Estudio de los procedimientos de anesthesia en CMA utilizados en Área III y IV de la comunidad de Cantabria en 2013-2014 / Study of anesthesia in ambulatory surgery procedures used in área III y and IV of the community of Cantabria

Los aspectos anestésicos de la Cirugía Mayor Ambulatoria (CMA) no suelen detallarse con precisión en las estadísticas oficiales de actividad sanitaria. Generalmente en España y en sus distintas comunidades autónomas se conoce la actividad quirúrgica ambulatoria, pero sin proporcionar datos anestésicos. Se recogieron las técnicas anestésicas administradas para procedimientos quirúrgicos en régimen de CMA de las distintas especialidades llevadas a cabo en el área III y IV del SCS durante los años 2013 y 2014. Se analizaron la actividad anestésica en primer lugar, y su relación con el ASA (escala de riesgo anestésico) en segundo lugar. De manera global, se observa un claro predominio de la Vigilancia Anestésica Monitorizada (VAM), que representa un 65% de la casuística. Esta técnica anestésica es la de elección en los procedimientos de oftalmología (especialidad con un peso importante en el total de pacientes de CMA), y con comorbilidades asociadas. La segunda técnica más utilizada fue la Anestesia General (AG) alrededor del 23% presentando porcentajes similares la técnica de AG con intubación orotraqueal respecto a la mascarilla laríngea. La suma de las anestesias locorregionales supuso un 10% del total, resultando la anestesia intradural la variedad más utilizada con un 6,8 y 7% respectivamente durante los años 2013 y 2014. La elección de la técnica anestésica se hará en función del paciente, de la intervención y de nuestra propia capacidad organizativa teniendo en cuenta en todo momento el coste-beneficio de los fármacos y del equipo empleados en su desarrollo

Anesthetic aspects of Ambulatory Surgery (AS) tend not precisely detailed in the official statistics of health activity. Usually in Spain and its different regions ambulatory surgical activity is known, but without providing data anesthetics. They administered anesthetic techniques for surgical procedures in the context of the various specialties CMA carried out in the area III and IV of SCS for the years 2013 and 2014 were collected. Anesthetic activity was first analyzed, and their relationship with ASA (scale of anesthetic risk) second. Globally, a clear predominance of Monitored Anesthesia Monitoring (VAM), which represents 65% of casuistry is observed. This is the anesthetic technique of choice in ophthalmology procedures (specialty with an important weight in the total of patients CMA), and comorbidities. The second most used technique was general anesthesia (GA) about 23% presenting similar percentages technique endotracheal intubation AG with respect to the LMA. The sum of regional blocks represented 10% of the total, resulting spinal anesthesia variety most commonly used with 6.8 and 7% respectively for the years 2013 and 2014. The choice of anesthetic technique will be based patient intervention and our own organizational capacity taking into account at all times the cost-effectiveness of drugs and equipment used in its development

A novel obesity model: synphilin-1-induced hyperphagia and obesity in mice.

AIMS: The pathogenesis of obesity remains incompletely understood and the exploration of the role of novel proteins in obesity may provide important insights into its causes and treatments. Here, we report a previously unidentified role for synphilin-1 in the control of food intake and body weight. Synphilin-1, a cytoplasmic protein, was initially identified as an interaction partner of alpha-synuclein, and has implications in Parkinson's disease pathogenesis related to protein aggregation. SUBJECTS AND METHODS: To study the in vivo role of synphilin-1, we characterized a human synphilin-1 transgenic mouse (SP1) by assessing synphilin-1 expression, plasma parameters, food intake and spontaneous activity to determine the major behavioral changes and their consequences in the development of the obesity phenotype. RESULTS: Expression of human synphilin-1 in brain neurons in SP1 mice resulted in increased food intake, body weight and body fat. SP1 mice also displayed hyperinsulinemia, hyperleptinemia and impaired glucose tolerance. Pair-feeding SP1 mice to amounts consumed by non-transgenic mice prevented the increased body weight, adiposity, hyperinsulinemia and hyperleptinemia demonstrating that these were all the consequences of increased food intake. Transgenic expression of synphilin-1 was enriched in hypothalamic nuclei involved in feeding control, and fasting-induced elevated endogenous synphilin-1 levels at these sites, suggesting that synphilin-1 is an important player in the hypothalamic energy balance regulatory system. CONCLUSION: These studies identify a novel function of synphilin-1 in controlling food intake and body weight, and may provide a unique obesity model for future studies of obesity pathogenesis and therapeutics.

Lower albumin levels in African Americans at colon cancer diagnosis: a potential explanation for outcome disparities between groups?

BACKGROUND AND AIM: Colorectal cancer is the third most common cancer and 3rd leading cause of cancer-related death in the USA. African Americans (AA) have inferior outcomes when matched for diagnosis stage and socioeconomic situation. Nutritional status, at diagnosis and its contribution to the observed cancer outcome disparity, between AA and non-Hispanic whites (nHw) has not been evaluated to date. The aim of the investigation was to determine if differences in nutritional surrogate markers, such as serum albumin and body mass index (BMI), exist at the time of colorectal cancer diagnosis between AA and nHw. METHODS: The University of Florida College of Medicine-Jacksonville endoscopy database was reviewed for all patients with a biopsied colorectal mass between January 2000 and December 2007. Patients were excluded if histology did not reveal colorectal adenocarcinoma or albumin/BMI was unavailable. Demographic data, tumor location, serum albumin within 60 days of diagnosis, presence of diabetes along with serum HbA1c were obtained. RESULTS: During the study period, 321 patients had colorectal masses discovered and 156 met entry criteria. There was no difference between ethnic groups regarding gender distribution, tumor location, diabetes presence, or BMI. Mean albumin was significantly less in AA compared to nHw (p < 0.01). This persisted after adjustment for gender, presence/absence of diabetes, and BMI. CONCLUSIONS: Lower albumin levels in AA indicate poorer nutritional status at colorectal cancer diagnosis compared to nHw. This may contribute to the outcome disparities observed between AA and nHw. Aggressive nutritional interventions to reverse this disparity should be evaluated.

Palliation of malignant rectal obstruction from invasive prostate cancer with multiple overlapping self-expanding metal stents.

Self-expandable metal stents (SEMS) are used for colonic neoplastic and extracolonic metastatic obstruction relief. Limited data exists on their use for locally invasive prostate cancer. We describe a unique approach using overlapping SEMS to alleviate a rectosigmoid obstruction from locally invasive prostate cancer. A patient with locally advanced prostate cancer presented with obstipation and lymphedema. Placement of overlapping rectosigmoid SEMS was performed, relieving the visualized rectosigmoid obstruction.

AMP-activated protein kinase in the brain.

Since its discovery as an important regulator of fuel utilization in the periphery, AMP-activated protein kinase (AMPK) has become a contender for many important cell-intrinsic and organismal roles regarding energy balance in the central nervous system. The challenge will be to delineate the mechanisms by which neuronal AMPK can respond to cellular energy requirements as well as whole body energy demands. Thus, under physiological conditions in the brain, hypothalamic AMPK responds to changes in energy balance/food intake, whereas under pathological conditions, AMPK responds globally in the brain to energy challenge. Modulation of fatty acid metabolism affects energy balance in a context-specific manner and may provide an insight into other mechanisms for selective activation or inhibition of AMPK activity for therapeutic applications.

Effects of eprosartan on mitochondrial membrane potential and H2O2 levels in leucocytes in hypertension.

We investigated whether circulating leucocytes from hypertensive patients exhibit more spontaneous, stimulated hydrogen peroxide (H2O2) production and greater mitochondrial membrane potential (Deltapsi) than those from normotensive individuals. We also investigated the effects of oral treatment with the angiotensin II (AT II) type 1 receptor blocker eprosartan (600 mg day(-1)) on these markers of oxidative stress. In 25 hypertensive patients and 28 healthy volunteers, spontaneous H2O2 formation was measured by flow cytometry after preincubation of buffy coat-leucocytes from fresh peripheral venous blood at 37 degrees C with 2',7' dichlorofluorescein. Stimulation of H2O2 formation by circulating leucocytes was elicited by the addition of tert-butylhydroperoxide (tBHP). Deltapsi was determined by flow cytometry after the addition of tetramethylrhodamine methyl ester (TMRM). Compared with healthy individuals, lymphocytes from hypertensive patients exhibited higher Deltapsi (12.28+/-3.20 vs 16.25+/-2.88 arbitrary fluorescence units (AFU), respectively; P<0.001) and greater spontaneous H2O2 production (4.75+/-5.15 vs 8.98+/-9.97 AFU, respectively; P<0.05). tBHP stimulation was associated with higher H2O2 levels in circulating leucocytes in patients with uncorrected hypertension than in normotensive individuals. H2O2 overproduction was corrected by eprosartan treatment. These results suggest that oxidative stress could be important in the pathogenesis of hypertension. Furthermore, measurement of leucocyte oxidant activities may be useful for the evaluation of oxidative stress, which may be reduced with the use of antihypertensive drugs. Our results demonstrate that treatment of hypertension with eprosartan normalizes blood pressure and corrects oxidative disturbances, suggesting that leucocytes could be a target for this drug.

Platelet activation and red blood cell phosphatidylserine exposure evaluated by flow cytometry in patients with Behçet's disease: are they related to thrombotic events?

Behçet's disease (BD) is associated with an increased risk of venous and arterial thromboses that are associated with morbidity and mortality increase, although the mechanisms are not well established. In the present study, we used whole blood cytometry to determine the exposure of CD62 on the surface of platelets and the expression of phosphatidylserine (PS) on the surface of circulating red blood cells. Microparticle and microaggregate formation from platelets were also determined in a well-classified group of 72 patients (39 males, 33 females, aged 46.5 +/- 12.5 years) with BD, in comparison with a well-matched control group of 72 healthy volunteers. Results showed no differences in the above-mentioned parameters when BD patients and controls were compared. However, when we compared BD patients with/without thrombosis using these parameters, there were significant differences between both groups. BD patients with previous thrombosis had a higher percentage of circulating CD62-positive platelets and a higher number of circulating microaggregates than those without thrombosis, suggesting that platelet activation may be involved in the development of thrombotic events in these patients.

Utilidad clínica de la citometría de flujo para valorar la activación plaquetaria en diversas patologías / The clinical utility of flow cytometry in the study of platelet activation in pathology

En los últimos años, la citometría de flujo ha experimentado un desarrollo espectacular, que la confirma como una importante tecnología con un gran potencial analítico. Sus principales ventajas derivan del hecho de poder trabajar directamente con sangre entera, sin la activación artefactual plaquetaria que frecuentemente se produce por la manipulación de la muestra, y de poder detectar simultáneamente diversos antígenos en subpoblaciones celulares bien identificadas. Estas características permiten detectar la presencia de plaquetas activadas in vivo, y valorar el efecto in vitro y ex vivo de diversos inhibidores y agonistas sobre la función plaquetaria. Sin embargo, su aplicación al estudio de la activación plaquetaria en la práctica clínica habitual, está lejos de ser un hecho, por lo que parece conveniente revisar el estado actual del tema

Flow cytometry has emerged in the past years as an pivotal technology with a big analytical importance. This technique offers the ability to make analysis of platelets with very little manipulation and also it offers the possibility to study various antigens simultaneously on the platelet surface in whole blood. These characteristics allow to detect subpopulations of platelets activated in vivo and evaluate the effect of inhibitors andagonists in vitro and ex vivo. However, at the moment the clinical utility of flow cytometry in the platelet function study has been not well established and therefore this review describes the current state of this topic

Intracerebroventricular CART peptide reduces food intake and alters motor behavior at a hindbrain site.

Peptides from cocaine- and amphetamine-regulated transcript (CART) reduce food intake in rats when injected into the lateral ventricle. Hypothalamic and hindbrain sites important in the control of feeding contain CART-immunoreactive fibers. To further define the site of CART's anorectic action, we compared feeding and other behavioral responses to third or fourth ventricular (3V, 4V) CART-(55-102) in 6-h food-deprived rats, both before and after cerebral aqueduct occlusion. 3V CART reduced the volume of Ensure consumed and resulted in fewer observations of eating and grooming within the 30-min test session. These reductions were significantly attenuated by aqueduct obstruction. 4V CART suppressed Ensure intake and resulted in decreased observations of feeding both with and without aqueduct blockade. 3V CART produced flat-backed postures and movement-associated tremors that were prevented by aqueduct obstruction. 4V CART also produced these signs, both with and without aqueduct blockade. We conclude that the major hypophagic effect of intracerebroventricular CART is mediated at a hindbrain site. The association of CART-induced feeding suppression with altered motor behavior questions the specificity of intracerebroventricular CART for actions on feeding.

¿Cómo y cuándo utilizar las heparinas en la clínica cardiológica diaria? / How an when to use heparin in clinical practice?

En la actualidad, la heparina no fraccionada y las heparinas de bajo peso molecular, que ejercen su efecto anticoagulante mediante la activación de la antitrombina III, tienen un papel fundamental en el tratamiento de diversas patologías cardíacas. En este artículo revisamos sus mecanismos de acción, características farmacológicas, así como sus indicaciones más comunes en la cardiología diaria: a) síndrome coronario agudo, b) intervencionismo coronario, c) prótesis mecánicas y fibrilación auricular, d) trombosis venosa profunda y tromboembolismo pulmonar. Sin embargo, existen áreas en las que el papel de este grupo farmacológico está por delimitar. En la actualidad, la heparina no fraccionada y las heparinas de bajo peso molecular, que ejercen su efecto anticoagulante mediante la activación de la antitrombina III, tienen un papel fundamental en el tratamiento de diversas patologías cardíacas. En este artículo revisamos sus mecanismos de acción, características farmacológicas, así como sus indicaciones más comunes en la cardiología diaria: a) síndrome coronario agudo, b) intervencionismo coronario, c) prótesis mecánicas y fibrilación auricular, d) trombosis venosa profunda y tromboembolismo pulmonar. Sin embargo, existen áreas en las que el papel de este grupo farmacológico está por delimitar. (AU)

Intracerebroventricular CART peptide reduces rat ingestive behavior and alters licking microstructure.

Intracerebroventricular administration of cocaine- and amphetamine-regulated transcript (CART) peptides reduces food intake and increases c-Fos in brain areas involved in the control of feeding. To discern behavioral mechanisms through which CART alters the microstructure of feeding, we injected CART-(55--102) (0.1, 0.5, 1, 2 microg, and saline controls) into the lateral ventricle of male Sprague-Dawley rats 5 min before dark onset and, using lickometers, monitored the ingestion of an Ensure liquid diet for the first 6 h of dark. At a threshold dose of 1 microg, CART dose dependently 1) decreased intake of Ensure in licks; 2) decreased meal size, but did not alter meal duration or number; 3) reduced initial lick rate of meals; and 4) significantly reduced burst number, licks/burst, and licks/cluster. CART dose dependently increased interlick interval (0.5 microg threshold, 192 +/- 4 vs. 183 +/- 3 ms, control; 1 microg: 201 +/- 1 ms; 2 microg: 214 +/- 6 ms). These data suggest that altered oral motor function, and possibly palatability perception, may be fundamental to the anorexigenic action of CART.

[Effect of cyclooxygenase inhibition on the adaptation of coronary blood flow to tachycardia]. / Efecto de la inhibición de la ciclooxigenasa en la adaptación del flujo coronario a la taquicardia.

BACKGROUND: The role of different endothelium-derived vasoactive substances in the regulation of coronary circulation during tachycardia is not well defined. In order to elucidate the contribution of prostacyclin to the adaptation of coronary blood flow to tachycardia, the effect of meclofenamate, a cyclooxygenase inhibitor on the coronary blood flow response to rapid atrial pacing was analyzed in a porcine model. METHODS: A group of seventeen pigs were instrumented for coronary blood flow, aortic pressure and atrial pacing. Heart rate was increased by 20 beats every 5 minutes. Coronary blood flow and aortic pressure were measured, and coronary resistance calculated, basally and at each pacing interval, before and after saline serum (n = 6), meclofenamate 5 mg/kg, i.v. (n = 7) or meclofenamate 35 mg/kg, i.v. (n = 4). RESULTS: Neither saline nor meclofenamate modified the normal increase of coronary blood flow provoked by rapid atrial pacing (163 +/- 28% increase before versus 172 +/- 29% after saline; 159 +/- 21% increase before versus 161 +/- 22% after meclofenamate low doses and 201 +/- 39% before vs 172 +/- 36 after meclofenamate high doses). There were no differences in the response of coronary vascular resistance to tachycardia before and after meclofenamate (44% reduction vs 40% respectively). CONCLUSION: Cyclooxygenase blockade does not modify the response of coronary circulation to rapid atrial pacing, suggesting that prostacyclin does not play a limiting role in the regulation of coronary blood flow during tachycardia in this model.

Basolateral and central amygdaloid lesions leave aversion to dietary amino acid imbalance intact.

Expression of c-fos is increased in the central amygdaloid nucleus (CE) of rats ingesting a diet with a severely imbalanced essential amino acid profile (IMB), at a time associated with development of a conditioned taste aversion (CTA). The CE and the basolateral amygdaloid nucleus (BL) both are reported to be involved in the development of CTA. Large amygdaloid lesions involving CE and BL mitigate the normal decrease in intake of IMB; this treatment also impairs CTA to a flavor cue associated with gastrointestinal discomfort. To differentiate their potential roles in aversive responses to IMB, we electrolytically lesioned CE and BL separately. Neither lesion attenuated IMB-induced anorexia, or prevented the avoidance of flavored solutions previously paired with IMB. In contrast, after saccharin-LiCl pairing, CE-lesioned animals showed attenuated CTA to saccharin solution in a two-bottle test. We conclude that neither the CE nor the BL is essential for the reduction of IMB intake, or for CTA associated with IMB. Furthermore, these results suggest that the aversive consequences of IMB intake do not involve gastrointestinal malaise-evoked neurotransmission involving the CE.

[In-hospital evolution and current prognosis of unstable angina]. / Evolución hospitalaria y pronóstico actual de la angina inestable.

INTRODUCTION AND PROGNOSIS: The prognosis of patients with unstable angina has improved in recent years resulting in a progressive reduction in hospital stay and treatment. The aim of this study was to know the current prognosis of patients with unstable angina in a non-selected population followed for up to 3 months. PATIENTS AND METHODS: 478 consecutive patients with unstable angina were studied. They were treated following a strict protocol and a management policy guided by symptoms and the results of an exercise test or a pharmacological stress test performed before hospital discharge. RESULTS: The mean age was 66 +/- 11 years with 30% being females. Thirty-five percent had a prior history of myocardial infarction, 61% presented ischemic changes on the admission ECG, and 16% had elevation of the CK-MB plasma levels. An echocardiogram was performed in 80% of the patients, a stress test in 62%, coronary angiography in 51%, and a revascularization procedure in 27% of the patients. During hospitalization, the incidence of mortality or myocardial infarction, refractory angina or ischemic complications was of 3.6%, 11% and 13%, respectively. After hospital discharge and during a 3-month follow-up, the incidence of these complications was of 3.3%, 9% and 10% (NS compared to the in-hospital period). Overall, from the time of hospital admission to the 3-month follow-up, 4.2% of the patients died, 7% died or had an infarction, 20% had refractory angina, and 26% had some ischemic complication. CONCLUSION: The in-hospital prognosis of unstable angina is currently good. However, patients discharged from hospital after stabilization, present an important number of ischemic complications during the following 3 months, similar to that presented by all patients during the acute phase.

DA1 receptor activity opposes anorectic responses to amino acid-imbalanced diets.

The serotonin3 (5-HT3) receptor plays an important role in the aminoprivic feeding model. Other neurochemical systems, including cholecystokinin (CCK) and dopamine (DA), are known to affect food intake. We pretreated rats systemically with tropisetron, a 5-HT3 receptor antagonist, alone and combined with antagonists of DA1 and DA2 receptors, and measured intake of an amino acid-imbalanced diet (IMB). As expected, tropisetron significantly increased intake of IMB. SCH-23390, a DA1 antagonist, increased IMB anorexia. When combined with tropisetron, DA2 antagonism with eticlopride reduced short-term intake of both the basal diet (BAS) and IMB. In the IMB model, specificity of 5-HT3-DA2 interactions, and of 5-HT3-CCK(A) interactions from previous studies, prompted investigation of CCK(A)-DA2 interactions; there appeared to be none. SKF-38393, a DA1 agonist, combined with the CCK(A) receptor antagonist, devazepide, increased BAS and tended to increase IMB intake. Thus, CCK(A)-DA1 interactions were not specific for IMB. These data suggest that DA1 receptor activity opposes IMB anorexia, possibly via an interaction with the 5-HT3 receptor.

CCK(A) and 5-HT3 receptors interact in anorectic responses to amino acid deficiency.

Serotonin3 (5-HT3) receptors in the periphery mediate anorectic responses to the amino acid deficiency, which occurs after eating amino acid-imbalanced diets (IMB). However, other neurochemical systems, notably cholecystokinin (CCK), are known to affect food intake. We pretreated rats systemically with tropisetron, a 5-HT3 receptor antagonist, alone and combined with antagonists of CCK(A) and CCK(B) receptors, and measured intake of an IMB. Devazepide, a CCK(A) receptor antagonist, appeared to interact with tropisetron in the anorectic responses to IMB, blunting the usual remediation of IMB anorexia by tropisetron. The CCK(B) receptor antagonist, L-365, 260, increased intake of both IMB and an amino acid-balanced basal diet (BAS) and did not interact with tropisetron. Our data suggest that activation of CCK(A) receptors is interactive with 5-HT3 receptor activity in mediating IMB anorexia in the aminoprivic feeding model.