Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document.

The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.

Healthy Lifestyle and Incidence of Metabolic Syndrome in the SUN Cohort.

We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The "Seguimiento Universidad de Navarra" (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 years, 67% women) initially free of metabolic syndrome were followed prospectively for a minimum of 6 years. To evaluate healthy lifestyle, nine habits were used to derive a Healthy Lifestyle Score (HLS): Never smoking, moderate to high physical activity (>20 MET-h/week), Mediterranean diet (≥4/8 adherence points), moderate alcohol consumption (women, 0.1⁻5.0 g/day; men, 0.1⁻10.0 g/day), low television exposure (<2 h/day), no binge drinking (≤5 alcoholic drinks at any time), taking a short afternoon nap (<30 min/day), meeting up with friends >1 h/day, and working at least 40 h/week. Metabolic syndrome was defined according to the harmonizing definition. The association between the baseline HLS and metabolic syndrome at follow-up was assessed with multivariable-adjusted logistic regressions. During follow-up, we observed 458 (4.24%) new cases of metabolic syndrome. Participants in the highest category of HLS adherence (7⁻9 points) enjoyed a significantly reduced risk of developing metabolic syndrome compared to those in the lowest category (0⁻3 points) (adjusted odds ratio (OR) = 0.66, 95% confidence interval (CI) = 0.47⁻0.93). Higher adherence to the Healthy Lifestyle Score was associated with a lower risk of developing metabolic syndrome. The HLS may be a simple metabolic health promotion tool.

Factores histológicos relacionados con resultados discordantes entre la biopsia y la prueba de ADN, en el diagnóstico del virus papiloma humano (VPH) / Histological factors associated with discordant results between biopsy and DNA testing in the diagnosis of human papillomavirus (HPV)

El diagnóstico de la infección cervical ocasionada por el virus del papiloma humano (VPH), se realiza básicamente a través de la biopsia y/o de métodos moleculares como la reacción en cadena de la polimerasa (PCR). Los resultados de estos estudios en ocasiones no coinciden. En este estudio se evalúa la posible influencia de diferentes factores asociados a resultados falsos positivos y a falsos negativos de ambas pruebas. Se analizaron 271 muestras de cuello uterino de pacientes que acudieron a la consulta ginecológica durante el período 1999-2009, a las cuales se les tomó biopsia por presentar hallazgos colposcópicos y/o citológicos sospechosos de infección por VPH. Tomando en consideración al resultado de PCR como prueba estándar de oro, la biopsia presentó 14% de falsos positivos y 16,6% de falsos negativos, el diagnóstico de VPH en biopsia y PCR presentó mayor concordancia cuando las muestras abarcan la zona de transformación endo-exocervical, así como la presencia de metaplasia escamosa en la muestra y el tamaño del fragmento mayor (>0,5 cm); mientras que el tiempo de fijación, el tipo e intensidad de la inflamación, la hemorragia y la erosión del epitelio no fueron significativos. En conclusión, a fin de disminuir la discrepancia de los resultados entre la biopsia y prueba de ADN, sería importante que la muestra de biopsia incluya la zona de transformación del cuello uterino y al menos un fragmento mayor de 0,5 cm.

The diagnosis of cervical infection caused by human papilloma virus (HPV) is made basically through the biopsy and/or molecular methods such as polymerase chain reaction (PCR). The results of these studies sometimes do not match. In this work is evaluated the possible influence of different factors associated with results false positive and false negative of both tests. Were analyzed 271 samples from uterin cervix of patients presenting to the gynecologist during the period 1999-2009, to which were taken biopsies due present findings colposcopics and/or cytological suspicious of HPV infection. Considering the result of PCR as gold standard test, biopsy showed 14% false positive and false negative 16.6%, the diagnostic of VPH in biopsy and PCR showed greater concordance when samples include endo-exocervical transformation zone, and the presence of squamous metaplasia in the sample and size of the largest fragment (>0.5 cm); while the fixation time, the type and intensity of inflammation, bleeding and erosion of the epithelium were not significant. In conclusion, in order to reduce the discrepancy between the results of the biopsy and test DNA, it is important that the biopsy sample includes the transformation zone of the uterin cervix and at least one fragment greater than 0.5 cm.

Accidentes cerebrovasculares prenatales diagnosticados en la etapa de lactante: serie de 10 pacientes / Prenatal cerebrovascular accidents diagnosed in the early infant stage: a series of 10 patients

Introducción. El accidente cerebrovascular (ACV) fetal o prenatal se define como un suceso isquémico, trombótico o hemorrágico arterial o venoso que acontece entre las 14 semanas de gestación y el inicio del parto. Pacientes y métodos. Estudio retrospectivo de una serie de 10 pacientes afectos de un ictus, presumiblemente fetal, desapercibido durante el embarazo y diagnosticado en la etapa de lactante; se destacan cuáles han sido los síntomas y la edad en que se han identificado. Resultados. De los 10 pacientes estudiados, ninguno presentaba antecedentes maternos relevantes, pero se detectaron cuatro amenazas de parto pretérmino que se resolvieron con las medidas habituales y sin hallazgos de alteración fetal posterior. Entre el segundo y tercer trimestre de vida es cuando se han realizado los estudios que han llevado al diagnóstico, y se ha indicado por la familia una menor movilidad de un hemicuerpo respecto al contralateral como motivo de consulta. Dos pacientes presentaban una trombofilia. Con una media de seguimiento de seis años, todos asocian una parálisis cerebral infantil, la tercera parte una epilepsia y el 75% tiene dificultades de aprendizaje o discapacidad intelectual. Conclusión. Cuando los ACV no se detectan prenatalmente, es importante que en la atención primaria se busquen y detecten los signos de alarma del desarrollo psicomotor del lactante de forma precoz para iniciar su estudio y procurar una rehabilitación lo más pronto posible (AU)

Introduction. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. Patients and methods. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. Results. None of the 10 patients studied presented any relevant events in the mothers’ medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. Conclusions. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible (AU)

[Prenatal cerebrovascular accidents diagnosed in the early infant stage: a series of 10 patients]. / Accidentes cerebrovasculares prenatales diagnosticados en la etapa de lactante: serie de 10 pacientes.

INTRODUCTION. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. PATIENTS AND METHODS. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. RESULTS. None of the 10 patients studied presented any relevant events in the mothers' medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. CONCLUSIONS. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible.

TITLE: Accidentes cerebrovasculares prenatales diagnosticados en la etapa de lactante: serie de 10 pacientes.Introduccion. El accidente cerebrovascular (ACV) fetal o prenatal se define como un suceso isquemico, trombotico o hemorragico arterial o venoso que acontece entre las 14 semanas de gestacion y el inicio del parto. Pacientes y metodos. Estudio retrospectivo de una serie de 10 pacientes afectos de un ictus, presumiblemente fetal, desapercibido durante el embarazo y diagnosticado en la etapa de lactante; se destacan cuales han sido los sintomas y la edad en que se han identificado. Resultados. De los 10 pacientes estudiados, ninguno presentaba antecedentes maternos relevantes, pero se detectaron cuatro amenazas de parto pretermino que se resolvieron con las medidas habituales y sin hallazgos de alteracion fetal posterior. Entre el segundo y tercer trimestre de vida es cuando se han realizado los estudios que han llevado al diagnostico, y se ha indicado por la familia una menor movilidad de un hemicuerpo respecto al contralateral como motivo de consulta. Dos pacientes presentaban una trombofilia. Con una media de seguimiento de seis años, todos asocian una paralisis cerebral infantil, la tercera parte una epilepsia y el 75% tiene dificultades de aprendizaje o discapacidad intelectual. Conclusion. Cuando los ACV no se detectan prenatalmente, es importante que en la atencion primaria se busquen y detecten los signos de alarma del desarrollo psicomotor del lactante de forma precoz para iniciar su estudio y procurar una rehabilitacion lo mas pronto posible.

Cerebelitis aguda fulminante: caso excepcional y de evolución fatal / Fulminant acute cerebellitis: an exceptional case with a fatal outcome

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Stable low molecular weight RNA profiling showed variations within Sinorhizobium meliloti and Sinorhizobium medicae nodulating different legumes from the alfalfa cross-inoculation group.

Four different low molecular weight (LMW) RNA profiles, designated I-IV, among 179 isolates from Medicago, Melilotus and Trigonella species growing in a field site in Northern Spain were identified. From sequence analysis of the 16S rRNA, atpD and recA genes as well as DNA-DNA hybridization analysis with representatives of each LMW RNA profile it was evident that isolates with LMW RNA profiles I and II belonged to Sinorhizobium meliloti and those displaying profiles III and IV to Sinorhizobium medicae. Therefore, two distinct LMW RNA electrophoretic mobility profiles were found within each of these two species. Collectively, LMW RNA profiles I and II (identified as S. meliloti) were predominant in Melilotus alba, Melilotus officinalis and Medicago sativa. Profiles III and IV (identified as S. medicae) were predominant in Melilotus parviflora, Medicago sphaerocarpa, Medicago lupulina and Trigonella foenum-graecum. All the four LMW RNA profiles were identified among isolates from Trigonella monspelliaca nodules. These results revealed a different specificity by the hosts of the alfalfa cross-inoculation group towards the two bacterial species found in this study.

Ultrastructural and chemotaxonomic analysis of a xylanolytic strain of Cryptococcus adeliensis isolated from sheep droppings in Spain.

Cryptococcus adeliensis was initially described as a psycrophilic species containing a single strain CBS 8351(T) isolated from decayed algae in Terre Adelie (Antartida). Later, a second strain of this species was isolated from an immunosuppressed patient affected by leukaemia in Germany and recently several strains from this species have been found in human patients and pigeon droppings of the same country. In this study, we isolated from sheep droppings in Spain a xylanolytic strain named LEVX01 that was phenotypically related to the strain CBS 8351(T) and showed a 100% similarity in the D1/D2 domain and 5.8S-ITS region sequences with respect to the remaining described strains of C. adeliensis. These findings suggest that this species has a wide geographical distribution and that the animal faeces are a common habitat for C. adeliensis. The chemotaxonomic analyses showed the absence of detectable amounts of xylose in the cell walls of the strains LEVX01 and CBS8351(T) in contrast to other Cryptococcus species. Interestingly, the ultrastructural study showed the presence of fimbriae in these two strains that could be involved in the attachment to the host cells and, as occurs in Candida albicans, they could also be a pathogenicity factor for the man.

A new approach for separating low-molecular-weight RNA molecules by staircase electrophoresis in non-sequencing gels.

Low-molecular-weight (LMW) RNA profiles, which include ribosomal and transfer RNA molecules with similar small sizes, are molecular signatures of microorganisms with a great potential in microbial identification. The greatest resolution of these profiles was achieved by staircase electrophoresis in sequencing gels. Nevertheless, this technique is difficult to use because it takes 7 h, the gels have large sizes and it is necessary to heat the system and to recycle the buffer to maintain the denaturing conditions and avoid smile effects. Most available sequencing slabs have no internal temperature control or homogenizing devices, which by contrast are present in some newly designed non-sequencing slabs. Nevertheless, these slabs present two important problems for separating LMW RNA molecules, the size of gels is only 20 cm (instead of 40 cm) and the maximum voltage that can be reached is only 840 V (instead 2400 V). Staircase electrophoresis follows a model in which the external polarization is incrementally modified with a constant time step value. In the present work, we experimentally confirmed that by reducing the time step and increasing the total number of steps a suitable resolution is achieved. Under these conditions, despite the smaller size of the gels and the lower values of the electric field, the intensity reaches higher values than in sequencing gels and the LMW RNA profiles are correctly separated in 5 h. The resolution of these profiles obtained in non-sequencing gels is similar to that obtained in sequencing ones facilitating the analysis of large populations of microorganisms in any laboratory.