Adjusted global antiphospholipid syndrome score (aGAPSS) is useful to predict relapses in patients with retinal vein occlusion.

BACKGROUND: A significant proportion of patients with retinal vein occlusion (RVO) are antiphospholipid antibodies (aPL) carriers. Relapsing disease occurs in nearly 10 % of cases and the role of aPL has not been established. The adjusted global antiphospholipid syndrome score (aGAPSS) was developed to assess the risk of clinical events in aPL carriers and its role in the management of RVO patients is unknown. OBJECTIVE: To analyze the values of aGAPSS in a large cohort of patients with RVO and population-based controls, and to assess its usefulness to predict RVO relapses. METHODS: Case-control study of RVO patients and population-based controls of similar age and sex. We have assessed and compared the aPL profile and the aGAPSS score in patients with and without relapsing disease and controls. RESULTS: Four-hundred and seventy-two RVO patients and 346 controls were included. Fifty-seven RVO patients had antiphospholipid syndrome (RVO-APS). Of them, 75.4 % had a high-risk profile compared to 3 % in controls (p = 0.0001). The median aGAPSS values were 8 [7-13], 3 [1-4], and 3 [0-4], in RVO-APS, RVO no-APS, and controls. Nineteen patients had had a recurrence of RVO before inclusion and 8 during the follow-up. APS was more prevalent in relapsing patients. In the adjusted multivariable regression model, the best predictor for RVO recurrence during the follow-up was an aGAPSS score ≥6 (OR 5.5, CI95% 1.3-23.7; p = 0.023). CONCLUSIONS: In patients with RVO, once the control of vascular risk factors has been optimized, the aGAPSS might help to identify those at risk of relapsing disease.

Attack and Defense Performance in Goalball: A Proposal for Throwing, Balance and Acoustic Reaction Evaluation.

Goalball is a sport for visually impaired athletes, where the roles of attack and defense change continuously during the game. Performance evaluation should consider the variables that determine the throwing and the stop and clearance of the ball. The aim of this study is to evaluate the precision and velocity of the ball throwing in goalball, besides core stability and balance as variables that determine an optimal throwing. Moreover, a novel acoustic reaction time is applied to analyze the defense performance. Eight goalball players (33 ± 9 years old; 77.8 ± 22.7 kg; 174 ± 13 cm; 10 ± 5 years of experience) were recruited to assess ball velocity, with a radar gun, and throwing accuracy. Anthropometry, static balance, and core stability were assessed using a computerized pressure platform. Acoustic reaction time was measured with a photoelectric system. A significant positive correlation was found between throwing speed and the years of experience (Ç· = 0.714, p = 0.047), height (Ç· = 0.786, p = 0.021), dominant leg surface area of the stabilogram (Ç· = 0.738, p = 0.037), and non-dominant leg center of pressure mean velocity (Ç· = 0.714, p = 0.017). In the present pilot study, height and years of experience are correlated to throwing velocity. This is also the first test proposal to assess throwing precision and complex acoustic reaction in goalball players, which could be used to assess the level of performance in future studies.

Effect of a Long Exercise Program in the Reduction of Musculoskeletal Discomfort in Office Workers.

The purpose of this study was to assess the effect of a six week exercise program to reduce the muscle tone of the trapezius and musculoskeletal discomfort (MED) of office workers. Twenty-six workers performed an exercise program based on: (1) stretching of cervical and/or dorsal region; (2) joint mobility of shoulders and rachis; (3) strengthening deep stabilizer and core muscles; and (4) scapula stabilizing exercises. A Myoton device was used to evaluate trapezius tone and the Cornell Musculoskeletal Discomfort Questionnaire was used to assess changes in MED at three points of evaluation: at the beginning (Pre_1) and at the end of the workday (Post_1), and after the training program (Pre_2). The Wilcoxon test and Cohen's d were performed to examine differences and effect sizes between evaluations. Main results show that trapezius tone remained constant during the workday, but decreased in the dominant upper trapezius (p = 0.003, ES = -0.60) and increased in the non-dominant middle trapezius (p = 0.016, ES = 0.45) after the exercise program, which eliminated significant muscle asymmetries. MED significantly decreased in the neck (p = 0.027, ES = -0.60) and upper back (p = 0.046, ES = -0.67). In conclusion, MED appears to improve in office workers after a six week training program, which may be explained by a decrease in trapezius tone and increase in the left middle trapezius tone.

Effect of Three Half-Squat Protocols on the Tensiomyographic Twitch Response and Tissue Damage of the Rectus Femoris and the Biceps Femoris.

The aim of this study was to analyse the acute effects of a concentric exercise and two different eccentric overload exercises (EOEs) on blood markers of muscle damage (i.e. creatine kinase [CK], lactate dehydrogenase [LDH], myoglobin [Myo], and malondialdehyde [MDA]) and muscle contractile properties. Ten healthy, young (27 ± 1.5 years, 179 ± 6 cm, 78.7 ± 10.8 kg), physically active men (3.5 ± 1.9 h·w-1) randomly performed three training sessions using the following protocols: a half-squat (HS) as a concentric exercise, and exercises using Versapulley (VP) or YoYo isoinertial technology (YIT) as EOEs (4 x 7 repetitions with a 2 min rest interval between sets). Blood samples and tensiomyography measurements were obtained after each training session. Repeated measures analysis of variance (ANOVA) followed by the Tukey test was used to detect differences between the four time points of each variable. The standardized difference or effect size (ES, 90% confidence limit) in the selected variables was calculated using the basal SD. After all exercises, a greater activity of CK, LDH, and concentration of Myo, and MDA were found compared to baseline values (p < 0.05). A substantially greater activity of CK, LDH, and Myo concentration, but not MDA, were found after EOEs when compared to the HS protocol. Substantially lower tensiomyography results in the rectus femoris (RF) were reported, irrespective of the exercise mode performed. Also, no substantial differences were obtained in the biceps femoris (BF) between EOEs and the HS protocol. Time of contraction (Tc) in the RF was possibly to very likely lower in the HS in comparison to EOEs. Additionally, muscular displacement (Dm) in the RF was substantially lower in the HS compared to EOEs. VP produced higher concentrations of damage markers than YIT and concentric exercise did. Furthermore, tensiomyography variables showed similar activation in both exercises, although higher specific fatigue (in the RF) was registered in the traditional HS.

Obstrucción venosa retiniana en receptores de trasplante de órgano sólido. Estudio de 4 casos y revisión de la literatura / Retinal vein occlusion in solid organ transplant recipients. Study of 4 cases and literature review

La obstrucción venosa retiniana (OVR) se ha relacionado fundamentalmente con los factores de riesgo vascular y con el glaucoma; sin embargo, existen pocos estudios de la OVR en pacientes con trasplante de órgano sólido. Se analizó una serie de 331 pacientes que presentaron OVR (de rama en 226 casos y central en 105 casos) a lo largo de 10 años y se compararon las características entre los 4 pacientes con antecedente de trasplante de órgano sólido (hepático, renal o bipulmonar) que presentaron una OVR y el resto. En nuestra serie la OVR en los trasplantados comenzó a edades más tempranas que en el resto de pacientes con OVR (58 vs. 68 años, respectivamente), afectó a la vena central de la retina (100% vs. 32%) y se asoció con la diabetes mellitus (75% vs. 25%) y con los tratamientos esteroideo (100% vs. 1%) e inmunosupresor (tacrolimus 75% vs. 0%)

Although retinal venous obstruction (RVO) has been primarily related to vascular risk factors and glaucoma, there are a few studies of RVO in patients with solid organ transplants. An analysis was performed on total of 331 patients who presented with RVO (branch RVO in 226 cases and central RVO in 105 cases) over a 10 year period, and the characteristics were compared with the 4 patients with a history of solid organ transplant (liver, renal, or bipulmonary) who presented with RVO. In this series, the onset of RVO in transplant patients occurred at earlier ages than in other patients with RVO (58 vs. 68 years, respectively), affected the central vein of the retina (100% vs. 32%), and was associated with diabetes mellitus (75% vs. 25%), as well as with steroidal (100% vs. 1%) and immunosuppressive (tacrolimus 75% vs. 0%) treatments

Anisocoria como manifestación inicial de esclerosis múltiple. Utilidad de la resonancia magnética nuclear de 3 teslas / Anisocoria as initial manifestation of multiple sclerosis. Use of 3 tesla magnetic resonance imaging

Mujer de 21 años que presenta midriasis arreactiva en ojo derecho que contrae con el test de pilocarpina al 1%. La angio-TC craneal y la resonancia magnética nuclear (RMN) de 1,5 T no detectaron anomalías. Ante una posterior limitación de la aducción, supraducción e infraducción de dicho ojo, se solicitó una RMN de 3 T, que evidenció una lesión del mesencéfalo en la salida del tercer par craneal. Tras mejoría, no tuvo nuevos episodios hasta 18 meses después, cuando acudió con una probable neuritis óptica y síntomas sistémicos. En este momento la RMN de 1,5 T detectó placas desmielinizantes infratentoriales y supratentoriales. La punción lumbar posterior y la evolución clínica confirmaron el diagnóstico de esclerosis múltiple recurrente-remitente

A 21-year-old woman seen in this clinic with non-reactive mydriasis in the right eye that contracted with 1% pilocarpine. Cranial angio-CT and 1.5 T magnetic resonance imaging (MRI) did not detect any disease. Given a subsequent limitation of adduction, supraduction, and infarction of the right eye, a 3 T MRI was requested. This showed a lesion of the midbrain at the exit of the 3rd cranial nerve. After improvement, no new episodes were observed until 18 months later, when the patient presented with probable optic neuritis and systemic symptoms. At this time the 1.5 T MRI detected infratentorial and supratentorial demyelinating plaques. A subsequent lumbar puncture and clinic outcome confirmed the diagnosis of relapsing-remitting multiple sclerosis

Retinal vein occlusion in solid organ transplant recipients. Study of 4 cases and literature review. / Obstrucción venosa retiniana en receptores de trasplante de órgano sólido. Estudio de 4 casos y revisión de la literatura.

Although retinal venous obstruction (RVO) has been primarily related to vascular risk factors and glaucoma, there are a few studies of RVO in patients with solid organ transplants. An analysis was performed on total of 331 patients who presented with RVO (branch RVO in 226 cases and central RVO in 105 cases) over a 10 year period, and the characteristics were compared with the 4 patients with a history of solid organ transplant (liver, renal, or bipulmonary) who presented with RVO. In this series, the onset of RVO in transplant patients occurred at earlier ages than in other patients with RVO (58 vs. 68 years, respectively), affected the central vein of the retina (100% vs. 32%), and was associated with diabetes mellitus (75% vs. 25%), as well as with steroidal (100% vs. 1%) and immunosuppressive (tacrolimus 75% vs. 0%) treatments.

Anisocoria as initial manifestation of multiple sclerosis. Use of 3 tesla magnetic resonance imaging. / Anisocoria como manifestación inicial de esclerosis múltiple. Utilidad de la resonancia magnética nuclear de 3 teslas.

A 21-year-old woman seen in this clinic with non-reactive mydriasis in the right eye that contracted with 1% pilocarpine. Cranial angio-CT and 1.5 T magnetic resonance imaging (MRI) did not detect any disease. Given a subsequent limitation of adduction, supraduction, and infarction of the right eye, a 3 T MRI was requested. This showed a lesion of the midbrain at the exit of the 3rd cranial nerve. After improvement, no new episodes were observed until 18 months later, when the patient presented with probable optic neuritis and systemic symptoms. At this time the 1.5 T MRI detected infratentorial and supratentorial demyelinating plaques. A subsequent lumbar puncture and clinic outcome confirmed the diagnosis of relapsing-remitting multiple sclerosis.

Uso del análisis de la capa de células ganglionares para el diagnóstico en la neuromielitis óptica anti-glucoproteína de la mielina del oligodendrocito / Use of ganglion cell layer analysis for diagnosing anti-glycoprotein neuromyelitis optica of oligodendrocyte myelin

Paciente de 26 años con episodios de neuritis óptica recurrentes en contexto de diagnóstico de sospecha de neuromielitis óptica. En el primer brote la paciente presentó gran afectación de la agudeza visual del ojo izquierdo; se objetivó en la tomografía de coherencia óptica afectación de la capa de células ganglionares en ambos ojos, que evidenciaba posible lesión extensa del nervio, que llegaba hasta el quiasma óptico. Así mismo, en la RMN con contraste se objetivó afectación del nervio óptico izquierdo de gran longitud que comprometía el quiasma y que permitía la sospecha etiológica de neuromielitis. A pesar de que los anticuerpos anti-MOG y anti-AQP4 fueron negativos en un primer momento, la afectación bilateral de las células ganglionares hizo sospechar una lesión extensa, que es más característica de las neuromielitis anti-MOG seropositivas

The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis

Use of ganglion cell layer analysis for diagnosing anti-glycoprotein neuromyelitis optica of oligodendrocyte myelin. / Uso del análisis de la capa de células ganglionares para el diagnóstico en la neuromielitis óptica anti-glucoproteína de la mielina del oligodendrocito.

The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis.

Validity and Reliability of a 10 Hz GPS for Assessing Variable and Mean Running Speed.

Our purpose was to assess the 10 Hz Viper GPS devices' validity and reliability (STATSport) in both instantaneous and mean speed measuring in accelerations and decelerations in straight-line running conditions. Eight amateur team sport players participated in the study, performing firstly 21 x 40 m sprints at submaximal incremental speed, and secondly 21 x 40 m sprints, with the first stage consisting of submaximal incremental speed, and the second stage of subsequent submaximal decreasing speed. Criteria systems used to evaluate the GPS validity were a radar gun for instantaneous speed, and timing-gates for mean speed. Reliability was measured with two GPS devices carried by the same athlete, running 10 x (20 m + 20 m) sprints with a 180º change of direction and a 10 s inter-set rest interval. Results showed an agreement between GPS devices and the criteria systems measuring instantaneous speed (r = 0.98; standardized mean bias (SMB) = -0.07; standard typical error (STE) = 0.22) and mean speed (r = 0.99; SMB = 0.38; STE = 0.17). The reliability study presented a nearly perfect correlation between devices, a trivial SMB and a small STE (r = 0.97; SMB = 0.04; STE = 0.23). 10 Hz GPS devices are an adequate solution to monitor straight-line running speed in acceleration and deceleration conditions, but we would like to draw attention to the small errors and bias detected, such as the speed overestimation compared with timing gates.

Genetic Analysis of Human Preimplantation Embryos.

Preimplantation development comprises the initial stages of mammalian development, before the embryo implants into the mother's uterus. In normal conditions, after fertilization the embryo grows until reaching blastocyst stage. The blastocyst grows as the cells divide and the cavity expands, until it arrives at the uterus, where it "hatches" from the zona pellucida to implant into the uterine wall. Nevertheless, embryo quality and viability can be affected by chromosomal abnormalities, most of which occur during gametogenesis and early embryo development; human embryos produced in vitro are especially vulnerable. Therefore, the selection of chromosomally normal embryos for transfer in assisted reproduction can improve outcomes in poor-prognosis patients. Additionally, in couples with an inherited disorder, early diagnosis could prevent pregnancy with an affected child and would, thereby, avoid the therapeutic interruption of pregnancy. These concerns have prompted advancements in the use of preimplantation genetic diagnosis (PGD). Genetic testing is applied in two different scenarios: in couples with an inherited genetic disorder or carriers of a structural chromosomal abnormality, it is termed PGD; in infertile couples with increased risk of generating embryos with de novo chromosome abnormalities, it is termed preimplantation genetic screening, or PGS.

Results of the performance verification of the CoaguChek XS system.

BACKGROUND: This is the first paper reporting a performance verification study of a point-of-care (POC) monitor for prothrombin time (PT) testing according to the requirements given in chapter 8 of the International Organization for Standardization (ISO) 17593:2007 standard "Clinical laboratory testing and in vitro medical devices - Requirements for in vitro monitoring systems for self-testing of oral anticoagulant therapy". The monitor under investigation was the new CoaguChek XS system which is designed for use in patient self testing. Its detection principle is based on the amperometric measurement of the thrombin activity generated by starting the coagulation cascade using a recombinant human thromboplastin. METHODS: The system performance verification study was performed at four study centers using venous and capillary blood samples on two test strip lots. Laboratory testing was performed from corresponding frozen plasma samples with six commercial thromboplastins. Samples from 73 normal donors and 297 patients on oral anticoagulation therapy were collected. Results were assessed using a refined data set of 260 subjects according to the ISO 17593:2007 standard. RESULTS: Each of the two test strip lots met the acceptance criteria of ISO 17593:2007 versus all thromboplastins (bias -0.19 to 0.18 INR; >97% of data within accuracy limits). The coefficient of variation for imprecision of the PT determinations in INR ranged from 2.0% to 3.2% in venous, and from 2.9% to 4.0% in capillary blood testing. Capillary versus venous INR data showed agreement of results with regression lines equal to the line of identity. CONCLUSION: The new system demonstrated a high level of trueness and accuracy, and low imprecision in INR testing. It can be concluded that the CoaguChek XS system complies with the requirements in chapter 8 of the ISO standard 17593:2007.

Leptin system in embryo development and implantation: a protein in search of a function.

Implantation is a crucial moment in the reproduction process that requires perfect synchronization between the embryo and the maternal endometrium. The embryo must reach the blastocyst stage and the endometrium must be prepared to receive it. An appropriate and specific molecular dialogue must also take place between them. There is ample evidence to show that the leptin system is implicated in this cross-talk. Examples are described. Although there is some controversy surrounding the data, they are supported by the presence of leptin receptor mRNA in mouse and human oocytes and embryos throughout preimplantation development. Otherwise, the leptin mRNA is only detected at the blastocyst stage in both human and mouse. Furthermore, leptin is found at higher concentrations in the conditioned media from competent human blastocysts than in those from arrested embryos, suggesting that this molecule is a marker for blastocyst viability. Given that expression of the leptin receptor increases in the human endometrium during the luteal phase, the secreted leptin could trigger its activation. Finally, leptin and the leptin receptor have been detected in implantation sites. All these findings point to the involvement of the leptin system in the molecular mechanism of the implantation process and embryo development.

Endometrial leptin and leptin receptor expression in women with severe/moderate endometriosis.

The leptin system has been implicated in reproductive function, acting at endocrine and paracrine levels. Recently, deregulation of this gene family has been linked to endometrial changes caused by endometriosis. In the present study, we compare the expression of leptin receptor mRNA during the pre-receptive (LH+2) and receptive (LH+9) phases in the eutopic endometrium from patients with severe/moderate endometriosis (n = 30) versus fertile controls (n = 12). In each patient, two endometrial samples were obtained at LH+2 and LH+9 in their natural cycles. When real-time quantitative fluorescent PCR was performed, an up-regulation of OB-RL and all the isoforms investigated was observed at LH+9 versus LH+2 in patients with and without endometriosis. However, no difference was found in the expression pattern of the total leptin receptor OB-RT, or in its long OB-RL and soluble HuB219.3 forms when the eutopic endometria of patients with severe/moderate endometriosis and fertile controls were compared. By means of in situ hybridization, total leptin receptor mRNA was localized in the luminal epithelium and the glands of the endometrium. The immunohistochemical analysis of the long form of leptin receptor was also performed in order to confirm these findings at the protein level. Finally, we have also shown similar leptin mRNA expression in both the control group and patients with endometriosis. In conclusion, we have not identified differences in the endometrial expression and localization of leptin and the leptin receptor when comparing the eutopic endometrium of women with severe/moderate endometriosis and fertile controls.

Autoimmune thrombocytopenia associated with hepatitis C virus infection.

We have retrospectively analyzed a series of 19 patients with hepatitis C virus (HCV) infection and chronic thrombocytopenia not attributable to hypersplenism or to other causes. Antiplatelet antibodies were present in 81% of cases. Response to prednisone was observed in 6 of 7 patients and 1 of 3 patients responded to intravenous immunoglobulins. No case of reactivation of liver disease was observed during or after therapy. We consider that the possibility of an underlying mechanism should be evaluated in thrombocytopenic patients with HCV infection who do not present hypersplenism. These patients could benefit from steroid treatment.

Dapsone for refractory chronic idiopathic thrombocytopenic purpura.

Fifteen patients with refractory chronic idiopathic thrombocytopenic purpura (ITP) were treated with dapsone (100 mg/d) for 1-31 months. The overall response rate to dapsone was 40%. Five patients responded in 1 month and one patient in 2 months. No pretreatment characteristics--sex, age, platelet count or duration of ITP--were correlated with response to dapsone. Treatment was well tolerated. The most frequent adverse effect was dose-related haemolytic anaemia. In our experience, dapsone provides an inexpensive and well-tolerated alternative for patients with ITP who had inadequate responses to conventional therapy.

Chronic idiopathic thrombocytopenic purpura in the elderly.

From a group of 118 patients with chronic idiopathic thrombocytopenic purpura (ITP), 43 were older than 60 years at diagnosis. In this report, we describe the clinical evolution and therapeutic response in young and old patients. The overal rate of hemorrhagic manifestations was similar in the two age groups, but a greater risk for severe bleeding was observed in elderly patients. There were no significant differences between old and young patients in response to steroids. In none of our patients was mortality associated with bleeding or side effects of the treatment. In conclusion, we have observed a more benign clinical course in elderly patients with chronic ITP as compared to previous reports.