Percepciones, reflexiones y aprendizajes de estudiantes de Medicina sobre una experiencia de tres años de Educación Basada en la Comunidad / Perceptions, reflections and learnings of Medicine students about a three-year experience of community-based education

Introducción: la Educación Basada en la Comunidad (EBC) representa una estrategia educativa que acerca la formación médica a la práctica real, y promueve una atención médica de mayor aceptabilidad que contempla la esfera social de los procesos de salud/enfermedad y aborda de forma adecuada las necesidades reales de la población. Existen, a la fecha, escasas publicaciones a nivel regional en las cuales los propios estudiantes reflexionen sobre este tipo de experiencias formativas. Objetivos: identificar y comunicar los principales aprendizajes obtenidos de una experiencia de EBC por parte de estudiantes de grado de Medicina. Metodología: se revisaron las sistematizaciones de experiencias confeccionadas por la primera cohorte que completó esta experiencia en el Instituto Universitario del Hospital Italiano de Buenos Aires. Se reflexionó sobre las principales dificultades observadas y los aprendizajes más significativos obtenidos a partir de dicha experiencia. Se establecieron dominios y codificaron los textos de las sistematizaciones generadas durante la cursada. Finalmente, se generó un mapa de conceptos a partir del cual se escribió este artículo. Resultados: esta experiencia tuvo para los estudiantes tres momentos bien definidos: una etapa inicial, caracterizada por incertidumbre y malestar; una intermedia, con aprendizaje estratégico y algo de transformación; y una avanzada, con aprendizaje profundo y situado. Conclusión: es recomendable que a las experiencias de EBC se les asigne el tiempo suficiente en las planificaciones y que finalicen con un proceso de reflexión promovido por el equipo docente. (AU)

Introduction: Community-Based Education (CBE) represents an educational strategy that brings medical training closer to real scenario practice, and promotes medical care of greater acceptability that contemplates the social sphere of health/disease processes and that adequately addresses the real needs of the population. To date, there are few publications at the regional level in which the students themselves reflect on this type of training experience. Objectives: to identify and communicate the main lessons learned from a CBE experience by Medicine-degree students.Methodology: the systematization of experiences made by the first cohort that completed this experience at the Instituto Universitario del Hospital Italiano de Buenos Aires was reviewed. We reflected on the main difficulties observed and the most significant lessons learned from this experience. Domains were established, and the texts of the systematization generated during the course were codified. Then, a concept map was generated from which this work was written. Results: this experience had three well-defined moments for the students: an initial stage, characterized by uncertainty and discomfort; an intermediate one, with strategic learning and some transformation; and an advanced one, with deep and situated learning. Conclusion: it is recommended that EBC experiences are assigned enough time in the planning and that they end with a reflection process promoted by the teaching team. (AU)

Glenoid version: the role of genetic and environmental factors on its variability. An MRI study on asymptomatic elderly twins.

BACKGROUND: Glenoid version is the most variable parameter of the shoulder joint. No authors investigated if intrinsic genetic factors or influences from extrinsic sources are responsible for its variability. AIM: We compared glenoid version between elderly monozygotic and dizygotic twins intending to separate the contributions of genetics from shared and unique environments. METHODS: Glenoid version of the dominant shoulder was assessed by MRI using Friedman's method in 30 pairs of elderly twins (16 monozygotic-14 dizygotic; mean age ± SD: 63.72 ± 3.37, 53-72). Heritability was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment was calculated as the difference between monozygotic correlation coefficient and the heritability index. According to job category, one way analysis of variance was used to estimate the differences between groups in the total sample and within zygosity groups. RESULTS: Glenoid version angle in monozygotic and dizygotic twins was -2° (SD: 2°) and -3° (SD: 3°), respectively (p = 0.334). Heritability index was 0.98, while the contributions of shared and unique environment were 0 and 0.02, respectively. According to working classes, no significant differences were found between the groups (p = 0.732, F = 0.31). CONCLUSIONS: Glenoid version is mainly genetically determined and only marginally influenced by environments.Level of evidence: III.

Epidemiology of rotator cuff surgery in Italy: regional variation in access to health care. Results from a 14-year nationwide registry.

PURPOSE: Rotator cuff (RC) disease is frequent and represents a common source of shoulder pain. The aim of this study is to analyse geographical differences in RC surgeries from 2001 to 2014 in Italy, a country with universal and free health care for its population. METHODS: An analysis of the Italian National Hospital Discharge records from 2001 to 2014 was performed. These data are anonymous and include patient's age, sex, domicile, region of hospitalization, length of the hospitalization and type of reimbursement (public or private). National and regional population data were obtained from the National Institute for Statistics (ISTAT) for each year. RESULTS: During the 14-year study period, 390,001 RC repairs were performed in Italy, which represented a mean incidence of 62.1 RC procedures for every 100,000 Italian inhabitants. Nevertheless, the incidence was very different if every single regional population is considered individually. Lombardy resulted to have the highest number of surgeries during the 14-year study period, with 27.95% (108,954) of the total national procedures performed in the 2001-2014 time span. More than half the surgeries (52.00%) were performed in only 3 regions of the northern part of Italy. CONCLUSIONS: This study shows the existence of geographical disparities in access to RC surgery and patients' necessity to migrate among regions in order to obtain it. Southern regions of Italy are characterized by a lower number of surgeries compared to the northern part of Italy.

Shoulder adhesive capsulitis and hypercholesterolemia: role of APO A1 lipoprotein polymorphism on etiology and severity.

PURPOSE: Relationship between shoulder adhesive capsulitis (AC) and hypercholesterolemia is known. The connecting link might be represented by the correlation between HDL and transforming growth factor beta (TGF-ß): normally, HDLs stimulate TGF-ß expression; the latter is employed in the development of fibrous tissue. We assess whether the presence of the Apo-A1-G75A-polymorphism, which is correlated to an enhanced HDL function, could be a risk factor for the genesis and severity of AC. METHODS: Peripheral blood samples of 27 patients [7M; 20F, mean age 54.81 (41-65)] with AC and hypercholesterolemia were submitted to polymerase chain reaction in order to evaluate the Apo-A1-G75A-polymorphism. Genome database was used as control. Two categories were obtained according to AC severity: type I (active forward flexion ≥ 100°) and type II (< 100°). Data were submitted to statistics. RESULTS: The prevalence of Apo-A1-G75A-polymorphism in the studied group and in the control group was 22.2% (10AG; 1AA; 16GG) and 19% (OR 1.22, IC 0.59-2.53, p > 0.05), respectively. Patients with type I and II capsulitis were 11 [flexion 148.0° (range 100°-165°)] and 16 [flexion 82.5° (range 50°-95°)], respectively. The prevalence of Apo-A1-G75A in type I was 18.1% (2AG; 9GG) and in type II was 56.3% (8GA; 1AA; 7GG), respectively (RR 1.87, IC 1.005-3.482, p < 0.05). CONCLUSIONS: Apo-A1-G75A-polymorphism is not necessary for the genesis, but it is a risk factor for severity of AC. LEVEL OF EVIDENCE: III.

Rotator cuff degeneration of the healthy shoulder in patients with unilateral arm amputation is not worsened by overuse.

PURPOSE: In order to evaluate whether overuse has a significant role in rotator cuff tear (RCT) aetiology, we evaluated both shoulders of patients with old unilateral arm amputation expecting a higher rate of RC degeneration in the healthy side. METHODS: Nineteen males and six females (mean age: 57.3 ± 10.1) with an old (>20 years) unilateral arm amputation were submitted to an MRI of both shoulders. Tendon status and muscle tropism were evaluated according to Sugaya and Fuchs classifications, respectively; the acromion humeral distance was measured. Statistical analysis was performed to verify the prevalence of Sugaya and Fuchs categories in each sides. RESULTS: A significant prevalence of Sugaya type II in the amputated side (p = 0.02) and of type I in the healthy side (p < 0.001) was found. Rotator cuff was healthy in 28 and 52% of amputated and non-amputated side, respectively. The mean acromio-humeral distances of the amputated and healthy side were 0.8 cm (SD: 0.1) and 0.9 cm (SD: 0.1), respectively, (p = 0.02). A significant prevalence of Fuchs type II category in the healthy side (p < 0.001) was found. Fuchs III/IV were observed in 40 and 12% of amputated and healthy side, respectively. CONCLUSIONS: The present study resizes the role of overuse on the aetiology of RCT. Cuff tear prevalence in not amputated shoulders, inevitably submitted to functional overload, was not higher than that of coetaneous subjects with two functional upper limbs. Shoulder non-use is a risk factor for rotator cuff tear. As the prevalence of rotator cuff degeneration/tear is higher in the amputee side, non-use is a more relevant risk factor than overuse. In the daily clinical practice, patients with rotator cuff tear should be encouraged to shoulder movement because rotator cuff tendon status could be worsened by disuse. LEVEL OF EVIDENCE: III.

Anterior cruciate ligament reconstruction in skeletally immature patients : a systematic review.

AIMS: Different methods of anterior cruciate ligament (ACL) reconstruction have been described for skeletally immature patients before closure of the growth plates. However, the outcome and complications following this treatment remain unclear. The aim of this systematic review was to analyse the outcome and complications of different techniques which may be used for reconstruction of the ACL in these patients. MATERIALS AND METHODS: We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This involved a comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using the following combinations of keywords, "knee", "anterior cruciate ligament", "reconstruction", "injury", "children", "adolescent", "skeletally immature", "open physis" and "surgery". RESULTS: A total of 53 studies met the inclusion criteria and were included for analysis. The overall rate of disturbance of growth after ACL reconstruction was 2.6%, with no statistical difference between transphyseal and physeal-sparing techniques. Physeal-sparing techniques had a lower rate of post-operative complications compared with transphyseal techniques (p = 0.0045). Outcomes assessed were Lysholm score, International Knee Documentation Committee (IKDC) score, the IKDC grade, the Tegner score and the KT-1000. Both techniques had similar clinical outcomes. CONCLUSIONS: This review reveals low rates of disturbance of growth after ACL reconstruction in skeletally immature patients. Although limited, the available evidence did not support any particular surgical technique when considering disturbance of growth or clinical outcome. Further randomised controlled trials are needed to investigate the efficacy of differing surgical techniques on outcomes in skeletally immature patients. Cite this article: Bone Joint J 2017;99-B:1053-60.

Adhesive capsulitis of the shoulder: pain intensity and distribution.

PURPOSE: Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. METHODS: The study group was composed of 278 (133M-145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. RESULTS: Intensity of shoulder pain caused by AC was higher in females (p < 0.05); it did not vary with the side and between patient younger and older than 55 years. Patients whose pain arose from more than 3 months suffered a lower intensity of shoulder pain. Furthermore, pain intensity was higher in the most severe form of AC (active forward flexion < 60°) (p < 0.05). Pain was localized predominantly on the anterior aspect of the shoulder (dermatomes C5-C6) and rarely extended beyond the distal third of the arm. No differences were found in pain distribution between male and female, between patients with pain from less or more than 3 months and between different levels of AC severity (p > 0.05). CONCLUSION: Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third. LEVELS OF EVIDENCE: Level IV.

Sleep quality and disturbances in patients with different-sized rotator cuff tear.

INTRODUCTION: The literature is unanimous in saying that shoulder pain, due to rotator cuff tear (RCT), may be mostly at night; to our knowledge, this statement is not supported by scientific evidence. Our aim was to investigate sleep quality and disturbances in patient with RCT and in a control group. MATERIALS AND METHODS: A case-control design study was used. We enrolled 324 consecutive patients (Group A) (156M-168F, mean age ± SD: 64.94 ± 6.97; range 47-74) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group (Group B) included 184 subjects (80M-104F, mean age ± SD = 63.34 ± 6.26; range 44-75) with no RCT. All participants were submitted to two standardized self-reported questionnaires evaluating sleep quality and disturbances: the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Data were submitted to statistics. RESULTS: We found no significant differences between the two groups according to both PSQI (Group A: 5.22 ± 2.59; Group B: 5.21 ± 2.39) and ESS (Group A: 2.59 ± 2.54; Group B: 5.76 ± 2.63), p > 0.05. Patients with small tears had average PSQI and ESS higher than patients with large and massive lesions (p < 0.005). Pearson's test showed that tear severity was negatively correlated with both sleep latency (r 2 = -0.35, ß = 0.069, p < 0.005) and sleep disturbances (r 2 = -0.65, ß = 0.053, p < 0.001). CONCLUSIONS: RCT is only one of the responsible causes for sleep disturbance in middle-aged and elderly subjects. Patients with small tears have a poorer sleep quality with respect to those with a more severe tear; particularly, they not only take more time to fall asleep, but also have a more disturbed sleep compared to patients with large and massive tears. LEVEL OF EVIDENCE: III.

Acromioclavicular joint cyst in ASA 3-4 patients.Whether and how quickly it recurs after aspiration and steroid injection.

We observed the clinical course, in the short-medium term, of patients with voluminous type II acromio-clavicular (AC) joint cyst who underwent aspiration and steroid injection regarded as the only possible treatment to avoid possible skin complications. Four patients (7.4% of cases described in literature) (3F-1M ; mean age 83 years, range : 78-87 years) with a voluminous ( > 7 cm) oval, no mobile, no fluctuant cyst overlying the AC joint, were retrospectively observed. The patients, judged by the anesthesiologist as ASA 3-4 patients, were merely submitted to cyst aspiration and steroid injection. The content of the cyst was microscopically analysed. All patients were clinically evaluated on the day of aspiration and after 14-30 days and after 1 year. Shoulder function and pain intensity were analysed with Constant score and VAS. We were able to aspirate 80-150 ml of amorphous joint fluid. At the first follow-up, all patients had a recurrence of the cyst, a lower grade of tension of the skin overlying the cyst and also a very little decreasing of pain intensity. After a month from aspiration, the cysts of the 4 patients had the same size as that present before aspiration. The range of motion, the average value of VAS and Constant were similar to those recorded before aspiration. In no case signs of infection or draining sinus occurred. Aspiration is a useless practice. However it is still a motive for discussion if the reduced suffering of the skin overlying the cyst after the aspiration has avoided, or simply postponed, an imminent complication.

Hertel 7 fracture of the humeral head. Can two different fixation systems (Diphos/PHP) lead to different outcomes? A retrospective study.

OBJECTIVE: To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 humeral head fractures treated with two different locking plates. MATERIALS AND METHODS: A total of 52 patients with type 7 humeral head fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded. RESULTS: The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p>0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p>0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the humeral head in each group, and a secondary screw perforation in a patient treated with Diphos. CONCLUSIONS: In patients with Hertel 7 proximal humeral fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of fracture.

Deltoid muscle tropism does not influence the outcome of arthroscopic rotator cuff repair.

BACKGROUND: Several different factors have been identified as causes of failure of rotator cuff (RC) repair. However, no studies focused on the role of the deltoid muscle. The aim of this study was to investigate the role of the deltoid tropism in the outcomes of arthroscopic RC repair procedures. MATERIALS AND METHODS: Nine male (45 %) and 11 female (55 %) patients who underwent arthroscopic RC repair were included in the study. The mean age was 63.5 ± 8.1 years (range 50-74 years), and the follow-up averaged 1.9 ± 1.3 years (range 1-5 years) after surgery. Clinical outcomes were assessed using the modified University of California, Los Angeles (UCLA) shoulder rating scale, Wolfgang criteria shoulder score and Oxford shoulder score (OSS). Functional outcomes were evaluated considering active and passive range of motion of the shoulder and muscle strength. The deltoid tropism was measured pre-operatively and post-operatively using T2-weighted transverse MRI images. RESULTS: No statistically significant correlation was found between the thickness of each portion of the deltoid muscle (vD, lD and dD) and the UCLA shoulder rating scale, Wolfgang shoulder score and OSS. At the same time, no statistically significant relationship was detected between the thickness of each portion of the deltoid muscle (vD, lD and dD) and the functional outcomes. CONCLUSIONS: The deltoid tropism does not influence the results of arthroscopic RC repair. Early RC repair may prevent the reduction in the tropism of the deltoid muscle. Nevertheless, further prospective randomized studies with larger samples are necessary to clarify the role of deltoid tropism in the outcomes of arthroscopic RC repair procedures.

Subacromial Space Width: Does Overuse or Genetics Play a Greater Role in Determining It? An MRI Study on Elderly Twins.

BACKGROUND: Age and peripheral microcirculation disorders are the main causes of rotator cuff degeneration. Acromion variants may affect subacromial space width, causing a pathological narrowing of the space that may compromise the cuff integrity. However, it is not clear if the subacromial space width is genetically determined or if it changes according to loading conditions. To clarify this unresolved question, we performed an MRI (magnetic resonance imaging) study with the aim of evaluating the acromiohumeral distance in a group of elderly monozygotic and dizygotic twins, and we analyzed the obtained data using the twin design to separate the contributions of shared and unique environments. METHODS: We identified twenty-nine pairs of elderly twins. On MRI scans, we evaluated the acromiohumeral distance and health status of the rotator cuff tendons. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, due to environmental factors that contribute to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. One-way ANOVA (analysis of variance) was used to estimate the differences among job categories, both in the total cohort and within zygosity groups. RESULTS: The intraclass correlation coefficient was substantially higher for monozygotic than for dizygotic twins, indicating a high degree of concordance of the acromiohumeral distance in pairs of individuals who shared 100% of their genes. The heritability index was 0.82, and shared and unique environmental contributions were both 0.09. There were no significant differences among subjects in different job categories, either in the total cohort (p = 0.685) or within the monozygotic (p = 0.719) and dizygotic groups (p = 0.957). CONCLUSIONS: The acromiohumeral distance is mainly genetically determined and only marginally influenced by external factors.

Does immobilization position after arthroscopic rotator cuff repair impact work quality or comfort?

PURPOSE: The purpose of this study was to quantify subjective discomfort and decrease in working performance in patients submitted to arthroscopic rotator cuff repair. METHODS: We enrolled 101 asymptomatic administrative employees (mean age 55). Subjects were asked to write a text using Microsoft Word and to make a table using Microsoft Excel, with and without shoulder braces which kept the right shoulder in neutral (brace A) and internal rotation (brace B). Total time needed to complete the tests and number of mistakes committed were annotated. Furthermore, a questionnaire to assess the subjective and interpersonal discomfort caused by the braces was compiled. Data were submitted to statistical analysis. RESULTS: When any brace is worn, both times and mistakes are higher than those registered without brace (p < 0.02). Both times and mistakes are higher for brace B in comparison with brace A (p < 0.02). Subjects wearing brace B had a severe/very severe discomfort degree three times higher than that registered in subjects wearing brace A. Finally, 91 % of subjects preferred brace A to brace B. DISCUSSION: If the choice of the brace is not supported by biological or clinical advantages, we recommend to use the brace that keeps the arm at the side, since it ensures better working performance and lower discomfort. It also received the greatest satisfaction of the respondents. LEVEL OF EVIDENCE: IV.

The impact of aging on rotator cuff tear size.

INTRODUCTION: The aim of our study was to establish if aging influences rotator cuff tear size. PATIENTS AND METHODS: We studied 586 consecutive patients (280 M, 306 F) mean age 59 years old (range 46-73) who underwent arthroscopic rotator cuff repair. Tear size was determined during surgery. For the purpose of our study, patients were divided into two groups based on age older than 60 years. A multinomial logistic regression model was applied to explore the association between age older than 60 years and tear size. We used the ANCOVA method to determine whether the aging influences the severity of the tear. All analyses were adjusted for gender. RESULTS: Age older than 60 years was associated with a twofold higher overall risk of tear occurrence (OR = 2.12, 95 % CI 1.44-3.01). While no association was detected between age older than 60 years and the probability of a small tear (OR = 0.58, 95 % CI 0.27-1.07), subjects older than 60 years were twice more likely to experience a large tear (OR = 2.29, 95 %CI 1.51-3.27) and three times more likely to experience a massive tear (OR = 3.09, 95 % CI 2.07-5.38) as opposed to younger subjects. Mean age significantly increased from small tear (53.8 years) to large tear (66.8 years) to massive tear (69.4 years) patients (ANCOVA: F(2, 437) = 16.487, p = 1.51 × 10(-7)). DISCUSSION: We found a significantly older mean age in patients with a more severe tear. Our data provide and confirm evidence that aging is a significant risk factor for the occurrence and severity of rotator cuff tears.

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

Characterization of a Pinus pinaster cDNA encoding an auxin up-regulated putative peroxidase in roots.

As part of a study to identify host plant genes regulated by fungal auxin during ectomycorrhiza formation, we differentially screened a cDNA library constructed from roots of auxin-treated Pinus pinaster (Ait.) Sol. seedlings. We identified three cDNAs up-regulated by auxin. Sequence analysis of one of these cDNAs, PpPrx75, revealed the presence of an open reading frame of 216 amino acids with the characteristic consensus sequences of plant peroxidases. The deduced amino acid sequence showed homology with Arabidopsis thaliana (L.) Heynh., Arachis hypogaea L. and Stylosanthes humilis HBK cationic peroxidases. Amino acid sequence identities in the conserved domains of plant peroxidases ranged from 60 to 100%. In PpPrx75, there are five cysteine residues and one histidine residue that are found at conserved positions among other peroxidases. A potential glycosylation site (NTS) is present in the deduced sequence. Phylogenetic analysis showed that PpPrx75 is closely related to two A. thaliana peroxidases. The PpPrx75 cDNA was induced by active auxins, ethylene, abscisic acid and quercetin, a flavonoid possibly involved in plant-microorganism interactions. Transcript accumulation was detected within 3 h following root induction by auxin, and the amount of mRNA increased over the following 24 h. The protein synthesis inhibitor cycloheximide did not inhibit indole-3-acetic acid-induced transcript accumulation, suggesting that PpPrx75 induction is a primary (direct) response to auxin. This cDNA can be used to study expression of an auxin-regulated peroxidase during ectomycorrhiza formation.

Characterization of an Aux/IAA cDNA upregulated in Pinus pinaster roots in response to colonization by the ectomycorrhizal fungus Hebeloma cylindrosporum.

• In an attempt to determine whether fungal auxin affects host plant gene expression during mycorrhizal formation, an auxin upregulated cDNA, Pp-iaa88, was isolated by differential screening of a cDNA library made from auxin-treated Pinus pinaster roots. • Pp-iaa88 codes for a polypeptide that shares extensive homology to auxin-inducible Aux/IAA proteins, which are supposed to act as transcription factors. Cycloheximide did not inhibit auxin-induced mRNA accumulation, indicating that Pp-iaa88 upregulation is a primary (direct) auxin response. • The level of Pp-iaa88 transcripts in roots increased following inoculation with either an indoleacetic acid-overproducing mutant or a wild-type strain of the ectomycorrhizal fungus Hebeloma cylindrosporum. With both strains, mRNA accumulation was detectable as soon as fungal hyphae reached the root and it increased during differentiation of symbiotic structures. The kinetics of Pp-iaa88 transcript accumulation was closely connected with the dynamics of symbiosis establishment and was more rapid with the mutant than with the wild-type strain. • As a putative transcription factor expressed at the very early stages of symbiosis establishment, Pp-iaa88 could play a key role in mycorrhizal formation.

Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients. CREED Investigators. Cardiovascular Risk Extended Evaluation in Dialysis patients.

AIM: To investigate the relationship between carotid atherosclerosis and some major cardiovascular risk factors in uremic patients on chronic dialysis. METHODS: A cross-sectional study was carried out in 119 unselected dialysis patients (89 on hemodialysis and 30 on chronic ambulatory peritoneal dialysis, CAPD). Fasting blood sampling for serum lipids, albumin, hemoglobin, and echo-colour-Doppler evaluation of common carotid arteries were performed in all patients (during the non-dialysis day in hemodialysis patients). In hemodialysis patients BP was measured before and after dialysis; in CAPD patients home BP values were recorded during the month before the study day. RESULTS: Ninety-five patients had at least one plaque and 57 had at least four plaques. Thirty-eight had mild and eleven severe carotid stenosis. In multiple regression models, the mean internal diameter of carotid arteries was explained (R=0.52, P=0.0001) by systolic pressure (r=0.39), serum cholesterol (r=-0.28), age (r=0.27) and smoking (r=0.24) while the degree of carotid stenosis was predicted (R=0.39, P=0.0001) by age (r=0.36) and smoking (r=0.25). The number of atherosclerotic plaques was explained (R=0.51, P=0.0001) by age (r=0.36), smoking (r=0.25) and pulse pressure (r=0.20), serum albumin just failing to reach statistical significance (P = 0.06). However, serum albumin was a significant and independent predictor of the number of atherosclerotic plaques (r=-0.26) in hemodialysis patients (n=89). Sex, diabetes, Kt/V, duration of dialysis treatment, hemoglobin, serum calcium and phosphate did not add any predictive power to the models. CONCLUSIONS: In dialysis patients arterial pressure and smoking are associated with carotid atherosclerosis. Serum albumin appears to serve as an independent predictor of carotid atherosclerosis.

Isolated partial tear of subscapularis muscle in a competitive water skier. A case report.

Partial tears of the subscapularis tendon associated with anterior shoulder dislocation, are frequently described while the isolated lesions of this tendon are quite rare. We report the case of a 33 years old water-skier who injured his right subscapularis muscle during a forced movement of adduction and internal rotation. Ultrasound evaluation and then MRI were used to depict the entity of the lesion. The ruptured tendon was surgically repaired using a MITEK anchor system. Four months after surgery, the athlete returned back to his full athletic activity.

[Renal volumetric echography in the newborn infant with an agenetic, dysplastic or obstructive contralateral kidney]. / Volumetría ecográfica renal en el recién nacido con riñón contralateral agenésico, displásico u obstructivo.

In newborn babies with congenital renal pathology type agenesia, dysplasia or obstruction is very important to know if there is intrautero vicariant growing of the contralateral kidney. To find out that we have proceeded to be ultrasound volume measurement of the normal renal unit, as this is a valuable parameter related to compensatory mechanisms. We have studied by ultrasounds 28 renal units (16 right, 12 left) in newborns with contralateral pathology: pyeloureteral stenosis in 10 cases, multicystic kidney in 13 cases, renal agenesia in 3 cases, obstructive ureterocele in 1 case and another one with ureterovesical stenosis. We considered renal function, length of the larger renal axis width and depth of the kidney mass. Renal function was normal in all cases. Analysis of objectives results show a clear difference between the volume of normal Kidneys in children with contralateral pathology and the control group constituted by 42 renal unit in normal newborns without urological pathology. We conclude with the real evidence of compensatory growing of the normal contralateral kidney during intrautero periods.