Efectividad de la movilidad cervicodorsal con característica socializadora y lúdica con relación al riesgo de caídas en adultos mayores con anteposición de cabeza y cuello: un ensayo clínico aleatorizado / Effectiveness of cervicodorsal mobility testing with socialising and playful features of falls risk in older adults with forward head and neck posture: A randomised clinical trial

Objetivo: El propósito del estudio fue comprobar la efectividad de la movilidad cervicodorsal con característica socializadora y lúdica en relación con el riesgo de caídas en adultos mayores con anteposición de cabeza y cuello. Material y métodos: El presente estudio fue un ensayo clínico aleatorizado con un diseño experimental, longitudinal, basado en la evaluación del riesgo de caídas mediante el Timed Up and Go en 3 grupos de 44 participantes posterior a 16 semanas, divididos en: grupo movilidad cervicodorsal, grupo movilidad cervicodorsal con característica socializadora y lúdica y grupo control que no realizó intervención. Los 132 participantes cumplieron los criterios de inclusión y exclusión: adultos mayores>60 años, con anteposición de cabeza y cuello, índice de masa corporal con sobrepeso y obesidad tipo 1 y sin enfermedades neurológicas, reumatológicas, sistémicas, inmunodepresivas, infecciosas u osteomusculares. Resultados: Hubo cambios estadísticamente significativos en la disminución del riesgo de caídas en ambos grupos que recibieron tratamiento (p<0,05). El grupo movilidad cervicodorsal disminuyó en promedio 5,43 segundos, y el grupo movilidad cervicodorsal con característica socializadora y lúdica disminuyó en promedio 5,78 segundos. Conclusión: La movilidad cervicodorsal con característica socializadora y lúdica fue efectiva en relación con la disminución del riesgo de caídas en adultos mayores con anteposición de cabeza y cuello, no observándose diferencias estadísticamente significativas entre los 2 grupos experimentales.

Objective: The purpose of the study was to assess the effectiveness of cervicodorsal mobility testing with a socialising and playful features in relation to falls risk in older adults with forward head and neck posture. Material and methods: The present study was a randomised clinical trial with a longitudinal, experimental design, based on assessment of falls risk using the Timed Up and Go Test in three groups of 44 participants after 16 weeks, divided into: cervicodorsal mobility group, cervicodorsal mobility group with socialising and playful features and a control group that did not take part in the intervention. The 132 participants met the inclusion and exclusion criteria: older adults>60 years of age, with forward head and neck posture, overweight body mass index and type 1 obesity and with no neurological, rheumatological, systemic, immunosuppressive, infectious, or musculoskeletal diseases. Results: There were statistically significant changes in decrease in falls risk in both groups receiving treatment (p<.05). The cervicodorsal mobility group decreased in risk by an average of 5.43seconds and the cervicodorsal mobility group with socialising and playful features decreased by an average of 5.78seconds. Conclusion: Cervicodorsal mobility with socialising and playful features was effective in reducing the risk for falls in older adults with forward head and neck posture and forward neck posture, and no statistically significant differences were observed between the two experimental groups.

Volcanic Vortex Rings: Axial Dynamics, Acoustic Features, and Their Link to Vent Diameter and Supersonic Jet Flow.

By injecting a mixture of gas and pyroclasts into the atmosphere, explosive volcanic eruptions frequently generate vortex rings, which are toroidal vortices formed by the jet's initial momentum. Here, we report high-speed imaging and acoustic measurements of vortex rings sourcing from gas-rich eruptive jets at Stromboli volcano (Italy). Volcanic vortex rings (VVRs) form at the vent together with an initial compression acoustic wave, VVRs maximum rise velocity being directly proportional to the amplitude and inversely proportional to the duration of the compression wave. The axial rise and acoustic signature of VVRs match well those predicted by recent fluid-dynamic experiments. This good match allows using the high-frequency (80-1,000 Hz) component of the jet sound and the time-dependent rise of VVRs to retrieve two key eruption parameters: the Mach number of the eruptive jets (<1.5) and vent diameter (∼0.7 m), respectively, the latter being confirmed independently by direct Uncrewed Aerial Vehicle observations.

Anticoagulación en enfermedad tromboembólica venosa / Anticoagulant therapy in venous thromboembolic disease

INTRODUCCIÓN: La enfermedad tromboembólica venosa está comprendida por la trombosis venosa profunda y el tromboembolismo pulmonar, las cuales son enfermedades comunes con alta morbilidad y mortalidad, incluso antes del diagnóstico. El tratamiento está basado principalmente en la terapia anticoagulante, con diferentes opciones dependiendo del ámbito clínico y la estabilidad del paciente (terapia oral vs parenteral). Objetivo: Revisar las diferentes opciones y escenarios clínicos para la indicación de terapia anticoagulante, basados en la evidencia médica actual. Metodología: Se realizó una búsqueda sistemática en las bases de datos PubMed, Scopus, Google Académico y Scielo sobre estudios que evaluaran la indicación de la terapia anticoagulante en pacientes con diagnóstico de enfermedad tromboembólica venosa, principalmente, estudios aleatorizados controlados y metaanálisis. Discusión y Resultados: Fueron encontrados estudios aleatorizados controlados donde se evidencian menores tasas de sangrado y recurrencia de la enfermedad tromboembólica venosa a favor de los anticoagulantes directos, excluyendo algunas situaciones especiales como cáncer y enfermedad renal crónica avanzada. Conclusión: La terapia anticoagulante es el pilar del tratamiento en la enfermedad tromboembólica, disminuyendo la morbilidad y mortalidad de esta entidad, aunque aumenta el riesgo de sangrado. Anteriormente, los anticoagulantes antagonistas de la vitamina K eran la única opción terapéutica, pero con altas tasas de sangrado, afortunadamente desde hace algunos años contamos con los anticoagulantes directos con mejores perfiles de seguridad y menor tasa de sangrado.

ABSTRACTS: Venous thromboembolic disease includes deep venous thrombosis and pulmonary embolism, which are common diseases with high morbidity and mortality. The treatment is based mainly on anticoagulant therapy, with different options depending on clinic context and patient stability (oral vs parenteral therapy). Objective: To review evidence based medical information regarding the use of anticoagulant therapy in venous thromboembolism. Methods: We performed a systematic review of PubMed, Scopus, Google scholar and Scielo databases, of randomized controlled studies and meta-analysis evaluating anticoagulant therapy in patients with thromboembolic venous disease. Results: Except for tromboembolic disease in patients with cancer or chronic kidney disease anticoagulation with direct (new) oral agents led to less bleeding episodes and lower relapse rate. Conclusion: anticoagulant therapy is the basis of treatment for thromboembolic disease, decreasing morbidity and mortality. New oral anticoagulants' are associated to better clinical results, notwithstanding a slight increase in bleeding episodes.

Necrotizing fasciitis following measles vaccine administration: a case report.

BACKGROUND: The occurrence of adverse events following immunization (AEFI) in national immunization programmes is very rare; however, if they occur causality assessment is conducted to identify the associated cause. In the report, we describe a case of severe necrotizing fasciitis in the left arm of a 9-month old boy following administration of the measles vaccine. CASE PRESENTATION: A 9-month old boy presented with swelling on the left upper arm and adjoining the chest area, low-grade continuous fever, frequent passage of loose watery stool and persistent cries 24 h after measles vaccine was administered on the left upper arm. On examination, he was mildly pale, febrile, anicteric. Extensive erythema of the left upper arm occurred thereafter with extensive scalded skin lesions involving the deltoid area, the upper chest wall and arm. This was followed by desquamation of the affected areas and severe necrosis. A diagnosis of severe necrotizing fasciitis was made. A causality assessment was conducted by the state AEFI committee using the detailed AEFI investigation forms to identify the cause of the incidence. CONCLUSION: Here we present a rare case of necrotizing fasciitis which could have been caused by incorrect use of reconstituted measles vaccine. Hence we recommend training of routine immunization service providers on proper vaccine management as well as intensified supervision of immunization sessions.

Experimental simulations of volcanic ash resuspension by wind under the effects of atmospheric humidity.

Ash deposited during volcanic eruptions can be resuspended by wind and become hazardous for health and infrastructure hours to decades after an eruption. Accurate resuspension forecasting requires accurate modelling of the threshold friction velocity of the volcanic particles (Uth*), which is the key parameter controlling volcanic ash detachment by wind. Using an environmental wind tunnel facility this study provides much needed experimental data on volcanic particle resuspension, with the first systematic parameterization of Uth* for ash from the regions Campi Flegrei in Italy and also Eyjafjallajökull in Iceland. In this study atmospheric relative humidity (and related ash moisture content) was systematically varied, from <10% to >90%, which in the case of the Eyjafjallajökull fine ash (<63 µm) produced a twofold increase in Uth*. Using the Campi Flegrei fine ash (<63 µm) an increase in Uth* of only around a factor of 1.5 was observed. Reasonable agreement with force balance resuspension models was seen, which implied an increase in interparticle adhesion force of up to a factor of six due to high humidity. Our results imply that, contrary to dry conditions, one single modelling scheme may not satisfy the resuspension of volcanic ash from different eruptions under wet conditions.

Patient-derived solitary fibrous tumour xenografts predict high sensitivity to doxorubicin/dacarbazine combination confirmed in the clinic and highlight the potential effectiveness of trabectedin or eribulin against this tumour.

BACKGROUND: Preclinical models that mimic pathological and molecular features of solitary fibrous tumour (SFT) represent an important tool to select effective regimes and novel compounds to be tested in the clinic. This study was aimed at developing two preclinical models of SFT, assessing their predictive value in the clinic and selecting potential novel effective treatments. MATERIAL AND METHODS: Two dedifferentiated-SFT (D-SFT) models obtained from patients' biopsies were grown in immunodeficient mice. The antitumour activity on these models of doxorubicin, dacarbazine (DTIC), ifosfamide (monotherapy or combination), trabectedin and eribulin was tested. Twelve SFT patients were treated with doxorubicin and DTIC. Response by RECIST, progression-free survival and overall survival were retrospectively evaluated, distinguishing malignant-SFT (M-SFT) and D-SFT. RESULTS: Two D-SFT patient-derived xenografts (PDXs) that represent the first available preclinical in vivo models of SFT were developed and characterised. Doxorubicin/DTIC, DTIC/ifosfamide, doxorubicin/ifosfamide combinations consistently induced better antitumour activity than the single-agents. Particularly, doxorubicin/DTIC combination caused a max tumour volume inhibition >80% in both models. Doxorubicin/DTIC combo showed activity also in the case-series. Best RECIST responses were: 6 responses (M-SFT = 2 of 7, D-SFT = 4 of 5), 1 stable disease, 5 progressions, with a 6-month median progression-free survival (M-SFT = 6, D-SFT = 10 months). The PDXs were very sensitive to trabectedin and eribulin. CONCLUSION: Doxorubicin plus DTIC combination was effective in our two D-SFT mice models and appeared to be active also in the clinic, especially in high-grade D-SFT patients. Among additional drugs tested in the PDXs, trabectedin and eribulin were highly effective, providing a rational to test these drugs in D-SFT patients.

Inducible ablation of dopamine D2 receptors in adult mice impairs locomotion, motor skill learning and leads to severe parkinsonism.

Motor execution and planning are tightly regulated by dopamine D1 and D2 receptors present in basal ganglia circuits. Although stimulation of D1 receptors is known to enhance motor function, the global effect of D2 receptor (D2R) stimulation or blockade remains highly controversial, with studies showing increasing, decreasing or no changes in motor activity. Moreover, pharmacological and genetic attempts to block or eliminate D2R have led to controversial results that questioned the importance of D2R in motor function. In this study, we generated an inducible Drd2 null-allele mouse strain that circumvented developmental compensations found in constitutive Drd2-/- mice and allowed us to directly evaluate the participation of D2R in spontaneous locomotor activity and motor learning. We have found that loss of D2R during adulthood causes severe motor impairments, including hypolocomotion, deficits in motor coordination, impaired learning of new motor routines and spontaneous catatonia. Moreover, severe motor impairment, resting tremor and abnormal gait and posture, phenotypes reminiscent of Parkinson's disease, were evident when the mutation was induced in aged mice. Altogether, the conditional Drd2 knockout model studied here revealed the overall fundamental contribution of D2R in motor functions and explains some of the side effects elicited by D2R blockers when used in neurological and psychiatric conditions, including schizophrenia, bipolar disorder, Tourette's syndrome, dementia, alcohol-induced delusions and obsessive-compulsive disorder.

Red wine intake but not other alcoholic beverages increases total antioxidant capacity and improves pro-inflammatory profile after an oral fat diet in healthy volunteers / El consumo de vino tinto pero no otras bebidas alcohólicas aumenta la capacidad antioxidante y mejora el perfil pro-inflamatorio después de una dieta rica en grasas oral en voluntarios sanos

Introduction. Different alcoholic beverages exert different effects on inflammation and oxidative stress but these results are controversial and scanty in some aspects. We analyze the effect of different alcoholic beverages after a fat-enriched diet on lipid profile, inflammatory factors and oxidative stress in healthy people in a controlled environment. Methods. We have performed a cross-over design in five different weeks. Sixteen healthy volunteers have received the same oral fat-enriched diet (1486kcal/m2) and a daily total amount of 16g/m2 of alcohol, of different beverages (red wine, vodka, brandy or rum) and equivalent caloric intakes as sugar with water in the control group. We have measured the levels of serum lipids, high sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNFα), interleukin 6 (IL-6), soluble phospholipase A2 (sPLA2), lipid peroxidation (LPO) and total antioxidant capacity (TAC). Results. Red wine intake was associated with decreased of mean concentrations of hsCRP, TNFα and IL-6 induced by fat-enriched diet (p<0.05); nevertheless, sPLA2 concentrations were not significantly modified. After a fat-enriched diet added with red wine, TAC increased as compared to the same diet supplemented with rum, brandy, vodka or the control (water with sugar) (p<0.05). Conclusions. Moderate red wine intake, but not other alcoholic beverages, decreased pro-inflammatory factors and increased total antioxidant capacity despite a fat-enriched diet intake in healthy young volunteers (AU)

Introducción. El efecto de las bebidas alcohólicas sobre la inflamación y el estrés oxidativo es variable y solo parcialmente conocido. Objetivo: analizar el efecto de diferentes bebidas alcohólicas sobre el perfil lipídico, factores de inflamación y estrés oxidativo en personas sanas con ingesta de una dieta enriquecida en grasas. Métodos. Se diseñó un estudio cruzado durante cinco semanas. Dieciséis voluntarios sanos recibieron la misma dieta enriquecida con grasa oral (1.486kcal/m2) más 16g/m2 de alcohol diarios, consumido como vino tinto, vodka, brandy o ron, o un equivalente calórico en el grupo control (azúcar y agua). Se midieron lípidos en suero, proteína C reactiva de alta sensibilidad (PCR-as), factor de necrosis tumoral (TNF) α, interleucina 6 (IL-6), fosfolipasa A2 soluble (sPLA2), la peroxidación lipídica (LPO) y la capacidad antioxidante total (TAC). Resultados. La ingesta de vino tinto se asoció con una disminución significativa de las concentraciones de PCR-as, TNFα e IL-6, inducida por una dieta rica en grasas (p <0,05). Las concentraciones de sPLA2 no se modificaron. El consumo de vino tinto, aún con una dieta rica en grasas, aumentó la capacidad antioxidante total comparada con el ron, brandy, vodka o el control (agua con azúcar) (p <0,05). Conclusiones. La ingesta moderada de vino tinto, pero no de otras bebidas alcohólicas, disminuyó las concentraciones de factores proinflamatorios y aumentó la capacidad antioxidante total, a pesar de la dieta enriquecida en grasa en voluntarios jóvenes sanos (AU)

Red wine intake but not other alcoholic beverages increases total antioxidant capacity and improves pro-inflammatory profile after an oral fat diet in healthy volunteers.

INTRODUCTION: Different alcoholic beverages exert different effects on inflammation and oxidative stress but these results are controversial and scanty in some aspects. We analyze the effect of different alcoholic beverages after a fat-enriched diet on lipid profile, inflammatory factors and oxidative stress in healthy people in a controlled environment. METHODS: We have performed a cross-over design in five different weeks. Sixteen healthy volunteers have received the same oral fat-enriched diet (1486kcal/m(2)) and a daily total amount of 16g/m(2) of alcohol, of different beverages (red wine, vodka, brandy or rum) and equivalent caloric intakes as sugar with water in the control group. We have measured the levels of serum lipids, high sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNFα), interleukin 6 (IL-6), soluble phospholipase A2 (sPLA2), lipid peroxidation (LPO) and total antioxidant capacity (TAC). RESULTS: Red wine intake was associated with decreased of mean concentrations of hsCRP, TNFα and IL-6 induced by fat-enriched diet (p<0.05); nevertheless, sPLA2 concentrations were not significantly modified. After a fat-enriched diet added with red wine, TAC increased as compared to the same diet supplemented with rum, brandy, vodka or the control (water with sugar) (p<0.05). CONCLUSIONS: Moderate red wine intake, but not other alcoholic beverages, decreased pro-inflammatory factors and increased total antioxidant capacity despite a fat-enriched diet intake in healthy young volunteers.

A biodistribution study of PEGylated PCL-based nanoparticles in C57BL/6 mice bearing B16/F10 melanoma.

One of the major drawbacks that limits the clinical application of nanoparticles is the lack of preliminary investigations related to their biocompatibility, biodegradability and biodistribution. In this work, biodegradable PEGylated polymer nanoparticles (NPs) have been synthesized by using macromonomers based on poly(ε-caprolaconte) oligomers. More in detail, NPs have been produced by adopting a surfactant-free semibatch emulsion polymerization process using PEG chains as a stabilizing agent. The NPs were also labeled with rhodamine B covalently bound to the NPs to quantitatively study their biodistribution in vivo. NPs were investigated in both in vitro and in vivo preclinical systems to study their biodistribution in mice bearing B16/F10 melanoma, as well as their biocompatibility and biodegradability. The NP concentration was evaluated in different tissues at several times after intravenous injection. The disappearance of the NPs from the plasma was biphasic, with distribution and elimination half-lives of 30 min and 15 h, respectively. NPs were retained in tumors and in filter organs for a long time, were still detectable after 7 d and maintained a steady concentration in the tumor for 120 h. 48 h after injection, 70 ± 15% of the inoculated NPs were excreted in the feces. The favorable tumor uptake, fast excretion and absence of cytotoxicity foster the further development of produced NPs as drug delivery carriers.

Mode of action of trabectedin in myxoid liposarcomas.

To elucidate the mechanisms behind the high sensitivity of myxoid/round cell liposarcoma (MRCL) to trabectedin and the suggested selectivity for specific subtypes, we have developed and characterized three MRCL xenografts, namely ML017, ML015 and ML004 differing for the break point of the fusion gene FUS-CHOP, respectively of type I, II and III. FUS-CHOP binding to the promoters of some target genes such as Pentraxin 3 or Fibronectin 1, assessed by chromatin immunoprecipitation, was strongly reduced in the tumor 24 h after the first or the third weekly dose of trabectedin, indicating that the drug at therapeutic doses causes a detachment of the FUS-CHOP chimera from its target promoters as previously shown in vitro. Moreover, the higher sensitivity of MRCL types I and II appears to be related to a more prolonged block of the transactivating activity of the fusion protein. Doxorubicin did not affect the binding of FUS-CHOP to target promoters. Histologically, the response to trabectedin in ML017 and ML015 was associated with a marked depletion of non-lipogenic tumoral cells and vascular component, as well as lipidic maturation as confirmed by PPARγ2 expression in western Blot. By contrast, in ML004 no major changes either in the cellularity or in the amount of mature were found, and consistently PPARγ2 was null. In conclusion, the data support the view that the selective mechanism of action of trabectedin in MRCL is specific and related to its ability to cause a functional inactivation of the oncogenic chimera with consequent derepression of the adypocytic differentiation.

The blight of pollution keratoconjunctivitis among children in oil-producing industrial areas of Delta State, Nigeria.

The rapid urbanization and industrialization of Warri and environs between 1968 and 1990 have some adverse consequences due to accumulation of diverse categories of pollutants from drilling, production, and refining of crude oil and production of petrochemicals, especially black carbon. Persistent itching, foreign body sensation, and specified areas of conjunctival/limbal discoloration were used as markers for pollution keratoconjunctivitis (PKC). Children attending eye clinics in Delta State government hospitals located at Warri, Ekpan, and Aladja were sampled. Warri and Ekpan, both oil-producing areas, were used as the experimental group. Aladja, also within the same location but a nonoil-producing area (steel industries), was used as the control. The levels of black carbon and tetraethyl lead (TEL) were measured in the tear film of 100 children selected by a simple random technique from each location. Biochemical assays showed that the tear samples contained some levels of TEL among the sample population, and the TEL content was 0.01 microg/mL for all the tear samples. Stereomicroscopy gave the following estimated values of black carbon content washed off the external adnexia of the sample population: Ekpan 2%/mL, Warri 1.5%/mL, and Aladja 0.6%/mL. The results also show that occurrence of the three major clinical signs and symptoms of PKC (persistent itching, foreign body sensation, specified limbal/conjunctival discoloration, respectively) were as follow: Ekpan, 79, 68, and 65%; Warri, 55, 53, and 50%; Aladja, 26, 22, and 16%. This indicates that higher particulate concentrations of black carbon correlated with increased prevalence of the markers for manifestation of PKC. This implies that the markers for PKC in this experiment are more pronounced in oil-producing areas.

The under utilization of honey in a deprived environment.

The study investigated the utilization of honey in the treatment and prevention of illness amongst 400 respondents in Oranfe Community, Ile-Ife, Osun State Nigeria. Data were collected by employing a structured and pretested open ended questionnaire. The data indicated that 21%, 17% and less than 5% of the respondents had used honey for wounds, respiratory tract infections and gastroenteritis respectively. Neither educational nor professional status had any significant influence on the usage of honey in the treatment and prevention of common illness (p > 0.05). The vast majority (55%) preferred refined sugar to honey. The study has some policy implications. The first is the need for an intensive nutrition education programme that will disseminate the health benefits of honey as a source of energy, essential nutrients and its antioxidant properties. The second is the need to promote its usage in clinical trials because of its antibacterial properties.

Hiperplasia suprarrenal congénita: diagnóstico, tratamiento y evolución a largo plazo / Congenital adrenal hyperplasia: diagnosis, treatment and long-term outcome

La hiperplasia suprarrenal congénita incluye los trastornos hereditarios de la síntesis suprarrenal del cortisol. Se conoce 5 formas clínicas, el déficit de 21 hidroxilasa es la forma más frecuente. El déficit de 21 hidroxilasa se puede categorizar clínicamente en formas clásicas (pérdida salina y virilizante simple) y formas no clásicas (sintomáticas y asintomáticas/crípticas). El presente trabajo revisa los aspectos diagnósticos y terapéuticos de la hiperplasia suprarrenal congénita, con especial referencia al déficit de 21 hidroxilasa y su evolución a largo plazo. Durante los últimos 30 años se han producido avances importantes, tanto diagnósticos como terapéuticos, que han permitido disminuir notablemente la morbimortalidad y posibilitar que los pacientes alcancen la edad adulta. El tratamiento persigue disminuir la secreción de corticotropina (ACTH) y el hiperandrogenismo suprarrenal subyacente, y reemplazar lo más fisiológicamente posible el déficit de glucocorticoides y mineralocorticoides. El tratamiento clínico con frecuencia se ve complicado por fases de hiperandrogenismo inadecuadamente controlado y/o hipercortisolismo iatrogénico. En la evolución a largo plazo, estos pacientes pueden presentar una serie de complicaciones entre las que se incluyen baja talla, obesidad, disminución de la densidad mineral ósea, disfunción gonadal, infertilidad y disfunción psicosexual en las mujeres. En la actualidad existen nuevas pautas terapéuticas en fase de investigación entre las que se incluyen el uso de antiandrógenos, inhibidores de la síntesis de estrógenos y la adrenalectomía (AU)

Childhood-onset congenital adrenal hyperplasia: long-term outcome and optimization of therapy.

Congenital adrenal hyperplasia is a general term applied to several disorders caused by inherited recessive defects of cortisol synthesis. The most common form is 21-hydroxylase deficiency, accounting for 95% of cases. The classical forms have an incidence of one in 15,000 and the non-classical forms about one in 1,000. The classical or severe phenotype presents in the newborn period or early infancy with virilization and adrenal insufficiency, with or without salt-losing; the non-classical or mild phenotype presents in late childhood or early adulthood with signs of hyperandrogenism. This wide range of clinical expression is explained by genetic variation. Although there is a certain amount of genotype-phenotype correlation, discrepancies have been described. During the last 30 years there has been a substantial improvement in diagnosis and treatment of this disease, and patients with CAH now reach adulthood. Treatment of this condition is intended to reduce excessive corticotropin secretion and replace glucocorticoids and mineralocorticoids as physiologically as possible. Clinical management is often complicated by periods of inadequately treated hyperandrogenism, iatrogenic hypercortisolism, or both. Long-term consequences in adult life may include short stature, obesity, diminished bone mass, gonadal dysfunction with low fertility rates and psychosexual dysfunction in females. New treatment approaches are under investigation, such as the use of anti-androgens, inhibitors of estrogen production and adrenalectomy for severely resistant cases.

Estado en la edad adulta y propuesta de optimización terapéutica de la hiperplasia suprarrenal congénita / No disponible

No disponible

Impairment of renal vasodilation with l-arginine is related to more severe disease in untreated hypertensive patients.

Data remain insufficient to place the decreased response to L-arginine in hypertensive patients within a consistent pathophysiological sequence. The aim of the present study in patients with essential hypertension was to assess the relationships between the response to L-arginine and a set of relevant clinical and laboratory parameters. In this prospective, interventional study, we administered L-arginine to untreated hypertensive individuals and healthy control subjects and measured the clearance of inulin and of para-aminohippurate and a set of biochemical and clinical variables. L-Arginine infusion revealed major differences between control subjects and 1 subgroup (group B) of hypertensive individuals. Group B hypertensives (n=18) had no increase in inulin clearance and no decrease in renal vascular resistance with L-arginine; however, in another subset of hypertensive patients (group A, n=27), the insulin clearance increased and renal vascular resistance decreased similar to the control group (group C, n=11). The ambulatory blood pressure monitoring in group B showed both an increased mean diastolic pressure and a "nondipper" pattern in the nocturnal regulation of arterial pressure. These findings in group B were accompanied by significant alterations in optic fundus and left ventricle hypertrophy and increased microalbuminuria (all, P<0.05). Furthermore, group B individuals had significantly lower values of HDL cholesterol and a higher baseline atherogenic index, plasma insulin level, and glucose/insulin index. We disclose a previously undescribed relationship between end organ repercussion and decreased renal hemodynamic response to L-arginine. Our results may help to understand the mechanisms that lead to target organ damage in hypertension.

Lipoabdominoplasty without undermining.

BACKGROUND: The classic abdominoplasty still provides the best aesthetic results, despite many advances in abdominoplasty techniques. However, this procedure is associated with a relatively high incidence of complications. OBJECTIVE: A new technique is described that combines lipoplasty with traditional abdominoplasty without undermining of the abdominal flap. METHODS: Lipoplasty proceeds from the region above the umbilicus to the flanks and the region below the umbilicus. The skin below the umbilical scar is resected as in classical abdominoplasty, but a thinner fatty layer with its connective tissue, lymphatic vessels, and blood vessels is preserved. Complementary lipoplasty is performed if necessary to remove excess fat. RESULTS: The procedure results in an improved body shape, better accommodation of the abdominal flap, and a more youthful appearance of the abdomen with less scarring and no incidence of "dog ears" or major complications. CONCLUSIONS: Lipoabdominoplasty without undermining enhances aesthetic results with fewer complications than traditional abdominal aesthetic surgery. Aesthetic Surg J 2001;21:518-526.).

Aumento de la secreción tubular de creatinina por L-arginina: un mecanismo con importancia práctica en la evaluación de la función renal por medio del aclaramiento de creatinina / Increase of tubular secretion of creatinine by L-arginine: a mechanism of practical importance in the evaluation of renal function by means of creatinine clearance

Antecedentes. La ingesta de carne aumenta la secreción tubular de creatinina. Este incremento se ha atribuido a la formación de nueva creatinina a partir de la creatina presente en las comidas. Sin embargo, esta hipótesis no se ha examinado de forma exhaustiva, ya que no existen estudios que usen infusiones de aminoácidos que no contengan creatina. Métodos. Realizamos un estudio intervencionista y prospectivo que incluía 34 individuos con función renal normal que participaban en un protocolo sobre hipertensión arterial. Se les administró una infusión continua de L-arginina (6 por ciento, iv, en cuatro períodos de 30 min a 50, 100, 200 y 300 ml/h). Se determinó el aclaramiento de creatinina (CCr) y de inulina (Cln) basal y durante la infusión de L-arginina, analizándose los efectos sobre la secreción tubular mediante comparación del CCr y el Cln y cálculo de la secreción tubular de creatinina (STCr). Resultados. La infusión de L-arginina indujo un aumento significativo tanto del CCr como del Cln. El CCr y el Cln fueron, respectivamente, 117,9 ñ 22,7 y 107,5 ñ 23 basalmente y 170,3 ñ 23 y 144,2 ñ 47,8 después de la infusión de L-arginina (en ambos casos p < 0,01). Este aumento fue simultáneo al aumento en la STCr desde 1,12 ñ 0,4 a 1,43 ñ 0,6 (p < 0,01). El CCr se correlacionó significativamente con el Cln en condiciones basales y a los 60 min de infusión (r = 0,365, p = 0,031 y r = 0,368, p = 0,038, respectivamente), pero no a los 120 min (r = 0,130, p = 0,412), tiempo que corresponde al incremento máximo del Cln y de la STCr. Conclusiones. El presente estudio demuestra que la infusión de L-arginina induce un aumento significativo del CCr, que excede del esperado por el aumento del filtrado glomerular, medido por el Cln, y que corresponde a un aumento de la STCr. Este fenómeno sugiere una nueva interpretación del efecto de los aminoácidos sobre el manejo de la creatinina en el túbulo, teniendo implicaciones prácticas en la evaluación de la función renal mediante el aclaramiento de creatinina (AU)

[Increase of tubular secretion of creatinine by L-arginine: mechanism of practical significance in the assessment of renal function based on creatinine clearance]. / Aumento de la secreción tubular de creatinina por L-arginina: un mecanismo con importancia práctica en la evaluación de la función renal por medio del aclaramiento de creatinina.

BACKGROUND: Tubular secretion of creatinine is increased by meat meals. This increment has been attributed to the formation of new creatinine from creatine contained in the cooked meals. However, no studies are available using amino acid infusions containing no creatine, which allow to further investigate the putative causes of increment in tubular creatinine secretion. METHODS: We performed a prospective, interventional study involving 34 individuals with normal renal function participating in a protocol on arterial hypertension. A continuous infusion of L-arginine (6%, i.v., in four 30 min periods at 50, 100, 200 and 300 ml/h) was administered. Creatinine (CCr) and inulin (CIn) clearances were determined at baseline and during L-arginine infusion. We analyzed the effects of L-arginine on tubular secretion by comparing CCr and CIn and calculated tubular secretion of creatinine (TSCr). RESULTS: L-arginine infusion induced a significant increase in both CCr and CIn. CCr and CIn were respectively 117.9 +/- 22.7 and 107.5 +/- 23, before and 170.3 +/- 23 and 144.2 +/- 47.8 after the infusion of L-arginine (both p < 0.01). This increase was simultaneous with an increment in TSCr from 1.12 +/- 0.4 to 1.43 +/- 0.6 (p < 0.01). CCr correlated significantly with CIn at baseline and at 60 min of infusion (r = 0.365, p = 0.031 and r = 0.368, p = 0.038, respectively), but not at 120 min (r = 0.130, p = 0.412), a time corresponding to the maximum increase in CIn and TSCr. CONCLUSIONS: L-arginine induces a substantial increase of CCr, which exceeds that expected from the increase in glomerular filtration rate measured by CIn and corresponds to an increment in TSCr. This phenomenon adds a new interpretation of the effect of amino acids on tubular handling of creatinine and has practical implications in the evaluation of renal function by means of creatinine clearance.