The CUN-BAE, Deurenberg Fat Mass, and visceral adiposity index as confident anthropometric indices for early detection of metabolic syndrome components in adults.

There is no definition for the metabolic syndrome; visceral obesity, elevated lipids and glucose, and hypertension coexist. The aim of the study is to determine which anthropometric indicators best determine it. Cross-sectional study in 418,343 Spanish workers. Metabolic syndrome was determined using the NCEP-ATPIII, IDF and JIS criteria. The anthropometric variables studied were: body mass index, waist circumference, waist-to-height ratio, CUNBAE, Deuremberg formula, body fat index, body surface index, normalized weight adjusted index, body roundness index, body shape index, visceral adiposity index (VAI), dysfunctional adiposity index, conicity index, metabolic score for visceral fat (METS-VF), waist triglyceride index. In men, the anthropometric indices with the largest areas under the ROC curve are VAI with ATPIII criteria and JIS. If we use the IDF criteria: waist circumference and METS-VF, with the same result. In women, the largest areas under the curve were observed with the Deuremberg formula in both ATPIII and JIS while with the IDF criteria it is METS-VF. The most useful anthropometric indices for identifying metabolic syndrome are CUN-BAE and Deuremberg, followed by the VAI. A single definition of metabolic syndrome should be agreed to determine the best anthropometric index with predictive capacity for its diagnosis.

Current Situation and Prognostic Evolution of Combined Heart-lung Transplantation in a European Union Country.

Background: This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure. Methods: A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD). Results: Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis. Conclusion: HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.

Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review.

BACKGROUND: Cognitive-motor interference (CMI) has been proposed as a valid marker of daily life impairment in Multiple Sclerosis (MS). The heterogeneity and scarce number of studies regarding CMI in MS has hampered the synthesis of the existing evidence. The present systematic review employed a mixed methods approach with the aim of identifying and describing variables under which CMI is particularly useful to assess patients with MS. RESULTS: MS patients showed significant CMI. The motor variables that were most sensitive in detecting significant CMI were velocity (m/s), cadence (steps/min), and double support (% gait cycle), which was also specific for MS. Among the cognitive tasks, Alternate Alphabet and Serial Subtracting 7 s were sensitive, whereas Verbal Fluency were both sensitive and specific to CMI in MS. CONCLUSIONS: CMI should be assessed in MS with a standardised dual task such as the Verbal Fluency task while walking, with measurements of the double support time and the effect on the cognitive task. The clinical usefulness of CMI in the assessment of patients with MS is discussed.

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

Supramolecular assembly of a thermoresponsive steroidal surfactant with an oppositely charged thermoresponsive block copolymer.

Supramolecular rearrangements are crucial in determining the response of stimuli sensitive soft matter systems such as those formed by mixtures of oppositely charged amphiphiles. Here mixtures of this kind were prepared by mixing the cationic block copolymer pAMPTMA30-b-pNIPAAM120 and an anionic surfactant obtained by the modification of the bile salt sodium cholate. As pure components, the two compounds presented a thermoresponsive self-assembly at around 30-35 °C; a micelle formation in the case of the copolymer and a transition from fibers to tubes in the case of the bile salt derivative. When both were present in the same solution they associated into mixed aggregates that showed complex thermoresponsive features. At room temperature, the core of the aggregate was comprised of a supramolecular twisted ribbon of the bile salt derivative. The block copolymers were anchored on the surface of this ribbon through electrostatic interactions between their charged blocks and the oppositely charged heads of the bile salt molecules. The whole structure was stabilized by a corona of the uncharged blocks that protruded into the surrounding solvent. By increasing the temperature to 30-34 °C the mixed aggregates transformed into rods with smooth edges that associated into bundles and clusters, which in turn induced clouding of the solution. Circular dichroism allowed us to follow progressive rearrangements of the supramolecular organization within the complex, occurring in the range of temperature of 20-70 °C.

Relation between lipoprotein subfractions and TSH levels in the cardiovascular risk among women with subclinical hypothyroidism.

OBJECTIVE: Subclinical hypothyroidism (SCH) is a common condition associated with increased cardiovascular risk. A standard treatment is yet to be established, as there is no consensus on the TSH cut-off values which should be used as indicators. Thus, the aim of this study was to assess cardiovascular risk in patients with SCH and to differentiate it according to TSH levels. DESIGN: This was an observational study conducted in an academic medical centre. PATIENTS: The study population consisted of 95 middle-aged women recently diagnosed with SCH and 65 euthyroid controls. MEASUREMENTS: We measured anthropometric parameters, lipid cardiovascular risk markers and lipoprotein subclasses of HDL and LDL. RESULTS: Patients with SCH exhibited a significant increase in triglycerides and atherogenic index of plasma and a significant reduction in HDL-cholesterol with respect to the control group after adjusted by age and BMI. A similar lipid profile was observed in both SCH groups. However, patients with TSH levels higher than 10 mIU/l showed a significant reduction in LDL particle size, which was associated with a higher prevalence of atherogenic pattern B. CONCLUSIONS: Our findings indicate that cardiovascular risk is affected in patients with TSH levels over 10 mIU/l, who have a lipid profile characteristic of atherogenic dyslipidemia.

Hamartoma endobronquial. Resección con fibrobroncoscopio / No disponible

No disponible

Crystal structure of chenodeoxycholic acid, ursodeoxycholic acid and their two 3beta,7alpha- and 3beta,7beta-dihydroxy epimers.

The crystal structures of chenodeoxycholic acid (CDCA), ursodeoxycholic acid (7beta isomer of CDCA) and their other two epimers (3beta,7alpha- and 3beta,7beta-isomers) have been resolved. The four isomers were recrystallized from p-xylene. CDCA crystal is hexagonal P6(5) while the crystals of the other three isomers are orthorhombic (P2(1)2(1)2(1) space group). Only the 3beta,7beta isomer forms an inclusion complex with the solvent with a 1:1 stoichiometry. In all cases, the three hydrogen bond sites (the two hydroxy groups, O3-H and O7-H, and the carboxylic acid group of the side chain, O24bO24a-H) simultaneously act as hydrogen bond donors and acceptors. By considering that O24a is always donor and O24b is always acceptor, the hydrogen bond sequences can be understood on the basis of the interaction between the two hydroxy groups. However the comparison between the four compounds is complicated by the existence of two molecules in the asymmetric unit in the UDCA crystal resulting in that the same hydrogen bond site (for instance O3) can be donor towards two different acceptors (either O7 or O24b). As in the case of the four isomers of deoxycholic acid (Steroids 2004, 69, 379), the other three isomers present a donor-->acceptor sequence, which is O7-->O3 when O3-H is beta and O3-->O7 when O3-H is alpha. The spatial orientation of the carboxylic acid of the side chain is referred to two almost perpendicular planes (defined by (1) the carbon atoms C1/C6-C17/C20 and by (2) the methyl groups C18-C19 and the two carbon atoms to which they are linked, C10 and C13, respectively). Only the side chain of CDCA evidences a positive deviation towards the hydrophobic beta side of the molecule.

Lung graft dysfunction in the early postoperative period after lung and heart lung transplantation.

BACKGROUND: We present a retrospective study of 9 years of experience in the management of graft dysfunction in the early postoperative period after lung transplantation (LT) and heart lung transplantation (HLT). MATERIAL AND METHODS: There were 190 LT and HLT (22.63% single LT, 71.05% bilateral sequential LT, and 7.36% HLT) performed from 1993 to 2002. Hemodynamic and respiratory parameters were monitored during the operative technique and critical care for the first 24 hours. We analyzed ischemic time, bypass need, and type of transplant. RESULTS: Lung graft dysfunction occurred in 37.2% of patients, but only in 12.2% was it severe. Nearly all patients were ventilated on a 50% fraction of inspired oxygen during the first 24-48 hours; 61.56% of patients were extubated before the first 5 postoperative day and 38.43% thereafter. The mean ischemia time for the first lung was 220 +/- 28 minutes: for the second lung, it was 378 +/- 31 minutes. The anesthetic time was 500-600 minutes. The variables associated with a significantly increased graft dysfunction were as follows: bilateral LT, and cardiopulmonary bypass requirement. The residence in the intensive care unit (ICU) was longer for patients with graft dysfunction than for those without that problem. Mortality directly related to graft dysfunction was only 4.07%. CONCLUSIONS: A correlation among graft ischemia and early postoperative morbidity and duration of ICU stay did not have a significant impact on mortality.

Successful prediction of the hydrogen bond network of the 3-oxo-12alpha-hydroxy-5beta-cholan-24-oic acid crystal from resolution of the crystal structure of deoxycholic acid and its three 3,12-dihydroxy epimers.

Crystal structures of p-xylene-crystallized deoxycholic acid (3alpha,12alpha-dihydroxy-5beta-cholan-24-oic acid) and its three epimers (3beta,12alpha-; 3alpha,12beta-; and 3beta,12beta-) have been solved. Deoxycholic acid forms a crystalline (P21) complex with the solvent with a 2:1 stoichiometry whereas crystals of the three epimers do not form inclusion compounds. Crystals of the 3beta,12beta-epimer are hexagonal, whereas the 3alpha,12beta-and 3beta,12alpha-epimers crystallize in the P2(1)2(1)2(1) orthorhombic space group. The three hydrogen bond sites (two hydroxy groups, i. e. O3-H, and O12-H, and the carboxylic acid group of the side chain, O24bO24a-H) simultaneously act as hydrogen bond donors and acceptors. The hydrogen bond network in the crystals was analyzed and the following sequences have been observed: two chains (abcabc... or acbacb... ) and two rings (abc or acb), which constitute a complete set of all the possible sequences which can be drawn for an intermolecular hydrogen bond network formed by three hydrogen bond donor/acceptor sites forming crossing hydrogen bonds. The orientation of O3-H (alpha or beta) determines the sequence of the acceptor and the donor groups involved in the pattern: O24a --> O12 --> O3 --> O24b when it is alpha and O24a --> O3 --> O12--> O24B when it is beta. These observations were used to predict the hydrogen bond network of p-xylene-crystallized 3-oxo,12alpha-hydroxy-5beta-cholan-24-oic acid. This compound has two hydrogen bond donor and three potential hydrogen bond acceptor sites. According to the previous sequence set, this compound should crystallize in the monoclinic P21 system, should form a complex with the solvent, O24b should not participate in the hydrogen bond network, and the chain sequence O24a --> O12 --> O3 would be followed. All predictions were confirmed experimentally.

Immunohistochemical expression of estrogen receptor beta in normal and tumoral canine mammary glands.

To date, two isoforms of estrogen receptors (ER) have been identified, cloned, and characterized from several species, estrogen receptor-alpha (ERalpha) and estrogen receptor-beta (ERbeta). Although the presence of ERalpha has been demonstrated in normal and tumoral canine mammary tissues, the issue of ERbeta expression has not been addressed in the dog. In this study, we have analyzed the expression of ERbeta in formalin-fixed, paraffin-embedded tissue samples of nonaltered mammary gland, 30 malignant (six complex carcinoma, 12 simple carcinoma, three carcinosarcoma, and nine carcinoma or sarcoma in benign tumor), and five benign (one fibroadenoma, one complex papilloma, one complex adenoma, and two benign mixed tumors) mammary tumors of the dog by using a polyclonal ERbeta antibody and the avidin-biotin-peroxidase complex immunohistochemical technique. Our results show that high numbers of normal ductal and acinar epithelium and approximately one third of canine mammary tumors express ERbeta. This expression was higher in benign than in malignant tumors. Furthermore, expression was higher in complex and mixed histologic subtypes of malignant tumors when compared with simple subtypes.

Apoptosis of thymocytes in experimental African Swine Fever virus infection.

This paper report on the lesions occurred in the thymus in experimental acute African swine fever (ASF). Twenty-one pigs were inoculated with the highly virulent ASF virus (ASFV) isolate Spain-70. Animals were slaughtered from 1 to 7 days post infection (dpi). Three animals with similar features were used as controls. Thymus samples were fixed in 10% buffered formalin solution for histological and immunohistochemical study and in 2.5% glutaraldehyde for ultrastructural examination. For immunohistochemical study, the avidin-biotin-peroxidase complex (ABC) technique was used to demonstrate viral protein 73 and porcine myeloid-histiocyte antigen SWC3 using specific monoclonal antibodies. Cell apoptosis was evaluated by the TUNEL assay. Blood samples were taken daily from all pigs and were used for leukocyte counts. The results of this study show a severe thymocyte apoptosis not related to the direct action of ASFV on these cells, but probably to a quantitative increase in macrophages in the thymus and their activation. A decrease in the percentage of blood lymphocytes was observed at the same time No significant vascular changes were observed in the study. With these results we suggest that ASFV infection of the thymus does not seem to play a critical role in the acute disease. Although severe apoptosis was observed, animals died because of the severe lesions found in the other organs.

A morphologic and immunohistochemical study of the bronchus-associated lymphoid tissue of pigs naturally infected with Mycoplasma hyopneumoniae.

Porcine enzootic pneumonia (PEN), caused by Mycoplasma hyopneumoniae (Mh), has been described in pigs in all geographic areas. The disease is characterized by high morbidity and low mortality rates in intensive swine production systems. A morphologic and immunohistochemical study was done to determine the cellular populations present in lung parenchyma of infected pigs, with special attention to the bronchus-associated lymphoid tissue (BALT). Polyclonal and monoclonal antibodies were used for the detection of antigens of Mh, T lymphocytes (CD3+, CD4+, and CD8+), IgG+ or IgA+ lymphocytes, and cells containing lysozyme, S-100 protein, major histocompatibility complex class II antigen or myeloid-histiocyte antigen. Findings in lung tissues associated with Mh infection were catarrhal bronchointerstitial pneumonia, with infiltration of inflammatory cells in the lamina propria of bronchi and bronchioles and alveolar septa. Hyperplasia of mononuclear cells in the BALT areas was the most significant histologic change. The BALT showed a high morphologic and cellular organization. Macrophages and B lymphocytes were the main cellular components of germinal centers. T lymphocytes were primarily located in perifollicular areas of the BALT, lamina propria and within the airway epithelium, and plasma cells containing IgG or IgA at the periphery of the BALT, in the lamina propria of bronchi and bronchioles, in alveolar septa, and around bronchial submucosal glands. The hyperplastic BALT in PEN cases consisted of macrophages, dendritic cells, T and B lymphocytes, and IgG+ and IgA+ plasma cells. CD4+ cells predominated over CD8+ cells. Local humoral immunity appears to play an important role in the infection.

Cutaneous lesions in experimental acute and subacute African swine fever: an immunohistopathological and ultrastructural study.

Histopathological, immunohistochemical and ultrastructural cutaneous changes are described in acute and subacute forms of experimental African Swine Fever (ASF). Fourteen 3-month-old Large White cross pigs were infected intramuscularly with the Dominican Republic 78 (DR78) ASF virus isolate and euthanized in pairs on alternatives days (3 to 17) post-inoculation (dpi). Three pigs were found dead at 8, 10 and 13 dpi, respectively. Antibodies against viral antigen Vp73, human fibrinogen, glycoprotein IIIa and Factor VIII-ra were used to evaluate viral antigen distribution, fibrin microthrombi and platelets in dermal vessels, respectively. Cutaneous lesions were characterised by vascular changes ranging from hyperaemia, mild oedema, scarce fibrin microthrombi and microhaemorrhages in euthanized animals, to generalized fibrin microthrombosis and microhaemorrhages in dead pigs. Secondary pustules and superficial folliculitis were observed in two animals dead at 10 and 13 dpi. Diffuse cytoplasmic Vp73 labelling was found in numerous intravascular monocytes and dermal macrophages. Ultrastructural studies showed mature viral particles in the lumen of dermal vessels but viral replication was not observed; nonetheless, microtubuloreticular structures were observed in the cytoplasm of some endothelial cells and macrophages which showed cytopathic effects, signs of cell activation or degeneration. Morphological and immunohistochemical evidences of platelet activation, degranulation and consumption were observed from 5 dpi onward.