Spontaneous pneumomediastinum in two young women.

SUMMARY: Spontaneous pneumomediastinum (SPM) is a rare benign condition which must be differentiated from secondary pneumomediastinum due to chest trauma, abscess formation or Boerhaave's syndrome. We present two young women with SPM due to chronic self-induced vomiting and starvation associated with psychosis and pregnancy-associated vomiting respectively. This report highlights the exclusionary diagnostic pathway, the principles of conservative management and the need for a tailored multidisciplinary approach to enhance patient recovery and prevent future recurrence.

[Prevalence of microbiologically-confirmed influenza in patients with influenza-like illness in primary care and clinical and epidemiological characteristics]. / Prevalencia de gripe confirmada microbiológicamente en pacientes con síntomas gripales en atención primaria y características clínico-epidemiológicas.

OBJECTIVE: We evaluated the prevalence of microbiologically-confirmed influenza infection among patients with influenza-like symptoms and compared the clinical and epidemiological characteristics of patients with and without influenza infection. METHODS: Retrospective study of a cohort of patients with influenza-like symptoms from 2016 to 2018 who participated in a clinical trial in thirteen urban primary centres in Catalonia. Different epidemiological data were collected. Patients rated the different symptoms and signs on a Likert scale (absent, little problem, moderate problem and severe problem) and self-reported the measure of health status with the EuroQol visual analogue scale. A nasopharyngeal swab was taken for microbiological isolation of influenza and other microorganisms. RESULTS: A total of 427 patients were included. Microbiologically confirmed influenza was found in 240 patients (56.2%). The percentage of patients with moderate-to-severe cough, muscle aches, tiredness and dizziness was greater among patients with microbiologically confirmed influenza. The self-reported health status was significantly lower among patients with true flu infection (mean of 36.3 ± 18.2 vs 41.7 ± 17.8 in patients without influenza; p<0.001). CONCLUSIONS: Clinical findings are not particularly useful for confirming or excluding the diagnosis of influenza when intensity is not considered. However, the presence of moderate-to-severe cough, myalgias, tiredness and dizziness along with a poor health status is more common in patients with confirmed flu infection.

Fetal thigh volumetry by three-dimensional ultrasound: comparison between multiplanar and VOCAL techniques.

OBJECTIVES: To evaluate the agreement between multiplanar and Virtual Organ Computer-aided AnaLysis (VOCAL()) techniques for the measurement of total fetal thigh volume and to assess the repeatability and reproducibility of measurements performed using these methods; to derive birth weight-predicting models for both methods and to compare their accuracies. METHODS: This was a cross-sectional study of 150 singleton pregnancies at 30-42 weeks of gestation in which ultrasound volumes of the fetal thigh were obtained within 48 hours of delivery and measured using multiplanar and VOCAL techniques. Bland-Altman analyses were performed to determine the agreement between the two methods, and to evaluate intraobserver and interobserver variability in a subset of 40 patients. Birth weight-predicting models were derived using total fetal thigh volumes obtained using the VOCAL (ThiV) and multiplanar (ThiM) methods as independent variables. The accuracies of these formulas were compared. RESULTS: The mean percentage difference between measurements performed using the VOCAL technique and the multiplanar technique was -0.04 and the 95% limits of agreement were -8.17 and 8.09. The mean percentage difference and 95% limits of agreement between paired measurements in the assessment of intraobserver and interobserver variability were -1.10 (-7.67 to 5.47) and 0.61 (-7.68 to 8.91) for the VOCAL technique and 1.03 (-6.35 to 8.41) and -0.68 (-11.42 to 10.06) for the multiplanar method, respectively. The best-fit formulas for predicting birth weight (BW) were: BW = 1025.383 + 12.775x ThiV; and BW = 1033.286 + 12.733x ThiM. There was no significant difference between the accuracies of these formulas. CONCLUSIONS: There is good agreement between the VOCAL and multiplanar techniques for assessment of total fetal thigh volume. Measurements performed using both methods are repeatable and reproducible. For prediction of birth weight, the formulas generated in this study can be used interchangeably.

Birth-weight prediction by two- and three-dimensional ultrasound imaging.

OBJECTIVES: To compare the accuracies of birth-weight predicting models derived from two-dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three-dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations. METHODS: A total of 210 patients were evaluated to create a formula-generating group (n = 150) and a prospective-validation group (n = 60). Polynomial regression analysis was performed on the first group to generate one equation based on 2D ultrasound measurements, one based on fetal thigh volume measured by the multiplanar technique (ThiM) and one based on fetal thigh volume obtained by the Virtual Organ Computer-aided AnaLysis (VOCAL()) method (ThiV). Paired-samples t-tests with Bonferroni adjustments were used to compare the performances of these equations in the formula-finding and the prospective-validation groups. The same approach was used to compare the accuracies of the new 2D and 3D formulae with those of both original and modified 2D equations from previous publications, as well as the 3D model reported by Chang et al. RESULTS: The formulae with the best fit for the prediction of birth weight were: estimated fetal weight (EFW) = - 562.824 + 11.962x AC x FDL + 0.009 x BPD(2)x AC(2) (where AC is abdominal circumference, FDL is femur diaphysis length and BPD is biparietal diameter), EFW = 1033.286 + 12.733 x ThiM, and EFW = 1025.383 + 12.775 x ThiV. For both the formula-generating and the prospective-validation groups, there were no significant differences between the accuracies of the new 2D and 3D models in the prediction of birth weight. When applied to our population, the performances of the modified and original versions of the previously published 2D equations and the performance of the original 3D formula reported by Chang et al. were all significantly worse than our models. CONCLUSIONS: We believe that the greatest sources of discrepancy in estimation of birth weight are the phenotypic differences among patients used to create each of the formulae mentioned in this study. Our data reinforce the need for customized birth-weight prediction formulae, regardless of whether 2D or 3D measurements are employed.

Cardosins in postembryonic development of cardoon: towards an elucidation of the biological function of plant aspartic proteinases.

Following on from previous work, the temporal and spatial accumulation of the aspartic proteinases (EC 3.4.23) cardosin A and cardosin B during postembryonic seed development of cardoon (Cynara cardunculus) was studied, mRNA and protein analyses of both cardosins suggested that the proteins accumulate during seed maturation, and that cardosin A is later synthesised de novo at the time of radicle emergence. Immunocytochemistry revealed that the precursor form of cardosin A accumulates in protein bodies and cell walls. This localisation in seeds is different from that previously described for cardoon flowers, suggesting a tissue-dependent targeting of the protein. It is known that procardosins are active and may have a role in proteolysis and processing of storage proteins. However, the presence of procardosin A in seeds could be related to the proposed role of the plant-specific insert in membrane lipid conversion during water uptake and solute leakage in actively growing tissues. This is in accordance with the recently proposed bifunctional role of aspartic proteinase precursor molecules that possess a membrane-destabilising domain in addition to a protease domain. Mature cardosin B, but not its mRNA, was detected in the first hours after seed imbibition and disappeared at the time of radicle emergence. This extracellular aspartic protease has already been implicated in cell wall loosening and remodelling, and its role in seed germination could be related to loosening tissue constraints for radicle protusion. The described pattern of cardosin A and B expression suggests a finely tuned developmental regulation and prompts an analysis of their possible roles in the physiology of postembryonic development.

Heart stroke volume and cardiac output by four-dimensional ultrasound in normal fetuses.

OBJECTIVE: To establish reference intervals for fetal heart stroke volume and cardiac output with gestation. METHODS: Fetal heart ventricular volumes were measured using the four-dimensional (4D) spatiotemporal imaging correlation (STIC) ultrasound technique in 140 normal singleton pregnancies at 12-34 weeks' gestation. The Virtual Organ Computer-aided AnaLysis (VOCAL) technique was used to obtain a sequence of six sections of each ventricular volume in systole and diastole. Each volume was obtained after a 30 degrees rotation from the previous one around a fixed axis extending from the apex of the heart to the point that divides symmetrically each atrioventricular valve. The contour of each ventricle was drawn manually and the 4D volumes of the left and right ventricle in systole and diastole were estimated. The stroke volume for each ventricle was then calculated by subtracting the one in systole from the one in diastole and the cardiac output was calculated by multiplying the stroke volume by the fetal heart rate. In 50 cases the stroke volumes were measured by the same sonographer twice and the intraobserver agreement of measurements was calculated. RESULTS: The left and right stroke volume and cardiac output increased exponentially with gestation, from respective mean values of 0.02 mL, 0.01 mL, 2.39 mL/min and 1.80 mL/min at 12 weeks to 0.30 mL, 0.32 mL, 43.46 mL/min and 46.72 mL/min at 20 weeks, and 2.07 mL, 2.67 mL, 284.71 mL/min and 365.99 mL/min at 34 weeks. The ratio of right to left stroke volume increased significantly with gestation from about 0.97 at 12 weeks to 1.13 at 34 weeks. In the Bland-Altman test, the mean percentage difference and 95% limits of intraobserver agreement for left stroke volume and right stroke volume were - 2.1 (-18.4, 14.2)% and - 0.8 (-16.4, 18.0)%, respectively. CONCLUSIONS: In normal fetuses the stroke volume and cardiac output increase between 12 and 34 weeks' gestation. The extent to which, in pathological pregnancies, possible deviations in these measurements from normal prove to be useful in the prediction of outcome remains to be determined.

Three-dimensional evaluation of mid-facial hypoplasia in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation.

OBJECTIVE: To investigate the mid-facial hypoplasia of fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation, by three-dimensional (3D) evaluation of the maxilla and the nasal bones. METHODS: A 3D volume of the fetal head was obtained before fetal karyotyping at 11 + 0 to 13 + 6 (median 12) weeks of gestation in 80 fetuses that were subsequently found to have trisomy 21 and in 862 fetuses subsequently found to be chromosomally normal. The multiplanar mode was used to obtain a sequence of transverse views of the fetal face and to demonstrate the maxilla, the adjacent rami of the mandible and the nasal bones. The maxillary depth, defined as the distance between the alveolus of the maxilla in the midline anteriorly and the midpoint of the line joining the rami posteriorly, was measured. Ossification of the nasal bones was considered to be normal if both bones were more echogenic than the overlying skin. RESULTS: In the chromosomally normal group the maxillary depth increased linearly with crown-rump length (CRL) from 3.1 mm at a CRL of 45 mm to 4.8 mm at a CRL of 84 mm, and in the trisomy 21 fetuses the depth was significantly smaller than normal (mean difference = - 0.3 mm, P < 0.001). There was no significant association between the delta maxillary depth and delta nuchal translucency thickness in either the trisomy 21 or the chromosomally normal fetuses. Impaired ossification of the nasal bones was observed in 3.1% of the chromosomally normal fetuses and in 60.0% of those with trisomy 21. The mean maxillary depth was significantly smaller in fetuses demonstrating impaired ossification than in those with normal ossification of the nasal bones (mean difference = -0.2 mm; 95% CI, -0.3 to -0.1, P = 0.001). CONCLUSIONS: In a high proportion of fetuses with trisomy 21 there is sonographic evidence of mid-facial hypoplasia at 11 + 0 to 13 + 6 weeks of gestation.

Placental volume in twin and triplet pregnancies measured by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks of gestation.

OBJECTIVE: To compare the placental volume at 11 + 0 to 13 + 6 weeks' gestation between singleton and multiple pregnancies and to examine the possible effect of chorionicity on placental volume. METHODS: The placental volume was measured by three-dimensional (3D) ultrasound using the Virtual Organ Computer-aided AnaLysis (VOCAL) technique in 290 consecutive twin and 37 triplet pregnancies at 11 + 0 to 13 + 6 weeks of gestation. For the comparison of twin, triplet and singleton placental volumes each measurement was expressed as a multiple of the median (MoM) for singletons, previously established from the study of 417 normal fetuses at 11 + 0 to 13 + 6 weeks of gestation. RESULTS: Median twin and triplet placental volumes were 1.66 and 2.28 MoM for singletons, respectively. In twins the placental volumes increased significantly with gestation from a median of 83.6 mL (5th and 95th centiles: 56.0 mL and 124.9 mL) at 11 + 0 weeks to 149.3 mL (5th and 95th centiles: 100.0 mL and 223.1 mL) at 13 + 6 weeks. The median MoM in monochorionic twins was not significantly different from that in dichorionic twins with fused placentas or dichorionic twins with separate placentas. In triplets the placental volumes increased significantly with gestation from a median of 114.9 mL (5th and 95th centiles: 77.6 mL and 170.1 mL) at 11 weeks to 217.9 mL (5th and 95th centiles: 147.2 mL and 322.5 mL) at 13 + 6 weeks. There were no significant differences in total placental volume between monochorionic and dichorionic triplets, monochorionic and trichorionic triplets, or dichorionic and trichorionic triplets. CONCLUSIONS: Placental volume in multiple pregnancies does not depend on chorionicity, and the rate of placental growth between 11 and 13 + 6 weeks is not significantly different between singletons, twins and triplets. Moreover, for a given gestational age the placental volume corresponding to each fetus in twins and triplets is 83% and 76%, respectively, of the placental volume in singletons.

Metopic suture in fetuses with Apert syndrome at 22-27 weeks of gestation.

OBJECTIVES: To examine the possible association of skull deformity and the development of the cranial sutures in fetuses with Apert syndrome. METHODS: Three-dimensional (3D) ultrasound was used to examine the metopic and coronal sutures in seven fetuses with Apert syndrome at 22-27 weeks of gestation. The gap between the frontal bones in the transverse plane of the head at the level of the cavum septi pellucidi was measured and compared to findings in 120 anatomically normal fetuses undergoing routine ultrasound examination at 16-32 weeks. RESULTS: In the normal group, the gap between the frontal bones in the metopic suture at the level of the cavum septi pellucidi, decreased significantly with gestation from a mean of 2.2 mm (5th and 95th centiles: 1.5 mm and 2.9 mm) at 16 weeks to 0.9 mm (5th and 95th centiles: 0.3 mm and 1.6 mm) at 32 weeks. In the seven cases with Apert syndrome, two-dimensional ultrasound examination demonstrated the characteristic features of frontal bossing, depressed nasal bridge and bilateral syndactyly. On 3D examination there was complete closure of the coronal suture and a wide gap in the metopic suture (15-23 mm). CONCLUSION: In normal fetuses, cranial bones are believed to grow in response to the centrifugal pressure from the expanding brain and proximity of the dura to the suture is critical in maintaining its patency. In Apert syndrome, the frontal bossing may be a mere consequence of a genetically predetermined premature closure of the coronal suture. Alternatively, there is a genetically predetermined deformation of the brain, which in turn, through differential stretch of the dura in the temporal and frontal regions, causes premature closure of the coronal suture and impaired closure of the metopic suture.

Metopic suture in fetuses with holoprosencephaly at 11 + 0 to 13 + 6 weeks of gestation.

OBJECTIVE: To investigate the development of the metopic suture in fetuses with holoprosencephaly at 11 + 0 to 13 + 6 weeks of gestation. METHODS: Three-dimensional (3D) ultrasound was used to measure the height and gap between the frontal bones in 200 normal fetuses and in nine fetuses with holoprosencephaly at 11 + 0 to 13 + 6 (median, 12) weeks of gestation. RESULTS: In the 200 normal fetuses, the height of the frontal bones increased significantly with gestation from a mean of 2.5 mm (5(th) and 95(th) centiles: 1.9 mm and 3.3 mm) at 11 weeks to 6.1 mm (5(th) and 95(th) centiles: 4.6 mm and 8.1 mm) at 13 + 6 weeks. The gap between the two frontal bones did not change significantly with gestation (mean: 1.5 mm; 5(th) centile: 1.0 mm; 95(th) centile: 2.0 mm). In fetuses with holoprosencephaly, the height of the frontal bones was significantly larger (mean difference, 5.6 SDs; range, 3.9-7.7 SDs; P < 0.0001) and the gap was significantly smaller (mean 0.2 mm, range 0-0.8 mm; P < 0.0001) than those in normal fetuses. CONCLUSIONS: Holoprosencephaly is associated with an accelerated development of the frontal bones and premature closure of the metopic suture.

Metopic suture in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation.

OBJECTIVE: To investigate the development of the frontal bones and metopic suture in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation. METHODS: Three-dimensional (3D) ultrasound was used to measure the height of and gap between the frontal bones in 75 fetuses with trisomy 21 and these were compared to the measurements in 200 normal fetuses at 11 + 0 to 13 + 6 (median, 12 + 6) weeks of gestation. RESULTS: In the fetuses with trisomy 21, compared to the normal fetuses, there was no significant difference in either the height of the frontal bones (mean difference 0.16 SD, range -1.78 to 2.17 SD; P = 0.369) or the gap between them (mean difference 0.012, 95% CI -0.073 to 0.097; P = 0.780). Additionally, within the group of trisomy 21 fetuses there were no significant differences in the development of the frontal bones and metopic suture between those with absent (n = 46) and those with present (n = 29) nasal bone. CONCLUSIONS: In trisomy 21 the development of the frontal bones and metopic suture is as normal and is independent from the development of the nasal bones.

Three-dimensional sonographic description of abnormal metopic suture in second- and third-trimester fetuses.

OBJECTIVE: To describe patterns of abnormal development of the metopic suture in association with fetal malformations during the second and third trimesters of pregnancy. METHODS: This was a cross-sectional study of the frontal bones and metopic suture in 11 fetuses at 17-32 weeks of gestation. Cases were selected because there were obvious abnormalities in the metopic sutures. In each case, a malformation was detected by two-dimensional (2D) ultrasound and the abnormality of the metopic suture was detected and evaluated on three-dimensional (3D) ultrasound, using transparent maximum mode. RESULTS: There were essentially four patterns of abnormality in the metopic suture: firstly, delayed development with a V- or Y-shaped open suture, which is found in normal fetuses at 12-16 weeks; secondly, a U-shaped open suture, presumably due to upward growth of the frontal bones with delayed closure; thirdly, premature closure of the suture, which is normally observed after 32 weeks; fourthly, the presence of additional bone between the frontal bones. Premature closure of the suture or additional bone between the frontal bones was observed in fetuses with holoprosencephaly and abnormalities of the corpus callosum, whereas the V-, Y- and U-shaped metopic sutures were observed in fetuses with facial defects involving the orbits, nasal bones, lip, palate and mandible, in the absence of holoprosencephaly and abnormal corpus callosum. CONCLUSIONS: This preliminary study describes the pattern of possible abnormalities of the metopic suture and should stimulate further investigation to establish the prevalence and evolution of abnormal sutures as well as the incidence and pattern of other associated defects.

Three-dimensional sonographic description of the fetal frontal bones and metopic suture.

OBJECTIVE: To describe the morphology of the frontal bones and metopic suture at 9-34 weeks of gestation using three-dimensional (3D) ultrasonography. METHODS: This was a cross-sectional study of the frontal bones and metopic suture in 16 fetuses at 9-34 weeks of gestation. 3D ultrasonography was used to obtain volumes of the whole fetal skull in the mid-sagittal plane. The volumes were analyzed using the rendering mode and transparent maximum mode in order to achieve a clear view of the frontal bones and the metopic suture. RESULTS: At 9 weeks, a small ossification center was visible in the middle of each supraorbital part of the frontal bones and by 11 weeks the frontal bones appeared as 'thick eyebrows'. In the second trimester there was progressive radial bone expansion and delineation of the metopic suture and in the third trimester there was closure of the metopic suture, starting from the glabella and moving upwards towards the anterior fontanelle. CONCLUSIONS: This study provides 3D ultrasound images that illustrate the process of ossification of the frontal bones and the subsequent development of the metopic suture during prenatal life.

Placental volume measured by three-dimensional ultrasound at 11 to 13 + 6 weeks of gestation: relation to chromosomal defects.

OBJECTIVE: To determine the potential value of measuring the placental volume at 11 to 13 + 6 weeks of gestation in screening for chromosomal defects. METHODS: The placental volume was measured using three-dimensional ultrasound in 500 consecutive singleton pregnancies immediately before chorionic villus sampling for fetal karyotyping at 11 to 13 + 6 (median, 12) weeks of gestation. RESULTS: The fetal karyotype was normal in 417 pregnancies and abnormal in 83. In the chromosomally normal group the mean placental volume increased significantly with gestation from a mean of 51 mL (5th and 95th centiles: 31.2 and 82.4 mL) at 11 weeks to 91 mL (5th and 95th centiles: 55.7 and 147.2 mL) at 13 + 6 weeks. In the chromosomally abnormal group the mean placental volume for gestational age was not significantly different from normal in trisomy 21 and Turner syndrome, but it was smaller in trisomies 13 and 18. CONCLUSIONS: The measurement of the placental volume at 11 to 13 + 6 weeks of gestation is unlikely to be a useful predictor of the major chromosomal defects. In trisomies 13 and 18 the small placental volume may be due to early-onset fetal growth restriction, which could be the consequence of impaired placental function.

Gestational sac volume measured by three-dimensional ultrasound at 11 to 13 + 6 weeks of gestation: relation to chromosomal defects.

OBJECTIVE: To determine the potential value of measuring the gestational sac volume (GSV) at 11 to 13 + 6 weeks of gestation in screening for chromosomal defects. METHODS: The GSV was measured using three-dimensional (3D) ultrasound in 500 consecutive singleton pregnancies immediately before chorionic villus sampling (CVS) for fetal karyotyping at 11 to 13 + 6 (median 12) weeks of gestation. RESULTS: The fetal karyotype was normal in 417 pregnancies and abnormal in 83. In the chromosomally normal group, the mean GSV increased significantly with gestational age from a mean of 69 mL at 11 weeks to 144 mL at 13 + 6 weeks (the standard deviation was 27 mL). In the chromosomally abnormal group, the mean GSV for gestational age was not significantly different from normal in fetuses with trisomy 21, trisomy 18 and Turner syndrome, but it was smaller in those with triploidy and trisomy 13. However, the mean GSV for crown-rump length (CRL) was significantly larger in trisomy 18, smaller in triploidy and trisomy 13, and not different from normal in trisomy 21 and Turner syndrome. The mean CRL for gestational age was significantly smaller than normal in trisomy 18, triploidy and trisomy 13. CONCLUSIONS: The measurement of the GSV at 11 to 13 + 6 weeks of gestation is unlikely to provide useful prediction of the major chromosomal defects. In trisomy 13 and triploidy, the small GSV may be due to early onset fetal growth restriction and reduced amniotic fluid volume. In trisomy 18, the increase in GSV is probably due to the presence of associated fetal abnormalities that interfere with fetal swallowing.

Assessment of the gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation by three-dimensional ultrasound.

OBJECTIVE: To detect the presence of a gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation and to verify if this gap could lead to the erroneous diagnosis of absent nasal bone. METHODS: Three-dimensional (3D) ultrasound was used to assess the fetal nose in 450 singleton pregnancies, immediately after two-dimensional (2D) evaluation of the nasal bones and screening for chromosomal defects by a combination of maternal age and the measurement of fetal nuchal translucency at 11 to 13 + 6 (median, 12) weeks of gestation. A 3D volume of the fetal face was acquired and then analyzed using the multiplanar mode. A sequence of transverse views was used to confirm the presence or absence of the nasal bones and when they were present any visible gap between them was measured. A perfectly mid-sagittal plane was then examined to determine if the nasal bone was visible or not. RESULTS: In 421/450 (93.6%) cases the nasal bone was present during 2D ultrasound. Using the multiplanar mode of 3D ultrasound, in 83/421 (19.7%) fetuses a gap between the nasal bones could be demonstrated and in 36/83 (43.4%) cases the nasal bone was found to be absent in the perfect mid-sagittal view. In 29/450 (6.4%) cases the nasal bones were absent during the 2D scan. In the 3D assessment there was absence of both bones in 25/29 (86.2%) cases and absence of one of the two bones in 4/29 (13.8%) cases. Chorionic villus sampling demonstrated that the fetal karyotype was normal in 404 and abnormal in 46 cases, including 31 cases of trisomy 21. There was absence of one or both nasal bones in three (0.7%) of the chromosomally normal fetuses, in 19 (61.3%) with trisomy 21 and in seven (46.7%) with other chromosomal defects. CONCLUSIONS: At 11 to 13 + 6 weeks of gestation there is a gap between the nasal bones in about 20% of fetuses, and in about 40% of these cases in the perfect mid-sagittal plane the nasal bone may erroneously be considered to be absent.

Two African swine fever virus proteins derived from a common precursor exhibit different nucleocytoplasmic transport activities.

African swine fever virus (ASFV), a large icosahedral deoxyvirus, is the causative agent of an economically relevant hemorrhagic disease that affects domestic pigs. The major purpose of the present study was to investigate the nuclear transport activities of the ASFV p37 and p14 proteins, which result from the proteolytic processing of a common precursor. Experiments were performed by using yeast-based nucleocytoplasmic transport assays and by analysis of the subcellular localization of different green fluorescent and Myc fusion proteins in mammalian cells. The results obtained both in yeast and mammalian cells clearly demonstrated that ASFV p14 protein is imported into the nucleus but not exported to the cytoplasm. The ability of p37 protein to be exported from the nucleus to the cytoplasm of both yeast and mammalian cells was also demonstrated, and the results clearly indicate that p37 nuclear export is dependent on the interaction of the protein with the CRM-1 receptor. In addition, p37 was shown to exhibit nuclear import activity in mammalian cells. The p37 protein nuclear import and export abilities described here constitute the first report of a nucleocytoplasmic shuttling protein encoded by the ASFV genome. Overall, the overlapping results obtained for green fluorescent protein fusions and Myc-tagged proteins undoubtedly demonstrate that ASFV p37 and p14 proteins exhibit nucleocytoplasmic transport activities. These findings are significant for understanding the role these proteins play in the replication cycle of ASFV.

Hipotensión ortostática en el anciano / Orthostatic hypotension in the elderly

En esta revisión se repasan las principales carac terísticas de la hipotensión ortostática que ocurre en el anciano. Se trata de una patología poco estudiada y poco detectada en las consultas de Atención Primaria. Se quiere resaltar su enorme preva lencia, la necesidad de una detección sistemática, la dificultad en el estudio diagnóstico, su importancia como factor de riesgo vascular en el grupo de pacientes con 65 años o más y se quieren dar pautas de abordaje y tratamiento desde la Atención Primaria (AU)

Molecular cloning and characterization of cDNA encoding cardosin B, an aspartic proteinase accumulating extracellularly in the transmitting tissue of Cynara cardunculus L.

Cardosins A and B are related aspartic proteinases from the pistils of Cynara cardunculus L., whose milk-clotting activity has been exploited for the manufacture of cheese. Here we report the cloning of cardosin B cDNA and its organ, tissue and cytological localization. The cDNA-derived amino acid sequence has 73% similarity with that of cardosin A and displays several distinguishing features. Cardosin B mRNA was detected in young inflorescences but not in pistils of fully opened inflorescences, indicating that its expression is developmentally regulated. The proteinase, however, accumulates in the pistil until the later stages of floral development. Immunocytochemistry with a monospecific antibody localized cardosin B to the cell wall and extracellular matrix of the floral transmitting tissue. The location of cardosin B in the pistil is therefore clearly different from that of cardosin A, which was found at protein storage vacuoles of the stigmatic papillae and has been suggested to be involved in RGD-mediated proteolytic mechanisms. In view of these results the possible functions of cardosin B in the transmitting tissue are discussed.