Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study

BACKGROUND

Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers.

METHODS

In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants.

RESULTS

At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations.

CONCLUSIONS

The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.

Commercially Accessible High-Performance Aluminum-Air Battery Cathodes through Electrodeposition of Mn and Ni Species on Fuel Cell Cathodes

This study presents a cost-effective method for producing high-performance cathodes for aluminum-air batteries. Commercial fuel cell cathodes are modified through electrodeposition of nickel and manganese species. The optimal conditions for electrodeposition are determined using a combination of structural (Raman, SEM, TEM) and electrochemical (LSV, EI, discharge curves) characterization techniques. The structural analysis confirms successful incorporation of nickel and manganese species onto the cathode surface. Electrochemical tests demonstrate enhanced electrochemical activity compared to unmodified cathodes. By combining the favorable properties of electrodeposited manganese species with nickel species, a high-performance cathode is obtained. The developed cathode exhibits capacities of 50 mA h cm-2 in aluminum-air batteries across a wide range of current densities. The electrodeposition method proves effective in improving electrochemical performance. A key advantage of this method is its simplicity and cost-effectiveness. The use of commercially available materials and well-established electrodeposition techniques allows for easy scalability and commercialization. This makes it a viable option for large-scale production of high-performance cathodes for the next-generation energy storage devices.

Chondrogenic Potential of Human Adipose-Derived Mesenchymal Stromal Cells in Steam Sterilized Gelatin/Chitosan/Polyvinyl Alcohol Hydrogels

Cross-linked polymer blends from natural compounds, namely gelatin (Gel), chitosan (CS), and synthetic poly (vinyl alcohol) (PVA), have received increasing scrutiny because of their versatility, biocompatibility, and ease of use for tissue engineering. Previously, Gel/CS/PVA [1:1:1] hydrogel produced via the freeze-drying process presented enhanced mechanical properties. This study aimed to investigate the biocompatibility and chondrogenic potential of a steam-sterilized Gel/CS/PVA hydrogel using differentiation of human adipose-derived mesenchymal stromal cells (AD-hMSC) and cartilage marker expression. AD-hMSC displayed fibroblast-like morphology, 90% viability, and 69% proliferative potential. Mesenchymal profiles CD73 (98.3%), CD90 (98.6%), CD105 (97.0%), CD34 (1.11%), CD45 (0.27%), HLA-DR (0.24%); as well as multilineage potential, were confirmed. Chondrogenic differentiation of AD-hMSC in monolayer revealed the formation of cartilaginous nodules composed of glycosaminoglycans after 21 days. Compared to nonstimulated cells, hMSC-derived chondrocytes shifted the expression of CD49a from 2.82% to 40.6%, CD49e from 51.4% to 92.2%, CD54 from 9.66 to 37.2%, and CD151 from 45.1% to 75.8%. When cultured onto Gel/CS/PVA hydrogel during chondrogenic stimulation, AD-hMSC changed to polygonal morphology, and chondrogenic nodules increased by day 15, six days earlier than monolayer-differentiated cells. SEM analysis showed that hMSC-derived chondrocytes adhered to the surface with extended filopodia and abundant ECM formation. Chondrogenic nodules were positive for aggrecan and type II collagen, two of the most abundant components in cartilage. This study supports the biocompatibility of AD-hMSC onto steam-sterilized GE/CS/PVA hydrogels and its improved potential for chondrocyte differentiation. Hydrogel properties were not altered after steam sterilization, which is relevant for biosafety and biomedical purposes.

Apendicectomía por único puerto asistida por laparoscopia versus técnica abierta convencional localizada, en pacientes con apendicitis aguda en el Hospital Universitario Clínica San Rafael

Introducción. La apendicectomía por puerto único, asistida por laparoscopia, ofrece una alternativa terapéutica en el abordaje de la apendicitis aguda. En el presente estudio, se evalúa el beneficio terapéutico de la técnica por único puerto asistida por laparoscopia y se compara esta técnica con la apendicectomía abierta. Materiales y métodos. Se trata de un estudio observacional analítico retrospectivo de cohorte, llevado a cabo en el Hospital Universitario Clínica San Rafael, de Bogotá. Se incluyeron 106 pacientes mayores de 15 años con apendicitis aguda, que fueron sometidos a apendicectomía por puerto único, asistida por laparoscopia o apendicectomía abierta. La relación entre el grupo con apendicectomía por laparoscopia y el de técnica abierta, fue de 1:1. Se incluyeron variables sociodemográficas, clínicas y quirúrgicas (tiempo quirúrgico, frecuencia de infección del sitio operatorio, estancia hospitalaria, dolor, reingresos y resultado estético). Resultados. La edad promedio fue de 32 años y la mayoría de los pacientes eran de sexo masculino. El tiempo operatorio fue menor en los casos de apendicectomía por puerto único, asistida por laparoscopia, con un promedio de 34,1 minutos. Según la escala análoga, el dolor posoperatorio fue de 2,2 con la técnica laparoscópica y de 3,2 con la apendicectomía abierta (p<0,05). Hubo ocho veces más reingresos entre los casos de apendicectomía abierta en comparación con la apendicectomía por un puerto, y el resultado estético fue satisfactorio en todos con esta última técnica. No se encontraron diferencias significativas en la estancia hospitalaria o la infección del sitio operatorio. La razón de momios (odds ratio, OR) fue inferior a 1 en variables como dolor, reingreso y menor tiempo quirúrgico, lo cual indica una menor probabilidad, en los que se usó un solo puerto. Discusión. La técnica por un solo puerto es segura, reproducible, equiparable en términos de días de estancia hospitalaria e infección de sitio operatorio, e incluso, produce mejores resultados en el tiempo quirúrgico, las escalas de dolor y el número de reingresos.