Sleep decreases neuronal activity control of microglial dynamics in mice.

Microglia, the brain-resident immune cells, are highly ramified with dynamic processes transiently contacting synapses. These contacts have been reported to be activity-dependent, but this has not been thoroughly studied yet, especially in physiological conditions. Here we investigate neuron-microglia contacts and microglia morphodynamics in mice in an activity-dependent context such as the vigilance states. We report that microglial morphodynamics and microglia-spine contacts are regulated by spontaneous and evoked neuronal activity. We also found that sleep modulates microglial morphodynamics through Cx3cr1 signaling. At the synaptic level, microglial processes are attracted towards active spines during wake, and this relationship is hindered during sleep. Finally, microglial contact increases spine activity, mainly during NREM sleep. Altogether, these results indicate that microglial function at synapses is dependent on neuronal activity and the vigilance states, providing evidence that microglia could be important for synaptic homeostasis and plasticity.

Extracción combinada tórax-abdomen en un donante en asistolia tipo III de Maastricht / Combined thorax-abdomen extraction in a Maastricht type III donor

La donación en asistolia (DA) tipo III de Maastricht o DA controlada es aquella en que el cese irreversible de la función circulatoria y respiratoria se produce tras la retirada de medidas de soporte vital. Dada la escasez de pulmones disponibles para trasplante, se está valorando cada vez con más frecuencia el inicio de programas con pulmones procedentes de DA. La extracción combinada tórax-abdomen en DA se lleva a cabo únicamente en doce centros en España, siendo todavía más excepcional el empleo combinado de extracción superrápida pulmonar con perfusión regional normotérmica abdominal. El primer caso de extracción pulmonar y abdominal en un donante en asistolia tipo III en Navarra con este tipo de técnicas de preservación supone un hito y el éxito alcanzado demuestra que es un procedimiento factible y seguro

Donation after circulatory death (Maastricht type III donation) or controlled cardiac death refers to the retrieval of organs for transplantation purposes following death confirmed using circulatory criteria after the withdrawal of life support. The persistent shortfall in organ availability has prompted the development of donation programs following circulatory death for lung transplantation. The combined thorax-abdomen extraction in these cases is carried out in only twelve centres in Spain, while the combined use of abdominal normothermic regional perfusion (NRP) is even more exceptional. The first case of pulmonary and abdominal extraction in a Maastricht type III donor in Navarre with this type of preservation techniques is a milestone and the success achieved shows that it is a feasible and safe procedure

[Combined thorax-abdomen extraction in a Maastricht type III donor]. / Extracción combinada tórax-abdomen en un donante en asistolia tipo III de Maastricht.

Donation after circulatory death (Maastricht type III donation) or controlled cardiac death refers to the retrieval of organs for transplantation purposes following death confirmed using circulatory criteria after the withdrawal of life support. The persistent shortfall in organ availability has prompted the development of donation programs following circulatory death for lung transplantation. The combined thorax-abdomen extraction in these cases is carried out in only twelve centres in Spain, while the combined use of abdominal normothermic regional perfusion (NRP) is even more exceptional. The first case of pulmonary and abdominal extraction in a Maastricht type III donor in Navarre with this type of preservation techniques is a milestone and the success achieved shows that it is a feasible and safe procedure.

Evaluación de la conciliación de la medicación en una Unidad de Traumatología / Evaluation of medication reconcilliation in a Trauma Unit

Introducción: El objetivo del estudio fue evaluar la tasa de discrepancias en la conciliación de la medicación realizada al ingreso de los pacientes en una Unidad de Traumatología, identificando los posibles factores de riesgo asociados a los errores de conciliación. Material y métodos: Se trata de un estudio observacional transversal realizado en un hospital de tercer nivel durante el periodo comprendido entre el 1 de mayo y el 16 de julio del 2012, en el que se elaboró un listado del tratamiento domiciliario del paciente contrastándose con la historia farmacoterapéutica recogida al ingreso en dicha unidad, para identificar los errores de conciliación. Estos se clasificaron en función del tipo y la relevancia de la discrepancia. Se realizó un análisis estadístico por regresión logística, utilizando como variable dependiente la existencia de discrepancias. Resultados: Ciento sesenta y cuatro pacientes fueron incluidos en el estudio, hallándose errores de conciliación en el 48,8%, de las cuales el 14,4% fueron considerados muy relevantes. De los pacientes ingresados de forma urgente, el 66,7% presentó discrepancias frente al 44,8% en pacientes programados. En total, se identificaron 153 errores de conciliación, siendo el tipo más frecuente el de omisión de algún medicamento (72%). Se detectó que por cada fármaco añadido al tratamiento domiciliario habitual el riesgo de presentar discrepancias aumenta en un 33%. Conclusión: Este estudio pone en evidencia la falta de exhaustividad en la recogida de la historia farmacoterapéutica de los pacientes al ingreso en la Unidad de Traumatología (AU)

Introduction: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Material and methods: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. Results: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. Conclusion: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit (AU)

Evaluation of medication reconcilliation in a Trauma Unit.

INTRODUCTION: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. MATERIAL AND METHODS: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. RESULTS: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. CONCLUSION: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit.

Glia: the many ways to modulate synaptic plasticity.

Synaptic plasticity consists in a change in synaptic strength that is believed to be the basis of learning and memory. Synaptic plasticity has been for a very long period of time a hallmark of neurons. Recent advances in physiology of glial cells indicate that astrocyte and microglia possess all the features to participate and modulate the various form of synaptic plasticity. Indeed beside their respective supportive and immune functions an increasing number of study demonstrate that astrocytes and microglia express receptors for most neurotransmitters and release neuroactive substances that have been shown to modulate neuronal activity and synaptic plasticity. Because glial cells are all around synapses and release a wide variety of neuroactive molecule during physiological and pathological conditions, glial cells have been reported to modulate synaptic plasticity in many different ways. From change in synaptic coverage, to release of chemokines and cytokines up to dedicated "glio" transmitters release, glia were reported to affect synaptic scaling, homeostatic plasticity, metaplasticity, long-term potentiation and long-term depression.

Selective cardiorespiratory and catecholaminergic areas express the hypoxia-inducible factor-1alpha (HIF-1alpha) under in vivo hypoxia in rat brainstem.

Under severe oxygen deprivation, all cells are able to express the transcription factor HIF-1, which activates a wide range of genes. Under tolerable hypoxia, chemosensory inputs are integrated in brainstem areas, which control cardiorespiratory responses. However, the molecular mechanisms of this functional acclimatization are unknown. We investigated when and where the inducible HIF-1alpha subunit is expressed in the rat brainstem in vivo, under physiological hypoxia. The regional localization of HIF-1alpha mRNA and protein was determined by in situ hybridization and immunocytochemistry in adult male rats exposed to moderate hypoxia (10% O2) for 1-6 h. HIF-1alpha protein was found in cell types identified by immunocytochemistry as catecholaminergic neurons. Hypoxia induced HIF-1alpha mRNA and protein in only some parts of the brainstem located dorsomedially and ventrolaterally, which are those involved in the cardiorespiratory control. No labelling was detected under normoxia. The protein was detected in glia and neurons after 1 and 6 h of hypoxia, respectively. A subset of A2C2 and A1C1 catecholaminergic neurons colocalized tyrosine hydroxylase and HIF-1alpha proteins under hypoxia, but no HIF-1alpha was detected in more rostral catecholaminergic areas. In contrast to cardiorespiratory areas, HIF-1alpha protein was already present under normoxia in glial cells of brainstem tracts but was not overexpressed under hypoxia, although HIF-1alpha mRNA was up-regulated. In conclusion, there appear to be two regulatory mechanisms for HIF-1alpha expression in the brainstem: hypoxic induction of HIF-1alpha protein in cardiorespiratory-related areas and constitutive protein expression unaffected by hypoxia in brainstem tracts.

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (II) micronutrient intake. Dieta y Riesgo de Enfermedades Cardiovasculares en España.

OBJECTIVE: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. METHODS: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people 'with cardiovascular risk' and 600 'without risk' answered a food frequency questionnaire. RESULTS: Significant increases in vitamin C, retinol, lycopenes, beta-cryptoxanthin and vitamin E intakes were found. Vitamin A, alpha-carotenoid and lutein intakes decreased. Vitamin B(12), B(6) and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B(12) and B(6) and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B(1) and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. CONCLUSION: Antioxidant vitamins and vitamin B(12), B(6) and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B(1) and zinc intakes are not appropriate.

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (I). Diet and Cardiovascular Events Risk in Spain.

BACKGROUNDS/AIMS: To investigate dietary habits and their evolution with regard to cardiovascular risk status in Spain. METHODS: Cross-sectional study performed in two phases in 1991 and 1996 in 43 primary care clinics. One thousand and two hundred people classified as 'with cardiovascular risk' and 600 'without risk' were studied. Each participant answered a food frequency questionnaire. RESULTS: The risk group did not change oil, cereals and dairy products consumption, decreased egg, legume and meat, and increased fish, fruits and vegetables intake. The control group differed in increasing dairy products and not decreasing eggs and vegetables consumption. A small decrease in energy intake happened, from 11,315. 1 to 10,941.5 kJ in the risk group (p < 0.05). Carbohydrates intake showed a not statistically significant falling trend from 41.3 to 40.6% in people at risk and 41.8 to 40.7% in those without risk. Protein intake increased in both groups up to 16.5% and fat consumption kept at around 42.9% in both groups. The decrease in saturated fat and increase in polyunsaturated fat were statistically significant in people at risk (p = 0.000). High cholesterol intakes were found. CONCLUSION: People with cardiovascular problems changed their dietary habits in a 'healthier' way than people without risk.

O2-sensing after carotid chemodenervation: hypoxic ventilatory responsiveness and upregulation of tyrosine hydroxylase mRNA in brainstem catecholaminergic cells.

Ventilatory responses to acute and long-term hypoxia are classically triggered by carotid chemoreceptors. The chemosensory inputs are carried within the carotid sinus nerve to the nucleus tractus solitarius and the brainstem respiratory centres. To investigate whether hypoxia acts directly on brainstem neurons or secondarily via carotid body inputs, we tested the ventilatory responses to acute and long-term hypoxia in rats with bilaterally transected carotid sinus nerves and in sham-operated rats. Because brainstem catecholaminergic neurons are part of the chemoreflex pathway, the ventilatory response to hypoxia was studied in association with the expression of tyrosine hydroxylase (TH). TH mRNA levels were assessed in the brainstem by in situ hybridization and hypoxic ventilatory responses were measured in vivo by plethysmography. After long-term hypoxia, TH mRNA levels in the nucleus tractus solitarius and ventrolateral medulla increased similarly in chemodenervated and sham-operated rats. Ventilatory acclimatization to hypoxia developed in chemodenervated rats, but to a lesser extent than in sham-operated rats. Ventilatory response to acute hypoxia, which was initially low in chemodenervated rats, was fully restored within 21 days in long-term hypoxic rats, as well as in normoxic animals which do not overexpress TH. Therefore, activation of brainstem catecholaminergic neurons and ventilatory adjustments to hypoxia occurred independently of carotid chemosensory inputs. O2-sensing mechanisms unmasked by carotid chemodenervation triggered two ventilatory adjustments: (i) a partial acclimatization to long-term hypoxia associated with TH upregulation; (ii) a complete restoration of acute hypoxic responsivity independent of TH upregulation.

[Type 2 Charcot-Marie-Tooth disease?]. / Enfermedad de Charcot-Marie-Tooth tipo 2.

INTRODUCTION AND DEVELOPMENT: Type 2 Charcot-Marie-Tooth disease (CMTD-2) is of similar prevalence to CMTD-1. The age of onset is very variable (ranging between the second and seventh decades). It is impossible to clinically differentiate CMTD-1 from type 2, but for equivalent degrees of muscle weakness, amyotrophia is more marked in the latter. The speed of motor and sensory nerve conduction are normal or minimally slower (> or = 38 m/s) and accompanied by a fall in the nerve potentials of the lower limbs, but not always in the upper limbs. These electrophysiological anomalies do not occur early and therefore do not permit rapid, presymptomatic diagnosis of carriers at risk. The histopathological changes are compatible with primary atrophy of the motor neurons of the anterior horns and of the sensory neurons of the ganglia of the posterior roots, with secondary degeneration of the distal axons of the peripheral nerves. Autosomal dominant transmission is the main mode of inheritance, but only a minority of families have genetic loci situated on chromosomes 1, 3 and 7. CONCLUSION: The first step in rapid molecular diagnosis and genetic treatment is to identify the genes situated in the currently known loci and discover new loci.

Ventilatory and central neurochemical reorganisation of O2 chemoreflex after carotid sinus nerve transection in rat.

1. The first step of this study was to determine the early time course and pattern of hypoxic ventilatory response (HVR) recovery following irreversible bilateral carotid sinus nerve transection (CSNT). The second step was to find out if HVR recovery was associated with changes in the neurochemical activity of the medullary catecholaminergic cell groups involved in the O2 chemoreflex pathway. 2. The breathing response to acute hypoxia (10% O2) was measured in awake rats 2, 6, 10, 45 and 90 days after CSNT. In a control group of sham-operated rats, the ventilatory response to hypoxia was principally due to increased respiratory frequency. There was a large reduction in HVR in the CSNT compared to the sham-operated rats (-65%, 2 days after surgery). Within the weeks following denervation, the CSNT rats progressively recovered a HVR level similar to the sham-operated rats (-37% at 6 days, -27% at 10 days, and no difference at 45 or 90 days). After recovery, the CSNT rats exhibited a higher tidal volume (+38%) than the sham-operated rats in response to hypoxia, but not a complete recovery of respiratory frequency. 3. Fifteen days after CSNT, in vivo tyrosine hydroxylase (TH) activity had decreased in caudal A2C2 (-35%) and A6 cells (-35%). After 90 days, the CSNT rats displayed higher TH activity than the sham-operated animals in caudal A1C1 (+51%), caudal A2C2 (+129%), A5 (+216%) and A6 cells (+79%). 4. It is concluded that HVR following CSNT is associated with a profound functional reorganisation of the central O2 chemoreflex pathway, including changes in ventilatory pattern and medullary catecholaminergic activity.

Enfermedad de charcot-marie-tooth tipo 2 / Type 2 charcot-marie-tooth disease

Introducción y desarrollo. La enfermedad de CharcotMarie-Tooth tipo 2 (ECMT 2) tiene una prevalencia similar a la de ECMT 1. El intervalo de edades de comienzo de la ECMT 2 es muy variable (entre la segunda y la séptima década). Clínicamente es imposible diferenciar la ECMT 1 de la de tipo 2, pero para un grado equivalente de debilidad muscular, la amiotrofia es más marcada en la segunda. Las velocidades de conducción nerviosa motora y sensitiva son normales o mínimamente enlentecidas ( 38 m/s) y se acompañan de la caída en la amplitud de los potenciales nerviosos en los miembros inferiores, y no siempre así en los superiores. Estas anomalías electrofisiológicas no son precoces y, por lo tanto, no permiten un rápido diagnóstico presintomático de los portadores en riesgo. Las alteraciones histopatológicas son compatibles con atrofia primaria de las neuronas motoras de las astas anteriores y de las neuronas sensitivas de los ganglios de las raíces posteriores, con degeneración secundaria de los axones distales de los nervios periféricos. La transmisión autosómica dominante es el modo principal de herencia, pero sólo una minoría de familias se han ligado a loci genéticos situados en los cromosomas 1, 3 y 7. Conclusión. Como paso previo para un rápido diagnóstico molecular y terapia génica, es necesario identificar los genes situados en los loci hasta ahora conocidos y descubrir otros nuevos (AU)

[Fibromuscular dysplasia of the cervicocephalic arteries. Report of two cases and review of the literature (author's transl)]. / Displasia fibromuscular de arterias cérvico-cefálicas. Presentación de dos casos y revisión de la literatura.

Two typical cases of fibromuscular dysplasia of the cervicocephalic arteries in two women of 61 and 48 years of age are reported. The angiograms revealed bilateral affectation of the internal carotid artery and of the right vertebral artery in one case, and of both vertebral and renal arteries in the other. The patients presented neurological symptoms corresponding to ischemia of the vertebro-basilar territory. The first case was treated with anti-platelet aggregates with positive results. An extensive review of 70 similar published cases is presented. Several characteristics are studied such as: age, sex, localization, symptoms, clinical course and treatment. The quantitative evaluation of these factors agrees with those of other reviews carried out by some other authors. Fibromuscular dysplasia is an arteriopathy of unknown etiology which has a predominant incidence among middle age females (83 percent approximately). The disease usually involves the renal arteries and the cervical segment (adjacent to C1-C2 interspace) of the carotid arteries. There was an association with single or multiple intracranial aneurisms in 22.86 percent of the cases. Vertebral arteries were affected in 28.57 percent of the cases, although vertebral angiograms were not performed in 35.7 percent of them. Transient episodes of cerebral ischemia is the most frequent clinical manifestation (42.85 percent of the cases.).

[Jadassohn's nevus sebaceus and nevus unius lateris. Report of an observation with multiple dysplasia (author's transl)]. / Nevus sebáceo de Jadassohn y nevus unius lateris: a propósito de una observación con manifestaciones displásicas múltiples.

The case of a female patient with multiple ectodermal and mesodermal malformations present since birth is reported. The cutaneous lesions were of two types: Jadassohn's nevus sebaceus and nevus unius lateris. These entities have been described in the literature as congenital dermatologic alterations of nevoid character and organoid structure. They can be considered as congenital epidermal nevi. In many cases, including this one, there are various associated disorders especially of the nervous system, eyes, and skeleton. Both syndromes are cutaneous hamartomas which can be differentiated histologically but not by the anomalies accompanying them. Their dermatologic aspects are very similar. The histopathologic characteristics of the skin lesions of nevus unius lateris consist of hyperkeratosis, acanthosis, and epidermal papillomatosis. In Jadassohn's nevus sebaceus there are also alterations of the skin adnexa, namely the absence of hair follicles and the presence of numerous mature sebaceus and hyperplastic glands. In general, the presence of organoid nevus may be a sign of multiple ectodermal and mesodermal malformations. Both syndromes are often present in the same patient, as in the case described here, and their etiology is the same. It is based on an alteration in embryogenic development affecting primarily, though not exclusively, the formations of ectodermal origin. Thus Jadassohn's nevus sebaceus and nevus unius lateris are both forms of phacomatosis. Clinical cases have in common the cutaneous cited above, either in combination or singly. The other possible signs and symptoms are variable, depending on which stage of embryogenic development is affected. There may be defects in the structures of both ectodermal and mesodermal origin.