Lot-to-lot consistency of a hexavalent DTwP-IPV-HB-PRP∼T vaccine and non-inferiority to separate DTwP-HB-PRP∼T and IPV antigen-matching vaccines at 6-8, 10-12, and 14-16 weeks of age co-administered with oral rotavirus vaccine in healthy infants in India: A multi-center, randomized, controlled study.

Background: Combination vaccines reduce the number of pediatric injections but must be as safe, immunogenic, and effective as each of the individual vaccines given separately. Additionally, consistency in manufacturing lots is essential for WHO prequalification. This study aimed to establish the lot-to-lot consistency of a fully liquid, hexavalent diphtheria (D)-tetanus (T)-whole-cell pertussis (wP)-inactivated poliovirus (IPV)-hepatitis B (HB)-Haemophilus influenzae b (PRP-T) (DTwP-IPV-HB-PRP∼T) vaccine and to demonstrate non-inferiority to licensed DTwP-HB-PRP∼T and IPV vaccines. Methods: A Phase III, randomized, active-controlled, and open-label study was conducted at multiple centers across India. Healthy infants who had received a birth dose of oral poliovirus vaccine and hepatitis B vaccine received one of three lots of DTwP-IPV-HB-PRP∼T or separate DTwP-HB-PRP∼T and IPV vaccines at 6-8, 10-12, and 14-16 weeks of age. Oral rotavirus vaccine was co-administered at 6-8 weeks of age and 10-12/14-16 weeks of age. DTwP-IPV-HB-PRP∼T lot-to-lot consistency and non-inferiority (pooled DTwP-IPV-HB-PRP∼T) versus DTwP-HB-PRP∼T and IPV post-third dose were assessed using seroprotection rates (anti-D, anti-T, anti-HBs, anti-PRP, anti-polio 1, 2, 3) and adjusted geometric mean concentrations (anti-PT, anti-FIM). Safety was assessed by parental reports. Results: Lot-to-lot consistency was demonstrated for DTwP-IPV-HB-PRP∼T and non-inferiority versus DTwP-HB-PRP∼T and IPV was confirmed with 95% CIs for seroprotection rate differences and adjusted geometric mean concentration ratios within pre-defined clinical margins. Pooled seroprotection rate was ≥ 99.7% for anti-D ≥ 0.01 IU/mL, anti-T ≥ 0.01 IU/mL, anti-HBs ≥ 10 mIU/mL, anti-PRP ≥ 0.15 µg/mL, and anti-polio 1, 2, and 3 ≥ 8 (1/dil) and vaccine response rate was 83.9% for anti-PT and 97.7% for anti-FIM. There were no safety concerns. Conclusions: Immunogenicity of three lots of the fully liquid DTwP-IPV-HB-PRP∼T vaccine was consistent and non-inferior to licensed comparators following vaccination at 6-8, 10-12, and 14-16 weeks of age. There were no safety concerns and no evidence of any effect of co-administration with rotavirus vaccine.

Antibody persistence following administration of a hexavalent DTwP-IPV-HB-PRP∼T vaccine versus separate DTwP-HB-PRP∼T and IPV vaccines at 12-24 months of age and safety and immunogenicity of a booster dose of DTwP-IPV-HB-PRP∼T in healthy infants in India.

Background: The combination of whole-cell pertussis (wP) antigens with established diphtheria (D), tetanus (T), hepatitis B (HB), Haemophilus influenzae type b (Hib), and inactivated poliomyelitis (IPV) antigens provides a high-quality DTwP-IPV-HB-PRP∼T vaccine. This study evaluated a DTwP-IPV-HB-PRP∼T booster coadministered with measles, mumps, and rubella (MMR) vaccine. Methods: Phase II, open-label, randomized study. Healthy toddlers who had previously completed a DTwP-IPV-HB-PRP∼T or separate DTwP-HB-PRP∼T and IPV primary vaccination series received a DTwP-IPV-HB-PRP∼T booster vaccine at 12-24 months of age. All participants had also received 1 or 2 doses of measles-containing vaccine between primary vaccination and enrolment (N = 100 and N = 6, respectively). Those who had received 1 prior measles-containing vaccine received an MMR dose either concomitantly (N = 50) or 28 days after (N = 50) the DTwP-IPV-HB-PRP∼T booster. Immunogenicity was evaluated using validated assays and safety by parental reports. Results: Pre-booster vaccination, 100.0% participants showed antibody persistence after DTwP-IPV-HB-PRP∼T or DTwP-HB-PRP∼T and IPV for anti-T (≥0.01 IU/mL), anti-Hib (≥0.15 µg/mL), and anti-polio 3 (≥8 1/dil) and at least 95.8% of participants for anti-D (≥0.01 IU/mL), anti-HB (≥10 mIU/mL), and anti-polio 1 and 2 (≥8 1/dil). For the pertussis antigens, pre-booster antibody persistence (≥2 EU/mL) ranged from 88.6 to 88.7% (anti-PT), 91.4-98.6% (anti-FHA), 69.0-74.3% (anti-PRN), and 97.1-97.2% (anti-FIM). For the booster response, seroprotection based on either the primary series or measles-containing vaccination regimen was 100.0% for anti-D and anti-T (≥0.01 IU/mL and ≥0.10 IU/mL), anti-HB (≥10 mIU/mL and ≥100 mIU/mL), anti-Hib (≥0.15 µg/mL and ≥1 µg/mL) and anti-polio 1, 2, and 3 (≥8 1/dil), and for the pertussis antigens booster response ranged from 88.6 to 91.8% (anti-PT), 91.1-95.9% (anti-FHA), 88.6-93.9% (anti-PRN), and 95.9-98.6% (anti-FIM). There were no safety concerns in any group. Conclusions: This study showed good antibody persistence of the DTwP-IPV-HB-PRP∼T vaccine and good immunogenicity and safety of a booster dose given with MMR in the second year of life.Clinical Trials Registry India Number: CTRI/2018/04/013375.

Safety and immunogenicity of a hexavalent DTwP-IPV-HB-PRP∼T vaccine versus separate DTwP-HB-PRP∼T and IPV vaccines in healthy infants in India.

Background: Multivalent vaccines containing whole-cell pertussis (wP) antigens combined with established diphtheria (D), tetanus (T), hepatitis B (HB), Haemophilus influenzae type b (Hib), and inactivated poliomyelitis (IPV) antigens allow the provision of a high-quality, affordable DTwP-IPV-HB-PRP∼T vaccine. Methods: Phase I/II, randomized, active-controlled, open-label study in healthy toddlers (Cohort I) and infants (Cohort II). Toddlers in Cohort I who had completed primary series D, T, P, HB, Hib, and polio vaccination received a booster dose of DTwP-IPV-HB-PRP∼T (N = 30) or DTwP-HB-PRP∼T + IPV (N = 15) vaccines at 15-18 months of age. After satisfactory review of safety data in Cohort I, infants in Cohort II received DTwP-IPV-HB-PRP∼T (N = 100) or DTwP-HB-PRP∼T + IPV (N = 50) at 6-8, 10-12, and 14-16 weeks of age. All infants in Cohort II had received previous oral polio and HB vaccines per country recommendations. Results: Booster and primary series vaccinations were well tolerated with no clinically significant differences between vaccine groups. Most adverse events were mild and resolved spontaneously; there were no vaccine-related serious adverse events and no deaths. In both vaccine groups, anti-D, anti-T, anti-HB, anti-Hib, and anti-polio 1, 2, and 3 seroprotection was 100% post-booster and post-primary series. For the pertussis antigens, booster response rate was > 86% in both groups. For the primary series, vaccine response rate was slightly higher for DTwP-IPV-HB-PRP∼T than DTwP-HB-PRP∼T + IPV for anti-PT (80.2% and 70.8%) and anti-FHA (81.3% and 68.8%), slightly lower for anti-PRN (72.5% and 81.3%), and similar in each group for anti-FIM (95.6% and 97.9%). Conclusions: This study demonstrated a good safety and immunogenicity profile of the hexavalent DTwP-IPV-HB-PRP∼T vaccine for infant primary series vaccination at 6-8, 10-12, and 14-16 weeks of age and booster vaccination at 15-18 months of age and supported progression to the next development phase.

Brassica sprouts exposed to microplastics: Effects on phytochemical constituents.

Microplastics (MPs) can affect plant biomass, tissue composition, and root traits. However, the effects of MPs on the synthesis of secondary metabolites and on the accumulation of bioactive compounds remain poorly studied. The objective of this work was to analyze accumulation of bioactive compounds in broccoli and radish sprouts grown hydroponically in a substrate containing seven different toxic amounts (from very low to extremely high) of low-density polyethylene (PE). Radish was more severely affected by microplastic pollution than broccoli. The effect on the phytochemical composition was statistically significant in both species compared to control. In this aspect, glucosinolate (GSL) content was negatively affected by MPs decreasing from 182 to 124 mg 100 g-1 at medium doses of MPs in broccoli, whereas these compounds drastically decreased from 253 to 151 mg 100 g-1 at the same doses in radish. Anthocyanin content significantly increased until medium doses of MPs ranging from 6.28 to 11.44 mg 100 g-1 in broccoli whereas in radish was from 2.44 to approximately 4 mg 100 g-1. In addition, other morphological and physiological parameter were considered. The analysis of malondialdehyde (MDA) showed significant effects on broccoli and radish in all the MP treatments. The results revealed that high loads of MPs in the substrate affect growth parameters, lipid peroxidation rate estimated by MDA, and phytochemicals of broccoli and radish sprouts, with differences in response to MPs pollution and intensity between species.

Four-year safety follow-up of the tetravalent dengue vaccine efficacy randomized controlled trials in Asia and Latin America.

OBJECTIVE: Our objective was to describe the risk of hospital admission for virologically confirmed dengue (VCD) and the risk of clinically severe hospitalized VCD occurring up to 4 years after the first dose (years 1 to 4) in three randomized clinical trials comparing tetravalent dengue vaccine with placebo. METHODS: The relative risks (RR) for hospitalized VCD from first dose to year 4 were estimated by year and age-group in individual and combined studies. RESULTS: Overall, from Year 1 to Year 4, 233 and 228 participants had at least one episode of hospitalized VCD in the vaccinated (n = 22 603) and placebo (n = 11 301) groups, respectively (RR = 0.511, 95% CI 0.42-0.62). Among these, 48 and 47 cases, respectively, were classified as clinically severe. In children aged ≥9 years, 88 and 136 participants had at least one episode of hospitalized VCD in the vaccinated (n = 17 629) and placebo (n = 8821) groups, respectively (RR = 0.324; 95% CI 0.24-0.43). In vaccinated participants aged <9 years, particularly in those aged 2-5 years, there were more hospitalized VCD cases compared with the control participants in Year 3 but not in Year 4. The overall RR in those aged <9 years for Year 1 to Year 4 was 0.786 (95% CI 0.60-1.03), with a higher protective effect in the 6-8 year olds than in the 2-5 year olds. CONCLUSIONS: The overall benefit-risk remained positive in those aged ≥9 years up to year 4, although the protective effect was lower in years 3 and 4 than in years 1 and 2.

Terapia de ondas de choque lineales en el tratamiento de la disfunción eréctil / Linear shock wave therapy in the treatment of erectile dysfunction

Introducción: La terapia de ondas de choque lineales (LSWT) es una nueva terapia no invasiva que utiliza ondas de choque de baja intensidad para inducir la angiogénesis local controlada y mejorar significativamente la función eréctil. Objetivo: Evaluar la eficacia de la LSWT en hombres con disfunción eréctil vasculogénica (DE) en un centro de atención de tercer nivel. Material y métodos: Se incluyeron 15 hombres de edades comprendidas entre 45 y 70 años, sexualmente activos con DE vascular leve y moderada, evaluados con el índice internacional de función eréctil (IIEF). El estudio se realizó en 3 etapas: detección, tratamiento y seguimiento. Recibieron 4 sesiones de LSWT semanales (RENOVA®) 5.000 ondas (0,09 mJ/mm2). La función eréctil se evaluó con IIEFF-EF, Perfil del encuentro sexual (SEP) y Cuestionario de evaluación global (GAQ) al mes y a los 6 meses después del tratamiento. Resultados: La tasa de éxito fue del 80% (12/15). Pacientes con DE leve 40% y DE moderada 60%. Se encontró una asociación positiva entre el IIEF-basal (promedio 14,23 pts) y IIEF un mes y 6 meses después del tratamiento (19,69 pts) una diferencia de 5,46 puntos (p < 0,013). Conclusiones: La factibilidad y tolerabilidad de este tratamiento, y sus características potenciales de rehabilitación, hacen que pueda ser una nueva opción terapéutica atractiva para pacientes con DE

Introduction: Linear Shock Wave Therapy (LSWT) is a new noninvasive therapy that uses low-intensity shock waves to induce local angiogenesis promising modality in the treatment of erectile dysfunction (ED). Objective: To evaluate the effectiveness of LSWT in men with vasculogenic erectile dysfunction (ED), in a Tertiary Care Center. Material and methods: Included 15 men aged 45-70 years, sexually active with mild and moderate vascular ED evaluated with the International Index of Erectile Function (IIEF). The study was conducted in three stage: screening, treatment and results. Treatment stage: 4 weekly sessions LSWT (RENOVA ®) 5000 waves (.09 mJ/mm2). Erectile function was assessed with IIEFF-EF, SEP (Sexual Encounter Profile) and GAQ (Global Assessment Questions) at one and six months after treatment. Results: The rate of success was 80% (12/15). Patients with mild ED (6/15) 40% and moderate ED (9/15) 60%. We found a positive association between IIEF-Basal (average 14.23 pts) and IIEF at one month and six months after therapy (19.69 pts) a difference of 5.46 pts. (P < .013). Conclusions: The feasibility and tolerability of this treatment, and rehabilitation potential features, make it this an attractive new treatment option for patients with ED

Linear shock wave therapy in the treatment of erectile dysfunction.

INTRODUCTION: Linear Shock Wave Therapy (LSWT) is a new noninvasive therapy that uses low-intensity shock waves to induce local angiogenesis promising modality in the treatment of erectile dysfunction (ED). OBJECTIVE: To evaluate the effectiveness of LSWT in men with vasculogenic erectile dysfunction (ED), in a Tertiary Care Center. MATERIAL AND METHODS: Included 15 men aged 45-70 years, sexually active with mild and moderate vascular ED evaluated with the International Index of Erectile Function (IIEF). The study was conducted in three stage: screening, treatment and results. Treatment stage: 4 weekly sessions LSWT (RENOVA ®) 5000 waves (.09mJ/mm(2)). Erectile function was assessed with IIEFF-EF, SEP (Sexual Encounter Profile) and GAQ (Global Assessment Questions) at one and six months after treatment. RESULTS: The rate of success was 80% (12/15). Patients with mild ED (6/15) 40% and moderate ED (9/15) 60%. We found a positive association between IIEF-Basal (average 14.23 pts) and IIEF at one month and six months after therapy (19.69 pts) a difference of 5.46 pts. (P<.013). CONCLUSIONS: The feasibility and tolerability of this treatment, and rehabilitation potential features, make it this an attractive new treatment option for patients with ED.

[Septic knee arthritis caused by Pseudomonas aeruginosa after anterior cruciate ligament reconstruction in an adolescent athlete]. / Artritis de rodilla por Pseudomonas aeruginosa posterior a reconstrucción de ligamento cruzado anterior en un adolescente deportista.

Anterior cruciate ligament reconstruction is a very frequent procedure. Postoperative infection after this procedure is a catastrophic, although infrequent, complication. According to the literature, it occurs in less than 1% of all reconstructions done in the United States. We present herein a case report of septic arthritis of the posterior knee associated with anterior cruciate ligament reconstruction.

Do cranial subdural hematomas migrate to the lumbar spine?

We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH.

Juvenile hormone synthesis: "esterify then epoxidize" or "epoxidize then esterify"? Insights from the structural characterization of juvenile hormone acid methyltransferase.

Juvenile hormones (JHs) play key roles in regulating metamorphosis and reproduction in insects. The last two steps of JH synthesis diverge depending on the insect order. In Lepidoptera, epoxidation by a P450 monooxygenase precedes esterification by a juvenile hormone acid methyltransferase (JHAMT). In Orthoptera, Dictyoptera, Coleoptera and Diptera epoxidation follows methylation. The aim of our study was to gain insight into the structural basis of JHAMT's substrate recognition as a means to understand the divergence of these pathways. Homology modeling was used to build the structure of Aedes aegypti JHAMT. The substrate binding site was identified, as well as the residues that interact with the methyl donor (S-adenosylmethionine) and the carboxylic acid of the substrate methyl acceptors, farnesoic acid (FA) and juvenile hormone acid (JHA). To gain further insight we generated the structures of Anopheles gambiae, Bombyx mori, Drosophila melanogaster and Tribolium castaneum JHAMTs. The modeling results were compared with previous experimental studies using recombinant proteins, whole insects, corpora allata or tissue extracts. The computational study helps explain the selectivity toward the (10R)-JHA isomer and the reduced activity for palmitic and lauric acids. The analysis of our results supports the hypothesis that all insect JHAMTs are able to recognize both FA and JHA as substrates. Therefore, the order of the methylation/epoxidation reactions may be primarily imposed by the epoxidase's substrate specificity. In Lepidoptera, epoxidase might have higher affinity than JHAMT for FA, so epoxidation precedes methylation, while in most other insects there is no epoxidation of FA, but esterification of FA to form MF, followed by epoxidation to JH III.

[Orthotopic liver transplantation. Experience in the University Hospital of Monterrey, N.L]. / Trasplante hepático ortotpico. Experiencia en el Hospital Universitario de Monterrey, N.L.

INTRODUCTION: Several programs of organ and tissues transplantation have been developed for over a decade at the University Hospital. OBJECTIVE: To describe long term complications and survival in the liver transplant program at the University Hospital, UANL. MATERIAL AND METHODS: The long term complications and survival were analyzed in the liver transplant program at the University Hospital Dr. José Eleuterio González in the period between 1991 and 2011. RESULTS: Ninety six liver transplants were performed during this period, four of them received one re-transplant and one patient received 2 retransplants. Most common long term complications were metabolic 62%, bony 31% and infectious 28%. Median survival was 78 months. CONCLUSIONS: Liver transplant program at the University Hospital UANL has grown, being the most active in the state of Nuevo Leon, with 1-, 5- and 10-years survival of 66.1, 53.3 and 46.2%, respectively.

An improved end-point fluorimetric procedure for the determination of low amounts of trypsin activity in biological samples using rhodamine-110-based substrates.

A novel end-point fluorimetric procedure based on the use of rhodamine-110-labeled specific substrate was developed to determine trypsin activities in biological samples. We evaluated the ability of trichloroacetic acid and acetic acid to stop the enzymatic reaction without hindering the detection of the fluorescence of rhodamine-110 released into the reaction mixture from the specific substrate (CBZ-L-alanyl-L-arginine)(2)-rhodamine-110. Trichloroacetic acid decreased markedly the fluorescence of rhodamine-110, even at low concentrations. On the other hand, the addition of 50 mmol/l acetic acid inactivated efficiently trypsin activity, causing minor effects on rhodamine-110 fluorescence. The proposed procedure was more sensitive than the spectrophotometric end-point method using N-alpha-benzoyl-DL-arginine-p-nitroanilide as substrate. The possibility of carrying out end-point fluorimetric assays improves the performance of monocell fluorimeters by setting specific conditions optimal for each enzyme activity independently of the fluorimeter. This method also allows replicate assays to be conducted simultaneously, resulting in considerable time saving and in increased performance of low-cost equipment.

Reconstrucción funcional de las secuelas de las fracturas del astrágalo / Functional reconstruction of the sequelae of talar fractures

Introducción. Cada vez son más frecuentes los traumatismos del tobillo o retropié en las que está involucrado el astrágalo, que en muchos casos pueden conducir a importantes secuelas que afecten permanente a la capacidad de caminar. Ello se debe a que el astrágalo se relaciona con tres articulaciones esenciales: tobillo, subastragalina y astrágalo- escafoidea; que precisan de una exacta reducción, lo que no siempre se obtiene, por lo que casi inevitablemente se producirá artrosis, deformidad o malalineamiento del pie, con incapacidad dolorosa permanente.Objetivos. El objetivo es salvar las articulaciones del tobillo y la subastragalina, lo que en su conjunto denominamos «articulación universal del retropié», manteniendo siempre que sea posible su funcionalidad armónica para adaptar el pie a la forma del terreno, así como equilibrar el funcionamientomuscular mediante el alargamiento del tendón deAquiles. A pesar de la complejidad de muchos de los casostratados, hemos encontrado que siempre han existido opciones de reconstrucción, por lo que consideramos que deben evitarse de manera primaria la talectomía o la artrodesis del tobillo o subastragalina, ya que provocarían el deterioro del resto de las articulaciones del pie y de la pierna.Conclusiones. En las pseudoatrosis y consolidaciones viciosas es eficaz la reconstrucción mediante osteotomías, injertos y osteosíntesis estables. En los casos en que no pueda salvarse la función, como necrosis avascular o artrosis avanzada, puede emplearse una prótesis de tobillo. Otra alternativade transición sería realizar una artrodesis del mismoo una artrodesis doble del retropié para, en un plazo nosuperior a 10 años y evitando así el deterioro del resto de articulaciones del pie, reconvertir la fusión y colocar una prótesis de tobillo, cuando el paciente tuviera una edad propicia para ello. En los casos de necrosis extensas, y sobre todo en jóvenes, estaría indicada la prótesis de astrágalo. En las secuelasde fracturas neuropáticas hemos tenido buenos resultadosrealizando reconstrucciones mediante amplias artrodesisy osteosíntesis muy rígidas que mejoran el brazo depalanca

Introduction. There is a growing incidence of ankle orhindfoot injuries that involve the talus. In many cases these can result in severe sequelae that permanently hinder the individual’s ability to walk. This is due to the fact that the talus is related with three essential joints, i.e. the ankle, the subtalar joint and the talo-navicular joint, which require an accurate reduction. However, as such a reduction is not alwaysachieved the inevitable consequence is osteoarthritisand foot deformity or malalignment that cause pain and permanent disability.Purpose. The aim is to salvage the ankle and subtalar joints, which make up what we normally call universal joint. Whenever possible the harmonious function of these structures should be preserved to adapt the foot to the shape of the terrain during ambulation and to balance the functioning of the muscles by means of a lengthening of the Achilles tendon.In spite of the complexity of most of the cases treated,we have observed that there have always been reconstruction options, which in our point of view indicates that tenotomies and ankle or subtalar arthrodeses should be avoided as a first choice since they will impair the remaining joints of the foot and the ankle.Conclusions. In nonunions and malunions, reconstructioncan be achieved through osteotomies, grafting and stable osteosynthesis. In cases in which function cannot be preserved, such as avascular necrosis or the advanced stages of osteoarthritis, an ankle prosthesis can be used. Another transitional alternative would be carrying out either an ankle arthrodesis or a double hindfoot arthrodesis and subsequently, after a period that must not exceed 10 years to avoid impairingthe remaining joints in the foot, reconvert the fusion and implant an ankle prosthesis in cases in which the patient is of the right age. In the presence of extensive necrosis, especially in young individuals, a talar prosthesis would be indicated.We have had very good results in sequelae of neuropathicfractures, where we have performed our reconstructionsby means of extensive arthrodesis and very rigidosteosynthesis that improve the patient’s lever arm

Reconstrucción funcional de las secuelas de las fracturas del astrágalo / Functional reconstruction of the sequelae of talar fractures

Introducción. Cada vez son más frecuentes los traumatismos del tobillo o retropié en las que está involucrado el astrágalo, que en muchos casos pueden conducir a importantes secuelas que afecten permanente a la capacidad de caminar. Ello se debe a que el astrágalo se relaciona con tres articulaciones esenciales: tobillo, subastragalina y astrágalo- escafoidea; que precisan de una exacta reducción, lo que no siempre se obtiene, por lo que casi inevitablemente se producirá artrosis, deformidad o malalineamiento del pie,con incapacidad dolorosa permanente.Objetivos. El objetivo es salvar las articulaciones del tobillo y la subastragalina, lo que en su conjunto denominamos «articulación universal del retropié», manteniendo siempre que sea posible su funcionalidad armónica para adaptar el pie a la forma del terreno, así como equilibrar el funcionamiento muscular mediante el alargamiento del tendón de Aquiles. A pesar de la complejidad de muchos de los casos tratados, hemos encontrado que siempre han existido opcionesde reconstrucción, por lo que consideramos que debenevitarse de manera primaria la talectomía o la artrodesis del tobillo o subastragalina, ya que provocarían el deterioro del resto de las articulaciones del pie y de la pierna.Conclusiones. En las pseudoatrosis y consolidaciones viciosas es eficaz la reconstrucción mediante osteotomías, injertos y osteosíntesis estables. En los casos en que no pueda salvarse la función, como necrosis avascular o artrosis avanzada, puede emplearse una prótesis de tobillo. Otra alternativa de transición sería realizar una artrodesis del mismoo una artrodesis doble del retropié para, en un plazo nosuperior a 10 años y evitando así el deterioro del resto de articulaciones del pie, reconvertir la fusión y colocar una prótesis de tobillo, cuando el paciente tuviera una edad propicia para ello. En los casos de necrosis extensas, y sobre todo en jóvenes, estaría indicada la prótesis de astrágalo. En las secuelasde fracturas neuropáticas hemos tenido buenos resultadosrealizando reconstrucciones mediante amplias artrodesisy osteosíntesis muy rígidas que mejoran el brazo depalanca

Introduction. There is a growing incidence of ankle orhindfoot injuries that involve the talus. In many cases these can result in severe sequelae that permanently hinder the individual’s ability to walk. This is due to the fact that the talus is related with three essential joints, i.e. the ankle, the subtalar joint and the talo-navicular joint, which require an accurate reduction. However, as such a reduction is not always achieved the inevitable consequence is osteoarthritis and foot deformity or malalignment that cause pain and permanentdisability.Purpose. The aim is to salvage the ankle and subtalar joints, which make up what we normally call universal joint. Whenever possible the harmonious function of these structures should be preserved to adapt the foot to the shape of the terrain during ambulation and to balance the functioning of the muscles by means of a lengthening of the Achilles tendon. In spite of the complexity of most of the cases treated,we have observed that there have always been reconstruction options, which in our point of view indicates that tenotomies and ankle or subtalar arthrodeses should be avoided as a first choice since they will impair the remaining joints of the foot and the ankle.Conclusions. In nonunions and malunions, reconstructioncan be achieved through osteotomies, grafting and stable osteosynthesis. In cases in which function cannot be preserved, such as avascular necrosis or the advanced stages of osteoarthritis, an ankle prosthesis can be used. Another transitional alternative would be carrying out either an ankle arthrodesis or a double hindfoot arthrodesis and subsequently, after a period that must not exceed 10 years to avoid impairing the remaining joints in the foot, reconvert the fusion andimplant an ankle prosthesis in cases in which the patient is of the right age. In the presence of extensive necrosis, especially in young individuals, a talar prosthesis would be indicated. We have had very good results in sequelae of neuropathicfractures, where we have performed our reconstructionsby means of extensive arthrodesis and very rigidosteosynthesis that improve the patient’s lever arm

Pie de Charcot: reconstrucción funcional y procedimientos de rescate / Charcot foot: Its functional reconstruction and salvage

El pie de Charcot se puede definir como una neuroartropatía que conduce a una deformidad y, con frecuencia, a una degeneración progresiva de las articulaciones del pie. Se caracteriza por luxaciones, fracturas, inestabilidad y, en algunos casos, ulceraciones. El tratamiento quirúrgico ha consistido tradicionalmente en la amputación por debajo de la rodilla, pero gracias a una mayor experiencia y conocimiento en la cirugía del pie y del tobillo es posible la reconstrucción en muchos casos. Estaría indicada cuando pueden aparecer o existen ulceraciones, si el pie es inestable, o cuando su morfología impide el uso de un calzado normal. En la mayoría de los casos, el realineamiento y la fusión del tobillo, la articulación subastragalina, astragaloescafoidea y posiblemente de otras articulaciones de la columna medial es lo más adecuado. A esto hay que añadir el alargamiento del gemelo o del tendón de Aquiles, ya que una excesiva flexión plantar es con frecuencia la causa que inicia la desestructuración de la parte media del pie, que es el área más afectada. Puede ser necesaria la resección de las prominencias plantares para prevenir la ulceración por una excesiva presión. Proporciona resultados satisfactorios cuando ha ocurrido una fusión espontánea en la parte dorsal de la prominencia. De lo contrario la resección conduce generalmente a un mayor colapso y a la recidiva de dichas prominencias y/o ulceraciones

Charcot foot can be defined as a neuroarthropathy leading to foot deformity and often progressive degeneration. It is frequently evidenced by dislocations and fractures, instability and, in some cases, ulceration. When surgery is considered, the traditional approach for most cases has been below-knee amputation, but as greater experience is gained in foot and ankle reconstruction procedures, the salvage of these feet has become a possibility. Charcot foot reconstruction is indicated when the soft tissues are at risk, the foot is unstable or the shape of the foot prevents it fitting into a normal shoe. In most cases, realignment and fusion of the ankle, subtalar, talonavicular, and possibly of other medial column joints is necessary, along with a gastroc slide or Achilles tendon lengthening as excessive plantar flexion is often the initiating force for breakdown in the midfoot, the most commonly affected area. Resection of plantar prominences may be needed to prevent ulceration from high pressure. This is successful when autofusion has occurred above the prominence; without fusion, resection is generally followed by more significant collapse and recurrence of prominences and/or ulceration

Análisis del Estrés Laboral y Estrés Oxidativo en profesionales de un servicio de Urgencias Hospitalarias / Occupational and Oxidative Stress in professionals of an Urgency Service

Fundamento: El ritmo de vida laboral actual, las exigenciasde determinados cargos y el grado de implicación profesionalse consideran factores básicos en la etiología de numerosaspatologías propias del envejecimiento.OBJETIVODeterminar estrés oxidativo y envejecimiento en profesionalescon elevado estrés laboral, analizando la influencia de factoressociodemográficos, laborales y el estilo de vida.MÉTODOSSe analizaron 70 profesionales del Servicio de Urgencias delHospital Gregorio Marañon de Madrid. Todos ellos cumplimentaronun cuestionario de características sociodemográficas, laboralesy estilo de vida. En todos se determinó la actividad de dos enzimasantioxidantes superóxido dismutasa (SOD) y catalasa (CAT)y los niveles de malondialdehído (MDA). El análisis estadísticoincluye “t” de Student, test de Kolmogorov-Smirnov y ANOVA. RESULTADOSAspectos sociodemográficos: los parámetros analizadosvarían en función de la edad, pero no por sexo, estado civil,número de hijos o procedencia. Aspectos laborales: mayor actividadenzimática (SOD y CAT) y niveles más altos de MDA enprofesionales del Servicio Urgencias que en grupo control. Influyenla categoría profesional, nivel de estudios, antigüedad en laprofesión y el estilo de vida.CONCLUSIONESEn profesionales sometidos a elevado estrés laboral seobserva un incremento del estrés oxidativo que podría desencadenartrastornos propios del envejecimiento

Background: The stressing conditions of nowadays working life,the specific requirements associated to several professions andthe level of personal implication at work are considered importantfactors in the aetiology of many pathologies related to aging.OBJECTIVETo determine oxidative stress and aging in professionalswhich are under high occupational stress, analysing the influenceof sociodemographic and occupational factors and life style.METHODS70 professionals of Urgency Service of Gregorio MarañonHospital took part in the study. A general questionnaire of sociodemographic,occupational and life style characteristics wasused. Superoxide dismutase (SOD), catalase (CAT) and malondialdehyde(MDA) were determined. The statistical analysisincluded: the Student “t” test, the Kolmogorov-Smirnov test andthe ANOVA. RESULTSAs far as sociodemographic aspects are concerned: theparameters analyzed vary with age, but not with sex, maritalstatus, number of children or place of birth. As for occupationalaspects: higher enzymatic activity (SOD and CAT) and MDAlevels were found in Urgency Service professionals as comparedwith the control group. Professional category, educationallevel and life style had an influence on those levels.CONCLUSIONSAn increase in oxidative stress is observed in professionalsunder high occupational stress. This increase could lead to agerelateddiseases

Comparative genomics of insect juvenile hormone biosynthesis.

The biosynthesis of insect juvenile hormone (JH) and its neuroendocrine control are attractive targets for chemical control of insect pests and vectors of disease. To facilitate the molecular study of JH biosynthesis, we analyzed ESTs from the glands producing JH, the corpora allata (CA) in the cockroach Diploptera punctata, an insect long used as a physiological model species and compared them with ESTs from the CA of the mosquitoes Aedes aegypti and Anopheles albimanus. The predicted genes were analyzed according to their probable functions with the Gene Ontology classification, and compared to Drosophila and Anopheles gambiae genes. A large number of reciprocal matches in the cDNA libraries of cockroach and mosquito CA were found. These matches defined known and suspected enzymes of the JH biosynthetic pathway, but also several proteins associated with signal transduction that might play a role in the modulation of JH synthesis by neuropeptides. The identification in both cockroach and mosquito CA of homologs of the small ligand binding proteins from insects, Takeout/JH binding protein and retinol-binding protein highlights a hitherto unsuspected complexity of metabolite trafficking, perhaps JH precursor trafficking, in these endocrine glands. Furthermore, many reciprocal matches for genes of unknown function may provide a fertile ground for an in-depth study of allatal-specific cell physiology. ESTs are deposited in GenBank under the accession numbers DV 017592-DV 018447 (Diploptera punctata); DR 746432-DV 747949 (Aedes aegypti); and DR 747950-DR 748310 (Anopheles albimanus).

Safety and immunogenicity of a pentavalent combination vaccine (diphtheria, tetanus, acellular pertussis, polio, and haemophilus influenzae type B conjugate) when administered as a fourth dose at 15 to 18 months of age.

A DTaP-IPV//PRP-T combination vaccine (Pentacel) has been universally used in Canada to provide immunization against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b with single injections at 2, 4, 6 and 18 months of age. This randomized, multicenter study was conducted to evaluate administration of a fourth dose of DTaP-IPV//PRP-T at 15 to 18 months of age, similar to the US immunization schedule. Participants who had received three doses of DTaP-IPV//PRP-T by 8 months of age were enrolled at 12 months and randomized to receive a fourth dose at 15, 16, 17 or 18 months. Antibody levels for each vaccine antigen were measured prior to and four weeks following booster vaccination. Overall, 1782 subjects were immunized and monitored for adverse events, and 735 were evaluated for immune responses. Preimmunization antibody levels differed minimally by age, for all antigens. The immune responses elicited by DTaP-IPV//PRP-T were comparable between participants vaccinated at 15 or 16 months and those vaccinated at 17 or 18 months, as demonstrated by specific antibody geometric mean titers, seroprotection/seroresponse rates, and reverse cumulative distribution curves. The fourth dose was well tolerated in all age groups. Toddlers at 15, 16, 17 or 18 months of age are equally suitable recipients for booster immunization with the DTaP-IPV//PRP-T vaccine.

Artroplastia de tobillo en el siglo XXI. Un avance en reconstrucción articular / Ankle arthroplasty in 21st century. One step forward in the joint reconstruction

Introducción. La artroplastia de tobillo es un método que se utiliza de nuevo, después de haber sido prácticamente abandonado por los malos resultados obtenidos al final de los años ochenta, como el tratamiento más idóneo de la artrosis de esta articulación. Revisión de la bibliografía. Su técnica es difícil puesto que requiere un buen conocimiento del funcionamiento del pie y tobillo, ya que la falta de corrección de lesiones asociadas en el pie como en el alineamiento de la tibia pueden provocar el fracaso del implante. Por ello, además de la técnica quirúrgica se analizan los procedimientos que hay que añadir a la artroplastia para conseguir devolver la funcionalidad a esta parte del miembro inferior. También se estudian las indicaciones y técnicas de revisión de la artroplastia de tobillo o de transformación de artrodesis en artroplastia. Resultados y conclusiones. Los resultados de las series de prótesis puestas son muy satisfactorios, por lo que a la vista de éstos es necesario cambiar las indicaciones de tratamiento de los procesos degenerativos que afectan al tobillo, implantando prótesis de nueva generación y reservando la artrodesis para indicaciones similares a otras articulaciones (rodilla y cadera) (AU)

Midgut exopeptidase activities in Aedes aegypti are induced by blood feeding.

Midgut extracts from Aedes aegypti females exhibited hydrolytic activities against synthetic substrates for carboxypeptidase A, carboxyopeptidase B and leucine-aminopeptidase. The three activities showed a broad pH optimum, with maximum activities at pH between 6.5 and 8.5. Enzymatic activities were further characterized by testing the effects of a variety of protease inhibitors. Captopril and 1-10-phenantroline inhibited the activities of carboxypeptidases A and B, while leuhistin, amastatin and bestatin inhibited aminopeptidase activity. Exopeptidase activities were induced by a blood meal and the highest activities were found during the peak of trypsin activity, about 20-24h after feeding. An amino acid meal failed to induce significant increases in any of the three exopeptidase activities. The amounts of exopeptidase activities induced were proportional to the protein concentration of the meal. The addition of soy-trypsin inhibitor to the protein meal blocked the post-feeding induction of exopeptidases. The features of the induction of synthesis of the three exopeptidase activities resembled the induction of synthesis of late trypsin during the second phase of digestion.