Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.

Bifidobacterium animalis ssp. lactis Bb12 induces IL-10 through cell membrane-associated components via TLR2 in swine.

AIM: To investigate the role of Toll-like receptor 2 (TLR2) in interleukin-10 (IL-10) production induced by Bifidobacterium animalis ssp. lactis Bb12 (Bb12) in swine immune cells. METHODS AND RESULTS: Blood-monocytes and cells from mesenteric lymph nodes were obtained from pigs and cultured with live Bb12 for 4 and 12 h. Transcript levels of IL-10 and TLR2 were analysed. Furthermore, TLR2 was blocked to determine its participation in IL-10 production. TLR2 blockade was achieved with neutralizing antibodies, followed by stimulation with Bb12. Bifidobacteria induced IL-10 production in both swine monocytes and mesenteric cells. Monocytes with TLR2 blockade had a decrease in IL-10 transcripts, while mesenteric cells did not. Bacterial cell wall components were responsible for Bb12-induced IL-10 production since no IL-10 was detected in the culture supernatant. CONCLUSIONS: We demonstrated that IL-10 production is largely mediated through the recognition of Bb12 structures by TLR2, as bacterial metabolites in the culture supernatant failed to induce IL-10 expression. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study provides evidence for the potential use of Bb12 in the swine industry; these bacteria can also be used as additional method to treat intestinal inflammation and enhance intestinal health in pigs.

Predictive factors of evolution of patients after pT0 radical cystectomy due to bladder cancer.

OBJECTIVES: To analyze the influence of the different pre - cystectomy factors, both clinical and pathological, in the follow up of patients with no residual tumor ( pT0) in the pathological examination of the radical cystectomy specimen as predictors of tumor recurrence. Secondly we intend to compare overall survival, disease free survival and cancer-specific survival with the rest of cystectomy patients in our series. METHODS: Between 1985 and 2010, radical cystectomy was performed in 280 patients with bladder cancer, being 41 pT0 (14.6%). We analyzed potential predictors for overall survival and disease-free survival: age, sex , number of transurethral resections of bladder tumor before cystectomy , tumor type , tumor grade, tumor stage, tumor size, number of tumors, associated Cis and previous instillations. We used univariate analysis of Cox regression. Survival analysis was performed using Kaplan - Meier curves and log-rank test. RESULTS: Mean age was 61.7 years and 37 patients were males (90.2%). Stages before cystectomy were pT1 in eight (19.5%) , pT2 in 31 (75.6%) and Cis in two (4.9 %) with tumor grade III in 37 (90.2%). Cystectomy specimens revealed the presence of papillary transitional cell carcinoma in 38 (92.7%) cases. The median number of pre-cistectomy-TURBT was one. Eleven patients (26.8%) received intravesical instillations. Six patients (14.63 %) had tumor recurrence and 10 (24.4 %) died from causes unrelated to the disease. None of the variables analyzed was statistically significant in the univariate analysis as a predictor of tumor recurrence. With a median follow up of 70 months (3-272) disease-free survival and overall survival at five years were 85.9% and 72.8% respectively. Compared to the non pT0 cystectomies in our series, pT0 had a statistically significant difference for better recurrence-free survival (63.4 % and 36.8%, respectively in pT0 and no-pT0 patients) (p〈0,05). CONCLUSIONS: According to the results, we have found a better outcome for pT0 patients after cystectomy compared to those with residual tumor. We have not found any pre - cystectomy predictive factor related to disease-free survival and overall survival.

Review of a series of cystectomies in women for bladder cancer:Complications and quality of life.

OBJECTIVES: To analyze the complications and quality of life after cystectomies performed in women with bladder cancer at our hospital. METHODS: Descriptive analysis of demographic data and early/late complications of cystectomies and urinary diversions performed in women at our hospital between 1990-2010. We also assessed quality of life using the Functional Assessment of Cancer Therapy-Bladder Cancer (ACT-BL) questionnaire and a comparison was drawn between groups of clinical variables. RESULTS: Out of 265 cystectomies, 25 (10%) were performed in women. The predominant urinary diversion was ureterosigmoidostomy (60%), followed by cutaneous ureterostomy (16%), orthotopic ileal neo-bladder Studer pouch (12%), ileal conduit (10%) and permanent nephrostomy (4%). Mean age was 55.75 years. The most commonly occurring early complications were prolonged ileus (20%) and urinary fistula (20%). Late complications included hydronephrosis (32%) and pyelonephritis (32%). The results of quality of life questionnaires were very similar for the different types of urinary diversions, with a mean score of 104.5 out of 156 points. CONCLUSIONS: Radical cystectomy is a high-risk procedure associated with many complications. In women, ureterosigmoidostomy may be a good choice for urinary diversion in selected patients, with a quality of life very similar to those with different urinary diversions.

[Therapeutic options for renal graft tumors]. / Opciones terapéuticas para tumores en el injerto renal.

Renal graft neoplasias are a rare complication,possibly due to the immunosuppressive therapy itself and increased susceptibility to potentially oncogenic viruses. Few case series have been reported in the literature on the treatment of such tumors, so far there is no clear consensus on how to deal with them. We conducted an exhaustive review of the literature to examine the treatment performed by different authors.

Baseline 18F-Fluorocholine PET/CT and bone scan in the outcome prediction of patients treated with radium 223 dichloride.

AIM: To establish the utility of baseline 18F-Fluorocholine (FCH) PET/CT and bone scintigraphy (BS) in the outcome prediction of patients with castration-resistant prostate cancer and bone metastases (CRPC-BM) treated with 223Ra. METHODS: Prospective, multicenter and non-randomized study (ChoPET-Rad study). FCH PET/CT and BS were performed before the initiation of 223Ra (basal FCH PET/CT and BS). Bone disease was classified attending the number of lesions in baseline BS and PET/CT. FCH PET/CT was semiquantitatively evaluated. Gleason score, baseline levels of prostate-specific antigen (PSA), alkaline phosphatase and lactate dehydrogenase were determined. Progression-free survival (PFS) and overall survival (OS) since the onset of 223Ra treatment was calculated. PFS was defined by PSA rising. Relations between clinical and imaging variables with PFS and OS were evaluated by Pearson, Mann-Whitney tests and Kapplan-Meier analysis. Univariate and multivariate Cox regression analysis was performed. RESULTS: Forty patients were evaluated. The median PFS and OS were of 3.0 ± 2.3 and 23.0 ± 4.2 months, respectively. 33 patients progressed and 13 died during the follow-up. The extension of the bone disease by FCH PET/CT (p = 0.011, χ2 = 10.63), BS (p = 0.044, χ2 = 8.04), SUVmax (p = 0.012) and average SUVmax (p = 0.014) were related to OS. No significant association was found for the PFS. ROC analysis revealed significant association of SUVmax, average SUVmax and basal PSA with OS. Only therapeutic failure was associated with OS in the multivariate analysis (HR = 3.6, p = 0.04). CONCLUSION: FCH PET/CT and BS had prognostic aim in the prediction of OS. None clinical or imaging variable was able to predict the PFS, probably due to the high rate of progressive disease.

Synchronization of complex networks of identical and nonidentical chaotic systems via model-matching control.

In this work, a synchronization scheme for networks of complex systems is presented. The proposed synchronization scheme uses a control law obtained with some definitions from graph theory and solving the Model-Matching Problem for complex networks. In particular, Rössler, Chen, Lorenz and Lü chaotic systems are used as complex chaotic systems into complex networks. Particular cases with regular and irregular networks of six identical chaotic systems are implemented, with some well-known topologies as star and ring small-world, and tree topologies. Highlighting, the obtained control law is applied to synchronize an irregular network of six different chaotic systems in a tree topology. The usefulness and advantages of the proposed synchronization scheme are highlighted performing numerical simulations of the chaotic complex networks.

[Renal transplantation in patients with a vascular aortobifemoral prosthesis]. / Trasplante renal sobre prótesis aortobifemoral.

INTRODUCTION: Nowadays, it is much more common in end stage renal disease patients with vascular grafts, to be kidney transplant candidates. We expose our experience in five cases. MATERIAL AND METHODS: Of all 1,483 kidneys transplanted in our center, 5 recipients had a previous aortobifemoral bypass (2 due to abdominal aortic aneurysm, and 3 due to vascular occlusive disease). We review the clinical features, outcome and complications in these patients. RESULTS: The vascular surgery was done 6 months to 16 years prior to transplantation. The renal transplant was done in iliac fossa with arterial anastomosis to the vascular graft. Surgical complications were: 1 renal artery thrombosis that was treated with thrombectomy, and 1 stricture at the ureterovesical junction. 2 patients dead at 6 months and 7 years with a functioning allograft and 3 patients live with functional allograft at 7 months, 3 years and 7 years. CONCLUSION: Kidney transplantation may be successful in selected patients with aortobifemoral bypass.

[Renal graft outcome in patients with associated liver transplant]. / Evolución del injerto renal en los pacientes con trasplante hepático asociado.

INTRODUCTION: Nearly 50% of liver transplant recipients have some degree of renal failure; patients in haemodialysis treatment have a higher risk of suffering hepatic diseases related to viral infections or concomitant pathologies. Improvement in surgical and organ preservation techniques and immunosuppressive therapy has permitted multiorganic transplants in patients needing both liver and kidney organs. OBJECTIVES: To review our results in renal transplants in those patients with liver and kidney transplants. MATERIAL AND METHOD: Retrospective study of the 15 patients with liver and kidney transplants performed in our Hospital. We have reviewed patients main characteristics, liver and renal failure causes, renal graft and patient outcome and complications relate to renal transplant. RESULTS: Between 1975 and December 2006 we performed 1483 kidney transplants and between 1991 and December 2006, 409 liver transplants. We performed multiorganic liver and kidney transplants to 15 patients (4 women and 11 men). The average for liver transplant recipients was 52.5+/-9.3 years (range 37-61) and for kidney transplant recipients was 51+/-12.5 years (35-66). Cold ischemia was 6.4+/-5.4 hours (6-8) in simultaneous liver-kidney transplant and 20.5+/-5.4 (8-27 hours) in non-simultaneous ones. Three patients had a renal transplant before the liver one (two functioning which had no changes after hepatic transplant but the other was lost due to IgA glomeruloneprhitis relapse and received a simultaneous kidney-liver transplant). Six patients received a simultaneous kidney-liver transplant and eight patients a renal transplant between 16 and 83 months (x=50.5+/-25.9 months) after the liver transplant. A renal graft was lost due to renal vein thrombosis and two due to IgA relapse; the others were functioning between 6 and 264 months of follow-up (x=92.5+/-66.7) with creatinine levels of 1.86+/-mg/100, (range 1-4.5). Four patients died due to hepatic failure between 8 months and 21 years after renal transplant and another died of oesophagus cancer 14 years after the kidney transplant, in all cases with functioning renal graft. There were no cases of kidney graft acute rejection in simultaneous transplants but there were five in non-simultaneous ones. Immunotherapy was based on steroids and tacrolimus. CONCLUSIONS: Liver-kidney transplants are worthy options in patients with hepatic and renal end failure. Acute rejection seems to have fewer incidences in simultaneous liver-kidney transplantation.

[Scrotal mass as result of the extension of a pancreatic pseudocyst]. / Masa escrotal como resultado de la extensión de un pseudoquiste pancreático.

There are several causes for orchitis and among them there are inflammatory process. We want to communicate the case of a young man with a clinical history and physical examination compatible with orchitis produced by the extension of a pancreatic pseudocyst that was not suspected in the beginning and discovered by imaging procedures.

[The useful of the science that has never been cited]. / Utilidad de la ciencia que nunca se ha citado.

No Abstract available.

[Fragile hip fracture in Mexico: Where are we today? Where do we want to go?] / Fractura de cadera por fragilidad en México: ¿En dónde estamos hoy? ¿Hacia dónde queremos ir?

INTRODUCTION: Hip fracture is considered the most serious consequence of falls and osteoporosis. 18% of women will suffer one and 25% die in the first year. Only 73% of survivors will walk as they did previously. We know little about the assistance and evolution of it in Mexico. Our goal was to review the current state of Mexican literature on hip fracture, compare Mexican studies with each other and with quality indicators. METHODS: We conducted a search of Mexican articles published between 2000-2017 with the key words: hip fracture, elderly, Mexico and hip fracture (in English) in the databases PubMed, EBSCO and Bibliomed. RESULTS: Twenty-one articles were included. No clinical trials, multidisciplinary unit reports, records, or meta-analyses were found. The average age was 76.9 years and 67.2% were women. No papers were found to report quality indicators. Comorbidity is reported little. The most common complications of hip fractures were delirium, pneumonia and pressure ulcers. Mortality in the acute phase was 0.97 to 12.5%. Special units were not reported. The cost of care oscillated between 1,261 and 13,641 USD. CONCLUSIONS: The scientific information on hip fractures in Mexico is sparse, heterogeneous and does not allow for conclusive results. Increasing the amount and quality of research in hip fractures in Mexico is required. It would also be advisable to disseminate the usefulness of multidisciplinary teams and registry of hip fractures, which would help to improve attention.

INTRODUCCIÓN: La fractura de cadera (FC) se considera la consecuencia más grave de las caídas y la osteoporosis. Dieciocho por ciento de las mujeres sufrirán una FC y 25% muere en el primer año. Sólo 73% de los supervivientes caminará como lo hacía previamente. Conocemos poco de la asistencia y evolución de la FC en México. OBJETIVO: Revisar el estado actual de la literatura mexicana sobre FC, comparar estudios mexicanos entre sí y con los indicadores de calidad. METODOLOGÍA: Se realizó una búsqueda de artículos mexicanos publicados entre 2000 y 2017 con las palabras clave: fractura de cadera, ancianos, México y hip fracture en las bases de datos PubMed, EBSCO y Bibliomed. RESULTADOS: Se incluyeron 22 artículos. No se encontraron ensayos clínicos, informes de unidades multidisciplinarias, registros, ni metaanálisis. La media de edad fue de 76.9 años y 67.2% fueron mujeres. No se encontraron trabajos que reportaran indicadores de calidad. La comorbilidad se describe poco. Las complicaciones más frecuentes de la FC fueron delirium, neumonía y úlceras por presión. La mortalidad en la fase aguda fue de 0.97 a 12.5%. No se reportaron unidades ortogeriátricas. El costo de atención osciló entre 1,261 y 13,641 dólares estadounidenses (USD). CONCLUSIONES: La información científica sobre FC en México es escasa, heterogénea y no permite obtener resultados concluyentes. Se requiere aumentar la cantidad y la calidad de la investigación en FC en México. Sería también conveniente difundir la utilidad de los equipos multidisciplinarios y registros de FC, lo que contribuiría a mejorar la atención.

[Rivastigmine solution prescribing habits in patients with Alzheimer-type dementia in Spain (RIVASOL study)]. / Hábitos de prescripción de rivastigmina en solución en pacientes con demencia de tipo Alzheimer en España (estudio RIVASOL).

INTRODUCTION: One of the most notable advances in the treatment of Alzheimer's disease today is the appearance of the drugs rivastigmine, donepezil, galanthamine and memantine. AIMS. We attempt to throw light on the dosage regimens, degree of effectiveness and safety profile of rivastigmine solution by means of a retrospective, descriptive, cross-sectional study known as the RIVASOL study. PATIENTS AND METHODS: The study involved 1516 patients (1386 of whom were evaluable) who had been diagnosed with Alzheimer-type dementia (ATD) according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV); these patients, who were selected by 157 participating physicians (neurologists, psychiatrists and geriatricians), gave their informed written consent and had been receiving treatment with rivastigmine solution over the past six months. The main variable was the rivastigmine solution treatment regimen and the secondary variables included socio-demographic data, health care data and the researcher's overall clinical impression from the time treatment was begun, among others. RESULTS: Most of the patients who were evaluated were attended by neurologists (57.4%). The mean time elapsed since Alzheimer's disease was diagnosed was 2.14 +/- 1.68 years. After approximately one year's treatment with rivastigmine solution, the mean score on the Folstein minimental test (MMSE) fell by 0.48 points. CONCLUSIONS: Rivastigmine solution represents a convenient means of administration for patients with moderate and moderately advanced phases of ATD; their cognitive performance is significantly improved with a reduction in the side effects due to a slower and more progressive adjustment of the initial dosage.

[The psychometric properties of the Spanish version of the stroke-adapted 30-item Sickness Impact Profile (SIP30-AI)]. / Propiedades métricas de la versión española del perfil de las consecuencias de la enfermedad de 30 ítems adaptado al ictus (SIP30-AI).

AIM: To assess the psychometric attributes of the stroke-adapted 30-item version of the Sickness Impact Profile, Spanish version (SA-SIP30), in stroke survivors. PATIENTS AND METHODS: 79 patients were evaluated (mean age: 68.1 years) by means of the modified Rankin Scale (m-RS), Scandinavian Stroke Scale (SSS), Barthel Index (BI), and the modified 23-item Beck-Hamilton's Depression Rating Scale (HDRS). Health-related quality of life was evaluated using the MOS-Short Form 36 (SF-36) and the SA-SIP30. RESULTS: SA-SIP30 mean score was 36.8. SA-SIP30 floor and ceiling effects were 3.8% and 0%. Regarding SA-SIP30 categories, floor effect ranged from 15.2% (social interaction) to 49.4% (alertness behavior), whereas ceiling effect ranged from 2.5% (social interaction) to 26.6% (household management). A floor effect was observed in seven SA-SIP30 categories. The internal consistency of SA-SIP30 (Cronbach's alpha = 0.87), physical (Cronbach's alpha = 0.89) and psychosocial (Cronbach's alpha = 0.75) dimensions were satisfactory. Standard error of measurement (SEM) values for each SA-SIP30 category ranged from 15.9 (household management) to 26.3 (ambulation). SEM values for overall SA-SIP30, physical and psychosocial dimensions were 8, 10 and 17.3, respectively. Corrected item-category correlations ranged from 0.17 (item 28) to 0.83 (item 23). A significant correlation (Spearman's correlation coefficient; p < 0.0001) between SA-SIP30 scores and BI (-0.71), m-RS (0.68), SSS (-0.67), HDRS (0.52), SF-36 physical (-0.67) and mental components (-0.51) was found. SA-SIP30 mean score significantly increased as m-RS increased (discriminative validity; Kruskal-Wallis, p < 0.0001). CONCLUSION: The Spanish-version of the SA-SIP30 has satisfactory internal consistency, convergent validity and discriminative validity in stroke patients.