Maternal genetics and diet modulate vitamin A homeostasis of the offspring and affect the susceptibility to obesity in adulthood in mice.

Perinatal nutrition exerts a profound influence on adult metabolic health. This study aimed to investigate whether increased maternal vitamin A (VA) supply can lead to beneficial metabolic phenotypes in the offspring. The researchers utilized mice deficient in the intestine-specific homeobox (ISX) transcription factor, which exhibits increased intestinal VA retinoid production from dietary ß-carotene (BC). ISX-deficient dams were fed a VA-sufficient or a BC-enriched diet during the last week of gestation and the whole lactation period. Total retinol levels in milk and weanling livers were 2- to 2.5-fold higher in the offspring of BC-fed dams (BC offspring), indicating increased VA supplies during late gestation and lactation. The corresponding VA-sufficient and BC offspring (males and females) were compared at weaning and adulthood after being fed either a standard or high-fat diet (HFD) with regular VA content for 13 weeks from weaning. HFD-induced increases in adiposity metrics, such as fat depot mass and adipocyte diameter, were more pronounced in males than females and were attenuated or suppressed in the BC offspring. Notably, the BC offspring were protected from HFD-induced increases in circulating triacylglycerol levels and hepatic steatosis. These protective effects were associated with reduced food efficiency, enhanced capacity for thermogenesis and mitochondrial oxidative metabolism in adipose tissues, and increased adipocyte hyperplasia rather than hypertrophy in the BC offspring. In conclusion, maternal VA nutrition influenced by genetics may confer metabolic benefits to the offspring, with mild increases in late gestation and lactation protecting against obesity and metabolic dysregulation in adulthood.NEW & NOTEWORTHY A genetic mouse model, deficient in intestine-specific homeobox (ISX) transcription factor, is used to show that a mildly increased maternal vitamin A supply from ß-carotene feeding during late gestation and lactation programs energy and lipid metabolism in tissues and protects the offspring from diet-induced hypertrophic obesity and hepatic steatosis. This knowledge may have implications for human populations where polymorphisms in ISX and ISX target genes involved in vitamin A homeostasis are prevalent.

Early Life Programming of Adipose Tissue Remodeling and Browning Capacity by Micronutrients and Bioactive Compounds as a Potential Anti-Obesity Strategy.

The early stages of life, especially the period from conception to two years, are crucial for shaping metabolic health and the risk of obesity in adulthood. Adipose tissue (AT) plays a crucial role in regulating energy homeostasis and metabolism, and brown AT (BAT) and the browning of white AT (WAT) are promising targets for combating weight gain. Nutritional factors during prenatal and early postnatal stages can influence the development of AT, affecting the likelihood of obesity later on. This narrative review focuses on the nutritional programming of AT features. Research conducted across various animal models with diverse interventions has provided insights into the effects of specific compounds on AT development and function, influencing the development of crucial structures and neuroendocrine circuits responsible for energy balance. The hormone leptin has been identified as an essential nutrient during lactation for healthy metabolic programming against obesity development in adults. Studies have also highlighted that maternal supplementation with polyunsaturated fatty acids (PUFAs), vitamin A, nicotinamide riboside, and polyphenols during pregnancy and lactation, as well as offspring supplementation with myo-inositol, vitamin A, nicotinamide riboside, and resveratrol during the suckling period, can impact AT features and long-term health outcomes and help understand predisposition to obesity later in life.

Saving time in the radiotherapy procedures for COVID-19 pneumonia treatment. A single-institution experience

Background The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities. Patients and methods At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated. Results Mean age of treated patients was 83 (72–91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25–58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry. Conclusions LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times (AU)

Elastolisis de la dermis media: Comunicación de un caso clínico y revisión de la literatura / Mid dermal elastolysis: A case report and review

Describimos el cuadro clínico de un paciente, que presenta placas y pápulas con aspecto de piel arrugada en papel de cigarrillo, localizadas en abdomen. El estudio histopatológico muestra ausencia de fibras elásticas, en una banda que compromete la porción media de la dermis. La elastolisis de la dermis media es una afección infrecuente, adquirida, idiopática o secundaria a un proceso inflamatorio previo, caracterizada por la pérdida focal de tejido elástico en la dermis media y sin compromiso extra cutáneo.

We describe a patient presenting plaques and papules -like wrinkled cigarette paper-, located in abdomen. Histopathological study shows absence of elastic fibers in a band that compromised the middle portion of the dermis. Mid dermal elastolysis is a rare, acquired idiopathic condition characterized by focal loss of elastic tissue in the middle dermis without extra cutaneous involment.

Pilomatrixoma: una presentación clínica atípica / Pilomatrixoma: An atypical presentation

El pilomatrixoma es un tumor anexial benigno, que deriva de las células matriciales del folículo piloso. Tiene dos picos de incidencia: entre los 5 y los 15 años y entre los 50 y 65 años. Aproximadamente el 60-80% de los casos, se desarrolla en la primera década de la vida. En adultos, generalmente es sub-diagnosticado debido a su baja frecuencia. Presentamos el caso de un pilomatrixoma en edad adulta, de rápido crecimiento y realizamos una breve revisión sobre el tema.

Pilomatrixoma is a benign adnexal tumor derived from the matrix cells of the hair follicle. It has two peaks of incidence: between 5 and 15 years and between 50 and 65 years. Approximately 60-80% of cases develop in the first decade of life. In adults, it is generally under-diagnosed due to its low frequency. We report the case of a pilomatrixoma in adulthood of rapid growth and a brief review on the subject.

Xantogranuloma juvenil del adulto: Reporte de un caso clínico y revisión de la literatura / Juvenile xanthogranuloma in adult: A case report and review

El xantoganuloma juvenil es una enfermedad benigna, poco frecuente en el adulto, forma parte del grupo de las histiocitosis de células no Langerhans, representando el 90 % de las mismas y el 15 % de éstas, se presentan en el adulto. El compromiso de otros órganos es excepcional. La evolución suele ser benigna con autoresolución de las lesiones. Presentamos el caso de una paciente de sexo femenino de 27 años de edad, que presentaba lesiones papulares de 15 días de evolución, en zona periocular, asintomáticas, las que fueron biopsiadas con diagnóstico histopatológico de xantogranuloma juvenil.

Juvenile Xanthogranuloma (JX) is an uncommon benign disease in adults, is part of the group of non-Langerhans cells histiocytosis, representing 90 % of them and 15% of these occur in adults. The involvement of other organs is exceptional. The evolution is usually benign with resolution of disease. We present a case of a female patient of 27 years who had papules with 15 days of evolution, in periocular area, asymptomatic, which were biopsied with histopathologic diagnosis of juvenile xanthogranuloma.

Púrpura de Schönlein-Henoch en un adulto asociada a losartán / Schönlein-Henoch purpura in an adult associated with losartan

La púrpura de Schönlein-Henoch, es una vasculitis sistémica de pequeños vasos, con depósitos de IgA en las paredes vasculares, que se caracteriza clínicamente por: púrpura palpable, artritis o artralgias, dolor abdominal y compromiso renal. Es más frecuente en niños pero puede presentarse en adultos. La etiología es desconocida, pero se la ha relacionado a infecciones vacunas, fármacos y en adultos a neoplasias. Presentamos el caso de una mujer de 74 años, que había comenzado a tomar losartán diez días previos al comienzo de los síntomas. Para normalización de la tensión arterial, se suspendió el losartán. Al reiniciar la droga, la paciente presentó nuevamente una púrpura palpable, en miembros inferiores.

Schönlein-Henoch purpura is a systemic vasculitis of small vessels with IgA deposits in vessel walls. It presents with palpable purpura, arthritis or arthralgia, abdominal pain and renal involvement. It is more common in children, but it can also be seen in adults. Although, the etiology is unknown, the illness has been associated with infections, vaccines, drugs and, in adults, with neoplasias, as well. A 74 year-old woman who had started taking losartan ten days before she started with the onset of symptoms are reported. Days after, the arterial tension normalized, so losartan was suspended. When the drug was reintroduced, the patient presented once again a palpable purpura on lower limbs.

Colaboración interprofesional en las sesiones clínicas conjuntas en una Unidad de Cuidados Intensivos: percepciones de enfermeras y médicos / Interprofessional collaboration in joint clinical sessions in an intensive care unit: Perceptions of nurses and physicians

INTRODUCCIÓN: La práctica colaborativa es un proceso interpersonal en el que interactúan diferentes disciplinas profesionales que comparten objetivos, participan en la toma de decisiones y proporcionan una atención integral y de calidad. Las sesiones clínicas conjuntas ofrecen la oportunidad de interactuar y mejorar la comunicación entre profesionales y optimizar los resultados en la práctica. OBJETIVOS: Explorar las percepciones de enfermeras y médicos sobre la práctica colaborativa en las sesiones clínicas conjuntas en Unidad de Cuidados Intensivos. MÉTODO: Estudio de análisis crítico del discurso, a través de entrevistas semiestructuradas y diarios de campo, usando como referencial teórico los conceptos de Campus, Capital y Habitus planteados por Pierre Bourdieu. PARTICIPANTES: enfermeras y médicos de una Unidad de Cuidados Intensivos, reclutados mediante muestreo intencional. Las entrevistas fueron codificadas por todos los investigadores, posteriormente se hizo una puesta en común y se interpretaron los datos en el contexto en el que fueron recogidos. RESULTADOS: Emergieron 5 categorías: 1) Concepto: integración e implicación de un equipo con aportaciones colectivas y objetivos compartidos, 2) importancia: aumenta la seguridad del paciente, mejora la satisfacción de los profesionales y la calidad de atención, 3) factores: la ausencia de cultura de organizaciones dificulta la práctica colaborativa, 4) rol: la enfermera percibió que tiene un rol pasivo (oyente) durante las sesiones clínicas y el médico un papel activo (comunicador), y 5) estrategias de mejora: establecer horario y conciliación de tareas interprofesionales. CONCLUSIONES: Existe una necesidad de empoderamiento en la participación activa por parte de las enfermeras en las sesiones clínicas conjuntas. El colectivo médico debe tener más en cuenta las percepciones humanísticas que pueden aportar otros profesionales. Fomentar la escucha activa en los médicos, mejorar la comunicación real por parte de las enfermeras y generar un espacio donde impere el respeto y la confianza, favorecerán la dinámica de trabajo interprofesional

INTRODUCTION: Collaborative practice is an interpersonal process in which different professional disciplines that share objectives interact, participate in decision-making and provide comprehensive and quality care. The joint clinical sessions offer the opportunity to interact and improve communication between professionals and optimise results in practice. AIM: To explore perceptions of nurses and physicians about collaborative practice in joint Intensive Care Unit clinical sessions. METHOD: Critical discourse analysis, through semi-structured interviews and field journals, using as theoretical reference the concepts of Campus, Capital and Habitus by Pierre Bourdieu. PARTICIPANTS: nurses and physicians of the Intensive Care Unit, who were recruited by intentional sampling. Semi-structured interviews were conducted and a discourse analysis was then performed. The interviews were coded by all the researchers, then shared and the data were interpreted in the context in which they were collected. RESULTS: Five categories emerged: 1) Concept: integration and involvement of a team with collective contributions and shared objectives, 2) importance: it increases patient safety, improves professional satisfaction and quality of care, 3) factors: the absence of culture organisations make collaborative practice difficult, 4) role: the nurse perceived that she plays a passive role (listener) during the clinical rounds and the physician an active role (communicator) and, 5) improvement strategies: to establish a schedule and balance interprofessional tasks. CONCLUSIONS: There is a need for empowerment in active participation by nursing staff in joint clinical sessions. The medical group should be more aware of the humanistic perceptions that other professionals can bring. Encouraging active listening in physicians, improving real communication by nursing staff and generating a space where respect and confidence prevail, will favour interprofessional work dynamics

Challenges in obesity research / Retos de investigación en obesidad

Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, be havioural and biological factors —often interrelated and many of them still unknown or poorly understood— can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue the rmogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity (AU)

La obesidad es el principal problema nutricional y uno de los principales problemas de salud en las sociedades desarrolladas. Conocer y entender los determinantes de la obesidad es clave para conseguir prevenirla y controlarla. Múltiples factores sociales, económicos, culturales, conductuales y biológicos —a menudo interrelacionados y muchos todavía desconocidos o mal conocidos— pueden contribuir al establecimiento y mantenimiento de fenotipos obesos. Aquí destacamos retos en relación con aspectos básicos de la obesidad y ciencia emergente para su control: la termogénesis en el tejido adiposo marrón y el “pardeamiento” (browning) de la grasa blanca como posibles dianas anti-obesidad, la infuencia del microbioma, y la genética, epigenética, nutrigenómica y nutrigenéticade la obesidad. También destacamos temasabier tos en relación con la alimentación y el estilo de vida como determinantes de la obesidad, incluyendo los mecanismos neuronales que subyacen a la motivación a la ingesta por claves ambientales, el control biológico de la actividad física espontánea, el posible papel de alimentos y componentes concretos de alimentos, y la importancia de la alimentación y el ambiente en etapas tempranas de la vida. Nos referimos asimismo a los retos en relación con la conexión de la obesidad con otras alteraciones y patologías, los retos sociales y económicos en relación con el estilo de vida y la producción de alimentos saludables para la prevención de la obesidad, y los retos tecnológicos en la investigación y tratamiento de la obesidad (AU)

Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough?

Background and purpose. Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. Materials and methods. Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. Results. Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. Conclusion. Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life

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Curative radiation therapy for very elderly bladder cancer patients with localized disease

Purpose: To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT). Methods: From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up. Results: The mean age of patients was 82 years (range 76-88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6-66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562-9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors. Conclusion: RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life

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Técnicas de cirugía mucogingival para el cubrimiento radicular / Mucogingival surgical procedures to attain root coverage

La recesión radicular puede desencadenar problemas de hipersensibilidad, caries radicular y problemas estéticos. Para corregir estos defectos y cubrir las superficies denudadas de las raíces se han propuesto gran variedad de técnicas de cirugía plástica periodontal. El propósito de este artículo es realizar una descripción detallada de diferentes procedimientos quirúrgicos para el cubrimiento radicular. Las técnicas de injerto gingival libre, injertos conectivos subepiteliales e injertos de matriz dérmica acelular son descritas paso a paso, según se encuentran definidas en la literatura. Para conseguir la máxima predictibilidad en el cubrimiento de las raíces denudadas es imprescindible diagnosticar con exactitud el caso y observar detalladamente todos los pasos de la técnica quirúrgica (AU)

Gingival recessions may be associated with problems such as dental hypersensitivity, root caries and unacceptable aesthetics. Different techniques are proposed in order to achieve root coverage and correction of the mucogingival defects. The purpose of this article is to present a review and the description of the most common procedures for root coverage. Among these techniques, the most popular procedures are the free gingival graft, the connective tissue grafts and acellular dermal grafts. In order to select the most predictable technique for root coverage, a proper diagnosis has to be established (AU)

Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study

This population-based study aims to assess prognosis of prostate cancer diagnosed with prostate-specific antigen (PSA) levels <4 ng/ml in routine care. Materials and methods We compared prostate cancer patients with low PSA values (n=59) with other prostate cancer patients (n=1330) by logistic regression and the Cox model using data from the Geneva Cancer Registry. Results Patients with low PSA values more frequently had early-stage and well differentiated tumours. Nevertheless, 35% presented with aggressive tumour characteristics or metastases. After adjustment for other prognostic factors, prostate cancer-specific mortality was similar for both groups (hazard ratio: 1.1; 95%CI: 0.6-2.2). Conclusion We conclude that cancer with low PSA values at diagnosis is not indolent (AU)

Ha nacido un nuevo boletín: hemos leído noticias terapéuticas y de prescripción / No disponible

Un boletín de medicamentos es un medio de difusión de información cuyo objetivo es promover el «uso racionalde medicamentos». La relevancia, actualidad y oportunidad son aspectos claves en la elaboración de sucontenido, así como la periodicidad, la distribución y sus destinatarios.Este artículo presenta la experiencia de un grupo de farmacéuticos de atención primaria en la elaboraciónde un boletín de medicamentos nacido de la necesidad de difundir información independiente sobre medicamentos,y destinado a los profesionales sanitarios de diversos ámbitos asistenciales. A continuación, sedetalla tanto el procedimiento seguido en su elaboración como los medios de difusión empleados, así comolas limitaciones a las que se han enfrentando los autores, como evaluar la calidad de la información y lasatisfacción de los lectores

A drug bulletin is a means of information dissemination aimed at the promotion of the Rational Use ofDrugs. The relevance, topicality and opportunity are key aspects in the preparation of its contents, as are theperiodicity, distribution and its target audience.This article presents the experience of a group of primary care pharmacists, in the preparation of a drugbulletin, born out of the need to spread independent information about drugs to health care professionals fromdifferent health care sectors. It gives details of the procedure followed during its preparation, the means ofdissemination used and limitations such as evaluating the quality and the satisfaction of readers

Seguimiento de un caso clínico en hospitalización a domicilio: una nueva alternativa / Follow-up of a case by the hospital-at-home service: a new alternative

Este artículo es la continuación de otros 2 publicados con anterioridad en Enfermería Clínica que describen la evolución clínica de María, una mujer de 26 años con síndrome de Down. En el primero se describía su ingreso en una unidad de cuidados intensivos (UCI) con el diagnóstico de neumonía atípica, durante el cual la paciente presentaba una situación de suplencia total. En el segundo se describía la evolución del proceso de destete, en el que presentó el problema de independencia de ansiedad, pero que se consiguió resolver favorablemente. María fue dada de alta a la unidad de hospitalización convencional con un informe de alta de enfermería en el que se registraron los cuidados llevados a cabo durante su ingreso en la UCI. Este tercer artículo presenta el seguimiento del caso por parte del equipo de la unidad de hospitalización a domicilio. El equipo de asistencia especializada le propuso a María continuar el ingreso con la posibilidad de estar en su domicilio, hasta que pudiera ser dada de alta y que se continuara su seguimiento desde atención primaria. Se exponen las valoraciones realizadas en 2 fases, una previa al ingreso en domicilio, en la que se evalúa la adecuación del ingreso extrahospitalario, y la otra en el propio domicilio, en la que se planifican los cuidados con María y su familia. Se identifica un problema de autonomía en higiene y el problema de independencia de manejo inefectivo del régimen terapéutico familiar. Ambos se abordan desde la asistencia especializada en el contexto del domicilio, en el que resulta fundamental el trabajo con la familia (AU)

The present article is a continuation of two previously published articles in ENFERMERíA CLíNICA that describe the clinical course of María, a 26-year-old woman with Down syndrome. The first article described the patient’s admission to the intensive care unit (ICU) with a diagnosis of atypical pneumonia. During admission, the patient was completely dependent. The second article described the weaning process when the patient showed anxiety, which was favorably resolved. Maria was discharged to a conventional ward with a nursing discharge report that contained the nursing careperformed during her stay in the ICU. The present article describes the patient’s follow-up by the hospital-at-hometeam.The specialized team suggested to María that she continue admission with the possibility of being at home until she could be discharged and followed-up by primary care. The evaluations were performed in 2 phases: a first evaluation before the patient’s return to home, in which the suitability of domiciliary care was evaluated, and a second evaluation in which care was planned with María and her family. A hygiene deficit and ineffective management of the family therapeutic regimen were identified. Both problems were approached by the specialized healthcare team within the context of domiciliary care, in which work with the family is essential (AU)

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma

INTRODUCTION: Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation. MATERIAL AND METHODS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric's Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson's correlation coefficient, Student's t-test and ROC curves. RESULTS: Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student's t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups. CONCLUSIONS: The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated (AU)

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Ectasia dural y dolor lumbar en el síndrome de Marfan / Dural ectasia and lumbar pain associated with Marfan syndrome

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Los cuidados enfermeros en Mallorca / Nursing treatment in Majorca

En este estudio la autoras analizan la aportación de las Hermanas de la Caridad de San Vicente de Paúl a los cuidados enfermeros en Mallorca durante el siglo XIX. Se han trabajado dos fuentes documentales: Las Reglas de Vida y un registro censal de la orden llamado Libro de Curia. En las Reglas se ha tratado de identificar la forma de actuar de las religiosas, buscando los aspectos de posible influencia en la salud de la población a la que asistían y los referentes a su dedicación como maestras, enfermeras y/o gestoras. En el Libro de Curia analizamos los datos sociales de las 320 primeras profesas que aparecen, valorando edad de ingreso, permanencia, ocupación y mortalidad de las hermanas, para compararlas, según fueran maestras o enfermeras(AU)

In this article, the authors analyze the role the «Sant Vicente de Paül» Sisters of Charity had in treating the ill in Majorca during the 19th Century. The authors carried out their research on two primary resources: The Rules of Life and a record of members of the order called the Book of the Curia. The authors tried to identify the methods the sisters followed in their work inside the Rules, searching for those aspects indicating their possible influence on the health of the population to whom they served as well as searching for references to their dedication as teachers, nurses and/or managers. In the Book of the Curia, the authors analyze the social data registered for the first 320 members of the order, evaluating their age upon entrance, their length of stay in the order, their job, and the cause of their death in order to compare these according to whether a sister was a teacher or a nurse(AU)

Testículos no palpables: experiencia del Hospital Central Especializado de Crianças Maria Pia / Nonpalpable testes: experience from the Hospital Central Especializado de Crianças Maria Pia

La incidencia de criptorquidia es del 1% en niños de 1 año de edad, siendo en el 20% de los casos el testículo no palpable. El objetivo de este trabajo fue estudiar la contribución de la cirugía mínimamente invasiva en el diagnóstico y tratamiento de estos pacientes. Los autores realizaron un estudio prospectivo, analítico y longitudinal durante el período de enero de 2001 a diciembre de 2004, englobando 89 niños portadores de 98 testículos no palpables sometidos a laparoscopia. Los autores analizaron los siguientes parámetros: localización del testículo no palpable, examen objetivo bajo anestesia general, ecografía inguinoescrotal, edad de la intervención, hallazgos laparoscópicos, tratamiento efectuado, resultados anatomopatológicos de las piezas extirpadas y seguimiento después de la cirugía (AU)

The incidence of cryptorchidism in children at age of 1 year is 1%, and 20% of these cases represent nonpalpable testes. The aim was to evaluate the use of minimal invasive surgery for the diagnosis and therapy of these patients. The authors made a prospective, analytical and longitudinal study from January 2001 through December 2004 in 89 consecutive boys undergoing laparoscopy for 98 impalpable testes. The following details were analyzed: examination under general anesthesia, ultrasound examination, age at surgery, findings at laparoscopy, operative procedure, results of the histology and follow up (AU)

La leptina en la regulación del balance energético / Leptin in the regulation of energy balance

La leptina, identificada en el año 1994 como una sustancia sintetizada en el tejido adiposo en cantidades proporcionales a la magnitud de las reservas grasas, se ha descrito como un factor importante en la regulación de la homeostasis energética del organismo, puesto que es capaz de inhibir la ingesta, estimular el gasto energético y regular otros procesos metabólicos periféricos implicados en el control de la expansión de la grasa corporal (secreción de insulina, lipólisis, transporte de glucosa). Sin embargo, la leptina es una sustancia pleiotrópica involucrada también en procesos de fertilidad, inflamación y en la angiogénesis, entre otros. Si bien estas acciones han estado bien delimitadas en algunos modelos animales de obesidad, el papel que desempeña la leptina en el hombre es menos claro, puesto que, al menos a nivel hipotalámico, parece existir una importante resistencia a los efectos de esta hormona. Los estudios administrando leptina recombinante realizados recientemente en humanos no aportan resultados suficientemente esperanzadores, puesto que no consiguen pérdidas de peso mayores a las que podemos obtener con otros fármacos existentes en el mercado actual y su administración subcutánea provoca algunos efectos secundarios indeseables. De todos modos, los resultados obtenidos deben ser considerados con cautela, siendo necesarios más estudios referidos a la actividad bioló- gica de la leptina en humanos que permitan determinar la repercusión clínica de la administración de esta hormona (AU)

Leptin, identified in 1994 as a substance synthesized in adipose tissue in amounts that are proportional to the magnitude of fat reserves, has been described as an important factor in the regulation of the body•s energy homeostasis as it is capable of inhibiting intake, stimulating energy expenditure and regulating other peripheral metabolic processes involved in the control of the spread of body fat (secretion of insulin, lipolysis, glucose transport). Nonetheless, leptin is a pleotropic substance also involved in fertility, inflammation and angiogenesis processes, among others. Although these actions have been well defined in certain animal models of obesity, the role played by leptin in humans is less clear since, at least at the hypothalamic level, there seems to be considerable resistance to the effects of this hormone. The trials which administered recombinant leptin to humans recently have not provided sufficiently hopeful results as the weight reductions obtained have not been greater than those achieved with other drugs currently available on the market and its subcutaneous administration has led to some undesirable side effects. In any case, the results obtained must be treated with caution, with further trials being needed on the biological activity of leptin in humans in order to determine the clinical repercussions of the administration of this hormone (AU)