[Intussusception: hospital admission for risk of recurrence or early discharge?] / Invaginación intestinal: ¿alta precoz o ingreso por riesgo de recidiva?

INTRODUCTION/PURPOSE: There is current debate about the need of hospitalization of patients with enema-reduced intussusception. The purpose of this study is to describe intussusception recurrence in a tertiary care children's hospital in order to evaluate the feasibility of ambulatory treatment. PATIENTS AND METHODS: Retrospective review of children diagnosed with intussusception from January 2009 to December 2013, identifying early recurrences as those that occurred between 12-72 hours after successful enema reduction and comparing the results with current literature. RESULTS: A total of 121 children (77 male - 44 female), with a mean age of 18,9±2,7 months and weight of 10,77±0,57 kg (CI 95%) were treated for intussusception. Enema reduction was attempted in 90,7% (n= 88) of the cases, with a success rate of 76,1% (n= 67). Early recurrence rate was 6% (n= 4), without associated complications, which is similar to recent meta-analysis results (5,4%); however, three patients required surgical exploration. Mean length of stay was 2 days for enema-reduced intussusception, which resulted in a total cost of 2,076.67 euro per patient. CONCLUSION: The low recurrence rate and scarce risk of complications suggests that an 8 to 12 hour observation is a feasible alternative to hospital admission, which results in social advantages including family welfare as well as management costs. These results are a starting point for prospective randomized controlled trials comparing both treatment modalities.

INTRODUCCION/OBJETIVO: En la literatura actual existe debate en cuanto a la necesidad de ingresar a los pacientes con invaginación intestinal (II) después de la reducción exitosa mediante enema. El propósito de este estudio es caracterizar la recidiva de las II en nuestro medio para valorar la posibilidad del tratamiento ambulatorio. PACIENTES Y METODOS: Estudio retrospectivo de los niños atendidos por II entre 2009 y 2013 definiendo como recidiva temprana la que ocurre entre las 12-72 horas post-reducción, comparando los resultados con la literatura actual. RESULTADOS: Se trataron 121 niños (77 varones - 44 mujeres), con edad de 18,9±2,7 meses y peso de 10,77±0,57 kg (IC 95%), por II. Se intentó reducción mediante enema en 90,7% (n= 88) de los casos, siendo efectivo en un 76,1% (n= 67). La tasa de recidiva temprana fue del 6% (n= 4), sin complicaciones asociadas, similar a lo referido en estudios de meta-análisis recientes (5,4%); tres precisaron tratamiento quirúrgico. La estancia hospitalaria media es de 2 días para las II tratadas conservadoramente, lo que supuso un gasto promedio de 2.076,67 euros por ingreso. CONCLUSION: Dada la baja tasa de recidiva temprana y escaso riesgo de complicaciones, la observación durante 8-12 horas es una alternativa al ingreso hospitalario, lo que conllevaría ventajas de bienestar socio-familiar y de gestión. Estos resultados sirven como punto de partida para estudios prospectivos randomizados entre ambas modalidades de tratamiento.

Characterization, expression and subcellular distribution of a novel MFP1 (matrix attachment region-binding filament-like protein 1) in onion.

MFP1 (matrix attachment region-binding filament-like protein 1) is a conserved nuclear and chloroplast DNA-binding protein encoded by a nuclear gene, well characterized in dicot species. In monocots, only a 90 kDa MFP1-related protein had been characterized in the nucleus and nuclear matrix of Allium cepa proliferating cells. We report here a novel MFP1-related nuclear protein of 80 kDa in A. cepa roots, with M(r) and pI values similar to those of MFP1 proteins in dicot species, and which also displays a dual location, in the nucleus and chloroplasts of leaf cells. However, this novel protein is not a nuclear matrix component. It shows a spotted intranuclear distribution in small foci differing from the nuclear bodies containing the 90 kDa protein. In electron microscopy analysis, the intranuclear foci containing the 80 kDa MFP1 appeared as small loose structures at the periphery of condensed chromatin patches. This protein was also located in the nucleolus. It was abundant in meristematic cells, but its level fell when proliferation stopped. This different expression and distribution, and its preferential location at the boundaries between heterochromatin and euchromatin, suggest that the novel 80 kDa protein might be associated with decondensed DNA and could play a role in chromatin organization.

DNA injury induced by 5-aminouracil and caffeine in G2 checkpoints path of higher plant cells.

This work evaluated the qualitative and quantitative cellular changes induced by treatment with 5-aminouracil (5-AU) and a combination of 5-AU and caffeine in plant cells in relation to DNA damage, repaired damage, and residual damage. As biological material, Allium cepa L. root tips were used, grown in filtered water, in darkness, with aeration at constant temperature of 25 degrees C +/- 0.5. Cell populations were synchronized using 5 mM caffeine in order to study the effects of 5-AU and caffeine/5-AU combined treatment on the DNA content and their incidence in the entrance to mitosis. The results showed a delay in the G2 period due to induced DNA damage by the 5-AU and caffeine/5-AU combined treatment, shown by aberrant metaphases, anaphases and telophases. The effect of caffeine in the combined treatment was heightened in spite of lengthening the checkpoints route that retains the cells in G2. The existence of G2 checkpoints was shown in the cell population studied, inducing lesions in the DNA, chromosomic aberrations and cellular instability.

HSP90 and checkpoint-dependent lengthening of the G2 phase observed in plant cells under hypoxia and cold.

Proliferating cells of Allium cepa L. roots became adapted to hypoxia (5% oxygen) and cold (10 degrees C) by acquiring new steady-state kinetics of growth. The cell cycle time increased from the 17.6 h in control meristems up to 29.7 and 69.0 h under hypoxia and cold conditions, respectively. Acclimation of the proliferating cells was stress specific. No acclimation took place after 24 h of heat treatment (40 degrees C). Under cold treatment, all cycle phases enlarged uniformly. However, under hypoxia, while the G(1) and S cycle phases roughly doubled in their timing, the expected checkpoint-dependent lengthening of G(2) did not take place. This failure in lengthening G(2) in response to hypoxia correlated with a failure in the overinduction of a single peptide with a molecular mass of about 134 kDa which is among those recognised by an HSP90 antibody. Moreover, the presence of this large peptide of the HSP90 family proved to be a marker for cell proliferation. It was always absent from the contiguous differentiated cells of the root. Lastly, the mitochondrial chaperonin recognized by an HSP60 antibody in these roots not involved in photosynthesis was always higher in the proliferating than in the nonproliferating cells.

Nuclear ploidy is contingent on the microtubular cycle responsible for plant cytokinesis.

Division of the plant cell relies on the preprophase band of microtubules (PPB)-phragmoplast system. Cells of onion (Allium cepa L.) root meristems were rendered binucleate by preventing the consolidation of cell plate formation in telophase with 5 mM caffeine. These binucleates developed either a single PPB around one of their two nuclei or two PPBs, one per nucleus, in the prophase of the ensuing mitosis. Prophase cells developing one single PPB were shorter in length (42.3 +/- 4.1 microm) than those developing 2 PPBs (49.8 +/- 4.1 microm), and interphase duration was inversely related to cell length. Cells whose length was less than or equal to 42 microm, i.e., which had not even reached the mean size of the small binucleates in prophase, were followed throughout mitosis. In metaphase, they always assembled two mitotic spindles (one per nucleus). However, the cells that had assembled a single PPB also developed a single phragmoplast in telophase, leading to polyploidization. As these meristematic cells were not wide enough to accommodate the midzones of both mitotic spindles in any single plane transversal to the cell elongation axis, the spindles tilted until their midzones formed a continuum where the single common phragmoplast assembled. Its position was thereby uncoupled from that of the preceding PPB. Subsequently, the chromosomes from two different half-spindles were included, by a common nuclear envelope, in a single tetraploid nucleus. Finally, the cytokinetic plate segregated the two tetraploid nuclei formed at each side of the phragmoplast into two independent sister cells.

A comparative solid-phase extraction study for the simultaneous determination of fluoxetine, amitriptyline, nortriptyline, trimipramine, maprotiline, clomipramine, and trazodone in whole blood by capillary gas-liquid chromatography with nitrogen-phosphorus detection.

This paper reports the simultaneous detection of the seven antidepressants fluoxetine, amitriptyline, nortriptyline, trimipramine, maprotiline, clomipramine, and trazodone in whole blood at concentration levels of 100-2000 ng/mL by gas chromatography with a nitrogen-phosphorus detector (GC-NPD). A comparative and validation study using two solid-phase extraction (SPE) columns, Chem Elut and Bond Elut Certify, were developed regarding their recovery, precision, sensitivity, and matrix purification efficiency. The Chem Elut columns, a diatomaceous earth, are closely related to conventional liquid-liquid extraction. The Bond Elut Certify columns, more recently developed in the market, are a mixed SPE: reversed-phase and cation exchange sorbent. Recoveries of the compounds using Chem Elut columns at 500 ng/mL were in the range 30-50%, with intra- and interassay precisions of less than 9% and 17%, respectively. Limits of detection (LODs) and quantitation (LOQs) ranged from 13 to 146 ng/mL and from 44 to 485 ng/mL, respectively. Recoveries of the compounds using Bond Elut Certify columns at 500 ng/mL were in the range 59-84% with intra- and interassay precisions of less than 8% and 11%, respectively. LODs and LOQs ranged from 8 to 67 ng/mL and from 25 to 223 ng/mL, respectively. An excellent linearity was observed with both extraction procedures from the LOQs up to 2000 ng/mL. Higher recoveries, cleaner extracts, better sensitivity, better precision, and less solvent consumption and disposal were achieved for the screening of these antidepressants with the use of the mixed SPE Bond Elut Certify compared with Chem Elut columns.

Simultaneous determination of viloxazine, venlafaxine, imipramine, desipramine, sertraline, and amoxapine in whole blood: comparison of two extraction/cleanup procedures for capillary gas chromatography with nitrogen-phosphorus detection.

A comparative study for the simultaneous gas chromatographic (GC) resolution and detection of the six antidepressants viloxazine, venlafaxine, imipramine, desipramine, sertraline, and amoxapine in whole blood at concentration levels of 100-2000 ng/mL was developed. Two extraction/cleanup analytical procedures were compared regarding their recovery, precision, sensitivity and matrix purification efficiency. The first procedure consists of the employment of Chem Elut columns (diatomaceous earth) and is based on the principle of liquid-solid absorption extraction that is closely related to conventional liquid-liquid extraction. The second focuses on the use of Bond Elut Certify columns and a mixed SPE, reversed-phase and cation-exchange sorbent, more recently developed for the market. Each procedure required 2.0 mL of whole blood extraction and injection into a capillary GC equipped with a nitrogen-phosphorus detector. Mepivacaine was used as the extraction standard (surrogate), and prazepam was used as the chromatographic standard. No interferences were found, and the time for the chromatographic analysis was 16 min for one sample. Recoveries of the compounds using Chem Elut columns at 500 ng/mL were in the range of 28-74% with intra-assay and interassay precisions of less than 7% and 19%, respectively. Limits of detection (LOD) and quantitation (LOQ) ranged from 39 to 153 ng/mL and from 128 to 504 ng/mL, respectively. Recoveries of the compounds using Bond Elut Certify columns at 500 ng/mL were in the range of 64-86% with intra-assay and interassay precisions of less than 4% and 10%, respectively. LODs and LOQs ranged from 21 to 100 ng/mL and from 70 to 330 ng/mL, respectively. An excellent linearity was observed with both procedures from the LOQs up to 2000 ng/mL. The use of the reversed-phase and cation-exchange sorbent Bond Elut Certify showed advantages compared with Chem Elut columns for the screening of these antidepressants such as higher recoveries, cleaner extracts, better sensitivity, better precision, and less solvent consumption and disposal.

Replication and G2 checkpoints: their response to caffeine.

Under long hydroxyurea treatments, evidence was obtained for the sequential activation of four checkpoints located between the onset of S phase and mitosis in Allium cepa L. root meristems. Biparametric flow cytometry (Br-DNA/total DNA) showed that cells initially accumulated at early S phase but, after a delay, they resumed replication and paused again at mid S phase. Cells not only overrode this second replication block but also any G2 checkpoint they encountered. Thus, a late mitotic wave was produced in the presence of hydroxyurea. The wave was formed by cells that had apparently completed their replication (normal mitoses), while others displayed anaphases/telophases with less than the expected DNA content and with chromosomal breaks (aberrant mitoses). The presence of aberrant mitoses is direct evidence for the undue override of the two G2 checkpoints responsible for surveillance of completion of DNA synthesis and repair, respectively. Caffeine selectively abrogated the G2 block produced by the checkpoint that controls post-replication DNA repair, as it advanced the entry of cells into an aberrant mitosis. However, caffeine proved not to be the universal checkpoint-evading agent as postulated. Caffeine did not modify the spontaneous override of the replication checkpoints. Moreover, it seems to enforce the checkpoint that controls the completion of DNA synthesis, as the appearance of the late wave of normal mitoses produced in the presence of hydroxyurea was prevented by the use of caffeine.

[Olive oil and inhibition of low density lipoprotein oxidation. Role of phenolic compounds]. / Aceite de oliva e inhibición de la oxidación de las lipoproteínas de baja densidad. Importancia de los compuestos fenólicos.

BACKGROUND: To investigate the protective effect of several olive oils with different phenolic composition on low density lipoprotein susceptibility to oxidation. PATIENTS AND METHODS: Refined olive oil (phenolic content: 0 mg/l caffeic acid equivalents [CAE]), common olive oil (0.1 and 0.3 mg/l CAE), and virgin olive oil diluted with refined olive oil (0.1 y 0.3 mg/l CAE), were added to isolated low density lipoprotein. Conjugated dienes formation was monitored after copper-mediated low density lipoprotein oxidation. RESULTS: An increase in the lag time of conjugated dienes formation after copper-mediated low density lipoprotein oxidation was observed linked to olive oil phenolic content (p < 0.0001, ANOVA). Multiple regression analysis showed that phenolics were the most significant antioxidants with 0.1 mg/l--increase in phenolic concentration, adjusted for alpha-tocopherol and beta-carotene, was 72 minutes (95% confidence interval [CI] 64 to 80 min) for common olive oil, and 111 min (CI 95%: 100-123 min) for virgin olive oil. In common olive oil alpha-tocopherol levels were significatively associated with the increase in the lag time (p = 0.003), reaching in virgin olive oil a borderline significant (p = 0.084). CONCLUSIONS: Olive oil containing phenolics showed more antioxidant effect on low density lipoprotein oxidation than refined olive in relation to its phenolic content. The nature of the phenolic content influences the antioxidant capacity of an olive oil.

Protective effect of olive oil and its phenolic compounds against low density lipoprotein oxidation.

The protective effect of phenolic compounds from an olive oil extract, and of olive oils with (extra-virgin) and without (refined) phenolic components, on low density lipoprotein (LDL) oxidation was investigated. When added to isolated LDL, phenolics [0.025-0.3 mg/L caffeic acid equivalents (CAE)] increased the lag time of conjugated diene formation after copper-mediated LDL oxidation in a concentration-dependent manner. Concentrations of phenolics greater than 20 mg/L inhibited formation of thiobarbituric-acid reactive substances after AAPH-initiated LDL oxidation. LDL isolated from plasma after preincubation with phenolics (25-160 mg/L CAE) showed a concentration-dependent increase in the lag time of conjugated diene formation after copper-mediated LDL oxidation. Refined olive oil (0 mg/L CAE) and extra-virgin olive oil (0.1 and 0.3 mg/L CAE) added to isolated LDL caused an increase in the lag time of conjugated diene formation after copper-mediated LDL oxidation that was related to olive oil phenolic content. Multiple regression analysis showed that phenolics were significantly associated with the increase in lag time after adjustment for effects of other antioxidants; alpha-tocopherol also achieved a statistically significant effect. These results indicate that olive oil phenolic compounds protect LDL against peroxyl radical-dependent and metal-induced oxidation in vitro and could associate with LDL after their incubation with plasma. Both types of olive oil protect LDL from oxidation. Olive oil containing phenolics, however, shows more antioxidant effect on LDL oxidation than refined olive oil.

Replication of 5 S ribosomal genes precedes the appearance of early nuclear replication complexes.

The present work shows that replication of the 5 S ribosomal genes differs in time and 3'deoxyadenosine sensitivity from replication of other nuclear genes, in Allium cepa L. root meristems. Fluorescence in situ hybridization with the pTa794 DNA probe which contains a complete 410 bp 5 S gene from Triticum aestivum allowed to detect four clusters of 5 S genes in these diploid cells (2n = 16), two of them in the short arm of the smallest metacentric chromosomal pair 7. Replication of the 5 S ribosomal genes occurred very early in interphase, as discerned by their resolution as doubled spots only two hours after interphase was initiated in synchronous binucleate cells. Codetection of nuclear replication (by immunodetection of 5-bromo-2'-deoxyuridine incorporation) showed that the replication of the 5 S ribosomal genes occurred before any incorporation of 5-bromo-2'deoxyuridine could be detected in the nuclei. The earliest Br-DNA detected in these cells followed a radial pattern from different foci apparently dispersed along some chromosomal arms. These structures seem to represent early replication complexes, as a result of the displacement of multiple DNA forks from the foci known as pre-replication complexes where the replication machinery of the earliest replicating genes assembles. No consistent positional correlation existed between the formation of the early replication complexes and the already replicated 5 S ribosomal clusters. Finally, nuclear replication but not that of the 5 S genes was prevented by 3'deoxyadenosine, and the earliest replicating 5 S ribosomal gene cluster differed in both sister nuclei resulting from the segregation of one single chromosome in anaphase.

[Safety and efficacy of OM-85-BV plus amoxicillin/clavulanate in the treatment of subacute sinusitis and the prevention of recurrent infections in children]. / Seguridad y eficacia de OM-85-BV más amoxicilina/clavulanato en el tratamiento de la sinusitis subaguda y prevención de infecciones recurrentes en niños.

A 6-month double-blind, prospective, randomized, placebo-controlled trial was conducted to establish the safety and efficacy of OM-85-BV in the treatment of subacute sinusitis and in the following prevention of the respiratory tract infections in 56 children from 18 months to 9 years of age. In the subacute phase of the sinusitis the patients were given one OM-85-BV capsule (3.5 mg of bacterial extracts) (n = 26) or placebo (n = 30), daily for ten days; additionally both groups took amoxicillin/clavulanate 40/10 mg/kg daily in three divided doses for 21 days. For the following two months the patients took one OM-85-BV capsule or placebo, ten days a month. In the subacute phase the OM-85-BV group of patients improved sooner (5.56 +/- 4.98 vs 10 +/- 8.49 days) and had a shorter convalescence (15.38 +/- 8.91 vs 20.28 +/- 7.17 days). During the six month follow-up the patients in the OM-85-BV group had a lower number of infections (1.56 +/- 0.3 vs 2.22 +/- 0.43) and required a lower number of drug treatments (1.47 +/- 0.32 vs 1.94 +/- 0.42). One patient treated with OM-85-BV presented a mild rash which disappeared three days after the drug discontinuation. We conclude that OM-85-BV is safe at pediatric ages, as well as accelerates the cure and improvement of subacute sinusitis while it lowers the incidence of respiratory infections.

Allelic diversity at the primate MHC-DMB locus: presence of a conserved tyrosine inhibitory motif in the cytoplasmic tail.

Ten new primate Mhc-DMB complete cDNA sequences have been obtained in chimpanzee (n=four), gorilla (n=three) and orangutan (n=three); this gene has not been previously studied in these species. Exonic allelism has been recorded all along the molecule domains and also in the leader peptide, but not in the transmembrane segment. An analysis of the residues critical in the conformation of the Mhc-DR peptide-binding site was done in order to look for a Mhc-DR homologue site; synonymous substitutions are favoured in this homologous HLA-DM region. This is another finding that supports the possibility that DM could not be typically presenting molecules. The immunoreceptor inhibition motif Tyr 230-Thr/Ser 231-Pro 232-Leu 233 (ITIM) is invariantly present in apes for at least 15 million years, and may have a double function: 1) To direct DMB-DMA molecules from the endoplasmic reticulum or cell surface towards the endosomal/lysosomal class II compartment and 2) to send an inhibitory signal to the cell in order to stop synthesis of unnecessary HLA-DR molecules, once all available antigenic peptides are loaded. Other molecules, like NK-cell receptors and Fc receptors, bear this type of tyrosine-based inhibitory motifs in order to switch off specific cell functions. DMB molecules (as previously shown in C4d molecules) do not present species-specific motifs in common chimpanzee, suggesting that this species is very close to gorilla or man; also, DMB, like C4d molecules, do not show a trans-species evolution pattern, suggesting the existence of extensive homogenization of DMB genes within each species or a recent generation of alleles. Finally, a clade grouping human and gorilla DMB cDNA sequences is obtained using a dendrogram (as for C4d trees); this is in contrast to others' results that obtain a human/chimpanzee clade using different DNA sequences.

Hepatoerythropoietic porphyria: neuroimaging findings.

CT and MR findings in two patients with hepatoerythropoietic porphyria are presented. CT scans showed atrophy and cortical mineralization at the same level. MR examination performed in one of the two patients showed mainly frontal cortical atrophy and punctate bright signal on T1- and T2-weighted sequences.

Relaxation therapy as an adjunct treatment for essential hypertension.

Essential hypertension is one of the leading problems seen by a family physician, and it is not easily treated. In some instances, a behavioral therapy may serve as a useful adjunct to the pharmacological treatment of this disease. Evidence indicates that relaxation therapy in combination with medical treatment results in significantly greater reductions in systolic and diastolic blood pressure than the use of medical treatment alone. Progressive muscle relaxation, Benson's "relaxation response," hypnosis, and blood pressure biofeedback are the four most common behavioral treatments for essential hypertension. The first two of these are both effective and well suited to use in a family practice.