Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data. / Arritmias cardiacas en la unidad de ictus: análisis de los datos de la monitorización cardiaca.

INTRODUCTION: Cardiac arrhythmias are frequent in acute stroke. Stroke units are widely equipped with cardiac monitoring systems. Pre-existing heart diseases and heart-brain interactions may be implicated in causing cardiac arrhythmias in acute stroke. This article analyses cardiac arrhythmias detected in patients hospitalised in a stroke unit. METHOD: Prospective observational study of consecutive patients admitted to a stroke unit with cardiac monitoring. We collected clinical data from patients and the characteristics of their cardiac arrhythmias over a 1-year period (2013). Time of arrhythmia onset, associated predisposing factors, and the therapeutic decisions made after detection of arrhythmia were examined. All patients underwent continuous cardiac monitoring during no less than 48hours. RESULTS: Of a total of 332 patients admitted, significant cardiac arrhythmias occurred in 98 patients (29.5%) during their stay in the stroke unit. Tachyarrhythmia (ventricular tachyarrhythmias, supraventricular tachyarrhythmias, complex ventricular ectopy) was present in 90 patients (27.1%); bradyarrhythmia was present in 13 patients (3.91%). Arrhythmias were independently associated with larger size of brain lesion and older age. In 10% of the patient total, therapeutic actions were taken after detection of significant cardiac arrhythmias. Most events occurred within the first 48hours after stroke unit admission. CONCLUSIONS: Systematic cardiac monitoring in patients with acute stroke is useful for detecting clinically relevant cardiac arrhythmias. Incidence of arrhythmia is higher in the first 48hours after stroke unit admission. Age and lesion size were predicted appearance of arrhythmias. Detection of cardiac arrhythmias in a stroke unit has important implications for treatment.

Vitamin D3 supplementation in COVID-19 patients with cardiovascular disease and gut dysbiosis.

BACKGROUND: The COVID-19 pandemic has highlighted the vulnerability of particular patient groups to SARS-CoV-2 infection, including those with cardiovascular diseases, hypertension, and intestinal dysbiosis. COVID-19 affects the gut, suggesting diet and vitamin D3 supplementation may affect disease progression. AIMS: To evaluate levels of Ang II and Ang-(1-7), cytokine profile, and gut microbiota status in patients hospitalized for mild COVID-19 with a history of cardiovascular disease and treated with daily doses of vitamin D3. METHODS: We recruited 50 adult patients. We screened 50 adult patients and accessed pathophysiology study 22, randomized to daily oral doses of 10,000IU vitamin D3 (n=11) or placebo (n=11). Plasma levels of Ang II and Ang-(1-7) were determined by radioimmunoassay, TMA and TMAO were measured by liquid chromatography and interleukins (ILs) 6, 8, 10 and TNF-α by ELISA. RESULTS: The Ang-(1-7)/Ang II ratio, as an indirect measure of ACE2 enzymatic activity, increased in the vitamin D3 group (24±5pg/mL vs. 4.66±2pg/mL, p<0.01). Also, in the vitamin D3-treated, there was a significant decline in inflammatory ILs and an increase in protective markers, such as a substantial reduction in TMAO (5±2µmoles/dL vs. 60±10µmoles/dL, p<0.01). In addition, treated patients experienced less severity of infection, required less intensive care, had fewer days of hospitalization, and a reduced mortality rate. Additionally, improvements in markers of cardiovascular function were seen in the vitamin D3 group, including a tendency for reductions in blood pressure in hypertensive patients. CONCLUSIONS: Vitamin D3 supplementation in patients with COVID-19 and specific conditions is associated with a more favourable prognosis, suggesting therapeutic potential in patients with comorbidities such as cardiovascular disease and gut dysbiosis.

Influence of manipulative skills on quality of life and activities of daily living in multiple sclerosis. / Influencia de la capacidad manipulativa en la calidad de vida y actividades de la vida diaria en la esclerosis múltiple.

INTRODUCTION: More than 50% of patients diagnosed with multiple sclerosis report problems with manipulative function and impairments in their daily lives due to this disorder. Therefore, the aim of the present study is to determine how pinch strength, prey strength and manipulative dexterity affect the quality of life and personal autonomy of people diagnosed with multiple sclerosis and to study whether there is a difference in these aspects between different types of multiple sclerosis. SUBJECTS AND METHODS: There was a total sample of 126 participants, of which 57 were controls and 69 cases. All of them were assessed with a Multiple Sclerosis Quality of Life-54 test, Nine-Hole Peg Test and Barthel Index. RESULTS: People with multiple sclerosis have worse pinch strength, prey strenght, manipulative dexterity, performance in basic activities of daily living and quality of life (p < 0.001). Prey strength is a conditioning factor for performance and quality of life in people with multiple sclerosis. As for the type of multiple sclerosis, relapsing-remitting multiple sclerosis presented better values (p < 0.001). CONCLUSIONS: The findings of this study point to the fact that patients diagnosed with multiple sclerosis have a decrease in prey strength, pinch strength, manipulative dexterity, quality of life and autonomy in activities of daily living compared to the healthy population.

TITLE: Influencia de la capacidad manipulativa en la calidad de vida y actividades de la vida diaria en la esclerosis múltiple.Introducción. Más de un 50% de los pacientes diagnosticados con esclerosis múltiple (EM) comunican problemas con la función manipulativa e impedimentos en su vida diaria a causa de esta alteración. Por ello, el objetivo del presente estudio es determinar la afectación que la fuerza de pinza, la fuerza de presa y la destreza manipulativa ejercen sobre la calidad de vida y la autonomía personal de las personas diagnosticadas de EM, y estudiar si existe diferencia de estos aspectos entre los distintos tipos de esta enfermedad. Sujetos y métodos. Se contó con una muestra total de 126 participantes, de los cuales 57 fueron controles, y 69, casos. A todos ellos se les evaluó con el Multiple Sclerosis Quality of Life-54, el Nine-Hole Peg Test, la dinamometría de pinza y de presa para la medición de la fuerza, y el índice de Barthel para la evaluación de las actividades básicas de la vida diaria. Resultados. Las personas con EM presentaron peores fuerza de pinza, fuerza de presa, destreza manipulativa, desempeño en actividades básicas de la vida diaria y calidad de vida (p < 0,001). La fuerza de presa es un factor condicionante en el desempeño de actividades básicas y calidad de vida en personas con EM. En cuanto al tipo de EM, el tipo remitente-recurrente presentó mejores valores (p < 0,001). Conclusiones. Los hallazgos de este estudio apuntan a que los pacientes diagnosticados con EM presentan una disminución en la fuerza de pinza, la fuerza de presa, la destreza manipulativa, la calidad de vida y la autonomía en las actividades de la vida diaria en comparación con la población sana.

Barriers associated with poor control in Spanish diabetic patients. A consensus study.

BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

Nuclear PARP-1 protein overexpression is associated with poor overall survival in early breast cancer.

BACKGROUND: Poly(ADP-ribose)polymerase-1 (PARP-1) is a highly promising novel target in breast cancer. However, the expression of PARP-1 protein in breast cancer and its associations with outcome are yet poorly characterized. PATIENTS AND METHODS: Quantitative expression of PARP-1 protein was assayed by a specific immunohistochemical signal intensity scanning assay in a range of normal to malignant breast lesions, including a series of patients (N = 330) with operable breast cancer to correlate with clinicopathological factors and long-term outcome. RESULTS: PARP-1 was overexpressed in about a third of ductal carcinoma in situ and infiltrating breast carcinomas. PARP-1 protein overexpression was associated to higher tumor grade (P = 0.01), estrogen-negative tumors (P < 0.001) and triple-negative phenotype (P < 0.001). The hazard ratio (HR) for death in patients with PARP-1 overexpressing tumors was 7.24 (95% CI; 3.56-14.75). In a multivariate analysis, PARP-1 overexpression was an independent prognostic factor for both disease-free (HR 10.05; 95% CI 5.42-10.66) and overall survival (HR 1.82; 95% CI 1.32-2.52). CONCLUSIONS: Nuclear PARP-1 is overexpressed during the malignant transformation of the breast, particularly in triple-negative tumors, and independently predicts poor prognosis in operable invasive breast cancer.

Elastography in musculoskeletal imaging: A tool or a toy?

Elastography is a novel imaging technique based on ultrasound that evaluates the deformability of tissues to help characterize lesions. It is widely used and has been validated in many tissues (e.g., liver, breast, thyroid). It is also used in the study of musculoskeletal disease. Although the use of elastography in musculoskeletal radiology is limited by the variability and heterogeneity of tissues, it is a very promising technique. In this article, we aim to review the usefulness, possible indications, limitations, and future perspectives of this technique in musculoskeletal radiology.

Long-term antibody response following SPUTNIK V primary vaccination in healthcare workers with and without history of SARS-CoV-2 infection: Prospective cohort study from a hospital in Argentina.

Background: In December 2020, Sputnik V was incorporated to the National COVID-19 Immunization Plan in Argentina. Studies had shown 98% of antibody response rate. To date, data on immunogenicity and antibody persistence in Argentina are scarce.The objective was to assess humoral immune response after two doses of Sputnik V in Health Care Workers (HCWs) at the Ricardo Gutierrez Children's Hospital (RGCH). Methods: A prospective, cohort study in HCWs immunized with two doses of Sputnik V between February and March 2021. The following variables were assessed: age, gender, risk factors for severe COVID-19 or mortality, immunosuppressive therapy and history of SARS-CoV-2. Blood samples were drawn on the day of the first dose, 28 days and 180 days after the second. Anti-Spike IgG was measured using an ELISA assay. Differences in immune response were evaluated according to study variables. Comparison analyses between groups with or without history of infection were performed, with T-test and ANOVA or Mann-Whitney tests. For each subject, we compared baseline values with 28 days and 180 days after the second vaccine.STATA version 14 and R Sofware were used for data analyses. Results: We included 528 individuals, mean age 41.5 years, 82.9% female, 14.4% (76/528) reported previous SARS-CoV-2 infection.All subjects developed antibodies post-vaccination. At day 28, concentrations were significantly higher in previously infected than naïve subjects (p < 0.001) with no differences according to age, gender and comorbidities.At day 180, 17% (95% CI 13.17-21.53) of naïve subjects were negative. Antibody concentrations decreased significantly in all subjects except in those who reported SARS-CoV-2 infection after vaccination (n = 31). This last group had significantly higher antibody concentrations. Conclusion: This study assessed immune response to a new COVID-19 vaccine in real life in a cohort of subjects. Antibody concentrations varied according to history of SARS-COV-2 infection and decreased over time.

MET phosphorylation predicts poor outcome in small cell lung carcinoma and its inhibition blocks HGF-induced effects in MET mutant cell lines.

BACKGROUND: Small cell lung carcinoma (SCLC) has poor prognosis and remains orphan from targeted therapy. MET is activated in several tumour types and may be a promising therapeutic target. METHODS: To evaluate the role of MET in SCLC, MET gene status and protein expression were evaluated in a panel of SCLC cell lines. The MET inhibitor PHA-665752 was used to study effects of pathway inhibition in basal and hepatocyte growth factor (HGF)-stimulated conditions. Immunohistochemistry for MET and p-MET was performed in human SCLC samples and association with outcome was assessed. RESULTS: In MET mutant SCLC cells, HGF induced MET phosphorylation, increased proliferation, invasiveness and clonogenic growth. PHA-665752 blocked MET phosphorylation and counteracted HGF-induced effects. In clinical samples, total MET and p-MET overexpression were detected in 54% and 43% SCLC tumours (n = 77), respectively. MET phosphorylation was associated with poor median overall survival (132 days) vs p-MET negative cases (287 days) (P < 0.001). Phospho-MET retained its prognostic value in a multivariate analysis. CONCLUSIONS: MET activation resulted in a more aggressive phenotype in MET mutant SCLC cells and its inhibition by PHA-665752 reversed this phenotype. In patients with SCLC, MET activation was associated with worse prognosis, suggesting a role in the adverse clinical behaviour in this disease.

Helmet-delivered continuous positive airway pressure with heliox in respiratory syncytial virus bronchiolitis.

AIM: The objective of this study was to check the feasibility and efficacy of helmet-delivered heliox-continuous positive airway pressure (CPAP) in infants with bronchiolitis. METHODS: Children <3 months of age diagnosed with respiratory syncytial virus bronchiolitis and recurrent apnoeas or a venous PCO(2) >55 mmHg or a transcutaneous oxygen saturation <92% in room air were eligible for inclusion in the study. CPAP was delivered by a noninvasive ventilator connected to a heliox port. The interface was a helmet. RESULTS: Eight consecutive infants fulfilled the inclusion criteria. Apnoeas were present in six children before respiratory support was started; they disappeared in five of them. Two infants had to be changed to pressure support noninvasive ventilation, and one of them required intubation. No side effects were recorded. CONCLUSION: We propose a relatively new device to deliver heliox-CPAP in small infants with bronchiolitis. Although this is just a descriptive study with a short sample, this system seems to be feasible and effective.

Effect of N-(n-butyl) thiophosphoric triamide and 3,4 dimethylpyrazole phosphate on gaseous emissions from grasslands under different soil water contents.

The intensification of grassland systems is leading to serious environmental risks due to the large input of nitrogen (N) in fertilizers and the subsequent gaseous losses. Addition of nitrification inhibitors (NI) or urease activity inhibitors to fertilizers could reduce these losses to the atmosphere. In the present study, the effects of the nitrification inhibitor 3,4-dimethylpyrazole phosphate (DMPP) and the urease activity inhibitor N-(n-butyl) thiophosphoric triamide (NBPT) were evaluated on NH3, N2O, NO, and CO2 emissions. Ammonium sulphate nitrate (ASN), urea and cattle slurry were applied at a rate of 70 kg N ha(-1) to a mixed clover-ryegrass sward in the Basque Country (northern Spain) under different soil water contents. NH3 and NO emissions were determined by photoacoustic and chemiluminescence respectively using an open chamber technique while N2O and CO2 emissions were measured by photoacoustic using a closed chamber technique. When the water filled pore space (WFPS) was under 60%, the application of NBPT reduced NO emissions a 34% on urea and an 18% on slurry, and the application of DMPP reduced them a 2% on ASN and a 4% on slurry. No significant effect was observed on NH3 losses. When WFPS was over 60%, no effect could be observed on NO and N2O emissions after the application of both inhibitors, but NH3 losses were reduced a 31% by NBPT when applied with the slurry. Carbon dioxide emissions were unaffected by the use of DMPP or NBPT at any soil water content. Neither grassland yield nor herbage N concentration were influenced by the application of both inhibitors.

[Success and failure predictors of non-invasive ventilation in acute bronchiolitis]. / Predictores de éxito y de fracaso en la ventilación no invasiva en la bronquiolitis aguda.

INTRODUCTION: The objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis. PATIENTS AND METHODS: Prospective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score 5, or oxygen saturation <92%, or venous CO(2) partial pressure (PCO(2)) 60 mm Hg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48 h. Need for intubation was considered as NIV failure. RESULTS: NIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2+/-2.2 vs. 3.5+/-0.8 kg, P=.011), lower age [1.8 (0.3-12.3) vs. 0.8 (0.4-4.3) months, P=.038)], lower heart rate (HR) before NIV began (176.3+/-19.1 vs. 160.4+/-9.7 beats/minute, P=.010), lower HR decrease at hours 1 (-16.0+/-17.3 vs.+1.1+/-11.6, P=.005) and 12 (-31.5+/-19.7 vs. -0.75+/-12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000-0.664 and OR 0.896; 95% CI: 0.809-0.993, respectively). CONCLUSIONS: NIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour.

[Preliminary clinical experience with PiCCO system in children with shock]. / Experiencia clínica de monitorización hemodinámica del shock mediante el sistema PiCCO.

PURPOSE: To evaluate the PiCCO hemodynamics monitor in terms of clinical usefulness in children with shock. METHODS: Prospective multicenter analytical study in children aged from one month to 18 years with shock admitted to five pediatric intensive care units. Measurements were made before and after three interventions: a) volume load; b) increases in vasoactive drugs; c) dosage changes of drugs that could lessen vascular resistance. Recorded parameters included thermodilution data, along with the usual hemodynamic parameters. RESULTS: A total of 120 measurements were performed on 35 patients: mean age 36 (2.6-156) months, mean weight 15 (5.8-72) kg. Shock etiology was septic in 37% of cases, cardiogenic in 26%, hypovolemic in 20% and neurogenic in 17%. No procedure related complication was noticed. Twenty-two volume challenges in 17 patients were registered. Volume load induced a significant intrathoracic blood volume index (ITBI) increase from 501(235-763) to 584 (418-810) ml/m(2), cardiac index (CI) 4.04 (2.58-6.25) to 4.48 (2.86-8.71) lmin-1m(2), and mean blood pressure from 74 (53-99) to 87 (59-112) mmHg. CI changes correlated with ITBI increase (r = 0.678, p = 0.001). 13 interventions to increase vasomotor tone were associated with an increase in contractility of 18% in systemic vascular resistance index (SVRI). CONCLUSIONS: Hemodynamic monitoring with the PiCCO system is feasible and seems safe in children with shock. PiCCO derived parameters could add clinically important information to assess preload state and its modifications with therapy.

Cranial nerve disorders: clinical manifestations and topography. / Sintomatología derivada de los pares craneales: Clínica y topografía.

The detection of pathological conditions related to the twelve cranial pairs represents a significant challenge for both clinicians and radiologists; imaging techniques are fundamental for the management of many patients with these conditions. In addition to knowledge about the anatomy and pathological entities that can potentially affect the cranial pairs, the imaging evaluation of patients with possible cranial pair disorders requires specific examination protocols, acquisition techniques, and image processing. This article provides a review of the most common symptoms and syndromes related with the cranial pairs that might require imaging tests, together with a brief overview of the anatomy, the most common underlying processes, and the most appropriate imaging tests for different indications.

Biochar reduces the efficiency of nitrification inhibitor 3,4-dimethylpyrazole phosphate (DMPP) mitigating N2O emissions.

Among strategies suggested to decrease agricultural soil N2O losses, the use of nitrification inhibitors such as DMPP (3,4-dimethylpyrazole phosphate) has been proposed. However, the efficiency of DMPP might be affected by soil amendments, such as biochar, which has been shown to reduce N2O emissions. This study evaluated the synergic effect of a woody biochar applied with DMPP on soil N2O emissions. A incubation study was conducted with a silt loam soil and a biochar obtained from Pinus taeda at 500 °C. Two biochar rates (0 and 2% (w/w)) and three different nitrogen treatments (unfertilized, fertilized and fertilized + DMPP) were assayed under two contrasting soil water content levels (40% and 80% of water filled pore space (WFPS)) over a 163 day incubation period. Results showed that DMPP reduced N2O emissions by reducing ammonia-oxidizing bacteria (AOB) populations and promoting the last step of denitrification (measured by the ratio nosZI + nosZII/nirS + nirK genes). Biochar mitigated N2O emissions only at 40% WFPS due to a reduction in AOB population. However, when DMPP was applied to the biochar amended soil, a counteracting effect was observed, since the N2O mitigation induced by DMPP was lower than in control soil, demonstrating that this biochar diminishes the efficiency of the DMPP both at low and high soil water contents.

Ubiquitin-independent degradation of p53 mediated by high-risk human papillomavirus protein E6.

In vitro, high-risk human papillomavirus E6 proteins have been shown, in conjunction with E6-associated protein (E6AP), to mediate ubiquitination of p53 and its degradation by the 26S proteasome by a pathway that is thought to be analogous to Mdm2-mediated p53 degradation. However, differences in the requirements of E6/E6AP and Mdm2 to promote the degradation of p53, both in vivo and in vitro, suggest that these two E3 ligases may promote p53 degradation by distinct pathways. Using tools that disrupt ubiquitination and degradation, clear differences between E6- and Mdm2-mediated p53 degradation are presented. The consistent failure to fully protect p53 protein from E6-mediated degradation by disrupting the ubiquitin-degradation pathway provides the first evidence of an E6-dependent, ubiquitin-independent, p53 degradation pathway in vivo.

The effect of cattle slurry electroflotation products as fertilizers on gaseous emissions and grassland yield.

The climatic conditions of the Basque Country (northern Spain) provide the favorable conditions for the growth of grasslands and the development of livestock enterprises. The intensification of the farms is leading to serious environmental risks due to the great generation of manures and slurries and their subsequent inefficient management. Their application involves N losses that can be pollutant. The environmental company ADE BIOTEC S.L. is developing the process called "electroflotation" with the aim of reducing the volume of slurries from intensive livestock farms. The process consists basically of an electrolysis of the slurry catalyzed by iron which leads to the flocculation of the solid particles, giving as a final result a solid and a liquid fraction. The objective of this work was to assess the usefulness of these two fractions as fertilizers. With this aim, the environmental risk of their application was determined regarding gaseous emissions to the atmosphere (i.e., of NO, NH(3), N(2)O, and CO(2)) and their fertilizer capacity was investigated by determining their effects on grassland yield and N uptake in comparison to the untreated slurry. The untreated slurry and the solid and the liquid fractions were all applied at a rate of 70 kg NH(4)(+)-N ha(-1). The application of the products of electroflotation did not affect N(2)O and CO(2) losses, being of the same magnitude as those caused by the application of the original slurry. However, after their application, a reduction in NH(3) volatilization losses was induced in the short term and a reduction in NO losses was caused in the long term. The solid and liquid fractions both increased biomass yield with respect to the untreated slurry. The solid fraction even induced a higher N uptake than the liquid fraction and the untreated slurry.

Data quality of animal health records on Swiss dairy farms.

High-quality data are essential for veterinary surveillance systems, and their quality can be affected by the source and the method of collection. Data recorded on farms could provide detailed information about the health of a population of animals, but the accuracy of the data recorded by farmers is uncertain. The aims of this study were to evaluate the quality of the data on animal health recorded on 97 Swiss dairy farms, to compare the quality of the data obtained by different recording systems, and to obtain baseline data on the health of the animals on the 97 farms. Data on animal health were collected from the farms for a year. Their quality was evaluated by assessing the completeness and accuracy of the recorded information, and by comparing farmers' and veterinarians' records. The quality of the data provided by the farmers was satisfactory, although electronic recording systems made it easier to trace the animals treated. The farmers tended to record more health-related events than the veterinarians, although this varied with the event considered, and some events were recorded only by the veterinarians. The farmers' attitude towards data collection was positive. Factors such as motivation, feedback, training, and simplicity and standardisation of data collection were important because they influenced the quality of the data.

[Low-grade collecting duct carcinoma of the kidney in a patient treated by dialysis]. / Carcinoma renal de los conductos colectores de bajo grado en un paciente en tratamiento con hemodiálisis.

Patient treated by dialysis for end-stage renal disease are at increased risk of many cancers, especially those of kidney and urinary tract. A 56 years old man who undergoing chronic dialysis, presented in ultrasonography a 2 cm complex cystic mass in the left kidney what was confirmed by computed tomography and magnetic resonance. A laparoscopic left nephrectomy was performed. Histological examination showed a low grade collecting duct carcinoma of the kidney. An infrequent variant of kidney tumor.

Delivery of replication-competent retrovirus expressing Escherichia coli purine nucleoside phosphorylase increases the metabolism of the prodrug, fludarabine phosphate and suppresses the growth of bladder tumor xenografts.

We have developed unique replication-competent retroviral (RCR) vectors based on murine leukemia virus that provide improved efficiency of viral delivery, allow for long-term transgene expression and demonstrate an intrinsic selectivity for transduction of rapidly dividing tumor cells. The purpose of this study was to evaluate the in vivo transduction efficiency and the therapeutic efficacy of the RCR vector mediated delivery of Escherichia coli purine nucleoside phosphorylase (PNP) in combination with fludarabine phosphate for bladder cancer. We constructed vectors containing green fluorescent protein (GFP) gene (ACE)-GFP) or PNP gene (ACE-PNP). KU-19-19 bladder tumors exhibited 28.3+/-16.1, 46.6+/-5.8 and 93.7+/-7.8% of GFP expression on 14, 18 and 26 days after intratumoral injection of ACE-GFP, respectively. GFP expression could not be observed in normal tissues surrounding the injected tumors. No detectable polymerase chain reaction products of GFP gene could be observed in any distant organs. Intratumoral injection of ACE-PNP, followed by systemically administered fludarabine phosphate, significantly inhibited the growth of pre-established KU-19-19 tumors. Our results indicate that RCR vectors are a potentially efficient gene delivery method and that the RCR vector mediated PNP gene transfer and fludarabine phosphate treatment might be a novel and potentially therapeutic modality for bladder cancer.

[Methodological aspects of integrated care pathways]. / Aspectos metodológicos de los procesos asistenciales integrados (PAI).

An Integrated Healthcare Pathway (PAI) is a tool which has as its aim to increase the effectiveness of clinical performance through greater coordination and to ensure continuity of care. PAI places the patient as the central focus of the organisation of health services. It is defined as the set of activities carried out by the health care providers in order to increase the level of health and satisfaction of the population receiving services. The development of a PAI requires the analysis of the flow of activities, the inter-relationships between professionals and care teams, and patient expectations. The methodology for the development of a PAI is presented and discussed in this article, as well as the success factors for its definition and its effective implementation. It also explains, as an example, the recent PAI for Hypoglycaemia in patients with Type 2 Diabetes Mellitus developed by a multidisciplinary team and supported by several scientific societies.