MS imaging and absorption methods visualizing sun filter skin spatial distribution and penetration.

Sunscreens must now be effective in protecting skin from ultraviolet, as well as visible/infrared radiation. Here, TriAsorB, a new broad-spectrum sun filter, was formulated with three other sunscreens and their distribution on human skin was studied using a standard penetration protocol and two novel mass spectrometry imaging techniques: atmospheric pressure matrix assisted laser desorption ionization (AP-MALDI) coupled to high resolution mass spectrometry and time of flight - secondary ion mass spectrometry (ToF-SIMS). The standard penetration protocol showed that sun filters absorption was very low, with most of the dose recovered at the surface (none entered the receptor fluid). Absorption was not increased in damaged skin. The results were confirmed by AP-MALDI and ToF-SIMS imaging of the spatial distribution of molecular species in cross-section samples of human skin. Each sun filter was detected on or in the stratum corneum, with a good homogenous coverage over the valleys and peaks of the skin, and correlated well with the distribution of endogenous biomarkers. In conclusion, conventional and novel imaging analysis methods showed that the sun filters remained mainly on the skin surface after topical application. Mass spectrometry imaging is a promising complementary approach to traditional skin penetration studies to visualize penetration of compounds.

A French retrospective study on clinical outcome in 102 choroid plexus tumors in children.

The aim of this study was to review and describe therapeutic approaches in children with choroid plexus tumor (CPT) based on a nationwide series. The World Health Organization classification subdivides these rare tumors into three histological subtypes corresponding to three grades of malignancy: low grade (grade I) choroid plexus papilloma (CPP), intermediate grade (grade II) atypical choroid plexus papilloma (aCPP) and high grade (grade III) choroid plexus carcinoma (CPC). This retrospective study included 102 French children younger than 18 years, treated from 2000 to 2012: 54 CPP, 26 aCPP and 22 CPC. The 5 year overall survival was 100% in CPP, 96.2% in aCPP and 64.7% in CPC. In patients with localized disease, complete surgical resection was achieved in 48/52 CPP, 20/26 aCPP and 7/14 CPC. In this group, patients with complete surgical resection had better event free survival than patients with partial resection (88.9 vs. 41.6%). 28 patients (1 CPP, 6 aCPP and 22 CPC) had adjuvant chemotherapy. 2 aCPP and 9 CPC had radiotherapy. We underlined the need for a central histological review to accurately analyze clinical data; we reported a much higher overall survival for CPC than in most previous CPT series probably including atypical teratoid rhabdoid tumors. In our series, the 5 years overall survival in CPC (64.7%) was higher than event free survival (25.2%) and could be interpreted as a clue for the efficiency of adjuvant/salvage therapy even if the heterogeneity of applied treatments in this retrospective series does not allow for meaningful statistical comparisons.

High-throughput microsatellite genotyping in ecology: improved accuracy, efficiency, standardization and success with low-quantity and degraded DNA.

Microsatellite markers have played a major role in ecological, evolutionary and conservation research during the past 20 years. However, technical constrains related to the use of capillary electrophoresis and a recent technological revolution that has impacted other marker types have brought to question the continued use of microsatellites for certain applications. We present a study for improving microsatellite genotyping in ecology using high-throughput sequencing (HTS). This approach entails selection of short markers suitable for HTS, sequencing PCR-amplified microsatellites on an Illumina platform and bioinformatic treatment of the sequence data to obtain multilocus genotypes. It takes advantage of the fact that HTS gives direct access to microsatellite sequences, allowing unambiguous allele identification and enabling automation of the genotyping process through bioinformatics. In addition, the massive parallel sequencing abilities expand the information content of single experimental runs far beyond capillary electrophoresis. We illustrated the method by genotyping brown bear samples amplified with a multiplex PCR of 13 new microsatellite markers and a sex marker. HTS of microsatellites provided accurate individual identification and parentage assignment and resulted in a significant improvement of genotyping success (84%) of faecal degraded DNA and costs reduction compared to capillary electrophoresis. The HTS approach holds vast potential for improving success, accuracy, efficiency and standardization of microsatellite genotyping in ecological and conservation applications, especially those that rely on profiling of low-quantity/quality DNA and on the construction of genetic databases. We discuss and give perspectives for the implementation of the method in the light of the challenges encountered in wildlife studies.

Health education for prevalent problems in prison, Ocaña-I proyect (Spain).

OBJECTIVE: Pilot project focusing on the implementation and evaluation of a health education (HE) program for inmates of the prison of Ocaña I (Spain). The objective was to analyze the intentions for change in health habits and perceptions, and to assess whether the HE-program had differential effects depending on whether the participants belonged to the PAIEM or not and their socio-demographic characteristics. METHODOLOGY: The participants were 65 men, who answered an ad hoc questionnaire at the end of each session. Data analysis applied was univariate and bivariate (one-way ANOVA, t-test for Equality of Means and Chi-Square test). RESULTS: The average rating of the sessions was 3.51 out of 4 (SD = 0.62). The percentage of positive answers about the intention to adopt healthy habits was higher among non-PAIEM subjects (84.8%) than among those who were part of this program (57.9%). All subjects having a couple indicated an intention to change negative habits, compared to 67.3% for those without a couple. The percentage of subjects who said that their perception on the issue had changed was highest among those without education (89.7%) than among those with education (61.5%). CONCLUSIONS: The evaluation of implanted HE-program implemented in the Ocaña I prison was very positive, there are differences between subjects belonging to the PAIEM and those who do not.

Mental disorder prevalence and associated risk factors in three prisons of Spain.

AIMS: To determine the lifetime and monthly prevalence of people with mental disorders and its association with sociodemographic factors and criminal risk in three Spanish prisons (Ocaña, Madrid I, II and VI). METHOD: Cross-sectional epidemiological study of a sample of 184 inmates. Socio-demographic and criminal data were collected by an ad hoc interview. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis I Disorders (SCID-I). RESULTS: Life prevalence of mental disorders was 90.2%. The most common mental disorders and substance abuse or dependence was 72.3%, followed by mood disorder (38.5%) and psychotic disorders (34.2%). Moreover, the prevalence of any mental disorder in the last month was 52.2%. The main psychotic disorder (20.7%) was followed by substance abuse or dependence (18.5%), and mood disorder state (13%). A socio-demographic profile as a risk for each disorder was found. DISCUSSION: The prevalence of people with mental disorders is very high in Spanish prisons, and is associated with a distinct demographic profile. It is essential to continue researching this reality, translating the results into therapeutic and preventive action adapted to the status of inmates to reduce social inequalities in this high priority public health situation.

Prevalencia de trastorno mental y factores de riesgo asociados en tres prisiones de España / Mental disorder prevalence and associated risk factors in three prison of Spain

Objetivos: Conocer la prevalencia vida y prevalencia mes de personas con trastorno mental y su asociación con factores de riesgo sociodemográficos y penales en tres centros penitenciarios de España (Ocaña I y II y Madrid VI). Material y Método: Estudio epidemiológico descriptivo transversal con una muestra de 184 internos. Los datos sociodemográficos y penales se recogieron mediante una entrevista ad hoc. Los trastornos mentales se evaluaron con la versión clínica de la Structured Clinical Interview for Diagnostic and Statical Manual of Mental Disorders Axis I Disorders (SCID-I). Resultados: La prevalencia vida de trastorno mental fue del 90,2%, siendo los trastornos mentales más frecuentes el abuso o dependencia de sustancias (72,3%), seguidos de los trastornos del estado de ánimo (38,5%) y los trastornos psicóticos (34,2%). La prevalencia de cualquier trastorno mental en el último mes fue del 52,2%, siendo el principal trastorno el psicótico (20,7%) seguido del abuso o dependencia de sustancias (18,5%), y del trastorno del estado de ánimo (13%). Para cada uno de los trastornos se encontró un perfil sociodemográfico como factor de riesgo. Discusión: La prevalencia de las personas con trastorno mental es muy elevada en las prisiones españolas, estando asociada a un perfil sociodemográfico característico. Es esencial continuar investigando esta realidad, traduciendo los resultados en acciones de tipo terapéutico y preventivo, adaptadas al estatus de los internos para reducir las desigualdades sociales en esta situación prioritaria de Salud Pública (AU)

Aims: To determine the lifetime and monthly prevalence of people with mental disorders and its association with socio-demographic factors and criminal risk in three Spanish prisons (Ocaña, Madrid I, II and VI). Method: Cross-sectional epidemiological study of a sample of 184 inmates. Socio-demographic and criminal data were collected by an ad hoc interview. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis I Disorders (SCID-I). Results: Life prevalence of mental disorders was 90.2%. The most common mental disorders and substance abuse or dependence was 72.3%, followed by mood disorder (38.5%) and psychotic disorders (34.2%). Moreover, the prevalence of any mental disorder in the last month was 52.2%. The main psychotic disorder (20.7%) was followed by substance abuse or dependence (18.5%), and mood disorder state (13%). A socio-demographic profile as a risk for each disorder was found. Discussion: The prevalence of people with mental disorders is very high in Spanish prisons, and is associated with a distinct demographic profile. It is essential to continue researching this reality, translating the results into therapeutic and preventive action adapted to the status of inmates to reduce social inequalities in this high priority public health situation (AU)

Respuesta a la carta del director. Sobre el artículo «Prevalencia de trastorno mental y factores de riesgo asociados en tres prisiones de España» / Response to the letter to the editor. About the «Prevalence of mental disorders and associated risk factors in three correctional facilities in Spain»

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Educacion para la salud en los problemas prevalentes del medio penitenciario, proyecto en Ocaña-I (España) / Health education for prevalent problems in prison, Ocaña-I proyect (Spain)

Objetivo: Proyecto piloto centrado en la implantación y evaluación de un programa de Educación para la Salud (EpS) en internos del Centro Penitenciario Ocaña I (España). El objetivo fue analizar las intenciones de cambio en los hábitos de salud y en la percepción, así como evaluar si el programa de EpS tenía efectos diferenciales dependiendo de si los participantes pertenecían o no al Programa de Atención Integral al Enfermo Mental (PAIEM) y de sus características sociodemográficas. Metodología: Los participantes fueron 65 varones que respondieron a un cuestionario ad hoc al finalizar cada sesión. Los análisis fueron univariantes y bivariantes (ANOVA de un factor, prueba t y test de independencia Chi-Cuadrado). Resultados: La valoración media de las sesiones fue de 3,51 sobre 4 (DE = 0,62). Las respuestas afirmativas sobre la intención de adoptar hábitos saludables fueron mayores entre los sujetos no pertenecientes al PAIEM (84,8%) que entre los que sí formaban parte del mismo (57,9%). Todos los sujetos con pareja indicaron tener intención de cambiar los hábitos negativos, frente al 67,3% entre aquellos sin pareja. El cambio en la percepción sobre el tema fue más alto entre los que no tenían estudios (89,7%) que entre aquellos que sí los tenían (61,5%). Conclusiones: La evaluación del programa de EpS implantado en el Centro Penitenciario Ocaña I fue muy positiva, existiendo diferencias entre los sujetos pertenecientes al PAIEM y los que no (AU)

Objective: Pilot project focusing on the implementation and evaluation of a health education (HE) program for inmates of the prison of Ocaña I (Spain). The objective was to analyze the intentions for change in health habits and perceptions, and to assess whether the HE-program had differential effects depending on whether the participants belonged to the PAIEM or not and their socio-demographic characteristics. Methodology: The participants were 65 men, who answered an ad hoc questionnaire at the end of each session. Data analysis applied was univariate and bivariate (one-way ANOVA, t-test for Equality of Means and Chi-Square test). Results: The average rating of the sessions was 3.51 out of 4 (SD = 0.62). The percentage of positive answers about the intention to adopt healthy habits was higher among non-PAIEM subjects (84.8%) than among those who were part of this program (57.9%). All subjects having a couple indicated an intention to change negative habits, compared to 67.3% for those without a couple. The percentage of subjects who said that their perception on the issue had changed was highest among those without education (89.7%) than among those with education (61.5%). Conclusions: The evaluation of implanted HE-program implemented in the Ocaña I prison was very positive, there are differences between subjects belonging to the PAIEM and those who do not (AU)

DNA metabarcoding multiplexing and validation of data accuracy for diet assessment: application to omnivorous diet.

Ecological understanding of the role of consumer-resource interactions in natural food webs is limited by the difficulty of accurately and efficiently determining the complex variety of food types animals have eaten in the field. We developed a method based on DNA metabarcoding multiplexing and next-generation sequencing to uncover different taxonomic groups of organisms from complex diet samples. We validated this approach on 91 faeces of a large omnivorous mammal, the brown bear, using DNA metabarcoding markers targeting the plant, vertebrate and invertebrate components of the diet. We included internal controls in the experiments and performed PCR replication for accuracy validation in postsequencing data analysis. Using our multiplexing strategy, we significantly simplified the experimental procedure and accurately and concurrently identified different prey DNA corresponding to the targeted taxonomic groups, with ≥ 60% of taxa of all diet components identified to genus/species level. The systematic application of internal controls and replication was a useful and simple way to evaluate the performance of our experimental procedure, standardize the selection of sequence filtering parameters for each marker data and validate the accuracy of the results. Our general approach can be adapted to the analysis of dietary samples of various predator species in different ecosystems, for a number of conservation and ecological applications entailing large-scale population level diet assessment through cost-effective screening of multiple DNA metabarcodes, and the detection of fine dietary variation among samples or individuals and of rare food items.

Involvement of small ArfGAP1 (SMAP1), a novel Arf6-specific GTPase-activating protein, in microsatellite instability oncogenesis.

Small ArfGAP1 (stromal membrane-associated protein 1, SMAP1), a GTPase-activating protein specific for ADP-ribosylation factor 6 (Arf6), which is a small GTPase acting on membrane trafficking and actin remodeling, is frequently mutated in various tumors displaying microsatellite instability (MSI), notably in MSI colorectal cancers (CRC). Genotyping of 93 MSI CRCs (40 stage II, 32 stage III and 21 stage IV) allowed us to underscore that SMAP1 mutation frequency was inversely correlated with disease stage (P=0.01). Analysis of 46 cancer cell lines showed that SMAP1 mutations occurred only in MSI tumors, and consisted exclusively in short insertion or deletion in the coding 10-adenine repeat, generating a premature termination codon located downstream the ArfGAP domain. SMAP1 transcript levels were significant decreased (P=0.006), and truncated SMAP1 protein could not be detected in cells displaying biallelic SMAP1 mutations, owing to its sensitivity to proteasome degradation. To investigate the role of SMAP1 mutations, we used the SMAP1-null HCT116 cell line and we established three isogenic SMAP1-complemented clones. Cell proliferation was first assessed in vivo using subcutaneous xenografts into immunodeficient mice. Tumors developed in all animals regardless of the cell line injected, but tumor volumes were significantly smaller for both SMAP1-complemented clones compared with HCT116 (P<0.0001, at the time of killing). In vitro, SMAP1 mutations also increased cell clonogenicity (P=0.02-0.04), cell proliferation (P=0.008) by shortening the G2/M phase and decreased cell invasiveness (P=0.03-0.003). In keeping, SMAP1-complemented HCT116 gained several mesenchymal markers (Snail, Slug and vimentin) considered as a hallmark of epithelial-to-mesenchymal transition. These observations are reminiscent of some clinical characteristics of MSI CRCs, notably their larger size and lower rate of metastasis. Our observations suggest that SMAP1 loss-of-function mutations in MSI CRC may contribute to the emerging oncogenic pathway involving abnormal Arf6 regulation.

La insuficiencia venosa crónica en el Sistema Nacional de Salud. Diagnóstico, indicaciones quirúrgicas y priorización de listas de espera. Documento de la Sociedad Española de Angiología y Cirugía Vascular (SEACV) y del Capítulo de Flebología y Linfología de la SEACV / Chronic venous insufficiency in the National Health System. Diagnosis, surgical indications and waiting list priorities. A document from the Spanish Association of Angiology and Vascular Surgery (SEACV) and the SEACV Phlebology Chapter

En un entorno de recursos limitados y de crisis, es importante clarificar las indicaciones absolutas y relativas de la cirugía de las varices para garantizar dicha prestación dentro del Sistema Nacional de Salud (SNS) en los casos necesarios y con los máximos criterios científicos disponibles. La Sociedad Española de Angiología y Cirugía Vascular (SEACV), como depositaria de la representatividad profesional, científica y/o técnica de todos sus socios en relación con las administraciones sanitarias, está obligada a estudiar y analizar las necesidades actuales y/o futuras que se presenten en la población de su ámbito, con respecto a la demanda de la especialidad. Presentamos un documento oficial de la SEACV y de su Capítulo Español de Flebología y Linfología (CEFyL) que sienta las bases científicas de la patología venosa y los criterios a tener en cuenta en el momento de valorar su aplicación futura en el SNS(AU)

In an environment with limited resources and a crisis, it is important to clarify the absolute and relative surgical indications of varicose veins, in order to guarantee this service within the National Health System in necessary cases, and with the maximum scientific criteria available. The Spanish Association of Angiology and Vascular Surgery (SEACV,), as the office that represents the professional, scientific and/or technical aspects of all its members with the Health Administrations, is obliged to study and analyse the current and future needs of the population in its area, as regards the demands of the Specialty. We present an official document by SEACV and its Spanish Chapter of Phlebology and Lymphology (CEFandL) that sets the scientific basis of venous pathology and the criteria to take into account when assessing its future application with the National Health System(AU)

DNA from soil mirrors plant taxonomic and growth form diversity.

Ecosystems across the globe are threatened by climate change and human activities. New rapid survey approaches for monitoring biodiversity would greatly advance assessment and understanding of these threats. Taking advantage of next-generation DNA sequencing, we tested an approach we call metabarcoding: high-throughput and simultaneous taxa identification based on a very short (usually <100 base pairs) but informative DNA fragment. Short DNA fragments allow the use of degraded DNA from environmental samples. All analyses included amplification using plant-specific versatile primers, sequencing and estimation of taxonomic diversity. We tested in three steps whether degraded DNA from dead material in soil has the potential of efficiently assessing biodiversity in different biomes. First, soil DNA from eight boreal plant communities located in two different vegetation types (meadow and heath) was amplified. Plant diversity detected from boreal soil was highly consistent with plant taxonomic and growth form diversity estimated from conventional above-ground surveys. Second, we assessed DNA persistence using samples from formerly cultivated soils in temperate environments. We found that the number of crop DNA sequences retrieved strongly varied with years since last cultivation, and crop sequences were absent from nearby, uncultivated plots. Third, we assessed the universal applicability of DNA metabarcoding using soil samples from tropical environments: a large proportion of species and families from the study site were efficiently recovered. The results open unprecedented opportunities for large-scale DNA-based biodiversity studies across a range of taxonomic groups using standardized metabarcoding approaches.

Utility of Ki67 immunostaining in the grading of pineal parenchymal tumours: a multicentre study.

AIMS: Pineal parenchymal tumours (PPTs) are rare neoplasms that are divided into pineocytoma (PC), pineoblastoma (PB) and PPT of intermediate differentiation (PPTID). Factors affecting the survival of patients with PPTs are morphological subtype and histological grading according to mitotic index and neurofilament immunostaining. Grading criteria to distinguish PPTIDs are difficult to define, particularly when using small specimens. The Ki67 labelling index (LI) might be helpful in distinguishing between grade II and III PPTIDs. Our study was performed to assess the predictive value of the Ki67 LI in a large cooperative series of PPTs and to evaluate whether inclusion of this data would improve and refine the World Health Organization classification. METHODS: A retrospective analysis of 33 PPTs was performed. The histological features of the tumours were reviewed and Ki67 LI scoring was evaluated by immunohistochemistry. Data were correlated with the patients' survival. RESULTS: The mean Ki67 LI was significantly different for tumour grades (0 in PC, 5.2 ± 0.4 in PPTID grade II, 11.2 ± 2.0 in PPTID grade III, 36.4 ± 6.2 in PB; P < 0.0001). However, there was no statistically significant difference in either overall or disease-free survival evaluated by the Kaplan-Meier method for patients with different grade tumours or Ki67 LI, possibly due to the different clinical management of patients in different centres. CONCLUSIONS: The Ki67 LI may be a useful additional tool for grading PPTs, more particularly in small tumour samples.

Documento de Consenso interdisciplinar para el tratamiento de la fibromialgia / Interdisciplinary Consensus Document for the treatment of fibromyalgia

Antecedentes. La elevada prevalencia y enorme impacto clínico y social de la fibromialgia, junto a la complejidad de su tratamiento, exigen consensos de actuación que sirvan de guía a los profesionales de la salud. Aunque existían algunos documentos similares en nuestro idioma, la mayoría habían sido realizados desde la perspectiva de una única disciplina. Objetivo. Desarrollar un consenso sobre el tratamiento de la fibromialgia realizado por representantes seleccionados y avalados por las principales sociedades médicas que intervienen en su tratamiento (reumatología, neurología, psiquiatría, rehabilitación y medicina de familia), así como representantes de las asociaciones de pacientes. Por otra parte, se enfatizó la comprensión de la enfermedad no como un trastorno homogéneo, sino como la suma de diferentes subtipos clínicos, con características sintomáticas específicas y necesidades terapéuticas distintas. Este abordaje representaba una necesidad percibida por los clínicos y una novedad respecto a consensos previos. Método. Se revisaron las diferentes clasificaciones clínicas que se han propuesto en fibromialgia, así como la evidencia científica de los tratamientos utilizados en esta enfermedad. Para la selección de la clasificación empleada y para la realización de las recomendaciones terapéutica, se emplearon algunas de las técnicas habituales para realizarlos consensos (grupo nominal y brainstorming). Conclusión. La clasificación de Giesecke de la fibromialgia en 3 subgrupos parece ser la que cuenta con mayor evidencia científica y la más útil para el clínico. La guía ofrece una serie de recomendaciones generales para todos los pacientes con fibromialgia. Pero, además, para cada subgrupo existen una serie de recomendaciones específicas de tipo farmacológico, psicológico y de modificación del entorno, que permitirán un abordaje personalizado del paciente con fibromialgia en dependencia de sus características clínicas individuales (dolor, depresión, niveles de catastrofización, etc) (AU)

Backgrounds. The elevated prevalence and enormous clinical and social impact of fibromyalgia, together with the complexity of its treatment, require action consensuses that guide health care professionals. Although there are some similar documents in our language, most have been made from the perspective of a single discipline. Objective. To develop a consensus on the treatment of fibromyalgia made by selected representatives and supported by the principal medical associations that intervene in its treatment (rheumatology, neurology, psychiatry, rehabilitation and family medicine) and representatives of the associations of patients. On the other hand, understanding the disease not as a homogenous disorders but also as the sum of different clinical subtypes, having specific symptomatic characteristics and different therapeutic needs is stressed. This approach represented a need perceived by the clinicians and a novelty regarding previous consensuses. Methods. The different clinical classifications proposed in fibromyalgia and the scientific evidence of the treatments used in this disease were reviewed. For the selection of the classification used and performance of the therapeutic recommendations, some of the usual techniques to obtain the consensus (nominal group and brainstorming) were used. Conclusion. The classification of Giesecke of fibromyalgia into 3 subgroups seems to have the greatest scientific evidence and the most useful for the clinician. The guide offers a series of general recommendations for all the patients with fibromyalgia. However, in addition, for each subgroup, there are a series of specific pharmacological and psychological-type recommendations and those of modification of the environment, which will make it possible to have a personalized approach to the patient with fibromyalgia in accordance with their individual clinical characteristics (pain, catastrophizing levels, etc.) (AU)

[Evolution of third-generation cephalosporin resistance in Enterobacteriaceae from 2000 to 2008 in a Perpignan hospital]. / Evolution de la résistance des entérobactéries aux céphalosporines de troisième génération de 2000 à 2008 au centre hospitalier de Perpignan.

The aim of this work was to evaluate the evolution of Enterobacteriaceae resistance to third generation cephalosporin (3CG) from 2000 to 2008 at Perpignan hospital. Were observed: the percentage of strains isolated from short stay wards, intensive care unit and medium and long-term care facility. The percentage of strains isolated from: urine, suppuration, tracheal aspiration, and blood have been evaluated. The proportion of Escherichia coli (E. coli) strains among the Enterobacteriaceae strains intermediate (I) or resistant (R) to 3GC was also evaluated.The number of Enterobacteriaceae intermediated (I) or resistant (R) to 3GC increased (402 %).The distribution of species I or R to 3GC has changed, decrease of Klebsielle pneumoniae and Enterobacter aeorogenes species, Escherichia.coli and Enterobacter cloacae became dominant in 2008. We noted the change of isolated species distribution, urines represent the main source of multiresistant Enterobacteriaceae (MRE), 72 % of strains. The profile of patients colonised or infected by MRE has changed. Patients mainly infected with hospital acquirred MRE changed to MRE colonised patients carrying the strain into the hospital. The association of fluorinated quinolone resistance and Extended-Spectrum Beta-Lactamase Enterobacteriaceae represented 51 % in 2000, became stable at 73 % from 2002. The association of fluorinated quinolone resistance and high-level Enterobacteriaceae cephalosporinase has increased from 21 % in 2000 to be stable at 50 % since 2006. The mesures to contain the spread of MRE strains remained inefficient because of outpatients circulation, multiresistant E. coli being community species.

Interdisciplinary consensus document for the treatment of fibromyalgia.

Backgrounds. The elevated prevalence and enormous clinical and social impact of fibromyalgia, together with the complexity of its treatment, require action consensuses that guide health care professionals. Although there are some similar documents in our language, most have been made from the perspective of a single discipline.Objective. To develop a consensus on the treatment of fibromyalgia made by selected representatives and supported by the principal medical associations that intervene in its treatment (rheumatology, neurology, psychiatry,rehabilitation and family medicine) and representatives of the associations of patients. On the other hand, understanding the disease not as a homogenous disorders but also as the sum of different clinical subtypes,having specific symptomatic characteristics and different therapeutic needs is stressed. This approach represented a need perceived by the clinicians and a novelty regarding previous consensuses.Methods. The different clinical classifications proposed in fibromyalgia and the scientific evidence of the treatments used in this disease were reviewed. For the selection of the classification used and performance of the therapeutic recommendations, some of the usual techniques to obtain the consensus (nominal group and brainstorming) were used.Conclusion. The classification of Giesecke of fibromyalgia into 3 subgroups seems to have the greatest scientific evidence and the most useful for the clinician. The guide offers a series of general recommendations for all the patients with fibromyalgia. However, in addition, for each subgroup, there are a series of specific pharmacological and psychological-type recommendations and those of modification of the environment, which will make it possible to have a personalized approach to the patient with fibromyalgia in accordance with their individual clinical characteristics (pain, catastrophizing levels, etc.).

Un proyecto de evaluación de resultados en psicoterapia psicoanalítica infanto-juvenil / A Project of evaluation of results in child and adolescent psychoanalytic psychotherapy

La evaluación de los tratamientos de psicoterapia psicoanalítica infantil es el objetivo principal de este trabajo. Del análisis de las variables de la población en tratamiento se destaca que aquellas psicoterapias que obtienen mejores resultados son las que su duración se acerca más a la preestablecida, las que se realizan en población de menor edad y en paciente con trastornos en que la ansiedad ocupa en papel predominante en la sintomatología clínica que presentan (AU)

This paper presents a Project of evaluation of child psychoanalytical psychotherapy treatments. The data analysis of the population studied revealed that psychotherapies obtaining the best results were those psychotherapies whose length came closest to the pre-established length, those undertaken with the youngest population groups and those with patients where anxiety had a predominant role amongst clinical symptoms (AU)

[Nontumoral epileptogenic lesions]. / Les lésions épileptogènes non tumorales.

Nontumoral epileptogenic lesions account for the major pathological group of surgical specimens obtained from patients with temporal or extratemporal drug-resistant epilepsy. Hippocampal sclerosis remains the predominant etiology, but cerebral cortical dysplasias actually make up the second major cause of nontumoral epilepsy and are increasingly recognized. The percentage of vascular lesions or glial/glio-mesodermal scars remains stable, but the minor or nonspecific lesion group is decreasing because of imaging investigation technique improvement.

Frequent alteration of DNA damage signalling and repair pathways in human colorectal cancers with microsatellite instability.

Accumulation of frameshift mutations at genes containing coding mononucleotide repeats is thought to be the major molecular mechanism by which mismatch repair-deficient cells accumulate functional alterations. These mutations resulting from microsatellite instability (MSI) can affect genes involved in pathways with a putative oncogenic role, but may also arise in genes without any expected role in MSI carcinogenesis because of the high mutation background of these tumours. We here screened 39 MSI colorectal tumours for the presence of mutations in 25 genes involved in DNA damage signalling and repair pathways. Using a maximum likelihood statistical method, these genes were divided into two different groups that differed significantly in their mutation frequencies, and likely represent mutations that do or do not provide selective pressure during MSI tumour progression. Interestingly, the so-called real-target mutational events were found to be distributed among genes involved in different functional pathways of the DNA metabolism, for example, DNA damage signalling (DNA-PKcs, ATR), double-strand break (DSB) repair (DNA-PKcs, RAD50), mismatch repair (MSH3, MSH6, MBD4) and replication (POLD3). In particular, mutations in MRE11 and/or RAD50 were observed in the vast majority of the tumours and resulted in the concomitant loss of immunohistochemical expression of both proteins. These data might explain why MSI colorectal cancers (CRC) behave differently in response to a wide variety of chemotherapeutic agents, notably those targeting DNA. More generally, they give further insights into how MSI leads to functional changes with synergistic effects in oncogenic pathways.