Daily artificial gravity partially mitigates vestibular processing changes associated with head-down tilt bedrest.

Microgravity alters vestibular signaling and reduces body loading, driving sensory reweighting. The unloading effects can be modelled using head-down tilt bedrest (HDT). Artificial gravity (AG) has been hypothesized to serve as an integrated countermeasure for the declines associated with HDT and spaceflight. Here, we examined the efficacy of 30 min of daily AG to counteract brain and behavior changes from 60 days of HDT. Two groups received 30 min of AG delivered via short-arm centrifuge daily (n = 8 per condition), either in one continuous bout, or in 6 bouts of 5 min. To improve statistical power, we combined these groups (AG; n = 16). Another group served as controls in HDT with no AG (CTRL; n = 8). We examined how HDT and AG affect vestibular processing by collecting fMRI scans during vestibular stimulation. We collected these data prior to, during, and post-HDT. We assessed brain activation initially in 12 regions of interest (ROIs) and then conducted an exploratory whole brain analysis. The AG group showed no changes in activation during vestibular stimulation in a cerebellar ROI, whereas the CTRL group showed decreased activation specific to HDT. Those that received AG and showed little pre- to post-HDT changes in left vestibular cortex activation had better post-HDT balance performance. Whole brain analyses identified increased pre- to during-HDT activation in CTRLs in the right precentral gyrus and right inferior frontal gyrus, whereas AG maintained pre-HDT activation levels. These results indicate that AG could mitigate activation changes in vestibular processing that is associated with better balance performance.

Brain and Behavioral Evidence for Reweighting of Vestibular Inputs with Long-Duration Spaceflight.

Microgravity alters vestibular signaling. In-flight adaptation to altered vestibular afferents is reflected in post-spaceflight aftereffects, evidenced by declines in vestibularly mediated behaviors (e.g., walking/standing balance), until readaptation to Earth's 1G environment occurs. Here we examine how spaceflight affects neural processing of applied vestibular stimulation. We used fMRI to measure brain activity in response to vestibular stimulation in 15 astronauts pre- and post-spaceflight. We also measured vestibularly-mediated behaviors, including balance, mobility, and rod-and-frame test performance. Data were collected twice preflight and four times postflight. As expected, vestibular stimulation at the preflight sessions elicited activation of the parietal opercular area ("vestibular cortex") and deactivation of somatosensory and visual cortices. Pre- to postflight, we found widespread reductions in this somatosensory and visual cortical deactivation, supporting sensory compensation and reweighting with spaceflight. These pre- to postflight changes in brain activity correlated with changes in eyes closed standing balance, and greater pre- to postflight reductions in deactivation of the visual cortices associated with less postflight balance decline. The observed brain changes recovered to baseline values by 3 months postflight. Together, these findings provide evidence for sensory reweighting and adaptive cortical neuroplasticity with spaceflight. These results have implications for better understanding compensation and adaptation to vestibular functional disruption.

Death Has Us in Check.

This digital self-portrait considers what pending loss of patients to a novel coronavirus (SARS-CoV-2) feels like. Your Move represents clinicians' struggles to help patients as a game of chess against death, who seems always one step ahead. The clinician is tired, and death is cheating, but giving up is not an option, no matter how bad his position on the board.

Herbicide determination in Brazilian propolis using high pressure liquid chromatography.

Propolis is a widely used medicinal product sourced by bees from vegetation that may be frequently irrigated with herbicides. Exposure to herbicides can affect bees' health and the quality of commercial propolis. The objective of this study was to calculate the concentrations of glyphosate, aminomethylphosphonic acid (AMPA), picloram and atrazine in different types of propolis from Brazil using high-performance liquid chromatography (HPLC). Four types of propolis (brown, green, red, and yellow) were evaluated for a total of 19 samples. Of these types of propolis, 47% tested positive for the herbicides atrazine (5 to 17.4 µg/g) and AMPA (10.2 to 11.3 µg/g). No samples were reported to be positive for glyphosate; however, the presence of AMPA indicates its existence. The concentrations observed in this study are less than international maximum-residue-level standards.

Propuesta de clasificación tomográfica preoperatoria para el tumor del cuerpo carotideo / Proposal for a preoperative tomographic classification for carotid body tumor

OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.

OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.

Neoplasia fusocelular - tumor de gist: presentación de un caso / Fusocellular neoplasia - gist tumor: presentation of a case

Los tumores del estroma gastrointestinal (TEGI) son las neoplasias mesenquimales más frecuentes del tracto digestivo con una frecuencia de 0,1 a 3 % de todas las neoplasias gastrointestinales. Son derivadas de las células intersticiales de Cajal, localizadas a lo largo del plexo mioentérico de la pared intestinal. Comprenden leiomisarcomas, leiomioblastomas, leimiomas, schwannomas. Están formadas por células fusiformes, en la mayoría, epitelioides o ambas. Se localizan predominantemente en estómago e intestino delgado. Inmunohistoquimicamente se detecta expresión de receptores KIT (antígeno CD117) que puede ser focal, variable o difusa. Involucran tumores benignos pero con potencial malignidad hasta sarcomas metastizantes. Su pronóstico se basa el tamaño y porcentaje de mitosis. La sintomatología depende del lugar de origen, en este caso como masa palpable abdominal y obstrucción intestinal. El tratamiento es la resección completa con márgenes limpios. En caso de metástasis preoperatoria, esta no cambia la conducta quirúrgica, debido a la posibilidad de obstrucción y sangrado. El Imatinib a dosis de 400 mg controla el crecimiento eventual de enfermedad residual. Se presenta el caso clínico de paciente con masa abdominal y cuadro de obstrucción intestinal que evoluciona a la perforación de un TEGI localizado en yeyuno proximal con cuadro peritoneal y absceso subfrenico. Se procede a resección intestinal con yeyuno yeyuno anastomosis resección completa. La histopatología reporta Tumor estronal gastrointestinal y la inmunohistoquimica Neoplasia Fusocelular. CONCLUSION: Los TEGI son de origen mesenquimal, comprenden espectro grande de tumores desde benignos, hasta carcomas altamente malignos. Los factores pronósticos se asocian al tamaño e índice mitótico del tumor. La inmunohistoquimica reporta su expresión para CD117. La resección quirúrgica completa es el pilar de tratamiento y en casos de resección incompleta o irresecabilidad puede usarse imatinib.

Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal neoplasms of the digestive tract with a frequency of 0.1 to 3% of all gastrointestinal neoplasms. They are derived from the interstitial cells of Cajal, located along the myoenteric plexus of the intestinal wall. They include leiomysarcomas, leiomioblastomas, leimiomas, schwannomas. They are made up of spindle cells, in the majority, epithelioids or both. They are located predominantly in the stomach and small intestine. Immunohistochemically, KIT receptor expression (CD117 antigen) is detected, and they can be focal, variable or diffuse. They involve benign but potentially malignancy tumors up to metastatic sarcomas. Their prognosis is based on the size and percentage of mitosis. The symptoms depend on the place of its origin. Treatment is complete resection with clean margins. In the case of preoperative metastases, this does not change the surgical approach, due to the possibility of obstruction and bleeding. Imatinib at a dose of 400 mg controls the eventual growth of residual disease. We present the clinical case of a patient with an abdominal mass and a small bowel obstruction that progresses to perforation of a GIST located in the proximal jejunum with a peritonitis and subphrenic abscess. Intestinal resection is performed with jejunum jejunoanastomosis and complete resection. Histopathology reports gastrointestinal stromal tumor and immunohistochemistry, Fusocellular neoplasia. Conclusion: GIST are of mesenchymal origin, they include a wide spectrum of tumors from benign to highly malignant sarcomas. Prognostic factors are associated with tumor size and mitotic index. Immunohistochemistry reports its expression for CD117. Complete surgical resection is the mainstay of treatment and in cases of incomplete resection or unresectability imatinib can be used.

Psychosocial factors and oral health practices of preschool-aged children: a qualitative study with Hispanic mothers.

OBJECTIVE: This qualitative study sought to gain an in-depth understanding of Hispanic mother's parenting experiences and perceptions about select psychosocial factors. How psychosocial factors influence mothers' engagement in recommended oral health-related behaviors for their preschool-aged children (3-5 years) was explored. Psychosocial resources and barriers explored included maternal knowledge about children's oral health, beliefs such as perceived self-efficacy and health locus of control, and parenting experience and stress. DESIGN: Six focus groups and one individual interview with lower-income, Hispanic mothers of preschoolers (n = 36 total participants) were conducted in Spanish at a community health clinic on the California-Mexico border during summer 2010. A bilingual dentist led all sessions using a set of open-ended guiding questions. All sessions were audio-taped, translated and transcribed in English. Transcripts were coded and analyzed for common themes. RESULT(S): Six themes were identified around dental knowledge, the mothers' primary role in performing the child's oral hygiene among multiple caregiving priorities, parenting challenges, perceived self-efficacy, perceived future outlook for their child's oral health, and family influences. Mothers recognized the importance of caring for primary teeth. However, few were knowledgeable about preventive practices to promote young children's oral health, such as the recommended ages for brushing or first dental visit. Mothers that were more knowledgeable expressed feeling more efficacious about maintaining their child's oral hygiene. All mothers believed they were primarily responsible for their child's oral health, and most held positive future expectations for their child's oral health. CONCLUSION: These findings provide insight into how Hispanic mothers of young children perceive their role as caregiver. Maternal knowledge and perceptions affect their ability to care for their child's oral health and should be accounted for in future interventions.

OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study.

BACKGROUND AND PURPOSE: OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome. METHODS: We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months. RESULTS: A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045). CONCLUSIONS: This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.

Efectividad de la profilaxis antibiótica en pacientes con colecistitis aguda sometidos a colecistectomía laparoscópica / Effectiveness of antibiotic prophylaxis in acute cholecystitis patients undergoing laparoscopic cholecystectomy

OBJETIVO: Determinar la efectividad de la profilaxis antibiótica con Cefazolina en pacientes sometidos a colecistectomía laparoscópica por Colecistitis Aguda MATERIAL Y MÉTODOS: Cohorte Prospectiva POBLACIÓN: Pacientes mayores de 18 años, con patología litiásica vesicular aguda, sometidos a colecistectomía laparoscópica. SEDE Y TEMPORALIDAD: Hospital Obrero Nº 1 de la Caja Nacional de Salud La Paz ­ Bolivia. Período comprendido entre el 1 de Julio de 2016 al el 31 de Diciembre de 2016. RESULTADOS: Se incluyeron 95 pacientes con Colecistitis Aguda divididos en dos grupos, el Grupo A (SIN profilaxis antibiótica) compuesto por 50 sujetos y el Grupo B (CON profilaxis antibiótica) de 45 sujetos. La edad promedio fue de 48 años, el peso de 70 kilos, la talla de 165 cm y el IMC de 27,4 km/ m2. El tiempo operatorio promedio fue de 50 (±22,815) minutos en el total del grupo, 45 min. (±18,460) en el grupo A y 60 min (±24,862) en el grupo B. La conversión a cirugía abierta fue de 9 sujetos (9,5%). La infección del sitio operatorio se presentó en 47 sujetos (49,5%), 30 sujetos (60%) EN EL GRUPO A y 18 en el grupo B (40%). El OR calculado es de 0,444 (IC 95% 0,195 ­ 1,011). CONCLUSIONES: La administración de Cefazolina en forma profiláctica, parece no disminuir la probabilidad de infección del sitio operatorio en colecistitis aguda abordada por laparoscopía

OBJECTIVE: To determine the effectiveness of antibiotic prophylaxis with Cefazolin in patients undergoing laparoscopic cholecystectomy due to Acute Cholecystitis. METHODS: Prospective Cohort POPULATION: Adult patients (older than 18 years), with acute lithiasic cholecystitis, who underwent laparoscopic cholecystectomy. PLACE AND TEMPORALITY: Hospital Obrero No. 1 of the Caja Nacional de Salud La Paz ­ Bolivia, from July to December 2016. RESULTS: A total of 95 patients with Acute Cholecystitis were enrolled and divided in to two groups, group A (without antibiotic prophylaxis) composed of 50 subjects and Group B, (with antibiotic prophylaxis) 45 subjects. The mean age was 48 years old, weight 70 Kg, hight 165 cm and a BMI of 27.4 kg/M2. The mean operating time was 50 minutes (+- 22.185), group A 45 minutes and group B 60 min. Conversion to open surgery happened in 9 patients (9,5%), all in group B. Surgical Site infection (SSI) occurred in 47 patients (49.5%), of whom 30 patients belong to group A (60%) and 18 patients to group B (40%). The calculated Odds ratio is 0.444 (IC 95% 0,195-1.011). There were no bile duct injuries or morality in this study. CONCLUSIONS: The prophylactic administration of Cefazolin does not seems to decrease the probability of SSI in acute cholecystitis treated laparoscopically.

Membrana de Quitosano con Aceites Esenciales de Romero y Árbol de Té: Potencial como Biomaterial / Membrane of chitosan with essential oils of Romero and Tree of Tea: Potential as biomaterial

RESUMEN: El quitosano (CH) tiene propiedades hemostáticas, cicatrizantes y estimulantes del sistema inmune del hospedero contra infecciones virales y bacterianas. Además es biodegradable, no tóxico, antimicrobiano, biocompatible y filmogénico. Estas propiedades han sido utilizadas para acarrear y liberar compuestos bioactivos para sus posibles usos en la salud humana. Por otro lado, los compuestos bioactivos como los aceites esenciales de gran volatilidad como romero (RMO) [Rosmarinus officinalis] y árbol de té (TTO) [Melaleuca alternifolia], pueden ser alternativa importante de uso como antioxidantes y antimicrobianos que podrían inducir cambios favorables en la membrana de CH. Por lo tanto, se incorporaron aceites esenciales de TTO y RMO (0.25, 0.50 y 1.00% v/v) en membranas de CH por el método de casting y se evaluaron su solubilidad, PVA, transparencia y capacidad de bloqueo de la luz ultravioleta, capacidad antioxidante y de protección del eritrocito humano. RMO y TTO redujeron la solubilidad (28-58%) y PVA (entre 28-58%) de las membranas de CH. Todas las membranas fueron amarillas, ligeramente opacas y con capacidad de bloquear la luz ultravioleta. También, las membranas mostraron relativa baja capacidad antioxidante por el radical ABTS (≈ 6 at 9 %), pero con excelente efecto protector sobre el eritrocito humano (> 63 %).

ABSTRACT: Chitosan (CH) has hemostatic properties and accelerated healing ability to stimulate the host immune system against viral and bacterial infections. It is also biodegradable, nontoxic, antimicrobial, biocompatible, and capable of forming membranes and to carry and to release bioactive compounds. These properties of CH can be useful to carry some volatile essential oils having bioactive compounds (antioxidants and antimicrobials) with potential application in human health as those as rosemary (RMO) [Rosmarinus officinalis] and tea tree (TTO) [Melaleuca alternifolia]. These essential oils were incorporated into the chitosan by the casting method in this study. The physical properties (solubility, PVA, transparency and blocking ultraviolet light) of these membranes with TTO and RMO (0.25, 0.50 and 1.00% v/v), antioxidant capacity and protection human erythrocyte were evaluated. TTO and RMO reduced solubility (28-58%) and PVA (between 28-58%) of CH membranes. All membranes were yellow, slightly opaque and they were able to block the ultraviolet light. Membranes also showed relatively low antioxidant capacity by the radical ABTS (≈ 6 at 9%), but it was accompanied by an excellent protective effect on the human erythrocyte (> 63%).

Gastric mucosa injury quantification in an ischemia - Reperfusion experimental model.

Gastric ischemia - reperfusion (I/R) injury is an important clinical problem, which is developed in more than 80% of critically ill patients. I/R is caused by interruption of blood supply to an organ or tissue followed by blood reflow into the exposed area, leading to multiple organ failure and death. Gastric reactance has been proposed to measure tissue injury caused by ischemia. The present study evaluates a new method to quantify gastric tissue damage due to I/R, and assess its relation to gastric reactance changes. Twenty Wistar rats were randomly assigned to 4 groups: control, ischemia, I/R 30 min, I/R 1 h. Local gastric ischemia was induced by clamping the celiac artery for 30 min and reperfusion was done for 30-60 min. In all groups, gastric impedance was measured, and then gastric mucosa samples were taken for light microscopy. There were statistical significant differences (p <;0.05) among the groups with respect to the index of gastric injury proposed, which was greater in I/R 1 h group. Also, impedance parameters increased in I/R groups with respect to control, and ischemia groups. The proposed index of gastric injury allowed gastric mucosa damage quantification, and it was related with gastric impedance increase, which is an objective method to evaluate tissue injury.

Prospection of genomic regions divergently selected in racing line of Quarter Horses in relation to cutting line.

Selection of Quarter Horses for different purposes has led to the formation of lines, including racing and cutting horses. The objective of this study was to identify genomic regions divergently selected in racing line of Quarter Horses in relation to cutting line applying relative extended haplotype homozygosity (REHH) analysis, an extension of extended haplotype homozygosity (EHH) analysis, and the fixation index (F ST) statistic. A total of 188 horses of both sexes, born between 1985 and 2009 and registered at the Brazilian Association of Quarter Horse Breeders, including 120 of the racing line and 68 of the cutting line, were genotyped using single nucleotide polymorphism arrays. On the basis of 27 genomic regions identified as selection signatures by REHH and F ST statistics, functional annotations of genes were made in order to identify those that could have been important during formation of the racing line and that could be used subsequently for the development of selection tools. Genes involved in muscle growth (n=8), skeletal growth (n=10), muscle energy metabolism (n=15), cardiovascular system (n=14) and nervous system (n=23) were identified, including the FKTN, INSR, GYS1, CLCN1, MYLK, SYK, ANG, CNTFR and HTR2B.

Tumor del estroma extra gastrointestinal (E-GIST) gigante de omento / Extra gastrointestinal stromal tumor (E-GIST) of the omentum

Introduction: Tumors that are pathologically and immunohistochemically similar to gastrointestinal stromal tumors (GIST), but coming from soft tissues of the mesentery or retroperitoneum are called extra gastrointestinal stromal tumors (E-GISTs) and are more aggressive than GISTs. Clinical case: We report a 46 years old woman operated for a uterine sarcoma with a liver metastasis of the tumor, subsequently subjected to radiotherapy. A new CAT scan showed a 21 x 12 cm tumor. Radiotherapy was discontinued and the patient refused chemotherapy. Four years later, the patient consulted in the emergency room for a partial bowel obstruction. A new CAT scan showed a tumor that occupied the abdominal and pelvic cavity. The patient was operated, finding a highly vascularized and multisystem tumor that was fused together with the omentum, which was excised. The pathological diagnosis of the surgical piece was a high risk GIST.

Introducción: Los tumores del estroma gastrointestinal (GIST) fueron clasificados inicialmente dentro de otros grupos de tumores (leiomioma, leiomioblastoma, leiomiosarcoma), llamándolos leiomiomas bizarros o leiomiomas celulares debido a su apariencia histológica similar. Con el advenimiento de la microscopia electrónica se demostró que sólo algunos de estos tumores presentaban evidencias ultraestructurales de diferenciación muscular lisa. Posteriormente, los avances en la biología molecular y la inmunohistoquímica han permitido diferenciarlos de otras neoplasias digestivas e identificarlos como una patología clínica e histopatológica propia. Los tumores que histopatológicamente e inmunohistoquímicamente son similares a los GIST, pero proceden de los tejidos blandos del mesenterio o el retroperitoneo sin presentar conexión, ni siquiera tenue, con la pared ni con la superficie serosa de las vísceras, son denominanados tumores del estroma extragastrointestinal (E-GIST) y han mostrado tener un comportamiento más agresivo que los GIST originados a nivel gástrico y similar a los intestinales. Reporte del caso: Paciente de 47 años quien desarrolló durante 8 años un tumor abdominal, que resultó ser un tumor del estroma gastrointestinal de omento, sometida a tratamiento quirúrgico. En 18 meses no ha presentado recidiva tumoral.

Dolor neuropático central en enfermedad de Parkinson / Central neuropathic pain in Parkinson's disease

Introducción: El dolor central es uno de los tipos de dolor que se presentan en los pacientes con enfermedad de Parkinson (EP). Debido a que su incidencia y su prevalencia no son elevadas, con frecuencia pasa desapercibido y, por consiguiente, los pacientes afectados no reciben tratamiento analgésico adecuado, lo cual incrementa su padecimiento. Este dolor es de tipo quemante, de inicio espontáneo, con periodos de exacerbación, pobremente localizado y usualmente más intenso en el lado motor más afectado. Su fisiopatología aún no está claramente definida. Desarrollo: Se realizaron una búsqueda y una selección sistemática de los estudios clínicos realizados en pacientes con EP, entre enero de 1986 y septiembre de 2010, que evaluaron el dolor neuropático central primario.Conclusiones: No se ha demostrado que el tratamiento con L-Dopa tenga efectos analgésicos sobre este dolor. Se requieren estudios futuros que permitan un mejor conocimiento de esta patología, para desarrollar mecanismos de prevención y tratamiento de esta enfermedad (AU)

Introduction: Central pain is one type of pain that occurs in patients with Parkinson's disease (PD). Because of its low incidence and prevalence, it often goes unnoticed and affected patients do not therefore receive adequate analgesic therapy, which increases their suffering. It is a burning pain with spontaneous onset and periods of exacerbation; pain is poorly localised and usually more intense on the more affected side. Its pathophysiology on patients with PD is not clearly defined. Methods: We performed a search and systematic selection of all clinical studies published from January 1986 to September 2010 concerning central neuropathic pain in Parkinson's disease. Conclusions: Treatment with L-Dopa has not been demonstrated to have an analgesic effect on this type of pain. Future studies are required to improve our understanding of this condition, and to develop interventions for preventing and treating it (AU)

Central neuropathic pain in Parkinson's disease.

INTRODUCTION: Central pain is one type of pain that occurs in patients with Parkinson's disease (PD). Because of its low incidence and prevalence, it often goes unnoticed and affected patients do not therefore receive adequate analgesic therapy, which increases their suffering. It is a burning pain with spontaneous onset and periods of exacerbation; pain is poorly localised and usually more intense on the more affected side. Its pathophysiology on patients with PD is not clearly defined. METHODS: We performed a search and systematic selection of all clinical studies published from January 1986 to September 2010 concerning central neuropathic pain in Parkinson's disease. CONCLUSIONS: Treatment with L-Dopa has not been demonstrated to have an analgesic effect on this type of pain. Future studies are required to improve our understanding of this condition, and to develop interventions for preventing and treating it.

The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients.

No useful method to directly monitor the level of end organ tissue injury is currently available clinically. Gastric reactance has been proposed to measure changes in a tissue structure caused by ischemia. The purpose of this study was to assess whether gastric reactance is a reliable, clinically relevant predictor of complications and a potentially useful tool to assess hypoperfusion in cardiovascular surgery patients. The value of gastric reactance measurements, standard hemodynamic and regional perfusion variables, and scores to predict postoperative complications were compared in 55 higher risk cardiovascular surgery patients with cardiopulmonary bypass. Low frequency gastric reactance, X(L), had a significant predictive value of postoperative persistent shock requiring more than 48 h of vasopressors and associated complications, before, during and after surgery (p < 0.05). Results suggest that reactance is an earlier predictor of patients at risk than all other variables tested. Patients with a high reactance (X(L) > 26) before surgery had a significantly higher incidence of complications, higher mortality and more days in the ICU than patients with a low reactance (X(L) < 13). X(L) was found to be a reliable and clinically relevant measurement. These results justify further clinical research to explore how this information may be used to improve patient management.

Actualización de las consecuencias físicas del abuso sexual infantil / Physical consequences of child sexual abuse: an update

La experiencia de abuso sexual conlleva importantes repercusiones en el bienestar físico y psicológico de la víctima. Se hace necesario conocer qué efectos puede tener esta experiencia sobre la salud, tanto para su posible detección temprana como para un tratamiento efectivo. Determinadas lesiones genitales y anales, la presencia de esperma, infecciones y enfermedades de transmisión sexual (gonococia, condilomas acuminados, sífilis) antes de la pubertad, así como el embarazo, pueden ser importantes indicadores de abuso sexual, si bien en la mayor parte de casos los hallazgos físicos son nulos en estas víctimas, dificultando la detección de estos casos. En la edad adulta, los dolores físicos, el trastorno de conversión, las crisis no epilépticas, el trastorno de somatización, trastornos ginecológicos, así como un inicio significativamente temprano de la menopausia, son algunos de los problemas físicos más frecuentemente presentes. Conclusiones: conocer los indicadores y consecuencias del abuso sexual para identificarlos y detectarlos tan pronto como sea posible se plantea como una necesidad de la que los profesionales del ámbito sanitario debemos ser conscientes para poder intervenir tempranamente y de forma efectiva en estos casos (AU)

Introduction: Child sexual abuse experience is usually followed by serious physical and psychological consequences. It is necessary to know the possible effects of this problem on the victim’s health to detect early these situations and to conduct effective treatments. Exposition: important physical indicators of child sexual abuse would include: genital and anal injuries, sperm, infections and sexually transmitted diseases (gonococci, condiloms, or genital warts, and syphilis) before puberty, and pregnancy. However, a great number of the cases do not present physical evidence, making difficult to detect. In adult victims, physical pain, conversion disorder, non-epileptic seizures, somatization, gynecological disorders, and early menopause, are some of the most frequent physical problems. Conclusions: health professionals must know the indicators and consequences of child sexual abuse to identify these cases as soon as possible and to early and effectively intervene onits serious consequences (AU)

Effects of chloroformic extracts from washed and unwashed papaya seeds (Carica papaya) on the sperm concentration of dogs.

Papaya seeds (Carica papaya Linn) have been found to have a significant effect on sperm characteristics in some mammals, including humans, but no studies have investigated the effects on dogs. In the present study, a significant decrease in sperm concentration was observed in a group of dogs treated with extracts from washed papaya seeds, but no decrease was observed in the group of dogs treated with non-washed seeds. An important effect of extract components from washed seeds such as fatty acids is probably involved in the reduction of sperm production because of Sertoli cell damage, as has been suggested for langur monkeys. Dilution of the active components in the non-washed papaya seeds or interference with some of the components may reduce the expected effect on spermatogenesis. This first report on the effects of a chloroformic extract of papaya seeds in dogs suggests that an increased dose is necessary to achieve azoospermia.

Biological risks to food crops fertilized with Ecosan sludge.

This paper presents the microbial effects of using Ecosan sludge in agriculture. Sludge from KwaZulu Natal in South Africa having a helminth ova content of around 30 HO/gTS, faecal coliforms of 10(6) CFU/gTS, faecal streptococi of 10(6) CFU/gTS and Salmonella spp. of 10(5) CFU/gTS were applied to soils to grow carrots and spinach at different rates. Results showed that helminth ova content in crops was always greater in leaves than in stems, with a content varying from 2 to 15 HO/gTS for spinach and sludge application rates of sludge of 0-37.5 ton/ha and from 2-8 HO/gTS in carrots crops for sludge application rates varying from 0 to35 ton/ha. Health risks resulting from crop consumption were calculated using the beta-poisson and the single-hit exponential models for Salmonella and helminths eggs, respectively. For Salmonella, no risks were found when consuming carrots for all the sludge rates studied while for spinach, risks were high but results were not deemed conclusive due to the technical methods used to measure bacteria. Concerning helminths, it was found that the morbidity rate will increase by 9% for the higher sludge application rates. To increase regional risks by 1% the egg content in crops needs to be less than 0.2 HO/gTS.

Gastric impedance spectroscopy in elective cardiovascular surgery patients.

Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in critically ill patients. The present study characterizes human gastric impedance spectral changes under gastric hypoperfusion in patients undergoing cardiovascular surgery, and evaluates spectral differences between patients with no evidence of gastric ischemia and complications, and patients who developed ischemia and complications. Cole and Kun parameters were calculated over time to characterize changes as tissue injury progresses. Gastric ischemia was determined by air tonometry. Impedance spectroscopy spectra were obtained from 63 cardiovascular surgery patients. The recorded spectra were classified into three groups: group 1 for patients without ischemia or complications, group 2 for patients with a short period of ischemia (less than 2 h) and group 3 for patients with more than 4 h of gastric ischemia and complications. Two distinct dispersion regions of the spectra centered at about 316 Hz and 215 kHz become clearer as tissue damage develops. The average spectrum in group 3 shows a significant difference in tissue impedance at all frequencies relative to group 1. The parameters obtained for human gastric tissue show significant changes that occur at different times and at different frequencies as ischemia progresses, and could be correlated with patient outcome. This confirms our hypothesis that hypoperfusion and ischemia cause evident changes in the impedance spectra of the gastric wall. Therefore, this technology may be a useful prognostic and diagnostic monitoring tool.