Efficacy of nutrition therapy with food rich in methionine for treating nonalcoholic fatty liver / Eficacia de la terapia nutricional con alimentos ricos en metionina para el tratamiento de hígado graso no alcohólico

Non-Alcoholic Fatty Liver disease (NAFLD) can lead to Non Alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer. The treatment for NAFLD involves modification of caloric intake and physical activity. NAFLD has a pro-oxidant nature; therefore, it is logical to suppose that the antioxidant methionine can be used as a treatment for this disease. Aim. This study aimed to evaluate the effect of high-methionine dietary therapy on patients with NAFLD. Materials and methods. A randomized clinical study was conducted over three months. In this study, 121 NAFLD patients participated, and the age of the participants was ≥ 20 years (experimental group included 56 and control group 65), all of whom were randomized and matched by sex, recluted from the ISSSTE hospital in Xalapa, Mexico. The patients were instructed to consume food to cover the recommended methionine daily doses, and the daily amount consumed was calculated. Methionine effect was measured as NAFLD regression and quality of life improvement. Results. Nutritional therapy induced NAFLD regression and diminished central fat accumulation, blood pressure, and the fatty liver index. Some parameters, such as liver enzymes, did not changed. The quality of life of patients improved after treatment. Conclusions. In this study, we show a hepatoprotective effect induced only in three months of chances in the diet, thus, a longer diet may generate more relevant benefits in the resistant parameters of our study(AU)

La enfermedad del hígado graso no alcohólico (NAFLD) puede conducir a la esteatohepatitis no alcohólica (NASH), la cirrosis y el cáncer de hígado. El tratamiento para NAFLD es la modificación de la ingesta calórica y la actividad física. Debido a que NAFLD tiene una naturaleza pro-oxidante; es lógico suponer que el antioxidante metionina puede utilizarse en el tratamiento de esta enfermedad. Objetivo. el presente trabajo evaluó el papel de la terapia nutricional con alimentos ricos en metioninaen pacientes con NAFLD. Materiales y Métodos. Se realizó un ensayo clínico aleatorizado durante tres meses. Participaron en el estudio 121 pacientes con NAFLD con edad ≥ 20 años (56 en el grupo experimental y 65 en el control), todos aleatorizados y pareados por sexo, reclutados de la Clínica Hospital ISSTE en la ciudad de Xalapa, México, en el año 2015. Se instruyó a los pacientes en consumir los alimentos hasta completar la dosis diaria recomendada de metioninay se calculó la cantidad diaria consumida. Su efecto se midió como la regresión de NAFLD y la mejora de la calidad de vida. Resultados. La terapia nutricional retrocedió NAFLD; disminuyó la acumulación de grasa central, la presión arterial y el índice de hígado graso. Algunos parámetros, como las enzimas de la función hepática, no se modificaron con el tratamiento. Otro parámetro fue la mejora de la calidad de vida de los pacientes tratados. Conclusiones. En este trabajo mostramos un impacto hepatoprotector producido con tan solo tres meses de cambios en la dieta, por lo que una dieta más prolongada podría generar beneficios aún más significativos en los parámetros resistentes en nuestro protocolo(AU)

Incidence trend of clinical characteristics and outcome of lung cancer in Ma'anshan District / 公共卫生与预防医学

Objective To investigate the incidence trend, clinical characteristics and prognosis of lung cancer in Ma'anshan area. Methods The data of 398 lung cancer patients admitted to the Department of Respiratory and Critical Care Medicine, Maanshan People's Hospital in Ma'anshan area from January 2018 to May 2022 were selected, and the composition ratio of age, sex, histology and outcome data and its change trend over time were analyzed. Results The minimum age of lung cancer patients in this area was 35 years old, the maximum age was 92 years old, and the average age was (69.94 ± 9.76) years old . The patients were mainly from 70 to 79 years old, followed by 60 to 69 years old and >80 years old . The number of patients was decreasing year by year . The patients with squamous cell carcinoma transferred from 60 to 69 years old to 70 to 79 years old, and adenocarcinoma mainly concentrated in 70 to 79 years old . The incidence of squamous cell carcinoma increased (P=0.006), while that of adenosquamous carcinoma decreased (P=0.005) . The improved discharge rate of lung cancer was increasing year by year (P<0.001) , and the cured discharge rate (P=0.044) was decreasing year by year. The improved discharge rate of men was increasing year by year (P=0.039) , while the improved discharge rate of women was decreasing and then increasing, and the improved discharge rate in 2020 was the lowest (P=0.027) . The mortality increased with age (P=0.002). Conclusion From 2018 to 2022, the number of patients in Ma'anshan area will decrease year by year . The patients were mainly in the 70-79 age group . The incidence rate of adenocarcinoma was the highest , while the incidence rate and age of squamous cell carcinoma were on the rise . The overall improvement discharge rate is increasing year by year , and the cure discharge rate is decreasing year by year. The improvement discharge rate for men is increasing year by year , and vice versa for women.

Reversión del bypass gástrico: indicaciones y resultados quirúrgicos / Gastric bypass reversal: surgical indications and results

Resumen Introducción: Debido a su eficacia en el tratamiento de la obesidad mórbida, el bypass gástrico (BPG) sigue siendo una intervención realizada frecuentemente. Sin embargo, un grupo reducido de pacientes puede desarrollar complicaciones nutricionales y metabólicas que no logran controlarse con un tratamiento médico óptimo. En estos casos, puede ser necesario reestablecer la continuidad del tracto gastrointestinal por medio de la reversión del BPG (R-BPG). Objetivo: Presentar las indicaciones y resultados obtenidos en una serie de pacientes sometidos a una R-BPG. Materiales y Método: Identificación y evaluación retrospectiva de todos los pacientes sometidos a una R-BPG en nuestra institución de manera consecutiva. Se registraron las características demográficas y antropométricas de la cirugía original y al momento de la reversión. Las complicaciones se registraron de acuerdo con la clasificación de Clavien-Dindo. Resultados: Se identificaron 7 pacientes en los cuales se realizó una R-BPG. En 2 casos la reversión fue por síndrome de intestino corto, en 3 casos por hipoglicemias severas refractarias a manejo médico y en 2 casos por diarrea crónica. La mediana de edad al momento de la reversión fue de 55 años. La mediana de tiempo desde la cirugía original hasta el momento de la reversión fue de 77 meses. La mediana de estadía hospitalaria fue de 6 días. No hubo complicaciones Clavien-Dindo ≥ III. La R-BPG logró revertir en todos los casos las complicaciones nutricionales y metabólicas. Conclusión: La restauración de la continuidad del tracto gastrointestinal permite el control de las complicaciones nutricionales y metabólicas.

Introduction: Due to its efficacy in the treatment of morbid obesity, roux-en-y gastric bypass (RYGB) continues to be a frequently performed intervention. However, a small group of patients may develop nutritional and metabolic complications that cannot be controlled with optimal medical treatment. In these cases, it may be necessary to reestablish the continuity of the gastrointestinal tract by reversing the RYGB (R-RYGB). Aim: To present the indications and results obtained in a series of patients who underwent to R-RYGB. Materials and Method: Identification and retrospective evaluation of all patients who underwent consecutive R-RYGB in our institution. Demographic and anthropometric characteristics of the original surgery and at the time of the reversal were recorded. Complications were classified according to Clavien-Dindo classification. Results: Seven patients were identified in whom an R-RYGB was performed. In 2 cases the reversal was due to short bowel syndrome, in 3 cases due to severe hypoglycemia refractory to medical treatment and in 2 cases due to chronic diarrhea. The median age at the time of the reversal was 55 years. The median time from primary surgery to reversal was 77 months. The median hospital stay was 6 days. There were no Clavien-Dindo complications ≥ III. The R-RYGB was able to reverse nutritional and metabolic complications in all cases. Conclusion: Restoring the continuity of the gastrointestinal tract allows control of nutritional and metabolic complications.

Histology and structure of the testicles in three species of Atelopus frogs (Anura: Bufonidae) endemic to the Sierra Nevada de Santa Marta, Colombia / Histología y estructura de los testículos en tres especies de ranas Atelopus (Anura: Bufonidae) endémicas de la Sierra Nevada de Santa Marta, Colombia

Abstract Introduction: Testicular histology constitutes one of the least explored aspects in frogs of the genus Atelopus. This taxonomic group shows an alarming population decline; therefore, its reproductive biology is one of the greatest topics of interest for its conservation. Objective: To describe the testicular morphology and the spermatogenetic lineage cells in adult males of Atelopus laetissimus, Atelopus nahumae, and Atelopus carrikeri in the Sierra Nevada de Santa Marta, Colombia. Methods: During June - July 2017 and 2018, sampling was conducted in the localities of San Lorenzo and Páramo Cebolletas, Sierra Nevada de Santa Marta (SNSM), to collect 15 adult males, 5 per species. Testes samples were fixed in Bouin to be processed by the standard paraffin-embedding technique. Histological sections (3 μm) were stained with Hematoxylin-eosin and Mallory-Heidenhain-Azan-Gomori's. For the description and photographic register of the germ cells, the photonic microscopy technique was used with the differential interference contrast system. Results: The testes are oval organs, compact, light yellow color, and with little vascularization. Externally, they are surrounded by a thin albuginea tunic constituted by regular dense connective tissue. Inside this layer, they are composed of numerous seminiferous tubules of hexagonal contour, in which germ cell cysts are distinguished at different stages of spermatogenesis (spermatogonia I and II, spermatocyte I and II, and early and late spermatids) and spermiogenesis (spermatozoa in fascicles and free spermatozoa). Separating the seminiferous structures is the interstitial tissue in which Leydig cells and blood vessels stand out. Additionally, in the cranial part of the testis, the Bidder's organ was found, formed by two distinguishable regions, the cortex and the medulla. In the cortex, there are previtellogénic oocytes of different sizes surrounded by a monolayer of flat follicular cells. For its part, the medullary region is the connective tissue that nourishes the oocytes and is constituted by blood capillaries. Conclusions: The gonads of the three species analyzed present a cystic cellular organization similar to other anurans, where all stages of spermatogenesis and spermiogenesis were identified, possibly indicating a continuous reproductive activity. Likewise, the Bidder's organ is reported for the first time in the three Atelopus species, which allows suggesting a possible sexual reversion in case of a population decrease of females as a reproductive strategy.

Resumen Introducción: La histología testicular constituye uno de los aspectos menos explorados en las ranas del género Atelopus. Este grupo taxonómico ostenta un declive poblacional alarmarte, es por ello, que su biología reproductiva resulta uno de los temas de mayor interés para su conservación. Objetivo: Describir la morfología testicular y las células del linaje espermatogénico en machos adultos de Atelopus laetissimus, Atelopus nahumae y Atelopus carrikeri en la Sierra Nevada de Santa Marta, Colombia. Métodos: Durante Junio - Julio de 2017 y 2018 se realizaron muestreos en las localidades de San Lorenzo y Páramo Cebolletas, Sierra Nevada de Santa Marta (SNSM), para recolectar 15 machos adultos, 5 por especie. Las muestras de testículo se fijaron en Bouin para ser procesadas mediante la técnica estándar de inclusión en parafina. Las secciones histológicas (3 μm) se tiñeron con Hematoxilina-eosina y Mallory-Heidenhain-Azan-Gomori's. Para la descripción y registro fotográfico de las células germinales, se utilizó la técnica de microscopía fotónica con el sistema de contraste diferencial de interferencia. Resultados: Los testículos son órganos ovalados, compactos, de color amarillo claro y con poca vascularización. Externamente, están rodeados por una delgada túnica albugínea constituida por tejido conectivo denso regular. Al interior de esta capa se componen por numerosos túbulos seminíferos de contorno hexagonal, en los que se distinguen quistes de células germinativas en diferentes etapas de la espermatogénesis (espermatogonia I y II, espermatocito I y II y espermátidas tempranas y tardías) y espermiogénesis (espermatozoides en fascículos y espermatozoides libres). Separando las estructuras seminíferas se halla el tejido intersticial en el que se destacan las células de Leydig y los vasos sanguíneos. Adicionalmente, en la parte craneal del testículo se encontró el órgano de bidder formado por dos regiones diferenciables, la corteza y la medula. En la corteza se aprecian ovocitos previtelogénicos en diferente tamaño rodeados por una monocapa de células foliculares planas. Por su parte, la región medular es el tejido conectivo que nutre los ovocitos y está constituido por capilares sanguíneos. Conclusiones: Las gónadas de las tres especies analizadas presentan una organización celular quística de manera similar con otros anuros, donde se identificó todos los estadios de la espermatogénesis y espermiogénesis indicando posiblemente una actividad reproductiva continua. Así mismo, se reporta por primera vez el órgano de bidder en las tres especies de Atelopus, lo cual permite sugerir una posible reversión sexual en caso de una disminución poblacional de las hembras como una estrategia reproductiva.

Action of heparin and acetylcholine modulators on the neurotoxicity of the toad Rhinella schneideri (Anura: Bufonidae) in Brazil / Acción de la heparina y moduladores de acetilcolina en la neurotoxicidad del sapo Rhinella schneideri (Anura: Bufonidae) en Brasil

Abstract Introduction: Rhinella schneideri is a toad widely distributed in South America and its poison is characterized by inducing cardiotoxicity and neurotoxicity. Objective: In this work, we investigated pharmacological strategies to attenuate the peripheral neurotoxicity induced by R. schneideri poison in avian neuromuscular preparation. Methods: The experiments were carried out using isolated chick biventer cervicis preparation subjected to field stimulation for muscle twitches recordings or exposed to acetylcholine and potassium chloride for contracture responses. Results: Poison (10 μg/ml) produced complete neuromuscular blockade in chick biventer cervicis preparation within approximately 70 min incubation (times for 50 and 90 % blockade: 15 ± 3 min and 40 ± 2 min, respectively; P < 0.05, N= 5); contracture responses to exogenous acetylcholine and KCl were unaffected by poison indicating no specificity with postsynaptic receptors or myotoxicity, respectively. Poison (10 μg/ml)-induced neuromuscular blockade was not prevented by heparin (5 and 150 IU/ml) under pre- or post-treatment conditions. Incubation at low temperature (23-25 °C) abolished the neuromuscular blockade; after raising the temperature to 37 °C, the complete neuromuscular blockade was slightly slower than that seen in preparations directly incubated at 37 °C (times for 50 and 90 % blockade: 23 ± 2 min and 60 ± 2.5 min, respectively; P < 0.05, N= 4). Neostigmine (3.3 μM) did not reverse the neuromuscular blockade in BC preparation whereas 3,4-diaminopyridine (91.6 μM) produced a partial and sustained reversal of the twitch responses (29 ± 7.8 % of maximal reversal reached in approximately 40 min incubation; P < 0.05, N= 4). Conclusions: R. schneideri poison induces potent peripheral neurotoxicity in vitro which can be partially reversible by 3,4-diaminopyridine.

Resumen Introducción: Rhinella schneideri está ampliamente distribuida en Suramérica y su veneno es caracterizado por inducir cardiotoxicidad y neurotoxicidad. Objetivo: En este trabajo, investigamos estrategias farmacológicas para atenuar la neurotoxicidad periférica inducida por el veneno de R. schneideri en preparaciones neuromusculares de aves. Métodos: Los experimentos fueron realizados usando preparaciones de biventer cervicis de pollos sometidas a estimulación de campo para el registro de las contracciones musculares o expuestas a la acetilcolina y al cloruro de potasio para la respuesta contractural. Resultados: El veneno (10 µg/ml) provocó un bloqueo neuromuscular completo en las preparaciones después de aproximadamente 70 min de incubación (tiempos para 50 y 90 % de bloqueo: 15 ± 3 min y 40 ± 2 min, respectivamente; P < 0.05, N = 5); las contracturas en respuesta a la acetilcolina y el KCl exógenos no fueron afectadas por el veneno, indicando que no hay una interacción especifica con receptores postsinápticos o miotoxicidad respectivamente. El bloqueo neuromuscular causado por el veneno (10 µg/ml) no fue prevenido por la heparina (5 y 150 UI/ml) bajo condiciones pre y post-tratamiento. La incubación a bajas temperaturas (23-25 ºC) abolió el bloqueo neuromuscular; después de aumentar la temperatura a 37 ºC, el bloqueo neuromuscular total fue levemente más lento que el visto en preparaciones directamente incubadas a 37 ºC (tiempos para 50 y 90 % de bloqueo: 23 ± 2 min y 60 ± 2.5 min, respectivamente; P < 0.05, N= 4). Neostigmina (3.3 µM) no revirtió el bloqueo neuromuscular, mientras que 3.4-diaminopiridina (91.6 µM) produjo una reversión parcial y sostenida de las respuestas neuromusculares (29 ± 7.8 % de la reversión máxima alcanzada en aproximadamente 40 min de incubación; P < 0.05, N = 4). Conclusiones: El veneno de R. schneideri indujo neurotoxicidad periférica potente in vitro, el cual puede ser revertido por 3.4-diaminopiridina.

Experiencia con idarucizumab como agente reversor de dabigatran / Experience with idarucizumab as a reverse agent of dabigatran

Resumen Los anticoagulantes orales directos (AOD), entre ellos dabigatrán, poseen un perfil riesgo-beneficio favorable comparados con warfarina y además no requieren monitoreo del efecto anticoagulante. Sin embargo, en ocasiones de sangrado con amenaza de vida o requerimiento de procedimiento quirúrgico de emergencia, es de gran utilidad revertir inmediatamente el efecto anticoagulante. Idarucizumab, fragmento de un anticuerpo monoclonal humanizado, revierte inmediatamente el efecto de dabigatrán y es actualmente el único agente reversor de un AOD disponible en Argentina. Presentamos una serie de 8 pacientes a los que se les administró idarucizumab para revertir el efecto de dabigatrán. Todos eran mayores de 65 años, recibían 110 o 150 mg cada 12 horas de dabigatrán y 7/8 estaban anticoagulados por fibrilación auricular; tres tenían indicación discutida para AOD y otro, una dosis mayor a la recomendada. Dos requirieron reversión debido a una cirugía de urgencia, y 6 tuvieron sangrado con amenaza de vida: tres hemorragias digestivas y tres sangrados intra-craneanos (en dos ocasiones traumático). En todos los casos se observó normalización de la hemostasia quirúrgica o control de sangrado crítico. No se observaron complicaciones trombóticas posteriores a la administración del antídoto. Dos fallecieron dentro de los 30 días de la administración por causas no relacionadas con la reversión. Ninguno de nuestros pacientes requirió administración de una segunda dosis de idarucizumab. Nuestro resultado es similar a lo informado en la literatura internacional.

Abstract Direct oral anticoagulants (DOACs), among them dabigatran, have a favorable benefit-risk profile compared with warfarin, and no monitoring of the anticoagulant effect is required. However, reversing the anticoagulant effect immediately is very useful in cases of life-threatening bleeding and emergency surgical procedure requirement. Idarucizumab, a humanized monoclonal antibody fragment, is currently the only reversal agent of a DOAC available in Argentina. Idarucizumab immediately reverse the effect of dabigatran. We present a series of 8 real-life clinical cases who received idarucizumab to reverse the effect of dabigatran. All of the patients were older than 65 years, were receiving 110 or 150 mg every 12 hours of dabigatran and 7/8 were anticoagulated because of atrial fibrillation. Three had a debatable indication for DOACs and another, a higher dose than recommended. Two required reversal due to emergency surgery, and 6 cases had life-threatening bleeding: three gastrointestinal hemorrhages and three intracranial bleeding (Two had a head trauma). In all cases normalization of surgical hemostasis or control of critical bleeding was observed. No hemorrhagic or thrombotic complications were observed after antidote administration. Two died within 30 days of administration of idarucizumab, due to causes unrelated to the reversal. None of our patients required administration of a second dose of idarucizumab. Our result is similar to that reported in international literature.

Different Quantitative Interferon-γ Response in Active Tuberculosis of Various Primary Infection Sites

Preparation and in vitro evaluation of pH-sensitive charge-reversal nanoparticles loaded with curcumin / 中草药

Objective: To prepare charge-reversal pH-sensitive nanoparticles loaded with curcumin (PCE/Cur NPs), and investigate the optimizing technology, physicochemical characterizations, and inhibitory effect on B16 cell. Methods: The β-carboxyl amidized cationic MPEG-PCL-PEI polymers (PCE) were negatively charged, which were prepared into the negative PCE/Cur NPs with pH dependence. When pH > 7, there was no charge-reversal. When pH < 6, the β-carboxyl amides were hydrolyzed rapidly into corresponding amines. As a result, PCE/Cur NPs became positively charged again. The obtained PCE/Cur NPs were characterized by detection of particle size, morphology study, drug loading, encapsulation efficiency, and release study. The effect of anti-migratory and anti-invasive actions of PCE/Cur NPs on B16 cell was investigated using MTT assays and wound healing test. Results: PCE/Cur NPs dependent on pH charge inversion were successfully prepared. The obtained PCE/Cur NPs were round, and the size was uniform, the adhesion was not found. The Results: showed that the prepared PCE/Cur NPs had the highest DL (8.0 ± 1.0)%, EE (90.0 ± 2.0)%, mean particle size of (80 ± 5) nm, and zeta potential of (-35 ± 5) mV. Within 48 h, the accumulative release rate was (69.2 ± 5.2)% (pH 7.4) and (71.2 ± 4.3)% (pH 5), respectively, and then PCE/Cur NPs released slowly. These Results: by MTT assay and wound healing assay indicated that PCE/Cur NPs not only inhibited the proliferation of B16 cells in a concentration- and time-dependent manner, but also can induce apoptosis. Conclusion: PCE/Cur NPs were prepared successfully, which might have great potential application in drug delivery system.

Masculinization of South American catfish (Rhamdia quelen) through dietary administration of 17α-methyltestosterone / Masculinización del pez Liso (Rhamdia quelen) mediante suministro dietario de 17α-metiltestosterona / Masculinização do Jundiá (Rhamdia quelen) através da administração dietética de 17α-metiltestosterona

Abstract Background: Production of monosex cultures of females is desirable in commercial aquaculture of certain species due to their higher growth rate. Ideally, females should be free of exogenous hormones. The initial step to produce hormone-free all-female offspring is masculinization of normal females to create sex reversed animals, called neomales, which are then be bred with normal females obtaining all-female offspring. Objective: To masculinize Rhamdia quelen fry by adding 17α-methyltestosterone (MT) hormone to the feed. Methods: Larvae of R. quelen were fed diets supplemented with 60, 80, or 100 mg MT/kg feed for 21 days. A control group was fed the same diet free of MT. At 150 days post-hatching, 30 fish of each treatment group were euthanized to evaluate gonadal changes using histological techniques. Results: MT significantly affected the differentiation of female gonads in the 60 and 80 mg MT/kg feed groups. Sex reversal was observed in all MT treatment groups, with 50, 40, and 20% neomales produced with 60, 80, and 100 mg MT/kg feed, respectively. Intersex gonads were observed only in the masculinization treatment groups. Inhibitory effects on gonadal development of females and males were observed at the highest MT doses. Conclusion: Dietary administration of MT effectively masculinizes R. quelen fry; however, the lowest dose of 60 mg/kg feed is recommended, since higher doses have inhibitory effects on gonadal development in both sexes.

Resumen Antecedentes: Debido a su mayor tasa de crecimiento, la producción de peces femeninos monosexo es deseable en acuicultura comercial de determinadas especies. Idealmente, las hembras deben estar libres de hormonas exógenas. El paso inicial para generar descendencia femenina libre de hormonas es la masculinización de hembras genéticas para producir animales sexualmente revertidos, llamados neomachos, los cuales se aparean luego con hembras genéticas para producir descendencia femenina. Objetivo: Masculinizar larvas de Rhamdia quelen con 17α-metiltestosterona (MT) incorporada en el alimento. Métodos: Larvas de R. quelen fueron alimentadas con dietas suplementadas con 60, 80 y 100 mg de MT/kg de alimento durante 21 días. Un grupo control recibió la misma dieta, sin MT. A los 150 días pos-eclosión, 30 peces de cada tratamiento fueron eutanasiados para evaluación gonadal mediante técnicas histológicas. Resultados: La MT afectó significativamente la diferenciación de las gónadas femeninas en las dosis de 60 y 80 mg MT/kg de alimento. El cambio de sexo se observó en los tratamientos con las dosis de 60, 80 y 100 mg MT/kg alimento, con 50, 40 y 20% de neomachos, respectivamente. En los tratamientos de masculinización se observaron gónadas intersexuales. En las dosis más altas de MT se observó inhibición del desarrollo gonadal de hembras y machos. Conclusiones: El suministro dietario de MT masculinizó las larvas de R. quelen. Se recomienda usar 60 mg/kg, ya que dosis mayores tienen efectos inhibidores en el desarrollo gonadal para ambos sexos.

Resumo Antecedentes: O cultivo monossexo feminino é desejável na aquicultura comercial de determinadas espécies devido à maior taxa de crescimento. Idealmente, as fêmeas devem ser livres de hormônios exógenos. O passo inicial para gerar descendências femininas livres destes hormônios é a masculinização de fêmeas normais para produzir animais revertidos sexualmente, os chamados neomachos. Os neomachos podem então ser cruzados com fêmeas normais para a produção de descendências femininas. Objetivo: Masculinizar larvas de R. quelen utilizando o hormônio 17α-metiltestosterona (MT) incorporado no alimento. Métodos: Larvas de R. quelen foram alimentadas com dietas suplementadas com MT nas doses de 60, 80 ou 100 mg/kg de alimento durante 21 dias. Um grupo controle foi alimentado com dieta similar livre de MT. Aos 150 dias pós-eclosão, 30 peixes de cada grupo de tratamento foram eutanasiados para avaliação gonadal através de técnicas histológicas. Resultados: O uso de MT afetou significativamente a diferenciação das gônadas femininas nas doses 60 e 80 mg/kg de alimento. A reversão sexual foi observada em todos os grupos tratados com MT, gerando 50, 40 e 20% de neomachos nas doses 60, 80 e 100 mg MT/kg de alimento, respectivamente. Gônadas intersexuais foram observadas somente nos tratamentos masculinizantes. Nas maiores doses de MT, efeitos inibitórios de desenvolvimento gonadal foram observados em fêmeas e machos. Conclusão: A administração dietética de MT efetivamente masculinizou larvas de R. quelen. No entanto, a dose mais baixa de 60 mg/kg de alimento é recomendada devido aos efeitos inibitórios das doses mais elevadas de MT no desenvolvimento gonadal de ambos os sexos.

Reversión laparoscópica de bypass gástrico con Y de Roux a anatomía normal, en paciente con malnutrición severa y diarrea: reporte de un caso / Laparoscopic reversal of Roux-en-Y gastric bypass to normal anatomy in patient with severe malnutrition and diarrhea: case report

Introducción: El bypass gástrico (BG) es una de las técnicas más utilizadas y con mejores resultados a largo plazo en obesidad y control de enfermedades metabólicas. Cierto grupo de pacientes presentan complicaciones de difícil manejo como dumping severo, caquexia y malnutrición severa. Presentaremos un caso de malnutrición severa por déficit de nutrientes asociada a diarrea crónica, tratada exitosamente mediante reversión laparoscópica del BG. Caso clínico: Mujer de 43 años, que a los 6 meses post-BG presenta cólicos abdominales posprandiales y diarrea crónica. Al año presenta anemia, déficit de vitaminas B y D y desnutrición severa. Recibe evaluación interdisciplinaria, descartando patologías psiquiátrica y gastrointestinal. Se inicia tratamiento nutricional. Tres meses después se realiza conversión laparoscópica de BG a anatomía normal. Al seguimiento mejora los índices nutricionales y la calidad de vida. Discusión: La pérdida excesiva de peso post-BG es rara. Existe poca información de cuándo indicar una reversión de BG a anatomía normal. La evaluación debe ser realizada por un equipo multidisciplinario. La posibilidad de restituir a anatomía normal es plausible y bien tolerado por los pacientes. El abordaje laparoscópico es factible y seguro.

Introduction: Roux-en-Y Gastric Bypass is one of the most common techniques used to obtain better long term control in obesity and metabolic diseases. Certain group of patients have complications which are difficult to manage, such as dumping, cachexia and severe malnutrition. We present the case of severe malnutrition with deficiency of micro-nutrients associated with chronic diarrhea, which is successfully treated by laparoscopic reversal of BG. Case report: 43 year old woman. Six months after Roux-en-Y Gastric Bypass surgery she presents postprandial abdominal colic pain associated with chronic diarrhea. A year after surgery she presents anemia, vitamin deficiency and severe malnutrition. She underwent interdisciplinary team assessment, rouling out psychiatric and gastrointestinal pathology. Nutritional therapy is initiated and three months later we performed conversion to normal anatomy with laparoscopic technique. Patient presents nutritional and quality of life improvement. Discussion: Excessive weight loss due to Roux-en-Y Gastric Bypass is rare. There is little information on when to perform reversal surgery of Roux-en-Y Gastric Bypass to normal anatomy. The evaluation must be conducted by a multidisciplinary team. The possibility of restoring normal anatomy is plausible and well tolerated. The laparoscopic approach is feasible and safe.

Research progress of reversion molecular targeted drug resistance in non-small cell lung cancer by curcumin / 中国药理学通报

In recent years,molecular biology has rapidly devel-oped,and molecular targeted therapy of non-small cell lung cancer has become a hot spot for the research. Although the tar-geted therapy has a big advantage compared with traditional chemotherapy,it is inevitable to encounter drug resistance in targeted therapy. Therefore,drug resistance has become the sig-nificant obstacle of targeted drugs for the treatment of non-small-cell lung cancer(NSCLC). Curcumin is the main extract of tu-meric rhizome,which harbours a wide range of antitumor activi-ties,and several studies have identified that curcumin exhibits reversion drug resistance against a variety of cancer cells. How-ever,there are few studies on curcumin reversion molecular tar-geted drug resistance. This review summarizes the recent pro-gress in resistance mechanism of targeted drug and the reversion resistance of curcumin.

Discussions on the key points in syndrome differentiation and intervention strategies for the emergent and severe diseases / 国际中医中药杂志

The emergent and severe diseases always shows the characteristics of acute course, severe condition, rapid changes, and many complications. The common treatments based on syndrome differentiation usually lacked dynamics and promptness. The treatment of emergent and severe diseases emphasized the importance of early interventions, which can reverse the acute trend of the diseases and improve the outcomes. This article discuessed in five parts, including the meaning and significance of trend identification, the physiological and pathological trend of the human body, the influence factors of diseases' trend, how to carry out a trend identification and intervention strategies of trend identification. It elaborated the theory about the trend identification in the emergent and severe diseases.

Traumatismo cráneo-encefálico (TCE) y anticoagulación: Aspectos esenciales. / Traumatic brain injury (TBI) and anticoagulation: Key points

Resumen: Los traumatismos craneoencefálicos (TCE) constituyen un motivo de consulta frecuente en cualquier Servicio de Urgencias. Estados Unidos reporta hasta 1,7 millones de afectados en un año. En España la cifra, solo de TCE leve, se estima en 92000 por año. Los varones, sobre todo después de 65 años, constituyen el grupo más afectado y la caída desde su altura el mecanismo más frecuente. La asociación con tratamiento anticoagulante oral (TAO), agrega mayor complejidad a su manejo y constituye un tema en revisión constante. La necesidad de revertir la anticoagulación, los métodos para lograrlo, la indicación de un segundo control tomográfico en los pacientes con TCE leve-moderado, los algoritmos que orienten y organicen mejor las posibles conductas a seguir, continúan siendo aspectos en revisión. Una adecuada valoración inicial, control TC solo ante deterioro neurológico, y reversión de anticoagulación con complejo protrombínico permiten un manejo eficaz.

Abstract: Traumatic brain injury (TBI) is a frequent reason of consultation in any Emergency Room. The United States report up to 1.7 million affected individuals persons. In Spain, the figure corresponding only to mild TBI is estimated at 92,000 patients per year. Males, specially after age 65, are the most affected group and the most frequent injury mechanism is a a all from their height. The association with oral anticoagulant therapy (OAT) increases the complexity of its managament and is an issue under permanent review. The need to reverse anticoagulation, the methods to achieve it, the prescription of a second CT control in patients with mild to moderate TBI, the algorithms to better guide and organize the possible courses of action are still issues under review. An adequate initial assessment, a CT control only in case of neurological damage and reversion of anticoagulation with prothrombin complex allow an effective management.

Caracterización clinicoepidemiológica de pacientes con estados reaccionales de lepra / Clinical and epidemiological characterization of patients with leprosy reactional states

Se realizó un estudio observacional y descriptivo de 50 pacientes con estados reaccionales de lepra, ingresados en el servicio de dermatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba durante el quinquenio 2009-2013, a fin de caracterizarles según algunas variables clinicoepidemiológicas, para lo cual además se empleó el cálculo porcentual y el test de correlación de Pearson. En la serie predominaron el sexo masculino (56,0 %), el grupo etario de 30-49 años (48,0 %) y la variedad clínica dimorfa lepromatosa (40,0 %); asimismo se observó que los estados reaccionales aparecieron principalmente después del tratamiento (64,0 %), por lo general con un único episodio (58,0 %), y que la reacción de reversión resultara más común (32,0 %), con una mayor frecuencia de la forma grave (69,0 %).

An observational and descriptive study of 50 patients with reactional states of leprosy, admitted in the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the five year period 2009-2013, in order to characterize them according to some clinical and epidemiological variables, for which the calculation percentage and the Pearson correlation test were also used. The male sex (56.0%), the age group 30-49 (48.0%) and the clinical variety dimorpha lepromatous (40.0%) prevailed in the series; it was also observed that the reactional states appeared mainly after the treatment (64.0%), in general with just one episode (58.0%), and that the reversion reaction was more common (32.0%), with a higher frequency in the severe type (69.0%).

The research of selenium on phenotype reversion of corpus cavernosum smooth muscle cells in hypertensive rats with erectile dysfunction / 实用医学杂志

Objective To validate the hypothesis that the phenotype reversion occurs in the smooth muscle cells in the corpus cavernosum of hypertensive rats with selenium food and explore selenium′s impact on erectile function. Methods 25 14-week-old male spontaneously hypertensive rates (SHR) were divided into 2 groups (SHR-ED-Se group n = 8 and SHR-ED-N group n = 9). SHR-ED-Se rats were fed with selenium diet, SHR-ED-N rats and WKY rats with normal diet. And 10 syngeneic normotensive rats (WKY) were used as control group. All rats were killed after 4-week feeding. Immunohistochemical staining and color image analysis system were used to observe expression of α-actin, desmin and osteopontin (OPN) in rats corpus cavernosum of different group. Results 2 SHR-ED-N rats died. Expression of α-actin of smooth muscle in corpus cavernosum in SHR-ED-N group was the lowest in all groups (P = 0.000), so did erection frequency (P 0.05). Conclusions Phenotype modulation of smooth muscle in corpus cavernosum of SHR rats can be reversed by selenium which means the smooth cells can transform from synthetic phenotype into the contractile phenotype, resulting ultimately in improving erectile function.

Research of Periplaneta americana L.reversing multi-drug resistance of hepatocellular carcinoma / 中国生化药物杂志

Objective To investigate the effect of extracts from Periplaneta americana L.on reversing MDR in HepG2/ADM.Methods HepG2/ADM was induced by continuous stepwise exposer to ADM.To investigate the effect of extractive from Periplaneta americana L.on drug resistance-associated protein( P-gp、MRP、LRP和BCRP) by immunocytochemical method and RT-PCR method.Results HepG2/ADM cells to ADM shows a strong multiple drug resistance that is 10.4 times,For DDP,5-FU showed weak resistance.The extractive from Periplaneta americana L.can cut the expression of P-gp and MRP1 protein in HepG2/ADM from immunocytochemical method,and it has statistically significant.The extractive from Periplaneta americana L.can cut the expression of P-gp gene,and it has statistically significant.Conclusion The extract from Periplaneta americana L.can effectively reverse MDR in HepG2/ADM,which targets for P-gp and MRP1 protein and P-gp gene of HepG2/ADM cells.

Reversión del bloqueo neuromuscular inducido por vecuronio: sugammadex o neostigmina / Reversal of vecuronium-induced neuromuscular blockade: sugammadex vs. neostigmine

Introducción: se han descrito diferencias entre la reversión de los bloqueantes neuromusculares con sugammadex y neostigmina. La mayoría concuerda que los resultados con sugammadex son superiores. Objetivos: comparar la capacidad del sugammadex y la neostigmina para revertir el bloqueo neuromuscular con vecuronio. Métodos: se realizó un estudio de casos y controles, para evaluar la capacidad del recobro muscular con vecuronio, tras la reversión con sugammadex y neostigmina. Se evaluó el recobro muscular por exploración clínica. Resultados: se estudiaron un total de 405 pacientes, al Grupo S, correspondieron 135 pacientes y al Grupo N 270. El tiempo medio de duración de la intervención quirúrgica, fue para el grupo S de 32,21±1,2 min y para el Grupo N de 33,16 ±1,2 min. El promedio de tiempo de la reversión en el grupo S fue de 2.2 minutos y en el grupo N de 14.4 min. La calidad de la recuperación, en ambos grupos fue buena, no obstante las diferencias observadas en la frecuencia de los revertidos con sugammadex, resultó estadísticamente significativa (p = 0.00001). Las complicaciones fueron mas frecuentes en el grupo N. Conclusiones: se corroboró la capacidad del sugammadex para revertir el bloqueo neuromuscular con vecuronio. El tiempo de reversión del bloqueo fue 6,54 veces más prolongado con neostigmina. La calidad de la recuperación fue 1.34 veces mejor con de sugammmadex. Las reacciones adversas fueron 11,02 veces mas frecuentes con neostigmina que con sugammadex.

Introduction: studies are available about the differences between reversal of neuromuscular blockers with sugammadex and neostigmine. Most studies agree that results are better when sugammadex is used. Objectives: compare the capacity of sugammadex and neostigmine to revert vecuronium-induced neuromuscular blockade. Methods: a case-control study was conducted to evaluate neuromuscular recovery with vecuronium after reversal with sugammadex and neostigmine. Muscular recovery was evaluated by clinical examination. Results: a total 405 patients were studied. Group S was composed of 135 patients and Group N of 270. Mean surgical duration was 32.21±1.2 min for Group S and 33.16 ±1.2 min for Group N. Average reversal time was 2.2 min in Group S and 14.4 min in Group N. The quality of recovery was good in both groups. However, the frequency differences found in patients reverted with sugammadex were statistically significant (p = 0.00001). Complications were more frequent in Group N. Conclusions: the capacity of sugammadex to revert vecuronium-induced neuromuscular blockade was confirmed. Reversal time was 6.54 longer with neostigmine. The quality of recovery was 1.34 times better with sugammadex. Adverse reactions were 11.02 times more frequent with neostigmine than with sugammadex.

O trauma narcísico-identitário e sua transferência / The narcissistic-identity trauma and its transference / El trauma narcisístico-identitario y su transferencia

Este trabalho explora a noção de um trauma primário relacionado com uma decepção narcísica primária produzida pela inadequação das respostas do ambiente, primeiro ante as expectativas e pré-concepções inatas do bebê. Esse trauma primário produz um sofrimento narcísico-identitário do tipo “agonia psíquica”, caracterizado por ser sem representação, sem saída e vivido como sendo sem fim. Para sobreviver, o sujeito tem de se retirar de si mesmo, se clivar de sua experiência. Em seguida, tem de desenvolver modalidades de defesa e de ligações não simbólicas para enfrentar o retorno dos traços das experiências de que se clivou, o “retorno do clivado”. Quando, durante um trabalho psica-nalítico, essas experiências retornam, geram formas de transferência paradoxal ou reações terapêuticas negativas, que impõem ao analista um paciente trabalho de reconstrução das relações primitivas com o ambiente primeiro.

This paper explores the notion of a primary trauma related to a primary narcissistic disillusion produced by the inadequacy of the responses of the first environment in face of the innate expectations and preconceptions of the baby. This primary trauma produces narcissistic-identity suffering of the “psychic agony” type, characterized by having no representation, no exit and by the fact that it is experienced as being endless. In order to survive, the subject must remove himself from his own self, cleaving himself from his experience. Next, he must develop non-symbolic modes of defense and of connections in order to face the return of the traces of the experiences from which he cleaved himself, «return of the cleaved¼. When, during psychoanalytic work, these experiences return, they generate forms of paradoxical transference or negative therapeutic reactions which impose on the analyst a patient work of reconstruction of the primary relations with the first environment.

Este trabajo explora la noción de un trauma primario relacionado a una decepción narcisista primaria producida por la inadecuación de las respuestas del ambiente primario ante las expectativas e ideas preconcebidas innatas del bebé. Ese trauma primario produce un sufrimiento narcisístico - identitario del tipo “agonía psíquica”, caracterizado por el hecho de ser sin representación, sin salida y vivido como si no tuviera fin. Para sobrevivir, el sujeto tiene que retirarse de él mismo, escindirse de su experiencia. Inmediatamente, tiene que desarrollar modalidades de defensa y de relaciones no simbólicas para enfrentar el retorno de los rasgos de las experiencias que escindió, “retorno de lo escindido”. Cuando, durante un trabajo psicoanalítico, esas experiencias retornan, las mismas generan formas de transferencia paradójica o reacciones terapéuticas negativas que imponen al analista un trabajo paciente de reconstrucción de las relaciones primitivas con el primer ambiente.

Expression of RECK in pancreatic carcinoma and its relationship with prognosis / 中华肝胆外科杂志

Objective To study the expression of reversion-inducing-cysteine-rich protein with Kazal motifs (RECK) in human pancreatic carcinoma tissues and pancreatic carcinoma cell lines; the effects of recombinant lentiviruses carrying RECK gene(LV-RECK) therapy on human pancreatic carcinoma xenograft in nude mice; and to find out the relationship between the expression of RECK and the prognosis of pancreatic carcinoma.Methods Immunohistochemical method was used to detect the expression of RECK in the resected specimens of pancreatic carcinoma and their corresponding normal pancreatic tissues in 42 patients.Western blotting was used to examine the expression of RECK in human pancreatic carcinoma cell lines (PANC-1,MIAPaCa-2,AsPC-1).Statistical analyses were performed to determine the relationship between RECK expression and the clinicopathological characteristics and prognosis in pancreatic carcinoma.Subcutaneous xenograft tumor models of human pancreatic carcinoma were established in nude mice.These nude mice were then divided into the experimental group,the negative control group and the blank control group randomly.The three groups of nude mice were intratumorally injected with LV-RECK,LV-EGFP and normal saline (NS) respectively.The antitumor effect was studied.Immunohistochemical method was used to detect the expression of RECK and microvessel density (MVD).Terminal deoxynucleotidyl transferase mediated dUTP-DIG nick end labeling (TUNEL) was used to detect the apoptosis of tumor cells.Survival analysis was performed.Results All three pancreatic carcinoma cell lines did not express RECK.The overall positive rate of RECK expression was 45.2 ％ (19/42) in pancreatic carcinoma,and 88.1 ％ (37/42) in normal pancreatic tissue.The expression level of RECK was significantly lower in the tumor tissues than in the normal tissues (P＜0.01).The expression of RECK was significantly associated with TNM stage,lymph node metastasis and local infiltration of pancreatic carcinoma (P＜0.05).Kaplan-Meier survival analysis revealed that the survival time was significantly longer in the RECK positive patient group than in the RECK negative patient group.Univariate Cox regression analysis revealed that RECK expression,TNM stage,lymph node metastasis and local infiltration were significantly related with prognosis for pancreatic carcinoma (P＜0.05).Multivariate Cox regression analysis revealed that only RECK expression remained as an independent significant factor in predicting the prognosis of pancreatic carcinoma (P ＜ 0.001).When compared with the negative control and the blank control groups,the volume of subcutaneous xenograft tumor in the experimental group was significantly decreased (P＜0.05).RECK protein in the experimental group was re-expressed.MVD of the experimental group was significantly less than those of the control groups (P＜0.05).Apoptotic index (AI)of the experimental group was significantly higher than those of the control groups (P＜0.05).The survival time of nude mice in the experimental group was significantly longer than those in the control groups (P＜0.05).Conclusions RECK expression was closely related to invasion,metastasis and prognosis of pancreatic carcinoma and it was an independent prognostic marker.RECK gene over-expression inhibited neovascularization of pancreatic carcinoma,induced apoptosis of tumor cells,inhibited the growth of tumor xenograft and improved the prognosis of tumor-bearing mice.These results suggest a possible new treatment for pancreatic carcinoma.