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martes, 4 de abril de 2017

Plasma rico en plaquetas y mezcla de ácido hialurónico para el tratamiento de la osteoartritis


              Plasma rico en plaquetas y mezcla de ácido hialurónico para el tratamiento de la osteoartritis: Evaluación reológica y biológica » Dr Víctor Hugo Limón López                                                               Platelet Rich Plasma and Hyaluronic Acid Blend for the Treatment of Osteoarthritis: Rheological and Biological Evaluation
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PLoS One. 2016 Jun 16;11(6):e0157048. doi: 10.1371/journal.pone.0157048. eCollection 2016.
Todos los derechos reservados para:
© 2016 Russo et alThis is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract
INTRODUCTION:
Osteoarthritis (OA) is the most common musculoskeletal disease. Current treatments for OA are mainly symptomatic and inadequate since none results in restoration of fully functional cartilage. Hyaluronic Acid (HA) intra-articular injections are widely accepted for the treatment of pain associated to OA. The goal of HA viscosupplementation is to reduce pain and improve viscoelasticity of synovial fluid. Platelet-rich plasma (PRP) has been also employed to treat OA to possibly induce cartilage regeneration. The combination of HA and PRP could supply many advantages for tissue repair. Indeed, it conjugates HA viscosupplementation with PRP regenerative properties. The aim of this study was to evaluate the rheological and biological properties of different HA compositions in combination with PRP in order to identify (i) the viscoelastic features of the HA-PRP blends, (ii) their biological effect on osteoarthritic chondrocytes and (iii) HA formulations suitable for use in combination with PRP.
MATERIALS AND METHODS:
HA/PRP blends have been obtained mixing human PRP and three different HA at different concentrations: 1) Sinovial, 0.8% (SN); 2) Sinovial Forte 1.6% (SF); 3) Sinovial HL 3.2% (HL); 4) Hyalubrix 1.5% (HX). Combinations of phosphate buffered saline (PBS) and the four HA types were used as control. Rheological measurements were performed on an Anton PaarMCR-302 rheometer. Amplitude sweep, frequency sweep and rotational measurements were performed and viscoelastic properties were evaluated. The rheological data were validated performing the tests in presence of Bovine Serum Albumin (BSA) up to ultra-physiological concentration (7%). Primary osteoarthritic chondrocytes were cultured in vitro with the HA and PRP blends in the culture medium for one week. Cell viability, proliferation and glycosaminoglycan (GAG) content were assessed.
RESULTS:
PRP addition to HA leads to a decrease of viscoelastic shear moduli and increase of the crossover point, due to a pure dilution effect. For viscosupplements with HA concentration below 1% the viscoelasticity is mostly lost. Results were validated also in presence of proteins, which in synovial fluid are more abundant than HA. Chondrocytes proliferated overtime in all different culture conditions. The proliferation rate was higher in chondrocytes cultured in the media containing PRP compared to the cultures with different HA alone. GAG content was significantly higher in chondrocytes cultured in PRP and HL blend.
DISCUSSION:
We investigated the rheological and biological properties of four different HA concentrations when combined with PRP giving insights on viscoelastic and biological properties of a promising approach for future OA therapy. Our data demonstrate that PRP addition is not detrimental to the viscosupplementation effect of HA. Viscosupplements containing low HA concentration are not indicated for combination with PRP, as the viscoelastic properties are lost. Although having the same rheological behavior of SF and HX, HL was superior in stimulating extracellular matrix production in vitro.
Resumen
INTRODUCCIÓN:
La osteoartritis (OA) es la enfermedad musculoesquelética más común. Los tratamientos actuales para la OA son principalmente sintomáticos e inadecuados ya que ninguno resulta en la restauración del cartílago completamente funcional. Las inyecciones intraarticulares de ácido hialurónico (HA) son ampliamente aceptadas para el tratamiento del dolor asociado a OA. El objetivo de la viscosuplementación de HA es reducir el dolor y mejorar la viscoelasticidad del líquido sinovial. El plasma rico en plaquetas (PRP) también se ha empleado para tratar la OA para posiblemente inducir la regeneración del cartílago. La combinación de HA y PRP podría proporcionar muchas ventajas para la reparación de tejidos. De hecho, conjuga la viscosuplementación de HA con las propiedades regenerativas de PRP. El objetivo de este estudio fue evaluar las propiedades reológicas y biológicas de diferentes composiciones de HA en combinación con PRP para identificar (i) las características viscoelásticas de las mezclas HA-PRP, (ii) su efecto biológico sobre los condrocitos osteoartríticos y (iii) ) Formulaciones HA adecuadas para su uso en combinación con PRP.
MATERIALES Y MÉTODOS:
Se han obtenido mezclas de HA / PRP mezclando PRP humano y tres diferentes HA a diferentes concentraciones: 1) Sinovial, 0,8% (SN); 2) Sinovial Forte 1,6% (SF); 3) Sinovial HL 3,2% (HL); 4) Hyalubrix 1,5% (HX). Se utilizaron como control las combinaciones de solución salina tamponada con fosfato (PBS) y los cuatro tipos de HA. Las mediciones reológicas se realizaron en un reómetro Anton PaarMCR-302. Se realizaron análisis de barrido de amplitud, barrido de frecuencia y rotación y se evaluaron las propiedades viscoelásticas. Los datos reológicos fueron validados realizando las pruebas en presencia de Bovine Serum Albumin (BSA) hasta concentración ultrafisiológica (7%). Los condrocitos osteoartríticos primarios se cultivaron in vitro con las mezclas HA y PRP en el medio de cultivo durante una semana. Se evaluó la viabilidad celular, la proliferación y el contenido de glicosaminoglicanos (GAG).
RESULTADOS:
La adición de PRP a HA conduce a una disminución de los módulos de cizallamiento viscoelástico y al aumento del punto de cruce, debido a un efecto de dilución puro.Para viscosupplements con concentración de HA por debajo del 1%, la viscoelasticidad se pierde en su mayoría. Los resultados fueron validados también en presencia de proteínas, que en el líquido sinovial son más abundantes que HA. Los condrocitos proliferaron en horas extras en todas las condiciones de cultivo. La tasa de proliferación fue mayor en los condrocitos cultivados en los medios que contenían PRP en comparación con los cultivos con diferentes HA solo. GAG contenido fue significativamente mayor en los condrocitos cultivados en PRP y HL mezcla.
DISCUSIÓN:
Se investigaron las propiedades reológicas y biológicas de cuatro diferentes concentraciones de HA cuando se combina con PRP dando una visión de las propiedades viscoelásticas y biológicas de un enfoque prometedor para la futura terapia de OA. Nuestros datos demuestran que la adición de PRP no es perjudicial para el efecto de viscosuplementación de HA. Los viscosuplementos que contienen baja concentración de HA no están indicados para la combinación con PRP, ya que se pierden las propiedades viscoelásticas. A pesar de tener el mismo comportamiento reológico de SF y HX, HL fue superior en estimular la producción de matriz extracelular in vitro.
PMID: 27310019 PMCID: PMC4911091 DOI: 10.1371 / journal.pone.0157048
PMID:   27310019   PMCID:  
DOI:  
#PRP#ácido hialuronico#osteoartritis
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Combo de geriatría / Geriatric combo

Abril 2, 2017. No. 2647







El impacto de la evaluación prequirúrgica geriátrica en los resultados postoperatorios en pacientes de edad avanzada sometidos a cirugía programada: una revisión sistemática.
The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review.
Anaesthesia. 2014 Jan;69 Suppl 1:8-16. doi: 10.1111/anae.12494.
Abstract
Comprehensive geriatric assessment is an established clinical approach. It reduces mortality and improves the physical wellbeing of older people in the community or hospitalised for medical reasons. Pre-operative comprehensive geriatric assessment seems a plausible method for reducing adverse postoperative outcomes. The objectives of this systematic review and narrative synthesis are to describe how pre-operative comprehensive geriatric assessment has been used in surgical patients and to examine the impact of comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery. We searched MEDLINE, EMBASE and Web of Science from 1980 to 2013 (week 26). We included five studies: two randomised controlled trials and three before-and-after intervention quasi-experimental studies. Patient populations, interventions and outcome measures varied between studies. Both the randomised trials showed benefit on postoperative outcomes, including medical complications. Two of the before-and-after studies reported a positive impact on postoperative length of stay and other outcomes. The heterogeneity of study methods, populations, interventions and outcomes precluded meta-analysis. Based on this narrative synthesis, pre-operative comprehensive geriatric assessment is likely to have a positive impact on postoperative outcomes in older patients undergoing elective surgery, but further definitive research is required. Clinical services providing pre-operative comprehensive geriatric assessment for older surgical patients should be considered.

Controversias en anestesia para cirugía no cardiaca en el anciano
Controversies in anaesthesia for noncardiac surgery in older adults.
Br J Anaesth. 2015 Dec;115 Suppl 2:ii15-25. doi: 10.1093/bja/aev396.
Abstract
As the population of the world is rapidly ageing, the amount of surgery being performed in older patients is also increasing. Special attention is required for the anaesthetic and perioperative management of these patients. The clinical and non-clinical issues specific to older surgical patients are reviewed, with a special emphasis on areas of debate related to anaesthesia care in this group. These issues include the role of frailty and disability in preoperative assessment, choice of anaesthesia technique for hip fracture, postoperative delirium, and approaches to shared decision-making before surgical procedures.
KEYWORDS: ageing; anaesthesia; frail elderly; geriatric anaesthesia; hip fracture

Sarcopenia y síndrome de fragilidad
Sarcopenia and the syndrome of frailty
Ajay Kumar Gupta1, Siddhartha Mishra
Egypt J Intern Med 28:133-139
Abstract
Sarcopenia is the process of loss of body mass, specifically the musculoskeletal tissue, with age, which ultimately leads to a syndrome of clinical entity poorly defined as frailty. It is probably as old as humanity itself. Functionally, frailty is described as a syndrome characterized by a progressive decrease in the body's reserve and declining resistance to stressors, possibly because of declining capacity of multiple physiologic systems resulting in higher vulnerability morbidity and mortality. Ayurveda also mentions morbidity occurring with advancing age and various options for its management. Elixirs are recommended in Ayurveda, popularly called 'rasayana', for recovery from the symptoms of frailty. Worldwide, because of the wide demographic profile, the process of ageing exerts its effects on geriatric populations at different ages. Europeans were the first to paraphrase the word frailty for the ageing process. With better medical care and nutrition, a substantial subset of populations survives longer than 60 years or longer worldwide. The most relevant aspect of the recognition of syndrome of frailty is that the process is, to some extent, reversible, provided that adequate attention is paid and a timely intervention is performed for the needy subset of population, which is likely to improve the quality of life markedly, besides resulting in an increased life span.

Sarcopenia en falla cardiaca. Mecanismos y estrategias de manejo
Sarcopenia in heart failure: mechanisms and therapeutic strategies.
J Geriatr Cardiol. 2016 Jul;13(7):615-24. doi: 10.11909/j.issn.1671-5411.2016.07.004.
Abstract
Chronic heart failure (CHF) is a highly prevalent condition among the elderly and is associated with considerable morbidity, institutionalization and mortality. In its advanced stages, CHF is often accompanied by the loss of muscle mass and strength. Sarcopenia is a geriatric syndrome that has been actively studied in recent years due to its association with a wide range of adverse health outcomes. The goal of this review is to discuss the relationship between CHF and sarcopenia, with a focus on shared pathophysiological pathways and treatments. Malnutrition, systemic inflammation, endocrine imbalances, and oxidative stress appear to connect sarcopenia and CHF. At the muscular level, alterations of the ubiquitin proteasome system, myostatin signaling, and apoptosis have been described in both sarcopenia and CHF and could play a role in the loss of muscle mass and function. Possible therapeutic strategies to impede the progression of muscle wasting in CHF patients include protein and vitamin D supplementation, structured physical exercise, and the administration of angiotensin-converting enzyme inhibitors and β-blockers. Hormonal supplementation with growth hormone, testosterone, and ghrelin is also discussed as a potential treatment.
KEYWORDS: Ghrelin; Muscle loss; Protein supplementation; Vitamin D
Inflamación y fragilidad en el anciano. Revisión sistemática y meta-análisis
Inflammation and frailty in the elderly: A systematic review and meta-analysis.
Ageing Res Rev. 2016 Nov;31:1-8. doi: 10.1016/j.arr.2016.08.006. Epub 2016 Aug 31.
Abstract
The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n=3232 frail, n=11,483 pre-frail and n=8522 robust, and 563 pre-frail+robust; 3 longitudinal studies n=3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD=1.00, 95%CI: 0.40-1.61) and 8568 pre-frail (SMD=0.33, 95%CI: 0.04-0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n=1057; SMD=1.12, 95%CI: 0.27-2.13) and pre-frailty (n=4467; SMD=0.56, 95%CI: 0.00-1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n=2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR=1.06, 95%CI: 0.78-1.44,) and IL-6 (OR=1.19, 95%CI: 0.87-1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed.
KEYWORDS: Aging; C-Reactive protein; Frailty; Inflammation; Interleukin-6; Pre-frailty

Genes asociados con la enfermedad de Alzheimer. Revisión y estado actual
Genes associated with Alzheimer's disease: an overview and current status.
Clin Interv Aging. 2016 May 17;11:665-81. doi: 10.2147/CIA.S105769. eCollection 2016.
Abstract
Alzheimer's disease (AD) is a progressive, neurodegenerative disease and the most common form of dementia in elderly people. It is an emerging public health problem that poses a huge societal burden. Linkage analysis was the first milestone in unraveling the mutations in APP, PSEN1, and PSEN2 that cause early-onset AD, followed by the discovery of apolipoprotein E-ε4 allele as the only one genetic risk factor for late-onset AD. Genome-wide association studies have revolutionized genetic research and have identified over 20 genetic loci associated with late-onset AD. Recently, next-generation sequencing technologies have enabled the identification of rare disease variants, including unmasking small mutations with intermediate risk of AD in PLD3, TREM2, UNC5C, AKAP9, and ADAM10. This review provides an overview of the genetic basis of AD and the relationship between these risk genes and the neuropathologic features of AD. An understanding of genetic mechanisms underlying AD pathogenesis and the potentially implicated pathways will lead to the development of novel treatment for this devastating disease.
KEYWORDS: Alzheimer's disease; amyloid precursor protein; biological pathways; genome-wide association studies; neuropathology; presenilin 1; presenilin 2

Libro de Geriatría
Book on Geriatrics
Edited by Craig S. Atwood, ISBN 978-953-51-0080-5, 246 pages, Publisher: InTech, Chapters published February 24, 2012 under CC BY 3.0 license
DOI: 10.5772/1893
With the baby boomer generation reaching 65 years of age, attention in the medical field is turning to how best to meet the needs of this rapidly approaching, large population of geriatric individuals. Geriatric healthcare by nature is multi-dimensional, involving medical, educational, social, cultural, religious and economic factors. The chapters in this book illustrate the complex interplay of these factors in the development, management and treatment of geriatric patients, and begin by examining sarcopenia, cognitive decline and dysphagia as important factors involved in frailty syndrome. This is followed by strategies to increase healthspan and lifespan, such as exercise, nutrition and immunization, as well as how physical, psychological and socio-cultural changes impact learning in the elderly. The final chapters of the book examine end of life issues for geriatric patients, including effective advocacy by patients and families for responsive care, attitudes toward autonomy and legal instruments, and the cost effectiveness of new health care technologies and services.

MOJ Gerontology & Geriatrics
Journal of Geriatric Oncology

Journal of the American Geriatrics Society
Revista / Journal

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

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