[Asthma : the contribution of biotherapies]. / Une décennie d'avancées dans l'asthme : l'apport des biothérapies.

Asthma is a chronic heterogeneous airway disease. There are different asthma inflammatory phenotypes with various responses to treatment and different disease severities. When asthma requires chronic systemic corticosteroids or hospitalizations despite maximal inhaled therapies in asthmatic patients in whom comorbidities have been managed and who are considered as compliant, the pulmonologist may propose biological treatment to reduce exacerbations and the dose of systemic corticosteroids. During the last ten years, the number of biologics for the management of type-2 severe asthma has increased. Anti-IgE monoclonal antibodies (omalizumab) are available for more than ten years and recommended in severe allergic asthma. New biologics are now available to block IL-5 (mepolizumab, reslizumab) or its receptor (benralizumab). These treatments allow a reduction of exacerbations and of the dose of systemic corticosteroids, an improvement in asthma control, in asthma quality of life and for some of them, an increase in lung function. New biologics will soon be available in Belgium for the management of severe asthma. In addition to the improvement of asthma control in severe asthma, biological treatments have improved the understanding of the mechanisms leading to severe asthma.

L'asthme est une maladie hétérogène chronique des voies aériennes. Il existe, en effet, différents phénotypes inflammatoires d'asthme induisant une réponse variable aux traitements et différents degrés de sévérité. Lorsque l'asthme est sévère et requiert le recours aux corticostéroïdes systémiques ou à des hospitalisations malgré un traitement de fond maximal chez un patient asthmatique bon observant dont les comorbidités ont été prises en charge, le pneumologue peut proposer un traitement biologique en vue de réduire les exacerbations et la dose de corticostéroïdes systémiques. Au cours des dix dernières années, les traitements biologiques dans la prise en charge de l'asthme sévère de type 2 se sont étoffés. A côté du traitement par anti-IgE (omalizumab), disponible depuis plus de 10 ans et recommandé dans l'asthme sévère extrinsèque, d'autres traitements bloquant l'IL-5 (mépolizumab, reslizumab) ou son récepteur (benralizumab) ont vu le jour. Ces traitements permettent une réduction des exacerbations et de la dose de corticostéroïdes systémiques, une amélioration du contrôle, des paramètres de qualité de vie et, pour certains d'entre eux, de la fonction respiratoire. D'autres traitements ciblés prometteurs seront bientôt disponibles en Belgique. En plus d'améliorer le contrôle symptomatique des patients asthmatiques sévères, les traitements biologiques ont permis de mieux comprendre les mécanismes conduisant au développement d'un asthme sévère.

A cortical study of the attention in military simulation tests. / Estudio cortical de la atencion en tests de simulacion militar.

INTRODUCTION: Attention is one of the most widely studied superior cerebral functions and base of many other cognitive processes. It is sometimes understood as concentration on a task or target. The level of execution of a task and the ability to process information are dependent on the state of cerebral activation of the subject. This brain activity can be recorded with the electroencephalogram (EEG). AIM: Attention is studied in states of rest and during the performance of tasks in military personnel, exploring the differences between two groups (cadets and officers/NCOs). SUBJECT AND METHODS: EEG signals have been recorded from 19 cadets and 17 officers of the General Military Academy and from the General Hospital of the Defense during military simulation tasks and in states of rest. Our team uses its own methodology of the dynamic systems and fractal techniques for the modeling and quantification of the EEG signals, in this case for the computation of the fractal dimension of the record of each derivation. The data obtained are subjected to a statistical study. RESULTS: Higher cortical global mean values were observed in the officers group. The dimension increases in both groups by raising the difficulty of the task in all areas of the brain except in the frontal zone. They highlight the significant differences between groups in the simulation task of driving combat vehicle in the central, parietal and temporal areas. CONCLUSIONS: The results obtained show that the two groups studied do not behave homogeneously in the same attention task that involves a video game.

TITLE: Estudio cortical de la atencion en tests de simulacion militar.Introduccion. La atencion es una de las funciones cerebrales superiores mas estudiadas en nuestros dias y la base de otros procesos cognitivos. En ocasiones se entiende como la concentracion en una tarea. El nivel de ejecucion de una tarea y la habilidad para procesar informacion son dependientes del estado de activacion cerebral, que puede registrarse mediante el electroencefalograma (EEG). Objetivo. Estudiar la atencion en estados de reposo y durante el desarrollo de tareas propias del personal militar, explorando las diferencias entre dos grupos (cadetes/mandos). Sujetos y metodos. Se han recogido señales de EEG de 19 cadetes y 17 oficiales de la Academia General Militar y del Hospital General de la Defensa durante tareas de simulacion militar y en estados de reposo. Nuestro equipo utiliza metodologia propia de sistemas dinamicos y tecnicas fractales para modelizar y cuantificar las señales del EEG, en este caso para el calculo de la dimension fractal del registro de cada derivacion. Los datos obtenidos en diversos estados cerebrales se someten a un estudio estadistico. Resultados. Se observan mayores valores de las medias globales corticales en el grupo de mandos. La dimension aumenta en ambos grupos al elevar la dificultad de la tarea en todas las areas cerebrales, salvo en la zona frontal. Destacan las diferencias significativas entre grupos en la tarea de simulacion de manejo de vehiculos de combate en las zonas central, parietal y temporal. Conclusiones. Los resultados obtenidos muestran que los dos grupos no se comportan de manera homogenea en la misma tarea de atencion que implica un videojuego.

Effectiveness of the sesquiterpene (-)-α-bisabolol in dogs with naturally acquired canine leishmaniosis: an exploratory clinical trial.

The use of natural products is a promising approach for treating visceral leishmaniosis. (-)-α-Bisabolol is a sesquiterpene that have been proved active in vivo on Leishmania infantum-infected mice without showing toxicity. A single-centre, parallel-group, randomized, exploratory study was designed to assess its efficacy in a canine leishmaniosis model involving naturally infected dogs. In this clinical trial, 12 dogs were allocated into two groups and were treated with either meglumine antimoniate (100 mg/kg) through subcutaneous route or (-)-α-bisabolol (30 mg/kg) through oral route for two treatment series of 30 days, separated by a 30-day interval. A 4-month follow-up period was established as well. Parasite loads in bone marrow, lymph node and blood were estimated through quantitative PCR. Antibody titres were determined through immunofluorescence antibody test and cytokine expression values were estimated through real-time reverse transcription-PCR. Treatment safety was assessed through the evaluation of weight, gastrointestinal alterations and hematological and biochemical parameters in blood. Analyses were performed before and after treatment, and after a 4-months follow-up period. Treatment with the sesquiterpene was effective at decreasing parasite loads and increasing gamma-interferon expression level. Dogs treated with (-)-α-bisabolol did not show any toxicity sign. These results were better than those obtained using the reference drug, meglumine antimoniate. The natural compound seemed to induce a Th1 immune response that led to parasitological and clinical improvement without showing any safety issue, suggesting a high potential for the treatment of canine and human visceral leishmaniosis.

Nutrición perioperatoria en protocolos quirúrgicos para una mejor recuperación postoperatoria (Protocolo ERAS) / Perioperative nutrition in ERAS Protocols

The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR. The nutritional perioperative interventions in the ERAS protocols, focus on avoiding prolonged preoperative fasting by oral carbohydrate loading up to two hours before surgery, accompanied by early postoperative feeding through the digestive tube. These nutritional perioperative interventions are safe and effective to reduce complications and postoperative stay, even in patients with well controlled type 2 diabetes. Nevertheless, their implementation and compliance are rather low, therefore, we must continue to make efforts in order to change perioperative nutritional management of our patients to achieve the best possible postoperative recovery.

[Perioperative nutrition in ERAS Protocols]. / Nutrición perioperatoria en protocolos quirúrgicos para una mejor recuperación postoperatoria (Protocolo ERAS).

The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR. The nutritional perioperative interventions in the ERAS protocols, focus on avoiding prolonged preoperative fasting by oral carbohydrate loading up to two hours before surgery, accompanied by early postoperative feeding through the digestive tube. These nutritional perioperative interventions are safe and effective to reduce complications and postoperative stay, even in patients with well controlled type 2 diabetes. Nevertheless, their implementation and compliance are rather low, therefore, we must continue to make efforts in order to change perioperative nutritional management of our patients to achieve the best possible postoperative recovery.

Sección de Gastroenterología Infantil del Hospital Universitario Gregorio Marañón / Pediatric Gastroenterology section of the Hospital Universitario Gregorio Marañón

La Sección de Gastroenterología, Hepatología y Nutrición Infantil del Hospital Materno Infantil del HGU Gregorio Marañón se dedica a la atención integral del paciente pediátrico con patología digestiva y con especial dedicación a la nutrición del niño enfermo en diferentes situaciones especiales (enfermedades oncohematológicas, niños con cardiopatías congénitas, enfermedades neuromusculares, postoperatorio de diferentes patologías quirúrgicas, enfermedades del riñón, enfermedades metabólicas, etc.). Dentro de las actividades asistenciales de la sección cabe destacar el seguimiento de diferentes patologías digestivas crónicas, como la enfermedad celíaca, la dedicación especial con novedosos proyectos asistenciales y de investigación en la enfermedad inflamatoria intestinal, así como la asistencia en enfermedades crónicas del hígado y páncreas, entre otras. En esta Sección se han desarrollado nuevas técnicas diagnósticas y se han fortalecido la aplicación de otras exploraciones complementarias complejas en el estudio de enfermedades digestivas, convirtiéndose en centro de referencia de algunas de ellas como sucede en el caso de trastornos de motilidad digestiva o el estudio de la microbiota intestinal. En este artículo se refleja la estructura de la unidad junto con una revisión de su actividad asistencial en patologías digestivas cada vez más complejas, la elaboración de las tareas docentes realizadas en nuestro centro y para otras entidades con gran difusión de las mismas, así como la importante labor de investigación clínica con participación en diferentes líneas de investigación (AU)

The Paediatric Gastroenterology, Hepatology and Nutrition Section of Maternal and Child Hospital HGU Gregorio Maranon is dedicated to comprehensive care of pediatric patients with digestive diseases with special attention to the nutrition of the sick child in different special situations (oncohaemathologic diseases, complex heart diseases, neuropaediatric diseases, postoperative of different surgical diseases, kidney diseases, metabolíc diseases…). Within the humanitarian assistance activities of the Section include monitoring of different chronic digestive diseases, such as celiac disease, special dedication to innovative care projects and research in inflammatory bowel disease, and such as assistance in chronic diseases of the liver and pancreas, among others. On the other hand, in our section we have developed new diagnostic techniques and strengthened the implementation of other complex complementary examinations in the study of digestive diseases, becoming a reference center for some of them as happens in the case of motility disorders and research of microbiome. In this article, the structure of the Section is reflected along with a review of their daily work in increasingly complex digestive diseases, as well as educational activities in our center and to other entities with widely distributed thereof, as well as the important work of clinical research with participation in different lines of research (AU)

Orbitopatía de Graves: una enfermedad poco conocida por el oftalmólogo. «El presente y el futuro está en los inhibidores de citoquinas. Cómo y cuándo utilizarlas» / Graves’ ophthalmopathy: A disease little-known by the ophthalmologist. The present and future is in cytokinase inhibitors. How and when to use them

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Screening exogenous fibrolytic enzyme preparations for improved in vitro digestibility of bermudagrass haylage.

Our objectives were to evaluate the effects of 12 exogenous fibrolytic enzyme products (EFE) on ruminal in vitro neutral detergent fiber digestibility (NDFD) and preingestive hydrolysis of a 4-wk regrowth of bermudagrass haylage (BH), to examine the accuracy of predicting NDFD with EFE activity measures, and to examine the protein composition of the most and least effective EFE at increasing NDFD. In experiment 1, effects of 12 EFE on NDFD of BH were tested. Enzymes were applied in quadruplicate to culture tubes containing ground BH. The suspension was incubated for 24 h at 25 °C before addition of rumen fluid media and further incubation for 24 h at 39 °C. The experiment was repeated twice. In addition, regression relationships between EFE activity measures and NDFD were examined. Compared with the values for the control, 9 EFE-treated substrates had greater NDFD (37.8 to 40.4 vs. 35.6%), 6 had greater total VFA concentration (59.1 to 61.2 vs. 55.4 mM), and 4 had lower acetate-to-propionate ratios (3.03 to 3.16 vs. 3.24). In experiment 2, EFE effects on preingestive fiber hydrolysis were evaluated by incubating enzyme-treated and untreated bermudagrass suspensions in quadruplicate for 24 h at 25 °C and examining fiber hydrolysis measures. Compared with values for the control, 3 EFE reduced neutral detergent fiber concentration (62.8 to 63.7 vs. 67.3%), 10 increased release of water-soluble carbohydrates (26.8 to 58.5 vs. 22.8 mg/g), and 8 increased release of ferulic acid (210 to 391 vs. 198 µg/g). Regression analyses revealed that enzyme activities accurately [coefficient of determination (R(2)) = 0.98] predicted preingestive hydrolysis measures (water-soluble carbohydrates, ferulic acid), moderately (R(2) = 0.47) predicted neutral detergent fiber hydrolysis, but poorly (R(2) ≤ 0.1) predicted dry matter and NDFD. In experiment 3, proteomic tools were used to examine the protein composition of the most and least effective EFE at improving NDFD. Relative to the least effective, the most effective EFE at increasing NDFD contained 10 times more endoglucanase III, 17 times more acetylxylan esterase with a cellulose-binding domain 1, 33 times more xylanase III, 25 times more ß-xylosidase, and 7.7 times more polysaccharide monooxygenase with cellulose-binding domain 1 and 3 times more swollenin. The most effective EFE had a much greater quantity of fibrolytic enzymes and key proteins necessary for hemicellulose and lignocellulase deconstruction. This study identified several EFE that increased the NDFD and in vitro fermentation of 4-wk BH and revealed why some EFE are more effective than others.

Quantitative analysis of performance on a progressive-ratio schedule: effects of reinforcer type, food deprivation and acute treatment with Δ9-tetrahydrocannabinol (THC).

Rats' performance on a progressive-ratio schedule maintained by sucrose (0.6M, 50 µl) and corn oil (100%, 25 µl) reinforcers was assessed using a model derived from Killeen's (1994) theory of schedule-controlled behaviour, 'Mathematical Principles of Reinforcement'. When the rats were maintained at 80% of their free-feeding body weights, the parameter expressing incentive value, a, was greater for the corn oil than for the sucrose reinforcer; the response-time parameter, δ, did not differ between the reinforcer types, but a parameter derived from the linear waiting principle (T0), indicated that the minimum post-reinforcement pause was longer for corn oil than for sucrose. When the rats were maintained under free-feeding conditions, a was reduced, indicating a reduction of incentive value, but δ was unaltered. Under the food-deprived condition, the CB1 cannabinoid receptor agonist Δ(9)-tetrahydrocannabinol (THC: 0.3, 1 and 3 mg kg(-1)) increased the value of a for sucrose but not for corn oil, suggesting a selective enhancement of the incentive value of sucrose; none of the other parameters was affected by THC. The results provide new information about the sensitivity of the model's parameters to deprivation and reinforcer quality, and suggest that THC selectively enhances the incentive value of sucrose.

Oleuropein or rutin consumption decreases the spontaneous development of osteoarthritis in the Hartley guinea pig.

OBJECTIVE: To assess the potential protective effects of three polyphenols oleuropein, rutin and curcumin, on joint ageing and osteoarthritis (OA) development. DESIGN: Sixty 4-week-old Dunkin-Hartley guinea pigs were randomized into four groups and received daily during 31 weeks either standard guinea pig diet (control group) or a standard guinea pig diet enriched with oleuropein (0.025%), rutin (0.5%) or rutin/curcumin (0.5%/0.25%) association. Biomarkers of OA (Coll2-1, Coll2-1NO2, Fib3-1, Fib3-2, ARGS), as well as inflammation prostaglandin E2 (PGE2) were quantified in the serum. Histological assessments of knee cartilage and synovial membrane were performed at week 4 (five young reference guinea pigs) and week 35. RESULTS: At week 35, guinea pigs in the control group spontaneously developed significant cartilage lesions with mild synovial inflammation. The histological scores of cartilage lesions and synovitis were well correlated with the increased level of serum biomarkers. Histologically, all treatments significantly reduced the cartilage degradation score (P < 0.01), but only oleuropein significantly decreased the synovial histological score (P < 0.05) and serum PGE2 levels (P < 0.01) compared to the control group. Coll2-1 was decreased by rutin and the combination of rutin/curcumin, Fib3-1 and Fib3-2 were only decreased by the rutin/curcumin mixture, while Coll2-1NO2 was significantly decreased by all treatments (P < 0.05). CONCLUSION: Oleuropein and rutin ± curcumin significantly slowed down the progression of spontaneous OA lesions in guinea pigs. While no additive effect was seen in the curcumin + rutin group, the differential effects of oleuropein and rutin on inflammatory and cartilage catabolic markers suggest an interesting combination for future studies in OA protection.

Comparación analgésica postquirúrgica de la infiltración corticoanestésica y la anestésica pura tras meniscectomía artroscópica de rodilla / Postoperative pain comparison between steroids anesthetic infiltration, and pure anesthetic infiltration after arthoscopic knee menisectomy

Objetivo: Evaluar la efectividad de las infiltraciones postquirúrgicas de anestésico local solo y combinado con corticoide, para el tratamiento del dolor e inflamación en el postoperatorio temprano en pacientes intervenidos de menisco artroscópicamente. Material y método: Estudio clínico prospectivo randomizado de 60 pacientes a los que se les practicó menisectomía artroscópica. Finalizada la intervención, los pacientes fueron asignados aleatoriamente a uno de los dos grupos de estudio y se infiltró en un grupo 10 ml de clorhidrato de bupivacaína al 0,5% y en el otro el mismo anestésico, asociado a triamcinolona acetónido (solución de 40 mg). La percepción del dolor fue medida objetivamente por la Escala Visual Análoga (EVA), registrándose el dolor postquirúrgico a las 2, 4 y 24 horas y a los 15 días y al mes, después de la intervención. Resultados: No se encontraron diferencias significativas entre los diferentes grupos de estudio. Conclusión: La infiltración anestésica postquirúrgica en dosis única es un procedimiento muy útil para el manejo del dolor postoperatorio en pacientes que requieren la realización de una menisectomía artroscópica (AU)

Objective: To evaluate the effectiveness of postoperative local anesthetic infiltration alone and combined with corticosteroid for the treatment of pain and inflammation in the early postoperative period in patients undergoing arthroscopic meniscal pathology. Material and method: A prospective randomized clinical study, 60 patients who underwent arthroscopic meniscectomy. After surgery, patients were randomly assigned to one of two study groups and infiltrated a group 10 ml of bupivacaine hydrochloride 0.5% and on the other the same anesthetic, associated with triamcinolone acetonide (solution of 40 mg). Pain perception was objectively measured by the Visual Analog Scale (VAS), postoperative pain recorded at 2, 4 and 24 hours and 15 days and a month after the intervention. Results: No significant differences were found between the different groups. Conclusion: Postoperative anesthetic infiltration single dose is a very useful procedure for the management of postoperative pain in patients requiring arthroscopic meniscectomy performing (AU)

Síndrome de Percheron: Lesiones talámicas bilaterales / Percheron Syndrome: Thalamic bilateral lesions

El síndrome de Percheron o infarto talámico bilateral sincrónico se considera infrecuente y de difícil diagnóstico clínico. Presentamos el caso de un paciente con lesiones isquémicas agudas en ambos tálamos y mesencéfalo anterior, compatibles con obstrucción del la arteria de Percheron. La compleja irrigación talámica y la variabilidad individual hacen que las lesiones isquémicas puedan presentarse en forma de lesiones bilaterales y confieren importancia a este cuadro. La Resonancia Magnética cerebral (RM) es fundamental en el correcto diagnóstico

Percheron Syndrome also known as bilateral synchronic thalamic infarction is consider as an infrequent of difficult diagnosis syndrome. We describe the case of a male patient presenting acute ischemic lesions in both thalamus and anterior mesencephalon caused by an obstruction of the Percheron artery. The complexity of thalamic vascularization and individual differences make ischemic lesions appear as bilateral, tha's the importance of this syndrome. Brain MRI is proposed as fundamental for a correct diagnosis

Effects of SKF-83566 and haloperidol on performance on progressive ratio schedules maintained by sucrose and corn oil reinforcement: quantitative analysis using a new model derived from the Mathematical Principles of Reinforcement (MPR).

RATIONALE: Mathematical models can assist the interpretation of the effects of interventions on schedule-controlled behaviour and help to differentiate between processes that may be confounded in traditional performance measures such as response rate and the breakpoint in progressive ratio (PR) schedules. OBJECTIVE: The effects of a D1-like dopamine receptor antagonist, 8-bromo-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-3-benzazepin-7-ol hydrobromide (SKF-83566), and a D2-like receptor antagonist, haloperidol, on rats' performance on PR schedules maintained by sucrose and corn oil reinforcers were assessed using a new model derived from Killeen's (Behav Brain Sci 17:105-172, 1994) Mathematical Principles of Reinforcement. METHOD: Separate groups of rats were trained under a PR schedule using sucrose or corn oil reinforcers. SKF-83566 (0.015 and 0.03 mg kg(-1)) and haloperidol (0.05 and 0.1 mg kg(-1)) were administered intraperitoneally (five administrations of each treatment). Running and overall response rates in successive ratios were analysed using the new model, and estimates of the model's parameters were compared between treatments. RESULTS: Haloperidol reduced a (the parameter expressing incentive value) in the case of both reinforcers, but did not affect the parameters related to response time and post-reinforcement pausing. SKF-83566 reduced a and k (the parameter expressing sensitivity of post-reinforcement pausing to the prior inter-reinforcement interval) in the case of sucrose, but did not affect any of the parameters in the case of corn oil. CONCLUSIONS: The results are consistent with the hypothesis that blockade of both D1-like and D2-like receptors reduces the incentive value of sucrose, whereas the incentive value of corn oil is more sensitive to blockade of D2-like than D1-like receptors.

Optimization of DNA isolation and PCR protocol for analysis and evaluation of genetic diversity of the medicinal plant, Anemopsis californica using RAPD.

Anemopsis californica is a perennial herbaceous plant that has been utilized as a medicinal plant for the treatment of various diseases. The present work was carried out with the objective of optimizing a method of extraction of the genomic DNA of A. californica and a PCR protocol and later to evaluate the existing genetic diversity among the genotypes deriving from different origins. For DNA extraction, we tested four procedures: with the CTA B-2 protocol, we obtained the highest yield (61.5±2.2 µg DNA/g of leaf tissues) and the best quality (A260/280 1.83±0.022). To estimate genetic variability, we utilized the randomly amplified polymorphism DNA (RAPD) technique, employing 20 oligonucleotides, of which only 18 generated reproducible banding patterns, producing 123 polymorphic bands generated, thus obtaining a polymorphism rate of 93.93% among the genotypes analyzed. The Jaccard similarity coefficient generated a variation ranging from 0.325-0.921, indicating a high level of genetic variation among the studied genotypes. An Unweighted pair-group method with arithmetic mean (UPGMA) group analysis indicated six distinct groups. The present optimized method for DNA isolation and RAPD protocol may serve as an efficient tool for further molecular studies.

2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla / The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document

La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia(SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias(SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: “La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH)and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: “Does this particular AABT reduce the transfusion rate or not? “All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation(GRADE) methodology (AU)

[The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. / 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Actualización del Documento Sevilla.

Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?¼ All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.

The sedative effects of hops (Humulus lupulus), a component of beer, on the activity/rest rhythm.

UNLABELLED: The hop (Humulus lupulus), a component of beer, is a sedative plant whose pharmacological activity is due principally to its bitter resins, especially to the α-acid component 2-methyl-3-buten-2-ol. The mechanism of action of the resin of hop consists of increasing the activity of the neurotransmitter γ-aminobutyric (GABA), inhibiting the central nervous system (CNS). OBJECTIVES: To analyze in an experimental model of diurnal animal the sedative effect of hop, a component of beer, on the activity/rest rhythm. METHODS: Experiments were performed with common quail (Coturnix coturnix) similar to humans in the sleep-wake rhythm, isolated in 25 × 25 × 25 cm methacrylate cages, with food and water ad libitum, in a room with artificial ventilation (22 ± 1 °C) and a lighting cycle of 12L/12D (n = 5). The doses administered, close to the content of non-alcoholic beer, were 1, 2 and 11 mg extract of hop as one capsule per day, at 18:00 h for one week. A control group received capsules only with a methylcellulose excipient and a basal group received no treatment. The chronobiological analysis of the animals' activity captured and logged by the software DAS24 was performed using the Ritme computer program (cosinor methods). RESULTS: With the dose of 2 mg, there was a statistically significant (p < 0.05) reduction of the arithmetic mean nocturnal activity (23 ± 3.0) with respect to the basal (38.56 ± 2.79), control (38.1 ± 2.8) and other doses groups 1 mg (52.04 ± 3.65) and 11 mg (47.47 ± 5.88). This dose of 2 mg, similar to the concentration in beer, was more effective in reducing nocturnal activity than the other doses of 1 and 11 mg, as well as preserving the circadian activity/rest rhythm. CONCLUSION: The concentration of 2 mg of hop extract effectively decreased nocturnal activity in the circadian activity rhythm. On the basis of this investigation, administration of non-alcoholic beer would be recommended due to its hop content and consequent sedative action, which would be an aid to nocturnal sleep.

Increased expression of the mineralocorticoid receptor in the brain of spontaneously hypertensive rats.

The mineralocorticoid receptor (MR) has been considered as both neuroprotective and damaging to the function of the central nervous system. MR may be also involved in central regulation of blood pressure. In the present study, we compared the expression of MR and the glucocorticoid receptor (GR) in the hippocampus and hypothalamus of 16-week-old spontaneously hypertensive rats (SHR) and normotensive control Wistar Kyoto (WKY) rats. In the hippocampus, MR expression was studied by in situ hybridization (ISH), quantitative polymerase chain reaction (PCR) and immunohistochemistry, whereas GR expression was analysed using the latter two procedures. Hypertensive animals showed an increased expression of MR mRNA in the whole hippocampus according to qPCR data and also in CA3 by ISH. Immunocytochemical staining for MR of the dorsal hippocampus, however, did not reveal differences between SHR and WKY rats. SHR showed elevated hypothalamic MR mRNA by qPCR, as well as an increased number of MR immunopositive cells in the magnocellular paraventricular region, compared to WKY rats. By contrast, expression levels of GR mRNA or protein in the hippocampus and hypothalamus of SHR were similar to those of WKY rats. Furthermore, we investigated the role of MR in the hypertensive rats by i.c.v. injection of the MR antagonist RU-2831. This compound produced a significant drop in blood pressure for SHR. In conclusion, MR expression is increased in the hippocampus and hypothalamus of SHR. We suggest that pathological MR overdrive may take responsibility for up-regulation of blood pressure and the encephalopathy of hypertension.