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To compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3) METHODS: We prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a 'standard' (240 mm) nail or a long nail and followed them up for 1 year.We found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075).We recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.

To analyse factors involved in the decision to optimise biologics in juvenile idiopathic arthritis.A "discrete-choice" methodology was used. In a nominal group meeting, factors which may influence physicians' decisions to optimise biological dose were identified, together with decision nodes. 1000Minds® was used to create multiple fictitious clinical scenarios based on the factors identified, and to deploy surveys that were sent to a panel of experts. These experts decided for each item which of two clinical scenarios prompted them to optimise the dose of biologic. A conjoint analysis was carried out, and the partial-value functions and the weights of relative importance calculated.In the nominal group, three decision nodes were identified: (1) time to decide; (2) to maintain/reduce or prolong interval; (3) what drug to reduce. The factors elicited were different for each node and included patient and drug attributes. The presence of macrophage activation syndrome (MAS), systemic involvement, or subclinical inflammation made the decision easier (highest weights). The presence of joints of difficult control and year of debut influenced the decision in some but not all, and in different directions. Immunogenicity, adherence, and concomitant treatments were also aspects taken into account.The decision to optimise the dose of biological therapy in children and youngster can be divided into several nodes, and the factors, both patient and therapy-related, leading to the decision can be detailed. These decisions taken by experts may be transported to practice, study designs, and guidelines.

Resumen Introduccion Aunque la edad en el ictus no condiciona los tratamientos de reperfusion, lleva implicitamente una fragilidad que condiciona el estado funcional y probablemente el pronostico y la evolucion. Objetivos Estudiar la fragilidad en pacientes con ictus isquemico tratados con trombectomia mecanica y de ≥ 80 anos de edad. Metodo Estudio observacional en poblacion ≥ 80 anos tras sufrir un ictus isquemico y tratarse con trombectomia mecanica, entre febrero y octubre de 2018. Se recogieron variables sobre factores de riesgo cardiovascular, tratamiento concomitante, datos correspondientes al episodio del ictus (gravedad neurologica y funcional con las escalas NIHS y Rankin modificada) y fragilidad (entrevista telefonica, enero-febrero 2019). Resultados La muestra fue de 65 personas. El 72% padecian hipertension arterial y el 43%, fibrilacion auricular. El 75% no estaban a tratamiento anticoagulante. El 78% fueron tratados antes de 6 h. El 82% no sufrieron complicaciones neurologicas. Se consiguio una reperfusion arterial completa en el 83%. El 27,69% puntuaron como no fragil (n = 28). Se observo relacion estadistica entre la fragilidad y la edad (p = 0,003). Discusion A nivel neurologico y funcional los ictus presentaban puntuaciones mayores (mas graves) en las escalas NIHS y Rankin modificada respecto a otros estudios de investigacion. Los pacientes mas mayores que sobrevivieron al ictus son en su mayoria no fragiles, por lo que la recuperacion deberia medirse en terminos de funcionalidad y calidad de vida y no tanto en base a la edad cronologica.

Resumen La enfermedad musculoesqueletica no tumoral en ninos representa un alto porcentaje de los estudios de medicina nuclear solicitados por el pediatra. Al tratarse de huesos y articulaciones inmaduros, en constante crecimiento y remodelacion, presentan peculiaridades fisiologicas y anatomicas propias que condicionan la necesidad de un abordaje especifico. Mediante varios escenarios clinicos frecuentes en la consulta medica (cojera, dolor de espalda o fiebre entre otros) hemos querido resumir los posibles hallazgos o artefactos que podemos encontrar en las diferentes exploraciones de medicina nuclear incluyendose gammagrafia osea e imagenes hibridas como la PET/TC. Para obtener imagenes de alta calidad se requiere una cuidadosa atencion a la tecnica y al posicionamiento en los ninos. La gammagrafia osea es un procedimiento de medicina nuclear pediatrica habitual y desempena un papel importante en el diagnostico de las enfermedades musculoesqueleticas, pudiendose complementar con tecnicas como la SPECT para mejorar la localizacion y precision diagnostica. Ademas, la 18F-FDG PET/TC se esta aplicando cada vez con mas frecuencia en la evaluacion de ninos. En este articulo se revisan las indicaciones habituales de, sobre todo, la gammagrafia osea y la 18F-FDG PET/TC en enfermedades musculoesqueleticas no tumorales pediatricas, como interpretarlas adecuadamente, siendo esencial conocer la distribucion fisiologica normal de cada radiofarmaco, asi como las variantes comunes del desarrollo pediatrico que pueden simular enfermedad, implicando posibles errores de interpretacion entre estructuras normales y patologicas.

Resume Introduction L’osteomyelite chronique non bacterienne (OCN) est une atteinte osseuse auto-inflammatoire pour laquelle il n’existe actuellement pas de recommandations standardisees concernant le diagnostic ou le traitement. L’objectif de cette etude est de decrire notre experience de la biotherapie chez des enfants atteints de cette maladie. Methodes Revue retrospective des dossiers de patients atteints d’OCN sous biotherapie suivis dans deux etablissements de soins tertiaires entre janvier 2007 et avril 2020. Chez la plupart des patients, la biotherapie instituee a ete un traitement ciblant le TNF, instauree en raison de la persistance de l’activite de la maladie apres un traitement standard par au moins deux medicaments (anti-inflammatoires non steroidiens et corticoides et/ou pamidronate). Resultats Vingt cinq dossiers de patients ont ete colliges, dont 19 (15 filles) n’ont pas repondu au traitement conventionnel. L’âge moyen au moment du diagnostic etait de 8,8 ± 2,9 ans et le delai moyen avant le diagnostic de 6,9 ± 8,3 mois. Tous les patients presentaient des douleurs osseuses et six sur 19 avaient egalement de la fievre. Les os touches etaient, par ordre de frequence, le femur (9 patients), la clavicule (6), le tibia (6) et les vertebres (5). Neuf enfants presentaient des lesions cutanees. La proteine reactive C (CRP) etait elevee chez 13 patients sur 19 (moyenne 20,2 ± 11,7 mg/l), et la vitesse de sedimentation (VS) etait elevee chez 16 patients sur 19 (moyenne 48 ± 29 mm/h). Tous les patients ont recu des anti-inflammatoires non steroidiens, 15 sur 19 du pamidronate, 10 sur19 des corticoides et les19 des anti-TNF. A la derniere visite de suivi, 10 patients sur 19 recevaient toujours une biotherapie (8 de l’adalimumab et 2 de l’infliximab) et 18 patients sur les19 etaient asymptomatiques. En ce qui concerne les effets indesirables, l’un des patients sous infliximab a developpe une osteomyelite a staphylococcus aureus et le second, une leishmaniose cutanee. Conclusions Cette etude montre que les anti-TNF semblent une alternative efficace et sure pour les patients atteints d’OCN refractaire aux traitements conventionnels.

Non-tumour musculoskeletal pathology in children represents a high percentage of the nuclear medicine studies requested by paediatricians. As these are immature bones and joints, in constant growth and remodelling, they present their own physiological and anatomical peculiarities that require a specific management for the paediatric age group. Using different clinical scenarios frequently observed in medical appointments (limping, back pain or fever, among others), we have summarised the possible findings or artefacts that can be obtained in the different Nuclear Medicine explorations, including bone scintigraphy and hybrid images such as PET/CT. To obtain high quality images requires careful attention to technique and positioning in children. Bone scintigraphy is a common paediatric nuclear medicine procedure and plays an important role in the diagnosis of musculoskeletal pathologies and can be complemented by techniques such as SPECT to improve localisation and diagnostic accuracy. In addition, 18F-FDG PET/CT is increasingly applied in the evaluation of children. This article reviews the usual indications of, mainly, bone scintigraphy and 18F-FDG PET/CT in paediatric non-tumour musculoskeletal diseases, how to interpret them properly, being essential to know the normal physiological distribution of each radiopharmaceutical, as well as the common variants of paediatric growth that can simulate disease, implying possible misinterpretations between normal and pathological structures.

Background Photodynamic therapy (PDT), mainly as a combined therapy, can still be considered a promising technology for targeted cancer treatment. Besides the several and essential benefits of PDT, there are some concerns and limitations, such as complex dosimetry, tumor hypoxia, and other mechanisms of resistance. In this study, we present how the cell culture model and cell culture conditions may affect the response to PDT treatment. It was studied by applying two different 3D cell culture, non-scaffold, and hydrogel-based models under normoxic and hypoxic conditions. In parallel, a detailed mechanism of the action of zinc phthalocyanine M2TG3 was presented. Methods Hydrogel-based and tumor spheroids consisting of LNCaP cells, were used as 3D cell culture models in experiments performed under normoxic and hypoxic (1% of oxygen) conditions. Several analyses were performed to compare the activity of M2TG3 under different conditions, such as cytotoxicity, the level of proapoptotic and stress-related proteins, caspase activity, and antioxidant gene expression status. Additionally, we tested bioluminescence and fluorescence assays as a useful approach for a hydrogel-based 3D cell culture. Results We found that M2TG3 might lead to apoptotic cancer cell death and is strongly dependent on the model and oxygen availability. Moreover, the expression of the genes modulated in the antioxidative system in 2D and 3D cell culture models were presented. The tested bioluminescence assay revealed several advantages, such as repetitive measurements on the same sample and simultaneous analysis of different parameters due to the non-lysing nature of this assay. Conclusions It was shown that M2TG3 can effectively cause cancer cell death via a different mechanism, depending on cell culture conditions such as the model and oxygen availability.

This work is the first report when multiharmonic analysis (MHA) was applied for electron paramagnetic resonance imaging (EPRI) for in vivo applications. Phantom studies were performed for established methodology, and in vivo imaging was conduct as a proof-of-concept. Phantom studies showed at least six times improvement of the signal – to – noise (S/N) ratio. Application MHA for 3D EPR in vivo imaging provides images of spin probe distribution in mouse head. The EPRI, in combination with nitroxide and trityl spin probe, was performed to obtained 3D EPR in vivo images using MHA. For both used spin probes, MHA provided images with better S/N ratio, especially in the case of nitroxide, where projections obtained using conventional CW did not allow for reconstructing reliable data. Trityl radical exhibited high resolution and quality of obtained images after MHA. The MHA methodology allows the selection of a second modulation amplitude even 40 times higher than the natural EPR linewidth of the spin probe without line shape distortion, which highly improves the sensitivity of the acquired signal and allowing for imaging mice regardless of their size in a routine animal experiment.

Background and objective Psychometrics is a simple, intuitive approach used in educational research and in multiple-choice questionnaires. Since 2009, the competitive examination through which access to residency programs in Spain is determined (MIR) has included questions related to radiological images. The objective of this paper is to show the results of the psychometric analysis of these questions with the aim of comparing their degree of difficulty, discriminative capacity, and internal structure with respect to those of the other questions on the examination. Material and methods We analyzed all questions on the examination since 2009, classifying them as clinical cases with and without radiological images, clinical cases with and without non-radiological images, multiple choice questions, and negative questions. We used classical test theory and item response theory to assess the difficulty and degree of discrimination of the questions. Results Of 225 questions, between 11% and 15% of the questions included in the examinations were associated with images. The questions associated with radiological images were more difficult (corrected difficulty index, 0.51) and had worse discriminative capacity. The increased difficulty of radiological questions was associated with worse discriminative capacity, especially if the clinical information provided was inadequate or if the clinical information was contrary to the radiological concept or if there had never been any questions about the concept in previoous MIR examinations. Conclusions To equalize the standards of the MIR examination, it is necessary to maintain an appropriate structure in devising radiology questions, with terms from the clinical context, appropriate use of distracters, and a lower level of difficulty, which could be achieved by using radiological images with typical radiological findings.

Resumen Antecedentes y objetivo La psicometria es una tecnica sencilla e intuitiva que se utiliza en el campo de la docencia y en el de los cuestionarios de respuesta multiple. El examen MIR incluye desde el ano 2009 preguntas asociadas a imagen radiologica. El objetivo de este trabajo es mostrar los resultados del analisis psicometrico de estas preguntas con objeto de comparar el grado de dificultad, la capacidad de discriminacion y la estructura interna respecto al resto de preguntas. Material y metodos Se seleccionaron todas las preguntas del examen desde el ano 2009 y se clasificaron en casos clinicos sin y con imagen radiologica, casos clinicos con imagen no radiologica, preguntas test y preguntas negativas. Se utilizo la teoria clasica de test y la teoria de respuesta al item para valorar la dificultad y el grado de discriminacion de las preguntas. Resultados Sobre 225 preguntas, los examenes incluyen entre un 11% y un 15% de preguntas asociadas a imagenes. Las preguntas asociadas a imagen radiologica son mas dificiles (grado de dificultad corregida [IDc] 0,51), con una menor capacidad de discriminacion. El aumento de la dificultad de la pregunta radiologica se relaciona con una menor discriminacion, sobre todo si la informacion clinica no es adecuada, o es contraria al concepto radiologico, o el concepto nunca ha sido preguntado a lo largo de la historia del MIR. Conclusiones Para poder igualar los estandares del examen MIR, es necesario mantener una adecuada estructura en la confeccion de las preguntas de radiologia, en terminos de entorno clinico, un adecuado uso de distractores y un menor nivel de dificultad, que se puede lograr mediante el uso de imagenes con hallazgos radiologicos tipicos.

Objective The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolisation were compared. Material and method Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. Results Eleven patients (17%) underwent embolisation, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolisation was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolisation. One patient suffered a hemispheric stroke after embolisation. No post-surgical complications were observed. Conclusions Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient.