Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.

Rapa Nui (Easter Island) Rano Raraku crater lake basin: Geochemical characterization and implications for the Ahu-Moai Period.

Rano Raraku, the crater lake constrained by basaltic tuff that served as the primary quarry used to construct the moai statues on Rapa Nui (Easter Island), has experienced fluctuations in lake level over the past centuries. As one of the only freshwater sources on the island, understanding the present and past geochemical characteristics of the lake water is critical to understand if the lake could have been a viable freshwater source for Rapa Nui. At the time of sampling in September 2017, the maximum lake depth was ~1 m. The lake level has substantially declined in the subsequent years, with the lake drying almost completely in January 2018. The lake is currently characterized by highly anoxic conditions, with a predominance of ammonium ions on nitrates, a high concentration of organic carbon in the water-sediment interface and reducing conditions of the lake, as evidenced by Mn/Fe and Cr/V ratios. Our estimates of past salinity inferred from the chloride mass balance indicates that it was unlikely that Rano Raraku provided a viable freshwater source for early Rapa Nui people. The installation of an outlet pipe around 1950 that was active until the late 1970s, as well as grazing of horses on the lake margins appear to have significantly impacted the geochemical conditions of Rano Raraku sediments and lake water in recent decades. Such impacts are distinct from natural environmental changes and highlight the need to consider the sensitivity of the lake geochemistry to human activities.

Does chewing coca leaves influence physiology at high altitude?

Andean Indians have used coca leaves (Erythroxylon coca and related species) for centuries to enhance physical performance. The benefits and disadvantages of using coca leaf have been a subject of many political debates. The aim of this study was to investigate the effects of chewing coca leaves on biochemical and physiological parameters. Cutaneous microdialysis catheters were used to estimate systemic biochemical changes. We subjected 10 healthy adult males (local residents) in Cajamarca (Peru, altitude 2700 m) to a standardised exercise routine on a stationary cycle ergometer. The blood pressure, oxygen saturation (digital), pulse, VO2 max and ECG (Holter monitor) were recorded before the exercise. Cutaneous microdialysis catheters were introduced in the forearm. The subjects were given to chew 8 g of coca leaves with a small amount of lime. They were then placed on the cycle ergometer for 20 min. Blood pressure, oxygen saturation, pulse, ECG and VO2 max were recorded. Pyruvate, glucose, lactate, glycerol and glutamate levels were estimated. Oxygen saturation, blood pressure, and pulse rate did not show any significant changes between the two groups. Glucose levels showed hyperglycaemic response. Glycerol, Lactate and Pyruvate increased. Glutamate remained unchanged. Similar changes were not seen in the controls. These results suggest that coca leaves have blocked the glycolytic pathway of glucose oxidation resulting in accumulation of glucose and pyruvate. The energy requirement for exercise is being met with beta-oxidation of fatty acids. The glycerol released was also getting accumulated since its pathway for oxidation was blocked. These experimental findings suggest that chewing coca leaves is beneficial during exercise and that the effects are felt over a prolonged period of sustained physical activity.

Versatile biologically inspired electronic neuron.

We present a biologically inspired electronic neuron based on a conductance model. The channels are constructed using linearly voltage controlled field effect transistors. A two channel and a three channel circuit is developed. The dynamical behavior of this system is studied, showing for the two channel circuit either class-I or class-II excitability and for the three channel circuit bursting and spike frequency adaptation. Voltage-clamp-type measurements, similar to the ones frequently used in neuroscience, are employed in order to determine the conductance characteristics of the electronic channels. We develop an empirical model based on these measurements that reproduces the different dynamical behaviors of the electronic neuron. We found that post-inhibitory rebound is present in the two channel circuit. Reliability and precision of spike timing is induced in the three channel circuit by injecting noise in the control variable of the slow channel that provides a negative feedback. The circuit is appropriate for the design of large scale electronic neural devices that can be used in mixed electronic-biological systems.

Synthesizing bird song.

In this work we present an electronic syrinx: an analogical integrator of the equations describing a model for sound production by oscine birds. The model depends on time varying parameters with clear biological interpretation: the air sac pressure and the tension of ventral syringeal muscles. We test the hypothesis that these physiological parameters can be reconstructed from the song. In order to do so, we built two transducers. The input for these transducers is an acoustic signal. The first transducer generates an electric signal that we use to reconstruct the bronchial pressure. The second transducer allows us to reconstruct the syringeal tension (in both cases, for the time intervals where phonation takes place). By driving the electronic syrinx with the output of the transducers we generate synthetic song. Important qualitative features of the acoustic input signal are reproduced by the synthetic song. These devices are especially useful to carry out altered feedback experiences, and applications as biomimetic resources are discussed.

Limits on the excitable behavior of a semiconductor laser with optical feedback.

Recently, it was proposed that semiconductor lasers with optical feedback present a complex behavior that can be described as noise driven excitable. In this work we investigate in which region of parameter space this description is adequate. We conclude that the region of the parameter space in which the system displays noise driven excitable behavior is a subset of the region in which presents low frequency fluctuations.

Electronic neuron within a ganglion of a leech (Hirudo medicinalis).

We report the construction of an electronic device that models and replaces a neuron in a midbody ganglion of the leech Hirudo medicinalis. In order to test the behavior of our device, we used a well-characterized synaptic interaction between the mechanosensory, sensitive to pressure, (P) cell and the anteropagoda (because of the action potential shape) (AP) neuron. We alternatively stimulated a P neuron and our device connected to the AP neuron, and studied the response of the latter. The number and timing of the AP spikes were the same when the electronic parameters were properly adjusted. Moreover, after changes in the depolarization of the AP cell, the responses under the stimulation of both the biological neuron and the electronic device vary in a similar manner.

Topologically inequivalent orbits induced by noise.

In this Letter we extend the concept of stochastic resonance. We show that in forced excitable systems noise can be responsible for the appearance of recurrences presenting a robust topological organization inequivalent to the periodic orbits of the deterministic system. As in stochastic resonance, these new structures are most pronounced at an optimal noise intensity.

Linfangioma en territorio de cabeza y cuello. A propósito de siete casos / Lynfhangioma in the head and neck area. A report of seven cases

Los linfangiomas son raras tumoraciones de carácter benigno derivadas de los vasos linfáticos. Se caracterizan por ser quistes y canales linfáticos de pared fina y constituidos por células endoteliales alineadas agrupadas de forma heterogénea y con un tamaño que varía desde unos pocos milímetros hasta más de 20 centímetros. En este artículo serían comentados los distintos aspectos de esta lesión, se valorarán las clasificaciones, aspectos diagnósticos así como las posibilidades terapéuticas. Se analizarán distintos aspectos del tratamiento quirúrgico, así como las posibilidades terapéuticas. Se analizarán distintos aspectos del tratamiento quirúrgico, así como las nuevas terapias con sustancias esclerosantes que están haciendo, dadas las limitaciones del tratamiento quirúrgico en algunos casos, que se replanteen algunas indicaciones terapéuticas (AU)

Tumoración mandibular de origen no infeccioso / Mandibular tumor not infectious origin

La principal causa de tumoraciones mandibulares en la infancia presenta una etiología infecciosa. Existen otras causas de tumoración mandibular si bien menos frecuentes, sí de importancia y que precisan tratamiento quirúrgico, este es el caso del Fibroma Ameloblástico. Presentamos un caso de Fibroma Ameloblástico en un paciente de 6 años, su presentación clínica, tratamiento realizado y diagnóstico diferencial (AU)

Dynamics of periodically forced semiconductor laser with optical feedback.

Recently it was proposed that semiconductor lasers with optical feedback present a regime where they behave as noise driven excitable units. In this work we report on an experimental study in which we periodically force one of these lasers and we compare the results with the solutions of a simple model. The comparison is based on a topological analysis of experimental and theoretical solutions.

Hemangiopericitoma en territorio de cabeza y cuello: a propósito de cuatro casos / Hemangiopericytoma of the head and neck area. A report of four cases

El hemangiopericitoma (Hpc) es un raro tumor que pertenece a la familia de los sarcomas y deriva de los pericitos de Zimmerman que rodean los vasos sanguíneos. Se trata de un tumor vascular (1 por ciento de los tumores vasculares) con un comportamiento paradójico, presentándose en la mayoría de los casos con características de un tumor benigno, aunque su índice de recurrencias y metástasis ascienden hasta un 50 por ciento. Por ello se trata como un tumor potencialmente maligno. En otras ocasiones presenta un comportamiento más agresivo. En este artículo aportamos cuatro nuevos casos a los ya publicados y hacemos un repaso meticuloso de la literatura en todo lo referente a esta neoplasia (AU)

Manejo quirúrgico del angiofibroma nasofaríngeo juvenil / Surgical management of the juvenile nasopharyngeal angiofibroma

Objetivo. Presentamos nuestra experiencia en el tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil (ANJ) en los últimos años, realizando a continuación una recopilación de las distintas posibilidades terapéuticas. Diseño. Han sido intervenidos tres pacientes diagnosticados a través de imagen y confirmados mediante estudio histopatológico. Resultados. Los pacientes tratados se encuentran actualmente asintomáticos, habiéndose extirpado a través del tratamiento quirúrgico en su totalidad excepto en un caso en el que persisten mínimos restos tumorales. Conclusiones. Las posibilidades terapéuticas del ANJ son muy variadas (tratamiento quirúrgico a cielo abierto o mediante endoscopia), radioterapia, quimioterapia, hormonoterapia y cirugía estereotáxica, debiendo individualizar cada caso a la hora de determinar el tratamiento a seguir. El tratamiento quirúrgico a cielo abierto es de elección en los tumores con estadio de Fisher superior a II (AU)

Expression and modulation of p42/p44 MAPKs and cell cycle regulatory proteins in rat pancreas regeneration.

Pancreatic growth occurs after CCK, CCK-induced pancreatitis, and pancreatectomy; the mechanisms involved remain unknown. This study evaluates mitogen-activated protein kinase (MAPK) activation and expression of cell cycle regulatory proteins after pancreatectomy to understand the cellular and molecular mechanisms involved in pancreas regeneration. Rats were killed 1-12 days after pancreatectomy, and p42/p44 MAPK activation, expression of the cyclins D and E, cyclin-dependent kinase (Cdk)-2 activity, retinoblastoma protein (pRb) hyperphosphorylation, and expression of the cyclin kinase inhibitors p15, p21, and p27 were examined. Pancreatic remnants exhibited sustained p42/p44 MAPK activation within 8 h. Cyclins D1 and E showed maximal expression after 2 and 6 days, coinciding with maximal hyperphosphorylation of pRb and Cdk2 activity. The expression of p15 vanished after 12 h, p27 disappeared gradually, and p21 increased early. The p27 complexed with Cdk2 dissociated after 2 days, whereas p21 associated in a reverse fashion. In conclusion, sustained activation of p42/p44 MAPKs and Cdk2 along with overexpression of cyclins D1 and E and reduction of p15 and p27 cyclin inhibitors occurred early after pancreatectomy and are active factors involved in signaling that leads to pancreas regeneration.

Requirement of the MAP kinase cascade for cell cycle progression and differentiation of human intestinal cells.

The intracellular signaling pathways responsible for cell cycle arrest and establishment of differentiated cells along the gut axis remain largely unknown. In the present study, we analyzed the regulation of p42/p44 mitogen-activated protein kinase (MAPK) in the process of proliferation and differentiation of human intestinal cells. In vitro studies were done in Caco-2/15 cells, a human colon cancer cell line that spontaneously differentiates into an enterocyte phenotype. In vivo studies were performed on cryostat sections of human fetal intestinal epithelium by indirect immunofluorescence. We found that inhibition of the p42/p44 MAPK signaling by the PD-98059 compound or by ectopic expression of the MAPK phosphatase-1 strongly attenuated E2F-dependent transcriptional activity in Caco-2/15 cells. p42/p44 MAPK activities dramatically decreased as soon as Caco-2/15 cells reached confluence. However, significant levels of activated p42 MAPK were detected in differentiated Caco-2/15 cells. Addition of PD-98059 during differentiation interfered with sustained activation of p42 MAPK and sucrase-isomaltase expression. Although p42/p44 MAPKs were expressed in both the villus tip and crypt cells, their phosphorylated and active forms were detected in the undifferentiated crypt cells. Our results indicate that elevated p42/p44 MAPK activities stimulate cell proliferation of intestinal cells, whereas low sustained levels of MAPK activities correlated with G1 arrest and increased expression of sucrase-isomaltase.

High prevalence of mollusc shell hypersensitivity pneumonitis in nacre factory workers.

Following the discovery of hypersensitivity pneumonitis caused by the inhalation of mollusc shell dust in two workers from a nacre-button factory, the health status of 26 workers employed in sawing mollusc shells was investigated. The evaluation included the administration of two questionnaires and radiological, functional and immunological assessments of all workers at the outset and 1 year later, when hygienic and therapeutic measures had been taken. Six workers, in whom specific inhalation challenge test was positive, were diagnosed with mollusc shell hypersensitivity pneumonitis, thus yielding a prevalence of 23%. Evidence of diffuse lung disease and systemic symptoms was found in these patients. Nonspecific bronchial hyperreactivity was also found more frequently in patients with mollusc shell hypersensitivity pneumonitis. Specific immunoglobulin G (IgG) level and specific skin testing failed to differentiate patients with mollusc shell hypersensitivity pneumonitis from other exposed workers; whereas, nonspecific skin testing, which was impaired in the patients, did differentiate. Bronchoalveolar lavage and transbronchial biopsy performed in patients with mollusc shell hypersensitivity pneumonitis were consistent with the disease. Removal from an environment containing mollusc shell dust was followed by regression of clinical, radiological and functional changes. The clinical picture of the 20 workers who did not present mollusc shell hypersensitivity pneumonitis remained unchanged, but functional decline was observed despite improvement in the environmental conditions of the factory. This report describes the first series of patients with mollusc shell hypersensitivity pneumonitis studied, and underlines the importance of careful follow-up of workers occupationally-exposed to mollusc shell dust.

[Renal traumatism: diagnostic protocol and therapeutic indications]. / Traumatismos renales: protocolo diagnóstico e indicaciones terapéuticas.

Review of 158 cases of renal traumatism attended ar the Urology Service of "La Fe" Hospital from 1984 to 1995. We analyze the indications of radiological study of the polytraumatized patient, the different classifications of renal traumatism and the changes produced in the diagnosis protocol, after substituting urography and arteriography for ultrasonography and CT in the Urgencies Area. We explain the treatment, complications and evolution of the patients in our series. 153 of the cases are closed traumatism and 5 of them are penetrating. Following the Chatelain's classification, 78.5% of the reviewed cases can be describes as traumatism grades I and II and in all the instances a conservative treatment was followed. Grades III and Iv (18.3%) were mostly treated surgically (82.7%) with 20.8% of complications that were solved conservatively except for one case, which required surgery. Every penetrating traumatism was dealt surgically and we practised nephrectomy in one of them (20%). We finally suggest, as the best moment for the reconstructive surgery, the period between the 3rd and the 10th day after the traumatism, due to the high rate of nephrectomy on the previous days and the technical difficulties which the haematoma fibrosis conveys on the subsequent.