Gastric Peroral Endoscopic Myotomy: A Specific Learning Curve.

INTRODUCTION: Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM. METHODS: Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy. RESULTS: Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001). CONCLUSION: Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.

Membrane localization of Junín virus glycoproteins requires cholesterol and cholesterol rich membranes.

Arenavirus morphogenesis and budding occurs at cellular plasma membrane; however, the nature of membrane assembly sites remains poorly understood. In this study we examined the effect of different cholesterol-lowering agents on Junín virus (JUNV) multiplication. We found that cholesterol cell depletion reduced JUNV glycoproteins (GPs) membrane expression and virus budding. Analysis of membrane protein insolubility in Triton X-100 suggested that JUNV GPs associate with cholesterol enriched membranes. Rafts dissociation conditions as warm detergent extraction and cholesterol removal by methyl-ß-cyclodextrin compound showed to impair GPs cholesterol enriched membrane association. Analysis of GPs transfected cells showed similar results suggesting that membrane raft association is independent of other viral proteins.

Lo que el médico general debe saber sobre lumbalgia inespecífica / What a general practitioner should know about acute nonspecific low back pain

La lumbalgia un problema que se caracteriza por su alta prevalencia en la población. El 80% de la población lo padece al menos una vez en la vida, en la mayoría de los casos no se encuentra ningún tipo de lesión que justifique el proceso, por lo que el problema será catalogado como lumbalgia inespecífica. No es una enfermedad ni un diagnóstico, sino un síntoma que puede ser secundario a patologías de muy diversa etiología y gravedad. Esta patología generalmente es benigna y su interés se centra en su elevada frecuencia, repercusión social, laboral y económica. Ante la problemática que el diagnóstico clínico era variable, e intervenían distintos especialistas, el 15 de diciembre de1999, fue lanzada la guía del programa COST B13 por la Comisión Europea con el objetivo de definir estándares de prevención, diagnóstico y tratamiento de la lumbalgia inespecífica basado en la evidencia científica, cubriendo tanto el ámbito de la atención primaria como especializada. Por ello que la presente revisión tiene el objetivo que el médico general diagnostique y trate esta patología apropiadamente, ya que el 90% de los casos se resuelven en el primer nivel de atención y apenas 1% requiere intervención quirúrgica. Rev Med Hondur 2009;77(2):75-81 Palabras clave: Lumbalgia, guía de practica clínica, atención primaria de salud...