Obstructive sleep apnea and periodic limb movement in children: is there really an association?

PURPOSE: Periodic limb movements (PLMs) can be found isolated or related to other sleep disorders, as Obstructive Sleep Apnea (OSA). Nevertheless, this association was described before the proposal for modification of the World Association of Sleep Medicine (WASM), which incorporated major changes modifying the definition of respiratory-related leg movements (RRLM) so that the relationship between OSA and PLM could be affected. METHODS: A total of 131 PSG were studied (children with ages from 5 to 12 years old), all referred because of a suspicion of sleep-disordered breathing (65 children were diagnosed of OSA, and 66 presented snoring but no sleep apnea). Leg movements were manually scored according to both 2006 and 2016 WASM/IRLSSG criteria. RESULTS: According to 2006 WASM rules, statistical differences were found, not only for PLM index (p 0.002), but all indexes. Nevertheless, according to new 2016 WASM rules, no statistical differences were found for PLM index (p 0.677), non-REM PLM index (p 0.299), REM PLM index (P 0.511) or PLM with arousal index (p 0.180), between OSA and non-OSA group. Positive correlation between PLM and RRLM have been found with both set of rules. The percentage of children with PLM>5/h is higher when using the prior PLM scoring criteria developed in 2006 (38.93%) versus the updated PLM scoring criteria (19.08%). CONCLUSION: The lack of association when using the new WASM/IRLSSG scoring rules together with the absence of a previous clear etiopathology explanation may suggest that the association between OSA and PLM might be indeed overestimated and that, perhaps, it really did not exist.

Intratumoral delivery of tavokinogene telseplasmid yields systemic immune responses in metastatic melanoma patients.

BACKGROUND: Interleukin 12 (IL-12) is a pivotal regulator of innate and adaptive immunity. We conducted a prospective open-label, phase II clinical trial of electroporated plasmid IL-12 in advanced melanoma patients (NCT01502293). PATIENTS AND METHODS: Patients with stage III/IV melanoma were treated intratumorally with plasmid encoding IL-12 (tavokinogene telseplasmid; tavo), 0.5 mg/ml followed by electroporation (six pulses, 1500 V/cm) on days 1, 5, and 8 every 90 days in the main study and additional patients were treated in two alternative schedule exploration cohorts. Correlative analyses for programmed death-ligand 1 (PD-L1), flow cytometry to assess changes in immune cell subsets, and analysis of immune-related gene expression were carried out on pre- and post-treatment samples from study patients, as well as from additional patients treated during exploration of additional dosing schedules beyond the pre-specified protocol dosing schedule. Response was measured by study-specific criteria to maximize detection of latent and potentially transient immune responses in patients with multiple skin lesions and toxicities were graded by the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). RESULTS: The objective overall response rate was 35.7% in the main study (29.8% in all cohorts), with a complete response rate of 17.9% (10.6% in all cohorts). The median progression-free survival in the main study was 3.7 months while the median overall survival was not reached at a median follow up of 29.7 months. A total of 46% of patients in all cohorts with uninjected lesions experienced regression of at least one of these lesions and 25% had a net regression of all untreated lesions. Transcriptomic and immunohistochemistry analysis showed that immune activation and co-stimulatory transcripts were up-regulated but there was also increased adaptive immune resistance. CONCLUSIONS: Intratumoral Tavo was well tolerated and led to systemic immune responses in advanced melanoma patients. While tumor regression and increased immune infiltration were observed in treated as well as untreated/distal lesions, adaptive immune resistance limited the response.

Graphene IoNanofluids, Thermal and Structural Characterization.

Graphene is considered a promising substance in applications related to the capture and reduction of the environmental impact of fluorinated gases. However, further research is still required to explore all related possibilities. In this work, the potential use in this context of nanofluids (NFs), obtained by dispersing graphene nanosheets in fluorinated ionic liquids (FILs) is investigated. As a starting step, a thermal and structural characterization for this type of IoNanofluids (IoNFs) is presented. The highly nanostructured nature of FILs has been recently demonstrated. The presence of fluorinated moieties is responsible for enhancing the accommodation of solutes such as small gases. The strong tendency to self-assemble forming continuous and supramolecular structures, and the versatility to rearrange in several conformational features allows the stabilization of nano colloidal systems. It is essential to perform a comprehensive study of their structural features to understand the behavior of this type of heterogeneous systems. Therefore, we present screening on the phase and structural behavior of these novel IoNFs to discover and develop optimized systems where FILs turn out to be advantageous. Thermogravimetric analysis (TGA) was employed to evaluate IoNFs mass losses with temperature, and their solid-fluid phase transitions were located using a differential scanning calorimeter (DSC). Their rheological properties were also determined through oscillatory experiments, obtaining the viscous and loss moduli. In addition, the structural percolation transition was also identified.

Tuning the electrical conductivity of exfoliated graphite nanosheets nanofluids by surface functionalization.

The electrical conductivity of exfoliated graphite in water nanofluids has been experimentally determined, and compared with the same property when the dispersed nanosheets have been oxidized. The effect of oxidation on this property is different if compared with the case of sintered dry nanosheets. In any case, for the sintered raw material the conduction behaves as expected in a metal, while for the nanofluid it shows values and trends typical of a weak electrolyte solution. The effect of oxidation on the electrical conductivity of exfoliated graphite can be explained as being caused by the dissociation in the fluid phase of the moieties resulting from the chemical functionalization process. This opens the possibility of designing a functionalization process to tune the nanofluid electrical conductivity.

Convergence palsy secondary to amoxicillin. / Parálisis de la convergencia secundaria a amoxicilina.

CASE REPORT: We present the case of an 11-year-old boy with acute diplopia in near vision secondary to transient convergence palsy, possibly in relation to amoxicillin. DISCUSSION: Convergence palsy is an uncommon eye disorder. The causes are reviewed, and amoxicilin is identified as presumptive etiologic agent. This is the first case reported.

High expression of cytochrome b 5 reductase isoform 3/cytochrome b 5 system in the cerebellum and pyramidal neurons of adult rat brain.

Cytochrome b 5 reductase (Cb 5R) and cytochrome b 5 (Cb 5) form an enzymatic redox system that plays many roles in mammalian cells. In the last 15 years, it has been proposed that this system is involved in the recycling of ascorbate, a vital antioxidant molecule in the brain and that its deregulation can lead to the production of reactive oxygen species that play a major role in oxidative-induced neuronal death. In this work, we have performed a regional and cellular distribution study of the expression of this redox system in adult rat brain by anti-Cb 5R isoform 3 and anti-Cb 5 antibodies. We found high expression levels in cerebellar cortex, labeling heavily granule neurons and Purkinje cells, and in structures such as the fastigial, interposed and dentate cerebellar nuclei. A large part of Cb 5R isoform 3 in the cerebellum cortex was regionalized in close proximity to the lipid raft-like nanodomains, labeled with cholera toxin B, as we have shown by fluorescence resonance energy transfer imaging. In addition, vestibular, reticular and motor nuclei located at the brain stem level and pyramidal neurons of somatomotor areas of the brain cortex and of the hippocampus have been also found to display high expression levels of these proteins. All these results point out the enrichment of Cb 5R isoform 3/Cb 5 system in neuronal cells and structures of the cerebellum and brain stem whose functional impairment can account for neurological deficits reported in type II congenital methemoglobinemia, as well as in brain areas highly prone to undergo oxidative stress-induced neurodegeneration.

Modulating the Optoelectronic Properties of Silver Nanowires Films: Effect of Capping Agent and Deposition Technique.

Silver nanowires 90 nm in diameter and 9 µm in length have been synthesized using different capping agents: polyvinyl pyrrolidone (PVP) and alkyl thiol of different chain lengths. The nanowire structure is not influenced by the displacement of PVP by alkyl thiols, although alkyl thiols modify the lateral aggregation of nanowires. We examined the effect of the capping agent and the deposition method on the optical and electrical properties of films prepared by Spray and the Langmuir-Schaefer methodologies. Our results revealed that nanowires capped with PVP and C8-thiol present the best optoelectronic properties. By using different deposition techniques and by modifying the nanowire surface density, we can modulate the optoelectronic properties of films. This strategy allows obtaining films with the optoelectronic properties required to manufacture touch screens and electromagnetic shielding.

Caveolin-rich lipid rafts of the plasma membrane of mature cerebellar granule neurons are microcompartments for calcium/reactive oxygen and nitrogen species cross-talk signaling.

In previous works, we have shown that L-type voltage-operated calcium channels, N-methyl-d-aspartate receptors (NMDAr), neuronal nitric oxide synthase (nNOS) and cytochrome b5 reductase (Cb5R) co-localize within the same lipid rafts-associated nanodomains in mature cerebellar granule neurons (CGN). In this work, we show that the calcium transport systems of the plasma membrane extruding calcium from the cytosol, plasma membrane calcium pumps (PMCA) and sodium-calcium exchangers (NCX), are also associated with these nanodomains. All these proteins were found to co-immunoprecipitate with caveolin-1 after treatment with 25mM methyl-ß-cyclodextrin, a lipid rafts solubilizing agent. However, the treatment of CGN with methyl-ß-cyclodextrin largely attenuated the rise of cytosolic calcium induced by l-glutamate through NMDAr. Fluorescence energy transfer imaging revealed that all of them are present in sub-microdomains of a size smaller than 200nm, with a peripheral distribution of the calcium extrusion systems PMCA and NCX. Fluorescence microscopy images analysis revealed high calcium dynamic sub-microcompartments near the plasma membrane in fura-2-loaded CGN at short times after addition of l-glutamate. In addition, the close proximity between sources of nitric oxide (nNOS) and superoxide anion (Cb5R) suggests that these nanodomains are involved in the fast and efficient cross-talk between calcium and redox signaling in neurons.

Characterization of prostate neuroendocrine cancers and therapeutic management: a literature review.

OBJECTIVES: Neuroendocrine prostate cancers (NEPCs) are rare. The current lack of consensus for clinical, biological and pathological characterization as well as therapeutic approach makes the management of those tumors a clinical challenge. This literature review aims to summarize available data on the characterization and management of patients with prostate cancer with a neuroendocrine element. We try to identify major controversies and uncertainties in order to understand all aspects of this particular entity. METHODS: We searched for all articles published and registered in the MEDLINE database before 31 November 2013 with the following search terms: (('prostatic neoplasms' (MeSH Terms)) AND ('carcinoma, neuroendocrine' (MeSH Terms)) OR ('carcinoma, small cell' (MeSH Terms))) AND (English (Language)). RESULTS: Case reports, letters or comments were excluded. We then selected relevant articles from titles and abstracts. Overall, 278 articles published between 1976 and November 2013 were identified. No definition of NEPC seems to be clearly established. Natural history of the disease reveals poor prognosis with median survival of up to 10 to 13 months. Histological characterization appears difficult. Serum markers could be helpful with some controversies in terms of prognostic significance. Concerning management, the majority of patients received local treatment combined with chemotherapy in case of early and localized disease. Few clinical trials described strategy for metastatic disease. CONCLUSIONS: The exploration of the different pathways implicated in the neuroendocrine differentiation of prostate cancers is essential for the comprehension of castration-resistance mechanisms. It will enable the identification of optimal therapeutic strategies for which no recommendation is currently established. Inclusion in prospective clinical trials appears necessary to identify the adequate strategy.

Oral self-administration of buprenorphine in the diet for analgesia in mice.

Postsurgical oral self-administration of analgesics in rodents is an interesting technique of providing analgesia, avoiding the negative effects of manipulation. Several strategies, using gelatin or nutella, have already been described. However, rodents require some habituation period to reach a good intake because of their neophobic behavior. The current study aimed to explore whether buprenorphine when mixed with an extruded diet offers a potential treatment option in the pain management of mice using a triple approach: by measuring the spontaneous intake in healthy animals; by using the hot-plate test; and finally by assessing the drug's ability to provide postoperative analgesia in a surgical intervention of moderate severity (intra-utero electroporation). Mice consumed during 20 hours, similar amounts of extruded diet alone, mixed with glucosaline, and mixed with buprenorphine (0.03 mg per pellet) or meloxicam (0.25 mg per pellet) both of which were diluted in glucosaline, showing that no neophobia was associated with these administrations. Relative increase from baseline latency (% maximal possible effect) in the hot-plate test at 20 h of administration was significantly higher for oral buprenorphine in diet 0.03 mg/pellet, and diet 0.15 mg/pellet, compared with placebo and no differences were found between those oral administrations and subcutaneous buprenorphine 0.1 mg/kg measured 3 h later. The treatment was also effective in attenuating the reductions in food consumption and body weight that occur after surgery. These data suggest that providing buprenorphine with the diet is a feasible and effective way of self-administration of analgesia in mice and does not cause neophobia and may easily contribute to the refinement of surgical procedures.

Flexible sensor based on carbon nanofibers with multifunctional sensing features.

Herein, we present the fabrication and characterization of a flexible gas sensor based on carbon nanofibers. The sensing device is composed of interdigitated silver electrodes deposited by inkjet printing on Kapton substrates, subsequently coated with carbon nanofibers as sensing element. Gas sensing response to CO, NH3 and humidity has been characterized in detail. Thermal, mechanical and electromagnetic radiation effects have also been studied and discussed from the point of view of the cross-sensitivity. The obtained results open the door for a new generation of flexible sensors with multifunctional sensing features, which are producible with scalable techniques based on low cost nanomaterials.

Evaluation of novel nystatin nanoemulsion for skin candidosis infections.

One of the most common fungal skin infections is candidosis. Topical application of drugs at the pathological sites offers potential advantage of direct drug delivery to the site of action. The main aim of this work was to evaluate an optimal nystatin nanoemulsion for topical application avoiding undesirable side effects as systemic absorption and toxicity. Surface morphology and droplet size distribution of nystatin nanoemulsion was determined by transmission electronic microscopy and dynamic light scattering. Vertical diffusion Franz-type cells and high-performance liquid chromatography were used to perform the in vitro release and ex vivo human skin permeation studies. Transdermal permeation parameters were estimated from the permeation values using different theoretical approaches. Microbiological studies were performed to evaluate the antifungal effect. Nanoemulsion exhibited a spherical shape with smooth surface and mean droplet size between 70 and 80 nm. The pharmacokinetic release showed the nanoemulsion is faster than commercial ointment Mycostatin(®) improving the potential therapeutic index. Permeation studies demonstrated nystatin was not absorbed into systemic circulation and the retained amount in the skin was sufficient to ensure an antifungal effect. This antifungal effect was higher for nystatin loaded nanoemulsion than nystatin itself. A therapeutic improvement of the nystatin nanoemulsion treatment compared with the classical ones was achieved.

L-type voltage-operated calcium channels, N-methyl-D-aspartate receptors and neuronal nitric-oxide synthase form a calcium/redox nano-transducer within lipid rafts.

Cytosolic calcium plays a leading role in the control of neuronal excitability, plasticity and survival. This work aims to experimentally assess the possibility that lipid rafts of the plasma membrane can provide a structural platform for a faster and tighter functional coupling between calcium and nitric-oxide signaling in neurons. Using primary cerebellar granule neurons (CGN) in culture this hypothesis has been experimentally assessed with fluorescence resonance energy transfer imaging, preparations of lipid rafts-enriched membrane fragments and western blotting. The results obtained in this work demonstrated that major calcium entry systems of the plasma membrane of CGN (L-type calcium channels and N-methyl-D-aspartate receptors) and nitric-oxide synthase are separated by less than 80 nm from each other within lipid rafts-associated sub-microdomains, suggesting a new role of lipid rafts as neuronal calcium/redox nano-transducers.

[Repair of a leaking bleb filtration with conjunctival and amniotic membrane transplantation]. / Comunicación corta. Reparación de ampolla filtrante postrabeculectomía con injerto de conjuntiva y membrana amniótica.

CLINICAL CASE: A 71-year-old woman presented with a leaking bleb after a combined phacotrabeculectomy performed 13 years ago. To construct a new filtering bleb, the necrotic area was fully excised. The amniotic membrane was inserted over the scleral flap underneath healthy conjunctiva edges. A conjunctiva-Tenon autograft from the contralateral eye was sutured and was sealed with fibrin adhesive. DISCUSSION: We propose a new surgical technique to repair late leak failures after trabeculectomy with mitomycin C in blebs with a large avascular area. Transplantation of amniotic membrane and conjunctival autograft may be used to repair late leak failures with inadequate conjunctiva to advance.

Neuroprotective actions of flavonoids.

The experimental evidences accumulated during last years point out a relevant role of oxidative stress in neurodegeneration. As anti-cellular oxidative stress agents flavonoids can act either as direct chemical antioxidants, the classic view of flavonoids as antioxidants, or as modulators of enzymes and metabolic and signaling pathways leading to an overshot of reactive oxygen species (ROS) formation, a more recently emerging concept. Flavonoids, a large family of natural antioxidants, undergo a significant hepatic metabolism leading to flavonoid-derived metabolites that are also bioactive as antioxidant agents. The development of more efficient flavonoid's based anti-oxidative stress therapies should also take into account their bioavailability in the brain using alternate administration protocols, and also that the major ROS triggering the cellular oxidative stress are not the same for all neurodegenerative insults and diseases. On these grounds, we have reviewed the reports on neuroprotection by different classes of flavonoids on cellular cultures and model animals. In addition, as they are now becoming valuable pharmacological drugs, due to their low toxicity, the reported adverse effects of flavonoids in model experimental animals and humans are briefly discussed.

Fitness effects of derived deleterious mutations in four closely related wild tomato species with spatial structure.

A key issue in evolutionary biology is an improved understanding of the genetic mechanisms by which species adapt to various environments. Using DNA sequence data, it is possible to quantify the number of adaptive and deleterious mutations, and the distribution of fitness effects of new mutations (its mean and variance) by simultaneously taking into account the demography of a given species. We investigated how selection functions at eight housekeeping genes of four closely related, outcrossing species of wild tomatoes that are native to diverse environments in western South America (Solanum arcanum, S. chilense, S. habrochaites and S. peruvianum). We found little evidence for adaptive mutations but pervasive evidence for strong purifying selection in coding regions of the four species. In contrast, the strength of purifying selection seems to vary among the four species in non-coding (NC) regions (introns). Using F(ST)-based measures of fixation in subdivided populations, we suggest that weak purifying selection has affected the NC regions of S. habrochaites, S. chilense and S. peruvianum. In contrast, NC regions in S. arcanum show a distribution of fitness effects with mutations being either nearly neutral or very strongly deleterious. These results suggest that closely related species with similar genetic backgrounds but experiencing contrasting environments differ in the variance of deleterious fitness effects.

[The geriatric patient and emergency care]. / El paciente geriátrico en urgencias.

Demand in emergency care has been growing progressively in recent years and this increase is more pronounced in the elderly population. Taking into account that the elderly patient requires more complex evaluations with a greater requirement for complementary tests and consultations with other specialists, longer stays in the emergency ward and a greater percentage of admissions, the progressive ageing of the population might come to have a serious repercussion on hospital emergency departments. It is vital to detect high risk elderly patients before assigning them a definitive placement. For this purpose it is important to install a sieving process amongst elderly patients who attend the emergency department in order to select those that will benefit from a comprehensive geriatric assessment and thus be able to design a specific care plan. Emergency intervention in elderly patients should not be faced exclusively as a medical problem, but functional, mental or social aspects should be taken into account. This represents a challenge for emergency care. This article considers different aspects such as the detection and assessment of the geriatric patient, as well as establishing certain recommendations for emergency setting.

[Quality of life in Alzheimer's disease]. / Calidad de vida en la enfermedad de Alzheimer.

INTRODUCTION: Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer's disease and its relationship with cognitive and functional measures. PATIENTS AND METHODS: Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer's disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student's t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. RESULTS: Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer's disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. CONCLUSIONS: Quality of life is evaluated in Alzheimer's disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects.