Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices.

BACKGROUND: The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited. AIM: To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics. SUBJECTS: 10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation. METHOD: B-mode ultrasound images for visualizing fetal breathing movements (FBM) or breathing akinesis (FBA), and the simultaneous RR-interval time series from maternal abdominal ECG recordings were obtained. The root-mean-square of successive differences of RR-intervals (RMSSD) was considered as a RSA-related parameter among the instantaneous amplitude of the high-frequency component (AMPHF) and its corresponding instantaneous frequency (IFHF), both computed by using empirical mode decomposition. Mean fetal heart-periods and RSA-related parameters were assessed during episodes of FBM and FBA in 30s length windows. RESULTS: FGR and Control groups presented RSA-related fluctuations during FBM and FBA. Also, both groups showed significant higher (p<0.001) values for the mean heart-period, RMSSD and AMPHF during FBM. No-significant differences (p>0.05) were found for the IFHF regardless of breathing activity (FBM vs. FBA). CONCLUSION: Growth-restricted fetuses without evident hemodynamic compromise exhibit a preserved autonomic cardiovascular regulation, characterized by higher values of RSA and mean heart-period in the presence of FBM. This physiological response reflects a compensatory strategy that may contribute to preserve blood flow redistribution to vital organs.

Recommendations of a group of experts for the pathological assessment of tumour regression of liver metastases of colorectal cancer and damage of non-tumour liver tissue after neoadjuvant therapy.

Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.

Liver, but not adipose tissue PEDF gene expression is associated with insulin resistance.

OBJECTIVE: Recent studies linked circulating pigment epithelium-derived factor (PEDF) to obesity-associated insulin resistance, but the main source of circulating PEDF is unknown. We aimed to investigate liver and adipose tissue PEDF gene expression in association with obesity and insulin resistance. DESIGN, SUBJECTS AND METHODS: Three (two cross-sectional and one longitudinal) independent cohorts have been studied, for adipose tissue (n=80 and n=30) and liver gene expression (n=32 and n=14). Effects of high glucose and cytokines on HepG2 cell line were also investigated. PEDF gene expression and circulating PEDF were analyzed using real-time PCR and ELISA, respectively. RESULTS: In a first cohort of subjects, PEDF relative gene expression was higher in subcutaneous (SC) than in omental (OM) adipose tissue (P<0.0001) being also higher in mature adipocytes compared with stromo-vascular cells (P<0.0001). However, OM PEDF relative gene expression was decreased in morbidly obese subjects (P=0.01). Both OM PEDF and OM PEDF receptor (PEDFR) correlated positively with lipogenic and lipolytic genes, and with genes implicated in the lipid vacuole formation. Circulating PEDF levels were not associated with fat PEDF gene expression. In the second cohort, SC PEDF was decreased in subjects with type 2 diabetes and did not change significantly after weight loss. We next explored circulating PEDF in association with markers of liver-related insulin resistance injury (alanine aminotransferase, r=0.59, P=0.001). Interestingly, liver PEDF gene expression increased with obesity and insulin resistance in men, being significantly associated with fasting glucose and glycated hemoglobin in two independent cohorts. In fact, high glucose led to increased PEDF in HepG2 cells, while inflammatory stimuli present in the adipose tissue environment downregulated PEDF. CONCLUSION: Liver, but not adipose tissue, might be the source of increased circulating PEDF linked to insulin resistance.

Effects of fetal respiratory movements on the short-term fractal properties of heart rate variability.

We evaluated the effect of fetal respiratory movements (RM) on the heart rate (HR) fractal dynamics.Abdominal ECG recordings were collected from low-middle-risk pregnant woman at rest. Mean gestational age was 34.8 ± 3.7 weeks. Ultrasound images were simultaneously acquired determining if RM were exhibited by fetuses. 13 pairs of HR series were compared. Each pair included 5 min of data from the same fetus either during the manifestation of RM or when there was no persistent indication of them. Detrended fluctuation analysis was applied to these series for obtaining the scaling exponent α1. HR series were also assessed using the conventional parameters RMSSD and HF power.The main findings of this contribution were the lack of significant changes in the scaling exponent α1 of fetal HR fluctuations as a result of RM. By contrast, HF power and RMSSD did show significant changes associated with the manifestation of fetal RM (p < 0.001 and p < 0.05, respectively). Yet the scaling exponent was the only parameter showing a significant relationship with the particular frequency of fetal RM (r s  = 0.6, p < 0.03). Given the invariability of α1 regarding the manifestation of fetal RM, we consider that the HR short-term fractal properties are convenient for assessing the cardiovascular prenatal regulation.

Short-term heart rate dynamics of pregnant women.

Aiming to detect the stage of gestation where dynamical changes of the RR fluctuations may occur, we assessed short-term fluctuations of low risk pregnant women. Ninety six, 10min ECG recordings were collected along gestation (7 to 39 weeks). Corresponding RR fluctuations series were analysed to obtain the RMSSD, α(1), α(1(mag)) and α(1(sign)) parameters. Four groups covering first, second and last trimesters of gestation were conformed. No significant changes in α(1), which was close to unit, and α(1(sign)) among gestational groups were identified. But, in accordance with previous findings, we did find a significant reduction of RMSSD along gestation, and significant short-term changes that indicate a higher degree of nonlinearity after about 26 weeks of gestation (α(1(mag))>0.5)). These results suggest that the short-term heart rate dynamics of low risk pregnant women do not become compromised during gestation, despite the increased haemodynamic demands and other ongoing adaptations. Yet the complexity of the mechanisms involved in the cardiac regulation of pregnant women does seem to increase from mid-pregnancy, possibly owing to new short-term control influences or to modifications regardless the strength of the regulatory interactions.

Short-term heart rate dynamics of women during labor.

We studied 10 minutes segments of heartbeat interval fluctuations from 18 young women in labor with normal outcome of pregnancy. Data of each studied case were classified into two distinct groups. One group involving segments where the uterine activity was observable (three or more contractions in ten minutes), and the other group of reference having segments with fewer uterine activity or not presenting contractions at all. For comparison, we also included segments collected during the last trimester of gestation prior to labor from a third group of women. Corresponding RR interval series were analyzed to estimate RR(mean), RMSSD, α(1), α(1(MAG)) and α(1(SIGN)) parameters. No significant differences among groups were identified in RMSSD, α(1) and α(1(MAG)) Nevertheless, α(1(SIGN)) did present significant differences in comparison with the last trimester results (p<0.007), revealing a subtle change in the temporal organization of maternal RR series during labor. Results of these parameters then suggest that during labor, despite preserving a concomitant non-linear influence, the maternal short-term autonomic cardiac regulation behaves with less antagonism.

Population-based incidence and survival of gastrointestinal stromal tumours (GIST) in Girona, Spain.

BACKGROUND: Gastrointestinal stromal tumours (GIST) are rare malignancies characterised by their association with KIT oncogene mutations. Until now, population-based reports of the incidence or survival of kit-confirmed GIST have been rare, and none have originated in Southern Europe. MATERIALS AND METHODS: We used the Girona Cancer Registry to identify malignant mesenchymal tumours of the digestive tract between 1994 and 2001, and performed c-kit testing in the tumour samples. Age-adjusted incidence rates and survival rates were calculated, and they were also analysed by sex and NIH risk categories. RESULTS: Forty-six cases were categorised as GIST. Fifty percent were localised in the stomach, 43.5% in small intestine, 4.3% in the omentum, and 2.2% in colon. Thirty-seven percent were classified as high risk of an aggressive behaviour, 30.4% as intermediate risk and 32.6% as low or very low risk. Only one patient received treatment with imatinib mesilate. The annual incidence by 100,000 inhabitants in crude rate, European age-standardised rate and world age-standardised rate was, respectively, 1.09, 0.90 and 0.65 cases. The relative 5-year survival rate was 74.7% for the entire cohort, and it was markedly lower in the high-risk cases (20.3%). CONCLUSIONS: We report the first population-based study of GIST incidence and survival in Southern Europe. The incidence rate is low and comparable with that of cancer registries from Northern Europe. Survival was favourable in our pre-imatinib population although it was low in high risk cases. Prognostic discrimination of the cases with intermediate, low, or very low risk is inadequate, and these categories should be considered jointly in the future. Our results will help researchers in establishing baseline values against which they can compare, in the future, the impact of imatinib and other Kit tyrosine inhibitors on survival.

Prenatal RR fluctuations dynamics: detecting fetal short-range fractal correlations.

OBJECTIVE: Several studies have suggested that the analysis of heart rate variability (HRV) during gestation provides indications of the development or maturation of fetal cardiovascular regulatory mechanisms. In this study, we evaluate the existence of short-range fractal-like correlations in fetal RR fluctuations data from the second half of human gestation. METHODS: Fifty-six short-term abdominal ECG recordings were obtained from low-middle-risk pregnant women. Gestational age varied from estimated 21 weeks to term. For comparison, RR-interval data of 51 healthy adults were also analysed. RESULTS: Principal findings along the gestational period explored were the existence of fractal RR dynamics in prenatal fetal data as revealed by the short-range scaling exponent alpha(1). No significant differences of alpha(1) (p = 0.4770) were found between fetal (median 1.2879) and adult data (median 1.3214), either between the fetal cases before or after 24 weeks (p = 0.6116) despite observing more variation at early stages. However, fetal RR data did involve lower magnitude in comparison with adults as we found significant differences in pNN20 and SDNN values. CONCLUSION: The fetal short-range fractal behaviour of RR data could then be linked to the functional development of the parasympathetic activity, which appears to become manifested before 21 weeks of gestation.

Comparison of RR-interval scaling exponents derived from long and short segments at different wake periods.

Heartbeat fluctuations show fractal-like correlations that are associated with highly adaptive cardiovascular regulatory systems. Moreover, the short-range fractal or scaling exponent alpha(1) extracted from these correlations has been found to be a predictor of mortality for subjects with an impaired left ventricular function. In general, the RR-interval data required for this analysis are derived from long-term ECG recordings during free-running conditions. Yet short-term recordings are more likely to be obtained in some practical circumstances, so becoming relevant to assess the possibility of obtaining representative alpha(1) exponents from these recordings. Here, we compare the alpha(1) exponents extracted from the RR-interval series (9:00 AM-6:00 PM) of 51 healthy adults in normal sinus rhythm and the alpha(1) calculated from three shorted segments of only 700 beats obtained from the same series at 9:00 AM, 1:30 PM and 5:00 PM. We found no significant differences between the scaling exponents derived from the whole 9 h series and the short segments at 9:00 AM and 5:00 PM, but did find significant differences when comparing the whole series with the short segment at 1:30 PM. Thus, only if the time of day is taken into consideration can short segments of heartbeat fluctuation data be used to obtain representative alpha(1) exponents.

Seguimiento de egresados de la licenciatura en enfermería de la eneo en 2000 a los tres años (2003) / Follow up of nursing graduates 2000-2003 National School of Nursing and Obstetrics

Antecedentes: El seguimiento de egresados de la ENEO ha sido una preocupación constante para la escuela desde hace mucho tiempo, sin embargo a partir de 1991 se estableció como proyecto institucional, llevando a cabo el seguimiento a los tres años de la terminación de sus estudios desde 1994 hasta 2004, en este informe se presenta el caso de 2003. Propósito: EI propósito de este trabajo es: Conocer la situación laboral de sus egresados: Actividades desempeñadas, condiciones laborales, satisfacción, perspectivas de desarrollo, antecedentes educativos y perspectivas de desarrollo, antecedentes personales para retroalimentar el proceso formativo de la carrera y orientar a alumnas y alumnos para su inserción al mercado laboral. Metodología: Estudio longitudinal descriptivo con enfoque cuantitativo. La población correspondió a 339 ex alumnos egresados de la Licenciatura del sistema escolarizado y la muestra encuestada fue de 59 egresados; los datos recabados se orientan al propósito de estudio. Para el análisis de los datos, se utilizaron pruebas de estadística descriptiva. Discusión y Conclusiones: Las características personales, académicas y laborales guardan similitud con otros seguimientos, sin embargo hay datos que lo caracterizan: Los índices de titulación continúan recuperando su tendencia positiva, sin embargo, los porcentajes de contratación se ven reducidos en comparación a los seguimientos de 2002 y 2001, las actividades que realizan con mayor frecuencia los egresados son congruentes con las áreas y con las categorías de contratación. En este seguimiento se destaca la opinión de los egresados en cuanto a la recepción de formación orientada a las actividades educativas de carácter preventivo.

Background: ENEO´S graduates follw-up hs been a constant concern to the School since a long time ago; how-wver, starting in 1991, an institutional project was established in order to carry out a three-year-after-graduating follow up since 1994 up to 2004. This presents the 2003 case. Purpase: Getting to know ENEO´s graduates warking situation: activities accomplished, laboral conditions, satisfaction, development perspectives, educative antecedents and, personal antecedents in order to feedback the carreer formative process and to guide students for their insertion within the labor market. Methodology: Descriptive longitudinal study with a quantitative foculs. Populataion was made of 339 Nursing graduated students in the scholastic system and the surveyed sample had 59 graduates; registered data went for the study purpase. Descriptive statistical tests were used for data analysis. Discussion and Conclusions: Personal, academical, and laboral characteristics are similar to those in other fol-low-ups;there are data, hawever, that characterize this one; grading indexes continue their positive trend, although hiring percentages are descreased compared to the 2002 and 2001 follow-ups. Activities graduated carry out more frequently are congruent with areas and categories for hiring. Within this fallow-up, graduates´ opinion about receiving and education-activities-oriented upbringing with a prevention character is highlighted.

Fatal right spontaneous haemothorax in Von Recklinghausen's disease.

Spontaneous massive haemothorax is uncommon and usually occurs as a result of pulmonary infarction, arteriovenous fistula, neoplasm, ruptured aortic aneurysm, rupture of pleural adhesions or pleural endometriosis. Massive haemothorax in Von Recklinghausen's disease occurs rarely but with potentially fatal results in spite of surgery. We present a case of a spontaneous massive exsanguinating haemothorax in a patient with neurofibromatosis type 1 caused by rupture of a branch of the right subclavian artery. Bleeding was probably due to neurofibromatous invasion of the arterial wall.

Effect of clenbuterol on growth performance in broilers

The objective of this study was to evaluate the effect of clenbuterol (CB), a beta2-adrenergic agonist, as a growth and weight gain promoter in broilers. Effects of CB were assessed, mixing it in feed at 0.0, 0.21, 0.42 and 0.84ppm, and feeding during four weeks to four groups (n=75) of 28 day-old Arbor Acres chickens. The body weight (BW) and food intake at 0, 12, 20 and 28 days of the study were recorded. Also abdominal fat (AF) and total muscle proteins were measured. Results indicate that from day 20 until the last of the experimental period (56-day-old), efficacy of CB was evident to increase growth and decrease AF deposition rates (P 0.01), in a dose-response pattern, suggesting that CB has a profitable growth promoting effect in broiler chickens.

Avaliou-se o efeito da administração de clenbuterol (CB) como promotor de ganho de peso em frangos, dos 28 (início do experimento) aos 56 dias de idade (final do experimento). CB foi adicionado às dietas nas dosagens de 0 (controle), 0,21, 0,42 e 0,84ppm. Utilizaram-se 75 frangos em cada tratamento, registrando-se o peso corporal, o consumo de alimento, a gordura abdominal e a proteína muscular. A partir do 20º dia do experimento (48 dias de idade) até o seu final o efeito da administração de CB foi significativo. Frangos que receberam dosagens mais elevadas de CB estavam mais pesados. Observou-se também diminuição na deposição de gordura no abdômen com o aumento das dosagens de CB na dieta.

Efeito da adiçäo de clenbuterol na dieta sobre o crescimento de frangos de corte / Effect of clenbuterol on growth performance in broilers

Avaliou-se o efeito da administraçäo de clenbuterol (CB) como promotor de ganho de peso em frangos, dos 28 (início do experimento) aos 56 dias de idade (final do experimento). CB foi adicionado às dietas nas dosagens de 0 (controle), 0,21, 0,42 e 0,84ppm. Utilizaram-se 75 frangos em cada tratamento, registrando-se o peso corporal, o consumo de alimento, a gordura abdominal e a proteína muscular. A partir do 20º dia do experimento (48 dias de idade) até o seu final o efeito da administraçäo de CB foi significativo. Frangos que receberam dosagens mais elevadas de CB estavam mais pesados. Observou-se também diminuiçäo na deposiçäo de gordura no abdômen com o aumento das dosagens de CB na dieta