Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR).

BACKGROUND: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice. METHODS: Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n=1345) or a new oral antipsychotic (AP) (n=277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review. RESULTS: At 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p<0.0001) and reduction in Clinical Global Impression Severity scores (-1.14 for RLAI versus -0.94 for APs, p=0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p<0.05) and days (18.74 versus 13.02, p<0.01) of hospitalizations at 24 months than oral AP patients. CONCLUSIONS: This 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

Monitoring and analysis of cardio respiratory and snoring signals by using an accelerometer.

In this paper we present a system based on a sensor of acceleration for acquisition and monitoring of diverse physiological signals, by extracting respiratory, cardiac and snoring components inside the main source. Digital signal processing techniques used frequently in Biomedical Engineering have been used. The acceleration produced by the cardiac signals, the respiratory movements and the vibrations generated by the snores are detected with help of an accelerometer placed on the skin of the subject in not invasive way. The presented device allows the monitoring of several biomedical parameters: heart rate (HR), heart rate variability (HRV), Sympathetic, parasympathetic and baroreflex activity, respiratory rhythms and their variations (bradypnea - tachypnea), snoring and abdominal-thoracic efforts. A simple and effective method and device [1] is provided for helping to the diagnosis of Sleep Apnea-Hypopnea Syndrome (SAHS) and other breathing disorders.

Basement membrane heterogeneity during chick development as shown by tomato (Lycopersicon esculentum) lectin binding.

Basement membranes (BMs) constitute a distinct compartment of the extracellular matrix (ECM). All BMs show a similar structural appearance but differ in molecular composition. These variations have critical functional implications. The aim of this study is to establish the pattern of the tomato lectin (Lycopersicon esculentum agglutinin--LEA) binding sites in the BMs of the developing chick embryo (stages 4-21, Hamburger and Hamilton, 1951) in order to achieve a better understanding of the molecular heterogeneity of BMs. The study was performed with transmission electron microscopy (TEM) histochemistry, and confocal laser microscopy. TEM showed that LEA bound to the lamina densa and to the lamina fibroreticularis of the BMs. Through the period studied, most of the LEA binding appeared in the ectodermal BM and its derivatives. In the limb bud, LEA binding to the ectoderm BM was more intense in the ventral half than in the dorsal half. Furthermore, LEA allowed the early (HH16) detection of the transverse fibrillar tracts. In the lens and in the inner ear primordium, the BMs were LEA positive through the placode and cup stages. The binding was progressively reduced through the vesicle stage. The BMs of the olfactory primordium, and of the Rathke's pouch were positive. In contrast, the BMs of the developing central nervous system were negative. The BMs of both the paraxial and the lateral plates of the mesoderm were negative, whereas the notochord and the BM of the Wolffian duct were positive. The endodermal BM and its derivatives were negative. The ECM located between the fusing endocardial tubes, and the BM of the fusion zone of the paired aortae, were positive. This suggested an active role of the LEA-positive glycoproteins in the fusion of endothelia. Our results show the heterogeneity of the chick embryo BMs during development. In addition, LEA constitutes an excellent marker for the primordial germ cells.

The conus valves of the adult gilthead seabream (Sparus auratus).

The conus (bulbo-ventricular) valves of teleosts perform a key function in the control of blood backflow during ventricular diastole. However, the structural characteristics of these valves are almost unknown. This paper presents a systematic anatomical, histological and structural study of the conus valves of the adult gilthead seabream (Sparus auratus). S. auratus shows two major left and right valves consisting of the leaflet and the supporting sinus. Each valvar leaflet can be divided into a stout proximal body and a flap-like distal region. The proximal body is structured into three layers: a luminal fibrosa, a dense cellular core and a parietal fibrosa. The luminal fibrosa is a collagenous structure extending the entire length of the leaflet, while the parietal fibrosa is restricted to the most proximal area. The dense cellular core consists of fibroblastic cells and a matrix rich in glycoconjugates, collagen and elastin. The histochemical and structural data suggest that the luminal fibrosa bears most of the force associated with valvar closure, while the cellular core acts as a cushion dampening vibrations and absorbing the elastic recoil. The sinus wall is a fibrous layer which shows proximal-distal differences in thickness. It also shows compositional differences that can be related to mechanical function. We describe the presence of a fibrous cylinder formed by the sinus wall, the fibrous interleaflet triangles and the fibrous layer that covers the inner surface of the conus myocardium. This fibrous cylinder constitutes the structural nexus between the ventricle, the conus and the bulbus arteriosus, provides support for the conus valves and separates the valvar complex from the surrounding tissues. The structure of the conus valves in S. auratus is different from that found in other vertebrates. Anatomical similarities between the conus valves and the mammalian arterial valves are emphasized. Each phyletic group appears to have developed specific structures in order to perform similar functions.

Neuronal body size correlates with the number of nucleoli and Cajal bodies, and with the organization of the splicing machinery in rat trigeminal ganglion neurons.

Trigeminal ganglion neurons comprise three main cell body-size types. This cell size heterogeneity provides an excellent neuronal model to study the cell size-dependent organization and dynamics of the nucleoli, Cajal (coiled) bodies (CBs), and nuclear speckles of pre-mRNA splicing factors, nuclear structures that play a key role in the normal neuronal physiology. We have analyzed the number of nucleoli and CBs and the structural and molecular organization of CBs and nuclear speckles in the three neuronal types by using immunofluorescence with antibodies that recognize nucleoli (fibrillarin), CBs (coilin), and nuclear speckles (snRNPs), confocal microscopy, and electron microscopy. Whereas the mean number of nucleoli per neuron decreases as a function of cell size, the number of CBs per cell significantly increases in large neurons in comparison with the small ones. In addition, large neurons have a higher proportion of CBs associated with the nucleolus. In all neuronal types, CBs concentrate coilin, fibrillarin, snRNPs, and the survival motor neuron protein (SMN). Immunostaining for snRNPs shows small speckle domains and extensive areas of diffuse nucleoplasmic signal in large neurons, in contrast with the large nuclear speckles found in small neurons. Furthermore, flow cytometric analysis shows that all neurons are in the range of diploid cells. These findings indicate that the fusion behavior of nucleoli, the formation of CBs and their relationships with the nucleolus, as well as the compartmentalization of the pre-mRNA splicing machinery, is related to cell body size in the trigeminal ganglion neurons. Because transcriptional activity is a basic determinant mechanism of cell size in diploid cells, we suggest that our findings reflect a distinct transcription-dependent organization of the nucleolus and splicing machinery in the three cell types of trigeminal ganglion neurons.

The three-dimensional microanatomy of the rabbit and human cornea. A chemical and mechanical microdissection-SEM approach.

The three-dimensional (3D) microanatomy of the cornea is the major determinant of its optical and mechanical properties. Scanning electron microscopy (SEM) is the most commonly used method to obtain information on the overall 3D microanatomy of organs. However, SEM has not been successful in revealing the 3D microanatomy of the cornea, because the interior of the cornea is too compact to be explored by the electron beam. In this study, the 3D organisation of the cells and extracellular materials of human and rabbit corneas was examined after exposure by HCl and NaOH digestion, and by microdissection by the adhesive tape method. In the cornea of both species, all epithelial cells exhibited microplicae regardless of their location. This raises doubts about the tear film-holding role assigned to the microplicae of the superficial cells. Human and rabbit corneas differed in the collagen fibre patterns of the epithelial basement membranes. The 3D organisation of the stromal lamellae was similar in both species. In humans and rabbits, the keratocytes showed similar 3D features. However, the surface of human keratocytes located near Descemet's membrane exhibited small fenestrations that were not present in the rabbit keratocytes. The pattern of keratocyte innervation by the stromal neural plexus and 3D keratocyte microanatomy confirms that keratocytes form a large intercommunicating network within the corneal stroma. Two morphologically discrete subpopulations of keratocytes located at different stromal levels were identified in both human and rabbit corneas, suggesting that keratocytes are not functionally homogeneous. In addition, the density of the stromal neural plexus appeared to be greater in rabbits than in humans. Clear differences between human and rabbit corneas were observed in the collagen arrangement in Descemet's membrane, which may reflect their different biomechanical requirements.

Evidence of a new transitory extracellular structure within the developing rhombencephalic cavity. An ultrastructural and immunoelectron-microscopic study in the chick.

The first rudiment of the central nervous system is a simple tube, the neural tube, and its cavities become the cerebro-ventricular system. The elements located within this system, their composition and precise morphogenetic role are poorly understood. This study used transmission (TEM) and scanning (SEM) electron microscopy, and immunoelectron microscopy, and describes in the chick the development, ultrastructure, composition, and regression of a previously undescribed extracellular structure located in close relationship with the luminal pole of the developing rhombencephalic tectoria lamina. We have called it the rhombencephalic roof network (RRN). The RRN was first observed in stage 12, closely related to a cluster of apoptotic cells. Between stages 15 and 18, the RRN attained its greatest development; it was rhomboid in shape and SEM revealed a network of fibers. Between stages 19 and 22, the RRN underwent a process of fragmentation and regression, and was not observed after stage 23. With TEM, the RRN appeared formed by amorphous ruthenium-red-positive material and sets of tubes between 4 and 25 nm in diameter. Each tube was formed by the superposition of annular units. Immunolabelling showed the presence of laminin and heparan sulfate proteoglycan in both the amorphous material and fibers; the former also contained tenascin. In terms of ultrastructure and composition, the fibers were similar to one the basic components of the lamina densa of basement membranes. The developing tectoria lamina exhibited openings as early as stage 12+, showing that the neural cavity is not a closed system and that the neural tube fluid (NTF) could be a circulating liquid. The presence in the RRN of three molecules of the extracellular materials actively involved in several developmental processes and the very early appearance of the RRN suggest that this structure plays a developmental role in rhombencephalic morphogenesis.

Epithelial involution and basement membrane loss during early rhombencephalic tectoria lamina development.

Extracellular material molecules play a key role in the regulation of morphogenesis and differentiation of a large number of organs including the central nervous system. However, the role of the neural basement membrane in the growth of different parts of the neural tube has yet to been delineated. Here, the structural and compositional modifications of the basement membrane (BM) of rhombencephalic tectoria lamina anlage (RTLA) have been examined during the process of RTLA epithelial attenuation. Between stages 10 to 11-the presumptive RTLA epithelium showed a structure, thickness and cell-proliferating capacity similar to those observed in other zones of the rhombencephalic walls. Moreover, the rhombencephalic vesicles were surrounded by a continuous BM that was heterogeneous both ultrastructurally and with regard to ruthenium red, laminin and tenascin distribution. After stage 11, the RTLA epithelium underwent a rapid process of attenuation and change to a stratified flattened epithelium. During this remodelling process, apoptosis and inhibition of both PCNA expression and 3H-thymidine uptake occurred in the RTLA epithelium. The BM of the RTLA underwent a process of degration at the beginning of the remodelling, and apoptosis and cell proliferation inhibition of RTLA epithelium were also observed. The loss of the biochemical signals encoded within the BM could lead to cell shape changes, cell proliferation inhibition and to the anoikis type of cell death. Our findings support the idea that the BM surrounding the neural tube plays a key role in controlling both the structure and growth of the CNS during the early developmental stages.

Abnormal tenascin expression in murine autosomal recessive polycystic kidneys.

The mechanisms responsible for renal cyst formation in congenital polycystic kidney disease (PKD) remain unknown. Changes in extracellular matrix (ECM) are regarded as an important pathogenic factor in PKD. Tenascin, an ECM glycoprotein implicated in abnormal growth in adult organs, has not been systematically evaluated in PKD. In this study, tenascin expression was studied by immunohistochemistry in the autosomal recessive polycystic kidneys of C57BL/6J (cpk/cpk) mice. Scanning electron microscopy was performed to determine the cyst types and their temporal evolution, and to establish correlations with the immunohistochemistry observations. Cystic lesions evolved in three main stages. Initially, the cysts appeared as segmental dilatations of both proximal and collecting ducts. In the second stage, the collecting duct cysts (CDCs) underwent rapid growth that led to the destruction of all other kidney elements. In the final stage, the CDCs reached their maximum size and the PKD mice died. Normal differentiated principal cells and three types of intercalated cells were present in the CDC epithelium. In all three stages an intense tenascin expression was detected selectively in the basement membranes of the cysts. In the last stage, an intense tenascin immunoreactivity was also observed in the interstitial fibrotic tissue. The abnormal presence of tenascin in the basement membranes of the cysts suggests that this glycoprotein is implicated in the pathogenesis of the cysts, possibly by stimulating cell proliferation.

Supraependymal cells and fibers during the early stages of chick rhombencephalic development.

Supraependymal cellular elements are a constant feature in the adult cerebroventricular system. However, there has been no analysis of their distribution and morphology during the embryonic stages of the chick brain. The ultrastructural features of the rhombencephalic luminal surface of chick embryos ranging from stage 10 to 22 were studied with both scanning and transmission electron microscopy. In addition, immunocytochemistry and confocal laser microscopy were used to examine the presence of 68 kD neurofilaments in supraependymal elements. The ultrastructural observations revealed significant morphological differences in the apical cell surface between the cells at rhombomere boundaries and those in the rhombomere bodies. These differences support the idea that the boundary and the body of rhombomeres contain two morphologically distinct cell types. Supraependymal (SE) cells and SE fibers were present in the rhombencephalon of all embryos studied from stage 12 to 22. The cells were bipolar spindle-shaped. The SE fibers showed a characteristic spatial pattern within the rhombencephalon, following a straight course parallel to the rhombomere boundaries. The SE fibers showed varicosities and their endings contained small vesicles. Both SE cells and SE fibers were positive for 68 kD neurofilaments. Their morphology and reactivity for neurofilaments indicate a neuronal function. The constant presence of SE cells and SE fibers on the surface of the developing rhombencephalon, their special pattern and close relationship with the neural tube fluid (NTF) suggest that these supraependymal elements may be involved in a neuronal signalling pathway between different parts of the same rhombomere and also in chemical communication and integration within the ventricular system, linking distant parts of the developing central nervous system by means of NTF.

Insulin-like growth factor I receptor gene expression during postnatal development of rabbit kidney.

BACKGROUND: Insulin-like growth factor-I (IGF-I) is a peptide growth factor whose biological effects are mediated through a specific receptor (IGF-IR). IGF-I and IGF-IR are detected in both fetal and adult kidneys and have both metabolic and growth effects. IGF-IR expression during postnatal kidney development is not well defined and the biological role of this receptor during the postnatal stage is not clearly established. The purpose of the present study was to analyze IGF-IR gene expression during the postnatal development of rabbit kidney to achieve a better understanding of the correlation between growth and differentiation of kidney tissues and IGF-IR expression. METHODS: Using in situ hybridization, we studied changes in IGF-IR expression in the kidneys of newborn rabbits and those up to 35 days old. Evaluation of the stage of kidney development and morphological maturation was made on histological sections stained with hematoxylin-eosin. RESULTS: High levels of IGF-IR gene expression in the rabbit kidney occurred in the last stages of postnatal development and in the adult stages; during the development of the subcapsular metanephrogenic zone, IGF-IR gene expression was not observed. IGF-IR mRNA was expressed by proximal and distal tubules and by collecting ducts after these tissues attained morphological maturation. The appearance of IGF-IR mRNA in these kidney structures followed a precise temporo-spatial sequence. IGF-IR was not expressed by renal corpuscles, Henle's loops, inner medullary collecting ducts, vessels, or interstitial cells at any study stage. CONCLUSIONS: The temporal and spatial patterns of IGF-IR gene expression during postnatal development of the rabbit kidney suggest that IGF-IR and its ligands are relevant for the acquisition of the function, and not for development events, by proximal and distal tubules and collecting ducts. This study also suggests that IGF-IR mRNA localization constitutes a useful marker to determine the functional maturation of these renal structures.

Lectin-binding sites and silver affinity of the macula densa basement membranes in the rabbit kidney.

Fluorochrome-labelled lectins and the Jones method of silver impregnation preceded by different oxidation and enzymatic digestion procedures were used to study the patterns of glycosylation and silver affinity of the macula densa (MD) and thick ascending limb (TAL) basement membranes of the rabbit kidney. The goal of this study was to analyse the morphological basis of MD basement membrane permeability and its possible role in modulation of the signal involved in tubuloglomerular feedback control of the juxtaglomerular apparatus. The lectin-binding pattern and silver affinity of basement membrane differed clearly from those of the TAL basement membrane. The former had greater WGA and Con A affinity than the latter. Furthermore, the MD basement membrane lost argyrophilia in permanganate oxidized sections whereas that of the TAL did not. The cell coat of MD cells differed from that of the TAL cells in that it had N-acetyl neuraminic acid and Con A binding sites. Our results suggest that the MD basement membrane has a distinctive macromolecular composition which may be related to its permeability to high molecular weight molecules.

Lectin-binding sites during postnatal differentiation of normal and cystic rabbit renal corpuscles.

Fluorochrome-labeled lectins were used to study the expression of glycoconjugates during the postnatal differentiation of normal and cystic rabbit renal corpuscles. Glomerular cysts (GC) are induced in the rabbit by a single injection of corticoids. The Bowman's capsule of these cysts is exclusively formed of podocytes (parietal podocytes). During normal development, the cell coat of the podocytes is intensely positive for wheat germ agglutinin (WGA) and Maclura pomifera agglutinin (MPA). This reaction decreases considerably during maturation, in parallel with an increase in the number of binding sites masked by terminal sialylation. Throughout the stages studied, the podocyte coat is peanut agglutinin (PNA)-negative, but it becomes intensely positive after neuraminidase treatment. Visceral and parietal podocytes in the glomerular cysts show the same pattern of glycosylation as the normal podocytes. In contrast, normal parietal cells only transiently expressed a weak reactivity to WGA and MPA during the first stages of differentiation, and did not express cryptic binding sites at any stage. The glomerular basement membrane (GBM) is positive to WGA, to succinylated WGA, and to MPA, in all the stages studied. Maturation of the GBM is characterized by expression of cryptic MPA-binding sites, and by a considerable increase in the number of cryptic PNA-binding sites. The basement membrane of the parietal layer of the cystic Bowman's capsule shows the same pattern of glycosylation, despite the fact that this epithelial layer is solely formed of podocytes and lacks endothelial cells. In contrast, the normal parietal basement membrane does not express PNA or MPA cryptic sites at any stage.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anomalous origin of the right coronary artery from the left sinus of Valsalva. Apropos of 2 cases]. / Origen anómalo de la arteria coronaria derecha del seno de Valsalva izquierdo. A propósito de dos casos.

Anomalous origin of right coronary artery from the left sinus of Valsalva is a uncommon congenital anomaly which is difficult to demonstrate angiographically. For many years pathologists classified it as a minor anomaly of no clinical significance. It has only recently been associated with significant manifestations of myocardial ischemia. These manifestations have included acute myocardial infarction, angina pectoris, syncope, ventricular tachycardia and fibrillation, and sudden death. Two patients with this anomaly are reported. One patient had angina pectoris in the absence of significant atheromatous coronary lesions. In the second patient the aberrant origin of the right coronary artery was associated to aortic valve disease. The possible physiopathology mechanisms responsible for manifestations of myocardial ischemia in patients with this anomaly are analyzed.

A scanning electron microscope study of the neck segment of the rabbit nephron.

The three-dimensional structure of the neck segment (NS) of the rabbit nephrons was studied by scanning electron microscopy (after fracture, micro-dissection, or after corrosion nephron casts), and by the air-cast method. The NS was observed at the glomerulotubular junction in 68.5% of all nephrons. In every case the NS appeared as a straight tube with its long axis oriented radially in relation to the glomerulus. Although the external diameter of the NS was smaller than that of the proximal tubule, its luminal diameter was greater. No valve-like structures were observed. Three cell types were observed in the NS: parietal-like, tubule-like, and intermediate. Parietal-like cells showed the same morphology as the parietal cells of the Bowman's capsule. Parietal-like cells constituted the only cell type in 25% of the NS. Tubule-like cells showed morphologic characteristics similar to proximal tubule cells; however, their microvilli were less numerous and exhibited an irregular pattern. Intermediate cells presented an intermediate morphology between tubule-like and parietal cells. In 75% of all NS, the three cellular types were present at the same time. The presence of tubule-like and intermediate cells is interpreted as the result of metaplasic transformation of the parietal cells. Our observations suggest that, in rabbits, the presence of the NS can be explained on the basis of phenotypical lability of the cells located at the glomerulo-tubular junction.

Basement membrane alterations during development and regression of tubular cysts.

Tubular cysts consisting of dilatation of the collecting ducts at the level of the subcapsular zone of the kidney were induced in newborn rabbits by a single injection of methylprednisolone acetate. We describe here the structural and compositional modifications of the tubular basement membrane (BM) during the formation, growth, and regression of the tubular cysts. During development of the tubular cysts the cystic BM appeared thickened and multilayered, with numerous matrix vesicles. Alcian blue- (AB) and ruthenium red- (RR) positive material distributed differently along the BM of control and cystic tubuli. While the amount of RR-positive material appeared increased in the cystic BM, no differences in the intensity of the AB staining could be discerned between normal and cystic tubuli. Immunofluorescent staining for laminin and type IV collagen appeared to be slightly decreased in the cystic tubuli. However, the amount of fibronectin appeared clearly increased. These changes in the cystic BM appear at the beginning of the tubular dilatation and are not observed in other renal BM. We suggest that there is a causal relationship between the modifications of the BM and the development of the tubular cysts. Glucocorticoids appear to modify the synthesis and/or secretion of the BM components. An abnormal BM should modify the spatial and chemical signals encoded within the BM that, in turn, could lead to abnormal behavior of the tubular cells. This may result in a loss of the normal developmental constraints imposed upon the tubular epithelium, which then undergoes cystic dilatation. During the regression of the cysts, the abnormalities of the BM progressively disappear. The sharp increase in the number of interstitial cells, which show close relationships with the components of the BM, suggests that these cells may be involved in the removal of the cyst BM.

A technique for fluorescence microscopy in semithin sections.

We describe here a procedure to improve contrast and resolution in fluorescence microscopy of sectioned tissues. Tissue fragments were fixed in ethanol-glacial acetic acid, embedded in diethylene glycol distearate, and semithin sectioned. This method maintains tissue antigenicity while preserving the structure of cells and tissues. The thinness of the sections eliminates scattered and emitted light from tissue structures outside the plane of focus. The procedure is simple and quick, and works excellently with fluorescein-conjugated lectins and antibodies.

Structural and morphometric characteristics of the basement membrane of rabbit parietal podocytes induced by corticoids.

This paper presents a structural and morphometric study of the basement membrane underlying the parietal epithelium of cysts developed in the rabbit kidney after a single postnatal injection of methylprednisolone acetate. This epithelium consists of podocyte-like cells named parietal podocytes. Our results show that the parietal podocytes synthesize their own basement membrane in vivo. However, the different laminae of this membrane present differences in structure and thickness when compared to the analogous layers of both the normal glomerular and parietal basement membranes. Differences between the different zones of the parietal podocytic basement membrane are also observed, depending upon the structure that surrounds the cyst (capillaries, interstitial cells or loose connective tissue). A lamina lucida, analogous to the lamina lucida interna of the glomerular basement membrane, is formed only in segments of the parietal podocytic basement membrane in close contact with endothelial or interstitial cells. The thickness of the lamina lucida externa of the parietal podocytic basement membrane appears regulated by the presence of interstitial cells and capillaries. In the zones in contact with capillaries, the lamina densa of the parietal prodocytic basement membrane appears thinner than in other segments. This fact, together with structural observations, suggests that the formation of a single basement membrane, interposed between the parietal podocytes and the endothelium, does not take place by fusion of the two basement membranes but by previous removal of the capillary basement membrane. In areas where the parietal podocytic basement membrane is in contact with loose connective tissue, a lamina fibroreticularis is observed. All these data indicate that the formation of the basement membrane by the parietal podocytes is influenced by nonpodocytic cells. Around the glomerular cysts, a tardy formation of capillaries is observed. Parietal podoytes can be hypothesized to synthesize an angiogenic factor that may be implicated in the process of angiogenesis.

[Intravenous streptokinase in acute myocardial infarction. A Mexican multicentric study]. / Estreptoquinasa intravenosa en el infarto agudo del miocardio. Estudio multicéntrico mexicano.

To evaluate the benefits of intravenous streptokinase (SQIV) in acute myocardial infarction (AMI), we joined a group of ten Mexican university hospitals, that were coordinated by the National Institute of Cardiology of Mexico. We included patients less than 70 years of age admitted to the hospital with less than 6 hours from the onset of chest pain during their first myocardial infarction. All patients had ST segment elevation of 1.5 mm or more, and none had contraindication for SQIV. They received 1.5 millions of SQIV in one hour. Reperfusion criteria included absence of pain, ST segment reduction and a rapid rise and fall of enzyme levels. Angiographic criterion for reperfusion was the permeability of the affected coronary vessel. Of 66 patients studied, 57 (86%) had clinical reperfusion; of the 24 available angiographic studies, 92% demonstrated reperfusion. Eight (12%) of the patients had minor complications and 7 (10%) had serious complications. There were 0 deaths. We concluded that SQIV is a useful therapeutic procedure, easy to perform in general hospitals.

Importancia del inicio precoz en la administración de estreptoquinasa intravenosa en el infarto agudo del miocardio / The importance of early administation of in acute myocardial infarction intravenous streptokinase

Para evaluar la importancia del tiempo de inicio de la terapia fibrinolítica con estreptoquinasa por vía intravenosa (EQIV) en la reperfusión coronaria, se estudiaron 34 pacientes consecutivos, con menos de 6 horas de iniciada la sintomatología del episodio de infarto agudo del miocardio y a quienes se les administró 1.5 de estreptoquinasa en 1 hora. En todos se realizó coronariografía en las primeras 72 horas. Se correlacionó el tiempo de inicio de la EQIV con los hallazgos coronariográficos. Los pacientes se dividieron en 3 grupos. El grupo I, de 0 de 2 horas con 12 pacientes; el grupo II, de 2 a 4 horas con 13 pacientes y el grupo III, de 4 a 6 horas con pacientes. Se observó reperfusión angiográfica en 24 pacientes (70.2%), p < 0.05. En el grupo I se obtuvo recanalización en 10 (83.3%). En el grupo II, 9 (69%) y el grupo III, 5 (55.5%), con significación estadística solo en el grupo I (p < 0.05). En este estudio también se demuestra la utilidad de los criterios enzimáticos y electrocardiográficos para precidir si ocurre reperfusión. No hubo mortalidad relacionada con el procedimiento. Se concluye que se obtiene un porcentaje de reperfusion mayor, cuanto mas precoz es el inicio de la terapia fibrinolítica