Frailty assessment has come to stay: Retrospective analysis pilot study of two frailty scales in oncological older patients undergoing colorectal surgery.

INTRODUCTION: Colorectal cancer is a disease of the elderly and its main treatment is surgery. Frailty, a clinical syndrome of decreased reserve, increases with age and has been recognized as a predictive factor for postoperative mortality. Our primary objective was to assess the association between two frailty scores and mortality within the first year after surgery, by retrospectively linking frailty scores to mortality data and comparing the strength of their association with mortality to that of the ASA Classification. The frailty scales used were: the Modified Frailty Index (MFI) and, the Risk Analysis Index-A (RAI-A) and the G8 screening test (G8). As secondary objectives, we assessed the relationship of the frailty scales with morbidity and compared all the scales with the ASA. MATERIAL AND METHODS: We retrospectively studied 172 patients aged 65 years and older who underwent laparoscopic colorectal surgery for cancer between January 2017 and June 2018, following them up for 1year after surgery. RESULTS: Both morbidity and mortality were significantly associated with all frailty scale scores (p<.001). The more frailty, the greater probability of prolonged hospital stay, complications, readmissions and emergency department visits. Using each scale, patients were categorized into two groups (frail and non-frail patients). The C-indexes for 1-year mortality with the RAI-A and, MFI and G8 were 0.89 and, 0.86 and 0.86 respectively. On the other hand, ASA status is not strongly associated with mortality, with a C-index of .63. DISCUSSION: Frailty scores should begin to influence medical and surgical strategies and further research is needed to develop guidelines for interventions in geriatric patients.

La evaluación de la fragilidad ha venido para quedarse: Estudio piloto retrospectivo de dos escalas de fragilidad en ancianos oncológicos intervenidos de cirugía colorrectal / Frailty assessment has come to stay: Retrospective analysis pilot study of two frailty scales in oncological older patients undergoing colorectal surgery

Introducción: El cáncer colorrectal es una enfermedad que habitualmente aparece en ancianos y su principal tratamiento continúa siendo quirúrgico. La fragilidad es síndrome clínico que se caracteriza por presentar una disminución de la reserva fisiológica, aumenta con la edad y ha sido reconocido como un factor predictivo de mortalidad postoperatoria. Nuestro objetivo primario ha sido evaluar la asociación entre dos escalas de fragilidad y la mortalidad a un año después de la cirugía, y comparando la fuerza de su asociación del poder predictivo de mortalidad de las escalas de fragilidad y la de la clasificación de la American Society of Anesthesiologists (ASA). Las escalas utilizadas fueron: Modified Frailty Index (MFI) y el Risk Analysis Index (RAI-A). Los objetivos secundarios han sido la evaluación de la relación de las escalas de fragilidad con la morbilidad y la comparación de estas con la clasificación ASA en cuanto a predicción de morbilidad. Material y métodos: Analizamos retrospectivamente 172 pacientes mayores de 65 años que fueron intervenidos de cirugía oncológica colorrectal laparoscópica desde enero de 2017 hasta junio de 2018 con un seguimiento de un año posterior a la cirugía. Resultados: La fragilidad esta significativamente asociada a la mortalidad y morbilidad (p < 0,001). A más fragilidad, mayor probabilidad de estancia hospitalaria, complicaciones, reingresos y visitas a urgencias. Los pacientes fueron categorizados en dos grupos (pacientes frágiles y no frágiles). Los C-index de la predicción a mortalidad a un año obtenidos con el RAI-A y el MFI fueron 0,89 y 0,86, respectivamente. Por otro lado, la clasificación ASA no se relaciona con mortalidad, su C-index fue del 0,63. Discusión: Las escalas de fragilidad deberían empezar a influenciar las intervenciones médicas y quirúrgicas, y se deberían implementar guías y protocolos que tuviesen en cuenta el grado de fragilidad de los pacientes geriátricos.(AU)

Introduction: Colorectal cancer is a disease of the elderly and its main treatment is surgery. Frailty, a clinical syndrome of decreased reserve, increases with age and has been recognized as a predictive factor for postoperative mortality. Our primary objective was to assess the association between twohree frailty scores and mortality. within the first year after surgery, by retrospectively linking frailty scores to mortality data and comparing the strength of their association with mortality to that of the ASA Classification. The frailty scales used were: the Modified Frailty Index (MFI) and, the Risk Analysis Index-A (RAI-A) and the G8 screening test (G8). As secondary objectives, we assessed the relationship of the frailty scales with morbidity and compared all the scales with the ASA. Material and methods: We retrospectively studied 172 patients aged 65 years. and older who underwent laparoscopic colorectal surgery for cancer between January 2017 and June 2018, following them up for 1 year after surgery. Results: Both morbidity and mortality were significantly associated with all frailty scale scores (p < 0.001). The more frailty, the greater probability of prolonged hospital stay, complications, readmissions and emergency department visits. Using each scale, patients were categorized into two groups (frail and non-frail patients). The C-indexes for 1-year mortality with the RAI-A and, MFI and G8 were 0.89 and, 0.86 and 0.86 respectively. On the other hand, ASA status is not strongly associated with mortality, with a C-index of 0.63. Discussion: Frailty scores should begin to influence medical and surgical strategies and further research is needed to develop guidelines for interventions in geriatric patients.(AU)

High SNP diversity in the non-toxic indigenous Jatropha curcas germplasm widens the potential of this upcoming major biofuel crop species.

BACKGROUND AND AIMS: Jatropha curcas (jatropha) is an oil crop cultivated in (sub)tropical regions around the world, and holds great promise as a renewable energy source. However, efforts to fully commercialize jatropha are currently hampered by the lack of genetic diversity in the extant breeding germplasm, and by the toxicity of its seeds meaning that its seed cake cannot be used as a protein source in animal feed, among other constraints. In Mexico, the species' native range, there are jatropha plants whose seeds are used to prepare traditional meals. This non-toxic jatropha 'type' is considered to harbour low genetic variation due to a presumed domestication bottleneck and therefore to be of limited breeding value; yet, very little is known regarding its origin and genetic diversity. METHODS: Using genotyping-by-sequencing (GBS), we extensively genotyped both indigenous toxic and non-toxic jatropha collected along roads and home gardens throughout southern Mexico. KEY RESULTS: Single nucleotide polymorphism diversity in non-toxic jatropha is relatively high, particularly in northern Veracruz state, the probable origin of this germplasm. Genetic differences between toxic and non-toxic indigenous genotypes are overall quite small. A a genome-wide association study supported a genomic region (on LG 8, scaffold NW_012130064), probably involved in the suppression of seed toxicity. CONCLUSIONS: Conservation actions are urgently needed to preserve this non-toxic indigenous, relatively wild germplasm, having potential as a fuel feedstock, animal feed and food source among other uses. More generally, this work demonstrates the value of conservation genomic research on the indigenous gene pool of economically important plant species.

Development and validation of a brief electronic screening test for cognitive impairment in multiple sclerosis (SCI-MS Test).

OBJECTIVE: Although cognitive impairment (CI) is common in multiple sclerosis (MS), it is difficult to suspect in patients with low disability and there is a lack of brief and effective CI screening tools with a define cut-off point to be used during routine clinic visits. This study aims to validate the Electronic Screening Cognitive Impairment in Multiple Sclerosis (SCI-MS) test for CI among MS patients. METHODS: Cross-sectional, observational study that included adult patients, diagnosed with MS, Expanded Disability Status Scale (EDSS) score ≤6.5, without relapses within the last 2 months and no depression symptoms. The SCI-MS test consists of two modules: questionnaire (SCI-MS-Q) and pictogram matching tool (SCI-MS-P) measured for score and time. At inclusion, patients completed the Beck Depression Inventory (BDI-II test), the Brief Repeatable Battery of Neuropsychological Test (BRB-N) and the SCI-MS. The SCI-MS feasibility, test-retest reliability and predictive validity were assessed. RESULTS: A total of 194 patients (59.3% female) were included: mean (SD) age of 42 (9) years, mean time since diagnosis of 10 (7) years, 89.7% relapsing-remitting MS, and median (Q1-Q3) EDSS of 2.0 (1.0-3.5). According to BRB-N, 26.8% of patients had CI. Internal consistency was high (Cronbach alpha: 0.97). The intra-class correlation coefficient was 0.88 for the SCI-MS-Q, 0.09 for the SCI-MS-P score and 0.48 for the SCI-MS-P time, corresponding to AUC of the ROC curves of 0.571, 0.574 and 0.714, respectively. For a clinically significant cut-off point of ≥60 seconds, the reached CI sensitivity of SCI-MS-P time was 0.75 and the specificity 0.51. CONCLUSION: SCI-MS showed good psychometric properties. SCI-MS-P time of pictogram completion had an acceptable diagnostic accuracy of CI in MS patients with low disability. SCI-MS-P time of pictogram completion tool is an easy and quick score that can help neurologists to early identify CI in MS patients that should be further assessed to confirm CI diagnosis and to describe its characteristics and mainly affected domains.

Behavioural, morphological and electrophysiological assessment of the effects of type 2 diabetes mellitus on large and small nerve fibres in Zucker diabetic fatty, Zucker lean and Wistar rats.

BACKGROUND: Peripheral neuropathy is a common complication in type 2 diabetes mellitus (T2DM). The most common presentation is in the form of a distal axonal sensory-motor polyneuropathy that involves large and small nerve fibres in variable proportion. METHODS: Zucker Diabetic Fatty (ZDF), Zucker Lean (ZL) and Wistar Han (WH) rats were used to assess the behavioural, morphological and electrophysiological effects that T2DM have on peripheral large and small nerve fibres of 6- to 40-week-old rats. RESULTS: ZDF rats presented mechanical hypersensitivity that initially worsened in parallel to the progression of diabetes and eventually reverted at later stages of the disease. The reversal from hypersensitivity to hyposensitivity paralleled a reduction in the number of intraepithelial skin nerve terminals and in the nerve fibre lengths. However, no increased levels of degeneration of dorsal root ganglion neurons were observed. Nerve conduction studies showed a reduction in sensory and motor nerve conduction velocity (CV) in hyperglycaemic ZDF rats. Microneurography showed significant alterations in several parameters of activity-dependent slowing (ADS) of mechano-insensitive C-nociceptors in ZDF rats. Surprisingly, some of these changes were also observed in ZL rats. Moreover, we found spontaneous activity in all three strains implying that C-nociceptors become hyperexcitable and spontaneously active not only in ageing hyperglycaemic ZDF rats but also in age-matched and apparently normoglycaemic ZL and WH rats fed with the same diet. CONCLUSIONS: ZDF rats presented a diabetic neuropathy involving large and small nerve fibres; additionally, ZL and WH rats also showed early small abnormalities in C-fibres, clearly detected by microneurography SIGNIFICANCE: This study provides a functional description of large and small nerve fibre function in a diabetic model that recapitulates many of the findings observed in patients suffering from type 2 diabetes mellitus.

Molecular simulation of gas adsorption and diffusion in a breathing MOF using a rigid force field.

Simulation of gas adsorption in flexible porous materials is still limited by the slow progress in the development of flexible force fields. Moreover, the high computational cost of such flexible force fields may be a drawback even when they are fully developed. In this work, molecular simulations of gas adsorption and diffusion of carbon dioxide and methane in NH2-MIL-53(Al) are carried out using a linear combination of two crystallographic structures with rigid force fields. Once the interactions of carbon dioxide molecules and the bridging hydroxyls groups of the framework are optimized, an excellent match is found for simulations and experimental data for the adsorption of methane and carbon dioxide, including the stepwise uptake due to the breathing effect. In addition, diffusivities of pure components are calculated. The pore expansion by the breathing effect influences the self-diffusion mechanism and much higher diffusivities are observed at relatively high adsorbate loadings. This work demonstrates that using a rigid force field combined with a minimum number of experiments, reproduces adsorption and simulates diffusion of carbon dioxide and methane in the flexible metal-organic framework NH2-MIL-53(Al).

Understanding Gas-Induced Structural Deformation of ZIF-8.

ZIF-8 is a zeolitic imidazolate framework with very good thermal and chemical stability that opens up many applications that are not feasible by other metal-organic frameowrks (MOFs) and zeolites. Several works report the adsorption properties of ZIF-8 for strategic gases. However, despite the vast experimental corpus of data reported, there seems yet to be a dearth in the understanding of the gas adsorption properties. In this work we provide insights at a molecular level on the mechanisms governing the ZIF-8 structural deformation during molecular adsorption. We demonstrate that the ZIF-8 structural deformation during the adsorption of different molecules at cryogenic temperature goes beyond the gas-induced rotation of the imidazolate linkers. We combine experimental and simulation studies to demonstrate that this deformation is governed by the polarizability and molecular size and shape of the gases, and that the stepped adsorption behavior is defined by the packing arrangement of the guest inside the host.

Rentabilidad y seguridad de la biopsia renal percutánea en riñones nativos con aguja automática de 16G / Safety and yield of percutaneous renal biopsy using an automatic 16G needle in native kidneys

ObjetivosLa biopsia renal percutánea guiada por ecografía es el procedimiento de elección para la obtención de material histológico de parénquima renal. La superioridad del uso de agujas automáticas con guía ecográfica ha quedado bien establecida en la literatura médica. Puesto que existe escasa información sobre el uso de agujas 16G, hemos revisado nuestra experiencia con esta técnica. Comunicamos nuestros resultados en relación con el rendimiento diagnóstico de las muestras obtenidas y a la tasa de complicaciones.Material y métodosSe han revisado 243 biopsias renales consecutivas realizadas en riñones nativos con agujas automáticas de 16G con y sin guía ecográfica. Se ha calculado la tasa de rentabilidad diagnóstica y se ha valorado el número de biopsias con informe anatomopatológico completo y la tasa de complicaciones mayores y menores asociadas a la biopsia. Se ha utilizado el test de Fisher para valorar la correlación entre la aparición de complicaciones mayores y la edad, función renal y presión diastólica.ResultadosSe obtuvo material histológico suficiente para establecer un diagnóstico en 228 de 243 biopsias (93,83%). Se detectaron complicaciones en 33 de 243 biopsias (13,5%), de la cuales 9 fueron mayores (3,7%) y 24 fueron menores (9,8%). De entre las complicaciones mayores, en 7 casos (2,8%) se realizó tratamiento exitoso con arteriografía renal y embolización supraselectiva. No encontramos ningún caso de nefrectomía o muerte asociada a la biopsia. Las complicaciones mayores se asociaron a una presión arterial diastólica elevada.ConclusiónLa biopsia renal percutánea con aguja automática de 16G es una buena alternativa, dada su eficacia y seguridad, para la obtención de muestras histológicas del riñón (AU)

ObjectivesUS-guided percutaneous renal biopsy is the procedure of choice for obtaining histological specimens from the renal parenchyma. The superiority of using automatic needles under US guidance is well established in the literature. However, little information is available about the use of 16G needles, so we reviewed our experience in this technique. We report the diagnostic yield and rate of complications for US-guided percutaneous renal biopsy using automatic 16G needles.Material and methodsWe reviewed 243 consecutive renal biopsies obtained from native kidneys using automatic 16G needles under US guidance. We calculated the diagnostic yield using the number of biopsies with a complete histological report and the rate of major and minor complications. We used Fisher's exact test to evaluate the correlation between the occurrence of major complications, patient age, renal function, and diastolic blood pressure.ResultsBiopsies yielded enough material to establish the diagnosis in 228 of 243 cases (93.83%). Complications were detected in 33 of 243 biopsies (13.5%); of these, 9 (3.7%) were major and 24 (9.8%) were minor. Seven patients in whom major complications occurred were successfully treated with renal arteriography and superselective embolization. We found no cases of nephrectomy or death associated to biopsy. Major complications were associated to elevated diastolic blood pressure.ConclusionThe efficacy and safety of percutaneous renal biopsy using an automatic 16G needle make it a good alternative to obtain histological specimens of the kidney (AU)

[Safety and yield of percutaneous renal biopsy using an automatic 16G needle in native kidneys]. / Rentabilidad y seguridad de la biopsia renal percutánea en riñones nativos con aguja automática de 16G.

OBJECTIVES: US-guided percutaneous renal biopsy is the procedure of choice for obtaining histological specimens from the renal parenchyma. The superiority of using automatic needles under US guidance is well established in the literature. However, little information is available about the use of 16G needles, so we reviewed our experience in this technique. We report the diagnostic yield and rate of complications for US-guided percutaneous renal biopsy using automatic 16G needles. MATERIAL AND METHODS: We reviewed 243 consecutive renal biopsies obtained from native kidneys using automatic 16G needles under US guidance. We calculated the diagnostic yield using the number of biopsies with a complete histological report and the rate of major and minor complications. We used Fisher's exact test to evaluate the correlation between the occurrence of major complications, patient age, renal function, and diastolic blood pressure. RESULTS: Biopsies yielded enough material to establish the diagnosis in 228 of 243 cases (93.83%). Complications were detected in 33 of 243 biopsies (13.5%); of these, 9 (3.7%) were major and 24 (9.8%) were minor. Seven patients in whom major complications occurred were successfully treated with renal arteriography and superselective embolization. We found no cases of nephrectomy or death associated to biopsy. Major complications were associated to elevated diastolic blood pressure. CONCLUSION: The efficacy and safety of percutaneous renal biopsy using an automatic 16G needle make it a good alternative to obtain histological specimens of the kidney.

Cultivo in vitro con colágeno y fibroblastos humanos de un equivalente de mucosa oral de espesor total / In vitro culture with collagen and human fibroblasts of a full-thickness oral mucosa equivalent

Objetivos. El presente trabajo tiene por objetivo obtener, mediantecultivo in vitro, láminas de tejido oral en las que se pueda identificar lasestructuras de una mucosa oral completa. La aplicación clínica del presenteestudio permitiría, en determinados casos, la sustitución del empleo de injertoslibres de piel o autólogos de mucosa oral por esta técnica. Material y Método.A partir de pequeñas biopsias de mucosa oral se hicieron cultivos primariosde queratinocitos. A partir de estos cultivos primarios se realizaron cultivossecundarios sobre una submucosa artificial constituida por colágeno y fibroblastoshumanos. Se analizaron histológicamente sus características in vitro, yulteriormente se procedió a la realización de injertos en ratones atímicospara conocer su comportamiento in vivo. Resultados. Los cultivos primariosfueron confluentes en un plazo mínimo de 10 días y máximo de 12 días, periodosimilar al observado para la confluencia de los cultivos secundarios. El tiempotranscurrido desde la toma de la muestra hasta la obtención de una mucosaartificial completa osciló entre los 20 y los 22 días, mostrando las característicashistológicas de una mucosa normal. Tras 17 días de injerto en ratonesinmunoincompetentes, sin ningún tipo de contingencia clínica, la caracterizaciónhistológica e inmunohistoquímica (citoqueratinas 13 y 19, colágenoIV y laminina) confirmó la similitud de la mucosa in vitro con la mucosa oralsana. Conclusión. Es posible mediante técnicas de cultivo in vitro la obtenciónde un equivalente de mucosa oral completa con colágeno y fibroblastos. Sibien esta mucosa muestra un importante grado de retracción, su manejo clínicoes muy favorable(AU)

Objectives. The objective of this study was to obtain,by in vitro culture, sheets of oral tissue in which complete oral mucosastructures can be identified. Clinical application of the findings ofthis study will allow the replacement of free skin grafts or autologousoral mucosa grafts by this technique in certain cases.Material and Method. Primary keratinocyte cultures were preparedfrom small biopsy samples of oral mucosa. Secondary cultures wereprepared from these primary cultures on an artificial submucosaconstituted by collagen and human fibroblasts. The cell cultureswere analyzed histologically in vitro and then used for graft implantsin athymic mice to study their behavior in vivo.Results. The primary cultures were confluent within a minimumperiod of 10 days and maximum of 12 days, which is similar to theperiod that the secondary cultures required to reach confluence.The time from sampling to achieving a complete artificial mucosaranged from 20 to 22 days. The artificial mucosa showed histologiccharacteristics of a normal mucosa. After 17 days of graftimplantation in immunoincompetent mice without any clinicalcontingency, histologic and immunohistochemical characterization(cytokeratins 19 and 13, collagen IV, and laminin) confirmed thesimilarity of the mucosa in vitro to healthy oral mucosa.Conclusion. A complete oral mucosa equivalent can be preparedwith collagen and fibroblasts using in vitro culture techniques.Although this mucosa shows considerable retraction, its clinicalhandling is very favorable(AU)

Computing the Heat of Adsorption using Molecular Simulations: The Effect of Strong Coulombic Interactions.

Molecular simulations are an important tool for the study of adsorption of hydrocarbons in nanoporous materials such as zeolites. The heat of adsorption is an important thermodynamic quantity that can be measured both in experiments and molecular simulations, and therefore it is often used to investigate the quality of a force field for a certain guest-host (g - h) system. In molecular simulations, the heat of adsorption in zeolites is often computed using either of the following methods: (1) using the Clausius-Clapeyron equation, which requires the partial derivative of the pressure with respect to temperature at constant loading, (2) using the energy difference between the host with and without a single guest molecule present, and (3) from energy/particle fluctuations in the grand-canonical ensemble. To calculate the heat of adsorption from experiments (besides direct calorimetry), only the first method is usually applicable. Although the computation of the heat of adsorption is straightforward for all-silica zeolites, severe difficulties arise when applying the conventional methods to systems with nonframework cations present. The reason for this is that these nonframework cations have very strong Coulombic interactions with the zeolite. We will present an alternative method based on biased interactions of guest molecules that suffers less from these difficulties. This method requires only a single simulation of the host structure. In addition, we will review some of the other important issues concerning the handling of these strong Coulombic interactions in simulating the adsorption of guest molecules. It turns out that the recently proposed Wolf method ( J. Chem. Phys. 1999, 110 , 8254 ) performs poorly for zeolites as a large cutoff radius is needed for convergence.

Influence of cation Na/Ca ratio on adsorption in LTA 5A: a systematic molecular simulation study of alkane chain length.

Recent adsorption isotherms of n-alkanes on Ca,Na-LTA-type zeolite afford development of a force field describing the interactions between calcium and n-alkanes in configurational-bias Monte Carlo simulations. The force field of Calero et al. (J. Am. Chem. Soc. 2004, 126, 11377-11386) is able to accurately describe the adsorption properties of linear alkanes in the sodium form of FAU-type zeolites. Here, we extend upon this type of force field by including calcium-type ions. The force field was fitted to reproduce the calcium and sodium cations positions on LTA 5A and the experimental adsorption properties of n-alkanes over all range of temperatures and pressures. This opens up a vast amount of experimental data on LTA 5A, both on adsorption and diffusion. Furthermore, evaluation of half a century of reported n-alkane adsorption data on LTA-type zeolites indicates that there are many inconsistencies between the various data sets, possibly as a result of (i) undisclosed calcium and sodium contents, (ii) less than perfect drying of the hygroscopic zeolite, and (iii) coadsorption of contaminants such as vacuum grease. Having obtained our force field, and confirmed its reliability on predictions outside the calibration set, we apply the force field on two "open" problems: (a) the heats of adsorption and Henry coefficient as a function of chain length and (b) the effect of cations in LTA-type zeolites. The molecular simulations shed new light on previous experimental findings, and we provide rationalizations on the molecular level that can be generalized to the class of cage/window-type nanoporous materials.

A coarse-graining approach for the proton complex in protonated aluminosilicates.

We have developed a computational framework for the adsorption of linear alkanes in protonated aluminosilicates. These zeolites contain trace amounts of water that form hydrated proton complexes. The presence of hydrated protons makes the simulations at the fully atomistic level difficult. Instead of constructing an elaborate and complex model, we show that an approach based on a coarse-graining of the proton-complex accurately describes the available experimental isotherms, Henry coefficients, heats of adsorption, and oxygen-proton distances. Our approach is supported by MP2 quantum mechanical simulations. The model gives remarkably good agreement with experimental data beyond the initial calibration set.

[Evaluation of the clinical manifestations in patients with reactions to the rabies vaccine or serum in the Ciego de Avila province (Cuba)]. / Evaluación de las manifestaciones clínicas en pacientes con reacciones a la vacuna o suero antirrábico en la provincia de Ciego de Avila (Cuba).

The present design is a descriptive study in which people bitten by animals, rabies treatment used and the reactions to it are described. The frequency of adverse effects to the vaccine and to the serum are pointed out. The forms of clinical presentation and the clinical symptoms of the reactions observed in the Ciego de Avila province, Cuba, in the period from 1981 to 2001, were evaluated. In this period prevailed the reactions to the heterologous serum and the reactions caused by the human rabies vaccine. Local reactions to the vaccine were more common than the systemic ones. Four neuroparalytic reactions produced by the vaccines were observed. The most frequent symptoms and signs of the patients with reaction to the vaccine were pruritus, rash, localized urticaria, papule in the point of injection and local pain. The clinical manifestations considered as reactions to the heterologous serum that prevailed in the patients were rash in gluteal regions, pruritus, local erythyema and fever. No patient was detected with neurological manifestations caused by the heterologous serum.

Evaluación de las manifestaciones clínicas en pacientes con reacciones a la vacuna o suero antirrábico en la provincia de Ciego de Ávila (Cuba) / Evaluation of the clinical manifestations in patients with reactions to the rabies vaccine or serum in the Ciego de Ávila province

El presente diseño es un estudio descriptivo en el que se describen las personas mordidas por animales, los tratamientos antirrábicos aplicados y las reacciones. Se señalan las frecuencias de eventos a la vacuna y al suero. Se evaluaron las formas de presentación y el cuadro clínico de las reacciones ocurridas en la provincia Ciego de Ávila (Cuba) en el período de 1981 a 2001. En esa etapa predominaron las reacciones al suero heterólogo sobre las producidas por la vacuna antirrábica humana. Las reacciones locales a la vacuna fueron más frecuentes que las sistémicas. Se presentaron 4 reacciones neuroparalíticas producidas por las vacunas. Los síntomas y signos más frecuentes de los pacientes con reacción a la vacuna fueron prurito, rash urticariano localizado, pápula en el punto de inyección y dolor local. Las manifestaciones clínicas que predominaron en los pacientes concluidos como reacciones al suero heterólogo fueron rash en glúteos, prurito, eritema local y fiebre. No se detectó ningún paciente con manifestaciones neurológicas producidas por el suero heterólogo (AU)

[Primary intracranial Ewing's sarcoma of the mastoid bone. A case report]. / Sarcoma de Ewing intracraneal primario de mastoides. Presentación de un caso.

INTRODUCTION: Ewing s sarcoma (ES) is a tumorous process that is found mainly in long bones and the pelvis, but its primary location is not often the intracranial zone. CASE REPORT: We report the case of a 5 year old patient who visited surgery 30 days before hospital admission with increased volume of the left mastoid bone, torticollis, balance disorders and discoordinated movements. A computerised tomography brain scan confirmed our suspicions of a tumorous lesion that was destroying the left mastoid bone, and was invading the projection of the left hemispherium cerebri and edges of the brain stem (mid brain). The patient was submitted to surgery and a partial excision was performed. A month later, another operation was carried out and the patient died after several days in the intensive care unit from serious respiratory complications. CONCLUSIONS: The tumour marker CD 99 is specifically used to diagnose ES. We think that, when faced with a patient suffering from ES, conduct must always be aggressive, with early surgery and, later, adjuvant therapy.

Spread of synaptic potentials through electrical synapses in Retzius neurones of the leech.

We studied the spread of excitatory postsynaptic potentials (EPSPs) through electrical synapses in Retzius neurones of the leech Haementeria officinalis. The pair of Retzius neurones in each ganglion is coupled by a non-rectifying electrical synapse. Both neurones displayed synchronous EPSPs of varying amplitudes and rise times. The kinetics of synchronous EPSPs was similar in 79 % of the EPSP pairs. In the remaining 21 %, one EPSP was smaller and slower than the other, suggesting its passive spread from the other neurone. The proportion of these events increased to 75 % in the presence of Mg(2+) in the bathing fluid. This spread of EPSPs from one neurone to another was tested by producing artificial EPSPs by current injection into the soma of one Retzius neurone. The artificial EPSPs were smaller and arrived more slowly at the soma of the coupled neurone. The coupling ratios for the EPSPs were proportional to the coupling ratio for long steady-state pulses in different neuronal pairs. Our results showed that EPSPs spread from one Retzius neurone to the other and support the idea that EPSP spread between electrically coupled neurones may contribute to the integration processes of neurones.