Virtual Reality Customized 360-Degree Experiences for Stress Relief.

The latest studies in virtual reality (VR) have evidenced the potential of this technology to reproduce environments from multiple domains in an immersive way. For instance, in stress relief research, VR has been presented as a portable and inexpensive alternative to chromotherapy rooms, which require an adapted space and are expensive. In this work, we propose a portable and versatile alternative to the traditional chromotherapy color-loop treatment through four different 360-degree virtual experiences. A group of 23 healthy participants (mean age 22.65 ± 5.48) were conducted through a single-session experience divided into four phases while their electroencephalography (EEG) was recorded. First, they were stressed via the Montreal imaging stress task (MIST), and then relaxed using our VR proposal. We applied the Wilcoxon test to evaluate the relaxation effect in terms of the EEG relative gamma and self-perceived stress surveys. The results that we obtained validate the effectiveness of our 360-degree proposal to significantly reduce stress (p-value = 0.0001). Furthermore, the participants deemed our proposal comfortable and immersive (score above 3.5 out of 5). These results suggest that 360-degree VR experiences can mitigate stress, reduce costs, and bring stress relief assistance closer to the general public, like in workplaces or homes.

Virtual Reality as a Portable Alternative to Chromotherapy Rooms for Stress Relief: A Preliminary Study.

Chromotherapy rooms are comfortable spaces, used in places like special needs schools, where stimuli are carefully selected to cope with stress. However, these rooms are expensive and require a space that cannot be reutilized. In this article, we propose the use of virtual reality (VR) as an inexpensive and portable alternative to chromotherapy rooms for stress relief. We recreated a chromotherapy room stress relief program using a commercial head mounted display (HD). We assessed the stress level of two groups (test and control) through an EEG biomarker, the relative gamma, while they experienced a relaxation session. First, participants were stressed using the Montreal imaging stress task (MIST). Then, for relaxing, the control group utilized a chromotherapy room while the test group used virtual reality. We performed a hypothesis test to compare the self- perceived stress level at different stages of the experiment and it yielded no significant differences in reducing stress for both groups, during relaxing (p-value: 0.8379, α = 0.05) or any other block. Furthermore, according to participant surveys, the use of virtual reality was deemed immersive, comfortable and pleasant (3.9 out of 5). Our preliminary results validate our approach as an inexpensive and portable alternative to chromotherapy rooms for stress relief.

Efficacy and safety of ustekinumab in real clinical practice. Retrospective multicentre study. ARAINF cohort. / Eficacia y seguridad de ustekinumab en la práctica clínica real. Estudio multicéntrico retrospectivo. Cohorte ARAINF.

INTRODUCTION: Ustekinumab, a monoclonal antibody that blocks interleukins 12/23, has proven in clinical trials its efficacy in inducing and maintaining clinical remission of Crohn's disease (CD). Its effectiveness and safety in actual clinical practice is less known and may differ from trials. OBJECTIVE: To evaluate its effectiveness and safety in clinical practice (intravenous induction pattern essentially), such as induction and over the long term, in patients with CD refractory to biological treatment. MATERIAL AND METHODS: Multicentre retrospective analysis (6 hospitals in Aragón), which includes all patients (N=69) with CD undergoing treatment with ustekinumab (either with intravenous or subcutaneous induction), who had at least 16 weeks of follow-up. The clinical response or remission has been evaluated at weeks 16, 24, 32 and 48 using the Harvey-Bradshaw index. RESULTS: A total of 69 patients have been included, mean age 42 years, 54% men. A percentage of 89.86 (95% CI [0.805, 0.949]) of the patients presented clinical improvement at week 16 (15.95% remission, 73.92% response). In the subsequent follow-up, this response has been maintained. Age (OR 0.95, P=.028) and smoking habits (OR 0.19, P=.027) have been identified by an ordinal regression model as predictors of poor treatment response while the need for biological change due to adverse effect (OR 96, P=.00017) and due to loss of secondary response (OR 7.07, P=.034) have been predictors of good response. No serious adverse effects have been reported that forced them to stop taking ustekinumab. CONCLUSION: Ustekinumab is effective and safe in real clinical practice to achieve induction and maintenance of the response in patients with refractory CD. Tobacco and age have been shown to be predictors of poor response, while the indication for adverse effect to previous biological and for loss of secondary response has been shown to be predictors of good response.

Effect of Texel crossbreeding on productive traits, carcass and meat quality of Segureña lambs.

BACKGROUND: The present study aimed to assess the effect of crossbreeding a local breed (Segureña, S × S) with Texel as the sire line (Texel × Segureña crossbred, T × S) on productive traits and meat quality attributes. Sixty-eight lambs (both males and females) from each genotype, weaned at about 45 days old and intensively fed with concentrates and cereal straw ad libitum until they were 72 days old, were used to assess productive traits, and ten animals from each genotype were used to assess meat quality. RESULTS: The crossbreeding with Texel improves productivity, with a greater weight at birth (+1 kg) and at slaughter (+3 kg) and a greater average daily gain (+29 g). T × S lambs had a better conformation, less carcass fatness, and higher content of muscle (+45 g kg-1 ) as opposed to a lower fat content (-50.6 g kg-1 ). With regard to meat quality, crossbreeding with Texel provided a meat with a higher protein content (+4 g kg-1 ) and a lower oleic acid content (21% less), although the differences were very scarce from a sensory point of view, and non-existent with respect to instrumental quality. CONCLUSION: Crossbreeding could comprise a useful tool in the production of ovine meat in local breeds, such as Segureña, within the Mediterranean Area, and, consequently, a way of increasing the profitability of the farms. © 2018 Society of Chemical Industry.

Effectiveness of mycophenolate mofetil in C3 glomerulonephritis.

C3 glomerulonephritis is a clinicopathologic entity defined by the presence of isolated or dominant deposits of C3 on immunofluorescence. To explore the effect of immunosuppression on C3 glomerulonephritis, we studied a series of 60 patients in whom a complete registry of treatments was available over a median follow-up of 47 months. Twenty patients had not received immunosuppressive treatments. In the remaining 40 patients, 22 had been treated with corticosteroids plus mycophenolate mofetil while 18 were treated with other immunosuppressive regimens (corticosteroids alone or corticosteroids plus cyclophosphamide). The number of patients developing end-stage renal disease was significantly lower among treated compared with untreated patients (3 vs. 7 patients, respectively). No patient in the corticosteroids plus mycophenolate mofetil group doubled serum creatinine nor developed end-stage renal disease, as compared with 7 (significant) and 3 (not significant), respectively, in patients treated with other immunosuppressive regimens. Renal survival (100, 80, and 72% at 5 years) and the number of patients achieving clinical remission (86, 50, and 25%) were significantly higher in patients treated with corticosteroids plus mycophenolate mofetil as compared with patients treated with other immunosuppressive regimens and untreated patients, respectively. Thus, immunosuppressive treatments, particularly corticosteroids plus mycophenolate mofetil, can be beneficial in C3 glomerulonephritis.

Contrast-induced encephalopathy in patients with advanced chronic kidney disease: What the nephrologist needs to know.

Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood-brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48-72h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and kidney replacement therapy (KRT) with hemodialysis (HD) in patients in chronic KRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.

Lung function and organ dysfunctions in 178 patients requiring mechanical ventilation during the 2009 influenza A (H1N1) pandemic.

INTRODUCTION: Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. RESULTS: During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated.Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. CONCLUSIONS: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings.

A Review of Automated Techniques for Assisting the Early Detection of Alzheimer's Disease with a Focus on EEG.

In this paper, we review state-of-the-art approaches that apply signal processing (SP) and machine learning (ML) to automate the detection of Alzheimer's disease (AD) and its prodromal stages. In the first part of the document, we describe the economic and social implications of the disease, traditional diagnosis techniques, and the fundaments of automated AD detection. Then, we present electroencephalography (EEG) as an appropriate alternative for the early detection of AD, owing to its reduced cost, portability, and non-invasiveness. We also describe the main time and frequency domain EEG features that are employed in AD detection. Subsequently, we examine some of the main studies of the last decade that aim to provide an automatic detection of AD and its previous stages by means of SP and ML. In these studies, brain data was acquired using multiple medical techniques such as magnetic resonance imaging, positron emission tomography, and EEG. The main aspects of each approach, namely feature extraction, classification model, validation approach, and performance metrics, are compiled and discussed. Lastly, a set of conclusions and recommendations for future research on AD automatic detection are drawn in the final section of the paper.

Quantitative Assessment of Stress Through EEG During a Virtual Reality Stress-Relax Session.

Recent studies have addressed stress level classification via electroencephalography (EEG) and machine learning. These works typically use EEG-based features, like power spectral density (PSD), to develop stress classifiers. Nonetheless, these classifiers are usually limited to the discrimination of two (stress and no stress) or three (low, medium, and high) stress levels. In this study we propose an alternative for quantitative stress assessment based on EEG and regression algorithms. To this aim, we conducted a group of 23 participants (mean age 22.65 ± 5.48) over a stress-relax experience while monitoring their EEG. First, we stressed the participants via the Montreal imaging stress task (MIST), and then we led them through a 360-degree virtual reality (VR) relaxation experience. Throughout the session, the participants reported their self-perceived stress level (SPSL) via surveys. Subsequently, we extracted spectral features from the EEG of the participants and we developed individual models based on regression algorithms to predict their SPSL. We evaluated stress regression performance in terms of the mean squared percentage error (MSPE) and the correlation coefficient (R 2). The results yielded from this evaluation (MSPE = 10.62 ± 2.12, R 2 = 0.92 ± 0.02) suggest that our approach predicted the stress level of the participants with remarkable performance. These results may have a positive impact in diverse areas that could benefit from stress level quantitative prediction. These areas include research fields like neuromarketing, and training of professionals such as surgeons, industrial workers, or firefighters, that often face stressful situations.

Mini Nutritional Assessment - Short Form Is a Useful Malnutrition Screening Tool in Patients with Liver Cirrhosis, Using the Global Leadership Initiative for Malnutrition Criteria as the Gold Standard.

BACKGROUND: The use of nutrition-screening tools in cirrhotic patients is not systematized. Recently, specific tools have been proposed for patients with cirrhosis, but their diagnostic capabilities have been scarcely studied. METHODS: This was a prospective study that includes outpatients with liver cirrhosis undergoing follow-up in the hepatology consultations of a tertiary-care university hospital. A trained gastroenterologist applied the screening tools: Liver Disease Universal Screening Tool (LDUST), Royal Free Hospital-Nutrition Prioritizing Tool (RFH-NPT), and Mini Nutritional Assessment-Short Form (MNA-SF). Subsequently, the diagnosis of malnutrition was made according to Global Leadership Initiative for Malnutrition (GLIM) criteria by an endocrinologist, who was blind to the results of the screening tools. RESULTS: Sixty-three patients (38.1% women, mean age 63.1 ± 9.9 years) with cirrhosis (60.3% Child-Pugh A, 34.9% Child-Pugh B, and 4.8% Child-Pugh C) were evaluated. The prevalence of malnutrition was 38.1% (15.9% moderate, 22.2% severe). Advanced stages of cirrhosis were associated with a higher prevalence of malnutrition (P = .021). MNA-SF was the most accurate screening tool, being superior to RFH-NPT and LDUST. It presented better sensitivity than RFH-NPT (88% [0.68-0.97] vs 67% [0.45-0.84], P = .031) and better specificity than both LDUST (97% [0.87-0.99] vs 62% [0.45-0.77], P < .001) and RFH-NPT (97% [0.87-0.99] vs 82% [0.67-0.93], P = .016). CONCLUSIONS: According to the GLIM criteria, malnutrition affected 38.1% of patients with cirrhosis, being severe in 22% of the patients. MNA-SF is the most accurate screening test, superior even to tools specifically designed for cirrhotic patients (LDUST).

Effect of Active-Edible Coating and Essential Oils on Lamb Patties Oxidation during Display.

The use of natural products to reduce the use of synthetic additives in meat products, reducing the oxidation and improving the shelf life is a current challenge. Meat quality from lamb patties during 10 days of display on modified atmosphere packaging (MAP) and active-edible coating were tested under six treatments: uncoated patties without coating (CON); patties with alginate coating (EC) and patties with coating and 0.1 or 0.05% of essential oils (EOs) from either thyme (TH 0.1; TH 0.05) or oregano (OR 0.1; OR 0.05). Display and treatment significantly modified (P < 0.001) all the studied meat quality variables (pH, color, water holding capacity, weight losses, thiobarbituric acid reactive substances (TBARS), antioxidant activity). Display produced discoloration and lipid oxidation, however, the samples with essential oils presented lower (P < 0.001) lipid oxidation than the CON or EC groups. Coated samples with or without EOs showed better color (lower lightness but higher redness and yellowness) and lower water losses (P < 0.001) than the CON. The addition of thyme EO caused a decrease (P < 0.001) in the consumer's overall acceptability, whereas no statistical differences appeared between CON, EC and oregano EO addition. Thus, using EOs as natural antioxidants, especially those from oregano at low dosages (0.05%), could be considered a viable strategy to enhance the shelf life and the product quality of lamb meat patties without damaging the sensory acceptability.

Influence of the ionic dialysance monitor on Kt measurement in hemodialysis.

BACKGROUND: Ionic dialysance can provide accurate monitoring of dialysis dose during each hemodialysis session. Increasingly, hemodialysis machines incorporate devices that measure ionic dialysance, allowing the dialysis dose to be determined noninvasively in real time and in each session. Because Kt product was proposed as a measure of hemodialysis dose to avoid the reverse J-shaped curve between urea reduction ratio or Kt/V and mortality, we investigated whether ionic dialysance values and Kt measurements are affected by different ionic dialysance monitors (Diascan and online clearance monitoring [OCM]) and dialysis machines. STUDY DESIGN: Four-period crossover. SETTING & PARTICIPANTS: 31 adult long-term hemodialysis patients using 2 different ionic dialysance monitors in 4 dialysis machines: Diascan in Hospal Integra and Gambro AK-200 machines and OCM in Fresenius 4008S and 5008 machines. PREDICTORS: Ionic dialysance monitor and machine used in 4 hemodialysis sessions for each participant. OUTCOMES: Kt and Kt/V measured by using ionic dialysance and serum urea nitrogen. RESULTS: Mean values for initial and final ionic dialysance were similar for Integra and AK-200 machines, both measured by using Diascan, and for the 4008S and 5008 machines, both measured by using OCM; however, OCM values tended to be greater in the 4008S and 5008 machines. Kt measured in the 4008S and 5008 machines was greater (59.6 +/- 12 and 58.6 +/- 11 L, respectively) than with the Integra and AK-200 machines (53.4 +/- 11 and 53.8 +/- 11 L). Mean urea reduction ratio and Kt/V were 78.0% +/- 8% and 1.89 +/- 0.43 for Diascan monitors and 79.6% +/- 8% and 1.99 +/- 0.44 for OCM monitors, respectively (P < 0.01). Differences between monitors in Kt determination were caused in part by a real difference in dialysis effectiveness (6%) and in part by an intermethod difference (4%). Kt adjusted by Kt/V differences was recalculated, and because of good correlation between Diascan and OCM, we were able to apply a formula (Kt(OCM) = 1.08 Kt(Diascan) - 2; r =0.95) that allowed both Kt quantification methods to be compared. LIMITATIONS: Nonblinded nonrandomized small sample. CONCLUSIONS: Kt is a valid method for judging dialysis dose in real time by using ionic dialysance measurements. Adjustments to correct intermethod differences may be necessary to ensure generalizability among ionic dialysance monitors.

Duration of Treatment with Corticosteroids and Recovery of Kidney Function in Acute Interstitial Nephritis.

BACKGROUND AND OBJECTIVES: Drug-induced acute interstitial nephritis represents an emerging cause of acute kidney disease, especially among polymedicated elderly patients. Although corticosteroids are frequently used, controversy exists about the timing of initiation, efficacy, safety, and duration of treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective study of 182 patients with biopsy-proven drug-induced acute interstitial nephritis from 13 Spanish centers. Exposure was defined as the length of corticosteroid treatment. The main outcome was the level of serum creatinine at month 6, with respect to baseline values. RESULTS: The most common offending agents were nonsteroidal anti-inflammatory drugs (27%). In 30% of patients, the offending drug could not be identified. The median time to suspected drug withdrawal was 11 days (interquartile range, 5-22). All patients presented with acute kidney disease and were treated with corticosteroids. The mean initial dose of prednisone was 0.8±0.2 mg/kg per day. High-dose corticosteroid treatment was maintained for 2 weeks (interquartile range, 1-4). After 6 months, the mean recovered GFR was 34±26 ml/min per 1.73 m2 and ten patients required maintenance dialysis. Use of high-dose corticosteroids for 3 weeks or treatment duration >8 weeks were not associated with better recovery of kidney function. In the multivariable analysis, delayed onset of steroid treatment (odds ratio, 1.02; 95% confidence interval, 1.0 to 1.04) and the presence of interstitial fibrosis of >50% on the kidney biopsy specimen (odds ratio, 8.7; 95% confidence interval, 2.7 to 27.4) were both associated with serum creatinine level at month 6 of >75%, with respect to baseline values. CONCLUSIONS: High-dose corticosteroid treatment for 3 weeks or prolonged treatment for >8 weeks were not associated with greater kidney function recovery in drug-induced acute interstitial nephritis. A delay in the initiation of corticosteroids resulted in worse recovery of kidney function.

Respiratory polygraphy monitoring of intensive care patients receiving non-invasive ventilation.

INTRODUCTION: Patients that started on Non-Invasive Ventilation (NIV) need to define several parameters selected on the basis of diurnal arterial blood gas and underlying disease. We hypothesize that respiratory polygraphy (RP) could be useful to monitor NIV. This retrospective work describes RP findings and their impact on the setting of continuous flow ventilators from patients on NIV of Intensive Care Unit (ICU). MATERIAL AND METHODS: Patient's data on NIV from at the ICU of Hospital Británico were included in this study. RP recordings were performed in all of them. Respiratory events, such as ventilatory pattern changes, impact on oximetry or tidal volume, were observed to modify the ventilatory mode after RP. RESULTS: The RP findings have contributes to change the ventilatory mode for one third of the patients. The mean values of expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) were not significantly different across all the population before or after RP: 8.7±0.3 vs. 8.6±0.4; p<0.88 and 18.6±0.6 vs. 17.7±0.7; p<0.26 respectively, however, half the patients presented > 2 cmH2O pressure value changes after RP. CONCLUSIONS: RP recordings could contribute to broad range of data useful to make decisions about changes in programming and allowed to identify adverse events related to positive pressure.

[Role of sex and age as predictors of an apnea and hypopnea index higher than 5/hour in patients with normal body mass index using respiratory polygraphy]. / Papel del sexo y de la edad como predictores de un índice de apneas e hipopneas superior a 5/hora en pacientes con índice de masa corporal normal usando poligrafía respiratoria domiciliaria.

INTRODUCTION: To establish whether predictors of sleep apnea (OSAHS) from patients with normal body mass index (BMI) could facilitate the prioritization of candidates for sleep tests. Aim To describe the role of sex and age as predictors of apnea and hypopnea index (AHI)>5 events per hour in patients with normal BMI (<25kg/m(2)). METHODS: Retrospective study of patients referred for home respiratory polygraphy level iii. RESULTS: One hundred and forty-three patients with BMI<25kg/m(2), of which 70 had OSA defined by an AHI>5/h were analyzed. The clinical variables to predict AHI>5/h in a multiple logistic regression model, found statistical significance for age>60 years (OR=5.67; 95% CI 2.38-13.53; P<.0001) and male (OR=3.15; 95% CI 1.47-6.73; P<.003). CONCLUSION: Forty-eight point ninety-five percent of normal weight patients in a population at risk had OSAHS defined by an AHI>5/h. The sex and age would be risk predictors in this population and most likely in men.

Tracheobronchial Tuberculosis Without Lung Involvement.

Endotracheal tuberculosis (ETTB) is an infrequent form of tuberculosis whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis. This case presents a 73-year-old man admitted to our hospital with fatigue, weakness, dry cough and weight loss. His chest X-ray was normal but the high resolution computed tomography (HRCT) showed normal parenchyma images with mediastinal and hilar lymphadenopathy. There was inflammation of the tracheal wall and infiltrates in pavement epithelium; however, the tracheal biopsy for acid-fast bacilli was negative. He was finally diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph nodes. Four drugs were prescribed and symptoms improved. EBUS-TBNA contributed to prompt diagnosis. The patient was treated and evolved without complications, such as tracheal stenosis.

An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document.

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterizes HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the the complement system, which can explain approximately 60% of the aHUS cases, and a number of mutations and polymorphisms have been functionally characterized. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activiation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management.

[Transitional bladder carcinoma TaG1: role of the EGFr tyrosin kinase activation in the cellular proliferation]. / Carcinoma transicional de vejiga no invasivo y bien diferenciado: papel de la activación tirosincinasa del receptor del factor de crecimiento epidérmico en la proliferación celular.

BACKGROUND AND OBJECTIVE: The purpose of this work was to study if the expression of EGFr oncoprotein and the rate of tumoral cell proliferation in TaG1 transitional bladder carcinoma were related and if this relationship influences the potential aggressivity of the neoplasia. PATIENTS AND METHOD: Twenty-eight patients with TaG1 (non-invasive papillary and well differentiated) transitional bladder carcinoma were randomly selected. EGFr was determined by a semiquantitative immunohistochemical method in three intensity levels. The proliferative tumoral cell activity was determined by the PCNA index, that is, the relation between the total number of tumor cells and the number of tumor cells with nuclear PCNA-immunoreactivity expressed in percentage. RESULTS: The rate of cellular tumour proliferation (PCNA index) was significantly higher in those tumors with EGFr's greater expression (p=0.005). The EGFr expression was associated with tumor recurrence (p=0.012). CONCLUSIONS: The major expression of EGFr oncoprotein in tumours with higher rate of cell proliferation indicates that it may be influenced by the activity of such oncoprotein. The binding of a ligand to the EGFr leads to intracellular tumor proliferation, hence possibly favouring a more aggressive biological behavior.

An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document.

Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Atypical HUS (aHUS) is a sub-type of HUS in which the TMA phenomena are the consequence of decreased regulation of the alternative complement pathway on cell surfaces due to a genetic cause. aHUS is an extremely rare disease that, despite the administration of standard treatment with plasma therapy, often progresses to terminal chronic renal failure with a high associated rate of mortality. In recent years, research has established the key role that the complement system plays in the induction of endothelial damage in patients with aHUS, through the characterisation of multiple mutations and polymorphisms in the genes that code for certain complement factors. Eculizumab is a monoclonal antibody that inhibits the terminal fraction of the complement protein, blocking the formation of a cell membrane attack complex. In prospective studies in patients with aHUS, administering eculizumab produces a rapid and sustained interruption in the TMA process, with significant improvements in long-term renal function and an important decrease in the need for dialysis or plasma therapy. In this document, we review and bring up to date the important aspects of this disease, with special emphasis on how recent advancements in diagnostic and therapeutic processes can modify the treatment of patients with aHUS.