Increasing Incidence of Pediatric Eosinophilic Esophagitis in the Southwest of Madrid, Spain.

OBJECTIVES: The incidence of eosinophilic esophagitis is unknown in our area. The aim of our study was to determine the incidence of eosinophilic esophagitis and its possible association with the most frequent absolute annual pollen counts. METHODS: A descriptive retrospective multicenter observational study was designed to calculate the incidence of eosinophilic esophagitis in children aged under 15 years in the southwest region of Madrid, Spain in 2002-2013 (data were provided by the Statistics Institute of Madrid). We collected data on age, sex, clinical presentation, and date of endoscopic diagnosis. Relative risk (RR) was estimated (Stata v.11) using negative binomial regression models to assess the association between incidence and pollen counts (provided by Subiza Clinic). RESULTS: The study population comprised 254 patients (192 male [75.6%], aged 0.5-14.99 years). The clinical presentation was esophageal impaction in 23.6%, dysphagia in 22%, gastroesophageal reflux-like symptoms in 44.9%, and other findings in 9.4%. The annual incidence from 2002 to 2013 per 100 000 children aged <15 years per year was, respectively, 0.81, 1.5, 0.37, 3.17, 3.07, 4.36, 6.87, 7.19, 8.38, 9.05, 9.14, and 9.68. The incidence of eosinophilic esophagitis increased by an average of 19% annually (RR, 1.19; 95%CI, 1.14-1.25; P<.001). In the overall analysis, the relationship between incidence and absolute annual and monthly counts during the pollen seasons of the respective pollen types was analyzed only for Platanus species, which had an RR >1 (1.17 and 1.06, respectively) (P<.05). CONCLUSION: The incidence of diagnosis of pediatric eosinophilic esophagitis increased by an average of 19% annually. No significant association was found between incidence and pollen counts, except for a weak association with Platanus species.

Synchronization dynamics induced on pairs of neurons under applied weak alternating magnetic fields.

Pairs of Helix aspersa neurons show an alternating magnetic field dependent frequency synchronization (AMFS) when exposed to a weak (amplitude B0 between 0.2 and 150 Gauss (G)) alternating magnetic field (AMF) of extremely low frequency (ELF, fM = 50 Hz). We have compared the AMFS patterns of discharge with: i) the synaptic activity promoted by glutamate and acetylcholine; ii) the activity induced by caffeine; iii) the bioelectric activity induced on neurons interconnected by electric synapses. AMFS activity reveals several specific features: i) a tight coincidence in time of the pattern and frequency, f, of discharge; ii) it is induced in the time interval of field application; iii) it is dependent on the intensity of the sinusoidal applied magnetic field; iv) elicited biphasic responses (excitation followed by inhibition) run in parallel for the pair of neurons; and v) some neuron pairs either spontaneously or AMF synchronized can be desynchronized under applied higher AMF. Our electron microscopy studies reveal gap-like junctions confirming our immunocytochemistry results about expression of connexin 26 (Cx26) in 4.7% of Helix neurons. AMF and carbenoxolone did not induce any significant effect on spontaneous synchronization through electric synapses.

The primary cilium of telocytes in the vasculature: electron microscope imaging.

Blood vessels are highly organized and complex structure, which are far more than simple tubes conducting the blood to almost any tissue of the body. The fine structure of the wall of blood vessels has been studied previously using the electron microscope, but the presence the telocytes associated with vasculature, a specific new cellular entity, has not been studied in depth. Interestingly, telocytes have been recently found in the epicardium, myocardium, endocardium, human term placenta, duodenal lamina propria and pleura. We show the presence of telocytes located on the extracellular matrix of blood vessels (arterioles, venules and capillaries) by immunohistochemistry and transmission electron microscopy. Also, we demonstrated the first evidence of a primary cilium in telocytes. Several functions have been proposed for these cells. Here, the telocyte-blood vessels cell proximity, the relationship between telocytes, exosomes and nervous trunks may have a special significance.

A presumptive new locus for autosomal dominant hypercholesterolemia mapping to 8q24.22.

Molecular testing of patients with autosomal dominant hypercholesterolemia (ADH) fails to detect a causal functional mutation in 15.25% of subjects. We studied an ADH pedigree in which known ADH-causing genes (LDLR, APOB and PCSK9) were excluded. Genome-wide analysis on 15 family members detected significant association for ADH and dbSNP RS ID rs965814 (G/A), located in 8q24.22 cytoband. ADH was significantly associated to rs965814 G allele (p < 0.05) in a case-control study based on 200 unrelated ADH subjects without LDLR or APOB gene defects and 198 normolipidemic controls. We chose 24 markers for a detailed analysis of 8q24.22 cytoband, now based on an extended set of family members (21 individuals). One particular 24 marker haplotype was significantly associated to both higher total and low-density lipoprotein-cholesterol concentrations. Similar results were found for a shorter haplotype, composed of the distal six markers from the complete haplotype. Therefore, a presumptive new locus for ADH could be located in 8q24.22 cytoband, a region not previously linked or associated to ADH.

Histopathological and Ultrastructural Changes after Electroporation in Pig Liver Using Parallel-Plate Electrodes and High-Performance Generator.

Irreversible electroporation (IRE) has gained attention as a new non-thermal therapy for ablation with important benefits in terms of homogeneous treatment and fast recovery. In this study, a new concept of high voltage generator is used, enabling irreversible electroporation treatment in large tissue volume using parallel plates. Unlike currently available generators, the proposed versatile structure enables delivering high-voltage high-current pulses. To obtain homogeneous results, 3-cm parallel-plates electrodes have also been designed and implemented. IRE ablation was performed on six female pigs at 2000 V/cm electric field, and the results were analysed after sacrifice three hours, three days and seven days after ablation. Histopathological and ultrastructural studies, including transmission and scanning electron microscopy, were carried out. The developed high-voltage generator has proved to be effective for homogeneous IRE treatment using parallel plates. The destruction of the membrane of the hepatocytes and the alterations of the membranes of the cellular organelles seem incompatible with cell death by apoptosis. Although endothelial cells also die with electroporation, the maintenance of vascular scaffold allows repairing processes to begin from the third day after IRE as long as the blood flow has not been interrupted. This study has opened new direction for IRE using high performance generators and highlighted the importance of taking into account ultrastructural changes after IRE by using electron microscopy analysis.

[Neurocristopathies: a high incidence of cerebral dysgenesis in patients with Hirschsprung's disease]. / Neurocrestopatías: alta frecuencia de disgenesias cerebrales en pacientes con enfermedad de Hirschsprung.

INTRODUCTION: Hirschsprung's disease (HD), or aganglionic megacolon, is a congenital disorder that is characterised by the absence of ganglion cells in the submucosal and myenteric plexuses of the intestine, which is caused by the failure of these cells to migrate from the neural crest (neurocristopathy). Cerebral dysgenesis and polymalformation syndromes have been reported in association with HD, thus suggesting an abnormal morphogenesis. AIM: To study the frequency of cerebral malformations in patients with HD in our environment. PATIENTS AND METHODS: We conducted a retrospective study of 41,666 live newborn infants, over the period 1993-2003, and 17 cases of HD where identified. RESULTS: The incidence of HD in the health district of the province of Albacete is 1.68 per 5,000 live newborn infants. Of the 17 patients with HD who were studied, 10 were isolated (58.8%) and seven (41.1%) were associated to other structural abnormalities and psychomotor retardation. Three of the cases in this latter group were due to chromosome pathology (trisomy 21, Down syndrome), two were caused by specific polymalformation syndromes (one Mowat-Wilson syndrome and one possible FG syndrome), one was due to a pattern of abnormalities that did not fit any known syndrome, and one had a normal phenotype and isolated cerebral dysgenesis. In all of cases the neuroimaging studies identified cerebral dysgenesis that was compatible with neuronal migration disorders. CONCLUSIONS: The frequency of association of HD, either isolated or within the context of a specific malformation syndrome, with neuronal migration disorders is high (23.5%). We suggest a full genetic and neurological evaluation should be carried out in patients with HD, together with brain imaging studies in order to rule out the possibility of cerebral dysgenesis.

Comparison of autologous bone marrow and adipose tissue derived mesenchymal stem cells, and platelet rich plasma, for treating surgically induced lesions of the equine superficial digital flexor tendon.

Several therapies have been investigated for equine tendinopathies, but satisfactory long term results have not been achieved consistently and a better understanding of the healing mechanism elicited by regenerative therapies is needed. The aim of this study was to assess the separate effects of autologous bone marrow (BM) and adipose tissue (AT) derived mesenchymal stem cells (MSCs), and platelet rich plasma (PRP), for treating lesions induced in the superficial digital flexor tendon (SDFT) of horses. Lesions were created surgically in both SDFTs of the forelimbs of 12 horses and were treated with BM-MSCs (six tendons), AT-MSCs (six tendons) or PRP (six tendons). The remaining six tendons received lactated Ringer's solution as control. Serial ultrasound assessment was performed prior to treatment and at 2, 6, 10, 20 and 45 weeks post-treatment. At 45 weeks, histopathology and gene expression analyses were performed. At week 6, the ultrasound echogenicity score in tendons treated with BM-MSCs suggested earlier improvement, whilst all treatment groups reached the same level at week 10, which was superior to the control group. Collagen orientation scores on histological examination suggested a better outcome in treated tendons. Gene expression was indicative of better tissue regeneration after all treatments, especially for BM-MSCs, as suggested by upregulation of collagen type I, decorin, tenascin and matrix metalloproteinase III mRNA. Considering all findings, a clear beneficial effect was elicited by all treatments compared with the control group. Although differences between treatments were relatively small, BM-MSCs resulted in a better outcome than PRP and AT-MSCs.

The autonomic innervation of the liver and gallbladder of Podarcis hispanica.

The innervation of the liver and gallbladder of the lizard Podarcis hispanica has been studied by the following methods: a) demonstration of cholinesterase activity; b) FIF method for catecholamines; and c) immunohistochemistry for VIP. The hepatic parenchyma of the reptile's liver show hepatocytes arranged in regular rows of hepatic cords, the portal triad being typical of higher vertebrates (birds and mammals). Nerve fibers are found in the scarce connective tissue distributed among the hepatocytes. The innervation is restricted to the big branches of blood vessels and biliary ducts. It is represented by cholinergic, noradrenergic and VIPergic fibers. The gallbladder shows a well developed cholinergic plexus with pyramidal cells in the interconnection points of the fiber network. The noradrenergic and VIPergic plexuses are also more widely distributed in the gallbladder than in the liver.

The autonomic innervation of the liver and gallbladder of Rana ridibunda.

1--The innervation of the liver and gallbladder of Rana ridibunda has been studied by the following methods: (a) demonstration of cholinesterase activity; (b) FIF method for catecholamines; (c) immunohistochemistry for VIP and (d) electron microscopy. 2--The hepatocytes are arranged in regular rows of hepatic cords, very little connective tissue is distributed in the parenchyma, the innervation being restricted to the big branches of blood vessels. 3--Well defined cholinergic and adrenergic plexuses surround the hepatic arteries, portal veins and biliary ducts. The VIPergic innervation is scarce in the liver but a richly branched plexus spreads in the wall of the gallbladder. 4--Cholinesterase-positive cells are widely distributed accompanying the nerve trunks of the gallbladder. The innervation distribution is prominent in the portion of the gallbladder next to the hepatic hilus. 5--A population of melanin-storing cells besides free melanin granules are present in the liver parenchyma and are prominent in the gallbladder where the melanocytes are disposed in close contact with blood vessels and nerve structures. We have observed that the number of these visceral melanocytes considerably increases in winter, particularly in the liver.

Submucosal plexus of terminal ileum: a study of the cholinergic and noradrenergic nerves in rats with streptozotocin-induced diabetes.

In order to study the type and degree of the alterations in the innervation of the intestine in experimental diabetes, a histochemical study on the cholinergic and noradrenergic nerves of the submucosal plexus of terminal ileum from rats with streptozotocin-induced diabetes was performed. The results obtained suggest that the diabetic animals keep the cholinergic activity undamaged 20 weeks after the induction of the illness, while the number of the catecholaminergic nerves appears to be markedly reduced.

Effects of experimental diabetes in the noradrenergic and cholinergic nerves of the rat small intestine.

An histochemical research on cholinergic and noradrenergic fibres of the adventitia layer and of the myenteric plexus of the terminal ileum from rats with streptozotocin-induced diabetes, after 20 weeks of evolution of the illness, was carried out to study changes in the innervation of the gut. The cholinergic nerves, revealed through their acetylcholinesterase activity, did not present alterations, but an evident reduction in number of the noradrenergic nerves and swollen intensely fluorescent varicosities, were observed, both in the perivascular and myenteric plexus of terminal ileum from diabetic animals.

Intrinsic innervation in the intestine of the lizard Podarcis hispanica.

The aim of this study was the description of the morphology and distribution of nerve structure elements in the intestine of the lizard Podarcis hispanica using different histochemical methods; namely acetylcholinesterase (AChE), formol-induced fluorescence for catecholamines (FIF), nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), and immunohistochemistry for vasoactive intestinal peptide (VIP), as well as substance P (SP) and electron microscopy. The AChE method showed fibres in the myenteric and submucosal plexus, with a higher fibre density in the large intestine. The highest number of related neurons was located in the myenteric plexus ganglia. Noradrenergic innervation was distributed through the myenteric and submucosal plexus, and also around blood vessels, with the highest fibre density in the large intestine. VIP immunohistochemistry showed a wide distribution of positive fibres throughout the intestine, although the highest density was again detected in the large intestine. Small positive cells for VIP were located at internodal segments in the plexus. SP labeling, although subtle, was present all along the intestine. It showed delicate varicose nets and few fibres innervating blood vessels. Small positive cells for SP were located in the large intestine. The indirect method to detect nitric oxide (NO)-producing system showed neural cells in the myenteric plexus ganglia of the large intestine. Electron microscopy showed ganglion neurons with scattered chromatin condensations, glial cells with higher electron density, and axons with varicosities occupied by different vesicles. We also identified certain cells as interstitial cells of Cajal due to their ultrastructural features. They were mostly located in the region of the myenteric plexus.

Enteric plexus and interstitial cells of Cajal: interrelationship in the stomach of Podarcis hispanica (Reptilia). An ultrastructural study.

The ultrastructure organization of the stomach enteric plexus was examined in the lizard Podarcis hispanica. The ganglions of the myenteric plexus present a low number of nerve cell bodies with a peculiar nucleus, which occasionally establish direct contacts with cells of the circular muscle layer. Glial cells are smaller than the neurones, and their nucleus is very electron-dense. They surround the axons that constitute the fibres of the myenteric plexus. Four main types of axon profile are described in a morphological consideration of the vesicle population. In the interstice of the circular muscle layer we describe two types of interstitial cells that, due to their ultrastructural characteristics, may be equivalent to the interstitial cells of Cajal which have been described in mammalians. These cells shows parallel distribution to the stomach nerve plexuses, establishing close contacts with them through their long cytoplasmic prolongations. By means of small gap-like unions, they contact both each other and the smooth muscle cells near them. We describe a submucous plexus, where neuronal bodies are scattered among bundles of nervous fibres, some of which are myelinated. A mucous plexus with isolated neurones is located in the lamina propria. Axonal varicosities containing vesicles contact with the cells of the mucous. Interconnected interstitial cells may also be found in this plexus.

Frog stomach enteric plexuses in culture: isolation, morphological characterization and bioelectrical recordings.

We have succeeded in the isolation, culture and morphological characterization of Rana ridibunda stomach enteric plexuses. We have furthermore obtained intra and extracellular bioelectric recordings from the explants in culture. The culture medium used (Eagle MEM), the collagenase digestion and the general culture conditions followed are similar to those applied to mammal enteric plexus explant cultures. The most striking difference is that the solutions were diluted to 70% in order to maintain the osmolar conditions required by the amphibian cells. Acetylcholinesterase, osmium tetroxide-zinc iodide- and para-formaldehyde-induced fluorescence methods reveal similar morphological images from the perivascular fibre plexuses. The different cell types observed by phase contrast light microscopy from the myenteric explants in culture have been identified by comparison with those revealed by the acetylcholinesterase method. The prevailing neurons show piramidal somas; other neurons are bipolar with oval somas and a third type shows oval somas tightly aligned, following sinusoidal courses. The intra and extracellular bioelectric recordings from the explants in culture show that the culture conditions we have applied preserve the electrophysiological properties of the neuronal membranes. These preliminary recordings will allow us to undertake the synaptic characterization of the gastrointestinal neurotransmitters in frogs.

Intrinsic and extrinsic innervation of the amphibians esophagic myenteric plexuses.

The innervation of Rana ridibunda esophagus myenteric plexuses has been studied by the following methods: demonstration of cholinesterase activity; FIF method for catecholamines; immunohistochemistry for VIP, SP and SOM, and conventional electron microscopy. The cholinergic innervation is important in the esophagus wall where, in addition to the well known extrinsic component, there is a rich intrinsic plexus with cells and fibres widely distributed. The esophagus, together with the intestine, are the Rana gut portions where the adrenergic component is more broadly expressed. The adrenergic innervation seems to be almost entirely of extrinsic origin. We have shown that, for the tested peptides, there is an intrinsic innervation represented by VIP, SP and SOM like plexuses. We do not discard nonetheless an extrinsic component. The ultrastructure reveals the morphological characteristics of the enteric neurons as well as the fine inter-relationships between the nervous elements and the functional components of the esophagic wall.

Acetylcholinesterase-positive and paraformaldehyde-induced-fluorescence-positive innervation in the upper eyelid of the sheep (Ovis aries).

This is the first study which describes the innervation of some eyelid structures, such as the glands of Moll and the glands of Zeiss. It is also the first to investigate the innervation pattern of the eyelid as a whole. We have studied the acetylcholinesterase-positive and paraformaldehyde-induced-fluorescence-positive (FIF+) innervation pattern of the different structures that constitute the upper eyelid of the sheep. There is widespread acetylcholinesterase-positive innervation in the epithelium, but not such an abundant FIF+ innervation. Both types of innervation are represented in the connective tissue by trunks or fibers that are distributed towards the different structures immersed within them. In the glands of Zeiss, cholinesterase-positive innervation is much more widespread than FIF innervation. On the contrary, the glands of Moll present denser FIF+ innervation than acetylcholinesterase-positive innervation. The Meibomian glands and the lachrymal glands show a rich acetylcholinesterase-positive and FIF+ innervation. Eyelid muscle innervation is mainly acetylcholinesterase-positive. In the conjunctive membrane there is no acetylcholinesterase-positive innervation, and only scarce FIF+ fibers can be demonstrated.

S-100 protein immunoreactivity in the upper eyelid of the sheep Ovis aries.

The aim of this work was to analyse the distribution pattern of S-100-immunoreactive elements in the upper eyelid of the sheep. This pattern may be of importance regarding the diagnosis and prognosis of eyelid tumours that are linked to deregulation of S-100 gene expression. Thirty upper eyelids taken from 15 adult male Ovis aries were studied by means of the peroxidase-antiperoxidase method for light microscopy. S-100-immunopositive cells were found in the eyelid edge. S-100-immunopositive steams and thinner fibres were found throughout the eyelid. These nerve processes typically were denser around glands, hair follicles and blood vessels. S-100-immunopositive elements may play a role as neuromodulator and also in the development of the vegetative innervation of the epithelium and its derivatives.

New insights into c-Ret signalling pathway in the enteric nervous system and its relationship with ALS.

The receptor tyrosine kinase Ret (c-Ret) transduces the glial cell line-derived neurotrophic factor (GDNF) signal, one of the neurotrophic factors related to the degeneration process or the regeneration activity of motor neurons in amyotrophic lateral sclerosis (ALS). The phosphorylation of several tyrosine residues of c-Ret seems to be altered in ALS. c-Ret is expressed in motor neurons and in the enteric nervous system (ENS) during the embryonic period. The characteristics of the ENS allow using it as model for central nervous system (CNS) study and being potentially useful for the research of human neurological diseases such as ALS. The aim of the present study was to investigate the cellular localization and quantitative evaluation of marker c-Ret in the adult human gut. To assess the nature of c-Ret positive cells, we performed colocalization with specific markers of cells that typically are located in the enteric ganglia. The colocalization of PGP9.5 and c-Ret was preferentially intense in enteric neurons with oval morphology and mostly peripherally localized in the ganglion, so we concluded that the c-Ret receptor is expressed by a specific subtype of enteric neurons in the mature human ENS of the gut. The functional significance of these c-Ret positive neurons is discussed.

Analysis of the Spanish national registry for pediatric home enteral nutrition (NEPAD): implementation rates and observed trends during the past 8 years.

BACKGROUND/OBJECTIVES: The home enteral nutrition (HEN) provides nutritional support to children with chronic diseases who are nutritionally compromised and allows them to be discharged more quickly from hospitals. In 2003, a web-based registry (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition -NEPAD-) was created with the objective of gathering information about pediatric HEN practices in Spain. AIM: The aim of this study was to report the implementation of the NEPAD (Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria, Pediatric Ambulatory and Home Enteral Nutrition) registry of pediatric HEN in Spain and to analyze data evolution trends from 2003 to 2010. SUBJECTS/METHODS: The data from the Spanish NEPAD registry were analyzed according to the following variables: demographic data, diagnosis, indication for HEN, nutritional support regime and administration route. RESULTS: Over the study period, 952 patients (1048 episodes) from 20 Spanish hospitals were included in the NEPAD registry. The most frequent indication for HEN was decreased oral intake (64%), and neurological disease was the most prevalent illness. HEN was delivered via a nasogastric tube in 573 episodes (54.7%), by gastrostomy in 375 episodes (35.8%), oral feeding in 77 episodes (7.3%) and by jejunal access in 23 episodes (2.2%). Significant differences in the mode of administration were observed based on the pathology of the child (χ(2), P<0.0001). The cyclic feeding was the most widely used technique for the administration of HEN. Most of the patients used a pump and a polymeric formula. Transition to oral feeding was the primary reason for discontinuation of this type of support. CONCLUSIONS: Since the NEPAD registry was established in Spain, the number of documented patients has increased more than 25-fold. Many children with chronic illness benefit from HEN, mainly those suffering from neurological diseases.