Seguridad del paciente en Resonancia Magnética / Patient safety in magnetic resonance imaging

El uso de campos magnéticos estáticos, gradientes de campo y ondas de radiofrecuencia suponen un reto de seguridad diferente a otras modalidades de imagen. Cada vez más centros trabajan con equipos de 3,0T que presentan mayores riesgos para el paciente frente a los de 1,5T. Hay una necesidad de actualización para el personal de radiología que le permita entender los riesgos y disminuirlos, pues pueden producirse incidentes graves e incluso mortales. El objetivo de este trabajo es presentar una revisión y actualización de los riesgos a los que se ven sometidos los pacientes durante la realización de un estudio de resonancia magnética.(AU)

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging study.(AU)

Patient safety in magnetic resonance imaging.

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.

User roles for emergency management in social media: Understanding actors' behavior during the 2018 Majorca Island flash floods.

Social media assemble multiple users' interactions across singular events. Authorities need to navigate this diversity to effectively communicate and promote collaborative strategies. During emergency situations, discerning "who is there" is even more important for authorities, as this tracing process can save lives reaching the appropriate targets. This article contributes to this problem during emergency situations by proposing a user role taxonomy. We argue that focusing on functional behaviors could bypass the complexity of defining audiences during critical events. We test our framework using data from the 2018 flash floods in Sant Llorenç, Majorca island (Spain). Results show a diverse set of audience roles that emerge during crisis and post-crisis stages. We also identify the inclination of actors to represent certain roles and not others. Our findings contribute to understand crisis development models, and also crisis coordination configurations, such as the four-channel model or the network coordination perspective. Practical implications for public managers vary from improving coordination to influence audience's behavior during crises.

PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study in patients with atrial fibrillation: Rationale, design and methods.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Catheter ablation aims to restore sinus rhythm. However, relapses occur in up to 30% of patients. A Mediterranean diet (MedDiet) enriched with extra-virgin olive oil (EVOO) substantially reduced the incidence of AF in the PREDIMED trial. The PREDIMAR will test a similar intervention in secondary prevention. Methods: PREDIMAR is a multicenter, randomized, single-blind trial testing the effect of a MedDiet enriched with EVOO to reduce tachyarrhythmia relapses after AF ablation. The primary outcome is the recurrence of any sustained atrial tachyarrhythmia after ablation (excluding those occurring only during the first 3 months after ablation). The target final sample size is 720 patients (360 per group) recruited from 4 Spanish hospitals. A remote intervention, maintained for 2 years, is delivered to the active intervention group including periodic phone calls by a dietitian and free provision of EVOO. The control group will receive delayed intervention after trial completion. Routine electrocardiogram (ECG) and Holter ECG are performed, and a portable cardiac rhythm monitoring device is provided to be worn by participants during 15 months. Results: Recruitment started in March 2017. Up to July 2019, 609 patients were randomized (average inclusion rate: 5.3 patients/wk). Retention rates after 18 months are >94%. Conclusions: If our hypothesis is confirmed, the utility of the MedDiet enriched with EVOO in slowing the progression of AF will be proven, preventing recurrences and potentially reducing complications.

Evaluación del servicio de entrega de medicación a domicilio desde la Farmacia Hospitalaria durante la pandemia COVID-19 / Medication home delivery service set up in a Hospital Pharmacy Department during the COVID-19 pandemic

OBJETIVO: Analizar el procedimiento de entrega a domicilio de medicación de dispensación hospitalaria instaurado en el Servicio de Farmacia Hospitalaria (SFH) durante la pandemia COVID-19. Conocer el perfil de pacientes que aceptan la dispensación domiciliaria, analizar por patología las dispensaciones a domicilio y evaluar el grado de satisfacción de los pacientes mediante una encuesta telefónica. MÉTODOS: Estudio observacional, retrospectivo y descriptivo. Se analizaron las entregas de medicación a domicilio desde el SFH en el periodo del 7 de abril al 7 de mayo. Las características clínicas y demográficas de los pacientes se obtuvieron a partir del programa informático de pacientes externos del SFH e historia clínica electrónica. El grado de satisfacción de los pacientes se evaluó mediante la realización de una encuesta telefónica posterior a la entrega a domicilio. RESULTADOS: Se realizaron 2.028 entregas de medicación a domicilio abarcando toda la Comunidad Autónoma de Madrid (CAM), con un grado de aceptación del 76,82%. La patología con mayor número de entregas fue VIH. Los pacientes con enfermedades inmunomediadas fueron los que mayor aceptación reportaron. El 99% de los pacientes se mostraron satisfechos con el servicio. CONCLUSIONES: El servicio de entrega de medicación a domicilio ha sido ampliamente aceptado por los pacientes, mostrando un alto grado de satisfacción con el mismo. Se han evitado desplazamientos al hospital, disminuyendo el riesgo de contagio. Los pacientes demandan la prolongación de este servicio fuera del periodo de pandemia y sugieren que se complemente con una consulta de atención farmacéutica por telefarmacia

OBJECTIVE: To analyze the home delivery process of hospital medication set up in a Hospital Pharmacy Department (HPD) during the COVID-19 pandemic. To asses the profile of patients who accept home delivering, to analyze home dispensations by pathology and to evaluate the patient satisfaction through a telephone survey. METHODS: Observational, retrospective and descriptive study. Medication home delivery from the HPD in the period from April 7 to May 7 was analyzed. Patients demographic and clinical characteristics were obtained from the outpatient software used at the HPD and the electronic medical record. The degree of patient satisfaction was assessed by conducting a telephone survey after home delivery. RESULTS: A total of 2,028 home deliveries were made to the entire Community of Madrid, with an acceptance rate of 76,82%, being HIV the pathology with the highest number of deliveries. Patients with immune-mediated diseases were the ones with the greater acceptance rate. Overall patient satisfaction with the service was 99%. CONCLUSIONS: Medication home delivery service has been widely accepted by patients, showing a high degree of satisfaction. Avoiding trips to the hospital has reduced the risk of contagion. Patients demand the continuation of this service after the pandemic and support Pharmaceutical Care by telepharmacy

Ultrasound control of magnet growing rod distraction in early onset scoliosis. / Control ecográfico en la distracción de los tallos de crecimiento magnéticos en la escoliosis de aparición precoz.

The growing rod technique is currently one of the most common procedures used in the management of early onset scoliosis. However, in order to preserve spine growth and control the deformity it requires frequent surgeries to distract the rods. Magnetically driven growing rods have recently been introduced with same treatment goal, but without the inconvenience of repeated surgical distractions. One of the limitations of this technical advance is an increase in radiation exposure due to the increase in distraction frequency compared to conventional growing rods. An improvement of the original technique is presented, proposing a solution to the inconvenience of multiple radiation exposure using ultrasound technology to control the distraction process of magnetically driven growing rods.

A new role of SNAI2 in postlactational involution of the mammary gland links it to luminal breast cancer development.

Breast cancer is a major cause of mortality in women. The transcription factor SNAI2 has been implicated in the pathogenesis of several types of cancer, including breast cancer of basal origin. Here we show that SNAI2 is also important in the development of breast cancer of luminal origin in MMTV-ErbB2 mice. SNAI2 deficiency leads to longer latency and fewer luminal tumors, both of these being characteristics of pretumoral origin. These effects were associated with reduced proliferation and a decreased ability to generate mammospheres in normal mammary glands. However, the capacity to metastasize was not modified. Under conditions of increased ERBB2 oncogenic activity after pregnancy plus SNAI2 deficiency, both pretumoral defects-latency and tumor load-were compensated. However, the incidence of lung metastases was dramatically reduced. Furthermore, SNAI2 was required for proper postlactational involution of the breast. At 3 days post lactational involution, the mammary glands of Snai2-deficient mice exhibited lower levels of pSTAT3 and higher levels of pAKT1, resulting in decreased apoptosis. Abundant noninvoluted ducts were still present at 30 days post lactation, with a greater number of residual ERBB2+ cells. These results suggest that this defect in involution leads to an increase in the number of susceptible target cells for transformation, to the recovery of the capacity to generate mammospheres and to an increase in the number of tumors. Our work demonstrates the participation of SNAI2 in the pathogenesis of luminal breast cancer, and reveals an unexpected connection between the processes of postlactational involution and breast tumorigenesis in Snai2-null mutant mice.

Análisis del síndrome Inestable-Doloroso de la articulación subastragalina mediante el sistema estrés dinámico BaroPodoTAC / Analysis of Unstable-painful Subtalar Joint Syndrome using Dynamic Stress System CT scan

Introducción: La inestabilidad de tobillo y de retropié coexisten frecuentemente sin que existan en la actualidad métodos objetivos no quirúrgicos para su diagnóstico diferencial. Además, la inestabilidad y el dolor en la articulación subastragalina pueden desembocar en la temida artrosis de retropié en pacientes de cualquier edad. El presente trabajo tiene como propósito principal comparar el rango de movilidad del retropié sintomático respecto al retropié sano en una serie consecutiva de pacientes afectos de inestabilidad de tobillo. Material y Método: Se diseñó un dispositivo que simula condiciones de carga con movimientos extremos de la articulación subastragalina sobre la mesa de TAC (Estrés-BaroPodo-TAC). Se realizó TAC en carga y en dos posiciones extremas de inversión-rotación interna y eversión-rotación externa sobre 26 pies de 13 pacientes diagnosticados de inestabilidad crónica de tobillo. Se midieron los ángulos de divergencia y flexión astrágalo-calcánea en las dos posiciones mencionadas y se calculó el rango de movimiento total. Se comparó el retropié problema con el retropié sano en cada paciente. Resultados: Los pies problemas presentaron mayor rango de movilidad de divergencia astrágalo-calcáneo que los pies sanos de los pacientes. No hubo diferencias en el rango de movilidad de flexión astrágalo-calcáneo. No se correlacionó estadísticamente el movimiento de divergencia en el plano axial con el movimiento de flexión astrágalo-calcánea en el plano sagital. Conclusión: Mediante este método se midió objetivamente mediante TAC el rango de movimiento de la articulación subastragalina. Los pacientes con inestabilidad de tobillo y dolor en retropié presentaron mayor rango de movilidad en la articulación subastragalina en el retropié doloroso respecto al contralateral (AU)

Introduction: In many cases, unstable ankle and heel coexist without there currently being any objective, non-surgical method for a differential diagnosis. Moreover, instability and pain in the subtalar joint could deteriorate into the so dreaded osteoarthritis of the heel in patients of any age. The main objective of this work is to compare the movement range of a symptomatic heel with regards to a healthy heel in a consecutive series of patients affected with ankle instability. Material and method: A device was designed to simulate weight-bearing conditions with extreme subtalar joint movement on the CAT scan examination table (Estrés-BaroPodo-TAC). A CAT scan was performed during weight-bearing and in two extreme positions of internal inversion rotation and external eversion rotation of 26 feet in 13 patients, all diagnosed with chronic, unstable ankle. The divergence and flexion of heel angles in the two positions mentioned and the total movement range was calculated. The heel problem was compared with the healthy heel in each patient. Results: The problem foot presented a greater range of heel divergence mobility than the patient’s healthy foot. There were no differences in the mobility range for heel flexion. The divergence of movement in the axial plane was not statistically correlated with the heel flexion movement in the sagittal plane. Conclusion: With this method, we objectively measured the movement range of the heel joint, using CAT scan. Patients with unstable ankle and heel pain presented a greater range of movement in the heel joint of the painful heel with respect to the contralateral movement (AU)

Early growth hormone (GH) treatment promotes relevant motor functional improvement after severe frontal cortex lesion in adult rats.

A number of studies, in animals and humans, describe the positive effects of the growth hormone (GH) treatment combined with rehabilitation on brain reparation after brain injury. We examined the effect of GH treatment and rehabilitation in adult rats with severe frontal motor cortex ablation. Thirty-five male rats were trained in the paw-reaching-for-food task and the preferred forelimb was recorded. Under anesthesia, the motor cortex contralateral to the preferred forelimb was aspirated or sham-operated. Animals were then treated with GH (0.15 mg/kg/day, s.c) or vehicle during 5 days, commencing immediately or 6 days post-lesion. Rehabilitation was applied at short- and long-term after GH treatment. Behavioral data were analized by ANOVA following Bonferroni post hoc test. After sacrifice, immunohistochemical detection of glial fibrillary acid protein (GFAP) and nestin were undertaken in the brain of all groups. Animal group treated with GH immediately after the lesion, but not any other group, showed a significant improvement of the motor impairment induced by the motor lesion, and their performances in the motor test were no different from sham-operated controls. GFAP immunolabeling and nestin immunoreactivity were observed in the perilesional area in all injured animals; nestin immunoreactivity was higher in GH-treated injured rats (mainly in animals GH-treated 6 days post-lesion). GFAP immunoreactivity was similar among injured rats. Interestingly, nestin re-expression was detected in the contralateral undamaged motor cortex only in GH-treated injured rats, being higher in animals GH-treated immediately after the lesion than in animals GH-treated 6 days post-lesion. Early GH treatment induces significant recovery of the motor impairment produced by frontal cortical ablation. GH effects include increased neurogenesis for reparation (perilesional area) and for increased brain plasticity (contralateral motor area).

El trasplante de astrocitos encapsulados mejoran el déficit motor en la habilidad manual producido por la lesión de la corteza frontal en ratas adultas / Transplant of encapsulated astrocyte ameliorate lesion-induced motor deficits in adults rats with frontal cortex injury

Objetivo: Investigar la capacidad de trasplantes de astrocitos encapsulados en esferas de alginato de recuperar el déficit en la habilidad manual producida por la lesión de la corteza frontal, en ratas adultas. Material y metodología: Se utilizaron ratas Wistar, y se emplearon pruebas conductuales, cultivos celulares, técnica de encapsulación de células y trasplantes. Los animales se condicionaron en un test de habilidad motora fina y se determinó su mano preferente. Se lesionó la corteza frontal contralateral a la mano preferente y se evaluó la efectividad de la lesión mediante el test de conducta. En un grupo de animales lesionados se trasplantó astrocitos encapsulados en esferas de alginato en la cavidad producida por la lesión; en un segundo grupo, se trasplantó tejido cortical fetal; y en un tercer grupo, se implantó esferas de alginato sin células. Resultados: A los tres meses post-trasplante, tanto los animales con trasplantes de astrocitos encapsulados como con trasplantes de tejido cortical mejoraron el déficit motor inducido por la lesión. Los animales con trasplantes de esferas de alginato vacías no experimentaron mejoría. Conclusión: Los trasplantes de astrocitos encapsulados mejoran, a largo plazo, el deficit motor. El alginato indujo efectos secundarios en el huésped (AU)

Objetive: To investigate whether transplants of encapsulated astrocytes in alginate spheres were able to recover the deficit in motor skills produced by frontal cortex lesion, in adult rats. Material and method: Male Wistar rats were used. Behavioral test, tissue culture, astrocyte transplants and immunocytochemical and histological techniques were applied. Animals were conditioned in a paw reaching for food task and the preferred paw determine. Lesion was produced in the frontal cortex contralateral to the preferred paw and the effectiveness of the lesion tested. In one group of lesion animals, encapsulated astrocytes in alginate spheres were implanted in the lesion cavity; in a second group, fetal cortical tissue was used as donor material; while in a third group empty alginate spheres were implanted. Results: Three months after grafting, the rats with encapsulated astrocyte or with fetal cortical tissue transplants ameliorated the lesion-induced motor deficit.The rats with implant of empty alginate spheres showed no improvement. Conclusion: Transplants of encapsulated astrocytes in alginate spheres induce a long- term improvement of motor lesion deficits. The alginate induced long-term side effects on the host (AU)

Periadolescent ethanol exposure reduces adult forebrain ChAT+IR neurons: correlation with behavioral pathology.

Substance abuse typically begins in adolescence; therefore, the impact of alcohol during this critical time in brain development is of particular importance. Epidemiological data indicate that excessive alcohol consumption is prevalent among adolescents and may have lasting neurobehavioral consequences. Loss of cholinergic input to the forebrain has been demonstrated following fetal alcohol exposure and in adults with Wernicke-Korsakoff syndrome. In the present study, immunohistochemistry for choline acetyltransferase (ChAT) was determined to assess forebrain cholinergic neurons (Ch1-4), and behavioral changes following periadolescent alcohol exposure. Wistar rats were exposed to intermittent ethanol vapor (14 h on/10 h off/day) for 35 days from postnatal day (PD) 22 to PD 57 (average blood alcohol concentration (BAC): 163 mg%). Rats were withdrawn from vapor and assessed for locomotor activity, startle response, conflict behavior in the open field, and immobility in the forced swim test, as adults. Rats were then sacrificed at day 71/72 and perfused for histochemical analyses. Ethanol vapor-exposed rats displayed: increased locomotor activity 8 h after the termination of vapor delivery for that 24 h period at day 10 and day 20 of alcohol vapor exposure, significant reductions in the amplitude of their responses to prepulse stimuli during the startle paradigm at 24 h withdrawal, and at 2 weeks following withdrawal, less anxiety-like and/or more "disinhibitory" behavior in the open field conflict, and more immobility in the forced swim test. Quantitative analyses of ChAT immunoreactivity revealed a significant reduction in cell counts in the Ch1-2 and Ch3-4 regions of the basal forebrain in ethanol vapor-exposed rats. This reduction in cell counts was significantly correlated with less anxiety-like and/or more "disinhibitory" behavior in the open field conflict test. These studies demonstrate that behavioral measures of arousal, affective state, disinhibitory behavior, and ChAT+IR, are all significantly impacted by periadolescent ethanol exposure and withdrawal in Wistar rats.

Quantitative assessment of serum free light chains in renal transplantation.

Plasma cell dyscrasias can cause renal disease. Sensitive methods have recently been introduced to quantify serum free light chains (sFLCs). Renal function may influence the variability of these methods, as shown in chronic kidney disease (CKD) patients, but this problem has not been widely addressed in renal transplant patients. Herein, we examined the association between polyclonal sFLC concentrations and renal function among a population of renal transplant patients. We studied 102 kidney allograft recipients and 53 CKD patients classified according to KDOQI (Kidney Disease Outcomes Quality Initiative) stages. None of them had been diagnosed with monoclonal gammopathy. sFLCs were quantified by nephelometry. Both serum κ and λ free light chain concentrations rose progressively through each stage of KDOQI among both transplant and nontransplant patients (P<.0001). In the former setting, sFLC concentrations significantly correlated, using a Spearman coefficient, with serum creatinine, and serum cystatin concentrations as well as estimated glomerular filtration rate: namely, 0.723, 0.797, and -0.711 for sκFLC and 0.705, 0.759, and -0.694 for sλFLC, respectively (P<.0001 in all cases). Spearman correlation coefficients in nontransplant patients were: 0.559, 0.848, and -0.766 for sκFLC and 0.702, 0.875, and -0.855 for sλFLC, respectively (P<.0001 in all cases). In conclusion, sFLCs must be interpreted cautiously due to their clear association with renal function. Therefore, renal transplantation did not produce changes that were different from those dependent on renal function.

Number of peripheral blood regulatory T cells and lymphocyte activation at 3 months after conversion to mTOR inhibitor therapy.

BACKGROUND: Mammalian target of rapamycin (mTOR) inhibitors are effective for induction and maintenance of regulatory T cells (Tregs). OBJECTIVE: To assess the effects of conversion from calcineurin inhibitors (CNIs) to mTOR on the number of circulating Tregs and lymphocyte activation. PATIENTS AND METHODS: In 18 renal transplant recipients receiving CNI therapy (cyclosporine in 9, and tacrolimus in 9), treatment was converted to mTOR inhibitors (everolimus in 14, and rapamycin in 4). Peripheral blood samples were obtained before and 3 months after conversion. The number of circulating Tregs was measured using flow cytometry, and defined as CD4+/CD25high/CD127low/CD27+/CD62L+/CD45RO+/Foxp3+. Lymphocyte activation was assessed indirectly according to production of intracellular adenosine triphosphate (iATP) on polyclonal activation using a phytohemaglutinin assay (Immuknow; Cylex, Inc, Columbia, Maryland). RESULTS: In 15 patients (83.3%), the absolute number of Tregs increased significantly (P=.001) after conversion (median, 16.35 cells/mm3; 95% confidence interval [CI], 13.97-21.94) vs 3 months after conversion (32.03 cells/mm3; 95% CI, 26.25-41.66). The iATP production decreased from 326 ng/mL (95% CI, 302-419) to 248 ng/mL (95% CI, 196-318; P=.02), and increased in 4 patients (22.22%). No significant correlation was demonstrated between Treg concentration and change in iATP production. No rejection episodes were reported during follow-up. CONCLUSIONS: Despite the small number of patients in whom therapy was converted from CNI inhibitors to mTOR inhibitors, the data suggest an increase in the absolute number of Tregs after conversion. In addition, the concentration of activated peripheral CD4+ T cells decreased to nearly that associated with risk of infection due to overimmunosuppression.

Kidney transplant recipients show an increase in the ratio of T-cell effector memory/central memory as compared to nontransplant recipients on the waiting list.

Studies of allotolerance in animal models do not usually consider the presence of preexisting memory T cells and activated immune status. However, humans are exposed throughout life to a multitude of external agents that enhance the immune memory. In this article, we consider the effect that a previous kidney transplant has on the number of regulatory T cells (Tregs), effector memory T cells (TEM), and central memory T cells (TCM). Sixty-three patients with end-stage renal disease were studied just before being transplanted (51 first transplants and 12 retransplants). The numbers of Tregs (CD4+ CD25highCD127lowCD27+CD62L+CD45RO+FOXP3+), TEM (CD3+CD45RO+CD62L+), and TCM (CD3+CD45RO+CD62L-) cell subsets were quantified in peripheral blood by flow cytometry. The absolute number of Tregs was slightly lower in patients with previous allografts (median, 95% confidence interval [CI]: 16.7 cells/mm3, 12-20.5) than in those who received their first transplants (median, 95% CI: 19.6 cells/mm3, 19.3-29.6; P-NS). Clearer differences were found with the number of CD3+ TCM, since the transplanted patients had lower numbers (238 cells/mm3, 153-323) than those who had not yet received transplants (378 cells/mm3, 317-439; P=.029). As a result, the TEM/TCM ratios of both CD4+ and CD8+ T cells in patients with previous allografts were higher than in those who received first transplants. In conclusion, the assessment of just the number of Tregs in renal transplant patients is not enough and must be read together with the number of TEM and TCM. The TEM:TCM ratio increases in patients with previous allografts, probably due to activation of the immune response in renal transplantation.

N-methyl-D-aspartate receptor subunit expression in adult and adolescent brain following chronic ethanol exposure.

Substantial evidence suggests that glutamatergic neurotransmission is a critical mediator of the experience-dependent synaptic plasticity that may underlie alcohol dependence. Substance abuse typically begins in adolescence; therefore, the impact of alcohol on glutamatergic systems during this critical time in brain development is of particular importance. The N-methyl-d-aspartate receptor (NMDAR) is involved in developmental mechanisms underlying neuronal differentiation and synaptogenesis and as such may be a target system for alcohol effects during adolescence. In the present study quantitative biochemical determinations were made of the relative abundance of different protein expressions of NMDAR subunits in adolescents and adults after 2 weeks of ethanol vapor exposure, and 24 h and 2 weeks following withdrawal. After 2 weeks of ethanol vapor exposure N-methyl-d-aspartate receptor NR1 subunit (NR1), N-methyl-d-aspartate receptor NR2A subunit (NR2A), and N-methyl-d-aspartate receptor NR2B subunit (NR2B) subunit expression was found to be increased in hippocampus of the adults. In contrast, 2 weeks of ethanol exposure resulted in no significant changes in NR1 and NR2B subunits and a reduction NR2A subunit expression in hippocampus in adolescents. Twenty-four h and 2 weeks following withdrawal from ethanol vapor NR1 and NR2A subunit expression in hippocampus was decreased in adolescents, whereas in adults it had returned to control levels. In frontal cortex, 2 weeks of chronic ethanol exposure produced decreases in NR1 subunit expression in both adults and adolescents but also produced decreases in NR2A and NR2B subunit expression in adults that returned or exceeded control levels by 2 weeks following withdrawal from ethanol vapor. These results demonstrate that NMDAR subunit composition can be modulated differentially between adolescents and adults by chronic ethanol exposure and withdrawal. These developmental differences in NMDAR subunits composition may also be associated with the enhanced vulnerability of the adolescent brain to ethanol dependence.

Human follicular fluid from superovulated women inhibits progesterone receptor-dependent gonadotropin-releasing hormone self-priming in an estrous cycle-dependent manner in the rat.

These experiments investigated the involvement of gonadotrope progesterone receptor (PR) in the effects of the putative gonadotropin surge-attenuating factor (GnSAF) on gonadotropin (LH and FSH) secretion. Human follicular fluids (hFF) used in this study were aspirated from follicles in gonadotropin-treated women for in vitro fertilization. Samples were subjected to two-fold charcoal extraction of steroid hormones and two-fold inhibin immunoprecipitation. Gonadotropin secretion parameters were assessed by specific radioimmunoassays. In the first experiment, the effects of hFF on both basal and GnRH-stimulated gonadotropin secretion and GnRH self-priming were studied in incubated hemipituitaries from rats on each day of the 4-day estrous cycle. hFF inhibited only GnRH self-priming in pituitaries from rats in diestrus. In the second experiment, immunohistochemical PR expression and action were evaluated in pituitaries from rats in diestrus. PR-positive (PR10A9 antibody) gonadotropes were detected (4-5/field 40x), and antiprogestins added to the incubation media blocked the ligand-independent (GnRH) activation of PR effects on GnRH selfpriming. Finally, the third experiment evaluated the effects of hFF on P-induced potentiation of GnRH-stimulated LH secretion. GnSAF bioactivity, as evidenced by inhibition of PR-induced potentiation of GnRH-stimulated LH secretion, was found in diestrous pituitaries incubated with hFF. The results indicate that GnSAF attenuated GnRH-dependent LH secretion in diestrus through the inhibition of PR-dependent GnRH self-priming.

Comparison between two methods of defining heat waves: a retrospective study in Castile-La Mancha (Spain).

INTRODUCTION: Following the 2003 heat wave, many European countries implemented heat-wave prevention plans. A number of aspects can prove fundamental in determining the effectiveness of such plans, and of these we sought to analyse the criteria used to define threshold temperatures and trigger a higher level of intervention. METHOD: Retrospective study of the days on which heat-wave thresholds were exceeded during the period 1974-2003 was conducted. We compared when and at what level the heat-wave prevention plan would have been activated using a statistical-meteorological criterion (as applied by the Spanish Ministry of Health & Consumer Affairs) versus a temperature-mortality criterion. RESULTS: The number of days on which the threshold was exceeded was far higher when the temperature-mortality criterion was applied. The temperature percentile at which a heat wave occurred was different for each province analysed and was inversely proportional to its respective ageing index. Using both criteria, there was an increase in heat-wave days per decade. CONCLUSION: The establishment of a heat-wave threshold temperature must be based on knowledge of the cause-effect relationship between temperature and the health of a given population. Mortality is an appropriate indicator of population health. The future effects of climate change render it essential for this relationship to be studied on a local scale, so as to enable truly efficient prevention plans to be drawn up.