Renin–angiotensin–aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial / Efecto de los bloqueantes del sistema renina-angiotensina-aldosterona en la progresión de enfermedad renal crónica en pacientes hipertensos añosos sin proteinuria: ensayo clínico Progresión de Enfermedad Renal Crónica en Ancianos

Introduction: Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Materials and methods: Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3–4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results: 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was −4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusions: In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023). (AU)

Introducción: Actualmente no existe suficiente evidencia sobre el efecto nefroprotector de los bloqueantes del sistema renina-angiotensina-aldosterona (BSRAA) en pacientes añosos con enfermedad renal crónica (ERC) sin proteinuria y sin cardiopatía. El objetivo es evaluar el efecto de los BSRAA en la progresión de la ERC en este grupo poblacional. Métodos: Se trata de un estudio prospectivo, aleatorizado, que compara la eficacia de los BSRAA vs. otros tratamientos antihipertensivos en la progresión renal en personas mayores de 65 años con ERC estadios 3 y 4 e índice albúmina/creatinina<30mg/g. Aleatorización 1:1 BSRAA o tratamiento antihipertensivo estándar. Se recogieron cifras tensionales y parámetros analíticos de un año previo a la aleatorización y durante el seguimiento. Resultados: Se incluyeron 88 pacientes seguidos durante tres años con edad media de 77,9±6,1 años. De estos, se aleatorizaron 40 al grupo BSRAA y 48 al estándar. La etiología de ERC fue: 53 vascular, 16 intersticial y 19 no filiada. En el primer grupo se observó una progresión de la ERC con una caída del filtrado glomerular estimado (FGe) de -4,3±1,1mL/min, mientras que en el grupo estándar un aumento del FGe durante el seguimiento de 4,6±0,4mL/min, p=0,024. No se apreciaron diferencias entre ambos en el control tensional, el número de antihipertensivos, la albuminuria, los niveles de potasio, la incidencia de eventos cardiovasculares ni la mortalidad durante el seguimiento. Conclusiones: En pacientes añosos no diabéticos con ERC no proteinúrica y sin cardiopatía el uso de BSRAA no añade beneficio en la progresión de la ERC. Ensayo clínico Progresión de Enfermedad Renal Crónica en Ancianos (PROERCAN) (NCT03195023). (AU)

Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial.

INTRODUCTION: Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS: Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. RESULTS: 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was -4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. CONCLUSIONS: In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).

The effect of renin–angiotensin–aldosterone system blockers on the progression of chronic kidney disease in hypertensive elderly patients without proteinuria: PROERCAN study. Rationale and design / Efecto de los bloqueantes del sistema renina-angiotensina-aldosterona en la progresión de la enfermedad renal crónica en pacientes añosos sin proteinuria: ensayo clínico PROERCAN. Diseño y justificación del estudio

INTRODUCTION: Blood pressure (BP) control is fundamental to the care of patients with chronic kidney disease (CKD), and is relevant at all stages of CKD. Renin-angiotensin-aldosterone system (RAAS) blockers have shown to be effective, not only in BP control but also in reducing proteinuria and slowing CKD progression. However, there is a lack of evidence for recommending RAAS blockers in elderly patients with CKD without proteinuria. The primary outcome of the present study is to evaluate the impact of RAAS blockers on CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS: The PROERCAN trial (trial registration, NCT03195023) is a multicentre open-label, randomized controlled clinical trial with 110 participants over 65 years-old with hypertension and CKD stages 3-4 without proteinuria. Patients will be randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs, and will be followed up for three years. Primary outcome is the estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcomes include BP control, renal and cardiovascular events, and mortality. RESULTS AND CONCLUSIONS: The design of this trial is presented here. The results will show if antihypertensive treatment with RAAS blockers has an impact on CKD progression in elderly patients without proteinuria. Any differences in BP control, cardiovascular events, and mortality with each antihypertensive treatment will be also clarified

INTRODUCCIÓN: El control de la presión arterial (PA) es fundamental para los pacientes con enfermedad renal crónica (ERC) y es relevante en todos los estadios de ERC. Los bloqueantes del sistema renina-angiotensina-aldosterona (BSRAA) han demostrado su efectividad no solo en el control de la PA sino también en la reducción de la proteinuria y de la progresión de la ERC. Sin embargo, no existe evidencia para recomendar el uso de BSRAA en pacientes añosos con ERC sin proteinuria. El objetivo principal del estudio es evaluar el impacto de los BSRAA en la progresión de ERC en pacientes añosos sin proteinuria. MATERIAL Y MÉTODOS: El estudio PROERCAN (NCT03195023) es un ensayo clínico multicéntrico, abierto, aleatorizado de 110 pacientes hipertensos, mayores de 65 años con ERC estadios3 y4 sin proteinuria. Los pacientes son aleatorizados 1:1 a recibir tratamiento con BSRAA u otros antihipertensivos y el seguimiento será de 3años. La variable principal es el descenso del filtrado glomerular estimado durante el tiempo de seguimiento. Las variables secundarias incluyen las cifras de PA, eventos renales y cardiovasculares y mortalidad. RESULTADOS Y CONCLUSIÓN: El diseño del ensayo clínico se desarrolla en el presente artículo. Los resultados determinarán si el tratamiento antihipertensivo con BSRAA tiene un impacto en la progresión de la ERC en pacientes añosos sin proteinuria. Así mismo, se aclararán las diferencias en el control de la PA, los eventos cardiovasculares y la mortalidad con los distintos tratamientos antihipertensivos

The effect of renin-angiotensin-aldosterone system blockers on the progression of chronic kidney disease in hypertensive elderly patients without proteinuria: PROERCAN study. Rationale and design.

INTRODUCTION: Blood pressure (BP) control is fundamental to the care of patients with chronic kidney disease (CKD), and is relevant at all stages of CKD. Renin-angiotensin-aldosterone system (RAAS) blockers have shown to be effective, not only in BP control but also in reducing proteinuria and slowing CKD progression. However, there is a lack of evidence for recommending RAAS blockers in elderly patients with CKD without proteinuria. The primary outcome of the present study is to evaluate the impact of RAAS blockers on CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS: The PROERCAN trial (trial registration, NCT03195023) is a multicentre open-label, randomized controlled clinical trial with 110 participants over 65 years-old with hypertension and CKD stages 3-4 without proteinuria. Patients will be randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs, and will be followed up for three years. Primary outcome is the estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcomes include BP control, renal and cardiovascular events, and mortality. RESULTS AND CONCLUSIONS: The design of this trial is presented here. The results will show if antihypertensive treatment with RAAS blockers has an impact on CKD progression in elderly patients without proteinuria. Any differences in BP control, cardiovascular events, and mortality with each antihypertensive treatment will be also clarified.

Organization of intensive cardiac care units in Europe: Results of a multinational survey.

BACKGROUND: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. METHODS: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14). RESULTS: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries. CONCLUSION: More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.

Cysteinyl leukotriene receptor (CysLT) antagonists decrease pentylenetetrazol-induced seizures and blood-brain barrier dysfunction.

Current evidence suggests that inflammation plays a role in the pathophysiology of seizures. In line with this view, selected pro-inflammatory arachidonic acid derivatives have been reported to facilitate seizures. Kainate-induced seizures are accompanied by leukotriene formation, and are reduced by inhibitors of LOX/COX pathway. Moreover, LTD4 receptor blockade and LTD4 synthesis inhibition suppress pentylenetetrazol (PTZ)-induced kindling and pilocarpine-induced recurrent seizures. Although there is convincing evidence supporting that blood-brain-barrier (BBB) dysfunction facilitates seizures, no study has investigated whether the anticonvulsant effect of montelukast is associated with its ability to maintain BBB integrity. In this study we investigated whether montelukast and other CysLT receptor antagonists decrease PTZ-induced seizures, as well as whether these antagonists preserve BBB during PTZ-induced seizures. Adult male albino Swiss mice were stereotaxically implanted with a cannula into the right lateral ventricle, and two electrodes were placed over the parietal cortex along with a ground lead positioned over the nasal sinus for electroencephalography (EEG) recording. The effects of montelukast (0.03 or 0.3 µmol/1 µL, i.c.v.), pranlukast (1 or 3 µmol/1 µL, i.c.v.), Bay u-9773 (0.3, 3 or 30 nmol/1 µL, i.c.v.), in the presence or absence of the agonist LTD4 (0.2, 2, 6 or 20 pmol/1 µL, i.c.v.), on PTZ (1.8 µmol/2 µL)-induced seizures and BBB permeability disruption were determined. The animals were injected with the antagonists, agonist or vehicle 30 min before PTZ, and monitored for additional 30 min for the appearance of seizures by electrographic and behavioral methods. BBB permeability was assessed by sodium fluorescein method and by confocal microscopy for CD45 and IgG immunoreactivity. Bay-u9973 (3 and 30 nmol), montelukast (0.03 and 0.3 µmol) and pranlukast (1 and 3 µmol), increased the latency to generalized seizures and decreased the mean amplitude of EEG recordings during seizures. LTD4 (0.2 and 2 pmol) reverted the anticonvulsant effect of montelukast (0.3 µmol). Montelukast (0.03 and 0.3 µmol) prevented PTZ-induced BBB disruption, an effect that was reversed by LTD4 at the dose of 6 pmol, but not at the doses 0.2 and 2 pmol. Moreover, the doses of LTD4 (0.2 and 2 pmol) that reverted the effect of montelukast on seizures did not alter montelukast-induced protection of BBB, dissociating BBB protection and anticonvulsant activity. Confocal microscopy analysis revealed that 1. PTZ increased the number of CD45+ and double-immunofluorescence staining for CD45 and IgG cells in the cerebral cortex, indicating BBB leakage with leukocyte infiltration; 2. while LTD4 (6 pmol) potentiated, montelukast decreased the effect of PTZ on leukocyte migration and BBB, assessed by double-immunofluorescence staining for CD45 and IgG cells in the cannulated hemisphere. Our data do not allow us ruling out that mechanisms unrelated and related to BBB protection may co-exist, resulting in decreased seizure susceptibility by montelukast. Notwithstanding, they suggest that CysLT1 receptors may be a suitable target for anticonvulsant development.

Reoperaciones posadenoidectomía por hiperplasia adenoidea obstructiva / Post-adenoidectomy reoperations due to obstructive adenoid hyperplasia

Introducción: La incidencia de reoperación posadenoidectomía, ya sea una segunda adenoidectomía o una amigdalectomía, no es conocida en nuestro medio. Publicaciones extranjeras muestran 2% de readenoidectomías y 8% de amigdalectomías posteriores. Objetivo: Describir las adenoidectomías efectuadas en nuestro centro, evaluar la prevalencia de reoperaciones y buscar posibles factores asociados a éstas. Material y método: Estudio retrospectivo descriptivo y analítico. Se revisaron fichas de pacientes adenoidectomizados por roncopatía con pausas respiratorias entre enero de 1999 y diciembre 2010. Se registraron datos demográficos, controles y nasofaringolaringoscopías (NFL). Se consignaron las reoperaciones (readenoidectomías y amigdalectomías). Resultados: Se revisaron 106 fichas. Un 55,7% de los pacientes eran hombres. A la NFL, 42% de los pacientes tenían adenoides grado 3y 58% grado 4 de Parikh. Un 5,6% de los pacientes fueron reoperados (1 adenoidectomía y 5 adenoamigdalectomías). Se observó diferencia significativa en edad (p =0,04) y tamaño amigdalino (p =0,004) entre los reoperados y lo no reoperados. No hubo asociación por sexo (p =0,45), asma (p =0,31) ni rinitis (p =0,18). Sin embargo, a la regresión logística multivariada, ninguna variable se asoció significativamente de manera independiente con la necesidad de reoperación. Conclusión: La prevalencia de reoperaciones fue similar a la publicada, no encontrándose asociación con otros factores.

Introduction: The incidence of post-adenoidectomy reoperation, be it a second adenoidectomy or a tonsillectomy, is unknown within our environment. Foreign publications show a 2% of re-adenoidectomies and an 8% of ulterior tonsillectomies. Aim: To describe the adenoidectomies performed at our center, to assess the prevalence of reoperations, and to seek possible associated factors to the latter. Material y method: Descriptive and analytical retrospective assessment. A review was performed of records for patients that between January of 1999 and December of 2010 underwent adenoidectomy on account of snoring pathology. Demographics, controls, nasopharyngolaryngoscopies and reoperations (re-adenoidectomies and tonsillectomies) were recorded. Results: The review entailed checking 106 records. 55,7% of patients were men. 42% of patients had Parikh?s Grade III adenoids and 58% showed Grade IV ones. 5,6% of patients underwent reoperation. A significant difference could be observed in age (p=0,04) and tonsillar size (p=0,004) between those that had and had not undergone reoperation. There was no gender association (p=0,45), neither for asthma (p=0,31) or rhinitis (p=0,18). Yet, by multivariate logistic regression, no variable was significantly associated by itself to the need for reoperation. Conclusion: Reoperation prevalence was similar to that published, and no association to other factors was discovered.

Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality.

BACKGROUND: Information regarding bloodstream infections (BSIs) in patients with kidney diseases is scarce and mainly derived from selected groups of patients. AIM: To assess the characteristics of BSI in an unselected population of patients with kidney disease, including renal transplant recipients and patients with chronic kidney failure who were receiving or not receiving dialysis. METHODS: A retrospective cohort study of all patients who presented with BSI in the nephrology department of a large teaching hospital. Clinical records were reviewed according to a pre-established protocol. Standard definitions were used. FINDINGS: In all, 155 episodes of BSI were recorded in 108 patients. The incidence of BSI was 77.3 episodes per 1000 admissions, and 4.5 episodes per 100 patient-years. Haemodialysis patients had the highest incidence of BSI. The distribution of micro-organisms was as follows: Gram-negative, 52.3%; Gram-positive, 46.5%; fungi, 1.2%. Escherichia coli was the most frequently isolated micro-organism (27%). The BSI was classed as bacteraemia of unknown source (29.7%), urinary tract infection (23.2%), vascular access infection (17.4%), and other (29.7%). Eighteen patients (11.6%) developed septic shock or multi-organ failure, and the same proportion had persistent bacteraemia. The crude mortality rate was 14.6%. The risk factors for mortality were high Charlson index, persistent bacteraemia, and absence of fever. CONCLUSION: Nephrology patients have a high incidence of BSI, particularly patients undergoing haemodialysis. The predominant micro-organisms causing BSI episodes were Gram-negative bacilli. Patients with kidney disease have high BSI-related morbidity and mortality. Risk factors for mortality were high Charlson comorbidity index and persistent BSI. The presence of fever during the BSI episodes was found to be a protective factor.

High-speed free-space quantum key distribution system for urban daylight applications.

We report a free-space quantum key distribution system designed for high-speed key transmission in urban areas. Clocking the system at gigahertz frequencies and efficiently filtering background enables higher secure key rates than those previously achieved by similar systems. The transmitter and receiver are located in two separate buildings 300 m apart in downtown Madrid and they exchange secure keys at rates up to 1 Mbps. The system operates in full bright daylight conditions with an average secure key rate of 0.5 Mbps and 24 h stability without human intervention.

High-sensitivity troponin T levels in kidney transplant recipients.

Cardiovascular disease (CVD) is still the leading cause of death among kidney transplant recipients. Validated biomarkers are important to identify patients at high risk for cardiovascular events and mortality. Cardiac troponins are one of the best available prognostic markers in this clinical situation, especially in chronic kidney disease and kidney transplant (KT) patients. The recently appeared high-sensitivity immunoassay to measure troponin T (hsTnT) has not yet been widely studied in the transplant population. We designed a cross-sectional study to evaluate hsTnT levels among 177 stable, asymptomatic patients, including 44.1% (78) males of overall mean age of 56.14 ± 14.25 years. Mean glomerular filtration rate estimated with the MDRD-4 (eGFR MDRD) formula was 48.93 ± 26.46 mL/min/1.73 m(2). Median hsTnT was 11 (interquartile range = 11-26) ng/L. Patients were classified according to their hsTnT levels: normal, below 14 ng/L (57.6%, n = 102 patients), and those with basally elevated levels. Upon univariate analysis, a significant association was found between higher hsTnT levels and several variables, including clinical features, such as age, sex or prior CVD; renal function indicators: creatinine, eGFR MDRD, and proteinuria; nutritional and inflammation markers: albumin, ferritin, and C-reactive protein; and several cardiac enzymes: creatine kinase myocardial band (CKMB), B-type natriuretic peptide, and its N-terminal fragment. A logistic regression model adjusted for age, sex, and variables significantly associated with higher hsTnT levels, showed that male gender, age, CKMB, and lower glomerular filtration rate to show independent relation to basally elevated levels of hsTnT among asymptomatic kidney transplant recipients.

Monitoring of circulating antibodies in a renal transplantation population: preliminary results.

BACKGROUND: The presence of circulating antibodies (CA) against human leukocyte antigen (HLA) and major-histocompatibility-complex class I-related chain A (MICA) antigens has been associated with worse renal function and reduced kidney allograft survival. We sought to describe the presence of donor-specific anti-HLA antibodies, non-donor specific antibodies, and antibodies against MICA antigens among a cohort of renal transplant recipients with respect to their evolution effects on renal function and occurrence of an acute rejection episode (AR) after transplantation. METHODS: This prospective study of 22 renal transplant recipients of deceased donor kidneys underwent studies of antibodies before and 3 months after grafting using Luminex technology. RESULTS: Ten patients (five men and five women) showed preexistent CA. Comparing patients with versus without preformed CA, we did not observe a significant difference in donor and recipient age or gender. Eight patients (80%) with CA had undergone induction treatment with anti-human-activated T-lymphocyte rabbit immunoglobulin and 2 (20%) with basiliximab. There were no differences between groups regarding the incidence of acute rejection episodes (ARE n = 3 each). There was one case of Banff grade IIB ARE in a patient without preexisting CA; the other episodes were low-grade cellular responses. There were no differences in other variables including cold ischemia time, HLA mismatches, panel-reactive antibody levels, number of transfusions, cytomegalovirus infection or renal function at discharge and 3 months later. Retransplantation was the only factor associated with preformed CA. Retransplantation and preformed CA were associated with CA at 3 months after transplantation. CONCLUSIONS: CA monitoring is important for highly sensitized renal transplants, although our experience failed to show a difference in graft survival or renal function in the first 3 months' follow-up.

Cirugía para el manejo del síndrome de apnea e hipopnea obstructiva del sueño y de la roncopatía: revisión de 71 casos clínicos / Surgery in the management of obstructive sleep apnea and hypopnea syndrome and snoring: review of 71 clinical cases

Introducción: El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) es una patología altamente prevalente y se asocia a importante comorbilidad cardiovascular. Su etiología es multifactorial. Dentro de las opciones terapéuticas, la cirugía de la vía aérea superior es una alternativa efectiva en casos seleccionados. Objetivo: Describir la experiencia del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile en cirugía de pacientes con diagnóstico de SAHOS. Material y método: Estudio retrospectivo descriptivo. Se analizan fichas clínicas, antecedentes demográficos y mórbidos, polisomnografía (PSG), tipo de cirugía, puntaje de Epworth pre y posoperatorio, estadía hospitalaria, complicaciones y seguimiento. Resultados: De un total de 71 pacientes (87 por ciento de sexo masculino, edad promedio de 44 años), el 88 por ciento por ciento tiene diagnóstico preoperatorio de sobrepeso u obesidad. Al 67 por ciento por ciento de los pacientes se les realizó PSG, en el 64 por ciento por ciento de ellas se demostró un SAHOS moderado a severo. En el 97 por ciento por ciento de los casos se realizó uvulopalatoplastía con radiofrecuencia (UPP), en el 62 por ciento por ciento septoplastía (SP) y en el 50 por ciento por ciento amigdalectomía. En el 98 por ciento por ciento de los pacientes se asociaron 2 a 4 técnicas, destacando la SP más UPP como la combinación más frecuente (15,45 por ciento por ciento). El promedio de estadía hospitalaria fue de 1,09 días. Sólo el 7 por ciento de los pacientes presentó complicaciones. El seguimiento promedio fue de 3,05 meses. Discusión: El rol de la cirugía es eliminar el colapso de la vía aérea superior, lo que se logra en la mayoría de los pacientes usando técnicas asociadas. Conclusión: La indicación de cirugía en SAHOS debiera combinar diferentes técnicas dependiendo de la localización anatómica de la obstrucción y el tipo de paciente a intervenir.

Introduction: The obstructive sleep apnea syndrome (OSA) is a highly prevalent disease and is associated with significant cardiovascular morbidity. Its etiology is multifactorial. Among the therapeutic options, surgery of the upper airway is an effective alternative in selected cases. Aim: To describe the experience of the Otorhinolaryngology Service of Hospital of the University of Chile in surgery of patients with OSA. Material and method: Retrospective descriptive study. We analyzed clinical and morbid records, demographic background, polysomnography (PSG), type of surgery, pre and post surgical Epworth scores, hospital stay, complications and follow-up. Results: Of a total of 71 patients (87 percent male, average age of 44 years), 88 percent had a preoperative diagnosis of overweight or obesity. 67 percent of patients were done a PSG, 64 percent of them showed a moderate to severe OSA. 97 percent of patients underwent radiofrequency uvulopalatoplasty (UPP), 62 percent septoplasty (SP) and 50 percent tonsillectomy. In 98 percent of patients, 2 to 4 associated techniques were used, highlighting the association of UPP plus SP as the most frequent combination (15.45 percent percent). The average hospital stay was 1.09 days. Only 7 percent percent of patients had complications. The average follow-up time was 3.05 months. Discussion: The role of surgery is to remove the collapse of the upper airway, which is achieved in most patients using associated techniques. Conclusion: Surgery for OSA should include different techniques combination, anatomical location of obstruction and patient's profile.

Microsatellites and Alu elements from the human MHC in Valencia (Spain): analysis of genetic relationships and linkage disequilibrium.

Two different sets of noncoding markers (microsatellites and Alu elements) from the human chromosome six were analysed in 106 individuals from Valencia (Spain), with the aim of exploring the effect of evolutionary forces on the genetic variability of the major histocompatibility complex (MHC) and assessing the potential usefulness of these genetic loci in phylogenetic studies. Linkage disequilibrium (LD) analyses revealed statistically significant associations among markers located in the MHC class I region, and also between the microsatellite D6S2792 and several genetic loci from MHC class I, II and III regions. Results of the Ewens-Watterson test indicated that only D6S2792 showed significant departure from selective neutrality. Despite the paucity of haplotype data in the literature, results of the phylogenetic analyses at world scale (Alu elements) showed that the genetic relationships of Valencia were mainly determined by the ethnic ancestry of the populations considered, whereas at European scale (microsatellites) population affinities were strongly influenced by geography. Our findings suggest that noncoding markers from the MHC such as Alu and microsatellite loci might have a potential value as lineage (ancestry) markers in investigations into evolutionary, medical and forensic perspectives.

Fracaso renal agudo en el contexto de un síndrome de Takotsubo / Acute kidney failure in the context of a Tako-Tsubo syndrome

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Improving the visualization of the Pareto-optimal front for the multi-response optimization of chromatographic determinations.

The paper shows tools to visualize and more easily interpret the effect that some experimental factors may exert on analytical responses of interest when optimization of several responses is needed. It is based on an adaptation of the parallel coordinate plot, a tool for graphical representation of points in multidimensional spaces that, theoretically and contrary to the usual Cartesian plots, does not have limits in the dimension of the points being depicted. The joint use of the Pareto-optimal solutions and their visualization allows a deeper knowledge about the problem at hand as well as the wise selection of the conditions of experimental factors for achieving specific goals about the responses. Although the methodology is for a general use, the procedure, its interpretation and usefulness is shown with several analytical cases in chromatography. The first one refers to the experimental conditions to obtain simultaneously the maximum allowable area for both the peak of the malachite green and its metabolite leucomalachite green in fish by liquid chromatography with tandem mass spectrometry detection (LC-MS/MS). The second one is about the simultaneous determination of steroid hormones estrone and 17-α-ethinylestradiol by gas chromatography-mass spectrometry (GC/MS). In the last case, the chromatographic separation by GC/MS of the diastereoisomers, α- and ß-estradiol is needed taking into account that these hormones have the same mass fragments.

Rol de TGF-B1 en la fibrosis de la piel inducida por radioterapia en cáncer de cabeza y cuello: [revisión] / Role of TGF-B1 in the skin fibrosis induced by radiotherapy in head and neck cancer: [review]

Introduction: radiotherapy (RT) is a major part of the treatment of head and neck cancer, but it can produce skin fibrosis and other complications. Fibrosis is produced by an increase of the fibroblasts (FB) and extra-cellular matrix proteins. TGF-b is one of the several factors implied in FB proliferation, and it is the most important element in the development of radiation fibrosis. Temporality of radiation fibrosis: there are two successive stages in the fibrosis development. An actively inflammatory with high TGF-b1 secretion one, and a second stage characterized by hypo-cellularity and low TGF-b1 secretion. TGF-b: an induction of TGF-b1 and its mRNA in animals skin during the first hours post irradiation have been demonstrated. By studying surgical skin biopsies post RT and fibrotic tissues post exposure to radiation, it was observed overexpression of TGF-b1. Discussion: there is a lot of new knowledge of the molecular process implied in radiation skin fibrosis. A future goal is to potentiate this information to improve our tools in prevention and treatment of fibrosis in patients that undergone RT because of cance.

Genetic position of Valencia (Spain) in the Mediterranean basin according to Alu insertions.

In this work, eight human-specific Alu insertion polymorphisms (ACE, TPA25, PV92, APO, FXIIIB, D1, A25, and B65) were typed in 106 unrelated healthy individuals born in the province of Valencia (Spain), with the aim of analyzing the genetic relationships between this region of the Iberian Peninsula and other Mediterranean populations. To that end, Alu data on Eastern European, Western European, and North African populations were compiled from previous studies. The genetic information was stressed by means of genetic distances (R matrix method), nonmetric multidimensional scaling (MDS) and analyses of molecular variance (AMOVA). In Valencia, the most common Alu insertion was APO (0.940), and the least frequent was A25 (0.104). The average gene diversity (GD) computed for the sample examined was comparatively high (0.382). The insertion frequencies estimated for the eight Alu markers were very similar to the mean frequencies calculated for the whole set of populations included in the study, suggesting the hybrid nature of the Valencia's gene pool. MDS and AMOVA results generated from Alu data reveal that the Mediterranean has acted as a strong genetic boundary between the north (Europe) and the south (Northern Africa), resulting in significant gene diversity between the populations of the two regions. Restricted exclusively to the European scope, we suggest the possibility that the Mediterranean could have also acted as a migratory passageway, propitiating the dissemination of cultures and genes between the east and west of Europe and giving rise to some homogenization of gene frequencies among coastal dwelling populations.

[43 cycles of anabolic steroid treatment studied in athletes: the uses and secondary effects]. / Estudio de 43 ciclos de tratamiento con anabolizantes esteroideos en deportistas: usos y efectos secundarios.

OBJECTIVE: To know the actual abuse of anabolic steroids by amateur athletes in our environment as well as actions and secondary effects resulting from such abuse. METHODS: Analytical observational study from May 1997 to November 1998. Forty-three therapy courses with anabolic steroids among 39 male athletes were studied. Diet and training were standardized for all participants. A verification was made that the test group started from a basal state. RESULTS: Duration of therapy was 6 weeks and the mean total dose was 2,928 mg. Significant differences were found in the test group regarding basal and post-therapy values for: transaminases (AST: 29.8 vs 45.0 IU/l, p < 0.001. ALT: 32.9 vs 51.4 IU/l, p < 0.01), cholesterol, HDL-cholesterol (31.4 vs 19.7 mg/dl, p < 0.01), LDL-cholesterol (145.9 vs 173.5 mg/dl, p < 0.01), LH (2.1 vs 0.2 U/l, p < 0.001), FSH (3.3 vs 0.4 U/l, p < 0.001), free testosterone (14.4 vs 34.0 pg/ml, p < 0.001), 17-beta-estradiol and arm muscular section (98.8 vs 103.7 cm2, p < 0.001). The inclusion of testosterone in therapy introduced a significant difference with respect to the use of synthetic anabolic agents alone, in total testosterone (4.5 vs 0.9 ng/ml, p < 0.001) and 17-beta-oestradiol, but neither with respect to free testosterone nor arm muscular section. An 84.6% of individuals in the problem group stated to complete two therapy courses in a year. CONCLUSIONS: The use of anabolic steroids increases the lean muscular mass. The most relevant secondary effects included: increased transaminase serum levels, change in the lipid profile and suppression of the hypothalamus-pituitary gland-gonad axis. The inclusion of testosterone did not increase the lean muscular mass.