Mice and Rats Exhibit Striking Inter-species Differences in Gene Response to Acute Stroke.

Neuroprotection in acute stroke has not been successfully translated from animals to humans. Animal research on promising agents continues largely in rats and mice which are commonly available to researchers. However, controversies continue on the most suitable species to model the human situation. Generally, putative agents seem less effective in mice as compared with rats. We hypothesized that this may be due to inter-species differences in stroke response and that this might be manifest at a genetic level. Here we used whole-genome microarrays to examine the differential gene regulation in the ischemic penumbra of mice and rats at 2 and 6 h after permanent middle cerebral artery occlusion (pMCAO; Raw microarray CEL data files are available in the GEO database with an accession number GSE163654). Differentially expressed genes (adj. p ≤ 0.05) were organized by hierarchical clustering, correlation plots, Venn diagrams and pathway analyses in each species and at each time-point. Emphasis was placed on genes already known to be associated with stroke, including validation by RT-PCR. Gene expression patterns in the ischemic penumbra differed strikingly between the species at both 2 h and 6 h. Nearly 90% of significantly regulated genes and most pathways modulated by ischemia differed between mice and rats. These differences were evident globally, among stroke-associated genes, immediate early genes, genes implicated in stress response, inflammation, neuroprotection, ion channels, and signal transduction. The findings of this study may have significant implications for the choice of species for screening putative stroke therapies.

Screening for people with glucose metabolism disorders within the framework of the DEMOJUAN project (DEMOnstration area for primary prevention of type 2 diabetes, JUAN Mina and Barranquilla, Colombia).

BACKGROUND: Until now, no systematic screening for T2D or prevention activities targeting T2D has been implemented in Colombia. The aims of this study were i) describe the feasibility of implementing the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose metabolism disorders (GMD) in the primary health care system in Barranquilla in Colombia during 2011 and 2012, and ii) to describe the risk factors for T2D in the population screened. METHODS: This screening was opportunistic among people aged 34-60 years living in five primary health care catchment areas in Barranquilla, Colombia. People with 13 or more FINDRISC points were invited to an oral glucose tolerance test (OGTT). RESULTS: Out of 14193 participants with the FINDRISC completed, 35% (n=4915) had a score of 13 points or higher (men 23%, women 40%). Among those with FINDRISC completed, the percentage of people with BMI<25 kg/m2 was 46% in men and 35% in women. The prevalence of screen-detected T2D was 18% in men and 12% in women, respectively, among those with FINDRISC >12 attending an OGTT. In both sexes the prevalence of isolated IGT, isolated IFG, and IFG and IGT combined were 8%, 11%, and 8%, respectively. CONCLUSIONS: In total, 2% of all 14 193 screened participants had undetected T2D and 7% GMD. This figure would potentially be 4.6% (T2D), respectively 15% (GMD) if all with a FINDRISC>12 attend the OGTT. Thus, we found the FINDRISC to be a useful tool to identify people with GMD. This article is protected by copyright. All rights reserved.

The Role of Low-Cost Microsurgical Training Models and Experience with Exercises Based on a Bovine Heart.

BACKGROUND: Microscopic training is essential for development of neurosurgical skills. A range of models is reported in the literature for this purpose, including live animals, exvivo, and synthetic material. Among the factors involved in selection and development of a training station, cost is a decisive one. METHODS: We present a low-cost model to practice microvascular anastomoses using a bovine heart and an artificial perfusion system. We also present a brief review of laboratory models for microsurgical training, focusing on the costs and reproducibility of the different options. RESULTS: Exvivo models are a great bridging point between nonbiologic and living animal training models. These models have major similarities to human vessels, such as lumen size and malleability of the arteries. The bovine heart model allowed the residents to gain confidence in handling vascular tissue in a microscopic environment. CONCLUSIONS: Although these models do not resemble anatomic landmarks in the human brain, the bovine heart model allowed the residents to gain confidence in handling vascular tissue in a microscopic environment.

Neurotransmitters in the mediation of cerebral ischemic injury.

Under physiological conditions, neurotransmitters shape neuronal networks and control several cellular and synaptic functions. In the mammalian central nervous system (CNS), excitatory and inhibitory neurotransmission are mediated in large part by glutamate and gamma-aminobutyric acid (GABA), which are excitatory and inhibitory neurotransmitters, respectively. Glutamate and GABA also play crucial roles in neurological disorders such as cerebral ischemia. Glutamate in particular causes excitotoxicity, known as one of the hallmark mechanisms in the pathophysiology of cerebral ischemic injury for more than thirty years. Excitotoxicity occurs due to excessive glutamate release leading to overactivation of postsynaptic glutamate receptors, which evokes a downstream cascade that eventually leads to neuronal dysfunction and degeneration. Also, a reduction in GABA receptor response after ischemia impedes these inhibitory effectors from attenuating excitotoxicity and thereby further enabling the excitotoxic insult. This review focuses on the mechanisms by which glutamate and GABA mediate excitotoxicity and ischemic injury. This article is part of the Special Issue entitled 'Cerebral Ischemia'.

Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy.

Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student's t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.

Cesárea electiva en gestante con fractura-hundimiento antigua en región frontal del cráneo / Pregnant With an Old Fracture-Sink in Skull Frontal Region Determines Elective Caesarean Section

Los traumatismos craneoencefálicos constituyen una epidemia silenciosa para la Organización Mundial de la Salud; y en específico, las fracturas de cráneo tienen una incidencia elevada en la sociedad moderna. El objetivo es presentar el caso de una embarazada con una fractura craneal antigua (fractura-hundimiento frontal) que condiciona la indicación de una cesárea electiva. Además, resulta una afectación anatómica poco habitual en la práctica de la Obstetricia. Se presenta una gestante de 22 años que a la edad de 4 años sufrió trauma craneoencefálico al caer accidentalmente desde un cuarto piso. Se impactó en la región frontal del cráneo con un recipiente de cerámica pesado. Quedó inconsciente y con sangrado profuso, se operó de urgencia y la paciente quedó sin secuela clínica de daño cerebral, pero con deformidad craneal por hundimiento de forma ovalada bien delimitada. Se determinó cesárea electiva por orientación del Programa Materno Infantil Nacional a las 40,5 semanas, peso del recién nacido 3 802 g y Apgar 9-9. Tuvo una evolución satisfactoria durante su atención prenatal y puerperio. La valoración y el manejo de una gestante con antecedentes de un traumatismo craneoencefálico antiguo requieren de un seguimiento multidisciplinario que involucre a obstetras, neurocirujanos, neurólogos y otros especialistas, con vistas a evitar las complicaciones que una afección como esta, pueden resultar letales para la madre o el feto(AU)

Cranium cerebral trauma constitutes a silent epidemic for the World Organization of the Health; and specifically skull fractures have risen incidence in the modern society. To present the case of a pregnant woman with an old cranial fracture (front fracture-sinking) that conditions the indication of elective caesarean operation. In addition, it is an unusual anatomical involvement in Obstetrics practice. We present the case of a 22 year-old pregnant that suffered encephalic skull trauma at the age of 4. This trauma is the result of her falling accidentally from a fourth floor to a heavy ceramic recipient and she impacted the front region of her skull. She was unconscious and bled profusely. She underwent urgent surgery. She survived without clinical sequel of cerebral damage but she has cranial sinking deformity in a well-defined oval way. Elective caesarean operation is determined by orientation from the national infantile maternal program to the 40,5 weeks, weight of the newly born 3 802 grams, Apgar 9-9. Satisfactory evolution during their prenatal attention and puerperium. Elective cesarean section is determined at 40.5 weeks, the newborn weight 3 802 g, Apgar 9-9, in alignment with the Cuban national program for the mother and the child. She had a satisfactory evolution during her prenatal and puerperal care. The assessment and management of a pregnant woman with a history of an old cranioencephalic trauma requires multidisciplinary monitoring involving obstetricians, neurosurgeons, neurologists and other specialists, for avoiding complications which can be lethal to the mother or the fetus(AU)

Caracterización de siete embarazadas con una atención prenatal deficiente desde un acercamiento a la familia / Characterization of seven pregnant women under poor prenatal care from an approach to their families

Introducción: Si la familia favorece la cohesión, la comunicación positiva, la armonía y la expresión afectiva entre sus miembros, de algún modo influye también en una embarazada con atención prenatal deficiente. Objetivo: Caracterizar a las embarazadas cuya atención prenatal es deficiente desde un acercamiento familiar. Métodos: Se realiza un estudio descriptivo en enero de 2015 a diciembre de 2016, consulta de obstetricia, Policlínico Universitario No. 1 Dr. Juan Manuel Páez Inchausti, Nueva Gerona, Isla de la Juventud. Universo: 879 mujeres embarazadas, la muestra: 7 embarazadas con una atención prenatal deficiente por definición operativa establecida según criterios de los investigadores. Las variables investigadas se recogen en una planilla de vaciamiento de datos, empleo de elementos de estadística descriptiva: cálculo de frecuencia absoluta y relativa. Resultados: Las 7 embarazadas vivían en un hogar disfuncional, hubo predominio del nivel de escolaridad regular, del tipo de familia extensa o extendida, del tamaño de la familia grande, así como tres generaciones que conviven en un mismo hogar. Conclusiones: Los resultados de este trabajo les ofrecen al médico y la enfermera de la familia las herramientas indispensables para el trabajo personalizado mediante acciones de impacto para lograr un cambio en el comportamiento de estas embarazadas, teniendo en cuenta que la familia pudiera estar influenciando de algún modo en estas embarazadas con una atención prenatal deficiente(AU)

Introduction: If the family favors cohesion, positive communication, harmony and affective expression among its members, this also influences a pregnant woman with poor prenatal care. Objective: To characterize pregnant women whose prenatal care is deficient from an approach to their families. Methods: A descriptive study was carried out from January 2015 to December 2016, in the obstetrics medical office of Dr. Juan Manuel Páez Inchausti University Polyclinic No. 1 in Nueva Gerona, Isla de la Juventud. The study population was 879 pregnant women and the sample was 7 pregnant women with deficient prenatal care by operative definition established according to the researchers' criteria. The variables investigated are included in a form after emptying the data, using elements of descriptive statistics: calculation of absolute and relative frequency. Results: The seven pregnant women lived in a dysfunctional home, there was a predominance of average schooling, of the extended or extended family type, of the big family size, as well as three generations that live in the same home. Conclusions: The results of this paper offer the family doctor and nurse the indispensable tools for personalized work through impact actions in order to achieve a change in the behavior of these pregnant women, taking into account that the family could be influencing some way in these pregnant women with poor prenatal care(AU)

Impacto de la anemia para una embarazada e importancia del riesgo preconcepcional / Impact of anemia on a pregnant woman and importance of preconception risk

Introducción: la anemia es la más frecuente de las enfermedades que puede coincidir con el embarazo o ser producida por este. En la actualidad se incentiva una metodología de atención al riesgo preconcepcional a partir de un nuevo enfoque que implica cambios en los procesos de atención a grupos específicos. Caso clínico: femenina de 33 años de edad, mestiza, procedencia urbana, ingeniera agropecuaria, menarquía 12 años, fórmula menstrual duración 4-5 días/ cada 30 días, historia obstétrica: embarazo 5, parto: no, abortos provocados: tres (años 2007, 2010, 2013). En el año 2012 tuvo embarazo ectópico tubario izquierdo complicado con hemoperitoneo. Al embarazarse nuevamente en febrero del 2016 en primer trimestre se constata hierro sérico en 1,6 µmol/L y sintomatología clínica anémica que mejoran ostensiblemente, produciéndose parto transpelviano a las 40,6 semanas, hierro sérico 22 µmol/L, evolución durante el puerperio satisfactoria. Conclusiones: la anemia es una complicación seria de la gestación que se aprecia en la sintomatología clínica de la embarazada del reporte. Este trabajo destaca la importancia del control del riesgo preconcepcional, por el carácter aleccionador del impacto clínico-social que tiene la anemia en esta embarazada sin control previo del riesgo preconcepcional(AU)

Introduction: Anemia is the most frequent disease that can coincide with or be produced by pregnancy. At present, a methodology of attention to preconception risk is encouraged, based on a new approach that involves changes in the processes of care delivery for specific groups. Clinical case: Female patient at age 33, mestizo, of urban origin, agricultural engineering, first period at age 12, menstrual formula duration 4-5 days within 30 days, obstetric history: pregnancy 5, no childbirth, three abortions (2007, 2010, 2013). In the year 2012, she had a left tubal ectopic pregnancy complicated with hemoperitoneum. When she was pregnant again in February 2016 in the first trimester, serum iron is found at 1.6 ?mol/L and anemic clinical symptomatology that is markedly improved is also found, with cross-pelvis delivery after 40.6 weeks, serum iron 22 ?mol/L, and satisfactory evolution. Conclusions: Anemia is a serious complication in pregnancy that can be manifested in the clinical symptoms of pregnant women. This work emphasizes the importance of preconception risk control because of the sobering character of the clinical and social impact of anemia in this pregnant woman without previous control of the preconception risk(AU)