Neurofilament light chain levels in pregnant multiple sclerosis patients: a prospective cohort study.

BACKGROUND AND PURPOSE: Neurofilament light chain is a cytoskeletal protein of neurons. Its levels are increasingly recognized as measures of neuroaxonal damage. The aim of this study was to explore serum neurofilament light chain (sNfL) levels in multiple sclerosis (MS) patients and healthy controls during pregnancy and puerperium. METHODS: This was a prospective, longitudinal, single-center study. sNfL concentration was assessed using a highly sensitive single-molecule array during pregnancy and in puerperium, in a cohort of 39 pregnant patients with relapsing multiple sclerosis (P-MS). Twenty-one healthy pregnant women (HPW) served as a control group. Eight P-MS suffered relapses during pregnancy (P-MS-R) in the first or second trimesters. RESULTS: No differences in pregnancy and delivery data were observed between P-MS and HPW. P-MS showed higher sNfL values than HPW in the first trimester, independently of the presence (P = 0.002) or not (P = 0.02) of relapses during pregnancy. However, in the third trimester, only P-MS-R showed higher sNfL values than HPW (P = 0.001). These differences extended to the puerperium, where P-MS-R showed higher sNfL values than those with no relapses during gestation (P = 0.02). CONCLUSION: These data strongly suggest that sNfL levels reflect MS activity during pregnancy. Additionally, the absence of relapses during pregnancy may have a beneficial effect on neurodegeneration during puerperium.

Multiple sclerosis and pregnancy: a single-centre prospective comparative study. / Esclerosis múltiple y embarazo: estudio unicéntrico prospectivo y comparativo.

INTRODUCTION: Multiple sclerosis (MS) is a autoimmune disorder which preferentially affects young women of childbearing age. During pregnancy, the annualized relapse rate (AAR) is modified, but pregnancy has no harm effect on the long-term course of the disease. We aimed to study the clinical course of our MS patients during pregnancy, and compare their obstetrics outcomes with a control group of non-MS patients. METHODS: A single centre prospective observational study was conducted. We assessed the reproductive history, MS history, pregnancy course and new-born outcome of a cohort of MS patients who had had a pregnancy between january 2007 and july 2012. We compared the global outcomes with a control cohort of 58 age-matched healthy pregnancies. RESULTS: Complete data from 35 consecutive women were analyzed, 40 deliveries. Control groups: 58 patients, 60 deliveries. EDSS at pregnancy 0,7. ARR before pregnancy 0,5. During pregnancy 0,3, after pregnancy 0,4. Twelve patients were on disease-modifying drugs (DMD) before pregnancy, 4 prenatal exposure occurs. The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference. In addition, compared to control group, there were also no differences in the obstetric outcomes. In MS cohort, we found a higher incidence of assisted reproductive treatments and lower breastfeeding rate, both statistically significant. CONCLUSIONS: Our series confirms that pregnancy has no negative long term impact on the progression of MS and also suggest that there is no additional morbidity in the pregnancy, comparing to the rest of the population.

Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases.

INTRODUCTION: Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE: To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS: Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS: We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS: Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.

Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study.

INTRODUCTION: Population ageing, the rising demand for healthcare, and the establishment of acute stroke treatment programs have given rise to increases in the number and complexity of neurological emergency cases. Nevertheless, many centres in Spain still lack on-call emergency neurologists. METHODS: We conducted a retrospective study to describe the role of on-call neurologists at Hospital General Universitario Gregorio Marañón, a tertiary care centre in Madrid, Spain. Sociodemographic characteristics, most common pathologies, diagnostic tests, and destination of the patients attended were recorded daily using a computer database. Results were compared with the general care data from the emergency department. RESULTS: The team attended 3234 patients (3.48% of the emergency department total). The mean number of patients seen per day was 11.15. The most frequent pathologies were stroke (34%), epilepsy (16%) and headache (8%). The mean stay in the emergency department was 7.17 hours. Hospital admission rate was 40% (7.38% of emergency hospital admissions). The main destinations for admitted patients were the stroke unit (39.5%) and the neurology department (33%). Endovascular or thrombolytic therapies were performed on 76 occasions. Doctors attended 70% of the patients during on-call hours. CONCLUSIONS: Emergency neurological care is varied, complex, and frequently necessary. Neurological cases account for a sizeable percentage of both patient visits to the emergency room and the total number of emergency admissions. The current data confirm that on-call neurologists available on a 24-hour basis are needed in emergency departments.

[Periodic plasmapheresis as maintenance treatment in relapsing-remitting multiple sclerosis, a new therapeutic line? A case report]. / Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso.

INTRODUCTION: Relapsing-remitting multiple sclerosis (RRMS) treatment has significantly changed in recent years because of the discovery of new molecules that have shown efficacy as maintenance treatment. However, the classical treatment for acute attacks is based on corticosteroids administration, being the periodical plasmapheresis the alternative treatment in the case of refractory patients. We introduce a case of relapsing-remitting multiple sclerosis treated with a classical acute attacks therapy: plasmapheresis. CASE REPORT: The case of a 39-year-old patient who was diagnosed with relapsing-remitting multiple sclerosis, postpartum debut and aggresive course, who, after suboptimal response to disease modifying therapies (alemtuzumab and ocrelizumab), receives combination treatment with outpatient periodic plasmapheresis every 3 weeks as maintenance therapy. Good tolerance and response. Clinical stability with this treatment. She has not required new hospital admissions for acute attacks of multiple sclerosis from February 2020 to March 2021. CONCLUSION: Although more specific studies are needed, this case provides information on a potential new maintenance treatment for patients with relapsing-remitting multiple sclerosis refractory to disease-modifying drug therapies.

TITLE: Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso.Introducción. El tratamiento de la esclerosis múltiple remitente-recurrente ha evolucionado significativamente en los últimos años con el descubrimiento de nuevas moléculas eficaces como tratamiento de mantenimiento. Por otro lado, el tratamiento de los brotes de esta enfermedad se basa clásicamente en corticoides, y en los casos refractarios a esta terapia se utiliza plasmaféresis. Presentamos un caso de esclerosis múltiple remitente-recurrente tratada periódicamente con una terapia que se ha utilizado clásicamente para los brotes: plasmaféresis. Caso clínico. Mujer de 39 años con esclerosis múltiple remitente-recurrente de inicio en el posparto, gran carga lesional y curso agresivo, en quien, ante una respuesta subóptima a terapias modificadoras de la enfermedad (alemtuzumab y ocrelizumab), se decide iniciar un tratamiento combinado junto con plasmaféresis periódicas ambulatorias cada tres semanas como tratamiento de mantenimiento. Se constata una buena tolerancia a esta terapia y evolución, y se produce estabilidad clínica. No ha requerido nuevos ingresos hospitalarios por brotes desde febrero de 2020 a marzo de 2021. Conclusión. Aunque es necesario que se realicen más estudios, este caso ofrece información sobre un potencial tratamiento de mantenimiento para pacientes con esclerosis múltiple remitente-recurrente refractaria a terapias con fármacos modificadores de la enfermedad.

Association of ferredoxin-NADP oxidoreductase with the chloroplastic pyridine nucleotide dehydrogenase complex in barley leaves

Barley (Hordeum vulgare L.) leaves were used to isolate and characterize the chloroplast NAD(P)H dehydrogenase complex. The stroma fraction and the thylakoid fraction solubilized with sodium deoxycholate were analyzed by native polyacrylamide gel electrophoresis, and the enzymes detected with NADH and nitroblue tetrazolium were electroeluted. The enzymes electroeluted from band S from the stroma fraction and from bands T1 (ET1) and T2 from the thylakoid fraction solubilized with sodium deoxycholate had ferredoxin-NADP oxidoreductase (FNR; EC 1.18.1.2) and NAD(P)H-FeCN oxidoreductase (NAD[P]H-FeCNR) activities. Their NADPH-FeCNR activities were inhibited by 2'-monophosphoadenosine-5'-diphosphoribose and by enzyme incubation with p-chloromercuriphenylsulfonic acid (p-CMPS), NADPH, and p-CMPS plus NADPH. They presented Michaelis constant NADPH values that were similar to those of FNRs from several sources. Their NADH-FeCNR activities, however, were not inhibited by 2'-monophosphoadenosine-5'-diphosphoribose but were weakly inhibited by enzyme incubation with NADH, p-CMPS, and p-CMPS plus NADH. We found that only ET1 contained two polypeptides of 29 and 35 kD, which reacted with the antibodies raised against the mitochondrial complex I TYKY subunit and the chloroplast ndhA gene product, respectively. However, all three enzymes contained two polypeptides of 35 and 53 kD, which reacted with the antibodies raised against barley FNR and the NADH-binding 51-kD polypeptide of the mitochondrial complex I, respectively. The results suggest that ET1 is the FNR-containing thylakoidal NAD(P)H dehydrogenase complex.

Green Roots: Photosynthesis and Photoautotrophy in an Underground Plant Organ.

The potential for photosynthetic and photoautotrophic growth was studied in hairy root cultures of Asteraceae and Solanaceae species. Upon transfer to light, initially heterotrophic root cultures of Acmella oppositifolia and Datura innoxia greened rapidly, differentiated chloroplasts, and developed light-dependent CO2 fixation in the cortical cells. Photosynthetic potential was expressed in root cultures of all the Asteraceae genera examined (Acmella, Artemisia, Rudbeckia, Stevia, and Tagetes). Hairy roots of A. oppositifolia and D. innoxia were further adapted to photoautotrophy by growing in the presence of light and added CO2 (1-5%) and by direct or sequential transfers into media containing progressively lower sugar concentrations. The transition to photoautotrophy was accompanied by an increase in CO2 fixation and in the specific activity of 1,5-ribulose-bisphosphate carboxylase/ oxygenase (Rubisco). During the adaptation of A. oppositifolia roots to photoautotrophy, the ratio of Rubisco to phosphoenolpyruvate carboxylase increased significantly, approaching that found in the leaves. The levels and patterns of alkaloids and polyacetylenes produced by Solanaceae and Asteraceae hairy roots, respectively, were dramatically altered in photomixotrophic and photoautotrophic cultures. Photoautotrophic roots of A. oppositifolia have been mainitained in vitro for over 2 years.

Epidemiology of Pneumocystis carinii pneumonia in southern Spain.

In order to investigate the impact of Pneumocystis carinii infection in southern Spain following the introduction of highly active anti-retroviral therapy (HAART), all cases of pneumocystosis between 1998 and 1999 were identified from data compiled by the national surveillance system. In total, 498 cases of pneumocystosis were recorded, of which 87% involved HIV-positive patients. The mean age, length of hospital stay and mortality were higher for HIV-negative patients. There was a higher number of cases in winter. Despite HAART implementation, pneumocystosis remains a significant health problem for both HIV-positive and HIV-negative patients.

[Activity of adenosine deaminase in acute brucellosis and complicated brucellosis]. / Estudio de la actividad de adenosina desaminasa en la brucelosis aguda y en la brucelosis complicada.

BACKGROUND: Adenosine deaminase (ADA) is an essential enzyme for the differentiation and proliferation of T lymphocytes and the monocyte-macrophage system. The basic immunitary response of brucellosis is cellular. To this end, ADA activity was evaluated in brucellosis. METHODS: Serum ADA activity was assessed by a colorimetric method in 67 patients with brucellosis, before therapy and at 1, 3 and 6 months of follow up. RESULTS: Serum ADA activity in brucellosis was higher than that in 52 healthy controls, both in those with the acute febrile noncomplicated form (48 patients) and in those with focal symptoms from one organ (19 patients) (p less than 0.0001 and p less than 0.001). There were no differences between both groups of brucellosis. There was a negative correlation between the duration of the disease and ADA activity. After therapy there was a rapid decrease of ADA values, more marked in patients with noncomplicated brucellosis. During the follow up, only one patient had a new increase in ADA activity, coincident with a clinical and bacteriological relapse, and previous to the increase of IgG anti-Brucella titers. CONCLUSIONS: The results indicate that adenosine deaminase activity is increased during the active stage of brucellosis. It can be considered as a biochemical follow up marker of the disease and, probably, as a marker of relapses.

Evaluation of two fiber optic-based solar collection and distribution systems for advanced space life support.

Growing plants in an enclosed controlled environment is crucial in developing bioregenerative life-support systems (BLSS) for space applications. The major challenge currently facing a BLSS is the extensive use of highly energy-intensive electric light sources, which leads to substantial energy wastes through heat dissipations by these lamps. An alternative lighting strategy is the use of a solar irradiance collection, transmission, and distribution system (SICTDS). Two types of fiber optic-based SICTDS, a Fresnel-lens Himawari and a parabolic-mirror optical waveguide (OW) lighting system, were evaluated. The overall efficiency for the OW SICTDS of 40.5% exceeded by 75% that for the Himawari of 23.2%. The spectral distributions of the light delivered by the Himawari and the OW SICTDS were almost identical and had practically no difference from that of terrestrial solar radiation. The ratios of photosynthetically active radiation (PAR) to total emitted radiation (k) of 0.39 +/- 0.02 for the Himawari and 0.41 +/- 0.04 for the OW SICTDS were statistically indistinguishable, were not significantly different from that of 0.042 +/- 0.01 for terrestrial solar radiation, and were comparable to that of 0.35 for a high-pressure sodium (HPS) lamp. The coefficients of variation (CV) of 0.34 and 0.39 for PPF distributions, both at 50 mm X 50 mm square grid arrays, corresponding to the Himawari and the OW SICTDS, respectively, were comparable with each other but were both significantly greater than the CV of 0.08 corresponding to the HPS lamp. The average fresh weight or dry weight of lettuce grown in the solar chamber with either the Himawari or the OW SICTDS showed no statistical difference from the average fresh weight or dry weight of lettuce grown in the reference chamber with the HPS lamp. The results of this study suggest that an SICTDS could help reduce the electric power demand in a BLSS.

[The Strategic Plan for the development of Internal Medicine in Andalusia]. / El Plan Estratégico para el desarrollo de la Medicina Interna en Andalucía.

The Strategic Plan for the Development of Internal Medicine in Andalusia arose from the need that the internal medicine doctors had to redefine the purpose and values of their specialty to cope with the numerous changes occurring in the health care area. The project was developed in three phases. First, the tendency of the health care system and current position of the specialty were analyzed. After, the internal and external opinions on the present-future of Internal Medicine were checked out. Finally, five strategic lines with their action plans were established. Specific objectives were defined within each line: results to be achieved, methodology according to action plan. After several years of collegial work in this initiative, very positive results have been achieved. We conclude that the Strategic Plan has been useful to better define the position of our specialty and to state which tools such as those mentioned are effective to cope with the new challenges that may occur in other groups.

Correlated responses to selection for wing length in allozyme systems of Drosophila melanogaster.

Significant changes of genotypic structure in 20 lines selected for wing length are detected by analysis of the allelic frequencies of several enzyme loci (XDH, LAP-D, EST-6, 1-APH, ADH, α-GPDH). These changes are not haphazard but a consequence of the effects of selection on the genetic structure of the population, since replicate lines always behave in a parallel way. The changes are larger in the lines selected for short wings, in which the genetic variability decreases considerably. This decrease is the result of selection for homozygosity, detected at the allozyme loci, but most probably reflects homozygosity of more or less extended chromosomal segments. Selection for wing length, especially for short wings, favoured recombinants of the initial founder chromosomes. Only in the 1-APH and the EST-6 loci, separated by 11.7 centimorgans on the genetic map, do the alleles linked in the founder lines change in parallel in the control and long wing lines. The correlated response in the allozyme allele frequencies cannot be accounted for by a direct influence of the allozymes on the variability in wing length. The changes in the EST-6, 1-APH and perhaps in the LAP-D, can be explained by a direct effect of natural selection on the allozyme loci, probably in interaction with the effect of selection for wing length on linked loci. This last effect seems to be the main factor contributing to the change detected in the XDH locus.