Impact of Intrapartum Antibiotic Prophylaxis on Offspring Microbiota.

Infants are born into a world filled with microbes and must adapt without undue immune response while exploiting the microbiota's ability to produce otherwise unavailable nutrients. The process by which humans and microbes establish this relationship has only recently begun to be studied with the aid of genomic methods. Nearly half of all pregnant women receive antibiotics during gestation to prevent maternal and neonatal infection. Though this has been largely successful in reducing early-onset sepsis, we have yet to understand the long-term consequences of antibiotic administration during gestation to developing infants. Studies involving antibiotic use in infants suggest that dysbiosis during this period is associated with increased obesity, allergy, autoimmunity, and chronic diseases in adulthood, however, research around the limited doses of intravenous antibiotics used for intrapartum prophylaxis is limited. In this mini review, we focused on the state of the science regarding the effects of intrapartum antibiotic prophylaxis on the newborn microbial colonization process. Although, the literature indicates that there is wide variety in the specific bacteria that colonize infants from birth, limited parenteral antibiotic administration prior to delivery consistently affects the microbiota of infants by decreasing bacteria in the phylum Bacteroidetes and increasing bacteria in the phylum Proteobacteria, thus altering the normal pattern of colonization that infants experience. Delivery by cesarean section and formula feeding magnify and prolong this effect. Our mini review shows that the impact of intravenous antibiotic administration during gestation has on early colonization, growth, or immune programming in the developing offspring has not been well studied in human or animal models.

Reducing the number of segments in unidirectional MLC segmentations.

In intensity-modulated radiation therapy (IMRT), fluence matrices obtained from a treatment planning system are usually delivered by a linear accelerator equipped with a multileaf collimator (MLC). A segmentation method is needed for decomposing these fluence matrices into segments suitable for the MLC, and the number of segments used is an important factor for treatment time. In this work, an algorithm for reduction of the number of segments (NS) is presented for unidirectional segmentations, where there is no backtracking of the MLC leaves. It uses a geometrical representation of the segmentation output for searching the key values in a fluence matrix that complicate its decomposition. The NS reduction is achieved by performing minor modifications in these values, under the conditions of avoiding substantial modifications of the dose-volume histogram, and does not increase in average the total number of monitor units delivered. The proposed method was tested using two clinical cases planned with the PCRT 3D treatment planning system.

Confirmación de la eficacia de un programa educativo interdisciplinar en pacientes con dolor de espalda crónico / Confirmed effectiveness of an interdisciplinary educational program in patients with chronic back pain

Actualmente, el dolor crónico se contempla no como un fenómeno meramente físico sino como un trastorno claramente influenciado por factores psicológicos y sociales. Si queremos que el tratamiento del dolor se encuentre acorde con esta concepción, deberemos abordar diferentes aspectos tanto médicos, como psicológicos y sociales. Las técnicas a aplicar deberán ser interdisciplinares. En un trabajo realizado durante los años 2001 y 2002, pudimos comprobar la eficacia de un programa interdisciplinar en el tratamiento del dolor de espalda crónico. Con el objetivo de corroborar dicha eficacia mediante un diseño distinto, diseñamos la presente investigación. Material y métodos: Los sujetos fueron 14 pacientes con dolor de espalda crónico. Todos los pacientes asistieron a un programa educativo interdisciplinar en el que se abordaron multitud de aspectos biopsicosociales a través de sesiones impartidas por distintos profesionales (anestesistas, traumatólogos, psicólogos de la salud, sexólogos, trabajadores sociales y fisioterapeutas). La eficacia se evaluó a través de un diseño intrasujetos de medidas repetidas. Concretamente las evaluaciones que se llevaron a cabo fueron cuatro. Dos anteriores al programa, y dos una vez finalizado el mismo. Los periodos temporales entre las evaluaciones fueron de tres meses. En todas las evaluaciones, se midió: el dolor, la ansiedad y la depresión. En la segunda y tercera evaluación, se preguntó sobre la disminución de toma de medicación analgésica. Así mismo en la tercera evaluación, justo al finalizar el programa, se evaluó la opinión de los pacientes acerca del programa. Los resultados apoyan la eficacia del programa ya que se logró disminuir de forma estadísticamente significativa y, en muchos casos, también clínicamente significativa la depresión y la ansiedad. El 35,7 por ciento de los sujetos disminuyó la toma de analgésicos. Los cambios que se lograron a través del programa se mantuvieron transcurridos tres meses después del mismo. La opinión de todos los pacientes respecto a la técnica interdisciplinar fue claramente positiva. Conclusión: Nuestros resultados corroboraron la eficacia del programa demostrada en nuestro estudio anterior. Los resultados de ambas investigaciones apoyando la eficacia del programa, al provenir de diseños diferentes, adquieren mayor solidez (AU)

[Patients with end-stage chronic renal insufficiency on programmed withdrawal from dialysis]. / Pacientes con insuficiencia renal crónica terminal retirados de diálisis bajo protocolización.

UNLABELLED: The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century. The dialysis population is aging and they have multiple medical problems. The choice may be between prolongation of quantity or quality of life. We evaluated a protocol for initiation of dialysis in patients with end stage renal failure and their subsequent withdrawal. We determined the factors predicting withdrawal of dialysis and revised the protocol to take account of these. We carried out an opinion poll of doctors and nurses about the effectiveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years. RESULTS: Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years. Vascular nephropathy is the principal disease predicting withdrawal from dialysis; the main precipitating cause is mental incapacity. The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal calm when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.

Pacientes con insuficiencia renal crónica terminal retirados de diálisis bajo protocolización / Voluntary discontinuation of dialysis

La retirada de diálisis no es motivo de investigación ni de tratamiento habitual en la literatura nefrológica española. Es un tema de debate que conlleva disyuntivas de tipo ético. Su presentación es frecuente actualmente en la clínica diaria. Con la prolongación de expectativas de vida de los pacientes, aumentan los dilemas acerca de la prolongación de esa vida en las mínimas condiciones de calidad.Se comprueba la utilidad de un protocolo de entrada/retirada de pacientes con insuficiencia renal crónica terminal, diseñando los parámetros pronósticos de retirada de diálisis, y revisando los parámetros que inciden en la toma de decisión de esa retirada. Se realiza una encuesta a los profesionales sobre la efectividad del protocolo. Se revisan prospectivamente las causas de muerte acaecidas en los últimos siete años.Los resultados muestran 30 pacientes retirados del total de 116 enfermos fallecidos durante ese tiempo. La nefropatía vascular es la enfermedad que plantea con mayor frecuencia la retirada de diálisis, siendo la causa inmediata la incapacidad mental.La disponibilidad de un protocolo de retirada de diálisis confiere un aceptable grado de satisfacción entre los profesionales y les da tranquilidad moral y tal vez legal, a pesar del vacío existente en ese sentido, ante unas tomas de decisiones eventualmente conflictivas, dado que un 26 por ciento de los fallecimientos son debidos a esa retirada. (AU)

Neurogenesis and neuronal regeneration in the adult reptilian brain.

Evidence accumulated over the last few decades demonstrates that all reptiles examined thus far continue to add neurons at a high rate and in many regions of the adult brain. This so-called adult neurogenesis has been described in the olfactory bulbs, rostral forebrain, all cortical areas, anterior dorsal ventricular ridge, septum, striatum, nucleus sphericus, and cerebellum. The rate of neuronal production varies greatly among these brain areas. Moreover, striking differences in the rate and distribution of adult neurogenesis have been noted among species. In addition to producing new neurons in the adult brain, lizards, and possibly other reptiles as well, are capable of regenerating large portions of their telencephalon damaged as a result of experimentally-induced injuries, thus exhibiting an enormous potential for neuronal regeneration. Adult neurogenesis and neuronal regeneration take advantage of the same mechanisms that are present during embryonic neurogenesis. New neurons are born in the ependyma lining the ventricles and migrate radially through the brain parenchyma along processes of radial glial cells. Several lines of evidence suggest that radial glial cells also act as stem cells for adult neurogenesis. Once they reach their final destination, the young neurons extend axons that reach appropriate target areas. Tangential migration of neurons alongside the ventricular ependyma has also been reported. Most of these tangentially migrating neurons seem to be destined for the olfactory bulbs and are, thus, part of a system similar to the mammalian rostral migratory stream. The proliferation and recruitment of new neurons appear to result in continuous growth of most areas showing adult neurogenesis. The functional consequences of this continuous generation and integration of new neurons into existing circuits is largely conjectural, but involvement of these phenomena in learning and memory is one likely possibility.

An epidemiological comparison of pain complaints in the general population of Catalonia (Spain).

Epidemiological studies help to establish the health status in a country and allow a better allocation of economic resources. This survey estimated pain prevalence in Catalonia (Spain), analysed its relationship with demographic variables and evaluated pain-associated disabilities. The study was carried out in 1964 adults via phone interviews asking about any pain complaint they experienced in the last 6 months, regardless of its intensity and duration. Overall pain prevalence was 78.6%, significantly lower in men, with a trend to decrease with age. Back (50.9%), head (42%) and legs (36.8%) were the most affected locations. Less educated people reported, in general, higher prevalences. Pain described to be most annoying was related to musculoskeletal disease (26.2%) and migraines (16.5%). Pain was either very severe or unbearable in 33% of the sample, with women and older people reporting higher intensities. Personal and social activities were affected in 25.4% of cases and in 10.4% they became virtually impossible. Both the limitation of activity and the need for bed rest, which occurred in 19.6% of those who suffered pain, were more common amongst unemployed people, whereas 10.2% of workers had to take days off work due to pain, and 3.3% were fully incapacitated by it. In conclusion, the prevalence of pain was clearly higher among women, with an inverse relationship to age. Back pain and headaches were most prevalent and pain was rated as very severe to unbearable in one third of the patients. Pain-associated disabilities were a frequent finding. The present survey reports that pain is a substantial problem in the Catalonian population and generally reflects the characteristics of data previously reported in Anglo-saxon and Scandinavian countries.

Postnatal neurogenesis in the telencephalon of turtles: evidence for nonradial migration of new neurons from distant proliferative ventricular zones to the olfactory bulbs.

Postnatal neurogenesis in the the turtle telencephalon was investigated by using bromodeoxyuridine immunocytochemistry and [3H]thymidine autoradiography. Red-eared slider turtles Trachemys scripta elegans (Cryptodira, Emydidae) 2-3 months old were injected with the thymidine analogue 5'-bromodeoxyuridine (BrdU) and allowed to survive for 7, 30, 90, and 180 days. Results indicate that cells in the walls of the lateral ventricles continue to proliferate postnatally. Shortly after BrdU treatment (seven days) most labelled cells were found in the walls of the lateral ventricles (ventricular zone: VZ). Labelled cells were particularly abundant in and around the ventricular sulci. The same pattern of labelling was found in the telencephalon of juvenile turtles (> two years old) injected with BrdU and killed seven day later, suggesting that the proliferative activity continues in the telencephalic VZ of turtles during juvenile stages of life and possibly into adulthood. With longer survival periods after BrdU administration (30, 90, and 180 days), the VZ of the telencephalon showed a similar pattern of labelling to that found at seven days. Furthermore, with survival periods of 90 and 180 days labelled cells resembling neurons were found in most telencephalic regions. The largest numbers of these putative neurons were found in the olfactory bulbs. By using [3H]thymidine autoradiography combined with electron microscopy these postnatally generated cells were confirmed as neurons. We conclude that postnatal neurogenesis occurs in the turtle telencephalon. This process is most prominent in the olfactory bulbs. From the pattern of proliferation of neuronal precursors in the VZ we infer that neurons recruited postnatally into the olfactory bulbs come from distant proliferative VZs in the walls of the lateral ventricles.

3-Acetylpyridine-induced degeneration and regeneration in the adult lizard brain: a qualitative and quantitative analysis.

The neurotoxin 3-acetylpyridine (3AP) produces highly selective neuronal damage in specific areas of the lizard brain. Following 3AP intoxication, proliferation and migration of replacement neurons born in the ventricular walls lead to regeneration of the lesioned areas. Earlier studies established the time course of 3AP-induced degeneration and subsequent regeneration in the medial cerebral cortex of adult lizards (Font, E., García-Verdugo, J.M., Alcántara, S. and Lopez-García, C., Neuron regeneration reverses 3-acetylpyridine-induced cell loss in the cerebral cortex of adult lizards, Brain Res., 551 (1991) 230-235 [13]). Complementary to our previous studies, we now provide a qualitative and quantitative account of the extent and distribution of neurotoxic damage in the brain as a whole of lizards treated with 3AP using Nissl and Golgi stains, a degeneration-sensitive reduced-silver method, and electron microscopy. Additionally, [3H]thymidine autoradiography was used to assess changes in the rate of neurogenesis caused by the 3AP treatment. Single doses of 3AP caused degenerative changes in all the cortical areas, anterior dorsal ventricular ridge, deep layers of the lateral cortex, lateral amygdaloid nucleus, and nucleus sphericus, while sparing other brain areas. The most frequent neuropathic change after 3AP treatment was clumping of the nuclear chromatin with formation of pyknotic nuclei. Occasionally, a second type of injury was observed in neurons of the cell layer of the dorsomedial cortex (DMC). 3AP also caused a conspicuous loss of dendritic spines in bipyramidal neurons of the dorsomedial and dorsal cortices possibly representing transneuronal degeneration. Numbers of [3H]thymidine-labeled cells were higher in lizards previously treated with 3AP than in controls. These results demonstrate that the neurotoxic lesion is capable of inducing an increase in the normal rate of adult neurogenesis. Whereas regeneration in the remaining areas was morphologically and histologically complete, in some animals, cell proliferation in the DMC resulted in formation of an abnormal cell plate.

A tangential neuronal migration in the olfactory bulbs of adult lizards.

Tritiated thymidine ([3H]thymidine) autoradiography at different times after experiments showed that postnatally generated neurones in the adult lizard olfactory bulbs are not generated in a local germinative zone but in the ventricular zone (VZ) of the cerebral hemispheres, which is a long distance from the olfactory bulbs. The new cells originating in the VZ of rostral telencephalon migrate to both main and accessory olfactory bulbs through the olfactory peduncle, along a highly restricted pathway orthogonal to the orientation of radial glial fibres. Our results suggest that the olfactory bulb interneurones of adult lizards may follow a tangential migration route from their germinative zone, as is the case in mammals.

Adult neurogenesis in the telencephalon of a lizard: a [3H]thymidine autoradiographic and bromodeoxyuridine immunocytochemical study.

A qualitative and quantitative evaluation of adult neurogenesis in the telencephalon of a lizard was conducted using [3H]thymidine autoradiography and immunocytochemical detection of 5'-bromodeoxyuridine (BrdU). The sites of cell proliferation, the fate, and the phenotype of cells born in adulthood were determined by short and long survival experiments (7 and 30 days). Adult specimens of the Moorish gecko, Tarentola mauritanica (Sauria, Gekkonidae), received subcutaneous injections of either BrdU or [3H]thymidine. Seven days after BrdU administration most labelled cells were in the walls (ventricular zone; VZ) of the lateral ventricles, particularly close to the sulcal zones. Labelled cells in the VZ of other ventricles were practically absent. Following 30 days, labelled cells outside the VZ were seen in most telencephalic regions: olfactory bulbs (OB), medial, dorsal, and lateral cortices (MC, DC, LC), anterior dorsal ventricular ridge (ADVR), nucleus sphericus (NS), and striatum (St). Electron microscopic examination of [3H]thymidine labelled cells found in these areas revealed their neuronal identity. No labelled neurons were detected in the dorsomedial cerebral cortex (DMC), septum (Sp), or elsewhere in the telencephalon. We conclude that neurogenesis occur in most regions of the adult lizard telencephalon. The most intense neuronal production occurs in the MC. Other telencephalic regions, such as the OB, ADVR, and NS, also show a considerable rate of adult neurogenesis. We infer from our results that the new neurons are born in the walls of the lateral ventricles and then migrate to their destinations. Furthermore, we report some evidence suggesting that neurons formed in adulthood in the olfactory bulbs are generated in the distant proliferative VZ. The functional significance of neurogenesis in the telencephalon of adult lizards is unclear, but it seems to be restricted to areas that have been implicated in olfactory plasticity, learning, and memory.

[Comparative study of the treatment of postoperative pain in function of the surgical service]. / Estudio comparativo del tratamiento del dolor postoperatorio en función del servicio quirúrgico.

HYPOTHESIS AND OBJECTIVES: A high level of pain has been observed among surgical patients and it has been suggested that surgical specialty may be an important factor in pain, although no relation has been conclusively demonstrated. In this study we compared the characteristics of postoperative pain and pain treatment given in several surgical services. PATIENTS AND METHODS: We studied 249 patients in orthopedic surgery and traumatology (OST, n = 95), general surgery (GS, n = 66), gynecology and obstetrics (GO, n = 51), urology (URO, n = 16), vascular surgery (VS, n = 9), ophthalmology (OPH, n = 7), otorhinolaryngology (ORL, n = 5). The characteristics of analgesic treatment (type of prescription, drug, route, dose and compliance) were recorded, as were degree of pain expressed on a visual analog scale and a verbal assessment scale 24 h after surgery, and level of patient satisfaction with the analgesic treatment. RESULTS: Thirty percent of the patients reported moderate to unbearable pain the day after surgery. Severe pain was most common in OST patients. Analgesics, mainly diclofenac (52%) and pethidine (36%), were prescribed by protocol for 93% of patients. Although there were differences among the various services, compliance with diclofenac prescription was better; compliance was high among GO patients for both drugs. Over half the patients reported having had severe or unbearable pain during the hours following surgery. Most said relief was sufficient or high (55%) with treatment and described themselves as satisfied or very satisfied (62%) with the analgesic received. Surgery on extremities was the most painful and generated the greatest dissatisfaction. CONCLUSIONS: This study suggests that type of surgery may condition the prevalence of and severity of postoperative pain. Although type of surgery and location are important factors, there are sufficient differences and deficiencies in treatment to explain, at least partly, the variation observed.

[The Prevalence of pain in hospitalized patients]. / Prevalencia del dolor en pacientes hospitalizados.

BACKGROUND: There are few studies evaluating the presence of pain in hospitalized patients. Different authors have suggested interest in epidemiological studies to establish the characteristics of pain at a hospitalary level. The present study was initiated to determine the prevalence of pain in acute and chronic patients admitted to hospital and to establish the relation of the pain with the prescription of analgesics. METHODS: Pediatric, acute and chronic adult patients pertaining to a hospital in Sabadell (Barcelona) were included in the study. Patients from resuscitation, ICU, neonatology and the emergency wards were excluded. The variables studied were presence of pain and the existence of analgesic prescription. The first was determined by interview with the patient, while the second was obtained directly from the clinical history. RESULTS: Fifty-five percent of the 217 adult patients with acute pathology manifest pain and in 45% of them total analgesics had been prescribed. The prevalence of pain was 61% among the 41 pediatric patients and 35% among the 98 adults with chronic disease. Prescription of analgesics was observed in 51 and 39%, respectively in the above groups of patients. The relation between the presence of pain and antialgic prescription was variable according to the groups. It must be emphasized that 50% of acute adult patients with pain did not have prescription of analgesics. Pain was present in all the pediatric patients with some analgesic prescribed. Sixty-eight percent of the chronic patients with prescribed analgesics also experienced pain. CONCLUSIONS: The prevalence of pain in the hospital environment is high, not only in pediatric but also in adult and geriatric patients. The high number of patients who do not receive analgesics despite pain and those in whom the treatment does not totally eradicate the symptoms is of note. Analgesic therapy must acquire greater revelance in hospitalary assistance.

[Analysis of the treatment of postoperative pain at 3 hospitals]. / Análisis del tratamiento del dolor postoperatorio en tres hospitales.

Postoperative pain management protocols have been examined in a total of 212 patients from three Spanish hospitals. Metamizole was the analgesic drug most frequently prescribed (50%) followed by pethidine (18.4%). To a lesser degree, aspirin, pentazocine, lysine acetylsalicylate, paracetamol and buprenorphine were used. Important differences among the hospitals were found when choosing the analgesic. The dosage prescribed varied and in general, drugs were prescribed at lower doses than the daily defined dose (DDD). Intramuscular route was the most used. Only 27.6% of the patients received the prescribed doses and 43.3% received a lower one. This was basically due to a greater interval of dosing. 14.6% of the patients were painless while 25.5% showed intense and unbearable pain. From this study one may conclude that when metamizole is preferably used as an analgesic drug, it is given at a smaller dose than that recommended and in addition, nurses decrease even more the doses. An important number of patients were found with intense pain even though analgesic drugs were given.

Acceptability of visual analogue scales in the clinical setting: a comparison with verbal rating scales in postoperative pain.

Pain is the clinical symptom most difficult to evaluate. Although clinical trials methodology have permitted assessment of pain objectively through rating scales, these strategies have not been used in clinical setting. The present study was undertaken to determine if visual analogue scales could be useful in the measurement of postoperative pain in usual medical practice. The study comprised 212 patients with abdominal, orthopedic or gynecological surgical procedures within the previous 24 h. Patients evaluated their pain using a verbal rating scale (VRS) of five points or a visual analogue scale (VAS) of 10 cm. The investigators also evaluated patient pain through a VAS. The results obtained showed that a high correlation between VRS and VAS could be established in all patients (p less than 0.001). The VAS of patients and researchers were also found to be highly correlated (p less than 0.001). When values of each group were compared by pain intensity a total agreement of VAS scores at low pain level could be established, but differences were found at high pain intensity levels, suggesting that physicians scored lower than patients when pain was severe to unbearable. It is concluded that VAS could be a reliable method to assess pain in clinical setting.