Insulin-like growth factor 2 and autophagy gene expression alteration arise as potential biomarkers in Parkinson's disease.

Insulin-like growth factor 2 (IGF2) and autophagy-related genes have been proposed as biomolecules of interest related to idiopathic Parkinson's disease (PD). The objective of this study was to determine the IGF2 and IGF1 levels in plasma and peripheral blood mononuclear cells (PBMCs) from patients with moderately advanced PD and explore the potential correlation with autophagy-related genes in the same blood samples. IGF1 and IGF2 levels in patients' plasma were measured by ELISA, and the IGF2 expression levels were determined by real-time PCR and Western blot in PBMCs. The expression of autophagy-related genes was evaluated by real-time PCR. The results show a significant decrease in IGF2 plasma levels in PD patients compared with a healthy control group. We also report a dramatic decrease in IGF2 mRNA and protein levels in PBMCs from PD patients. In addition, we observed a downregulation of key components of the initial stages of the autophagy process. Although IGF2 levels were not directly correlated with disease severity, we found a correlation between its levels and autophagy gene profile expression in a sex-dependent pattern from the same samples. To further explore this correlation, we treated mice macrophages cell culture with α-synuclein and IGF2. While α-synuclein treatment decreased levels Atg5, IGF2 treatment reverted these effects, increasing Atg5 and Beclin1 levels. Our results suggest a relationship between IGF2 levels and the autophagy process in PD and their potential application as multi-biomarkers to determine PD patients' stages of the disease.

A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation.

PURPOSE: There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)-guided zero-fluoroscopy approach (ZFA) for RFA. METHODS: Consecutive patients (n = 111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure. RESULTS: ZFA success was achieved in 80 (72%) procedures. BMI > 35 kg/m2 resulted in the only independent predictor of ZFA failure (OR = 6.10, 95% CI 1.15-46.49, p = 0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63 s, p < 0.001), total emitted fluoroscopy dose (0.2 vs. 6.0 mGy, p < 0.001), dose area product (0.04 vs. 1.4 Gy*cm2, p < 0.001), and effective dose (0.8 vs. 27.2 mSv*100, p < 0.001). Complete pulmonary vein isolation was achieved in all procedures. No difference was observed between the groups in in-hospital complication rate (0.9% vs. 1.8%, p = 0.99). CONCLUSIONS: This is the largest study proving procedural feasibility, safety, and efficacy of TEE-guided AF-ablation with a complete or near-complete avoidance of radiological exposure, without using intracardiac echocardiography.

Effect assessment of chelators on bioaccessible and total chromium extraction in soils polluted by chromite processing wastes.

Solid wastes from chromium-processing facilities, when used as fill material, have generated chromium point source contamination of soils and groundwaters, that remains after decades in many urban and peri urban areas all over the world, causing environmental impacts that need to be addressed in a sustainable economic, social and environmental way. Representative surface soil samples, from a polluted area affected by chromite wastes burials, were used to carry on a feasibility study on Phytoextraction applicability, and chelating agents' selection to reduce environmental risks, considering chromium bioaccessible forms reduction as an objective. Tests for natural (only vegetation), and induced phytoextraction (plants + chelating agents) applicability were performed at greenhouse facilities under controlled conditions at two rounds. Natural phytoextraction tests, using first wheat and then corn plants, allowed to observe a low but significant 4,8% reduction in soil chromium. At induced phytoextraction trials, when comparing the action of the different chelating agents versus a blank on final soil chromium concentration, the results were not so conclusive globally (0,5% less soil chromium in trials in which the first crop was wheat followed by corn, and 2% in trials in which the first and the second crop was corn). In each group, the most "effective" chelating agent differed: EDDS for the first set, MGDA for the second one.The addition of chelating compounds in the soil could result in an increasing of the Cr oxidizable fraction mainly composed by Cr species associated to the organ mineral complexes.

Asociación entre variables de empuje Isométrico de media pierna (EIMP) con variables antropométricas y cualidades físicas en jugadores varones de Rugby Amateurs / Relationships between Isometric Mid-Thigh pull with anthropometric variables and physical qualities in Amateur Rugby players / Relações entre a puxada isométrica do meio da coxa com variáveis antropométricas e qualidades físicas em jogadores amadores de rugby

Objetivo: el objetivo de este estudio es describir el perfil de las variables del EIMP entre las dos posiciones de juego y determinar las posibles asociaciones con las características antropométricas y las cualidades físicas de un grupo de jugadores Rugby amateurs chilenos. Hipótesis: es por eso por lo que podemos plantear como hipótesis la existencia de asociaciones entre las variables de EIMP y las cualidades físicas de los jugadores de RU. Diseño metodológico: este estudio tiene un diseño de cohorte observacional, descriptivo y correlacional. Se investigó la asociación existente entre las variables de EIMP con las pruebas físicas y las variables antropométricas. Fueron evaluados treinta y dos jugadores de rugby varones de nivel amateurs chilenos (promedio ( DE, edad, 23,3 ( 5,4 años). Resultados: para la variable Masa Muscular se encontraron asociaciones grandes (r = 0.53) (p = 0.001) con la FM y asociaciones moderadas (r = 0,48) (r = 0,47) (r = 0,44) (r = 0,46) con F50, F100, F150 y F200 respectivamente. También se pueden observar las asociaciones grandes (R2 = 0,305) (R2 = 0,297) (R2 = 0,267) entre 1RM PB y F200, F100 y F150, respectivamente. Conclusión: en conclusión, este estudio puede demostrar la existencia de asociaciones estadísticamente significativas entre algunas de las variables antropométricas y físicos con las variables de Fuerza de EIMP en jugadores de RU amateurs chilenos.

OBJECTIVE: The objective of this study is to describe the profile of the EIMP variables between two playing positions and to determine its possible associations with anthropometric characteristics and physical qualities of a group of Chilean amateur rugby players. HYPOTHESIS: There are associations between the EIMP variables and the physical qualities of UR players. METHODOLOGICAL DESIGN: This study has an observational, descriptive and correlational cohort design. The association between the EIMP variables, from the physical tests, and the anthropometric variables was investigated. Thirty-two Chilean amateur-level male rugby players were evaluated (mean ( SD, age, 23.3 ( 5.4 years). RESULTS: For the Muscle Mass variable, large associations were found (r=0.53) (p=0.001) to FM, and moderate associations (r=0.48) (r=0.47) (r=0.44) (r =0.46) to F50, F100, F150, and F200 respectively. Large associations (R2=0.305) (R2=0.297) (R2=0.267) between 1RM PB and F200, F100, and F150, respectively, can also be observed. CONCLUSION: In conclusion, this study can demonstrate the existence of statistically significant associations between some of the anthropometric and physical variables and the EIMP Strength variables in Chilean amateur UR players.

OBJETIVO: O objetivo deste estudo é descrever o perfil das variáveis EIMP entre as duas posições de jogo e determinar as possíveis associações com as características antropométricas e qualidades físicas de um grupo de jogadores amadores de rugby chilenos. HIPÓTESE: É por isso que podemos hipotetizar a existência de associações entre as variáveis do EIMP e as qualidades físicas dos jogadores do RU. DESENHO METODOLÓGICO: Este estudo tem um desenho de coorte observacional, descritivo e correlacional. Investigou-se a associação entre as variáveis do EIMP com os testes físicos e as variáveis antropométricas. Trinta e dois jogadores de rugby masculinos de nível amador chileno foram avaliados (média ( DP, idade, 23,3 ( 5,4 anos). RESULTADOS: Para a variável Massa Muscular foram encontradas grandes associações (r=0,53ejercicio y cualidades físicos) (r=0,47) (r=0,44) (r=0,46) com F50, F100, F150 e F200 respectivamente. Grandes associações (R2=0,305) (R2=0,297) (R2=0,267) entre 1RM PB e F200, F100 e F150 respebaloncestotambém podem ser observadas. CONCLUSÃO: Em conclusão, este estudo pode demonstrar a existência de associações estatisticamente significativas entre algumas das variáveis antropométricas e físicas com as variáveis EIMP Força em jogadores amadores do RU chilenos.

Mutismo selectivo: análisis psicodinámico desde la teoría de D. Winnicot / Selective mutism: psychodinamic analysis from Winnicott's theory

El Mutismo Selectivo (MS) es un trastorno poco frecuente dentro de la psiquiatría infantil. La prevalencia en estudios internacionales en niños entre 4 y 7 años va desde un 0,7 a un 2%, y la prevalencia es mayor en mujeres que en hombres. El desarrollo del MS ocurre antes de la edad de 5 años y mas comúnmente entre los 2,5 y los 4 años. El objetivo del presente es revisar algunos elementos de la evidencia actual acerca del MS y poder ampliar la mirada desde un análisis psicodinámico en base a la Teoría de Winnicott. Palabras claves: Mutismo selectivo, Winnicott, ansiedad, agresividad.

Selective Mutism (SM) is a rare disorder in child psychiatry. The prevalence in international studies in children between 4 and 7 years old ranges from 0.7 to 2%, and the prevalence is higher in females than in males. The onset of SM occurs before the age of 5 years of age and more commonly between 2.5 and 4 years of age. The objective of the present study is to review some elements of the current evidence about SM and to be able to broaden the view from a psychodynamic analysis based on Winnicott's theory. Key words: Selective mutism, Winnicott, anxiety, aggression.

Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is remarkably common in elderly people with highly prevalent comorbid conditions. Despite its increasing in prevalence, there is no evidence-based effective therapy for HFpEF. We sought to evaluate whether inspiratory muscle training (IMT) improves exercise capacity, as well as left ventricular diastolic function, biomarker profile and quality of life (QoL) in patients with advanced HFpEF and nonreduced maximal inspiratory pressure (MIP). DESIGN AND METHODS: A total of 26 patients with HFpEF (median (interquartile range) age, peak exercise oxygen uptake (peak VO2) and left ventricular ejection fraction of 73 years (66-76), 10 ml/min/kg (7.6-10.5) and 72% (65-77), respectively) were randomized to receive a 12-week programme of IMT plus standard care vs. standard care alone. The primary endpoint of the study was evaluated by positive changes in cardiopulmonary exercise parameters and distance walked in 6 minutes (6MWT). Secondary endpoints were changes in QoL, echocardiogram parameters of diastolic function, and prognostic biomarkers. RESULTS: The IMT group improved significantly their MIP (p < 0.001), peak VO2 (p < 0.001), exercise oxygen uptake at anaerobic threshold (p = 0.001), ventilatory efficiency (p = 0.007), metabolic equivalents (p < 0,001), 6MWT (p < 0.001), and QoL (p = 0.037) as compared to the control group. No changes on diastolic function parameters or biomarkers levels were observed between both groups. CONCLUSIONS: In HFpEF patients with low aerobic capacity and non-reduced MIP, IMT was associated with marked improvement in exercise capacity and QoL.

Alternatives to endotracheal intubation for patients with neuromuscular diseases.

OBJECTIVE: To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease. DESIGN: We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse decreases in oxyhemoglobin saturation and relieve respiratory distress that occurred despite oxygen therapy and appropriate medication. Noninvasive mechanical ventilation was delivered by volume ventilators (Breas PV 501) alternating nasal/oronasal and oral interfaces. RESULTS: Noninvasive management was successful in averting death and endotracheal intubation in 79.2% of the acute episodes. There were no significant differences in respiratory function between the successfully treated and unsuccessfully treated groups before the current episode. Bulbar dysfunction was the independent risk factor for failure of noninvasive treatment (P < 0.05; odds ratio, 35.99%; 95% confidence interval, 1.71-757.68). CONCLUSIONS: Intubation can be avoided for some patients with neuromuscular disease in acute respiratory failure by some combination of noninvasive mechanical ventilation and mechanically assisted coughing. Severe bulbar involvement can limit the effectiveness of noninvasive management.

Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study.

OBJECTIVE: To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients. DESIGN: In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation. RESULTS: The baseline values were 93.50 +/- 2.26% for SpO2 in ambient air, 18.50 +/- 4.23 cm H2O for PIP, 4.67 +/- 1.37 cm H2O for Pawm, and 1.03 +/- 0.25 J/liters for WOBv. Only WOBv changed significantly, decreasing after tracheal suctioning (P < 0.05), whereas all variables improved significantly after mechanical insufflation-exsufflation. CONCLUSION: For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.

Effect of lung mechanics on mechanically assisted flows and volumes.

OBJECTIVE: To correlate the air flows generated by mechanical insufflation-exsufflation as a function of pressure delivery in a lung model at two pulmonary compliance and three airway resistance settings. DESIGN: With each combination of pulmonary compliances of 25 and 50 ml/cm H2O and airway resistances of 6, 11, and 17 cm H2O/liter/sec, ten cycles of mechanical insufflation-exsufflation were applied using pressure deliveries of 40 to -40, 50 to -50, 60 to -60, and 70 to -70 cm H2O. The resulting peak exsufflation flows and volumes were recorded. RESULTS: In a multivariate analysis, the pulmonary compliance, airway resistance, and pressure delivery were all found to significantly affect exsufflation flows and volumes such that a decreased pulmonary compliance or an increased airway resistance produced a decrease in exsufflation flow and volume, whereas an increased pressure delivery produced greater exsufflation flow and volume. CONCLUSION: Although mechanical insufflation-exsufflation pressures of 40 to -40 cm H2O are generally adequate for most patients with normal lung compliance and airway resistance, higher settings are often required when compliance decreases, by obesity or scoliosis, and possibly when airway resistance is increased.

Maduración ósea de niños de 0 a 6 años: muñeca y mano; I Parte. Análisis cuantitativo / Bone maturation of children from 0 to 6: wrist and hand; Part I. Quantitative analysis

Se describe la maduración ósea de la muñeca y de la mano de niños entre 0 y 6 años de edad, según el atlas de Greulich y Pyle (GP) y los recuentos (scores) TW20, RUS y CARP de Tenner y Whitehouse. Los niños chilenos maduran en forma similar a GP hasta el año, pero después están francamente retrasados. Las niñas maduran similarmente a GP hasta los dos años, después están retrasadas moderadamente y parece que se igualan a los patrones de GP a los siete años. Se hace muy difícil explicar este comportamiento suponiendo que la muestra chilena sufre de desnutrición

Maduración osea de niños de 0 a 6 años: muñeca y mano; II Parte. Análisis de probitos para huesos aislados / Bone maturation of children from 0 to 6: wrist and hand; Part II. Probit analysis for isolated bones

Se utilizó el método de status y probito para determinar los promedios y desviaciones típicas de la edad a la cual niños chilenos alcanzan los estados de maduración ósea de Tanner-Whitehouse de la muñeca y mano. Las niñas maduran más tempranamente, pero no en forma regular para todos los huesos. Hay indicios de que el hueso ganchoso madura más tempranamente en los varones en la vida intrauterina. Hay varios valores de probabilidad de la prueba de X2 que son o muy próximos a 1.0 o inferiores a 0.001 lo que es extraordinariamente irregular