Lower estimated glomerular filtration rate at admission is associated with a worse outcome in older patients with hip fracture who undergo surgical treatment

BACKGROUND

We assessed the relationship of estimated glomerular filtration rate values at hospital admission on the outcome of surgically treated older adults who had suffered a hip fracture.

METHODS

Prospective study that included patients > 65 years of age, surgically treated for primary hip fracture, with no pathologic or high-energy trauma aetiology admitted to a tertiary teaching hospital between 2018 and 2019. We stratified patients based on their estimated glomerular filtration rate at admission and examined its association to demographic and clinical variables, including 90-day post-discharge mortality.

RESULTS

The study included 942 hip fracture patients. Lowered estimated glomerular filtration rate was significantly associated to a worsening of the functional status, higher incidence of medical postoperative complications, higher postoperative renal dysfunction, and greater number of blood transfusions. Mortality displayed a staircase pattern, increasing with decreasing estimated glomerular filtration rate. Patients with estimated glomerular filtration rate <60 had significantly higher mortality at 90 days after discharge. In-hospital mortality rate was 10.7% in hip fracture patients with chronic kidney disease who experienced a significant variation in the estimated glomerular filtration rate (>5 mL/min/1.73m2) on admission in comparison to baseline values.

CONCLUSION

Older adult patients treated for hip fracture with lower glomerular filtration rate values have poorer functional status and worse prognosis. A significant clinical variation of estimated glomerular filtration rate upon hospital admission for hip fracture may be associated with increased in-hospital mortality of chronic kidney disease patients.

Autologous mesenchymal stem cell transplantation for spinal fusion: 10 years follow-up of a phase I/II clinical trial

Posterolateral spinal fusion is the standard surgical approach for patients with degenerative disc disease. In our previously published article, we reported a 5-years follow-up of a phase I/II clinical trial in patients undergoing spinal fusion with autologous mesenchymal stem cells (MSCs) embedded in tricalcium phosphate. In the current manuscript, we have updated the results with a 10-year follow-up, the longest reported to date in this setting. After clinical and radiological evaluation, safety of the procedure was further confirmed in all 11 treated patients, with no evidence of tumor, infection, inflammatory reaction, or heterotopic ossification related to the administration of MSCs. Regarding clinical efficacy, low back pain and radicular pain (both assessed by the visual analogue scale-VAS), and the Owestry Disability Index remained significantly lower compared to pre-intervention. Radiologic evaluation demonstrated spinal fusion in all cases, improving over time. Finally, quality of life improved significantly also during follow-up. In summary, the use of tricalcium phosphate-embedded autologous MSCs with lumbar posterolateral arthrodesis is safe and potentially provides long-term benefits for 10 years.

Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis

(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I-II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5-10 mL of saline and 5% human albumin) in a single dose of 0.5-1 × 10⁶ cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective.

Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

OBJECTIVE

To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral.

MATERIAL AND METHODS

Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones.

RESULTS

There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care.

CONCLUSION

Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

OBJECTIVE

To analyse referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2 referral scenarios in order to determine the impact of variability on referral.

MATERIAL AND METHODS

Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones.

RESULTS

There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (p<0.001). Due to a large number of referrals, 2 scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2 scenarios assumed provides a significant reduction in the demand for care.

CONCLUSION

Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

INTRODUCTION

Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes.

MATERIALS AND METHODS

We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival.

RESULTS

The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times.

DISCUSSION

Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

INTRODUCTION

Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes.

MATERIALS AND METHODS

We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival.

RESULTS

The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times.

DISCUSSION

Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Therapeutic potential of mesenchymal stromal/stem cells in critical-care patients with systemic inflammatory response syndrome

BACKGROUND

Despite notable advances in the support and treatment of patients admitted to the intensive care unit (ICU), the management of those who develop a systemic inflammatory response syndrome (SIRS) still constitutes an unmet medical need.

MAIN BODY

Both the initial injury (trauma, pancreatitis, infections) and the derived uncontrolled response promote a hyperinflammatory status that leads to systemic hypotension, tissue hypoperfusion and multiple organ failure. Mesenchymal stromal/stem cells (MSCs) are emerging as a potential therapy for severe ICU patients due to their potent immunomodulatory, anti-inflammatory, regenerative and systemic homeostasis-regulating properties. MSCs have demonstrated clinical benefits in several inflammatory-based diseases, but their role in SIRS needs to be further explored.

CONCLUSION

In the current review, after briefly overviewing SIRS physiopathology, we explore the potential mechanisms why MSC therapy could aid in the recovery of this condition and the pre-clinical and early clinical evidence generated to date.

Long-term efficacy of autologous bone marrow mesenchymal stromal cells for treatment of knee osteoarthritis

Knee osteoarthritis is the most prevalent joint disease and a frequent cause of pain, functional loss and disability. Conventional treatments have demonstrated only modest clinical benefits whereas cell-based therapies have shown encouraging results, but important details, such as dose needed, long-term evolution or number of applications required are scarcely known. Here we have reanalyzed results from two recent pilot trials with autologous bone marrow-derived mesenchymal stromal cells using the Huskisson plot to enhance quantification of efficacy and comparability. We find that cell doses of 10, 40 and 100 million autologous cells per knee provided quite similar healing results and that much of the effect attained 1 year after cell application remained after 2 and 4 years. These results are encouraging because they indicate that, apart from safety and simplicity: (i) the beneficial effect is both significant and sizeable, (ii) it can be achieved with a single injection of cells, and (iii) the effect is perdurable for years.Trial registration: EudraCT 2009-017405-11; NCT02123368. Registered 25 April 2014-Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02123368?term=02123368&draw=2&rank=1.

Anterior cruciate ligament innervation in primary knee osteoarthritis

OBJECTIVE

To relate the Anterior Cruciate Ligament (ACL) innervation and histologic degeneration status to the knee osteoarthritis radiologic and functional status.

DESIGN

Prospective observational study including 30 consecutive patients affected by primary knee osteoarthritis undergoing Total Knee Arthroplasty (TKA). All patients suffering secondary knee osteoarthritis, an antecedent of an infectious process, malignant process, autoimmune disorder, or previous knee surgery were excluded. We recorded biodemographic, clinical, and radiologic variables of all participants previous to the TKA procedure. ACL tissue was harvested during TKA standard procedure and the obtained sample was fixed in 4% formalin and paraffin-embedded. ACL cross-sections were stained by haematoxylin-eosin and Gallego staining for elastic and collagen fibers, and Sevier-Munger silver staining for nervous tissue.

RESULTS

ACL samples histologic degeneration classification reported 15.4% normal, 23.1% slight, 26.9% mild, 11.5% moderate and 23.1% marked. We noted 46.2% large nervous fascicles, 15.4% medium fascicles, 3.8% small fascicles, and no nerve fibers were found in 34.6% ACL samples. No significant correlation was found between the histologic degeneration and the nervous fiber quantification (p>0.05, in all cases). We noted a significant histologic degeneration inverse correlation with the VAS scale (p=0.016), and nervous fiber quantification correlation with Lequesne maximum distance walked punctuation (p=0.043). We also noted greater nervous fiber quantification with minor radiological knee osteoarthritis (Kellgren-Lawrence grade II).

CONCLUSIONS

ACL degeneration and innervation deficit may play a role in primary knee osteoarthritis onset, but the lack of a defining relationship among the different parameters assessed justifies further research in greater populations.

Quality assessment of orthopedic surgery referral request letters from primary care consultation: Evaluation of a Spanish healthcare area

BACKGROUND

One of the most requested referrals for specialist consultations from primary care (PC) is orthopedic surgery (OS). The purpose of this work was to analyze the number, characteristics, and quality of PC referral request letters in a Spanish healthcare area to their OS reference department.

MATERIALS AND METHODS

The referral rates for 10 years were collected, and a total of 6,225 referral letters issued during the first half of 2019 were analyzed in detail. Gender, age, patient provenance, as well as priority and other process descriptors (type of pathology, suspected diagnosis, exploratory signs, imaging tests) were assessed. A scoring system was developed to evaluate the quality of the referral to an OS consultation: Quality evaluation in OS (QEOS) model.

RESULTS

The rate of referral to OS is rising. The mean age of the referred patient was 53 years and 59.3% were women. Degenerative pathologies justified most referral requests (65.7%), most of which related to the spine (24.2%) or the knee (23.2%). In the QEOS analysis of the referral request letters, we noted that only 36.5% described some physical exploration, 32.9% image tool request, 25.8% indicated the pharmacological treatment, and 11.2% subsequent physiotherapy, resulting in a poor average quality of PC to OS patient referral.

CONCLUSION

There is a growing demand for patient referral from PC to OS, however, the number, content, and quality of referral request letters varies greatly. The QEOS tool can be the germ of a simple evaluation system that would help in the improvement of the process of continuous care.

MSCs from polytrauma patients: preliminary comparative study with MSCs from elective-surgery patients

Background

Polytrauma is a major clinical problem due to its impact on morbidity and mortality, especially among the younger population. Its pathophysiology is not completely elucidated, and the study of the involvement of certain cell populations with therapeutic potential, such as mesenchymal stromal cells (MSCs), is an area of growing interest, as mesenchymal cells have anti-inflammatory, immunoregulatory, and osteogenic potential.

Methods

In the present preliminary work, we have evaluated the characteristics of MSCs in terms of proliferation, immunophenotype, cell cycle, clonogenic capacity, and multilineage differentiation ability in a series of 18 patients with polytrauma and compared them to those from otherwise healthy patients undergoing elective spinal surgery.

Results

MSCs from polytrauma patients displayed higher proliferative potential with significantly higher cumulative population doublings, increased expression of some important cell adhesion molecules (CD105, CD166), and an early pre-osteogenic differentiation ability compared to those of the control group.

Conclusions

MSCs could potentially be of help in the repair process of polytrauma patients contribute to both cell-tissue repair and anti-inflammatory response. This potential should be further explored in larger studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-021-02500-9.

Functional Status Geriatric Scores: Single-Handed Tools for 30-Day Mortality Risk After Hip Fracture

Background

The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. This work aims to appraise the Barthel Index, Katz Index, Lawton-Brody Index, and Physical Red Cross Scale registered in the Comprehensive Geriatric Assessment at admission on the of 30-day death probability after hip fracture surgery.

Methods

Prospective study including 899 hip fracture patients over 65. Bed-ridden, non-surgically treated patients, and high energy trauma or tumoral etiology fractures were excluded. Variables distribution were assessed by χ², U-Mann Whitney and we performed binary logistic regression and equal tailed Jeffreys 95% CI for risk assessment. P<0.05 was considered statistically significant.

Results

We noted a 30-day mortality rate of 5.9%. We related Barthel Index (OR=0.986 [0.975–0.996], p=0.010), Katz Index (OR=1.254 [1.089–1.444], p=0.002), Lawton-Brody Index (OR=0.885 [0.788–0.992], p=0.037), and Physical Red Cross Scale (OR=1.483 [1.094–2.011], p=0.011) with the 30-day mortality of patients after hip fracture surgery. We also validated the Barthel Index inflection point (0–55) (OR_BI(0–55)=2.428 [1.379–4.275], p=0.002) and Katz Index inflection point (A-B) (OR_KI(A-B)=0.493 [0.273–0.891], p=0.019) for the assessment of the highest risked patients.

Conclusion

The geriatric functional status scores would be useful multifunctional and standalone tools in the assessment of hip fracture patients as singly predictors of 30-day mortality.

30-day mortality after hip fracture surgery: Influence of postoperative factors

Purpose

The 30-day mortality rate after hip fracture surgery has been considered as an indirect indicator of the quality of care. The aim of this work is to analyse preoperative and postoperative factors potentially related to early 30-day mortality in patients over 65 undergoing hip fracture surgery.

Methods

Prospective cohort study including all consecutive primary hip fracture patients over 65 admitted to Trauma and Orthopaedics department from January 1, 2018 to December 31, 2019. Bed-ridden, non- surgically treated patients, and high energy trauma or tumoral aetiology fractures were excluded. A total of 943 patients were eligible (attrition rate: 2.1%). Follow-up included 30-days after discharge. We noted the 30-day mortality after hip fracture surgery, analysing 130 potentially related variables including biodemographic, fracture-related, preoperative, and postoperative clinical factors. Qualitative variables were assessed by χ², and quantitative variables by non-parametric tests. Odds ratio determined by binary logistic regression. We selected preventable candidate variables for multivariate risk assessment by logistic regression.

Results

A total of 923 patients were enrolled (mean age 86.22±6.8, 72.9% women). The 30-day mortality rate was 6.0%. We noted significant increased mortality on men (OR = 2.381[1.371–4.136], p = 0.002), ageing patients (OR_year = 1.073[1.025–1.122], p = 0.002), and longer time to surgery (OR_day = 1.183[1.039–1146], p<0.001), on other 20 preoperative clinical variables, like lymphopenia (lymphocyte count <10³/μl, OR = 1.842[1.063–3.191], p = 0.029), hypoalbuminemia (≤3.5g/dl, OR = 2.474[1.316–4.643], p = 0.005), and oral anticoagulant intake (OR = 2.499[1.415–4.415], p = 0.002), and on 25 postoperative clinical variables, like arrhythmia (OR = 13.937[6.263–31.017], p<0.001), respiratory insufficiency (OR = 7.002[3.947–12.419], p<0.001), hyperkalaemia (OR = 10.378[3.909–27.555], p<0.001), nutritional supply requirement (OR = 3.576[1.894–6.752], p = 0.021), or early arthroplasty dislocation (OR = 6.557[1.206–35.640], p = 0.029). We developed a predictive model for early mortality after hip fracture surgery based on postoperative factors with 96.0% sensitivity and 60.7% specificity (AUC = 0.863).

Conclusion

We revealed that not only preoperative, but also postoperative factors have a great impact after hip fracture surgery. The influence of post-operative factors on 30-day mortality has a logical basis, albeit so far they have not been identified or quantified before. Our results provide an advantageous picture of the 30-day mortality after hip fracture surgery.

Effect of pharmacological treatment prior to admission on the outcome of older hip fracture patients

PURPOSE

We aim to relate the pharmacological treatment at admission of hip fracture patients with their prognosis.

METHODS

We designed a prospective study including 436 hip fracture patients. We classified all the pharmacological treatment prior to admission of each patient into 25 groups according to their active agent and indications. We followed-up patients for one year for survival, emergency department visits (EDV), and in-hospital re-admissions (RAD). Differential analysis was performed by chi-square test, U-Mann Whitney test, and logistic regression. In all cases, p ≤ 0.05 was considered statistically significant.

RESULTS

At 30-day follow-up, 14.9% patients noted EDV, 9.2% RAD, and 3.2% dead. Patients taking beta-blockers (p = 0.046), loop diuretics (p = 0.018) or antiparkinsonian (p = 0.009) showed an increased 30-day EDV; patients taking benzodiazepines (p = 0.014), loop diuretics (p = 0.009) or antiparkinsonian (p = 0.009), an increased 30-day RAD. At one-year follow-up, 50.7% patients noted EDV, 30.7% RAD, and 22.7% dead. Patients taking oral antidiabetics (p = 0.006) noted a greater one-year EDV; patients taking major opioids (p = 0.001), benzodiazepines (p = 0.016), cardiac agents (p = 0.046), loop diuretics (p = 0.042), beta-blockers (p = 0.018), oral anticoagulants (p = 0.013) or gastric prophylaxis (p = 0.020), greater RAD; patients taking cardiac agents (p = 0.024), loop diuretics (p = 0.006) or oral anticoagulants (p = 0.015), increased 1-year mortality rate.

CONCLUSIONS

The pharmacological treatment noted at admission for hip fracture patients is related to the outcome, in a dose-independent way. The pharmacological treatment could be an additional parameter that could help us to improve the decision-making process and the resource assignation of hip fracture patients. A proper medication review upon admission because of a hip fracture is warranted.

Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis

Background

Mesenchymal stromal cells are a safe and promising option to treat knee osteoarthritis as previously demonstrated in different clinical trials. However, their efficacy, optimal dose and addition of adjuvants must be determined. Here, we evaluated the clinical effects of a dose of 100 × 10⁶ bone marrow mesenchymal stromal cells (BM-MSCs) in combination with Platelet Rich Plasma (PRGF®) as adjuvant in a randomized clinical trial.

Methods

A phase II, multicenter, randomized clinical trial with active control was conducted. Sixty patients diagnosed with knee OA were randomly assigned to 3 weekly doses of PRGF® or intraarticular administration of 100 × 10⁶ cultured autologous BM-MSCs plus PRGF®. Patients were followed up for 12 months, and pain and function were assessed using VAS and WOMAC and by measuring the knee range of motion range. X-ray and magnetic resonance imaging analyses were performed to analyze joint damage.

Results

No adverse effects were reported after BM-MSC administration or during follow-up. According to VAS, the mean value (SD) for PRGF® and BM-MSC with PRGF® went from 5 (1.8) to 4.5 (2.2) (p = 0.389) and from 5.3 (1.9) to 3.5 (2.5) (p = 0.01), respectively at 12 months. In WOMAC, the mean (SD) baseline and 12-month overall WOMAC scores in patients treated with PRGF® was 31.9 (16.2) and 22.3 (15.8) respectively (p = 0.002) while that for patients treated with BM-MSC plus PRGF® was 33.4 (18.7) and 23.0 (16.6) (p = 0.053). Although statistical significances between groups have been not detected, only patients being treated with BM-MSC plus PRGF® could be considered as a OA treatment responders following OARSI criteria. X-ray and MRI (WORMS protocol) revealed no changes in knee joint space width or joint damage.

Conclusions

Treatment with BM-MSC associated with PRGF® was shown to be a viable therapeutic option for osteoarthritis of the knee, with clinical improvement at the end of follow-up. Further phase III clinical trials would be necessary to confirm the efficacy.

Trial registration Clinical Trials.gov identifier NCT02365142. Nº EudraCT: 2011-006036-23

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

Objective

To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients.

Methods

We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post‐surgical stay, and in‐hospital mortality according to the healthcare model applied.

Results

Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A‐B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009).

The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in‐hospital follow‐up, there was a reduction in in‐hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance.

Conclusions

The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically‐treated patients.

Risk factors for periprosthetic joint infection after total knee arthroplasty

INTRODUCTION

Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties is increasing, so infections could also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee arthroplasty.

METHODS

This is a case-control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca. We included 66 TKA PJI patients and 66 control TKA patients. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed by logistic regression and attributable risk fraction assessed.

RESULTS

Prolonged operative time (> 90') and tourniquet time (> 60') were the most relevant risk factors described (OR 40.77, AFE 0.97, p > 0.001 and OR 37.14, AFE 0.97, p < 0.001, respectively). The use of non-antibiotic-laded cement (OR 3.62), obesity (BMI > 30, OR 8.86), diabetes (OR 2.33), high ASA grade (III-IV, OR 15.30), and blood transfusion requirement (OR 4.60) were also statistically significant risk factors for TKA PJI.

CONCLUSIONS

Our study provides evidence concerning that operative time, tourniquet time, cement type, diabetes, obesity, ASA grade, and blood transfusion requirement as independently associated risk factors for TKA PJI. Modifiable risk factors were specifically relevant, so we should be able to reduce the infection rate.

Geriatric scores can predict long-term survival rate after hip fracture surgery

BACKGROUND

The management of hip fractures is nowadays mainly performed in Orthogeriatric Units, one of whose fundamental tools is the application of geriatric scores. The purpose of this study is to establish the potential usefulness of Barthel Index, Katz Index, Lawton-Brody Index and Physical Red Cross Scale geriatric scores as predictors of survival rate and readmission rate in older patients after hip fracture surgery.

METHODS

We designed a prospective single-center observational study, including 207 older adults over age 65 who underwent hip fracture surgery in the first half of 2014 and followed up to September 2018. Cumulative survival and readmission rates were analyzed by Kaplan-Meier; group comparison, by Log-Rank and hazard ratio, by Cox regression.

RESULTS

We found statistical differences (p < 0.001) for cumulative survival rate by every geriatric score analyzed (BI HR = 0.98 [0.97,0.99]; KI HR = 1.24 [1.13-1.37]; LBI HR = 1.25 [1.16, 1.36]; PCRS HR = 1.67 [1.37,2.04]). Furthermore, we could determinate an inflection point for survival estimation by Barthel Index (BI 0-55/60-100*, p < 0.001, HR = 2.37 [1.59,3.53]), Katz Index (KI A-B*/C-G, p < 0.001, HR = 2.66 [1.80, 3.93], and Lawton-Brody Index (LBI 0-3/4-8*, p < 0.001, HR = 3.40 [2.09,5.25]). We reveal a correlation of the Charlson Index (p = 0.002) and Katz Index (p = 0.041) with number of readmissions for the study period.

CONCLUSIONS

The geriatric scores analyzed are related to the cumulative survival rate after hip fracture surgery for more than 4 years, independently of other clinical and demographic factors. Katz Index in combination with Charlson Index could also be a potential predictor of the number of readmissions after surgery for hip fracture patients.

Autologous mesenchymal stromal cells embedded in tricalcium phosphate for posterolateral spinal fusion: results of a prospective phase I/II clinical trial with long-term follow-up

BACKGROUND

Posterolateral spinal fusion with autologous bone graft is considered the "gold standard" for lumbar degenerative disc disease (DDD) when surgical treatment is indicated. The potential role of mesenchymal stromal cells (MSCs) to replace the bone graft in this setting has not been fully addressed.

OBJECTIVE

To analyze the safety, feasibility and potential clinical efficacy of the implantation of autologous MSCs embedded with tricalcium phosphate as a therapeutic alternative to bone graft in patients with DDD during posterolateral spine fusion.

STUDY DESIGN

Phase I/II single-arm prospective clinical trial.

METHODS

Eleven patients with monosegmental DDD at L4-L5 or L5-S1 level were included. Autologous bone marrow-derived MSC were expanded in our Good Manufacturing Practice (GMP) Facility and implanted during spinal surgery embedded in a tricalcium phosphate carrier. Monitoring of patients included a postoperative period of 12 months with four visits (after the 1st, 3rd, 6th, and 12th month), with clinical and radiological assessment that included the visual analog scale (VAS), the Oswestry disability index (ODI), the Short-Form Health Survey (SF-36), the vertebral fusion grade observed through a simple Rx, and the evaluation of possible complications or adverse reactions. In addition, all patients were further followed up to 5 years for outcome.

RESULTS

Median age of patients included was 44 years (range 30-58 years), and male/female ratio was (6/5) L4-L5 and L5-S1 DDD was present five and six patients, respectively. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell implantation. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 80% of patients achieved lumbar fusion at the end of the follow-up. No adverse effects related to the procedure were recorded.

CONCLUSIONS

The use of autologous MSCs for spine fusion in patients with monosegmental degenerative disc disease is feasible, safe, and potentially effective.

TRIAL REGISTRATION

no. EudraCT: 2010-018335-17 ; code Identifier: NCT01513694 ( clinicaltrials.gov ).

Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC)

Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.

Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II)

Background

Mesenchymal stromal cells (MSCs) are a promising option to treat knee osteoarthritis (OA). Their safety and usefulness have been reported in several short-term clinical trials but less information is available on the long-term effects of MSC in patients with osteoarthritis. We have evaluated patients included in our previous randomized clinical trial (CMM-ART, NCT02123368) to determine their long-term clinical effect.

Materials

A phase I/II multicenter randomized clinical trial with active control was conducted between 2012 and 2014. Thirty patients diagnosed with knee OA were randomly assigned to Control group, intraarticularly administered hyaluronic acid alone, or to two treatment groups, hyaluronic acid together with 10 × 10⁶ or 100 × 10⁶ cultured autologous bone marrow-derived MSCs (BM-MSCs), and followed up for 12 months. After a follow up of 4 years adverse effects and clinical evolution, assessed using VAS and WOMAC scorings are reported.

Results

No adverse effects were reported after BM-MSCs administration or during the follow-up. BM-MSCs-administered patients improved according to VAS, median value (IQR) for Control, Low-dose and High-dose groups changed from 5 (3, 7), 7 (5, 8) and 6 (4, 8) to 7 (6, 7), 2 (2, 5) and 3 (3, 4), respectively at the end of follow up (Low-dose vs Control group, p = 0.01; High-dose vs Control group, p = 0.004). Patients receiving BM-MSCs also improved clinically according to WOMAC. Control group showed an increase median value of 4 points (− 11;10) while Low-dose and High-dose groups exhibited values of − 18 (− 28;− 9) and − 10 (− 21;− 3) points, respectively (Low-dose vs Control group p = 0.043). No clinical differences between the BM-MSCs receiving groups were found.

Conclusions

Single intraarticular injection of in vitro expanded autologous BM-MSCs is a safe and feasible procedure that results in long-term clinical and functional improvement of knee OA.

Immunomodulatory effects of bone marrow versus adipose tissue-derived mesenchymal stromal cells on NK cells: implications in the transplantation setting

INTRODUCTION

The ability of mesenchymal stromal cells (MSC) to suppress T-cell function has prompted their therapeutic use for graft-versus-host disease (GVHD) control. However, as MSC also modulate the activity of NK cells, which play an important role in graft-versus-leukemia (GVL) reaction, their administration could hamper this beneficial effect of allogeneic hematopoietic stem cell transplantation. MSC can be expanded from several sources, especially bone marrow and fat, but it is not well established if the cell source makes a difference in their immunoregulatory capacity.

OBJECTIVE

The aim of this study was to compare the immunomodulatory effect of MSC derived from bone marrow (BM-CSM) or adipose tissue (AT-MSC) on NK cells, to determine whether the use of MSC from one or the other origin could be more favorable to preserve NK cell activity and, therefore, GVL.

METHODS

Human NK cells were stimulated with IL-15 in the presence of BM-MSC or AT-MSC. The effect of both MSC populations on NK cell proliferation, cell cycle progression, and CD56 expression was analyzed by flow cytometry. Cytokine secretion was measured by ELISA, and cytotoxic activity was assessed by calcein release assays.

RESULTS

Although both BM-MSC and AT-MSC induced a similar inhibition of NK cell proliferation, only BM-MSC decreased significantly NK cell cytotoxic activity and showed a trend for a higher reduction of IFN-γ secretion.

CONCLUSION

These results suggest that, in the context of GVHD inhibition, the use of AT-MSC rather than BM-MSC could further preserve NK cell activity and, thus, favor GVL.

Ex vivo identification and characterization of a population of CD13(high) CD105(+) CD45(-) mesenchymal stem cells in human bone marrow

Introduction

Mesenchymal stem cells (MSCs) are multipotent cells capable of self-renewal and multilineage differentiation. Their multipotential capacity and immunomodulatory properties have led to an increasing interest in their biological properties and therapeutic applications. Currently, the definition of MSCs relies on a combination of phenotypic, morphological and functional characteristics which are typically evaluated upon in vitro expansion, a process that may ultimately lead to modulation of the immunophenotypic, functional and/or genetic features of these cells. Therefore, at present there is great interest in providing markers and phenotypes for direct in vivo and ex vivo identification and isolation of MSCs.

Methods

Multiparameter flow cytometry immunophenotypic studies were performed on 65 bone marrow (BM) samples for characterization of CD13^high CD105⁺ CD45^– cells. Isolation and expansion of these cells was performed in a subset of samples in parallel to the expansion of MSCs from mononuclear cells following currently established procedures. The protein expression profile of these cells was further assessed on (paired) primary and in vitro expanded BM MSCs, and their adipogenic, chondrogenic and osteogenic differentiation potential was also determined.

Results

Our results show that the CD13^high CD105⁺ CD45⁻ immunophenotype defines a minor subset of cells that are systematically present ex vivo in normal/reactive BM (n = 65) and that display immunophenotypic features, plastic adherence ability, and osteogenic, adipogenic and chondrogenic differentiation capacities fully compatible with those of MSCs. In addition, we also show that in vitro expansion of these cells modulates their immunophenotypic characteristics, including changes in the expression of markers currently used for the definition of MSCs, such as CD105, CD146 and HLA-DR.

Conclusions

BM MSCs can be identified ex vivo in normal/reactive BM, based on a robust CD13^high CD105⁺ and CD45⁻ immunophenotypic profile. Furthermore, in vitro expansion of these cells is associated with significant changes in the immunophenotypic profile of MSCs.

Electronic supplementary material

The online version of this article (doi:10.1186/s13287-015-0152-8) contains supplementary material, which is available to authorized users.

Transcriptomic profile induced in bone marrow mesenchymal stromal cells after interaction with multiple myeloma cells: implications in myeloma progression and myeloma bone disease

Despite evidence about the implication of the bone marrow (BM) stromal microenvironment in multiple myeloma (MM) cell growth and survival, little is known about the effects of myelomatous cells on BM stromal cells. Mesenchymal stromal cells (MSCs) from healthy donors (dMSCs) or myeloma patients (pMSCs) were co-cultured with the myeloma cell line MM.1S, and the transcriptomic profile of MSCs induced by this interaction was analyzed. Deregulated genes after co-culture common to both d/pMSCs revealed functional involvement in tumor microenvironment cross-talk, myeloma growth induction and drug resistance, angiogenesis and signals for osteoclast activation and osteoblast inhibition. Additional genes induced by co-culture were exclusively deregulated in pMSCs and predominantly associated to RNA processing, the ubiquitine-proteasome pathway, cell cycle regulation, cellular stress and non-canonical Wnt signaling. The upregulated expression of five genes after co-culture (CXCL1, CXCL5 and CXCL6 in d/pMSCs, and Neuregulin 3 and Norrie disease protein exclusively in pMSCs) was confirmed, and functional in vitro assays revealed putative roles in MM pathophysiology. The transcriptomic profile of pMSCs co-cultured with myeloma cells may better reflect that of MSCs in the BM of myeloma patients, and provides new molecular insights to the contribution of these cells to MM pathophysiology and to myeloma bone disease.

Preclinical activity of the oral proteasome inhibitor MLN9708 in Myeloma bone disease

PURPOSE

MLN9708 (ixazomib citrate), which hydrolyzes to pharmacologically active MLN2238 (ixazomib), is a next-generation proteasome inhibitor with demonstrated preclinical and clinical antimyeloma activity, but yet with an unknown effect on myeloma bone disease. Here, we investigated its bone anabolic and antiresorptive effects in the myeloma setting and in comparison with bortezomib in preclinical models.

EXPERIMENTAL DESIGN

The in vitro effect of MLN2238 was tested on osteoclasts and osteoclast precursors from healthy donors and patients with myeloma, and on osteoprogenitors derived from bone marrow mesenchymal stem cells also from both origins. We used an in vivo model of bone marrow-disseminated human myeloma to evaluate MLN2238 antimyeloma and bone activities.

RESULTS

Clinically achievable concentrations of MLN2238 markedly inhibited in vitro osteoclastogenesis and osteoclast resorption; these effects involved blockade of RANKL (receptor activator of NF-κB ligand)-induced NF-κB activation, F-actin ring disruption, and diminished expression of αVβ3 integrin. A similar range of MLN2238 concentrations promoted in vitro osteoblastogenesis and osteoblast activity (even in osteoprogenitors from patients with myeloma), partly mediated by activation of TCF/β-catenin signaling and upregulation of the IRE1 component of the unfolded protein response. In a mouse model of bone marrow-disseminated human multiple myeloma, orally administered MLN2238 was equally effective as bortezomib to control tumor burden and also provided a marked benefit in associated bone disease (sustained by both bone anabolic and anticatabolic activities).

CONCLUSION

Given favorable data on pharmacologic properties and emerging clinical safety profile of MLN9708, it is conceivable that this proteasome inhibitor may achieve bone beneficial effects in addition to its antimyeloma activity in patients with myeloma.

Secular changes in Paget's disease: contrasting changes in the number of new referrals and in disease severity in two neighboring regions of Spain

SUMMARY

We studied the changes in the number of new referrals with Paget's disease of bone (PDB) and severity of PDB in a high prevalence focus and its neighboring region. Referral of patients changed only in the high prevalence focus. The severity of PDB decreased in both regions. These results could suggest the effects of an environmental influence on disease activity.

INTRODUCTION

The prevalence and severity of PDB have decreased in several countries over recent years. We previously reported a high radiological prevalence of PDB in Vitigudino. Here we sought to determine if secular changes in the number of new referrals and severity of PDB had occurred over recent years.

METHODS

We studied 280 patients with clinically diagnosed PDB who were evaluated at a regional referral center for metabolic bone disease between 1986 and 2009. Changes in the number of new referrals were calculated by relating these data to the number of subjects at risk as determined by population registers. Trends in disease severity were analyzed with alkaline phosphatase (ALP) activity and disease extent on scan.

RESULTS

Referrals from the Vitigudino region increased substantially between 1986 and 2003 but fell markedly between 2004 and 2009, although by this time there had been depopulation of the region due to emigration. No significant changes in the rates of referral occurred in the remainder of Salamanca. ALP activity and disease extent decreased in Salamanca, but only ALP activity decreased in Vitigudino. Referrals rate and severity of PDB in Vitigudino were greater than in the remainder of Salamanca.

CONCLUSIONS

Referral of patients with clinically diagnosed PDB has remained stable for most of Salamanca during the past 24 years, but substantial changes have been observed in Vitigudino. In agreement with other reports, the severity of PDB has decreased in both regions consistent with the effects of an environmental influence on disease activity.

The streams of Gorgona Natural National Park within the global context: an introduction to the special issue

Este artículo destaca la importancia de las islas para proponer y probar hipótesis en ecología de arroyos y, por lo tanto, aboga por la implementación de estudios de referencia en la isla Gorgona (Pacífico colombiano). En primer lugar, resume estudios ecológicos pasados ​​en arroyos en la isla Gorgona y describe una serie de artículos resultantes de una encuesta reciente. Estos documentos informan que la isla Gorgona exhibe un clima marítimo, una cubierta de selva tropical y una litología basáltica e intrusiva, todas características típicas de islas en otros lugares. También describen que a pesar del efecto insular sobre la biota de los arroyos, la proximidad (<50 km) de la isla a la costa del Pacífico de Colombia facilitó la dispersión de muchos componentes faunísticos y florísticos del continente, brindando así una oportunidad única para estudiar los arroyos costeros. en el Chocó Biogeográfico. Por último, el estado de la isla Gorgona como parque natural establecido en 1984, y una historia relativamente bien conocida de usos de la tierra, pueden contribuir aún más a apoyar programas de investigación con objetivos a largo plazo y gran escala

Características físico-químicas de las quebradas del Parque Nacional Natural Gorgona, Pacífico colombiano

En Colombia son escasos los estudios biogeoquímicos en quebradas naturales. Por esa razón se midieron varios parámetros físico-químicos y las concentraciones de carbono orgánico disuelto, nitrógeno total, fósforo total, cloruros y sulfatos para aproximarnos al papel de procesos geológicos, atmosféricos y biológicos en las quebradas de la Isla Gorgona en periodos de baja y alta precipitación durante 2008. Las aguas superficiales son prístinas por los bajos contenidos de nitrógeno. La litología volcánica, predominantemente basáltica e instrusiva ultramáfica, posiblemente determina la ocurrencia de aguas salinas (conductividad > 500 μMhos/cm), neutro-alcalinas (pH < 8,5) y ricas en fósforo total (< 200 μg/l). Los aerosoles marinos son los posibles responsables de una alta concentración de cloruros (> 2 mg/l). La concentración de carbono orgánico disuelto fue mayor en bosques maduros (> 60 mg/l) que en secundarios y rastrojos (< 60 mg/l). La baja concentración de sulfatos sugiere que no hay aportes atmosféricos desde fuentes industriales o volcánicas, aunque existen emisiones submarinas de gases en La Azufrada. El disturbio hidrológico alteró la concentración de los elementos dependiendo de su naturaleza y de las características de las cuencas.

Patrones espacio-temporales de la estructura y composición de la hojarasca en las quebradas del Parque Nacional Natural Gorgona

Este trabajo estima la estructura y composición de la tafocenosis de la hojarasca acumulada en el lecho de nueve quebradas de la isla Gorgona en abril y junio de 2008. La pácora (Cespedesia macrophylla) fue la especie dominante en términos de biomasa total en toda la isla, aunque fue más abundante en las quebradas cuyos bosques ribereños fueron deforestados antes de la declaración del parque nacional o están sometidos a disturbios naturales (e.g., caída de árboles y los derrumbes) que frecuentemente abren el dosel. Sin embargo, se registraron más de cien morfoespecies, veintidós de las cuales se registraron en ambos muestreos. La mayor parte de las especies aporta poca biomasa y número de hojas, y por lo tanto no parecen ser funcionalmente importantes. Además de las especies dominantes, la biomasa total, abundancia total (número de hojas) y riqueza de la tafocenosis difiere significativamente entre las quebradas posiblemente como consecuencia del estado sucesional del bosque ribereño. Durante la época de lluvias se redujo significativamente la biomasa de la hojarasca acumulada.

[Effects mangrove conversion to pasture on density and shell size of two gastropods in the Turbo River Delta (Urabá Gulf, Caribbean coast of Colombia)]

Mangrove deforestation is widespread in the Greater Caribbean but its impact on macrobenthos has not been evaluated to date. In order to assess the impact of mangrove conversion to pasture, densities and shell sizes of two dominant gastropods (Neritina virginea and Melampus coffeus) were compared among four mangrove types: 1) Rhizophora mangle-dominated fringing mangroves, 2) Avicennia germinans-dominated basin mangroves, 3) Mixed-species basin mangroves, and 4) A. germinans- basin mangroves converted to pastures, in the Turbo River Delta (Urabá Gulf, Colombia). Mangrove types were polygon-delimited with satellite images and color aerial photographs were taken in 2009. Various (n<5) polygons per mangrove type were sampled in January, July and December 2009, and a total (n<20) 0.025m2-quadrats were randomly placed along each polygon. Forest structure variables, pore-water physicochemical variables and sediment-grain metrics were measured in the four mangrove types. Mean density and size of both gastropod species were measured. The results showed that the mean density and size of both species were significantly greater in R. mangle-fringing mangroves. N. virginea density decreased gradually towards the A. germinans-basin mangroves seemly related to the diadromous life-history. This species nearly disappeared in the neighboring pastures because individuals were constrained to a few remaining flooded areas. In the pastures, M. coffeus individuals were clumped in the remaining A. germinans trees due to its climbing behavior as a pulmonate. We hypothesize that the decline of these two gastropods was related to physical microhabitat (e.g. trees, prop roots, and seedlings) degradation, and alteration of soil properties (e.g. temperature, pH, organic matter content). Finally, we also hypothesize that the local extinction of N. virginea due to clear-cutting may exert strong negative effects on the ecosystem function because it is a dominant omnivore.

Cambios multianuales y espaciales de la composición y estructura del ensamblaje de insectos acuáticos en las quebradas perennes de la Isla Gorgona, Colombia

Este estudio presenta un análisis del cambio multi-anual de los años 1986, 1993 y 2008, de la composición y estructura del ensamble de insectos acuáticos en cinco quebradas en las vertientes Este (Ilú, Iguapoga y Pizarro) y Oeste (Cocal Norte y La Camaronera o Cocal Sur) de Isla Gorgona, Colombia. Se compararon datos de estudios previos desarrollados por Calá en 1986 y Zamora et al. en 1993 y los obtenidos por el proyecto GIS-BIO en 2008. Se realizaron comparaciones en tres escalas espaciales: isla (diversidad γ), vertientes (β) y quebradas (α). El número de órdenes en 1986, 1993 y 2008 fue 8, 7 y 9, respectivamente. Entre 1993 y 2008 aumentaron el número de familias (de 17 a 27) y el de géneros (de 24 a 51). Debido al incremento en el número de taxones, la similitud (Sorensen) entre 1993 y 2008, fue 57,8% en términos de la composición de familias y 32,0% en relación de géneros. El índice de diversidad de Shannon-Wiener (H’) aumentó en el tiempo, en 1993 el promedio para la isla fue 1,92 (1,67-2,12 nats/ind.) y en 2008 fue 2,54 (2,30-2,82 nats/ind.). La dominancia (D) (< 0,19) y la equidad (J’) (> 0,68) en promedio fueron similares en ambos períodos. Al comparar las vertientes, la Este presentó mayor número de familias y géneros en ambos períodos. La similitud de la composición faunística entre ellas fue mayor para el año 2008 (74%) que 1993 (50%); por tanto, el recambio de géneros (diversidad β) entre vertientes fue inverso. La relación entre la diversidad local y regional fue de tipo I (insaturada) que para 1993 y 2008. Los patrones temporales y espaciales podrían ser explicados por la deforestación que sufrió el área “El Poblado” durante el funcionamiento de la penitenciaria entre 1960 y 1984. El bosque nativo a lo largo de varias quebradas fue reemplazado por cultivos de “pan-coger”, o sometido a entresaca de madera. Adicionalmente, se construyó una microcentral eléctrica en una de las quebradas. Desde la declaración de Isla Gorgona como Parque Nacional Natural en 1984, las cuencas impactadas entraron en un proceso de recuperación natural. Los muestreos en 1993 y 2008 representaron trayectorias de sucesión de 10 y 24 años, respectivamente. Sin embargo, no se descarta en los resultados, un efecto por las diferencias en el esfuerzo de muestreo entre años y la no disponibilidad para Suramérica de claves taxonómicas para la identificación de los organismos en los años 90s. Ésto se apoya en una mayor tasa de registros nuevos de familias y géneros en la vertiente Oeste, cuyo paisaje ha presentado mínima intervención humana.

The hydroclimatology of Gorgona Island: seasonal and ENSO-related Patternsa

Most small watersheds in the Tropical Eastern Pacific remain ungauged, and discharge analyses using gauge and simulated data have been published only for a few large rivers. I analyzed a 20-yr record of rainfall and stream discharge from Gorgona Island, a natural national park located 30 km offshore in the Pacific Ocean of Colombia to explore intra- and inter-annual patterns and drivers. Gorgona Island receives > 6.600 mm of annual rainfall thus feeding numerous permanent streams. Inter Tropical Convergence Zone-driven seasonal rainfall patterns (unimodal) were consistent regardless of interannual variability. However, a large yearly variation was observed between May and August. Monthly and annual rainfall in Gorgona Island was greater than at a neighboring continental-coastal area, suggesting the occurrence of orographic and convective rain. El Niño Southern Oscillation slightly influenced interannual variation in rainfall, but it strongly influenced stream discharge. The importance of the Chocó Jet Current and Meso-Scale Stationary Systems is discussed

Macroinvertebrate assemblages in Gorgona Island streams: spatial patterns during two contrasting hydrologic periods

Studies comparing various streams are scarce in tropical insular systems and inexistent in Colombia. In order to understand the spatial patterns of macroinvertebrates in tropical insular streams, and the environmental drivers of such patterns, we tested for patterns among streams but using a nested sampling design from streams to microhabitats in Gorgona Island (Colombia, Tropical Eastern Pacific) during two seasons (low and high precipitation). We found that benthic macroinvertebrate assemblages showed clear differences among streams despite of the variability within nested levels. Hydrologic disturbance tended to homogenize spatial patterns in most of the streams. Although ordinations of sampling units using either macroinvertebrate composition or environmental variables were not fully consistent, it was evident that water physicochemistry influenced by underlying geology was a pervasive driver of macroinvertebrate distribution. We highlight the importance of incorporating multiscale sampling designs for studying distributions of macroinvertebrates in tropical islands, and for biomonitoring.

Sobre los filtros que determinan la distribución y la abundancia de los macroinvertebrados diádromos y no-díadromos en cada nivel jerarárquico del paisaje fluvial en islas

Los ecosistemas fluviales presentes en las islas son importantes ya que albergan especies con historias de vida particulares. Algunas de ellas son organismos diádromos como peces, camarones, cangrejos y caracoles que constantemente migran entre las cabeceras de los ríos y los estuarios o el océano para completar sus ciclos de vida. Otros, como los insectos, constituyen la fauna no-diádroma, la cual debido a su limitada capacidad de dispersión, a las altas tasas de especiación y al aislamiento propio de cada isla, podría encontrarse restringida a una región insular. Esta clara diferencia en las estrategias de vida, hace necesario el relevamiento de información acerca de los patrones de abundancia y distribución y de los procesos responsables en todos los niveles de la jerarquía espacial (regiones, microcuencas, segmentos, tramos, hábitats y microhábitats), con el fin de establecer medidas que garanticen un manejo adecuado tendiente a la conservación de estos ecosistemas. Por ello, este trabajo presenta una revisión sobre los principales factores que determinan la estructura de los ensambles diádromos y no-diádromos, y que operan en cada nivel jerárquico de las quebradas insulares. 

Analysis of the immune system of multiple myeloma patients achieving long-term disease control by multidimensional flow cytometry

Multiple myeloma remains largely incurable. However, a few patients experience more than 10 years of relapse-free survival and can be considered as operationally cured. Interestingly, long-term disease control in multiple myeloma is not restricted to patients with a complete response, since some patients revert to having a profile of monoclonal gammopathy of undetermined significance. We compared the distribution of multiple compartments of lymphocytes and dendritic cells in the bone marrow and peripheral blood of multiple myeloma patients with long-term disease control (n=28), patients with newly diagnosed monoclonal gammopathy of undetermined significance (n=23), patients with symptomatic multiple myeloma (n=23), and age-matched healthy adults (n=10). Similarly to the patients with monoclonal gammopathy of undetermined significance and symptomatic multiple myeloma, patients with long-term disease control showed an expansion of cytotoxic CD8(+) T cells and natural killer cells. However, the numbers of bone marrow T-regulatory cells were lower in patients with long-term disease control than in those with symptomatic multiple myeloma. It is noteworthy that B cells were depleted in patients with monoclonal gammopathy of undetermined significance and in those with symptomatic multiple myeloma, but recovered in both the bone marrow and peripheral blood of patients with long-term disease control, due to an increase in normal bone marrow B-cell precursors and plasma cells, as well as pre-germinal center peripheral blood B cells. The number of bone marrow dendritic cells and tissue macrophages differed significantly between patients with long-term disease control and those with symptomatic multiple myeloma, with a trend to cell count recovering in the former group of patients towards levels similar to those found in healthy adults. In summary, our results indicate that multiple myeloma patients with long-term disease control have a constellation of unique immune changes favoring both immune cytotoxicity and recovery of B-cell production and homing, suggesting improved immune surveillance.

The epoxyketone-based proteasome inhibitors carfilzomib and orally bioavailable oprozomib have anti-resorptive and bone-anabolic activity in addition to anti-myeloma effects

Proteasome inhibitors (PIs), namely bortezomib, have become a cornerstone therapy for multiple myeloma (MM), potently reducing tumor burden and inhibiting pathologic bone destruction. In clinical trials, carfilzomib, a next generation epoxyketone-based irreversible PI, has exhibited potent anti-myeloma efficacy and decreased side effects compared with bortezomib. Carfilzomib and its orally bioavailable analog oprozomib, effectively decreased MM cell viability following continual or transient treatment mimicking in vivo pharmacokinetics. Interactions between myeloma cells and the bone marrow (BM) microenvironment augment the number and activity of bone-resorbing osteoclasts (OCs) while inhibiting bone-forming osteoblasts (OBs), resulting in increased tumor growth and osteolytic lesions. At clinically relevant concentrations, carfilzomib and oprozomib directly inhibited OC formation and bone resorption in vitro, while enhancing osteogenic differentiation and matrix mineralization. Accordingly, carfilzomib and oprozomib increased trabecular bone volume, decreased bone resorption and enhanced bone formation in non-tumor bearing mice. Finally, in mouse models of disseminated MM, the epoxyketone-based PIs decreased murine 5TGM1 and human RPMI-8226 tumor burden and prevented bone loss. These data demonstrate that, in addition to anti-myeloma properties, carfilzomib and oprozomib effectively shift the bone microenvironment from a catabolic to an anabolic state and, similar to bortezomib, may decrease skeletal complications of MM.

Dasatinib as a bone-modifying agent: anabolic and anti-resorptive effects

BACKGROUND

Bone loss, in malignant or non-malignant diseases, is caused by increased osteoclast resorption and/or reduced osteoblast bone formation, and is commonly associated with skeletal complications. Thus, there is a need to identify new agents capable of influencing bone remodeling. We aimed to further pre-clinically evaluate the effects of dasatinib (BMS-354825), a multitargeted tyrosine kinase inhibitor, on osteoblast and osteoclast differentiation and function.

METHODS

For studies on osteoblasts, primary human bone marrow mensenchymal stem cells (hMSCs) together with the hMSC-TERT and the MG-63 cell lines were employed. Osteoclasts were generated from peripheral blood mononuclear cells (PBMC) of healthy volunteers. Skeletally-immature CD1 mice were used in the in vivo model.

RESULTS

Dasatinib inhibited the platelet derived growth factor receptor-β (PDGFR-β), c-Src and c-Kit phosphorylation in hMSC-TERT and MG-63 cell lines, which was associated with decreased cell proliferation and activation of canonical Wnt signaling. Treatment of MSCs from healthy donors, but also from multiple myeloma patients with low doses of dasatinib (2-5 nM), promoted its osteogenic differentiation and matrix mineralization. The bone anabolic effect of dasatinib was also observed in vivo by targeting endogenous osteoprogenitors, as assessed by elevated serum levels of bone formation markers, and increased trabecular microarchitecture and number of osteoblast-like cells. By in vitro exposure of hemopoietic progenitors to a similar range of dasatinib concentrations (1-2 nM), novel biological sequelae relative to inhibition of osteoclast formation and resorptive function were identified, including F-actin ring disruption, reduced levels of c-Fos and of nuclear factor of activated T cells 1 (NFATc1) in the nucleus, together with lowered cathepsin K, αVβ3 integrin and CCR1 expression.

CONCLUSIONS

Low dasatinib concentrations show convergent bone anabolic and reduced bone resorption effects, which suggests its potential use for the treatment of bone diseases such as osteoporosis, osteolytic bone metastasis and myeloma bone disease.

[Long-term analysis of minimally invasive surgery in knee arthroplasty]

BACKGROUND

Knee arthroplasty is the treatment of choice for gonarthrosis. The development of minimally invasive surgery (MIS) requires assessing results based on the classical approaches and this is the purpose of our study.

METHODS

Randomized, prospective study comparing two groups; one underwent MIS (45 patients) and the second one a classical approach (51 patients); both groups were comparable. The following variables were assessed in the immediate postoperative period and at 4 and 8 years: blood loss, pain according to the VAS, flexion and extension and quality of life measured with the SF-36.

RESULTS

In the immediate postoperative period we observed statistically significant differences (p < 0.05) in favor of the MIS approach in pain, hospital stay and blood loss. However, this was not observed at 4 and 8 years concerning pain, quality of life and range of motion. We observed an improvement in the functional scale and quality of life compared with the preoperative status, without any differences when both groups were compared.

CONCLUSIONS

The MIS technique results in a better immediate postoperative period, but no differences were seen in the choice of the approach 4 and 8 years after surgery.

Bone marrow mesenchymal stem cells for improving hematopoietic function: an in vitro and in vivo model. Part 2: Effect on bone marrow microenvironment

The aim of the present study was to determine how mesenchymal stem cells (MSC) could improve bone marrow (BM) stroma function after damage, both in vitro and in vivo. Human MSC from 20 healthy donors were isolated and expanded. Mobilized selected CD34⁺ progenitor cells were obtained from 20 HSCT donors. For in vitro study, long-term bone marrow cultures (LTBMC) were performed using a etoposide damaged stromal model to test MSC effect in stromal confluence, capability of MSC to lodge in stromal layer as well as some molecules (SDF1, osteopontin,) involved in hematopoietic niche maintenance were analyzed. For the in vivo model, 64 NOD/SCID recipients were transplanted with CD34+ cells administered either by intravenous (IV) or intrabone (IB) route, with or without BM derived MSC. MSC lodgement within the BM niche was assessed by FISH analysis and the expression of SDF1 and osteopontin by immunohistochemistry. In vivo study showed that when the stromal damage was severe, TP-MSC could lodge in the etoposide-treated BM stroma, as shown by FISH analysis. Osteopontin and SDF1 were differently expressed in damaged stroma and their expression restored after TP-MSC addition. Human in vivo MSC lodgement was observed within BM niche by FISH, but MSC only were detected and not in the contralateral femurs. Human MSC were located around blood vessels in the subendoestal region of femurs and expressed SDF1 and osteopontin. In summary, our data show that MSC can restore BM stromal function and also engraft when a higher stromal damage was done. Interestingly, MSC were detected locally where they were administered but not in the contralateral femur.

Titanium and tantalum as mesenchymal stem cell scaffolds for spinal fusion: an in vitro comparative study

INTRODUCTION

In the last few years, great interest has been focused on tissue engineering as a potential therapeutic approach for musculoskeletal diseases. The role of metallic implants for spinal fusion has been tested in preclinical and clinical settings. Titanium and tantalum have excellent biocompatibility and mechanical properties and are being used in this situation. On the other hand, the therapeutic role of mesenchymal stem cells (MSC) is extensively explored for their multilineage differentiation into osteoblasts.

OBJECTIVES

In vitro comparison of titanium and tantalum as MSCs scaffolds.

MATERIAL AND METHODS

In the present study, we have compared the in vitro expansion capacity, viability, immunophenotype (both explored by flow cytometry) and multi-differentiation ability of MSC cultured in the presence of either titanium or tantalum fragments. The adherence of MSC to either metal was demonstrated by electron microscopy.

RESULTS

Both metals were able to carry MSC when transferred to new culture flasks. In addition, our study shows that culture of MSC with titanium or tantalum improves cell viability and maintains all their biological properties, with no significant differences regarding the metal employed.

CONCLUSION

This would support the use of these combinations for clinical purposes, especially in the spinal fusion and reconstruction setting.