[Identification by images of the patient with diabetic foot of the type of injuries that required or will require amputation]. / Identificación por imágenes del paciente con pie diabético del tipo de lesiones que requirieron o requerirán amputación.

INTRODUCTION: Diabetes is a chronic-degenerative disease that develops after pancreatic dysfunction. An estimated 422 million people in the world are currently diagnosed with diabetes. One of its most common complications is diabetic foot. It is estimated that about 15% of diabetic patients will have lower extremities ulcers. MATERIAL AND METHODS: It is an observational, descriptive, prospective and cross-sectional study. It aims to know what the initial injuries that triggered an amputation in a complicated diabetic foot. Patients were presented with clinical photographs with images typical of pathologies for recognition. RESULTS: A total of 50 patients were included between January 2017 and July 2019. Of these 78% (38) patients were male, 22% (11) female. 22 patients (44%) recognized as the onset of diabetic foot an ulcer, 13 with blisters (26%), 10 with hyperkeratosis (20%), 5 with hammer toes (10%). CONCLUSIONS: 96% of patients were able to identify at least one injury as a predisposing factor for the onset of their complicated diabetic foot. The presentation of clinical photographs proved to be a patient-accepted tool. By identifying their initial injury we can determine which injury and where, where, it gave rise to the complication that led them to amputation. This information can help to perform preventive measures to limit amputations in the pelvic limbs of diabetic patients.

INTRODUCCIÓN: La diabetes es una enfermedad crónico degenerativa que se desarrolla posterior a una disfunción del páncreas. Se estima que actualmente hay 422 millones de personas en el mundo que cuentan con el diagnóstico de diabetes. Una de sus complicaciones más frecuentes es el pie diabético. Se estima que alrededor de 15% de los pacientes diabéticos tendrán úlceras en las extremidades inferiores. MATERIAL Y MÉTODOS: Es un estudio observacional, descriptivo, prospectivo y transversal. Su objetivo es conocer cuáles son las lesiones iniciales que desencadenaron una amputación en un pie diabético complicado. A los pacientes se les mostraron fotografías clínicas con las imágenes típicas de las patologías para su reconocimiento. RESULTADOS: Se incluyó un total de 50 pacientes entre Enero de 2017 y Julio de 2019. De éstos, 78% (38) pacientes fueron masculinos, 22% (11) femeninos. 22 pacientes (44%) reconocieron el inicio del pie diabético con una úlcera, 13 con flictenas (26%), 10 con hiperqueratosis (20%), cinco con dedos en martillo (10%). CONCLUSIONES: 96% de los pacientes lograron identificar al menos una lesión como factor predisponente para la aparición de pie diabético complicado. La presentación de fotografías clínicas resultó ser una herramienta aceptada por los pacientes. Mediante la identificación de su lesión inicial podemos determinar qué lesión y en qué sitio dio origen a la complicación que los llevó a la amputación. Esta información puede contribuir a tomar medidas preventivas para limitar las amputaciones en los miembros pélvicos de los pacientes diabéticos.

Symbiosis with systemic fungal endophytes promotes host escape from vector-borne disease.

Plants interact with a myriad of microorganisms that modulate their interactions within the community. A well-described example is the symbiosis between grasses and Epichloë fungal endophytes that protects host plants from herbivores. It is suggested that these symbionts could play a protective role for plants against pathogens through the regulation of their growth and development and/or the induction of host defences. However, other endophyte-mediated ecological mechanisms involved in disease avoidance have been scarcely explored. Here we studied the endophyte impact on plant disease caused by the biotrophic fungus, Claviceps purpurea, under field conditions through (1) changes in the survival of the pathogen´s resistance structure (sclerotia) during overwintering on the soil surface, and (2) effects on insects responsible for the transportation of pathogen spores. This latter mechanism is tested through a visitor exclusion treatment and the measurement of plant volatile cues. We found no significant effects of the endophyte on the survival of sclerotia and thus on disease inocula. However, both pathogen incidence and severity were twofold lower in endophyte-symbiotic plants than in non-symbiotic ones, though when insect visits were prevented this difference disappeared. Endophyte-symbiotic and non-symbiotic plots presented different emission patterns of volatiles suggesting that they can play a role in this protection. We show a novel indirect ecological mechanism by which endophytes can defend host grasses against diseases through negatively interacting with intermediary vectors of the epidemic process.

A birefringent polarization modulator: Application to phase measurement in conoscopic interference patterns.

Conoscopic interferometry for crystal characterization is a very well-known technique with increasing applications in different fields of technology. The advantage of the scheme proposed here is the introduction of a polarization modulator that allows the recovery of the phase information contained in conoscopic interferograms. This represents a real advantage since the most relevant physical information of the sample under study is usually contained in the phase of the fringe pattern. Moreover, this technique works successfully even when there are no visible fringes. The setup employed is a simple conoscopic interferometer where the elements under study correspond to two birefringent crystal slabs and a commercial mica wave plate. It allows the crystals to be characterized and the wave plate retardance to be measured as a function of the angle of incidence. The modulator itself consists of a single tiltable crystal plate which, by means of phase shifting techniques, permits the recovery of a phase map for each sample. It is inexpensive and it can be easily calibrated, so it works with a wide range of phase shifting interferometry algorithms. We show that our scheme is easily adaptable to algorithms that require either a low or high amount of interferograms.

Birefringent phase demodulator: application to wave plate characterization.

The scope of this work is to present a phase demodulator that enables the recovery of temporal phase information contained in the phase difference between two signals with different polarizations. This demodulator is a polarization interferometer that may consist only of a uniaxial crystal slab and a polarizer sheet. The phase shift between two orthogonal components of the electric field is translated into space by means of birefringent crystals, which act as demodulators or phase analyzers with great robustness. The experimental scheme utilized is based on a simple conoscopic interference setup. Each portion of the space in which the interference pattern is projected contains not only the unknown temporal phase we want to recover, but also a phase shift due to the uniaxial crystal itself. The underlying idea is developing simultaneous phase shifting with uniaxial crystals. Thus, different phase recovery techniques can be applied in order to maximize their ability to track high-speed signals. Depending on the characteristics of the fringe pattern, it will permit phase recovery via different classical procedures. In order to prove the demodulator under different experimental and signal processing schemes, we employed it for wave plate characterization. The results obtained not only allow some wave plate features such as axes determination and retardance to be characterized, but also prove the working principle and capabilities of the demodulator.

Novel achromatic single reflection quarter-wave retarder: design and measurement.

In this work, we present an achromatic quarter-wave retarder whose design is based upon the reflection properties of an isotropic-anisotropic interface. In theory, it is possible to obtain a π/2 phase shift by means of a total internal reflection at an isotropic-isotropic interface. However, in order to achieve such a phase shift, it is necessary to use a medium with a particularly high refractive index. We have previously shown that these phase shifts can be achieved by means of a total internal reflection in an isotropic-uniaxial interface, which allows the use of smaller refractive index media. By means of this property, we designed, built, and characterized a novel quarter-wave retarder that makes it possible to obtain circularly polarized light from a linear polarization state. We developed some guidelines that allowed us to obtain a device of competitive performance, low cost, and manageable manufacture.

Factores pronósticos de incapacidad funcional en pacientes con fractura de cadera / Prognostic factors of functional impairment in hip fracture patients

Objetivo. Conocer los factores que determinan la recuperación funcional tras haber sufrido una fractura de cadera. Método. Se ha realizado un estudio de cohortes sobre 333 fracturas de cadera en pacientes mayores de 65 años, que ingresaron en el Hospital Regional Universitario Carlos Haya entre febrero de 2004 y febrero de 2005. Hemos recogido datos epidemiológicos, clínicos y de actividad funcional de dichos pacientes mediante la aplicación de escalas de uso generalizado, para conocer la funcionalidad que presentan antes de la fractura y en el seguimiento posterior, mediante entrevistas telefónicas a los 6 meses tras la misma. Resultados. A los 6 meses de la fractura los factores pronósticos de incapacidad funcional son la edad, el hecho de estar institucionalizado, presentar una mala funcionalidad previa a la fractura, ser dependiente para las actividades básicas de la vida diaria y la circunstancia de haber presentado una fractura extracapsular o que haya sido sometida a osteosíntesis. Conclusiones. Podemos conocer el pronóstico del paciente con fractura de cadera al ingreso, el uso de sistemas de fijación extramedular no ha mostrado buenos resultados en nuestro trabajo frente a la artroplastia. La osteosíntesis intramedular (usada únicamente en 5 casos) junto a un inicio precoz de la rehabilitación podrían mejorar los resultados funcionales de estos pacientes, ya que ha demostrado ser superior en las fracturas pertrocantéreas inestables y en las subtrocantéreas (AU)

Aim. To determine the factors that affect functional recovery after a hip fracture. Methods. A study was conducted on a cohort of 333 patients aged 65 years or over with hip fractures who were admitted to Carlos Haya hospital between February 2004 and February 2005. Epidemiological, clinical and functional activity data were recorded by applying generally used scales to determine the patients’ functionality before and after the fracture, by means of telephone interviews 6 months after the fracture. Results. Prognostic factors of functional incapacity 6 months after the fracture were age, being institutionalised, having poor functionality before the fracture, being dependent for basic activities of daily living and having had an extracapsular fracture or undergoing osteosynthesis. Conclusions. It is possible to determine the prognosis of a hip fracture patient on admission. The use of extramedullary fixation systems failed to show good results compared with arthroplasty. Intramedullary osteosynthesis (used only in 5 patients), and an early start of rehabilitation could improve the functional results of these patients. In fact, intramedullary nailing has demonstrated better outcomes in unstable trochanteric and subtrochanteric femoral fractures vs Dynamic Screw and Plate (AU)

An RGD sequence in the P2Y(2) receptor interacts with alpha(V)beta(3) integrins and is required for G(o)-mediated signal transduction.

The P2Y(2) nucleotide receptor (P2Y(2)R) contains the integrin-binding domain arginine-glycine-aspartic acid (RGD) in its first extracellular loop, raising the possibility that this G protein-coupled receptor interacts directly with an integrin. Binding of a peptide corresponding to the first extracellular loop of the P2Y(2)R to K562 erythroleukemia cells was inhibited by antibodies against alpha(V)beta(3)/beta(5) integrins and the integrin-associated thrombospondin receptor, CD47. Immunofluorescence of cells transfected with epitope-tagged P2Y(2)Rs indicated that alpha(V) integrins colocalized 10-fold better with the wild-type P2Y(2)R than with a mutant P2Y(2)R in which the RGD sequence was replaced with RGE. Compared with the wild-type P2Y(2)R, the RGE mutant required 1,000-fold higher agonist concentrations to phosphorylate focal adhesion kinase, activate extracellular signal-regulated kinases, and initiate the PLC-dependent mobilization of intracellular Ca(2+). Furthermore, an anti-alpha(V) integrin antibody partially inhibited these signaling events mediated by the wild-type P2Y(2)R. Pertussis toxin, an inhibitor of G(i/o) proteins, partially inhibited Ca(2+) mobilization mediated by the wild-type P2Y(2)R, but not by the RGE mutant, suggesting that the RGD sequence is required for P2Y(2)R-mediated activation of G(o), but not G(q). Since CD47 has been shown to associate directly with G(i/o) family proteins, these results suggest that interactions between P2Y(2)Rs, integrins, and CD47 may be important for coupling the P2Y(2)R to G(o).

P2Y(2) nucleotide receptor signaling in human monocytic cells: activation, desensitization and coupling to mitogen-activated protein kinases.

Activation of P2Y(2) receptors by extracellular nucleotides has been shown to induce phenotypic differentiation of human promonocytic U937 cells that is associated with the inflammatory response. The P2Y(2) receptor agonist, UTP, induced the phosphorylation of the MAP kinases MEK1/2 and ERK1/2 in a sequential manner, since ERK1/2 phosphorylation was abolished by the MEK1/2 inhibitor PD 098059. Other results indicated that P2Y(2) receptors can couple to MAP kinases via phosphatidylinositol 3-kinase (PI3K) and c-src. Accordingly, ERK1/2 phosphorylation induced by UTP was inhibited by the PI3K inhibitors, wortmannin and LY294002, and the c-src inhibitors, radicicol and PP2, but not by inhibitors of protein kinase C (PKC). The phosphorylation of ERK1/2 was independent of the ability of P2Y(2) receptors to increase the concentration of intracellular free calcium, since chelation of intracellular calcium by BAPTA did not diminish the phosphorylation of ERK1/2 induced by UTP. A 5-minute treatment with UTP reduced U937 cell responsiveness to a subsequent UTP challenge. UTP-induced desensitization was characterized by an increase in the EC(50) for receptor activation (from 0.44 to 9.3 microM) and a dramatic ( approximately 75%) decrease in the maximal calcium mobilization induced by a supramaximal dose of UTP. Phorbol ester treatment also caused P2Y(2) receptor desensitization (EC(50) = 12.3 microM UTP and maximal calcium mobilization reduced by approximately 33%). The protein kinase C inhibitor GF 109203X failed to significantly inhibit the UTP-induced desensitization of the P2Y(2) receptor, whereas the protein phosphatase inhibitor okadaic acid blocked receptor resensitization. Recovery of receptor activity after UTP-induced desensitization was evident in cells treated with agonist for 5 or 30 min. However, P2Y(2) receptor activity remained partially desensitized 30 min after pretreatment of cells with UTP for 1 h or longer. This sustained desensitized state correlated with a decrease in P2Y(2) receptor mRNA levels. Desensitization of ERK1/2 phosphorylation was induced by a 5-minute pretreatment with UTP, and cell responsiveness did not return even after a 30-minute incubation of cells in the absence of an agonist. Results suggest that desensitization of the P2Y(2) receptor may involve covalent modifications (i.e., receptor phosphorylation) that functionally uncouple the receptor from the calcium signaling pathway, and that transcriptional regulation may play a role in long-term desensitization. Our results indicate that calcium mobilization and ERK1/2 phosphorylation induced by P2Y(2) receptor activation are independent events in U937 monocytes.

Monoclonal antibodies to P24 and P61 immunodominant antigens from Nocardia brasiliensis.

We prepared a Nocardia brasiliensis cell extract and purified two immunodominant antigens with molecular weights of 61,000 and 24,000. The isolated proteins were shown to be reasonably pure when analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (8 to 18% polyacrylamide gradient) and stained with Coomassie blue and silver nitrate. By using an immunoelectrotransfer blot method (Western blotting), we demonstrated that these two purified proteins reacted strongly with serum from N. brasiliensis-infected mycetoma patients. To obtain anti-P61 and anti-P24 monoclonal antibodies (MAbs), we used an N. brasiliensis cell extract as the antigen for the first immunization; 2 weeks later female mice were reimmunized with a semipurified antigen containing the P24 or P61 fraction. A booster injection was given 3 days before the fusion was carried out. Two hybrids that reacted strongly with P24 were cloned by limiting dilution, the generated MAbs were analyzed for isotyping, and their specificity was tested in a Western blot assay with cell extracts from Nocardia asteroides and Mycobacterium tuberculosis cultures. Anti-P24 MAbs were shown to be specific for N. brasiliensis HUJEG-1 and did not cross-react with either the N. asteroides or M. tuberculosis strains used. However, additional studies with several N. asteroides and N. brasiliensis strains are needed to investigate whether there are cross-reactions between strains or species when these MAbs are used. The anti-P61 and anti-24 MAbs were used to locate the antigen in N. brasiliensis cells by immunofluorescence. The lack of reaction with intact cells suggests that the P24 and P61 antigens are not exposed in the complete bacterial cell surface or that the recognized epitopes are different. Only one anti-P61 MAb that reacted specifically with the N. brasiliensis cell extract was obtained.