Papel del Doppler de la vena femoral en pacientes con insuficiencia cardiaca aguda: resultados de un estudio multicéntrico prospectivo / Role of the femoral vein doppler in acute heart failure patients: results from a prospective multicentric study

Antecedentes y objetivo El objetivo de nuestro estudio es definir el papel de la ecografía Doppler pulsada (PW-Doppler) de la vena femoral común en la evaluación de la dilatación de la vena cava inferior (VCI), la probabilidad de hipertensión pulmonar, la insuficiencia tricuspídea y la excursión sistólica del plano anular tricuspídeo (TAPSE). Métodos Se trata de un estudio prospectivo en dos hospitales en 74 pacientes ingresados con insuficiencia cardiaca aguda. Se realizó ecografía PW-Doppler de vena femoral común, ecocardiografía y evaluación de la VCI en el momento del ingreso, así como PW-Doppler y ecografía de VCI al alta hospitalaria. Resultados La detección de un flujo pulsátil (138 exploraciones) tuvo una curva ROC excelente para la detección de VCI mayor de 2cm (AUC 0,931, Sn95%, Sp 90%, VPP 93%, VPN 94%) con una odds ratio (OR) de 211,2 (intervalo de confianza del 95% 48,13-926,72). La pulsatilidad del flujo también tuvo el mayor rendimiento en la detección de la hipertensión pulmonar (AUC 0,8, Sn 95%, Sp 64%, VPP 84%, VPN 84%) y en la detección de la insuficiencia tricuspídea moderada-grave (AUC 0,79, Sn 95%, Sp 67%, VPP 88%, VPN 78%). Si el flujo es continuo, podemos descartar razonablemente una disminución del TAPSE (VPN 89%). Conclusión La detección del flujo PW-Doppler de vena femoral común puede ser una ventana alternativa para la detección de una dilatación de la VCI de 2cm, TR significativa y la probabilidad de hipertensión pulmonar elevada en la insuficiencia cardiaca aguda. También permite descartar razonablemente la disfunción del ventrículo derecho en casos de normalidad en estos pacientes (AU)

Background and objective The aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the common femoral vein in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). Methods This is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. Results The detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13-926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). Conclussion Detection of PW-Doppler flow of the common femoral vein may be an alternative window for the detection of an IVC dilation of 2cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients (AU)

Role of the femoral vein doppler in acute heart failure patients: results from a prospective multicentric study.

BACKGROUND AND OBJECTIVE: The aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the Common Femoral Vein (CFV) in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). METHODS: This is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care (POC) cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. RESULTS: The detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13-926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). CONCLUSSION: Detection of PW-Doppler flow of the CFV may be an alternative window for the detection of an IVC dilation of 2cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients.

Persistent lymph nodes after curative chemoradiotherapy for head and neck cancer: imaging predictors of response for decision-making.

PURPOSE: To identify response predictors in patients with head and neck squamous cell carcinoma (N + HNSCC) and persistent lymph nodes after curative chemoradiotherapy treatment (CCRT). MATERIALS AND METHODS: Consecutive patients with N + HNSCC treated with CCRT and persistent lymph nodes at first follow-up between 2015 and 2021 were identified and analyzed. Complete response was defined as the absence of lymph node metastatic involvement in patients with salvage lymphadenectomy or the absence of progression after 1 year of successive follow-ups. Tumour type and location, staging, and human papillomavirus (HPV) status were considered for analysis. The number and size of lymph nodes, type, shape, enhancement and margins on diagnostic and follow-up CT were also analyzed. RESULTS: The cohort included 46 patients with 134 pathological lymph nodes. Logistic regression models showed the following variables to be significant: performance of salvage lymphadenectomy (OR 0.094, [CI 95% 0.004-0.61], p = 0.037); the type of lymphadenopathy on diagnostic CE-CT (solid vs. cystic) (N1: OR = 4.11, [CI 95% 1.11-17.93], p = 0.042 and N3: OR 6.42, [CI 95% 1.2-42.56], p = 0.036); the change of shape (round to oval) on the follow-up CE-CT (OR 9.76, [CI 95% 1.79-8.57], p = 0.016) and the time in days between CCRT and the first follow-up CE-CT (OR 1.06, [CI 95% 1.004-1.13], p = 0.048). CONCLUSIONS: In our experience, the presence of solid lymph nodes on pre-treatment CT and the change in shape from round to oval on post-treatment CT are predictors of response to treatment in patients with N + HNSCC persistent lymph nodes after CCRT. Increasing the temporal interval between treatment and follow-up CT should be considered to avoid unnecessary nodal dissections.

Sinonasal mucosal melanomas: defining profiles for better survival outcomes.

BACKGROUND: Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. METHODOLOGY: A retrospective cohort study was conducted at the Hospital Clinic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. RESULTS: Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. CONCLUSIONS: We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients' profiles that will benefit from a better survival outcome.

Breaking Down Barriers: Easter Island's First Telestroke Thrombolysis Experience and Case Report.

Easter Island (Rapa Nui), Chile, is remote, located in the Polynesian Triangle in Oceania. The closest continental point is Chile, 3,512 km east. It has a population of 7,750 inhabitants, who are Chilean citizens, and receives more than 60,000 tourists a year. For this entire population, there is a medium complexity hospital without a neurology specialist. In 2019, local professionals were trained in a Telestroke program with remote clinical support conducted by neurologists located on mainland Chile. We present a 50-year-old native male, with unknown medical history, who suddenly presented right-half-body weakness and aphasia. He was evaluated via Telestroke consultation, and thrombolysis with tenecteplase was indicated. The patient improved rapidly and 45 min later the NIHSS score was 0 points. To our knowledge, this is the first reported case of Telestroke treatment in such a remote area, highlighting the importance of telemedicine to overcome geographical and technological stroke care barriers and to improve patients' outcome, no matter where they live.

Life cycle assessment, C footprint and carbon balance of virgin olive oils production from traditional and intensive olive groves in southern Spain.

Olive oil production shapes the socio-economic and environmental life of many areas of the Mediterranean basin, especially southern Spain, the highest olive oil-producing region worldwide. Olive grove cultivation is tending to intensify from traditional low-density to intensive and high-density cropping systems, which might result in higher environmental impacts. The aim of this study is to estimate the environmental impacts, carbon (C) footprint and carbon balance of producing virgin origin olive oil in Spain from four traditional rainfed, four irrigated, and three intensive olive farms, including the processing phase. Environmental impacts of producing 1 kg of unpacked virgin olive oil at the farm and industrial phases were quantified with the Life Cycle Assessment (LCA) tool and a "cradle-to-gate" approach using data from surveys at these farms and 12 olive oil mills. On average, the farming phase accounted for 76.3% of the EIs. Therefore, to reduce the impact of the virgin olive oils production, most of the efforts should be made especially in the farming phase. Despite the high variability between seasons and between independent replicates of the same farming system, intensive farming had significant higher impacts on most environmental impact categories than traditional rainfed farming, mainly due to the application of nitrogen fertilizer, plant protection products and herbicides. In terms of climate change, the environmental impact of the functional unit is in the ranges of 1.80-2.41, 1.59-2.78 and 2.28-3.26 kg of CO2 eq. for traditional rainfed, irrigated and intensive, respectively. C footprint was negative and averaged -5.5, -4.3 and -2.7 kg CO2 eq. Olive groves are efficient atmospheric CO2 sinks mainly by fixing CO2 into permanent and non-permanent trees structures. The lower intensification of the traditional rainfed groves contributed more in mitigating the increase of atmospheric CO2. Finally, the C footprint and C balance are negative, especially in traditional irrigated and intensive farming. The application of organic sources of fertilizer and the implementation of temporary spontaneous cover crops, both technically and economically feasible, are sound strategies to achieve a positive carbon balance and reduce the impacts of olive cultivation.

Perfil dermatoglífico y potencialidades físicas de niñas de gimnasia artística de competencia: Comparación con no gimnastas / Dermatoglyphic profile in competitive artistic gymnastics girls: Comparison with non-gymnasts / Perfil dermatoglífico e potencial físico de meninas concorrentes em ginástica artística: comparação com não ginastas

OBJETIVO: Identificar las potencialidades físicas, a través de perfiles dermatoglíficos, de niñas gimnastas de competencia comparadas con niñas no gimnastas. MÉTODO: Se midieron niñas no gimnastas (n=50) y niñas gimnastas (n=50) participantes en el Campeonato Regional de bases 2018, Zona 1 Norte de México, de los estados de Sonora, Sinaloa, Baja California, Baja California Sur y Chihuahua. Lo anterior a través del método dermatoglífico informatizado, sobre la base del protocolo propuesto por Cummins y Midlo, que consiste en la toma de las huellas de los 10 dedos de las manos. RESULTADOS: Las gimnastas exhiben mayor coordinación motora, agilidad y resistencia, ya que presentan valores más altos en marcas dactilares como verticilos y delta 10. Absolutamente todas las formulas encontradas en las gimnastas presentan verticilos (coordinación y agilidad), aunque en diferente proporción. Las fórmulas que más se repiten en ambos grupos son presillas>verticilos (gimnastas 48% y no gimnastas 44%) y verticilos> presillas (gimnastas 26% y no gimnasta 16%). Notando que, aunque en las niñas no gimnastas también aparecen dichas formulas, en este grupo tienden a diversificarse de forma clara. CONCLUSIONES: Se logra definir que los verticilos, que correlacionan con coordinación y agilidad, son huellas de suma importancia en la práctica de la gimnasta, que junto con un delta 10 (promedio) de 14 y un alto conteo de líneas en los dedos de la mano izquierda, como elementos indispensables en el perfil dermatoglífico en la gimnasia

OBJECTIVE: To identify the physical potentialities, through dermatoglyphic profiles, of competitive gymnast girls compared to non-gymnast girls. METHOD: Non-gymnast girls (n = 50) and gymnast girls (n = 50) participating in the 2018 Regional Base Championship, Zone 1 North of Mexico, of the states of Sonora, Sinaloa, Baja California, Baja California Sur and Chihuahua The above through the computerized dermatoglyphic method, on the basis of the protocol proposed by Cummins and Midlo, which consists of making the fingerprints of the 10 fingers. RESULTS: Gymnasts exhibit greater motor coordination, agility and endurance, since they have higher values in fingerprints such as whorls and delta 10. Absolutely all the formulas found in gymnasts have whorls (coordination and agility), although in different proportions. The formulas that are repeated in both groups are loops>whorls (gymnasts 48% and not gymnasts 44%) and whorls>loops (gymnasts 26% and non-gymnasts 16%). Noting that, although in non-gymnast girls such formulas also appear, in this group they tend to diversify clearly. CONCLUSIONS: It is possible to define that whorls, which correlate with coordination and agility, are traces of the utmost importance in the gymnast's practice, which together with a delta 10 (average) of 14 and a high count of lines on the fingers of the left hand, as essential elements in the dermatoglyphic profile in gymnastics

OBJETIVO: Identificar as potencialidades físicas, por meio de perfis dermatoglíficos, de meninas ginastas de competição em comparação com não ginastas. MÉTODO: Foram medidas meninas não ginastas (n = 50) e meninas ginastas (n = 50) que participam do Campeonato Regional de 2018, Zona 1 ao norte do México, dos estados de Sonora, Sinaloa, Baja California, Baja California Sur e Chihuahua O exposto acima, pelo método dermatoglífico computadorizado, com base no protocolo proposto por Cummins e Midlo, que consiste em fazer as impressões digitais dos 10 dedos. RESULTADOS: As ginastas apresentam maior coordenação motora, agilidade e resistência, pois apresentam valores mais altos nas impressões digitais como espirais e delta 10. Absolutamente todas as fórmulas encontradas nas ginastas possuem vértices (coordenação e agilidade), embora em proporções diferentes. As fórmulas repetidas nos dois grupos são presilha>espirais (ginastas 48% e não ginastas 44%) e espirais>presilha (ginastas 26% e não ginastas 16%). Observando que, embora em meninas sem ginasta, essas fórmulas também apareçam, nesse grupo elas tendem a diversificar claramente. CONCLUSÕES: É possível definir que espirais, que se correlacionam com coordenação e agilidade, são traços de extrema importância na prática da ginasta e que, juntamente com um delta 10 (médio) de 14 e uma contagem alta de linhas nos dedos da mão esquerda, como elementos essenciais no perfil dermatoglyphic na ginástica

Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. / Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19.

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

A wavelet neural control scheme for a quadrotor unmanned aerial vehicle.

Wavelets are designed to have compact support in both time and frequency, giving them the ability to represent a signal in the two-dimensional time-frequency plane. The Gaussian, the Mexican hat and the Morlet wavelets are crude wavelets that can be used only in continuous decomposition. The Morlet wavelet is complex-valued and suitable for feature extraction using the continuous wavelet transform. Continuous wavelets are favoured when high temporal and spectral resolution is required at all scales. In this paper, considering the properties from the Morlet wavelet and based on the structure of a recurrent high-order neural network model, a novel wavelet neural network structure, here called a recurrent Morlet wavelet neural network, is proposed in order to achieve a better identification of the behaviour of dynamic systems. The effectiveness of our proposal is explored through the design of a decentralized neural backstepping control scheme for a quadrotor unmanned aerial vehicle. The performance of the overall neural identification and control scheme is verified via simulation and real-time results.This article is part of the theme issue 'Redundancy rules: the continuous wavelet transform comes of age'.

Hernia perineal tras amputación abdominoperineal laparoscópica en cirugía de cáncer del recto / Perineal hernia after laparoscopic abdominoperineal resection in rectal cáncer surgery

Las hernias perineales son una enfermedad rara. Su incidencia se estima en un 1% después de la amputación abdominoperineal y en 3-10% de las resecciones pélvicas para los tumores malignos. Se puede definir como la protrusión del contenido intestinal a través del suelo pélvico. Las hernias perineales se clasifican como congénitas, primarias debido a defectos del piso pélvico o secundarias a la cirugía en la cavidad pélvica. Las hernias perineales secundarias tras amputación abdominoperineal para el cáncer rectal se describen por primera vez en 1939 por Yeomans. En 2007 Veenhof4 publicó un caso de hernia perineal secundaria a amputación abdominoperineal por laparoscopia. Presentamos el caso de un paciente en el postoperatorio temprano de una amputación laparoscópica abdominoperineal con una obstrucción secundaria a una hernia perineal

Perineal hernias are a rare disease. Its incidence is estimated at 1% after abdominoperineal amputation and in 3-10% of pelvic resections for malignant tumors. It can be defined as the protrusion of the intestinal contents through the pelvic floor. Perineal hernias are classified as congenital, primary due to pelvic floor defects or secondary to surgery in the pelvic cavity. Secondary perineal hernias after abdominoperineal amputation for rectal cancer is first described in 1939 by Yeomans. In 2007 Veenhof4 published a case of perineal hernia secondary to abdominoperineal amputation by laparoscopy. We present a case of a patient in the early postoperative period, of a laparoscopic abdominoperineal amputation, with an obstructive condition secondary to a perineal hernia

Galectin-1 in stable liver transplant recipients.

INTRODUCTION: The achievement of a state of tolerance and minimization of the immunosuppressive load form part of the "Holy Grail" in solid organ transplantation. Galectin-1 recently has been described to be involved in the maintenance of a tolerant environment, but there is no evidence of its role in human liver transplantation. The aim of our study was to measure the serum levels of galectin-1 in stable liver transplant recipients. METHODS: Serum levels of galectin-1 were determined in 30 stable liver transplant recipients who had been free of rejection episodes for at least 8 years. Fifteen patients with an acute rejection episode and 34 healthy subjects were used as the control group. RESULTS: The concentrations of galectin-1 were significantly higher in stable liver transplant recipients compared with healthy subjects and with the acute rejection group. CONCLUSIONS: These preliminary results indicate that galectin-1 is upregulated in stable liver transplant recipients. Thus, our results extend the recent findings that galectin-1 may play an immune-suppressive role in liver transplantation. It remains to be established whether it might help to induce tolerance in liver transplantation.

Modelos de intervención y la salud pública en Colombia / Models of intervention and public health in Colombia

Actualmente en Colombia se presentan problemas de salud pública relacionados con enfermedades transmisibles, enfermedades crónicas no transmisibles, salud infantil, salud mental, salud laboral informal y sexual y reproductiva. Muchos de estos problemas son considerados como prioridades de intervención en las políticas públicas por ser de gran magnitud, con amplio potencial de intervención y prevención, la mortalidad que generan es evitable, presentan una alta carga de enfermedad (generan gran discapacidad) y tienen un alto costo económico si no son prevenidas y atendidas oportunamente (alto costo por omisión).

Comparison of chi-squared automatic interaction detection classification trees vs TNM classification for patients with head and neck squamous cell carcinoma.

OBJECTIVES: To compare chi-squared automatic interaction detection (CHAID) classification trees vs the seventh edition of the TNM classification for patients with head and neck squamous cell carcinoma and to assess whether CHAID classification trees might improve results obtained with the TNM classification. DESIGN: Patient disease was classified according to CHAID classification trees and the TNM classification, and the results were compared. SETTING: Academic research. PATIENTS: A total of 3373 patients with carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. MAIN OUTCOME MEASURES: The 2 classification methods were evaluated objectively, measuring intrastage homogeneity (hazard consistency), interstage heterogeneity (hazard discrimination), and disease stage distribution among patients (balance). In addition, to assess agreement between CHAID classification trees and the TNM classification, we calculated the κ statistic, weighted linearly and quadratically. RESULTS: Objective evaluation of the quality of the classification methods indicated that CHAID classification trees performed better than the TNM classification in terms of hazard consistency (2.51 for CHAID and 3.01 for TNM) and hazard discrimination (70.9% for CHAID and 52.7% for TNM) but not balance (-31.7% for CHAID and -15.5% for TNM). Analysis of concordance between the classification methods showed that the quadratic κ statistic was 0.77 (95% CI, 0.76-0.78) and the linear κ statistic was 0.59 (95% CI, 0.57-0.60) (P < .001 for both). CONCLUSION: CHAID classification trees performed better than the TNM classification and offer potential inclusion of new prognostic factors.

Association of HLA-DRB1*16 with chronic discoid lupus erythematosus in Mexican mestizo patients.

BACKGROUND: Chronic discoid lupus erythematosus (CDLE) is present in 15-30% of patients with systemic lupus erythematosus (SLE). Approximately 5% of CDLE cases can evolve to SLE at some stage of the disease. AIM: The aim of this study was to determine gene frequencies of HLA-DRB1 alleles in Mexican mestizo patients with CDLE, irrespective of the presence of systemic disease. METHODS: The study comprised 28 Mexican mestizo patients with CDLE who were attending the Passover Dermatology Centre, in Mexico City. HLA-DRB1 and DQ allele typing was performed by sequence-specific oligotyping after DNA amplification using PCR. The study also included 99 ethnically matched healthy individuals as controls. RESULTS: In the patient group, a significantly increased gene frequency was found for the HLA-DR4 (P = 0.016, OR = 2.24, 95% CI 1.14-4.38) and HLA-DR16 alleles (P = 0.005, OR = 5.51, 95% CI 1.49-21.08). CONCLUSION: HLA-DRB1 alleles seem to be involved in the genetic susceptibility to CDLE in the Mexican mestizo population.

Safety and immunogenicity of a zoster vaccine in varicella-zoster virus seronegative and low-seropositive healthy adults.

OBJECTIVE: To evaluate immunogenicity and tolerability of a live attenuated zoster vaccine in varicella-zoster virus (VZV) seronegative or low-seropositive adults > or = 30 years of age. STUDY DESIGN: Double-blind, placebo-controlled, randomized, multicenter study. Subjects were enrolled in two stages by prescreened serostatus. Subjects with a low VZV antibody titer (< or = 5 gpELISA units/mL) were enrolled in Stage 1. Subjects with undetecable VZV antibodies and no safety issues identified during Stage 1 were enrolled in Stage 2. All enrolled subjects were randomized 4:1 to receive one dose (approximately 50,000 PFU) of zoster vaccine or placebo and were followed for safety for 42 days postvaccination. Primary objectives/hypotheses: (1) no vaccine-related serious adverse experiences (AE); (2) < or = 1 laboratory-confirmed varicella-like rash with > 50 lesions within 42 days postvaccination. SECONDARY OBJECTIVE: summarize the VZV antibody response postvaccination. RESULTS: Twenty-one subjects (age 27 to 69 years; median 34) enrolled (1148 prescreened); 18 (including 4 seronegative subjects) received vaccine and 3 (including 1 seronegative subject) received placebo. Twenty subjects completed the study; one subject withdrew for reasons unrelated to safety. No serious vaccine-related AE or laboratory-confirmed varicella-like rashes with > 50 lesions were reported. In the zoster vaccine group, all 4 of the initially seronegative subjects (age 32 to 36 years; median 33.5) seroconverted and 6 of the 13 (46.2%) initially seropositive subjects had a > or = 4-fold rise in VZV-specific antibody titer at 6 weeks postvaccination. CONCLUSIONS: The zoster vaccine appears to be immunogenic and generally well tolerated in healthy adults > or = 30 years of age, regardless of initial VZV antibody serostatus.

In vitro mesothelialization of prosthetic materials designed for the repair of abdominal wall defects.

The aim of this study was to evaluate the in vitro response of mesothelial cells (MC) in terms of their ability to cover different biomaterials. MC were harvested from human omentum. The MC from the first passage were seeded onto different biomaterials from 10 min to 24 h: PL-PU99 (polypropylene-polyurethane); DM (ePTFE); PL (polypropylene); and PL + Col (polypropylene-collagen). The prosthetic surface covered was examined by microscopy and quantified. PL-PU99: The MC were adhered to the biomaterial 10 min post-incubation. At 4 h, the 53.12+/-7.86% of the prosthesis were coated with polygonal cells. At 12 h, 96.32+/-11.32% of the biomaterial was coated. DM: between 30 min to 8 h, the MC cells form small, round colonies. At 12 h, polygonal and fusiform secretory cells were observed (68.94+/-5.78%). 93.54+/-11.49% of surface was coated after 24 h. PL: only isolated cells were observed on the prosthesis. PL + Col: MC form a monolayer over prosthetic surface after 18 h (90.21+/-9.76). We conclude: (a) MC formed a stable monolayer over all the biomaterials tested with the exception of the PL due to its porosity. (b) The PL-PU99 showed the greatest potential for in vitro mesothelialization compared to the PL-Col and DM prostheses.

Inflammatory cells induce neointimal growth in a rat arterial autograft model.

Subendothelial invasion by leukocytes is a sign of intimal thickening in arteriosclerosis and in the response of a vessel to mechanical damage. Our study was designed to establish whether these cells are implicated in the formation of a neointima in an autologous arterial graft model in the rat and to evaluate the effects of cyclosporin A (CsA). Three study groups were established according to whether the animals were treated with CsA-Cp (Sandimmun), CsA-Et (ethanol vehicle) or received no treatment (control group). Both drug forms were administered (5 mg/kg/day, s.c.) from 4 days prior to surgery until the time of sacrifice. Antibodies specific for lymphocytes (CD4, CD8), monocytes/macrophages-ED1, smooth muscle alpha-actin and the von Willebrand factor (vWF) were used to identify the cells in the grafted arterial wall. In control grafts, the neointima had formed by 2 weeks post-implant. However, the cells comprising this layer generally presented no positivity whatsoever towards the antibodies employed. At 50 days, the new layer was observed to be formed by a vWF-positive endothelium and alpha-actin-positive cells. In all three groups, several polymorphonuclear (PMN) cells adhered to the denuded luminal surface from 7 days onwards. In the treated animals, neutrophils and monocytes were seen to infiltrate intimal and medial layers during the later post-implant stages. Around the third week post-implant, the neointima had reached the grafted segment from the distal portion of the recipient artery, and by 50 days it was similar to that seen in control specimens. Our findings suggest that: a) neutrophils play a role in neointimal thickening in this arterial autograft model; and b) CsA promotes the adhesion and infiltration of neutrophils in the injured arterial wall.

The use of ischaemic vessels as prostheses or tissue engineering scaffolds after cryopreservation.

OBJECTIVE: to evaluate the condition of organ donor arteries subjected to prolonged cold-ischaemia followed by cryopreservation, for their possible use as vascular grafts. MATERIALS AND METHODS: fresh specimens of human iliac artery from organ donors were used as controls. These arteries were divided into two portions, one of which was cryopreserved in an automated freezer. A further group of arteries was immersed in Wisconsin solution and kept for 4 days at 4 degrees C (cold-ischaemia). After this period, the arteries were also cut into two, and one of these portions was cryopreserved. All the cryopreserved arterial segments were stored for a month and then subjected to automated gradual thawing. The thawed specimens were evaluated by light microscopy, scanning and transmission electron microscopy, immunohistochemical analysis (MMPs, elastin, CD31, von Willebrand factor) and the in situ detection of fragmented DNA (TUNEL method). RESULTS: the most marked changes induced by cryopreservation were partial vessel deendothelialisation and morphological changes in cells of the intima that were in the process of detachment. No significant changes were observed in the medial layer, other than discrete elastic fibre fragmentation. Following cold-ischaemia, the endothelium was the most affected layer, with large denuded areas and exposure of the fibroelastic layer. Increased MMP-2 expression was also noted after cold-ischaemia. When subjected to both cold-ischaemia and cryopreservation, a large proportion of endothelial cells showed positivity for the TUNEL technique, however, no significant difference was observed between the ischaemic and the ischaemic/cryopreserved specimens. CONCLUSIONS: prolonged cold-ischaemia causes some additional damage to the arterial wall compared to cryopreservation alone. However, the structural component of the ischaemic vessel remains in a condition that is suitable for subsequent cryopreservation and use as a vessel substitute or a scaffold for tissue engineering.

In vitro interaction of bacteria with polypropylene/ePTFE prostheses.

The infection of an implanted prosthetic material can have serious consequences on the tissue integration of the implant and the scarring process in the host, and may even necessitate replacement of the prosthesis. This study was designed to explore the in vitro effects of Staphylococcus aureus (Sa) and Staphylococcus epidermidis (Se) on polypropylene (PL) and expanded polytetrafluoroethylene (ePTFE) prostheses. Fragments of PL and ePTFE were placed in a medium previously inoculated with Sa, Se or Sa + Se (1 x 10(8) cfu Sa or/and Se). Bacterial effects on the biomaterials were evaluated for 30 days through scanning electron microscopy (SEM). In order to confirm the presence of bacteria on the prostheses, specimens were Gram stained and challenged with an antibody against protein-A (a specific Sa bacterial wall component). In both methods, specimens were examined by light microscopy. The presence of bacteria as microcolonies or biofilms was detected at PL filament cross-over regions after 30 days. Bacterial colonization of the ePTFE fragments was observed in internodal areas, which led to the deformation of prosthetic filaments. The present findings indicate that Sa and Se colonize the cross-over regions of the PL filaments, whereas in ePTFE prostheses, it is the internodal areas which are mostly affected. The latter areas are of difficult access to defence agents.