Effect of intravenous lidocaine on ischemia-reperfusion injury in DIEP microsurgical breast reconstruction. A prospective double-blind randomized controlled clinical trial.

BACKGROUND: Ischemia-reperfusion injury in free flaps is associated with tissue damage and is one of the main factors causing flap failure in reconstructive microsurgery. The aim of this study is to assess whether any ischemia-reperfusion injury takes place during a microsurgical flap reconstruction as seen through the levels of malondialdehyde (MDA) and superoxide dismutase, biomarkers of oxidative stress, and to analyze the effect of lidocaine in this process. METHODS: Twenty-four patients operated for immediate breast reconstruction using the Deep Inferior Epigastric Perforator free flap technique were divided into two groups: one group was treated with a lidocaine intravenous perfusion and the other group with a saline perfusion. MDA and superoxide dismutase (SOD) levels were measured at several points before, during, and after surgery. RESULTS: There was an increase in MDA levels in both groups, but the lidocaine group experienced a decrease during reperfusion. On the other hand, we observed a rise in SOD levels in both groups, but a decrease during reperfusion in the placebo group. However, these differences between groups were not statistically significant. CONCLUSIONS: The decreased SOD activity and increased MDA content in our research prove a redox imbalance and high reactive oxygen species levels in flaps, indicating that tissues experience ischemia-reperfusion injury during microsurgical reconstruction. Lidocaine may have a protective effect in free flap surgery, but our results were not statistically significant, so further studies will be required.

CK2 regulates 5-HT4 receptor signaling and modulates depressive-like behavior.

The serotonergic neurotransmitter system has been widely implicated in the pathophysiology of mood-related disorders such as anxiety and major depressive disorder (MDD). The onset of therapeutic efficacy of traditional antidepressants is delayed by several weeks. The 5-HT4 receptor has emerged as a new therapeutic target since agonists of this receptor induce rapid antidepressant-like responses in rodents. Here we show that the 5-HT4 receptor is regulated by CK2, at transcriptional and post-transcriptional levels. We present evidence, in two different CK2α knockout mouse lines, that this regulation is region-specific, with the 5-HT4 receptor upregulated in prefrontal cortex (PFC) but not striatum or hippocampus where CK2α is also ablated. 5-HT4 receptor signaling is enhanced in vitro, as evidenced by enhanced cAMP production or receptor plasma membrane localization in the presence of CK2 inhibitor or shRNA targeting CK2α. In vivo, 5-HT4 receptor signaling is also upregulated since ERK activation is elevated and sensitive to the inverse agonist, GR113808 in the PFC of CK2α KO mice. Behaviorally, KO mice as well as mice with AAV-mediated deletion of CK2α in the PFC show a robust 'anti-depressed-like' phenotype and display an enhanced response to antidepressant treatment when tested in paradigms for mood and anxiety. Importantly, it is sufficient to overexpress the 5-HT4 receptor in the mPFC to generate mice with a similar 'anti-depressed-like' phenotype. Our findings identify the mPFC as the region that mediates the effect of enhanced 5-HT4 receptor activity and CK2 as modulator of 5-HT4 receptor levels in this brain region that regulates mood-related phenotypes.

Real-time observation of antigen-antibody association using a low-cost biosensing system based on photonic bandgap structures.

In this letter, we present experimental results of antibody detection using a biosensor based on photonic bandgap structures, which are interrogated using a power-based readout technique. This interrogation method allows a real-time monitoring of the association process between the antigen probes and the target antibodies, allowing the instantaneous observation of any interaction event between molecules. because etunable lasers and optical spectrum analyzers are avoided for the readout, a drastic reduction of the final cost of the platform is obtained. Furthermore, the performance of the biosensing system is significantly enhanced due to the large number of data values obtained per second.

Manejo de las lesiones atípicas del tronco del encéfalo en niños con neurofibromatosis tipo 1 / Management of atypical lesions of the brain stem in children with neurofibromatosis type 1

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Alteraciones del pelo como signo de enfermedad mitocondrial / Hair disorders as sign of mitochondrial disease

Introducción: Los trastornos de la cadena respiratoria mitocondrial conllevan una disminución del aporte energético celular, lo que puede afectar al crecimiento y al desarrollo del pelo. Objetivo: Valorar si una técnica sencilla, como es el análisis microscópico del pelo, podría servir como herramienta de orientación diagnóstica de las enfermedades mitocondriales. Resultados: Se estudiaron 13 pacientes con enfermedad mitocondrial, de los cuales 6 tenían el pelo quebradizo y fino, pero sólo uno de ellos presentaba alteraciones más concretas(pili torti et canaliculi). En el grupo de controles sanos no se observó ninguna alteración. Conclusiones: Las alteraciones del pelo pueden formar parte del amplio espectro clínico de las enfermedades mitocondriales. Sin embargo, al ser tan inespecíficas, por sí solas son poco útiles como herramienta de orientación diagnóstica(AU)

Introduction: Disorders of the mitochondrial respiratory chain lead to a decrease in celular energy supply and this can affect hair growth and development. Objective: The aim of this study was to assess whether microscopic hair examination could be used as an easy diagnostic tool of mitochondrial diseases. Results: 6 out of 13 patients with mitochondrial disease had fragile and thin hair, but only one had specific alterations (pilitorti et canaliculi). The healthy control group revealed no apparent abnormality. Conclusions: Hair disorders might belong to the broad spectrum of presenting symptoms of mitochondrial diseases. However, these anomalies are unspecific and have not much performance as diagnostic tool(AU)

Real-time and low-cost sensing technique based on photonic bandgap structures.

A technique for the development of low-cost and high-sensitivity photonic biosensing devices is proposed and experimentally demonstrated. In this technique, a photonic bandgap structure is used as transducer, but its readout is performed by simply using a broadband source, an optical filter, and a power meter, without the need of obtaining the transmission spectrum of the structure; thus, a really low-cost system and real-time results are achieved. Experimental results show that it is possible to detect very low refractive index variations, achieving a detection limit below 2×10(-6) refractive index units using this low-cost measuring technique.

Single-strand DNA detection using a planar photonic-crystal-waveguide-based sensor.

We report an experimental demonstration of single-strand DNA (ssDNA) detection at room temperature using a photonic-crystal-waveguide-based optical sensor. The sensor surface was previously biofunctionalized with ssDNA probes to be used as specific target receptors. Our experiments showed that it is possible to detect these hybridization events using planar photonic-crystal structures, reaching an estimated detection limit as low as 19.8 nM for the detection of the complementary DNA strand.

Síndrome de Lennox-Gastaut en España: estudio epidemiológico retrospectivo y descriptivo / Lennox-Gastaut syndrome in Spain: a descriptive retrospective epidemiological study

Introducción. El síndrome de Lennox-Gastaut (SLG) es uno de los síndromes epilépticos más graves de la infancia. Se aracteriza por la presencia de varios tipos de crisis, un trazado electroencefalográfico característico y la frecuente asociación de retraso mental. No existen datos precisos sobre la epidemiología del SLG en España. Objetivo. Describir el perfil epidemiológico del SLG en España. Pacientes y métodos. Estudio epidemiológico retrospectivo de una serie de 331 pacientes con SLG procedentes de 50 hospitales españoles. Se consideraron casos de SLG aquellos pacientes que tenían al menos dos de los tres tipos de crisis características del SLG (crisis tónicas axiales, ausencias atípicas y crisis atónicas) junto con actividad intercrítica difusa de punta-onda lenta (< 3 Hz) en el electroencefalograma en vigilia. Resultados. La edad media de los pacientes fue de de 18,2 ± 13,5 años. El 62% eran varones y el 97% tenía retraso cognitivo. El 54% de los casos fue de etiología sintomática. Los tipos de crisis más frecuentes fueron las tónicas axiales (89%), seguidas de las ausencias atípicas (84%) y las crisis atónicas (69%). El 99% de los pacientes fue tratado con politerapia, siendo los fármacos más frecuentemente empleados el ácido valproico, la lamotrigina y el topiramato. Conclusiones. Los resultados del estudio son consistentes con los de estudios previos realizados en poblaciones de características similares. El elevado porcentaje de pacientes con SLG con retraso cognitivo condiciona en esta encefalopatía epiléptica una gran repercusión, tanto familiar como social (AU)

Introduction. Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic syndromes in childhood. It is characterised by the presence of several types of seizures, a characteristic electroencephalographic trace and its frequent association with mental retardation. There are no accurate data on the epidemiology of LGS in Spain. Aim. To describe the epidemiological profile of LGS in Spain. Patients and methods. We conducted a retrospective epidemiological study of a series of 331 patients with LGS from 50 Spanish hospitals. Patients were considered to be cases of LGS if they had at least two of the three types of seizures that characterise LGS (axial tonic seizures, atypical absences and atonic seizures) and displayed slow diffuse intercritical spikewave activity (< 3 Hz) in the electroencephalogram in wakefulness. Results. The mean age of the patients was 18.2 ± 13.5 years. Of the total sample, 62% were males and 97% had cognitive retardation. And 54% of cases had a symptomatic aetiology. The most frequent types of seizures were axial tonic (89%), followed by the atypical absent type (84%) and atonic seizures (69%). In all, 99% of patients were treated with polytherapy, the most commonly used drugs being valproic acid, lamotrigine and topiramate. Conclusions. The results of the study are in line with those from previous analyses carried out in populations with similar characteristics. The high percentage of LGS patients with cognitive retardation in this epileptic encephalopathy results in important family and social repercussions (AU)

Epilepsias focales benignas en lactantes, niños y adolescentes / Benign focal epilepsies in infancy, childhood and adolescence

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La codificación en neurología pediátrica: un buen indicador de la calidad asistencial / Coding in paediatric neurology: a good indicator of the quality of health care

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Bacteremia después de biopsias de próstata dirigidas por ultrasonido / Bacteremia after ultrasound guided transrectal prostate biopsy

Propósito: Determinar la incidencia de bacteremia después de biopsias por sextantes y octantes de próstata. Material y métodos. Se trata de un estudio prospectivo realizado en un lapso de tiempo de 5 meses, en el servicio de cografía urológica de la Clínica de Marly, en los pacientes que llegan remitidos para biopsias prostáticas por sospecha de cáncer de próstata. El examen es realizado por un único urólogo especialista, utilizando un ecógrafo Siemens Sonoline Prima, con un transductor biplanar de 5 a 7,5 MHz. Las biopsias ecodirigidas se obtienen con aguja de biopsia 18 gauge y pistola de biopsia automática. Las muestras se marcan y analizan por separado. Se obtiene una muestra de orina inmediatamente antes del examen, que se envía al laboratorio para urocultivo. Todos los pacientes se citan a las 24 horas del examen para toma del hemocultivo, el cual se procesa con antibiograma si se detecta crecimiento bacteriano. La preparación del paciente consiste en la toma de antibiótico (Ciprofloxacina) por 3 días, y la colocación de un enema evacuador previo al examen. Resultados: El estudio incluyó 69 pacientes. El promedio de edad del grupo de estudio fue de 62.9 años, con un volumen promedioprostático de 46.78 cc. La incidencia de bacteremia fue de 7.24 por cien, (n=5). No se observó diferencia en la incidencia de bacteremia en pacientes que toman antibiótico profiláctico genérico o comercial, ni en las biopsias por sextantes vs.octantes. El 32.69 por cien de los pacientes a quienes se le toman biopsias (n=104) tienen carcinoma de próstata. No existió diferencia significativa para la detección del cáncer prostático entre la toma de biopsias por octantes y sextantes. Conclusiones: En este estudio se encontró una incidencia de bacteremia y cuadro de sepsis, mas baja que la comparada con las estadísticas informadas en la literatura. Las técnicas actuales de biopsias transrectales ecodirigidas con la toma de múltiples muestras obtenidas con aguja fina, son seguras c...

Baja masa ósea y factores ginecológicos asociados en mujeres climatéricas / Low bone mass density and gynecological factors in climacteric women

Introducción. El objetivo de este estudio ha sido estimar la prevalencia de baja masa ósea en mujeres y medir su asociación con factores ginecológicos. Sujetos y método. Estudio poblacional transversal de una muestra representativa de la población femenina de 45 a 69 años del departamento sanitario de Gandía (Comunidad Valenciana). Se ha practicado absorciometría radiológica de doble energía periférica con PIXI Lunar(R), y se han recogido mediante encuesta las variables ginecológicas de 822 mujeres. Resultados. La prevalencia estimada ha sido del 40,3% (intervalo de confianza [IC] 95%: 36,9-43,7) para la baja masa ósea: con un 11,7% (IC 95%: 9,6-14,1) para osteoporosis y un 28,7% (IC 95%: 25,5-31,8) para osteopenia. Se observó asociación de baja masa ósea (BMO) con la edad de menarquia, odds ratio ajustada (ORaj) por edad para 13 y más años de 1,35 (IC 95%:1,01-1,81); con la presentación de menopausia quirúrgica, ORaj =1,95 (IC 95%: 1,05-3,61) y con el periodo fértil de 37 a 39 años, ORaj = 0,44 (IC 95%: 0,29-0,66) y 0,55 (IC 95%: 0,34-0,90) entre 40 y 46 años. Conclusiones. La presencia de ciertos datos de la historia ginecológica, como la menarquia a partir de los 13 años, la menopausia quirúrgica y un periodo fértil menor de 37 años deben ser considerados como indicadores de sospecha para la existencia de baja masa ósea periférica(AU)

Introduction. This study has aimed to estimate the frequency of low bone mass density in women and to measure its association with gynecological factors. Subjects and method. Cross-sectional study of a representative sample of the female population aged 45 to 69 years in a Health Care Department of Valencia (Spain). A peripheral dual-energy X-ray absorptiometry with PIXI Lunar® was performed and the gynecological variables of 822 women were obtained by survey. Results. The estimated prevalence was 40.3% (95% CI: 36.9-43.7) for low bone mass: with 11.7% (95% CI: 9.6-14.1) for osteoporosis and 28.7% (95% CI:25.5-31.8) for osteopenia. An association between BMD and age of menarche, OR adjusted by age, for 13 years or above of 1.35 (95% CI :1.01-1.81) and with fertility time from 37 to 39 years, adjusted OR = 0.44 (95% CI: 0.29-0.66) and 0.55 (0.34-0.90) between 40 and 46 years was observed. Conclusions. The presence of certain data in the gynecology background such as menarche age 13, surgical menopause and fertility time below 37 years should be considered as indicators to suspect peripheral low bone mass(AU)

Capacidad predictiva de la densiometría de calcáneo en mujeres climatéricas / Predictive capacity of calcaneal densitometry in climateric women

Material y métodos. Estudio de la capacidad predictiva del PIXI Lunar(R) en el calcáneo derecho con respecto al densitómetro DXA-Lunar(R), a través de las mediciones practicadas en 100 mujeres entre 46 y 70 años. La validez y seguridad se ha obtenido mediante la estimación de la sensibilidad, especificidad, precisión y valores predictivos para la categorización de la muestra como osteoporosis (OP) y baja masa ósea (BMO). Resultados. La precisión estimada para el PIXI como predictor de OP y BMO ha sido del 72,7% (intervalo de confianza [IC] 95%: 62,7-81,0) con referencia a la densitometría de doble energía de rayos X (DXA) de columna y del 73% (IC 95%: 63,0-81,2) y 75% (IC 95%: 65,2-82,9) para la DXA de cadera, respectivamente. La máxima sensibilidad se observó para la BMO comparada con la DXA de fémur, 93,7% (IC 95%: 81,8-98,4) y la máxima especificidad se obtuvo para OP con respecto a DXA de columna, 75,6% (IC 95%: 64,6-84,1). Conclusiones. La categorización realizada con el PIXI de calcáneo se corresponde mejor a la DXA de fémur. Su uso puede servir para clasificar una población según su densidad mineral ósea

Material and methods. We conducted a study of the predictive capacity of PIXI Lunar(R) in the right calcaneus with respect to DXA-Lunar(R) densitometry through measurements carried out in 100 women between 46 and 70 years of age. Validity and safety were assessed by measuring the sensitivity, specificity, accuracy, and predictive values for the classification of the sample as osteoporosis (OP) and low bone mass (LBM). Results. The estimated accuracy of PIXI as a predictor of OP and LBM was 72.7% (95% CI: 62.7-81.0) with respect to spinal DXA and 73% (95% CI: 63.0-81.2) and 75% (95% CI: 65.2-82.9), respectively for hip DXA. The maximum sensitivity was observed for LBM as compared to DXA of the femur, 93.7% (95% CI:81.8-98.4) and the maximum specificity was obtained for OP with respect to spinal DXA, 75.6% (95% CI: 64.6-84.1). Conclusions. Classification using PIXI of the calcaneus corresponds best to DXA of the femur. PIXI can be used to classify a population according to its bone mineral density

Leucoencefalopatía con sustancia blanca evanescente: a propósito de un caso / Leukoencephalopathy with vanishing white matter: a case report

Introducción. La leucoencefalopatía con sustancia blancaevanescente es una enfermedad hereditaria de transmisión autosómicarecesiva individualizada en 1997. Más tarde se identificaronlas anomalías genéticas responsables: diferentes mutaciones encualquiera de los cinco genes que codifican las cinco subunidadesdel factor de iniciación de la traducción eIF2B. Desde entonces, elespectro clínico de esta entidad se ha mostrado mucho más amplioy su frecuencia mucho mayor de lo imaginado inicialmente. Presentamosun caso de la forma clínica clásica, el primero segúnnuestro conocimiento publicado hasta la fecha en España. Casoclínico. Niña de 5 años que desde hace dos presenta una inestabilidadde la marcha recientemente agravada tras un traumatismo craneoencefálicoleve. En la exploración presenta una ataxia cerebelosaglobal y una espasticidad generalizada. La resonancia magnética(RM) muestra una afectación difusa y simétrica de la sustanciablanca cerebral con la presencia de cavidades en las que la intensidad de la señal, así como el espectro protónico, son similares alos del líquido cefalorraquídeo. El estudio genético revela una mutacióndel gen que codifica eIF2B-épsilon. Conclusiones. Una RMsugerente, aun en una presentación atípica, indicaría descartaruna mutación de los genes que codifican eIF2B. Esto posibilitaríael diagnóstico precoz de esta enfermedad, probablemente más prevalentede lo imaginado, lo que permitiría el consejo genético ycontribuiría a establecer un correlato genotipo-fenotipo que permitiríaademás la estimación pronóstica

Introduction. Leukoencephalopathy with vanishing white matter is an autosomal recessive hereditary disease thatwas first reported in 1997. Some time later the genetic anomalies responsible for the disease were identified, these beingdifferent mutations in any of the five genes that code for the five subunits of the translation initiation factor, eIF2B. Since then,the clinical spectrum of this condition has proved to be much broader and far more frequent than was initially believed. Wereport on a case of the classical clinical form, which is to our knowledge the first to be published in Spain to date. Case report.A 5-year-old female who presented gait instability that recently got worse following a mild traumatic head injury. Theexamination revealed overall cerebellar ataxia and generalised spasticity. Magnetic resonance imaging (MRI) showed diffuseand symmetrical involvement of the white matter of the brain with the presence of cavities in which the signal intensity and theproton spectrum were similar to those of cerebrospinal fluid. The genetic study revealed a mutation of the gene that codes foreIF2B-epsilon. Conclusions. A suggestive MRI scan, even in an atypical presentation, would be enough to rule out a mutationof the genes that code for eIF2B. This would make it possible to reach an early diagnosis of this disease, which is probablymore prevalent than is currently thought. This would allow genetic counselling to be conducted and would help to establish agenotype-phenotype correlate that would also make it possible to offer an estimated prognosis

[Leukoencephalopathy with vanishing white matter: A case report]. / Leucoencefalopatía con sustancia blanca evanescente: a propósito de un caso.

INTRODUCTION: Leukoencephalopathy with vanishing white matter is an autosomal recessive hereditary disease that was first reported in 1997. Some time later the genetic anomalies responsible for the disease were identified, these being different mutations in any of the five genes that code for the five subunits of the translation initiation factor, eIF2B. Since then, the clinical spectrum of this condition has proved to be much broader and far more frequent than was initially believed. We report on a case of the classical clinical form, which is to our knowledge the first to be published in Spain to date. CASE REPORT: A 5-year-old female who presented gait instability that recently got worse following a mild traumatic head injury. The examination revealed overall cerebellar ataxia and generalised spasticity. Magnetic resonance imaging (MRI) showed diffuse and symmetrical involvement of the white matter of the brain with the presence of cavities in which the signal intensity and the proton spectrum were similar to those of cerebrospinal fluid. The genetic study revealed a mutation of the gene that codes for eIF2B-epsilon. CONCLUSIONS: A suggestive MRI scan, even in an atypical presentation, would be enough to rule out a mutation of the genes that code for eIF2B. This would make it possible to reach an early diagnosis of this disease, which is probably more prevalent than is currently thought. This would allow genetic counselling to be conducted and would help to establish a genotype-phenotype correlate that would also make it possible to offer an estimated prognosis.

[The neuropsychology of epilepsy: what factors are involved?]. / Neuropsicología de la epilepsia: qué factores están implicados?

INTRODUCTION: The epileptic child is three times more likely to have cognitive problems from other neurological pathologies, depending on three facts: the effect exerted by the epilepsy itself, any associated previously-existing neuropsychosocial deficits, and the side effects of the antiepileptic drug (AED). A certain degree of deterioration is universally accepted, although the factors involved in its production are not specified, but are generally accepted as being due to multiple causes. We analyse the relation between neuropsychology and epilepsy in neuropaediatrics. DEVELOPMENT: The relation between epilepsy and behaviour must be seen as the exception rather than the rule, unless there are co-existing personality disorders and/or mental deficiency. The cognitive effects of AED depend on the drug, on the dosages employed and the polypharmacy, and these effects can be both adverse and favourable. The differences observed between one drug and another are open to criticism, although monitored administration of suitable doses generally produces moderate adverse side effects, as evaluated using reliable appraisal methods (MIDDRA). Scaling time in the introduction of the drug is important, especially with some new AED. The mechanisms governing production vary, but an understanding of the mechanism of action improves cognitive functioning thanks to the control over the seizures. In infancy, idiopathic cognitive reactions are produced. The main disorders are a diminished reaction and information processing time with alterations affecting memory, attention and language. CONCLUSIONS: Epilepsy is associated to a number of different, generally moderate, cognitive problems. The age of onset, the type of syndrome, its aetiology, the response to treatment and polypharmacy are multifactorial elements conditioning the side effects. There is a need for batteries of tests capable of forecasting the future and controlling the progression of cognition during treatment. The side effects of AED affecting cognition and behaviour are generally moderate, but they may be important in the case of a particular child.