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Background: Early screw loosening, a relevant complication after posterior thoracolumbar fusion, indicates high mechanical stress during rod connection. Force Control is a surgical technology that goes beyond the usual to identify, control and minimize intended and unintended, usually unnoticed forces to achieve the most stressless fixation. Optimized, extremely lightweight instruments support this principle on part of the pedicle screw system (PSS). The study objective is to evaluate the safety and efficacy of a novel PSS for Force Control fusion surgery., Methods: In this literature-controlled observational study, patients underwent surgery with a PSS that supports Force Control. Safety is demonstrated 1 year postoperatively by non-inferiority in screw loosening rate and efficacy by non-inferiority in ODI improvement. Secondary endpoints: 2-year ODI, spine-related AEs and outcomes. Statistical significance p<0.025 (Bonferroni correction 0.05/2)., Results: 75 patients enrolled, main diagnoses were trauma (73.3%), spinal stenosis (17.3%), degenerative disc disease (6.7%). Screw loosening rate at 1-year was 2.7%, being not inferior (p=0.005) to the control group at 9.2%. Mean ODI improvement of 49.3 showed non-inferiority (p<0.001) versus 35.2 in the control group. Mean 2-year ODI was 19, mean VAS back pain improved from 80.3 to 24.1 (3-month) and 21.6 (1-year). The implant-related revision rate was 4.1%., Conclusions: Force Control, aiming to go beyond the familiar by controlling intended and unintended forces to achieve the most stressless fixation, is a safe and efficient method. Lightweight instruments are designed to allow identifying, controlling and reducing mechanical stress. Patients benefit from Force Control regarding screw loosening and clinical outcome., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The initial assessment of cardiovascular risk in patients undergoing lower limb revascularization surgery is crucial to minimize complications and improve outcomes. This study aims to determine if the iliac calcium score (ICS) serves as a cardiologic risk marker by examining its correlation with the coronary calcium score (CCS) in these patients., Methods: This prospective observational single-center study included 248 patients with critical limb ischemia undergoing revascularization procedures from January 2022 to June 2023. Baseline characteristics such as age, gender, smoking status, comorbidities, and clinical status were recorded. CCS and ICS were calculated using preoperative computed tomography angiography. Multiple linear regression identified significant predictors of ICS, including CCS, iliac intima-media thickness (i-IMT), coronary artery disease, diabetes, chronic kidney disease, hypertension, dyslipidemia, and smoking., Results: The study population had a mean age of 74.4 years, 83.86% male. Significant correlations were found between ICS and CCS (Pearson r = 0.34, P < 0.001) and between ICS and i-IMT (Pearson r = 0.35, P < 0.001). Regression analysis revealed significant predictors for ICS, including CCS (coefficient = 1.808, P < 0.0001), i-IMT (coefficient = 3.11, P < 0.0001), coronary artery disease (coefficient = 11.94, P = 0.042), diabetes (coefficient = 19.59, P = 0.002), chronic kidney disease (coefficient = 11.79, P < 0.0001), and hypertension (coefficient = 22.10, P = 0.001). Dyslipidemia and smoking did not show significant associations with ICS., Conclusions: The ICS shows a statistically significant association with the CCS and i-IMT in patients undergoing lower limb revascularization surgery. This correlation suggests that ICS reflects vascular calcification patterns like those observed in coronary arteries. Further studies are needed to explore this relationship in diverse patient populations and under varying clinical conditions., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Coronary artery calcification (CorCa) identifies high cardiovascular risk in the general population. In this setting, aortic valve calcification (AoCa) showed contradictory results. Our goal has been to assess the prognostic power of CorCa and AoCa in patients with chest pain who underwent an ECG-gated cardiac multidetector CT (cardiac-MDCT)., Methods: A total of 528 patients without previous known coronary artery disease, with chest pain who underwent a cardiac-MDCT multidetector, were retrospectively recruited. The primary endpoint included death, acute coronary syndrome, stroke, and heart failure., Results: A total of 61 patients (11.6%) had an event during a mean follow-up of almost 6 years (5.95 ± 2.98). The most frequent event was acute coronary syndrome (6.4%). Total mortality was 4.5%. Patients with CorCa > 0 had more events than those without CorCa (17.3% versus 4.3%; p < 0.001). Likewise, when only patients without AoCa were considered (n = 118), clinical events were more frequent in those with CorCa (12.7% versus 3.6%; p = 0.004). After excluding patients with coronary artery disease, events were more frequent in those with CorCa (12.6% versus 4.3%; p = 0.004). The higher the Agatston score, the more frequent the events. Patients with AoCa  > 0 had more events than those without (16.5% versus 7.3%; p < 0.001), but in patients without CorCa, no difference in events was seen (6.2% versus 3.6%; p = 0.471). A Cox regression analysis showed age, smoking, prior stroke, and CorCa but not AoCa to be independently related to events., Conclusions: In summary, CorCa, but not AoCa, is related to cardiovascular events in patients with chest pain who undergo a cardiac-MDCT., Clinical Relevance Statement: We show that coronary artery calcification, but not aortic valve calcification, detected in a coronary CT scan is tightly related to cardiovascular events. Although this is a message already shown by other groups in the general population, we do believe that this work is unique because it is restricted to patients with chest pain sent to coronary CT. In other words, our work deals with what we face in our routine everyday practice., Key Points: • The presence and the amount of coronary artery calcification are associated with cardiovascular events in patients with chest pain. • Aortic valve calcification is not associated with cardiovascular events in patients with chest pain., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Introduction and Objectives: Final position of the neo-commissures is uncontrolled during transcatheter aortic valve implantation (TAVI), potentially hindering coronary access and future procedures. We aimed to develop a standard method to achieve commissural alignment with the ACURATE neo valve., Methods: The relationship between native and TAVI neo-commissures was analyzed in 11 severe aortic stenosis patients undergoing TAVI. Based on computed tomography analysis, an in silico model was developed to predict final TAVI commissural posts position. A modified implantation technique, accurate commissural alignment (ACA) and a dedicated delivery system were developed. TAVI implants were tested in 3-dimensional (3D) printed models and in vivo. Commissural misalignment and coronary overlap (CO) were analyzed., Results: The in silico model accurately predicted final position of commissural posts irrespective of the implantation technique performed (correlation coefficient, 0.994; 95%CI, 0.989-0.998; P<.001). TAVI implant with patient-specific rotation was simulated in 3D printed models and in 9 patients. ACA-oriented TAVI implants presented adequate commissural alignment in vivo (mean commissural misalignment of 7.7 ±3.9°). None of the ACA oriented implants showed CO, whereas in silico conventional implants predicted CO in 6 of the 9 cases., Conclusions: Accurate commissural alignment of the ACURATE neo device is feasible by inserting the delivery system with a patient-specific rotation based on computed tomography analysis. This is a simple and reproducible method for commissural alignment that can be potentially used for all kinds of TAVI devices., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Archaeological research in the Dolmen of El Pendón (Reinoso, Burgos, Spain) has brought to light the complex biography of a megalithic monument used throughout the 4th millennium cal. BC. The ossuary of this burial holds the bones of nearly a hundred individuals who suffered from diverse pathologies and injuries. This study presents the discovery of a skull with two bilateral perforations on both mastoid bones. These evidences point to a mastoidectomy, a surgical procedure possibly performed to relieve the pain this prehistoric individual may have suffered as a result of otitis media and mastoiditis. The hypothesis of surgical intervention is also supported by the presence of cut marks at the anterior edge of the trepanation made in the left ear. Furthermore, the results of this paper demonstrate the survival of the individual to both interventions. Given the chronology of this dolmen, this find would be the earliest surgical ear intervention in the history of mankind., (© 2022. The Author(s).)

Background: Degenerative disc disease often causes severe low-back pain, a public health problem with huge economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Autologous mesenchymal stromal cells (MSC) treatments have shown feasibility, safety and strong indications of clinical efficacy. We present here a randomized, controlled trial using allogeneic MSC, which are logistically more convenient than autologous cells., Methods: We randomized 24 patients with chronic back pain diagnosed with lumbar disk degeneration and unresponsive to conservative treatments into 2 groups. The test group received allogeneic bone marrow MSCs by intradiscal injection of 25 × 10 cells per segment under local anesthesia. The control group received a sham infiltration of paravertebral musculature with the anesthetic. Clinical outcomes were followed up for 1 year and included evaluation of pain, disability, and quality of life. Disc quality was followed up by magnetic resonance imaging., Results: Feasibility and safety were confirmed and indications of clinical efficacy were identified. MSC-treated patients displayed a quick and significant improvement in algofunctional indices versus the controls. This improvement seemed restricted to a group of responders that included 40% of the cohort. Degeneration, quantified by Pfirrmann grading, improved in the MSC-treated patients and worsened in the controls., Conclusions: Allogeneic MSC therapy may be a valid alternative for the treatment of degenerative disc disease that is more logistically convenient than the autologous MSC treatment. The intervention is simple, does not require surgery, provides pain relief, and significantly improves disc quality.

Background: The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis., Methods: A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography., Results: As a summary of the results on motion preservation, computed tomography scans showed that 63% of the cervical arthroplasties in Group A presented good mobility at the first check point (December 2010), whereas cervical arthroplasties in Group B and Group C had 74% and 65% severe motion restrictions, respectively (Grade III or Grade IV, according to McAfee classification). The differences between groups were statistically significant when comparing Groups A and B, and Groups A and C (P < 0.05), but there were no differences between Groups B and C (P < 0.05). At the second check point (December 2014), the good mobility was just preserved in the 26% of the disk replacements (all in Group A)., Conclusions: Our results showed that, although cervical disks provide optimal mid-term results, the incidence of HO seems to increase with time. Long term studies, with a larger sample size should be conducted to evaluate the appearance of HO and cervical motion after total disk replacement., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohńs disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease., (Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.)

Objectives: To describe and compare the demographic and health characteristics and drug use patterns in a group of drug dependent individuals who were actively using drugs versus those in different types of treatment. To analyze the interventions used with the different groups., Design: Descriptive study., Setting: Users at the Association for Aid to Drug Dependent Persons (Asociación de Ayuda al Drogodependiente, ACLAD) in the city of Valladolid in northwestern Spain., Patients: 1224 drug dependent persons., Measures: We reviewed the medical records for a 30-month period for users who were seen at a treatment center and who were participating in a damage reduction program. We recorded demographic, drug use and clinical variables and compared changes., Results: We studied 1224 patients in all. One-third had human immunodeficiency virus infection, 63% had markers for previous hepatitis A infection, 48% had markers for hepatitis B, and 68.5% for hepatitis C. The Mantoux test was positive in 39.1%. We found differences in the prevalence of infections between active drug users and users in treatment, between drug dependent persons receiving different types of treatment, and between different periods of study., Conclusions: There were clear differences in demographic and health characteristics and drug use patterns between users. Those who were not in rehabilitation were in worse health, and were studied in less detail that other groups of drug users. During follow-up we noted a slight improvement in their health conditions, along with a tendency toward improved primary care interventions.