Access to healthcare in Chilean prisons: an inmates' perspective.

OBJECTIVES: To analyze the perception of access to Chilean prisons in a representative national sample of persons deprived of liberty as well as to examine the most important covariates of such access. MATERIALS AND METHODS: This study uses secondary data from the First National Survey on the Quality of Prison Life (2014), which investigated inmates' perceptions regarding access to health services inside the prisons. To do this, it uses descriptive statistics and a logistic regression model. RESULTS: Descriptive results at the national level show that access to health services in prisons tends to be "difficult" (44.7% of cases in this category). Multivariate logistic regression results indicate that men (OR=0.43) and those who reported better infrastructure (OR=0.70) were less likely to report "difficult access to health services". On the other hand, prison inmates (OR=1.61) and those who had reported higher levels of mistreatment (OR=1.26) were associated with a higher probability of reporting "difficult access to health services". DISCUSSION: Our study suggests that access to health care is dynamically linked to other aspects of life within prisons such as the composition of the prison population (gender), some of the material aspects of prisons (infrastructure, type of facility), and even some relational aspects (level of mistreatment/abuse). Future studies could further extend the debate on healthcare in prisons, incorporating more complex both variables and analyses.

Association of QRS Complex Fragmentation with QT Interval Prolongation in Patients with Ischemic Heart Disease.

BACKGROUND: The fragmented QRS complex (FQRS) was found to be associated to malignant ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy and other entities. There is scant data available correlating the presence of FQRS with QT interval prolongation in patients with ischemic heart disease (IHD). METHODS: A descriptive, retrospective, cross-sectional study was performed in 123 patients with IHD to analyze and correlate the presence of FQRS with QT interval prolongation in the conventional 12-leads electrocardiogram in patients with documented chronic IHD. RESULTS: There were 62% male patients. The mean age was 63.8±12.6 years. Thirty six (44%) patients had fragmented QRS (64% men and 36% women). The duration of QT and QTc, the mean values were 413±59ms, and 463±67ms, respectively. Of the 36 patients with FQRS, 23 patients have prolongation of the QTc interval, and 13 patients did not present it. Of the 45 patients without FQRS, 21 of them have prolongation of the QTc interval, and 24 patients did not have it. These data resulted in a sensitivity of 52% with a moderate SnNout, a specificity of 65% with moderate SpPin, a positive predictive accuracy of 64%, a negative predictive accuracy of 53%. These data resulted in a prevalence of 54%. CONCLUSION: the presence of FQRS in the ECG has a moderate sensitivity and specificity, as well as, moderate negative and positive predictive value of the existence of QT interval prolongation in patients with ischemic heart disease.

Acceso a la atención sanitaria en cárceles chilenas: una mirada desde los internos / Access to healthcare in Chilean prisons: an inmates' perspective

Objetivos: analizar la percepción de acceso a las cárceles chilenas en una muestra representativa nacional de personas privadas de libertad y examinar las covariables más importantes de dicho acceso. Materiales y métodos: este estudio utiliza datos secundarios de la Primera Encuesta Nacional de Calidad de Vida Penitenciaria (2014), e indaga en torno a la percepción de los internos de ambos sexos respecto al acceso a los servicios de salud en el interior de las cárceles. Para ello, utiliza datos estadísticos descriptivos y un modelo de regresión logística ordenada. Resultados: los resultados descriptivos en el ámbito nacional muestran que el acceso a los servicios de salud en las cárceles tiende a ser "difícil" (el 44,7% de casos en esta categoría). Los resultados multivariados de la regresión logística ordenada indican que los hombres (con una razón de posibilidades u odds ratio, OR=0,43) y quienes reportaron mejor infraestructura (OR=0,70) tenían menores probabilidades de reportar un "difícil acceso a servicios de salud". Por otra parte, los internos de las cárceles concesionadas (OR=1,61) y quienes habían reportado mayores grados de maltrato (OR=1,26) se asociaron a mayores probabilidades de reportar un "difícil acceso". Discusión: el estudio sugiere que la facilidad en el acceso a la atención de salud está vinculada de forma dinámica a otros aspectos de la vida en el interior de las cárceles, como a la composición de la población penal (sexo), a los aspectos materiales de la prisión (infraestructura, tipo de cárcel) e, inclusive, a algunos aspectos relacionales (nivel de maltrato). Futuros estudios podrían expandir la discusión en torno a la temática salud y la cárcel, incorporando variables y análisis más complejos

Objectives: to analyze the perception of access to Chilean prisons in a representative national sample of persons deprived of liberty as well as to examine the most important covariates of such access. Materials and methods: this study uses secondary data from the First National Survey on the Quality of Prison Life (2014), which investigated inmates' perceptions regarding access to health services inside the prisons. To do this, it uses descriptive statistics and a logistic regression model. Results: descriptive results at the national level show that access to health services in prisons tends to be "difficult" (44.7% of cases in this category). Multivariate logistic regression results indicate that men (OR=0.43) and those who reported better infrastructure (OR=0.70) were less likely to report "difficult access to health services". On the other hand, prison inmates (OR=1.61) and those who had reported higher levels of mistreatment (OR=1.26) were associated with a higher probability of reporting "difficult access to health services". Discussion: our study suggests that access to health care is dynamically linked to other aspects of life within prisons such as the composition of the prison population (gender), some of the material aspects of prisons (infrastructure, type of facility), and even some relational aspects (level of mistreatment/abuse). Future studies could further extend the debate on healthcare in prisons, incorporating more complex both variables and analyses

A multigene array for measurable residual disease detection in AML patients undergoing SCT.

AML is a diagnosis encompassing a diverse group of myeloid malignancies. Heterogeneous genetic etiology, together with the potential for oligoclonality within the individual patient, have made the identification of a single high-sensitivity marker of disease burden challenging. We developed a multiple gene measurable residual disease (MG-MRD) RQ-PCR array for the high-sensitivity detection of AML, retrospectively tested on 74 patients who underwent allo-SCT at the NHLBI in the period 1994-2012. MG-MRD testing on peripheral blood samples prior to transplantation demonstrated excellent concordance with traditional BM-based evaluation and improved risk stratification for post-transplant relapse and OS outcomes. Pre-SCT assessment by MG-MRD predicted all clinical relapses occurring in the first 100 days after allo-SCT compared with 57% sensitivity using WT1 RQ-PCR alone. Nine patients who were negative for WT1 prior to transplantation were correctly reclassified into a high-risk MG-MRD-positive group, associated with 100% post-transplant mortality. This study provides proof of principle that a multiple gene approach may be superior to the use of WT1 expression alone for AML residual disease detection.

Production of tissue plasminogen activator (t-PA) in Aspergillus niger.

A protease-deficient strain of Aspergillus niger has been used as a host for the production of human tissue plasminogen activator (t-PA). In defined medium, up to 0.07 mg t-PA (g biomass)(-1) was produced in batch and fed-batch cultures and production was increased two- to threefold in two-phase batch cultures in which additional glucose was provided as a single pulse at the end of the first batch growth phase. Production was increased [up to 1.9 mg t-PA (g biomass)(-1)] by the addition of soy peptone to the defined medium. The rate of t-PA production in batch cultures supplemented with soy peptone (0.2 to 0.6 mg t-PA L(-1) h(-1)) was comparable to rates observed previously in high-producing mammalian or insect cell cultures. In glucose-limited chemostat culture supplemented with soy peptone, t-PA was produced at a rate of 0.7 mg t-PA L(-1) h(-1). Expression of t-PA in A. niger resulted in increased expression of genes (bipA, pdiA, and cypB) involved in the unfolded protein response (UPR). However, when cypB was overexpressed in a t-PA-producing strain, t-PA production was not increased. The t-PA produced in A. niger was cleaved into two chains of similar molecular weight to two-chain human melanoma t-PA. The two chains appeared to be stable for at least 16 h in culture supernatant of the host strain. However, in general, <1% of the t-PA produced in A. niger was active, and active t-PA disappeared from the culture supernatant during the stationary phase of batch cultures, suggesting that the two-chain t-PA may have been incorrectly processed or that initial proteolytic cleavage occurred within the proteolytic domain of the protein. Total t-PA (detected by enzyme-linked immunoassay) also eventually disappeared from culture supernatants, confirming significant extracellular proteolytic activity, even though the host strain was protease-deficient.

Comparative study of an Eden model for the irreversible growth of spins and the equilibrium Ising model.

The magnetic Eden model (MEM) [N. Vandewalle and M. Ausloos, Phys. Rev. E 50, R635 (1994)] with ferromagnetic interactions between nearest-neighbor spins is studied in (d+1)-dimensional rectangular geometries for d=1,2. In the MEM, magnetic clusters are grown by adding spins at the boundaries of the clusters. The orientation of the added spins depends on both the energetic interaction with already deposited spins and the temperature, through a Boltzmann factor. A numerical Monte Carlo investigation of the MEM has been performed and the results of the simulations have been analyzed using finite-size scaling arguments. As in the case of the Ising model, the MEM in d=1 is noncritical (only exhibits an ordered phase at T=0). In d=2 the MEM exhibits an order-disorder transition of second order at a finite temperature. Such transition has been characterized in detail and the relevant critical exponents have been determined. These exponents are in agreement (within error bars) with those of the Ising model in two dimensions. Further similarities between both models have been found by evaluating the probability distribution of the order parameter, the magnetization, and the susceptibility. Results obtained by means of extensive computer simulations allow us to put forward a conjecture that establishes a nontrivial correspondence between the MEM for the irreversible growth of spins and the equilibrium Ising model. This conjecture is certainly a theoretical challenge and its confirmation will contribute to the development of a framework for the study of irreversible growth processes.

Hemorragia subdural recurrente como forma de presentación del síndrome de Ehlers-Danlos de tipo IV

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Effect of the nitrogen source on pyruvate content and rheological properties of xanthan

Batch and fed batch cultivations of Xanthomonas campestris with varying amounts of the N source (NH4Cl) yield xanthan polymers which differ in pyruvate content. Analyzing the rheological properties of the xanthans produced exhibits that it is not only the molecular mass but also the pyruvate content that affects the viscosity of xanthan solutions. However, there is obviously no simple functional dependency but rather a step increase in viscosity when going from below 2 to above 3 wt % of pyruvate.

Interdependent domains controlling the enzymatic activity of mitogen-activated protein kinase kinase 1.

The activation of human mitogen-activated protein kinase kinase 1 (MKK1) is achieved by phosphorylation at Ser218 and Ser222 within a regulatory loop. Partial activation was achieved by replacing these residues with aspartic/glutamic acid. Higher activity was obtained by introducing four acidic residue substitutions in the regulatory loop, indicating that acidic residues in the loop stabilize an active configuration by the introduction of negative charge. Activation of MKK1 is also achieved by deleting residues 44-51, N-terminal to the consensus catalytic core. Although substitution of residues within this segment by alanine does not affect activity, introduction of proline residues elevates kinase activity, indicating that activation results from perturbation of secondary structure within residues 44-51. Pseudosubstrate inhibition, a commonly observed mechanism of kinase regulation, is not operative in this process. Both the acidic substitutions and the N-terminal deletion increase Vmax, V/K(m),ERK2, and V/K(m),ATP, as is also observed following phosphorylation of wild-type MKK1. A synergistic enhancement of these steady-state rate parameters occurs upon combining the mutations, suggesting that conformational changes induced by mutagenesis together mimic those seen upon phosphorylation.

Constitutively active mitogen-activated protein kinase kinase 1 (MAPKK1) and MAPKK2 mediate similar transcriptional and morphological responses.

Both mitogen-activated protein kinase kinase 1 (MAPKK1) and MAPKK2 function downstream of the proto-oncogene product Raf in signaling pathways that affect cell proliferation and differentiation. The isoforms were previously shown to be differentially regulated in two significant ways: (a) MAPKK1, but not MAPKK2, was phosphorylated and inactivated by the cyclin-dependent kinase p34cdc2; and (b) p21 Ras formed a ternary complex with Raf/MAPKK1 but not with Raf/MAPKK2. To further characterize the regulation and function of the two isoforms, we compared their mode of activation by v-Mos and examined the transcriptional and morphological responses that they mediate in cultured mammalian cells. v-Mos enhanced the enzymatic activity of both isoforms to the same extent, by about 600-fold. Constitutively active MAPKK2 mutants were generated by introducing the same deletion and amino acid substitutions that have been shown to activate MAPKK1, suggesting that the conformational changes that lead to their activation are analogous. These mutants potentiated transcription from a promoter containing AP1-responsive elements and induced morphological transformation when expressed in mammalian cells, matching outcomes observed with constitutively active MAPKK1. The specific activity of p42 MAPK in the transformed cells was 3-fold higher than in cells expressing wild-type MAPKK, thereby implicating p42 MAPK as a common effector in vivo, and suggesting that sustained activation of p42 MAPK may represent a critical factor that contributes to the development of the transformed state. Altogether, the results demonstrate that the two isoforms elicit similar responses in vivo despite differences in their regulation.

Determination of v-Mos-catalyzed phosphorylation sites and autophosphorylation sites on MAP kinase kinase by ESI/MS.

MAP kinase kinase (MAPKK), a key component of the MAP kinase cascade, is activated through phosphorylation by several protein kinases, including the oncogene v-Mos and its cellular counterpart, c-Mos. The v-Mos-catalyzed phosphorylation sites on recombinant MAPKK1 were identified by electrospray ionization mass spectrometry as S218 and S222, located within a sequence that aligns with the T loop structure of cAMP-dependent protein kinase; these are the same as the Raf-1 phosphorylation site identified previously [Alessi, D. R., et al. (1994) EMBO J. 13, 1610-1619]. Phosphorylation of these sites was kinetically ordered, with S222 preferred over S218. Intramolecular autophosphorylation of these sites was kinetically ordered, with S222 preferred over S218. Intramolecular autophosphorylation of MAPKK occurred at several residues and was increased upon the stimulation of MAPKK activity by v-Mos. Major autophosphorylation sites were residues S298 and Y300. Minor autophosphorylation sites included T23, S299, S218, and either S24 or S25. Sequence similarities were noted between MAPKK autophosphorylation sites and exogenous phosphorylation sites on MAP kinase. Phosphorylation of either S218 or S222 was sufficient for partial MAPKK activation by Mos, and phosphorylation of S222 alone was sufficient for autophosphorylation at S298 and Y300. Mass spectral analysis was also performed on MAPKK1 purified from rabbit skeletal muscle. The peptide containing S218 and S222 was observed in only a singly phosphorylated form, and the peptide containing S298, S299, and Y300 was observed in multiply phosphorylated forms, suggesting that MAPKK is only partially phosphorylated within the T loop but significantly modified in the autophosphorylation loop under physiological conditions.

Transformation of mammalian cells by constitutively active MAP kinase kinase.

Mitogen-activated protein (MAP) kinase kinase (MAPKK) activates MAP kinase in a signal transduction pathway that mediates cellular responses to growth and differentiation factors. Oncogenes such as ras, src, raf, and mos have been proposed to transform cells by prolonging the activated state of MAPKK and of components downstream in the signaling pathway. To test this hypothesis, constitutively active MAPKK mutants were designed that had basal activities up to 400 times greater than that of the unphosphorylated wild-type kinase. Expression of these mutants in mammalian cells activated AP-1-regulated transcription. The cells formed transformed foci, grew efficiently in soft agar, and were highly tumorigenic in nude mice. These findings indicate that constitutive activation of MAPKK is sufficient to promote cell transformation.

A nasal trumpet orthosis to maintain nares openings and respiratory function for patients with facial burns: a case report.

Management of facial burns is a challenge to the burn team because it may lead to functional and cosmetic compromise. Severe scarring of the nares may lead to nasal occlusion. This article introduces a method of maintaining nasal patency that allows respiratory exchange through the use of a custom-fabricated, semirigid tubular orthosis. The technique for fabrication is reviewed, and the use of the device is addressed through a case report. This inexpensive, readily available device is useful in preventing nasal occlusion that results from scar formation.