de una prótesis de rodilla ha sido significativamente inferior cuando hemos empleado bloques de corte personalizados, que cuando hemos empleado otros sistemas. Abstract Objective To demonstrate if there is a difference in the time that the surgery is prolonged to implant a knee prosthesis according to the instrumentation system used. Material and methods Retrospective analysis of the duration of 243 interventions (skin-to-skin time and ischemia time) performed by the same surgeon. Seventy-two cases operated with conventional instruments (IC), 68 by means of computer assisted surgery (CAS) and 103 with personalized instrumentation system (PSI). Results IC skin-to-skin time 87,85 min (SD 11,86). IC ischemia time 94,44 min (SD 11,49). Computer assisted surgery skin-to-skin time 123,46 min (SD 11,27). Computer assisted surgery ischemia time 129,63 min (SD 11,37). PSI skin-to-skin time 78,69 min (SD 13,06). PSI ischemia time 84,63 min (SD 12,06). There is a significant difference between PSI and the other instrumentation systems (p 0,000). Conclusions In our study, the time consumption for the implantation of a knee prosthesis has been significantly lower when cutting blocks have been used, than when we have used other systems.

Evolución clínica y presencia de edema óseo subcondral a los dos años de tratamiento con implante de condrocitos autólogos de alta de densidad en la rodilla Publication date: Available online 28 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): J.M. López-Alcorocho, L. Aboli, E. Rodríguez-Iñigo, I. Guillén-Vicente, M. Guillén-Vicente, R. Caballero, M. Casqueiro, T.F. Fernández-Jaen, S. Abelow, P. Guillen-García Resumen Antecedentes y objetivo Recientemente se ha descrito una nueva modalidad de la técnica de implante de condrocitos autólogos sobre membrana de colágeno i/iii llamada HD-ACI (High Density Autologous Chondrocyte Implantation) que está basada en el aumento de la densidad celular. El objetivo de este trabajo fue estudiar la evolución clínica y la incidencia de la aparición de edema óseo en pacientes con lesiones de cartílago en la rodilla tratados con HD-ACI al año y a los 2 años de la intervención. Métodos Se trata de un estudio retrospectivo en 40 pacientes con lesiones condrales grado iii-iv. Todos los pacientes fueron tratados con HD-ACI con una dosis celular de 5 × 106 condrocitos/cm2 de lesión. La percepción subjetiva de la mejora de los síntomas/funcionalidad se valoró mediante la escala del Comité Internacional de Documentación de la Rodilla (IKDC, International Knee Documentation Committee). La presencia de edema óseo se evaluó a los 6, 12 y 24 meses de seguimiento por resonancia magnética. Comité Internacional de Documentación de la Rodilla (IKDC) Resultados Los valores de IKDC mostraron una mejoría significativa a los 12 y 24 meses (p < 0,001). La diferencia media de IKDC entre la visita basal y los 12 meses fue de 26,3 puntos y de 31,6 puntos a los 24 meses. El 27,5% de los pacientes presentaron edema óseo subcondral a los 2 años de seguimiento. Conclusiones HD-ACI es un tratamiento efectivo y seguro que mejora el dolor, la percepción clínica y la funcionalidad de la articulación. No se ha encontrado correlación entre la presencia de edema óseo y la evolución clínica de los pacientes. Abstract Background Recently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type i/iii membrane) based on increasing cell density called HD-ACI (High Density Autologous Chondrocyte Implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1-2 years of follow-up. Methods This is a retrospective study performed with forty patients with chondral injuries grade iii-iv. All patients were treated with HD-ACI with a cellular dose of 5 × 106 chondrocytes /cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. Results IKDC values showed a significant improvement at 12 and 24 months (P < .001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. Conclusions HD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients' clinical outcome.

Tratamiento quirúrgico protocolizado de las tríadas terribles de codo. Resultados y complicaciones Publication date: Available online 22 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): M. Álvarez Muñoz, Juan María Pardo García, L. García Lamas, M. Porras Moreno, V. Jiménez Díaz, D. Cecilia López Resumen Introducción La tríada terrible de codo es una enfermedad asociada a altas tasas de complicaciones, por ello queremos estudiar los resultados y las complicaciones. Material y métodos Se ha utilizado la base de datos de nuestro hospital durante 2005-2015, recogiendo características del paciente, de la fractura, de la cirugía y las complicaciones asociadas, así como resultados funcionales y rango de movilidad. Resultados Se obtuvieron un total de 62 tríadas, de las cuales 27 (43%) eran mujeres y 35 (56%) eran hombres. A todos se les realizó un abordaje lateral de Kaplan y en aquellos que lo necesitaron se complementó con un abordaje medial para reparar el LCM. La cabeza radial se sintetizó en 14 (22%) casos, se colocó una prótesis en 45 (74%) de casos y otras actuaciones en 3 (5%) casos. La osteosíntesis de la apófisis coroides se realizó mediante arpón ± sutura transósea en 41 (62%) pacientes y mediante síntesis en 12 (19%) casos. En 9 (14%) casos no se realizó ninguna actuación. En el 100% de los casos se reparó el LCL y en 9 (14%) hubo que reparar también el LCM. Un 22% de los pacientes precisaron FE por inestabilidad tras la técnica quirúrgica. Respecto a resultados, se obtuvo un rango de movilidad de entre 120°/–20° de flexoextensión y 98°/85° de pronosupinación. En cuanto a complicaciones, obtuvimos un total de 17 (27%). Conclusiones Las tríadas de codo son lesiones osteoligamentosas complejas donde es necesario realizar una cirugía protocolizada, a pesar de lo cual, existen un 27% de complicaciones. Abstract Background Terrible triad of elbow is a complex lesion with a high rate of complications. Our goal is to analyse both clinical results and complications after performing protocolised surgery. Material and methods The database of our hospital was used during 2005-2015, collecting characteristics of the patient, the fracture, the surgery and the associated complications, as well as functional results and range of mobility. Results A total of 62 triads were obtained, of which 27 (43%) were women and 35 (56%) were men. All had a Kaplan lateral approach and those who needed it were complemented with a medial approach to repair the LCM. The radial head was synthesized in 14 (22%) cases, a prosthesis was placed in 45 (74%) cases and other actions in 3 (5%) cases. Osteosynthesis of the choroid process was performed by transosseous harpoon±suture in 41 (62%) patients and by synthesis in 12 (19%) cases. In 9 (14%) cases, no action was taken. In 100% of the cases the LCL was repaired and in 9 (14%) the LCM also had to be repaired. Twenty-two percent of the patients required ESA due to instability after the surgical technique. With respect to results, a range of mobility was obtained between 120°/–20° of flexoextension and 98°/85° of pronosupination. In terms of complications, we obtained a total of 17 (27%). Conclusions Elbow triads are complex lesions where protocolised surgery is necessary, nevertheless the complication rate was 27% in our series.

Lesión del labrum superior anteroposterior (SLAP) en el entorno laboral Publication date: Available online 17 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): F. Navío-Fernández, I. Miranda, E. Sánchez-Alepuz, M. Shahin, E. Pastor-Fernández, V. Carratalá, F.J. Lucas Resumen Antecedentes y objetivo La lesión del labrum superior anteroposterior (SLAP) es una conocida causa de dolor y disfunción del hombro en pacientes activos. El objetivo fue estudiar las lesiones de SLAP en población laboral y valorar la fiabilidad de la exploración física y las técnicas de imagen en el diagnóstico de las lesiones de SLAP en el entorno laboral. Material y métodos Revisión retrospectiva de 58 lesiones de SLAP tratadas en nuestra mutua laboral desde 2005 hasta 2015 en 815 pacientes en los que se realizó una artroscopia de hombro. Se han recogido datos del mecanismo lesional, datos clínicos, pruebas complementarias (comparando el informe radiológico inicial con el de un radiólogo especializado en musculoesquelético), hallazgos artroscópicos y tratamiento realizado. Resultados El mecanismo lesional más frecuente ha sido la lesión aguda levantando peso, en la mayoría de casos, por encima de la cabeza. La lesión de SLAP se sospechó en el 41% con anamnesis y exploración física, en el 29% de los informes radiológicos iniciales y en el 52% en los informes del radiólogo especialista en musculoesquelético. Presentaron lesiones asociadas el 78%, la mayoría lesiones del manguito rotador. Conclusión La lesión de SLAP en el entorno laboral es infrecuente y muchas veces se diagnostica durante una artroscopia realizada por otra lesión. La artrorresonancia magnética y la resonancia magnética tienen menos fiabilidad que la evaluación clínica para su diagnóstico. Un radiólogo especializado en musculoesquelético podría mejorar la rentabilidad de las pruebas de imagen en el diagnóstico de estas lesiones. Abstract Background and objective Superior labral anterior to posterior (SLAP) injuries are widely recognised as a cause of pain and dysfunction in the shoulders of active patients. The aims of the present study were to analyze SLAP injuries in the workplace, and to evaluate the reliability of physical examination and imaging techniques for the diagnosis of work-related SLAP injuries. Material and methods Retrospective chart review of 58 SLAP injuries treated in our occupational health centre from 2005 to 2015 in 815 patients undergoing shoulder arthroscopy. Data were collected on mechanism of injury, clinical proceedings, complementary tests (contrasting the initial magnetic resonance imaging report with that of a radiologist specializing in musculoskeletal pathology), arthroscopy findings and treatments performed. Results The most common mechanism of injury was acute injury while handling weight, in the majority of cases, above the head. SLAP injury was suspected in 41% of cases through anamnesis and physical exam, in 29% through the initial magnetic resonance imaging report, and in 52% through the specialised radiologist's report. In 78%, associated injuries were present, the most common being rotator cuff injuries. Conclusions SLAP injuries in the workplace are rare and are often a diagnostic finding during surgical intervention performed for a different associated injury. Arthro-magnetic resonance imaging and magnetic resonance imaging have lower reliability than physical exams in the diagnosis of work-related SLAP injuries. A radiologist specializing in musculoskeletal pathology could probably improve the reliability of imaging test interpretation in work-related SLAP injuries.

Fracturas de astrágalo. Resultados funcionales en pacientes politraumatizados Publication date: Available online 8 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): F.J. Hierro-Cañas, P. Andrés-Cano, G. Rabadán-Márquez, M.A. Giráldez-Sánchez, P. Cano-Luis Resumen Las fracturas de astrágalo son lesiones poco frecuentes (0,1-0,9%) y con un alto índice de complicaciones. Una de las situaciones en las que puede darse una fractura de astrágalo es en el contexto de un politraumatismo, lo que puede comprometer aún más el pronóstico funcional. El objetivo del presente trabajo ha sido analizar los resultados funcionales en los pacientes con fracturas de astrágalo según se produjeran en el contexto de un politraumatismo o no. Estudio observacional sobre una cohorte retrospectiva de 24 pacientes intervenidos por fractura de astrágalo en nuestro centro (2008-2016). Se agruparon según fuesen politraumatizados (ISS > 16) o no (ISS ≤ 16). Revisión de variables sociodemográficas, radiográficas, funcionales (escala EVA de dolor y FADI –Foot and Ankle Disability Index–) y la aparición de complicaciones como artrosis o necrosis avascular. Revisión de 25 fracturas de astrágalo en 24 pacientes con una edad media de 38 años (19-75) y un seguimiento medio de 4,2 años (0,5-9). Según el ISS un 44% de pacientes (11) fueron politraumatizados y un 56% (14) no. Respecto a los resultados funcionales entre politraumatizados y no politraumatizados, la puntuación media según la escala FADI fue de 62 puntos y de 76,9 respectivamente y según la escala EVA fue de 5,8 y 4,3 puntos respectivamente. Respecto a las complicaciones, en el grupo de politraumatizados se presentaron en un 64% de los pacientes y en los no politraumatizados en un 43%. Un 36% de los pacientes politraumatizados tuvieron signos clínicos y radiológicos de artrosis subastragalina y un 27% fueron intervenidos mediante una artrodesis frente al 35% y al 27% del grupo de no politraumatizados, Respecto a la necrosis avascular del astrágalo, se registro un 27% frente a un 0% de los no politraumatizados. Abstract Talar fractures are uncommon lesions (0.1-0.9%) and have a high rate of complications. One of the situations in which a fracture of the talus can occur is in the context of polytrauma which may further compromise the functional prognosis. The aim of this study was to analyze the functional results in patients with talar fractures whether or not they occurred in the context of polytrauma. Observational study on a retrospective cohort of 24 patients operated in our centre (2008-2016). They were grouped according to whether they were polytraumatized (ISS > 16) or not (ISS ≤ 16). Review of sociodemographic, radiographic, functional variables (VAS pain scale and FADI –Foot and Ankle Disability Index–) and the onset of complications such as arthrosis, arthrodesis or avascular necrosis. Review of 25 talar fractures in 24 patients with a mean age of 38 years (19-75) and a mean follow-up of 4.2 years (0.5-9). According to the ISS, 44% of patients (11) were polytraumatized and 56% (14) were not. The average score according to the FADI scale was 62 points for the polytraumatized patients and 76.9 for the non-polytraumatized patients. The pain according to the VAS scale was 5.8 points in the group of polytraumatized patients and 4.3 in the non-polytraumatized patient group. Regarding complications, 64% of the polytraumatized patients and 43% of the non-traumatized patients had a complication. 36% of the polytraumatized patients had clinical and radiological signs of subtalar arthrosis compared to 35% of the non-traumatized patients, of whom 27% underwent arthrodesis compared to 28% of the non-traumatized patients. 27% of the polytraumatized patients were diagnosed with avascular necrosis as opposed to 0% of the non-polytraumatized patients.

Estudio antropométrico de la glena humana en una población española normal Publication date: Available online 8 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): L. Rosales-Rosales, A.P. Rosales-Varo, M.A. García-Espona, O. Roda-Murillo, I. Montesinos, P. Hernandez-Cortés Resumen Objetivo El objetivo de este estudio es evaluar el tamaño de la glena en una población española normal, compararla con resultados previos en otras poblaciones y relacionarlo con los tamaños de implante que se comercializan para la artroplastia invertida de hombro. Material y métodos Estudio antropométrico de la glena humana utilizando tomografías computarizadas de 154 pacientes con edades superiores a 30 años, realizados entre enero de 2015 y diciembre de 2017. Se valoran tomografías computarizadas de hombro con cortes de 2 mm de grosor y 0 mm de intervalo entre cortes, en algoritmo óseo y de partes blandas, realizándose reconstrucción 3 D sobre la cual se obtienen mediciones de longitud y anchura de la glena. El punto superior de la glena se determinó en la zona superior del ovoide de la glena, en el tubérculo supraglenoideo, justo por debajo del reborde circunferencial que rodea la glena. El punto inferior se determinó como el punto más alejado del punto superior en el contorno de la glena, a nivel superior del reborde circunferencial que rodea la glena. Los puntos anterior y posterior fueron determinados como los extremos del eje transversal mayor en un plano perpendicular al eje superoinferior, por dentro del reborde circunferencial que rodea la glena. Las diferencias entre sexos, edad, altura, peso y relaciones de tamaños fueron evaluados. Resultados La glena tiene un eje longitudinal medio de 28,78 mm y una anchura de 20,27 mm. Los valores del tamaño de la glena son significativamente diferentes en hombres y mujeres, siendo mayor en hombres. El tamaño de la glena está bien correlacionado con la estatura del paciente, existiendo una asociación positiva entre la estatura y la longitud y anchura de la superficie glenoidea. Las metaglenas circulares disponibles hoy en el mercado presentan tamaños no inferiores a 24-25 mm de diámetro. Conclusión La población del sur de España presenta un tamaño de la superficie glenoidea inferior a la población americana y semejante a la cohorte asiática. Los datos antropométricos expresados pueden ser útiles para la elección de la metaglena más apropiada en la población del sur de España. Abstract Objective To evaluate the size of the glenoid in a southern Spanish population, to compare it with previous results from other populations and determine the size of the implants that are marketed for shoulder arthroplasty. Material and methods Between January 2015 and December 2017, an anthropometrical study of the human glenoid was performed using computed axial tomography scans (CT) of 154 patients over 30 years old. The glenoid dimensions were analysed 3-dimensionally using 2 mm interval thicknesses, determining the average height and width of the glenoid. The upper point of the glenoid geometry was determined as the supraglenoid tubercle of the ovoid glenoid surface, where the long head of the biceps tendon is thought to originate. The lower point was then positioned at the furthest point from the upper point on the glenoid contour. Anterior and posterior points were determined such that the 3-dimensional anterior-posterior distance was maximized on the plane perpendicular to the upper-lower axis. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were also evaluated. Results The glenoid had an average height of 28.78 mm and width of 20.27 mm. The values were significantly different between the men and the women, being greater in the men. The glenoid size is well correlated with the patient's size. Direct correlations exist between the glenoid height and width and the glenoid size and the patient's height. The available metaglenoids currently on the market are no bigger than 25-24 mm. Conclusion In comparison, the southern Spanish population have a glenoid size similar to the Caucasian population, but smaller than that of the American population. The data shown could be useful to improve the design of shoulder prostheses for the southern Spanish population.

Determinantes sociodemográficos de la comprensión de la información clínica en pacientes hospitalizados intervenidos de cirugía traumatológica Publication date: Available online 7 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): E.M. García-García, B. Sánchez-Sabater, I. Medrano-Morte, A. Luna-Maldonado Resumen Introducción El proceso de la información clínica es el pilar de la relación médico-paciente; comienza con la información proporcionada antes de la firma del consentimiento informado y finaliza al terminar la relación médico-enfermo. La influencia de las variables demográficas en el proceso de información ha sido poco estudiada en el paciente hospitalizado intervenido quirúrgicamente. En este estudio respondemos a dos cuestiones: 1) ¿Influye el género en el proceso de información en estos pacientes? 2) ¿Existen otros factores que influyan en el mismo? Método Estudio prospectivo realizado a través de un cuestionario diseñado «ad hoc» en una muestra de 200 pacientes ingresados tras la realización de una intervención quirúrgica en el servicio de Cirugía Ortopédica y Traumatología en nuestro hospital. El muestreo se ha realizado de manera aleatoria simple. Resultados Hemos hallado diferencias en la concordancia de las respuestas por género en la pregunta sobre el tipo de prioridad de la cirugía, siendo la mujer la que mejor lo conoce (p = 0,04). El resto de preguntas no muestran diferencias por género. Sin embargo, en la población analizada, son la edad y el nivel de estudios los principales factores modificadores de la comprensión, y ambos están relacionados con el género (p < 0,0001; p = 0,003, respectivamente). Conclusiones En la práctica clínica es importante tener presente aquellos factores que influyen en el proceso de información. Según nuestros resultados, los factores que definen una mayor vulnerabilidad con relación al proceso de información son la edad y el bajo nivel de estudios. Abstract Introduction The clinical information process is the basis of the doctor-patient relationship. It starts with the information provided before signing informed consent and ends on the termination of the doctor-patient relationship. The influence of demographic variables in the information process has not been thoroughly studied for inpatients undergoing surgery. In this study we aim to answer two questions: 1) Does gender have an influence on the information process for these patients? 2) Are there other factors that affect the process? Method A prospective study carried out using an 'ad hoc' designed survey on a 200-inpatient sample after undergoing surgery in the trauma and orthopaedics department of our hospital. Sampling was simple random. Results We found differences in the consistency of the answers by gender in the question regarding surgical priority, with the women having a better understanding of it (p = .04). The rest of the questions show no differences by gender. However, in the population analyzed, age and educational level are the main modifiers of understanding, and they are both related to gender (p < .0001; p = .003, respectively). Conclusions In clinical practice, it is fundamental to keep in mind the factors that affect the information process. According to our results, the factors that define greater vulnerability in relation to the information process are age and low educational level.

Carcinoma de células de Merkel de localización y presentación atípica Publication date: Available online 6 May 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): R. Fernández-Regueiro, F.J. Suárez-Sánchez, J. Morís-de la-Tassa Resumen El tumor de células de Merkel es un tumor cutáneo raro, de elevada malignidad, mal pronóstico y baja supervivencia. Se caracteriza por su tendencia a la invasión ganglionar y vascular, y por un alto porcentaje de recurrencia locorregional en el año siguiente a la extirpación quirúrgica. Afecta a adultos entre los 60 y 80 años, y se localiza preferentemente en cabeza y cuello. Presentamos el caso de un varón de 85 años que acude por masa glútea ulcerada de 4 meses de evolución. El diagnóstico se realizó por estudio histopatológico e inmunohistoquímico. Un diagnóstico precoz y un tratamiento adecuado son importantes para mejorar el pronóstico de estos enfermos. Abstract Merkel cell tumour is a rare skin tumour of high malignancy, poor prognosis and low survival. It is characterized by its tendency to lymph node and vascular invasion and by a high percentage of locoregional recurrence in the year following surgical removal. It affects adults between 60 and 80 years of age and often occurs in the head and neck. We present the case of an 85-year-old man presenting with an ulcerated gluteal mass of 4 months' evolution. Diagnosis was by histopathological and immunohistochemical study. Early diagnosis and appropriate treatment are important to improve the prognosis of these patients.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com