Capi-score: a quantitative algorithm for identifying disease patterns in nailfold videocapillaroscopy.

OBJECTIVES: The European Alliance of Associations for Rheumatology (EULAR) supports the use of nailfold videocapillaroscopy (NVC) to identify disease patterns (DPs) associated with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Recently, EULAR proposed an easy-to-manage procedure, a so-called Fast Track algorithm, to differentiate SSc from non-SSc patterns in NVC specimens. However, subjectivity among capillaroscopists remains a limitation. Our aim was to perform a software-based analysis of NVC peculiarities in a cohort of samples from SSc and RP patients and, subsequently, build a Fast Track-inspired algorithm to identify DPs without the constraint of interobserver variability. METHODS: NVCs were examined by 9 capillaroscopists. Those NVCs whose DPs were consensually agreed (≥2 out of 3 interobservers) were subsequently analysed with an in-house developed software. Each variable's results were grouped according to the consensually agreed DPs in order to identify useful hallmarks to categorise them. RESULTS: Eight-hundred and fifty-one NVCs (21 957 images) whose DPs had been consensually agreed were software-analysed. Appropriate cut-offs set in capillary density and percentage of abnormal and giant capillaries, tortuosities and hemorrhages allowed DP categorization and the development of the CAPI-Score algorithm. This consisted of 4 rules: Rule 1, SSc vs non-SSc, accuracy 0.88; Rules 2 and 3, SSc-early vs SSc-active vs SSc-late, accuracy 0.82; Rule 4, non-SSc normal vs non-SSc non-specific, accuracy 0.73. Accuracy improved when the analysis was limited to NVCs whose DPs had achieved full consensus among interobservers. CONCLUSIONS: The CAPI-Score algorithm may become a useful tool to assign DPs by overcoming the limitations of subjectivity.

Detection of Aeromonas salmonicida subsp. salmonicida infection in zebrafish by labelling bacteria with GFP and a fluorescent probe based on the siderophore amonabactin.

Zebrafish (Danio rerio) is an excellent model to study bacterial infections in fish and their treatment. We used zebrafish as a model of infection for Aeromonas salmonicida subsp. salmonicida (hereinafter A. salmonicida), the causative agent of fish furunculosis. The infection process of A. salmonicida was studied by immersion of zebrafish larvae in 2 different doses of the bacteria and the fish mortality was monitored for three days. The bacterium caused a high mortality (65 %) in zebrafish larvae only when they were exposed to a high bacterial concentration (107 bacterial cells/mL). To evaluate the use of fluorescence microscopy to follow A. salmonicida infection in vivo, two different fluorescent strains generated by labeling an A. salmonicida strain with either, the green fluorescent protein (GFP), or with a previously reported siderophore amonabactin-sulforhodamine B conjugate (AMB-SRB), were used. The distribution of both labeled bacterial strains in the larvae tissues was evaluated by conventional and confocal fluorescence microscopy. The fluorescent signal showed a greater intensity with the GFP-labeled bacteria, so it could be observed using conventional fluorescence microscopy. Since the AMB-SRB labeled bacteria showed a weaker signal, the larvae were imaged using a laser scanning confocal microscope after 48 h of exposure to the bacteria. Both fluorescent signals were mainly observed in the larvae digestive tract, suggesting that this is the main colonization route of zebrafish for waterborne A. salmonicida. This is the first report of the use of a siderophore-fluorophore conjugate to study a bacterial infection in fish. The use of a siderophore-fluorophore conjugate has the advantage that it is a specific marker and that does not require genetic manipulation of the bacteria.

Ocean warming and freshening effects on lipid metabolism in coastal Antarctic phytoplankton assemblages dominated by sub-Antarctic species.

Marine phytoplankton can utilize different strategies to cope with ocean warming and freshening from glacial melting in polar regions, which are disproportionally impacted by global warming. In the present study, we investigated the individual and combined effects of a 4 °C increase in seawater temperature (T+) and a 4 psu decrease in salinity (S-) from ambient values on biomass, nutrient use, fatty acid composition and lipid damage biochemistry of natural phytoplankton assemblages from Potter Cove (25 de Mayo/King George Island, Antarctica). Experiments were conducted by exposing the assemblages to four treatments during a 7-day incubation period using microcosm located along shore from January 23 to 31, 2016. The N:P ratio decreased in all treatments from day 4 onwards, but especially under high temperature (T+). Lipid damage was mainly detected under S0T+ and S-T+ conditions, and it decreased when the production of the antioxidant α-tocopherol increased. This antioxidant protection resulted in a build-up of phytoplankton biomass, especially at T+. Under the combined effect of both stressors (S-T+), the concentration of ω3 fatty acids increased, potentially leading to higher-quality FA composition. These results, which were related to the dominance of sub-Antarctic species in phytoplankton assemblages, contribute to the understanding of the potential consequences of ocean warming and increase seawater freshening on the trophic webs of the Southern Ocean.

First-principles prediction of multiple stationary states in glass-forming liquids.

In the present work, the Non-Equilibrium Self-Consistent Generalized Langevin Equation (NESCGLE) theory is used to predict the final state of glass-forming liquids subjected to different cooling processes. We show that the NESCGLE theory correctly describes two essential features of the glass transition. Such features are the structural recovery and the dependence of the final state with the cooling rate. We demonstrate that below a particular temperature Tc, the system is unable to equilibrate, independently of the cooling rate. We show that the equilibrium state is only reached for the quasistatic process. Additionally, we show how, from the NESCGLE theory, it is possible to deduce a relaxation model of structural recovery, for which we obtain molecular expressions of the parameters.

Mexican consumers at the point of meat purchase. Pork choice.

Use of within-consumer preference replication and systematic image manipulation in surveying showed that consumers in four cities across Mexico had similar strategies for pork choice. New surveying tools also determined preferred levels of the characteristics used in the decision-making process. The most important choice criteria were colour (31% chose dark and 21% light red), and fat cover (42% chose lean and 8% fatty). Marbling and drip were less used, but are nevertheless important given that 21% of consumers used three or four characteristics to make their choice. Split colour and marbling preferences and a range of acceptable limits for both, and a preference for the leanest fat cover available were observed. Preferences within the normal range of pork colour, fat cover achieved through trimming and drip countered by an absorbent pad all favour industry practice. Unfortunately, preferences for minimal or no marbling and fat cover likely result in a compromised gustative experience for many Mexican consumers.

Resistance of Arctic phytoplankton to ocean acidification and enhanced irradiance.

The Arctic Ocean is a region particularly prone to ongoing ocean acidification (OA) and climate-driven changes. The influence of these changes on Arctic phytoplankton assemblages, however, remains poorly understood. In order to understand how OA and enhanced irradiances (e.g., resulting from sea-ice retreat) will alter the species composition, primary production, and eco-physiology of Arctic phytoplankton, we conducted an incubation experiment with an assemblage from Baffin Bay (71°N, 68°W) under different carbonate chemistry and irradiance regimes. Seawater was collected from just below the deep Chl a maximum, and the resident phytoplankton were exposed to 380 and 1000 µatm pCO2 at both 15 and 35% incident irradiance. On-deck incubations, in which temperatures were 6 °C above in situ conditions, were monitored for phytoplankton growth, biomass stoichiometry, net primary production, photo-physiology, and taxonomic composition. During the 8-day experiment, taxonomic diversity decreased and the diatom Chaetoceros socialis became increasingly dominant irrespective of light or CO2 levels. We found no statistically significant effects from either higher CO2 or light on physiological properties of phytoplankton during the experiment. We did, however, observe an initial 2-day stress response in all treatments, and slight photo-physiological responses to higher CO2 and light during the first five days of the incubation. Our results thus indicate high resistance of Arctic phytoplankton to OA and enhanced irradiance levels, challenging the commonly predicted stimulatory effects of enhanced CO2 and light availability for primary production.

Mexican consumers at the point of meat purchase. Beef choice.

Within-consumer preference replication achieved through systematic image manipulation was used in consumer surveys in four cities across Mexico (Mexico City, n=195; Guadalajara, n=100; Hermosillo, n=132; Veracruz, n=61) to study beef preferences. Images of beef steaks controlled for lean and fat colour, fat cover and marbling were presented to consumers to determine the characteristics used in beef choice and the levels of preference of these characteristics. The most important choice criteria were fat cover (62% preferring little fat cover) and marbling (59% preferring non-marbled). Lean colour was also important with 24% and 29% choosing light and dark red beef, respectively. Fat colour was the least important of the four attributes studied (18% and 19% choosing white and yellow, respectively), but was nevertheless important given that 43% of consumers used three or four characteristics to make their choice. Imported and domestic beef in the Mexican marketplace appear to respond to the range of consumers' beef preferences at the point of purchase.

[Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society]. / Sueño saludable: evidencias y guias de actuacion. Documento oficial de la Sociedad Española de Sueño.

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed.

The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina.

OBJECTIVE: To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina. DESIGN: Multicentre collaborative cross-sectional study. SETTING: Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area. POPULATION: Women giving birth in participating hospitals during a 1-year period. METHODS: All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively. MAIN OUTCOME MEASURES: Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate. RESULTS: A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7). CONCLUSIONS: This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.

Development of a multiplex PCR assay to detect gastroenteric pathogens in the feces of Mexican children.

Acute gastroenteritis (AGE) is a major cause of childhood morbidity and mortality worldwide; the etiology of AGE includes viruses, bacteria, and parasites. A multiplex PCR assay to simultaneously identify human Astrovirus (HAstV), Calicivirus (HuCVs), Entamoeba histolytica (E. histolytica), and enteroinvasive Escherichia coli (EIEC) in stool samples is described. A total of 103 samples were individually analyzed by ELISA (enzyme-linked immunosorbent assays) and RT-PCR/PCR. HAstV and HuCVs were detected in four out of 103 samples (3.8 %) by RT-PCR, but ELISAs found only one sample as positive for HuCVs (2.5 %). E. histolytica was identified in two out of 19 samples (10.5 %) and EIEC in 13 out of 20 samples (70 %) by PCR, and all PCR products were sequenced to verify their identities. Our multiplex PCR results demonstrate the simultaneous amplification of different pathogens such as HAstV, EIEC, and E. histolytica in the same reaction, though the HuCVs signal was weak in every replicate. Regardless, this multiplex PCR protocol represents a novel tool for the identification of distinct pathogens and may provide support for the diagnosis of AGE in children.

Relación del consumo de alimentos de alto índice glicémico en la dieta y los niveles de HbA1c en individuos Diabéticos Tipo 2 en tratamiento con dieta y/o Metformina

En la actualidad aún no existe consenso acerca de recomendaciones claras sobre el uso de IG (índice glicémico) de los alimentos para el control dietético de la DM2 (diabetes mellitus 2). Distintas entidades proponen el uso de conteo de CHO (hidratos de carbono), pues no se cuenta con evidencia suficiente para la planificación dietética en base al IG. El objetivo de este estudio fue relacionar el consumo de alimentos de alto IG con el control glicémico de pacientes DM 2 del programa de salud cardiovascular de tres CESFAM (centro de salud familiar) de la comuna de Santiago, Chile. Se seleccionaron 40 sujetos a quienes se les realizó evaluación antropométrica y una encuesta de frecuencia de consumo alimentaria de 30 dias modificada. Se obtuvieron IG, CG (carga glicémica), número de porciones de alto IG consumidas/dia y cantidad de CHO totales consumidos/día. Éstos se correlacionaron con valores de HbA1c (hemoglobina glicosilada) de los últimos 3 meses obtenidos de la ficha clínica. La edad promedio total fue 58.6 ± 9.5 años. El porcentaje de obesidad fue 62,5% y el promedio IMC de 32.5. El valor promedio de HbA1c fue 7.08 ± 1.6, para HbA1c <7% fue 57.5%. La cantidad total de CHO ingerida/dia fue de 403.8 g. El promedio de IG y CG fue de 78.5 y 317.5 g respectivamente. El número total de porciones de alimentos con IG alto consumido al día fue 21.8. Se obtuvo correlación estadísticamente significativa entre HbA1c y número de porciones de alto IG (r= 0.56 p=0.002). Para el resto de las variables no se encontró correlación con significancia estadística (p>0.05). Por cada porción extra de alimentos con alto IG se observó un aumento de la HbA1c en un 0,9%. En nuestra población estudiada la cantidad de alimentos con alto IG consumidos/dia se correlacionó signicativamante con los valores de HbA1c.

Relationship of consumption of high glycemic index food in the diet and levels of HbA1c in type 2 diabetic patients treated with diet and / or Metformin. At present there is still no clear consensus on recommendations on the use of GI of foods for the dietary management of T2DM. Rather different entities propose the use of carbohydrate counting, because there is not even enough evidence for dietary planning based on this index. The aim of this study was to relate consumption of high GI food with glycemic control of type 2 diabetes patients from the cardiovascular health program of 3 CESFAM (Family Health Centers) in Santiago, Chile. Forty individuals were selected, anthropometric measurements were conducted as well as a modified poll of frequency of food consumption of 30 days. Data from GI, GL, number of servings with high GI consumed per day and total amount of CARB consumed per day. Correlations were determined with values of HbA1c of the last 3 month obtained from the medical record. The average age was 58.6 ± 9.5 years. The percentage of obesity was 62,5% and the average BMI was 32,5. The average HbA1c value was 7.08 ± 1.6, for HbA1c <7% it was 57,5%. The total amount of CARB ingested/day was 403,8 g. The average of GI and GL was 78.5 and 317.5 respectively. The total number of servings of food with high GI ingested per day was 21,8. There was a statistically significant correlation between HbA1c and number of servings with high GI (r= 0.56 p=0.002). For the remaining variables there was no statistically significant correlation (p>0.05). For each extra serving of high GI food there was an increase of 0.9% of HbA1c. In our research population the amount of food with high GI ingested per day was significantly correlated with values of HbA1c.

Approaches targeting K(V)10.1 open a novel window for cancer diagnosis and therapy.

K(V)10.1 has recently become generally accepted as a promising cancer target, as it is ectopically expressed in the majority of solid tumors. Due to its cell-surface accessibility, K(V)10.1 has a strong potential for tumor treatment and diagnosis. Given that its mode of action is likely independent of conventional cancer pathways such as tyrosine kinases, K(V)10.1 opens a novel window for treating cancer. In this review we will give an overview of the current status of data linking K(V)10.1 to cancer, and propose techniques that could exploit K(V)10.1's properties for the management of cancer.

Proyecto de educación alimentaria y nutricional: Espacios de Alimentación a través de la Fotografía / Food and nutrition education project: Feeding Spaces Through photography

La Fundación ph 15 y el Programa de Desarrollo de Políticas Alimentarias y Nutricionales (Subsecretaría de Promoción Social del Ministerio de Desarrollo Social del Gobierno de la Ciudad de Buenos Aires) han conformado un equipo de trabajo para llevar a cabo un proyecto de educación alimentaria y nutricional (EAN) con los adolescentes que integran el taller de Fotografía de dicha Fundación. El programa apuesta al abordaje interdisciplinario de determinadas situaciones a través de la EAN, intentando realizar un enfoque desde los múltiples factores (sociales, nutricionales, culturales, étnicos, etc.) que intervienen en la alimentación. Con la Fundación ph 15 se compartió la mirada de trabajar desde metodologías participativas utilizando la fotografía como herramienta original de expresión y testimonio. El proyecto estuvo dirigido a niños, adolescentes y jóvenes entre once y veintiocho años. Se comenzó esta experiencia en el Barrio General Belgrano, conocido como Villa 15 (Ciudad Oculta), teniendo en cuenta que en este se registra el mayor porcentaje de problemas nutricionales de la Ciudad Autónoma de Buenos Aires. La primera etapa de este proyecto se concretó a través de cuatro talleres (de septiembre de 2007 a julio de 2008), trabajando con conceptos básicos de alimentación saludable y seguridad alimentaria. La propuesta fue partir desde la recuperación de saberes culturales, de hábitos alimentarios y costumbres de los adolescentes, con el fin de trabajar y analizar los distintos factores que influye en los mismos. Los chicos pudieron debatir cuestiones que aparecen como naturales relacionadas con la seguridad alimentaria y que les permitirá revisar futuros hábitos, comportamientos y posicionamientos en relación a este derecho fundamental y/o vital, la alimentación saludable.

Proyecto de educación alimentaria y nutricional: Espacios de Alimentación a través de la Fotografía / Food and nutrition education project: Feeding Spaces Through photography

La Fundación ph 15 y el Programa de Desarrollo de Políticas Alimentarias y Nutricionales (Subsecretaría de Promoción Social del Ministerio de Desarrollo Social del Gobierno de la Ciudad de Buenos Aires) han conformado un equipo de trabajo para llevar a cabo un proyecto de educación alimentaria y nutricional (EAN) con los adolescentes que integran el taller de Fotografía de dicha Fundación. El programa apuesta al abordaje interdisciplinario de determinadas situaciones a través de la EAN, intentando realizar un enfoque desde los múltiples factores (sociales, nutricionales, culturales, étnicos, etc.) que intervienen en la alimentación. Con la Fundación ph 15 se compartió la mirada de trabajar desde metodologías participativas utilizando la fotografía como herramienta original de expresión y testimonio. El proyecto estuvo dirigido a niños, adolescentes y jóvenes entre once y veintiocho años. Se comenzó esta experiencia en el Barrio General Belgrano, conocido como Villa 15 (Ciudad Oculta), teniendo en cuenta que en este se registra el mayor porcentaje de problemas nutricionales de la Ciudad Autónoma de Buenos Aires. La primera etapa de este proyecto se concretó a través de cuatro talleres (de septiembre de 2007 a julio de 2008), trabajando con conceptos básicos de alimentación saludable y seguridad alimentaria. La propuesta fue partir desde la recuperación de saberes culturales, de hábitos alimentarios y costumbres de los adolescentes, con el fin de trabajar y analizar los distintos factores que influye en los mismos. Los chicos pudieron debatir cuestiones que aparecen como naturales relacionadas con la seguridad alimentaria y que les permitirá revisar futuros hábitos, comportamientos y posicionamientos en relación a este derecho fundamental y/o vital, la alimentación saludable.(AU)

Delayed lupus nephritis.

OBJECTIVE: To describe and analyse the clinical and immunological characteristics of a large series of patients with delayed lupus nephritis (LN). METHODS: A cross-sectional study was carried out. Patients with systemic lupus erythematosus (SLE) who developed renal involvement >or=5 years after the first manifestation(s) of the disease (delayed LN, n = 48) were compared with patients with SLE in whom LN developed within 5 years or less after SLE appeared (early-onset LN, n = 187). A control group, the no LN (NLN) group, comprised patients with longstanding SLE (duration of disease >10 years) who had never shown signs of renal involvement (n = 164). RESULTS: The group with delayed LN was positively associated with Sjögren's syndrome, lung involvement and antiphospholipid syndrome as compared with early LN. However, its renal clinical expression and histopathological patterns were similar to those of early-onset LN. The frequency of anti-dsDNA, anti-Sm and anti-RNP antibodies was higher in patients with LN than in the NLN group, as was the frequency of low complement levels. Jaccoud's arthropathy was a protective factor for nephritis. CONCLUSIONS: Delayed LN is not uncommon in patients with SLE. The identified risk factors might aid in its diagnosis and enhance the ability to identify patients at risk for this complication of SLE.

Effect of an acid mine drainage effluent on phytoplankton biomass and primary production at Britannia Beach, Howe Sound, British Columbia.

We investigated the effect of acid mine drainage (AMD) from an abandoned copper mine at Britannia Beach (Howe Sound, BC, Canada) on primary productivity and chlorophyll a levels in the receiving waters of Howe Sound before, during, and after freshet from the Squamish River. Elevated concentrations of copper (integrated average through the water column >0.050 mgl(-1)) in nearshore waters indicated that under some conditions a small gyre near the mouth of Britannia Creek may have retained the AMD from Britannia Creek and from a 30-m deep water outfall close to shore. Regression and correlation analyses indicated that copper negatively affected primary productivity during April (pre-freshet) and November (post-freshet). Negative effects of copper on primary productivity were not supported statistically for July (freshet), possibly because of additional effects such as turbidity from the Squamish River. Depth-integrated average and surface chlorophyll a were correlated to copper concentrations in April. During this short study we demonstrated that copper concentrations from the AMD discharge can negatively affect both primary productivity and the standing stock of primary producers in Howe Sound.

Cirugía fetal experimental en un modelo animal para la corrección de mielomeningocele / Experimental fetal surgery in an animal model for the correction of myelomeningocele

Introducción. El mielomeningocele representa una de las malformaciones congénitas más frecuentes y severas en humanos, que afecta aproximadamente a 1 de cada 2.000 recién nacidos en el mundo. Tiene una enorme significación médica y social, por la importante morbilidad a que se asocia, con gran cantidad de secuelas y un elevado coste en salud. Existe sólida evidencia que apoya la necesidad de tratamiento precoz. Dentro de las posibilidades de tratamiento actuales tiene especial interés la reparación quirúrgica durante la vida intrauterina. El trabajo con un modelo animal constituye el paso previo necesario a la intervención en humanos. Objetivos. En concordancia con otros grupos de investigadores, hemos elegido un modelo animal que permita conocer los resultados de la reparación de la columna vertebral en mielomenigoceles creados instrumentalmente. Material y métodos. Durante el período de mayo de 2002 hasta mayo de 2004 se ha reclutado un grupo de 23 ovejas de raza merina a las que se les realizó quirúrgicamente, a los 80 días de preñez, un mielomeningocele, realizando una laminectomía lumbar de 1 a 4 con apertura del canal medular y exposición del contenido al líquido amniótico. Las ovejas fueron aleatorizadas para ser incluidas en tres grupos: un grupo control y dos grupos de intervención. En uno de ellos se realizó una reparación neuroquirúrgica convencional y en el otro grupo se realizó una reparación colocando una membrana de tejido dérmico porcino acelular cultivado. Resultados. Los corderos del grupo control nacieron con manifestaciones clínicas severas de la enfermedad (tres de cinco corderos), con incapacidad en la deambulación e incontinencia de esfínteres; en los corderos de ambos grupos de intervención las manifestaciones clínicas de espina bífida fueron leves (cuatro de cinco corderos), con dificultad leve en la deambulación y continencia de esfínteres. Conclusiones. Los resultados alcanzados por el trabajo, debido al reducido número de intervenciones, no son concluyentes, pero muestran una tendencia a favor de la intervención de reparación intraútero del mielomeningocele. Las consecuencias de estos resultados en la práctica clínica deberán ser observadas a la luz de los resultados del Management of Myelomeningocele Study (MOMS) que se desarrolla actualmente en Estados Unidos en cuatro centros. Comentario final. La realización del presente trabajo ha tenido enorme significación para los autores ya que se ha reunido un equipo multidisciplinario que incluye anestesiólogos, neurocirujanos, neonatólogos, obstetras, veterinarios, enfermeros, neurólogos, etc., y se ha alcanzado el objetivo de adquirir nuevas destrezas que serán fundamentales para el manejo futuro de la cirugía fetal intraútero (AU)

Introduction. Myelomeningocele is one of the most frequent and severe congenital defects in humans, affecting approximately one in 2000 worldwide. This pathology is of great medical and social relevance due to its high morbidity, multiple sequela and high social cost. There is supporting evidence in favor of early treatment, particularly through intra uterine surgical correction. The work on animal models is a required preliminary step before intervention on humans. Objectives. In agreement with several other investigative groups we have chosen an animal model that allows us to know the results of spine correction in surgically induced myelomeningocele. Material and methods. Between may of 2002 and may of 2004 we recruited 23 sheep on which we induced myelomeningocele surgically at 80 days of gestational age, through 1 to 4 lumbar laminectomy with opening of bone marrow channel and exposure to amniotic fluid. AH sheep were randomized to be included in three groups: control group A, and intervention groups B (conventional intervention) and C (conventional plus noncellular porcine skin patch. Results. Neonate lambs (three out of five) in the control group presented with severe clinical disease related disabilities, namely walking impairment and incontinence. Lambs in B and C groups showed less severe impairment: slight walking handicap and lack of incontinence. Conclusions. Owing to the small sampling the results we reached are not conclusive, though they show a trend in favor of intrauterine correction of myelomeningocele. Relevance of these findings should be availed for clinical practice through the results from Management of Myelomeningocele Study (MOMS), currently ongoing in four UScenters. Final comment. The present trial represents an important advance for all participants in that it gathered a multidisciplinary team composed of anesthesiologists, neurosurgeons, pediatric neurosurgeons, obstetricians, pediatricians, vets, nurses, etc., and has led us to the acquisition of essential handskills for the future management of intra uterine fetal surgery (AU)

Influence of amino-terminal structures on kinetic transitions between several closed and open states in human erg K+ channels.

Gating kinetics of human ether-a-go-go (eag)-related gene (HERG) K+ channel expressed in Xenopus oocytes was studied using non-inactivating channel variants carrying different structural modifications in the amino terminus. A kinetics model was elaborated to describe the behavior of full-length channels, that includes at least three open states besides the three closed states previously proposed. Deletion of the HERG-specific proximal domain (HERG D138-373) accelerated all individual forward transitions between closed states. Whereas relatively large amplitude depolarizations were required to drive full-length HERG channels to more distal open states, these were reached more easily in channels without proximal domain. Alteration of the initial eag/PAS domain by introduction of a short amino-acid sequence at the beginning of the amino terminus did not alter transitions between closed states, but prevented the channels from reaching the farthest open states that determine slower deactivation rates. This indicates that the presence of specific amino-terminal structures can be correlated with the occurrence of distinctive molecular transitions. It also demonstrates that both proximal and eag/PAS domains in the amino terminus contribute to set the gating characteristics of HERG channels.

Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais / Laringopharingeal reflux: prospective study that compare early laryngoscopic finds and 2 channel and 24 hours esophageal testing

Introduçäo: Manifestaçöes laríngeas do refluxo gastro-esofágico säo problemas cada vez mais comuns. Estudos revelam alta associaçäo com sensaçäo de "globus", rouquidäo crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigaçäo diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivos: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificaçöes dietéticas. Forma de estudo: clínico prospectivo randomizado. Método: 61 pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesöes laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6 por cento apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5 por cento), pigarro (60,8 por cento), tosse (29,4 por cento), "globus" (23,5 por cento) e sialorréia (19,6 por cento). Associaçäo de sintomas: dois (67,4 por cento); três (41,2 por cento) e quatro (21,5 por cento). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7 por cento cursaram com melhora dos sintomas após 6 meses. Em 95,9 por cento dos pacientes tratados houve melhora laringoscópica. Conclusöes: Houve uma correlaçäo importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderäo fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeiçäo do especialista