Facial Paralysis, Modification to Labbé Technique.

Background: Facial paralysis is one of the conditions that affect functionally, emotionally and aesthetically to patients greatly. Multiple techniques have been described for its treatment, and we consider that Labbé's technique is the one that most surprises with its results. Materials and Methods: In the Specialty Hospital "Dr. Bernardo Sepúlveda" National Medical Center Century XXI (CMN SXXI), Mexican Institute of Social Security (IMSS), three cases are presented: patients with facial paralysis due to trauma, surgical damage on the VII cranial nerve and conditions due to otological and idiopathic infections. Four modifications to the original Labbé technique are proposed to execute it more easily: trans-zygomatic oblique osteotomy, to reach directly the coronoid process; osteotomy of the descending coronoid; radiated suture fixation at 180° for temporary muscle replacement with positional replacement of the sutures trans-operatively; and the next day of the intervention with the patient awake, fixation of the orbicularis muscle of the lips, to the temporal tendon previously referenced. The modifications and results obtained are shown. Results: The modifications offer a better surgical technique and very favorable results. Conclusions: The modification to Labbé technique gives excellent results in the treatment of permanent facial paralysis, improving facial symmetry, salivary incontinence, facial tone, improving speech, giving the patient movement on the affected side and the ability to smile again.

Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer.

Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.

[Prophylactic application of medicated calcium sulphate in uncemented total hip prosthesis]. / Aplicación profiláctica de sulfato de calcio medicado en prótesis total de cadera no cementada.

The increase in total hip arthroplasty occurs by many factors, such as increasing life expectancy, improving surgical technique as well as innovating the design and implant material. However, despite technological advances, peri-prosthetic infection has remained one of the most devastating complications. This study evaluates the prophylactic application of calcium sulfate pearls medicated in the femoral canal and acetabular surface to prevent peri-prosthetic infections in patients who underwent total uncemented primary hip arthroplasty against a control group by measuring acute phase reactants. 146 patients, 67 were applied calcium sulfate pearls medicated and 79 prophylactic antibiotic intravenous in the period from 2013 to 2016. To perform the diagnosis of peri-prosthetic infection was assessed PCR associated with VSG, communication between fistula and prostheses and positive culture in 2 or more different sites. There was a decrease in the values of acute-phase reactants in patients who were given calcium sulfate pearls. 14 patients presented infection in the control group and 3 in the study group. The prophylactic use of calcium sulphate pearls within the medullary canal and acetabular surface is an option for the prophylaxis of peri-prosthetic infections, however the study deserves follow-up with more patients.

El incremento en la cirugía de artroplastía total de cadera es motivado por muchos factores, como el aumento en la expectativa de vida, mejoría continua en la técnica quirúrgica e innovaciones en el diseño y los materiales de los implantes que, sumados, han convertido a este procedimiento en una solución efectiva a la degeneración articular, con excelentes resultados. Sin embargo, a pesar de los avances tecnológicos, la infección periprotésica se ha mantenido como una de las complicaciones más devastadoras. Este estudio evalúa la aplicación profiláctica de perlas de sulfato de calcio medicadas en el canal femoral y superficie acetabular para prevenir infecciones periprotésicas en pacientes que fueron sometidos a una artroplastía total de cadera primaria no cementada contra un grupo control mediante la medición de reactantes de fase aguda y cultivo de líquido sinovial. Se sometieron al estudio 146 individuos: 67 a quienes se les aplicaron perlas de sulfato de calcio medicado y 79 a quienes se les aplicó antibiótico profiláctico intravenoso de Septiembre de 2013 a Agosto de 2016. Como método diagnóstico de infección periprotésica temprana se evaluaron la proteína C reactiva asociada a velocidad de sedimentación globular aumentada, una fístula que comunicara con la prótesis, cultivo positivo de dos o más sitios periprotésicos de líquido sinovial o tejido. Los resultados clínicos demostraron que hubo una disminución en los valores de los reactantes de fase aguda en los sujetos a quienes se les aplicaron las perlas de sulfato de calcio medicado. Se encontró que 14 personas presentaron infección en el grupo con profilaxis parenteral, comparado con tres del grupo con profilaxis local con perlas de sulfato de calcio medicado; ambos grupos con ceftriaxona. Se consideró que el uso profiláctico de perlas de sulfato de calcio dentro de canal medular y la superficie acetabular es una buena opción para prevenir infecciones periprotésicas en quienes han sido sometidos a una artroplastía total de cadera primaria no cementada; sin embargo el estudio amerita seguimiento con más pacientes para tener significancia estadística.

Correlation of radiological and immunochemical parameters with clinical outcome in patients with recurrent glioblastoma treated with Bevacizumab.

BACKGROUND: Some phase 2 trials had reported encouraging progression-free survival with Bevacizumab in monotherapy or combined with chemotherapy in glioblastoma. However, phase 3 trials showed a significant improvement in progression free survival without a benefit in overall survival. To date, there are no predictive biomarker of response for Bevacizumab in glioblastoma. METHODS: We used Immunochemical analysis on tumor samples and pretreatment and post-treatment perfusion-MRI to try to identify possible predictive angiogenesis-related biomarkers of response and survival in patients with glioblastoma treated with bevacizumab in the first recurrence. We analyzed histological parameters: vascular proliferation, mitotic number and Ki-67 index; molecular factors: MGMT promoter methylation, EGFR amplification and EGFR variant III; immunohistochemical: MET, Midkine, HIF1, VEGFA, VEGF-R2, CD44, Olig2, microvascular area and microvascular density; and radiological: rCBV. RESULTS: In the statistical analysis, no significant correlation of any histological, molecular, microvascular or radiological parameters could be demonstrated with the response rate, PFS or OS with bevacizumab treatment. CONCLUSION: Unfortunately, in this histopathological, molecular, immunohistochemical and neuroradiological study we did not find any predictive biomarker of response or survival benefit for Bevacizumab in glioblastoma.

Correction to: SEOM clinical guideline for treatment of kidney cancer (2017).

The conflict of interest declaration was published incorrectly in the original version.

Modified Le Fort III Osteotomy: Different Applications.

SUMMARY: Based on the new concepts of the modified Le Fort III osteotomy (MLFIIIO), Three variations of this technique are implemented: (A) the modified osteotomy Le Fort III Champy (1980) technique to be described with the use of surgical guides, and subciliary approach or an transconjunctival approach. Excellent technique for horizontal advancement no further to 6 mm, without requiring any type of graft.. (B) The modified Le Fort III osteotomy in "Z": to solve horizontal (posterior anterior) problems of more than 6 mm without bone grafting. It is itself a modification of the technique described by Champy. (C) The modified Le Fort III osteotomy ascending: modified the original technique described by Bell and Epker with interpositional grafts, was modified by the called ascendant, making it higher in cases where the patient has an acceptable nasal bridge, but exorbitism the lateral wall of the orbit. Le Fort III osteotomy combined with a Le Fort I osteotomy and a front implant. METHOD: As pointed out in Part I for the modified oblique Le Fort III osteotomy, methods for the design of the osteotomy Le Fort III property will depend on the requirements of individual patients, and this has led us to design specific techniques for the deformity. RESULTS: Patients have a right projection of the middle third, and protection of the eyeball. CONCLUSIONS: The techniques presented for the advancement of the middle third have excellent results with the ability to be tailored to each patient deformity.

Correction to: SEOM clinical guideline of diagnosis and management of low-grade glioma (2017).

The original version of this article unfortunately contained a mistake. Figure 3 was incorrect.

SEOM clinical guideline of diagnosis and management of low-grade glioma (2017).

Diffuse infiltrating low-grade gliomas include oligodendrogliomas and astrocytomas, and account for about 5% of all primary brain tumors. Treatment strategies for these low-grade gliomas in adults have recently changed. The 2016 World Health Organization (WHO) classification has updated the definition of these tumors to include their molecular characterization, including the presence of isocitrate dehydrogenase (IDH) mutation and 1p/19p codeletion. In this new classification, the histologic subtype of grade II-mixed oligoastrocytoma has also been eliminated. The precise optimal management of patients with low-grade glioma after resection remains to be determined. The risk-benefit ratio of adjuvant treatment must be weighed for each individual.

SEOM clinical guideline for treatment of kidney cancer (2017).

The goal of this article is to provide recommendations about the management of kidney cancer. Based on pathologic and molecular features, several kidney cancer variants were described. Nephron-sparing techniques are the gold standard of localized disease. After a randomized trial, sunitinib could be considered in adjuvant treatment in high-risk patients. Patients with advanced disease constitute a heterogeneous population. Prognostic classification should be considered. Both sunitinib and pazopanib are the standard options for first-line systemic therapy in advanced renal cell carcinoma. Based on the results of two randomized trials, both nivolumab and cabozantinib should be considered the standard for second and further lines of therapy. Response evaluation for present therapies is a challenge.

[Clinical and radiographic evaluation of a new percutaneous technique for moderate to severe hallux valgus deformity]. / Evaluación clínica y radiográfica de una nueva técnica percutánea para la corrección de la deformidad en hallux valgus moderada a severa.

Hallux valgus is considered the most common musculoskeletal deformity, with a prevalence of 88%. There are more than 130 surgical techniques for its treatment; currently, percutaneous ones are popular; however, they do not take into account the metatarsal-phalangeal correction angle. The aim of this study is to propose a modified technique for the correction of the percutaneous metatarsal-phalangeal and inter-metatarsal angles and to evaluate its clinical and radiological results. MATERIAL AND METHODS: An experimental, prospective and longitudinal study in 10 patients with moderate to severe hallux valgus according to the classification of Coughlin and Mann were collected; the results were evaluated with the AOFAS scale at 15, 30, 60 and 90 days. The McBride technique and the technique of percutaneous anchor with the proposed amendment were performed. RESULTS: The AOFAS scale was applied as described, finding a progressive increase of the rating; the average correction of the inter-metatarsal angle was 8.8 degrees and of the metatarsal-phalangeal, 9.12. DISCUSSION: The modified technique of percutaneous anchor showed clear clinical and radiographic improvements in the short term. Our modified technique is proposed for future projects, including a large sample with long-term follow-up.

El hallux valgus es considerado la deformidad del aparato locomotor más frecuente, con una prevalencia de 88%. Existen más de 130 técnicas quirúrgicas para su tratamiento; actualmente se encuentra de moda el uso de técnicas de anclaje percutáneas; sin embargo, no toman en cuenta la corrección del ángulo metatarsofalángico. El objetivo del siguiente estudio es mostrar la técnica modificada de anclaje percutáneo con corrección del ángulo metatarsofalángico e intermetatarsiano, así como la evaluación clínica y radiológica. Material y métodos: Se realizó un estudio experimental, prospectivo y longitudinal en una muestra de 10 pacientes con el diagnóstico de hallux valgus moderado a severo según la clasificación Coughlin y Mann; se evaluaron los resultados con la escala de AOFAS a los 15, 30, 60 y 90 días. Se realizaron las técnicas de McBride y de anclaje percutáneo con la modificación propuesta. Resultados: La escala AOFAS mostró un aumento progresivo de la puntación; la corrección media del ángulo intermetatarsiano fue de 8.8 grados y del metatarsofalángico, 9.12. Discusión: La técnica modificada de anclaje percutáneo mostró evidente mejoría clínica y radiográfica en el seguimiento de los pacientes, lo que comprueba que es una técnica aceptable a mediano plazo. Nuestra técnica modificada se desarrollará como una línea de investigación a futuro con un mayor número de pacientes y seguimiento a largo plazo.

Risk factors associated with milk fever occurrence in grazing dairy cattle.

The aim of this study was to determine risk factors associated with milk fever (MF) occurrence in Costa Rican grazing dairy cattle. A total of 69,870 cows from 126 dairy herds were included in the study. Data were collected in the Veterinary Automated Management and Production Control Program software by the Population Medicine Research Program of the Veterinary Medicine School, National University of Costa Rica, from 1985 to 2014. To determine the risk factors for MF, 2 logistic regression mixed models were evaluated. The first model used breed, month of calving, ecological life zone, herd nested within ecological life zone, and parity as fixed effects. The second model excluded first-lactation animals and cows without production information, had the same fixed effects of the first model, and added previous MF case, previous lactation length, previous dry period length, previous corrected 305-d milk yield, and calving interval length as fixed effects. Both models used animal and year as random effects. Of the 235,971 recorded lactations, 4,312 (1.83%) reported MF event. The significantly associated risk factors for MF occurrence, ranked by their highest odds ratio (OR), were parity (OR = 52.59), previous dry period length (OR = 4.21), ecological life zone (OR = 3.20), breed (OR = 3.04), previous corrected 305-d milk yield (OR = 2.39), previous MF case (OR = 2.35), and month of calving (OR = 1.36). The findings of this study are the first data reported using an epidemiological approach to study risk factors for MF in Costa Rican dairy cattle. Some of these results might be used to improve preventive management practices at the farms to reduce the incidence of this metabolic disease in grazing dairy herds.

Antimicrobial and anti-inflammatory activities, wound-healing effectiveness and chemical characterization of the latex of Jatropha neopauciflora Pax.

ETHNOPHARMACOLOGICAL RELEVANCE: Jatropha neopauciflora Pax is an endemic species to Mexico, and its latex is used in traditional medicine to treat mouth infections when there are loose teeth and to heal wounds. In this research, we evaluated the antimicrobial activity, wound healing efficacy and chemical characterization of J. neopauciflora latex in a murine model. MATERIALS AND METHODS: The antibacterial activity was determined using Gram positive and negative strains, the antifungal activity was determined using yeast and filamentous fungi, and the wound healing efficacy of the latex was determined using the tensiometric method. The anti-inflammatory activity was evaluated using the plantar oedema model in rats, administering the latex orally and topically. Cytotoxic activity was determined in vitro in two different cell lines. Antioxidant capacity, total phenolics, total flavonoids, reducing carbohydrates and latex proteins were quantified. The latex analysis was performed by High Performance Liquid Chromatography (HPLC). Finally, molecular exclusion chromatography was performed. RESULTS: The latex demonstrated antibacterial activity. The most sensitive strains were Gram positive bacteria, particularly S. aureus (MIC=2mg/mL), and the latex had bacteriostatic activity. The latex did not show antifungal activity. The latex demonstrated a wound-healing efficacy, even the positive control (Recoveron). The orally administered latex demonstrated the best anti-inflammatory activity and was not toxic to either of the 2 cell lines. The latex had a high antioxidant capacity (SA50=5.4µg/mL), directly related to the total phenolic (6.9mg GAE/mL) and flavonoid (12.53µg QE/mL) concentration. The carbohydrate concentration was 18.52µg/mL, and fructose was the most abundantly expressed carbohydrate in the latex (14.63µg/mL, 79.03%). Additionally, the latex contained proteins (7.62µg/mL) in its chemical constitution. As secondary metabolites, the HPLC analysis indicated the presence of phenols and flavonoids. CONCLUSIONS: The J. neopauciflora latex promotes the wound healing process by avoiding microorganism infections, inhibiting inflammation and acting as an antioxidant.

New clinical trials regulation in Spain: analysis of royal decree 1090/2015.

The coming into force of Directive 2001/20/EC represented a step forward in harmonising clinical trial regulation in European countries, guaranteeing a uniform protection of subjects participating in clinical research across Europe. However, it led to a disproportionate increase in the bureaucratization, and thus, it became evident that procedures needed to be simplified without detriment to patient's safety. Thus, Regulation 536/2014, that repealed Directive 2001/20/EC, with the aim of decreasing the growing bureaucratization and stimulating clinical research in Europe, established simplified procedures, such as regulating a common procedure for authorising trials in Europe, the institution of strict assessment timelines, or the definition of new concepts, such as "low-intervention clinical trial". The legal form of a Regulation allowed the norm to be directly applied to Member States without the need for transposition. By means of the new Royal Decree, the national legislation is adapted to make the application of the regulation feasible and it allows the development of the aspects that the Regulation leaves to national legislation. Both documents seek to stimulate clinical research with medicinal products to foster knowledge, facilitate transparency, and reinforce subjects' safety. This will surely be the case, but with this revision, we will look at the novelties and key aspects that are most relevant to investigators and we will analyse the consequences for all parties involved in clinical research.

Haptoglobin and serum amyloid A in subacute ruminal acidosis in goats / Haptoglobina y proteína amilóide sérica A en acidosis ruminal subaguda en cabras

Ruminal acidosis is a frequent disorder that occurs in goats as a consequence of feedingmistakes in animals not adapted to a diet of easily fermentable carbohydrates. The subacuteform of the disease is difficult to diagnose because no apparent signs are shownand the acid-base parameters may remain within the normal range. The present studyaimed at testing the hypothesis that haptoglobin (Hp) and serum amyloid A (SAA), the two major acute phase proteins in ruminants, may be useful as markers of subacuteacidosis in goats.A subacute acidosis was induced in six Murciano-Granadina goats through a diet of60% mixed feed-40% alfalfa hay offered during 5 days to goats not adapted to eatmixed feed. Two goats were rumen-fistulated to investigate the effect of feeding onruminal pH. Sampling of blood and urine of all animals was done before the inductionof the acidosis, during 5 days after the onset of induction and for 18 days after theinduction (recovery period). Ruminal pH in the fistulated goats dropped to less than 5.5 during the inductionperiod, and half of the goats had diarrhea on the third day after the induction of acidosis. Acid-base parameters showed that the acid-base compensatory mechanisms wereefficient in maintaining the equilibrium. Serum Hp had a moderate increase duringthe induction period, while SAA did not change. These results suggest that Hp mightbe a potential marker for ruminal acidosis in goats.

La acidosis ruminal es un trastorno frecuente en cabras como consecuencia de errores en el manejo alimentario en animales no adaptados a dietas que contienen carbohidratos fácilmente fermentables. La forma subaguda de la enfermedad es de difícil diagnóstico toda vez que no muestra evidencia de signos clínicos claros y los parámetrosácido-básicos pueden permanecer en el rango normal. El presente estudio tuvo porobjetivo probar la hipótesis de que la haptoglobina y la proteína amilóide sérica A, las dos proteínas de fase aguda más importantes en rumiantes, pueden ser útiles como marcadores de acidosis subaguda en cabras. Se indujo acidosis ruminal a seis cabras de la raza Murciano-Granadina, no adaptadas al consumo de concentrado, mediante el suministro de una dieta con 60% de concentradoy 40% de heno de alfalfa durante 5 días. Dos cabras fueron sometidas a fistulaciónruminal para comprobar el efecto del tratamiento sobre el pH del rumen. A todos los animales se les tomaron muestras de sangre y orina el día anterior a la inducción,durante el período de inducción y hasta 18 días después de la inducción (período de recuperación). El pH ruminal cayó a menos de 5,5 durante el período de inducción de acidosis en lascabras fistuladas, mientras que la mitad de las cabras tuvieron diarrea al tercer día de la inducción de acidosis. Los parámetros gasométricos indicaron que los mecanismoscompensatorios fueron eficientes para mantener el equilibrio ácido-básico. La haptoglobinasérica presentó un aumento moderado durante el período de inducción de acidosis,mientras que la amilóide sérica A no presentó cambios. Los resultados sugierenque la haptoglobina puede utilizarse como un potencial indicador de acidosis ruminalen cabras.

Body condition and protein supplementation positively affect periovulatory ovarian activity by non LH-mediated pathways in goats.

Effects of rumen undegradable intake protein (UIP) supplementation on ovarian activity and serum insulin, GH, and LH were evaluated in goats having low or high body condition (BC). Goats with either low BC (n=16, 28.7+/-0.8 kg BW, BC=2.1+/-0.3) or high BC (n=16, 38.4+/-0.8 kg, BC=3.2+/-0.3) received, during 40-days, one of the two protein supplementation levels: without UIP or with UIP (120 g goat(-1)d(-1)). Oestrus was synchronized with two i.m. doses of PGF(2alpha), and jugular blood samples were collected from 36 to 42 h after the second prostaglandin injection at 15 min intervals. Serum concentrations of insulin, LH, and GH were measured The number of preovulatory follicles and the number of corpora lutea (CL) were evaluated by transrectal ultrasonography at 1 and 4 days after the second prostaglandin dose, respectively. Does with higher BC had more CL than those in the lower condition group (2.8+/-0.2 versus 1.8+/-0.2, P<0.05). Similarly, goats receiving UIP supplementation had more follicles (2.6+/-0.2 versus 1.9+/-0.2, P<0.05) and tended to have more CL (2.6+/-0.2 versus 2.0+/-0.2, P=0.05) than does not receiving UIP. Neither BCS nor UIP supplementation affected serum GH or LH concentrations, pulsatility, or area under the curve. High BC does produced more insulin (1.92+/-0.17 versus 0.81+/-0.17 ng/mL, P<0.01 ng/mL) than lower BC goats; the same for UIP-supplemented (1.69+/-0.18 versus 1.04+/-0.18, P<0.05). Results suggest that the increased ovarian activity observed in both UIP-supplemented and higher BC goats was not the result of changes in LH or GH, suggesting effects at a local level, through changes in insulin in a non-GnRH-gonadotrophin dependent manner.

Tomographic findings in traumatic globe evulsion caused by blunt head trauma.

Evulsion of the globe as a result of trauma is a rarity; to the best of our knowledge, only four "evulsions of the globe" have been described. We present the case of a 35-year-old Hispanic woman with traumatic evulsion of the right eye and subarachnoid haemorrhage. The management of brain injury was the priority over preservation of globe structures. We briefly describe the tomographic features of this uncommon situation and the proposed "evulsion" mechanism.

Infliximab in Hispanics: characterization of response to infliximab in an ethnic minority with Crohn's disease

PURPOSE: The incidence and prevalence of Crohn's disease (CD) varies geographically and with racial/ ethnic background. The highest frequency of occurrence is in North America and Northern Europe. Incidence is highest among Caucasians, lower in blacks and Hispanics, and lowest in Asians. However in the mid-1980s and 1990s, the incidence and prevalence increased in continental Europe, the Middle East, the Pacific Rim, Africa, and Latin America. An increase in the incidence of CD has been noted in Puerto Rico, although our population differs genetically from other described CD populations. A study in our population showed lower prevalence of ASCA and no NOD2 in our CD patients. Infliximab, a TNFa antibody, is effective in refractory inflammatory CD and in fistulizing disease. Since limited data exists regarding CD in Hispanics, the fastest growing minority group in the United States, we designed this retrospective study with patients treated with infliximab at our institution. We wanted to determine if the response to infliximab in genetically admixed Hispanics differed from that previously reported. METHODS: Baseline characteristics, infusion related information and clinical response was abstracted from medical records. Clinical response was classified as complete response, partial response, and nonresponse. RESULTS: The study included 15 patients treated for refractory inflammatory disease, 9 for fistulizing disease, and 11 for both. The positive response rate was 83%(29/35) and the non response rate was 17%(6/35). Overall the patients with complete, partial, and no response were 13/35(37%), 16/35(46%), and 6/ 35(17%), respectively. No statistically significant association was found between response and disease location. Significant association was found between response and fistula type (p = 0.02). Steroid withdrawal was possible in 21/31 patients (68%). In terms of safety, 9/35 patients (26 %) suffered an adverse reaction, 4 patients required therapy discontinuation. CONCLUSION: This study suggests that infliximab has similar global response, allowance of steroid withdrawal and safety in Hispanics as in other populations. Ethnicity does not seem to influence response rate to infliximab.

Fish oil (n-3) polyunsaturated fatty acids beneficially affect biliary cholesterol nucleation time in obese women losing weight.

It has been reported that intake of (n-3) polyunsaturated fatty acids (PUFA) reduces the risk of coronary heart disease and decreases biliary cholesterol saturation in the bile of gallstone patients. We investigated the effect of n-3 PUFA on cholesterol saturation index (CSI) and nucleation time (NT) in obese subjects who were losing weight. This was a double-blind, placebo-controlled clinical trial. Obese women (n = 35) with a body mass index (BMI) > or = 30 kg/m(2), with no prior history of gallstones or cholecystectomy by ultrasound were first studied to ensure absence of stones or biliary sludge. The women were then assigned to a hypocaloric regimen [5.02 MJ (1200 kcal)/d] and to receive 1200 mg/d of ursodeoxycholic acid (UDCA), 11.3 g/d of (n-3) PUFA or a placebo for 6 wk. BMI, CSI and NT were recorded at baseline and at the end of the experimental period. BMI decreased 5.75 +/- 2.7%/mo (range, 1.5-12.42%/mo) during the experiment. The CSI did not change in any of the groups. Cholesterol NT decreased significantly in the UDCA and placebo groups, but not in the (n-3) PUFA group. None of the women had developed gallstones at 6 wk. These results suggest that (n-3) PUFA maintain the CSI and NT in obese women during rapid weight loss, which probably results in the prevention of cholesterol gallstone formation.

The relation between hyperventilation and pediatric syncope.

OBJECTIVE: The objective was to evaluate prospectively the role of hyperventilation in the development of neurocardiogenic syncope in children during head-upright tilt testing (HUTT). STUDY DESIGN: Tilt testing was performed in 34 children (mean age 10.6 years) with clinical suspicion of syncope. Respiratory rate and end-tidal carbon dioxide pressure were continuously monitored during HUTT. RESULTS: Tilt test was negative in 12 cases; 3 (25%) patients of this group exhibited hyperventilation any time during the test. In the remaining 22 cases the HUTT was positive, and 15 (68.2%) patients of this group exhibited hyperventilation at the onset of clinical symptoms and during syncope. In the positive HUTT group, the mean time elapsed from the tilt to the onset of syncope and the mean time elapsed from the onset of clinical symptoms to syncope (latency time) were significantly longer for patients who hyperventilated than for those who did not hyperventilate, (21.8 vs 11.5 minutes) (P =.002) and (78 vs 51 seconds) (P =.04), respectively. CONCLUSIONS: Spontaneous hyperventilation could play a relevant role in the pathophysiology of pediatric neurocardiogenic syncope, and it could point out a specific subtype of response to orthostatic stress in susceptible patients. We suggest the inclusion of capnography in tilt-test protocols could improve the assessment of syncope in children.