Clockwise rotation of perspective view improves spatial recognition of complex environments in aging.

Deciphering the human spatial cognition system involves the development of simple tasks to assess how our brain works with shapes and forms. Prior studies in the mental rotation field disclosed a clockwise rotation bias on how basic stimuli are perceived and processed. However, there is a lack of a substantial scientific background for complex stimuli and how factors like sex or aging could influence them. Regarding the latter point, it is well known that our spatial skills tend to decline as we grow older. Hence, the hippocampal system is especially sensitive to aging. These neural changes underlie difficulties for the elderly in landmark orientation or mental rotation tasks. Thus, our study aimed to check whether the effect of clockwise and anticlockwise rotations in the spatial recognition of complex environments could be modulated by aging. To do so, 40 young adults and 40 old adults performed the ASMRT, a virtual spatial memory recognition test. Results showed that young adults outperformed old adults in all difficulty conditions (i.e., encoding one or three boxes positions). In addition, old adults were affected more than young adults by rotation direction, showing better performance in clockwise rotations. In conclusion, our study provides evidence that aging is particularly affected by the direction of rotation. We suggest that clockwise bias could be linked with the cognitive decline associated with aging. Future studies could address this with brain imaging measures.

Preparation, Properties and Water Dissolution Behavior of Polyethylene Oxide Mats Prepared by Solution Blow Spinning.

The relationship between processing conditions, structure and morphology are key issues to understanding the final properties of materials. For instance, in the case of polymers to be used as scaffolds in tissue engineering, wound dressings and membranes, morphology tuning is essential to control mechanical and wettability behaviors. In this work, the relationship between the processing conditions of the solution blow spinning process (SBS) used to prepare nonwoven mats of polyethylene oxide (PEO), and the structure and morphology of the resulting materials are studied systematically, to account for the thermal and mechanical behaviors and dissolution in water. After finding the optimal SBS processing conditions (air pressure, feed rate, working distance and polymer concentration), the effect of the solvent composition has been considered. The structure and morphology of the blow spun fibers are studied as well as their thermal, mechanical behaviors and dissolution in water. We demonstrate that the morphology of the fibers (size and porosity) changes with the solvent composition, which is reflected in different thermal and mechanical responses and in the dissolution rates of the materials in water.

[Bouveret syndrome: unusual cause of gallstone ileus]. / Síndrome de Bouveret: causa inusual de íleo biliar.

Introduction: Bouveret syndrome consists of an obstruction of the gastric outlet due to the impaction of a gallstone in the duodenal bulb after migration through a cholecystoduodenal fistula. Clinical Case: Patient with diffuse colicky abdominal pain, diarrhea and yellowish vomiting. The imaging tests carried out reveal significant gastric and duodenal dilation with the presence of gas at the gallbladder level with the existence of a cholecystoduodenal fistula with a rounded intraluminal image in the proximal jejunum compatible with migrated lithiasis. The patient underwent emergency surgery through an enterotomy with removal of the calculus and its closure. Discussion: Discussion: Bouveret's syndrome is a rare gallstone ileus condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnosis and treatment strategies are required for optimal management and results, with endoscopic treatment or open surgery being the two treatments available for resolution of the condition. Conclusion: Bouveret syndrome is a life-threatening condition with gastric outlet obstruction caused by large gallstones. In most cases, a CT scan is required for diagnosis, and although in some cases percutaneous and endoscopic treatments can be successful as first-line treatment, most patients require surgery to remove stones.

Introducción: El síndrome de Bouveret consiste en una obstrucción de la salida gástrica debido a la impactación de un cálculo biliar en el bulbo duodenal después de la migración a través de una fístula colecistoduodenal. Caso Clínico: Paciente con cuadro de dolor abdominal difuso de tipo cólico, diarreas y vómitos de aspecto amarillento. Las pruebas de imagen realizadas ponen de manifiesto una importante dilatación gástrica y duodenal con presencia de gas a nivel vesicular con la existencia de una fistula colecistoduodenal con una imagen redondeada intraluminal en yeyuno proximal compatibles con litiasis migrada. El paciente fue intervenido de urgencia mediante una enterotomía con la extracción del calculo y cierre de la misma. Discusión: El síndrome de Bouveret es una condición poco común de íleo biliar que causa una morbilidad y mortalidad significativa y, a menudo, ocurre en ancianos con comorbilidades importantes. Se requieren estrategias de diagnóstico y tratamiento individuales para un manejo y resultado óptimos, siendo el tratamiento endoscópico o la cirugía por vía abierta los dos tratamientos disponibles para la resolución del cuadro. Conclusión: El síndrome de Bouveret es una afección potencialmente mortal con obstrucción de la salida gástrica causada por cálculos biliares grandes. En la mayoría de los casos, se requiere una tomografía computarizada para su diagnóstico y si bien en algunos casos, los tratamientos percutáneos y endoscópicos pueden tener éxito como tratamiento de primera línea, la mayoría de los pacientes precisan de una cirugía para la extracción de cálculos.

Mice with hyper-long telomeres show less metabolic aging and longer lifespans.

Short telomeres trigger age-related pathologies and shorter lifespans in mice and humans. In the past, we generated mouse embryonic (ES) cells with longer telomeres than normal (hyper-long telomeres) in the absence of genetic manipulations, which contributed to all mouse tissues. To address whether hyper-long telomeres have deleterious effects, we generated mice in which 100% of their cells are derived from hyper-long telomere ES cells. We observe that these mice have longer telomeres and less DNA damage with aging. Hyper-long telomere mice are lean and show low cholesterol and LDL levels, as well as improved glucose and insulin tolerance. Hyper-long telomere mice also have less incidence of cancer and an increased longevity. These findings demonstrate that longer telomeres than normal in a given species are not deleterious but instead, show beneficial effects.

Acute Community-Acquired Bacterial Meningitis: Update on Clinical Presentation and Prognostic factors.

The epidemiology of community-acquired bacterial meningitis (CABM) in adults has changed significantly in the past several years. Despite substantial improvement in patient care, CABM remains a major cause of morbidity and mortality. Thus, new prognostic factors could help improve patient stratification. We conducted a multicenter retrospective study to determine the clinical pattern of CABM in an urban area of Western Europe and to identify potential predictors of unfavorable prognosis and complicated course. Over a period of 6-8 years, 79 adult CABM cases were treated at three tertiary hospitals. A Glasgow Outcome Scale (GOS) score of ≤4 was defined as unfavorable outcome. Predictors of unfavorable prognosis or complicated course were identified through logistic-regression analysis. S. pneumoniae was the most frequent pathogen (34%). 82% of patients exhibited at least two of five signs, including fever, neck stiffness, altered mental status, headache and nausea. Almost 50% presented focal neurological deficits; the overall mortality rate was 15%. In the multivariate analysis, risk factors for an unfavorable outcome included a GCS score of ≤13, female sex, and etiology by L. monocytogenes and gram-negative bacilli. However, risk factors for systemic complications were a GCS score of ≤13 and reduced platelet count, whereas C-Reactive Protein (CRP) increase was associated with a higher rate of neurological complications. Patients with non-pneumococcal CABM were more prone to an unfavorable outcome, probably because of underutilization of empiric ampicillin in patients at risk of listeriosis and because the suspicion of pneumococcal infection was facilitated by the existence of otitis and the higher yield of Gram's stain. Patients presenting a GCS of ≤13, thrombocytopenia and/or increased CRP, may benefit from more aggressive care to avoid in-hospital complications and neurological sequelae.

Effectiveness and limitations of an incident-reporting system analyzed by local clinical safety leaders in a tertiary hospital: Prospective evaluation through real-time observations of patient safety incidents.

The effectiveness of a hospital incident-reporting system (IRS) on improve patient safety is unclear. This study objective was to assess which implemented improvement actions after the analysis of the incidents reported were effective in reduce near-misses or adverse events.Patient safety incidents (PSIs), near misses and adverse events, notified to the IRS were analyzed by local clinical safety leaders (CSLs) who propose and implement improvement actions. The local CSLs received training workshops in patient safety and analysis tools. Following the notification of a PSI in the IRS, prospective real-time observations with external staff were planned to record and rated the frequency of that PSI. This methodology was repeated after the implementation of the improvement actions.Ultimately, 1983 PSIs were identified. Surgery theaters, emergency departments, intensive care units, and general adult care units comprised 82% of all PSIs. The PSI rate increased from 0.39 to 3.4 per 1000 stays in 42 months. A significant correlation was found between the reporting rate per month and the number of workshop-trained local CSLs (Spearman coefficient = 0.874; P = .003). A total of 24,836 real-time observations showed a statistically significant reduction in PSIs observed in 63.15% (categories: medication P = .044; communication P = .037; technology P = .009) of the implemented improvements actions, but not in the organization category (P = .094). In the multivariate analyses, the following factors were associated with the reduction in near misses or adverse events after the implementation of the improvement actions: "adverse event" type of PSI (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.93-5.74), "disussion group" type of analysis (OR, 2.45; 95% CI, 1.52-3.76), and root cause type of analysis (OR, 2.32; 95% CI: 1.17-3.90).The implementation of a hospital IRS, together with the systematization of the method and analysis of PSIs by workshop-trained local CSLs led to an important reduction in the frequency of PSIs.

AAV9-mediated telomerase activation does not accelerate tumorigenesis in the context of oncogenic K-Ras-induced lung cancer.

Short and dysfunctional telomeres are sufficient to induce a persistent DNA damage response at chromosome ends, which leads to the induction of senescence and/or apoptosis and to various age-related conditions, including a group of diseases known as "telomere syndromes", which are provoked by extremely short telomeres owing to germline mutations in telomere genes. This opens the possibility of using telomerase activation as a potential therapeutic strategy to rescue short telomeres both in telomere syndromes and in age-related diseases, in this manner maintaining tissue homeostasis and ameliorating these diseases. In the past, we generated adeno-associated viral vectors carrying the telomerase gene (AAV9-Tert) and shown their therapeutic efficacy in mouse models of cardiac infarct, aplastic anemia, and pulmonary fibrosis. Although we did not observe increased cancer incidence as a consequence of Tert overexpression in any of those models, here we set to test the safety of AAV9-mediated Tert overexpression in the context of a cancer prone mouse model, owing to expression of oncogenic K-ras. As control, we also treated mice with AAV9 vectors carrying a catalytically inactive form of Tert, known to inhibit endogenous telomerase activity. We found that overexpression of Tert does not accelerate the onset or progression of lung carcinomas, even when in the setting of a p53-null background. These findings indicate that telomerase activation by using AAV9-mediated Tert gene therapy has no detectable cancer-prone effects in the context of oncogene-induced mouse tumors.

Preparation and Characterization of Polymer Composite Materials Based on PLA/TiO2 for Antibacterial Packaging.

Polymer composite materials based on polylactic acid (PLA) filled with titanium dioxide (TiO2) nanoparticles were prepared. The aim of this work was to investigate the antibacterial action of TiO2 against a strain of E. coli (DH5α) to obtain information on their potential uses in food and agro-alimentary industry. PLA/TiO2 systems were prepared by a two-step process: Solvent casting followed by a hot-pressing step. Characterization was done as a function of particle size (21 nm and <100 nm) and particle content (0%, 1%, 5%, 10%, and 20%, wt %). Structural characterization carried out by X-ray diffraction (XRD) and Fourier Transformed Infrared spectroscopy (FTIR) did not reveal significant changes in polymer structure due to the presence of TiO2 nanoparticles. Thermal characterization indicated that thermal transitions, measured by differential scanning calorimetry (DSC), did not vary, irrespective of size or content, whereas thermogravimetric analysis (TGA) revealed a slight increase in the temperature of degradation with particle content. Bacterial growth and biofilm formation on the surface of the composites against DH5α Escherichia coli was studied. Results suggested that the presence of TiO2 nanoparticles decreases the amount of extracellular polymeric substance (EPS) and limits bacterial growth. The inhibition distances estimated with the Kirby-Bauer were doubled when 1% TiO2 nanoparticles were introduced in PLA, though no significant differences were obtained for higher contents in TiO2 NPs.

Generation of mice with longer and better preserved telomeres in the absence of genetic manipulations.

Although telomere length is genetically determined, mouse embryonic stem (ES) cells with telomeres of twice the normal size have been generated. Here, we use such ES cells with 'hyper-long' telomeres, which also express green fluorescent protein (GFP), to generate chimaeric mice containing cells with both hyper-long and normal telomeres. We show that chimaeric mice contain GFP-positive cells in all mouse tissues, display normal tissue histology and normal survival. Both hyper-long and normal telomeres shorten with age, but GFP-positive cells retain longer telomeres as mice age. Chimaeric mice with hyper-long telomeres also accumulate fewer cells with short telomeres and less DNA damage with age, and express lower levels of p53. In highly renewing compartments, such as the blood, cells with hyper-long telomeres are longitudinally maintained or enriched with age. We further show that wound-healing rates in the skin are increased in chimaeric mice. Our work demonstrates that mice with functional, longer and better preserved telomeres can be generated without the need for genetic manipulations, such as TERT overexpression.

Bacteriemia primaria por Clostridium como forma de presentación de cáncer de ciego / Carcinoma of the cecum presenting as bacteraemia caused by Clostridium

No disponible

La identificación de personas mediante pruebas genéticas y bancos de perfiles de ADN / The identification of individuals through genetic testing and DNA profiling banks

No disponible

Regional variations in test requiring patterns of general practitioners in Spain.

OBJECTIVE: To analyze the requesting patterns for a range of laboratory tests ordered in 2009 from eight laboratories providing services to eight health areas, using appropriate indicators. DESIGN: Indicators measured every test request per 1,000 inhabitants, and indicators that measured the number of tests per related test requested by general practitioners were calculated. The savings generated, if each Health Care Department achieved the appropriate indicator standard, were also calculated. Laboratory Information System registers were collected, and indicators were calculated automatically in each laboratory using a data warehouse application. RESULTS: There was a large difference in demand for tests by health areas. The ratio of related tests also showed a great variability. The savings generated if each Health Care Department had achieved the appropriate indicator standard were €172,116 for free thyroxine, €18,289 for aspartate aminotransferase, and €62,678 for urea. CONCLUSIONS: Considerable variability exists in general practitioners' demand for laboratory tests.

Evaluation of PSA testing by general practitioners: regional study in the autonomic Community of Valencia.

OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs). METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists. RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant. CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings.

Evaluación de la solicitud de antígeno prostático específico por atención primaria: estudio piloto regional en la comunidad valenciana / Evaluation of psa testing by general practitioners: regional study in the autonomic community of valencia

OBJETIVO: El objetivo del estudio es la valoración del patrón de solicitud de PSA por los médicos de Atención Primaria (AP).MÉTODOS: Estudio transversal de la solicitud de PSA por médicos de AP en nueve Departamentos de Salud. Se evaluó el número de solicitudes de PSA y el porcentaje de PSA solicitados a menores de 50 años (PSA<50/PSAtotal) y también a menores de 40 años respecto del total de PSA solicitados (PSA<40/PSAtotal).También se calculó el porcentaje de varones mayores de 50 años atendidos y se comparó con el número de PSA solicitados a esa población. Para dos de los Departamentos, también se compararon estos datos con los mismos para médicos especialistas en Urología.RESULTADOS: En siete de los Departamentos la demanda en 2009 es superior a la del año 2008. La demanda a varones menores de 40 años se mantiene estable y a varones menores de 50 años aumenta progresivamente a lo largo del periodo del estudio. Las diferencias entre los valores de los indicadores para urólogos y médicos de AP son significativas.CONCLUSIONES: El número de solicitudes de PSA y el porcentaje realizado a varones menores de 50 años ha ido incrementándose y la variabilidad en la solicitud es elevada, lo que indica la necesidad de establecer estrategias orientadas a la adecuación de la demanda mediante la comunicación entre profesionales(AU)

OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs).METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists.RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant.CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings(AU)

Evaluación del patrón de solicitud de hemoglobina glucosilada por Atención Primaria: estudio piloto regional en la Comunidad Valenciana / An evaluation of glycosylated hemoglobin requesting patterns in a primary care setting: a pilot experience in the Valencian Community (Spain)

Objetivo Mostrar el patrón de solicitud de hemoglobina glucosilada (HbA1c) en ocho departamentos de salud mediante el cálculo de indicadores de adecuación de la demanda. Métodos Estudio transversal en el que se recogen el número de HbA1c solicitadas desde Atención Primaria durante los años 2008 y 2009. Como indicador de adecuación se calculó el porcentaje de valores de HbA1c con resultado inferior a 6,5%. Las variables y los indicadores se recogieron y calcularon de forma automatizada. También se calculó en cada departamento de salud el número de determinaciones de HbA1c teóricas que deberían haber sido solicitadas según datos de prevalencia conocida. Resultados se observó un incremento progresivo de la demanda de determinaciones de HbA1c y, aproximadamente el 54% de los valores de HbA1c en siete de estos ocho departamentos fueron inferiores a 6,5%. El número de HbA1c teóricas que deberían haber sido solicitadas según la prevalencia de diabetes fue mayor que el número solicitado en todos los departamentos. Conclusión Los resultados parecen indicar la inadecuación en la solicitud de la HbA1c en los departamentos de salud estudiados, no sólo por la probable sobreutilización en pacientes no diabéticos sino por la infrautilización en pacientes que sí lo son (AU)

Objective To assess the pattern of glycosylated hemoglobin (HbA1c) requests by clinicians from eight health departments by calculating indicators of demand appropriateness. Methods A cross-sectional study of the number of HbA1c requests by primary care clinics in 2008 and 2009. The indicator of demand appropriateness was the proportion of HbA1c values lower than 6.5%. Variables were collected and indicators were automatically calculated. The number of HbA1c measurements that should theoretically have been requested according to known diabetes prevalence data was also calculated. Results A progressive increase was seen in demand for HbA1c measurements. Approximately 54% of HbA1c values obtained in seven of the eight departments studied were lower than 6.5%. The number of theoretical HbA1c requests that would have been expected based on the known prevalence of diabetes was higher than the number of HbA1c requests in all departments. Conclusion The results appear to suggest that HbA1c requests by the health departments studied were not always appropriate. HbA1c measurements were probably overused in patients without diabetes and underused in patients with diabetes (AU)

[An evaluation of glycosylated hemoglobin requesting patterns in a primary care setting: a pilot experience in the Valencian Community (Spain)]. / Evaluación del patrón de solicitud de hemoglobina glucosilada por Atención Primaria: estudio piloto regional en la Comunidad Valenciana.

OBJECTIVE: To assess the pattern of glycosylated hemoglobin (HbA(1c)) requests by clinicians from eight health departments by calculating indicators of demand appropriateness. METHODS: A cross-sectional study of the number of HbA(1c) requests by primary care clinics in 2008 and 2009. The indicator of demand appropriateness was the proportion of HbA(1c) values lower than 6.5%. Variables were collected and indicators were automatically calculated. The number of HbA(1c) measurements that should theoretically have been requested according to known diabetes prevalence data was also calculated. RESULTS: A progressive increase was seen in demand for HbA(1c) measurements. Approximately 54% of HbA(1c) values obtained in seven of the eight departments studied were lower than 6.5%. The number of theoretical HbA(1c) requests that would have been expected based on the known prevalence of diabetes was higher than the number of HbA(1c) requests in all departments. CONCLUSION: The results appear to suggest that HbA(1c) requests by the health departments studied were not always appropriate. HbA(1c) measurements were probably overused in patients without diabetes and underused in patients with diabetes.

Intentional mixed buccal cell reference sample in a paternity case.

We report a case where an alleged father (AF) attempted to substitute someone else's saliva sample for his reference sample in a paternity analysis. Buccal cells were collected from the AF and the child, and DNA analysis was performed using an autosomal STR loci (Identifiler). The profile from the AF showed extra peaks in some loci, as well as a much higher "X" allele peak relative to the "Y" allele peak at the amelogenin locus. After conducting reanalysis by another technician with another set of positive and negative controls, it was concluded that the only source of the mixed profile was by intentional introduction by the AF, at the time of sampling, of some foreign human biological material, most likely saliva from a woman. Owing to the inconclusive results, when the AF was called back to the lab and the peculiar results were explained to him, he admitted that he had introduced into his mouth saliva from another person in an attempt to be excluded as the father of the child. Although tampering with DNA reference samples is not common, some individuals may attempt to contaminate or otherwise adulterate specimens before DNA tests. Personnel responsible for sampling should be aware of this possibility and should try to establish procedures to avoid the problem.

Social benefits of non-criminal genetic databases: missing persons and human remains identification.

A Missing Persons Genetic Identification Program (Phoenix Program) was implemented in Spain in order to try to identify cadavers and human remains that could not be identified using traditional forensic approaches; to our knowledge, this is the first database ever implemented and in function in the world. Two separate mitochondrial DNA (mtDNA) databases have been generated and comparisons can be made automatically to match identical or similar sequences contained in both databases. One database is called the Reference Database (RD), which contains mtDNA sequences from maternal relatives of missing persons that provide the samples voluntarily after informed consent. The other database is called the Questioned Database (QD) and is comprised of mtDNA data on unknown remains and cadavers that could not be unequivocally identified. The combined database is a civil database designed solely for human identification and because of the informed consent and voluntary donation of reference samples is different from other databases now used to solve criminal cases. It is timely and incumbent on other willing countries to begin an international collaboration so compatibility and full utility can be enjoyed with this kind of non-criminal database.