Revisiones_bibliográficas TyO

miércoles, 1 de marzo de 2017

La regeneración ósea en la era de las células madre: ¿juego seguro para el paciente?

http://www.traumaysiniestros.com.mx/academia/la-regeneracion-osea-en-la-era-de-las-celulas-madre-juego-seguro-para-el-paciente/

Bone regeneration in the stem cell era: safe play for the patient?

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28238087

https://link.springer.com/article/10.1007%2Fs10067-017-3581-1

De:

Musacchio E1,Veronese N2

Clin Rheumatol.

2017 Feb 25. doi: 10.1007/s10067-017-3581-1. [Epub ahead of print]

Abstract

The past decade has seen outstanding scientific progress in the field of stem cell (SC) research and clinical application. SCs are convenient both technically and biologically: they are easy to find and to culture and they can differentiate in virtually all tissues and even in whole organs. Induced pluripotent stem cells (iPSs) are a type of pluripotent SC generated in vitro directly from mature cells through the introduction of key transcription factors. The use of iPSs, however tantalizing, poses serious safety concerns because of their genomic instability. Recently, it has been suggested that the main mechanism of SC action relies on paracrine signals. Therefore, the secretome would be primarily responsible for SC effects. The therapeutical use of secretome is safer and more reliable and offers manufacturing, handling and transportation advantages. The authors discuss current applications of SCs with particular respect to bone regeneration stressing the possible risks that may arise from incautious employments of SCs-particularly when associated with stimulating factors. Safety issues hamper the advancement of SC-based innovative therapies and raise the need for novel standards to adequately address and rule out inconsistency and other concerns, considering the permanent nature of SC treatments. Many biological aspects concerning dose, time and site of administration are still to be elucidated. Solid clinical data and trials with long-term follow-ups are highly recommended as a means to evaluate the risk/benefit ratio of each potential intervention and to provide patients with clear and accurate information.

KEYWORDS:

Cell differentiation; Growth factor; Induced pluripotent stem cell; Risk; Safety; Transformation; Tumourigenesis

Resumen

La última década ha sido testigo de un progreso científico sobresaliente en el campo de la investigación con células madre (CS) y la aplicación clínica. Los SC son convenientes tanto técnica como biológicamente: son fáciles de encontrar y de cultivar y pueden diferenciarse en prácticamente todos los tejidos e incluso en órganos enteros. Las células madre pluripotentes inducidas (iPSs) son un tipo de SC pluripotencial generado in vitro directamente a partir de células maduras mediante la introducción de factores clave de transcripción. El uso de iPSs, aunque tentador, plantea serias preocupaciones de seguridad debido a su inestabilidad genómica. Recientemente, se ha sugerido que el mecanismo principal de la acción SC se basa en las señales parácrinas. Por lo tanto, el secretome sería el principal responsable de los efectos de SC. El uso terapéutico de secretome es más seguro y más confiable y ofrece ventajas de fabricación, manipulación y transporte. Los autores analizan las aplicaciones actuales de SCs con particular respeto a la regeneración ósea enfatizando los posibles riesgos que pueden derivarse de los empleos incumplidos de SCs, particularmente cuando están asociados con factores estimulantes. Las cuestiones de seguridad dificultan el avance de las terapias innovadoras basadas en SC y plantean la necesidad de nuevas normas para abordar y descartar adecuadamente la inconsistencia y otras preocupaciones, teniendo en cuenta la naturaleza permanente de los tratamientos SC. Todavía hay que dilucidar muchos aspectos biológicos relativos a la dosis, el tiempo y el lugar de administración. Los sólidos datos clínicos y los ensayos con seguimiento a largo plazo son altamente recomendados como un medio para evaluar la relación riesgo / beneficio de cada intervención potencial y proporcionar a los pacientes información clara y precisa.
PALABRAS CLAVE:
Diferenciación celular; Factor de crecimiento; Células madre pluripotentes inducidas; Riesgo; La seguridad; Transformación; Tumourigénesis

PMID: 28238087 DOI:

10.1007/s10067-017-3581-1

[PubMed – as supplied by publisher]

#regeneración ósea #células madre #Diferenciación celular #Factor de crecimiento #Células madre pluripotentes inducidas

Técnicas de cobertura de heridas: Injerto de piel dividida

Wound coverage techniques: Split Skin Grafting

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/Z8sZXSWeJgQ

Courtesy:
Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University
Philadelphia
Pennsylvania
USA
www.orthoclips.com

Narrated, annotated lecture 1 of 3 on general principles of wound coverage and skin grafts from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.

Categoría
- Comedia
Licencia
- Licencia de YouTube estándar

Piernas arqueadas en niños

http://www.ortopediapediatricaisunza.com.mx/academia/piernas-arqueadas-en-ninos/

Tibial Bowing in Children

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/SLwosdrnJjA

Courtesy : Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Educational video describing the condition of tibial bowing.

Become a friend on facebook:
http://www.facebook.com/drebraheim

Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC

Categoría
Licencia

Formación

Licencia de YouTube estándar

#piernasarqueadas #niños #Tibial Bowing #children

ML en cesárea / Laryngeal Mask Airway for Cesarean Delivery

Febrero 28, 2017. No. 2614

Mascarilla laríngea en cesárea. Estudio de 5 años retrospectivo de cohortes

Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study.

Geng ZY1, Wang DX1.

Chin Med J (Engl). 2017 20th Feb;130(4):404-408. doi: 10.4103/0366-6999.199833.

Abstract

BACKGROUND: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). METHODS: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. RESULTS: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. CONCLUSIONS: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

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