Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center.

BACKGROUND: Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. METHODS: A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. RESULTS: A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. CONCLUSIONS: Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with less bleeding, and no difference in the number of complications. This procedure lowers costs by decreasing the duration of the hospital stay, making is feasible to perform it at any institution with appropriately trained personnel.

The Wnt1 ligand/Frizzled 3 receptor system plays a regulatory role in the achievement of the 'in vitro' capacitation and subsequent 'in vitro' acrosome exocytosis of porcine spermatozoa.

The aim of this work was to determine the existence of a functional Wnt/ß-catenin signaling pathway in boar spermatozoa, which would be linked with the already well-known GSK-3 signaling pathway. This was first confirmed by detecting the presence of the specific Frizzled 3 receptor in these cells. Furthermore, this signaling pathway was activated in boar spermatozoa subjected to 'in vitro' capacitation (IVC) and subsequent progesterone-induced 'in vitro' acrosome exocytosis (IVAE) by incubating cells with separate concentrations of Wnt1 ligand, the Wnt/ß-catenin signaling pathway-specific effector. Incubation with the Wnt1 ligand increased the rhythm of the time-dependent reduction in sperm viability during the achievement of both IVC and IVAE. This finding was concomitant with an increase in the percentage of spermatozoa with altered membrane fluidity and permeability determined through both merocyanine-540 and YO-PRO-1 stains. While the Wnt1 ligand did not affect total sperm motility during the achievement of the IVC, it induced a fast and transient increase in the overall motility patterns in spermatozoa subjected to IVAE. This IVAE-linked action was related to a decrease in the percentage of cells with high mitochondrial membrane potential and an increase in the percentage of cells with high intracellular Fluo-3-marked Ca(2+) content. In conclusion, our results suggest that the Wnt1 ligand-modulated Wnt/ß-catenin signaling pathway plays a relevant role in the modulation of both IVC and subsequent, progesterone-induced IVAE. Furthermore, our data indicate that the transduction pathways by which the Wnt1 ligand acts on IVC and IVAE are different, and that the Wnt/ß-catenin pathway is independent from GSK-3 activity in the achievement of IVC.

Subcutaneous abatacept versus intravenous abatacept: a phase IIIb noninferiority study in patients with an inadequate response to methotrexate.

OBJECTIVE: To compare the efficacy and safety of subcutaneous (SC) and intravenous (IV) abatacept. METHODS: In this phase IIIb double-blind, double-dummy, 6-month study, patients with rheumatoid arthritis (RA) and inadequate responses to methotrexate were randomized to receive 125 mg SC abatacept on days 1 and 8 and weekly thereafter (plus an IV loading dose [∼10 mg/kg] on day 1) or IV abatacept (∼10 mg/kg) on days 1, 15, and 29 and every 4 weeks thereafter. The primary end point for determining the noninferiority of SC abatacept to IV abatacept was the proportion of patients in each group meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) at month 6. Other efficacy end points, immunogenicity, and safety were also assessed. RESULTS: Of 1,457 patients, 693 of 736 (94.2%) treated with SC abatacept and 676 of 721 (93.8%) treated with IV abatacept completed 6 months. At month 6, 76.0% (95% confidence interval 72.9, 79.2) of SC abatacept-treated patients versus 75.8% (95% confidence interval 72.6, 79.0) of IV abatacept-treated patients achieved an ACR20 response (estimated difference between groups 0.3% [95% confidence interval -4.2, 4.8]), confirming noninferiority of SC abatacept to IV abatacept. Onset and magnitude of ACR responses and disease activity and physical function improvements were comparable between the SC and IV abatacept-treated groups. The proportions of adverse events (AEs) and serious AEs over 6 months were 67.0% and 4.2%, respectively, in the SC abatacept-treated group and 65.2% and 4.9%, respectively, in the IV abatacept-treated group, with comparable frequencies of serious infections, malignancies, and autoimmune events between groups. SC injection site reactions (mostly mild) occurred in 19 SC abatacept (IV placebo)-treated patients (2.6%) and 18 IV abatacept (SC placebo)-treated patients (2.5%). Abatacept-induced antibodies occurred in 1.1% of SC abatacept-treated patients and 2.3% of IV abatacept-treated patients. CONCLUSION: SC abatacept provides efficacy and safety comparable with that of IV abatacept, with low immunogenicity and high retention rates, consistent with the established IV abatacept profile. Rates of injection site reactions were low. SC abatacept will provide additional treatment options, such as an alternative route of administration, for patients with RA.

A cDNA for nuclear-encoded chloroplast translational initiation factor 2 from a higher plant is able to complement an infB Escherichia coli null mutant.

Formation of the initiation translation complex containing the three initiation factors, IF1, IF2, and IF3, tRNA(fMet), and GTP constitutes the earliest event in the protein synthesis. IF2, a GTP-binding protein, is the principal factor involved in selecting and binding fMet-tRNA(fMet) to the 30 S ribosomal subunit. Although some chloroplast initiation translational factors have been identified and purified from algae, none of these factors have been characterized from plants. In this work, we report the molecular characterization of a nuclear-encoded chloroplastic IF2 gene from common bean (PvIF2cp). We show that the PvIF2cp gene encodes a protein containing a chloroplast translocation signal peptide, able to target a green fluorescent protein fusion protein to chloroplasts. A high accumulation of PvIF2cp transcript was found in photosynthetic tissues, whereas low mRNA levels were detected in etiolated plants and in nonphotosynthetic organs. Additional data indicate that the PvIF2cp transcript accumulation is modulated by light. The PvIF2cp gene encodes a functional factor, since the PvIF2cp conserved region, containing the G-domain and the C-terminal end, complements an Escherichia coli infB null mutation. Phylogenetic analysis using the PvIF2cp conserved region suggests that the PvIF2cp gene originated via endosymbiotic gene transfer to the nucleus and that it may be a useful marker for phylogeny reconstruction.

Trasplante renal: experiencia de un cuarto de siglo del servicio de urología del Hospital del Salvador, 1975-1999 / Renal transplant: 25 years experience of the urological service at Hospital del Salvador, 1975-1999

Presentamos nuestra experiencia de 406 trasplantes realizados por el Servicio de Urología y Nefrología del Hospital del Salvador entre los años 1975 y 1999, se analizaron en forma retrospectiva las complicaciones de 384 transplantes, realizados a 352 pacientes. La distribución de los transplantes fue de un 57,3 por ciento a pacientes de sexo masculino y 42,7 por ciento a pacientes de sexo femenino, con un promedio de edad de 38,1 años. La mayor parte de los órganos transplantados provinieron de donante cadáver (57,8 por ciento). La anastomosis venosa se realizó a la cava inferior en 41 por ciento de los casos, y a la ilíaca en un 59 por ciento. La anastomosis arterial fue de tipo término-terminal a la hipogástrica en un 63 por ciento y término lateral a la ilíaca en 37 por ciento de las unidades renales trasplantadas. En la mayor parte de los implantes ureterales se utilizó la técnica de Gregoire (92 por ciento) y en el resto Leadbetter-Politano al inicio del programa. Se presentaron 110 complicaciones de origen quirúrgico: las complicaciones urológicas (14,6 por ciento) fueron las de mayor frecuencia y dentro de ellas, la más importante fue la obstrucción ureteral. La incidencia de complicaciones vasculares fue de 5,7 por ciento, siendo la más frecuente la estenosis de la arteria renal. El linfocele que requirió tratamiento se presentó sólo en 12 pacientes (3,2 por ciento). A julio de 1999 el 77,8 por ciento de los riñones trasplantados están funcionantes. La causa más importante de perdida del injerto, fue la inmunológica (63 casos). Se analizan casuística y sus resultados

Three genes whose expression is induced by stress in Saccharomyces cerevisiae.

In this work we report the isolation and characterization of three genes induced by different stress conditions in the yeast Saccharomyces cerevisiae. These genes, named GRE1, GRE2 and GRE3, were identified by the differential display technique using total RNAs obtained from yeast grown under hyperosmotic conditions. Northern analysis of RNA obtained from different growth conditions shows that their corresponding transcripts accumulate not only in response to osmotic stress but also to ionic, oxidative and heat stress. Analysis of the deduced amino acid sequences indicated that GRE1, GRE2 and GRE3 correspond to ORFs YPL223C, YOL151W and YHR104W, respectively. Additionally, it suggested that GRE1 encodes a hydrophilic polypeptide that it is not homologous to any known protein but has features resembling the late embryogenesis abundant (LEA) proteins characterized in higher plants; GRE2 encodes a putative reductase with similarity to plant dihydroflavonol-4-reductases; and GRE3 codifies for a keto-aldose reductase highly related to fungal xylose-reductases. The three genes are induced in the late growth phases in agreement with the presence of PDS elements in their promoter regions. The three of them are under the control of the HOG pathway, even though GRE1 and GRE2 promoter regions do not present the consensus core STRE sequence. In addition, GRE1 and GRE3 are regulated negatively by the cAMP-PKA transduction pathway and positively by the transcriptional factors Msn2p and Msn4p. Gene disruptions of the GRE genes did not show a phenotype in any of the tested stress conditions.

Characterization of Phaseolus vulgaris cDNA clones responsive to water deficit: identification of a novel late embryogenesis abundant-like protein.

Six cDNA clones from Phaseolus vulgaris, whose expression is induced by water deficit and ABA treatment (rsP cDNAs) were identified and characterized. The sequence analyses of the isolated clones suggest that they encode two types of late-embryogenesis abundant (LEA) proteins, a class-1 cytoplasmic low-molecular-weight heat shock protein (lmw-HSP), a lipid transfer protein (LTP), and two different proline-rich proteins (PRP). One of the putative LEA proteins identified corresponds to a novel 9.3 kDa LEA-like protein. During the plant response to a mild water deficit (psi w = -0.35 MPa) all genes identified present a maximal expression at around 16 or 24 h of treatment, followed by a decline in expression levels. Rehydration experiments revealed that those genes encoding PRPs and LTP transiently re-induce or maintain their expression when water is added to the soil after a dehydration period. This is not the case for the lea genes whose transcripts rapidly decrease, reaching basal levels a few hours after rehydration (4 h). Under water deficit and ABA treatments, the highest levels of expression for most of the genes occur in the root, excluding the ltp gene whose maximum expression levels are found in the aerial regions of the plant. This indicates that for these genes, both water deficit and ABA-dependent expression are under organ-specific control. The data presented here support the importance of these proteins during the plant response to water deficit.

[Therapeutic efficacy of vaginal administration of bromocryptin in patients with hyperprolactinemia]. / Efectividad terapéutica de la bromocriptina (BEC) administrada por vía vaginal en pacientes con hiperprolactinemia.

Oral bromoergocriptine (BEC) is currently the treatment of choice in women with hyperprolactinemia secondary to a prolactinoma. However, undesirable side effects (of variable type and intensity) are frequently present in these women due to both local irritation and to a direct effect upon the central nervous system. The present work was undertaken as a pilot study to assess the therapeutic effectiveness of vaginally administered BEC and to corroborate if the side effects are less frequent and of minor intensity when compared to oral BEC. Initially, 16 women were included, but two of them did not accept to continue in the study; thus, a total of 14 women with hyperprolactinemia (> or = 40 ng/ml) were divided in two groups: Group A encompassed five women, aged 27 to 36 years old, two with normal menstrual cycles and three with oligomenorrhea; all had primary or secondary sterility during 3 to 12 years and galactorrhea from 6 months to 3 years; in only one patient a brain computerized axial tomography (CAT) was performed which showed the existence of a macroprolactinoma. All received oral BEC (2.5-5 mg/day, except one patient with 10 mg/day). Group B included nine women, aged 26 to 36 years old, four had normal menstrual cycles and five had oligomenorrhea; all had primary or secondary sterility during the last 2 to 7 years and eight out of nine, also had galactorrhea during 1 to 8 years; in four of them a CAT was performed showing a pituitary microadenoma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multifactorial analysis of the blood levels of LH, FSH and estradiol in relation to ovular harvesting rates, fertilization and segmentation in patients undergoing assisted reproduction (GIFT-FIVTE)]. / Análisis multifactorial de los niveles séricos de LH, FSH y Estradiol en relación a las tasas de captura ovular, fertilización y segmentación en pacientes de reproducción asistida (GIFT-FIVTE).

This study shows that there is certain tendency to asssign more value to the observation of follicular growth by ultrasound than to hormonal levels "per se". However, the appreciation of growth is only part of the phenomenon of development and ovarian maturity, for that, surveillance with hormonal monitor of ovarian response keeps with a most important role in Assisted Reproduction Clinica. The basal levels, mainly of FSH and in a less degree LH, inversely correlate with the amount of retrieved ovocytes. Estradiol values should be interpreted with a fixed point of reference, as the day of HCG administration, and a direct relation is seen between estradiol levels and captured ovocytes; however, is of highest usefulness to value the conduct of estradiol level, with the knowledge that the prognosis for good capture rates improves with ascending values and above 700 pg in the day of HCG administration.

Programa de actividad física y recreativa para adulto mayor / Program of physical and recreative activity for elderly

Se estudia los efectos de la actividad física y recreativa en el mejoramiento y mantenimiento de la capacidad física, en los rangos de movilidad articular, coordinación, ritmo y equilibrio, y desarrollo de la relaciones interpersonales y psicoafectivas en el adulto mayor

[Hypothalamo-hypophyseal amenorrhea. I. The clinical and laboratory manifestations]. / Amenorrea hipotálamo-hipofisaria. I. Manifestaciones clínicas y de laboratorio.

This study included 15 women 18-36 years old with primary or secondary amenorrhea, low FSH and LH, a negative response to clormadinone and serum prolactin (Prl) levels less than 20.0 ng/ml. The following tests were performed on alternate days: LH and FSH determinations every 20 minutes (pulses) during 2-4 hours (n = 15); LH and FSH response to a single dose of GnRH 100 micrograms IV (n = 15) and after administration of 100 micrograms IM of GnRH daily during four consecutive days (n = 7); TRH test 200 micrograms IV (n = 9); oral metoclopramide-Prl induced response (10 mg) (n = 2); one to three basal determinations of cortisol, estradiol (E2), T3, T4, and TSH (n = 15). All patients had serum E2 levels less than 10.0 pg/ml and none showed a regular LH or FSH pulsatility. In seven patients (group A) serum LH had a 10-30 fold increase above basal levels in response to GnRH, while the other eight patients (group B) showed no response at all; serum FSH changes were most irregular in both group. In group A no other hormonal deficiencies were detected, while in group B only three patients had an isolated LH-FSH deficiency, and in the other five this deficiency was accompanied by Prl, TSH, and/or ACTH lack. The present results suggest that: 1) group A represents isolated GnRH deficiency and the amenorrhea has hypothalamic etiology; 2) group B had LH-FSH deficiency of pituitary origin, in most cases associated to other pituitary hormone deficiencies; 3) the lack of LH response to an initial single dose of GnRH is not an absolute indicator of hypophyseal amenorrhea.

gltBDF operon of Escherichia coli.

A 2.0-kilobase DNA fragment carrying antibiotic resistance markers was inserted into the gltB gene of Escherichia coli previously cloned in a multicopy plasmid. Replacement of the chromosomal gltB+ gene by the gltB225::omega mutation led to cells unable to synthesize glutamate synthase, utilize growth rate-limiting nitrogen sources, or derepress their glutamine synthetase. The existence of a gltBDF operon encoding the large (gltB) and small (gltD) subunits of glutamate synthase and a regulatory peptide (gltF) at 69 min of the E. coli linkage map was deduced from complementation analysis. A plasmid carrying the entire gltB+D+F+ operon complemented cells for all three of the mutant phenotypes associated with the polar gltB225::omega mutation in the chromosome. By contrast, plasmids carrying gltB+ only complemented cells for glutamate synthase activity. A major tricistronic mRNA molecule was detected from Northern (RNA blot) DNA-RNA hybridization experiments with DNA probes containing single genes of the operon. A 30,200-dalton polypeptide was identified as the gltF product, the lack of which was responsible for the inability of cells to use nitrogen-limiting sources associated with gltB225::omega.

Streptococcal infections and their sequelae in the upper respiratory tract.

Local sequelae of group A beta-hemolytic streptococci (GABHS) are common and can vary from otitis media, sinusitis, cervical adenitis associated with generalized adenopathy, peritonsillitis and persisting symptoms in spite of therapy, GABHS is one of the pathogens isolated in acute or chronic otitis media and in acute maxillary sinusitis. In cervical adenitis associated with generalized adenopathy GABHS is, along with S. aureus, the most commonly recovered bacteria. In peritonsillitis, GABHS can be recovered alone or in combination with anaerobes in 50% of the cases. These sequelae are usually associated with a slow clinical response to therapy and a high percentage of relapses, reinfections, and chronic infections in the presence of a penicillin-sensitive GABHS. One of the possible causes of these so-called failures is the interference that beta-lactamase producing bacteria can have on the activity of penicillin and similar compounds. When to select a beta-lactamase-resistant antibiotic for the treatment of an apparent penicillin-sensitive infection remains an important area for further research.

Medición de volemia en el embarazo normal y su posible aplicación en el tratamiento de los síndromes hipertensivos del embarazo / Plasma volume measurements in normal pregnancy and possible application in the treatment of pregnancy hipertensive syndromes

Se estudia el volumen plasmático en 76 pacientes, logrando 94 determinaciones de volumen plasmático a diferentes edades gestacionales. Se agruparon las mediciones en ocho categorías, calculándose el promedio y desviación standard para cada una. Se constituye una tabla y un gráfico que muestra la variación de volemia a lo largo del embarazo normal. La volemia aumenta desde un 16,4 cc/cm entre las 9 y 12 semanas, hasta un 23,3 cc/cm entre las 33 semanas de amenorrea y desde ahí termina en un plateau o un leve aumento, lo que representa un aumento de 42,1%. Se aplica el concepto de nmecanismo predominante productor de hipertensión arterial al diagnóstico diferencial y al tratamiento de S.H.E., orientando el uso no de la restricción de sal en la dieta, de diuréticos o vasodilatadores según corresponda. Se discuten otras posibles aplicaciones de la medición de la volemia en la Obstetricia

Embarazo normotópico y ectópico concomitante: presentación de dos casos / Normo and ectopic simultaneous pregnancies: 2 cases

Se presentan dos casos de coincidencia de embarazo normotópico y ectópico tubario, en el Hospital de Puerto Octay. En ambos, el embarazo tubario se complicó, motivando el ingreso hospitalario; sólo en uno de los casos sobrevive el embarazo normotópico, llegando a parto de término. Se revisa la literatura disponible y discuten sus mecanismos etiológicos

Trastornos cardiovasculares en el lupus eritematoso sistemico.Revision de dos casos con lesiones poco frecuentes. / Cardiovascular disorders in systemic lupus erythematosus. Review of 2 cases with less frequent injuries

Se presentan dos casos de pacientes de lupus eritematoso sistemico (LES) con alteraciones cardiovasculares poco frecuentes, como lesion del aparato valvular aortico en un caso y trastornos compatibles con miocardiopatia congestiva secundaria en el segundo; en ambas enfermas se encontro lesion miocardica extensa que produjo un cuadro de insuficiencia cardiaca rebelde al tratamiento medico y que culmino con la muerte. las alteraciones cardiovasculares en el LES son multiples, y varian entre lesiones como pericarditis y miocarditis y tratamientos del sistema de conduccion del corazon y alteraciones en las arterias coronarias asi como en las valvulas auriculoventriculares, y menos frecuentemente en la sigmoidea aortica. La miocardiopatia lupica, complicacion poco frecuente de esta colagenopatia, parece estar relacionada con trastornos de la naturaleza intima de sus estructuras celulares, los cuales son mediados por fenomenos inmunologiocs, algunos de ellos todavia no bien definidos