Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño / Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Introducción: Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos: Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio –índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15–. Se estudió a 58 pacientes con polisomnografía. Resultados: Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones: En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.(AU)

Introduction: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients’ pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. Patients and methods: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. Results: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. Conclusions: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.(AU)

[Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders]. / Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.

INTRODUCTION: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. PATIENTS AND METHODS: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. RESULTS: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. CONCLUSIONS: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

TITLE: Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.Introducción. Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos. Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio ­índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15­. Se estudió a 58 pacientes con polisomnografía. Resultados. Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones. En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.

International Cross-Sectional Survey among Healthcare Professionals on the Management of Cow's Milk Protein Allergy and Lactose Intolerance in Infants and Children.

Purpose: The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow's milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods: A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results: Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion: The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.

El proceso vasculítico de las úlceras aftosas recidivantes orales podría ser inducido por una microbiota intestinal alterada. segunda parte / Vasculitis process of recurrent aphtae´s ulcers could be induced by altered gut microbiota. Second part

Basados en evidencia clínicas, epidemiológicas e inmunológicas, publicadas en los últimos años, consideramos que, cambios en la microbiota intestinal, pueden desempeñar un rol esencial en la incidencia de numerosos desordenes inflamatorios. Expertos reconocidos han encontrado que una microbiota comensal normal, puede, bajo ciertas circunstancias mutar a patogénica y provocar reacción inmunológica activa e inducir inflamación. En este trabajo se presenta la siguiente hipótesis: "la vasculitis como proceso fisiopatogénico de las RAU estaría inducida en su persistencia, morbilidad y recurrencia por una microbiota intestinal alterada."(AU)

We believe, based on clinical, epidemiological an immunological evidence that could be possible that changes in the intestinal microbiota may be an essential factoring in the incidence of oral inflammatory disorders. Experten have found that a normal microbiota ,, under certain circumstances, produce pathogenic mutations, inducing immunological reaction . This work presents the following hypothesis:: : " Vasculitis as the fisiopathogenic process of RAU coulbe induced in its persistencity, morbidity and recurrence by an altered gut microbiota. " (AU)

El procesovasculítico de las úlceras aftosas recidivantes orales podría ser inducido por una microbiota intestinal alterada. Primera p / Vasculitis process of recurrent aphtae´s ulcers could be induced by altered gut microbiota. First part

Los últimos estudios realizados por expertos en Genética, Biología y Microbiología tratan, entre otros capítulos, sobre la composición de la microbiota intestinal, sus propiedades benéficas y su funcionalidad. Además, especialmente resaltan la relación de esta microbiota con diferentes tejidos del organismo, estableciendo una interrelación con las microbiotas de los distintos órganos del cuerpo humano. En base a ello se establece en esta presentación una hipótesis, teniendo en cuenta la influencia que también podría ejercer la microbiota intestinal sobre la homeostasis y los problemas de inflamación y otras lesiones más severas de la mucosa bucal, por ejemplo, sobre las úlceras aftosas recidivantes (RAU).(AU)

Considering Recurrent Aphthae´s Ulcers, known as RAU, as local vasculitis lesions, with high morbidity, and difficult treatment, its etiology remains unknown until now. It was published about its high incidence and prevalence in HIV+ patients affecting immunocompetent individuals as well. It is referred an immune histochemical study of this illness that included a leucocitoclastic vasculitis It was analized immunology of oral mucosa and RAU microbiota.(AU)

Utilidad de los estudios no invasivos en la enfermedad arterial obstructiva periférica en Atención Primaria / Utility of non-invasive studies in peripheral occlusive arterial disease in primary care

La enfermedad arterial obstructiva periférica (EAOP) es una patología con alta prevalencia en nuestro medio, cuyo diagnóstico debe llevar asociados los estudios necesarios para descartar la existencia de enfermedad vascular en otros sectores, fundamentalmente a nivel coronario y carotídeo. La Atención Primaria debe asumir, junto con la atención especializada, el diagnóstico, control de factores de riesgo cardiovascular y seguimiento de los pacientes con EAOP, para lo cual precisa de una coordinación entre los dos niveles asistenciales, así como el disponer de métodos sencillos en cuanto a su realización, pero fiables en cuanto a su interpretación. Estos criterios los reúne la toma de presión arterial sistólica en tobillo mediante doppler y la realización del índice tobillo/brazo (AU)

Peripheral occlusive arterial disease (PAOD) is a highly prevalent condition in our media. Others studies should be associated to its diagnosis in order to rule out the existence of vascular disease in other sectors, primarily on the coronary and carotid level. Primary Health Care must participate in coordination with Specialized Health Care in the diagnosis, cardiovascular risk control and follow-up of patients with PAOD. Thus, there must be coordination between the two care levels and simple diagnostic methods with reliability for their interpretation are needed. These simple methods are systolic blood pressure measured at the ankle with doppler probe and ankle/ brachial Index (AU)

Tratamiento quirúrgico de la arteria femoral profunda en su tercio distal con interposición de un collarete venoso de Miller / Surgical treatment of the distal third of the deep femoral artery with interposition of a miller vein cuff

Objetivo. Evaluar la revascularización de la arteria femoral profunda (AFP) distal, como técnica para salvarla extremidad en pacientes con isquemia crítica. Pacientes y métodos. Mediante un estudio retrospectivo se analizaronlos casos de los pacientes ingresados con el diagnóstico de isquemia crítica, en quienes se llevó a cabo una revascularizaciónprotésica de la AFP distal con interposición de collarete de Miller y se desestimaron los casos con gangrenas extensas.Se incluyeron en el estudio 30 casos, 26 hombres (86,7%) y cuatro mujeres (13,3%), con una edad media de 72 ±9 años. Los motivos del ingreso fueron el dolor en reposo en 22 casos (73,3%) y la presencia de lesiones tróficas superficialesen ocho casos (26,6%). Se realizaron 3 derivaciones iliofemorales, 3 reconstrucciones del sector femoral, 17 derivacionesfemorofemorales, 4 axilobifemorales, 1 alargamiento desde una derivación iliofemoral previa y 2 alargamientosdesde derivaciones aortobifemorales realizadas con anterioridad. Resultados. El seguimiento medio fue de 18 meses(rango: 15-60 meses). El índice tobillo/brazo postoperatorio aumentó una media de 0,25 ± 0,1. La mortalidad peroperatoriafue nula, con nueve fallecimientos tardíos no relacionados con la cirugía, dos de origen cardíaco, cuatro de causaneoplásica y tres no filiados. La permeabilidad primaria al final del período (18 meses) fue del 86,7%, con una permeabilidadsecundaria del 93,3%. No se detectaron infecciones protésicas y la tasa de salvamento de extremidad al final delperíodo fue del 93,3%. Conclusiones. La revascularización de la AFP en casos seleccionados, como alternativa para salvarla extremidad, es una opción válida con escasas complicaciones, un excelente éxito técnico y una buena tasa de salvamentode la extremidad(AU)

Aim. To determine if surgical treatment of the distal portion of deep femoral artery (DFA) is a valid techniquefor limb salvage in patients with critical limb ischemia. Patients and methods. A retrospective study analyzing admittedpatients with critical limb ischemia was performed. These patients underwent a DFA revascularization with interpositionof a Miller cuff, excluding those with extensive gangrene. Thirty cases were found, 26 male and 4 women with amean age of 72 ± 9 years. The admission diagnosis was rest pain in 22 cases (73.3%), and trophyc lesions in 8 cases(26.6%). The procedures performed were 3 ilio-femoral bypasses, 3 femoral sector reconstructions, 17 femoro-femoralbypasses, 4 axilo-femoral bypasses, 1 extension from a previous ilio-femoral bypass and 2 extensions from previous aortobifemoralbypasses. Results. The mean follow up time was 18 months (15-60). Postoperative ABI increase was 0.25 ± 0.1,and postoperative mortality was none, with 9 deaths none related with the surgical procedure, 2 heart related, 4 neoplasicand 3 non determined. The primary patency rate was 86.7% with a secondary patency rate of 93.3%. No graft infectionswere detected and the limb salvage rate was 93.3%. Two amputations were performed, one due to a graft failure and onedue to gangrene progression. Conclusions. The revascularization of the distal portion of the DFA in selected patients isa valid technique for limb salvage, achieving an excellent technical success with few complications and a good limbsalvage rate(AU)

Pseudooclusión carotídea sintomática: tratamiento quirúrgico y resultados / Symptomatic pseudo-occlusion of the carotid artery: surgical treatment and outcomes

Introducción. Estudios multicéntricos recientes sugieren un dudoso beneficio de la endarterectomía carotídea (EC) en pacientes con pseudooclusión carotídea (POC). Objetivo. Evaluar el resultado clínico y hemodinámico de la EC en las POC sintomáticas. Pacientes y métodos. Entre 1999 y 2005 se intervinieron 13 pacientes con POC interna (3,96% de la cirugía carotídea) sintomáticas: siete con infarto cerebral (53,8%), tres con accidente isquémico transitorio (23,1%), dos con amaurosis fugaz (15,4%) y uno con síncopes de repetición (7,7%). En todos se realizó eco-Doppler y angiografía. Criterios diagnósticos del eco-Doppler: oclusión origen carótida interna, flujo en goteo o señal distal amortiguada. Criterios diagnósticos de la angiografía: obstrucción origen carótida interna con relleno filiforme distal. Se indicó la revascularización quirúrgica en todos ellos. Resultados. En 12 pacientes se pudo revascularizar la carótida interna (92,3%) y en uno se hizo su ligadura (7,7%). Técnica de revascularización: 11 EC y un bypass a carótida interna distal. Morbimortalidad quirúrgica del 0%. Control clínico: 3-69 meses (media: 31,6 meses) mediante eco-Doppler de troncos supraaórticos y transcraneal, encontrándose todos vivos, asintomáticos y con permeabilidad de la carótida interna. La reserva hemodinámica homolateral postoperatoria se ha encontrado normalizada en la mayoría de los pacientes. Conclusiones. Se considera indicada la intervención quirúrgica en casos sintomáticos de POC, ya que logra la repermeabilización de la carótida y la normalización de la reserva hemodinámica en un alto porcentaje, previniendo además la aparición de nueva sintomatología a largo plazo

Introduction. Recent multicentre studies suggest dubious benefits for carotid endarterectomy (CE) in patients with pseudo-occlusion of the carotid artery (POC). Aim. To evaluate the clinical and haemodynamic outcomes of CE in cases of symptomatic POC. Patients and methods. Between 1999 and 2005 interventions were carried out on 13 patients with symptomatic pseudo-occlusion of the internal carotid artery (3.96% of the carotid surgery conducted): seven with cerebral infarction (53.8%), three with transient ischemic attack (23.1%), two with amaurosis fugax (15.4%) and one with recurring syncopes (7.7%). Doppler ultrasonography and angiography recordings were performed in all cases. Diagnostic criteria for Doppler ultrasonography were occlusion with its origin in the internal carotid artery, a drip flow or attenuated distal signals. Diagnostic criteria for angiography were occlusion with its origin in the internal carotid artery with filiform distal filling. Surgical revascularisation was indicated in all cases. Results. The internal carotid artery was revascularised in 12 patients (92.3%) and ligation was performed in one of them (7.7%). Revascularisation technique: 11 CE and one distal internal carotid artery bypass. Surgical morbidity and mortality rates of 0%. Clinical monitoring: 3-69 months (mean: 31.6 months) using transcranial and supra-aortic trunk Doppler ultrasonography; all patients were alive, asymptomatic and with patency of the internal carotid artery. The post-operative homolateral haemodynamic reserve was found to be at normal levels in most of the patients. Conclusions. Surgical intervention is considered to be indicated in symptomatic cases of POC, as it achieves repatency of the carotid artery and normalises the haemodynamic reserve in a high percentage of cases; it also prevents the appearance of new symptoms in the long term

Pseudooclusión carotídea. A propósito de un caso / Pseudo-occlusion of the carotid artery. A case report

No disponible

Influencia de la carótida contralateral en los resultados de la endarterectomía carotídea / The influence of the contralateral carotid artery in the outcome of carotid endarterectomies

Introducción. La oclusión carotídea contralateral puede considerarse un factor de riesgo de la endarterectomía carotídea (EAC). Objetivo. Valorar los resultados de la EAC según el estado de la carótida contralateral. Pacientes y métodos. Estudio de cohortes retrospectivo en el que se incluyen 291 pacientes (edad media: 67,5 ± 8 años; 86% varones), a los que se realizaron 320 EAC en siete años (1998-2004). Control clínico medio: 27 ± 22 meses. Indicaciones de intervención: estenosis sintomáticas > 70% y asintomáticas preoclusivas. Clasificados los pacientes en cuatro grupos: oclusión contralateral (grupo A, 52 pacientes), estenosis contralateral grave (B, 50 pacientes), estenosis contralateral < 70% (C, 78 pacientes), y carótida contralateral normal (D, 140 pacientes). Las características de los grupos y tasas perioperatorias de muerte e ictus se comparan mediante test de χ2. Se calcula la supervivencia libre de eventos neurológicos mediante tablas de vida Kaplan-Meier. Resultados. Los cuatro grupos resultaron comparables en factores de riesgo, indicación de intervención y técnica quirúrgica, excepto en utilización de shunt. La mortalidad perioperatoria global fue del 1,9%, sin diferencias entre grupos, aunque mayor en B. Las tasas de ictus perioperatorio fueron 3,8, 4, 1,3 y 1,5% (A, B, C y D, respectivamente; p = 0,23). La morbilidad neurológica fue significativamente mayor en A + B respecto a C + D (9,8 frente a 4,1%; p = 0,04). En el control clínico a medio-largo plazo no hubo tampoco diferencias entre los grupos. Conclusiones. El estado lesional de la carótida contralateral influye en los resultados de la EAC. La estenosis contralateral grave eleva la morbimortalidad perioperatoria en igual o mayor proporción que la oclusión contralateral

INTRODUCTION. Contralateral carotid occlusion can be considered a risk factor for a carotid endarterectomy (CEA). AIMS. To evaluate the outcomes of CEA according to the status of the contralateral carotid artery. PATIENTS AND METHODS. A retrospective cohort study was conducted with a sample of 291 patients (mean age 67.5 ± 8 years; 86% males), who underwent 320 CEA over a period of seven years (1998-2004). Mean clinical follow-up: 27 ± 22 months. Indications for surgical intervention: symptomatic > 70% and asymptomatic preocclusive stenoses. Patients were classified in four groups: contralateral occlusion (group A, 52 patients), severe contralateral stenosis (B, 50 patients), contralateral stenosis < 70% (C, 78 patients), and normal contralateral carotid (D, 140 patients). The characteristics of the groups and the perioperative death and stroke rates were compared using the chi squared test. Rates of survival free of neurological events were calculated by means of the Kaplan-Meier life tables. RESULTS. The four groups were found to be comparable as regards risk factors, indications for surgical intervention and surgical procedure, except in relation to the use of shunts. Overall perioperative mortality was 1.9% with no significant differences among groups, although it was slightly higher in group B. Perioperative stroke rates were 3.8, 4, 1.3 and 1.5% (A, B, C and D, respectively; p = 0.23). Neurological morbidity was significantly higher in A + B than in C + D (9.8 versus 4.1%; p = 0.04). No differences were found among groups in the medium-long term clinical follow-up either

Crystal structure of the central region of bovine fibrinogen (E5 fragment) at 1.4-A resolution.

The high-resolution crystal structure of the N-terminal central region of bovine fibrinogen (a 35-kDa E(5) fragment) reveals a remarkable dimeric design. The two halves of the molecule bond together at the center in an extensive molecular "handshake" by using both disulfide linkages and noncovalent contacts. On one face of the fragment, the Aalpha and Bbeta chains from the two monomers form a funnel-shaped domain with an unusual hydrophobic cavity; here, on each of the two outer sides there appears to be a binding site for thrombin. On the opposite face, the N-terminal gamma chains fold into a separate domain. Despite the chemical identity of the two halves of fibrinogen, an unusual pair of adjacent disulfide bonds locally constrain the two gamma chains to adopt different conformations. The striking asymmetry of this domain may promote the known supercoiling of the protofibrils in fibrin. This information on the detailed topology of the E(5) fragment permits the construction of a more detailed model than previously possible for the critical trimolecular junction of the protofibril in fibrin.

[The efficacy of neurophysiological examination in the diagnosis of carpal tunnel syndrome]. / Eficacia del examen neurofisiológico en el diagnóstico del síndrome del túnel del carpo.

INTRODUCTION: The validity of studies of nerve conduction in the diagnosis of carpal tunnel syndrome has been sufficiently demonstrated, especially the speed of nerve conduction across the carpus. It has also been proved that the result of the test varies according to its use. OBJECTIVE: This study is to evaluate the result of the study of nerve conduction in the diagnosis of carpal tunnel syndrome in a population attending a clinical neurophysiology department for examination of suspected neuro-muscular disorders of the upper limit. PATIENTS AND METHODS: We selected the cut-off points of the values of speed of nerve conduction along the median nerve from the thumb (E1) and palm of the hand (E2). Those showing the best sensitivity and specificity were chosen (53 and 51 m/s respectively). We assessed the pre-test and post-test probability to measure the examination result. There was little contribution from this examination to the diagnosis of carpal tunnel syndrome in this population. CONCLUSIONS: The high pre-test probability of a disorder is a cause of low efficacy of the examination done to confirm this and the opposite occurs when it is done to rule it out. The efficacy of an examination should be measured in the setting in which it is used since this does not depend only on its intrinsic characteristics but also on how it is used.

Eficacia del examen neurofisiológico en el diagnóstico del síndrome del túnel del carpo / The efficacy of neurophysiological examination in the diagnosis of carpal tunnel syndrome

Introducción. La validez de los estudios de conducción nerviosa en el diagnóstico del síndrome del túnel carpiano está suficientemente probada y, en concreto, de la velocidad de conducción del nervio mediano a través del carpo. También está probado que el rendimiento de un examen varía con el uso que se hace del mismo.Objetivo. Este estudio trata de evaluar el rendimiento del estudio de conducción nerviosa, para el diagnóstico del síndrome del túnel carpiano, en una población que acude a un servicio de neurofisiología clínica para examen por sospecha de afectación neuromuscular de miembro superior. Pacientes y métodos. Se seleccionan los puntos de corte en los valores de velocidad de conducción nerviosa del nervio mediano desde el primer dedo (E1) y palma de la mano (E2). Se eligen los que mejor sensibilidad y especificidad muestran (53 y 51 m/s, respectivamente). Se evalúa la probabilidad preprueba y posprueba para medir el rendimiento del examen. La contribución del examen al diagnóstico del síndrome del túnel carpiano, en esta población, es baja. Conclusiones. La elevada probabilidad preprueba de una patología es causa del bajo rendimiento del examen que se hace para confirmarla y la inversa si es para descartarla. Para que un examen sea útil debe aportar un valor significativo a un diagnóstico. El rendimiento de un examen debe hacerse en el medio en que se emplea ya que no sólo depende de sus características intrínsecas sino del uso que del mismo se hace (AU)

Diagnosis and documentation of central nervous system dysfunctions with craniocorpography after surgical removal of acoustic neurinomas.

Among other tests, craniocorpography (CCG) was performed in 21 patients after acoustic neurinoma surgery. After surgery, 17 patients (81%) had a developing vestibular compensation or an already normal CCG pattern; 3 patients (14%) had signs of persisting central nervous system dysfunction, either localized to the brain stem or in combination with a cerebellar dysfunction, and 1 patient showed a delayed but sufficient compensation after removal of a neurinoma that compressed central nervous system structures. Brain stem and cerebellar dysfunctions caused by tumor compression demonstrated a better vestibular compensation than dysfunctions caused by surgical manipulation, despite no evidence of cerebellar alteration. As an adjunct to complete neuro-otologic and neurologic examinations CCG could become a useful tool in the topodiagnosis of central nervous system dysfunctions after acoustic neurinoma surgery and therefore in the documentation and follow-up process of these patients.

Levansucrase from Acetobacter diazotrophicus SRT4 is secreted via periplasm by a signal-peptide-dependent pathway.

Acetobacter diazotrophicus SRT4 secretes a constitutive levansucrase (LsdA) (EC 2.4.1.10) that is responsible for sucrose utilization. Immunogold electron microscopical studies revealed that LsdA accumulates in the periplasm before secretion. The periplasmic and extracellular forms of the enzyme were purified to homogeneity. Both proteins exhibited similar physical and biochemical characteristics indicating that LsdA adopts its final conformation in the periplasm. The N-terminal sequence of mature LsdA was pGlu-Gly-Asn-Phe-Ser-Arg as determined by PSD-MALDI-TOFMS (post-source decay-matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry). Comparison of this sequence with the predicted precursor protein revealed the cleavage of a 30-residue typical signal peptide followed by the formation of the pyroglutamic acid (pGlu) residue. Thus, in contrast with other Gram-negative bacteria, A. diazotrophicus secretes levansucrase by a signal-peptide-dependent mechanism.

Sodium transport kinetics, cell membrane lipid composition, neural conduction and metabolic control in type 1 diabetic patients. Changes after a low-dose n-3 fatty acid dietary intervention.

BACKGROUND: A decreased content of n-3 fatty acids in erythrocyte membrane of type 1 diabetic patients, which is inversely related to plasma levels of HbA(1c), has been reported previously. Our aim in this study was to observe the changes after a low-dose n-3 fatty acid (330 mg/day docosahexaenoic acid and 630 mg/day eicosapentanoic acid) dietary intervention in the lipid composition of cell membrane and metabolic control (measured according to plasma HbA(1c) levels). Since changes in both parameters may alter transmembrane sodium transport or influence parameters measuring target organ damage, we also studied the neural conduction quality and activity of four sodium transporters. METHODS: Eighteen type 1 diabetic patients were randomly assigned to continue their usual diet (control group) or to supplement their diet with a daily low dose of n-3 fatty acids (supplemented group). The changes between baseline and end values of the following parameters were compared: HbA(1c), lipid and phospholipid composition of cell membrane, activity of four ion carriers and neural conduction quality. RESULTS: The dietary supplementation caused statistically significant changes in membrane lipid composition, particularly an increase of C22:6 (n-3) and the total n-3 fatty acid (respectively +0.90+/-1.14% vs. -0.44+/-1.23% and +1.36+/-1.62% vs. -0.5+/-1.80%, p<0.05). After the dietary supplementation, we also observed a significant decrease of HbA(1c) (-2.00+/-1.9% vs. -0.13+/-0.48%, p<0.05), without significant changes in the dose of insulin required, an increase in the motor conduction velocity by the median nerve (+2.12 +/-1.35 m/s vs. -0.8+/-2.34 m/s, p<0.05) and a decrease of the V(max) of the Na(+)-Li(+) countertransport (-96.6+/-111.2 vs. +58.1+/-81.3 micromol/l cell/h(-1), p<0.01). CONCLUSION: A low-dose omega-3 fatty acid dietary supplementation may change the fatty acid composition of the cell membrane and improve the metabolic control of diabetes. Using this dose, we also observed a decrease of the maximal rate of Na(+)-Li(+) countertransport and a slight improvement of neural conduction.

Structure and sites of phosphorylation of 14-3-3 protein: role in coordinating signal transduction pathways.

The 14-3-3 family are homo- and heterodimeric proteins whose biological role has been unclear for some time, although they are now gaining acceptance as a novel type of 'adaptor' protein that modulates interactions between components of signal transduction pathways, rather than by direct activation or inhibition. It is becoming apparent that phosphorylation of the binding partner and possibly also the 14-3-3 proteins may regulate these interactions. 14-3-3 isoforms interact with a novel phosphoserine (Sp) motif on many proteins, RSX1,2SpXP. The two isoforms that interact with Raf-1 are phosphorylated in vivo on Ser185 in a consensus sequence motif for proline-directed kinases. The crystal structure of 14-3-3 indicates that this phosphorylation could regulate interaction of 14-3-3 with its target proteins. We have now identified a number of additional phosphorylation sites on distinct mammalian and yeast isoforms.

Crystallization of a 14-3-3 protein.

Crystals of the tau (tau) isoform of the 14-3-3 family of proteins were grown and shown to belong to the orthorhombic space group P2(1)2(1)2(1) with cell dimensions a = 70.29, b = 79.3, c = 101.00 A. The crystals were needle-like in morphology and less than 10 micro m in two dimensions. Diffraction data were collected using synchrotron radiation sources from flash-cooled crystals. Native data extended to a resolution of 2.6 A and mercury and platinum derivatives diffracted to 3.4 and 3.9 A, respectively. The structure has been solved recently. Here the protein crystallization procedures, the characterization of the crystals and the correlation between crystal habit and diffraction quality are reported.

Post-translationally modified 14-3-3 isoforms and inhibition of protein kinase C.

This report compares the ability of individual members of the 14-3-3 protein family to inhibit particular protein kinase C (PKC) isoforms. We also show that two of these 14-3-3 isoforms (alpha and delta) specific to mammalian and avian brain are in vivo post-translationally modified forms of beta and zeta respectively. The presence of this modification enhances the activity of 14-3-3 as an inhibitor of protein kinase C nearly two fold. A method for analysing isoforms of 14-3-3 on acid-urea gels is also described. This permits the complete separation of all major isoforms and their unequivocal identification by a range of isoform specific antisera. The activity of recombinant 14-3-3 and isoforms renatured by a novel method after separation by reverse phase HPLC are compared. The effects of diacylglycerol and the phorbol ester, PMA (phorbol 1 2-myristate 13 acetate) on the inhibition suggest that one of the sites of interaction of 14-3-3 may be the cysteine-rich (C1) domain in PKC.