Exposure to p,p´-DDE during early pregnancy, anthropometry, and gestational age at birth, in a flower-growing region of Mexico.

Prenatal exposure to dichlorodiphenyldichloroethylene (p,p´-DDE) may interfere with fetal development; however, studies evaluating anthropometry and gestational age at birth show inconsistent results. Typically, p,p´-DDE exposure has been measured during the third trimester and missed the key early pregnancy period. We evaluated the association between p,p´-DDE exposure before week 18 of pregnancy and anthropometry at birth, as well as gestational length, in 170 mother-child pairs from a cohort study in a flower-growing mexican region. Maternal serum p,p´-DDE concentrations were determined by gas chromatography. The associations between p,p´-DDE and z-scores of birth weight, birth length, and gestational age were evaluated by linear multiple regression models. Logistic regression models were used for low birth weight and small size for gestational age. Effect modification by child's sex was explored. The average gestational age at the blood sample extraction was 10.6 weeks. p,p'-DDE was detected in 64.7% of mothers, at a geometric mean of 0.24 ng/mL. Prenatal p,p´-DDE exposure was not associated with the birth outcomes in the whole sample. However, a high p,p´-DDE exposure was marginally associated with greater small for gestational age risk in male newborns (OR≥0.076ng/mL vs <0.076 ng/mL = 3.09, 95% CI: 0.61; 15.58), but not in female (p for interaction = 0.08).Even though, we found no reductions in anthropometric measurements or gestational length associated with early prenatal p,p´-DDE exposure, the potential effect modification by infant's sex in terms of small for the gestational age risk deserves future studies.

Survivin in Breast Cancer: A Review.

Breast cancer is the most frequently diagnosed cancer in women and ranks second among causes for cancer-related death in women. Gene technology has led to the recognition that breast cancer is a heterogeneous disease composed of different biological subtypes, and genetic profiling enables the response to chemotherapy to be predicted. This fact emphasizes the importance of selecting sensitive diagnostic and prognostic markers in the early disease stage and more efficient targeted treatments for this disease. One such prognostic marker appears to be survivin. Many studies have shown that survivin is strongly expressed in different types of cancers. Its overexpression has been demonstrated in breast cancer, and high activity of the survivin gene has been associated with a poor prognosis and worse survival rates.

La relación entre la calidad en el servicio, satisfacción del cliente y lealtad del cliente: un estudio de caso de una empresa comercial en México / The relationship between service quality, customer satisfaction, and customer loyalty: A case study of a trading company in Mexico

Resumen La calidad en el servicio se considera una alternativa para que las empresas puedan obtener una ventaja competitiva y sostenible en un entorno económico globalizado. Las pequeñas y medianas empresas deben ofrecer una mayor calidad en el servicio que las empresas grandes, y así obtener la preferencia de los clientes. El objetivo de este estudio fue identificar la relación entre la variable calidad en el servicio y las variables satisfacción del cliente y lealtad del cliente. Se utilizó el coeficiente de correlación de Spearman y un método estadístico basado en análisis factorial exploratorio que apunta a extraer la varianza máxima del conjunto de datos dentro de cada factor. Los resultados permitieron observar una correlación altamente significativa, positiva y fuerte de la variable de calidad en el servicio con satisfacción del cliente (r = 0.820) y lealtad del cliente (r = 0.803). Un hallazgo importante también fue la asociación entre la dimensión aspectos tangibles con las variables satisfacción del cliente (r = 0.910) y lealtad del cliente (r = 0.919). Por otro lado, en el análisis factorial, a través de la varianza total explicada, se observó que el autovalor es superior a 1 en los cinco primeros casos, donde el porcentaje de la varianza alcanza un valor máximo de 54.886 % en su primer factor. Entonces, con cinco factores se consigue explicar un 73.713 % de la varianza de todos los datos originales. El estudio presentó la limitación de su aplicación en solo una empresa. Se confirmó que a través de una mejor atención y servicio al cliente, la calidad en el servicio constituye una excelente herramienta para la rentabilidad y sostenibilidad de la empresa.

Abstract Service quality is considered an alternative for companies to obtain a competitive and sustainable advantage in a globalized economic environment. Small and medium-sized enterprises must offer a higher quality of service than large companies, and thus obtain customer preference. The objective of this study was to identify the relationship between service quality variable and the customer satisfaction and customer loyalty variables. Spearman's correlation coefficient was used, and a statistical method based on exploratory factor analysis, aiming to extract the maximum variance of the data set within each factor. The results allowed observing a highly significant, positive, and strong correlation, with values of r = 0.820 and r = 0.803, between the variables of service quality, customer satisfaction, and customer loyalty. An important finding was the association between the tangible aspects dimension with the customer satisfaction and customer loyalty variables, with values of r = 0.910 and r = 0.919, respectively. On the other hand, in the factor analysis, through the explained total variance, it was observed that the eigenvalue is greater than 1 in the first five cases, where the percentage of the variance reaches a maximum value of 54.886 % in its first factor. Then, with five factors, 73.713 % of the variance of all the original data is explained. The study presented the limitation of its application in only one company. It was confirmed that, through better customer care and service, service quality constitutes an excellent tool for the profitability and sustainability of the organization.

Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible.

PURPOSE: To evaluate the safety and efficacy of ocular cyclosporine in the prevention of the development of ocular graft versus host disease (oGVHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) in comparison with historic data. DESIGN: We developed a longitudinal, observational, prospective nonrandomized study. We evaluated the feasibility of prophylactic use of topical cyclosporine A (CsA) to prevent or decrease the incidence of oGVHD and compared this with historic data. METHODS: Patients undergoing AHSCT were treated with prophylactic topical CsA for 12 months after engraftment, followed by serial ophthalmic evaluations, including the Schirmer test. RESULTS: Twenty patients were included. No serious adverse effects were reported. Poor adherence was documented in 15% of patients. In spite of observing extra-ocular GVHD (acute and chronic GVHD incidence of 50 and 45%, respectively), only 1 in 20 patients developed oGVHD over the 20-month follow-up for the entire cohort. No statistically significant difference was observed in the incidence of oGVHD when compared to a historical cohort. CONCLUSIONS: Topical CsA as a prophylactic measure for oGVHD, administered over a period of 1 year after grafting, is safe and feasible and may decrease the incidence of ophthalmic manifestations of GVHD. These findings must be confirmed in a randomized trial.

Toxic Effect of Cadmium, Lead, and Arsenic on the Sertoli Cell: Mechanisms of Damage Involved.

Over the past decades, an increase has been described in exposure to environmental toxins; consequently, a series of studies has been carried out with the aim of identifying problems associated with health. One of the main risk factors is exposure to heavy metals. The adverse effects that these compounds exert on health are quite complex and difficult to elucidate, in that they act at different levels and there are various signaling pathways that are implicated in the mechanisms of damage. The Sertoli cells plays a role of vital importance during the process of spermatogenesis, and it has been identified as one of the principal targets of heavy metals. In the present review, cadmium, lead, and arsenic are broached as altering the physiology of the Sertoli cells, citing mechanisms that have been cited in the literature.

In Vitro Evaluation of Damage by Heavy Metals in Tight and Gap Junctions of Sertoli Cells.

The Sertoli cell plays a vital role during the spermatogenesis process and has been identified as one of the main targets of the toxic action of heavy metals on the seminiferous epithelium. In the present work, the effect of lead (Pb), Arsenic (As), and Cadmium (Cd) in primary cultures of Sertoli cells was analyzed by measuring the expression of the genes Cldn11, Ocln, and Gja1 that participate in the tight and gap junctions, which are responsible for maintaining the blood-testis barrier. Sertoli cells were isolated from the testes of Wistar rats. Sertoli cell cultures were exposed separately and at the same concentrations of three heavy metals for 48 h. Subsequently, gene expression was measured by real-time polymerase chain reaction. In the morphological analysis of the cultures, after 24 h, the cultures exposed to Cd showed greatest detachment of the monolayer, followed by those exposed to As and Pb. As for gene expression patterns, As induced a decrease in the expression of the Cldn11 gene at 24 and 48 h (p < 0.01) and in that of Ocln at 24 (p < 0.001) and 48 h (p < 0.01), whereas Cd induced overexpression of the Gja1 gene from day 1 of exposure (p < 0.001) and subexpression of the Ocln gene (p < 0.05) at 24 h. Because each of these three metals generated different expression patterns in the three genes, we can postulate that the mechanisms of damage that they induce are different; therefore, the effect that they exert on the Sertoli cell occurs through different pathways, generating changes in structural proteins, altering Sertoli cell morphology, and compromising its function in the regulation of the spermatogenesis process.

Levocarnitine Decreases Intradialytic Hypotension Episodes: A Randomized Controlled Trial.

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo-controlled quadruple-blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P < 0.001). Hemodialysis is frequently perplexed by intradialytic hypotension episodes. Levocarnitine supplementation before each hemodialysis session efficiently diminishes the intradialytic hypotension episodes. This is a new application method that must be considered and explored.

[Bone cement implant as an alternative for orbital floor reconstruction: A case report]. / Implante de cemento óseo como alternativa para la reconstrucción de piso orbitario: reporte de caso.

BACKGROUND: The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE: To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE: A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS: The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.

Gluteoplastia tridimensional mediante distribución volumétrica precisa / Three-dimensional gluteoplasty by precise volumetry

Introducción y objetivo. La gluteoplastia mediante lipoinyección debe ser una cirugía segura que partiendo de una planificación adecuada, permita un aumento moderado enfatizando contornos y mejorando la forma natural de la región glútea. Debe permitir obtener resultados predecibles, duraderos y reproducibles, además de ser aplicable en una amplia variedad de pacientes. Presentamos un método de gluteoplastia de aumento sistematizada con lipoinyección que además de ser reproducible, permite obtener resultados consistentes, naturales y permanentes, distribuyendo estratégicamente volúmenes en cuadrantes. Pacientes y método. Con mínima manipulación del lipoaspirado, infiltramos cantidades controladas en 9 cuadrantes en cada nalga. El cuadrante central representa la zona de máxima proyección y recibe la mitad del volumen. Denominamos zonas primarias a los 4 cuadrantes en los ejes X-Y, zonas que reciben el 40% del volumen infiltrado. Las zonas secundarias o menores corresponden a los cuadrantes situados entre los cuadrantes principales, y reciben el 10% del volumen total. Resultados. Entre 2008 y 2013 intervenimos a 75 pacientes para aumento y remodelación de glúteos con la técnica descrita, todas mujeres de 24 a 52 años. Las pacientes presentaron una convalecencia favorable y una satisfacción del 93%. Nueve pacientes presentaron seromas que se resolvieron mediante aspiración en consultorio. No se presentaron complicaciones mayores. Conclusiones. Presentamos un método de remodelación glútea mediante lipoinyección que, además de ofrecer excelentes resultados, predecibles, consistentes, naturales y permanentes, es lógico y reproducible (AU)

Background and Objective. Gluteoplasty by lipoinjection must be a safe procedure that starting of a precise surgical plan, allows a moderate augmentation, emphasizing contours, and improving the natural shape of the buttock. It must enable us to deliver predictable, durable, and reproducible results, and must be applicable to a wide variety of patients. We present a new systemized surgical approach for buttock augmentation/reshaping with lipografts that in addition to being reproducible, delivers consistent, natural and permanent results by strategically distributing volume into quadrants. Methods. Minimizing lipoaspirate manipulation, lipoinjection is performed in controlled quantities into 9 quadrants in each buttock. The central quadrant presents the maximum-projection zone and receives half of the total volume. Primary zones correspond to the 4 quadrants on X and Y axis; they receive 40% of the total volume. Secondary zones correspond to the quadrants between primary zones and they receive 10% or the total volume. Results. Between 2008 and 2013, we treated 75 patients for buttock augmentation/reshaping with the described technique, all women between 24 and 52 years old. All patients experienced a favorable convalescence. Nine patients underwent ambulatory seroma aspiration with complete resolution. There were no mayor complications in this series. Conclusions. We present a buttock augmentation/reshaping method by controlled lipoinjection that besides offering excellent, predictable, consistent, natural and permanent results, is logic-based and reproducible (AU)

New insights into glycopeptide antibiotic binding to cell wall precursors using SPR and NMR spectroscopy.

Glycopeptide antibiotics, such as vancomycin and teicoplanin, are used to treat life-threatening infections caused by multidrug-resistant Gram-positive pathogens. They inhibit bacterial cell wall biosynthesis by binding to the D-Ala-D-Ala C-terminus of peptidoglycan precursors. Vancomycin-resistant bacteria replace the dipeptide with the D-Ala-D-Lac depsipeptide, thus reducing the binding affinity of the antibiotics with their molecular targets. Herein, studies of the interaction of teicoplanin, teicoplanin-like A40926, and of their semisynthetic derivatives (mideplanin, MDL63,246, dalbavancin) with peptide analogues of cell-wall precursors by NMR spectroscopy and surface plasmon resonance (SPR) are reported. NMR spectroscopy revealed the existence of two different complexes in solution, when the different glycopeptides interact with Ac2KdAlaDAlaOH. Despite the NMR experimental conditions, which are different from those employed for the SPR measurements, the NMR spectroscopy results parallel those deduced in the chip with respect to the drastic binding difference existing between the D-Ala and the D-Lac terminating analogues, confirming that all these antibiotics share the same primary molecular mechanism of action and resistance. Kinetic analysis of the interaction between the glycopeptide antibiotics and immobilized AcKdAlaDAlaOH by SPR suggest a dimerization process that was not observed by NMR spectroscopy in DMSO solution. Moreover, in SPR, all glycopeptides with a hydrophobic acyl chain present stronger binding with a hydrophobic surface than vancomycin, indicating that additional interactions through the employed surface are involved. In conclusion, SPR provides a tool to differentiate between vancomycin and other glycopeptides, and the calculated binding affinities at the surface seem to be more relevant to in vitro antimicrobial activity than the estimations from NMR spectroscopy analysis.

Zernike vs. Bessel circular functions in visual optics.

PURPOSE: We propose the Bessel Circular Functions as alternatives of the Zernike Circle Polynomials to represent relevant circular ophthalmic surfaces. METHODS: We assess the fitting capabilities of the orthogonal Bessel Circular Functions by comparing them to Zernike Circle Polynomials for approximating a variety of computationally generated surfaces which can represent ophthalmic surfaces. RESULTS: The Bessel Circular Functions showed better modelling capabilities for surfaces with abrupt variations such as the anterior eye surface at the limbus region, and influence functions. From our studies we find that the Bessel Circular Functions can be more suitable for studying particular features of post surgical corneal surfaces. CONCLUSIONS: We show that given their boundary conditions and free oscillating properties, the Bessel Circular Functions are an alternative for representing specific wavefronts and can be better than the Zernike Circle Polynomials for some important cases of corneal surfaces, influence functions and the complete anterior corneal surface.

Intracoronary infusion of CD133+ endothelial progenitor cells improves heart function and quality of life in patients with chronic post-infarct heart insufficiency.

AIM: To assess the safety and efficacy of the intracoronary infusion of CD133+ hematopoietic stem cells to improve ventricular function and quality of life in candidates for heart transplantation due to post-infarct chronic heart failure. METHODS: We selected seven candidates for heart transplantation (six males/one female, age range 44-65 years) in whom all treatment alternatives were exhausted (angioplasty/stent and bypass surgery). These subjects had a symptomatic New York Heart Association (NYHA) scale of at least II and ejection fractions (EFs) below 35%. After obtaining informed consent, CD133+ cells were obtained by stimulation with granulocyte-colony stimulating factor, apheresis, and separation with magnetic beads. Stem cells were implanted in the infarcted zone via intracoronary percutaneous angiography. Evaluations (NYHA scale classification, plasma concentration of pro-B-natriuretic-peptide and the risk of sudden death, echocardiography, cardiac magnetic resonance, and gated-SPECT with MIBI) were performed at baseline and at 3, 6, 12, and 24 months after cell infusion. RESULTS: Stem cell isolation was efficient and safe (around 10(7) cells/patient and >92% CD133+ viable cells). Two patients died during observation due to noncardiac conditions. In the five remaining subjects, the NYHA scale improved and no accounts of hospital admissions for heart failure were documented. Plasma concentrations of pro-B-natriuretic peptide and the risk of sudden death clearly decreased, while the EF increased significantly to 35% and 40% by echocardiography and cardiac MRI, respectively (P=.013 and .009, respectively) 24 months after treatment. No other major adverse events were noticed. CONCLUSIONS: The intracoronary inoculation of CD133+ stem cells was safe and effective to improve ventricular contraction and symptomatic class function in patients with refractory post-infarct heart failure.

Surface plasmon resonance immunoassay analysis of pituitary hormones in urine and serum samples.

BACKGROUND: Direct determination of four pituitary peptide hormones: human thyroid stimulating hormone (hTSH), growth hormone (hGH), follicle stimulating hormone (hFSH), and luteinizing hormone (hLH) has been carried out using a portable surface plasmon resonance (SPR) immunosensor. METHODS: A commercial SPR biosensor was employed. The immobilization of the hormones was optimized and monoclonal antibodies were selected in order to obtain the best sensor performance. Assay parameters as running buffer and regeneration solution composition or antibody concentration were adjusted to achieve a sensitive analyte detection. RESULTS: The performance of the assays was assessed in buffer solution, serum and urine, showing sensitivity in the range from 1 to 6 ng/mL. The covalent attachment of the hormones ensured the stability of the SPR signal through repeated use in up to 100 consecutive assay cycles. Mean intra- and inter-day coefficients of variation were all <7%, while batch-assay variability using different sensor surfaces was <5%. CONCLUSIONS: Taking account both the excellent reutilization performance and the outstanding reproducibility, this SPR immunoassay method turns on a highly reliable tool for endocrine monitoring in laboratory and point-of-care (POC) settings.

SAFE TEENS: facilitators of and barriers to adolescent preventive care discussions.

BACKGROUND AND OBJECTIVES: This study's goal was to describe the topics discussed during adolescent preventive care visits and to identify facilitators and barriers of these discussions among physicians in family medicine residency programs. METHODS: Forty-six family physicians in five residency programs used SAFE TEENS study cards to record data during 321 visits with adolescents ages 11--21 years. The study cards included a checklist of 31 potential topics organized under 10 categories. Closed- and open-ended questions were used to explore facilitators and barriers. RESULTS: The topics most frequently discussed were under the categories of toxins (tobacco, alcohol, and drugs), environment (school, home, and friends), sexuality, and exercise. Physicians were more likely to conduct preventive care discussions in the clinical context of a physical examination and with a new patient. Parents being present for part of the visit, a reminder system, and the recognition of developmental stage were also significant facilitators. The presence of competing demands was the strongest barrier. CONCLUSIONS: To increase the number of adolescent preventive care discussions, family medicine educators should stress that visits with established patients and visits for reasons other than a physical examination are also opportunities to provide preventive care. The development of electronic reminder systems would also be useful.

Correlates of medication knowledge and adherence: findings from the residency research network of South Texas.

BACKGROUND: Medication adherence is a complex phenomenon, influenced by a variety of factors. Most adherence research focuses on one medicine and does not represent the realities of clinical family medicine. This analysis examined factors associated with medication knowledge and adherence in family medicine patients with chronic conditions. METHODS: The Residency Research Network of South Texas (RRNeST) enrolled 150 patients with chronic disease who "sometimes have trouble taking medicines." Seventy-five percent were Latinos. This cross-sectional analysis used baseline survey data from an intervention study. Investigators correlated medication knowledge and adherence with known predictors--patient, health, medication, economic, and physician factors. New variables related to patients' motivation to change treatment behaviors ("importance" and "confidence") were also included. RESULTS: Linear regression analysis demonstrated that patient satisfaction, education level, and confidence were associated with better medication knowledge. Higher confidence, Spanish language, better functional and health status, and more prescription medicines were correlated with medication adherence. CONCLUSIONS: We recommend that family physicians enhance medication adherence by providing good information about treatment and counseling strategies to build patients' confidence. Our findings suggest that poor health status can be a barrier to, rather than a motivator for, treatment adherence.