Association between e-cigarette and conventional cigarette use among Spanish adolescents. / Asociación entre el uso de cigarrillos electrónicos y cigarrillos convencionales en adolescentes españoles.

In recent years, studies have highlighted the upward trend in electronic cigarette use among adolescents, as well as the potential of e-cigarette use to lead to subsequent conventional cigarette use. The study's aims were two-fold: 1) to examine the progression from e-cigarette use to conventional cigarette use; and 2) to analyze the differences in the severity of smoking pattern among dual users (i.e., e-cigarette and conventional cigarette use), cigarette-only smokers, and e-cigarette-only users in a Spanish adolescent population. Data were obtained from the ESTUDES, a representative survey of addictive behaviors of Spanish adolescents aged 14-18, which was comprised of 38,010 adolescents (Mage = 15.69; SD = 1.19; 51.35% females). Results indicate that lifetime e-cigarette use increased the prevalence of subsequent conventional cigarette use by 1.86 times (95% CI 1.74, 1.99), and the prevalence of conventional cigarette use in the last month by 2.38 times (95% CI 2.19, 2.58), independently of whether the e-cigarette contains nicotine or not. Dual users showed a higher percentage of daily smokers, and a greater number of cigarettes per day, a higher use of e-cigarettes with nicotine, and an earlier age of smoking onset. Regarding risk perception, e-cigarette-only users perceived both conventional tobacco and e-cigarettes as less harmful (all p-values < .001). These findings document the strength of association between e-cigarette and conventional cigarettes, and underscore the importance of developing legal restrictions and prevention strategies aimed at reducing e-cigarette use, which in turn would reduce tobacco use.

En los últimos años, algunos estudios han destacado la tendencia ascendente en el uso del cigarrillo electrónico entre adolescentes, así como el potencial para el posterior consumo de cigarrillos convencionales. Este estudio tuvo dos objetivos: 1) examinar la progresión del cigarrillo electrónico al cigarrillo convencional; y 2) analizar las diferencias en el patrón de gravedad del tabaquismo entre consumidores duales (i.e., cigarrillos electrónicos y convencionales), fumadores de cigarrillos y consumidores de cigarrillos electrónicos. Los datos se obtuvieron de la encuesta ESTUDES, una encuesta nacional que recoge información de conductas adictivas en adolescentes entre 14 y 18 años, la cual consta de 38 010 personas (Medad = 15,69; DT = 1,19; 51,35% mujeres). Los resultados indicaron que haber usado alguna vez un cigarrillo electrónico incrementó la probabilidad de un consumo posterior de cigarrillos 1,86 veces (IC 95% 1,74-1,99), y la probabilidad de consumir tabaco en el último mes 2,38 veces (IC 95% 2,19-2,58), independientemente de si los cigarrillos electrónicos contienen o no nicotina. Los consumidores duales mostraron un mayor porcentaje de fumadores diarios, un mayor número de cigarrillos al día, un mayor uso de cigarrillos electrónicos con nicotina y una edad de inicio más temprana. Con respecto a la percepción de riesgo, los adolescentes que han usado solo cigarrillos electrónicos percibían tanto el tabaco como los cigarrillos electrónicos como menos dañinos (todos los valores p < ,001). Estos hallazgos indican la fuerte asociación entre los cigarrillos electrónicos y los convencionales, y subrayan la importancia de desarrollar restricciones legales y estrategias preventivas dirigidas al cigarrillo electrónico, lo que reduciría a su vez el consumo de tabaco.

The silent epidemic of lymphogranuloma venereum inside the COVID-19 pandemic in Madrid, Spain, March 2020 to February 2021.

Despite social distancing measures implemented in Madrid to prevent the propagation of SARS-CoV-2, a significant increase (57.1%; 28.5 to 38.5 cases/month) in cases of lymphogranuloma venereum was detected during the COVID-19 pandemic. This unusual scenario might have accelerated a shift in Chlamydia trachomatis (CT) epidemiology towards a higher proportion of L genotypes compared with non-L genotypes in CT-positive samples. Our data underscore the importance of surveillance of sexually transmitted infections during the pandemic, in particular among vulnerable populations.

Systematic Review of Preventive Programs for Reducing Problem Gambling Behaviors Among Young Adults.

Young adulthood is a developmental period from late adolescence to one's late twenties or early thirties. Prevalence studies internationally have reported that individuals in this age group tend to have the highest rates of problem gambling. However, much of the prevention work designed to minimize the risk of problem and disordered gambling has been primarily focused on school settings and aimed at high school students. The objective of this study was to summarize the existing literature on the effectiveness of prevention programs aimed at reducing the prevalence of gambling problems in young adults. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic academic databases were consulted in order to examine the studies conducted during the last 20 years. After removing duplicates and adhering to the inclusion and exclusion criteria, nine studies were included in this review. All studies targeted college or university students and followed a selective or indicated prevention strategy. A Personalized Normative Feedback approach was incorporated in most of the studies, which had generally good results in reducing and/or minimizing at-risk or problem gambling. The limited number of studies included in this review highlights the need to address scientific quality standards before proceeding with the design, implementation and widespread dissemination of these preventive programs as well as the need to ensure the program's efficacy prior to implementation.

Substance Use and Gambling Patterns Among Adolescents: Differences According to Gender and Impulsivity.

Although alcohol, tobacco and cannabis are the most prevalent drugs used by adolescents, gambling is a growing concern due to its increasing popularity. To date there have been few studies exploring the existing patterns of concurrent use of drugs and gambling in adolescents. This study aims to identify subpopulations of adolescents using different substances and gambling activities, to explore gender differences and to examine impulsivity as a predictor of class membership. A cross-sectional survey was carried out in 22 high-schools, and 1644 adolescents were assessed (54.1% males; mean age = 15.21 years, SD = .75). Participants reported their last-year frequency of using alcohol, tobacco and cannabis, as well as bingo, poker, other casino games, sports betting, lottery, scratch tickets and electronic gaming machines. Problem drinking was evaluated with the Rutgers Alcohol Problems Index, and gambling severity with the South Oaks Gambling Scale for Adolescents. Impulsivity was assessed using a Delay Discounting task, the Barratt Impulsiveness Scale and the Impulsive Sensation-Seeking Scale. Based on a latent class model of drugs and gambling activities, four subpopulations of males and five of females were found. General impulsivity and sensation seeking were the most consistent predictors of class membership. These novel findings support the need to consider specific groups of adolescents engaging in different patterns of addictive behaviors when implementing selective prevention strategies.

Gambling Motives Questionnaire validation in adolescents: Differences based on gambling severity and activities. / Validación del Cuestionario de Motivos de Juego en adolescentes: Diferencias según la gravedad y las actividades de juego.

Self-reported reasons for gambling have been highlighted as crucial to understanding why adults develop problems with gambling. However, research on motives among adolescents remains scarce. The aim of this study is to explore the factorial structure of the Gambling Motives Questionnaire (GMQ) and to analyze differences in motives among adolescents, depending on the gambling activity and level of gambling severity. A total of 698 adolescent gamblers (M = 15.24, SD = .76) were assessed. As well as the GMQ, the South Oaks Gambling Screen (SOGS-RA) questionnaire was used. Gamblers were classified into three categories (strategic, non-strategic, and mixed) according to the activities engaged in during the last year. An Exploratory Factor Analysis was conducted followed by a Confirmatory Factor Analysis in order to explore the internal structure of the GMQ. Three two-way between-groups Analyses of Variance (ANOVA) were conducted to explore differences in motives according to the type of activity and the gambling severity levels. According to the factorial structure of the GMQ, three main groups of motivations were found: enhancement, coping and social. Compared to non-problem gamblers, problem gamblers scored higher on all motives. Moreover, gamblers seeking enhancement prefer strategic games, those gambling to cope with stress use non-strategic games more frequently, while social gamblers do not show a preference for either strategic or non-strategic games. In conclusion, gambling motives are related to gambling severity and structural characteristics of gambling. These findings may be useful from a prevention standpoint.

Los motivos de juego han sido considerados como variables clave para comprender el desarrollo de problemas asociados al mismo en adultos. Sin embargo, la literatura sobre las motivaciones de los adolescentes para jugar es escasa. El presente estudio tiene como objetivo explorar la estructura factorial del Cuestionario de Motivos de Juego (GMQ) y analizar las diferencias de los motivos de los adolescentes según la actividad de juego y la gravedad de los problemas asociados. Se evaluó una muestra de 698 jugadores adolescentes (M = 15,24, DT = ,76) a los que se les aplicó, además del GMQ, el cuestionario South Oaks Gambling Screen (SOGS-RA). Los jugadores fueron clasificados en tres categorías (estratégicos, no estratégicos, mixtos) según el tipo de juegos utilizados durante el último año. Para el estudio de la estructura interna del GMQ se realizó un primer Análisis Factorial Exploratorio y un segundo Análisis Factorial Confirmatorio. Se emplearon tres Análisis de Varianza (ANOVA) de dos vías para evaluar las diferencias en motivos entre los niveles de gravedad y tipo de actividad. De acuerdo con la estructura factorial del GMQ, existen tres principales grupos de motivaciones para jugar: búsqueda de emociones positivas, afrontamiento del estrés y causas sociales. En comparación con los jugadores sin problema, los jugadores problemáticos puntuaron más alto en todos los motivos. Además, los jugadores que buscan emociones positivas se decantan más por los juegos estratégicos, los que utilizan el juego para afrontar el estrés utilizan más los no estratégicos, mientras que los jugadores sociales no presentan preferencia por ninguno de los dos. En conclusión, la motivación para jugar se encuentra en relación con la gravedad y las características del juego. Estos resultados son de utilidad desde el punto de vista de la prevención.

What Predicts What? Self-Reported and Behavioral Impulsivity and High-Risk Patterns of Alcohol Use in Spanish Early Adolescents: A 2-Year Longitudinal Study.

BACKGROUND: The directionality of the relationship between impulsivity and heavy drinking patterns remains unclear. Recent research suggests it could be reciprocal and depends on different facets of impulsivity and different patterns of drinking. The aim of this study was to analyze this potential reciprocal relationship between self-reported and behavioral measures of impulsivity and sensation seeking with specific patterns of heavy drinking in a sample of Spanish adolescents across 2 years. METHODS: The study has a cross-lagged prospective design in which participants were evaluated 3 times over 2 years (once a year). Participants were 1,430 adolescents (53.9% male; mean age at study commencement = 13.02, SD = 0.51) from 22 secondary schools in Spain. Computerized versions of the following instruments were used: 2 subscales of Impulsive Sensation Seeking, 2 behavioral measures (Stroop Test and Delay Discounting [DD] task), frequency of intoxication episodes (IE), and the Rutgers Alcohol Problem Index to evaluate alcohol-related problems (ARP). Random intercepts cross-lagged panel models of reciprocal relationships between impulsivity measures and alcohol use outcomes were used. RESULTS: Individual levels of self-reported impulsivity and sensation seeking significantly predicted prospective involvement in IE and ARP. Performance in behavioral measures (Stroop Test and DD) did not predict subsequent heavy drinking or alcohol problems. No measure of drinking was found to be a significant predictor of prospective changes in impulsivity. CONCLUSIONS: Within-person levels of self-reported impulsivity and sensation seeking significantly predicted further heavy drinking from as early as 13 years old, whereas behavioral measures were not predictive. In our study, neither IE nor ARP predicted prospective changes in impulsivity. Further studies should address additional specific relationships between facets of impulsivity and specific outcomes of heavy drinking.

Endogenous transplacental transmission of Neospora caninum during successive pregnancies across three generations of naturally infected sheep.

Endogenous transplacental transmission, which occurs during pregnancy as the result of reactivation of a latent infection in the dam, is the main mechanism of propagation of Neospora caninum within cattle herds. However, the importance of this propagation mechanism has not yet been evaluated in relation to ovine neosporosis. In this study, involving three generations of ewes naturally infected by N. caninum, we demonstrated that endogenous transplacental transmission may also be highly efficient in the ovine host since transmission of infection occurred in 96.6% of gestations and the congenital infection rate ranged between 66.7 and 93%. Nevertheless, parasite burdens decreased gradually in consecutive generations. Reactivation of latent infections had a strong impact on the pregnancy outcome, with high mortality rates recorded in the offspring of the two first generations of ewes (21.4-46.1%). Histological examination of the brain revealed that all aborted foetuses had characteristic lesions of neosporosis (necrotic glial foci) and a few parasite cysts, whereas most stillborn and newborn lambs that died shortly after birth had non-specific lesions (mild glial foci without necrosis) and parasite cysts were more frequent. Microsatellite analysis revealed scarce genetic variability in the N. caninum population, in accordance with a scenario in which infections were of a single origin and were exclusively maintained by clonal propagation through endogenous transplacental transmission.

Activated protein C ß-glycoform promotes enhanced noncanonical PAR1 proteolysis and superior resistance to ischemic injury.

Activated protein C (APC) is an anticoagulant protease that initiates cell signaling via protease-activated receptor 1 (PAR1) to regulate vascular integrity and inflammatory response. In this study, a recombinant APC variant (APC(N329Q)) mimicking the naturally occurring APC-ß plasma glycoform was found to exhibit superior PAR1 proteolysis at a cleavage site that selectively mediates cytoprotective signaling. APC(N329Q) also enhanced integrin αMß2-dependent PAR1 proteolysis to exert significantly improved antiinflammatory activity on macrophages compared with wild-type APC. Recent therapeutic applications of recombinant APC in ischemic stroke models have used APC variants with limited anticoagulant activity to negate potential bleeding side effects. Using a mouse model of ischemic stroke and late t-PA intervention, the neuroprotective activity of a murine APC variant with limited anticoagulant activity (mAPC(PS)) was compared with an identical APC variant except for the absence of glycosylation at the APC-ß sequon (mAPC(PS/N329Q)). Remarkably, mAPC(PS/N329Q) limited cerebral ischemic injury and reduced brain lesion volume significantly more effectively than mAPC(PS). Collectively, this study reveals the importance of APC glycosylation in controlling the efficacy of PAR1 proteolysis by APC and demonstrates the potential of novel APC variants with superior cytoprotective signaling function as enhanced therapeutic agents for the treatment of ischemic stroke.

Study of cases of abiraterone discontinuation due to toxicity in pre-chemotherapy after 1 year's experience.

Abiraterone acetate is a potent and irreversible inhibitor of cytochrome p450 17A1 that suppresses androgen synthesis. It is approved for chemotherapy-naive and docetaxel-treated patients with metastatic castration-resistant prostate cancer. We describe the protocol for use of abiraterone in metastatic castration-resistant prostate cancer chemotherapy naive patients has been implanted in our centre and we review the cases of those patients whose adverse effects have forced the discontinuation of treatment. The side effects fit the safety profile of abiraterone, speed of their appearance and severity indicate that you should perform a thorough follow-up of these patients especially in the early phases of treatment.

Long-term reliability and stability of behavioral measures among adolescents: The Delay Discounting and Stroop tasks.

Delay Discounting (DD) and the Stroop test are two fundamental tasks for the assessment of impulsivity and inhibitory control, core features of several behavioral disorders. Although the study of reliability and temporal stability is important, only studies with adults and small samples have been carried out. The aim of this study is to assess the one-year reliability and temporal stability of both tasks among adolescents. A total of 1375 adolescents (M = 13.08 years old, SD = 0.51) made up the final sample (53.5% males). The results showed moderate stability and good reliability for both DD (α = 0.90) and Stroop (α = 0.85). Indices based on the reaction times and not the number of errors are recommended when using the Stroop test. These results support the use of both behavioral tasks in longitudinal research among adolescents.

Prevalence of Problem Gambling Among Adolescents: A Comparison Across Modes of Access, Gambling Activities, and Levels of Severity.

The high availability and accessibility of online gambling have recently caused public concern regarding the potential increase of gambling-related problems among young people. Nonetheless, few studies among adults and none among adolescents have explored specific characteristics of gamblers as a function of gambling venues to date. This study sought to analyze the prevalence of gambling among a sample of adolescents in the last year, as well as sociodemographic and gambling-related characteristics as possible predictors of at-risk and problem gambling. The sample comprised 1313 adolescents aged 14-18 years. Participants were asked to respond to several questions regarding their gambling behavior. Chi square and ANOVA tests were performed in order to explore differences between groups, and a set of multinomial regressions established significant severity predictors. The prevalence of at-risk and problem gambling was 4 and 1.2 %, respectively. Regression analyses showed that having a relative with gambling problems predicted at-risk gambling. Both living with only one parent or not living with parents at all, and the prevalence of Electronic Gambling Machines in the last year were associated with problem gambling. Mixed-mode gambling was a predictor of both at-risk and problem gambling. Our findings extend previous research on gambling among adolescents by exploring gambling behavior according to different modes of access. Although the prevalence of exclusive online gambling among the total sample was low, these results support the need to consider specific subgroups of gamblers and their concrete related features when conducting both indicated prevention and treatment protocols for adolescents.

Short Leukocyte Telomere Length Is Associated With Cardioembolic Stroke Risk in Patients With Atrial Fibrillation.

BACKGROUND AND PURPOSE: The risk of cardioembolic stroke in patients with atrial fibrillation (AF) cannot be accurately assessed and novel tools are needed to improve prediction. We hypothesize that telomere shortening constitutes a novel risk factor for cardioembolic stroke in patients with AF. METHODS: The peripheral blood leukocyte telomere length (LTL) was determined by real-time polymerase chain reaction in 187 patients with AF, 93 of them without stroke history and 94 of them having suffered 1 cardioembolic stroke. Percentiles were calculated according to LTL values in the nonstroke group to estimate the cardioembolic stroke risk associated with LTL using logistic regression models. RESULTS: Short LTL values were independently and dose-dependently associated with an increased risk of cardioembolic stroke, with an odds ratio (95% confidence interval) of 2.93 (1.24-6.94) and 6.26 (2.01-19.52), respectively, for sex, hypertension, diabetes mellitus, heart failure, and age-adjusted models using the LTL 10th and 5th percentile cut-offs, respectively. CONCLUSIONS: Telomere shortening is associated with cardioembolic stroke risk in patients with AF. Prospective studies are encouraged to establish the value of LTL to improve prediction tools to categorize cardioembolic stroke risk in AF.

Identification of new markers of recurrence in patients with unprovoked deep vein thrombosis by gene expression profiling: the retro study.

OBJECTIVE: The aim of this study was to assess differences in the gene expression profile of peripheral blood cells between patients with early recurrent thrombosis vs. patients without recurrent events after withdrawal of anticoagulant therapy for a first episode of unprovoked deep vein thrombosis (uDVT), to identify novel predictors of recurrence. METHODS: In the discovery population (N = 32), a microarray RNA assay followed by RT-PCR confirmation were performed. In the validation population (N = 44) a multiple RT-PCR-based strategy was applied to assess genes differentially expressed in the discovery population. RESULTS: The sex-adjusted Linear Model for Microarray Data analysis showed 102 genes differentially expressed (P < 0.01) in the discovery population. Nineteen of them underwent further confirmation in the validation population. The gene encoding for Acyl-CoA Synthetase Family Member 2 (ACSF2) was underexpressed in recurrent DVT patients in both, the discovery (P = 0.007) and validation populations (P = 0.004). In the receiver operator characteristic (ROC) analysis, the areas under the curve of ACSF2 expression were 0.77 and 0.80, respectively. CONCLUSIONS: For the first time an association between ACSF2 expression and the risk of recurrent DVT is suggested. Should this association be confirmed in larger prospective studies, ACSF2 could become useful for the selection of patients requiring extended anticoagulant therapy.

Contingency management for substance use disorders in Spain: Implications for research and practice.

OBJECTIVE: We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges. METHOD: Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed. RESULTS: Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date. CONCLUSION: The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain.

sPLA2-V inhibits EPCR anticoagulant and antiapoptotic properties by accommodating lysophosphatidylcholine or PAF in the hydrophobic groove.

The endothelial protein C receptor (EPCR) plays an important role in cardiovascular disease by binding protein C/activated protein C (APC). EPCR structure contains a hydrophobic groove filled with an unknown phospholipid needed to perform its function. It has not been established whether lipid exchange takes place in EPCR as a regulatory mechanism of its activity. Our objective was to identify this phospholipid and to explore the possibility of lipid exchange as a regulatory mechanism of EPCR activity driven by the endothelially expressed secretory group V phospholipase A(2) (sPLA(2)-V). We identified phosphatidylcholine (PCh) as the major phospholipid bound to human soluble EPCR (sEPCR). PCh in EPCR could be exchanged for lysophosphatidylcholine (lysoPCh) and platelet activating factor (PAF). Remarkably, lysoPCh and PAF impaired the protein C binding ability of sEPCR. Inhibition of sPLA(2)-V, responsible for lysoPCh and PAF generation, improved APC binding to endothelial cells. EPCR-dependent protein C activation and APC antiapoptotic effect were thus significantly enhanced. In contrast, endothelial cell supplementation with sPLA(2)-V inhibited both APC generation and its antiapoptotic effects. We conclude that APC generation and function can be modulated by changes in phospholipid occupancy of its endothelial cell receptor.

Neospora caninum infection as a cause of reproductive failure in a sheep flock.

Neospora caninum has been detected only sporadically in cases of ovine abortion, and it has therefore traditionally been considered as an unimportant parasite in small ruminants. This study was carried out with the aim of identifying the pathogen causing serious reproductive problems on a commercial sheep farm. Sera from all rams and ewes tested negative for antibodies against Border disease virus, Schmallenberg virus and Coxiella burnetii, and infections by these agents were therefore ruled out. Nevertheless, seropositivity to N. caninum and/or Toxoplasma gondii was detected, although the seroprevalence was higher in the case of N. caninum. The percentage of lambings and the number of lambs per dam were significantly lower in ewes that were seropositive to N. caninum while no effect on these parameters was detected in ewes that were seropositive to T. gondii. There was also no evidence of infection by T. gondii in the foetal/lamb tissues analyzed by PCR and/or immunohistopathological techniques. On the contrary, the DNA of N. caninum was detected in 13 out of 14 foetuses/lambs descendant from dams seropositive to this parasite. Characteristic lesions caused by N. caninum and/or its antigen were also detected. Genotyping of the N. caninum DNA revealed only two closely related microsatellite multilocus genotypes. The results clearly demonstrate that infection by N. caninum was the cause of the low reproductive performance of this sheep flock.

Neospora caninum infection during early pregnancy in cattle: how the isolate influences infection dynamics, clinical outcome and peripheral and local immune responses.

This work studies the influence of Neospora caninum intra-species diversity on abortion outcome, infection dynamics in terms of parasite dissemination and peripheral-local immune responses in pregnant cattle. Animals were intravenously inoculated at day 70 of pregnancy with 107 tachyzoites of two isolates showing marked differences in virulence in vitro and in pregnant mouse models: Nc-Spain7, a high virulence isolate, and Nc-Spain8, a low-to-moderate virulence isolate. After inoculation, pregnancy was monitored, and dams were culled when foetal death was detected. Foetal mortality occurred in all infected heifers between days 24 and 49 post-infection (pi), however, it was detected sooner in Nc-Spain7-infected animals (median day = 34) than those inoculated with Nc-Spain8 (median day = 41) with a trend towards significance (P < 0.11). Similar histological lesions were observed in placentomes and in most of the foetuses from the two infected groups. However, parasites were more frequently detected in the placenta and foetuses by PCR and in the foetal brain by immunohistochemistry in Nc-Spain7-infected animals. Specific antibodies were detected starting at day 13 post-infection in all infected cattle, with higher IgG levels in Nc-Spain7-infected group. IFN-γ and IL-4 profiles also varied between infected groups in PBMC stimulation assays. Infected animals showed significant increases in their cytokine mRNA levels (IFN-γ, IL-4, IL-10, IL-12p40 and TNF-α) in the caruncle at time of foetal death. Differences between the infected groups were also observed for cytokine profiles. These results demonstrate the influence of the N. caninum isolate on foetal death outcome, infection dynamics and immune responses in cattle.

[Gastrointestinal lesions and characteristics of acute gastrointestinal bleeding in acenocoumarol-treated patients]. / Lesiones gastrointestinales y características de las hemorragias digestivas agudas en los pacientes anticoagulados con acenocumarol.

UNLABELLED: In the last few years, the number of anticoagulated patients has significantly increased and, as a consequence, so have hemorrhagic complications due to this therapy. We analyzed gastrointestinal (GI) bleeding because it is the most frequent type of major bleeding in these patients, and we hypothesized that they would have lesions responsible for GI bleeding regardless of the intensity of anticoagulation, although excessively anticoagulated patients would have more serious hemorrhages. OBJECTIVES: To study the characteristics of anticoagulated patients with GI bleeding and the relationship between the degree of anticoagulation and a finding of causative lesions and bleeding severity. PATIENTS AND METHODS: We prospectively studied 96 patients, all anticoagulated with acenocoumarol and consecutively admitted to hospital between 01/01/2003 and 09/30/2005 because of acute GI bleeding. We excluded patients with severe liver disease, as well as nine patients with incomplete details. RESULTS: The incidence of GI bleeding requiring hospitalization was 19.6 cases/100,000 inhabitants-year. In 90% of patients, we found a causative (85% of upper GI bleeding and 50% of lower GI bleeding) or potentially causative lesion, and 30% of them required endoscopic treatment, without differences depending on the intensity of anticoagulation. No relationship was found between the type of lesions observed and the degree of anticoagulation in these patients. Patients who received more intense anticoagulation therapy had more severe hemorrhages (23% of patients with an INR ≥4 had a life-threatening bleed versus only 4% of patients with INR <4). CONCLUSIONS: We found an incidence of 20 severe GI bleeding episodes in anticoagulated patients per 100,000 inhabitants-year, with no difference in localization or in the frequency of causative lesions depending on the intensity of anticoagulation. Patients receiving more intense anticoagulation had more severe GI bleeding episodes.

Laparoscopic limited liver resection decreases morbidity irrespective of the hepatic segment resected.

OBJECTIVES: The laparoscopic approach is widely used in abdominal surgery. However, the benefits of laparoscopy in liver surgery have hitherto been insufficiently established. This study sought to investigate these benefits and, in particular, to establish whether or not the laparoscopic approach is beneficial in patients with lesions involving the posterosuperior segments of the liver. METHODS: Outcomes in a cohort of patients undergoing mostly minor hepatectomy (50 laparoscopic and 52 open surgery procedures) between January 2000 and December 2010 at the University Clinic of Navarra were analysed. The two groups displayed similar clinical characteristics. RESULTS: Patients submitted to laparoscopic liver resection (LLR) had a lower risk for complications [odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.74; P = 0.013] and shorter hospital stay (OR = 0.08, 95% CI 0.02-0.27; P < 0.001) independently of the presence of classical risk factors for complications. In the cohort of patients with lesions involving posterosuperior liver segments (20 laparoscopic, 21 open procedures), LLR was associated with significantly fewer complications (OR = 0.16, 95% CI 0.04-0.71) and a lower risk for a long hospital stay (OR = 0.1, 95% CI 0.02-0.43). CONCLUSIONS: This study confirms that the laparoscopic approach to hepatic resection decreases the risk for post-surgical complications and lengthy hospitalization in patients undergoing minor liver resections. This beneficial effect is observed even in patients with lesions located in segments that require technically difficult resections.