Use of coffee pulp and sorghum mixtures in the production of n-demethylases by solid-state fermentation.

One of the compounds generally found in the residues of the coffee and tea industries is caffeine, which in high concentration is toxic to various organisms, making it necessary to find an adequate treatment for these residues. Biotechnological treatments using enzymes can be an alternative to valorize and detoxify these residues. However, mixtures of substrates have not been evaluated to improve production. Therefore, the present investigation aimed to study the effect of different proportions of sorghum-coffee pulp mixtures as a substrate in solid-state fermentation with the fungus Rhizopus oryzae (MUCL 28168) for the production of n-demethylases. To evaluate the synergistic and antagonistic effects of coffee pulp and sorghum mixtures on n-demethylase enzyme production, a simplex-centroid design, using four levels: 1 (100%), 1/4 (25%), 1/2 (50%), 3/4 (75%). Results obtained were favorable, achieving a caffeine demethylase activity of 18.762 U/g, and reducing the caffeine content in the coffee pulp.

Enzymatic Biotransformation of Pomegranate Ellagitannins: Initial Approach to Reaction Conditions.

BACKGROUND: Ellagitannase (Ellagitannin acyl hydrolase) is an inducible enzyme with great potential use in food industry since allows the ellagic acid release from ellagitannins. OBJECTIVE: In this work, ellagitannase was produced by the fungus Aspergillus niger GH1 in solid state fermentation using polyurethane foam as solid support and pomegranate husk ellagitannins as sole carbon source and ellagitannase inducer and an initial approach to the enzymatic reaction conditions was reached. MATERIALS AND METHODS: Ellagitannase was produced by Aspergillus niger GH1 in solid state fermentation and the ideal reaction conditions for ellagitannase activity based on ellagic acid quantification as ellagitannins biotransformation product by high performance liquid chromatographic are reported. RESULTS: The enzyme ideal reaction conditions were substrate concentration of 1 mg.mL-1, 60 °C and pH 5.0, during 10 min of reaction. The kinetic enzyme constants (V max = 30.34 mM.mL-1.min-1 and K m = 1.48 x 103 mM) using punicalagin assubstrate were determined. CONCLUSION: The assay was completed in a short time and may find application in future studies of ellagic acid production.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Bacterial lipopolysaccharide induces rainbow trout myotube atrophy via Akt/FoxO1/Atrogin-1 signaling pathway.

Lipopolysaccharide (LPS) is considered as a powerful inducer of muscle atrophy in higher vertebrates due to skeletal muscle cell recognition of the endotoxin and a consequent activation of catabolic signaling pathways. In contrast, there is no evidence of LPS directly inducing skeletal muscle atrophy in lower vertebrates, such as fish. For years it has been assumed that fish are resistant to LPS, mainly due to differences in the key features of toll-like receptor (TLR) signaling pathways when compared with mammals. In this study, we report that the stimulation of cultured rainbow trout (Oncorhynchus mykiss) myotubes with LPS (100 ng/ml) resulted in a transient decrease in the pAkt/Akt ratio, a subsequent reduction in the pFoxO1/FoxO1 ratio, and a significant increase in atrogin-1 transcript expression. Preincubation with polymyxin B, an LPS-neutralizing agent, and 740 Y-P, an agonist of p85-PI3K, blocked the effects of LPS. Additionally, LPS treatment induced an increase in protein ubiquitination and a reduction in myotube diameter, both of which are associated with muscular atrophy that is not observed under polymyxin B and 740 Y-P pretreatments. Finally, rainbow trout myotubes expressed the genes tlr1, tlr3, tlr5m, tlr8a1, tlr8a2, tlr9, and tlr22, with significantly increased expressions of tlr5m and tlr9 under LPS stimulation. These results indicate that LPS is an inducer of fish skeletal muscle atrophy and suggest that TLR5M and TLR9 may play important roles in detecting LPS, which supports for the first time the hypothesis that LPS is a direct inducer of skeletal muscle atrophy in teleost species.

Insulin-like growth factor-1 suppresses the Myostatin signaling pathway during myogenic differentiation.

Myogenic differentiation is a complex and well-coordinated process for generating mature skeletal muscle fibers. This event is autocrine/paracrine regulated by growth factors, principally Myostatin (MSTN) and Insulin-like Growth Factor-1 (IGF-1). Myostatin, a member of the transforming growth factor-ß superfamily, is a negative regulator of skeletal muscle growth in vertebrates that exerts its inhibitory function by activating Smad transcription factors. In contrast, IGF-1 promotes the differentiation of skeletal myoblasts by activating the PI3K/Akt signaling pathway. This study reports on a novel functional crosstalk between the IGF-1 and MSTN signaling pathways, as mediated through interaction between PI3K/Akt and Smad3. Stimulation of skeletal myoblasts with MSTN resulted in a transient increase in the pSmad3:Smad3 ratio and Smad-dependent transcription. Moreover, MSTN inhibited myod gene expression and myoblast fusion in an Activin receptor-like kinase/Smad3-dependent manner. Preincubation of skeletal myoblasts with IGF-1 blocked MSTN-induced Smad3 activation, promoting myod expression and myoblast differentiation. This inhibitory effect of IGF-1 on the MSTN signaling pathway was dependent on IGF-1 receptor, PI3K, and Akt activities. Finally, immunoprecipitation assay analysis determined that IGF-1 pretreatment increased Akt and Smad3 interaction. These results demonstrate that the IGF-1/PI3K/Akt pathway may inhibit MSTN signaling during myoblast differentiation, providing new insight to existing knowledge on the complex crosstalk between both growth factors.

Sequencing and de novo assembly of the red cusk-eel (Genypterus chilensis) transcriptome.

The red cusk-eel (Genypterus chilensis) is an endemic fish species distributed along the coasts of the Eastern South Pacific. Biological studies on this fish are scarce, and genomic information for G. chilensis is practically non-existent. Thus, transcriptome information for this species is an essential resource that will greatly enrich molecular information and benefit future studies of red cusk-eel biology. In this work, we obtained transcriptome information of G. chilensis using the Illumina platform. The RNA sequencing generated 66,307,362 and 59,925,554 paired-end reads from skeletal muscle and liver tissues, respectively. De novo assembly using the CLC Genomic Workbench version 7.0.3 produced 48,480 contigs and created a reference transcriptome with a N50 of 846bp and average read coverage of 28.3×. By sequence similarity search for known proteins, a total of 21,272 (43.9%) contigs were annotated for their function. Out of these annotated contigs, 33.5% GO annotation results for biological processes, 32.6% GO annotation results for cellular components and 34.5% GO annotation results for molecular functions. This dataset represents the first transcriptomic resource for the red cusk-eel and for a member of the Ophidiimorpharia taxon.

The cAMP response element binding protein (CREB) is activated by insulin-like growth factor-1 (IGF-1) and regulates myostatin gene expression in skeletal myoblast.

Myostatin, a member of the Transforming Growth Factor beta (TGF-ß) superfamily, plays an important role as a negative regulator of skeletal muscle growth and differentiation. We have previously reported that IGF-1 induces a transient myostatin mRNA expression, through the activation of the Nuclear Factor of Activated T cells (NFAT) in an IP3/calcium-dependent manner. Here we examined the activation of CREB transcription factor as downstream targets of IGF-1 during myoblast differentiation and its role as a regulator of myostatin gene expression. In cultured skeletal myoblast, IGF-1 induced the phosphorylation and transcriptional activation of CREB via IGF-1 Receptor/Phosphatidylinositol 3-Kinase (PI3K)/Phospholipase C gamma (PLC γ), signaling pathways. Also, IGF-1 induced calcium-dependent molecules such as Calmodulin Kinase II (CaMK II), Extracellular signal-regulated Kinases (ERK), Protein Kinase C (PKC). Additionally, we examined myostatin mRNA levels and myostatin promoter activity in differentiated myoblasts stimulated with IGF-1. We found a significant increase in mRNA contents of myostatin and its reporter activity after treatment with IGF-1. The expression of myostatin in differentiated myoblast was downregulated by the transfection of siRNA-CREB and by pharmacological inhibitors of the signaling pathways involved in CREB activation. By using pharmacological and genetic approaches together these data demonstrate that IGF-1 regulates the myostatin gene expression via CREB transcription factor during muscle cell differentiation.

Endarterectomía carotídea en pacientes con enfermedad cerebrovascular isquémica / Carotid endarterectomy in patientes with cerebralvascular ischemic illness

INTRODUCCIÓN. La identificación de los pacientes portadores de enfermedad carotídea, sintomática o no, y con riesgo de padecer un Ictus, proporcionará a los cirujanos vasculares la oportunidad de realizar una intervención quirúrgica profiláctica, la endarterectomía carotídea para su prevención; la cual es superior al mejor tratamiento médico. OBJETIVOS. Evaluar los resultados de la endarterectomía carotídea en pacientes con enfermedad cerebrovascular isquémica; conocer la distribución de sus formas clínicas según sexo; los porcentajes de estenosis entre pacientes sintomáticos y asintomáticos;y determinar los tipos y características de dicho proceder quirúrgico. SUJETOS Y MÉTODOS. La muestra estuvo compuesta por 61 pacientes, con una edad promedio de 65,7 años; 21 mujeres (34,4%) y 40 hombres (65,5%), portadores de enfermedad cerebro vascular extra-craneal. Se extrajo de las historias clínicas las siguientes variables: interrogatorio e historia de la enfermedad; examen físico, clínico y vascular; ultrasonido vascular carotídeo, previo y posterior al acto quirúrgico, ecocardiograma; RX de tórax; electrocardiograma; analítica sanguínea y estudios angiográficos. RESULTADOS. Se encontró que el 81,97% de los pacientes eran sintomáticos con una proporción similar para hombres (82,5%) y mujeres (80,95%). Se constató que el accidente trombótico isquémico fue la forma clínica que predominó con un 44,26%, seguida por la disfunción cerebral crónica (24,59%), el stroke (11,47%) y el soplo en la base del cuello (3,28%), con una aparición similar en hombres y mujeres (42,5% vs 42,86 %). Se pudo observar una elevada frecuencia de pacientes sintomáticos (N=50, 81,97%) y de ellos el 62,3% (N=38) presentaron una estenosis carotídea entre el 70% y 99%. En la mayoría de los casos se empleó la endarterectomía con cierre directo (N=57, 93,4%). El tiempo promedio de clampeo fue de 27,3 min. CONCLUSIONES. La endarterectomía carotídea es el método de excelencia en el tratamiento de la estenosis carotídea (AU)

INTRODUCTION. Surgery is highly beneficial in patients with a symptomatic stenosis of 70% or greater. The identification of the patient whit carotid lesion and the benefit is unknown in asymptomatic patients. Surgery has also been shown to reduce the risk of stroke, carotid endarterectomy for their prevention; it is the best of medical treatment. OBJECTIVE. Evaluate the carotid endarterectomy in patient with cerebrovascular ischemic illness; know the distribution according to sex and ways clinical; the stenosis, percentages of stenosis among patient symptomatic and asymptomatic; and to determine the characteristic and types surgical proceed. METHODS. The sample was integrated by 61 patients; 21 women (34,4%) and 40 men (65,5%), with an age average of 65,7 year-old; payees of extra brain -cranial vascular of illness. The variables of it was extracted clinical histories of those the following ones: history of and ofinterrogation of the illness; physical examine, and of vascular clinical; vascular ultrasound, and surgical carotid of act of tothe later one of previous, echocardiogram; RX of the thorax; EKG; angiographic of studies, and sanguine analytic complement.RESULTS. 81,97 % of high rail of it was found that of proportion women of and of men (82,5%) of for similar of one of cheat of symptomatic of they were of patient of those (80,95%). The % of an of cheat of it prevailed 44,26% that of form clinic of it was of ischemic thrombotic accident of high rail of it was verified that, chronicle of the cerebral dysfunction of for of followed (24,59%), neck of super of base of blow of high rail of and suddenly of (11,47%) high (3,28%) rail, appearance women of and of men of in similar of one of cheat (42,5% versus 42,86%). One could observe a high frequency of and of symptomatic (n=50; 81,97%) of patient of carotid stenosis of one of they presented of 62,3% (n=38) high rail 62,30 of them it enters and of rail high between 70% and 99%. In most of the direct one of closing of cheat of endarterectomy of employment of you of cases of those (n=57; 93,4%). Average of time of high rail of it was of clamper of 27,3 minutes. CONCLUSION. Carotid endarterectomy remains the standard revascularization technique for the prevention of ischemic stroke resulting from severe carotid stenosis (AU)

Mix gonadal dysgenesis associated with ring Y chromosome mosaics in a phenotypic male.

Ring chromosomes are present in 1 in 25,000 human fetuses; 99% arise de novo while less than 1% of rings are inherited. This chromosomal rearrangement may arise through a cytogenetic mechanism involving breaks in chromosome arms and fusion of the proximal broken ends, leading to a loss of distal material. Most patient Y ring chromosomes are present in a 45,X/46,X,r(Y) mosaic karyotype; molecular analyses of infertile men have shown that it is not rare to find r(Y) in these patients. However, the clinical spectrum in those cases with a 45,X cell line is broad and depends on the percentage of the monosomic cell line in different tissues. Y chromosome abnormalities and 45,X mosaic karyotypes are often associated with disorders of sex determination. Here, we report a male patient with hypospadias, cryptorchidism and a mosaic karyotype containing a low proportion of 45,X monosomic cells and multiple ring Y chromosomes in peripheral blood. Clinical, surgical, and molecular evidence was sufficient for a diagnosis of mixed gonadal dysgenesis. We suggest that a detailed cytogenetic and molecular analysis should be done in all males with bilateral descended testes and infertility.

[Neonatal diagnostic protocol of the Hirschsprung's disease]. / Fiabilidad de la manometría anorrectal para el diagnóstico de la enfermedad de Hirschsprung en neonatos: experiencia de 25 años.

UNLABELLED: Suction rectal biopsy (SRB) is the gold-standard for the diagnosis of Hirschsprung's disease (HD), but may not be applied before the first month of age. We propose a diagnostic protocol that allows the management of these patients. MATERIAL AND METHODS: A retrospective analytic study is done, analysing the results of our protocol. A rectal manometry (RM) is done to any patient with clinical symptoms of HD. When first test is positive (no reflex), we practice a weekly RM till the end of the neonatal period when we propose the SRB for the confirmation of the diagnosis. RESULTS: From 1980 to 2006 we have performed 503 tests in 391 HD's suspected neonates. Mean age in the first study was 15.19 days. In 54 cases, final diagnosis was EH. Rate of false-negative was 0.9%, sensibility 99%. Rate of non-usefull studies without sedation was 8%, being minor (2.97%) with sedation (OR = 2.853; p = 0.008). CONCLUSIONS: The protocol with a weekly RM allows the management of these patients because of a reliable diagnosis. Sedation has two positives effects: the reduction of the time of the study and the improvement of the results.

Fiabilidad de la manometría anorrectal para el diagnóstico de la enfermedad de Hirschsprung en neonatos: experiencia de 25 años / Neonatal diagnostic protocol of the Hirschsprung´s disease

El gold-standard para el diagnóstico de la enfermedad de Hirschsprunges la biopsia rectal por succión (BRS), pero no debería aplicarse antes del mes de vida. Presentamos un protocolo diagnóstico que permite el manejo neonatal de estos pacientes. Material y métodos. Estudio analítico retrospectivo de los resultados del protocolo en el cual se realiza una manometría rectal (MR)ante todo paciente con sospecha de EH con sondas de diseño propio. Si el resultado es positivo, se repiten semanalmente hasta el final del periodo neonatal, cuando se realiza la BRS. Resultados. 1980-2006 realizamos 503 registros en 391 pacientes, con una edad media al primer estudio de 15,86 días. En 54 casos se confirmó el diagnóstico de EH. La tasa de falsos negativos fue de 0,9%,con una sensibilidad del 99%. La tasa de estudios no válidos fue del 8%sin sedación, siendo menor (2,9%) con la sedación, presentando una OR=2,853 (p=0,008).Conclusiones. El protocolo de MR semanales aporta un diagnóstico de sospecha fiable que permite el manejo del paciente neonatal. Con la sedación de los pacientes se acorta el tiempo de estudio y se logran casi 3 veces más estudios válidos (AU)

Suction rectal biopsy (SRB) is the gold-standard for the diagnosis of Hirschsprung´s disease (HD), but may not be applied before the first month of age. We propose a diagnostic protocol that allows the management of these patients. Material and Methods. A retrospective analytic study is done, analysing the results of our protocol. A rectal manometry (RM) is done to any patient with clinical symptoms of HD. When first test is positive(no reflex), we practice a weekly RM till the end of the neonatal period when we propose the SRB for the confirmation of the diagnosis. Results. From 1980 to 2006 we have performed 503 tests in 391HD’s suspected neonates. Mean age in the first study was 15.19 days. In 54 cases, final diagnosis was EH. Rate of false-negative was 0.9%,sensibility 99%. Rate of non-usefull studies without sedation was 8%,being minor (2.97%) with sedation (OR=2.853; p=0.008).Conclusions. The protocol with a weekly RM allows the management of these patients because of a reliable diagnosis. Sedation has two positives effects: the reduction of the time of the study and the improvement of the results (AU)

[Intraluminal impedance technique in the diagnosis of apparent life-threatening events (ALTE)]. / Importancia de la impedanciometría esofágica en el diagnóstico de los episodios aparentemente letales.

BACKGROUND: Apparent life threatening events (ALTE) affect children younger than one year. This syndrome is characterized by several symptoms: apnoea, change in colour or muscle tone, coughing or gagging. Approximately 50 percent of these children are diagnosed of an underlying pathology that explains the ALTEs, being gastroesophageal reflux one of the most important conditions to investigate. AIM: To demonstrate the effectiveness of intraluminal impedance technique for the diagnosis of the gastroesophageal reflux associated to ALTEs in infants. MATERIALS AND METHODS: Stationary esophageal manometric is used to define the low esophageal sphincter, a pH and impedance 24 hours was recorded. We determinate association between gastroesophageal reflux-ALTEs and characterisation of the reflux that occurs. RESULTS: Intraluminal esophageal impedance has been made to 16 children with the diagnosis of ALTEs between 1 and 6 months of age (mean of age 3.04 months). 23.4 episodes of reflux (9,500-31,275, P25 and P75 respectively) have been diagnosed by pHmetry whereas with impedance the number of reflux obtained were 70.88 (60.25 - 80.00), 36.21% acid and 63.78% weakly acidic. We have found 4 episodes of apnoea in one patient that seems to be connected with gastroesophageal reflux (3 nonacid and one acid event) in a statistically positive relation (SI > or = 50%; SSI > or = 10%). CONCLUSIONS: Intraluminal gastroesophageal impedance is a useful method for the diagnosis of gastroesophageal reflux in infants who present a gastric alkaline content most of time, allowing in addition, to differentiate between acid and nonacid reflux. According to our sample, the patients with the diagnosis of ALTEs do not present greater rate of gastroesophageal reflux than the healthy population of the same age. Only in one patient we have found a statistically significant relation between reflux and apnoea.

Importancia de la impedanciometría esofágica en el diagnóstico de los episodios aparentemente letales / Intraluminal impedance technique in the diagnosis of apparent life-threatening events (ALTE)

Los episodios aparentemente letales (EAL) afectan a niños menores de un año y se caracterizan por la combinación de varios síntomas: apnea, cambio de coloración o de tono, tos o ahogamiento. En más de la mitad de estos niños se diagnostica una causa subyacente siendo el reflujo gastroesofágico una de las entidades más importantes a descartar. Objetivo. Demostrar la eficacia de la impedanciometría para el diagnóstico del reflujo gastroesofágico asociado a EAL en lactantes. Material y métodos. Se realiza manometría esofágica estacionaria para la localización del esfínter esofágico inferior y registro de 24 horas de pH e impedancia. Determinamos asociación reflujo gastroesofágico- EAL, y caracterización del tipo de reflujo que lo produce. Resultados. Se realiza estudio a 16 niños diagnosticados de EAL de entre 1 y 6 meses de edad(media 3,04 meses). Mediante pH metría, hemos diagnosticado una media de 23,40 episodios de reflujo (9,500-31,275, P25 y P75 respectivamente),mientras que con la realización de impedanciometría en número de reflujos obtenido es de 70,88 de media (60,25 - 80,00), siendo además posible diferenciar entre reflujos ácidos y no ácidos (36,21% y 63,78%cada uno). En tan sólo un paciente hemos hallado 4 episodios de apnea que se relaciona en todos los casos de manera estadísticamente positiva(SI >= 50%; SSI >= 10%) con reflujo gastroesofágico. Conclusiones• La impedanciometría esofágica es un método útil para el diagnóstico de reflujo en lactantes que presentan alcalinización del estómago la mayor parte del tiempo, permitiendo además, la diferenciación entre reflujos ácidos y no ácidos• Basándonos en nuestra muestra, los pacientes diagnosticados de EAL no presentan mayor tasa de reflujos gastroesofágicos que la población sana de la misma edad• Tan sólo en un paciente hemos encontrado relación estadísticamente significativa entre el reflujo y las apneas (AU)

Background. Apparent life threatening events (ALTE) affect children younger than one year. This syndrome is characterized by several symptoms: apnoea, change in colour or muscle tone, coughing or gagging. Approximately 50 percent of these children are diagnosed of an underlying pathology that explains the ALTEs, being gastroesophagealreflux one of the most important conditions to investigate. Aim. To demonstrate the effectiveness of intraluminal impedance technique for the diagnosis of the gastroesophageal reflux associated to ALTEs in infants. Material sand methods. Stationary esophageal manometric is used to define the low esophageal sphincter, a pH and impedance 24 hours was recorded. We determinate association between gastroesophageal reflux-ALTEs and characterisation of the reflux that occurs. Results. Intraluminal esophagealimpedance has been made to 16 children with the diagnosis of ALTEs between 1 and 6 months of age (mean of age 3.04 months). 23.4episodes of reflux (9,500-31,275, P25 and P75 respectively) have been diagnosed by pH metry whereas with impedance the number of reflux obtained were 70.88 (60.25 - 80.00), 36.21% acid and 63.78% weakly acidic. We have found 4 episodes of apnoea in one patient that seems to be connected with gastroesophageal reflux (3 non-acid and one acid event)in a statistically positive relation (SI >= 50%; SSI >= 10%).Conclusions.• Intraluminal gastroesophageal impedance is a useful method for the diagnosis of gastroesophageal reflux in infants who present a gastricalkaline content most of time, allowing in addition, to differentiate between acid and non-acid reflux• According to our sample, the patients with the diagnosis of ALTEs do not present greater rate of gastroesophageal reflux than the healthy population of the same age• Only in one patient we have found a statistically significant relation between reflux and apnoea (AU)

Improved detection of myocardial perfusion reversibility by rest-nitroglycerin Tc-99m-MIBI: comparison with TI-201 reinjection.

BACKGROUND: The role of nitroglycerin (NTG) in Tc-99m-methoxyisobutil isonitrile (MIBI) studies to improve the assessment of myocardial viability in patients with coronary artery disease and its comparison with TI-201 reinjection has not yet been clarified. This study aimed to test whether sublingual administration of NTG could improve the capability of Tc-99m-MIBI to detect reversibility in exercise-induced perfusion defects and to compare it with the TI-201 stress-redistribution-reinjection protocol. METHODS AND RESULTS: Thirty-eight patients (33 men, 5 women; mean age 49.3 +/- 8.2 years with previous myocardial infarction [mean evolution 7.1 +/- 3.9 months]) underwent exercise, redistribution, and reinjection TI-201 imaging, as well as exercise, rest, and NTG MIBI myocardial scintigraphy (3-day protocol). A total of 494 myocardial segments were assessed by quantitative analysis. Of the 136 myocardial segments with fixed defects on exercise-rest sestamibi imaging, 109 (80%) did not change after NTG MIBI study, and 27 (20%) demonstrated enhanced uptake. In the 140 myocardial segments with fixed defects on exercise-redistribution thallium imaging, 112 (80%) did not improve after TI-201 reinjection study, and 28 (20%) showed increased activity. The observed agreement on reversibility detection between NTG MIBI and TI-201 reinjection, with the 210 segments with perfusion defects used for this analysis on both studies, was 78%, with a significant kappa = .56 +/- .07 SE. CONCLUSION: Our data suggest that the use of an NTG MIBI protocol results in an incremental improvement for detecting exercise-induced perfusion defect reversibility and achieves results similar to those from a TI-201 reinjection protocol.

The role of maternal employment and depression in the psychological adjustment of chronically ill, mentally retarded, and well children.

Used path analysis to test a conceptual model of the relationship among maternal employment status, maternal depression, and reported child behavior problems. Ss were 95 mothers of children in 4 conditions: cystic fibrosis, diabetes, mental retardation, and well. Regardless of child chronic condition or family SES, mothers not employed outside the home had higher levels of depression than employed mothers. Maternal depression, in turn, was associated with higher levels of reported child behavior problems. Controlling for SES and maternal depression, mental retardation was associated with more child behavior problems, but chronic illness (cystic fibrosis and diabetes) was not associated with more behavior problems. The findings underscore the need to examine the adjustment of children with chronic disorders in the context of their mothers' well-being, particularly when mothers are the principal informants regarding child adjustment.