[Characteristics of the stroke alert process attended by 061 ARAGON assistance units from 2010 to 2016. Factors influencing times of response and access to fibrinolytic treatment]. / Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis.

AIM: To study the response times of stroke code assistance by care units of 061 ARAGON, analyzing factors involved and their relationship with availability to fibrinolytic treatment in the hyperacute phase. PATIENTS AND METHODS: Transversal descriptive study on outpatient care from the registry of cases attended by 061 ARAGON health care units to patients with stroke code during the period 2010-2016. RESULTS: A total of 1743 patients were attended (54.6% males), with a mean age of 72.83 ± 13.1 years. There was a higher number of strokes attended in 2015 and 2016 (372 and 366 respectively), compared to the average of 201 strokes per year in the rest of the years. 27,2% of patients were treated between 08:00-11:59 h, the most frequent time interval. Regarding the time, it took to take care of the patient, the average was 71.93 ± 33.64 minutes with a longer response time in Teruel. When influence of the hour interval on the percentage of cases treated with fibrinolysis was analyzed, a higher rate of fibrinolysis was observed when it was activated between 12:00-15:59 h (28.1%). CONCLUSIONS: In 55,3% of patients, the 061 response time was greater than 60 minutes, but this time were not conditioned by the activation time. However, there were differences in the percentage of cases fibrinolysed in the different time intervals, suggesting that factors other than the response time of 061 influence the indication of fibrinolytic treatment.

TITLE: Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis.Objetivo. Estudiar los tiempos de respuesta en la atención al código ictus por unidades asistenciales del 061 ARAGÓN, analizando los factores implicados y su relación con el acceso al tratamiento fibrinolítico en la fase hiperaguda. Pacientes y métodos. Estudio descriptivo transversal sobre la asistencia extrahospitalaria a partir del registro de casos atendidos por unidades asistenciales del 061 ARAGÓN a pacientes con código ictus durante el período 2010-2016. Resultados. Se recogieron 1.743 pacientes con código ictus (54,6%, varones), con una edad media de 72,83 ± 13,1 años. El número de ictus atendidos en 2015 y 2016 (372 y 366, respectivamente) fue mayor que la media de 201 ictus anuales en el resto de los años. El 27,2% de los pacientes fueron atendidos entre las 08:00 y las 11:59 h, intervalo horario con mayor frecuentación. Respecto al tiempo que se tardó en atender al paciente, la media fue de 71,93 ± 33,64 minutos, con ma­yor tiempo de respuesta en Teruel. Cuando se analizó la influencia del intervalo horario sobre el porcentaje de casos tratados con fibrinólisis, se observó una mayor tasa de fibrinólisis cuando se activó entre las 12:00 y las 15:59 h (28,1%). Conclusión. En el 55,3% de los pacientes, el tiempo de respuesta del 061 fue mayor de 60 minutos, pero este tiempo no se vio condicionado por la hora de activación. Sin embargo, sí había diferencias en el porcentaje de casos de fibrinólisis en los diferentes intervalos horarios, lo que sugiere que factores distintos al tiempo de respuesta del 061 influyen en la indicación del tratamiento fibrinolítico.

Evaluation of the anorectal motor response after percutaneous stimulation of the posterior tibial nerve in patients with fecal incontinence.

BACKGROUND: The effect of posterior tibial nerve stimulation (PTNS) on the mechanisms of anal continence has not been fully demonstrated. The aim of this study was to assess the anal manometric response after percutaneous PTNS in patients with fecal incontinence (FI). METHODS: This was a prospective study in patients with FI undergoing 1 weekly session of percutaneous PTNS for 8 weeks. A clinical assessment (Wexner scale) and a complete study of up to 22 manometric parameters were carried out prior to treatment and 2-4 weeks after the end of treatment. RESULTS: A total of 32 patients were evaluated. After therapy, there was a decrease in the average Wexner score [12.6 (± 5.2) to 9.5 (± 5.2) (P < 0.005)] and an increase in the "anal canal length at rest" [4.55 (± 0.60) to 4.95 (± 0.21) P = 0.004], without observing variations in other manometric parameters. The decrease in the Wexner score was significantly correlated with an increase in the "pressure at 5 cm at rest" after therapy (r = 0.464 P = 0.030). CONCLUSIONS: In our study, PTNS was associated with a significant decrease in the Wexner score and with an increase in the functional length of the anal canal at rest. The improvement in the Wexner scale was correlated with an increase in pressure at rest in the theoretical area of the anorectal junction.

Computer vision-based analytical chemistry applied to determining iron in commercial pharmaceutical formulations.

Two different computer vision-based analytical chemistry (CVAC) methods were developed to quantify iron in the commercial pharmaceutical formulations Ferbisol® and Ferro sanol®. The methods involve using a digital camera or a desktop scanner to capture a digital image of a series of Fe2+ standard solutions and the unknown sample upon reaction with o-phenanthroline. The images are processed with appropriate software (e.g., the public domain programme ImageJ, from NIH) to obtain a numerical value (analytical signal) based on colour intensity. The fact that such a value is proportional to the analyte concentration allows one to construct a calibration graph from the standards and interpolate the value for the sample in order to determine its concentration. The results thus obtained were compared with those provided by a spectrophotometric method and the US Pharmacopoeia's recommended method. The differences never exceeded 2%. The two proposed methods are simple and inexpensive; also, they provide an effective instrumental alternative to spectrophotometric methods which can be especially beneficial in those cases where purchasing and maintaining a spectrophotometer is unaffordable.

Determinants of physical activity in daily life in candidates for lung transplantation.

BACKGROUND: Participation in daily physical activity (PA) has never been objectively assessed in candidates for lung transplantation (LTx). The main research questions were: 1) How active are LTx-candidates in daily life? 2) What are determinants of activity behavior before LTX? METHODS: Ninety-six candidates for LTx (diagnosis of COPD or interstitial lung disease; mean age 55 ± 7 years) underwent measurements of PA, pulmonary function, 6-min walking distance (6MWD), muscle force and health-status (SF-36 scale). RESULTS: Patients were markedly inactive (5% of waking hours walking, 26% standing and 69% sedentary). Backward multiple regression identified 6MWD (expressed as % of predicted value; ß = 73.0 steps, partial r(2) = 0.36, p = 0.00), a higher score on the energy/fatigue scale of the SF-36 (ß = 28.6 steps, partial r(2) = 0.09, p = 0.00) and a higher expiratory muscle force (expressed as % of predicted value; ß = 11.8 steps, partial r(2) = 0.05, p = 0.02) as determinants of daily steps. Minutes of mild to moderate (≥2 METs) activity were determined by 6MWD (expressed as % of predicted value; ß = 2.14 min, partial r(2) = 0.30, p = 0.00), inspiratory muscle force (expressed as % of predicted value; ß = 0.33 min, partial r(2) = 0.04, p = 0.05) and seasonal influences (spring/summer vs. autumn/winter: ß = 18.95 min, partial r(2) = 0.04, p = 0.05). The overall fit of the models was r(2) = 0.50 and r(2) = 0.38, respectively. CONCLUSIONS: The 6MWD was the main determinant of an inactive lifestyle in these patients. Respiratory muscle force, energy and fatigue and seasonal variations explained some additional variability in activity behavior. Patients should be encouraged to participate in interventions aimed at improving physical fitness and participation in daily physical activity before LTx.

Efectividad del ejercicio físico terapéutico en pacientes con claudicación intermitente por enfermedad arterial periférica: una revisión / Effectiveness of therapeutic physical exercise in patients with intermittent claudication due to peripheral arterial disease: A review

ResumenEntre las medidas fisioterapéuticas que se indican para la mejoría de los pacientes con enfermedad arterial periférica y que presentan claudicación intermitente (CI), el programa de ejercicio físico terapéutico se considera una de las más eficaces por su bajo riesgo frente a tratamientos invasivos y su control de los factores de riesgo cardiovascular.ResumenEl objetivo de la presente revisión es determinar la efectividad de los programas terapéuticos de ejercicio físico en pacientes con CI, grado ii de Fontaine y Leriche.ResumenPara ello, hemos analizado catorce ensayos clínicos, en los que se incluye un total de 1.686 participantes de ambos sexos, con una edad media superior a 65 años.ResumenEn general, los diferentes programas de ejercicio físico examinados hablan de una mejoría significativa de la funcionalidad de los pacientes con CI, al caminar hasta alcanzar el umbral de dolor, 3 veces por semana y durante un mínimo de 3 meses, seguidos de una etapa de mantenimiento (AU)

AbstractThe therapeutic exercise program is considered to be one of the most effective of the physiotherapy procedures indicated for Arterial Peripheral Disease (APD) with Intermittent Claudication (IC). This is because it has a lower risk than invasive treatments while it also controls the cardiovascular risk factors.AbstractThis review has aimed to determine the effectiveness of the therapeutic exercise programs in patients with IC, Stage II of Fontaine and Leriche classification. To do so, we analyzed 14 clinical trials, in which 1686 patients from both genders were enrolled, with an average age greater than 65 years.AbstractIn general, the different exercise programs reviewed showed significant improvement in the performance of patients with IC when they walked until reaching a pain threshold, three times per week for a minimum of 3 months, followed by a maintenance program (AU)

Título de grado en Fisioterapia: valoración de las competencias por parte del estudiante / Physiotherapy Degree: student evaluation of competences

ObjetivoEste estudio pretende valorar la opinión que los estudiantes de fisioterapia tienen en relación a la importancia y el grado de formación recibido en las competencias recogidas en el Libro blanco del título de grado en Fisioterapia.Material y métodosEl estudio se realizó mediante una encuesta pasada a un total de 45 estudiantes de segundo y tercer curso de la titulación de Fisioterapia.Material y métodosPor cada uno de los bloques en los que se distribuyeron los ítems de la encuesta, se analizaron 4 aspectos: las competencias valoradas como más y menos importantes, las competencias con mejor formación recibida, y las competencias con necesidad de una mayor formación.ResultadosEn relación a estos aspectos, observamos que: a) las competencias relacionadas con la asistencia clínica son las valoradas como más importantes; b) las competencias menos valoradas son las referidas a la gestión en la práctica profesional; c) las competencias que destacan por su buena formación son aquellas relativas al enfoque biopsicosocial del paciente, y d) las competencias en las que consideran necesaria una mayor formación son las metodologías de la investigación, la evaluación y la comunicación.ConclusionesLa formación en competencias contemplada en el Grado en Fisioterapia incluye el desarrollo profesional del fisioterapeuta en los ámbitos asistencial, investigador, gestor y docente. La opinión del estudiante permite conocer cuáles son los puntos a reforzar para que la implementación del Grado en Fisioterapia cumpla con los objetivos establecidos por la comunidad de fisioterapeutas europea, en respuesta a la demanda social actual(AU)

ObjectiveThe primary goal of this study is to evaluate physiotherapy students’ assessment about the importance of their competences training level during their Academic Years. These competences have been taken from the “Libro blanco del Título de Grado en Fisioterapia”.Material and methodsA survey was given to our Physiotherapy students to gather as much information as possible about their training development. 45 Physiotherapy Degree students, second and third academic year, participated in this study.Material and methodsThe survey was designed in different blocks. In each block, we tried to gather different information so as to evaluate if the competences planned had been developed properly. Therefore, the different items in each block have helped as to assess which competences have been considered the most or less important, which of these competences have been better training, and which competences needed more training.ResultsReferring to the four blocks planned and described, in the previous chapter, we can manage to display the following information results: A) Students considered practical clinical attendance as the most important; B) However, those competences applied to professional practice management were considered as the less important; C) Also, they underlined as very relevant for their Physiotherapy education those competences focused on patients bio-psychosocial aspects; D) Finally, they considered necessary for their Physiotherapy education the training in aspects as research methodologies, patients’ assessment and communication.ConclusionsAccording to the information gathered, training competences in Physiotherapy Degree includes: physiotherapy professional development, research strategies, management and teaching development. The information given by our students let us know which are the most relevant and significant points to (..) (AU)

Pulsed infrared light therapy does not increase nitric oxide concentration in the blood of patients with type 1 and type 2 diabetes mellitus.

The purpose of this study was to determine if NO blood concentrations increased acutely following an 8-week course of pulsed infrared light therapy (PILT) which could be linked to an improvement in peripheral protective sensation (PPS) in patients who have profound chronic diabetic peripheral neuropathy. A total of 22 subjects with the diagnosis of type 1 (N = 2) or type 2 (N = 20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for 8 weeks) for 30 min per treatment. Venous blood samples were taken during the last 5 min of treatment from veins in the dorsum of the control and experimental feet and were later analyzed for NO concentration. Contrary to the popular supposition, PILT treatments actually resulted in a significantly (P < 0.05) decreased concentration of NO. Additionally, there were no significant differences between the treated and untreated feet. Since in individuals where PILT has significantly improved PPS, PILT did not stimulate an increased NO content in the blood, it appears that infrared light improves peripheral protective sensation in patients by a mechanism other than an increased NO production.

La Diplomatura de Fisioterapia en el Espacio Europeo de Educación Superior: la visión del discente / Physiotherapy Degree in the European Space for Higher Education: View of student

La adaptación al Espacio Europeo de Educación Superior (EEES) promueve un nuevo paradigma del proceso de enseñanza y aprendizaje. En éste, el docente proporciona al discente un enfoque más autónomo de las estrategias de aprendizaje, lo que supone prestar una atención especial al principal protagonista de este proceso: el estudiante. El principal objetivo de este estudio es investigar y evaluar, por un lado, el nivel de conocimiento y, por otro, qué piensa y qué espera (o que motivación da al estudiante este nuevo paradigma metodológico) el estudiante de la adaptación de la titulación de fisioterapia al EEES. Para acometer este objetivo, nuestro enfoque metodológico se ha basado en una serie de entrevistas individuales, semiestructuradas, a tres discentes de la Escuela de Fisioterapia de la Universitat de València (EUFUV) y, a continuación, hemos analizado cualitativamente los datos recogidos. A partir de los datos obtenidos, podemos concluir que el estudiante ve en el nuevo título de grado en Fisioterapia el cumplimiento de alguna de sus expectativas, como la equiparación de la titulación española a la de los demás Estados de la Unión Europea. Por otra parte, podemos inferir falta de información y de implicación del alumnado, aspecto que puede estar condicionado por el reconocimiento de su opinión y su esfuerzo(AU)

The implementation of a homogenous framework of the European Space for HigherEducation (EEES) leads to a new paradigm in the teaching-learning process. In thiseducational process, the educator supervises the students’ autonomous learning process.ARTICLE IN PRESS0211-5638/$ - see front matter & 2008 Publicado por Elsevier Espan˜a, S.L.doi:10.1016/j.ft.2008.07.003 Autor de correspondencia.Correo electro´nico: angeles.cebria@uv.es (M.A`. Cebria` Iranzo).Fisioterapia 2008;30(4):180–185Thus, this new methodological approach calls for special attention to the most importantsubject of this new process: the student.The main objective of this study is to investigate, on the one hand, the level of thestudents’ knowledge, and on the other, their way of thinking, and what they really expect(or what motivation this new methodological paradigm causes in the student) from theadaptation (or implementation) of the Degree in Physiotherapy within the European Spacefor Higher Education. Therefore, we have designed some strategies based on individualquestionnaires to obtain information from three physiotherapy students at the Universityof Valencia (EUFUV). Finally, we have analyzed qualitatively the data collected.Based on the data obtained, we have come to the conclusion that students can obtain, inthis New Degree in Physiotherapy, some of their expectations such as the standardizationof Spanish Degrees with the rest of the European Community. On the other hand, we caninfer from this study that students lack of information and compromise, an aspect that canbe conditioned by the recognition of their own opinion and effort(AU)

[Analysis of the patient safety culture in hospitals of the Spanish National Health System]. / Análisis de la cultura sobre seguridad del paciente en los hospitales del Sistema Nacional de Salud español.

BACKGROUND AND OBJECTIVES: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS. MATERIAL AND METHOD: The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA. RESULTS: A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians. CONCLUSIONS: Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.

La Diplomatura de Fisioterapia en el nuevo Espacio Europeo de Educación Superior: la visión del docente / Physiotherapy Degree in the new European Higher Education Area: view of lecturer

El proceso de convergencia europea, donde se circunscribe el nuevo Espacio Europeo de Educación Superior (EEES), es el gran reto que acontece al presente y futuro de las universidades europeas. Este contexto de renovación de los actuales estudios superiores en forma de grado, es origen de experiencias diversas, opiniones confrontadas y cambios que requieren un gran esfuerzo en diferentes ámbitos. El presente trabajo tiene por objetivo estudiar el proceso de Convergencia Europea desde una perspectiva social. Concreta el estudio en la Diplomatura de Fisioterapia de la Universitat de València, y trata de responder a la cuestión: ¿cómo experimenta el docente el conjunto de transformaciones que acompañan esta adaptación al proyecto europeo de enseñanza superior? Para ello, hemos realizado entrevistas individuales semiestructuradas a tres docentes de la Escuela de Fisioterapia de la Universitat de València (EUFUV), y analizado cualitativamente los datos recogidos, interpretando la manera y el grado de impacto que el conjunto de cambios que acompañan al EEES tiene sobre el docente. A la vista del análisis textual de las entrevistas, observamos que en general los docentes no están suficientemente informados ni implicados en el proceso de convergencia. En conclusión, destacamos que la motivación del docente es fundamental, y que su visión es imprescindible en el debate sobre la mejor forma de adaptarse al cambio institucional, académico y de metodología

The conversing European process of higher education has created a challenge for present and future Project at European universities. This revision process of current university studies is directed towards new degree systems resulting from the evaluation of opinions, needs requirements which demand a great effort in different fields. This article examines as its main goal the European converging process from a social perspective. Thus, our focus will be physiotherapy studies at the University of Valencia and we will try to give an answer to the following question: 'How do educators feel about the transformation to this new educational proposal for higher education in Europe?' This study has been based on a interview survey on three physiotherapy educators (lecturers) of the School of Physiotherapy at the University of Valencia. The data have been analysed from a qualitative perspective to understand the influence which these changes in European higher education has had on educators. In conclusion, the first approach to the interview surveys analysed reveal that educators (lecturers), in general, have insufficient information and are not following this new educational conversing process. In addition, we would like to underline that motivating the university educators is one of the main aspects on which the converging process should be based. The vision and opinion of educators (lecturers) are indispensable in this debate so as to adapt it to institutional, academic and methodological changes required by European conversing process

[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy]. / Evaluación de un programa de atención farmacéutica dirigido a mejorar la adherencia al tratamiento antirretroviral.

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

Isolation and characterization of an avirulent Candida albicans yeast monomorphic mutant.

Mutagenesis of Candida albicans strain ATCC 26555 with N-methyl-nitro-N-nitrosoguanidine followed by plating on solid yeast nitrogen base-N-acetylglucosamine medium at 37 degrees C yielded colony morphology variants that were characterized as forming smooth colonies, in contrast to the rough colonies formed by the parental strain. One yeast monomorphic mutant, CAL4, was studied in detail. Strain CAL4 is defective in filamentous growth, unable to form hyphae or pseudohyphae in vivo and in vitro. These filamentous structures are not elicited by commonly used external stimuli such as serum. The mutant had no obvious alterations in its mannan, glucan or chitin content. The total quantity of non-covalently linked wall proteins was reduced in the mutant strain, but the electrophoretic pattern shown by these proteins was identical to that of proteins from the parental strain. CAL4 showed major differences from the parental strain in its formation of covalently linked wall proteins. An important aspect of these differences lay in the practical absence of proteins recognized by two monoclonal antibodies, 1B12 and 3H8, which are considered valuable tools in the diagnosis of candidiasis in part because they normally react strongly with all strains. The C. albicans mutant, blocked in yeast-mycelium transition, was avirulent in a mouse model, although it was able to grow in animal tissues.

[Check-ups with brain SPECT in electroconvulsive therapy in patients with severe drug-resistant depressive episodes and Parkinson's disease]. / Control con SPECT cerebral en la terapia electroconvulsiva en pacientes con episodio depresivo grave farmacorresistente y enfermedad de Parkinson.

We have studied three women (66,72 and 72 years) with Parkinson's disease of 11, 6 and 21 years of evolution and drug-resistant severe depressive episodes treated with electroconvulsive therapy (ECT). We have performed a brain SPECT (99mTc-HMPAO) before and after the ECT. The clinical improvement of the severe depressive episodes were measured using the Hamilton score. The first patient did not experience any clinical improvement (Hamilton score 42 to 42). In this patient the brain SPECT before treatment presented a reduced perfusion in the posterior parietal region, anterior cingulate cortex and medial frontal and parietal cortex. After the treatment, the brain SPECT did not present significant variations. The second patient presented a moderate clinical improvement (Hamilton score 46 to 36) and also presented moderate improvement in the neurological symptoms. The brain SPECT before the treatment showed reduced perfusion in the left temporal cortex and medium-posterior parietal cortex. After the treatment, it also did not reflect significant variations. The third patient experienced a very good response to the ECT sessions (Hamilton score 45 to 10) and also an improvement regarding the neurological symptoms. This patient presented a reduced perfusion in the medium-posterior parietal regions in the brain SPECT performed before the treatment; these regions presented a moderate improvement in the brain SPECT performed after the treatment. The patient who presented a significant neurological and psychiatric improvement also presented an improvement in the perfusion of the decreased areas in the brain SPECT and showed fewer alterations in the baseline brain SPECT compared with the others. The brain SPECT could have a prognostic (and confirmation) role regarding clinical improvement induced by ECT in resistant depression in Parkinson's disease. ECT is an alternative in treatment of severe depressive drug-resistant episodes associated to the Parkinson's disease.

Control con SPECT cerebral en la terapia electroconvulsiva en pacientes con episodio depresivo grave farmacorresistente y enfermedad de Parkinson / Control with brain SPECT in electroconvulsive therapy in patients with severe depressive drugresistant episodes and Parkinson's disease

Hemos estudiado tres mujeres de 62, 72 y 72 años con enfermedad de Parkinson de 11, 6 y 21 años de evolución y episodios depresivos graves fármaco-resistentes, tratados con terapia electro-convulsiva (TEC). La mejoría clínica de la depresión se midió utilizando la escala de Hamilton. Hemos realizado un SPECT cerebral (99mTcHMPAO) antes y después de la realización de la TEC. La primera paciente no experimentó ninguna mejoría clínica estable (puntuación en la escala de Hamilton de 42 a 42). En esta paciente el SPECT cerebral de perfusión antes del tratamiento presentaba disminución de la perfusión en áreas parietales posteriores, córtex cingular anterior y medial, córtex frontal y parietal. Tras el tratamiento el SPECT no sufrió variaciones significativas. La segunda paciente presentó una mejoría clínica moderada (Hamilton de 46 a 36) y en la sintomatología neurológica. El SPECT cerebral previo al tratamiento mostraba perfusión reducida en el córtex temporal izquierdo y parietal medio-posterior. Tras el tratamiento no experimentó cambios significativos. La tercera paciente respondió de manera muy satisfactoria a la TEC (Hamilton de 45 a 10 e importante mejoría de los síntomas neurológicos). Esta paciente presentaba una perfusión disminuida en las regiones parietales medias y posteriores en el estudio previo al tratamiento. Estas regiones presentaron una mejoría moderada en el estudio posterior. La paciente que presentó mejoría neurológica y psiquiátrica significativa, presentó también una mejoría en la perfusión de las áreas más afectadas en el SPECT cerebral previo y además mostraba menos alteraciones en el estudio basal que las otras pacientes. El SPECT cerebral podría tener un papel pronóstico (y de confirmación) respecto a la mejoría clínica inducida por TEC en la depresión resistente en la enfermedad de Parkinson. La TEC es una alternativa en el tratamiento de los episodios depresivos graves fármaco-resistentes asociados a la enfermedad de Parkinson (AU)

Técnica de compensación mediante uso de segmentos en el tratamiento craneoespinal / Compensation technique using segments in the craniospinal treatment

Propósito: Describir la técnica utilizada en la radioterapia del eje craneoespinal en el Servicio de Oncología Radioterápica del Hospital LA FE, en cuyos campos se utilizan segmentos adicionales para optimizar la distribución de dosis resultante. Material y método: Para todos los pacientes se lleva a cabo una simulación virtual que permite localizar las estructuras críticas y determinar con precisión las colindancias entre los campos. En la planificación dosimétrica tridimensional (3D) se homogeneiza la distribución de dosis en el plano sagital, añadiendo eventualmente segmentos (1 ó 2) que apantallen las zonas sobredosificadas, durante una determinada proporción de las unidades de monitor. Resultados y discusión: La técnica descrita permite una adecuada optimización en este complejo tipo de tratamientos sin variar apenas el tiempo de planificación basada en la simulación virtual (AU)

Reaggregation and binding of cell wall proteins from Candida albicans to structural polysaccharides.

Urea or hot sodium dodecyl sulphate extracted a significant amount of the same proteins from the matrix of the cell wall of the yeast form and mycelial cells of Candida albicans. Gel filtration analysis of the urea-extracted proteins revealed that they occurred in the form of large complexes which were unaffected by up to 8 M urea. Among them, proteins en route to becoming covalently associated within the wall scaffold were identified by their reaction with specific antibodies. When urea was removed by dialysis, some of these proteins specifically reassociated into large aggregates which bound strongly with ConA, whereas others remained soluble in smaller associated products. The ability of some of these proteins to bind to the insoluble wall polysaccharides was also assessed. No self-assembling proteins were able to bind to glucans and/or chitin. Specificity of the binding to polysaccharides made of beta-bound glucosyl or N-acetylglucosaminyl residues was determined by the competitive effect of several disaccharides. Whereas laminaribiose and diacetylchitobiose were strong inhibitors of protein binding to both glucan and chitin, lactose, maltose and sucrose were ineffective.

Study of supramolecular structures released from the cell wall of Candida albicans by ethylenediamine treatment.

Candida albicans cell wall components were analyzed by ethylenediamine (EDA) treatment. Based on their different solubility properties, the cell wall components produced three fractions (A, B, and C). Fractions B (EDA-soluble, water-insoluble) and C (EDA-insoluble) contained glucan, chitin, and protein in different proportions. After zymolyase (mainly a beta-glucanase complex) or chitinase treatment of fractions B and C, more polysaccharides and proteins were solubilized by a second EDA treatment, suggesting that the solubility of the polymers in EDA depends on the degree of polymer interactions. Western blot analysis using two monoclonal antibodies (1B12 and 4C12) revealed electrophoretic patterns that were similar in mycelial and yeast morphologies, except that in material obtained from mycelial walls, an additional band was detected with MAb 1B12. Fluorescence microscopy of cell wall fractions treated with FITC-labeled Con-A, Calcofluor white, and FITC-labeled agglutinin showed that glucan and mannoproteins are uniformly distributed in fractions B and C, while chitin is restricted to distinct patches. Transmission electron microscopy demonstrated that fraction C maintained the original shape of the cells, with an irregular thickness generally wider than the walls. When fraction C was treated with chitinase, the morphology was still present and was maintained by an external glucan layer, with an internal expanded fibrillar material covering the entire cellular lumen. Degradation of the glucan skeleton of fraction C with zymolyase resulted in the loss of the morphology.

Involvement of transglutaminase in the formation of covalent cross-links in the cell wall of Candida albicans.

Activity of the enzyme glutaminyl-peptide--glutamylyl-transferase (EC 2.3.2.13; transglutaminase), which forms the interpeptidic cross-link N epsilon-(gamma-glutamic)-lysine, was demonstrated in cell-free extracts obtained from both the yeast like and mycelial forms of Candida albicans. Higher levels of enzymatic activity were observed in the cell wall fraction, whereas the cytosol contained only trace amounts of activity. Cystamine, a highly specific inhibitor of the enzyme, was used to analyze a possible role of transglutaminase in the organization of the cell wall structure of the fungus. Cystamine delayed protoplast regeneration and inhibited the yeast-to-mycelium transition and the incorporation of proteins into the cell wall. The incorporation of covalently bound high-molecular-weight proteins into the wall was sensitive to cystamine. Proteic epitopes recognized by two monoclonal antibodies, one of which is specific for the mycelial walls of the fungus, were also sensitive to cystamine. These data suggest that transglutaminase may be involved in the formation of covalent bonds between different cell wall proteins during the final assembly of the mature cell wall.

Structural mannoproteins released by beta-elimination from Candida albicans cell walls.

Mild alkaline solutions (beta-elimination), after removing the non-covalently bonded wall materials by hot SDS, released 13% and 26% of remaining wall proteins from mycelial and yeast cells of Candida albicans, respectively. When the beta-elimination was carried out after digestion of the walls with chitinase, four-fold more proteinaceous materials were released from mycelium and a similar amount in yeast walls. The solubilized materials were shown to be highly polydisperse, and endo-glycosidase H reduced their polydispersity and molecular masses, revealing different electrophoretic patterns in yeast and mycelial cell walls. The solubilized mycelial proteins carried N-glycosidic sugar chains and the epitopes recognized by two monoclonal antibodies were preserved, although showing a different behaviour in yeast walls. These results are consistent with the idea that significant amounts of intrinsic O-glycosylated mannoproteins are interconnected in the walls of C. albicans.

Structural organization of the components of the cell wall from Candida albicans.

The organization of the components of the cell wall from Candida albicans was studied by means of sequential treatment with hot SDS, anhydrous ethylenediamine (EDA) and lytic enzymes, followed by chemical and microscopic analyses of the different separated fractions. The EDA-insoluble fraction retained the original morphology of the wall, which was destroyed by beta-glucanase, but not by chitinase treatments. Staining with fluorescent lectins revealed distinct distributions of mannoproteins, glucans and chitin in the wall. Amino acid analysis of SDS-extracted walls, and the EDA-soluble and -resistant fractions gave similar results, with seven amino acids making up about 70% of the total protein weight. Treatment of the EDA-insoluble fraction with Zymolyase or chitinase released fragments of variable size whose susceptibility to these and other hydrolases suggests that they are made of glucan, chitin and mannan oligomers associated with proteins. Treatment of the Zymolyase-insoluble residue with chitinase released a series of low-molecular-mass oligomers made of neutral sugars, GlcNAc and amino acids, mainly lysine. It is suggested that they represent fragments of the core making up the scaffold of the cell wall of the fungus.