Exposure to 2.45 GHz radiofrequency modulates calcitonin-dependent activity and HSP-90 protein in parafollicular cells of rat thyroid gland.

In this study we analyzed the response of parafollicular cells in rat thyroid gland after exposure to radiofrequency at 2.45 GHz using a subthermal experimental diathermy model. Forty-two Sprague Dawley rats, divided into two groups of 21 rats each, were individually exposed at 0 (control), 3 or 12 W in a Gigahertz Transverse Electro-Magnetic (GTEM) chamber for 30 min. After radiation, we used simple or fluorescence immunohistochemistry to measure calcitonin cells or cellular stress levels, indicated by the presence hyperplasia of parafollicular cells, heat shock protein (HSP) 90. Immunomarking of calcitonin-positive cells was statistically significant higher in the thyroid tissue of rats exposed to 2.45 GHz radiofrequency and cell hyperplasia appeared 90 min after radiation at the SAR levels studied. At the same time, co-localized expression of HSP-90 and calcitonin in parafollicular cells was statistically significant attenuated 90 min after radiation and remained statistically significantly low 24 h after radiation, even though parafollicular cell levels normalized. These facts indicate that subthermal radiofrequency (RF) at 2.45 GHz constitutes a negative external stress stimulus that alters the activity and homeostasis of parafollicular cells in the rat thyroid gland. However, further research is needed to determine if there is toxic action in human C cells.

Rewiring of the apoptotic TGF-ß-SMAD/NFκB pathway through an oncogenic function of p27 in human papillary thyroid cancer.

Papillary thyroid carcinoma (PTC), the most frequent thyroid cancer, is characterized by low proliferation but no apoptosis, presenting frequent lymph-node metastasis. Papillary thyroid carcinoma overexpress transforming growth factor-beta (TGF-ß). In human cells, TGF-ß has two opposing actions: antitumoral through pro-apoptotic and cytostatic activities, and pro-tumoral promoting growth and metastasis. The switch converting TGF-ß from a tumor-suppressor to tumor-promoter has not been identified. In the current study, we have quantified a parallel upregulation of TGF-ß and nuclear p27, a CDK2 inhibitor, in samples from PTC. We established primary cultures from follicular epithelium in human homeostatic conditions (h7H medium). TGF-ß-dependent cytostasis occurred in normal and cancer cells through p15/CDKN2B induction. However, TGF-ß induced apoptosis in normal and benign but not in carcinoma cultures. In normal thyroid cells, TGF-ß/SMAD repressed the p27/CDKN1B gene, activating CDK2-dependent SMAD3 phosphorylation to induce p50 NFκB-dependent BAX upregulation and apoptosis. In thyroid cancer cells, oncogene activation prevented TGF-ß/SMAD-dependent p27 repression, and CDK2/SMAD3 phosphorylation, leading to p65 NFκB upregulation which repressed BAX, induced cyclin D1 and promoted TGF-ß-dependent growth. In PTC samples from patients, upregulation of TGF-ß, p27, p65 and cyclin D1 mRNA were significantly correlated, while the expression of the isoform BAX-ß, exclusively transcribed in apoptotic cells, was negatively correlated. Additionally, combined ERK and p65 NFκB inhibitors reduced p27 expression and potentiated apoptosis in thyroid cancer cells while not affecting survival in normal thyroid cells. Our results therefore suggest that the oncoprotein p27 reorganizes the effects of TGF-ß in thyroid cancer, explaining the slow proliferation but lack of apoptosis and metastatic behavior of PTC.

Kidney Transplantation at a Southern Brazilian University Hospital: A 35-Year Practice Review.

BACKGROUND: The Nephrology Unit at São Lucas Hospital, a University Hospital in Southern Brazil, has recently reached 35 years since its first kidney transplant. Few centers in the area have made a longitudinal analysis of processes, problems, grafts, and patient survival changes along this time. METHODS: A single-center, retrospective study was performed. Data were separated into different eras, based on the nature of immunosuppression used: pre-cyclosporine (1978-1986), cyclosporine (1987-1997), mycophenolate introduction (1998-2002), new immunosuppressant drugs (2003-2007), and the current period (2008-2013). RESULTS: Between April 27, 1978, and April 30, 2013, 1231 transplants were performed. Significant differences were detected among different eras. The number of transplants has been progressively increasing, to include significantly older recipients (and donors), at a longer waiting list time, receiving organs that underwent longer cold ischemia time (P < .001). Yet, fewer acute rejection episodes and lower incidence of myocardial infarction and post-transplant diabetes mellitus (P < .001) were detected. In the present era, patient survival at 1, 3, and 5 years is 98.3%, 94.6%, and 90.5% respectively, for living donors, and 92.4%, 87.2%, and 80.7% for deceased donors, respectively. Living donor graft survival is 92.2%, 88.7%, and 82.4%, respectively, whereas deceased donor survival is 80.4%, 71.1%, and 63.7%, respectively. CONCLUSIONS: This retrospective analysis has significant historical value. It assembles and depicts a long follow-up period of a transplant series at a single Brazilian center. Throughout the eras, organ and patient survival increased, with fewer rejection episodes or complications, yet with overall decreased graft function.

Does Thymoglobulin Induction Increase Susceptibility to Carbapenem-Resistant Acinetobacter baumannii Sepsis-related Death in Expanded Criteria Donors?

BACKGROUND: Solid organ transplant recipients are susceptible to antibiotic-resistant infections and carbapenem-resistant Acinetobacter baumannii (CRAB) has recently been recognized as a serious complication in solid organ recipients. High mortality rates have been described. METHODS: We retrospectively analyzed 807 transplantations and detected 10 patients who died 24 hours after the diagnosis of septicemia, all with CRAB-positive blood cultures. Recipients were followed up for at least 1 year and were stratified into the following groups: Group 1, patients alive; Group 2, patients that died due to other causes except Acinetobacter infection; and Group 3, patients who died within 24 hours of CRAB diagnosis. RESULTS: CRAB-positive patients died a median of 3.17 (range, 1.81-18.7) months after transplantation. In these patients, expanded criteria donors (ECDs) were more frequent (P < .001), as were the use of anti-thymocyte globulin (ATG) induction (P = .02) and delayed graft function (P = .01). For ECD recipients, death rate from any cause, whether induced with ATG or not, was 25% and 20.6%, respectively (odds ratio [OR], 1.28; confidence interval [CI] 95%, 0.56-2.91; P = .68). The death rate from CRAB-related sepsis was 10.3% and 0% whether receiving ATG or not, respectively (OR, 15.49; CI 95%, 0.87-277.16; P = .014). There was a 25.75-fold increase in the death rate in ECD kidney recipients induced with thymoglobulin and with CRAB-related sepsis. CONCLUSION: Transplants from ECDs and induced with thymoglobulin may be at increased risk of CRAB death in 24 hours when compared with patients with standard donors and induced with thymoglobulin.

Acute Graft Pyelonephritis Occurring up to 30 Days After Kidney Transplantation: Epidemiology, Risk Factors, and Survival.

Acute graft pyelonephritis is a very common infection in renal transplantation. The impact of acute graft pyelonephritis (AGPN) on graft and patient outcome has not yet been established. Eight hundred seventy kidney and kidney-pancreas transplants were retrospectively studied, over last 13 years, to verify occurrence of AGPN in the first 30 days post-transplantation. We found that 112 patients (15.8%) presented post-transplantatiom AGPN up to 30 days after a kidney transplantation. The occurrence was higher in older patients (P = .005) and in those with ureteral stents (P = .06). Escherichia coli was the most frequent microorganism in urine cultures (32%). Ureteral stent (relative risk = 1.7; confidence interval [CI], 1.1-2.5; P = .018) was a major risk factor for AGPN as well as older ages (RR = 1.02; CI 1.01-1.04; P = .001), length of hospitalization stay (RR = 1.01; CI, 1.01-1.02; P < .001), and anti-thymocyte globulin (ATG) induction (RR = 1.6; CI, 1.022-2.561; P = .04). Long-term graft and patient survival was significantly lower in patients with pyelonephritis in the first 30 days after transplantation (OR 1.43; 95% CI, 0.95-2.16; P = .024 and OR 1.77; 95% CI, 1.12-2.80; P = .006, respectively). Acute pyelonephritis in the first 30 days after transplantation is therefore associated with a lower long-term graft and patient survival.

EMF radiation at 2450 MHz triggers changes in the morphology and expression of heat shock proteins and glucocorticoid receptors in rat thymus.

AIMS: Electromagnetic fields (EMFs) can act as inducers or mediators of stress response through the production of heat shock proteins (HSPs) that modulate immune response and thymus functions. In this study, we analyzed cellular stress levels in rat thymus after exposure of the rats to a 2.45 GHz radio frequency (RF) using an experimental diathermic model in a Gigahertz Transverse Electromagnetic (GTEM) chamber. MAIN METHODS: In this experiment, we used H&E staining, the ELISA test and immunohistochemistry to examine Hsp70 and Hsp90 expression in the thymus and glucocorticoid receptors (GR) of 64 female Sprague­Dawley rats exposed individually to 2.45 GHz (at 0, 1.5, 3.0 or 12.0 W power). The 1 g averaged peak and mean SAR values in the thymus and whole body of each rat to ensure that sub-thermal levels of radiation were being reached. KEY FINDINGS: The thymus tissue presented several morphological changes, including increased distribution of blood vessels along with the appearance of red blood cells and hemorrhagic reticuloepithelial cells. Levels of Hsp90 decreased in the thymus when animals were exposed to the highest power level (12 W), but only one group did not show recovery after 24 h. Hsp70 presented no significant modifications in any of the groups. The glucocorticoid receptors presented greater immunomarking on the thymic cortex in exposed animals. SIGNIFICANCE: Our results indicate that non-ionizing sub-thermal radiation causes changes in the endothelial permeability and vascularization of the thymus, and is a tissue-modulating agent for Hsp90 and GR.

Influence of chlorine added to drinking water during the preslaughter feed withdrawal on microbiology and morphology of the broiler gastrointestinal tract.

The objective of this experiment was to test the effects of the addition of chlorine to broiler drinking water during a 12-h preslaughter feed withdrawal period on reduction of the quantities of microorganisms, such as Escherichia coli and enterococci, in broiler crops and ceca. Reduction of these microorganisms would likely also reduce contamination of broiler meat by pathogenic bacteria during processing. It was also investigated if the chlorine caused some intestinal damage that could disseminate the microorganisms to the carcass. A total of 40 Cobb male broilers were used. Samples of crop and cecal content were collected for microbiological analysis, and duodenum and jejunum were used for morphological analysis from 10 birds in each treatment. The most probable number (MPN) of E. coli and enterococci in the collected samples of crop and ceca and the measure of the free residual chlorine in water were determined. The scanning electron microscopy from duodenum and jejunum was used to illustrate the mucosa integrity. The chlorine added to water was efficient in reducing the quantities of microorganisms in broiler crops and improved the integrity of the mucosa. Therefore, preslaughter feed withdrawal should be coupled with crop disinfection, because preslaughter feed withdrawal increases the MPN of enterococci and E. coli in broiler crops. So, it presents a higher risk for carcass contamination during slaughterhouse processing and, consequently, a higher risk for public health.

Sodium levels for Japanese quail at initial phases.

The aim of this research was to determine the nutritional requirements of sodium for Japanese quail (Coturnix coturnix Japonica) during the periods of 1 to 21 d and 22 to 40 d of age, as well as to evaluate the residual effect on egg production and densitometry bone traits from 41 to 63 d. Two experiments were developed. Experiment 1: 360 Japanese quail were used, from 1 to 21 d of age. Treatments consisted of 5 sodium levels (0.06, 0.12, 0.18, 0.24, and 0.30%). Experiment 2: 240 Japanese quail were used, from 22 to 40 d. Treatments consisted of 5 sodium levels (0.04, 0.12, 0.20, 0.28, and 0.36%). In both experiments, weight gain, final weight, and feed conversion presented a quadratic trend, whereas water intake presented a linear trend. Treatments did not affect the densitometry of bone traits, although they presented a quadratic influence on tibia ash, calcium, and calcium:phosphorus ratio. Therefore, the nutritional requirement of sodium for Japanese quail from 1 to 21 d and from 22 to 40 d is 0.222% and 0.253%, respectively.

Histological and molecular features of lipomatous and nonlipomatous adipose tissue in familial partial lipodystrophy caused by LMNA mutations.

OBJECTIVES: Type 2 familial partial lipodystrophy (FPLD2) is a rare adipose tissue (AT) disease caused by mutations in LMNA, in which lipomas appear occasionally. In this study, we aimed to histologically characterize FPLD2-associated lipomatosis and study the expression of genes and proteins involved in cell cycle control, mitochondrial function, inflammation and adipogenesis. DESIGN AND PATIENTS: One lipoma and perilipoma fat from each of four subjects with FPLD2 and 10 control subjects were analysed by optical microscopy. The presence of inflammatory cells was evaluated by immunohistochemistry. Real-time RT-PCR and Western blot were used to evaluate gene and protein levels. RESULTS: Adipocytes from lipodystrophic patients were significantly larger than those of controls, in both the lipomas and perilipoma fat. Lipodystrophic AT exhibited CD68(+) macrophages and CD3(+) lymphocytes infiltration. TP53 expression was reduced in all types of lipomas. At protein level, C/EBPß, p53 and pRb were severely disturbed in both lipodystrophic lipomas and perilipoma fat coming from lipoatrophic areas, whereas the expression of CEBPα was normal. Mitochondrial function genes were less expressed in lipoatrophic fat. In both lipomas and perilipoma fat from lipoatrophic areas, the expression of adipogenes was lower than controls. CONCLUSIONS: Even in lipomas, the adipogenic machinery is impaired in lipodystrophic fat coming from lipoatrophic regions in FPLD2, although the histological phenotype is near-normal, exhibiting low-grade inflammatory features. Our results suggest that the p53 pathway and some adipogenic proteins, such as CEBPα, could contribute to the maintenance of this near normal phenotype in the remnant AT present in these patients.

The effects of single and repeated exposure to 2.45 GHz radiofrequency fields on c-Fos protein expression in the paraventricular nucleus of rat hypothalamus.

This study investigated the effects of microwave radiation on the PVN of the hypothalamus, extracted from rat brains. Expression of c-Fos was used to study the pattern of cellular activation in rats exposed once or repeatedly (ten times in 2 weeks) to 2.45 GHz radiation in a GTEM cell. The power intensities used were 3 and 12 W and the Finite Difference Time Domain calculation was used to determine the specific absorption rate (SAR). High SAR triggered an increase of the c-Fos marker 90 min or 24 h after radiation, and low SAR resulted in c-Fos counts higher than in control rats after 24 h. Repeated irradiation at 3 W increased cellular activation of PVN by more than 100% compared to animals subjected to acute irradiation and to repeated non-radiated repeated session control animals. The results suggest that PVN is sensitive to 2.45 GHz microwave radiation at non-thermal SAR levels.

Curva de aprendizaje de la discectomía microendoscópica para el tratamiento de la hernia discal lumbar / Learning curve of microendoscopic discectomy for the treatment of lumbar disc herniation

Objetivo. Evaluar la curva de aprendizaje de la Discectomía Microendoscópica (MED) para el tratamiento de la hernia discal lumbar. Material y métodos. Estudio clínico observacional prospectivo de 120 pacientes intervenidos mediante técnica MED. La curva de aprendizaje se determinó atendiendo a la duración del procedimiento, las complicaciones y la tasa de conversión a cirugía abierta. Además se cuantificó el alivio del dolor, la mejoría del estado funcional y el grado de satisfacción del paciente, con un seguimiento de 5 años en todos los casos. Resultados. La duración de la intervención fue disminuyendo a lo largo de la serie para estabilizarse en torno a 62–69min después de los primeros 48 procedimientos. Se presentó alguna complicación en 14 pacientes (11,7%) la más frecuente fue el desgarro dural (3 casos, todos durante el proceso de aprendizaje de la técnica). En 6 ocasiones (5%) fue preciso reconvertir el procedimiento a técnica abierta (4 de ellos en los primeros 30 casos de la serie). Discusión y conclusiones. El periodo de aprendizaje de la MED abarcó entre 30–48 procedimientos. Superada esta etapa, fue excepcional la conversión a técnica abierta y no se produjeron complicaciones relacionadas con la técnica. La MED es un procedimiento predecible y seguro que permite tratar todo tipo de hernias discales a través de una incisión de 18 mm sin seccionar ni desinsertar la musculatura, y que ofrece unos resultados equiparales a los obtenidos con técnicas convencionales debido a que se basa en sus mismos principios quirúrgicos de descompresión radicular (AU)

Objective. To evaluate the learning curve of the Microendoscopic Discectomy (MED) for the treatment of lumbar disc herniation. Material and methods. Prospective observational clinical study of 120 patients operated by MED technique. The learning curve was assessed using surgery time, complication rate and conversion rate. The relief of pain, improvement of functional status and patient satisfaction were also assessed. The follow-up time after surgery was 5 years in all cases. Results. The duration of surgical operating time decreased over the course of the study to stabilise around 62–69min. There were complications in 14 patients (11.7%), the most frequent of which was incidental durotomy (3 cases, all during the learning curve period). There were six (5%) conversions to open discectomy (4 patients in the first 30 cases). After this stage, conversion to open procedure was exceptional and there were no complications related to technique. The MED is a predictable and safe procedure that can treat all types of herniated discs through an 18 mm incision without detaching the muscles, providing similar results to those obtained with conventional techniques, as it is based on the same surgical principles (AU)

Reduced adipogenic gene expression in fibroblasts from a patient with type 2 congenital generalized lipodystrophy.

AIMS: Beradinelli-Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation. METHODS: Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy. RESULTS: The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts. CONCLUSIONS: The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

Densitometric and biochemical values of broiler tibias at different ages.

The objective of this experiment was to determine the normal values of bone radiographic density (BRD) by using the optical densitometry in radiographic images and the biochemical values represented by serum calcium, ash percentage, and minerals (calcium, phosphorus, and magnesium) from tibia ash of Cobb broilers at 8, 22, and 43 d of age. A total of 14 broilers were used for densitometric analysis, and 15 were used for biochemical dosages. The BRD values increased (P < 0.05) with age and in all tibia regions (proximal epiphysis, diaphysis, and distal epiphysis), concluding that growth was a determinative factor for bone performance, demanding a higher BRD during broiler development. Tibia proximal epiphysis presented higher BRD values in relation to the other bone regions (P < 0.05), as a result of a possible biomechanical adaptation to ligaments and tension of the muscle tendons at this region, allowing the support of the muscle mass increase. The serum calcium values were kept constant, as a result of the appropriate nutritional levels of the diet that supported the animal homeostasis. The bone ash and mineral percentage increased (P < 0.05) at 22 d of age, due to the higher mineral requirement in this age. The correlation between bone densitometry and the invasive techniques showed that the bone densitometry can substitute the determination of mineral percentage in the ash. This experiment presented normal values of the noninvasive and invasive methods more used in aviculture, allowing us to compare, subsequently, pathological and physiological values or results of broilers fed with different diets.

Tratamiento de la estenosis del receso lateral mediante laminectomía microendoscópica: resultados a un año de evolución / Treatment of lateral recess stenosis by means of microendoscopic decompressive laminectomy: results at one year

Objetivo: valorar la eficacia de la descompresión radicular de la estenosis del receso lateral lumbar por técnica microendoscópica.Material y métodoestudio longitudinal prospectivo de 60 pacientes diagnosticados de estenosis de canal lumbar e intervenidos mediante descompresión por vía microendoscópica usando un retractor tubular METRx de 18mm según la técnica METRx (Medtronic Sofamor Danek, Memphis, Estados Unidos). Se evalúan los resultados con la escala visual analógica del dolor (EVA), el índice de discapacidad de Oswestry (ODI), el grado subjetivo de satisfacción percibido por el paciente y la clasificación modificada de Macnab.Resultadosla media±desviación estándar de edad es 54,5±10 años, 34 (56,7%) son varones y 26 (43,3%), mujeres. El área más afectada es L5 (63,33%). La media de tiempo de la intervención quirúrgica fue 85,17±18min. La media de estancia hospitalaria postoperatoria fue 4±1,2 días. El tiempo de seguimiento de los pacientes fue de 12 meses. Obtuvimos un 66,6% de resultados buenos o excelentes; con una satisfacción subjetiva buena en el 68,3% de los pacientes. La disminución media del ODI al año con respecto al preoperatorio es de 34,3±26,2 puntos, la de EVA de extremidades inferiores es de 6,2±2,6 puntos, y en la EVA lumbar, de 1,6±1,8 puntos, todas con significación estadística (p<0,05).Conclusioneslos datos recabados en nuestra experiencia nos indican que la laminectomía descompresiva microendoscópica es una técnica segura y efectiva para el tratamiento de la estenosis del receso lateral lumbar y una alternativa en las técnicas mínimamente invasivas de la columna (AU)

Purpose: To determine the efficacy of microendoscopic radicular decompression of lumbar lateral recess stenosis.Materials and methodsProspective longitudinal study of 60 patients diagnosed with lumbar spinal stenosis and treated by microendoscopic decompression using a METRx 18-mm tubular retractor according to the METRx (Medtronic Sofamor Danek, Memphis, USA) technique. The results were evaluated using a Visual Analog Scale pain score (VAS), the Oswestry Disability Index (ODI), a patient satisfaction questionnaire and the modified Macnab criteria.ResultsMean age was 54.5±10 years; 34 (56.7%) subjects were male and 26 (43.3%) women. The most affected level was L5 (63.33%). Mean OR time was 85.17±18min. Mean postoperative hospital stay was 4±1.2 days. Follow-up was 12 months. We obtained 66.6% good or excellent results and obtained a good subjective satisfaction level in 68.3% of patients. Mean ODI decrease was 34.3±26.2 points, lower-limb VAS was 6.2±2.6 points, and lumbar VAS 1.6±1.8 points; all these results were statistically significant (p<0.05).ConclusionsThe results obtained indicate that, in our experience, microendoscopic decompressive laminectomy is a safe and effective technique for the treatment of the lumbar lateral recess stenosis (AU)

The action of pulse-modulated GSM radiation increases regional changes in brain activity and c-Fos expression in cortical and subcortical areas in a rat model of picrotoxin-induced seizure proneness.

The action of the pulse-modulated GSM radiofrequency of mobile phones has been suggested as a physical phenomenon that might have biological effects on the mammalian central nervous system. In the present study, GSM-exposed picrotoxin-pretreated rats showed differences in clinical and EEG signs, and in c-Fos expression in the brain, with respect to picrotoxin-treated rats exposed to an equivalent dose of unmodulated radiation. Neither radiation treatment caused tissue heating, so thermal effects can be ruled out. The most marked effects of GSM radiation on c-Fos expression in picrotoxin-treated rats were observed in limbic structures, olfactory cortex areas and subcortical areas, the dentate gyrus, and the central lateral nucleus of the thalamic intralaminar nucleus group. Nonpicrotoxin-treated animals exposed to unmodulated radiation showed the highest levels of neuronal c-Fos expression in cortical areas. These results suggest a specific effect of the pulse modulation of GSM radiation on brain activity of a picrotoxin-induced seizure-proneness rat model and indicate that this mobile-phone-type radiation might induce regional changes in previous preexcitability conditions of neuronal activation.

Resultados terapéuticos a corto plazo de la infiltración con toxina botulínica ante el fracaso del tratamiento convencional de 7 pacientes con epicondilitis / Short-term outcome of a-botulinum toxin infiltration in 7 epicondylitis patients in whom coventional treatment failed

Introducción. La epicondilitis es un trastorno que cursa con dolor en la inserción proximal del músculoextensor radial corto del carpo. El tratamiento habitual se basa en reposo y medidas farmacológicas, fisioterapia, infiltraciones con corticoides y uso de ortesis. Cuando fracasa el tratamiento conservador, disponemos de la alternativa quirúrgica. El objetivo es evaluar la respuesta de los pacientes con epicondilitis rebeldes a tratamiento conservador con toxina botulínica tipo A (TB-A). Material y métodos. Realizamos un estudio prospectivo con 7 pacientes diagnosticados de epicondilitis, con un tiempo de evolución mínimo de 4 meses, en los que fracasó el tratamiento conservador. Antes de tomar una decisión quirúrgica, se les aplicó una única infiltración de TB-A, entre 25 y 50 UI de Botox. Se recogen como variables: dosis aplicada, dolor a la palpación y con la maniobra de extensión resistida de la muñeca y efectos secundarios.Resultados. Obtuvimos una mejoría importante del dolor en todos los pacientes tras 1 mes de la aplicación de TB-A. La paresia de la musculatura extensora del carpo apareció en las 2 primeras semanas con una resolución completa entre los 2-8 primeros meses posinfiltración.Conclusión. El tratamiento de la epicondilitis resistente a tratamiento conservador mediante la aplicación de TB-A es un tratamiento eficaz, que mejora en todos los casos la sintomatología clínica

Introduction. Epicondylitis is a disorder that causes pain in the proximal insertion of the extensor carpi radialis brevis muscle. The most common treatment is rest and pharmacological measures, physical therapy, infiltrations with corticoids and orthosis. Surgery can be alternatively used when conservative treatments fail. The objective is assess the response of patients with persistent epicondylitis to botulinum toxin A (TB-A). Materials and methods. A prospective study was carried out with 7 patients diagnosed with epicondylitis (a minimum of 4 months prior to the research), who had failed in their response to conservative treatments. Prior to a surgical decision, each of them was applied a single application of TB-A (25-50 U of Botox).Variables included: dose amount, pain following palpation and pain following resisted wrist extension maneuvers and secondary effects. Results. All patients experienced important improvement. Paresis in forearm muscles appeared in the first two weeks with complete resolution 2-8 months after infiltration. Conclusion. The treatment of epicondylitis resistant to conservative treatments through TB-A application constitutes effective treatment with clinical pictures improvement in all cases

Growth hormone and somatostatin directly inhibit gastric ghrelin secretion. An in vitro organ culture system.

Ghrelin is a 28-amino-acid hormone produced mainly by the stomach which strongly promotes food intake. It is the only known peripheral orexigenic hormone that induces the release of GH. Ghrelin has been proposed as a link between the enteric system and central regulation of energy balance and growth. Although it has recently been the focus of extensive study, the secretion mechanism is not yet well characterized. The aim of this study was to test the direct effect of hormones from the somatotropic axis on ghrelin release directly from the stomach. To this end, an organ culture model of gastric tissue explants from rat donors was used. These stomach explants were incubated in 6 well plates for 1, 2, and 3 h after treatment with either GH, GHRH, SS or IGF-I, all them at 10(-6) M. After incubation, the medium was collected and the amount of ghrelin secreted by the gastric tissue was measured by radioimmunoassay. It was observed that GH and SS significantly decreased gastric ghrelin secretion, while GHRH and IGF-1 had no effect on the present model. These results would confirm the capacity of GH and SS to act directly upon gastric level, inhibiting ghrelin secretion in vitro.

Recommendations from SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA on nutrition in the HIV-infected patient.

OBJECTIVE: to make recommendations on the approach to nutritional problems (malnutrition, cachexia, micronutrient deficiency, obesity, lipodystrophy) affecting HIV-infected patients. METHODS: these recommendations have been agreed upon by a group of expertes in the nutrition and care of HIV-infected patients, on behalf of the different groups involved in drafting them. Therefore, the latest advances in pathophysiology, epidemiology, and clinical care presented in studies published in medical journals or at scientific meetings were evaluated. RESULTS: there is no single method of evaluating nutrition, and diferent techniques--CT, MRI, and DXA--must be combined. The energy requirements of symptomatic patients increase by 20-30%. There is no evidence to support the increase in protein or fat intake. Micronutrient supplementation in only necessary in special circumstances (vitamin A in children and pregnant woman). Aerobic and resistance excercise is beneficial both for cardiovascular health and for improving lean mass and muscular strength. It is important to follow the rules of food safety at every stage in the chain. Therapeutic intervention in anorexia and cachexia must be tailored, by combining nutritional and pharmacological support (appetite stimulants, anabolic steroids, and, in some cases, testosterone). Artificial nutrition (oral supplementation, enteral or parenteral nutrition) is safe and efficacious, and improves nutritional status and response to therapy. In children, nutritional recommendations must be made early, and are a necessary component of therapy. CONCLUSION: appropriate nutritional evaluation and relevant therapeutic action are an essential part of the care of HIV-infected patients.

Recommendations from SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/ GESIDA on nutrition in the HIV-infected patient / Recomendaciones de SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA sobre nutrición en el paciente con infección por VIH

Objective: to make recommendations on the approach to nutritional problems (malnutrition, cachexia, micronutrient deficiency, obesity, lipodystrophy) affecting HIV-infected patients. Methods: these recommendations have been agreed upon by a group of expertes in the nutrition and care of HIV-infected patients, on behalf of the different groups involved in drafting them. Therefore, the latest advances in pathophysiology, epidemiology, and clinical care presented in studies published in medical journals or at scientific meetings were evaluated. Results: there is no single method of evaluating nutrition, and diferent techniques —CT, MRI, and DXA— must be combined. The energy requirements of symptomatic patients increase by 20-30%. There is no evidence to support the increase in protein or fat intake. Micronutrient supplementation in only necessary in special circumstances (vitamin A in children and pregnant woman). Aerobic and resistance excercise is beneficial both for cardiovascular health and for improving lean mass and muscular strength. It is important to follow the rules of food safety at every stage in the chain. Therapeutic intervention in anorexia and cachexia must be tailored, by combining nutritional and pharmacological support (appetite stimulants, anabolic steroids, and, in some cases, testosterone). Artificial nutrition (oral supplementation, enteral or parenteral nutrition) is safe and efficacious, and improves nutritional status and response to therapy. In children, nutritional recommendations must be made early, and are a necessary component of therapy. Conclusion: appropriate nutritional evaluation and relevant therapeutic action are an essential part of the care of HIV-infected patients

Objetivo: realizar recomendaciones sobre el abordaje de los problemas nutricionales (malnutrición, caquexia, déficit de micronutrientes, obesidad, lipodistrofia) presentes en la infección VIH. Métodos: estas recomendaciones se han consensuado por un grupo de expertos en nutrición y en atención al enfermo VIH, en representación de las distintas sociedades firmantes. Para ello se han revisado los últimos avances fisiopatológicos, epidemiológicos y clínicos recogidos en estudios publicados en revistas médicas o presentados en congresos. Resultados: no existe un único método de valoración nutricional, debiendo combinarse cuestionarios y técnicas como TAC, RNM y DEXA. Los requerimientos energéticos en enfermos sintomáticos aumentan en un 20-30%. No existe evidencia que respalde el incremento del aporte proteico o graso. La suplementación de micronutrientes sólo es necesaria en circunstancias especiales (Vitamina A en niños y embarazadas). El ejercicio aeróbico de resistencia es beneficioso tanto para la salud cardiovascular como para mejorar la masa magra y la fuerza muscular. Es importante seguir normas de seguridad en toda la cadena alimentaria. La intervención terapéutica en la anorexia y caquexia debe ser individualizada, combinando soporte nutricional y farmacológico (estimulantes del apetito, agentes anabolizantes y testosterona en algún caso). La nutrición artificial (suplementación oral, nutrición enteral o parenteral) es segura y eficaz, mejorando el estado nutricional y la respuesta al tratamiento. En niños, las recomendaciones nutricionales deben ser muy precoces, formando necesariamente parte del tratamiento. Conclusión: La adecuada valoración nutricional y la pertinente actuación terapéutica son parte esencial de la asistencia del enfermo VIH

Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease.

OBJECTIVE: The aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. PATIENTS AND EXPERIMENTAL DESIGN: A total of 165 Crohn s disease patients were studied, considering previous surgery related to Crohn's disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate. RESULTS: Carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations. CONCLUSIONS: As previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease.