Trimethylamine N-oxide levels are associated with NASH in obese subjects with type 2 diabetes.

AIMS: Trimethylamine N-oxide (TMAO), choline and betaine serum levels have been associated with metabolic diseases including type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). These associations could be mediated by insulin resistance. However, the relationships among these metabolites, insulin resistance and NAFLD have not been thoroughly investigated. Moreover, it has recently been suggested that TMAO could play a role in NAFLD by altering bile acid metabolism. We examined the association between circulating TMAO, choline and betaine levels and NAFLD in obese subjects. METHODS: Serum TMAO, choline, betaine and bile acid levels were measured in 357 Mexican obese patients with different grades of NAFLD as determined by liver histology. Associations of NAFLD with TMAO, choline and betaine levels were tested. Moreover, association of TMAO levels with non-alcoholic steatohepatitis (NASH) was tested separately in patients with and without T2D. RESULTS: TMAO and choline levels were significantly associated with NAFLD histologic features and NASH risk. While increased serum TMAO levels were significantly associated with NASH in patients with T2D, in non-T2D subjects this association lost significance after adjusting for sex, BMI and HOMA2-IR. Moreover, circulating secondary bile acids were associated both with increased TMAO levels and NASH. CONCLUSIONS: In obese patients, circulating TMAO levels were associated with NASH mainly in the presence of T2D. Functional studies are required to evaluate the role of insulin resistance and T2D in this association, both highly prevalent in NASH patients.

The Role of Occlusal Factors in the Presence of Noncarious Cervical Lesions in Young People: A Case-Control Study.

OBJECTIVE:: The aim of this retrospective case-control study was to evaluate the influence of different occlusal characteristics and self-referred bruxism in the presence of noncarious cervical lesions (NCCLs). METHODS AND MATERIALS:: The participants were 280 students (140 cases and 140 controls), with an average age of 24.5 years, from six schools of dentistry in Spain. Clinical examination was carried out to record the NCCLs and the static and dynamic occlusal characteristics. The side of mastication and bruxism was collected by questionnaire. Data variables were analyzed by means of univariate and multivariate logistic regression. Odds ratios and the respective 95% confidence intervals were calculated ( p<0.05). RESULTS:: The presence of NCCLs was significantly more likely in subjects with protrusive interferences (odds ratio [OR]=1.82); with lateral interferences, especially on the nonworking side (OR= 1.77); or who were self-reported bruxists (OR=1.72). In the multivariate analysis, protrusive interferences, bruxism, age, and the presence of attrition were risk factors for the development of NCCLs. These factors resulted in a model with an area under the receiver-operating characteristic curve of 0.667 and a positive predictive value of 61.43%. CONCLUSIONS:: There was no significant relationship between most occlusal factors and the presence of NCCLs. Only bruxism, protrusive interferences, age, and occlusal wear were risk factors. The predictive model was not sufficiently explanatory. Occlusal factors alone do not appear to be sufficient to explain the presence of NCCLs.

Selective tonicity-induced expression of the neutral amino-acid transporter SNAT2 in oligodendrocytes in rat brain following systemic hypertonicity.

Sodium-coupled neutral amino-acid transporter member 2 (SNAT2) belongs to the family of neutral amino-acid transporters. SNAT2 is encoded by the gene Slc38a2, whose expression was reported to increase in vitro in fibroblasts, endothelial and renal cells exposed to a hypertonic medium. SNAT2 tonicity-induced expression brings about cellular accumulation of amino-acid, which contributes to osmoadaptation to hypertonicity. Since brain osmoadaptation is observed in relationship to neurological disorders resulting from pathological osmotic imbalances in blood plasma, we have investigated, through immunocytochemistry, SNAT2 expression in brain of rats subjected to systemic hypertonicity. Following prolonged systemic hypertonicity (24 h), small, strongly immunolabeled elements were observed that were not present in sham-treated animals. They were evenly distributed in the gray matter, with a lower density in the forebrain and a higher density in the brain stem. However the highest density by far was observed in white matter, where they were frequently aligned in chain-like rows. These observations suggested an oligodendrocyte location that was further established by double immunofluorescent labeling, using the oligodendrocyte phenotypic markers 2'-3'-cyclic nucleotide 3'phosphodiesterase and carbonic anhydrase II. SNAT2-positive elements were found associated with oligodendrocyte cell bodies, while oligodendrocyte processes were devoid of labeling. A quantitative analysis performed in the cerebral cortex indicated that virtually all SNAT2-positive elements were associated with oligodendrocyte cell bodies and conversely that the overwhelming majority of oligodendrocytes showed SNAT2 immunolabeling. The tonicity-induced expression of SNAT2 was not observed following acute systemic hypertonicity (6 h). Our results suggest that the osmoadaptation of brain oligodendrocytes to hypertonicity relies upon amino-acid accumulation through the tonicity-induced expression of SNAT2. The possible significance of these findings in relationship to the selective loss of oligodendrocytes observed in osmotic demyelination syndrome is discussed.

Carcinoma basocelular metastásico en la región parotídea: un nuevo caso / Basal cell carcinoma metastatic to the parotid area: case report

El carcinoma basocelular es la tumoración cutánea maligna más frecuente. Junto con el carcinoma espinocelular su localización habitual es a nivel de cabeza y cuello y a diferencia de éste la tasa de metástasis regionales es mucho más baja. Presentamos el caso de una mujer de 85 años con un carcinoma basocelular a nivel del pabellón auricular derecho, que inicialmente se trató mediante extirpación y cierre. A los 2 años presentó recidiva local en la zona inferior del pabellón auricular y en la exploración física se apreció una tumoración dura a nivel submandibular derecho. Se realizó punción aspiración con aguja fina (PAAF) que fue positiva para metástasis de carcinoma basocelular. La Tomografía Axial Computerizada (TAC) mostraba una masa única en la región submandibular no adherida a la mandíbula. El tratamiento consistió en extirpación de la recidiva local y parotidectomía superficial más vaciamiento cervical funcional del lado derecho. La paciente se negó a realizar tratamiento con radioterapia complementaria. En la actualidad la paciente está viva y realiza revisiones periódicas (AU)

Basal cell carcinoma is the most common cutaneous malignancy. As the scamous cell carcinoma its first location is in head and neck, but the rate of regional metastases is much lower. ;;We present the case of an 85-year-old woman with a basal cell carcinoma located on the ear. ;;She was first treated by local excision and direct suture. Two years later presented a local recurrence in the lower part of the ear. At this time a physical neck exam revealed a submandibular node. ;;Fine needle aspiration was positive for basal cell carcinoma metastases, and a Computed Tomography (CT) showed a single mass in the submandibular region not in contact with bone. ;;Treatment consisted on a wide local excision, superficial parotidectomy and ipsilateral functional neck dissection. ;;The patient refused postoperative radiotherapy treatment. ;;At this moment the woman is alive and under periodical revision (AU)

Immunohistochemical localization of the amino acid transporter SNAT2 in the rat brain.

SNAT2 is a neutral amino acid carrier that belongs to the system A family. Since its function in the nervous system remains unclear, we have analyzed its distribution in the rat CNS using specific antisera. Although SNAT2 is expressed widely in the CNS, it is enriched in the spinal cord and the brainstem nuclei, especially those of the auditory system. At the cellular level, SNAT2 was preferentially located in neuronal cell bodies and processes, although it was also strongly expressed in the meninges and ependyma. In astrocytes, the localization of SNAT2 was more restricted since it was intensely expressed in the perivascular end-feet, glia limitans, cerebellar astrocytes and Bergmann glia, but it was less intense in astrocytes of the cerebral parenchyma. Among neurons, the primary sensory neurons of the mesencephalic trigeminal nucleus appeared to be those that most strongly express SNAT2, but many other neurons, including cortical pyramidal cells and their dendrites were also intensely stained. In several regions the transporter was detected in axons, especially in the brainstem, and its presence in both dendrites and axons was confirmed by confocal microscopy and ultrastructural studies. However, while SNAT2 was observed in the large principal dendrites and the small distal dendrites, it was only found in axonal shafts and was excluded from terminals. Some glutamatergic neurons were among the more intensely labeled cells whereas SNAT2 was not detected on GABAergic neurons. The expression of SNAT2 partially coincides with that reported for SNAT1, especially in glutamatergic neurons. Hence, both proteins could fulfill complementary roles in replenishing glutamate pools and be differentially regulated under different physiological conditions. They also seem to co-localize in non-neuronal cells probably contributing to amino acid fluxes through the blood-brain barrier.

[Detection of malnutrition on admission to hospital]. / Detección de malnutrición al ingreso en el hospital.

In view of the high prevalence of malnutrition in hospitals as shown by some studies and in the light of its direct impact on the increase in morbidity and mortality among hospitalized patients, it is necessary to ensure the early identification of this condition. This would allow appropriate nutritional treatment to be instituted as soon as possible for patients at risk who require it. The present multi-centric study included the participation of hospitals in the northern region of the country which have a Nutrition Unit, with use of the Overall Subjective Assessment and a few basic parameters. The study analyzed the nutritional status on admission of 620 patients hospitalized in the Internal Medicine and General Surgery areas during the months of December, 1999, January, February and March, 2000. We detected moderate malnutrition or suspected malnutrition in 20% of the patients studied and severe malnutrition in 18.2%, with a greater incidence in Internal Medicine. Malnutrition was mainly evidenced by weight loss of more than 5% and a reduction in subcutaneous fat and muscle mass. In addition, there are functional limitations on performing everyday activities. Changes in dietary intake were present in 40.8% of the patients. The associated gastro-intestinal symptoms included anorexia, which affected 37.7% of the group studied. Malnutrition is most frequently linked with infectious diseases, problems in circulation and with the digestive apparatus. We feel that the Overall Subjective Assessment, together with the measurement of height and weight, should be used systematically with patients on admission, as it is a simple and effective method for the identification of patients with nutritional risk.

Detección de malnutrición al ingreso en el hospital / Detection of malnutrition on admission to hospital

Dada la alta prevalencia de la malnutrición hospitalaria que muestran algunos estudios y conociendo su repercusión directa sobre el incremento de la morbi-mortalidad de los pacientes hospitalizados, se hace necesaria la identificación precoz de la misma. Esto permitiría implantar lo antes posible un adecuado tratamiento nutricional a los pacientes de riesgo que lo precisen. En el presente trabajo multicéntrico participaron hospitales de la zona norte del país, que disponen de unidad de nutrición, utilizando la valoración subjetiva global y algunos parámetros básicos. Se estudió el estado nutricional al ingreso de 620 pacientes hospitalizados en las áreas de medicina interna y cirugía general, durante los meses de diciembre de 1999, enero, febrero y marzo de 2000.Destacamos malnutrición moderada o sospecha de malnutrición en el 20 por ciento de los pacientes estudiados, y malnutrición grave en el 18,2 por ciento, siendo mayor la incidencia en medicina interna. La malnutrición se evidencia sobre todo con pérdida de peso superior al 5 por ciento y disminución de grasa subcutánea y de masa muscular. Además hay limitación funcional para realizar la actividad normal. Presentaron cambios en la ingesta dietética el 40,8 por ciento de los enfermos. Entre los síntomas gastrointestinales que se asocian, destaca la anorexia, que afecta al 37,7 por ciento del grupo estudiado. La malnutrición se relaciona más frecuentemente con las enfermedades infecciosas, aparato circulatorio y aparato digestivo. Creemos que la valoración subjetiva global, junto con la medición de la talla y el peso, deberían utilizarse de forma sistemática al ingreso del enfermo, por tratarse de un método sencillo y eficaz para la identificación de pacientes en riesgo nutricional (AU)

In view of the high prevalence of malnutrition in hospitals as shown by some studies and in the light of its direct impact on the increase in morbidity and mortality among hospitalized patients, it is necessary to ensure the early identification of this condition. This would allow appropriate nutritional treatment to be instituted as soon as possible for patients at risk who require it. The present multi-centric study included the participation of hospitals in the northern region of the country which have a Nutrition Unit, with use of the Overall Subjective Assessment and a few basic parameters. The study analyzed the nutritional status on admission of 620 patients hospitalized in the Internal Medicine and General Surgery areas during the months of December, 1999, January, February and March, 2000. We detected moderate malnutrition or suspected malnutrition in 20% of the patients studied and severe malnutrition in 18.2%, with a greater incidence in Internal Medicine. Malnutrition was mainly evidenced by weight loss of more than 5% and a reduction in subcutaneous fat and muscle mass. In addition, there are functional limitations on performing everyday activities. Changes in dietary intake were present in 40.8% of the patients. The associated gastro-intestinal symptoms included anorexia, which affected 37.7% of the group studied. Malnutrition is most frequently linked with infectious diseases, problems in circulation and with the digestive apparatus. We feel that the Overall Subjective Assessment, together with the measurement of height and weight, should be used systematically with patients on admission, as it is a simple and effective method for the identification of patients with nutritional risk (AU)

Caracterización de una población bruxista y evaluación de la terapéutica mediante análisis cluster / Characterization of a bruxist population and therapeutical evaluation by means of a cluster analysis

El efecto de la férula oclusal y el TENS ha sido estudiado en una muestra de 24 pacientes bruxistas (apretadores y rechinadores) que fueron diagnosticados por medio de un cuestionario y anamnesis. Se estudiaron diferentes variables tanto cualitativas como cuantitativas, atendiendo a aspectos psicológicos, de oclusión tanto estática como dinámica, actualidad electromiográfica e índices electromiográficos en músculos posturales y elevadores y presencia de desarreglos internos de la articulación temporomandibular. El método estadístico utilizado fue el análisis cluster. Los resultados no mostraron claramente una discriminación entre grupos tanto entre apretadores y rechinadores como entre los dos tipos de tratamiento...

Electromiografía de superficie e índices de balance muscular en posición de reposo en pacientes bruxistas / Surface electromyography and muscle balance indexes on the resting position of bruxist patients

En 24 bruxistas diagnosticados por cuestionario y anamnesis se determinó, por electromiografía de superficie, la actividad eléctrica de los músculos elevadores mandibulares, de los digástricos y de los músculos esternocleidomastoideos y trapecios, así como los índices de asimetría, de actividad y de torque en la posición de reposo mandibular. Los resultados muestran que esta posición es mantenida con una mínima actividad muscular con mayor contribución relativa de los temporales anteriores y de los trapecios. Se constata también una leve asimetría de predominio izquierdo...

Value of the carpal compression test in the diagnosis of carpal tunnel syndrome.

In order to determine the efficacy of the carpal compression test (CCT) in the diagnosis of the carpal tunnel syndrome (CTS), we conducted a prospective study on 200 consecutive hands diagnosed as having CTS. A control group of 100 healthy volunteers with no symptoms of CTS were also assessed. The results of the CCT in the patients and controls were compared with those obtained with Phalen's and Tinel's tests. CCT achieved a sensitivity of 87%, and a specificity of 95%. It is a simple, fast and very reliable provocative test, and should be routinely used in the diagnosis of CTS. This test is also an appropriate manoeuvre in wrists with limited range of motion or pain that cannot be assessed with Phalen's wrist flexion test.

[Basic ideas on the diagnosis and treatment of burns of the male genitalia]. / Nociones básicas sobre diagnóstico y tratamiento de las quemaduras en los genitales masculinos.

OBJECTIVES: The main characteristics of burn injuries of the male genitalia and the basic principles of treatment are described. METHODS/RESULTS: Of 77 patients in the Burns Unit of this hospital, 7 (9%) had lesions to the external genitalia. Four of these patients had superficial dermal (grade IIA), 2 had deep dermal (grade IIB) and one had total dermal or subdermal burn injuries (grade III-IV) to the genitalia. The superficial lesions were treated medically and deep burns required surgery. RESULTS: At one-year follow-up, no functional sequelae were observed except in the patient with total dermal burn injuries, who developed right testicular atrophy and azoospermia, but preserved erection and ejaculation. CONCLUSIONS: Burn injuries to the external genitalia are uncommon. These lesions do not often require surgical treatment, and usually heal spontaneously. Despite their dramatic appearance, cure with no cosmetic or functional sequelae is often the rule.