Targeted Electromyographic Biofeedback With Endoanal Electrostimulation for Anal Incontinence.

Purpose. Anal incontinence (AI) is a disabling condition with a variable response to conservative physical therapies. We assess the utility of combining electromyographic biofeedback with endoanal electrostimulation targeted to the weakest areas of the pelvic floor using the MAPLe® probe (Multiple Array Probe Leiden Novuqare). Methods. Patients with AI unresponsive to conservative measures were assessed before and after treatment with anorectal manometry (ARM), electromyography (EMG), Wexner Continence Scoring, Visual Analog Scoring (VAS), FIQL and SF-12 quality of life determination. Results. Of 29 patients in the final analysis, there was an improvement in the mean Wexner continence score from 13.59 to 8.03 and a concomitant improvement in the reported VAS from 3.45 to 6.72. Both Wexner continence and VAS scores were maintained during follow-up. Maximum voluntary manometric contraction significantly improved from 91.76 mmHg to 110.33 mmHg with no changes in resting pressure. The EMG values ​​(µV) that significantly improved included the average and peak resistance, the average general voluntary contraction, and the average and peak voluntary contraction for both the external anal sphincter and the puborectalis. In the FIQL, behavior, depression and shame domains improved after treatment and during follow-up with lifestyle improvements detected at 6 and 12 months. Physical and mental components of the SF-12 improved at 6 and 12 months. Conclusions. Targeted electromyographic biofeedback and endoanal electrostimulation using MAPLe® probe in AI patients sustainably improves objective ARM and EMG parameters along with subjective reporting of continence severity, VAS, and quality of life.

Mitigation of greenhouse gases in dairy cattle via genetic selection: 2. Incorporating methane emissions into the breeding goal.

The objective of this study was to analyze the impact of incorporating enteric methane into the breeding objective of dairy cattle in Spain, and to evaluate both genetic and economic response of traits in the selection index under 4 scenarios: (1) the current ICO (Spanish total merit index), used as benchmark; (2) a hypothetical penalization of methane emissions through a carbon tax; (3) considering methane as a net energy loss for the animal; and (4) desired genetic response to reduce methane production by 20% in 10 yr. A bio-economic model was developed to derive the economic values for production and methane traits in each scenario. The estimated economic values for methane were estimated at -€1.21/kg and -€0.32/kg for scenarios 2 and 3, respectively. When merged with other traits in the selection index, methane had less economic importance (1-5%) than milk protein yield (39-42%) or milk fat yield (27-28%). Under these scenarios, selection resulted in an unfavorable response in methane emissions when it was included with an economic weight, with an increase in methane estimated from 0.52 to 0.60 kg/cow per year. Small differences in total profit per cow per year were observed between indices. The incorporation of methane production into the breeding objective had a negligible effect on production, with minor reductions in the expected genetic gain for fat and protein yields and in total economic benefits. However, total methane emissions in the dairy industry in Spain were estimated to decrease between 2 and 5% in the next 10 yr due to positive genetic trends for milk yield and an expected decrease in the total number of dairy cows. Additionally, methane intensity per 1 billion liters of milk would decrease in all scenarios. The uncertainty in the genetic parameters of methane and in carbon prices were tested in a sensitivity analysis, resulting in small deviations from the benchmark scenario. A major effect was observed only under the desired genetic response scenario. In this case, it was possible to achieve a 20% reduction of methane production in 10 yr via selective breeding but at the expense of a larger ad hoc weight (33%) of methane in the selection index and decelerating the genetic gain for production traits from 6 to 18%. This study shows the potential of including environmental traits in the selection indices while retaining populations profitable for producers.

Mitigation of greenhouse gases in dairy cattle via genetic selection: 1. Genetic parameters of direct methane using noninvasive methods and proxies of methane.

Records of methane emissions from 1,501 cows on 14 commercial farms in 4 regions of Spain were collected from May 2018 to June 2019. Methane concentrations (MeC) were measured using a nondispersive infrared methane detector installed within the feed bin of the automatic milking system during 14- to 21-d periods. Rumination time (RT; min/d) was collected using collars with a tag that registered time (minutes) spent eating and ruminating. The means of MeC and methane production (MeP) were 1,254.28 ppm and 182.49 g/d, respectively; mean RT was 473.38 min/d. Variance components for MeC, MeP, and RT were estimated with REML using pedigree and genomic information in a single-step model. Heritabilities for MeC and MeP were 0.11 and 0.12, respectively. Rumination time showed a slightly larger heritability estimate (0.17). The genetic correlation between MeP and MeC was high (>0.95), suggesting that selection on either trait would lead to a positive correlated response on the other. Negative correlations were estimated between RT and MeC (-0.24 ± 0.38) and MeP (-0.43 ± 0.35). Methane concentration and MeP had slightly positive correlations with milk yield (0.17 ± 0.39 and 0.21 ± 0.36), protein percentage (0.08 ± 0.32 and 0.30 ± 0.45), protein yield (0.22 ± 0.41 and 0.31 ± 0.35), fat percentage (0.02 ± 0.40 and 0.27 ± 0.36), and fat yield (0.27 ± 0.28 and 0.29 ± 0.28) from bivariate analyses. Rumination time had positive correlations with milk yield (0.41 ± 0.75) and protein yield (0.26 ± 0.57) and negative correlations with fat yield (-0.45 ± 0.32), protein percentage (-0.15 ± 0.38), and fat percentage (-0.40 ± 0.47). A positive approximated genetic correlation was estimated between fertility and MeC (0.10 ± 0.05) and MeP (0.18 ± 0.05), resulting in slightly higher CH4 production when selecting for better fertility [days open estimated breeding values (EBV) are expressed with mean 100 and SD 10, inversely related to days from calving to conception; that is, greater days open EBV implies better fertility]. Positive correlations were also estimated for stature with MeC and MeP (0.30 ± 0.04 and 0.43 ± 0.04, respectively). Other type traits (chest width, udder depth, angularity, and capacity) were positively correlated with methane traits, possibly because of higher milk yield and higher feed intake from these animals. Rumination time showed positive EBV correlations with production traits and type traits, and negative correlations with somatic cell count and body condition score. Based on the genetic correlations and heritabilities estimated in this study, methane is measurable and heritable, and estimates of genetic correlations suggest no strong opposition to current breeding objectives in Spanish Holsteins.

The gradient boosting algorithm and random boosting for genome-assisted evaluation in large data sets.

In the next few years, with the advent of high-density single nucleotide polymorphism (SNP) arrays and genome sequencing, genomic evaluation methods will need to deal with a large number of genetic variants and an increasing sample size. The boosting algorithm is a machine-learning technique that may alleviate the drawbacks of dealing with such large data sets. This algorithm combines different predictors in a sequential manner with some shrinkage on them; each predictor is applied consecutively to the residuals from the committee formed by the previous ones to form a final prediction based on a subset of covariates. Here, a detailed description is provided and examples using a toy data set are included. A modification of the algorithm called "random boosting" was proposed to increase predictive ability and decrease computation time of genome-assisted evaluation in large data sets. Random boosting uses a random selection of markers to add a subsequent weak learner to the predictive model. These modifications were applied to a real data set composed of 1,797 bulls genotyped for 39,714 SNP. Deregressed proofs of 4 yield traits and 1 type trait from January 2009 routine evaluations were used as dependent variables. A 2-fold cross-validation scenario was implemented. Sires born before 2005 were used as a training sample (1,576 and 1,562 for production and type traits, respectively), whereas younger sires were used as a testing sample to evaluate predictive ability of the algorithm on yet-to-be-observed phenotypes. Comparison with the original algorithm was provided. The predictive ability of the algorithm was measured as Pearson correlations between observed and predicted responses. Further, estimated bias was computed as the average difference between observed and predicted phenotypes. The results showed that the modification of the original boosting algorithm could be run in 1% of the time used with the original algorithm and with negligible differences in accuracy and bias. This modification may be used to speed the calculus of genome-assisted evaluation in large data sets such us those obtained from consortiums.

Comparison of methods for the implementation of genome-assisted evaluation of Spanish dairy cattle.

The aim of this study was to evaluate methods for genomic evaluation of the Spanish Holstein population as an initial step toward the implementation of routine genomic evaluations. This study provides a description of the population structure of progeny tested bulls in Spain at the genomic level and compares different genomic evaluation methods with regard to accuracy and bias. Two bayesian linear regression models, Bayes-A and Bayesian-LASSO (B-LASSO), as well as a machine learning algorithm, Random-Boosting (R-Boost), and BLUP using a realized genomic relationship matrix (G-BLUP), were compared. Five traits that are currently under selection in the Spanish Holstein population were used: milk yield, fat yield, protein yield, fat percentage, and udder depth. In total, genotypes from 1859 progeny tested bulls were used. The training sets were composed of bulls born before 2005; including 1601 bulls for production and 1574 bulls for type, whereas the testing sets contained 258 and 235 bulls born in 2005 or later for production and type, respectively. Deregressed proofs (DRP) from January 2009 Interbull (Uppsala, Sweden) evaluation were used as the dependent variables for bulls in the training sets, whereas DRP from the December 2011 DRPs Interbull evaluation were used to compare genomic predictions with progeny test results for bulls in the testing set. Genomic predictions were more accurate than traditional pedigree indices for predicting future progeny test results of young bulls. The gain in accuracy, due to inclusion of genomic data varied by trait and ranged from 0.04 to 0.42 Pearson correlation units. Results averaged across traits showed that B-LASSO had the highest accuracy with an advantage of 0.01, 0.03 and 0.03 points in Pearson correlation compared with R-Boost, Bayes-A, and G-BLUP, respectively. The B-LASSO predictions also showed the least bias (0.02, 0.03 and 0.10 SD units less than Bayes-A, R-Boost and G-BLUP, respectively) as measured by mean difference between genomic predictions and progeny test results. The R-Boosting algorithm provided genomic predictions with regression coefficients closer to unity, which is an alternative measure of bias, for 4 out of 5 traits and also resulted in mean squared errors estimates that were 2%, 10%, and 12% smaller than B-LASSO, Bayes-A, and G-BLUP, respectively. The observed prediction accuracy obtained with these methods was within the range of values expected for a population of similar size, suggesting that the prediction method and reference population described herein are appropriate for implementation of routine genome-assisted evaluations in Spanish dairy cattle. R-Boost is a competitive marker regression methodology in terms of predictive ability that can accommodate large data sets.

Assets of imputation to ultra-high density for productive and functional traits.

The aim of this study was to evaluate different-density genotyping panels for genotype imputation and genomic prediction. Genotypes from customized Golden Gate Bovine3K BeadChip [LD3K; low-density (LD) 3,000-marker (3K); Illumina Inc., San Diego, CA] and BovineLD BeadChip [LD6K; 6,000-marker (6K); Illumina Inc.] panels were imputed to the BovineSNP50v2 BeadChip [50K; 50,000-marker; Illumina Inc.]. In addition, LD3K, LD6K, and 50K genotypes were imputed to a BovineHD BeadChip [HD; high-density 800,000-marker (800K) panel], and with predictive ability evaluated and compared subsequently. Comparisons of prediction accuracy were carried out using Random boosting and genomic BLUP. Four traits under selection in the Spanish Holstein population were used: milk yield, fat percentage (FP), somatic cell count, and days open (DO). Training sets at 50K density for imputation and prediction included 1,632 genotypes. Testing sets for imputation from LD to 50K contained 834 genotypes and testing sets for genomic evaluation included 383 bulls. The reference population genotyped at HD included 192 bulls. Imputation using BEAGLE software (http://faculty.washington.edu/browning/beagle/beagle.html) was effective for reconstruction of dense 50K and HD genotypes, even when a small reference population was used, with 98.3% of SNP correctly imputed. Random boosting outperformed genomic BLUP in terms of prediction reliability, mean squared error, and selection effectiveness of top animals in the case of FP. For other traits, however, no clear differences existed between methods. No differences were found between imputed LD and 50K genotypes, whereas evaluation of genotypes imputed to HD was on average across data set, method, and trait, 4% more accurate than 50K prediction, and showed smaller (2%) mean squared error of predictions. Similar bias in regression coefficients was found across data sets but regressions were 0.32 units closer to unity for DO when genotypes were imputed to HD density. Imputation to HD genotypes might produce higher stability in the genomic proofs of young candidates. Regarding selection effectiveness of top animals, more (2%) top bulls were classified correctly with imputed LD6K genotypes than with LD3K. When the original 50K genotypes were used, correct classification of top bulls increased by 1%, and when those genotypes were imputed to HD, 3% more top bulls were detected. Selection effectiveness could be slightly enhanced for certain traits such as FP, somatic cell count, or DO when genotypes are imputed to HD. Genetic evaluation units may consider a trait-dependent strategy in terms of method and genotype density for use in the genome-enhanced evaluations.

Coordinated and sequential activation of neutral and acidic DNases during interdigital cell death in the embryonic limb.

Interdigital tissue regression during embryonic development is one of the most representative model systems of morphogenetic cell death, but the degenerative cascade accounting for this process awaits clarification. Although the canonical apoptotic caspase pathway appears to be activated in the interdigital mesenchyme committed to die, neither genetic nor chemical blockage of caspases or their downstream effectors, is sufficient to prevent cell death. Hence, alternative and/or complementary dying pathways must also be responsible for this degenerative process. In this work we have chosen to study the endonucleases during the regression of the interdigital tissue of avian embryos to gain insights into the molecular mechanisms accounting for programmed cell death in this system. We show that caspase activated DNase, which is a neutral DNase associated with the caspase apoptotic pathway, appears to be the main endonuclease only at an initial phase of interdigit regression. However at peak stages of the degenerative process, the acidic DNases L-DNase II and lysosomal DNase IIB become predominant in the system and markers for cell autophagy become moderately up-regulated. Consistent with the activation of acidic endonucleases we observed that microenvironmental pH value in the interdigits decreased to levels only appropriate for acidic enzymes. Furthermore, we found that overexpression of lysosomal DNase IIB in embryonic limb mesoderm promoted cell death, which was also accompanied by up-regulation and activation of L-DNase II. Up-regulation of acidic DNases was maintained in interdigits explanted to culture dishes, where the participation of exogenous professional phagocytes of hematopoietic origin is avoided. Finally, and consistent with all our findings, up-regulation of acidic DNases was much reduced in the webbed interdigits of duck embryos, characterized by a rudimentary interdigital degenerative process. We conclude that the regression of the interdigital tissue involves a coordinated and sequential activation of the caspase and lysosomal degenerative molecular cascades.

[Primary tumours and pseudotumors of the hand in adults. Epidemiological analysis of cases, management and evolution]. / Tumores y seudotumores primarios de la mano en adultos. Análisis epidemiológico de casos, manejo y evolución.

INTRODUCTION: Tumors in the hand are rare, and malignant tumors in the hand are peculiar; However, primary pseudotumoral lesions of the hand, such as ganglion, are very frequent. Most of the tumors found in the bone and soft tissue can be presented in the same way in the hand but their frequency and distribution is different. Despite the low incidence of benign and malignant tumors in the hand, these can be locally invasive or compromise the hand function. The main objective of this study is to determine the epidemiology, types, location and management of tumors and pseudotumors of the hand in adults in the Mexican population. MATERIAL AND METHODS: We designed a retrospective study by review of clinical records of patients in our institution with diagnosis of tumors or pseudotumors in hand from January 2007 to December 2016 evaluating variables such as age, gender, laterality, Diagnosis, histological lineage, localization and treatment. RESULTS: Our study comprises 215 patients with an average age of 44.23 years, predominantly women. Pseudotumors are the most frequently encountered (synovial cyst), followed by benign soft tissue tumors, benign bone tumors, and, finally, malignant tumors. DISCUSSION: After all we suggests a possible new classification for the hand that is simple, reproducible and give guidance for treatment. The need for a classification system is imminent to standardize diagnostics, guide future research, focus treatments and preserve hand function.

INTRODUCCIÓN: Los tumores en la mano son poco frecuentes y los tumores malignos son particularmente raros; sin embargo, las lesiones seudotumorales primarias de la mano, como gangliones, son muy frecuentes. La mayoría de los tumores que se encontraron en el hueso y tejido blando pueden presentarse de igual manera en la mano, pero su frecuencia y distribución es distinta. A pesar de la baja incidencia de los tumores benignos y malignos en la mano, éstos pueden ser localmente invasivos o comprometer su función. El objetivo principal de este estudio es determinar la epidemiología, tipos, localización y manejo de los tumores y seudotumores de la mano en adultos en población mexicana. MATERIAL Y MÉTODOS: Se diseñó un estudio retrospectivo mediante revisión de expedientes clínicos de pacientes de nuestra institución con diagnóstico de tumores o seudotumores en la mano de Enero de 2007 a Diciembre de 2016 evaluando variables como edad, género, lateralidad, abordaje diagnóstico, estirpe histológica, localización y tratamiento. RESULTADOS: Nuestro estudio comprende 215 pacientes con una edad promedio de 44.23 años, predominantemente mujeres. Los seudotumores son los que con más frecuencia se detectan (quiste sinovial), seguidos de los tumores benignos de tejido blando, tumores óseos benignos y, por último, los tumores malignos. DISCUSIÓN: Después de todo, sólo sugerimos una clasificación para la mano que es sencilla y reproducible y dar orientación para el tratamiento. La necesidad de un sistema de clasificación es inminente para estandarizar los diagnósticos, guiar futuras investigaciones, enfocar tratamientos y preservar la función de la mano, independientemente de la epidemiología que se observe.

Long-term storage in liquid nitrogen does not affect cell viability in cardiac valve allografts.

Liquid nitrogen is the most common medium used by tissue banks for the storage of cryopreserved heart valves. This study evaluates the effect of the length of storage on human cryopreserved heart valves. Human tissues (14 aortic and 13 pulmonary) were frozen in a controlled-rate freezer (1 degrees C/min) and stored in the liquid phase of a nitrogen tank for 9.1+/-1.6 years. The preservative solution was medium M199 containing 5% human serum albumin and 10% Me(2)SO. After thawing in a water bath at 42 degrees C, the cryoprotectant was removed. Then, fragments from vascular wall and leaflet were dissected. Explant cultures and histological studies were performed in order to assess cell viability and structural integrity. CD90 and CD31 expression was analysed in cultured cells using flow cytometry. Light microscopy, immunofluorescence staining and laser scanning confocal microscopy were used to evaluate cell viability and extracellular matrix components. Electron microscopy was used for ultrastructural study. Cell cultures could be obtained from all the specimens assayed. Cells grew from explants showing a fibroblastic phenotype. CD90 expression was common in cultured cells but a low percentage of cells expressed CD31. Histological results showed a good preservation estructure in both leaflets and vascular walls. Morphological features of cellular irreversible damage were very rare. No differences which could be due to length of allograft storage period were observed. We concluded that allografts stored in liquid nitrogen up to 13 years did not significantly undergo loss of cell viability other than that due to disinfection, freezing and thawing protocols.

Correlation between beta-adrenoceptors and G-protein-coupled receptor kinases in pretransplantation heart failure.

INTRODUCTION: Prolonged catecholamine overstimulation of the myocardium in chronic heart failure causes a reduction in the number and functionality of beta1-adrenoceptors (beta1-AR) of the heart. Desensitization of beta1-AR is mediated by their phosphorylation by a group of cytosolic kinases (G-protein-coupled receptor kinases GRK). In advanced heart failure, an increase in GRK levels associated with the severity of the disease has been observed. OBJECTIVE: The objective of this study was to analyze messenger RNA (mRNA) levels of beta1-AR in the myocardium of patients who underwent transplantation for advanced heart failure and their correlation with expression of the major cardiac isoenzymes of GRK. MATERIALS AND METHODS: Myocardial tissue samples were obtained from the left ventricles of 14 explanted hearts of patients who underwent transplantation for dilated (n = 7) and ischemic (n = 7) cardiomyopathy. RT-PCR techniques were used to analyze mRNA levels of beta1-AR and the isoenzymes GRK2, GRK3, and GRK5. RESULTS: We observed a significant correlation between beta1-AR and the 3 subtypes of GRK (R(2) = 0.668, 0.71, and 0.318, respectively). CONCLUSIONS: In patients with advanced heart failure pretransplantation, we observed a significant correlation between beta1-AR and GRK2 and GRK3 levels. GRK5, the subtype predominantly expressed in the myocardium, showed a lesser correlation with beta1-AR levels.

Differences in early postoperative complications in elective and emergency heart transplantation.

INTRODUCTION AND OBJECTIVES: The immediate postoperative period is a critical phase in heart transplantation. Severe complications occur that may influence short-term and medium-term morbidity and mortality in these patients. The aim of this study was to analyze the incidence of severe complications in emergency and nonemergency transplantations. MATERIALS AND METHODS: We studied 152 patients who underwent heart transplantation between 2001 and 2007. Combined transplantations and retransplantations were excluded. Two groups were considered: emergency transplantations (36 patients, 24%) and elective transplantations. We compared survival and occurrence of infection, primary graft failure (PGF), renal and hepatic failure, respiratory complications, cardiac tamponade, arrhythmias, reoperation, and intensive care unit (ICU) stay. RESULTS: The emergency transplantation group had a greater number of ischemic patients, with a more prolonged cardiopulmonary bypass time, and a larger proportion of donors were women. Overall mortality in the intensive care unit was 2.6%, with no differences between groups. However, emergency procedures were significantly associated with a higher incidence of PGF, need for intraaortic balloon pump, and a more prolonged mechanical ventilation time, as well as a greater number of bacterial infections and a significantly longer ICU stay. CONCLUSIONS: In our series, emergency transplantation showed no greater perioperative mortality. We observed a greater number of severe complications, such as PGF, bacterial infection, and more prolonged mechanical ventilation time.

Incomplete posterior hyaloid detachment after intravitreal pegaptanib injection in diabetic macular edema.

PURPOSE: Posterior hyaloid adherences play a role in the pathogenesis of diabetic macular edema (DME). Intravitreal antivascular endothelial growth factor (VEGF) drugs are presently being used to treat DME. The authors report one case of incomplete posterior hyaloid detachment (PHD) following intravitreal pegaptanib to treat DME. This case shows a combined mechanism of DME resolution by anti VEGF and PHD. METHODS: Prospective, interventional, single case report. One male patient with bilateral DME was treated by intravitreal pegaptanib in his right eye every 6 weeks for 6 months (five injections) and followed for 42 months. RESULTS: Central macular thickness decreased from 511 to 376 microm at month 4 in the treated eye and remained within 10% of this value during follow-up. The posterior hyaloid became taut and partially detached after the third injection and was almost completely detached 1 year later. Visual acuity remained unchanged in both eyes during follow-up. CONCLUSIONS: PHD may play an important role in cases where macular thickness is successfully reduced or better acuity is achieved after intravitreal injections.

Effect of topical anesthetics on intraocular pressure and pachymetry.

PURPOSE: The determination of intraocular pressure (IOP) by noncontact tonometry (NCT) has been reported to be affected by central corneal thickness (CCT) and by the instillation of topical anesthetics. METHODS: In order to determine the influence of topical anesthetics on CCT and IOP measured by NCT, 80 eyes from 49 patients were examined before and after the instillation of topical anesthetics. RESULTS: Average age was 55.3 years (SD 18.4, range 18 to 93). Twenty-eight patients were female and 21 were male. Average basal IOP was 16.1 mmHg (SD 5.2, range 8 to 35.3). IOP was 14.8 mmHg (SD 4.6, 7.4 to 32.4) (p=0.0005, Student t test for paired data) 5 minutes after topical anesthetics instillation. CCT averaged 541 micronm (SD 32, range 482 to 604) before topical anesthetic drops and 541 micronm (SD 32, 490 to 607, p=0.89, Student t test for paired data) 5 minutes after topical anesthetics instillation. CONCLUSIONS: The study confirms that the instillation of topical anesthetics causes a reduction in IOP. These changes do not seem to be associated with changes in CCT.

[Ultrasound findings in spontaneous and postoperative anal pain]. / Hallazgos ecográficos en la proctalgia espontánea u postoperatoria.

OBJECTIVE: To assess the use of endoanal ultrasounds to identify anal pain etiology in patients with either spontaneous or post-operative pain, and to review the most frequent causes. METHODS: A descriptive study of ultrasound findings in patients with anal pain during the last six years was performed. All ultrasound scans were performed using a B&K Diagnostic Ultrasound System (Cheetah 2003, B&K Medical, Gentofte, Denmark) with a 7-MHz endoprobe providing 360 degrees images. RESULTS: Ninety-five cases of anal pain were studied by endoanal ultrasonography. Sixty-seven cases of anal pain ocurred in patients with previous perineal or pelvic surgery: anal fissure (48), Hemorrhoidectomy (12), episiotomy (4), fistula (2), and prostatectomy (1). After fissure surgery, incomplete sphincterotomy was the first cause of anal pain. Twenty-eight patients had no previous surgery, and more than 57.14% of them were found to have internal anal sphincter hypertrophy. CONCLUSIONS: Patients with anal pain can be studied by endoanal ultrasounds in spite of the use of an endoprobe. With this exploration a cause of pain is found in 81.93% of cases. Internal anal sphincter hypertrophy is the most frequent finding associated with spontaneous anal pain.

[Photodynamic therapy with verteporfin in choroidal neovascularization after refractive surgery]. / Terapia fotodinámica con verteporfina en neovascularización coroidea después de cirugía refractiva.

PURPOSE: To analyze the results obtained with Photodynamic Therapy (PDT) to treat subfoveal and juxtafoveal Choroidal Neovascularization (CNV) in patients with high myopia corrected by Laser-Assisted in situ Keratomileusis (LASIK) or by implanting a Phakic Intraocular Lens (PIOL). METHODS: We analyzed the results from 14 highly myopic eyes corrected by LASIK (seven cases) or by PIOL implantation (seven cases), which later developed CNV and were treated by PDT with verteporfin. RESULTS: Mean Best Corrected Visual Acuity (BCVA) after refractive surgery was 0.45 SD 0.17 (range, 0.2 to 0.8), with residual spherical equivalent (RSE) -0.5 SD 1.8 D (range, 1 to 5.5 D). After CNV appearance, BCVA was 0.10 SD 0.19 (range, 0.025 to 0.7). CNV was treated in all cases by PDT (mean, 2.0 SD 0.8 treatments). After CNV closure, the mean BCVA improved up to 0.22 SD 0.18 (range, 0.1 to 0.63) (RSE -1.4 SD 1.4 D, range, 0.5 to -4 D). Differences in RSE after refractive surgery and after PDT, and differences between BCVA after CNV appearance and final were not statistically significant (p=0.82 and p=0.06, respectively, Student's t test paired data). CONCLUSION: We consider that PDT is effective in achieving closure of CNV in myopic patients after refractive surgery without inducing changes in spherical equivalent.

Four and a half domain 2 (FHL2) scaffolding protein is a marker of connective tissues of developing digits and regulates fibrogenic differentiation of limb mesodermal progenitors.

Four and a half LIM domain 2 (FHL2) is a multifunctional scaffolding protein of well-known function regulating cell signalling cascades and gene transcription in cancer tissues. However, its function in embryonic systems is poorly characterized. Here, we show that Fhl2 is involved in the differentiation of connective tissues of developing limb autopod. We show that Fhl2 exhibits spatially restricted and temporally dynamic expression around the tendons of developing digits, interphalangeal joint capsules, and fibrous peridigital tissue. Immunolabelling analysis of the skeletal progenitors identified a predominant, but not exclusive, cytoplasmic distribution of FHL2 being associated with focal adhesions and actin cytoskeleton. In the course of chondrogenic differentiation of cultures of limb skeletal progenitors, the expression of Fhl2 is down-regulated. Furthermore, cultures of skeletal progenitors overexpressing Fhl2 take on a predominant fibrogenic appearance. Both gain-of-function and loss-of-function experiments in the micromass culture assays revealed a positive transcriptional influence of Fhl2 in the expression of fibrogenic markers including Scleraxis, Tenomodulin, Tenascin C, ßig-h3, and Tgif1. We further show that the expression of Fhl2 is positively regulated by profibrogenic signals including Tgfß2, all-trans-retinoic acid, and canonical Wnt signalling molecules and negatively regulated by prochondrogenic factors of the bone morphogenetic protein family. Expression of Fhl2 is also regulated negatively in immobilized limbs, but this influence appears to be mediated by other connective tissue markers, such as Tgfßs and Scleraxis.

[Strength and function of hand before and after release of carpal tunnel in patients with type 2 diabetes mellitus by open and endoscopic approach. Case-control study]. / Fuerza y función de mano antes y después de liberación de túnel del carpo en pacientes con diabetes mellitus tipo 2 por abordaje abierto y endoscópico. Estudio de casos y controles.

BACKGROUND: Carpal tunnel syndrome (CTS) is the upper extremity neuropathy more frequent. Treatments led to the entrapment of the median nerve in the carpal tunnel are more complicated and the results less promising and unsatisfactory in diabetic patients. The objective of this study is to compare the results of strength and hand function in healthy patients against patients with diabetes mellitus type 2 (DM2) with a diagnosis of CTS before and after the open and endoscopic release of the carpal tunnel. MATERIAL AND METHODS: This is an observational, retrospective and descriptive study for a period of five years where we evaluated the results in healthy patients and with DM2, with diagnosis of CTS who underwent surgical treatment by open or endoscopic approach; we applied the DASH questionnaire, force grip and clamp fine measurements, presence of infection, pain and complications. RESULTS: The results of 86 patients evaluated, showed a statistical association in the decrease in scores on the functional scale DASH with both approaches, association between remission of hypoesthesias in healthy patients with either of the two approaches as opposed to diabetic patients and association between developing DM2 and complications in the short term. CONCLUSION: Both approaches improve symptoms and function of the hand in healthy and diabetic patients, but the fi rst group will present cases of complete remission in contrast to the group of diabetic patients.

ANTECEDENTES: El síndrome del túnel del carpo (STC) es la neuropatía más frecuente de la extremidad superior a nivel mundial. Los tratamientos dirigidos para el atrapamiento del nervio mediano en el túnel del carpo son más complicados y los resultados menos prometedores e insatisfactorios en pacientes diabéticos. El objetivo de este estudio es comparar los resultados de fuerza y función de la mano en pacientes sanos contra pacientes con diabetes mellitus tipo 2 (DM2) con diagnóstico de STC antes y después de la liberación abierta y endoscópica del túnel del carpo. MATERIAL Y MÉTODOS: Se diseñó un estudio observacional, retrospectivo y descriptivo durante un período de cinco años en el que se evaluaron pacientes sanos y con DM2 con diagnóstico de STC que fueron sometidos a tratamiento quirúrgico por abordaje abierto o endoscópico y a quienes se les aplicó el cuestionario DASH, mediciones de fuerza de prensión y pinza fi na, presencia de hipoestesias, dolor y complicaciones. RESULTADOS: Los resultados de los 86 pacientes evaluados mostraron una asociación estadística en la disminución de los puntajes de la escala funcional DASH con ambos abordajes, asociación entre la remisión de hipoestesias en pacientes sanos con cualquiera de los dos abordajes a diferencia de los pacientes diabéticos y asociación entre padecer DM2 y tener complicaciones a corto plazo. CONCLUSIÓN: Ambos abordajes mejoran los síntomas y función de la mano en pacientes sanos y diabéticos, pero el primer grupo presentará casos de remisión completa a diferencia del grupo de pacientes diabéticos.

Intravitreal bevacizumab for adult-onset vitelliform dystrophy: a case report.

PURPOSE: Adult-onset foveomacular vitelliform dystrophy (AFVD) is often misdiagnosed as occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The authors report the anatomic and functional outcome of intravitreal bevacizumab in a case of AFVD associated with a suspected occult CNV. METHODS: Prospective, interventional, single case report. One female patient with decreased visual acuity (VA) and metamorphopsia secondary to AFVD received one single intravitreal injection of bevacizumab 1.25 mg. RESULTS: The patient reported unchanged VA and decreased metamorphopsia 6 weeks after the injection. Fluorescein angiography (FA) and optical coherence tomography (OCT) showed progressive decrease of subretinal fluid until complete disappearance. VA, OCT, and FA remained unchanged during 10 months follow-up. CONCLUSIONS: Intravitreal bevacizumab showed a morphologic improvement and stable VA in a patient with AFVD. Further case series are required to confirm this observation.

Release hallucinations and visual loss as first manifestations of postoperative unilateral blindness.

PURPOSE: Release hallucinations (RH) with insight into the unreality of the hallucination have been reported in association with severe vision loss. Postoperative blindness following nonocular surgery may appear associated with central retinal artery occlusion (CRAO) caused by incorrect head positioning during surgery, intraoperative hypotension, and atherosclerosis. RH may initially mask the loss of vision. METHODS: Case report. RESULTS: A 27-year-old woman who had undergone lumbar spinal surgery for right L4-L5 discal herniation developed left eye visual loss and complex visual hallucinations immediately after surgery. Her symptoms were initially considered hallucinations related to the anesthesia and not taken into consideration until 4 days later. Ophthalmic examination disclosed CRAO probably caused by ocular compression during surgery. Optic nerve atrophy appeared during the following 6 years. CONCLUSIONS: Doctors and auxiliary personnel should be aware that visual hallucinations may be a sign of actual vision damage.