Quality of clinical practice guidelines about red blood cell transfusion.

BACKGROUND: Red blood cell (RBC) transfusions are essential in health care. The quality of recommendations included in clinical practice guidelines (CPG), regarding this intervention, has not been systematically evaluated. This paper systematically assessed CPGs for RBC-transfusion, to appraise their methodological quality, to explore changes in quality over time, and to assess the consistency of the hemoglobin threshold (HT) recommendations. METHODS: We searched for CPGs that included recommendations of RBC-transfusion in generic databases, compiler entities, registries, clearinghouses and guideline developers. Three reviewers extracted data on CPGs characteristics and HT recommendations, independently appraised the quality of the studies using AGREE II and resolved disagreements by consensus. RESULTS: We examined 16 CPGs. Mean scores (mean ± SD) were: scope and purpose (59.4% ± 19.8%), stakeholder involvement (43.2% ± 22.6%), rigor of development (50% ± 25%), clarity of presentation (74.4% ± 12.6%), applicability (19.4% ± 18.8%), and editorial independence (41% ± 30%). Seven CPGs recommended a restrictive strategy for RBC transfusion; four CPGs gave a guarded statement considering an HT of 7 g/dL, as safe to prescribe an RBC transfusion. Eight CPGs did not provide an HT stating that RBC transfusions should not be prescribed by HT alone. CONCLUSIONS: Only 3 out of the 16 evaluated CPGs were "recommended" by the independent evaluators. Four domains "stakeholder involvement," "rigor of development," applicability," and "editorial independence" had serious shortcomings. Recommendations about the use of an HT for RBC-transfusion were heterogeneous among guidelines. Greater efforts are needed to provide high-quality CPGs in the RBC-transfusion practice.

Unraveling the induction of phytoene synthase 2 expression by salt stress and abscisic acid in Daucus carota.

Phytoene synthase (PSY) is the first committed enzyme of the carotenoid biosynthesis pathway and the most important point of regulation. Carotenoids are precursors of abscisic acid (ABA), which mediates abiotic stress tolerance responses in plants. ABA activates the synthesis of its own precursors through induction of PSY expression. Carrot, a species that accumulates very high amounts of carotenoids in its reserve root, has two PSY paralog genes that are expressed differentially in the root. Here, we determined that DcPSY2 expression is induced by salt stress and ABA. A DcPSY2 promoter fragment was obtained and characterized. Bioinformatic analysis showed the presence of three ABA responsive elements (ABREs). Through overexpressing pPSY2:GFP in Nicotiana tabacum we determined that all three ABREs are necessary for the ABA response. In the carrot transcriptome, we identified three ABRE binding protein (DcAREB) transcription factor candidates that localized in the nucleus, but only one, DcAREB3, was induced under ABA treatment in carrot roots. We found that AREB transcription factors bind to the carrot DcPSY2 promoter and transactivate the expression of reporter genes. We conclude that DcPSY2 is involved in ABA-mediated salt stress tolerance in carrot through the binding of AREB transcription factors to its promoter.

Osteoartropatía hipertrófica primaria y queratodermia palmoplantar: a propósito de un caso / Primary hypertrophic osteoarthropathy and palmoplantar keratoderma: a case report

La acropaquia es un trastorno que puede presentarse en forma aislada o formar parte del síndrome de osteoartropatía hipertrófica, entidad caracterizada por periostosis, dolor articular y acropaquia. Cuando este síndrome es causado por una mutación genética específica, se denomina osteoartropatía hipertrófica primaria. Este raro desorden hereditario se asocia, además, a alteraciones dermatológicas típicas, como hiperseborrea, acné, engrosamiento de pliegues faciales, entre otras. Una asociación rara vez descrita es la queratodermia palmoplantar. Se presenta el caso de una mujer de 46 años con osteoartropatía hipertrófica primaria asociada a queratodermia palmoplantar que asistió a la unidad de dermatología del Hospital Gustavo Fricke, Viña del Mar, Chile.

Clubbing is a disorder that can be an isolated finding or be part of the hypertrophic osteoarthropathy syndrome, an entity characterized by periostosis, joint pain and clubbing. When this syndrome is caused by a specific genetic mutation, it is called primary hypertrophic osteoarthropathy. This rare hereditary disorder is also associated with typical dermatological findings, such as hyperseborrhea, acne and facial feature coarsening. An association rarely described is palmoplantar keratoderma. We present the case of a 46-year-old woman with primary hypertrophic osteoarthropathy and palmoplantar keratoderma who came to the dermatology unit of Gustavo Fricke Hospital, Viña del Mar, Chile.

Eritema ab igne: a propósito de un caso / Erythema AB Igne: a case study

El eritema ab igne es una enfermedad cutánea inusual causada por la exposición crónica de la piel al calor en niveles menores de los necesarios para que ocurra una quemadura. Clínicamente se caracteriza por la presencia de telangiectasias reticuladas e hiperpigmentación de la piel. Su sitio de aparición típico es la zona anterior de los muslos, habitualmente en mujeres que se exponen a una fuente cercana de calor. No existe tratamiento efectivo descrito en la literatura actual y su progresión solo puede prevenirse mediante la eliminación de la exposición al calor. Presentamos un caso de una mujer de 50 años con antecedentes de esclerosis múltiple y psoriasis, que consultó por mácula hiperpigmentada e indolora localizada en región anterior de ambos muslos, de un mes de evolución, que apareció luego de la aplicación de almohadilla térmica por 2 semanas en zona descrita. Al examen físico destacaba la presencia de mácula hiperpigmentada de bordes difuminados, aspecto reticular, color marrón rojizo oscuro, localizada en región anterior de ambos muslos. Se realizó diagnóstico clínico de eritema ab igne, indicándose suspensión del uso de almohadilla térmica. No se indicó manejo específico. Actualmente persiste con hiperpigmentación.

Erythema ab igne is an unusual skin disease caused by chronic exposure to heat at levels too low to cause burns. It is characterized clinically by reticulated telangiectasias and hyperpigmentation of the skin. It is typically seen in anterior thighs, usually in women exposed to a close source of heat. No effective treatment has been described in the literature and progression can be prevented only by suspending the exposure to heat. We present the case of a 50 year old woman with multiple sclerosis and psoriasis who complained of painless hyperpigmented macules on both anterior thighs of one month duration after using a thermal cushion on the region for two weeks. She had dark reddish brown hyper-pigmented, reticulated macules with diffuse borders on each anterior thigh. Erythema ab igne was diagnosed and the use of the thermal cushion was discontinued. No specific treatment was given. The hyperpigmentation persisted.

La empatía como punto de partida para estructurar la ética en Edith Stein / The empathy as a starting point for structuring ethics in Edith Stein

Desde la aproximación fenomenológica que realiza Edith Stein para la comprensión de la estructura óntica y dinamismo de la acción propiamente humana, se puede considerar la empatía como un acto propio de la persona, el cual está presente en la constitución del individuo psicofísico, y es desde donde se establece el dinamismo perfectivo de ésta. Dando lugar así, a la comprensión de la persona como un ser-con-los-demás, desde donde se establecerán las bases para una ética de la persona considerada en su ser relacional, eludiendo cualquier posible individualismo. La persona al ser una estructura abierta, abierta hacia dentro y hacia fuera, hacia sí mismo y hacia el otro, permite la fundamentación de un ethos relacional, del Yo-Tú, del que emerge el nosotros, y por tanto una comprensión más acabada del bien común.(AU)

From the phenomenological approach that Edith Stein proposed, for understanding the ontological structure and dynamism of human action, empathy can be considered as an act of the person, which is present in the constitution of the Psycho-physical Individual, and establish the perfective dynamism of the person. Leading to the understanding of the person as a being - with -others, from where establishes the basis of an ethic that consider the individual as a relational being, avoiding any possible individualism. The person that is an open structure, open inward and outward, toward himself and toward the other , allows the foundation of a relational ethos, and ethos of the I-Thou, from which emerges the "us?, and a better understanding of the common good.(AU)

La empatía como punto de partida para estructurar la ética en Edith Stein / The empathy as a starting point for structuring ethics in Edith Stein

Desde la aproximación fenomenológica que realiza Edith Stein para la comprensión de la estructura óntica y dinamismo de la acción propiamente humana, se puede considerar la empatía como un acto propio de la persona, el cual está presente en la constitución del individuo psicofísico, y es desde donde se establece el dinamismo perfectivo de ésta. Dando lugar así, a la comprensión de la persona como un ser-con-los-demás, desde donde se establecerán las bases para una ética de la persona considerada en su ser relacional, eludiendo cualquier posible individualismo. La persona al ser una estructura abierta, abierta hacia dentro y hacia fuera, hacia sí mismo y hacia el otro, permite la fundamentación de un ethos relacional, del Yo-Tú, del que emerge el nosotros, y portanto una comprensión más acabada del bien común.(AU)

From the phenomenological approach that Edith Stein proposed, for understanding the ontological structure and dynamism of human action, empathy can be considered as an act of the person, which is present in the constitution of the Psycho-physical Individual,and establish the perfective dynamism of the person. Leading to the understanding of the person as a being - with -others, from where establishes the basis of an ethic that consider the individual as a relational being, avoiding any possible individualism. The person that is an open structure, open inward and outward, toward himself and toward the other, allows the foundation of a relational ethos, and ethos of the I-Thou, from which emerges the 'us‟, and a better understanding of the common good.(AU)

Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases.

BACKGROUND: Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). METHODS: This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. RESULTS: A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m2. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. CONCLUSIONS: PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.

Levels of lycopene ß-cyclase 1 modulate carotenoid gene expression and accumulation in Daucus carota.

Plant carotenoids are synthesized and accumulated in plastids through a highly regulated pathway. Lycopene ß-cyclase (LCYB) is a key enzyme involved directly in the synthesis of α-carotene and ß-carotene through the cyclization of lycopene. Carotenoids are produced in both carrot (Daucus carota) leaves and reserve roots, and high amounts of α-carotene and ß-carotene accumulate in the latter. In some plant models, the presence of different isoforms of carotenogenic genes is associated with an organ-specific function. D. carota harbors two Lcyb genes, of which DcLcyb1 is expressed in leaves and storage roots during carrot development, correlating with an increase in carotenoid levels. In this work, we show that DcLCYB1 is localized in the plastid and that it is a functional enzyme, as demonstrated by heterologous complementation in Escherichia coli and over expression and post transcriptional gene silencing in carrot. Transgenic plants with higher or reduced levels of DcLcyb1 had incremented or reduced levels of chlorophyll, total carotenoids and ß-carotene in leaves and in the storage roots, respectively. In addition, changes in the expression of DcLcyb1 are accompanied by a modulation in the expression of key endogenous carotenogenic genes. Our results indicate that DcLcyb1 does not possess an organ specific function and modulate carotenoid gene expression and accumulation in carrot leaves and storage roots.

Light-dependent changes in plastid differentiation influence carotenoid gene expression and accumulation in carrot roots.

Carrot is an important nutritional crop due to the high levels of pro-vitamin A carotenoids (ß-carotene and, to a lower extent, α-carotene) that accumulate in its storage root during secondary growth. In this work we show that in carrots, contrary to that reported for aerial organs of other plant species, light has a profound effect on root development by inhibiting root thickening, preventing the differentiation of chromoplasts and eventually repressing the expression of most genes required for the biosynthesis of ß-carotene and α-carotene and to a lesser extent genes for xanthophylls and apocarotenoids biosynthesis. We observed a correlation in the carotenoid profile and the patterns of gene expression during the development of root segments grown either in the light or in the dark, which suggests a transcriptional regulation for carotenoid synthesis during carrot root development. Furthermore, our work supports the conclusion that the differentiation of chromoplasts coincides with carotenoid accumulation during the later stages of development of underground storage roots.

Daucus carota as a novel model to evaluate the effect of light on carotenogenic gene expression.

Carotenoids are synthesized in prokaryotic and eukaryotic organisms. In plants and algae, these lipophilic molecules possess antioxidant properties acting as reactive oxygen species scavengers and exert functional roles in hormone synthesis, photosynthesis, photomorphogenesis and in photoprotection. During the past decade almost all carotenogenic genes have been identified as a result of molecular, genetic and biochemical approaches utilizing Arabidopsis thaliana as the model system. Studies carried out in leaves and fruits of A. thaliana and tomato determined that light regulates carotenoid biosynthesis preferentially through the modulation of carotenogenic gene transcription. In this work we showed for the first time that light induces accumulation of psy1, pds and zds2 transcripts in leaves of Daucus carota (carrot), a novel plant model. In addition, modified roots of carrots exposed to light accumulate zds1, whereas the pds gene is highly repressed, suggesting that some carotenogenic genes, which are expressed in roots, are regulated by light. Additionally, light negatively regulates the development of the modified carrot root in a reversible manner. Therefore, this suggests that light affects normal growth and carotenogenic gene expression in the modified root of carrot plants. The molecular insight gained into the light-regulated expression of carotenoid genes in this and other model systems will facilitate our understanding of the regulation of carotenoid biosynthesis to improve the prospects for the metabolic engineering of carotenoid production in plants.

Daucus carota as a novel model to evaluate the effect of light on carotenogenic gene expression

Carotenoids are synthesized in prokaryotic and eukaryotic organisms. In plants and algae, these lipophilic molecules possess antioxidant properties acting as reactive oxygen species scavengers and exert functional roles in hormone synthesis, photosynthesis, photomorphogenesis and in photoprotection. During the past decade almost all carotenogenic genes have been identified as a result of molecular, genetic and biochemical approaches utilizing Arabidopsis thaliana as the model system. Studies carried out in leaves and fruits of A. thaliana and tomato determined that light regulates carotenoid biosynthesis preferentially through the modulation of carotenogenic gene transcription. In this work we showed for the first time that light induces accumulation of psy 1, pds and zds2 transcripts in leaves of Daucus carota (carrot), a novel plant model. In addition, modified roots of carrots exposed to light accumulate zdsl, whereas the pds gene is highly repressed, suggesting that some carotenogenic genes, which are expressed in roots, are regulated by light. Additionally, light negatively regulates the development of the modified carrot root in a reversible manner. Therefore, this suggests that light affects normal growth and carotenogenic gene expression in the modified root of carrot plants. The molecular insight gained into the light-regulated expression of carotenoid genes in this and other model systems will facilitate our understanding of the regulation of carotenoid biosynthesis to improve the prospects for the metabolic engineering of carotenoid production in plants.