Endurance exercise training increases APPL1 expression and improves insulin signaling in the hepatic tissue of diet-induced obese mice, independently of weight loss.

Hepatic insulin resistance is the major contributor to fasting hyperglycemia in type 2 diabetes. The protein kinase Akt plays a central role in the suppression of gluconeogenesis involving forkhead box O1 (Foxo1) and peroxisome proliferator-activated receptor gamma co-activator 1 alpha (PGC-1α), and in the control of glycogen synthesis involving the glycogen synthase kinase beta (GSK3ß) in the liver. It has been demonstrated that endosomal adaptor protein APPL1 interacts with Akt and blocks the association of Akt with its endogenous inhibitor, tribbles-related protein 3 (TRB3), improving the action of insulin in the liver. Here, we demonstrated that chronic exercise increased the basal levels and insulin-induced Akt serine phosphorylation in the liver of diet-induced obese mice. Endurance training was able to increase APPL1 expression and the interaction between APPL1 and Akt. Conversely, training reduced both TRB3 expression and TRB3 and Akt association. The positive effects of exercise on insulin action are reinforced by our findings that showed that trained mice presented an increase in Foxo1 phosphorylation and Foxo1/PGC-1α association, which was accompanied by a reduction in gluconeogenic gene expressions (PEPCK and G6Pase). Finally, exercised animals demonstrated increased at basal and insulin-induced GSK3ß phosphorylation levels and glycogen content at 24 h after the last session of exercise. Our findings demonstrate that exercise increases insulin action, at least in part, through the enhancement of APPL1 and the reduction of TRB3 expression in the liver of obese mice, independently of weight loss.

Chest wall kinematics and respiratory muscle action in walking healthy humans.

We studied chest wall kinematics and respiratory muscle action in five untrained healthy men walking on a motor-driven treadmill at 2 and 4 miles/h with constant grade (0%). The chest wall volume (Vcw), assessed by using the ELITE system, was modeled as the sum of the volumes of the lung-apposed rib cage (Vrc,p), diaphragm-apposed rib cage (Vrc,a), and abdomen (Vab). Esophageal and gastric pressures were measured simultaneously. Velocity of shortening (V(di)) and power [Wdi = diaphragm pressure (Pdi) x V(di)] of the diaphragm were also calculated. During walking, the progressive increase in end-inspiratory Vcw (P < 0.05) resulted from an increase in end-inspiratory Vrc,p and Vrc,a (P < 0.01). The progressive decrease (P < 0.05) in end-expiratory Vcw was entirely due to the decrease in end-expiratory Vab (P < 0.01). The increase in Vrc,a was proportionally slightly greater than the increase in Vrc,p, consistent with minimal rib cage distortion (2.5 +/- 0.2% at 4 miles/h). The Vcw end-inspiratory increase and end-expiratory decrease were accounted for by inspiratory rib cage (RCM,i) and abdominal (ABM) muscle action, respectively. The pressure developed by RCM,i and ABM and Pdi progressively increased (P < 0.05) from rest to the highest workload. The increase in V(di), more than the increase in the change in Pdi, accounted for the increase in Wdi. In conclusion, we found that, in walking healthy humans, the increase in ventilatory demand was met by the recruitment of the inspiratory and expiratory reserve volume. ABM action accounted for the expiratory reserve volume recruitment. We have also shown that the diaphragm acts mainly as a flow generator. The rib cage distortion, although measurable, is minimized by the coordinated action of respiratory muscles.

A spectrum in the pathology of toxoplasmosis in patients with acquired immunodeficiency syndrome.

We describe a variety of toxoplasmic lesions in seven patients with the acquired immunodeficiency syndrome. The first patient had multiple small-intestinal ulcers associated with Toxoplasma tachyzoites and high antibody titers; he died of disseminated histoplasmosis. The second patient, who died of tuberculosis, also had an inactive chronic Toxoplasma infection, with tissue cysts in the brain that were associated with glial nodules. A third patient died of Toxoplasma encephalitis, manifested by multiple foci of necrosis associated with Toxoplasma tachyzoites, cysts, and hypertrophic arteritis. A fourth patient had been treated for toxoplasmic encephalitis with co-trimoxozol (trimethoprim-sulfamethoxazole combination) for 3 to 4 days and showed degenerating tachyzoites associated with necrotic areas. A fifth patient, treated for toxoplasmic encephalitis with co-trimoxazol for 14 days, had necrotic lesions associated with Toxoplasma antigen and a few cysts. A sixth patient with encephalitis and Toxoplasma tachyzoites and young cysts in the biopsy showed healed brain lesions after 22 days of treatment. A seventh patient, diagnosed radiologically and serologically with Toxoplasma encephalitis, was treated for 7 months; his ring-enhancing lesions subsided, and he died of a central nervous system lymphoma. Toxoplasma could not be isolated from the brain, although toxoplasmic DNA was detected in the brain and heart by polymerase chain reaction. The pathogenesis of the range of these lesions, their diagnosis, and the possibility of terminating Toxoplasma infection by prolonged chemotherapy are discussed.

[Hydroxyapatite and its use in raising the alveolar ridge]. / L'idrossiapatite ed il suo impiego per il rialzo delle creste alveolari.

Hydroxyapatite is a mineral substance which, day after day, is getting success, in the field of odontology, thanks to the versatility of its uses. After having been employed on the different methods that the dentist has at his disposal, in order to make up for the alveolar ridge atrophy, a case has been explained, that has been solved through the use of porous hydroxyapatite, referred to as "Interpore 200".

[Diffuse malignant mesothelioma. Presentation of 10 cases and review of the literature]. / Mesotelioma maligno difuso. Presentación de 10 casos y revisión de laliteratura.

The authors study ten cases of malignant diffuse mesothelioma diagnosed histologically in the CH-Dr-AAM-CSS. Of the ten cases eight were men and two women, from 22 to 73 years of age. No evidence of exposure to asbestos was elicited by the nature of their occupation or their place of residence. The clinical findings in all cases is similar to those found in this type of disease. The radiologic findings were limited: pleural effusion, pulmonary fibrosis, and pulmonary mass. To make a definitive diagnosis it was necessary to use an invasive procedure. Examination of sputum, bronchial washings and endobronchial biopsies did not contribute to the diagnosis. The cytological examination of pleural and ascitic fluid resulted in a diagnosis of malignancy. In four cases the diagnosis was made by closed pleural biopsy; in five other cases it was necessary to obtain specimens by thoracotomy. In the last case the diagnosis was made at autopsy. The authors reviewed the original slides and additional slides from the paraffin blocks of the biopsies and of the autopsy. The diagnoses made by the pathologists were listed according to the classification of the AFIP (1).

[Helicobacter pylori infection and the risk of gastric carcinoma. Report of a case]. / Infección por Helicobacter pylori y el riesgo de carcinoma gástrico. Presentación de un caso.

The authors present the clinical history of a patient with gastritis of the antrum who subsequently had early gastric cancer of the antrum. The authors review the literature on the infection by Helicobacter pylori as a risk factor for gastric carcinoma. The infection produces chronic gastritis, gastric ulcer, duodenal ulcer and is a probable risk factor for gastric carcinoma.

[Angiosarcoma of the heart and its spontaneous rupture. A rare cause of effusive-constrictive pericarditis. A case report and review of the literature]. / Angiosarcoma del corazón y su ruptura espontánea. Rara causa de pericarditis efusivo-constrictiva. Presentación de un caso y revisión de la literatura.

The authors present the clinical history of a male 44 year old patient who was hospitalized with the diagnosis of pericardial constriction and effusion and operated on as an emergency because of spontaneous cardiac rupture and was found to have a cardiac adenosarcoma. They review the literature in order to discuss a very rare cause of hemopericardium and constrictive pericarditis with epidemiologic, diagnostic, therapeutic and prognostic commentaries and secondly, to try to establish if this type case does not represent a diagnostic problem for the ecocardiographer since an angiosarcoma that occupies the pericardial space can be confused with a hemopericardium. They also mention other imaging studies that are used to better characterize and diagnose these tumors.

Development of S-SAP markers based on an LTR-like sequence from Medicago sativa L.

The Sequence-Specific Amplification Polymorphism (S-SAP) method, recently derived from the Amplified Fragment Length Polymorphism (AFLP) technique, produces amplified fragments containing a retrotransposon LTR sequence at one end and a host restriction site at the other. We report the application of this procedure to the LTR of the Tms1 element from Medicago sativa L. Genomic dot-blot analysis indicated that Tms1 LTRs represent about 0.056% of the M. sativa genome, corresponding to 16 x 10(3) copies per haploid genome. An average of 66 markers were amplified for each primer combination. Overall 49 polymorphic fragments were reliably scored and mapped in a F(1) population obtained by crossing diploid M. falcata with M. coerulea. The utility of the LTR S-SAP markers was higher than that of AFLP or SAMPL (Selective Amplification of Microsatellite Polymorphic Loci) markers. The efficiency index of the LTR S-SAP assay was 28.3, whereas the corresponding values for AFLP and SAMPL markers were 21.1 and 16.7, respectively. The marker index for S-SAP was 13.1, compared to 8.8 for AFLP and 9.5 for SAMPL. Application of the Tms1 LTR-based S-SAP to double-stranded cDNA resulted in a complex banding pattern, demonstrating the presence of Tms1 LTRs within exons. As the technique was successfully applied to other species of the genus Medicago, it should prove suitable for studying genetic diversity within, and relatedness between, alfalfa species.

[Histoplasmosis of the central nervous system. Report of 2 cases and review of the literature]. / Histoplasmosis del sistema nervioso central: Reporte de dos casos y revisión de la literatura.

The involvement of the central nervous system by histoplasma is an infrequent complication. The clinical diagnosis is difficult because the microscopic examination and the culture of the spinal fluid are frequently negative. In this article we report two cases of meningitis by Histoplasma capsulatum in patients with acquired immunodeficiency syndrome. The first case is a meningitis without evidence of disseminated histoplasmosis in a patient who had been treated with amphotericin B. The histologic appearance was that of a granulomatous inflammation of the meninges and the underlying nervous tissue. The second case is a disseminated histoplasmosis with involvement of the central nervous system. This consists of macrophages filled with histoplasma invading the meninges and underlying nervous tissue without associated inflammation.

[Acute fatty liver in pregnancy. A diagnosis to be considered]. / Hígado graso agudo en el embarazo. Un diagnóstico a considerar.

The clinical records and follow up of two patients with jaundice in the third trimester of pregnancy and final diagnosis of acute fatty liver of pregnancy (AFLP) are reported. The purpose of this paper is to orient clinicians on the appropriate diagnostic approach in every woman with jaundice in the third trimester of pregnancy.

[The syndrome of renal and pulmonary vasculitis with positive neutrophil anticytoplasmic antibodies and antibasement membrane antibodies. A case report]. / Síndrome de vasculitis renal y pulmonar con anticuerpos anticitoplasma de neutrófilos y anticuerpos antimembrana basal positivos. Informe de un caso.

The authors present a case of Goodpasture's syndrome with necrotizing vasculitis of spleen and appendix. Serological examination shows antiglomerular basement membrane antibodies and antineutrophil cytoplasmic antibodies. The authors review the literature to establish if this or other similar cases can be considered a distinct disease entity. The authors also mention the laboratory methods that are currently being used to classify more precisely the vasculitides associated with glomerulonephritis.

[The cardiovascular manifestations of Marfan's syndrome. A case report and review of the management]. / Manifestaciones cardiovasculares en el síndrome de Marfán. Presentación de un caso y revisión del manejo.

The authors present the clinical history of a patient with Marfan's syndrome (MS) and aortic insufficiency, who expired at 22 years of age, in order to illustrate the clinical evolution and review the management of this problem. It is known that patients with MS and heart failure due to dilatation of the aortic annulus have an early mortality of almost 100%. The authors conclude that echocardiographic follow up of these patients is vital in their medical and surgical management and that the use of beta blockers is the best medical therapy, and that prophylactic surgery with composite graft (aortic valve and ascending aorta) gives the best survival rate.

Chest wall hyperinflation during acute bronchoconstriction in asthma.

The mechanics of the chest wall was studied in seven asthmatic patients before and during histamine-induced bronchoconstriction (B). The volume of the chest wall (VCW) was calculated by three-dimensional tracking of 89 chest wall markers. Pleural (Ppl) and gastric (Pga) pressures were simultaneously recorded. VCW was modeled as the sum of the volumes of the pulmonary-apposed rib cage (VRC,p), diaphragm-apposed rib cage (VRC,a), and abdomen (VAB). During B, hyperinflation was due to the increase in end-expiratory volume of the rib cage (0.63 +/- 0.09 L, p < 0.01), whereas change in VAB was inconsistent (0.09 +/- 0.07 L, NS) because of phasic recruitment of abdominal muscles during expiration. Changes in end-expiratory VRC,p and VRC,a were along the rib cage relaxation configuration, indicating that both compartments shared proportionally the hyperinflation. VRC,p-Ppl plot during B was displaced leftward of the relaxation curve, suggesting persistent activity of rib cage inspiratory muscles throughout expiration. Changes in end-expiratory VCW during B did not relate to changes in FEV(1) or time and volume components of the breathing cycle. We concluded that during B in asthmatic patients: (1) rib cage accounts largely for the volume of hyperinflation, whereas abdominal muscle recruitment during expiration limits the increase in VAB; (2) hyperinflation is influenced by sustained postinspiratory activity of the inspiratory muscles; (3) this pattern of respiratory muscle recruitment seems to minimize volume distortion of the rib cage at end-expiration and to preserve diaphragm length despite hyperinflation.

[Solid and papillary epithelial neoplasm of the pancreas. Report of 2 cases]. / Neoplasia epitelial sólida y papilar del páncreas. Descripción de dos casos.

Solid and papillary epithelial tumor of the pancreas occurs mainly in young women and its main characteristic is the appearance of an abdominal mass which progressively increases in size. The radiologic, surgical and pathological correlation shows that it is a tumor of low grade malignancy with a favorable prognosis, after therapy and according to the location of the tumor. The authors report the clinical history of the first two confirmed cases of this entity in Panama, which occurred in 1985 and 1992, respectively, in women less than 25 years of age.