Transversus abdominis release with biosynthetic mesh for large ventral hernia repair: a 5-year analysis of clinical outcomes and quality of life.

INTRODUCTION: Transversus abdominis release (TAR) may provide an optimal plane for mesh placement for large ventral hernias requiring medial myofascial flap advancement. Long-term outcomes of TAR for large ventral hernia repair (VHR) remains under-studied. This study aims to assess longitudinal clinical outcomes and quality of life (QoL) following large VHR with TAR and resorbable biosynthetic mesh. METHODS: Retrospective review of clinical outcomes and prospective QoL was performed for patients undergoing VHR with poly-4-hydroxybutyrate mesh and TAR from 2016 to 2021. Patients with ≤ 24 months of follow-up, defects ≤ 150 cm2, and parastomal hernias were excluded. Cost-related data was collected for each patient's hospital course. QoL was compared using paired Wilcoxon signed-rank tests. RESULTS: Twenty-nine patients met inclusion criteria. Median age and BMI were 61 years (53.2-68.1 years) and 31.4 kg/m2 (26.1-35.3 kg/m2). Average hernia defect was 390cm2 ± 152.9 cm2. All patients underwent previous abdominal surgery and were primarily Ventral Hernia Working Group 2 (58.6%). Two hernia recurrences (6.9%) occurred over the median follow-up period of 63.1 months (IQR 43.7-71.3 months), with no cases of mesh infection or explantation. Delayed healing and seroma occurred in 27 and 10.3% of patients, respectively. QoL analysis identified a significant improvement in postoperative QoL (p < 0.005), that continued throughout the 5-year follow-up period, with a 41% overall improvement. Cost analysis identified the hospital revenue generated was approximately equal to the direct costs of patient care. Higher costs were associated with ASA class and length of stay (p < 0.05). CONCLUSION: Large VHR with resorbable biosynthetic mesh and TAR can be performed safely, with a low recurrence and complication rate, acceptable hospital costs, and significant improvement in disease-specific QoL at long-term follow-up.

High molar ratios of tumor necrosis factor α (TNF α) soluble receptors I and II to the TNF ligand in human plasma from male veterans with comorbid posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI).

Background and Objectives: Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with chronic inflammation, as inferred from increased, but variable, peripheral levels of cytokines. We sought proof of concept for the notion that peripheral cytokine binding proteins and/or soluble receptors can confound measures of cytokines in those with a history of physical and psychological traumatic exposures. Efforts were focused on one of the major cytokines involved in inflammation, tumor necrosis factor-α (TNF-α). Methods: We examined blood plasma concentrations of TNF-α, its soluble receptors (TNF-soluble receptors (sR) I and TNFsRII), and C-reactive protein (CRP-1) in a cohort of US Veterans. In a previous study, CRP-1 was shown to be reduced by probiotic anti-inflammatory treatment in this patient cohort. All participants (n = 22) were diagnosed with PTSD and had a history of mild TBI with persistent post-concussive symptoms. Exclusion criteria included medications directly targeting inflammation. Results: Molar concentrations of soluble TNFsRI and II exceeded concentrations of the TNF-α ligand. TNFsRI, but not TNFsRII, was significantly associated with CRP-1 (Spearman Rho correlations = 0.518; p=.016 and 0.365; p = .104, respectively). Conclusions: TNF soluble receptors may bind to and sequester free TNF-α, suggesting that only measuring ligand concentrations may not provide a fully comprehensive view of inflammation, and potentially lead to inaccurate conclusions. TNFsRI concentration may provide a better estimate of inflammation than TNF-α for those with PTSD and post-acute mTBI with post-concussive symptoms, a hypothesis that invites further testing in larger studies.

[Mortality rate after a hip fracture in a low-income population in an orthopedic training hospital]. / Tasa de mortalidad después de una fractura de cadera en población con bajos ingresos económicos, en un hospital de entrenamiento ortopédico.

INTRODUCTION: Hip fracture are an important cause of morbidity and mortality in old patients. The one-year mortality after a hip fracture increase between 14 to 47%. The main objective was to analyze the risk factors associated with mortality after a hip fracture in a low-income population. MATERIAL AND METHODS: Retrospective study of patients with traumatic hip fracture in a four-year period in an orthopedic training hospital. The data collected was age, gender, Charlson comorbidity index (CCI), delay time in days for surgery, duration in hours for surgical procedure, transfusion. Two groups were analyzed, alive patients and deceased patients. RESULTS: A total of 96 patients with traumatic hip fracture was analyzed. Mortality rate in the first year was pf 16.6%, and at the end of the follow-up was 32.2%. The alive patients showed better values of CCI with a value of 4.2 ± 1.1 versus 5.2 ± 1.0 in the deceased patients. When compared delay time for surgery and duration of surgical procedure did not observe significant difference between patients alive and deceased. CONCLUSION: The delay time of surgery did not affect the mortality after a traumatic hip fracture in old patients with economic low-income.

INTRODUCCIÓN: Las fracturas de cadera representan una causa importante de morbimortalidad en los adultos mayores. La mortalidad a un año posterior a una fractura de cadera incrementa entre 14 y 47%. El objetivo de este estudio fue analizar los factores de riesgo que impactan la tasa de mortalidad posterior a una fractura de cadera en una población de bajos recursos. MATERIAL Y MÉTODOS: Se analizaron de manera retrospectiva pacientes con fractura de cadera traumática en un período de cuatro años en un hospital universitario con entrenamiento ortopédico. Los datos recolectados incluyeron edad, género, índice de comorbilidad de Charlson (CCI), tiempo en días para la cirugía y duración del procedimiento quirúrgico, así como necesidad de transfusión. Se analizaron dos grupos, pacientes vivos y pacientes fallecidos. RESULTADOS: Se evaluó un total de 96 adultos mayores con fractura de cadera. La tasa de mortalidad durante el primer año fue de 16.6%, mientras que al final del seguimiento fue de 32.2%. El grupo de sobrevivientes presentó una mejor evaluación de acuerdo con el CCI con valor de 4.2 ± 1.1 versus 5.2 ± 1.0 en los pacientes fallecidos. No se encontró diferencia estadísticamente significativa en la mortalidad entre ambos grupos al comparar los días de espera de tiempo quirúrgico y la duración de la cirugía. CONCLUSIÓN: El retraso de la cirugía no afecta la tasa de mortalidad después de una fractura de cadera en pacientes de edad avanzada con bajo ingreso económico.

Tasa de mortalidad después de una fractura de cadera en población con bajos ingresos económicos, en un hospital de entrenamiento ortopédico / Mortality rate after a hip fracture in a low-income population in an orthopedic training hospital

Resumen: Introducción: Las fracturas de cadera representan una causa importante de morbimortalidad en los adultos mayores. La mortalidad a un año posterior a una fractura de cadera incrementa entre 14 y 47%. El objetivo de este estudio fue analizar los factores de riesgo que impactan la tasa de mortalidad posterior a una fractura de cadera en una población de bajos recursos. Material y métodos: Se analizaron de manera retrospectiva pacientes con fractura de cadera traumática en un período de cuatro años en un hospital universitario con entrenamiento ortopédico. Los datos recolectados incluyeron edad, género, índice de comorbilidad de Charlson (CCI), tiempo en días para la cirugía y duración del procedimiento quirúrgico, así como necesidad de transfusión. Se analizaron dos grupos, pacientes vivos y pacientes fallecidos. Resultados: Se evaluó un total de 96 adultos mayores con fractura de cadera. La tasa de mortalidad durante el primer año fue de 16.6%, mientras que al final del seguimiento fue de 32.2%. El grupo de sobrevivientes presentó una mejor evaluación de acuerdo con el CCI con valor de 4.2 ± 1.1 versus 5.2 ± 1.0 en los pacientes fallecidos. No se encontró diferencia estadísticamente significativa en la mortalidad entre ambos grupos al comparar los días de espera de tiempo quirúrgico y la duración de la cirugía. Conclusión: El retraso de la cirugía no afecta la tasa de mortalidad después de una fractura de cadera en pacientes de edad avanzada con bajo ingreso económico.

Abstract: Introduction: Hip fracture are an important cause of morbidity and mortality in old patients. The one-year mortality after a hip fracture increase between 14 to 47%. The main objective was to analyze the risk factors associated with mortality after a hip fracture in a low-income population. Material and methods: Retrospective study of patients with traumatic hip fracture in a four-year period in an orthopedic training hospital. The data collected was age, gender, Charlson comorbidity index (CCI), delay time in days for surgery, duration in hours for surgical procedure, transfusion. Two groups were analyzed, alive patients and deceased patients. Results: A total of 96 patients with traumatic hip fracture was analyzed. Mortality rate in the first year was pf 16.6%, and at the end of the follow-up was 32.2%. The alive patients showed better values of CCI with a value of 4.2 ± 1.1 versus 5.2 ± 1.0 in the deceased patients. When compared delay time for surgery and duration of surgical procedure did not observe significant difference between patients alive and deceased. Conclusion: The delay time of surgery did not affect the mortality after a traumatic hip fracture in old patients with economic low-income.

Decreased food anticipatory activity of obese mice relates to hypothalamic c-Fos expression.

During daily Food Restriction (FR), obese Neotomodon alstoni mice present decreased Food Anticipatory Activity (FAA) compared to lean mice. Here, we investigated whether FOS expression in hypothalamic nuclei involved in food synchronization and anticipation parallels decreased FAA during daily FR of obese N. alstoni. Locomotor activity of lean and obese mice in ad libitum feeding conditions was monitored for at least two weeks. Then, a gradual restriction of food access was followed to establish a 5h period of daily food access. FR was maintained during at least two weeks before sacrifice of mice at the starting point of the feeding period. Obese mice subjected to FR displayed an overall reduction of FOS-positive (FOS+) hypothalamic neurons, while lean mice in a similar protocol exhibited an increase in FOS+ neurons within the arcuate and dorsomedial hypothalamic nuclei. These results are consistent with decreased FAA displayed by obese mice in comparison to lean mice. Furthermore, limbic system areas of lean mice, such as the cingulate cortex and the hippocampus, showed an increase in FOS during FR, while no responses were observed in obese mice. The daily food intake of obese mice was severely reduced during FR, compared to the ad libitum condition, whereas food intake in lean mice was not affected by FR. Current data suggests that decreased hypothalamic and limbic neuronal activation may contribute to the reduction of FAA in obese N. alstoni mice.

Cryptosporidium spp, comparative diagnosis and geospatial distribution in diarrheic calves from dairy farms, Valdivia, Chile / Diagnóstico comparativo y distribución geoespacial de Cryptosporidium spp, en terneros diarreicos en lecherías de Valdivia, Chile

Objective. To determine the Cryptosporidium spp. infection frequency by using Ziehl-Neelsen and Auramine stains on samples obtained from diarrheic calves from milking farms of the Valdivia province. To compare both diagnostic tests and to determine the geospatial distribution of the infections caused by this protozoan. Materials and methods. 221 fecal samples of diarrheic calves of 24 milking farms of the Valdivia province were studied. The processing and analysis of the samples was done by Ziehl-Neelsen (ZN) and Auramine (AU) staining techniques, and the results were compared by McNemar statistical test and the concordance level was determined by kappa index. A map was also generated to determine the geospatial distribution of Cryptosporidium infections. Results. 57.9% of all the animals tested were classified as positive with the ZN stain test, while 55.6% of all the animals turned out positive for the AU stain test. The McNemar test showed no significant difference between both diagnostic techniques (p>0.05), while the kappa index showed proper concordance between tests (k=0.73). 100% of the farms studied showed protozoan presence demonstrating the broad distribution of the parasite, however, and considering the previous factor, it was not possible to determine geospatial associations for the parasite distribution. Conclusions. The infection frequency of Cryptosporidium is higher than 50% in the milking farms studied from the Valdivia province. No difference between the Ziehl-Neelsen and Auramine staining techniques was demonstrated showing very consistent results. It was possible to detect that the number of farms infected correspond to 100% of the farms analyzed.

Objetivo. Determinar la frecuencia de infección por Cryptosporidium spp., mediante las tinciones de Ziehl-Neelsen y Auramina en terneros diarreicos de predios lecheros de la provincia de Valdivia. Comparar ambas pruebas diagnósticas y determinar la distribución geoespacial de las infecciones causadas por este protozoo. Materiales y métodos. Se estudiaron 221 muestras fecales de terneros diarreicos pertenecientes a 24 predios de la provincia de Valdivia. El procesamiento y análisis de las muestras se realizó mediante tinción de Ziehl-Neelsen (ZN) y Auramina (AU); y ambas técnicas se compararon mediante la prueba estadística de McNemar y su nivel de concordancia se determinó mediante índice kappa. Se generó además un mapa para determinar la distribución geoespacial de las infecciones por Cryptosporidium. Resultados. Del total de animales muestreados, 57.9% resultaron positivos a ZN, mientras que 55.6% fueron positivo para AU. En la prueba de McNemar no hubo diferencia significativa entre los métodos diagnósticos estudiados (p>0.05), en tanto el índice kappa determinó una concordancia buena entre ambas pruebas (k=0.73). Del total de predios georeferenciados el 100% resultó positivo a la presencia del protozoo; demostrándose que ésta parasitosis tiene una amplia distribución; sin embargo, dado este factor, no fue posible determinar asociaciones geoespaciales sobre la distribución de éste. Conclusiones. La frecuencia de infección por Cryptosporidium supera el 50% en los predios lecheros de la provincia de Valdivia. No hubo diferencia entre las técnicas Ziehl-Neelsen y Auramina con resultados concordantes. Fue posible detectar que el número de predios infectados corresponde al 100% de los predios analizados.

Evaluation of the presence of endocrine-disrupting compounds in dissolved and solid wastewater treatment plant samples of Gran Canaria Island (Spain).

Liquid and solid samples from two wastewater treatment plants (WWTPs) on Gran Canaria Island (Spain) have been tested for the presence of compounds with endocrine-disrupting properties. The selected degradation stages were sampled bimonthly from each WWTP over the 12-month period from July 2010 to July 2011. The analytical methods used for the determination of the endocrine-disrupting compounds (EDCs) were based on on-line solid phase extraction, microwave-assisted extraction (MAE), and ultrasonic-assisted extraction (UAE) coupled to UHPLC-MS/MS. All of the hyphenated methodologies employed in this work showed good recoveries (72-104%) and sensitivities, with LODs lower than 7.0 ng L(-1) and 6.3 ng g(-1) for the dissolved and solid fractions, respectively. We have also evaluated the estrogenicity of the samples in terms of their estradiol equivalent concentrations (EEQs). The chemical analysis of the selected EDCs revealed fairly low concentrations for both natural and synthetic oestrogens, alkylphenolic compounds, and bisphenol-A in each of the dissolved, particulate, and sludge samples (ng L(-1) or ng g(-1)). However, the estimated estrogenic activity indicated that the majority of samples could represent an important environmental risk, clearly surpassing the threshold to exert deleterious consequences on living beings.

Prolactin fractions from lactating rats elicit effects upon sensory spinal cord cells of male rats.

Recently it has been suggested that the neurohormone prolactin (PRL) could act on the afferent nociceptive neurons. Indeed, PRL sensitizes transient receptor potential vanilloid 1 (TRPV1) channels present in nociceptive C-fibers and consequently reduces the pain threshold in a model of inflammatory pain. Accordingly, high plasma PRL levels in non-lactating females have been associated with several painful conditions (e.g. migraine). Paradoxically, an increase of PRL secretion during lactation induced a reduction in pain sensitivity. This difference could be attributed to the fact that PRL secreted from the adenopituitary (AP) is transformed into several molecular variants by the suckling stimulation. In order to test this hypothesis, the present study set out to investigate whether PRL from AP of suckled (S) or non-suckled (NS) lactating rats affects the activity of the male Wistar wide dynamic range (WDR) neurons. The WDR neurons are located in the dorsal horn of the spinal cord and receive input from the first-order neurons (Ab-, Ad- and C-fibers). Spinal administration of prolactin variant from NS rats (NS-PRL) or prolactin variant from S rats (S-PRL) had no effect on the neuronal activity of non-nociceptive Ab-fibers. However, the activities of nociceptive Ad-fibers and C-fibers were: (i) increased by NS-PRL and (ii) diminished by S-PRL. Either NS-PRL or S-PRL enhanced the post-discharge activity. Taken together, these results suggest that PRL from S or NS lactating rats could either facilitate or depress the nociceptive responses of spinal dorsal horn cells, depending on the physiological state of the rats.

Gastrectomía en manga transumbilical con técnica simplificada: técnica y resultados quirúrgicos en 100 pacientes / Simplifi ed transumbilical sleeve gastrectomy: technique and surgical results in 100 patients

Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplified sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS® or GelPoint® multiport, and a 5mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confirming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m². Mean operative time was 56.4 +/- 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 +/- 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left flank simplifies the procedure, allowing the use of rigid instruments.

Introducción: El abordaje transumbilical, ha demostrado ser seguro en diferentes procedimientos. Se han reportado series de casos de gastrectomía en manga transumbilical (GMTU), con diferentes variaciones. Objetivo: Es presentar la técnica y resultados quirúrgicos de una técnica de GMTU simplificada, utilizando instrumental rígido. Material y Métodos: 94 mujeres y seis hombres, fueron sometidos a GMTU, seleccionados por un equipo multidisciplinario. La técnica quirúrgica consiste en una incision transumbilical, introducción de dispositivo SILS® o GelPoint®, y un trocar de 5 mm metálico en el flanco izquierdo. Se utilizó instrumental rígido en todos los pacientes. La disección de la curvatura mayor se realiza desde 4-5 cm proximal al píloro, hasta el pilar izquierdo. La sección gástrica se completa con stapler, calibrando con una sonda de 36 fr transpilórica. Se realiza hemostasia selectiva con clips metálicos. Se realizó estudio baritado a diez pacientes aleatorios, confirmando forma tubular adecuada. Resultados: El rango de IMC preoperatorio fue de 30-43 kg/m². El tiempo operatorio promedio fue de 56,4 +/- 16,7 min. No se requirió conversión a técnica multitrocar o laparotómica. Cuatro pacientes presentaron complicaciones precoces: dos hemoperitoneos, una filtración antral y una enterotomía inadvertida. Se reintervino a dos pacientes. No hubo mortalidad. El tiempo de hospitalización fue de 2,3 +/- 0,5 días. El resultado cosmético fue satisfactorio para todos los pacientes. Conclusión: La GMTU es un procedimiento factible y seguro con la técnica expuesta. La inserción del trocar de 5 mm accesorio, simplifica el procedimiento, permite el uso de instrumental rígido, y lo convierte en un procedimiento reproducible.

Guía clínica: consenso para Chile en enfermedad de Fabry / Clinical guidelines: Chilean consensus in Fabry disease

Fabry's disease is an X-linked recessive inborn error of metabolism of glycosphingolipids, caused by the deficiency of the lisosomal enzyme alpha-galactosidase. It is a rare disease with an estimated incidence rate of approximately 1:80.000 to 1:117,000 births in the general population. Recently, the growing knowledge about this disease has permitted the development of enzyme replacement therapy, which has modified the prognosis and quality of life of these patients. In Chile, the real incidence is unknown, but the increase in the number of patients diagnosed during the last five years, mainly in the north of the country. This guide was prepared with the intention of establishing a consensus for the diagnosis, treatment and monitoring of the patients with Fabry disease based on the present available scientific evidence.

La enfermedad de Fabry es un error innato del catabolismo de los glucoesfingolipidos, de herencia recesiva ligada al cromosoma X, causado por la deficiencia de la enzima lisosomal alfa-galactosidasa A (alfa-gal A). Es un defecto poco frecuente, con una incidencia estimada de 1:80.000 a 1:117.000, entre la población general. Recientemente, el creciente conocimiento acerca de esta enfermedad, ha permitido el desarrollo de la terapia de reemplazo enzimático, la cual ha modificado el pronóstico y calidad de vida de los pacientes. En Chile, se desconoce la incidencia real, pero el aumento del número de pacientes diagnosticados durante los últimos cinco años, principalmente en la zona norte del país, ha generado un mayor interés por esta enfermedad. Esta guía fue elaborada con la intención de establecer un consenso para el diagnóstico, tratamiento y seguimiento de los pacientes con enfermedad de Fabry, basado en la evidencia científica, actualmente disponible.

Determination of various estradiol mimicking-compounds in sewage sludge by the combination of microwave-assisted extraction and LC-MS/MS.

In this work, we present the development and application of a microwave assisted extraction followed by liquid chromatography-tandem mass spectrometry methodology (MAE-LC-MS/MS) for the determination of various estradiol-mimicking compounds in sewage sludge samples. For the purification of the MAE extracts, we have employed a solid phase extraction (SPE) clean-up procedure, previously optimised. The entire method provides recoveries between 71.7% and 103.1%, with relative standard deviation lower than 11.1% and limits of detection ranging from 0.6 to 3.5 ng g(-1). The developed method was applied to samples from three wastewater treatment plants (WWTPs) located in Las Palmas of Gran Canaria (Spain), two of which had a conventional activated sludge treatment (AST), whereas the third treatment plant had an advanced membrane bioreactor treatment (MBR). All of the analytes in the study, including (nonylphenol (NP), octylphenol (OP), and some of their ethoxylated chains AP(n)EOs (n ≤ 7), 17ß-estradiol (E2), estriol (E3), 17α-ethynylestradiol (EE) and bisphenol-A (BPA)), were found in almost all samples in concentrations ranging from 0.9 to 710.2 ng g(-1).

Determination of alkylphenol polyethoxylates, bisphenol-A, 17α-ethynylestradiol and 17ß-estradiol and its metabolites in sewage samples by SPE and LC/MS/MS.

Recently, many chemicals released into the environment have been shown to mimic endogenous hormones such as estradiol. It has been demonstrated that these compounds cause several adverse effects on wildlife and humans, such as the feminization of animal species, development of physical abnormalities and birth defects, and reproductive failure. In an effort to model the behaviour of some endocrine-disrupting chemicals (EDCs) and to establish the level of contamination in sewage samples, a quantitative method for the simultaneous determination of nonylphenol, octylphenol and corresponding ethoxylates (1-12), 17α-ethynylestradiol, bisphenol-A, and 17ß-estradiol and two of its metabolites have been developed. Identification and quantification were achieved by high performance liquid chromatography-tandem mass spectrometry (LC-ESI-MS/MS). Satisfactory detection limits (between 0.5-6 ng L(-1) in the dissolved phase and 1.4-12.7 ng g(-1) in the particulate phase) and analyte recoveries (between 60% and 108%) were achieved for target compounds. The optimised method was applied to the determination of EDCs in liquid sewage samples collected from a wastewater treatment plant (WWTP) in Las Palmas de Gran Canaria (Spain). Concentrations of EDCs ranged from <10 ng L(-1) to nearly 1200 ng L(-1) in the dissolved phase, and from 0.005 µg g(-1) to 2.8 µg g(-1) in the suspended particulate matter.

Eritrasma, revisión / Erythrasma, review

El eritrasma es una infección superficial de la piel que afecta la capa córnea y es causado por una bacteria grampositiva, Corynebacterium minutissimum. Se presenta como manchas eritematosas a marrón en grandes pliegues y como descamación y maceración en pliegues interdigitales; es asintomática, aunque en algunos casos se acompaña de prurito. El diagnóstico es clínico por luz de Wood que da una fluorescencia rojo coral de las áreas afectadas. Su curso es benigno, aunque persiste si no se da un tratamiento adecuado.

Erythrasma is a superficial skin infection of the stratum corneum caused by a gram-positive bacteria, Corynebacterium minutissimum. It is characterized by reddish-brown areas affecting occluded intertriginous zones such as axillae, inframammary folds, and as irregular scaly patches or macerated lesions on toeweb spaces. It is asymptomatic, though sometimes accompanied by pruritus. Clinical diagnosis is supported by a red fluorescence under Wood s light examination. It is benign, yet persistent if not adequately treated.

Brainstem prolactin-releasing peptide neurons are sensitive to stress and lactation.

Prolactin-releasing peptide (PrRP) was originally thought to participate in the control of adenohypophyseal prolactin secretion, but its predominant expression in a subset of medullary noradrenergic neurons is more in line with roles in interoceptive and/or somatosensory information processing. To better define functional contexts for this peptide system, immuno- and hybridization histochemical methods were used to monitor the capacity of PrRP neurons to display activational responses to lactation, suckling, acute footshock or hypotensive hemorrhage. PrRP mRNA signal was reduced in the medulla of lactating dams, relative to both male and diestrus female controls, with cell counts revealing 42% and 43% reductions in the number of positively hybridized cells in the nucleus of the solitary tract (NTS) and ventrolateral medulla, respectively. Lactating mothers killed after a 90 min suckling episode (following 4 h pup removal) failed to show induced Fos expression in identified medullary PrRP neurons, despite the fact that responsive neurons were detected in other aspects of the caudal NTS. By contrast, acute exposure to hypotensive (25%) hemorrhage or footshock each activated substantial complements of medullary neurons expressing PrRP mRNA. A substantially greater fraction of the total medullary PrRP population exhibited sensitivity to footshock than hemorrhage (71 versus 39%, respectively). These results suggest that medullary PrRP neurons are negatively regulated by (presumably hormonal) changes in lactation, and are not recruited to activation by suckling stimuli. These populations exhibit differential sensitivity to distinct acute stressors, and may participate in the modulation of adaptive neuroendocrine and autonomic responses to each.

Developmental norms for the Gardner Steadiness Test and the Purdue Pegboard: a study with children of a metropolitan school in Brazil

Norms for the Gardner Steadiness Test and the Purdue Pegboard were developed for the neuropsychological assessment of children in the metropolitan area of Rio de Janeiro. A computer-generated unbiased sample of 346 children with a mean age of 9.4 years (SD = 2.76), who were attending a large normal public school in this urban area, was the subject of this study. Two boys were removed from the study, one for refusing to participate and the other due to severe strabismus. Therefore, the final sample contained 344 children (173 boys and 171 girls). Sex and age of the child and hand preferred for writing, but not ethnic membership or social class, had significant effects on performance in the Gardner Steadiness Test and the Purdue Pegboard. Girls outperformed boys. Older children performed better than younger children. However, the predictive relationship between age of the child and neuropsychological performance included linear and curvilinear components. Comparison of the present results to data gathered in the United States revealed that the performance of this group of Brazilian children is equivalent to that of US children after Bonferroni's correction of the alpha level of significance. It is concluded that sex and age of the child and hand preferred for writing should be taken into account when using the normative data for the two instruments evaluated in the present study. Furthermore, the relevance of neurobehavioral antidotes for the obliteration of some of the probable neuropsychological effects of cultural deprivation in Brazilian public school children is hypothesized

Oral-disease prevention in children with cancer: testing preventive protocol effectiveness.

UNLABELLED: Mucositis, gingivitis, herpetic stomatitis and candidiasis are a potential source of systemic infection in patients undergoing chemotherapy. Their severity and incidence may be reduced with procedures based on the prevention and elimination of sources causing oral infection and irritation. OBJECTIVE: The purpose of this investigation was to evaluate the effectiveness of an Oral Disease Preventive Protocol in children with cancer, subjected to chemotherapy and prior to application of dentobacterial infection control. MATERIAL AND METHODS: A controlled clinical test was run, with random assignations, on twelve 5-to-12-year-old patients diagnosed with Acute Lymphoblastic Leukemia (ALL) or Lymphoma, evaluated for twelve months, with a total of 154 evaluations. Five patients were boosted with oral physiotherapy, with non-alcoholic 0.05% fluoride mouthwashes, with topical application of myconazole oral gel; seven patients were given instructions on oral physiotherapy. RESULTS: There were no significant differences between the groups under evaluation (p>0.05). Of the oral complications evaluated, gingivitis registered the highest percentage (60%), followed by mucositis (18%) and candida albicans infection (7%). Most affected were the submandibular and cervical ganglions (59% and 41%, respectively). CONCLUSIONS: Prior control of sources causing oral infection and irritation effectively prevents complications during non-surgical cancer therapy.

Recombinant canine IL-13 receptor alpha2-Fc fusion protein inhibits canine allergen-specific-IgE production in vitro by peripheral blood mononuclear cells from allergic dogs.

Human IL-13, like IL-4, is involved in the regulation of B-cell development, IgE synthesis and allergic responses. However, because IL-13 does not affect either murine Ig class switching or IgE production in vitro, the use of murine models to study the role of IL-13 in IgE-mediated diseases has been limited. In this communication, we report that recombinant protein of canine IL-13 (rcaIL-13) stimulates production of allergen-specific-IgE in vitro by peripheral blood mononuclear cells (PBMC) from flea allergen-sensitized dogs, and that this stimulation activity is specifically inhibited by recombinant protein of canine IL-13Ralpha2 and Fc fragment of canine IgG heavy chain (rcaIL-13Ralpha2-Fc). The data suggest that the regulatory effects of IL-13 on IgE production in canine PBMC are similar to those reported in humans. Thus, canine IL-13 may be a central mediator of allergic diseases in dogs, and allergic dogs may be excellent models for research on IgE-mediated diseases in humans.

Inability to noninvasively diagnose gastric intestinal metaplasia in Hispanics or reverse the lesion with Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori infection has been linked with the development of gastric adenocarcinoma and its precursor lesion, intestinal metaplasia (IM). The presence of gastric IM is not associated with symptoms, which makes identification of individuals with this lesion difficult. It is not clear whether eradication of H. pylori infection leads to reversal of gastric IM or the potential decrease in the risk of cancer in these patients. GOALS: The purpose of this pilot study was to define the prevalence of gastric IM in a population at high risk for gastric cancer (Southwestern Hispanics), examine the ability of noninvasive testing to identify individuals with the lesion, and determine whether eradication of H. pylori infection reverses gastric IM in this population. STUDY: Subjects from the Tucson metropolitan area were recruited, and baseline data, including the presence of upper gastrointestinal (UGI) symptoms, urinary sodium, and serum pepsinogen levels, were obtained. Upper endoscopy was performed and six gastric biopsies from specific anatomic sites were obtained, followed by methylene blue staining with targeted biopsies from blue-stained mucosa. Biopsies were evaluated for the presence of H. pylori infection and gastric IM. A subset of patients with gastric IM were treated to eradicate H. pylori infection. Follow-up exams with methylene blue staining, including biopsies for histology and rapid urease testing, were performed for up to 48 months. RESULTS: There were 84 subjects with a mean age of 53.0 years; 24 (29%) had gastric IM and 65 (77%) had H. pylori. There was no significant association between gastric IM and age, gender, UGI symptoms, H. pylori, or urine sodium. There was an association identified between gastric IM and a decreased pepsinogen I:II ratio (p = 0.03). Of the 11 individuals with gastric IM treated for H. pylori infection, 9 had successful therapy and underwent at least 2 follow-up examinations. The mean length of follow-up was 3.3 years. Eight of the nine (89%) had gastric IM identified histologically at the final endoscopic exam. CONCLUSIONS: H. pylori infection and gastric IM are frequent findings in Southwestern Hispanics, a high-risk population for gastric cancer. Noninvasive testing is not clinically useful in distinguishing individuals within this group who harbor gastric IM. Although eradication of H. pylori infection may lead to a decrease in the amount of gastric IM in some individuals, the lesion may be detected in the majority of individuals after more than 3 years of follow-up. These data suggest that therapy for H. pylori may not eliminate the risk of gastric cancer once IM has developed.

Actividad antimicrobiana de extractos orgánicos aislados de Aplysina fistularis (Demospongiae: Aplysinidae) / Antimicrobial activity of organic extracts isolated from Aplysina fistularis (Demospongiae: Aplysinidae)

Organic extracts of the sponge Aplysina fistularis (Pallas 1766) were tested for antimicrobial activity against Gram positive bacteria (Staphylococcus aureus) and Gram negative bacteria (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa). The minimal inhibitory concentration (MIC) and toxic activity of extract were determined. Susceptibility trials of organic fractions obtained by VLC: Hexane, EtOAc and CHCl3 showed that EtOAc fraction has antibacterial activity against E. coli, while CHCl3 fraction inhibited E. coli and S. aureus growth. The later refractioning of EtOAc fraction and the biodirected assays showed that fractions F12 and F13 of EtOAc/Hex and EtOAc F14 were bioactive against Gram positive and Gram negative bacteria. Only EtOAc/MeOH Sf2 from subfractionig of EtOAc F14 produced inhibition for E. coli and S. aureus. In Sf2 EtOAc/MeOH, MIC was moderate for S. aureus (MIC > 256 g/ml). F4 CHCl3/MeOH produced a high inhibition in S. aureus (MIC = 0.125 g/ml) and for E. coli (MIC > 16 g/ml). F10 CHCl3/MeOH showed a moderate activity against S. aureus (MIC > 128 g/ml) and low activity against E. coli (MIC = 512 g/ml). F10 CHCL3/MeOH did no present toxic activity against Artemia salina. The fractiorts F4 CHCL3/MeOH and Sf2 EtOAc/MeOH were toxic for this organism when the concentration was higher than 100 microg/ml. LC50 in both cases was 548.4 and 243.4 microg/ml respectively. Secondary metabolites of medium polarity obtained from A. fistularis have a wide spectrum of anti bacterial activity. Toxicity analysis suggests that only F10 CHCL3/MeOH has potential as an antimicrobial agent for clinical use.

Long-term follow-up of intestinal metaplasia of the gastric cardia.

OBJECTIVE: Recent studies have found a relatively high prevalence of gastric cardia intestinal metaplasia in individuals presenting for elective upper endoscopy. It has been hypothesized that this lesion may be a precursor of gastric cardia cancer. Our objective was to identify the incidence of dysplasia in patients with gastric cardia intestinal metaplasia. METHODS: Twenty-eight patients who had previously been identified with cardia intestinal metaplasia had follow-up examinations performed. None of the patients had dysplasia at the time of diagnosis. All had an examination at 1 yr, and 20 patients had an examination at 3 yr after diagnosis. During follow-up examinations all patients underwent vital staining with methylene blue to help identify areas of intestinal metaplasia in the cardia. Two to four biopsies were taken from blue-stained mucosa. Histological specimens were stained using a combination of hematoxylin and eosin with Alcian blue at pH 2.5. RESULTS: There were 27 men and one woman with a mean age of 69.8 yr (range, 48-83 yr). The mean length of follow-up was 2.5 yr (range, 12-46 months). Only one patient was diagnosed with dysplasia (low-grade) during the study, for an incidence of 1.4% per yr. CONCLUSIONS: The prevalence (0%) and incidence (1.4%/yr) of dysplasia in cardia intestinal metaplasia are low. Although further studies are needed, screening and surveillance for gastric cardia intestinal metaplasia is unlikely to be clinically useful for the prevention of gastric cardia cancer.