Defunciones por enfermedad renal crónica en Chile según sexo, grupo etario y región entre los años 2021 y 2022 / Deaths from chronic kidney disease in Chile by sex, age group and region between 2021 and 2022

Introducción: La enfermedad renal crónica (ERC) es una afección persistente en la función y estructura renal. La prevalencia de ERC varía mundialmente, siendo más común en personas con diabetes e hipertensión. Además, la tasa de mortalidad por ERC ha disminuido en Chile en los últimos años. Objetivo general: describir las defunciones por ERC en Chile según sexo, grupo etario y región, entre los años 2021 y 2022. Metodología: estudio observacional descriptivo transversal. Se obstuvieron datos sobre ERC según sexo, grupo etario y región desde el Departamento de Estadística e Información en Salud (DEIS). Se utilizó estadística descriptiva y se calculó la tasa de mortalidad. Para el análisis estadístico se utilizó el programa Microsoft Excel. Este estudio no requirió revisión por comité de ética y no existen conflictos de interés. Resultados: Durante 2021-2022 se estudiaron 2478 defunciones por enfermedad renal crónica (ERC). Hubo un aumento del 15.85% en el número total de defunciones. La tasa de mortalidad general fue de 12.54 por cada 100.000 habitantes. Ambos sexos tuvieron tasas de mortalidad similares. El grupo etario de 81-90 años tuvo la mayor cantidad de muertes. La Región Metropolitana registró la mayoría de las defunciones. Discusión: La tasa de mortalidad en Chile es similar a países desarrollados, con tendencia al aumento en ambos sexos. El mayor número de defunciones en mayores de 61 años y la variación de las tasas de mortalidad por región podrían deberse a factores de riesgo cardiovascular. El enfrentamiento de la ERC debe enfocarse en estrategias de prevención y diagnóstico precoz.

Introduction: Chronic Kidney Disease (CKD) is a persistent condition affecting renal function and structure. The prevalence of CKD varies worldwide, with a higher incidence among individuals with diabetes and hypertension. Moreover, the mortality rate due to CKD has decreased in recent years in Chile. General objective: To describe CKD-related deaths in Chile according to sex, age group, and region between 2021 and 2022. Materials and methods: A descriptive cross-sectional observational study was conducted using data obtained from the Department of Health Statistics and Information (DEIS). Descriptive statistics were used and the mortality rate was calculated. Microsoft Excel was used for the statistical analysis. This study did not require ethical committee review, and there are no conflicts of interest. Results: A total of 2478 deaths due to CKD were studied during 2021-2022, with a 15.85% increase in the overall number of deaths. The general mortality rate was 12.54 per 100,000 inhabitants. Both sexes had similar mortality rates, and the 81-90 age group had the highest number of deaths. The Metropolitan Region registered the majority of the deaths. Discussion: The mortality rate in Chile is comparable to developed countries, with an increasing trend in both sexes. The higher number of deaths among individuals over 61 years old and the variation in mortality rates by region may be attributed to cardiovascular risk factors. Addressing CKD requires a focus on prevention and early diagnosis strategies.

Pigmentary mosaicism as a recurrent clinical manifestation in three new patients with mosaic trisomy 12 diagnosed postnatally: cases report and literature review.

BACKGROUND: To date, only twenty-one cases diagnosed postnatally with mosaic trisomy 12 have been reported. The most frequent phenotypic manifestations are developmental delay, dysmorphic facial features, congenital heart defects, digital alterations, and pigmentary disorders. In the present report, detailed clinical and genetic profiles of three unrelated new patients with mosaic trisomy 12 are described and compared with previously reported cases. CASE PRESENTATION: In the present report, we include the clinical, cytogenetic, and molecular description of three Mexican patients diagnosed postnatally with mosaic trisomy 12. At phenotypic level, the three patients present with developmental delay, dysmorphic facial features, congenital heart defects and skin pigmentary anomalies. Particularly, patient 1 showed unique eye alterations as bilateral distichiasis, triple rows of upper lashes, and digital abnormalities. In patient 2 redundant skin, severe hearing loss, and hypotonia were observed, and patient 3 presented with hypertelorism and telecanthus. Hyperpigmentation with disseminated pigmentary anomalies is a common trait in all of them. The cytogenetic study was carried out under the strict criteria of analysis, screening 50-100 metaphases from three different tissues, showing trisomy 12 mosaicism in at least one of the three different tissues analyzed. With SNParray, the presence of low-level mosaic copy number variants not previously detected by cytogenetics, and uniparental disomy of chromosome 12, was excluded. STR markers allowed to confirm the absence of uniparental disomy as well as to know the parental origin of supernumerary chromosome 12. CONCLUSIONS: The detailed clinical, cytogenetic, and molecular description of these three new patients, contributes with relevant information to delineate more accurately a group of patients that show a heterogeneous phenotype, although sharing the same chromosomal alteration. The possibility of detecting mosaic trisomy 12 is directly associated with the sensitivity of the methodology applied to reveal the low-level chromosomal mosaicism, as well as with the possibility to perform the analysis in a suitable tissue.

Enfermedad Diverticular: análisis de defunciones según sexo, grupo etario y regiones en Chile

Objetivo: Describir las defunciones por enfermedad diverticular de intestino en el período 2016 - 2020 en Chile según sexo, grupo etario y región. Material y Método: Estudio descriptivo. Se describieron 406 defunciones por enfermedad diverticular según sexo, grupo etario y región entre los años 2016-2020, realizando un análisis estadístico con el software IBM SPSS Statistics ® que incluyó una Prueba Binomial para análisis de defunciones según "sexo" y la Prueba de Kruskal Wallis para el estudio de significancia entre las variables "sexo" y "grupo etario". Se utilizó un intérvalo de confianza del 99% (p < 0,01). Resultados: se obtuvo una tasa de mortalidad 0,46/100.000 habitantes para el período estudiado. El sexo femenino fue predominante con una relación cercana a 3:1 (p < 0,01). Las defunciones aumentaron con la edad y el grupo etario con mayor número de defunciones fue el de 80-89. Se demostró relación entre sexo y grupo etario (p < 0,01). Las regiones con mayor tasa de mortalidad observada fueron Magallanes, Valparaíso y Maule. Discusión: La tasa de mortalidad es similar a la reportada a nivel mundial. Las mujeres mueren en una proporción mayor que los hombres, tal como es descrito en otros estudios. La mayor tasa de mortalidad observada en algunas regiones del país se podría asociar a la elevada prevalencia de factores de riesgo para la enfermedad. Conclusión: Las defunciones por enfermedad diverticular disminuyeron desde el año 2018, se evidencia que las mujeres presentan un número significativamente mayor de defunciones que los hombres y que existieron diferencias por región.

Aim: To describe deaths from diverticular bowel disease in the period 2016-2020 in Chile according to sex, age group and region. Material and Method: Descriptive study. 406 deaths due to diverticular disease were described according to sex, age group and region between the years 2016-2020, performing a statistical analysis with the IBM SPSS Statistics ® software that included a Binomial Test for analysis of deaths according to "sex" and the Kruskal Wallis Test for the study of significance between the variables "sex" and "age group". A 99% confidence interval (p < 0.01) was used. Results: A mortality rate of 0.46/100,000 inhabitants was obtained for the period. The female sex was predominant in a ratio close to 3:1 (p < 0.01). Deaths increased with age and the age group with the higher number of deaths was 80-89. A relationship between sex and age group was demonstrated (p < 0.01). The regions with the highest observed mortality rate were Magallanes, Valparaíso and Maule. Discussion: The mortality rate is similar to that reported worldwide. Women die at a higher rate than men, as described in other studies. The higher mortality rate observed in some regions of the country could be associated with the high prevalence of risk factors for the disease. Conclusion: Deaths from diverticular disease decreased since 2018, in conjunction with showing that women present a significantly higher number of deaths than men and that there were differences by region.

Body packing: tráfico de drogas y cirugía. Reporte de un caso / Body packing: drug traffic and surgery. Case report

Resumen Objetivo: Exponer el caso de un paciente con intoxicación aguda por cocaína en contexto de un body packing syndrome, considerando sus aspectos médico-quirúrgicos y legales. Materiales y Método: Se obtuvo la ficha clínica, con resguardo de anonimato, de un paciente que acude al servicio de urgencia (SU) y que es intervenido y evolucionando posteriormente en el Hospital el Pino de San Bernardo, Chile. Resultados: Paciente fue sometido a una gastrotomía, una enterotomía y una colotomía después de haber sido estabilizado por paro cardiorrespiratorio presentado en SU. Es trasladado a unidad de cuidados intensivos (UCI) donde evoluciona desfavorablemente. Discusión: El body packing syndrome es una entidad clínica infrecuente que, en la minoría de los casos, puede presentar complicaciones severas que requieren de un tratamiento médico-quirúrgico inmediato. Conclusión: Considerando que tanto el consumo como el tráfico de drogas se mantienen como un importante problema de salud pública y que sus consecuencias pueden ser devastadoras, es importante tener conocimiento sobre el tema.

Aim: To present the case of a patient with acute cocaine intoxication in the context of body packing syndrome, taking into consideration its medical-surgical and legal aspects. Materials and Method: A clinical record with anonymity protection was obtained, from a patient who was admitted to the emergency room and who was subsequently operated on and managed at Hospital El Pino in San Bernardo, Chile. Results: Patient underwent a gastrotomy, an enterotomy and a colotomy after being stabilized from a cardiorespiratory arrest in the emergency room. He was transferred to the Intensive Care Unit (ICU) where he evolved unfavorably. Discussion: Body packing is an infrequent clinical entity that, in a few cases, may develop severe complications that require immediate medical-surgical treatment, in addition to notification to authorities. Conclusion: Considering that both drug use and traffick remain as an important public health concern and that as its consequences may be devastating, it is important to have a knowledge on the subject.

UPD(14)mat and UPD(14)mat in concomitance with mosaic small supernumerary marker chromosome 14 in two new patients with Temple syndrome.

Temple syndrome (TS14) can be originated by maternal uniparental disomy (UPD(14)mat), paternal deletion, or epimutation, leading to disturbances in 14q32.2 imprinted region. The most frequent phenotypic manifestations are prenatal and postnatal growth failure, hypotonia, developmental delay, small hands/feet, precocious puberty, and truncal obesity. However, the diagnosis can be challenging due to the clinical overlap with other imprinting disorders such as Silver-Russell or Prader-Willi syndromes. Although rare, TS14 has been also reported in patients with concomitant UPD(14)mat and mosaic trisomy 14. In the present report, the clinical and genetic profiles of two new patients with TS14 are described. SNParray and MS-MLPA, allowed the determination of segmental UPD(14)mat and the hypomethylation of MEG3 gene. Additionally, in one of our patients we also observed by cytogenetics a small supernumerary marker chromosome that led to partial trisomy 14 in mosaic. Only few patients with concomitant UPD(14)mat and mosaic partial trisomy 14 have been reported. Our patients share cardinal TS14 phenotypic features that are associated to the genetic abnormalities detected; however, we also observed some clinical features such as fatty liver disease that had not previously been reported as part of this syndrome. The detailed clinical, cytogenetical and molecular description of these two new patients, contributes to a more accurately delineation of this syndrome.

Secretagogin expression in the mouse olfactory bulb under sensory impairments.

The interneurons of the olfactory bulb (OB) are characterized by the expression of different calcium-binding proteins, whose specific functions are not fully understood. This is the case of one of the most recently discovered, the secretagogin (SCGN), which is expressed in interneurons of the glomerular and the granule cell layers, but whose function in the olfactory pathway is still unknown. To address this question, we examined the distribution, generation and activity of SCGN-positive interneurons in the OB of two complementary models of olfactory impairments: Purkinje Cell Degeneration (PCD) and olfactory-deprived mice. Our results showed a significant increase in the density of SCGN-positive cells in the inframitral layers of olfactory-deprived mice as compared to control animals. Moreover, BrdU analyses revealed that these additional SCGN-positive cells are not newly formed. Finally, the neuronal activity, estimated by c-Fos expression, increased in preexisting SCGN-positive interneurons of both deprived and PCD mice -being higher in the later- in comparison with control animals. Altogether, our results suggest that the OB possesses different compensatory mechanisms depending on the type of alteration. Particularly, the SCGN expression is dependent of olfactory stimuli and its function may be related to a compensation against a reduction in sensory inputs.

Fases clínicas de la COVID-19. Diagnóstico diferencial / Clinical phases of COVID-19. Differential diagnosis

La enfermedad COVID-19 es provocada por el virus SARS-CoV-2, que presenta una variedad de síntomas en los que el tiempo de evolución es un factor pronóstico muy importante en estos pacientes. Además se ha visto que algunos marcadores analíticos y las pruebas radiológicas pueden ayudar a predecir una evolución desfavorable. Los enfermos de mayor edad presentan manifestaciones clínicas más graves y cursos más prolongados de la enfermedad. Además, conocer las fases patológicas y de gravedad de la enfermedad es de gran importancia en el manejo de la misma. Por último, en el diagnóstico diferencial es importante apoyarse en una buena historia clínica más allá de las determinaciones analíticas o las pruebas de imagen

The Covid-19 illness is caused by the SARS-CoV-2 virus which presents a wide range of symptoms. The period of time in which these symptoms develop is an important factor in reaching a diagnosis for patients. In addition, it has been observed that some analytical indicators and radiological testing can be helpful to predict a possible negative development in patients. Older patients show more serious clinical manifestations and longer evolution time of illness. Furthermore, understanding pathological and critical stages of the illness is of great importance in its clinical handling. Lastly, it is important to base the differential diagnosis on a reliable medical record and to look beyond analytical and image testing

Nanotechnology in reproduction: Vitamin E nanoemulsions for reducing oxidative stress in sperm cells.

Vitamin E is considered a powerful biological antioxidant; however, its characteristics such as high hydrophobicity and low stability limit its application. We propose to use nanotechnology as an innovative tool in spermatology, formulating nanoemulsions (NE) that accommodate vitamin E, protecting it from oxidation and promoting its release into the medium. The protective effect of the NE against oxidative stress was assessed in red deer epididymal sperm incubated at 37 °C. Cryopreserved sperm from eleven stags were thawed and extended to 400 × 106 sperm/ml in Bovine Gamete Medium (BGM). Once aliquoted, the samples were supplemented with the NE at different concentrations (0, 6 and 12 mM), with or without induced oxidative stress (100 µM Fe2+/ascorbate). The samples were evaluated after 0, 2 and 4 h of incubation at 37 °C. Motility (CASA), viability, mitochondrial membrane potential, acrosomal status, lipoperoxidation (C11 BODIPY 581/591), intracellular reactive oxygen species (ROS) production and DNA status (SCSA®) were assessed. After 2 and 4 h of incubation, the NE were able to prevent the deleterious effects of oxidative stress, thus improving total and progression motility (P ˂0.05). Moreover, the highest concentration tested (12 mM) improved almost every sperm kinematic variable (P ˂0.05) and preserved sperm viability in samples subjected to oxidative stress. In addition, 12 mM of NE protected the acrosomes integrity, maintained and protected mitochondrial activity, prevented sperm lipoperoxidation and reduced ROS production (P ˂0.05) in samples subjected to oxidative stress. This work indicates for the first time that vitamin E formulated in NE could be a new approach against sperm oxidative damage. This could be highly relevant for sperm physiology preservation in the context of assisted reproduction techniques.

Genetic and clinical characterization of 73 Pigmentary Mosaicism patients: revealing the genetic basis of clinical manifestations.

BACKGROUND: Pigmentary mosaicism constitutes a heterogeneous group of skin pigmentation alterations associated with multisystem involvement. The aim of this study was to establish a complete cytogenetic and molecular characterization of PM patients, emphasizing on searching for possible low chromosomal mosaicism and on establishing an accurate genotype-phenotype correlation. RESULTS: A total of 73 patients were included (3 months to 18 years of age), 52% male and 48% female. Observed in 69 (95%) patients, the most frequent pattern of pigmentation was fine and whorled BL, which was associated with disseminated skin extent in 41 (59%) patients. Central nervous system (84%) alterations were the most frequent observed in the group of patients, followed by the musculoskeletal (53%) and ophthalmologic (27%) alterations. Considering the pattern of pigmentation, no significant differences in association with skin extent or extracutaneous manifestations were detected. Following a strict cytogenetic analysis strategy, screening metaphases from three different tissues (peripheral blood, hyperpigmented and hypopigmented skin) we found that 23/73 patients had chromosomal abnormalities classified as follows: 1) Mosaic with 2 or more different cell lines with structural alterations n = 19; 2) Polyploidy (mosaic) n = 1 and 3) Alterations in all cells in three different tissues n = 3. SNP array, array CGH and FISH were useful for the complete characterization of the chromosomal aberrations, for the detection of microdeletions in patients with normal karyotype but with strong clinical suspicious of chromosomal alteration, and for a better establishment of genotype-phenotype correlation. In 2 patients we found genes associated with some of the extracutaneous manifestations (SHH, MNX1, PPP2R2C). CONCLUSIONS: This group of 73 patients finely described is the largest series of patients with pigmentary mosaicism reported worldwide. As we showed in this study, the followed analysis strategy allowed the detection of cytogenetic and molecular abnormalities, and made possible the establishment of genotype-phenotype associations in some patients. An important limitation of our study was the analysis of fibroblasts cultures instead of melanocytes and keratinocytes. In some cases the direct molecular DNA analysis of skin biopsy could be another choice.

Proceso de Atención de Enfermería a una lactante con neumonía basado en patrones funcionales de Marjory Gordon / Nursing Care Process on an infant suffering from pneumonia based on the Marjory Gordon Functional Patterns

El Proceso de Atención de Enfermería (PAE) que se presenta tiene como objetivo: Identificarlas necesidades alteradas, corregir, mantener y rehabilitar al paciente por medio de la aplicación de conocimientos y procedimientos, con la finalidad de que este recobre en el menor tiempo posible su salud, en este caso una lactante con neumonía. Hoy en día, la neumonía es la causa principal de muerte de niños menores de 5 años en todo el mundo, su principal afectación son los alvéolos pulmonares, lo que compromete el patrón respiratorio. Esta enfermedad si no es tratada oportunamente puede tener complicaciones como: fallo respiratorio agudo, absceso pulmonar, insuficiencia cardiaca congestiva. Es entonces cuando el personal de Enfermería juega un papel importante en la ejecución de intervenciones, que ayuden a mantener la permeabilidad y la estabilidad de la vía aérea. Se identificaron las necesidades prioritarias con base en los 11 patrones funcionales de Marjory Gordon; se diseñó un plan de cuidados individualizado encaminado al mantenimiento del patrón respiratorio, para este se utilizaron las taxonomías: NANDA, NIC y NOC. Los resultados obtenidos fueron satisfactorios, se logró disminución de la dificultad respiratoria, mejoría en la permeabilidad de la vía aérea, mantenimiento de la frecuencia cardiaca y prolongación de periodos de sueño; sin embargo debido a que la paciente presentaba una desnutrición severa con evolución de 6 meses, no pudo modificarse ese patrón y aunado a la gravedad del padecimiento falleció.

The Nursing Attention Process (NAP) aims to identify altered needs, and correct, maintain and rehabilitate the patient through the use of knowledge and procedures, so that he/she can be healthy as soon as possible. In this study, the patient was an infant suffering from pneumonia. Currently, pneumonia is the world's principal cause of death in children younger than 5 years old. Indeed, consequences of not treating this illness on time include acute respiratory arrest, lung abscesses, and congestive cardiac insufficiency. Here, is when the nursing staff has a crucial role at maintaining the permeability and stability of the respiratory airways of these patients. Priority needs were identified through the 11 functional pattern of Marjory Gordon. An individualized care plan was designed and aimed to the maintenance of the child's respiratory patterns. NANDA, NIC and NOC taxonomies were used. Satisfactory results included a decrease in the respiratory difficulty, an improvement in the airway permeability, the maintenance of the cardiac rate, and the improvement of sleep time. However, due to a 6 month previous malnutrition, and the complications of this illness, unfortunately this patient died.

Infection control attitudes and perceptions among dental students in Latin America: implications for dental education.

UNLABELLED: Latin American dental schools are at diverse stages in the continuum of implementation of infection control (IC) programmes that comply with evidence-based recommendations. Poor IC training may result in low compliance and negative attitudes against patients infected with blood borne pathogens (BBP). OBJECTIVE: To evaluate students' knowledge on IC and attitudes toward occupational BBP risks, in six dental schools in Latin America. METHODS: This survey was administered to convenience samples of dental students at one school in Costa Rica; four schools in Mexico, and one in Venezuela. The questionnaire included Likert-type scale evaluations of agreement with statements. Study variables included knowledge about and confidence in recommended IC procedures, degree of concern about HIV and HBV transmission in dental settings, and attitudes toward patients infected with BBP. Possible associations between variables were analysed using Pearson's Chi square and Kruskal Wallis tests. RESULTS: Substantial numbers of students had incomplete knowledge and often lacked confidence on IC and procedures; believed that HIV and HBV could be transmitted during clinical procedures; felt worried about occupational exposure to BBP, and held prejudices towards HIV and HBV infected individuals. CONCLUSIONS: Educational efforts are needed to enhance IC teaching and compliance. Diverse educational resources and international networks for research collaboration are available from organisations specialised in IC, hopefully paving the way to harmonising regional standards.

Dosimetric assessment of radon in a vegetable system.

An alpha-dose calculation due to radon uptake in anthers of Tradescantia, clone 4430, has been performed. Probability distribution density of the dose in the pollen mother cells was calculated by means of a model that simulates the interaction of separate alpha-particles with these cells. It is shown that alpha-radiation from either radon or its decay products surrounding the buds does not reach pollen mother cells because of the short-range alpha-particles. However, it is suggested that radon diffuses through the gap structure of the bud to the anther from which a radon-gas adsorption process takes place. Absorbed-dose calculations in the anther are discussed as well as their relationship to the experimental results of micronucleus induction in pollen mother cells. The radon concentration interval used (0.85 kBq m(-3)-98.16 kBq m(-3)) is equivalent to the exposure to an average environmental radon concentration (40 Bq m(-3)) for 2.3 months or 22.1 years, respectively. The lowest radon concentration to induce micronuclei was 12.1 kBq m(-3), which is 15 times in excess of that adopted for old buildings in Canada.

Recombinant angiostatin prevents retinal neovascularization in a murine proliferative retinopathy model.

Retinal neovascularization is central to the pathogenesis of proliferative diabetic retinopathy, the leading cause of blindness among the middle-aged population. Angiostatin, a proteolytic fragment of plasminogen is one of the most promising inhibitors of angiogenesis currently in clinical trials. Here we show that recombinant angiostatin can inhibit retinal neovascularization in a mouse model of proliferative retinopathy. Because proliferative diabetic retinopathy is a recurrent disease, effective therapy will need to be sustained. Recombinant adeno-associated viruses permit long-term expression of transfected genes; however, they can only accommodate a small insert sequence. Thus, we engineered and tested a shortened recombinant angiostatin derivative containing a signal sequence to permit secretion. Recombinant protein was purified from the medium of transfected HEK293 cells and injected subcutaneously into treated animals. The retinal vasculature was analyzed in retinal flat mounts and using immunohistochemically stained sections. Both methods demonstrate that this short, secreted form of angiostatin is effective in reducing the development of blood vessels in a nontumor environment and has therapeutic potential for neovascular retinopathies such as diabetic retinopathy, retinopathy of prematurity, retinal vein occlusion and, possibly, age-related macular degeneration.

Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique.

Carbon dioxide (CO2) laser blepharoplasty with orbicularis oculi muscle tightening and periorbital skin resurfacing is a safe procedure that produces excellent aesthetic results and diminishes the occurrence of complications associated with skin and muscle resection in the lower lid, particularly permanent scleral show and ectropion. The authors present a review of 196 cases of carbon dioxide laser blepharoplasty and periocular laser skin resurfacing performed at their center from April of 1994 to September of 1998. Of these cases, 113 patients underwent four-lid blepharoplasty, 59 underwent upper lid blepharoplasty only, and 24 underwent lower lid blepharoplasty only. Prophylactic lateral canthopexy was performed in 24 patients. Concomitant procedures (brow lift/rhytidectomy/rhinoplasty) were performed in 92 patients. The carbon dioxide laser blepharoplasty procedure resulted in no injuries to the globe, cornea, or eyelashes. Combined with laser tightening of the orbicularis oculi muscle and septum and periocular skin resurfacing, the transconjunctival approach to lower blepharoplasty preserves lower lid skin and muscle. Elimination of the traditional scalpel skin/muscle flap procedure results in a dramatically lower complication rate, particularly with regard to permanent ectropion and scleral show. Laser shrinkage of the orbicularis muscle and septum through the transconjunctival incision enables the correction of muscle aging changes such as orbicularis hypertrophy and malar festoons. The addition of periocular resurfacing enables the correction of skin aging changes of the eyelid that are not addressed by traditional scalpel blepharoplasty. In addition, lateral canthopexy constitutes an important adjunct to the laser blepharoplasty procedure for the correction of lower lid canthal laxity.

DNA sequence motifs which direct adeno-associated virus site-specific integration in a model system.

The DNA sequence motifs which direct adeno-associated virus type 2 site-specific integration are being investigated using a shuttle vector, propagated as a stable episome in cultured cell lines, as the target for integration. Previously, we reported that the minimum episomal targeting elements comprise a 16-bp binding motif (Rep binding site [RBS]) for a viral regulatory protein (Rep) separated by a short DNA spacer from a sequence (terminal resolution site [TRS]) that can serve as a substrate for Rep-mediated nicking activity (R. M. Linden, P. Ward, C. Giraud, E. Winocour, and K. I. Berns, Proc. Natl. Acad. Sci. USA 93:11288-11294, 1996; R. M. Linden, E. Winocour, and K. I. Berns, Proc. Natl. Acad. Sci. USA 93:7966-7972, 1996). We now report that episomal integration depends upon both the sequence and the position of the spacer DNA separating the RBS and TRS motifs. The spacer thus constitutes a third element required for site-specific episomal integration.

Wound healing at the local level: the stunned wound.

Many factors can negatively impact the wound-healing process leading to recalcitrant wounds. Biochemical and cellular commonalties can be identified across a number of wound etiologies. Healing data for various wound etiologies are presented, but these outcomes fail to show significant differences. Tissue perfusion, debridement, and wound fluid management can all impact healing. This review article discusses these topics and introduces a theoretical concept, the "stunned wound."

Simplified production of a recombinant human angiostatin derivative that suppresses intracerebral glial tumor growth.

Angiostatin is an endogenous inhibitor of tumor neovascularization that inhibits the proliferation of endothelial cells. Production of sufficient quantities of biologically active angiostatin by the enzymatic cleavage of plasminogen has proven difficult in that it has delayed clinical testing. We have cloned, expressed, and purified a recombinant human angiostatin derivative (K1-3) using a mammalian expression system. Through the addition of a secretory signal and polyhistidine sequence tag, K1-3 can be purified from post-culture medium by simple column chromatography. Purified K1-3 protein is apparently folded in an active conformation, as evidenced by its ability to bind to lysine-Sepharose. In vitro, recombinant K1-3 significantly suppressed endothelial cell proliferation in a dose-dependent manner with an IC50 of 50 nM. Using an animal model of intracranial brain tumors in immune-competent rats, systemic administration of purified recombinant K1-3 resulted in up to 85% suppression of tumor growth (P = 0.011). Growth suppression was accompanied by a 32% decrease (P = 0.01) in tumor neovascularization. This study demonstrates a simple method to produce a biologically active recombinant angiostatin derivative. The ability to suppress intracerebral tumor growth after systemic administration suggests that K1-3 is likely to have therapeutic value in the treatment of malignant glial tumors.

Diabetic foot ulcers: A framework for prevention and care.

Complications secondary to diabetes, such as diabetic foot ulcers, continue to be a major worldwide health problem. At the same time, health care systems are changing rapidly, causing concern about the quality of patient care. While the ultimate effect of current changes on health care professionals and patient outcomes remain uncertain, measures commonly used to reduce costs, e.g., disease and multi- disciplinary management strategies, have been shown to help prevent the occurrence of diabetic ulcers. In addition, utilizing a multi- disciplinary approach, the principles of off-loading and optimal wound care, the vast majority of diabetic foot ulcers can be expected to heal within 12 weeks of treatment. Education of primary care providers and patients is paramount.

[Adult T cell leukemia lymphoma in Chile. A clinical pathologic and molecular study of 26 patients]. / Leucemia linfoma T del adulto en Chile. Estudio clínico-patológico y molecular de 26 pacientes.

BACKGROUND: Adult T cell leukemia lymphoma is a lymphoproliferative syndrome etiologically associated to human T cell lymphotropic virus type I. AIM: To describe the clinical and laboratory features of 26 Caucasian Chilean patients, with HTLV-I positive adult T-cell leukemia lymphoma (ATLL). MATERIAL AND METHODS: Diagnostic criteria included clinical features, cell morphology, immunophenotype, HTLV-I serology and/or DNA analysis by Southern blot or PCR. RESULTS: According to the clinical presentation, 12 cases had the acute ATLL form, 6 had a lymphoma, 4 the chronic form and 4 had smoldering ATLL. The median presentation age was 50 years, younger than the Japanese patients, but significantly older than patients from other South American countries (e.g. Brasil, Jamaica, Colombia). The main clinical features: lymphadenopathy, skin lesions and hepatosplenomegaly, were similar in frequency to those of patients from other countries, except for the high incidence of associated neurological disease. Tropical Spastic Paraparesis (TSP) in our series of ATLL, was seen in one third of the patients (8/26). A T-cell immunophenotype was shown in all 26 cases and HTLV-I serology was positive in 25/26 patients. Molecular analysis on the seronegative patient showed clonal integration of proviral HTLV-I DNA into the lymphocytes DNA, and thus he may have been a poor responder to the retroviral infection. Proviral DNA integration was also demonstrated in 15/16 patients being clonal in 10, polyclonal in 3 (all smoldering cases) and oligoclonal in one. CONCLUSIONS: ATLL in Chile has similar clinical and laboratory features than the disease in other parts of the world, except for a younger age than Japanese patients but older than those from other Latin American countries and a high incidence of patients with associated TSP. Detailed morphological and immunophenotypic analysis of the abnormal circulating lymphocytes, together with the documentation of HTLV-I by serology and/or DNA analysis are key tests for the identification of this disease.