Parálisis facial, la importancia de realizar una buena historia clínica / Facial palsy, the importance of taking a good medical history

La parálisis facial plantea un diagnóstico diferencial amplio en Pediatría, sobre todo cuando se acompaña de sintomatología que orienta en contra de una parálisis de Bell, por lo que resulta imprescindible realizar una correcta anamnesis. La enfermedad de Lyme es una de las posibles causas de parálisis facial, habiendo sido poco descrita en niños en España. Presentamos el caso de un varón de 11 años con diagnóstico de parálisis facial asociada a infección por B. burgdorferi con evolución favorable tras tratamiento con doxiciclina. (AU)

Facial palsy poses a wide differential diagnosis in pediatrics, especially when it is accompanied by symptoms that make it doubtful whether Bell's palsy is present. It is essential to perform a correct anamnesis to rule out diagnoses that require early detection and treatment to improve the prognosis. Lyme disease (EL) is one of the possible causes of facial palsy, having been seldom described in children in Spain. We present the case of an 11-years-old male with diagnosis of facial palsy associated with B. burgdorferi infection with favorable evolution after treatment with doxycycline. (AU)

Evaluation of Bioactive Effects of Five Plant Extracts with Different Phenolic Compositions against Different Therapeutic Targets.

Plant extracts rich in phenolic compounds have been reported to exert different bioactive properties. Despite the fact that there are plant extracts with completely different phenolic compositions, many of them have been reported to have similar beneficial properties. Thus, the structure-bioactivity relationship mechanisms are not yet known in detail for specific classes of phenolic compounds. In this context, this work aims to demonstrate the relationship of extracts with different phenolic compositions versus different bioactive targets. For this purpose, five plant matrices (Theobroma cacao, Hibiscus sabdariffa, Silybum marianum, Lippia citriodora, and Olea europaea) were selected to cover different phenolic compositions, which were confirmed by the phytochemical characterization analysis performed by HPLC-ESI-qTOF-MS. The bioactive targets evaluated were the antioxidant potential, the free radical scavenging potential, and the inhibitory capacity of different enzymes involved in inflammatory processes, skin aging, and neuroprotection. The results showed that despite the different phenolic compositions of the five matrices, they all showed a bioactive positive effect in most of the evaluated assays. In particular, matrices with very different phenolic contents, such as T. cacao and S. marianum, exerted a similar inhibitory power in enzymes involved in inflammatory processes and skin aging. It should also be noted that H. sabdariffa and T. cacao extracts had a low phenolic content but nevertheless stood out for their bioactive antioxidant and anti-radical capacity. Hence, this research highlights the shared bioactive properties among phenolic compounds found in diverse matrices. The abundance of different phenolic compound families highlights their elevated bioactivity against diverse biological targets.

Neuroprotection with Bioactive Compounds.

Bioactive compounds are found in foods in small quantities and represent extra nutritional constituents known to exert beneficial effects on health beyond their nutritional value [...].

Automated spatial localization of ankle muscle sites and model-based estimation of joint torque post-stroke via a wearable sensorised leg garment.

Assessing a patient's musculoskeletal function during over-ground walking is a primary objective in post-stroke rehabilitation, due to the importance of walking recovery for everyday life. However, the quantitative assessment of musculoskeletal function currently requires lab-constrained equipment, and labor-intensive analyses, which hampers assessment in standard clinical settings. The development of fully wearable systems for the online estimation of muscle-tendon forces and resulting joint torque would aid clinical assessment of motor recovery, it would enhance the detection of neuro-muscular anomalies and it would consequently enable highly personalized treatments. Here, we present a wearable technology that combines (1) a soft garment for the human leg sensorized with 64 flexible and dry electromyography (EMG) electrodes, (2) a generalized and automated algorithm for the localization of leg muscle sites, and (3) an EMG-driven musculoskeletal modeling framework for the estimation of ankle dorsi-plantar flexion torques. Our results showed that the automated clustering algorithm could detect muscle locations in both healthy and post-stroke individuals. The estimated muscle-specific EMG envelopes could be used to drive forward person-specific musculoskeletal models and estimate resulting joint torques accurately across all healthy and post-stroke individuals and across different walking speeds (R2  > 0.82 and RMSD  < 0.16). The technology we proposed opens new avenues for automated muscle localization and quantitative musculoskeletal function assessment during gait in both healthy and neurologically impaired individuals.

Interactive Temperature and CO2 Rise, Salinity, Drought, and Bacterial Inoculation Alter the Content of Fatty Acids, Total Phenols, and Oxalates in the Edible Halophyte Salicornia ramosissima.

In this work, we studied the combined effect of increased temperature and atmospheric CO2, salt and drought stress, and inoculation with plant-growth-promoting rhizobacteria (PGPR) on the growth and some nutritional parameters of the edible halophyte Salicornia ramosissima. We found that the increase in temperature and atmospheric CO2, combined with salt and drought stresses, led to important changes in S. ramosissima fatty acids (FA), phenols, and oxalate contents, which are compounds of great importance for human health. Our results suggest that the S. ramosissima lipid profile will change in a future climate change scenario, and that levels of oxalate and phenolic compounds may change in response to salt and drought stress. The effect of inoculation with PGPR depended on the strains used. Some strains induced the accumulation of phenols in S. ramosissima leaves at higher temperature and CO2 while not altering FA profile but also led to an accumulation of oxalate under salt stress. In a climate change scenario, a combination of stressors (temperature, salinity, drought) and environmental conditions (atmospheric CO2, PGPR) will lead to important changes in the nutritional profiles of edible plants. These results may open new perspectives for the nutritional and economical valorization of S. ramosissima.

A Review on Polyphenols in Salicornia ramosissima with Special Emphasis on Their Beneficial Effects on Brain Ischemia.

There has been an increasing interest in the consumption of halophytes as a healthy food in the last few years. Salicornia ramosissima is a seasonal Mediterranean halophyte with an interesting profile of bioactive compounds, including more than 60 identified polyphenols with a broad range of biological activities. Accumulating evidence supports the role of dietary polyphenols in the prevention of cardiovascular diseases, such as stroke. Stroke is the second cause of death worldwide and it is estimated that a substantial proportion of stroke incidence and recurrence may be prevented by healthier dietary patterns. Here, we have grouped the phenolic acids and flavonoids identified in S. ramosissima and reviewed their potential protective effect on brain ischemia, which are mostly related to the reduction of oxidative stress and inflammation, the inhibition of cell death pathways and their role in the preservation of the vascular function. Despite the fact that most of these compounds have been reported to be neuroprotective through multiple mechanisms, human studies are still scarce. Given the safe profile of polyphenols identified in S. ramosissima, this halophyte plant could be considered as a source of bioactive compounds for the nutraceutical industry.

Using Metal-Organic Framework HKUST-1 for the Preparation of High-Conductive Hybrid Membranes Based on Multiblock Copolymers for Fuel Cells.

Novel proton-conducting hybrid membranes consisting of sulfonated multiblock copolymer of polysulfone and polyphenylsulfone (SPES) reinforced with a HKUST-1 metal-organic framework (MOF) (5, 10, and 20 wt. %) were prepared and characterized for fuel cell applications. The presence of the MOF in the copolymer was confirmed by means of FE-SEM and EDS. The hybrid membranes show a lower contact angle value than the pure SPES, in agreement with the water uptake (WU%), i.e., by adding 5 wt. % of the MOF, this parameter increases by 20% and 40% at 30 °C and 60 °C, respectively. Additionally, the presence of the MOF increases the ion exchange capacity (IEC) from 1.62 to 1.93 mequivH+ g−1. Thermogravimetric analysis reveals that the hybrid membranes demonstrate high thermal stability in the fuel cell operation temperature range (<100 °C). The addition of the MOF maintains the mechanical stability of the membranes (TS > 85 MPa in the Na+ form). Proton conductivity was analyzed using EIS, achieving the highest value with a 5 wt. % load of the HKUST-1. This value is lower than that observed for the HKUST-1/Nafion system. However, polarization and power density curves show a remarkably better performance of the hybrid membranes in comparison to both the pure SPES and the pure Nafion membranes.

Cannabidiol markedly alleviates skin and liver fibrosis.

Cannabidiol (CBD) has been suggested as a potential therapy for inflammatory and fibrotic diseases. Cannabidiol was demonstrated to reduce alcohol-induced liver inflammation and steatosis but its specific activity on the fibrotic process was not investigated. Herein, the antifibrotic effects of cannabidiol in the skin were analysed in vitro using NIH-3T3 fibroblasts and human dermal fibroblasts and in vivo using the bleomycin-induced model of skin fibrosis. In a second model, non-alcoholic liver fibrosis was induced in mice by CCl4 exposure. Cannabidiol was administered daily, intraperitoneally in mice challenged with bleomycin and orally in CCl4 mice, and skin and liver fibrosis and inflammation were assessed by immunochemistry. Cannabidiol inhibited collagen gene transcription and synthesis and prevented TGFß-and IL-4 induced fibroblast migration. In the bleomycin model, cannabidiol prevented skin fibrosis and collagen accumulation around skin blood vessels, and in the CCl4 model cannabidiol significantly attenuated liver fibrosis measured by picrosirius red and Tenascin C staining and reduced T cell and macrophage infiltration. Altogether, our data further support the rationale of the medicinal use of this cannabinoid, as well as cannabis preparations containing it, in the management of fibrotic diseases including Systemic Sclerosis and Non-Alcoholic Fatty Liver Disease.

Clinical Characteristics of Omicron (B.1.1.529) Variant in Children: A Multicenter Study in Spain

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Hypoxia Tolerant Species: The Wisdom of Nature Translated into Targets for Stroke Therapy.

Human neurons rapidly die after ischemia and current therapies for stroke management are limited to restoration of blood flow to prevent further brain damage. Thrombolytics and mechanical thrombectomy are the available reperfusion treatments, but most of the patients remain untreated. Neuroprotective therapies focused on treating the pathogenic cascade of the disease have widely failed. However, many animal species demonstrate that neurons can survive the lack of oxygen for extended periods of time. Here, we reviewed the physiological and molecular pathways inherent to tolerant species that have been described to contribute to hypoxia tolerance. Among them, Foxo3 and Eif5A were reported to mediate anoxic survival in Drosophila and Caenorhabditis elegans, respectively, and those results were confirmed in experimental models of stroke. In humans however, the multiple mechanisms involved in brain cell death after a stroke causes translation difficulties to arise making necessary a timely and coordinated control of the pathological changes. We propose here that, if we were able to plagiarize such natural hypoxia tolerance through drugs combined in a pharmacological cocktail it would open new therapeutic opportunities for stroke and likely, for other hypoxic conditions.

Foramina parietalia permagna: evaluación clínico radiológica de una familia española con mutación no descrita en el gen ALX4 / Foramina parietalia permagna: Clinical radiological evaluation of a Spanish family with an undescribed mutation in the Alx4 gene

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Sulfonated Polysulfone/TiO2(B) Nanowires Composite Membranes as Polymer Electrolytes in Fuel Cells.

New proton conducting membranes based on sulfonated polysulfone (sPSU) reinforced with TiO2(B) nanowires (1, 2, 5 and 10 wt.%) were synthesized and characterized. TiO2(B) nanowires were synthesized by means of a hydrothermal method by mixing TiO2 precursor in aqueous solution of NaOH as solvent. The presence of the TiO2(B) nanowires into the polymer were confirmed by means of Field Emission Scanning Electron Microscopy, Fourier transform infrared and X-ray diffraction. The thermal study showed an increase of almost 20 °C in the maximum temperature of sPSU backbone decomposition due to the presence of 10 wt.% TiO2(B) nanowires. Water uptake also is improved with the presence of hydrophilic TiO2(B) nanowires. Proton conductivity of sPSU with 10 wt.% TiO2(B) nanowires was 21 mS cm-1 (at 85 °C and 100% RH). Under these experimental conditions the power density was 350 mW cm-2 similar to the value obtained for Nafion 117. Considering all these obtained results, the composite membrane doped with 10 wt.% TiO2(B) nanowires is a promising candidate as proton exchange electrolyte in fuel cells (PEMFCs), especially those operating at high temperatures.

Environmental Conditions of Dance Rooms and Its Impact on Dance Conservatories Teachers' Health (An Andalusian Study).

Dance teachers have to be in long hours dancing. That entails repetitive movements, loud live music, and as well as forcing their voices. These demands can implicate severe health problems and other kind of illness as discomfort, stress, etc. However, the Spanish Ministry of Health only recognize as professional disease for this line of work, the vocal nodules. For this reason, this research studies the health problems in dance teachers in Andalusia, correlating the results of a survey carried out in different conservatories from Andalusia with measurement of noise emissions levels, assessment of noise exposure, and assessment of thermal environment in the classes measuring the thermal environment variables. To the authors' knowledge, this is the first study where the influence of several sounds, such as tapping, castanets, and live music, on the health of dance teachers, musicians, and singers during flamenco classes has been researched. Results showed a correlation between some diseases, such as stress and the high level of sound in the classes. The sound levels were well above those established by European regulations reaching values higher than 85 dB(A) as equivalent continuous sound levels during the class time. This European regulation is stablished for an 8 h/day period, five days per week. The thermal environments are no adequate for this activity, mainly for high temperatures in Cordoba during summer. To improve the current working conditions, some recommendations were given to reduce the number of class hours and establish rest shifts, provide more information on health risks, or renovate the floor of some classrooms.

Phase Transformation Dynamics in Sulfate-Loaded Lanthanide Triphosphonates. Proton Conductivity and Application as Fillers in PEMFCs.

Phase transformation dynamics and proton conduction properties are reported for cationic layer-featured coordination polymers derived from the combination of lanthanide ions (Ln3+) with nitrilo-tris(methylenephosphonic acid) (H6NMP) in the presence of sulfate ions. Two families of materials are isolated and structurally characterized, i.e., [Ln2(H4NMP)2(H2O)4](HSO4)2·nH2O (Ln = Pr, Nd, Sm, Eu, Gd, Tb, Er, Yb; n = 4-5, Series I) and [Ln(H5NMP)]SO4·2H2O (Ln = Pr, Nd, Eu, Gd, Tb; Series II). Eu/Tb bimetallic solid solutions are also prepared for photoluminescence studies. Members of families I and II display high proton conductivity (10-3 and 10-2 S·cm-1 at 80 °C and 95% relative humidity) and are studied as fillers for Nafion-based composite membranes in PEMFCs, under operating conditions. Composite membranes exhibit higher power and current densities than the pristine Nafion membrane working in the range of 70-90 °C and 100% relative humidity and with similar proton conductivity.

Neuroprotection with the cannabigerol quinone derivative VCE-003.2 and its analogs CBGA-Q and CBGA-Q-Salt in Parkinson's disease using 6-hydroxydopamine-lesioned mice.

The quinone derivative of the non-psychotropic cannabinoid cannabigerol (CBG), so-called VCE-003.2, has been recently investigated for its neuroprotective properties in inflammatory models of Parkinson's disease (PD) in mice. Such potential derives from its activity at the peroxisome proliferator-activated receptor-γ (PPAR-γ). In the present study, we investigated the neuroprotective properties of VCE-003.2 against the parkinsonian neurotoxin 6-hydroxydopamine (6-OHDA), in comparison with two new CBG-related derivatives, the cannabigerolic acid quinone (CBGA-Q) and its sodium salt CBGA-Q-Salt, which, similarly to VCE-003.2, were found to be active at the PPAR-γ receptor, but not at the cannabinoid CB1 and CB2 receptors. First, we investigated their cytoprotective properties in vitro by analyzing cell survival in cultured SH-SY5Y cells exposed to 6-OHDA. We found an important cytoprotective effect of VCE-003.2 at a concentration of 20 µM, which was not reversed by the blockade of PPAR-γ receptors with GW9662, supporting its activity at an alternative site (non-sensitive to classic antagonists) in this receptor. We also found CBGA-Q and CBGA-Q-Salt being cytoprotective in this cell assay, but their effects were completely eliminated by GW9662, thus indicating that they are active at the canonical site in the PPAR-γ receptor. Then, we moved to in vivo testing using mice unilaterally lesioned with 6-OHDA. Our data confirmed that VCE-003.2 administered orally (20 mg/kg) preserved tyrosine hydroxylase (TH)-positive nigral neurons against 6-OHDA-induced damage, whereas it completely attenuated the astroglial (GFAP) and microglial (CD68) reactivity found in the substantia nigra of lesioned mice. Such neuroprotective effects caused an important recovery in the motor deficiencies displayed by 6-OHDA-lesioned mice in the pole test and the cylinder rearing test. We also investigated CBGA-Q, given orally (20 mg/kg) or intraperitoneally (10 mg/kg, i.p.), having similar benefits compared to VCE-003.2 against the loss of TH-positive nigral neurons, glial reactivity and motor defects caused by 6-OHDA. Lastly, the sodium salt of CBGA-Q, given orally (40 mg/kg) to 6-OHDA-lesioned mice, also showed benefits at behavioral and histopathological levels, but to a lower extent compared to the other two compounds. In contrast, when given i.p., CBGA-Q-Salt (10 mg/kg) was poorly active. We also analyzed the concentrations of dopamine and its metabolite DOPAC in the striatum of 6-OHDA-lesioned mice after the treatment with the different compounds, but recovery in the contents of both dopamine and DOPAC was only found after the treatment with VCE-003.2. In summary, our data confirmed the neuroprotective potential of VCE-003.2 in 6-OHDA-lesioned mice, which adds to its previous activity found in an inflammatory model of PD (LPS-lesioned mice). Additional phytocannabinoid derivatives, CBGA-Q and CBGA-Q-Salt, also afforded neuroprotection in 6-OHDA-lesioned mice, but their effects were lower compared to VCE-003.2, in particular in the case of CBGA-Q-Salt. In vitro studies confirmed the relevance of PPAR-γ receptors for these effects.

Eficacia del retiro quirúrgico de Essure para el alivio del dolor pélvico: serie de casos / Surgical removal of the Essure device as a response to pelvic pain: case series

Resumen OBJETIVO: Evaluar la eficacia del retiro quirúrgico del Essure como medida para aliviar el dolor pélvico ocasionado, presuntamente, por este dispositivo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo de una serie de casos. Se revisaron las historias clínicas de las pacientes atendidas entre el 1 de enero de 2016 y el 15 de agosto de 2018 en el Complexo Hospitalario Universitario de Ourense para la extracción quirúrgica del dispositivo Essure. Parámetros de estudio: datos demográficos, historial médico, información de la inserción, características del dolor, tipo de intervención, hallazgos durante la intervención y posoperatorios. Los datos se analizaron con el programa SPSS, versión 24 para Windows. RESULTADOS: Se intervinieron 11 pacientes y 7 de ellas tuvieron dolor abdominal después de la colocación del dispositivo, con una tardanza media de aparición de 3.75 años. La técnica quirúrgica más practicada fue la salpingectomía bilateral (7 de 11 pacientes). 7 de las 11 pacientes continuaron con dolor luego de la extracción del dispositivo; de ellas, 2 tenían diagnóstico previo de dolor crónico y 3 antecedente de cirugía abdominal. CONCLUSIONES: En esta muestra de pacientes a quienes se extrajo el Essure, el retiro no resultó eficaz para aliviar el dolor en casi dos tercios de ellas. Esto pone de relieve que la extracción no garantiza la eliminación del dolor. Las investigaciones futuras deberán dirimir porqué en algunos casos la cirugía de extracción no resulta efectiva.

Abstract OBJECTIVE: To evaluate the efficacy of the surgical removal of Essure in the elimination of pelvic pain caused, presumably, by this device. MATERIALS AND METHODS: A descriptive study of case series was conducted retrospectively. A review was performed of the medical histories of all the patients (11 in total) who underwent surgical removal of Essure devices at the University Hospital of Ourense (Spain) in the period between 1 January 2016 and 15 August 2018. The following items were collected: demographic data, medical history, data related to the insertion, characteristics of the pain, type of intervention, findings during the intervention and postoperative findings. The total number of patients intervened during that period was 11. The data was analyzed with the statistical software SPSS version 24 for Windows. RESULTS: Eleven patients were operated and 7 of them had abdominal pain after placement of the device, with an average delay of appearance of 3.75 years. The most practiced surgical technique was bilateral salpingectomy (7 of 11 patients). 7 of the 11 patients continued with pain after removal of the device; of them, 2 had previous diagnosis of chronic pain and 3 antecedents of abdominal surgery. CONCLUSIONS: It is evident that surgical removal of the Essure insert was not effective in almost two-thirds of the patients under study, which highlights that its removal does not guarantee the elimination of pain. Future research should determine why in some cases surgical removal is not effective.

EHP-101, an oral formulation of the cannabidiol aminoquinone VCE-004.8, alleviates bleomycin-induced skin and lung fibrosis.

Systemic sclerosis (SSc) or scleroderma is a chronic multi-organ autoimmune disease characterized by vascular, immunological, and fibrotic abnormalities. The etiology of SSc is unknown, but there is growing evidence that dysfunction of the endocannabinoid system (ECS) plays a critical role in its development. Since the semi-synthetic cannabinoquinoid VCE-004.8 could alleviate bleomycin (BLM)-induced skin fibrosis, we have investigated an oral lipid formulation (EHP-101) of this dual PPARγ/CB2 receptors activator for the prevention of skin- and lung fibrosis and of collagen accumulation in BLM challenged mice. Immunohistochemistry analysis of the skin showed that EHP-101 could prevent macrophage infiltration as well as the expression of Tenascin C (TNC), vascular cell adhesion molecule 1 (VCAM1), and the α-smooth muscle actin (SMA). EHP-101 could also prevent the reduced expression of vascular CD31 typical of skin fibrosis. RNAseq analysis of skin biopsies showed a clear effect of EHP-101 in the inflammatory and epithelial-mesenchymal transition transcriptomic signatures. TGF-ß-regulated genes [matrix metalloproteinase-3 (Mmp3), cytochrome b-245 heavy chain (Cybb), lymphocyte antigen 6E (Ly6e), vascular cell adhesion molecule-1 (Vcam1) and Integrin alpha-5 (Itga5)] were induced in BLM mice and repressed by EHP-101 treatment. By intersecting differentially expressed genes in EHP-101-treated mice with a dataset of human scleroderma intrinsic genes, 53 overlapped genes were discovered, including biomarkers of SSc like the C-C motif chemokine 2 (Ccl2) and the interleukin 13 receptor subunit alpha 1 (IL-13Ra1) genes. Taken together, these data provide a rationale for further developing VCE-004.8 as an orally active agent to alleviate scleroderma and, possibly, other fibrotic diseases as well.