David Pescador

Chondrosarcoma of the scapula secondary to radiodermatitis

INTRODUCTION The 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 CASE We 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 CONCLUSION Operations that respect or try to preserve the function of the upper limb must be taken into consideration in tumors of the pectoral girdle.

Comparative analysis of the immunomodulatory capacities of human bone marrow– and adipose tissue–derived mesenchymal stromal cells from the same donor

BACKGROUND AIMS The immunomodulatory properties of mesenchymal stromal cells (MSCs), together with their tissue regenerative potential, make them interesting candidates for clinical application. METHODS In the current study, we analyzed the in vitro immunomodulatory effects of MSCs derived from bone marrow (BM-MSCs) and from adipose tissue (AT-MSCs) obtained from the same donor on both innate and acquired immunity cells. BM-MSCs and AT-MSCs were expanded to fourth or fifth passage and co-cultured with T cells, monocytes or natural killer (NK) cells isolated from human peripheral blood and stimulated in vitro. The possible differing impact of MSCs obtained from distinct sources on phenotype, cell proliferation and differentiation, cytokine production and function of these immune cells was comparatively analyzed. RESULTS BM-MSCs and AT-MSCs induced a similar decrease in NK-cell proliferation, cytokine secretion and expression of both activating receptors and cytotoxic molecules. However, only BM-MSCs significantly reduced NK-cell cytotoxic activity, although both MSC populations showed the same susceptibility to NK-cell-mediated lysis. AT-MSCs were more potent in inhibiting dendritic-cell (DC) differentiation than BM-MSC, but both MSC populations similarly reduced the ability of DCs to induce CD4(+) T-cell proliferation and cytokine production. BM-MSCs and AT-MSCs induced a similar decrease in T-cell proliferation and production of inflammatory cytokines after activation. CONCLUSIONS AT-MSCs and BM-MSCs from the same donor had similar immunomodulatory capacity on both innate and acquired immunity cells. Thus, other variables, such as accessibility of samples or the frequency of MSCs in the tissue should be considered to select the source of MSC for cell therapy.

New model to explain the EQ-5D VAS in patients who have undergone spinal fusion.

BackgroundIn 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.MethodsHowever, 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.ResultsThese 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’.ConclusionsAbove 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.

Regeneration of hyaline cartilage promoted by xenogeneic mesenchymal stromal cells embedded within elastin-like recombinamer-based bioactive hydrogels

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 < 0.05). Immunofluorescence against a human mitochondrial antibody three months post-implantation showed that the hMSCs were integrated into the de novo formed tissue, thus suggesting their ability to overcome the interspecies barrier. Hence, we conclude that the use of xenogeneic MSCs embedded in an ELR-based hydrogel leads to the successful regeneration of hyaline cartilage in osteochondral lesions.Graphical Abstract

Intraneural ganglion cyst on the external popliteal nerve.

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.

A congenital dislocation of the trapeziometacarpal joint.

Dear Sir, A 19-year-old woman presented with left wrist pain over the distal radioulnar joint after falling on her hand. She had no previous history of injury or pain in the hand and no relevant familial history. X-ray examination showed a trapeziometacarpal joint dislocation with a vertical orientation of the trapezium (Fig 1) whereas the right hand and wrist were normal (Fig 2). The patient reported no pain, swelling or limitation of range of motion at the left trapeziometacarpal joint. Clinical examination was normal. The strength of pinch was 5 kg in the left hand and 6 kg in the right, consistent with the fact that she was right-handed. The wrist pain had disappeared by 1 month after the fall and she was able carry out normal daily activities. Instability of the trapeziometacarpal joint can be a precursor of osteoarthritic changes (Hunter et al., 2005). Instability of this joint has been described in association with Ehlers–Danlos syndrome (Gamble et al., 1989). In our case there was no joint hypermobility and therefore we assume that the dislocation was probably congenital. Congenital abnormalities of the trapeziometacarpal joint are rare and to best of our knowledge only one case of bilateral dislocation has been reported (Oberthur and Stip, 1956). The case reported by Rushforth (1949) could represent an advanced stage with arthritic changes. In the present case, the instability had been asymptomatic for several years, and as the wrist pain seemed to be caused by the recent injury we decided not to treat and simply keep the patient under review.

A linear regression model can estimate hip fracture incidence

Hip fractures are a real health problem in the elderly [1]. Before launching a program for hip fracture prevention, knowing the incidence of hip fractures in a determined region is mandatory. In 2006 we published in Archives of Osteoporosis a manuscript on the incidence of osteoporotic hip fractures in our area (Salamanca, Spain) over the period 1994–2002, establishing a mathematical regression model to estimate the number of fractures up to 2015 [2]. Following the same methods used in this previous work [2], we collected data on hip fractures during the period 2004–2009 in order to ascertain whether the proposed model proved to be exact or not. These data are presented in Tables 1 and 2, and they show that the incidence of osteoporotic hip fractures in 2004–2009 concurs with the estimation of our mathematical model. Although incidence of fractures is increasing with time, it seems to reach a plateau or even showing some decrease. Some authors have pointed out the fact that the incidence of hip fractures is declining in the last few years [3, 4]. This change in the trend towards a decrease in hip fracture incidence is not homogeneous and may vary among

Human Bone Marrow Mesenchymal Stromal Cells Promote Bone Regeneration in a Xenogeneic Rabbit Model: A Preclinical Study

Significant research efforts have been undertaken during the last decades to treat musculoskeletal disorders and improve patients 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.

Digestive Fistula Due to Acetabular Protrusion: Case Report and Review of the Literature: 由髖臼突起引起的消化瘺 -- 病例報告和文獻綜述

Intrapelvic migration of the acetabular component after primary or revision hip arthroplasty is a rare complication. We present a case of an intrapelvic migration of the acetabular component after a revision hip arthroplasty which led to an enteric fistula to the hip joint as well as to a sigmoid colon perforation.

Finite element analysis and cadaveric cinematic analysis of fixation options for anteriorly implanted trabecular metal interbody cages

PurposeTo 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.MethodsA 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).ResultsThe L4–L5 spinal unit with an anterior interbody cage and two staples was 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.ConclusionThe 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.