CD43 signals prepare human T cells to receive cytokine differentiation signals.

T cells are increasingly used for passive immunotherapy and bone marrow transplantation. Proper ex-vivo management of the cells is important for the desired therapeutic effects. For differentiation into effector cells of the Th1 and Th2 phenotypes, T-cells require signals from IFNγ and IL-4, respectively. Naïve cells have an extremely low expression of the specific receptors that recognize these cytokines, indicating that in order to differentiate, cells need to perceive other signals that will enable them to sense the cytokine milieu. CD43 has been proposed as one of the molecules that make the initial contacts with antigen presenting cells. We report here that in cord blood, adult naïve and total human T cells, CD43 signals induced the expression of both IFNγ and IL-4 receptors, mediate their capping, increased their signaling and augmented differentiation mediated by these receptors. CD43 signals also stimulated the expression of IFNγ and in neonatal cells that of IL-4 as well. These data demonstrate an important role for CD43 signals in T-cell preparedness for differentiation into effector cells.

Síndrome antisintetasa / Antisynthetase syndrome

El Síndrome Antisintetasa, es una enfermedad poco frecuente perteneciente al grupo de las miopatías inflamatorias de origen inmunológico. Su caracterización inmunológica es muy variable y de allí las distintas manifestaciones clínicas de su presentación y su difícil diagnóstico. Se presenta un paciente femenino de 42 años de edad, con diagnóstico de Artritis Reumatoide (AR), con 9/10 puntos por puntaje para AR por EULAR 2011, anti-CCP +, RF -, desde octubre de 2011, en tratamiento con Prednisona y Metotrexate. Acude en febrero de 2012 por presentar disnea progresiva y tos con expectoración verdosa. Recibe antibioticoterapia sin respuesta. Se realiza TC de Tórax dónde se evidencia fibrosis pulmonar y bronquiectasias por tracción, con imágenes en panal de abeja a predominio de segmentos inferiores y posteriores. Durante su estancia hospitalaria presenta debilidad muscular proximal con elevación de CK a 4.969 U/L. , se realiza biopsia de músculo, que reporta miopatía inflamatoria; electromiografía, con patrón característico de miopatía inflamatoria y perfil inmunológico, obteniéndose Anti-Jo1 positivo, 0,885 (Negativo < 0,250). En el contexto de un síndrome poliarticular inflamatorio, una enfermedad pulmonar intersticial y una miopatía inflamatoria proximal con Anti Jo-1 (+); se realiza diagnóstico definitivo de Síndrome Antisintetasa.

This is a rare disease, member of the inflammatory myopathies of immunological origin. It has a very variable immunologic profile which makes the diagnosis difficult. We present a female patient 42 years- old, with the diagnosis of Rheumatoid Arthritis (RA), with 9/10 points of EULAR 2011 Score for RA diagnosis and RF -, Anti CCP +, in October of 2011; her treatment at that time was prednisone and methotrexate. In February of 2012, she consulted to the emergency with dyspnea and productive cough. She received antibiotics with no response. The chest Computerized Tomography evidenced pulmonary fibrosis, traction bronchiectasis and honeycombe images in posterior and inferior segments of both lungs. During her hospitalization, she presented proximal muscular weakness with CK elevation to 4.969 U/L. The muscle biopsy, which concluded inflammatory myopathy, the electromyography had the characteristic pattern of inflammatory myopathy and the immunologic profile, with a positive Anti-Jo1 0,885 (Negative <0,250). In the context of a polyarticular syndrome, an interstitial lung disease and a proximal inflammatory myopathy with a positive Anti-Jo1, we made the final diagnosis of Antisynthetase syndrome.

Short and medium-term effects of two-phase olive mill waste application on olive grove production and soil properties under semiarid mediterranean conditions.

A five-year field study was conducted to evaluate the potential use of oiled and de-oiled two-phase olive mill waste (TPOMW and DTPOMW, respectively) as soil amendment on a representative olive grove soil: a Cutanic Luvisol. Treatments included a non-amended control, TPOMW1, TPOMW2, DTPOMW1 and DTPOMW2 (30, 60, 27 and 54Mgha(-1) dry weight equivalent). Significant increases (P<0.05) in organic carbon, total N, available P and K, and aggregate stability were observed in the amended soils. Leaf analysis showed significant increases in N, P, and K concentrations in treated plots after the two first years of TPOMW or DTPOMW amendments. Also, a general increase in olive production was observed in the treated plots, this increase being higher in the TPOMW1 and DTPOMW1 treated soils. After five years of repeated TPOMW and DTPOMW application, the increase in yield was 29%, 9.8%, 30%, and 19% for TPOMW1, TPOMW2, DTPOMW1, and DTPOMW2, respectively. Raw TPOMW and DTPOMW have the potential to be valuable soil amendments and source of organic matter, with a positive effect on olive yield, and closing the cycle of residues-resources.

Tratamiento ambulatorio con insulina intravenosa a través de un catéter central en una paciente con síndrome de resistencia a la insulina subcutánea / Ambulatory intravenous insulin therapy by a venous central catheter access in a patient with subcutaneous insulin resistance syndrome

El síndrome de resistencia a la insulina subcutánea es una causa poco frecuente de diabetes inestable, caracterizada por un mal control glucémico pese al empleo de altas dosis de insulina subcutánea y que mejora, junto con la disminución de los requerimientos de insulina, cuando ésta se administra por vía intravenosa. Su etiología es desconocida y su manejo clínico resulta muy difícil, dada la necesidad de emplear una vía alternativa a la subcutánea para el tratamiento ambulatorio. Presentamos el caso de una paciente con este síndrome en la que se decidió colocar un acceso venoso central con bomba de infusión adaptada como solución provisional hasta contar con un dispositivo de administración de insulina intraperitoneal, que es el tratamiento más comúnmente aceptado en la actualidad (AU)

The subcutaneous insulin resistance syndrome is a rare cause of brittle diabetes, defined as diabetes mellitus poorly controlled with high doses of subcutaneous insulin, which ameliorates, together with a reduction of insulin requirements, when insulin is intravenously infused. Its cause is unknown and its clinical management very difficult, because of the need to use an alternative to the subcutaneous route for ambulatory therapy. We report the case of a patient with this syndrome, in which a venous central access connected to anadapted insulin pump was placed as a temporary solution until having an intraperitoneal insulin infusion device, the currently most accepted treatment for this condition (AU)

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía urgente / Cervical Hematoma after disectomy for spondylosis. An idication of urgent tracheotomy

Se presenta un caso clínico de hematoma cervical tras cirugía de espondilosis cervical que precisó traqueotomía urgente por imposibilidad de intubación orotraqueal. Esta enfermedad en grado avanzado, denominada también mielopatía cervical espondilótica, es la consecuencia más seria de la degeneración del disco cervical intervertebral

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopahty, is themost serious consequence of cervical intervertebral disc degeneration

[Nasal osteocartilaginous necrosis caused by cocaine. Our experience with two patients]. / Necrosis osteocartilaginosa nasal por cocaína. Nuestra experiencia en dos pacientes.

Sinonasal osteocartilaginous necrosis induced by the abuse of inhaled cocaine must be considered in the differential diagnosis of those pathologies that produce facial midline destructions. We report two cases corresponding to women admitted in our Hospital because of such entity. There were analysed their respective clinical histories, exploration data, complementary tests, medical-surgical treatment and evolution. Cocaine is one of the drugs that has increased in last 10 years producing an elevated number of complications, as we could proved on the bibliographic review performed.

Necrosis osteocartilaginosa nasal por cocaína. Nuestra experiencia en dos pacientes / Nasal osteocartilaginous necrosis by cocaine. Our experience in two patients

Las necrosis osteocartilaginosas nasosinusales debidas al abuso de cocaína por vía inhalatoria deben considerarse en el diagnóstico diferencial de las patologías que ocasionan destrucción de la línea media facial. Presentamos los casos clínicos de dos mujeres que fueron ingresadas en nuestro Hospital por este motivo. Analizamos sus historias clínicas respectivas, datos de la exploración, pruebas complementarias, tratamiento médico-quirúrgico y evolución. La cocaína es una de las drogas que ha experimentado un mayor incremento consumista en los últimos 10 años lo que ha dado lugar a un mayor número de complicaciones, como se pone de manifiesto en la revisión bibliográfica realizada

Sinonasal osteocartilaginous necrosis induced by the abuse of inhaled cocaine must be considered in the differential diagnosis of those pathologies that produce facial midline destructions. We report two cases corresponding to women admitted in our Hospital because of such entity. There were analysed their respective clinical histories, exploration data, complementary tests, medical-surgical treatment and evolution. Cocaine is one of the drugs that has increased in last 10 years producing an elevated number of complications, as we could proved on the bibliographic review performed

Influence of hepatocyte-rich liver cell mixture and liver fibroblasts on prolonging graft islet survival in rats without immunosuppressive drugs.

BACKGROUND: We noted that a liver cell suspension, made up of a mixture of several kinds of hepatic cells, affected allogenic islet survival when it was transplanted into the liver, mixed with the islets or separately. AIM: To study if this effect was related to a liver cell mixture rich in hepatocytes (hp) or to liver fibroblasts (fb). METHODS: We studied 14 groups of rats: (A) a sham group with saline; (B) a group receiving transplantation with hepatic cells alone; (C) a control group, with islets alone via the portal vein, without hepatic cells (hp or fb). For the other groups, we used a different ratio of cells/islets (100 : 1, 150 : 1 and 200 : 1) and different co-transplantation techniques with both types of cells. For the D, E, J groups, a mixture of hepatocytes (hepatocyte-rich liver cell mixture) or fibroblasts with islets was injected into the portal vein. For the other groups, we used a sequential procedure with a 15 minute interval between a first injection of hp or fb into the portal vein or into the vena cava, and a second injection of islets always into the portal vein; thus, it was a sequential portal/portal procedure with hepatocyte-rich liver cell mixture (hp) (F, G) or fibroblasts (K, L) and a sequential cava/portal with hp (H, I) or fibroblasts (M, N). RESULTS: Most of the co-transplantation groups showed functional islets (blood glucose < 250 mg/dl) on the first or second day of transplantation; after several days they once again had high glucose levels, though not as high as pre-transplantation. There was statistical significance (p < 0.001) between the presence or not of hepatic cells to obtain prolongation of graft survival (blood glucose < 250 mg/dl). Statistical significance (p < 0.001) was found for several sequential groups with hp (F, I) and fb (K, L). It was also remarkable that 3 rats (37.5 %) from the I group (sequential cava/portal with hp/islets 200 : 1) were euglycemic (blood glucose < 150 mg/dl) for more than 3 months. ANOVA showed a large interaction between the type of transplant performed and the cellular ratio used, with a significance of p < 0.001. Histological studies in rats with prolonged euglycemia, showed insulin-producing cell aggregates in the liver, while there was a remarkable decrease in insulin-producing cells in the remaining islets of pancreatic tissue. CONCLUSION: The results showed a marginal prolongation of islet graft survival when they are co-transplanted with a hepatocyte-rich liver cell mixture or with liver fibroblasts. The mechanism does not seem to be a cellular interaction between different hepatic cells and islets, but some kind of cellular interaction or released factor from either two cell types on the immune system, blocking or modulating it, at least temporarily.

Behaviour of simazine in soil amended with the final residue of the olive-oil extraction process.

Addition of organic wastes to agricultural soils is becoming a common practice as a disposal strategy and to improve the physical and chemical soil properties. However, in order to optimise the use of organic wastes as soil amendments, their effect on the behaviour of other compounds that are also used in agriculture, such as pesticides, needs to be assessed. In this work, we have investigated the effects of the addition of the final solid residue of the new technology of olive-oil extraction (extracted alperujo or solid olive-mill waste, SOMW2) on the sorption, degradation and leaching of the herbicide simazine in a sandy loam soil. The results are compared with those of a previous study, where the intermediary by-product of the olive-oil processing technology (unextracted alperujo or SOMW1) was applied to the same soil. The soil was amended in the laboratory with SOMW2 at two different rates (5% and 10% w/w). Simazine sorption isotherms showed a great increase in herbicide sorption after SOMW2 addition to soil. SOMW2 addition also increased sorption irreversibility. Incubation studies revealed reduced biodegradation of simazine in the soil amended with SOMW2 compared to the unamended soil. Breakthrough curves of simazine in handpacked soil columns showed that SOMW2 addition retarded the vertical movement of the herbicide through the soil and greatly reduced the amount of herbicide available for leaching. Interestingly, the results were quantitatively different from those obtained for the intermediary by-product SOMW1, illustrating the importance of the specific characteristics of the organic amendment in determining its effect on pesticide behaviour.

Disección espontánea de arteria vertebral: una causa de infarto cerebral isquémico en la infancia / Spontaneous dissection of vertebral artery: a cause of ischemic brain infarction in childhood

La enfermedad cerebrovascular en pediatría, va alcanzado día a día mayor importancia en base al mejor conocimiento de las numerosas entidades que pueden constituir factores de riesgo para ictus en niños y adolescentes y sobre todo a la mejor identificación de casos, por el gran avance en el diagnóstico mediante técnicas de neuroimagen. Dentro de las múltiples causas conocidas, las disecciones arteriales espontáneas del territorio vertebrobasilar, suponen una causa documentada, aunque rara, de ictus cerebral isquémico en la infancia. Se describe el caso de una adolescente con un infarto cerebral isquémico secundario a disección espontánea de la arteria vertebral en su trayecto extracraneal (AU)

[Unilateral versus bilateral neck exploration in the surgery of primary hyperparathyroidism]. / Exploración cervical unilateral versus bilateral en la cirugía del hiperparatiroidismo primario.

The aim of this study is to know the indications, advantages and disadvantages of a unilateral neck exploration versus bilateral in the primary hyperparathyroidism (HPT) surgery. Since april 1990 to april 2002 we have operated 80 patients diagnosed of HPT. They where divided in different groups in function of the results of the clinic exploration intact paratohormone results (PTHi turbo). In 48 patients (60%) we have done an unilateral cervical surgical exploration (in 9 cases we have determined the PTHi turbo) with good postoperative results. In 32 patients we have realised a bilateral exploration with exposition of both recurrent nerves, based on the discordance between the image exploration and because we were not able to have the intro-operative dose of turbo of PTHi, which use parameter we defend because of its contrasted efficiency, with less surgical time and less iatrogenic possibilities.

Exploración cervical unilateral versus bilateral en la cirugía del hiperparatiroidismo primario / Unilateral neck exploration versus bilateral one in the surgery of primary hyperparathyroidism

El objetivo de este estudio es conocer las indicaciones, ventajas e inconvenientes de una exploración cervical unilateral versus bilateral en la cirugía del hiperparatiroidismo primario (HPT). Para ello, desde abril de 1990 y hasta abril de 2002, hemos intervenido 80 pacientes diagnosticados de HTP. Primero fueron divididos en varios grupos en función de los resultados de la exploración clínica, pruebas de paratohorma intacta (PTHi turbo). En 48 de los 80 pacientes (60 por ciento) se realizó una exploración quirúrgica cervical unilateral (en 9 casos se determinó la PTHi turbo) con buenos resultados posoperatorios. Sobre 32 pacientes se realizó una exploración bilateral con exposición bilateral con exposición de ambos recurrentes, por discordancia entre las pruebas de imagen por no disponer entonces de la dosificación turbo intraoperatoria de PTHi, parámetro cuya utilización defendemos por su eficacia contrastada, menor tiempo quirúrgico y menor posibilidad de yatrogenia (AU)

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Influencia del cocultivo de islotes pancreáticos con células hepáticas sobre la liberación de insulina y sobre la implantación de los islotes en hígado sin inmunosupresión / Influence of co-culture of pancreatic islets with hepatic cells on insulin release and on implantation of islets in liver without immunosuppression

El objetivo de este trabajo es estudiar la influencia de las células hepáticas sobre la liberación de insulina cuando se co-cultivan con islotes, así como la influencia que puedan tener sobre la implantación de los islotes en el hígado en ratas Wistar, sin el empleo de drogas inmunosupresoras. In vitro tenemos 2 grupos: A) Cultivo de islotes solos y B) Co-cultivo de islotes y células hepáticas, ambos durante 7 días. Se realiza un estudio morfológico, numérico y de liberación de insulina. In vivo tenemos 7 grupos de Tx: A) Tx ficticio con suero fisiológico (4), B) Tx-ch solas (4), C) Tx-1 solos (6), D) Tx-I solos tras cultivo 7 días (5), E) Tx-1 co-cultivados con ch 24 h (5), F) Tx-I co-cultivados con ch 7 días (7) y G) Tx-I co-cultivados con ch 48 h, en placas transwell (5). La proporción de ch/I ha sido de 150:1. ENI ha sido de 1678 ñ 343 con pureza del 90 por ciento. Análisis de datos mediante el test de ANOVA del SPSS 8.0.In vitro: observamos una gran diversidad celular hepática, un descenso en el ENI durante el co-cultivo, sin embargo la insulino-liberación es mayor en los islotes co-cultivados con ch (p < 0.005). In vivo: Los días de euglucemia tras el Tx han sido: grupo A (0 ñ 0), B (0 ñ 0), C( 2.0 ñ 3.098), D 1.8 ñ 2.17), E (8.6 ñ 12.33), F (9.14 ñ 11.02) y G (0 ñ 0). Los resultados de E y F, confirman un efecto favorable de las ch sobre la implantación de los islotes alogénicos en hígado, consiguiéndose un 20 por ciento y un 14.3 por ciento de reversión de la diabetes. El resultado de G parece indicar la posibilidad de que más que una interacción celular entre las ch e islotes, se trate más bien de la secreción constante de algún producto, y este sea el responsable de la supervivencia de los islotes implantados en hígado. (AU)

Nefropatía diabética / Diabetic nephropathy

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Determinación de PTH I en la cirugía del hiperparatiroidismo. Nuestra experiencia / PTH I assay in surgery of hyperparathyroidism. Our experience

Nuestro Servicio de ORL lleva realizadas un total de 90 paratiroidectomías desde abril de 1990 hasta el 2000 sobre 92 pacientes remitidos con diagnóstico de hiperparatiroidismo. De ellos, 67 pacientes fueron diagnosticados de hiperparatiroidismo primario; 22, secundario y 3 casos correspondían a hiperparatiroidismos terciarios. Analizamos una serie de variables preoperatorias y postoperatorias, entre las que destacamos la reciente determinación de los niveles de la PTH i rápida. El tipo de cirugía que realizamos fue la resección de adenoma en 63 casos; 23 pacientes fueron sometidos a una paratiroidectomía subtotal y 4 a paratiroidectomía total. En 2 pacientes intervenidos se realizó cirugía exploradora cervical sin hallar patología paratiroidea. Comparamos los resultados obtenidos con otras series publicadas y creemos útil la determinación de los niveles de paratohormona rápida (PTH i) pre y postoperatoria (actualmente sólo 3 casos) para predecir la respuesta clínica de los pacientes con diagnóstico de hiperparatiroidismo (AU)

Our Service of Otolaryngology has performed 90 parathyroidectomies at all since april 1990 to 2000 on 92 patients sent to us with diagnosis of hyperparathyroidism. 67 patients were diagnosed as primary hyperparathyroidism; 22 as secondary and 3 cases corresponded to tertiary hyperparathyroidism. We analysed a string of variables before and after the surgery standing out the recent estimate of rapid PTH i levels. The kind of surgery we performed was the removal of adenoma in 63 cases; 23 patients were put to subtotal parathyroidectomy and 4 to a total one. An exploratory neck surgery was performed in two patients without finding a parathyroid pathology. We compare the obtained results with other published series and we think it can be useful to determinate the rapid paratohormone levels (PTH i) pre and postsurgery (only used in 3 cases by now) in order to predict the clinic response of the patients with hyperparathyroidism (AU)

Anomalous coronary artery origin associated with bicuspid aortic valve in a patient with rheumatic mitral stenosis: a case report.

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva associated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.