Un caso de neumonía organizada tras la ruptura intracapsular de implantes mamarios de silicona / A case of organized pneumonia after intracapsular rupture of silicone breast implants

La neumonía organizada es una entidad poco frecuente, caracterizada por la formación de conglomerados fibroblásticos intraalveolares conocidos como cuerpos de Masson, que puede ser criptogénica o secundaria a una respuesta inmunitaria a diversos estímulos, tales como enfermedades hematológicas, autoinmunitarias, exposición a sustancias químicas, fármacos, tóxicos, etc. Detectada y tratada de forma precoz, suele tener una buena respuesta a la corticoterapia, aunque si se diagnostica de forma tardía, la afectación pulmonar puede ser extensa, y, además, si el estímulo antigénico persiste, la respuesta al tratamiento será incompleta. Presentamos el caso clínico de una paciente de 65 años de edad quien hace 18 meses aproximadamente presentó la rotura intracapsular de sus implantes mamarios, 27 años después de su colocación. Con el mismo tiempo de evolución ha desarrollado progresivamente disnea, tos seca y dolor inframamario, habiendo llegado al diagnóstico de neumonía organizada bilateral difusa, asociada a dicha rotura de implantes.

Organizing pneumonia is a rare entity, characterized by the formation of intraalveolar fibroblastic conglomerates known as Masson bodies, which may be cryptogenic or secondary to an immune response to various stimuli, such as hematological, autoimmune diseases, exposure to chemical substances, drugs, toxics, etc. If it is detected and treated early, it usually has a good response to corticosteroid therapy, although if it is diagnosed late, the lung involvement can be extensive, and furthermore, if the antigenic stimulus persists, the response to treatment will be incomplete. We present the clinical case of a 65-year-old patient who had intracapsular rupture of her breast implants approximately 18 months ago, 27 years after their placement. With the same evolution time, she progressively developed dyspnea, dry cough and under mammary pain, having reached the diagnosis of diffuse bilateral organizing pneumonia, associated with implant rupture.

Near Infrared Spectroscopy (NIRS) for the determination of the milk fat fatty acid profile of goats.

Milk fatty acid (FA) composition is important for the goat dairy industry because of its influence on cheese properties and human health. The aim of the present work was to evaluate the feasibility of NIRS reflectance (oven-dried milk using the DESIR method) and transflectance (liquid milk) analysis to predict milk FA profile and groups of fats in milk samples from individual goats. NIRS analysis of milk samples allowed to estimate FA contents and their ratios and indexes in fat with high precision and accuracy. In general, transflectance analysis gave better or similar results than reflectance mode. Interestingly, NIRS analysis allowed direct prediction of the Atherogenicity and Thrombogenicity indexes, which are useful for the interpretation of the nutritional value of goat milk. Therefore, the calibrations obtained in the present work confirm the viability of NIRS as a fast, reliable and effective analytical method to provide nutritional information of milk samples.

Successful ultrarapid cryopreservation of wild Iberian ibex (Capra pyrenaica) spermatozoa.

A method for cryopreserving wild ibex sperm at high cooling rates was developed. To design a freezing solution based on Tris, citric acid, and glucose (TCG), two preliminary experiments were performed using glycerol (GLY) and dimethyl sulfoxide (DMSO) at different concentrations (5%, 10%, 20%). The 10% GLY + 10% DMSO combination reduced (P < 0.05) frozen-thawed sperm motility, which reached a minimum when 20% GLY + 20% DMSO was used. In the second experiment, sperm tolerance to three sucrose concentrations was evaluated (100-mM sucrose, 300-mM sucrose, 500-mM sucrose). Frozen-thawed sperm motility and sperm viability decreased (P < 0.05) at concentrations above 300 mM. The ultrarapid cooling procedure finally used involved a TCG egg yolk (ey)-based extender with 100-mM sucrose, either alone or with 5% GLY with or without BSA. Two warming procedures (37 °C vs. 60 °C) were also evaluated. The TCG ey with 100-mM sucrose but without GLY/BSA returned the best sperm quality variables. Slow warming at 37 °C strongly affected (P < 0.05) sperm motility and viability in all groups. Sperm selection by density gradient centrifugation produced no motile sperm when slow warming was performed. In contrast, when fast warming was used, sperm selection increased (P < 0.05) percentage of motility, viability, and the percentage of sperms with intact acrosomes. Heterologous in vivo fertilization involving domestic goats was performed to evaluate the in vivo fertilization capacity of the ultrarapidly cooled cryopreserved sperm (in TCG-ey + 100 mM sucrose), with warming undertaken at 60 °C. Inseminations of domestic goats resulted in three pregnancies (3 of 16, 18.7% fertility). In conclusion, ibex spermatozoa are strongly sensitive to high concentrations of permeable cryoprotectants and sucrose. However, the combination of ultrarapid cooling, using TCG-ey + 100-mM sucrose, and fast warming at 60 °C, followed by sperm selection by density gradient centrifugation to collect the motile sperm, has a positive effect on sperm viability.

Identification of two paralogous caprine CD36 genes that display highly divergent mRNA expression profiles.

The CD36 molecule plays a pivotal role in a variety of immunological and cellular processes, including pathogen recognition, inflammation and apoptosis. Herein, we demonstrate that this gene is duplicated in goats, with two copies (CD36 and CD36-like) that display highly divergent mRNA expression profiles. In this way, CD36 mRNA is mostly expressed in the adipose tissue and heart whilst CD36-like mRNA shows a high expression in the liver. We have also found evidence of the presence of two paralogous CD36 and CD36-like genes in the bovine genome, suggesting that CD36 duplication took place before goat-cattle radiation, i.e. at least 20 MYR ago. Finally, we have characterized the polymorphism of the coding regions of the goat CD36 and CD36-like genes. In doing so, we have identified one synonymous polymorphism at the CD36-like gene (c.390A>C) that displays a significant association (P=0.04) with milk somatic cell count, a parameter often used to diagnose mastitis in domestic ruminants.

Aspectos clínico-quirúrgicos de la hidatidosis hepática, una zoonosis de creciente preocupación / Clinical and surgical aspects of hydatidosis

Hydatidosis is common in Southern Chile and it is usually located in the liver. The complications of surgical procedures for liver hydatidosis, which fluctuate from 11 to 86 percent, are superposed to the own complications of the disease. The frequency of surgical complications is associated with evolutionary complications of the cysts, the need to perform additional procedures to treat the disease in other simultaneous locations and previous surgical interventions for the disease. Operative mortality is lower than 5 percent. The surgical treatment of hydatidosis is divided in four phases: isolation of the surgical zone, cyst evacuation, treatment of cyst complications and treatment of residual cavity. The conservative surgical procedures are marsupialization, cystostomy, Posadas intervention and cystojejunostomy. Surgical procedures involving resection are pericys-tectomy, subtotal cystectomy and liver resections. The role of laparoscopic surgery is still under evaluation.

La hidatidosis es una zoonosis endémica en el sur de Chile, por lo que tenemos la oportunidad de tratar un número importante de pacientes, especialmente hepática, localización más común de esta enfermedad. La hidatidosis hepática (HH) tiene morbilidad y mortalidad propia debido a sus complicaciones evolutivas, a lo que se agrega el riesgo de complicaciones asociados a los procedimientos quirúrgicos, cuya morbilidad se ha reportado entre 11 por ciento y 86 por ciento; la que se ha relacionado con intervenciones previas por HH, complicaciones evolutivas de los quistes, la necesidad de realizar procedimientos adicionales como el tratamiento de la enfermedad en otras localizaciones simultáneas. La mortalidad reportada es inferior al 5 por ciento. Sin embargo, tanto morbilidad como mortalidad persisten altas a pesar de los avances tecnológicos terapéuticos. El tratamiento quirúrgico de la HH se puede dividir en cuatro fases: aislamiento de la zona quirúrgica, evacuación del quiste, tratamiento de las complicaciones del quiste; y tratamiento de la cavidad residual. Por otro lado, la cirugía de la HH se puede clasificar en procedimientos conservadores (marsupialización, quistostomía, operación de Posadas y quistoyeyunostomía) y resectivos (periquistectomía, quistectomía subtotal y resecciones hepáticas). Por último, cabe señalar el rol de la cirugía laparoscópica, que aún se encuentran en evaluación.

Association between the polymorphism of the goat stearoyl-CoA desaturase 1 (SCD1) gene and milk fatty acid composition in Murciano-Granadina goats.

Genetic variability of the caprine stearoyl-CoA desaturase 1 (SCD1) gene has been investigated by sequencing a 4.7-kb cDNA in 6 goats from the Murciano-Granadina and Malagueña breeds. Sequence alignment revealed the existence of one synonymous polymorphism at exon 5 (c.732C>T) and one nucleotide substitution (c.*3504G>A) at exon 6 that encodes the 3' untranslated region (UTR). Moreover, the existence of a previously reported 3'UTR polymorphism involving a 3-bp indel (c.*1902_1904delTGT) was confirmed. Single nucleotide polymorphism and haplotype-based association analyses revealed suggestive associations between genetic variability of the SCD1 locus and lactose, stearic, polyunsaturated, and conjugated linoleic fatty acid contents. Associations with milk fatty acid composition might be explained by the global effects that SCD1 exerts on mammary gland lipid metabolism through the down-modulation of key transcription factors. Interestingly, the performance of an in silico analysis revealed that the c.*1902_1904delTGT polymorphism involves a considerable change in the secondary structure of the SCD1 mRNA. Gene reporter assays and quantitative PCR analysis would be needed to assess if this mutation has a causal effect on milk polyunsaturated and conjugated linoleic fatty acid levels by altering the amount of SCD1 transcripts in mammary epithelial cells.

Pleiotropic effects of the goat prolactin receptor genotype on milk fatty acid composition.

In the lactating mammary gland, prolactin (PRL) stimulates the synthesis of lactose as well as fatty acid uptake, lipogenesis, and triacylglycerol synthesis. Associations between bovine PRL receptor (PRLR) genotype and fat yield have been reported, which illustrates the role of PRL in conveying lipids toward the udder as well as in stimulating their local synthesis during lactation. Conversely, and to the best of our knowledge, the effects of PRLR genotype on milk fatty acid content have not been studied so far in any mammalian species. In this study, we sequenced most of the coding region of the caprine PRLR gene in several individuals from the Malagueña and Murciano-Granadina breeds. This approach allowed us to identify 2 long and short mRNA isoforms, produced by alternative splicing, and 4 single-nucleotide polymorphisms (SNPs), namely, c.177T>C, c.1131G>A, c.1201G>A and c.1355C>T. Two of these SNPs are nonsynonymous and involve G401R (c.1201G>A) and T452I (c.1355C>T) amino acid substitutions in the cytoplasmic domain of PRLR, which plays a fundamental role in signal transduction. Performance of an association analysis with milk composition traits in a Murciano-Granadina goat population revealed highly suggestive effects on palmitoleic acid content, whereas suggestive effects were detected for other fatty acids, such as palmitic and linoleic. These results are consistent with the pleiotropic effects of PRL on mammary gland lipid metabolism and milk composition.

Short communication: genetic variability in the predicted microRNA target sites of caprine casein genes.

The main goal of the current work was to identify single nucleotide polymorphisms (SNP) that might create or disrupt microRNA (miRNA) target sites in the caprine casein genes. The 3' untranslated regions of the goat alpha(S1)-, alpha(S2)-, beta-, and kappa-casein genes (CSN1S1, CSN1S2, CSN2, and CSN3, respectively) were resequenced in 25 individuals of the Murciano-Granadina, Cashmere, Canarian, Saanen, and Sahelian breeds. Five SNP were identified through this strategy: c.175C>T at CSN1S1; c.109T>C, c.139G>C, and c.160T>C at CSN1S2; and c.216C>T at CSN2. Analysis with the Patrocles Finder tool predicted that all of these SNP are located within regions complementary to the seed of diverse miRNA sequences. These in silico results suggest that polymorphism at miRNA target sites might have some effect on casein expression. We explored this issue by genotyping the c.175C>T SNP (CSN1S1) in 85 Murciano-Granadina goats with records for milk CSN1S1 concentrations. This substitution destroys a putative target site for miR-101, a miRNA known to be expressed in the bovine mammary gland. Although TT goats had higher levels (6.25 g/L) of CSN1S1 than their CT (6.05 g/L) and CC (6.04 g/L) counterparts, these differences were not significant. Experimental confirmation of the miRNA target sites predicted in the current work and performance of additional association analyses in other goat populations will be an essential step to find out if polymorphic miRNA target sites constitute an important source of variation in casein expression.

Polymorphism of the caprine malic enzyme 1 ( ME1) gene and its association with milk quality traits in Murciano-Granadina goats.

Malic enzyme 1 plays a fundamental role in lipid metabolism because it yields a significant amount of the NADPH necessary for fatty acid biosynthesis. In ruminants, however, its contribution to this biochemical process seems to be less relevant than in other livestock species. In this study, we have partially sequenced the goat ME1 gene with the aim of identifying polymorphic sites. Structural analysis of the goat ME1 amino acid partial sequence evidenced the existence of two dinucleotide-binding motifs, located at positions 158 to 163 (GLGDLG) and 301 to 306 (GAGEAA), and three amino acid residues (E245, D246 and D269) involved in the binding of Mn2+ and strongly conserved among mammalian species. Moreover, multiple sequence alignment allowed us to identify four single nucleotide polymorphisms at exons 5 (c.483C > T), 6 (c.667G > A), 9 (c.927C > T) and 11 (c.1200G > A). The effects of ME1 genotype on milk production and composition traits were investigated in a Murciano-Granadina goat population. None of the associations found reached statistical significance after applying Benjamini-Hochberg correction. At most, associations with uncorrected P-values below 0.01 were observed for C16:0, C18:1n-9t and total conjugated linoleic acids. These negative results reinforce the notion that ME1 plays an ancillary role in ruminant lipogenesis.

Short communication: Effect of alphaS1-casein (CSN1S1) and kappa-casein (CSN3) genotypes on milk composition in Murciano-Granadina goats.

The effects of the caprine alpha(S1)-casein (CSN1S1) polymorphisms on milk quality have been widely demonstrated. However, much less is known about the consequences of the kappa-casein (CSN3) genotype on milk composition in goats. Moreover, the occurrence of interactions between CSN3 and CSN1S1 genotypes has not been investigated. In this study, an association analysis between CSN1S1 and CSN3 genotypes and milk quality traits was performed in 89 Murciano-Granadina goats. Total milk yield as well as total protein, fat, solids-not-fat, lactose, alpha(S1)-casein (CSN1S1), and alpha(S2)-casein (CSN1S2) contents were recorded every other month during a whole lactation (316 observations). Data analysis using a linear mixed model for repeated observations revealed no interaction between the CSN1S1 and CSN3 genotypes. With regard to the effect of the CSN3 locus, AB and BB genotypes were significantly associated with higher levels of total casein and protein content compared with the AA CSN3 genotype. In strong contrast with French breeds, the CSN1S1 genotype did not affect protein, casein, and fat concentrations in Murciano-Granadina goats. These results highlight the importance of taking into consideration the CSN3 genotype when performing selection for milk composition in dairy goats.

New estrus synchronization and artificial insemination protocol for goats based on male exposure, progesterone and cloprostenol during the non-breeding season.

This study assesses the effectiveness of a method designed to induce and synchronize ovulation in goats during the non-breeding season, allowing for systematic timed artificial insemination (AI), without the need for prior estrus detection. This method (IMA.PRO2) induces ovulation through the "male effect" and a single 25 mg dose of progesterone given at the time of buck exposure, and early lysis of the induced corpus luteum by the administration of 75 microg of cloprostenol 9 days later. The method was tested in three separate experiments. In experiment 1, estrus was detected in 87.5% of the treated goats 37.0 +/- 1.4 h after cloprostenol administration, with the preovulatory LH surge occurring 40.5 +/- 1.6 h after the cloprostenol injection. In experiment 2, data from 503 does revealed no significant differences in fertility rates between two groups inseminated 48 h (65.5+/-4.0%) or 52 h (63+/-3.0%) after receiving cloprostenol. In experiment 3, 2184 does, comprising 37 replicate groups on 12 farms, were randomly assigned to two trial subgroups. Does in the first subgroup were treated with the IMA.PRO2 method and goats from the second group were given intravaginal progestagens for 11 days, plus 350 IU of eCG and 75 microg of cloprostenol on Day 9 of this treatment. Goats from both subgroups were cervically inseminated at the same time, 50 h after cloprostenol administration in the first group and 46 h after sponge removal in the second. The pregnancy rate achieved with the new method was 64.6%, significantly higher than the yield observed for the use of progestagens plus eCG (46.8%, P<0.01). The simple method proposed as an alternative to the use of progestagen-eCG treatment provides good pregnancy rates to AI undertaken at a fixed time point, and reduces the amount of hormone needed to synchronize estrus in the animals.

Short communication: Identification of two polymorphisms in the goat lipoprotein lipase gene and their association with milk production traits.

Lipoprotein lipase (LPL) is a glycoprotein that plays a central role in plasma triglyceride metabolism by hydrolyzing triglyceride-rich chylomicrons and very low density lipoproteins. The activity of milk LPL has been shown to differ among several goat breeds, suggesting the existence of a genetic polymorphism influencing the functional properties of this enzyme. We have characterized the complete coding sequence of the goat LPL gene in 18 individuals belonging to 3 breeds. The coding region of the goat LPL cDNA was 1,437 bp long and encoded a protein of 478 amino acids. Moreover, we have identified 2 single nucleotide polymorphisms (SNP) including a G50C missense mutation, which involved a Ser-->Thr amino acid replacement at position 17 of the signal peptide, and a C2094T substitution in the 3' untranslated region. A univariate mixed model was used to evaluate the association between LPL genotypes and milk production and composition in 130 Murciano-Granadina goats. The G50C SNP was suggestively associated with milk fat content and tended to affect the milk dry weight basis. The C2094T SNP was not associated with any of the measured traits.

Goat acetyl-coenzyme A carboxylase alpha: molecular characterization, polymorphism, and association with milk traits.

Acetyl-coenzyme A carboxylase alpha (ACACA), the major regulatory enzyme of fatty acid biosynthesis, catalyzes the conversion of acetyl-CoA to malonyl-CoA. We have sequenced 5.5 kb of the goat ACACA cDNA in 18 individuals. The translated cDNA sequence encodes 1,832 AA and shares a high AA identity (99%) with the ovine and bovine ACACA orthologous sequences. One silent single nucleotide polymorphism was identified at exon 45 (C5493T). The genotyping of this polymorphism in 4 goat breeds, Murciano-Granadina, Teramana, Majorera, and Malagueña, showed that it was segregating in all 4 breeds at variable frequencies. In addition, a mixed animal model was used to evaluate the association of C5493T genotypes with milk traits. Results from this study show that the C5493T mutation was suggestively associated with fat yield, lactose content, and somatic cell count.

Oestrous behaviour and development of preovulatory follicles in goats induced to ovulate using the male effect with and without progesterone priming.

The objective of the current study was to examine follicular dynamics in goats induced to ovulate by using the male effect with or without progesterone pretreatment. Ten Murcian-Granadina goats were treated with a single dose of 25 mg of progesterone in olive oil on the day of male effect induction (Day 0), whereas ten does remained untreated. Changes in the ovarian follicular population and onset of oestrous behaviour were checked daily from Day 0 to the day on which ovulation was detected by ultrasonography. All of the treated goats and only 20% of control goats (P < 0.001) showed oestrous behaviour between 72 and 96 h after the introduction of bucks. Differences in follicle growth were found between the groups. The control goats exhibiting oestrous behaviour during the first 4 days of ovarian screening and all of the goats treated with progesterone had their preovulatory follicles in growing phase. However, the largest follicles in control does not showing oestrus in these first 4 days were in regressing phase, being necessary for the emergence of new preovulatory follicles from a new follicular wave between Days 6 and 7, for exhibition of oestrous behaviour and subsequent ovulation. In conclusion, the appearance of short luteal phases and delayed ovulation in goats treated with the male effect during seasonal anoestrous depends on the stage of follicle development at the time of buck introduction. A single injection of progesterone stimulates the emergence of a new follicular wave, able to grow and give adequate ovulation after induction of the male effect.

Origin and fate of preovulatory follicles after induced luteolysis at different stages of the luteal phase of the oestrous cycle in goats.

The effect of day of induced luteolysis on follicle dynamics, oestrus behaviour and ovulatory response in goats was studied by administering cloprostenol on Day 5 (n=10), Day 11 (n=10), or Day 16 (n=10) after detection of oestrus. Stage of the luteal phase affected the interval from cloprostenol injection to onset of oestrus, with behavioural oestrus being observed earlier in goats treated early in the luteal phase (43.4+/-3.2 h on Day 5 versus 57.0+/-2.6 h on Day 11 and 56.7+/-2.7 h on Day 16, P<0.01). The group treated on Day 5 also tended to have a higher proportion of does which exhibited oestrus behaviour (P=0.07) and ovulation (P=0.06). In all the cycles, at least one of the ovulatory follicles arose from antral follicles present in the ovary at cloprostenol injection. In 66.7% of monovular cycles, the ovulatory follicle was the largest follicle on the day of luteolysis. In 33.3% of polyovulatory cycles, one of the ovulatory follicles was the largest one present when cloprostenol was administered. In 80% of polyovulatory cycles, the second ovulatory follicle was present on the day of luteolysis; but in the three remaining cycles, the second ovulatory follicle emerged later. This shows that the largest follicle may not exert dominance over other follicles in the goat. Evaluation of follicular dynamics in different phases of luteal activity in current experiment showed an attenuation of dominance in the mid-luteal period. In does treated early or late in the luteal phase, the number of new growing follicles decreased with time (P<0.01 and 0.05, respectively), the mean number of follicles reaching 4-5mm in size also decreased (P<0.001 and 0.01, respectively) and the number of regressing follicles increased (P<0.05). These effects did not reach statistical significance in does treated in the mid-luteal phase.

Plasma inhibin A determination at start superovulatory FSH treatments is predictive for embryo outcome in goats.

To test whether inhibin A assays can be used for the prediction of yields in embryo programmes in goats, 50 does were treated with 45 mg FGA sponges (Chronogest) for 16 days plus a single dose of 100 microg i.m. cloprostenol on Day 14, just before the start of administration of eight doses of 1.25 ml of Ovagen twice daily for 4 days. At first FSH injection, the number and size of all follicles > or =2 mm was assessed by transrectal ultrasound and plasma inhibin A levels were measured by specific dimeric assay. There was a positive correlation between number of follicles > or =6 mm (8.8 +/- 0.5) and inhibin A levels at first FSH dose (193.2 +/- 14.5 pg/ml, P<0.05). The mean number of corpora lutea on Day 7 after sponge removal was related to the total number of follicles with a diameter of 2-6 mm at the onset of the FSH treatment (15.3 +/- 0.7, P<0.05). The total number of embryos recovered was related to the number of follicles with 4-6 mm in size (6.2 +/- 0.5, P<0.05) and to the inhibin A levels at first FSH dose (P<0.05). These results suggest that follicles > or =4 mm are the source of inhibin prior to FSH stimulation and are the main source of oocytes resulting in the number of viable embryos recovered after a superovulatory treatment. Hence, the response to superovulatory treatments in goats in terms of the number of embryos can be predicted from either the population of follicles determined by ultrasound or the plasma inhibin A levels at start of the superovulatory FSH treatment.

Know well to do good

Health care should be entrusted to professionals who have received well-rounded training in the humanitarian as well as the technical aspects of such care. Training of this sort is essential for effective resolution of ethical conflicts that arise in professional practice. Starting from that premise, this article examines a number of ethical problems commonly encountered by nurses in the course of their daily work