191 research outputs found
Platelet autologous growth factors decrease the osteochondral regeneration capability of a collagen-hydroxyapatite scaffold in a sheep model
No full textCurrent research aims to develop innovative approaches to improve chondral and osteochondral regeneration. The objective of this study was to investigate the regenerative potential of platelet-rich plasma (PRP) to enhance the repair process of a collagen-hydroxyapatite scaffold in osteochondral defects in a sheep model
Microbiota and thyroid disease. An updated systematic review
No full textStudies analyzing the relationship between microbiota composition and the thyroid have been increasing rapidly in recent years, and evidence has recently come to light about the involvement of the gut microbiota in various aspects of thyroid pathology. Recently, besides studies analyzing the microbiota composition of different biological niches (salivary microbiota or thyroid tumor microenvironment) in patients with thyroid disorders, some studies have been carried out in peculiar subcategories of patients (pregnant women or obese). Other studies added a metabolomic insight into the characterization of fecal microflora in an attempt to enlighten specific metabolic pathways that could be involved in thyroid disorder pathogenesis. Lastly, some studies described the use of probiotics or symbiotic supplementation aimed at modulating gut microbiota composition for therapeutic purposes. The aim of this systematic review is to analyze the last advancements in the relationship between gut microbiota composition and thyroid autoimmunity, extending the analysis also to nonautoimmune thyroid disorders as well as to the characterization of the microbiota belonging to different biological niches in these patients. The overall results of the present review article strengthen the existence of a bidirectional relationship between the intestine, with its microbial set, and thyroid homeostasis, thus supporting the newly recognized entity known as the gut-thyroid axis
Second generation issues in cartilage repair
No full textIn recent years, regenerative techniques, such as autologous chondrocyte implantation (ACI), have emerged as a potential therapeutic option for the treatment of chondral lesions. However, the good results reported have to be weighed against the number of problems that can be observed with traditional ACI methods. To address these problems, the so-called second generation ACI techniques have been developed. Autologous chondrocyte transplantation on a 3-dimensional matrix was introduced in clinical practice from 1998 to 1999 and results at short to medium-term follow-up are well documented for different types of scaffolds. These techniques may be used for the treatment of large chondral lesions in the young, active population and highly competitive athletes, but long-term and randomized controlled studies will be needed to confirm reliability of these procedure
Universalizar la educación media en Uruguay : ausencias,tensiones y desafíos
No full textgrafs., tablasEste libro es el resultado de una investigación desarrollada en la Facultad de Ciencias Sociales de la Universidad de la República con el apoyo de la Comisión Sectorial de Investigación Científica (CSIC). Mediante un enfoque interdisciplinario y triangulación metodologica, el proyecto se propuso identificar los desafíos sociales, educativos, políticos y económicos que suponen hoy para Uruguay cumplir con el mandato de obligatoriedad de los ciclos básico y superior de la educación media consagrado en la Ley de Educación de 2008.La Universidad al servicio de la República – INTRODUCCIÓN -- El proyecto -- La temática en estudio -- El derecho a la educación y la obligatoriedad escolar -- La educación como derecho a través de los acuerdos internacionales -- Del dicho al hecho: principales requisitos para efectivizar el derecho a la educación -- El derecho a la educación y la obligatoriedad escolar en las leyes de educación en Uruguay -- El binomio “derecho a la educación-obligatoriedad escolar” -- ¿QUIÉNES EJERCEN EL DERECHO A LA EDUCACIÓN MEDIA EN URUGUAY? Abordaje analítico-descriptivo del tema -- El acceso al nivel medio -- El nivel educativo alcanzado -- Tipo de provisión del servicio educativo: centros públicos y privados -- Trayectorias educativas -- Desigualdades en las trayectorias educativas -- Situaciones educativas -- ¿Quiénes desertan del nivel medio sin completarlo? -- SUJETOS INVISIBLES: LA OPINIÓN DE LOS ADOLESCENTES Y JÓVENES -- Motivos para no iniciar la educación media -- Motivos para estudiar en educación media -- Motivos de deserción de la educación media -- ¿Cómo enfrentar la deserción? La opinión de quienes iniciaron educación media -- La comparación entre ENJ 1990 y ENAJ 2008: motivos por los que los jóvenes estudian en educación media -- LOS DESAFÍOS SOCIALES DE LA OBLIGATORIEDAD -- Estudiantes ideales, estudiantes reales -- El ajuste entre la experiencia subjetiva de los estudiantes y la institución educativa -- Las diferencias en la continuidad educativa entre varones y mujeres -- La vinculación entre la educación y el trabajo -- La articulación entre el sistema de cuidados y el sistema educativo -- La familia de los alumnos -- ¿Qué educación media queremos? Entre el elitismo y el universalismo -- El fin de la educación media para la clase media -- Contexto socio-histórico -- El desencanto -- La falta de rumbo -- LOS DESAFÍOS PEDAGÓGICOS EN EL MARCO DE UNA OFERTA HOMOGÉNEA -- Enfoque del tema -- La múltiples tensiones de la educación media contemporánea -- La histórica búsqueda de la equidad a través de la homogeneidad -- La reciente generación de programas de inclusión educativa -- Factores visualizados como obstáculos a la universalización de la educación media -- El cambio educativo en el horizonte: algunas pistas -- Las tensiones de la expansión del ciclo medio -- LOS DESAFÍOS INSTITUCIONALES -- El diseño institucional del sistema educativo uruguayo -- El entramado institucional de la educación media en la Ley de Educación del 2008 168 -- La coordinación de las políticas: algunas observaciones generales de los entrevistados -- Consejos Desconcentrados, CODICEN y Poder Ejecutivo: evaluaciones puntuales sobre la coordinación del sistema educativo uruguayo -- LOS DESAFÍOS ECONÓMICOS -- ¿Cómo medir los recursos necesarios para la universalización de la educación media? -- La demanda no cubierta y la estimación de infraestructura adicional -- Los costos -- El impacto fiscal -- CONCLUSIONES -- REFERENCIA
Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: Prospective study results at a minimum 7-year follow-up
No full textBACKGROUND:
Articular cartilage lesions, with their inherent limited healing potential, remain a challenging problem for orthopaedic surgeons. Various approaches have been proposed to treat these lesions; nevertheless, opinions on indications and clinical efficacy of these techniques are still controversial.
PURPOSE:
To evaluate the outcome of osteochondral autografts for treatment of femoral condyle cartilage lesions at a medium-to long-term follow-up.
STUDY DESIGN:
Case series; Level of evidence, 4.
METHODS:
We prospectively evaluated 30 patients (mean age, 29.3 years) with full-thickness knee chondral lesions (<2.5 cm(2)) treated with arthroscopic autologous osteochondral transplantation. Thirteen patients underwent previous surgery, while 17 patients were operated on for the first time. In 19 patients, associated procedures were performed. All patients were evaluated at 2- and 7-year follow-up. The International Cartilage Repair Society form, Tegner score, and magnetic resonance imaging were used for clinical evaluation.
RESULTS:
The International Cartilage Repair Society objective evaluation showed 76.7% of patients had good or excellent results at 7-year follow-up, and International Knee Documentation Committee subjective score significantly improved from preoperative (34.8) to 7-year follow-up (71.8). The Tegner evaluation showed a significant improvement after the surgery at 2- and 7-year follow-up (from 2.9 to 6.2 and 5.6, respectively); however, we noticed reduced sports activity from 2- to 7-year follow-up. Magnetic resonance imaging evaluation showed good integration of the graft in the host bone and complete maintenance of the grafted cartilage in more than 60% of cases.
CONCLUSION:
The results of this technique at medium- to long-term follow-up are encouraging. This arthroscopic 1-step surgery appears to be a valid solution for treatment of small, grade III to IV cartilage defects
Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: Prospective nonrandomized study at 5 years
No full textBACKGROUND:
Various approaches have been proposed to treat articular cartilage lesions, which are plagued by inherent limited healing potential.
PURPOSE:
To compare the clinical outcome of patients treated with second-generation autologous chondrocyte implantation implants with those treated with the microfracture repair technique at 5-year follow-up.
STUDY DESIGN:
Cohort study; Level of evidence, 2.
METHODS:
Eighty active patients (mean age, 29.8 years) and grade III to IV cartilage lesions of the femoral condyles or trochlea were treated with arthroscopic second-generation autologous chondrocyte implantation Hyalograft C or microfracture (40 patients per group). Patients achieved a minimum 5-year follow-up and were prospectively evaluated.
RESULTS:
Both groups showed statistically significant improvement of all clinical scores from preoperative interval to 5-year follow-up. There was a significant improvement for the International Knee Documentation Committee subjective score from pre-operative to 5-year follow-up (Wilcoxon test, P < .001). In the microfracture group, the International Knee Documentation Committee objective score increased from 2.5% normal and nearly normal knees before the operation to 75% normal and nearly normal knees at 5-year follow-up, and the subjective score increased from 41.1 +/- 12.3 preoperatively to 70.2 +/- 14.7 at 5-year follow-up. In the group treated with Hyalograft C, the International Knee Documentation Committee objective score increased from 15% normal and nearly normal knees before the operation to 90% normal and nearly normal knees at 5-year follow-up, and its subjective score increased from 40.5 +/- 15.2 preoperatively to 80.2 +/- 19.1 at 5-year follow-up (Wilcoxon test, P < .001). When comparing the groups, better improvement of the International Knee Documentation Committee objective (P < .001) and subjective (P = .003) scores was observed in the Hyalograft C group at 5-year follow-up. The return to sports at 2 years was similar in both groups and remained stable after 5 years in the Hyalograft C group; it worsened in the microfracture group.
CONCLUSION:
Both methods have shown satisfactory clinical outcome at medium-term follow-up. Better clinical results and sport activity resumption were noted in the group treated with second-generation autologous chondrocyte transplantation
Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review
No full textThe use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the RoB 2.0 for randomized controlled trials (RCTs) and the modified Coleman Methodology Score (mCMS) for all studies. A total of 20 clinical studies (735 patients) was identified, 12 on PRP injections and eight on cell-based therapies (five from bone marrow, two from adipose tissue, and one from amniotic fluid). The publication trend increased over time, with over 50% of articles published from 2019. The literature analysis showed only six RCTs, all on PRP injections. The mCMS showed an overall fair methodology (mean score 59.4). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results, with the treatment success being inversely proportional to the severity of OA. Further high-level controlled trials are needed before drawing more definitive conclusions on the real potential of orthobiologics for the injective treatment of patients affected by hip OA
Total adrenalectomy versus subtotal adrenalectomy for bilateral pheochromocytoma: meta-analysis
No full textBackground: Bilateral pheochromocytomas are rare and often heritable. Total adrenalectomy leads to a definitive oncological cure, with subsequent definitive hypocortisolism. Subtotal adrenalectomy is a possible alternative. The aim of this study was to assess the effects of total adrenalectomy and subtotal adrenalectomy on bilateral pheochromocytoma in terms of post-surgical rate of recurrence, metastatic disease, and steroid dependence. Methods: Systematic searches in the bibliographic databases PubMed, Embase, and Europe PMC were performed for 1945 to 1 June 2023. PRISMA guidelines were followed and the PICO strategy was applied to English-language studies comparing subtotal adrenalectomy with total adrenalectomy. A random-effects model was used to assess the different outcomes for studies with high heterogeneity. The Newcastle-Ottawa scale and the Risk Of Bias In Non-randomized Studies of Interventions ('ROBINS-I') tool were used to assess quality and risk of bias. Results: From a total of 12 909 studies, 1202 patients (from 10 retrospective studies) were eligible for the meta-analysis. In six studies, including 1176 patients, the recurrence rate after subtotal adrenalectomy and total adrenalectomy was 14.1 versus 2.6 per cent respectively (OR 4.91, 95 per cent c.i. 1.30 to 18.54; P = 0.020; I2 72 per cent). In nine studies, including 1124 patients, the rate of post-surgical steroid dependence was 93.3 versus 11.6 per cent after total adrenalectomy and subtotal adrenalectomy respectively (OR 0.003, 95 per cent c.i. 0.0003 to 0.03; P < 0.00001; I2 66 per cent). Based on two studies, including 719 patients, no differences were evident regarding the occurrence of post-surgery metastatic disease. Conclusion: Subtotal adrenalectomy leads to less post-surgical primary adrenal insufficiency, but leads to a higher postoperative recurrence rate. Future prospective randomized studies, with clear eligibility criteria, are needed to confirm these results
- …
