The hyperbenthic environment: A forgotten habitat for plastic pollution.

This study investigates the abundances and composition of microplastics (MP) among the shallow layers of a coastal Mediterranean Marine Protected Area (Cabrera MPA), seafloor sediments, hyperbenthic environment, and the water column. The mid waters samples were collected mid-way between the sea surface and the seafloor and hyperbenthic samples at the water layer adjacent to the seafloor. Sampling was carried out on patchiness seafloor of Posidonia oceanica meadows. The seafloor sediments showed a mean abundance of 378,769.20 ± 508,109.11 MPs/m3, three orders of magnitude higher than the hyperbenthic (209.17 ± 117.07 MPs/m3), and the mid waters layer (106.48 ± 107.17 MPs/m3). An increasing vertical gradient in MP abundances, mainly composed of fibers was observed. Fibers were made-up mainly of polystyrene (PS, 25 %), expanded polystyrene (EPS, 18 %) and cellulose acetate (CA, 16 %). The results stress the need to increase efforts to find solutions to mitigate fiber pollution in the marine environment.

Research-based flow cytometry assays for pathogenic assessment in the human B-cell biology of gene variants revealed in the diagnosis of inborn errors of immunity: a Bruton's tyrosine kinase case-study.

Introduction: Inborn errors of immunity (IEI) are an expanding group of rare diseases whose field has been boosted by next-generation sequencing (NGS), revealing several new entities, accelerating routine diagnoses, expanding the number of atypical presentations and generating uncertainties regarding the pathogenic relevance of several novel variants. Methods: Research laboratories that diagnose and provide support for IEI require accurate, reproducible and sustainable phenotypic, cellular and molecular functional assays to explore the pathogenic consequences of human leukocyte gene variants and contribute to their assessment. We have implemented a set of advanced flow cytometry-based assays to better dissect human B-cell biology in a translational research laboratory. We illustrate the utility of these techniques for the in-depth characterization of a novel (c.1685G>A, p.R562Q) de novo gene variant predicted as probably pathogenic but with no previous insights into the protein and cellular effects, located in the tyrosine kinase domain of the Bruton's tyrosine kinase (BTK) gene, in an apparently healthy 14-year-old male patient referred to our clinic for an incidental finding of low immunoglobulin (Ig) M levels with no history of recurrent infections. Results and discussion: A phenotypic analysis of bone marrow (BM) revealed a slightly high percentage of pre-B-I subset in BM, with no blockage at this stage, as typically observed in classical X-linked agammaglobulinemia (XLA) patients. The phenotypic analysis in peripheral blood also revealed reduced absolute numbers of B cells, all pre-germinal center maturation stages, together with reduced but detectable numbers of different memory and plasma cell isotypes. The R562Q variant allows Btk expression and normal activation of anti-IgM-induced phosphorylation of Y551 but diminished autophosphorylation at Y223 after anti IgM and CXCL12 stimulation. Lastly, we explored the potential impact of the variant protein for downstream Btk signaling in B cells. Within the canonical nuclear factor kappa B (NF-κB) activation pathway, normal IκBα degradation occurs after CD40L stimulation in patient and control cells. In contrast, disturbed IκBα degradation and reduced calcium ion (Ca2+) influx occurs on anti-IgM stimulation in the patient's B cells, suggesting an enzymatic impairment of the mutated tyrosine kinase domain.

Breaking the paradigm: Marine sediments hold two-fold microplastics than sea surface waters and are dominated by fibers.

We conducted one of the first studies to integrate the quantification and characterization of microplastics (MPs), including fibers, in different habitats (sea surface, seafloor and beach sediments) of a coastal Mediterranean marine protected area, analyzing their ingestion in several marine species. The objectives of the study were to evaluate the distribution of MPs according to shape and polymer, to assess the contribution of fibers to local plastic pollution and to evaluate their ingestion in fish and invertebrates species that inhabit the study area (Pagrus pagrus, Serranus scriba, Spondyliosoma cantharus, Diplodus vulgaris, Oblada melanura, Holothuria forskalii, Holothuria tubularis, Holothuria polis, Arbacia lixula, Paracentrotus lividus, Modiolus barbatus, Mytilus galloprovincialis and Arca noae). A total of 111 environmental samples were analyzed. The mean abundance of MPs (excluding fibers) quantified in beach sediments (13,418.86 ± 28,787.99 MPs/m2) was two orders of magnitude higher than that found in seafloor sediments (76.92 ± 108.84 MPs/m2), which in turn was two orders of magnitude higher than sea surface samples (0.17 ± 0.39 MPs/m2). The fibers were the most abundant shape of MPs identified in all habitats. Variability in MPs ingestion was detected between species, with ingestion rates ranging from 43 % to 100 % for general MPs and ranging from 7 % to 100 % for fibers. The highest ingestion was observed in Holoturians, representing suitable bioindicators for plastic pollution. The composition of the polymer varies weakly depending on habitats and biota, but the result is strongly correlated with the morphology of the plastic. Fibers were mainly composed of cellulose acetate (29 %), styrofoam of polystyrene (18 %), and filaments, films and fragments of polyethylene and polypropylene. The results highlighted the need to expand integrated approaches to effectively study marine plastic pollution and to undertake efficient actions to limit the input of plastics, particularly fibers, into the marine environment.

Guía metodológica para la elaboración de un programa estructurado de educación terapéutica: del diseño a la evaluación / Methodological guidelines for preparing a structured therapeutic education program: From design to evaluation

Antecedentes y objetivo La educación terapéutica (ET) es eficaz e imprescindible en un contexto de prevalencia creciente de enfermedades crónicas, siendo necesarias herramientas para la planificación de programas estructurados. El objetivo fue elaborar una guía para el diseño y evaluación de un programa de ET. Métodos 1) Se constituyó un grupo multidisciplinario de 8 referentes en ET, cronicidad, calidad y seguridad, del hospital y la universidad. 2) Se realizó una revisión exhaustiva de la literatura científica sobre planificación de programas de ET dirigidos a pacientes crónicos, familiares o cuidadores. 3) El texto final se sometió a comentarios y sugerencias de participantes, del hospital y de atención primaria, en un curso sobre metodología de información y ET. Las recomendaciones fueron consensuadas, por unanimidad, por el grupo redactor. Resultados Se obtuvo un procedimiento normalizado de trabajo dirigido a profesionales implicados en planificación de programas de ET, basado en recomendaciones internacionales. El documento está estructurado en apartados: a) Definición del problema de salud y análisis de situación. b) Estructura del programa (recursos humanos y materiales); objetivos (salud, conducta y educativos) y metodología. c) Circuito que sigue el paciente y familia/cuidador en el programa. d) Evaluación e indicadores. La evaluación del procedimiento, en el marco de los cursos de metodología, fue favorable. Conclusiones La metodología aportada por este documento servirá de instrumento para planificar de forma homogénea y sistematizada los programas educativos, unificando criterios en su redacción. Sin embargo, requerirá su adaptación a la condición y la población a que se dirija cada programa (AU)

Background and objective Therapeutic patient education (TPE) is effective and essential in the context of the growing prevalence of chronic diseases in which tools are needed for planning structured programs. The objective of this project was to develop guidelines for designing and assessing a TPE program. Methods 1) We assembled a multidisciplinary group of 8 leaders in TPE, chronicity, quality and safety from the hospital and the university. 2) We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients, their relatives and caregivers. 3) The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology. The recommendations were unanimously agreed upon by the writing group. Results We obtained a standardised work procedure targeted at professionals involved in planning TPE programs, based on international recommendations. The document is structured into sections: a) Definition of the health problem and analysis of the situation; b) Program structure (human resources and materials); objectives (health-related, behaviour-related and educational) and methodology; c) Path the patient and family/caregiver follows in the program; and d) Assessment and indicators. Assessment of the procedure, within the framework of the methodology courses, was favourable. Conclusions The methodology provided by this document serves as an instrument for the standardised and systematic planning of educational programs and unifies the criteria in their drafting. However, the document needs to be adapted to the condition and population to which each program is address (AU)

Methodological guidelines for preparing a structured therapeutic education program: From design to evaluation.

BACKGROUND AND OBJECTIVE: Therapeutic patient education (TPE) is effective and essential in the context of the growing prevalence of chronic diseases in which tools are needed for planning structured programs. The objective of this project was to develop guidelines for designing and assessing a TPE program. METHODS: 1) We assembled a multidisciplinary group of 8 leaders in TPE, chronicity, quality and safety from the hospital and the university. 2) We conducted an exhaustive review of the scientific literature on the planning of TPE programs directed at chronically ill patients, their relatives and caregivers. 3) The final text underwent comments and suggestions by participants from the hospital and primary care centre during a course on information and TPE methodology. The recommendations were unanimously agreed upon by the writing group. RESULTS: We obtained a standardised work procedure targeted at professionals involved in planning TPE programs, based on international recommendations. The document is structured into sections: a) Definition of the health problem and analysis of the situation; b) Program structure (human resources and materials); objectives (health-related, behaviour-related and educational) and methodology; c) Path the patient and family/caregiver follows in the program; and d) Assessment and indicators. Assessment of the procedure, within the framework of the methodology courses, was favourable. CONCLUSIONS: The methodology provided by this document serves as an instrument for the standardised and systematic planning of educational programs and unifies the criteria in their drafting. However, the document needs to be adapted to the condition and population to which each program is addressed.

Mutations in PIK3R1 can lead to APDS2, SHORT syndrome or a combination of the two.

Mutations in PIK3R1 gene have been associated to two different conditions: a primary immunodeficiency, called APDS2, of recent description and SHORT syndrome. 47 patients with APDS2 have been reported to date, only one of them sharing both PIK3R1-related phenotypes. Here we describe two more patients affected by APDS2 and SHORT syndrome, which highlights that this association may not be so infrequent. We recommend that patients with mutations in PIK3R1 gene should be assessed by both clinical immunologists and clinical geneticists.

Guía de laboratorio para el diagnóstico y seguimiento de pacientes con gammapatías monoclonales / Laboratory guidelines for the diagnosis and follow-up of patients with monoclonal gammopathies

Se presenta una guía elaborada por el grupo de Inmunoquímica de la Sociedad Española de Inmunología con el objetivo de proporcionar una herramienta práctica para el diagnóstico y seguimiento de las gammapatías monoclonales. Se revisan las características clínicas y analíticas de los diferentes tipos de gammapatía monoclonal, las guías de consenso internacionales y las técnicas utilizadas para la detección y seguimiento del componente monoclonal (AU)

We present guidelines from the Immunochemistry group of the Spanish Society for Immunology that are designed to provide a practical tool for the diagnosis and follow-up of monoclonal gammopathies. We review the clinical and analytical features of various monoclonal gammopathies, international consensus guidelines and techniques used to detect and follow-up monoclonal components (AU)

Laboratory guidelines for the diagnosis and follow-up of patients with monoclonal gammopathies.

We present guidelines from the Immunochemistry group of the Spanish Society for Immunology that are designed to provide a practical tool for the diagnosis and follow-up of monoclonal gammopathies. We review the clinical and analytical features of various monoclonal gammopathies, international consensus guidelines and techniques used to detect and follow-up monoclonal components.

Serum properdin consumption as a biomarker of C5 convertase dysregulation in C3 glomerulopathy.

Properdin (P) stabilizes the alternative pathway (AP) convertases, being the only known positive regulator of the complement system. In addition, P is a pattern recognition molecule able to initiate directly the AP on non-self surfaces. Although P deficiencies have long been known to be associated with Neisseria infections and P is often found deposited at sites of AP activation and tissue injury, the potential role of P in the pathogenesis of complement dysregulation-associated disorders has not been studied extensively. Serum P levels were measured in 49 patients with histological and clinical evidence of C3 glomerulopathy (C3G). Patients were divided into two groups according to the presence or absence of C3 nephritic factor (C3NeF), an autoantibody that stabilizes the AP C3 convertase. The presence of this autoantibody results in a significant reduction in circulating C3 (P < 0·001) and C5 levels (P < 0·05), but does not alter factor B, P and sC5b-9 levels. Interestingly, in our cohort, serum P levels were low in 17 of the 32 C3NeF-negative patients. This group exhibited significant reduction of C3 (P < 0·001) and C5 (P < 0·001) and increase of sC5b-9 (P < 0·001) plasma levels compared to the control group. Also, P consumption was correlated significantly with C3 (r = 0·798, P = 0·0001), C5 (r = 0·806, P < 0·0001), sC5b-9 (r = -0·683, P = 0·043) and a higher degree of proteinuria (r = -0·862, P = 0·013). These results illustrate further the heterogeneity among C3G patients and suggest that P serum levels could be a reliable clinical biomarker to identify patients with underlying surface AP C5 convertase dysregulation.

Recomendaciones de vacunación frente a neumococo en enfermos renales en España / Recommendations for vaccination against pneumococcus in kidney patients in Spain

La enfermedad neumocócica invasiva (ENI) supone un grave problema en algunos grupos de riesgo: los pacientes con enfermedad renal crónica estadios 4 y 5 y aquellos con estadio 3 y tratamiento inmunosupresor, síndrome nefrótico o diabetes. Estos individuos son más susceptibles de adquirir la infección y más propensos a padecer cuadros de mayor gravedad y peor evolución. Entre las estrategias para prevenir la ENI se encuentra la vacunación, aunque las coberturas vacunales en este grupo son más bajas de lo deseable hoy en día. Actualmente, disponemos de dos vacunas para el adulto. La vacuna polisacárida (VNP23), que se emplea en mayores de 2 años de edad desde hace décadas, es la que mayor número de serotipos (23) incluye, pero no genera memoria inmunitaria, provoca un fenómeno de tolerancia inmunitaria y no actúa sobre la colonización nasofaríngea. La vacuna conjugada (VNC13) puede emplearse desde lactantes hasta la edad adulta (la indicación en mayores de 18 años ha recibido la aprobación de la Agencia Europea de Medicamentos en julio de 2013) y genera una respuesta inmunitaria más potente que la VNP23 frente a la mayoría de los 13 serotipos en ella incluidos. Las 16 sociedades científicas más directamente relacionadas con los grupos de riesgo para padecer ENI han trabajado en la discusión y elaboración de una serie de recomendaciones vacunales basadas en las evidencias científicas respecto a la vacunación antineumocócica en el adulto con condiciones y patología de base que se recogen en el documento «Consenso: Vacunación antineumocócica en el adulto con patología de base». En el presente texto se recogen las recomendaciones de vacunación para la población de enfermos renales crónicos (AU)

Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to infections and more prone to suffering more severe and worsening symptoms. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes most serotypes (23), but it does not generate immune memory, causing the immune tolerance phenomenon and it does not act on nasopharyngeal colonisation. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that it includes. The 16 scientific societies most directly associated with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document "Consensus: Pneumococcal vaccination in adults with underlying pathology". This text sets out the vaccination recommendations for the chronic kidney disease population (AU)

Recommendations for vaccination against pneumococcus in kidney patients in Spain.

UNLABELLED: Invasive pneumococcal disease (IPD) is a serious problem in some risk groups: patients with stage 4 and 5 chronic kidney disease, stage 3 CKD undergoing immunosuppressive treatment, nephrotic syndrome or diabetes. These individuals are more susceptible to infections and more prone to suffering more severe and worsening symptoms. Vaccination is one of the strategies for preventing IPD, although vaccination coverage in this group at present is lower than desired. Currently, there are two vaccinations for adults. The polysaccharide vaccine (PPSV23), used for decades in patients over the age of 2, includes most serotypes (23), but it does not generate immune memory, causing the immune tolerance phenomenon and it does not act on nasopharyngeal colonisation. The conjugate vaccine (VNC13) can be used from infancy until adulthood (advice in patients over 18 years old received approval from the European Medicines Agency in July 2013) and generates a more powerful immune response than PPSV23 against the majority of the 13 serotypes that it includes. The 16 scientific societies most directly associated with the groups at risk of IPD have discussed and drafted a series of vaccination recommendations based on scientific evidence related to pneumococcal vaccination in adults with underlying conditions and pathologies, which are the subject of the document “ CONSENSUS: Pneumococcal vaccination in adults with underlying pathology”. This text sets out the vaccination recommendations for the chronic kidney disease population.

Performance of a single stage vertical flow constructed wetland system treating raw domestic sewage in Brazil.

This study investigated the behaviour of two intermittently fed vertical flow constructed wetlands (one planted with Tifton 85 and the other unplanted) working in parallel, treating raw municipal sewage in Brazil for a population equivalent around 100 inhabitants. Based on a monitoring programme of over 2 years, the following items were evaluated: influence of batch frequency and the presence of Tifton 85 on the wetlands performance in terms of several physico-chemical and biological constituents. The unit with plants performed better than the one without, indicating a positive influence of the presence of plants. More attachment by total and volatile solids and larger amount of bacteria involved in the nitrogen cycle were observed in the planted filter medium, which can explain its higher nitrification and solids removal. The application of a smaller influent volume with a higher batch frequency improved the performance of both units. No signs of medium clogging have been observed in both units. The system simplicity and the good removal efficiency of organic matter, suspended solids, ammonia and helminth eggs indicate its high applicability in small communities in developing countries such as Brazil.

Sports injuries in Brazilian blind footballers.

The purpose of this study was to assess the characteristics and prevalence of sports-related injuries in visually disabled athletes of the Brazilian football 5-a-side team. The participants were 13 male athletes, all classified as B1 visual class, members of the Brazilian team, who played in five consecutive international competitions. Data were collected using the Brazilian Paralympic Committee and the Brazilian Confederation of Sports for the Blind report form. From the total of 13 athletes, 11 succumbed to some form of injury during the 5 competitions, which incorporated 23 matches, representing a prevalence of 84.6%. A total of 35 sports injuries were recorded, giving a clinical incidence of 2.7 injuries per athlete and an injury risk of 0.85 and an incidence rate of 0.12 injuries per match. Traumatic injuries (80%) were more common than overuse injuries (20%) (p<0.05). The highest distribution of injury was in the lower limbs (80%), followed by the head (8.6%), spine (5.7%) and upper limbs (5.7%). The body regions most affected were the knee (28.6%), feet (17.1%), ankle (11.4%) and thigh (11.4%). Contusions (31.4%), sprains (25.7%) and tendinopathy (8.6%) were the most frequent diagnoses. This is the first study to describe the nature and prevalence of sports-related injuries in 5-a-side football in blind athletes. The results are important in guiding strategies to inform the implementation of preventive pathways and provide a strong rationale for the compulsory use of additional protective equipment.

The pathophysiology of triose phosphate isomerase dysfunction in Alzheimer's disease.

Alzheimer's disease (AD), the most prevalent neurodegenerative disease worldwide, has two main hallmarks: extracellular deposits of amyloid ß-peptide (Aß) and intracellular neurofibrillary tangles composed by tau protein. Most AD cases are sporadic and are not dependent on known genetic causes; aging is the major risk factor for AD. Therefore, the oxidative stress has been proposed to initiate the uncontrolled increase in Aß production and also to mediate the Aß's deleterious effects on brain cells, especially on neurons from the cortex and hippocampus. The production of free radicals in the presence of nitric oxide (NO) yields to the peroxynitrite generation, a very reactive agent that nitrotyrosinates the proteins irreversibly. The nitrotyrosination produces a loss of protein physiological functions, contributing to accelerate AD progression. One of the most nitrotyrosinated proteins in AD is the enzyme triosephosphate isomerase (TPI) that isomerises trioses, regulating glucose consumption by both phosphate pentose and glycolytic pathways and thereby pyruvate production. Hence, any disturbance in the glucose supply could affect the proper brain function, considering that the brain has a high rate of glucose consumption. Besides this directly affecting to the energetic metabolism of the neurons, TPI modifications, such as mutation or nitrotyrosination, increase methylglyoxal production, a toxic precursor of advanced glycated end-products (AGEs) and responsible for protein glycation. Moreover, nitro-TPI aggregates interact with tau protein inducing the intraneuronal aggregation of tau. Here we review the relationship between modified TPI and AD, highlighting the relevance of this protein in AD pathology and the consequences of protein nitro-oxidative modifications.

La medición individual de la presión de oclusión arterial permitereducir la presión de inflado del torniquete de isquemia en la artroscopia de rodilla ambulatoria / Individual measurement of the arterial occlusion pressure reduces the inflation pressure of the ischemia tourniquet needed for knee arthroscopy

Introducción: en la cirugía artroscópica de rodilla la presión del torniquete de isquemia suele fijarse arbitrariamente entre 250 y 350 mm Hg. La medición de la presión de oclusión arterial (POA) permite ajustar individualmente la presión de inflado al mínimo necesario para obtener condiciones quirúrgicas similares. Medimos la POA mediante Eco-Doppler para determinar la presión de inflado del torniquete y evaluamos la calidad del campo quirúrgico obtenido en pacientes ambulatorios programados para artroscopia de rodilla bajo anestesia general. Material y métodos: se incluyeron 50 pacientes intervenidos de meniscectomía(40) y ligamentoplastia (10). Se midió la POA en la arteria tibia posterior incrementando progresivamente la presión de inflado hasta la desaparición de la onda Doppler. La presión de inflado del torniquete se ajustó a 30 mmHg por encima de la presión de oclusión obtenida para cubrirlas variaciones intraoperatorias de presión arterial. El cirujano, ajeno a este (..) (AU)

Background: Common tourniquet inflation pressures used for knee arthroscopy vary between 250 y 350 mm Hg. Individual measurement of the arterial occlusion pressure (AOP) allows for adjusting the inflation pressure to the minimum necessary to obtain a similar operation conditions. We measured the AOP by Doppler ultrasound to determine the tourniquet inflation pressure and evaluated the quality of the surgical field obtained in outpatients undergoing knee arthroscopy under general anesthesia. Methods: Fifty patients undergoing meniscectomy (40) or cruciate ligament repair (10) were included. The AOP was measured in the posterior tibialartery by increasing the tourniquet pressure until the Doppler ultrasound wave completely disappeared. To account for intraoperative blood pressure (..) (AU)

Role of H(2)O(2) in hypertension, renin-angiotensin system activation and renal medullary disfunction caused by angiotensin II.

BACKGROUND AND PURPOSE: Activation of the intrarenal renin-angiotensin system (RAS) and increased renal medullary hydrogen peroxide (H(2) O(2) ) contribute to hypertension. We examined whether H(2) O(2) mediated hypertension and intrarenal RAS activation induced by angiotensin II (Ang II). EXPERIMENTAL APPROACH: Ang II (200 ng·kg(-1) ·min(-1) ) or saline were infused in Sprague Dawley rats from day 0 to day 14. Polyethylene glycol (PEG)-catalase (10 000 U·kg(-1) ·day(-1) ) was given to Ang II-treated rats, from day 7 to day 14. Systolic blood pressure was measured throughout the study. H(2) O(2) , angiotensin AT(1) receptor and Nox4 expression and nuclear factor-κB (NF-κB) activation were evaluated in the kidney. Plasma and urinary H(2) O(2) and angiotensinogen were also measured. KEY RESULTS: Ang II increased H(2) O(2) , AT(1) receptor and Nox4 expression and NF-κB activation in the renal medulla, but not in the cortex. Ang II raised plasma and urinary H(2) O(2) levels, increased urinary angiotensinogen but reduced plasma angiotensinogen. PEG-catalase had a short-term antihypertensive effect and transiently suppressed urinary angiotensinogen. PEG-catalase decreased renal medullary expression of AT(1) receptors and Nox4 in Ang II-infused rats. Renal medullary NF-κB activation was correlated with local H(2) O(2) levels and urinary angiotensinogen excretion. Loss of antihypertensive efficacy was associated with an eightfold increase of plasma angiotensinogen. CONCLUSIONS AND IMPLICATIONS: The renal medulla is a major target for Ang II-induced redox dysfunction. H(2) O(2) appears to be the key mediator enhancing intrarenal RAS activation and decreasing systemic RAS activity. The specific control of renal medullary H(2) O(2) levels may provide future grounds for the treatment of hypertension.

Decrease in the expression of N-methyl-D-aspartate receptors in the nucleus tractus solitarii induces antinociception and increases blood pressure.

N-methyl-D-aspartate receptors (NMDAR) have a role in cardiovascular control at the nucleus tractus solitarii (NTS), eliciting increases or decreases in blood pressure (BP), depending on the area injected with the agonists. In spite of the association between cardiovascular control and pain modulation, the effects of manipulating NMDAR in pain responses have never been evaluated. In this study, we decreased the expression of NMDAR in the NTS using gene transfer to target receptor subunits and evaluate long-term effects. Seven days after the injection of lentiviral vectors containing the NR1a subunit cDNA of NMDAR, in antisense orientation, into the intermediate NTS of Wistar rats, BP was measured, and the formalin test of nociception was performed. The antisense vector induced a decrease of NR1 expression in the NTS and elicited BP rises and hypoalgesia. Antisense vectors inhibited formalin-evoked c-Fos expression in the spinal cord, indicating decreased nociceptive activity of spinal neurons. Using a time-course approach, we verified that the onset of both the increases in BP and the hypoalgesia was at 4 days after vector injection into the NTS. The injection of NMDA into the NTS reversed the effects of antisense vectors in pain behavioral responses and spinal neuronal activation and decreased BP and heart rate. The present study shows that the NR1 subunit of the NMDAR at the NTS is critical in the regulation of tonic cardiovascular and nociceptive control and shows an involvement of the nucleus in the modulation of sustained pain.

Comparación de la presión de oclusión y de la tolerancia al torniquete de isquemia en la pantorrilla y en el tobillo para cirugía ambulatoria de antepié / No disponible

Introducción: En la cirugía de antepié el torniquete de isquemia puede colocarse en la pantorrilla o en el tobillo. La presión de inflado necesaria para ocluir la circulación arterial es proporcional al diámetro de la extremidad y varía con la posición del torniquete. Comparamos la presión de oclusión y la tolerancia al torniquete en la pantorrilla y en el tobillo. Material y métodos: Estudio prospectivo en 50 pacientes programados para cirugía de hallux valgus a los que se les realizó la valoración en ambas localizaciones del torniquete en orden aleatorio. Se monitorizó la onda de pulso en el primer dedo del pie y el doppler pulsado en la arteria tibial posterior. La presión de inflado inicial del torniquete se ajustó al valor de la presión sistólica y se incrementó progresivamente hasta la desaparición completa de la onda de pulso y del doppler. A los 5 minutos se registró el grado de disconfort en una escala verbal de 0 a 10. Resultados: La presión de oclusión fue significativamente inferior en el tobillo, medida tanto por doppler (183 ± 20 vs.196 ± 30mmHg; p < 0,0001), como por onda de pulso (183 ± 20 vs.193 ±27 mmHg; p = 0,0002). No hubo diferencias entre la presión de oclusión medida por onda de pulso y el doppler pulsado en el tobillo, pero la presión de oclusión medida por doppler fue significativamente mayor en la pantorrilla (193 ± 27 vs.196 ± 30 mmHg; p =0,02). El grado de molestia también fue significativamente menor en el tobillo (2 ± 2 vs. 5 ± 3; p < 0,0001). Conclusiones: La presión de oclusión del manguito de isquemia en el tobillo es significativamente menor, es mejor tolerada que en la pantorrilla y puede medirse fácilmente sólo con un pulsioxímetro (AU)

Introduction: The pneumatic tourniquet can be placed at the calf or at the ankle for forefoot surgery. The cuff pressure needed to occlude arterial blood flow (OP) is proportional to the diameter of the extremity, varying with the position of the cuff. We compared the OP and patient tolerance to calf versus ankle tourniquet. Methods: We prospectively studied 50 patients scheduled forhallux valgus repair, who were assessed for both cuff positions in random order. OP was measured by pulse waveform on the first toe and pulsed doppler of the posterior tibial artery. The cuff was progressively inflated in 10 mmHg increments starting from the systolicpressure value until complete loss of pulse waveform and pulsed doppler. This pressure was maintained during 5 minutes to assess the discomfort in a verbal scale (0-10).Results: OP was significantly lower in the ankle measured bypulsed doppler (183 ± 20 vs.196 ± 30 mmHg; p < 0.0001), and pulse waveform (183 ± 20 vs.193 ± 27 mmHg; p = 0.0002). No differences were found between OP measured by pulse waveform and by pulsed doppler at the ankle. However the OP measured bypulsed doppler was significantly higher than pulse waveform at the calf (193 ± 27 vs.196 ± 30 mmHg; p = 0.02). Patients reported lower discomfort scores when the tourniquet was placed at the ankle(2 ± 2 vs.5 ± 3; p < 0.0001).Conclusions: The OP is lower when the tourniquet is placed at the ankle and can be easily measured by pulse waveform placed on the toes. The ankle tourniquet is also better tolerated than the calf tourniquet (AU)

Giardia duodenalis: kinetics of cyst elimination and the systemic humoral and intestinal secretory immune responses in gerbils (Meriones unguiculatus) experimentally infected.

This study aimed to determine the pre-patent period and to evaluate the kinetics of cyst elimination and the systemic humoral (IgA, IgG(1), IgG(2a), IgM, IgE) and intestinal secretory (IgA) immune responses in gerbils (Meriones unguiculatus) experimentally innoculated with different doses of Giardia duodenalis trophozoites. Forty-eight animals aged 6-8 weeks were used, equally distributed among six groups, five groups innoculated with different doses of trophozoites (10(1), 10(2), 10(3), 10(4), 10(5)) and one control (non-infected) group. Coproparasitological examinations were carried out daily up to 91 days after inoculation (d.a.i.) to determine the pre-patent period and the kinetics of cyst elimination. Blood and stool samples were weekly collected for antibody assays. The pre-patent period was observed from the 9 d.a.i. onwards, with intermittent elimination of variable quantities of cysts up to 27 d.a.i.. All infected gerbils, irrespective of the dose received, were able to mount systemic humoral immune responses as evidenced by specific IgM titers from 7 to 28 d.a.i., corresponding to the peak of cyst elimination, followed by high and persistent IgG1 titers. Intestinal secretory responses were also seen with two peaks of fecal IgA titers, corresponding to IgM and IgG1 response peaks, respectively. In conclusion, systemic and intestinal humoral immune responses were related to the control of giardiasis in this experimental model.