Evolución de los pacientes con insuficiencia cardiaca aguda secundaria a infarto agudo de miocardio tratados con ventilación mecánica no invasiva / Outcome of patients with acute heart failure secondary to acute myocardial infarction treated with noninvasive mechanical ventilation

Introducción y objetivos: La ventilación no invasiva (VNI) es capaz de reducir la necesidad de intubación endotraqueal y la mortalidad de los pacientes con insuficiencia cardiaca aguda (ICA). Sin embargo, de muchos de los ensayos clínicos se ha excluido a los pacientes con ICA secundaria a síndrome coronario agudo o infarto agudo de miocardio (SCA-IAM). El objetivo de este estudio es comparar la efectividad de la VNI entre pacientes con ICA desencadenada por SCA-IAM y por otras causas. Métodos: Estudio prospectivo de cohortes, durante un periodo de 20 años, de todos los pacientes con ICA tratados con VNI ingresados en una unidad de cuidados intensivos. Se agrupó a los pacientes por la presencia o ausencia de SCA-IAM como causante del evento de ICA. Se definió el fracaso de la VNI por la necesidad de intubación endotraqueal o muerte. Resultados: Se analizó a 1.009 pacientes, 403 (40%) con SCA-IAM y 606 (60%) con otras etiologías. La VNI fracasó en 61 casos (15,1%) del grupo de SCA-IAM y 64 (10,6%) del grupo sin SCA-IAM (p=0,031), sin diferencias en la mortalidad hospitalaria (el 16,6 y el 14,9%; p=0,478). Conclusiones: El SCA-IAM como causa desencadenante de la ICA no influye en el pronóstico de los pacientes con insuficiencia respiratoria aguda que precisan asistencia respiratoria no invasiva (AU)

Introduction and objectives: Noninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. Methods: Prospective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. Results: A total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478). Conclusions: The presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support (AU)

Comparison of different diluents based on liposomes and egg yolk for ram semen cooling and cryopreservation.

BACKGROUND: Sperm cryopreservation is an important tool for breed improvement, nonetheless, spermatozoids of rams are extremely sensitive to cryopreservation. AIMS: The present research was to compare a liposome-based (OptiXcell: OX) diluent, a commercial TRIS-egg yolk (Optidyl: OP) and a citrate egg yolk-based (CY) diluent on ovine semen quality through the cryopreservation process. METHODS: Semen was collected from four sexually mature Dorper rams during the natural breeding season. After collection, semen was evaluated and diluted in OX, OP or CY diluent and was cooled from 37°C to 4°C for 2 h (refrigerated semen, RS), after that semen-filled straws were placed in liquid nitrogen (LN) vapour for 10 min, then immersed into LN at -196°C (cryopreserved semen, CS) and stored until evaluation. RESULTS: For fresh semen (FS), similar values (P>0.05) were obtained from the 3 diluents [motility (4.2 ± 0.3), viability (75.4 ± 3.2), hypo-osmotic swelling test (HOST) (59.2 ± 2.1), and normality (84.7 ± 3.5)]. The motility values were higher for RS with OX and CY (4.0 ± 0.2 and 3.6 ± 0.3, respectively) compared to OP (3.0 ± 0.21; P<0.05). The viability was reduced after refrigeration and freezing (P<0.05). Refrigerated semen viability was similar for OX (65%), CY (63%) and OP diluents (60%; P>0.05), but for frozen semen, viability was lower in the CY diluent (P<0.05). Membrane integrity (HOST) in OX (53.6 ± 1.7) was similar to that in OP (50.7 ± 1.5; P>0.05) but higher than in CY (48.7 ± 1.5; P<0.05). CONCLUSION: No difference was found between the OX diluents and those made with egg yolk in terms of sperm parameters; however, the OX diluent was more efficient in protecting the integrity of membrane in freezing/thawing semen.

Un nuevo concepto para un antiguo dolor: «carpalgia», dolor en la muñeca / A new concept for an old pain: 'carpalgia'; pain in the wrist

Objetivo. Se pretende proponer a la comunidad científica de cirugía ortopédica, traumatología y médica en general el uso de un nuevo término para describir semiológicamente el dolor musculoesquelético de muñeca. Hallazgos. Es frecuente en el campo médico el uso términos de raíces grecolatinas. El resultado obtenido se expresa en el neologismo «carpalgia», definiéndose así como el dolor musculoesquelético de la región de la muñeca. Conclusiones. El uso de otros términos relacionados con dolor musculoesquelético al nivel del hombro (omalgia), rodilla (gonalgia), metatarso (metatarsalgia), columna vertebral (cervicalgia, dorsalgia, lumbalgia) o la cadera (coxalgia) han demostrado su importancia mediante su aplicabilidad en distintas publicaciones médicas de los últimos años. Sustentados por la gran cantidad de casos que acuden a la consulta médica, la aplicación del termino carpalgia facilitará la comunicación científica. Así como la publicación y la búsqueda de nuevos trabajos relacionados con el tema. El uso de este neologismo obtendrá resultados a futuro favorables y confiables al estar sustentados por el presente trabajo. Por supuesto, es de prever que, como todo proceso de universalización, revisión o actualización involucre la participación de las sociedades médicas y del gremio mismo para su progresiva inclusión (AU)

Objective. The idea of this article is to propose to the general use of a new term to semiologically describe musculoskeletal wrist pain. Findings. The use of terms with Greco-Latin roots is common in the medical field. The result is expressed in the newly coined word (neologism) 'carpalgia', defined as musculoskeletal pain in the region of the wrist. Conclusions. The use of other terms related to musculoskeletal pain of the shoulder (omalgia), knee (gonalgia), metatarsus (metatarsalgia), spine (cervicalgia, lumbalgia), or hip (coxalgia) terms have demonstrated their importance through their applicability in different medical journals in recent years. Supported by the large number of cases that are seen by doctors, the application of the term 'carpalgia' is an aid to scientific communication, as well as the publication and search for new article related to the topic. The use of this neologism will obtain favourable and reliable results on being supported by this work future. Of course, it is expected that like any process of universalisation, a review or update will involve the participation of medical societies and the members themselves for its gradual inclusion (AU)

A new concept for an old pain: "Carpalgia"; pain in the wrist. / Un nuevo concepto para un antiguo dolor: «carpalgia¼, dolor en la muñeca.

OBJECTIVE: The idea of this article is to propose to the general use of a new term to semiologically describe musculoskeletal wrist pain. FINDINGS: The use of terms with Greco-Latin roots is common in the medical field. The result is expressed in the newly coined word (neologism) "carpalgia", defined as musculoskeletal pain in the region of the wrist. CONCLUSIONS: The use of other terms related to musculoskeletal pain of the shoulder (omalgia), knee (gonalgia), metatarsus (metatarsalgia), spine (cervicalgia, lumbalgia), or hip (coxalgia) terms have demonstrated their importance through their applicability in different medical journals in recent years. Supported by the large number of cases that are seen by doctors, the application of the term "carpalgia" is an aid to scientific communication, as well as the publication and search for new article related to the topic. The use of this neologism will obtain favourable and reliable results on being supported by this work future. Of course, it is expected that like any process of universalisation, a review or update will involve the participation of medical societies and the members themselves for its gradual inclusion.

In vitro effect of sodium fluoride on antioxidative enzymes and apoptosis during murine odontogenesis.

Excessive fluoride ingestion has been identified as a risk factor for fluorosis and oxidative stress. The oxidative stress results from the loss of equilibrium between oxidative and antioxidative mechanisms that can produce kinase activation, mitochondrial disturbance and DNA fragmentation, resulting in apoptosis. Actually many people are exposed to no-adverted fluoride consumption in acute or chronic way. The aim of this study was to determine the effect of sodium fluoride on first molar germ in relation to its effect on antioxidative enzymes immunoexpression and apoptosis. Thirty first molar germs from 1-day-old Balb/c mice were cultured for 24 h with sodium fluoride (0 mM, 1 mM and 5 mM). Immunoexpression determination of CuZnSod, MnSod, catalase, Bax, Bid, caspase 8, caspase 9, caspase 3 and TUNEL assay were performed. Cellular disorganization in ameloblast and odontoblast-papilla zones was observed. CuZnSod and MnSod immunoexpression decrease in experimental groups. Caspase 8, caspase 3, Bax, Bid increase expression and more TUNEL positive cells in both experimental groups than control, suggest that apoptosis induced by fluoride is related to oxidative stress due to reduction of the enzymatic antioxidant.

Predictores clínicos y mamográficos de infiltración neoplásica de la piel en el cáncer de mama / Clinical and mammographic predictors of neoplastic infiltration of the skin in breast cancer

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Regulation of Cbl phosphorylation by the Abl tyrosine kinase and the Nck SH2/SH3 adaptor.

The Cbl proto-oncogene product is tyrosine phosphorylated in response to a wide variety of stimuli. Cbl and the Abl nonreceptor tyrosine kinase both bind to SH3 domains from the SH2/SH3 adaptor Nck, and are candidate effectors for Nck function. Numerous additional SH2- and SH3-domain-mediated interactions are also possible between Cbl, Abl, and Nck. We find that these three signaling proteins associate when overexpressed in mammalian cells and can regulate each other's activity. Co-expression of wt Cbl together with c-Abl, the activity of which is normally repressed in vivo, led to extensive Abl-dependent phosphorylation of Cbl. The major proline-rich region of Cbl was required for its phosphorylation by c-Abl, but not by a constitutively activated Abl mutant, suggesting Cbl activates c-Abl by engaging its SH3 domain. Efficient phosphorylation of Cbl and its stable association with Abl required the SH2 domain of Abl, suggesting that SH2-phosphotyrosine interactions prevent dissociation of active Abl from Cbl. We also show that overexpression of Nck could repress the phosphorylation of Cbl by Abl in vivo. Studies with Nck mutants suggested that the Nck SH2 domain is responsible for inhibiting the activity of Abl toward both Cbl and Nck itself, most likely by competing with the Abl SH2 for tyrosine-phosphorylated binding sites.

Abl family kinases and Cbl cooperate with the Nck adaptor to modulate Xenopus development.

We previously showed that overexpression of the Nck Src homology (SH) 2/SH3 adaptor in Xenopus embryos induced developmental defects including anterior truncation and mesoderm ventralization. Mutagenic analysis indicated that this was due to relocalization of endogenous proteins that bind the first two SH3 domains of Nck. We therefore screened a Xenopus expression library with Nck SH3 domains to identify Nck-interacting proteins, and evaluated candidate binding proteins for a potential role in Nck-induced anterior truncation/ventralization. Of 39 binding proteins analyzed, only the Abl-related kinase Arg and the Cbl proto-oncogene product bound preferentially to the first two SH3 domains in tandem compared with the individual domains, consistent with a role in the developmental phenotype. High level overexpression of c-Abl or Arg alone induced anterior truncation, as did lower levels of an activated form of Abl; Cbl alone had no effect. In a sensitized system where subthreshold amounts of a ventralizing Nck mutant were expressed, co-expression of the combination of Abl or Arg and Cbl at modest levels strongly potentiated anterior truncation, while Arg, Abl, or Cbl alone were without effect. These results suggest a role for both Cbl and Abl family kinases in patterning the Xenopus embryo.

Tumor filodes de mama. Análisis de 22 casos / Phyllodes tumor of the breast. Analysis of 22 cases

Introducción y objetivos. El tumor filodes es una neoplasia infrecuente de la mama cuyo tratamiento, en lo que se refiere a la extensión de la exéresis, es aún objeto de controversia. Se analizan los resultados obtenidos en una serie de pacientes portadoras de esta neoplasia que hemos tenido oportunidad de tratar. Pacientes y método. Entre 1986 y 1997 fueron diagnosticadas y remitidas al servicio de cirugía de nuestro centro 22 pacientes portadoras de tumor filodes de mama. Retrospectivamente, fueron analizados los datos correspondientes a edad, localización y dimensiones del tumor, así como las características histológicas de benignidad o malignidad, el tratamiento efectuado (exéresis local frente a mastectomía) y el período libre de la enfermedad tras la intervención. Resultados. La edad media fue de 48 años (rango, 36-77). El tumor se localizó más frecuentemente en los cuadrantes superoexternos (15 casos) y sus dimensiones eran inferiores a 5 cm en 7 pacientes; entre 5-10 cm en 13 pacientes y mayor de 10 cm en 2 casos. Fueron clasificados como benignos 14 nódulos y como malignos 7 casos, no pudiéndose determinar en un caso. Fueron practicadas 12 exéresis locales (11 benignos y uno maligno) y 10 mastectomías (6 malignos, 3 benignos y uno indeterminado). Solamente una paciente falleció durante el seguimiento, a los 5 meses de habérsele practicado una mastectomía. El carácter de benignidad o malignidad se relacionó con el tamaño (p = 0,03). Sin embargo, no se encontraron diferencias significativas entre la recidiva y la histología y el tratamiento efectuado (tumorectomía frente a mastectomía). Conclusiones. Los tumores filodes de mama, independientemente del tipo de exéresis practicada, presentan un pronóstico bueno a largo plazo. Se hace necesaria la realización de estudios controlados prospectivos para evaluar el tipo de cirugía ideal (AU)

Lipidemia en 150 cordones umbilicales para detectar un factor de riesgo coronario. / Lipidemia in 150 umbilical cords to detect a coronary risk factor

Se establecen las concentraciones de colesterol, trigliceridos, fosfolipidos, acidos grasos libres y lipoproteinas en un primer grupo de 100 recien nacidos (55 varones, 45 mujeres) considerados clinicamente normales, no habiendose podido demostrar la existencia de diferencias en los valores entre ambos sexos. Por medio del estudio lipidico determinado en un segundo grupo de 50 cordones ubilicales se pudo confirmar, mediante el metodo de las "rectas de alerta" y "rectas de accion" la validez estadistica de la cifra del colesterol asi como de los trigliceridos plasmaticos. En este segundo grupo se determinaron, ademas, el colesterol transportado por la alfa-lipoproteina (HDL) y beta-lipoproteina (LDL). Los valores hallados en la sangre del cordon umbilical de ambos grupos son muy inferiores a los que se encuentran en etapas mas avanzadas de la vida. Debido al hecho de que la frecuencia de las alteraciones del transporte lipidico caracteristica de la hiperlipoproteinemia de tipo IIa alcanzo una cifra del 4%, se concluye que seria conveniente estudiar la lipidemia del cordon umbilical en los recien nacidos, especialmente en aquellos de "alto riesgo" que presenten historia familiar positiva para aterosclerosis precoz o muerte subita y/o evidencias de alteraciones del transporte lipidico en uno o ambos progenitores

Lipidemia en 150 cordones umbilicales para detectar un factor de riesgo coronario. / Lipidemia in 150 umbilical cords to detect a coronary risk factor

Se establecen las concentraciones de colesterol, trigliceridos, fosfolipidos, acidos grasos libres y lipoproteinas en un primer grupo de 100 recien nacidos (55 varones, 45 mujeres) considerados clinicamente normales, no habiendose podido demostrar la existencia de diferencias en los valores entre ambos sexos. Por medio del estudio lipidico determinado en un segundo grupo de 50 cordones ubilicales se pudo confirmar, mediante el metodo de las "rectas de alerta" y "rectas de accion" la validez estadistica de la cifra del colesterol asi como de los trigliceridos plasmaticos. En este segundo grupo se determinaron, ademas, el colesterol transportado por la alfa-lipoproteina (HDL) y beta-lipoproteina (LDL). Los valores hallados en la sangre del cordon umbilical de ambos grupos son muy inferiores a los que se encuentran en etapas mas avanzadas de la vida. Debido al hecho de que la frecuencia de las alteraciones del transporte lipidico caracteristica de la hiperlipoproteinemia de tipo IIa alcanzo una cifra del 4%, se concluye que seria conveniente estudiar la lipidemia del cordon umbilical en los recien nacidos, especialmente en aquellos de "alto riesgo" que presenten historia familiar positiva para aterosclerosis precoz o muerte subita y/o evidencias de alteraciones del transporte lipidico en uno o ambos progenitores