Erección prolongada dolorosa / Prolonged painful erection

El priapismo es una erección peneana prolongada y dolorosa, que ocurre sin estímulo sexual previo. Existen dos tipos principales, el priapismo de alto flujo y el priapismo de bajo flujo. Aunque en la mayoría de las ocasiones la causa subyacente será desconocida, puede ser la primera manifestación de una enfermedad grave. En el paciente pediátrico con una erección prolongada se debe diferenciar entre la erección peneana recurrente y los distintos tipos de priapismo, puesto que cada entidad requiere un manejo concreto e implica un pronóstico diferente. (AU)

Priapism is a prolonged and painful penile erection, which occurs without prior sexual stimulation. There are two main types, high-flow priapism and low-flow priapism. Although on most occasions the underlying cause will be unknown, it may be the first manifestation of serious disease. In the pediatric patient with prolonged erection we must differentiate between recurrent penile erection and the different types of priapism since each entity requires a specific management and implies a different prognosis. (AU)

A web-enabled, school-based intervention for bullying prevention (LINKlusive): a cluster randomised trial.

Background: There is a need for more sustainable interventions and for assessing the effectiveness of school-based universal anti-bullying programmes in vulnerable populations. We assessed the efficacy of a multicomponent, web-enabled, school-based intervention that aims to improve school climate and reduce bullying (LINKlusive) relative to conventional practices (control condition). Methods: We conducted a cluster randomised controlled trial in primary and secondary schools in Madrid, Spain. The primary outcome measure was peer-reported bullying victimisation after the 12-week intervention (study endpoint). We analysed data using longitudinal mixed-effects models. The trial was registered with the ISRCTN registry (15719015). Findings: We included 20 schools (10 in each group); 6542 students participated at baseline; 6403 were assessed at study endpoint. After the intervention, there was a statistically significant reduction in bullying victimisation in both the intervention (OR 0.61, 95% CI [0.41, 0.90]) and control groups (OR 0.69, 95% CI [0.51, 0.92]), with no evidence of differences in the whole sample (OR 0.89, 95% CI [0.58, 1.36]; aOR 0.89, 95% CI [0.58, 1.37]). Subgroup analyses showed a statistically significant effect of LINKlusive on bullying victimisation in primary education (aOR 0.68, 95% CI [0.47, 0.98]). In students with peer-reported bullying victimisation at baseline, LINKlusive showed a statistically significant effect on depression (-1.43, 95% CI [-2.46, -0.40], adjusted standardised mean difference (SMD) -0.41) and quality of life (2.18, 95% CI [0.80, 3.56], adjusted SMD 0.45). Interpretation: LINKlusive could be effective in reducing bullying victimisation in primary school students. Sustainable whole-school interventions to promote mental health and reduce risk factors are warranted to improve outcomes in young people, especially in the early years of education. Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.

Identification and Characterization of Adipose Tissue-Derived Human Antibodies With "Anti-self" Specificity.

We have previously shown that the human obese adipose tissue (AT) contributes to increased secretion of adipocyte-specific IgG antibodies in individuals with obesity. This occurs without any exogenous stimulation, because the ongoing process of cell death in the obese AT leads to the release of "self" antigens able to induce chronic stimulation of B cells. We have identified several mechanisms responsible for the release of "self" antigens, such as hypoxia, cell cytotoxicity, and DNA damage. In this paper, we confirm and extend our initial observation on a different cohort of individuals, and we show that also the plasma of these individuals is enriched in IgG antibodies with specificities for adipocyte-derived antigens. Adipocyte-specific IgG secreted in the obese AT are significantly correlated with those present in plasma. Using immunoprecipitation and mass spectrometry, we have identified these antigenic specificities. The antigens are almost exclusively intracellular or cell-associated, usually not recognized as "self" antigens, but they are released by cells dying in the AT. We also show for the first time that the adipocytes in the obese AT contribute to the secretion of IgG autoimmune antibodies and this seems to be due to their expression of the antigen-presenting molecules CD1d and, to a much lesser extent, MHC class II, as our mechanistic experiments performed in mice have shown. These results may lead to the development of novel therapeutic strategies to control autoimmunity.

Comparative lipid profiling dataset of the inflammation-induced optic nerve regeneration.

In adult mammals, retinal ganglion cells (RGCs) fail to regenerate following damage. As a result, RGCs die after acute injury and in progressive degenerative diseases such as glaucoma; this can lead to permanent vision loss and, eventually, blindness. Lipids are crucial for the development and maintenance of cell membranes, myelin sheaths, and cellular signaling pathways, however, little is known about their role in axon injury and repair. Studies examining changes to the lipidome during optic nerve (ON) regeneration could greatly inform treatment strategies, yet these are largely lacking. Experimental animal models of ON regeneration have facilitated the exploration of the molecular determinants that affect RGC axon regeneration. Here, we analyzed lipid profiles of the ON and retina in an ON crush rat model using liquid chromatography-mass spectrometry. Furthermore, we investigated lipidome changes after ON crush followed by intravitreal treatment with Zymosan, a yeast cell wall derivative known to enhance RGC regeneration. This data is available at the NIH Common Fund's Metabolomics Data Repository and Coordinating Center (supported by NIH grant, U01-DK097430) website, the Metabolomics Workbench, http://www.metabolomicsworkbench.org, where it has been assigned Project ID: PR000661. The data can be accessed directly via it's Project DOI: doi: 10.21,228/M87D53.

Quantitative Metabolomics Using Isotope Residue Outlier Analysis (IROA®) with Internal Standards.

Various research strategies involving biomarker discovery and mechanistic studies in system biology depend on reproducible and reliable quantification of all metabolites from tissue(s) of interest. Contemporary analytical methods rely on mass spectrometry-based targeted and/or untargeted metabolomics platforms. The robustness of these analyses depends on the cleanliness of the samples, accuracy of the database, resolution of the instrument, and, the most variable of the list, the personal preferences of the researcher and the instrument operator. In this chapter, we introduce a simple method to prepare murine liver samples and carry it through the Isotope Ratio Outlier Analysis (IROA®) pipeline. This pipeline encompasses sample preparation, LC-MS-based peak acquisition, proprietary software-based library creation, normalization, and quantification of metabolites. IROA® offers a unique platform to create and normalize a local library and account for run-to-run variability over years of acquisition using the internal standards (IROA®-IS) and long-term reference standards (IROA®-LTRS).

Analyses of Cholesterol and Derivatives in Ocular Tissues Using LC-MS/MS Methods.

Cholesterol is considered one of the most abundant sterols present in mammals, amphipathic in nature, and a key constituent of the cell membrane. Its unique chemical structure consisting of four linked hydrocarbon rings, with an aliphatic chain on one end and a hydroxyl group on the other, confers it the ability to form hydrogen bonds with other lipid classes, like phospholipids or sphingolipids head groups. However, due to its hydrophobic moiety, the fatty acid chain, free cholesterol (FC) it is difficult to be analyzed via electrospray ionization (ESI). The method presented in this chapter to identify and quantify free cholesterol and cholesteryl esters (CE) is based on the chemical derivatization of the sample, strategy devised to avoid the problematic of ESI. However, relevant mention should be made to an alternative separation protocol, which uses ultrahigh performance liquid chromatography and in-source collision-induced dissociation to achieve a simultaneous quantification of FC, CE, and triglycerides (TG).

Immature and Mature Collagen Crosslinks Quantification Using High-Performance Liquid Chromatography and High-Resolution Mass Spectrometry in Orbitrap™.

Different methodologies for collagen quantification have been described in the past. Introduction of mass spectrometry combined with high-performance liquid chromatography (HPLC) is a high-resolution tool, which has generated novel applications in biomedical research. In this study, HPLC coupled to electrospray ionization (ESI) tandem mass spectrometry (HPLC-ESI-MS/MS) was used to characterize tissue samples from AVFs done in rats. These findings helped create a protocol for identifying and quantifying components of immature and mature collagen crosslink moieties. Two different internal standards were used: epinephrine and pyridoxine. Quantification curves were drawn by means of these standards. The goal of the experiment was to achieve accurate quantification with the minimum amount of sample. Time and cost of experiment were considerably minimized. Up to date, this method has not been tested for crosslinking quantification.

HSD18B7 Enzyme Assay Technique Using a Triple Quadrupole Mass Spectrometer.

Enzymes exist in all biological systems to catalyze vital biochemical reactions. The reactivity of an enzyme and the extent of its influence on product formation can give insight to understanding the physiological changes that can take place. The enzyme HSD17B7, involved in the cholesterol biosynthesis pathway, may play a role in influencing underlying changes during transition of disease, specifically in eyes at normal state to eyes that have glaucoma. In this work, we present a method to test the enzymatic activity level of HSD17B7 between normal and glaucomatous optic nerves to assess whether enzymatic upregulation of cholesterol biosynthesis may play a role in glaucoma.

Isotopic Ratio Outlier Analysis (IROA) of Aqueous Humor for Metabolites.

"Omics" revolution during the last few decades has vastly increased the understanding of the biological processes that remained obscure in part due to the lack of quality data. Genomics, transcriptomics, epigenomics, proteomics, lipidomics, metabolomics, and microbiomics form an invaluable array of fields that contribute holistically to a global understanding of the intertwined roles of the basic constituents of life and how they comprehensively paint a picture of disease. Metabolomics, in particular, is the study of metabolites, which are the products of cellular metabolic processes (small molecules, i.e., fatty acids, amino acids, or carbohydrates, are part of metabolomics). In this chapter, it is explained how to achieve a metabolomics profiling of aqueous humor using a special isotopic carbon labeling, a novel technique that combines a tremendous effectiveness with simplicity. The very nature of this technique guarantees the exclusion of false positives, since the algorithms are based on the recognition of unique isotopic patterns.

Labeled quantitative mass spectrometry to study the host response during aspergillosis in the common bottlenose dolphin (Tursiops truncatus).

Aspergillosis is a fungal infection caused by Aspergillus molds that can affect both humans and animals. Despite advances in diagnostics and therapy, medical management of this disease remains difficult. Expansion of the basic knowledge regarding its pathophysiology in animals is critical to aid in the identification of new biomarkers of infection for diagnosis and therapeutic targets. For such a purpose, proteomics can be used by addressing protein changes during various disease processes. In the present study, a mass spectrometry analysis based on isobaric tagging for relative and absolute quantitation (iTRAQ®) was applied for direct identification and relative quantitation of proteins in blood collected from 32 Aspergillus-diseased common bottlenose dolphins (Tursiops truncatus, 32 samples) in comparison with blood from 55 other dolphins (55 samples from 41 clinically-normal controls and from 14 cetaceans with miscellaneous non-Aspergillus inflammation diseases) and ten convalescent dolphins (28 samples). Sixty-six and 40 proteins were found to be ≥2.0-fold over- and underrepresented versus miscellaneous non-Aspergillus inflammatory dolphins, respectively, and most were confirmed vs. clinically-normal controls and convalescents. Many proteins which play a role in the adaptive immune response were identified, including MHC proteins and others involved in catalytic activity like the NADPH-ubiquinone oxido-reductases. Overall, iTRAQ® appears to be a convenient proteomic tool greatly suited for exploratory ex vivo studies focusing on pathophysiology. This technique should be considered as a preliminary step before validation of new diagnostic markers.

Optic Nerve Lipidomics Reveal Impaired Glucosylsphingosine Lipids Pathway in Glaucoma.

Purpose: To determine major differences in lipid profile between human control and glaucomatous optic nerve. To assess major enzymes in lipid pathway if aberration is revealed for a lipid class by profiling. Methods: Optic nerve (ON) samples were obtained from human cadaveric donors [control (n = 11) and primary open-angle glaucoma (POAG; n = 12)]; the lipids were extracted using Bligh and Dyer methods. Control and glaucoma donors were all Caucasians age 72.3 ± 5.9 and 70.3 ± 10.5 (inclusive of both sexes), respectively. Lipids were extracted after weighing the tissue; the protein amounts in the corresponding aqueous phase of organic solvent extraction were recorded. High-resolution mass spectrometry was performed using a Q-exactive mass spectrometer coupled with an EASY-nLC 1000 liquid chromatograph instrument. Bioinformatics and statistical analysis were performed using LipidSearch v.4.1 and MetaboAnalyst 4.0/STATA 14.2. Protein amounts were determined using Bradford's method. Western blot, ELISA, and immunohistochemistry utilized established protocols and were performed for protein quantification and localization, respectively. Additional donor tissues were utilized for Western blot, ELISA, and immunohistochemistry. Results: Principal component analysis (PCA) placed control and glaucomatous ONs in two distinct groups based on analysis of lipid profiles. Total lipid, total phospholipids, total ceramide, and total sphingolipids were similar (without significant difference) between control and glaucoma. However, we found a significant increase in glucosylsphingosine in glaucoma compared to control samples. We found similar levels of glucocerebrosidase (GBA), ceramide glucosyltransferase (UGCG), decreased nonlysosomal glucocerebrosidase (GBA2), and increased lysosomal and nonlysosomal acylsphingosine amidohydrolase (ASAH1 and ASAH2) levels in glaucomatous ON compared to control. Conclusions: We found significant differences in glucosylsphingosine lipids, consistent with decreased GBA and GBA2 and increased ASAH1 and ASAH2 immunoreactivity in glaucoma, suggesting the potential impairment of sphingolipid enzymatic pathways in lysosomal and nonlysosomal cellular compartments.

Translational proteomic study to address host protein changes during aspergillosis.

Aspergillosis is a fungal disease due to Aspergillus molds that can affect both humans and animals. As routine diagnosis remains difficult, improvement of basic knowledge with respect to its pathophysiology is critical to search for new biomarkers of infection and new therapeutic targets. Large-scale proteomics allows assessment of protein changes during various disease processes. In the present study, mass spectrometry iTRAQ® (isobaric tags for relative and absolute quantitation) protocol was used for direct identification and relative quantitation of host proteins in diseased fluids and tissues collected from an experimental rat model challenged with Aspergillus, as well as in blood obtained from naturally-infected penguins. In all, mass spectrometry analysis revealed that proteome during aspergillosis was mostly represented by proteins that usually express role in metabolic processes and biological process regulation. Ten and 17 proteins were significantly ≥4.0-fold overrepresented in blood of Aspergillus-diseased rats and penguins, respectively, while five and 39 were negatively ≥4.0-fold depleted within the same samples. In rat lungs, 33 proteins were identified with positive or negative relative changes versus controls and were quite different from those identified in the blood. Except for some zinc finger proteins, kinases, and histone transferases, and while three pathways were common (Wnt, cadherin and FGF), great inter-species variabilities were observed regarding the identity of the differentially-represented proteins. Thus, this finding confirmed how difficult it is to define a unique biomarker of infection. iTRAQ® protocol appears as a convenient proteomic tool that is greatly suited to ex vivo exploratory studies and should be considered as preliminary step before validation of new diagnostic markers and new therapeutic targets in humans.

Quantitative Proteomic Analysis of Human Aqueous Humor Using iTRAQ 4plex Labeling.

iTRAQ 4plex method enables multiplexing of up to four samples for simultaneous quantitation to improve sensitivity and scope of proteomic analysis. Here, we describe iTRAQ 4plex labeling of human aqueous humor specimens followed by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and data analysis for peptide identification and quantitation using Proteome Discoverer software. The protocol can be applied for other animals as well; however, pooling of specimens may be required to obtain sufficient amount of protein for labeling.

Application of mass spectrometry to elucidate the pathophysiology of Encephalitozoon cuniculi infection in rabbits.

Encephalitozoon cuniculi is a microsporidian species which can induce subclinical to serious disease in mammals including rabbits, a definitive natural host. The pathophysiology of infection has not been comprehensively elucidated. In this exploratory study, we utilized two mass spectrometry approaches: first, the analysis of the humoral response by profiling the microsporidian antigens as revealed by Western blot screening, and second, implementing the iTRAQ®-labeling protocol to focus on the changes within the host proteome during infection. Seven E. cuniculi proteins were identified at one-dimensional gel regions where specific seropositive reaction was observed by Western blot, including polar tube protein 3, polar tube protein 2, and for the first time reported: heat shock related 70kDa protein, polysaccharide deacetylase domain-containing protein, zinc finger protein, spore wall and anchoring disk complex protein EnP1, and translation elongation factor 1 alpha. In addition, there was a significant increase of nine host proteins in blood samples from E. cuniculi-diseased rabbits in comparison with non-diseased control subjects undergoing various inflammatory processes. This included serum paraoxonase, alpha-1-antiproteinase F precursor and alpha-1-antiproteinase S-1 which have presumptive catalytic activity likely related to infection control, and cystatin fetuin-B-type, an enzyme regulator that has been poorly studied to date. Notably, 11 proteins were found to be statistically increased in rabbits with neurological versus renal clinical presentation of E. cuniculi infection. Overall, this novel analysis based on mass spectrometry has provided new insights on the inflammatory and humoral responses during E. cuniculi infection in rabbits.

Utility of Moderate and High-Resolution Mass Spectrometry for Class-Specific Lipid Identification and Quantification.

The study of lipidomics has been dramatically enhanced by using mass spectrometry techniques.With the purpose of identification and/or quantification of the lipids object of study, mass spectrometry has been proven to be the best approach, where three main techniques are currently being used: electrospray ionization (ESI), liquid chromatography (LC/MS), and matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (Han et al. Mass Spectrom Rev 31:134-178, 2012). In order to avoid the problems generated by gradient concentration using liquid chromatography, here we describe the method used for the lipidomics analysis using moderate and high-resolution mass spectrometry for class-specific lipid identification and quantification for phospholipid species using ESI-MS/MS.

Phospholipidomic Studies in Human Cornea From Climatic Droplet Keratopathy.

Climatic droplet keratopathy (CDK) is an acquired degenerative disease predominantly affecting males over 40 years old. It results in progressive corneal opacities usually affecting both eyes. CDK is multifactorial and its etiology remains unknown. Our recent findings are consistent with CDK pathology being driven by environmental factors with oxidative stress playing an important role (e.g.,, contributing to lipid peroxidation) rather than climate factors. The changes in corneal lipid composition affected by environmental factors remain understudied. The purpose of this study was to systematically investigate phospholipids profile (phosphatidylcholine [PC] and phosphatidylserine [PS]) in corneas from CDK patients using tandem mass spectrometry. Samples from CDK areas and from non-affected areas were obtained from patients diagnosed with CDK who underwent cataract surgery, were subjected to lipid extraction using a modified Bligh and Dyer method; protein concentrations were determined using the Bradford's method. Lipids were identified and subjected to ratiometric quantification using TSQ Quantum Access Max triple quadrupole mass spectrometer, using appropriate class specific lipid standards. All phospholipid classes showed lower total amounts in affected areas compared to control areas from CDK's corneas. Comparative profiles of two phospholipid classes (PC, PS) between CDK areas and control areas showed several common species between them. We also found a few unique lipids that were absent in CDK areas compared to controls and vice versa. Lower amount of phospholipids in CDK areas compared to control areas could be attributed to the lipid peroxidation in the affected corneal regions as a consequence of increased oxidative stress. J. Cell. Biochem. 118: 3920-3931, 2017. © 2017 Wiley Periodicals, Inc.

Educación superior en Internet e impacto en la cultura de la calidad asistencial de los cuidados / No disponible

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The purpose of this paper is to reveal the impact that our online methodology is having around not only in quality culture but also in health care training. In Universidad Internacional de La Rioja (UNIR) Health Sciences School, we have a great interest in offering professional training to meet society demands. Since 2014, several degrees related to quality health care have been developed. Online higher education is contributing significantly to the culture of quality. The concern for the quality in health care has been around for ages, as much as the own exercise of medicine, there are many variables involved (scientific and technical aspects such as diagnosis, treatment, prevention and rehabilitation). Our master degree in «Seguridad clínica del paciente y gestión de la calidad asistencial» provides practical training through virtual face-to-face workshops, improving professional skills in the field of public health and quality patient health care. Communication skills are developed for the management of teams in crisis, epidemiology studies and appropriate risk management measures are developed for implementation in different health organizations. The online teaching methodology is having a great impact in disseminating patient safety culture, being accessible to all health specialties and allowing for excellent access to information and knowledge, wich is constantly growing. In addition, the master degree in «Cuidados Paliativos Pediátricos» provides training in care to all pediatric patients, either in the terminal situation or with a deadly disease. These skills aim to improve care and quality of life for these patients (infants, children and teenagers) and their families, in a comprehensive and personalized way, guaranteeing respect for their dignity and the right to their autonomy. In these degrees, the purpose, besides the training in equipping health management tools for staff, is to focus medical and nurse training on care quality, understood as offering a comprehensive, personalized and rigorous service to achieve the objectives of Health. Conclusions: Our online higher education approach is having a great interest and impact improving health care and patient safety. The accessibility of this methodology and the closeness with teachers through virtual face-to-face classes and forums, combined with clinical practices, is postulated as a new teaching model to spread culture of quality in medical education. Seminars or day-conferences are held on specific topics to encourage professional relationships. Some health management models that are proposed are common to our degrees taught for international experts shaping a very specialized area of knowledge around the management of the health care quality

Apendicitis en lactantes. Casuística de 25 años / Appendicitis in infants. 25 year case series

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Anthropometric indices to assess body-fat changes during a multidisciplinary obesity treatment in adolescents: EVASYON Study.

BACKGROUND & AIMS: The main objectives of weight loss interventions in children and adolescents are to decrease fat mass while maintaining fat-free mass. Several methods are available to assess childhood and adolescence obesity, such as weight and height, bioelectrical impedance, skin-fold thickness measurements and other laboratory methods. The aim was to assess simple anthropometric indices as predictors of body-fat changes, using dual-energy X-ray absorptiometry measurements as reference method. METHODS: Multi-intervention approach (diet, physical activity and psychological support in a family-group-based treatment) was implemented with a one-year follow-up in 13-to-16-year-old overweight or obese Spanish adolescents. A total of 83 adolescents were recruited from Granada and Zaragoza, males (n = 43) (31.6 kg/m(2)) and females (n = 40) (32.0 kg/m(2)). We measured body composition with anthropometry and dual-energy X-ray absorptiometry. All measurements were made at baseline, and after 2 and 13 months. Random coefficient regression model was used to calculate the proportion of body composition changes during follow-up that would be explained by simple body composition indices based on anthropometric measures. RESULTS: After controlling for age and Tanner stage, body mass index explained 76.5% of body composition changes in males and 90.1% in females, while fat mass index (assessed by skin-folds) explained 78.9% of body composition changes in males and 84.0% of body composition changes in females. CONCLUSIONS: In conclusion, we found that BMI was a good indicator of body fat composition changes in children and adolescents, although FMI assessed by anthropometry was also a good indicator.