Elevated blood metal ion levels in patients undergoing instrumented spinal surgery: a systematic review and meta-analysis.

BACKGROUND CONTEXT: Elevated blood metal levels have been reported in patients after spinal surgery using metallic implants. Although some studies have suggested an association between heightened blood metal concentrations and potential adverse effects, estimates of the incidence of abnormal metal levels after spinal surgery have been inconsistent. PURPOSE: The aims of this systematic review and meta-analysis were to assess: (1) mean differences in blood metal ion levels between patients undergoing spinal fusion surgery and healthy controls, (2) odds of elevated blood metal ion levels after surgery compared to presurgery levels, and (3) pooled incidence of elevated blood metal ions overall and by metal type. STUDY DESIGN: Systematic review and meta-analysis. PATIENTS SAMPLE: The patient sample included 613 patients from 11 studies who underwent spinal surgery instrumentation. OUTCOME MEASURES: Blood metal ion concentrations and the incidence of patients with elevated metal levels compared with in those the control group. METHODS: A comprehensive search was conducted in PubMed, EMBASE, Scopus, and Cochrane Library to identify studies reporting blood metal ion levels after spinal fusion surgery. Mean differences (MD), odds ratios (OR), and incidence rates were pooled using random effects models. Heterogeneity was assessed using I2 statistics, and fixed-effects models were used if no heterogeneity was detected. Detailed statistical analysis was performed using the Review Manager version 5.4 software. RESULTS: The analysis included 11 studies, with a total of 613 patients. Mean blood metal ion levels were significantly higher after spinal fusion surgery (MD 0.56, 95% CI 0.17-0.96; I2=86%). Specifically, titanium levels were significantly elevated (MD 0.81, 95% CI 0.32-1.30; I2=47%). The odds of elevated blood metal ions were higher after surgery (OR 8.17, 95% CI 3.38-19.72; I2=41%), primarily driven by chromium (OR 23.50, 95% CI 5.56-99.31; I2=30%). The incidence of elevated chromium levels was found to be 66.98% (95% CI 42.31-91.65). CONCLUSION: In conclusion, blood metal ion levels, particularly titanium and chromium, were significantly increased after spinal fusion surgery compared to presurgery levels and healthy controls. Approximately 70% of the patients exhibited elevated blood levels of chromium and titanium.

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis.

PURPOSE: The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. METHODS: PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. RESULTS: A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10 years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8 years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. CONCLUSIONS: This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28 years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study.

BACKGROUND: With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS: National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS: We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS: One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.

Retinal Nerve Fiber Layer Analysis in Children With Migraine With and Without Aura Using Optical Coherence Tomography: A Case-Control Study.

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness in children with migraine, with and without aura, compared to healthy controls using optical coherence tomography (OCT). METHODS: In this cross-sectional case-control study, patients with a diagnosis of migraine with aura (MwA) or without aura (MwoA) were considered and healthy children were included as controls. Age, sex, duration of migraine, number of episodes per month, duration of episodes, and use of prophylactic treatment with magnesium were recorded. All patients underwent complete ophthalmologic, neurologic, and pediatric examination. Optic nerve OCT images were obtained using Heidelberg Spectralis OCT (Heidelberg Engineering) and mean global RNFL thickness and the average thickness for each sector were noted. RESULTS: Thirty-seven children were included: 17 with migraine (9 MwoA and 8 MwA) and 20 controls, the mean age being 13.8 ± 2.9 (range: 8 to 16) and 13.4 ± 2.5 (range: 7 to 16) years, respectively. No significant differences in RNFL thickness were found when comparing all patients who had migraine with healthy controls. However, children with MwA showed statistically significant reductions in RNFL thickness in the temporal (mean difference: 7.83; 95% CI: 0.52 to 15.14, P = .027) and inferior-temporal (mean difference: 16.06; 95% CI: 1.95 to 30.16, P = .027) sectors compared to patients with MwoA. None of the other sectors showed statistically significant differences between groups (all P > .05). In the migraine group, negative correlations were detected between the number of episodes per month and RNFL thickness in the nasal-superior quadrant (r = -.420; P = .021). CONCLUSIONS: Children with MwA may present a decrease in RNFL thickness, which is associated with the number of episodes per month. [J Pediatr Ophthalmol Strabismus. 2023;60(3):196-202.].

Epidemiological Aspects of Maternal and Congenital Toxoplasmosis in Panama.

In Panama, epidemiological data on congenital toxoplasmosis are limited, making it difficult to understand the scope of clinical manifestations in the population and factors that may increase the risk of infection. This study provides insight into the epidemiological situation of maternal and congenital toxoplasmosis in Panama and contributing information on the burden of this disease in Central America. Blood samples were collected from 2326 pregnant women and used for the detection of anti-T. gondii antibodies. A high seroprevalence (44.41%) was observed for T. gondii infection in pregnant women from different regions of Panama, with an estimated incidence rate of congenital toxoplasmosis of 3.8 cases per 1000 live births. The main risk factors associated with T. gondii infection using bivariate statistical analysis were an elementary level education and maternal age range of 34-45 years. Multivariate statistical analyses revealed that in some regions (San Miguelito, North and West regions), the number of positive cases correlated with the presence of pets, stray dogs and the consumption of poultry. In other regions (East and Metropolitan regions), the absence of pets was considered a protective factor associated with negative cases, while the presence of stray cats and the age range of 25-34 years did not represent any risk in these regions.

Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study.

INTRODUCTION: Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS: A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS: 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS: In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.

Impacto de políticas de vigilancia en el uso de antibióticos en sala de neonatología del Hospital del Niño, Dr. José Renán Esquivel, Panamá julio 2015 a junio 2016 / Impact of surveillance policies on the use of antibiotics in the neonatal ward of the Hospital del Niño, Dr. José Renán Esquivel, Panama July 2015 to June 2016.

Introducción: Los antibióticos son los medicamentos más comúnmente utilizados en las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue evaluar el impacto de la implementación de intervenciones sobre el uso de antibióticos en la sala de neonatología del Hospital del Niño Dr. José Renán Esquivel. Panamá, República de Panamá. Materiales y métodos: En este estudio se realizó una evaluación retrospectiva del uso de antibióticos en dos períodos, antes y después de la implementación de intervenciones en las políticas de uso de antibióticos. El uso de antibióticos se cuantificó por días de tratamiento (DDT) días de tratamiento antibiótico / 1000 días-paciente y dosis de tratamiento antibiótico (DOT) / 1000 días- paciente. El análisis estadístico de las frecuencias en ambos períodos se realizó mediante el valor de X2. Se aceptó como significancia estadística valores de p <0.05 para intervalos de confianza del 95%. Resultados:  Obtuvimos una muestra de 600 recién nacidos para los dos períodos y de estos ingresaron a nuestro estudio 555 recién nacidos. El 60.35 % de los recién nacidos que ingresaron al estudio en el primer período recibieron antibióticos y un 52.96% en el segundo grupo de estudio. Al realizar el análisis de proporciones en DOT y DDT de ambos períodos hubo una diferencia estadísticamente significativa en el DOT y DDT luego de las intervenciones en el uso de antibióticos. (p ≤ 0.001). Observamos una disminución en el número de cursos de antibióticos ( 2 ó más) de 41 (23.8%) a 22 (15.3%) entre el primer y segundo período. Los antibióticos más usados en ambos grupos de estudio fueron la ampicilina y la gentamicina. Conclusión: Hubo una diferencia estadísticamente significativa en el análisis de las proporciones de DOT y DDT luego de las intervenciones en las políticas de uso de antibióticos.

Introduction: Antibiotics are the drugs most commonly used in neonatal intensive care units (NICU). The objective of this study was to evaluate the impact of the implementation of interventions on the use of antibiotics in the neonatal unit of the Children Hospital "Dr. José Renán Esquivel" Materials and methods: This study was a retrospective evaluation of the use of antibiotics in two periods, before and after the implementation of interventions in antibiotic use policies. The use of antibiotics was quantified by days of treatment (DDT), days of antibiotic treatment / 1000 patient days and dose of antibiotic treatment (DOT) / 1000 patient days. The statistical analysis of the frequencies in both periods was carried out using the value of X2. Values ​​of p <0.05 for 95% confidence intervals were accepted as statistical significance. Results: We obtained a sample of 600 newborns for the two periods and of these 555 newborns entered our study. 60.35% of the newborns that entered the study in the first period received antibiotics and 52.96% in the second study group. When performing the analysis of proportions in DOT and DDT of both periods there was a statistically significant difference in DOT and DDT after the interventions in the use of antibiotics. (p ≤ 0.001). We observed a decrease in the number of antibiotics course of 41 (23.8%) received two or more courses of antibiotics in the first period and in the second to 22 (15.3%). The antibiotics most used in both periods were ampicillin and gentamicin. Conclusion: There was a statistically significant difference in the analysis of the proportions of TOD and DDT after interventions in antibiotic use policies.

IgG4-Related Disease: Results From a Multicenter Spanish Registry.

IgG4-related disease (IgG4-RD) is a rare entity consisting of inflammation and fibrosis that has been described in multiple organs. Concrete diagnostic criteria have been established recently and there is a lack of large series of patients.To describe the clinical presentation, histopathological characteristics, treatment and evolution of a series of IgG4-RD Spanish patients.A retrospective multicenter study was performed. Twelve hospitals across Spain included patients meeting the current 2012 consensus criteria on IgG4-RD diagnosis.Fifty-five patients were included in the study, 38 of whom (69.1%) were male. Median age at diagnosis was 53 years. Thirty (54.5%) patients were included in the Histologically Highly Suggestive IgG4-RD group and 25 (45.5%) in the probable IgG4-RD group. Twenty-six (47.3%) patients had more than 1 organ affected at presentation. The most frequently affected organs were: retroperitoneum, orbital pseudotumor, pancreas, salivary and lachrymal glands, and maxillary sinuses.Corticosteroids were the mainstay of treatment (46 patients, 83.6%). Eighteen patients (32.7%) required additional immunosuppressive agents. Twenty-four (43.6%) patients achieved a complete response and 26 (43.7%) presented a partial response (<50% of regression) after 22 months of follow-up. No deaths were attributed directly to IgG4-RD and malignancy was infrequent.This is the largest IgG4-RD series reported in Europe. Patients were middle-aged males, with histologically probable IgG4-RD. The systemic form of the disease was frequent, involving mainly sites of the head and abdomen. Corticosteroids were an effective first line treatment, sometimes combined with immunosuppressive agents. Neither fatalities nor malignancies were attributed to IgG4-RD.

Síndrome de Prune Belly: Diagnóstico y manejo

El síndrome de Eagle-Barret o síndrome de Prune Belly también conocido como "síndrome de abdomen en ciruela pasa", es un cuadro cuya etiología aún se desconoce. Se caracteriza por la de ciencia de la musculatura de la pared abdominal, dilatación del tracto urinario y criptorquidia bilateral. La incidencia estimada es de 1 en 35,000 a 1 en 50,000 recién nacidos vivos, ocurriendo aproximadamente más del 95% de los casos en masculinos. Las manifestaciones clínicas de la triada de anormalidades presentes en esta entidad, van desde el defecto muscular presente en la pared abdominal, que consta solamente de piel y peritoneo, razón por la cual el tejido dérmico presenta una serie de estriaciones, que permiten la palpación fácil de las vísceras, asociándose además una alteración del sistema urogenital que se caracteriza por la dilatación de la vejiga como consecuencia de una obstrucción distal, con reflujo vesico-ureteral. Se describe un neonato con Síndrome de abdomen en ciruela pasa, de sexo masculino, nacido de 40 semanas de gestación y pesó 3 050 g al nacer. El examen clínico mostró un neonato con un abdomen globuloso, con redundancia de la piel que huelga a los costados rebosantes, la palpación del abdomen no descubre la tonalidad muscular. No se palpa visceromegalia y hay presencia normal de ruidos hidroaéreos. El examen físico del tórax y cardiovascular no reportó datos patológicos. Examen neurológico normal. La ecografía renal mostró alteraciones en el tracto urinario. Revela además criptorquidia bilateral. Este caso destaca la importancia del diagnóstico temprano y el manejo adecuado del paciente tanto a nivel primario como en el tercer nivel de atención; ya que si ofrecemos el manejo adecuado podemos brindarle a este tipo de pacientes un mejor pronóstico de vida.

Eagle-Barrett syndrome, formerly known as prune-belly syndrome, it's a disease whose etiology is still unknown. It's characterized by deficiency of abdominal wall musculature,a dilated urinary tract,and bilateral cryptorchidism. The estimated incidence is 1 in 35,000 to 1 in 50,000 live births, with more than 95% of cases occurring in males. Clinical manifestations of the triad of abnormalities present in this entity, ranging from muscle defect present in the abdominal wall, consisting only of skin and peritoneum, reason why the dermal tissue presents a series of striations, allowing easy palpation of the viscera, further associating an alteration of the urogenital system characterized by the expanded bladder following a distal obstruction, with vesicoureteral reflux. We report the case of a male neonate born after 40 weeks of gestation with a body weight of 3 050 g with Prune Belly syndrome. The physical examination revealed a distended abdomen with redundant skin that wrinkle like a prune, no visceromegaly was found and normal abdominal sounds were heard. The examination of thorax and cardiovascular systems were normal. The neurologic exam was normal. A renal ultrasound revealed alteration of the urogenital system. Bilateral cryptorchidism was also observed. This case highlights the importance of early diagnosis andappropriatemanagement both in primary health as tertiary,because if we bring the adequate treatment we will be able to o er to this patients a better life prognosis.

Urinoma, un traumatismo olvidado / Urinoma: a forgetful trauma

Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure

Urinoma, un traumatismo olvidado / Urinoma: a forgetful trauma

Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal(AU)

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure(AU)

Impact of routine fluconazole prophylaxis for premature infants with birth weights of less than 1250 grams in a developing country.

Systemic fungal infections are associated with substantial case-morbidity and fatality rates in premature infants. Considerable evidence indicates that prophylaxis with fluconazole given to premature infants reduces the risk of invasive fungal infection. There is scant information from developing countries. A comparative study of 2 years, one with fluconazole prophylaxis and the other without was conducted in all premature babies weighing less than 1250 g at birth. Fluconazole was administered in 3 mg/kg doses, given every 48 hours, starting on day 3 of life, for a period of 6 weeks. Documented systemic Candida infection was the primary outcome. A total of 271 and 252 patients, respectively, were evaluated during the year before (control group) and after (treatment group) routine fluconazole prophylaxis. The control group developed 21 Candida infections (7.7%) while the treatment group had only 3 Candida infections (1.1%). This difference was statistically significant (P = 0.007; odds ratio, 0.13; 95% confidence interval, 0.03-0.47). The number needed to treat to prevent one case was 7. Although case-fatality rates for documented Candida infection were similar in both periods (76% vs. 67%), fewer deaths attributed to the fungal infection were noted in the prophylaxis year (6% vs. 1%, P = 0.003). Routine fluconazole prophylaxis given to premature infants of less than 1250 g at birth is associated with a significant impact on frequency of documented systemic Candida infections.

MFN2 mutation distribution and genotype/phenotype correlation in Charcot-Marie-Tooth type 2.

Mutations in mitofusin 2 (MFN2) have been reported in Charcot-Marie-Tooth type 2 (CMT2) families. To study the distribution of mutations in MFN2 we screened 323 families and isolated patients with distinct CMT phenotypes. In 29 probands, we identified 22 distinct MFN2 mutations, and 14 of these mutations have not been reported before. All mutations were located in the cytoplasmic domains of the MFN2 protein. Patients presented with a classical but rather severe CMT phenotype, since 28% of them were wheelchair-dependent. Some had additional features as optic atrophy. Most patients had an early onset and severe disease status, whereas a smaller group experienced a later onset and milder disease course. Electrophysiological data showed in the majority of patients normal to slightly reduced nerve conduction velocities with often severely reduced amplitudes of the compound motor and sensory nerve action potentials. Examination of sural nerve specimens showed loss of large myelinated fibres and degenerative mitochondrial changes. In patients with a documented family history of CMT2 the frequency of MFN2 mutations was 33% indicating that MFN2 mutations are a major cause in this population.

A peroxidase gene expressed during early developmental stages of the parasitic plant Orobanche ramosa.

Broomrapes (Orobanche spp.) are holoparasitic weeds that cause devastating losses in many economically important crops. The molecular mechanisms that control the early stages of host infection in Orobanche are poorly understood. In the present study, the role of peroxidase has been examined during pre-infection growth and development of O. ramosa, using an in vitro model system. Peroxidase activity was histochemically localized at the tips of actively growing radicles and nascent attachment organs. Addition of exogenous catalase resulted in a significant reduction in the apical growth rate of the radicle. The prx1 gene encoding a putative class III peroxidase was cloned from a cDNA library of O. ramosa and was found to be expressed specifically during the early stages of the parasitic life cycle. The exogenous addition of sucrose resulted in significantly reduced prx1 transcript levels and in a dramatic change in radicle development from polarized apical growth to isotropic growth and the formation of tubercle-like structures. The results indicate an important role of peroxidases during the early parasitic stages of Orobanche.

An improved axenic system for studying pre-infection development of the parasitic plant Orobanche ramosa.

BACKGROUND AND AIMS: Broomrapes (Orobanche spp.) are holoparasitic weeds that cause devastating losses in many economically important crops. The molecular mechanisms that control early stages of host infection in Orobanche are poorly understood, partly due to the lack of experimentally tractable in vitro systems that allow the efficient application of molecular tools. Here an improved axenic system for the analysis of pre-infection stages in O. ramosa in the absence of the host plant is described. METHODS: An optimized protocol for seed disinfection, based on formaldehyde, was developed. Orobanche ramosa seeds were conditioned in Petri dishes with filter paper, stimulated by addition of the synthetic strigol analogue GR24, and the percentage of germination as well as attachment-organ formation was determined. KEY RESULTS: Treatment of O. ramosa seeds with tobacco-root exudate or with GR24 resulted in highly reproducible germination rates around 70 %. A conditioning period of 8 d was both necessary and sufficient to allow optimal germination in response to GR24. Conditioned seeds that were dehydrated for several months remained fully responsive to GR24 without the need of a new conditioning period. Treatments as short as 5 min with GR24 were sufficient to fully and irreversibly induce the seed germination response. Approximately half of the germinated seeds initiated attachment-organ development. Similar rates of attachment organ induction were also detected in the rare cases of seeds that had germinated spontaneously on water. CONCLUSIONS: The results suggest that the conditioning period produces persistent changes in the seeds required for responsiveness to external stimulants. The rapid action of GR24 suggests that it may act via a receptor-mediated signalling mechanism. While germination in O. ramosa is induced by exogenous stimuli, attachment organ differentiation appears to be triggered by unknown endogenous signals. The new in vitro culture system will have useful applications for the molecular analysis of early stages of parasitic development in Orobanche.

Emoções de raiva associadas à gastrite e esofagite / Anger emotions associated to gastritis and oesofagitis

Os objetivos foram avaliar como a raiva se relaciona à gastrite e esofagite, e compreender a raiva quanto a experiência, expressão, estado crônico, gênero e idade. Foram avaliados 41 homens e 68 mulheres, distribuídos em quatro faixas etárias, entre 20 e 60 anos. Os dados foram obtidos do Inventário de Expressão de Raiva como Estado e Traço (STAXI), da entrevista psicológica e do prontuário. Os sujeitos vivenciavam sentimentos de raiva, reprimida e direcionada para dentro; mostravam alto grau de impulsividade e sensibilidade a críticas. Homens apresentaram traços de raiva de maior intensidade do que mulheres. Houve alta frequência de raiva de 20 a 29 anos e de 40 a 49. O controle da raiva foi maior entre 50 e 60 anos e menor entre 20 e 30 anos. Apresentaram índices acima da média em raiva crônica, predominantes nos homens e em sujeitos de 40 a 50 anos.

Emoções de raiva associadas à gastrite e esofagite / Anger emotions associated to gastritis and oesofagitis

Os objetivos foram avaliar como a raiva se relaciona à gastrite e esofagite, e compreender a raiva quanto a experiência, expressão, estado crônico, gênero e idade. Foram avaliados 41 homens e 68 mulheres, distribuídos em quatro faixas etárias, entre 20 e 60 anos. Os dados foram obtidos do Inventário de Expressão de Raiva como Estado e Traço (STAXI), da entrevista psicológica e do prontuário. Os sujeitos vivenciavam sentimentos de raiva, reprimida e direcionada para dentro; mostravam alto grau de impulsividade e sensibilidade a críticas. Homens apresentaram traços de raiva de maior intensidade do que mulheres. Houve alta frequência de raiva de 20 a 29 anos e de 40 a 49. O controle da raiva foi maior entre 50 e 60 anos e menor entre 20 e 30 anos. Apresentaram índices acima da média em raiva crônica, predominantes nos homens e em sujeitos de 40 a 50 anos. (AU)

Bradycardia related to hypoglycaemia.

Alterations in blood glucose levels are known to be involved in electrocardiogram changes. Various types of arrhythmias have been reported. We present here the case of an 81-year-old woman presenting with transient atrial fibrillation while being treated for hypoglycaemia with dextrose infusion, and finally developing a sinus rhythm. The presence of alterations in glucose blood levels should always be considered as a potential cause of transient atrial fibrillation.