Interleukin 27, Similar to Interferons, Modulates Gene Expression of Tripartite Motif (TRIM) Family Members and Interferes with Mayaro Virus Replication in Human Macrophages.

BACKGROUND: The Tripartite motif (TRIM) family includes more than 80 distinct human genes. Their function has been implicated in regulating important cellular processes, including intracellular signaling, transcription, autophagy, and innate immunity. During viral infections, macrophages are key components of innate immunity that produce interferons (IFNs) and IL27. We recently published that IL27 and IFNs induce transcriptional changes in various genes, including those involved in JAK-STAT signaling. Furthermore, IL27 and IFNs share proinflammatory and antiviral pathways in monocyte-derived macrophages (MDMs), resulting in both common and unique expression of inflammatory factors and IFN-stimulated genes (ISGs) encoding antiviral proteins. Interestingly, many TRIM proteins have been recognized as ISGs in recent years. Although it is already very well described that TRIM expression is induced by IFNs, it is not fully understood whether TRIM genes are induced in macrophages by IL27. Therefore, in this study, we examined the effect of stimulation with IL27 and type I, II, and III IFNs on the mRNA expression profiles of TRIM genes in MDMs. METHODS: We used bulk RNA-seq to examine the TRIM expression profile of MDMs treated with IFNs or IL27. Initially, we characterized the expression patterns of different TRIM subfamilies using a heatmap. Subsequently, a volcano plot was employed to identify commonly differentially expressed TRIM genes. Additionally, we conducted gene ontology analysis with ClueGO to explore the biological processes of the regulated TRIMs, created a gene-gene interaction network using GeneMANIA, and examined protein-protein interactions with the STRING database. Finally, RNA-seq data was validated using RT-qPCR. Furthermore, the effect of IL27 on Mayaro virus replication was also evaluated. RESULTS: We found that IL27, similar to IFNs, upregulates several TRIM genes' expression in human macrophages. Specifically, we identified three common TRIM genes (TRIM19, 21, and 22) induced by IL27 and all types of human IFNs. Additionally, we performed the first report of transcriptional regulation of TRIM19, 21, 22, and 69 genes in response to IL27. The TRIMs involved a broad range of biological processes, including defense response to viruses, viral life cycle regulation, and negative regulation of viral processes. In addition, we observed a decrease in Mayaro virus replication in MDMs previously treated with IL27. CONCLUSIONS: Our results show that IL27, like IFNs, modulates the transcriptional expression of different TRIM-family members involved in the induction of innate immunity and an antiviral response. In addition, the functional analysis demonstrated that, like IFN, IL27 reduced Mayaro virus replication in MDMs. This implies that IL27 and IFNs share many similarities at a functional level. Moreover, identifying distinct TRIM groups and their differential expressions in response to IL27 provides new insights into the regulatory mechanisms underlying the antiviral response in human macrophages.

Interleukin 27, like interferons, activates JAK-STAT signaling and promotes pro-inflammatory and antiviral states that interfere with dengue and chikungunya viruses replication in human macrophages.

Interferons (IFNs) are a family of cytokines that activate the JAK-STAT signaling pathway to induce an antiviral state in cells. Interleukin 27 (IL-27) is a member of the IL-6 and/or IL-12 family that elicits both pro- and anti-inflammatory responses. Recent studies have reported that IL-27 also induces a robust antiviral response against diverse viruses, both in vitro and in vivo, suggesting that IFNs and IL-27 share many similarities at the functional level. However, it is still unknown how similar or different IFN- and IL-27-dependent signaling pathways are. To address this question, we conducted a comparative analysis of the transcriptomic profiles of human monocyte-derived macrophages (MDMs) exposed to IL-27 and those exposed to recombinant human IFN-α, IFN-γ, and IFN-λ. We utilized bioinformatics approaches to identify common differentially expressed genes between the different transcriptomes. To verify the accuracy of this approach, we used RT-qPCR, ELISA, flow cytometry, and microarrays data. We found that IFNs and IL-27 induce transcriptional changes in several genes, including those involved in JAK-STAT signaling, and induce shared pro-inflammatory and antiviral pathways in MDMs, leading to the common and unique expression of inflammatory factors and IFN-stimulated genes (ISGs)Importantly, the ability of IL-27 to induce those responses is independent of IFN induction and cellular lineage. Additionally, functional analysis demonstrated that like IFNs, IL-27-mediated response reduced chikungunya and dengue viruses replication in MDMs. In summary, IL-27 exhibits properties similar to those of all three types of human IFN, including the ability to stimulate a protective antiviral response. Given this similarity, we propose that IL-27 could be classified as a distinct type of IFN, possibly categorized as IFN-pi (IFN-π), the type V IFN (IFN-V).

Mayaro virus infection elicits a robust pro-inflammatory and antiviral response in human macrophages.

Mayaro virus (MAYV), the etiological agent of Mayaro fever (MAYF), is an emergent arbovirus pathogen belonging to Togaviridae family. MAYF is characterized by high inflammatory component that can cause long-lasting arthralgia that persists for months. Macrophages are viral targets and reservoirs, key components of innate immunity and host response. Given the importance of this pathogen, our aim was to determine the inflammatory and antiviral response of human monocyte-derived macrophages (MDMs) infected with MAYV. First, we established the replication kinetics of the virus. Thereafter, we determined the expression of pattern recognition receptors, NF-ĸB complex, interferons (IFNs), two interleukin 27 (IL27) subunits, IFN-stimulated genes (ISGs), and the production of cytokines/chemokines. We found that human MDMs are susceptible to MAYV infection in vitro, with a peak of viral particles released between 24- and 48-hours post-infection (h.p.i) at MOI 0.5, and between 12 and 24 h.p.i at MOI 1. Interestingly, we observed a significant decline in the production of infectious viral particles at 72 h.p.i that was associated with the induction of antiviral response and high cytotoxic effect of MAYV infection in MDMs. We observed modulation of several genes after MAYV infection, as well, we noted the activation of antiviral detection and response pathways (Toll-like receptors, RIG-I/MDA5, and PKR) at 48 h.p.i but not at 6 h.p.i. Furthermore, MAYV-infected macrophages express high levels of the three types of IFNs and the two IL27 subunits at 48 h.p.i. Moreover, we found higher production of IL6, IL1ß, CXCL8/IL8, CCL2, and CCL5 at 48 h.p.i as compared to 6 h.p.i. A robust antiviral response (ISG15, APOBEC3A, IFITM1, and MX2) was observed at 48 but not at 6 h.p.i. The innate and antiviral responses of MAYV-infected MDMs differ at 6 and 48 h.p.i. We conclude that MAYV infection induces robust pro-inflammatory and antiviral responses in human primary macrophages.

Multitranscript analysis reveals an effect of 2-deoxy-d-glucose on gene expression linked to unfolded protein response and integrated stress response in primary human monocytes and monocyte-derived macrophages.

BACKGROUND: Glycolytic inhibitor 2-deoxy-d-glucose (2-DG) binds to hexokinase in a non-competitive manner and phosphoglucose isomerase in a competitive manner, blocking the initial steps of the glycolytic pathway. Although 2-DG stimulates endoplasmic reticulum (ER) stress, activating the unfolded protein response to restore protein homeostasis, it is unclear which ER stress-related genes are modulated in response to 2-DG treatment in human primary cells. Here, we aimed to determine whether the treatment of monocytes and monocyte-derived macrophages (MDMs) with 2-DG leads to a transcriptional profile specific to ER stress. METHODS: We performed bioinformatics analysis to identify differentially expressed genes (DEGs) in previously reported RNA-seq datasets of 2-DG treated cells. RT-qPCR was performed to verify the sequencing data on cultured MDMs. RESULTS: A total of 95 common DEGs were found by transcriptional analysis of monocytes and MDMs treated with 2-DG. Among these, 74 were up-regulated and 21 were down-regulated. Multitranscript analysis showed that DEGs are linked to integrated stress response (GRP78/BiP, PERK, ATF4, CHOP, GADD34, IRE1α, XBP1, SESN2, ASNS, PHGDH), hexosamine biosynthetic pathway (GFAT1, GNA1, PGM3, UAP1), and mannose metabolism (GMPPA and GMPPB). CONCLUSIONS: Results reveal that 2-DG triggers a gene expression program that might be involved in restoring protein homeostasis in primary cells. GENERAL SIGNIFICANCE: 2-DG is known to inhibit glycolysis and induce ER stress; however, its effect on gene expression in primary cells is not well understood. This work shows that 2-DG is a stress inducer shifting the metabolic state of monocytes and macrophages.

Role of weight lost in breast cancer-related lymph / Importancia de la pérdida de peso en el linfedema secundario a cáncer de mama

Objective: Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. Methods: Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. Results: Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [−50 (−248 to 141) ml vs. 130 (−148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. Conclusions: Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus – right from the start – on weight management or weight-loss in obese patients.(AU)

Objetivo: Analizar los datos recopilados en la práctica clínica rutinaria sobre el impacto combinado de la actividad física y la reducción del índice de masa corporal (IMC) en la reducción de la prevalencia de linfedema secundario a cáncer de mama (BCRL). Métodos: Análisis de los datos obtenidos por la unidad de rehabilitación especializada, de 99 pacientes durante 18 meses, tras prescribirse una dieta específica, un programa deportivo y una terapia descongestiva completa (TDC). En las visitas de seguimiento se recopilaron datos personales, volumen del órgano afectado, peso, nivel de actividad física y FACT-B+4 (Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer). Resultados: Aunque el índice de masa corporal medio no reflejó cambios durante el periodo de evaluación, cerca del 13% de las pacientes habían perdido peso en la segunda semana de seguimiento, incrementándose este porcentaje al 30% en la tercera semana. Las mujeres que experimentaron pérdida de peso durante la tercera visita de seguimiento presentaron una reducción del volumen del órgano afectado [-50 (-248-141)ml vs. 130 (-148-355)ml, p<0,05] en comparación con las pacientes que habían ganado peso. No se estableció relación alguna entre la actividad física y los cambios de volumen de linfedema. Conclusiones: Aparte del tratamiento convencional con ortésicos y drenaje linfático manual, la prevención y tratamiento de BCRL debe centrarse, desde el inicio, en la gestión del peso o la pérdida de peso en las pacientes obesas.(AU)

Role of weight lost in breast cancer-related lymph.

OBJECTIVE: Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. METHODS: Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. RESULTS: Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [-50 (-248 to 141) ml vs. 130 (-148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. CONCLUSIONS: Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus - right from the start - on weight management or weight-loss in obese patients.

What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

BACKGROUND: Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. METHODS: Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25-79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. RESULTS: Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. CONCLUSIONS: SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).

Intervención cognitivo-conductual para trastornos del sueño en adultos mayores / Cognitive-behavioral intervention on senior adults with sleep disorders / Intervenção cognitivo-comportamental para transtornos do sono em idosos

Los trastornos del sueño en el adulto mayor son un problema manifestado con frecuencia, que afecta la calidad de vida y tiene impacto en los costos y el cuidado de salud. La actual forma de manejo de estos problemas se relaciona con prescripciones de fármacos, los cuales tienen efectos secundarios y aumenta su vulnerabilidad. En este contexto, el objetivo de esta investigación es evaluar la efectividad de una intervención cognitivo y conductual, que pretende mejorar el sueño mediante el cambio de los hábitos deficientes, así como el desafío de los pensamientos, las actitudes y las creencias negativas acerca del mismo. El método incluyó intervenciones cognitivo-conductuales grupales, con evaluaciones pre y post intervención. Los resultados indican una media de 9 (Pittsburgh) al inicio del programa y 4.9 al finalizar. Se concluye que la intervención a corto plazo consigue cambios significativos en hábitos e higiene del sueño. Esta investigación orienta a los profesionales de enfermería en la aplicación de estrategias hacia el bienestar del adulto mayor y el desarrollo de la disciplina en el marco del fortalecimiento de cuidados esenciales y fundamentales en procesos vitales.

Sleep disorders among senior adults are a frequent problem which has important impacts on their quality of life, and the costs of healthcare. The current management of these disorders is based on drug prescriptions, which in turn, have secondary effects and also enhance underlying conditions and vulnerabilities. Within this context, the objective of this study was to assess the effectiveness of a cognitive behavioral intervention aimed at improving the quality of sleep of these persons by modifying negative habits, thoughts, and beliefs. The method included group cognitive-behavioral interventions with pre and post assessments. The corresponding results showed a mean of 9 (Pittsburg) at the beginning of the program, and a mean of 4.9 at the end. It was thus concluded that the intervention, in the short term, helped to achieve significant improvements in relation to the sleep hygiene of these persons. This study can orient nursing professionals to establish strategies aimed at the wellbeing of senior adults; all within the vital processes and essential care strengthening framework.

Os transtornos do sono no idoso são um problema manifestado com frequência e que afeta a qualidade de vida e tem impacto nos custos e no cuidado de saúde. A atual forma de manejo destes problemas relaciona-se com prescrições de fármacos, os quais têm efeitos secundários e aumenta sua vulnerabilidade. Neste contexto, o objetivo desta pesquisa é avaliar a efetividade de uma intervenção cognitivo e comportamental, que pretende melhorar o sono mediante a mudança dos hábitos deficientes, assim como o desafio dos pensamentos, as atitudes e as crenças negativas acerca de si próprio. O método incluiu intervenções cognitivo-comportamentais grupais, com avaliações pre e post intervenção. Os resultados indicam uma média de 9 (Pittsburg) ao início do programa e 4.9 para finalizar. Conclui-se que a intervenção a curto prazo consegue câmbios significativos em hábitos e higiene do sono. Esta pesquisa orienta aos profissionais de enfermagem na aplicação de estratégias para o bem-estar do idoso e do desenvolvimento da disciplina no marco do fortalecimento de cuidados essenciais e fundamentais em processos vitais.

Sphingomyelin derivatives increase the frequency of microvesicle and granule fusion in chromaffin cells.

Sphingomyelin derivatives like sphingosine have been shown to enhance secretion in a variety of systems, including neuroendocrine and neuronal cells. By studying the mechanisms underlying this effect, we demonstrate here that sphingomyelin rafts co-localize strongly with synaptosomal-associated protein of 25Kda (SNAP-25) clusters in cultured bovine chromaffin cells and that they appear to be linked in a dynamic manner. In functional terms, when cultured rat chromaffin cells are treated with sphingomyelinase (SMase), producing sphingomyelin derivatives, the secretion elicited by repetitive depolarizations is enhanced. This increase was independent of cell size and it was significant 15min after initiating stimulation. Interestingly, by evaluating the membrane capacitance we found that the events in control untreated cells corresponded to two populations of microvesicles and granules, and the fusion of both these populations is clearly enhanced after treatment with SMase. Furthermore, SMase does not increase the size of chromaffin granules. Together, these results strongly suggest that SNARE-mediated exocytosis is enhanced by the generation of SMase derivatives, reflecting an increase in the frequency of fusion of both microvesicles and chromaffin granules rather than an increase in the size of these vesicles.

HIV/AIDS stigma: measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women.

Despite the increased interest in HIV/AIDS stigma and its negative effects on the health and social support of people living with HIV/AIDS (PLWHA), little attention has been given to its assessment among Latino gay/ bisexual men and transgender women (GBT) living with HIV/AIDS. The purpose of this paper is twofold: to develop a multidimensional assessment of HIV/AIDS stigma for Latino GBT living with HIV/AIDS, and to test whether such stigma is related to self-esteem, safe sex self-efficacy, social support, and alcohol, and drug use. The sample included 170 HIV+ Latino GBT persons. The results revealed three dimensions of stigma: internalized, perceived, and enacted HIV/AIDS stigma. Enacted HIV/AIDS stigma comprised two domains: generalized and romantic and sexual. Generalized enacted HIV/AIDS stigma was related to most outcomes. Internalized HIV/AIDS stigma mediated the associations between generalized enacted HIV/AIDS stigma and self-esteem and safe sex self-efficacy. In addition, romantic and sexual enacted HIV/AIDS stigma significantly predicted drug use. Perceived HIV/AIDS stigma was not associated with any outcome. These findings expand the understanding of the multidimensionality of stigma and the manner in which various features impact marginalized PLWHA.

Espasticidad postictus con patrón distónico en paciente con tumor glómico carotídeo: aplicación de toxina botulínica tipo A / Post-stroke spasticity with dystonic pattern in patient with carotid glomus tumor: application of botulin toxin type A

Los tumores del glomus carotídeo son lesiones de crecimiento lento e infrecuentes. Por la localización anatómica se recomienda su extirpación. Se presenta un paciente de 35 años con tumor del glomus carotídeo derecho agresivo. Se realizó embolización prequirúrgica; 24 horas después presentó ictus en territorio de la arteria cerebral media derecha, objetivándose en resonancia magnética nuclear material de embolización, apareciendo paresia facial izquierda leve. Se interviene tras 5 meses, presenta postcirugía: parálisis facial izquierda central, voz bitonal, disfagia leve, hemiparesia izquierda espástica de predominio braquial. Recibió tratamiento con toxina botulínica tipo A (TboA) en miembros izquierdos, seguido de estiramientos de la musculatura afectada. Objetivando en revisiones seriadas: mejoría en el dolor, patrón de marcha, posición del miembro superior y mejoría funcional. El tratamiento con TboA producirá mejoría global en patrones distónicos si se selecciona la musculatura y la dosis de forma correcta, obteniendo mejoras en funcionalidad y calidad de vida (AU)

Carotid glomus tumor are uncommon and slow growing lesions. Removal is recommended due to their anatomical localization. The case of a 35-year old patient with aggressive right carotid glomus tumor is presented. Presurgery embolization was performed. At 24 hour, the patient suffered stroke in the right middle cerebral artery territory, observing embolization material with the MRI, mild left facial paresis appearing. Surgery was performed 5 months later. Post-surgery, the patient has left central facial paralysis, bitonal voice, mild dysphagia, left spastic hemiparesis with brachial predominance. The patient was treated with botulinum toxin type A (TboA) in left limbs, followed by stretchings of the affected muscles. The seriated check-up studies showed improvement in pain, gait pattern, position of the upper limb as well as functional improvement. Treatment with TboA would produce an overall improvement in dystonic patterns, if the muscles and the dose are correctly selected, obtaining improvements in functionality and quality of life (AU)

Evaluación de calidad asistencial en la utilización de toxina botulínica para el tratamiento de la espasticidad postictus en adultos / Quality evaluation of clinical practice in treatment with botulinum neurotoxin in adults with spasticity post-stroke

Introducción. El ictus es la enfermedad neurológica más común y la espasticidad una de sus secuelas más discapacitantes. La toxina botulínica (TBo) es utilizada en el tratamiento de la espasticidad por su capacidad de bloquear la liberación de acetilcolina en la unión neuromuscular. La frecuente indicación de este tratamiento ha derivado en la creación de consultas específicas en las unidades de Neurorrehabilitación. Objetivo. Evaluar la calidad asistencial científico-técnica del tratamiento realizado en nuestra unidad en pacientes con espasticidad post-ictus, utilizando como indicador de calidad la evidencia clínica disponible. Pacientes y método. Búsqueda bibliográfica con las palabras clave botulinum neurotoxin y stroke; selección aleatoria de 50 historias de pacientes en seguimiento en la unidad de Neurorrehabilitación, de los cuales 23 cumplieron los criterios de inclusión. Se recogieron seis variables: diagnóstico clínico, afectación motora, escala Ashworth modificada, tratamiento con TBo, músculos infiltrados y técnica utilizada. Resultados. Hay suficiente evidencia para recomendar la utilización de la TBo en el tratamiento de la espasticidad para reducir el tono muscular y mejorar la función pasiva, pero no existe una técnica de infiltración determinada que haya demostrado mayor efectividad. En nuestra muestra en el 61% de los pacientes la indicación de tratamiento fue la más recomendable, aunque en el 13% no se pudo valorar por falta de datos. Discusión. Son necesarios más estudios para analizar la efectividad sobre la función activa y las repercusiones en calidad de vida, delimitando el grupo diana para el tratamiento con TBo y podamos realizar un análisis de calidad más exacto(AU)

Introduction. Stroke is the most common neurological disease causing disability, mainly by spasticity. Botulinum neurotoxin (BTx) is used to treat that problem by means of its pharmacological action, blocking acetylcholine release at neuromuscular junctions. It is so frequent that some specific outpatient departments (included in Neurorehabilitation) are created to be focused in that treatment. Objective. Make an evaluation related to science quality evidence in BTx treatment applying to clinical practice with spasticity post-stroke at our department. Patients and methods. A literature research with botulinum neurotoxin and stroke as key words; and a randomised selection of Neurorehabilitation patients’ 50 medical charts. Only 23 patients adjusted to inclusion criteria. We studied 5 variables: main injury, motor impairment, modified Ashworth scale, treatment with BTx, muscles injected and injection technique. Results. There are evidence based recommendations to treat with BTx stroke patients with spasticity in order to reduce muscle tone and improve passive function. However, there is no evidence based recommendation about what the best injection technique is. In our study 61% of patients got the most recommended treatment, but we couldn’t evaluate 13% of patients. Discussion. We would need more trials that test BTx's results in active function and its quality of life consequences. It would let us evaluate more accurately our clinical practice by getting a target group to be treated(AU)

Cirugía metabólica: ¿una nueva alternativa para el tratamiento de la diabetes mellitus tipo 2? / Metabolic surgery: new alternative for diabetes mellitus type 2?

Type 2 Diabetes Mellitus is a global epidemic. Classical studies have demonstrated the benefits of tight glycemic control, showing a decrease in complications and mortality. Current therapy based on changes in lifestyle and medication accomplishes these goals in an insufficient number of patients. Follow up of obese patients undergoing bariatric surgery has shown us a significant reduction in overweight and control comorbidities. In diabetic patients, there is adequate glycemic control, decreased insulin resistance, and decrease in glycosylated hemoglobin.The pathophysiological mechanisms that explain these effects are being studied, and includes benefits associated with significant and sustained weight loss, and mechanisms independent of weight loss that appear early after surgery. The latter would be due to changes in GI anatomy induced by surgery, including activation of the entero insular axis, exclusion of the foregut, and stimulation of the distal ileum with enhanced incretin production. Since the surgery seems to have an effect on diabetes that is primary, specific and independent of weight loss, authors have suggested de idea of extending surgical indication to diabetic patients with BMI <35. Initial surgical experience in this group of patients show encouraging results, however, at this point there is insufficient data to generalize its indication. The results of on going surgical protocols will help to clarify the role of surgery in the treatment of Type 2 Diabetes in patients with BMI <35.

Brain organization mirrors caste differences, colony founding and nest architecture in paper wasps (Hymenoptera: Vespidae).

The cognitive challenges that social animals face depend on species differences in social organization and may affect mosaic brain evolution. We asked whether the relative size of functionally distinct brain regions corresponds to species differences in social behaviour among paper wasps (Hymenoptera: Vespidae). We measured the volumes of targeted brain regions in eight species of paper wasps. We found species variation in functionally distinct brain regions, which was especially strong in queens. Queens from species with open-comb nests had larger central processing regions dedicated to vision (mushroom body (MB) calyx collars) than those with enclosed nests. Queens from advanced eusocial species (swarm founders), who rely on pheromones in several contexts, had larger antennal lobes than primitively eusocial independent founders. Queens from species with morphologically distinct castes had augmented central processing regions dedicated to antennal input (MB lips) relative to caste monomorphic species. Intraspecific caste differences also varied with mode of colony founding. Independent-founding queens had larger MB collars than their workers. Conversely, workers in swarm-founding species with decentralized colony regulation had larger MB calyx collars and optic lobes than their queens. Our results suggest that brain organization is affected by evolutionary transitions in social interactions and is related to the environmental stimuli group members face.

Caracterización de pacientes y de uso de medicamentos en un grupo de adultos mayores asistentes a una actividad promocional de geriatría / Characterization of patients and pharmaceutical preparations use in a group of adults attending majors to a promotional activity of geriatrics

Study objectives: To establish frequency of polypharmacy, proportion of use of drugs without prescriptions, and personal mean monthly expenditure on drugs among elderly people attendingto a promotional activity on geriatrics at the Hospital Clínico de la Universidad de Chile. Methods: Observational study that analyses answers given by 235 elderly people who attended to the promotional activity on geriatrics. Results: The 99.6percent interviewees lived in the Metropolitan Region, 82.6 percent were females, a big number of them had ages between 60 and 69 years. The 63.8 percent were affiliated to the public secure of heath (FONASA). The 41.6 percent of those nonaffiliated to FONASA expended between 10,000 and 50,000 Chilean pesos by month to buy drugs. The 32.3 percent received polypharmacy (5 drugs), and 17.4 percent of interviewees used auto-prescribed drugs. It was observed a greater frequency of auto-indicated drugs among women (34 percent) than men (24.4 percent). The 235 interviewees communicated a total of 857 diseases (3.64 +- 1.89 diseases/patient), being arterial hypertension the most frequent one (19.1 percent). Conclusion: It seems important to develop other type of studies in Chile that permit to establish frequency of polypharmacy amongelderly people, and its outcomes on health quality of life, clinical and economic conditions.

Sarcopenia en la pérdida funcional: rol del ejercicio / Sarcopenia in functional lost: excercise role

Sarcopenia is refers to the gradual decline in muscle mass and quality noted with advancing age, but is not only present in that’s condition. In the last time appear new names proposal how myoestheatosis of the aging in reference at changes in the fat composition of the mass muscle. Factors implicated in the etiology of sarcopenia include decreased physical activity, malnutrition, increase inflammatory activity, oxidative stress and abnormalities in the hormonal and the vitamin axes and others. There is growing evidence linking sarcopenia to the frailty and functional disability, falls, decreased bone density, glucose intolerance contributes significantly to the morbidity, decrease in quality of life, and health care cost in the elderly. Exercise has been shown to increase strength, aerobic capacity, and muscle protein synthesis, in both young and older people, however, exercise does not reverse all age – related changes, but is a strong tool for maintain the autonomy. In special of the strength and resistence together with adequate nutritional state.

Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo: un análisis crítico del estado actual / Cardiovascular prevention and attitude of people towards behavior changes: state of the art

In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.

Uso de Sustancias en Mujeres con Desventaja Social: Riesgo para el Contagio de VIH/SIDA.

BACKGROUND: Epidemiological characterization in Chile points to the feminization, pauperization and heterosexualization of the HIV epidemic, which indicates increased risk for socially disadvantaged women. When the use of substances is added to this, the vulnerability of this group in terms of HIV is magnified. OBJECTIVE: To describe the use of substances in socially disadvantaged women and to identify HIV/AIDS risk factors associated with the use or consumption of substances. MATERIAL AND METHOD: 52 women were interviewed as part of the project "Testing an HIV prevention intervention in Chilean women" GRANT # RO1 TW 006977. Socio-demographic and substance use variables are described through descriptive statistics, and the relationship between variables is analyzed using correlation tests. RESULTS: The results reveal a socio-demographic profile that places women in a vulnerable situation regarding transmission of HIV/AIDS, with high indices of substance use amplifying risk. CONCLUSIONS: These finding indicate the need for interventions focusing on HIV prevention in women that incorporate the risks associated with the consumption of substances.

Depresión y calidad de vida en el alcoholismo / Depression and life quality in alcoholism

This paper intends to compare quality of life and its relationships with depressive symptomatology in alcoholic patients. We selected two groups the first, patients assisting a recovery center for alcoholics, and the second, patients that had attended this center in the past. Both groups received the SF-36 and the Beck Depression Inventory. Comparing the results from both groups, we could not find a significant direct relationship between patient’s appreciation about quality of life, measured by SF-36, and presence of depression, measured in the Beck Inventory.

El objetivo del presente estudio es comprar el nivel de calidad de vida y su vinculación con la sintomatología depresiva en sujetos alcohólicos. Para estos fines se han considerado dos muestras de sujetos, aquellos que están en tratamiento en un club de recuperados alcohólicos en el momento del estudio y aquellos que han pertenecido a esta institución y se encontraban en sus hogares sin asistir a las actividades de este centro. Ambas muestras se aplicaron los instrumentos de evaluación de calidad de vida (SF-36) y de presencia de síntomas depresivos (Inventario de Depresión de Beck). Al comparar ambos grupos y al efectuar las pruebas estadísticas, no se logró establecer una directa relación entre las apreciaciones acerca de la calidad de vida y la presencia de síntomas depresivos en el conjunto de la población estudiada.

[Thalamo-cortical system and consciousness]. / El sistema tálamo-cortical y la consciencia.

After reviewing the concept of the specific and non specific thalamo-cortical systems, the connectivity of the relay and intralaminar nuclei is analyzed as well as the recent data concerning the chemical identity of thalamic neurones, the concept and distribution of "matrix" and "core" neurones and its functional role. The intrinsic electrical properties of thalamic neurones, its mode of discharge--depending of the membrane potential level--and its functional significance in the context of the brain's global activity are discussed. Of special interest are the studies on the effects of lesion of the relay and intralaminar nuclei as well as its repercussion in the interpretation of the sensory perception. After intralaminar nuclei lesion the individual is not aware of the nformation conveyed through the specific channels. It follows a discussion on the importance of the temporal and spatial mapping in the elaboration of perception and cognition. Due to the intrinsic electrical properties and the connectivity of thalamic neurones two groups of corticothalamic loops are generated, which resonate at a frequency of 40 Hz. The specific thalamo-cortical loops give the content of cognition and the no specific loop, the temporal binding required for the unity of the cognitive experience. Consciousness is then, a product of the resonant thalamo-cortical activity, and the dialogue between the thalamus and cortex, the process that generates subjectivity, the unique experience we all recognized as the existence of the "self".