The perfect storm: Cutaneous leishmaniasis in troops deployed in the Atlantic forest of Argentina.

American cutaneous leishmaniasis (ACL) is the most prevalent form of leishmaniasis, associated with an ulcerative and stigmatizing mucocutaneous pathology. This study assessed the incidence of Leishmania (Viannia) braziliensis in members of the Argentine Army who were exposed to sandfly bites in Iguazú National Park (INP), northeastern Argentina, during an outbreak of ACL in 2019, and the presence of Leishmania in rodents, opossums and phlebotomine sandflies collected in the area of exposure. Samples from military personnel, wild animals and phlebotomine sandflies were analysed. A total of 20 (40%) patients among the Army personnel and two Akodon montensis rodents (11%) were positive for the presence of Leishmania sp. genes by PCR, while Nyssomyia whitmani and Migonemyia migonei, competent vectors of Leishmania, were also found at the same site. Sequences of hsp70 DNA fragments obtained from human samples confirmed the identity of L. (V.) braziliensis. The risk to which military personnel carrying out activities in the forest are exposed is highlighted, and this risk extends to any worker and visitor who circulates without protection in the INP, coming into contact with transmission "hot spots" due to the concentration of vectors, reservoirs and/or parasites.

Mathematical and Statistical Evaluation of Reverse Osmosis in the Removal of Manganese as a Way to Achieve Sustainable Operating Parameters.

Manganese is the Earth's crust's third most abundant transition metal. Decades of increased mining activities worldwide have inevitably led to the release of large amounts of this metal into the environment, specifically in water resources. Up to a certain level, manganese acts as an essential micronutrient to maintain health and support the growth and development of microorganisms, plants, and animals, while above a specific limit, manganese can cause toxicity in aquatic and terrestrial ecosystems. There are conventional ways to remove manganese from water, such as chemical precipitation, sorption, and biological methods. However, other treatments have yet to be studied much, such as reverse osmosis (RO), which has demonstrated its effectiveness in the removal of heavy metals and could be a suitable alternative for manganese removal if its energy consumption is reduced. This research presents mathematical and statistical modeling of the behavior of a system in laboratory-scale RO. The principal finding was that it is possible to remove Mn using the RO operated with low pressures without decreasing the sustainable removal efficiency. Reducing the operating costs of RO opens the possibility of implementing RO in different contexts where there are problems with water contamination and economic limitations.

[Assessment of pain in patients with rheumatic disease under biological therapy treatment].

BACKGROUND: To assess pain in patients with rheumatic disease under biological therapy treatment. METHODS: Observational retrospective study of patients with rheumatic disease under biological therapy treatment who visited the health care center as outpatients in February/August 2020. We collected demographic (sex and age), clinical (diagnosis, pain presence, intensity, and location), and pharmacological (biological therapy, concomitant treatment with traditional DMARDs, and analgesic treatment) variables from the electronic medical records and Farmatools Dominion®. RESULTS: We included 138 patients; mean age was 56 years and 71% were female. The most frequent diagnosis (47%) was ankylosing spondylitis. Anti-TNF-a was the most prescribed biological drug (64%); 60.1% of study patients received traditional drugs, particularly methotrexate and leflunomide (51.8 and 28.9%, respectively). Pain was reported in 81% of the cases, particularly in hands (73.2%) and knees (69.6%); mean pain intensity was 6.5 (VAS). Although 83.3% of the patients had been prescribed analgesics, pain persisted in 84.8% of the cases (VAS >4), being severe or very severe in 67.9%. Over half of the patients (52.2%) used more than one analgesic. The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (60%), paracetamol (52.2%), and opioids (56.5%). NSAIDs controlled pain (14.5%) better than opioids (8.3%); there was no post-treatment improvement of pain in 29.6% of the patients. The number of prescribed drugs increased with pain intensity (rho= 0.264; p= 0.006). CONCLUSION: Almost 70% of study patients had uncontrolled severe rheumatic-related pain. This implies a challenge for esta­blishing effective treatments for this type of pain.

Evaluación del dolor en pacientes con patologías reumáticas entratamiento con terapias biológicas / Assessment of pain in patients with rheumatic disease under biological therapy treatment

Fundamento: El objetivo fue evaluar el dolor en pacientes con patologías reumáticas en tratamiento con terapias biológicas. Material y métodos: Estudio observacional, retrospectivo, de pacientes con enfermedad reumatológica tratada con terapias biológicas, atendidos en consulta externa en febrero/agosto de 2020. Se recogieron variables demográficas (sexo y edad), clínicas (diagnóstico, presencia de dolor, intensidad y localización) y farmacológicas (terapia biológica, tratamiento concomitante con FAME tradicionales, y tratamiento analgésico). Las fuentes de información utilizadas fueron la historia clínica electrónica y Farmatools Dominion®. Resultados: Se incluyeron 138 pacientes, con edad media 56 años, 71% mujeres. El diagnóstico más frecuente fue espondilitis anquilosante (47%). El fármaco biológico más utilizado fue anti TNF-α (64%) y el 60,1% recibían fármacos tradicionales, especialmente metotrexato y leflunomida (51,8 y 28,9%). El 81% de los pacientes presentaban dolor, especialmente en manos (73,2%) y rodillas (69,6%), de intensidad media 6,5 en la escala EVA. El 84,8% de los pacientes no tenía el dolor controlado (EVA >4) y era severo o muy severo en el 67,9% de los pacientes, a pesar de que el 83,3% tenían pautado tratamiento antiálgico, el 52,2% con más de un fármaco, con antiinflamatorios no esteroideos (AINE) (60%), paracetamol (52,2%) y opioides (56,5%). El dolor se controló mejor con AINE (14,5%) que con opioides (8,3%); en un 29,6% el dolor no mejoraba con el tratamiento. El número de fármacos aumentó con la intensidad del dolor (rho = 0,264; p = 0,006). Conclusiones: Más del 69% de los pacientes presentaba dolor no controlado y severo, reflejando el desafío que supone instaurar un tratamiento efectivo para el dolor.(AU)

Background: To assess pain in patients with rheumatic disease under biological therapy treatment. Methods. Observational retrospective study of patients with rheumatic disease under biological therapy treatment who visited the health care center as outpatients in February/August 2020. We collected demographic (sex and age), clinical (diagnosis, pain presence, intensity, and location), and pharmacological (biological therapy, concomitant treatment with traditional DMARDs, and analgesic treatment) variables from the electronic medical records and Farmatools Dominion®. Results: We included 138 patients; mean age was 56 years and 71% were female. The most frequent diagnosis (47%) was ankylosing spondylitis. Anti-TNF-α was the most prescribed biological drug (64%); 60.1% of study patients received traditional drugs, particularly methotrexate and leflunomide (51.8 and 28.9%, respectively). Pain was reported in 81% of the cases, particularly in hands (73.2%) and knees (69.6%); mean pain intensity was 6.5 (VAS). Although 83.3% of the patients had been prescribed analgesics, pain persisted in 84.8% of the cases (VAS >4), being severe or very severe in 67.9%. Over half of the patients (52.2%) used more than one analgesic. The most frequently prescribed medications were non-steroidal anti-inflammatory drugs (NSAIDs) (60%), paracetamol (52.2%), and opioids (56.5%). NSAIDs controlled pain (14.5%) better than opioids (8.3%); there was no post-treatment improvement of pain in 29.6% of the patients. The number of prescribed drugs increased with pain intensity (rho = 0.264; p = 0.006). Conclusion. Almost 70% of study patients had uncontrolled severe rheumatic-related pain. This implies a challenge for establishing effective treatments for this type of pain.(AU)

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center.

Obstructive sleep apnea (OSA) is the most common respiratory disease in the developed world and is commonly treated with positive airway pressure therapy (PAP). Recently, hypoglossal nerve (HNS) has been introduced as alternative treatment for OSA patients with PAP intolerance. We report the initial results with HNS treatment from Spain. Patients with OSA and PAP intolerance were screened for HNS treatment with the Inspire™ system. After implantation and activation, efficacy was evaluated with polysomnography and indication-specific questionnaires. Adherence data was recorded from the stimulation system. 18 patients (51.83 ± 11.64 years, 94% male, mean Body Mass Index 27.94 ± 3.20) received an Inspire™ UAS system and were included for analysis. Mean procedure time was 202.83 ± 64.87 min. and average hospital stay 26.67 ± 7.54 h. Mean Apnea-Hypopnea-Index was reduced by 63.44% (p ≤ 0.0001), while daytime sleepiness improved to a mean ESS score of 6.60 ± 1.25 (p ≤ 0.0001 Therapy response (AHI reduction > 50% and final AHI < 20), was reached in 64.70 and normalization of daytime sleepiness (final ESS score < 10) in 100% of patients. Therapy adherence was 6.32 ± 1.71 h per night. HNS is a safe and leads to effective OSA control and symptom normalization in selected OSA patients with PAP intolerance. Stimulation therapy is well accepted, as demonstrated by high adherence. Implementation of HNS therapy into an OSA program in Spain is feasible with acceptable learning curve and moderate resource utilization.

Conciliación terapéutica al ingreso hospitalario en el servicio de urgencias / Therapeutic Reconciliation on Admission to Hospital in the Emergency Department

Objetivos: Evaluar el proceso de conciliación de la medicación en el Servicio de Urgencias y analizar los problemas relacionados con la medicación identificados, su gravedad potencial y las intervenciones farmacéuticas realizadas durante este proceso. Métodos: Estudio observacional prospectivo, realizado en el Servicio de Urgencias de un hospital de tercer nivel. Se recogieron los datos correspondientes durante tres meses (abril-junio 2020). Se elaboraron criterios de priorización, para poder seleccionar a los pacientes con mayor riesgo de sufrir errores de conciliación. El proceso de conciliación se llevó a cabo mediante: Historia Clínica Electrónica, historial farmacoterapéutico de atención primaria y prescripción electrónica en el Servicio de Urgencias. Se consideraron errores de conciliación todas las discrepancias no justificadas por el médico y se valoraron su gravedad potencial según National Coordinating Council for Medication Error Reporting and Prevention. Resultados: Se incluyeron 23 pacientes, 13 fueron hombres. La edad media fue de 77,8 años (DE 11,2). Durante el proceso de conciliación se encontraron 116 discrepancias, de éstas 56 (48,3%) precisaron aclaración. Se detectaron 36 errores de conciliación, éstos fueron por: omisión medicamento (n=18; 50%), error de dosis (n=13; 36,1%) o error en la frecuencia de administración (n=5; 13,9%). La aceptación de estas intervenciones de conciliación fue del 92,6%. Además, se realizaron 22 intervenciones farmacéuticas con una aceptación del 100%.Conclusiones: La realización de un proceso de conciliación de la medicación en el Servicio de Urgencias ha evitado errores de medicación, la mayoría de ellos con relevancia clínica y ha mejorado la atención farmacoterapéutica de estos pacientes.(AU)

Objectives: To evaluate the medication reconcilia-tion procedure in the Emergency Department and to analyze the medication-related problems identi-fied, their potential severity and the pharmaceutical interventions made during this process.Methods: It was conducted a prospective and ob-servational study in the Emergency Department of a tertiary care hospital. Data were collected during three months (April-June 2020). Priority criteria were developed in order to select patients with a higher risk of suffering reconciliation errors. The reconciliation process was carried out by means of: Electronic Medical Record, primary care pharma-cotherapeutic history and electronic prescription in the Emergency Department. All discrepancies not justified by the physician were considered reconciliation errors and their potential severity was assessed according to the National Coordinating Council for Medication Error Reporting and Preven-tion.Results: 23 patients were included, 13 were men. The average age was 77.8 years (SD 11.2). During the reconciliation process 116 discrepancies were found, 56 (48.3%) of which required clarification. 36 reconciliation errors were detected, these were due to: medication omission (n = 18; 50%), dosage error (n = 13; 36.1%) or administration frequency error (n = 5; 13.9 %). The uptake of these reconciliation interventions was 92.6%. In addition, 22 pharma-ceutical interventions were performed with 100% acceptance.Conclusions: The implementation of a medication reconciliation process in the Emergency Depart-ment prevented medication errors, most of them with clinical relevance. Besides, it improved the pharmacotherapeutic care of these patients.(AU)

Molecular Phylogeny, Character Evolution, and Biogeography of Hydrangea Section Cornidia, Hydrangeaceae.

Background: Hydrangea section Cornidia consists of 26 currently accepted species and a yet undefined number of new species and erroneously synonymized taxa. This clade consists of (sub)tropical lianas occurring from northern Mexico to southern Chile and Argentina, and one species from Southeast Asia. Currently, no molecular phylogenetic hypothesis is available that includes more than a few species of this section. Hence, a resolved and well-sampled molecular phylogenetic hypothesis may help to enforce taxonomic decisions. In this study, we present a phylogenetic framework based on sequences from two low copy nuclear genes from a comprehensive taxon sampling of H. section Cornidia and a selection of outgroups. Our phylogenetic reconstructions prove the non-monophyly of the traditionally recognized subsections Monosegia and Polysegia and their corresponding series, Speciosae and Aphananthae, and Synstyleae and Chorystyleae, respectively. Three morphologically defined species were recovered with high support as monophyletic, namely, Hydrangea panamensis, Hydrangea serratifolia, and Hydrangea tarapotensis. However, statistical support for some shallow nodes did not allow to refute, with high support, the monophyly of several of the herein recognized species for which more than one individual could be analyzed. Based on the obtained phylogenetic framework, we reconstructed the evolution of selected reproductive characters. Hydrangea section Cornidia is the only genus section for which dioecism has been extensively documented. Our character reconstruction of sexual dimorphism shows that dioecism is the ancestral state in this section and that this was reversed to monoecy in Hydrangea seemannii and Hydrangea integrifolia. Character reconstruction for the enlarged marginal flowers recovered their presence as the ancestral character state in H. section Cornidia, although at least three internal lineages independently lost them; thus, losses were reconstructed to be more likely than gain. With respect to the flower color, more species exhibit white than red flowers, and white is reconstructed as the ancestral state. Cornidia also shows an unusual disjunct geographic distribution between Asia and Central Mesoamerica-South America, as it is not present in the USA and Canada. The origin of Cornidia is reconstructed to be the New World with higher probability, and the presence of one species in Asia is likely due to long-distance dispersal.

Disentangling Species Delineation and Guiding Conservation of Endangered Magnolias in Veracruz, Mexico.

The Mexican state of Veracruz has suffered very high deforestation rates in the last few decades, and despite the establishment of protected areas and conservation projects, primary forest is now mainly persisting in mostly small, scattered, fragmented remnants. New species of Magnolia section Talauma in this state have been described with little to no reference to the already existing ones, potentially resulting in over-splitting, obscuring their taxonomic delineation and conservation status, and consequently conservation programs. To study the conservation units and their genetic diversity, we here employ 15 microsatellite markers on a highly representative sampling of 254 individuals of what are presumed to be five Magnolia species. The results support at least three species and maximum five main conservation units. We propose downgrading the latter to four, given morphological, ecological, demographical, and geographical considerations. Two out of the three sympatrically occurring species in the rainforest in the Los Tuxtlas volcanic area have weak genetic evidence to be considered separate species. Similarly, the individuals in the Sierra de Zongolica in central Veracruz, who bear a very high morphological and genetic similarity to Magnolia mexicana, have weak genetic evidence to be recognised as a separate species. Nonetheless, the individuals could be identified as Magnolia decastroi based on morphology, and further research including the full range of this species is recommended.

Towards Conservation of the Remarkably High Number of Daisy Trees (Asteraceae) in Mexico.

Mexico is floristically the fourth most species-rich country in the world, and Asteraceae is the most diverse vascular plant family in this country. The species exhibits a wide range of growth forms, but the tree-like habit, appropriately named daisy trees, is heavily underestimated, even though slightly different tree definitions are handled. Very little is known about their precise species number or conservation status in Mexico, so we update here the list of known Mexican daisy tree species, summarize their very diverse uses, present a general panorama of their present and future distribution, and discuss their conservation status. A bibliographic review and herbarium study were carried out, carefully curated taxonomical ocurrence maps were prepared for each species, and a climatic suitability modelling approach was used to characterise the spatial patterns of Mexican Asteraceae trees. With 149 daisy tree species, the country ranks second at a global level; within the country, their greatest diversity is found in central and western Mexico. A decrease in diversity is estimated in areas that currently host the highest species richness, whereas the hotspot regions are estimated to show an increase in species diversity, so climate change is not a threat to all Mexican daisy tree species.

On Hydrangea peruviana, an endangered species from Ecuador, and Hydrangea oerstedii, very common in Costa Rica and Panama, and seven threatened Central and South American Hydrangeas, which have been confounded with these.

Hydrangea section Cornidia, currently consisting of 19 accepted taxa, occurs from Mexico to Chile and Argentina, with one species in southeast Asia. Its representatives are root-climbing lianas which may grow up to 60 m high in the tree canopy of temperate to (sub)tropical forests. Our extensive field work throughout its distribution area, study of herbarium specimens and ongoing molecular studies have resulted in the discovery of species new to science, as well as new insights into the circumscription of many taxa. We here present amended descriptions for seven Hydrangea species of Central and South America and discuss the taxonomical situation of two Colombian Hydrangeas, including an identification key, illustrations, and distribution maps. Field work was carried out in Costa Rica, Panama, Ecuador and Peru, including exploration in areas where the genus had not been collected before. These specimens and observations were complemented with the study of specimens of 41 herbaria of North, Central and South America, as well as Europe. Detailed morphological studies of all species were carried out, based on living plants in their natural habitat, as well as on dried specimens from our own collections and all available herbarium material. Type material was studied in detail for all species concerned. Based on an extensive number of morphological characters, combined with distribution patterns, phenological differences and ecological preferences, including molecular data in most cases, Hydrangea peruviana and H. oerstedii are clearly distinct taxa, as well as the other seven species mentioned here, which had been synonymized with either of these two species. The present study results in the recognition of 26 species in section Cornidia and exemplifies the urgent need for profound taxonomic studies in plants, as in many families we do not dispose of well-circumscribed units for conservation to mitigate the already occurring unprecedented loss of biodiversity.

ResumenHydrangea sección Cornidia, que actualmente consiste en 19 taxones aceptados, se distribuye desde México hasta Chile y Argentina, con una especie en el sureste asiático. Sus representantes son lianas trepadoras que pueden crecer hasta 60 m de altura en la copa de los árboles de los bosques templados a (sub)tropicales. Nuestro extenso trabajo de campo en toda su área de distribución, la revisión de especímenes de herbario y los estudios moleculares en curso han dado como resultado el descubrimiento de especies nuevas para la ciencia, así como conocimiento nuevo sobre la circunscripción de muchos taxones. Aquí presentamos descripciones enmendadas para siete especies de Hydrangea de Centro y Suramérica y discutimos la situación taxonómica de dos Hydrangeas colombianas, incluyendo una clave de identificación, ilustraciones y mapas de distribución. El trabajo de campo se llevó a cabo en Costa Rica, Panamá, Ecuador y Perú, incluída la exploración en áreas donde el género no había sido recolectado antes. Estos especímenes y observaciones se complementaron con el estudio de especímenes de 41 herbarios de Norte, Centro y Suramérica, así como de Europa. Se llevaron a cabo estudios morfológicos detallados de todas las especies, basados ​​en plantas vivas en su hábitat natural, así como en muestras secas de nuestras propias colecciones y todo el material de herbario disponible. El material tipo se estudió en detalle para todas las especies en cuestión. En base a una gran cantidad de caracteres morfológicos, combinados con patrones de distribución, diferencias fenológicas y preferencias ecológicas, incluyendo datos moleculares en la mayoría de los casos, Hydrangea peruviana y H. oerstedii son taxones claramente distintos, así como las otras siete especies mencionadas aquí, que habían sido sinonimizadas con cualquiera de estas dos especies. El presente estudio resulta en el reconocimiento de 26 especies en la sección Cornidia y ejemplifica la necesidad urgente de estudios taxonómicos profundos en plantas, ya que en muchas familias no disponemos de unidades de conservación bien circunscritas para mitigar la pérdida de biodiversidad sin precedentes.

Wheat storage proteins: changes on the glutenins after wheat infection with different isolates of Fusarium graminearum

Wheat gluten proteins are decisive for the industrial properties of flour, so alterations resulting from grain infection with Fusarium graminearum produce changes in the glutenin content that affect the baking properties. This work analyzes the high-molecular-weight glutenin changes from wheat flour with different degrees of F. graminearum infection at field, since these proteins are determinant for the quality properties of flour. Wheat cultivars-on field trials-infected with F. graminearum isolates of diverse aggressiveness showed severity values between 9.1 and 42.58% and thousand kernel weight values between 28.12 and 32.33 g. Negative correlations between severity and protein content and positive correlations between yield and protein content were observed, employing reversed-phase high-performance liquid chromatography and polyacrylamide gel electrophoresis. Furthermore, the protein signal changes were in agreement for both methodological approaches. Also, the degree of disease observed and the protein changes on infected wheat cultivars varied in relation with the aggressiveness of the isolate responsible for the infection. The principal component analysis showed a close arrangement among protein values obtained by HPLC. For each cultivar, two principal components were obtained, which explained 80.85%, 88.48%, and 93.33% of the total variance (cultivars Sy200, AGP Fast, and Klein Tigre respectively). To our knowledge, the approaches employed for the analysis of protein changes according to the degree of disease, as well as the thorough statistical analysis, are novel for the study of Fusarium Head Blight

No disponible

Wheat storage proteins: changes on the glutenins after wheat infection with different isolates of Fusarium graminearum

Wheat gluten proteins are decisive for the industrial properties of flour, so alterations resulting from grain infection with Fusarium graminearum produce changes in the glutenin content that affect the baking properties. This work analyzes the high-molecular-weight glutenin changes from wheat flour with different degrees of F. graminearum infection at field, since these proteins are determinant for the quality properties of flour. Wheat cultivars-on field trials-infected with F. graminearum isolates of diverse aggressiveness showed severity values between 9.1 and 42.58% and thousand kernel weight values between 28.12 and 32.33 g. Negative correlations between severity and protein content and positive correlations between yield and protein content were observed, employing reversed-phase high-performance liquid chromatography and polyacrylamide gel electrophoresis. Furthermore, the protein signal changes were in agreement for both methodological approaches. Also, the degree of disease observed and the protein changes on infected wheat cultivars varied in relation with the aggressiveness of the isolate responsible for the infection. The principal component analysis showed a close arrangement among protein values obtained by HPLC. For each cultivar, two principal components were obtained, which explained 80.85%, 88.48%, and 93.33% of the total variance (cultivars Sy200, AGP Fast, and Klein Tigre respectively). To our knowledge, the approaches employed for the analysis of protein changes according to the degree of disease, as well as the thorough statistical analysis, are novel for the study of Fusarium Head Blight

No disponible

Wheat storage proteins: changes on the glutenins after wheat infection with different isolates of Fusarium graminearum.

Wheat gluten proteins are decisive for the industrial properties of flour, so alterations resulting from grain infection with Fusarium graminearum produce changes in the glutenin content that affect the baking properties. This work analyzes the high-molecular-weight glutenin changes from wheat flour with different degrees of F. graminearum infection at field, since these proteins are determinant for the quality properties of flour. Wheat cultivars-on field trials-infected with F. graminearum isolates of diverse aggressiveness showed severity values between 9.1 and 42.58% and thousand kernel weight values between 28.12 and 32.33 g. Negative correlations between severity and protein content and positive correlations between yield and protein content were observed, employing reversed-phase high-performance liquid chromatography and polyacrylamide gel electrophoresis. Furthermore, the protein signal changes were in agreement for both methodological approaches. Also, the degree of disease observed and the protein changes on infected wheat cultivars varied in relation with the aggressiveness of the isolate responsible for the infection. The principal component analysis showed a close arrangement among protein values obtained by HPLC. For each cultivar, two principal components were obtained, which explained 80.85%, 88.48%, and 93.33% of the total variance (cultivars Sy200, AGP Fast, and Klein Tigre respectively). To our knowledge, the approaches employed for the analysis of protein changes according to the degree of disease, as well as the thorough statistical analysis, are novel for the study of Fusarium Head Blight.

Tissue-engineering approaches in pancreatic islet transplantation.

Pancreatic islet transplantation is a promising alternative to whole-pancreas transplantation as a treatment of type 1 diabetes mellitus. This technique has been extensively developed during the past few years, with the main purpose of minimizing the complications arising from the standard protocols used in organ transplantation. By using a variety of strategies used in tissue engineering and regenerative medicine, pancreatic islets have been successfully introduced in host patients with different outcomes in terms of islet survival and functionality, as well as the desired normoglycemic control. Here, we describe and discuss those strategies to transplant islets together with different scaffolds, in combination with various cell types and diffusible factors, and always with the aim of reducing host immune response and achieving islet survival, regardless of the site of transplantation.

Indications, complications, and outcomes following surgical management of locally advanced and metastatic renal cell carcinoma.

INTRODUCTION: Surgery may set the basis for a potential cure or would provide the best achievable quality of life in locally advanced or metastatic renal cell carcinoma (mRCC). However, survival extension with this approach would be scarce and not exempt from adverse events, thus preventing its recommendation in an already frail patient. An evidence based analysis on the role of surgery in each of the possible clinical scenarios involved under this heading may provide a clear picture on this issue and would be of value in the decision making process. Areas covered: Current literature was queried in PubMed/Medline in a systematic fashion. Manuscripts included were selected according to the quality of the data provided. A narrative review strategy was adopted to summarize the evidence acquired. Expert commentary: A surgery-based multimodal treatment approach should be strongly considered after adequate counseling in locally advanced and mRCC, since it may provide for additional benefits in terms of survival. However, a critical reevaluation of its adequacy, optimal timing, and selection of ideal candidates is currently ongoing.

Fibroblasts accelerate islet revascularization and improve long-term graft survival in a mouse model of subcutaneous islet transplantation.

Pancreatic islet transplantation has been considered for many years a promising therapy for beta-cell replacement in patients with type-1 diabetes despite that long-term clinical results are not as satisfactory. This fact points to the necessity of designing strategies to improve and accelerate islets engraftment, paying special attention to events assuring their revascularization. Fibroblasts constitute a cell population that collaborates on tissue homeostasis, keeping the equilibrium between production and degradation of structural components as well as maintaining the required amount of survival factors. Our group has developed a model for subcutaneous islet transplantation using a plasma-based scaffold containing fibroblasts as accessory cells that allowed achieving glycemic control in diabetic mice. Transplanted tissue engraftment is critical during the first days after transplantation, thus we have gone in depth into the graft-supporting role of fibroblasts during the first ten days after islet transplantation. All mice transplanted with islets embedded in the plasma-based scaffold reversed hyperglycemia, although long-term glycemic control was maintained only in the group transplanted with the fibroblasts-containing scaffold. By gene expression analysis and histology examination during the first days we could conclude that these differences might be explained by overexpression of genes involved in vessel development as well as in ß-cell regeneration that were detected when fibroblasts were present in the graft. Furthermore, fibroblasts presence correlated with a faster graft re-vascularization, a higher insulin-positive area and a lower cell death. Therefore, this work underlines the importance of fibroblasts as accessory cells in islet transplantation, and suggests its possible use in other graft-supporting strategies.

Valoración de tutores clínicos y estudiantes de medicina respecto a las rotaciones en centros de atención primaria y hospitales / Evaluation of clinical tutors and medical students regarding clinical rotations in primary healthcare centers and hospitals

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Abdominal strength in voiding cystometry: a risk factor for recurrent urinary tract infections in women.

INTRODUCTION AND HYPOTHESIS: Recurrent urinary tract infections are a common condition in women. The aim of this study is the evaluation of lower urinary tract dysfunctions that are risk factors for recurrent urinary tract infections in women. METHODS: We conducted a case-control study in 49 women with recurrent urinary tract infections (rUTIs) and 49 control women without rUTIs, comparing the urinary symptoms and urodynamic data of both groups. RESULTS: The main significant differences between these groups were age (the women were older in the control group) and the value of abdominal pressure during voiding cystometry (this was higher in the group with rUTIs). After controlling age as a confounding factor, it was confirmed that the value of maximum abdominal pressure during voiding was the only factor to facilitate the rUTIs and the ideal cut-off was 28 cm H(2)O. CONCLUSIONS: Abdominal strength in the voiding phase constitutes a risk factor for recurrent urinary tract infections in women.

Nephron-sparing surgery in renal cell carcinoma: current perspectives on technical issues.

Surgical resection remains the standard treatment for renal cell carcinoma. Although historically the concept of wide excision of the affected kidney dictated surgical thinking for more than half a century, a better understanding of the biology of this tumor, standardized staging, and changing patterns of presentation permit today a refined management approach with nephron-sparing surgery, thus limiting potential long-term morbidity by maximizing the preservation of functional renal parenchyma. This paper aims to review the current status of nephron-sparing surgery for solid renal masses with an emphasis on indications, preoperative assessment, and operative technical issues, summarizing the most recent existing data on the subject.