Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19 / Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic

Objetivo: Valorar la repercusión de la alteración de la continuidad asistencial en pacientes con diabetes mellitus tipo 2 (DM2) durante la pandemia de COVID-19. Material y método: Estudio de seguimiento entre los años 2018 y 2020 de los pacientes con DM2 de un centro de salud. Las actividades asistenciales y preventivas realizadas para su seguimiento fueron comparadas con pruebas estadísticas adecuadas al tipo y distribución de cada variable para un nivel de significación p≤0,05. Resultados: La muestra inicial fue de 587 pacientes con hemoglobina glicosilada (A1c) en 2018 (54% varones), con una edad de 66±11 años en un rango de 29-91 años. En 2020 disminuyeron todos los indicadores de atención: se determinó A1c al 68% de los pacientes (382/558 tras 29 fallecimientos); el 59% permanecía con buen control, el 17% con mal control, el 10% mejoró y el 14% empeoró (p<0,001). Empeoraron menos los pacientes que tenían realizados ECG y retinografía en 2018, aunque no en 2020, que aquellos que no los tenían en 2018, pero sí en 2020 (16 vs. 25%; p<0,001 y 13 vs. 42%; p=0,002). Quienes disminuyeron sus visitas al médico de familia y enfermera presentaron menor empeoramiento que los que las aumentaron (14 vs. 26%; p<0,001 y 17 vs. 23%; p<0,001). Conclusiones: La desatención impidió el control del 32% de los pacientes. El peor control en 2020 fue menor en quienes estaban controlados en 2018, y en quienes disminuyeron su asistencia al centro de salud en 2020. Probablemente una adecuada formación pre-pandémica en autocuidados ha llevado al empoderamiento del paciente durante periodo pandémico (AU)

Aim: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. Material and method: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. Results: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). Conclusions: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period (AU)

[Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic]. / Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19.

AIM: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. MATERIAL AND METHOD: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. RESULTS: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). CONCLUSIONS: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period.

Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

Background and objectives. This is the first multi-center study intended to document the prevalence, characteristics, and associations of depression in Medicine patients at the time of hospital discharge and their referral to Primary Care (PC). Methods. Adult patients randomly selected among consecutive admissions to Medicine wards in 8 hospitals in Spain, covering health districts, were examined in a two-phase 'case-finding' procedure. Standardized, Spanish versions of instruments were used, including the Standardized Polyvalent Psychiatric Interview (SPPI) and Cumulative Illness Rating Scale (CIRS). Cases of depression were diagnosed according to ICD-10 general hospital research criteria. Results. Three hundred and twelve patients with treatable depression and 777 non-depressed controls were identified. In a conservative estimate, the global prevalence of major depression was 7.1%, dysthymia 4.2% and adjustment depression 7.1%, and 51.9% of cases were of moderate/ severe intensity. Depression was more frequent in women, the differences being significant in all categories of depression. The prevalence of depression was lower in individuals aged 85 or more years, the differences being significant in cases of both dysthymia and adjustment depression. A clear pattern of decreasing prevalence with age was observed in women. The depressed had as an average five medical systems affected, and higher CIRS scores compared with the controls, the differences being significant in cases of both major depression and dysthymia. Conclusions. This is the first report showing a considerable prevalence of treatable cases of depression in Medicine patients at the time of hospital discharge and referral to PC. Depression is associated with the severity of the medical condition, and differences observed by age and sex have clinical implications. Paper read at the 3rd Annual Meeting of the European Association of Psychosomatic Medicine, Nuremberg 2015.

Assessment of body composition in cystic fibrosis: agreement between skinfold measurement and densitometry / Evaluación de la composición corporal en adultos con fibrosis quística: concordancia entre la densitometría y la antropometría

Introduction: few studies have evaluated body composition (BC) through different techniques, and the degree of agreement between them in adults with cystic fibrosis (CF). Objectives: to describe BC using techniques to assess nutritional status and to test their concordance in CF. Methods: a cross-sectional study in CF patients in a clinically stable situation. Nutritional assessment was performed using skinfold measurement (SM) and densitometry (DXA). Fat-free mass index (FFMI) was also determined. The diagnosis of malnutrition was established if body mass index (BMI) < 18.5 kg/m2. Fat-free mass (FFM) malnutrition was diagnosed when FFMI was < 17 kg/m2 in males and < 15 kg/m2 in females (FFMI: fat-free mass in kg/height in m2). Results: forty-one patients were studied (twenty-two females, 53.7 %); median age was 29.8 (interquartile range, 20.9-33.7); BMI was 21.6 (19.8-23.0). Only four (9.8 %) patients had a BMI < 18.5. By DXA, FFM (kg) results were: median, 52.8 (47.8-56.9) with FFMI of 17.9 (16.7-19.3) in males and 36.7 (33.1-38.9) in females, FFMI of 14.7 (14.2-15.8). Twenty (48.6 %) patients presented FFM malnutrition, with 16.7 % of males and 59.1 % of females being affected. By SM, the FFMI was 18.7 (17.2-20.0) in males and 14.9 (14.2-15.8) in females; moreover, sixteen (39.1 %) patients presented malnutrition of FFM, with 20.8 % of males and 61.8 % of females being affected. For FFM (kg), high concordance was obtained between SM and DXA (intraclass correlation coefficient of 0.950); likewise when they were compared by applying the ESPEN criteria for FFM malnutrition. However, when the techniques were compared to classify malnutrition according to FFMI, the kappa coefficient was only moderate (k = 0.440). The mean difference between FFM by DXA and SM was +1.44 ± 0.62 kg in favor of SM, with greater dispersion as FFM increased. Conclusions: the prevalence of FFM malnutrition is high in adult CF patients, despite a normal BMI, especially in females (AU)

Introducción: pocos estudios han evaluado la composición corporal (BC) mediante diferentes técnicas y el grado de concordancia entre ellas en adultos con fibrosis quística (FQ). Objetivos: describir la BC mediante técnicas de evaluación Nutricional y comprobar su concordancia en la FQ. Métodos: estudio transversal de adultos con FQ en situación de estabilidad clínica. La evaluación Nutricional se realizó mediante medición de pliegues cutáneos (SM) y densitometría (DXA). También se determinó el índice de masa libre de grasa (FFMI). El diagnóstico de desnutrición se estableció si el índice de masa corporal (IMC) era < 18,5 kg/m2. Se diagnosticó desnutrición por masa libre de grasa (FFM) cuando el FFMI era < 17 kg/m2 en los hombres y < 15 kg/m2 en las mujeres (FFMI: masa libre de grasa en kg/estatura en m2). Resultados: se estudiaron cuarenta y un pacientes (veintidós mujeres (53,7 %), con una edad media de 29,8 años (rango intercuartílico, 20,9-33,7) y un IMC de 21,6 (19,8-23,0). Solo cuatro (9,8 %) pacientes tenían un IMC < 18,5. Mediante DXA, los resultados de FFM (kg) fueron (mediana y RIC): 52,8 (47,8-56,9) con FFMI de 17,9 (16,7-19,3) en los varones y 36,7 (33,1-38,9) en las mujeres con FFMI de 14,7 (14,2-15,8). Veinte (48,6 %) pacientes presentaban desnutrición del FFM, con el 16,7 % de varones y el 59,1 % de mujeres afectados. Mediante el SM, el FFMI fue de 18,7 (17,2-20,0) en los varones y de 14,9 (14,2-15,8) en las mujeres; además, dieciséis (39,1 %) pacientes presentaban malnutrición del FFMI, con el 20,8 % de varones y el 61,8 % de mujeres afectados. En el caso de la FFM (kg), se obtuvo una alta concordancia entre el SM y la DXA (coeficiente de correlación intraclase de 0,950); igualmente cuando se compararon las técnicas aplicando los criterios ESPEN para la desnutrición de la FFM. Sin embargo, cuando se compararon las técnicas para clasificar la malnutrición según el FFMI, el coeficiente kappa fue solo moderado (coeficiente kappa = 0,440) (AU)

[Effectiveness of the TG/HDL-C ratio to improve GLP-1 prescription in patients with type 2 diabetes in primary care]. / Efectividad de la ratio TG/c-HDL en la mejora de la prescripción de GLP-1 en pacientes con diabetes tipo 2 en atención primaria.

AIMS: Check the usefulness of ratio TG/HDL-C≥2.5 to improve the effectiveness of GLP-1 prescribing in patients with type 2 diabetes (DM2) in primary care, and determine whether any patient profile would higher benefit. DESIGN: Descriptive cross-sectional study. LOCATION: Barranco Grande Health Center, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: Poor control according to the current criteria was compared to poor control according to the proposed rule. To determine who would benefit, the sociodemographic, clinical, therapeutic and follow-up characteristics were analyzed. Descriptive, bivariate and multivariate statistical analysis was performed. RESULTS: No predominant characteristics were found in the patients who would be prescribed GLP-1 according to the proposed rule, but those that reached a significance P<.20 were included as potential explanatory factors in a multivariate binary logistic regression model. The adjustment of the model retained the factors of therapeutic non-compliance (OR 3.40 [1.58-5.02]; P=.003), evolution of DM2 less than 15 years (OR 2.74 [1.10-4.89]; P=.031), number of prescribed anti-diabetes drugs (OR 2.30 [1.88-2.81]; P<.001) and age under 65 years (OR 1.67 [1.08-2.58]; P=.021). CONCLUSIONS: The use of the rule that we propose for the prescription of GLP-1 (2018 recommendations of the GDPS network combined with the TG/HDL-C ratio≥2.5 or BMI≥30kg/m2), instead of the current criterion adopted by the National Health System, would allow to broaden the spectrum of application of the drug in patients with poor control of their DM2.

Role of the A(2B) receptor-adenosine deaminase complex in colonic dysmotility associated with bowel inflammation in rats.

BACKGROUND AND PURPOSE: Adenosine A(2B) receptors regulate several physiological enteric functions. However, their role in the pathophysiology of intestinal dysmotility associated with inflammation has not been elucidated. Hence, we investigated the expression of A2B receptors in rat colon and their role in the control of cholinergic motility in the presence of bowel inflammation. EXPERIMENTAL APPROACH: Colitis was induced by 2,4-dinitrobenzenesulfonic acid (DNBS). Colonic A(2B) receptor expression and localization were examined by RT-PCR and immunofluorescence. The interaction between A(2B) receptors and adenosine deaminase was assayed by immunoprecipitation. The role of A(2B) receptors in the control of colonic motility was examined in functional experiments on longitudinal muscle preparations (LMPs). KEY RESULTS: A(2B) receptor mRNA was present in colon from both normal and DNBS-treated rats but levels were increased in the latter. A(2B) receptors were predominantly located in the neuromuscular layer, but, in the presence of colitis, were increased mainly in longitudinal muscle. Functionally, the A(2B) receptor antagonist MRS 1754 enhanced both electrically-evoked and carbachol-induced cholinergic contractions in normal LMPs, but was less effective in inflamed tissues. The A(2B) receptor agonist NECA decreased colonic cholinergic motility, with increased efficacy in inflamed LMP. Immunoprecipitation and functional tests revealed a link between A(2B) receptors and adenosine deaminase, which colocalize in the neuromuscular compartment. CONCLUSIONS AND IMPLICATIONS: Under normal conditions, endogenous adenosine modulates colonic motility via A2B receptors located in the neuromuscular compartment. In the presence of colitis, this inhibitory control is impaired due to a link between A2B receptors and adenosine deaminase, which catabolizes adenosine, thus preventing A(2B) receptor activation.

Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations.

This study examined pre-exposure prophylaxis (PrEP) acceptability among female sex workers, male-to-female transgendered persons and men who have sex with men in Lima, Peru. Focus groups explored social issues associated with PrEP acceptability and conjoint analysis assessed preferences among eight hypothetical PrEP scenarios with varying attribute profiles and their relative impact on acceptability. Conjoint analysis revealed that PrEP acceptability ranged from 19.8 to 82.5 out of a possible score of 100 across the eight hypothetical PrEP scenarios. Out-of-pocket cost had the greatest impact on PrEP acceptability (25.2, P < 0.001), followed by efficacy (21.4, P < 0.001) and potential side-effects (14.7, P < 0.001). Focus group data supported these findings, and also revealed that potential sexual risk disinhibition, stigma and discrimination associated with PrEP use, and mistrust of health-care professionals were also concerns. These issues will require careful attention when planning for PrEP roll-out.

Serum cardiac troponin I concentrations transiently increase in rats given rosiglitazone.

Rosiglitazone, a peroxisome proliferator-activated receptor γ (PPARγ) agonist of the thiazolidinedione class, is a major insulin-sensitizing drug widely used to treat type-2 diabetes. Rosiglitazone causes myocardial hypertrophy in rodents and increases the risk of cardiac events in man. To better characterize its cardiac effects, male Wistar rats were orally administered 0, 10 or 80 mg/kg/day rosiglitazone. Myocardial gene expression profiling, hematology, histopathology and clinical chemistry, including measurement of serum cardiac troponin (cTn) I concentration with the ultrasensitive assay, were evaluated after 6 and 24h and 7 and 14 days of dosing. Heart weight was increased 10% after 7 days and 16% after 14 days of dosing at 80 mg/kg/day in the absence of microscopic changes. At the transcriptomic level, the number of differentially expressed probes was small: it was most at 24h in rats given 80 mg/kg rosiglitazone with 356 differentially regulated probes (fold change >1.3 fold, p<0.05). Also, gene categories typically associated with myocardial damage were not over-represented. Most importantly, serum cTnI concentrations in 5/9 rats after 7 days of dosing at 80 mg/kg/day were above the upper limit of serum cTnI concentration. cTnI concentrations after 14 days of dosing were similar between rats given the vehicle and rosiglitazone at 80 mg/kg. This is the first study to detect increases of serum cTnI concentrations in rats administered rosiglitazone. In light of reported cardiac events in patients chronically dosed with PPARγ agonists, our results support serum cTnI concentrations as an early biomarker of cardiac liability.

Control of enteric neuromuscular functions by purinergic A(3) receptors in normal rat distal colon and experimental bowel inflammation.

BACKGROUND AND PURPOSE: Adenosine A(3) receptors mediate beneficial effects in experimental colitis, but their involvement in enteric neuromuscular functions during bowel inflammation is undetermined. This study investigated the regulatory role of A(3) receptors on colonic motility in the presence of experimental colitis. EXPERIMENTAL APPROACH: Colitis was induced in rats by 2,4-dinitrobenzenesulfonic acid. A(3) receptors and adenosine deaminase (ADA, adenosine catabolic enzyme) mRNA were examined by RT-PCR. Tissue distribution of A(3) receptors was detected by confocal immunofluorescence. The effects of 2,3-ethyl-4,5-dipropyl-6-phenylpyridine-3-thiocarboxylate-5-carboxylate (MRS1523) (MRS, A(3) receptor antagonist), 2-chloro-N(6) -(3-iodobenzyl)-adenosine-5'-N-methyluronamide (2Cl-IB-MECA) (CIB, A(3) receptor agonist), dipyridamole (DIP, adenosine transport inhibitor) and ADA were assayed on contractile responses evoked by electrical stimulation (ES) or carbachol in colonic longitudinal muscle preparations (LMP). KEY RESULTS: RT-PCR showed A(3) receptors and ADA mRNA in normal colon and their increased level in inflamed tissues. Immunofluorescence showed a predominant distribution of A(3) receptors in normal myenteric ganglia and an increased density during colitis. MRS enhanced ES-induced cholinergic contractions in normal LMP, but was less effective in inflamed tissues. After pretreatment with dipyridamole plus ADA, to reduce extracellular adenosine, CIB decreased cholinergic motor responses of normal LMP to ES, with enhanced efficacy in inflamed LMP. A(3) receptor ligands did not affect carbachol-induced contractions in LMP from normal or inflamed colon. CONCLUSIONS AND IMPLICATIONS: Normally, adenosine modulated colonic cholinergic motility via activation of A(3) receptors in the myenteric plexus. A(3) receptor-mediated tonic inhibitory control by adenosine was impaired in inflamed bowel, despite increased density of functioning and pharmacologically recruitable A(3) receptors.

[Management of distal ureter in laparoscopic nephroureterectomy]. / Abordaje del uréter distal en la nefroureterectomía laparoscópica.

INTRODUCTION: Nephroureterectomy is one of the procedures for which a laparoscopic approach is more clearly indicated. However, despite the long experience available, management of the distal ureter is still difficult. MATERIALS AND METHODS: Thirty-two laparoscopic nephroureterectomies were performed from November 2004 to December 2008. The procedure used was endoscopic resection of distal ureter and earlier ligation of the ureter in the laparoscopic time in 13 patients, a laparoscopic bladder cuff in 13 patients, and an open bladder cuff in 3 patients. RESULTS: Mean operating time was 221.53 min (125-315 min), and mean postoperative stay of 27 patients was 4.6 days. Conversion to open surgery and discontinuation of the procedure for local tumor progression were required in one patient each. Mean patient follow-up was 17.8 months. No local relapse or metastasis occurred in the ports. CONCLUSION: The most common procedures continue to be endoscopic resection and the open bladder cuff depending on indication. Any laparoscopic approach to upper urothelial tumors must strictly comply with oncological principles. The reported procedure is in our experience the fastest, most simple, and most effective for this purpose. In our opinion, the therapeutic algorithm provided is adequate for management of the distal ureter in laparoscopic nephroureterectomy.

Abordaje del uréter distal en la nefroureterectomía laparoscópica / Management of distal ureter in laparoscopic nephroureterectomy

Introducción: la nefroureterectomía laparoscópica constituye una de las indicaciones más claras para el abordaje laparoscópico, pero a pesar de la larga experiencia acumulada sigue presentando dificultades en lo concerniente al abordaje del uréter distal. Material y métodos: desde noviembre de 2004 hasta diciembre de 2008 hemos realizado un total de 32 nefroureterectomías laparoscópicas. En 13 casos lo hemos hecho mediante desinserción endoscópica previa y clipaje precoz del uréter en el tiempo laparoscópico, en otros 13 con rodete vesical laparoscópico y en tres casos con rodete vesical por vía abierta. Resultados: el tiempo quirúrgico medio ha sido de 221,53 minutos (125-315 minutos) y la estancia postoperatoria media ha sido de 4,6 días sobre 27 casos. Hemos tenido un único caso de reconversión a cirugía abierta, así como un único caso de suspensión del procedimiento por progresión local del tumor. El seguimiento medio de los pacientes ha sido de 17,8 meses. No hemos tenido ningún caso de recidiva local ni de metástasis en los puertos. Conclusión: los procedimientos más comunes siguen siendo la desinserción endoscópica y el rodete vesical abierto según las indicaciones. Cualquier abordaje laparoscópico de los tumores de urotelio superior ha de ser exquisito en el cumplimiento de los criterios oncológicos. La técnica que hemos descrito constituye en nuestra experiencia la más rápida, sencilla y eficaz para este fin. Consideramos que el algoritmo terapéutico que presentamos es adecuado para el manejo del uréter distal en la nefroureterectomía laparoscópica (AU)

Introduction: Nephroureterectomy is one of the procedures for which a laparoscopic approach is more clearly indicated. However, despite the long experience available, management of the distal ureter is still difficult. Materials and methods: Thirty-two laparoscopic nephroureterectomies were performed from November 2004 to December 2008. The procedure used was endoscopic resection of distal ureter and earlier ligation of the ureter in the laparoscopic time in 13 patients, a laparoscopic bladder cuff in 13 patients, and an open bladder cuff in 3 patients. Results: Mean operating time was 221.53 min (125-315 min), and mean postoperative stay of 27 patients was 4.6 days. Conversion to open surgery and discontinuation of the procedure for local tumor progression were required in one patient each. Mean patient follow-up was 17.8 months. No local relapse or metastasis occurred in the ports. Conclusion: The most common procedures continue to be endoscopic resection and the open bladder cuff depending on indication. Any laparoscopic approach to upper urothelial tumors must strictly comply with oncological principles. The reported procedure is in our experience the fastest, most simple, and most effective for this purpose. In our opinion, the therapeutic algorithm provided is adequate for management of the distal ureter in laparoscopic nephroureterectomy (AU)

Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: a 2-year randomized controlled study.

BACKGROUND: Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited. The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors. METHOD: A 2-year randomized controlled trial with blind assessments. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and/or previous clinical relapse were allocated to psychosocial family intervention, individual counselling and standard treatment versus individual counselling and standard treatment. RESULTS: Family intervention was associated with fewer clinical relapses, hospitalizations and major incidents, and an improvement in positive and negative symptoms, social role performance, social relations, employment and family burden. The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group. The effects of family intervention were independent of compliance and prognostic factors. CONCLUSIONS: Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors.

Radiopharmaceutical pharmacokinetics in animals: critical considerations.

Since the advent of single photon emission computerized tomography (SPECT) and positron emission tomography (PET) various chemical ligands have been labeled with radionuclides and evaluated as tracer compounds in animal models to ascertain their suitability as potential radiopharmaceuticals for humans. In the absence of a defined algorithm to predict the diagnostic efficacy of a radiopharmaceutical, any new radioligand has to undergo preclinical evaluation even if it has excellent in vitro properties. Until now few studies have produced pharmacokinetic data that could be translated from animal models directly to humans. The purpose of this review is to highlight some critical aspects to consider during the development and validation phase of a new radiopharmaceutical. Interspecies differences and the absence of knowledge of physiological mechanism can become challenging drawbacks for obtaining a successful radiopharmaceutical. In this context, the influence of ABC transporters in neuroimaging, the effect of plasma protein binding and the consequence of anesthesia with reference to interspecies differences will be discussed with illustrative examples.

[Laparoscopic radical nephrectomy in big surgical specimens]. / Nefrectomía radical laparoscópica en piezas quirúrgicas de gran tamaño.

INTRODUCTION: The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience. OBJECTIVES: The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 g of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay. MATERIALS AND METHODS: Since July 2004 to July 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens. RESULTS: The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1 intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series. DISCUSSION: Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava.

Nefrectomía radical laparoscópica en piezas quirúrgicas de gran / Laparoscopic radial nephrectomy in big surgical specimens

Introducción: La cirugía retroperitoneal constituye la indicación más indiscutible para el abordaje laparoscópico. Todavía persisten indicaciones de cirugía abierta en función de la complejidad del caso y de la experiencia del cirujano. Objetivos: El objetivo principal es comunicar nuestra experiencia de nefrectomía radical laparoscópica en pacientes con tumores ≥7 cm o con piezas quirúrgicas cuyo peso haya sido ≥700 g. Analizaremos sus características, la tasa de complicaciones intraoperatorias, el tiempo quirúrgico, el curso postoperatorio así como la estancia postoperatoria. Material y métodos: Desde julio del 2004 hasta julio del 2008 hemos realizado un total de 104 nefrectomías radicales laparoscópicas. Hemos seleccionado un subgrupo de 41 pacientes con criterios de pieza quirúrgica de gran tamaño. Resultados: El tiempo quirúrgico medio ha sido de 184,3 minutos. Hemos tenido un caso de reconversión a cirugía abierta y un fallecimiento intraoperatorio por causa cardiológico. La estancia media global ha sido de 3,51 días. La tasa de complicaciones y el curso postoperatorio son comparables a toda la serie. Discusión: La nefrectomía laparoscópica es técnicamente menos compleja que la prostatectomía radical laparoscópica. Sin embargo, sus posibles complicaciones entrañan una gravedad mucho mayor. Los casos más complejos han de ser abordados por vía laparoscópica sólo cuando existe una dilatada experiencia. En general, en nuestro centro relegamos a cirugía abierta las piezas que sobrepasan la línea media y los casos con trombo tumoral que afecte a la vena renal principal y a la VCI (AU)

Introduction: The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience. Objectives: The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 g of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay. Materials and methods: Since july 2004 to july 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens. Results: The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series. Discussion: Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava (AU)

Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study.

AIMS: This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. SETTING: The largest social security hospital in Colombia with a neonatal intensive care unit. SUBJECTS: At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. INTERVENTIONS: Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. OUTCOME MEASURES: The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. RESULTS: 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. CONCLUSION: Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children.

Preorganized macromolecular gene delivery systems: amphiphilic beta-cyclodextrin "click clusters".

Gene delivery systems based on the beta-cyclodextrin scaffold have been synthesized by combining the copper(I)-catalyzed azide-alkyne coupling ("click chemistry") and an efficient acylation method of the secondary hydroxyls; molecular flexibility, charge density and hydrophobic-hydrophilic balance are critical parameters that can be fine-tuned by the click approach.

Effect of gender and school level on disordered eating behaviours and attitudes in Mexican adolescents.

The aim of this study was to assess eating behaviours and attitudes in a community sample of 615 adolescent Mexican students recruited at a middle school (192 boys and 226 girls; mean age +/- standard deviation 13.56+/-0.09) and high school (90 boys and 107 girls; mean age 16.04+/-0.12 years), who completed the Eating Attitudes Test (EAT), the Bulimia Test (BULIT) and the Body Shape Questionnaire (BSQ). Multiple analysis of variance revealed the significant effect of gender on the negative feelings, body dissatisfaction, drive of thinness and perceived social pressure subscales, and school level on the body dissatisfaction and food preoccupation subscales. Among the high school girls, the gender x school level interaction had a significant effect on negative feelings, body dissatisfaction, drive of thinness, food preoccupation and perceived social pressure subscales. These data support previous findings concerning gender, and also suggest that perceived social pressure in the case of girls and food preoccupation in the case of boys could be important factors in the natural development of eating disorders.

The glucose-lowering agent sodium tungstate increases the levels and translocation of GLUT4 in L6 myotubes through a mechanism associated with ERK1/2 and MEF2D.

AIMS/HYPOTHESIS: The aim of this study was to investigate the action of the glucose-lowering compound sodium tungstate on glucose transport in muscle myotubes and to unravel the molecular events underlying the effects observed. METHODS: We studied the effects of tungstate on 2-deoxy-D: -glucose uptake, levels and translocation of the glucose transporters GLUT4 and GLUT1, and Glut4 (also known as Slc2a4) promoter activity. We also measured the modifications of individual components of the signalling pathways involved in the effects observed. RESULTS: Tungstate increased 2-deoxy-D: -glucose uptake in differentiated L6 myotubes through an increase in the total amount and translocation of GLUT4 transporter. The effects on glucose uptake were additive to those of insulin. Tungstate activated transcription of the Glut4 promoter, as shown by an increase in Glut4 mRNA, and by a promoter reporter assay. The assay of deletions of the Glut4 promoter indicated that the effect of tungstate is mediated by the myocyte enhancer factor 2 (MEF2)-binding domain. Accordingly, MEF2 levels and DNA binding activities were increased in response to the treatment. Tungstate-induced glucose uptake and GLUT4 transcriptional activation were dependent on the activation of extracellular signal-regulated kinases 1 and 2 (ERK1/2), while no changes were observed in the phosphorylation state of the beta subunit of the insulin receptor, in the phosphatidylinositol 3-kinase pathway or in the activation of 5'AMP-activated protein kinase. CONCLUSIONS/INTERPRETATION: Tungstate activates glucose uptake in myotubes through a novel ERK1/2-dependent mechanism. This effect is exerted by an increase in the content and translocation of the GLUT4 transporter. This is the first report of a glucose-lowering compound activating Glut4 transcription through an ERK1/2-dependent increase in MEF2 levels.