[Validity and usefulness of the RAE-CMBD studying patients hospitalised with influenza]. / Validez y utilidad del RAE-CMBD en el estudio de los pacientes hospitalizados con gripe.

OBJECTIVE: Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the Hospital Care Activity Record - Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection. METHODS: Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay. RESULTS: A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). CONCLUSIONS: The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery / Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera

Introduction: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methods: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. Results: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. Discussion: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.(AU)

Introducción: La artroplastia de cadera es el tratamiento de elección para las fracturas desplazadas del cuello de fémur en la población de edad avanzada. La luxación de la prótesis de cadera es una de las complicaciones potenciales tras la artroplastia de cadera, pero falta información actualizada sobre el efecto de la luxación en la supervivencia de los pacientes mayores con fractura de cadera tratados mediante hemiartroplastia de cadera. Nuestro objetivo es evaluar el efecto de la luxación de la prótesis de cadera (hemiartroplastia) como factor aislado, en la función de supervivencia de los pacientes. Materiales y métodos: Realizamos un estudio multicéntrico retrospectivo, que incluyó a 6.631 pacientes mayores de 65 años con fractura de cuello de fémur tratados quirúrgicamente mediante hemiartroplastia. Se realizaron cortes de seguimiento a los 30 días, 6 semanas, 90 días y un año del alta hospitalaria, determinando la tasa de luxación de cadera y la supervivencia de los pacientes. Resultados: La población femenina representó el 78,7%, y la edad media de la población fue de 85,2±6,7 años. La incidencia de luxación de la prótesis de cadera fue del 1,9% en los primeros 90 días tras el alta, lo que representa el 91,54% de las luxaciones primarias observadas anualmente. Se registró un aumento estadísticamente significativo de las tasas de mortalidad de los pacientes que presentaban al menos un evento de luxación de la prótesis de cadera (del 16,0 al 24,6% a los 90 días del alta, y del 29,5 al 44,7% al año), y también una disminución significativa de la función de supervivencia de los pacientes a los 90 días (p=0,016) y al año de seguimiento (p<0,001). Los eventos de luxación recurrente (26,15%) mostraron tasas de mortalidad aún más altas (hasta el 60,6%, p<0,001). El modelo multivariante de regresión de Cox determinó que la luxación de la prótesis de cadera es la única variable significativa (p=0,035) que afecta a la...(AU)

[Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera / Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

Introducción: La artroplastia de cadera es el tratamiento de elección para las fracturas desplazadas del cuello de fémur en la población de edad avanzada. La luxación de la prótesis de cadera es una de las complicaciones potenciales tras la artroplastia de cadera, pero falta información actualizada sobre el efecto de la luxación en la supervivencia de los pacientes mayores con fractura de cadera tratados mediante hemiartroplastia de cadera. Nuestro objetivo es evaluar el efecto de la luxación de la prótesis de cadera (hemiartroplastia) como factor aislado, en la función de supervivencia de los pacientes. Materiales y métodos: Realizamos un estudio multicéntrico retrospectivo, que incluyó a 6.631 pacientes mayores de 65 años con fractura de cuello de fémur tratados quirúrgicamente mediante hemiartroplastia. Se realizaron cortes de seguimiento a los 30 días, 6 semanas, 90 días y un año del alta hospitalaria, determinando la tasa de luxación de cadera y la supervivencia de los pacientes. Resultados: La población femenina representó el 78,7%, y la edad media de la población fue de 85,2±6,7 años. La incidencia de luxación de la prótesis de cadera fue del 1,9% en los primeros 90 días tras el alta, lo que representa el 91,54% de las luxaciones primarias observadas anualmente. Se registró un aumento estadísticamente significativo de las tasas de mortalidad de los pacientes que presentaban al menos un evento de luxación de la prótesis de cadera (del 16,0 al 24,6% a los 90 días del alta, y del 29,5 al 44,7% al año), y también una disminución significativa de la función de supervivencia de los pacientes a los 90 días (p=0,016) y al año de seguimiento (p<0,001). Los eventos de luxación recurrente (26,15%) mostraron tasas de mortalidad aún más altas (hasta el 60,6%, p<0,001). El modelo multivariante de regresión de Cox determinó que la luxación de la prótesis de cadera es la única variable significativa (p=0,035) que afecta a la...(AU)

Introduction: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methods: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. Results: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. Discussion: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.(AU)

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery. / [Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera.

INTRODUCTION: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS: The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery.

INTRODUCTION: Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes. MATERIALS AND METHODS: We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival. RESULTS: The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DISCUSSION: Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Carbon Monoxide poisoning and Air Embolism following Hysteroscopic Myomectomy: a case report.

INTRODUCTION: Uterine myomas are the most common benign uterine tumors. Hysteroscopic myomectomy has grown as a standard minimally invasive surgical procedure, but this technique is not free from complications. CASE: An hysteroscopic myomectomy was performed on a 38 years-old woman. During the awakening after the procedure, she presented focal neurological deficits, thus arterial blood gas test and total body computerized tomography (CT) scan were urgently carried out. They revealed a very high carboxyhemoglobin level and abdominal venous air embolism. The patient stayed in Trendelenburg position and under mechanical ventilation with 100% oxygen concentration. Fortunately, a few hours later she was fully awake and was able to be successfully extubated, being discharged to the surgical ward three days later fully recovered. CONCLUSION: Carbon monoxide poisoning during hysteroscopic resection is a rare but potentially fatal complication that anesthetists, gynecologists, and critical care physicians should be aware of.

First report of Escherichia coli O157:H7 in ready-to-eat sushi.

AIMS: The aim of this study was to evaluate the microbiological quality of commercially prepared ready-to-eat (RTE) sushi by enumerating aerobic mesophilic bacteria (AMB) and thermotolerant coliforms (TC) and detecting Escherichia coli and Salmonella ssp. An isolate was identified as E. coli O157:H7 which was evaluated for its virulence and antimicrobial resistance profiling as well as its ability to form biofilms on stainless steel. METHODS AND RESULTS: There were four sampling events in seven establishments, totalling 28 pools of sushi samples. Mean AMB counts ranged between 5·2 and 7·7 log CFU per gram. The enumeration of TC varied between 2·1 and 2·7 log MPN per gram. Salmonella ssp. were not detected, and one sample was positive for E. coli and was identified as E. coli O157:H7. To the best of our knowledge, this is the first report of E. coli O157:H7 in sushi samples in the world literature. This isolate presented virulence genes stx1, stx2, eae and hlyA. It was also susceptible to 14 antimicrobials tested and had the ability to form biofilms on stainless steel. CONCLUSIONS: There is a need to improve the good hygiene practices adopted in establishments selling sushi in the city of Pelotas, Brazil. In addition, the isolated E. coli O157:H7 carries a range of important virulence genes being a potential risk to consumer health, as sushi is a RTE food. This isolate also presents biofilm formation ability, therefore, may trigger a constant source of contamination in the production line of this food. SIGNIFICANCE AND IMPACT OF THE STUDY: The increase in the consumption of sushi worldwide attracts attention regarding the microbiological point of view, since it is a ready-to-eat food. To our knowledge, this was the first time that E. coli O157:H7 was identified in sushi samples.

Antimicrobial susceptibility and molecular typing of toxigenic clinical isolates of Clostridium difficile causing infections in the south of Spain.

Antimicrobial susceptibility to 6 antimicrobial agents, PCR-ribotyping and molecular genetics of fluoroquinolone resistance was assessed in 70 toxigenic clinical isolates of C. difficile recovered from patients attended in a hospital in southern Spain with suspected Clostridium difficile infection. Moxifloxacin was the least active drug, mainly driven by the aminoacid substitution Thr82Ile in GyrA, while PCR-ribotype 078 was the most prevalent lineage identified and grouped several of the fluoroquinolone resistant isolates.

Multicenter Study of Method-Dependent Epidemiological Cutoff Values for Detection of Resistance in Candida spp. and Aspergillus spp. to Amphotericin B and Echinocandins for the Etest Agar Diffusion Method.

Method-dependent Etest epidemiological cutoff values (ECVs) are not available for susceptibility testing of either Candida or Aspergillus species with amphotericin B or echinocandins. In addition, reference caspofungin MICs for Candida spp. are unreliable. Candida and Aspergillus species wild-type (WT) Etest MIC distributions (microorganisms in a species-drug combination with no detectable phenotypic resistance) were established for 4,341 Candida albicans, 113 C. dubliniensis, 1,683 C. glabrata species complex (SC), 709 C. krusei, 767 C. parapsilosis SC, 796 C. tropicalis, 1,637 Aspergillus fumigatus SC, 238 A. flavus SC, 321 A. niger SC, and 247 A. terreus SC isolates. Etest MICs from 15 laboratories (in Argentina, Europe, Mexico, South Africa, and the United States) were pooled to establish Etest ECVs. Anidulafungin, caspofungin, micafungin, and amphotericin B ECVs (in micrograms per milliliter) encompassing ≥97.5% of the statistically modeled population were 0.016, 0.5, 0.03, and 1 for C. albicans; 0.03, 1, 0.03, and 2 for C. glabrata SC; 0.06, 1, 0.25, and 4 for C. krusei; 8, 4, 2, and 2 for C. parapsilosis SC; and 0.03, 1, 0.12, and 2 for C. tropicalis The amphotericin B ECV was 0.25 µg/ml for C. dubliniensis and 2, 8, 2, and 16 µg/ml for the complexes of A. fumigatus, A. flavus, A. niger, and A. terreus, respectively. While anidulafungin Etest ECVs classified 92% of the Candida fks mutants evaluated as non-WT, the performance was lower for caspofungin (75%) and micafungin (84%) cutoffs. Finally, although anidulafungin (as an echinocandin surrogate susceptibility marker) and amphotericin B ECVs should identify Candida and Aspergillus isolates with reduced susceptibility to these agents using the Etest, these ECVs will not categorize a fungal isolate as susceptible or resistant, as breakpoints do.

Application of transit data analysis and artificial neural network in the prediction of discharge of Lor River, NW Spain.

Transit data analysis and artificial neural networks (ANNs) have proven to be a useful tool for characterizing and modelling non-linear hydrological processes. In this paper, these methods have been used to characterize and to predict the discharge of Lor River (North Western Spain), 1, 2 and 3 days ahead. Transit data analyses show a coefficient of correlation of 0.53 for a lag between precipitation and discharge of 1 day. On the other hand, temperature and discharge has a negative coefficient of correlation (-0.43) for a delay of 19 days. The ANNs developed provide a good result for the validation period, with R(2) between 0.92 and 0.80. Furthermore, these prediction models have been tested with discharge data from a period 16 years later. Results of this testing period also show a good correlation, with R(2) between 0.91 and 0.64. Overall, results indicate that ANNs are a good tool to predict river discharge with a small number of input variables.

Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión / Opinion survey on information, communication and treatment in an Emergency Department

Objetivo. Conocer aspectos concretos acerca de la información y la comunicación con los usuarios de los servicios de urgencias hospitalarias y el trato recibido en ellos a través de una encuesta telefónica. Métodos. Estudio prospectivo en 2 servicios de urgencias hospitalarias de Salamanca. Se incluyeron en el estudio 400 pacientes (edad media 56,4 ± 20,5 años; 58,4% mujeres). Se realizó una encuesta telefónica con 19 ítems. Doce de ellos recogían las respuestas en escala tipo Likert, con puntuaciones de 1 (muy mal) a 5 (muy bien). El resto permitían responder «sí» o «no». Resultados. El 86% de los pacientes evaluaron positivamente el trato recibido por los profesionales en general, el 92% el respeto mostrado, el 87% el trato de los médicos y el 71% el trato recibido por enfermería. El 27,5% no recuerda haber recibido información del personal del punto azul (profesionales especialmente capacitados para dar información). Se encontró significación estadística (p = 0,045) en relación a la amabilidad y respeto mostrado por enfermería. La mayoría de los pacientes que fueron ingresados en el área de observación del servicio de urgencias no fueron informados sobre los horarios de visita (p = 0,003). Conclusiones. La percepción del trato recibido por los pacientes es buena, mientras que en relación a la información y comunicación es ostensiblemente mejorable y podría ser evaluada utilizando la encuesta que proponemos, ya que permite detectar y utilizar los puntos débiles de estos aspectos de la asistencia sanitaria como lanzaderas de las iniciativas de implementación (AU)

Objective. To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. Methods. A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4 ± 20.5 years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer 'yes' or 'no'. Results. The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P = .045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P = .003). Conclusions. Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives (AU)

[Opinion survey on information, communication and treatment in an Emergency Department]. / Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión.

OBJECTIVE: To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. METHODS: A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4±20.5years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer "yes" or "no". RESULTS: The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P=.045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P=.003). CONCLUSIONS: Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives.

[Progressive multifocal leukoencephalopathy in the province of Cadiz, Spain]. / Leucoencefalopatía multifocal progresiva en la provincia de Cádiz, España.

INTRODUCTION: Progressive multifocal leukoencephalopathy (PML), which is caused by the reactivation of an infection due to the JC human polyoma virus, affects immunocompromised patients and more especially those infected by the human immunodeficiency virus. It produces a multifocal neurological clinical picture due to the destruction of oligodendrocytes and the subsequent demyelination. AIMS: To analyse the epidemiological, semiological and radiological characteristics of a sample of patients diagnosed with PML in the province of Cadiz, and to study their rates of survival. PATIENTS AND METHODS: Our sample consisted of 23 patients with PML who presented an unfavourable immunological situation and deficient therapeutic compliance. Factors studied included time to progression of the symptoms, clinical features, neuroimaging and survival. RESULTS: The mean time elapsed between the appearance of symptoms and diagnosis was 30 days. There was a wide range of manifestations: motor symptoms were the most prevalent and cognitive compromise was far less common. All the patients submitted to magnetic resonance imaging of the head and only eight of those who underwent computerised axial tomography displayed multiple insults. The mean survival time was 60 days in the case of the seven deaths and over two years in those who survived. CONCLUSIONS: The symptoms of the patients were similar to those reported in the literature, except for the absence of dementia. Magnetic resonance imaging was better than tomography at detecting multiple, dispersed insults and is more cost-effective for diagnosing PML. The survival time of most of the patients was higher than that reported in previous studies.

C3H/HeJ mice carrying a toll-like receptor 4 mutation are protected against the development of insulin resistance in white adipose tissue in response to a high-fat diet.

AIMS/HYPOTHESIS: Inflammation is associated with obesity and has been implicated in the development of diabetes and atherosclerosis. During gram-negative bacterial infection, lipopolysaccharide causes an inflammatory reaction via toll-like receptor 4 (TLR4), which has an essential function in the induction of innate and adaptative immunity. Our aim was to determine what role TLR4 plays in the development of metabolic phenotypes during high-fat feeding. MATERIALS AND METHODS: We evaluated metabolic consequences of a high-fat diet in TLR4 mutant mice (C3H/HeJ) and their respective controls. RESULTS: TLR4 inactivation reduced food intake without significant modification of body weight, but with higher epididymal adipose tissue mass and adipocyte hypertrophy. It also attenuated the inflammatory response and increased glucose transport and the expression levels of adiponectin and lipogenic markers in white adipose tissue. In addition, TLR4 inactivation blunted insulin resistance induced by lipopolysaccharide in differentiated adipocytes. Increased feeding efficiency in TLR4 mutant mice was associated with lower mass and lower expression of uncoupling protein 1 gene in brown adipose tissue. Finally, TLR4 inactivation slowed the development of hepatic steatosis, reducing the liver triacylglycerol content and also expression levels of lipogenic and fibrosis markers. CONCLUSIONS/INTERPRETATION: TLR4 influences white adipose tissue inflammation and insulin sensitivity, as well as liver fat storage, and is important in the regulation of metabolic phenotype during a fat-enriched diet.

Liver-specific deletion of insulin receptor substrate 2 does not impair hepatic glucose and lipid metabolism in mice.

AIMS/HYPOTHESIS: Hepatic insulin resistance is thought to be a critical component in the pathogenesis of type 2 diabetes but the role of intrinsic insulin signalling pathways in the regulation of hepatic metabolism remains controversial. Global gene targeting in mice and in vitro studies have suggested that IRS2 mediates the physiological effects of insulin in the liver. Reduced hepatic production of IRS2 is found in many cases of insulin resistance. To investigate the role of IRS2 in regulating liver function in vivo, we generated mice that specifically lack Irs2 in the liver (LivIrs2KO). MATERIALS AND METHODS: Hepatic insulin signalling events were examined in LivIrs2KO mice by western blotting. Glucose homeostasis and insulin sensitivity were assessed by glucose tolerance tests and hyperinsulinaemic-euglycaemic clamp studies. The effects of high-fat feeding upon glucose homeostasis were also determined. Liver function tests were performed and expression of key metabolic genes in the liver was determined by RT-PCR. RESULTS: Proximal insulin signalling events and forkhead box O1 and A2 function were normal in the liver of LivIrs2KO mice, which displayed minimal abnormalities in glucose and lipid homeostasis, hepatic gene expression and liver function. In addition, hepatic lipid homeostasis and the metabolic response to a high-fat diet did not differ between LivIrs2KO and control mice. CONCLUSIONS/INTERPRETATION: Our findings suggest that liver IRS2 signalling, surprisingly, is not required for the long-term maintenance of glucose and lipid homeostasis, and that extra-hepatic IRS2-dependent mechanisms are involved in the regulation of these processes.

Detection of hepatitis E virus in patients sera in southern Spain.

The aim of the present study was to detect acute Hepatitis E virus (HEV) infection in patients with abnormal alanine transaminase (ALT) in which other viral hepatitis infections had been excluded in southern Spain, an area adjacent to regions where this disease is endemic. Of 336 sera tested 30 (8.92%) were positive for IgM antibodies against HEV (anti-HEV IgM) and 7 (2.08%) were negative in a repeated assay. Immunoblot analysis (IBA) was applied to the 37 positive sera in the first assay; its results were positivity for 26 (7.73%), ambiguous for 5 and negative for 6 sera. Amplification of ORF1 and ORF2 of HEV by means of nested RT-PCR was carried out with the 37 sera that were either positive or ambiguous by ELISA; a positive result was obtained only with one serum for the ORF2 protein. IgM antibodies against the HEV ORF2 protein could be a useful marker in the diagnosis of acute infection and a substitute for the determination of viral RNA in serum; this is of both diagnostic and epidemiological importance as it would allow the patients transmitting the infection to be recognized by means of a simple determination of antibodies. The sequence of the ORF2 fragment of HEV occurring in samples taken from both humans and animals amplified in this study has considerable homology with the sequences of HEV strains/isolates of European origin. These results demonstrate that an autochthonous HEV circulates in Spain.

Asthma camp. Quality of life questionnaires.

Asthma is one of the most common chronic chilhood disease. Asthmatic children need a self-management educational program, besides the medical treatment and clinical control. Camps are the ideal place to complete the educational program, to get the right control of the disease and to build the child confidence. Madrid Castilla la Mancha Allergy Society organizes every year a summer camp in a town, near Madrid. Fifty-four children stay for one week with certified allergists, fellows-in-training, nurses and cheer-leaders.Fifty-four children from 8 to 14 years old, with moderate to severe asthma participate in the camp. The camp includes educational, athletic and social activities. Campers participate daily in instructive and didactic teaching sessions. We evaluate quality of life with a questionaire filled in the camp and two months later. Results are analysed into two age groups, one between 8-10 years old and the other from 11 to 14 years old. The first group get a good management and improve their vision of the disease, quite the contrary, adolescents face up to a chronic disease with daily treatment, feeling asthma as a restriction of their autonomy. Even so, they identify crisis and learn to control them in an special risky life period. Asthma camps is a good experience for both groups and also for sanitary equipment.