Asociación de parámetros bioquímicos del metabolismo óseo con progresión y/o desarrollo de nuevas calcificaciones aórticas / Association of biochemical parameters of bone metabolism with progression and/or development of new aortic calcifications

Objetivo: Los parámetros bioquímicos siguen siendo la opción más utilizada para el seguimiento de pacientes con alteraciones metabólicas óseas. El objetivo del estudio fue valorar la asociación de algunos marcadores bioquímicos del metabolismo óseo con aparición y progresión de calcificaciones aórticas. Material y métodos: Se seleccionaron aleatoriamente 624 hombres y mujeres mayores de 50 años que cumplimentaron un cuestionario y a los que se realizaron dos radiografías laterales dorso?lumbares y densitometría ósea. Cuatro años más tarde, en 402 sujetos se repitieron los mismos estudios junto con un estudio bioquímico. Resultados: La edad y la proporción hombres fue superior en los que tuvieron “progresión global” de calcificación aórtica (progresión de las ya existentes más las nuevas). Los niveles séricos de calcio y calcitriol fueron significativamente superiores y los de osteocalcina significativamente inferiores en los que se observó “progresión global” de calcificación aórtica. El análisis multivariante mostró que únicamente la osteocalcina se asoció de forma independiente con “progresión global” de calcificación aórtica, con una disminución del 18% por cada incremento de 1 ng/mL en los niveles de osteocalcina (odds ratio (OR)=0,82; intervalo de confianza del 95% (IC 95%): 0,71-0,92). La categorización de la osteocalcina en terciles mostró que los sujetos del primer tercil (<4,84 ng/mL) se asociaron con mayor proporción de nuevas calcificaciones aórticas: (OR=2,45; IC 95%: 1,03-3,56) respecto al tercer tercil (>6,40 ng/mL). Conclusión: Los niveles séricos de osteocalcina podrían ser un marcador bioquímico para evaluar la aparición y/o a evolución de la calcificación aórtica. No obstante, se necesita determinar con mayor precisión como podría ejercer este efecto protector en el proceso de calcificación vascular (AU)

Objetive: Biochemical parameters continue to be the most widely used option for the follow-up of patients with bone metabolic disorders. The objective of our study was to assess the association of some biochemical markers of bone metabolism with the appearance and progression of aortic calcifications. Material and methods: In this study, 624 men and women older than 50 years were selected at random. The participants completed a questionnaire and underwent two lateral dorsal-lumbar x-rays and bone densitometry. Four years later, the same studies were repeated in 402 subjects along with a biochemical study. Results: Age and the proportion of men were higher in those who had “global progression” of aortic calcification (progression of the existing ones plus new ones). The serum levels of calcium and calcitriol were significantly higher and those of osteocalcin significantly lower in which “global progression” of aortic calcification was observed. Multivariate analysis showed that only osteocalcin was independently associated with “global progression” of aortic calcification, with an 18% decrease for each 1 ng/mL increase in osteocalcin levels (odds ratio (OR)=0, 82; 95% confidence interval (95% CI): 0.71-0.92). The categorization of osteocalcin into tertiles showed that the subjects of the first tertile (<4.84 ng/mL) were associated with a higher proportion of new aortic calcifications: (OR=2.45; 95% CI: 1.03-3, 56) with respect to the third tertile (>6.40 ng/mL). Conclusion: Serum levels of osteocalcin could be a biochemical marker to evaluate the appearance and/or evolution of aortic calcification. However, it is necessary to determine with greater precision how it could exert this protective effect in the process of vascular calcification. (AU)

Nuevo nomenclátor estandarizado en oftalmología: Criterios e indicadores cuantitativos de baremación de actos médicos / A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures

OBJETIVO: Elaborar un nuevo nomenclátor de actos y procedimientos médicos en oftalmología, basado en la Clasificación Internacional de Enfermedades CIE-9-MC. Establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración. Determinar los algoritmos necesarios para el cómputo de las tarifas retributivas por acto médico. MÉTODOS: Sobre el nomenclátor vigente, se eliminaron los procesos obsoletos, añadieron otros nuevos, modificaron descriptores, agruparon procedimientos con descripciones similares y trasladaron de grupo otros, por razones de complejidad quirúrgica. Se definieron los criterios de baremación para el cálculo de las retribuciones médicas: formación y complejidad (U), responsabilidad profesional (R) y valor salud (V), con sus indicadores cuantitativos, respectivamente: periodo de formación necesario para dominar una técnica, frecuencia de complicaciones que agravan la situación preoperatoria, y días de incapacidad laboral que ocasiona el proceso. Se definieron las Unidades Relativas de Valor (URV) como la suma de puntos de U, R y V. La tarifa final por acto médico se calculará como el producto del número de URV por su coste unitario y por el coeficiente de ponderación (CP). RESULTADOS: Se elaboró un nuevo nomenclátor con 161 actos médicos agrupados en consultas, procedimientos diagnósticos (PR.DX), procedimientos terapéuticos (PR.TX) e intervenciones quirúrgicas (IQ) crecientes en complejidad desde el grupo 0 hasta el grupo 8. Para cada uno de los actos se describieron los siguientes caracteres: códigos OMC y CIE-9-MC, término descriptor, grupo, modificación propuesta: sin cambios o mínimos en los descriptores, agrupación de actos por definiciones similares, cambio de grupo de origen, actos eliminados y nuevos procedimientos. Asimismo, fueron puntuados los tres criterios de baremación: U entre 1-4, R entre 0-3 y V entre 0-3. Mediante su suma se calcularon el número de URV por acto médico (entre 1 y 10), que junto con el coste unitario de la URV y el CP (entre 0,05 y 1) determinarán la tarifa final. CONCLUSIONES: El nuevo nomenclátor de oftalmología actualiza y mejora el catálogo antiguo, adecuando los procedimientos a los descriptores recogidos en la CIE-9-MC e incorporando todas las técnicas actuales. Adicionalmente, la declaración de los principios generales permite definir nuevos criterios de baremación, indicadores cuantitativos, escalas de valoración y algoritmos de cómputo de las tarifas por acto médico

PURPOSE: To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. METHODS: The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). RESULTS: A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1-4 points, and R and V between 0-3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. CONCLUSIONS: The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures

Antropometría y fuerza, su influencia sobre el test sit and reach / Anthropometry and Strength, Its Influence on the Sit And Reach Test

Se analiza la influencia que tienen las variables cineantropométricas y dinamométricas sobre el test Sit and Reach en deportistas amateur. Se tomaron veinte variables antropométricas, cuatro pruebas de dinamometría, el test Sit and Reach y la actividad física realizada. Encontramos diferencias significativas en los valores de flexibilidad entre hombres y mujeres. Las ecuaciones de predicción fueron diferentes en hombres y en mujeres (30.6% y 32.5%), en las mujeres apareció la talla como factor influyente. La ecuación general de predicción calculada se obtiene un 39,1% (moderada). Hombres y mujeres se diferencian significativamente en todas las variables antropométricas excepto en pliegue subescapular y suprailiaco. ¿Qué otros factores influirían sobre una posible predicción del resultado? Los valores de flexibilidad no se consideran influenciados por las variables antropométricas, dinamométricas y la tipología de actividad física realizada. El índice de fuerza no correlaciona con el valor del test Sit and Reach

Analyzes the influence of kinanthropometric and dynamometric variables on the Sit and Reach test in amateur athletes. We used twenty anthropometric variables, four dynamometry tests, the Sit and Reach test and the amount of physical activity practiced. Significant differences were found between men and women in terms of flexibility levels. The prediction equations were differed according to gender (30.6% men and 32.5% women), height being an influential factor in women. The general prediction equation calculated, the level is 39.1% (moderate). Men and women show significant differences in all anthropometric variables except subscapular and suprailiac skinfolds. What other factors influence the kind of results that can be expected? The results of the flexibility test are not influenced by the anthropometric and dynamometric variables, or by the type of physical activity performed. The strength index does not correlate with the Sit and Reach test value

Impacto de la calcificación vascular en la mortalidad y salud ósea en pacientes con trasplante renal / Impact of vascular calcification on bone health andmortality in kidney transplant patients

OBJETIVOS: Evaluar la prevalencia de calcificación vascular y fracturas vertebrales en una cohorte de pacientes sometidos a trasplante renal, y su asociación con mortalidad por todas las causas y disfunción del injerto, así como la relación con parámetros bioquímicos del metabolismo óseo y mineral. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional, unicéntrico, en el que se incluyeron 405 pacientes sometidos a trasplante renal, con recogida de parámetros clínicos, bioquímicos, epidemiológicos y de calcificación vascular radiológica y fracturas vertebrales mediante radiografía simple en el momento del trasplante, con un seguimiento mínimo de dos años, evaluando mortalidad cardiovascular y por todas las causas y descenso del filtrado glomerular. Se dispuso además de 39 estudios de densitometría ósea realizados en los meses previos al trasplante. RESULTADOS: La supervivencia de los pacientes fue significativamente menor en el grupo de pacientes con calcificación vascular (131 ± 1,5 meses sin calcificación frente a 110 ± 3,5 meses con calcificación vascular, p < 0,001). Se observó un mayor descenso del filtrado glomerular estimado (FGE) mediante la fórmula CKD-EPI en todos los pacientes que presentaban calcificación vascular, siendo esta un factor de riesgo independiente (OR = 2,7; IC 95%: 1,6-4,4; p < 0,001). La prevalencia de fracturas vertebrales fue significativamente mayor en el grupo de calcificación vascular (12%), independientemente de otros factores de riesgo (OR = 9,2; IC 95%: 1,2-73,4; p = 0,036). Se ha asociado la prevalencia de fracturas vertebrales con menor masa ósea en cadera evaluada mediante densitometría ósea (T-score -1,2 vs. -2,4, p = 0,02) CONCLUSIONES: La calcificación vascular previa al trasplante, evaluada mediante un método sencillo, barato y accesible como la radiografía simple, condiciona la morbimortalidad del paciente sometido a trasplante renal y tiene un gran impacto sobre la evolución de la función del injerto, independientemente de otros factores de riesgo tradicionales. La asociación entre la fragilidad ósea, la calcificación vascular y el pronóstico del paciente y del injerto renal nos debe hacer pensar en añadir la densitometría ósea en el protocolo de inclusión en lista de espera de trasplante. Es relevante promover no sólo la mejor salud vascular posible sino también promover el menor impacto en el tejido óseo en la progresión de la enfermedad renal crónica antes del momento del trasplante

OBJETIVE: To assess the prevalence of vascular calcification and vertebral fractures in a cohort of patients undergoing kidney transplantation and its association with all graft-related causes of mortality and dysfunction, as well as the relationship with biochemical parameters of bone and mineral metabolism. MATERIAL AND METHODS: Prospective, observational, single-center study, which included 405 patients undergoing kidney transplants, with collection of clinical, biochemical, epidemiological parameters, and of radiological vascular calcification and vertebral fractures by simple radiography at the time of transplantation, with a minimum follow-up of two years. We assessed cardiovascular mortality and all causes and decreased glomerular filtration. In addition, 39 bone densitometry studies carried out in the months prior to transplantation were reported. RESULTS: Patient survival was significantly lower in the group of patients with vascular calcification (131 ± 1.5 months without calcification compared to 110 ± 3.5 months with vascular calcification, p < 0.001). A greater decrease in the estimated glomerular filtration rate (GFR) was observed using the CKD-EPI formula in all patients who presented vascular calcification, this being an independent risk factor (OR = 2.7; 95% CI: 1.6-4, 4; p < 0.001). The prevalence of vertebral fractures was significantly higher in the vascular calcification group (12%), independently of other risk factors (OR = 9.2; 95% CI: 1.2-73.4; p = 0.036). The prevalence of vertebral fractures has been associated with lower hip bone mass assessed by bone densitometry (T-score -1.2 vs. -2.4, p = 0.02) CONCLUSIONS: Vascular calcification prior to transplantation, evaluated using a simple, cheap and accessible method such as plain radiography, determines the morbidity and mortality of the patient undergoing a kidney transplant and has a great impact on the evolution of graft function, regardless of other risk factors. traditional. The association between bone fragility, vascular calcification and the prognosis of the patient and the renal graft should make us think about adding bone densitometry to the protocol for inclusion in the transplant waiting list. It is relevant to promote not only the best possible vascular health but also to promote the least impact on bone tissue in the progression of chronic kidney disease before the time of transplantation

Peripheral administration of lactate produces antidepressant-like effects.

This corrects the article DOI: 10.1038/mp.2016.179.

Peripheral administration of lactate produces antidepressant-like effects.

In addition to its role as metabolic substrate that can sustain neuronal function and viability, emerging evidence supports a role for l-lactate as an intercellular signaling molecule involved in synaptic plasticity. Clinical and basic research studies have shown that major depression and chronic stress are associated with alterations in structural and functional plasticity. These findings led us to investigate the role of l-lactate as a potential novel antidepressant. Here we show that peripheral administration of l-lactate produces antidepressant-like effects in different animal models of depression that respond to acute and chronic antidepressant treatment. The antidepressant-like effects of l-lactate are associated with increases in hippocampal lactate levels and with changes in the expression of target genes involved in serotonin receptor trafficking, astrocyte functions, neurogenesis, nitric oxide synthesis and cAMP signaling. Further elucidation of the mechanisms underlying the antidepressant effects of l-lactate may help to identify novel therapeutic targets for the treatment of depression.

Grado en que se alcanzan los objetivos de control en pacientes con diabetes de tipo 2 en diferentes grupos poblacionales / Level at which control objectives are reached in patients in different population groups with type 2 diabetes

Introducción. Existe evidencia del elevado riesgo macro- y microvascular de los pacientes con diabetes. El objetivo de este estudio era determinar el grado de control en pacientes con diabetes de tipo 2 en diferentes grupos poblacionales. Material y métodos. Diseño: estudio descriptivo transversal; emplazamiento: Atención Primaria. Servicio Madrileño de Salud, Madrid. Año: 2014. Participantes: pacientes mayores de 14 años con diagnóstico de diabetes de tipo 2. Número de participantes: n=6.674. Mediciones principales: variables sobre el grado de control (HbA1c, tensión arterial sistólica [TAS], tensión arterial diastólica [TAD], cLDL) y variables sobre características del paciente (demográficas, otros FRCV, complicaciones). Resultados. La media de edad de los pacientes con HbA1c controlada fue de 67,8 vs. 62,9 años en los no controlados (p<0,001). Los pacientes con diagnóstico de hipertensión arterial (HTA) tenían un porcentaje de control mayor con respecto a los no diagnosticados en HbA1c, TAS, TAD y cLDL: 51 vs. 37%; 62 vs. 43%; 75 vs. 47% y 57 vs. 44%, respectivamente; con diagnóstico de dislipidemia: 51 vs. 39%; 60 vs. 49%; 70 vs. 56% y 56 vs. 46%. Con diagnóstico de macroangiopatía: 46 vs. 45%; 58 vs. 54%; 71 vs. 62% y 15 vs. 60%. Todas las diferencias eran estadísticamente significativas (p<0,001). Más del 50% de los pacientes sin diagnóstico de HTA tenían TAS>140mmHg o TAD>90mmHg. Más del 25% de los pacientes con HTA o dislipidemia y cifras no controladas no recibían tratamiento farmacológico. Conclusión. El control era mejorable en todos los grupos, sobre todo en los jóvenes y en los pacientes con riesgo cardiovascular especialmente elevado por la presencia de otros FRCV o de macroangiopatía. Un porcentaje importante de pacientes con cifras de TA y de cLDL no controladas no estaban diagnosticados de HTA o dislipidemia ni recibían tratamiento farmacológico (AU)

Introduction. There is evidence of increased macro- and micro-vascular risk in diabetic patients. The objective of this study was to determine the level of control in patients in different population groups with type 2 diabetes. Material and methods. Design. Descriptive cross-sectional study. Location: Primary care. Madrid Health Service. Year: 2014. Subjects: Patients over 14 years with type 2 diabetes. Number of patientes: n=6674. Measurements. Variables on the degree of control (HbA1c, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL-c) and variables on patient characteristics (demographic, other cardiovascular risk factors, complications). Results. The mean age of patients with controlled HbA1c was 67.8 years vs. 62.9 years in the uncontrolled (P<.001). Patients diagnosed with hypertension have a higher percentage of control with respect to the undiagnosed in HbA1c, SBP, DBP and LDL-c: 51 vs. 37%, 62 vs. 43%, 75 vs. 47% and 57 vs. 44% respectively; diagnosed with dyslipidaemia: 51 vs. 39%, 60 vs. 49%, 70 vs. 56% and 56 vs. 46%. With a diagnosis of macroangiopathy: 46 vs. 45%, 58 vs. 54%, 71 vs. 62% and 15 vs. 60%. All differences were statistically significant (P<.001). Over 50% of patients without a diagnosis of hypertension had an SBP> 140mmHg or DBP> 90mmHg. Over 25% of patients with hypertension or DL and uncontrolled levels were not receiving drug treatment. Conclusion. Control was improved in all groups, especially in younger patients, with particularly high cardiovascular risk by the presence of other cardiovascular risk factors or macroangiopathy. A significant percentage of patients with uncontrolled BP and cLDL were not diagnosed or receiving drug treatment (AU)

Efecto de la enzima antioxidante catalasa en la calcificación vascular y desmineralización ósea / Effects of the catalase antioxidant enzyme in vascular calcification and bone demineralization

Objetivos: Evaluar el papel de la enzima antioxidante catalasa sobre el proceso de calcificación vascular asociada a insuficiencia renal crónica (IRC) y su efecto sobre la masa ósea. Material y métodos: Se utilizaron ratones C57/BL6J salvajes (WT) y transgénicos (TG), que sobreexpresan la enzima catalasa, a los que se les indujo IRC. Se utilizaron como control ratones WT y TG con intervención simulada. Transcurridas 16 semanas los animales se sacrificaron, obteniendo suero para analizar marcadores bioquímicos, el trozo residual de riñón, la aorta y las tibias. Se utilizó igualmente un modelo in vitro de cultivo primario de células de músculo liso vascular (CMLV) procedentes de aorta de ratón WT y TG sometidas durante 8 días a un medio calcificante con 3 mM de fósforo y 2 mM de calcio. Resultados: Solo en animales WT con IRC se observó un incremento significativo en la expresión génica de Runx2 y del depósito renal de calcio y un deterioro de la estructura ósea a nivel trabecular. Este efecto no se observó en ratones TG con IRC. Solo en las CMLV de ratones WT, la adición de medio calcificante produjo un aumento del contenido en calcio, de la expresión proteica de Runx2 y de las especies reactivas de oxígeno mitocondriales con una menor expresión proteica de la enzima catalasa. Conclusiones: La sobreexpresión de la enzima catalasa redujo el proceso de calcificación tanto in vivo como in vitro, mostrando in vivo que ese descenso se acompañó de una mejora en los parámetros óseos estudiados (AU)

Objetives: Assess the role of the catalase antioxidant enzyme in the vascular calcification process associated with chronic renal failure (CRF) and its effect on bone mass. Material and methods: Wild type C57/BL6J mice (WT) and transgenic mice (TG) were used, that overexpress the catalase enzyme, to which CRF was induced. Control WT and TG mice were used in simulated intervention. After 16 weeks, the mice were sacrificed, with serum samples taken for biochemical markers as well as residual pieces of kidney, aorta and tibias. An in vitro model of primary culture of smooth vascular muscle cells (SVMC) taken from the WT and TG aorta which underwent eight days of 3 mM phosphorus and 2 mM calcium calcifying medium. Results: A significant increase in Runx2 gene expression, calcium renal deposit and bone structure deterioration at trabecular level was only detected in WT mice with CRF. This was not observed in TG mice with CRF. Only in the case of WT mice SVMC, did added calcification medium raise calcium levels, proteic Runx2 expression and the reactive oxygen species of mitochondria with low catalase enzyme. Conclusions: Calcifying catalase over-expression was observed in both in vivo and in vitro, with in vivo showing that this reduction was accompanied by an improvement in bone parameters under study (AU)

Manejo de vía aérea difícil con inducción inhalatoria en paciente con síndrome de Lennox-Gastaut y traumatismo cervical / Management of difficult airway with inhalation induction in a patient with Lennox-Gastaut syndrome and neck injury

El síndrome de Lennox-Gastaut es una encefalopatía epileptiforme de la infancia, caracterizado por convulsiones frecuentes de difícil tratamiento asociadas a retraso mental. Presentamos el caso de un varón de 21 años con síndrome de Lennox-Gastaut y dislocación facetaria cervical bilateral traumática a nivel de C6-C7 con compresión del canal medular como consecuencia de una caída durante una crisis convulsiva. En este caso describimos el manejo de la vía aérea difícil prevista en un paciente despierto, no colaborador, que presenta lesión medular a nivel cervical. Se plantea una estrategia de abordaje de la vía aérea difícil que nos permita un control rápido y seguro de esta con la mejor tolerancia posible por parte del paciente, buscando conservar la inmovilización cervical para no aumentar el daño neurológico. Dentro de esta estrategia se definió como plan A la inducción inhalatoria con sevoflurano para mantener la respiración espontánea, y la intubación traqueal con Airtraq®. Consideramos que el videolaringoscopio Airtraq® junto con la inducción inhalatoria con sevoflurano es una alternativa eficaz y válida en el manejo de la vía aérea difícil prevista con inmovilización cervical (AU)

Lennox-Gastaut syndrome is a childhood epileptic encephalopathy, and is characterized by frequent and difficult to treat seizures associated with mental retardation. The case is presented of a 21 year-old male with Lennox-Gastaut syndrome, with bilateral cervical facet joint dislocation fracture at C6-C7 and spinal canal compression as a result of a fall during a seizure. In this case the management of the difficult airway expected in an awake and uncooperative patient, with cervical spinal cord injury is described. An airway management strategy was proposed, that allowed a rapid and safe airway control with the best possible tolerance and maintaining the neck immobilised, so as not to increase neurological injury. Within this strategy, plan A was defined as inhalation induction with sevoflurane to maintain spontaneous breathing and tracheal intubation with Airtraq®. We believe that the Airtraq® video laryngoscope with inhalational induction with sevoflurane is a valid and effective alternative in the management of expected difficult airway (AU)

Aplicación de un programa de entrenamiento de fuerza en futbolistas jóvenes / Implementation of a resistance training on young football players

El objetivo de este estudio, es comprobar el efecto de un programa de 20 sesiones de entrenamiento específico de fuerza en futbolistas jóvenes. Participaron 38 sujetos en el estudio, divididos en un grupo experimental (GE) y un grupo control (GC). Al GE se le administró un entrenamiento de fútbol y un trabajo específico de fuerza; mientras el GC sólo efectuó práctica de fútbol. Ambos fueron evaluados al inicio y al final del programa, con el objetivo de conocer su fuerza dinámica máxima en los flexores y extensores de la rodilla; su masa muscular en las extremidades inferiores; el porcentaje de grasa; y, por último, la velocidad en las pruebas de 10 y 20 metros. Únicamente el GE mejora de forma muy significativa la fuerza dinámica máxima (p<0,01). No se encuentran diferencias en la masa muscular, ni en la velocidad. El GE y el GC incrementan el porcentaje de grasa corporal (AU)

The aim of this study is to check the effect of a specific training strength program on young footballers. 38 players took place in the study; they were divided into an experimental group (EG) and a control group (CG). The EG added a specific strength work to their football workout, whereas the CG just practised football. Both of them were assessed at the beginning and at the end of the program to know their maximum dynamic strength in their flexor and extensor muscles of their knees; their muscle mass in their lower extremities; their body mass and fat percentage; and their speed in the 10 and 20 metres trials. Just the EG improves remarkably their maximum dynamic strength … No differences in their muscle mass or in their movement strength are found. The EG and the CG increase their MBRate and their body fat (AU)

Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology

PURPOSE: To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS: From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS: 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS: In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue (AU)

No disponible

[Renal cell carcinoma and exposure to trichloroethylene: are the French limits of occupational exposure relevant?]. / Cancer du rein et expositions au trichloroéthylène: les valeurs limites d'exposition professionnelle françaises en vigueur sont-elles adaptées ?

BACKGROUND: Several studies have investigated the association between trichloroethylene (TCE) exposure and renal cell cancer (RCC) but findings were inconsistent. The analysis of a case control study has shown an increased risk of RCC among subjects exposed to high cumulative exposure. The aim of this complementary analysis is to assess the relevance of current exposure limits regarding a potential carcinogenic effect of TCE on kidney. METHODS: Eighty-six cases and 316 controls matched for age and gender were included in the study. Successive jobs and working circumstances were described using a detailed occupational questionnaire. An average level of exposure to TCE was attributed to each job-period in turn. The main occupational exposures described in the literature as increasing the risk of RCC were assessed as well as non-occupational factors. A conditional logistic regression was performed to test the association between TCE and RCC risk. Three exposure levels were studied (average exposure during the eight-hour shift): 35ppm, 50ppm and 75ppm. Potential confounding factors identified were taken into account at the threshold limit of 10% (p=0.10) (body mass index [BMI], tobacco smoking, occupational exposures to cutting fluids and to other oils). RESULTS: Adjusted for tobacco smoking and BMI, the odd-ratios associated with exposure to TCE were respectively 1.62 [0.77-3.42], 2.80 [1.12-7.03] and 2.92 [0.85-10.09] at the thresholds of 35ppm, 50ppm and 75ppm. Among subjects exposed to cutting fluids and TCE over 50ppm, the OR adjusted for BMI, tobacco smoking and exposure to other oils was 2.70 [1.02-7.17]. CONCLUSION: Results from the present study as well as those provided in the international literature suggest that current French occupational exposure limits for TCE are too high regarding a possible risk of RCC.

Helmet use and the risk of neck or cervical spine injury among users of motorized two-wheel vehicles.

OBJECTIVE: To quantify the effects of wearing a helmet on head and facial injury among users of motorized two-wheel vehicles and to determine if helmet use increases the risk of neck and cervical spine injury. DESIGN/METHOD: A population-based study involving injured riders from the Rhône Road Trauma Registry from 1996 to 2005. Victims were only included if they had an injury to a body region other than (or in addition to) the head, face, neck, or cervical spine. Thus, inclusion was not affected by helmet use by the rider. The risk of head, face, neck, and cervical spine injury was assessed, with helmet use as the exposure of interest using logistic regression analyses. Adjusted odds ratios and corresponding confidence intervals were calculated. RESULTS: Helmet use significantly decreased the risk of head and facial injuries. The adjusted odds ratios for non-helmeted riders were 2.43 (95% CI 2.05 to 2.87) and 3.02 (95% CI 2.48 to 3.67), respectively. There was no association between helmet use and the occurrence of neck or cervical spine injuries. The adjusted odds ratios for non-helmeted riders were 0.86 (95% CI 0.60 to 1.23) and 1.04 (95% CI 0.78 to 1.39), respectively. CONCLUSION: Helmets protect users of motorized two-wheel vehicles against head and facial injury without increasing the risk of neck or cervical spine injury.

Whiplash risk estimation based on linked hospital-police road crash data from France and Spain.

OBJECTIVES: To investigate potential risk factors for whiplash injury as a function of crash configuration and driver's characteristics, and to provide information on over-reporting and under-reporting of whiplash. DESIGN: A case-control study of drivers involved in two-car injury collisions. Cases were drivers who had a diagnosis of whiplash injury, with or without another injury. Controls were drivers without diagnosed whiplash injury. SETTING: Hospital registries linked to police crash databases for Barcelona (Spain) and the "Département du Rhône" (France). MAIN OUTCOME MEASURES: Relative risks of whiplash and 95% confidence intervals were estimated using a modified Poisson regression. RESULTS: Of the 8720 drivers involved in car-to-car crashes recorded in the French database, 12.2% were diagnosed with whiplash; the corresponding figure in the Spanish database was 12.0% of 7558 drivers. Female drivers and drivers in rear-impact collisions were most likely to have a whiplash diagnosis, although the absolute number of whiplash cases was greater in front and side impacts. Wearing a seatbelt, being in a heavier car, and age greater than 65 years were associated with a lower risk of whiplash injury. Drivers with other injuries were also more often diagnosed as having a whiplash injury, except the most severely injured. CONCLUSIONS: Devices aimed at reducing the occurrence of whiplash injuries, such as dynamic headrest systems, should be adapted to the characteristics of at-risk occupants, especially women, and should address the mechanics of front and side impacts in addition to rear impacts.

Limits of the quasi-induced exposure method when compared with the standard case-control design. Application to the estimation of risks associated with driving under the influence of cannabis or alcohol.

The disparities between the quasi-induced exposure (QIE) method and a standard case-control approach with crash responsibility as disease of interest are studied. The 10,748 drivers who had been given compulsory cannabis and alcohol tests subsequent to involvement in a fatal crash in France between 2001 and 2003 were used to compare the two approaches. Odds ratios were assessed using conditional and unconditional logistic regressions. While both approaches found that drivers under the influence of alcohol or cannabis increased the risk of causing a fatal crash, the two approaches are not equivalent. They differ mainly with regards to the driver sample selected. The QIE method results in splitting the overall road safety issue into two sub-studies: a matched case-control study dealing with two-vehicle crashes and a case-control study dealing with single-vehicle crashes but with a specific control group. Using a specific generic term such as "QIE method" should not hide the real underlying epidemiological design. On the contrary, the standard case-control approach studies drivers involved in all type of crashes whatever the distribution of the responsibility in each crash. This method also known as "responsibility analysis" is the most relevant for assessing the overall road safety implications of a driver characteristic.

Phosphorylation of neurofilament subunit NF-M is regulated by activation of NMDA receptors and modulates cytoskeleton stability and neuronal shape.

The cytoskeleton is essential for the structural organization of neurons and is influenced during development by excitatory stimuli such as activation of glutamate receptors. In particular, NMDA receptors are known to modulate the function of several cytoskeletal proteins and to influence cell morphology, but the underlying molecular and cellular mechanisms remain unclear. Here, we characterized the neurofilament subunit NF-M in cultures of developing mouse cortical neurons chronically exposed to NMDA receptor antagonists. Western blots analysis showed that treatment of cortical neurons with MK801 or AP5 shifted the size of NF-M towards higher molecular weights. Dephosphorylation assay revealed that this increased size of NF-M observed after chronic exposure to NMDA receptor antagonists was due to phosphorylation. Neurons treated with cyclosporin, an inhibitor of the Ca(2+)-dependent phosphatase calcineurin, also showed increased levels of phosphorylated NF-M. Moreover, analysis of neurofilament stability revealed that the phosphorylation of NF-M, resulting from NMDA receptor inhibition, enhanced the solubility of NF-M. Finally, cortical neurons cultured in the presence of the NMDA receptor antagonists MK801 and AP5 grew longer neurites. Together, these data indicate that a blockade of NMDA receptors during development of cortical neurons increases the phosphorylation state and the solubility of NF-M, thereby favoring neurite outgrowth. This also underlines that dynamics of the neurofilament and microtubule cytoskeleton is fundamental for growth processes.

Road crash involvement and professional status: a prospective study using the French Gazel cohort.

OBJECTIVES: To assess professional status (PS) differences in the risk of road crash involvement (RCI) (irrespective of crash severity), and to examine the underlying mechanism by evaluating the role of exposure to road risk (ERR). METHOD: A total of 15,271 subjects selected from the French GAZEL cohort were studied. A proportional hazard model for recurrent events was used to calculate the relative risks (RR) of RCI associated with PS. The associations between RCI and PS were investigated by adjusting for ERR (kilometers travelled and risk behaviors on the road). RESULTS: In all, 1890 RCI were reported. Managers have greater crude RCI risk than unskilled workers (male, RR=1.30; female, RR=1.44). This difference was no longer statistically significant when adjusting for factors describing the drivers' behaviors. Female managers' risks were also insignificant when adjusted for vehicle kilometers travelled (VKT). Managers seemed at lower risk of injury when involved in a crash. CONCLUSION: Socially advantaged subjects have the greatest RCI risk. Qualitative and quantitative ERR factors explain these disparities. These results highlight the importance to focus on ERR when studying the effect of an individual characteristic on RCI. They also highlight the importance to analyse separately the "RCI" and the "susceptibility to injury".

Lesiones del plexo braquial. A propósito de un caso / Brachial plexus injuries. A case report

Las lesiones del plexo braquial son más frecuentes de lo que se pueda pensar, y las padecen generalmente personas jóvenes. Comprometen gravemente la función del miembro superior produciendo parálisis sensitiva, motora y vegetativa que, con frecuencia, se acompaña de un dolor neuropático intenso, llegando a repercutir en el estado psicológico del paciente. Los conceptos claves del tratamiento son una buena elección del momento adecuado de la intervención y del establecimiento de las prioridades al restaurar la función. Las técnicas quirúrgicas incluyen neurólisis, injertos nerviosos, neurotizaciones y transferencias musculares libres. Se presenta un caso de lesión del plexo braquial como ejemplo sobre etiología y técnicas quirúrgicas de reparación en las diferentes etapas de la evolución clínica

The brachial plexus injuries are more frequent that it can be thought. Young people used to suffer it more frequently than other people. They compromise seriously the function of the upper limb causing a sensitive, motor and vegetative paralysis that, frequently, it is accompanied by an intense neuropatic pain with repercussion in the psychological condition of the patient. The key concepts of the treatment are a good election of the moment of the surgery and the establishment of the priorities when the function were recovered. The surgical techniques include neurolysis, nervous grafts, neurotizations and free muscular transfers. It is presented a case of brachial plexus injury as an example about the aetiology and the surgical techniques of reparation in the different stages of the clinical evolution

Glucemia y cetonemia en diabéticos tipo 1 en el ambiente controlado de una colonia de verano / Blood glucose and ketone monitoring in type 1 diabetic patients in the controlled environment of a summer camp

Introducción: La medida del β -hidroxibutirato (β-HB), además de la glucemia es, en ciertas ocasiones, de gran utilidad en niños y adolescentes con diabetes. Se realizó un estudio con el objetivo de observar la relación entre glucemia, cetonemia y cetonuria en la población pediátrica y adolescente con diabetes mellitus tipo 1 (DM1) en una colonia de vacaciones en diferentes circunstancias: ayunas, hiperglucemia aguda, ejercicio físico moderado, y para determinar la utilidad de la determinación de cetonemia en el control de la diabetes durante dicha época. Pacientes y métodos: Un total de 47 participantes (25 varones y 22 mujeres), cuya media de la última hemoglobina glucosilada (HbA1C) previa al estudio fue de 7,7 ± 1,5 %, participaron en este seguimiento. La media de edad de los niños fue de 11,7 ± 1,8 años, con 3,0 ± 2,7 años de evolución de la diabetes. Su índice de masa corporal fue de 18,3 ± 3,9 kg/m2 (SDS ­0,16 ± 0,44), la dosis de insulina 0,8 ± 0,4 U/kg/día y el número de dosis por día entre 2 y 4, con una mediana de 3. Se registraron las determinaciones de glucemia y cetonemia (medidas ambas con el sistema OptiumO, Abbott Diabetes Care) y cetonuria (KetodiastixO, Bayer) en distintas situaciones. Para el análisis estadístico se usó el programa SPSS 11.5. Resultados: Los datos de cetonemia antes y 45 min antes y después del ejercicio físico moderado no mostraron elevaciones significativas de cuerpos cetónicos (0,1 ± 0,03 mmol/l frente a 0,23 ± 0,07 mmol/l, respectivamente; ns). Un 17,02 % de los participantes presentó niveles de cuerpos cetónicos igual o superior a 0,5 mmol/l preprandiales, si bien se resolvieron antes de 1 h (menos una, que se resolvió a las 3 h). Se encontró una mayor presencia de β -HB antes del desayuno (0,12 ± 0,17 mmol/l) que en cualquier hora del día (0,02 ± 0,05 mmol/l) (p < 0,001). La media de las glucemias que cursaron con cetosis (β -HB ≥ 0,5 mmol/l) fue de 174,5 ± 64,7 mg/dl, discretamente superior a la media global de las glucemias (156,87 ± 87,8 mg/dl). Hubo un alto porcentaje de casos en los que no se pudieron determinar los cuerpos cetónicos en orina por la dificultad de obtener la muestra (entre 24,5 y 58,6 % de los casos en los diferentes grupos de estudio). Conclusiones: La medida conjunta de la glucemia con la cetonemia en una colonia de verano permitió hacer un seguimiento seguro de los participantes y observar que la mayoría de las cetonemias registradas se produjeron antes del desayuno, con glucemias discretamente elevadas, y que desaparecieron rápidamente. Un total de 45 min de ejercicio físico moderado no parecen contribuir a la formación de cuerpos cetónicos si el control metabólico es bueno. El β -HB es un buen parámetro para discriminar cuándo es adecuada la práctica de ejercicio físico. La dificultad de la medida de cuerpos cetónicos en orina por falta de muestra se salva con la posibilidad de medir cuerpos cetónicos en sangre

Introduction: Control of blood ketone levels and glycemia is advisable in certain situations in type 1 diabetic children and adolescents. The aims of this study were to assess the relationship between glycemia, ketonemia and ketonuria in children and adolescents in a summer camp under different conditions (fasting, casual hyperglycemia, moderate physical exercise) and to assess the utility of ketonemia determinations in diabetes control during this time. Patients and methods: There were 47 participants (25 boys and 22 girls), with a mean HbA1c determination prior to enrollment of 7.7 ± 1.5 %. The mean age was 11.7 ± 1.8 years and the mean time from onset of diabetes was 3.0 ± 2.7 years. The mean body mass index was 18.3 ± 3.9 kg/m2 (SDS ­0.16 ± 0.44), the mean insulin dose was 0.8 ± 0.4 U/kg/ day, and the number of doses per day was between 2 and 4 (median = 3). Blood glucose and ketones (both measured with the Optium(R) system, Abbott Diabetes Care) and urine ketones (Ketodiastix®, Bayer) were determined in different situations. Statistical analysis was performed with the SPSS 11.5 program. Results: Ketonemia results 45 minutes before and after moderate physical activity showed no significant increase in ketones (0.1 ± 0.03 vs 0.23 ± 0.07 mmol/l, ns). Preprandial blood ketone levels of ≥ 0.5 mmol/l were found in 17.02 % of participants. Ketonemia was resolved during the first hour in all participants except one, in whom ketonemia resolved in 3 hours. Blood ketones were higher before breakfast than during the rest of the day (0.12 ± 0.17 vs 0.02 ± 0.05, p < 0.001). The mean glycemia level with ketosis (β -HB ≥ 0.5 mmol/l) was 174.5 ± 64.7 mg/dl, a value slightly higher than the overall mean glycemia value (156.87 ± 87.8 mg/dl). Ketonuria could not be measured in a high percentage of participants due to the difficulty of obtaining samples (between 24.5 % and 58.6 % in the different study groups). Conclusions: Measurement of glycemia together with ketonemia in a summer camp allows reliable follow-up of glycemic control to be performed. Ketonemia usually occurred before breakfast in parallel with slightly elevated glycemia, but resolved quickly. Moderate physical activity for 45 minutes does not seem to significantly increase blood ketones if metabolic control is normal. β -HB is a useful parameter to determine whether moderate physical exercise is advisable or not. The lack of urinary ketone tests due to the difficulties of obtaining a sample can currently be solved by blood ketone measurement

Second harmonic imaging and scoring of collagen in fibrotic tissues.

We compare second harmonic generation (SHG) to histological and immunohistochemical techniques for the visualization and scoring of collagen in biological tissues. We show that SHG microscopy is highly specific for fibrillar collagens and that combined SHG and two-photon excited fluorescence (2PEF) imaging can provide simultaneous three-dimensional visualization of collagen synthesis and assembly sites in transgenic animal models expressing GFP constructs. Finally, we propose several scores for characterizing collagen accumulation based on SHG images and appropriate for different types of collagen distributions. We illustrate the sensitivity of these scores in a murine model of renal fibrosis using a morphological segmentation of the tissue based on endogenous 2PEF signals.