Neovascular Progression and Retinal Dysfunction in the Laser-Induced Choroidal Neovascularization Mouse Model.

The mouse model of laser-induced choroidal neovascularization (LI-CNV) has been widely used to study neovascular age-related macular degeneration; however, it still lacks a comprehensive characterization. Here, CNV was induced in the eyes of 12-week-old C57BL/6J male mice by argon laser irradiation. We studied the CNV lesion progression of an LI-CNV mouse cohort by using multimodal imaging (color fundus, optical coherence tomography (OCT), and fluorescence angiography, focal electroretinography features for 14 days, and related cytokines, angiogenic factors, and reactive gliosis for 5 days. CNV lesions involving the rupture of the Bruch's membrane were confirmed using funduscopy and OCT after laser photocoagulation. During the initial stage, from the CNV induction until day 7, CNV lesions presented leakage observed by using fluorescence angiography and a typical hyperreflective area with cell infiltration, subretinal leakage, and degeneration of photoreceptors observed through OCT. This correlated with decreased retinal responses to light. Moreover, inflammatory and angiogenic markers were reduced to basal levels in the first 5 days of CNV progression. In contrast, reactive gliosis and the VEGF expression in retinal sections were sustained, with infiltration of endothelial cells in the subretinal space. In the second stage, between days 7 and 14 post-induction, we observed stabilization of the CNV lesions, a hyperfluorescent area corresponding to the formation of fibrosis, and a partial rescue of retinal function. These findings suggest that the LI-CNV lesion development goes through an acute phase during the first seven days following induction, and then the CNV lesion stabilizes. According to these results, this model is suitable for screening anti-inflammatory and anti-angiogenic drugs in the early stages of LI-CNV. At the same time, it is more convenient for screening anti-fibrotic compounds in the later stages.

Repeated Topical Administration of 3 nm Cerium Oxide Nanoparticles Reverts Disease Atrophic Phenotype and Arrests Neovascular Degeneration in AMD Mouse Models.

Increased oxidative stress in the retina and retinal pigment epithelium is implicated in age-related macular degeneration (AMD). Antioxidant cerium oxide nanoparticles (CeO2NPs) have been used to treat degenerative retinal pathologies in animal models, although their delivery route is not ideal for chronic patient treatment. In this work, we prepared a formulation for ocular topical delivery that contains small (3 nm), nonaggregated biocompatible CeO2NPs. In vitro results indicate the biocompatible and protective character of the CeO2NPs, reducing oxidative stress in ARPE19 cells and inhibiting neovascularization related to pathological angiogenesis in both HUVEC and in in vitro models of neovascular growth. In the in vivo experiments, we observed the capacity of CeO2NPs to reach the retina after topical delivery and a subsequent reversion of the altered retinal transcriptome of the retinal degenerative mouse model DKOrd8 toward that of healthy control mice, together with signs of decreased inflammation and arrest of degeneration. Furthermore, CeO2NP eye drops' treatment reduced laser-induced choroidal neovascular lesions in mice by lowering VEGF and increasing PEDF levels. These results indicate that CeO2NP eye drops are a beneficial antioxidant and neuroprotective treatment for both dry and wet forms of AMD disease.

Cell therapy with hiPSC-derived RPE cells and RPCs prevents visual function loss in a rat model of retinal degeneration.

Photoreceptor loss is the principal cause of blindness in retinal degenerative diseases (RDDs). Whereas some therapies exist for early stages of RDDs, no effective treatment is currently available for later stages, and once photoreceptors are lost, the only option to rescue vision is cell transplantation. With the use of the Royal College of Surgeons (RCS) rat model of retinal degeneration, we sought to determine whether combined transplantation of human-induced pluripotent stem cell (hiPSC)-derived retinal precursor cells (RPCs) and retinal pigment epithelial (RPE) cells was superior to RPE or RPC transplantation alone in preserving retinal from degeneration. hiPSC-derived RPCs and RPE cells expressing (GFP) were transplanted into the subretinal space of rats. In vivo monitoring showed that grafted cells survived 12 weeks in the subretinal space, and rats treated with RPE + RPC therapy exhibited better conservation of the outer nuclear layer (ONL) and visual response than RPE-treated or RPC-treated rats. Transplanted RPE cells integrated in the host RPE layer, whereas RPC mostly remained in the subretinal space, although a limited number of cells integrated in the ONL. In conclusion, the combined transplantation of hiPSC-derived RPE and RPCs is a potentially superior therapeutic approach to protect retina from degeneration in RDDs.

Transcriptomics analysis of Ccl2/Cx3cr1/Crb1rd8 deficient mice provides new insights into the pathophysiology of progressive retinal degeneration.

Chronic oxidative stress and immune dysregulation are key mechanisms involved in the pathogenesis of most retinal degenerative diseases, including age-related macular degeneration. The Ccl2-/-/Cx3cr1-/-/Crb1rd8/rd8 mouse model develops a progressive degeneration phenotype, with photoreceptor atrophy, drusen-like lesions or pigment alterations at an early age; however, the role of oxidative stress and immune function in the pathogenesis of the model is poorly understood. We performed a comprehensive characterization of the Ccl2-/-/Cx3cr1-/-/Crb1rd8/rd8 mouse to evaluate how these pathways influence pathogenesis. We generated a Ccl2-/-/Cx3cr1-/- double-knockout (DKO) mouse on a C57BL/6N background (with the rd8 mutation of the Crb1 gene), assessed its retina status and function during 9 months in both in vivo and post-mortem analysis, and performed a comprehensive transcriptomic analysis. DKOrd8 mice presented focal retinal lesions with increased infiltration of microglia and involvement of Müller cells. Lesions progressed to thinning of the photoreceptor nuclear layer, causing a loss in retinal function. Transcriptomics analysis revealed major differential expression of genes involved in oxidative stress and neuronal function, in particular genes related to the mitochondrial electron transport chain and antioxidant cellular response. Our results suggest that alterations in chemokine signaling combined with the rd8 mutation in Ccl2-/-/Cx3cr1-/-/Crb1rd8/rd8 mice involve early changes in several pathways associated with age-related macular degeneration, highlighting the relevance of these processes in the pathological retinal degeneration in the DKOrd8 model.

Expression of Melatonin and Dopamine D3 Receptor Heteromers in Eye Ciliary Body Epithelial Cells and Negative Correlation with Ocular Hypertension.

BACKGROUND: Experiments in the late nineties showed an inverse relationship in the eye levels of melatonin and dopamine, thereby constituting an example of eye parameters that are prone to circadian variations. The underlying mechanisms are not known but these relevant molecules act via specific cell surface dopamine and melatonin receptors. This study investigated whether these receptors formed heteromers whose function impact on eye physiology. We performed biophysical assays to identify interactions in heterologous systems. Particular heteromer functionality was detected using Gi coupling, MAPK activation, and label-free assays. The expression of the heteroreceptor complexes was assessed using proximity ligation assays in cells producing the aqueous humor and human eye samples. Dopamine D3 receptors (D3Rs) were identified in eye ciliary body epithelial cells. We discovered heteromers formed by D3R and either MT1 (MT1R) or MT2 (MT2R) melatonin receptors. Heteromerization led to the blockade of D3R-Gi coupling and regulation of signaling to the MAPK pathway. Heteromer expression was negatively correlated with intraocular hypertension. CONCLUSIONS: Heteromers likely mediate melatonin and dopamine actions in structures regulating intraocular pressure. Significant expression of D3R-MT1R and D3R-MT1R was associated with normotensive conditions, whereas expression diminished in a cell model of hypertension. A clear trend of expression reduction was observed in samples from glaucoma cases. The trend was marked but no statistical analysis was possible as the number of available eyes was 2.

Potentiation of cannabinoid signaling in microglia by adenosine A2A receptor antagonists.

Neuroprotective M2-skewed microglia appear as promising to alter the course of neurodegenerative diseases and G protein-coupled receptors (GPCRs) are potential targets to achieve such microglial polarization. A common feature of adenosine A2A (A2A R) and cannabinoid CB2 (CB2 R) GPCRs in microglia is that their expression is upregulated in Alzheimer's disease (AD). On the one hand, CB2 R seems a target for neuroprotection, delaying neurodegenerative processes like those associated to AD or Parkinson's diseases. A2A R antagonists reduce amyloid burden and improve cognitive performance and memory in AD animal models. We here show a close interrelationship between these two receptors in microglia; they are able to physically interact and affect the signaling of each other, likely due to conformational changes within the A2A -CB2 receptor heteromer (A2A -CB2 Het). Particularly relevant is the upregulation of A2A -CB2 Het expression in samples from the APPSw ,Ind AD transgenic mice model. The most relevant finding, confirmed in both heterologous cells and in primary cultures of microglia, was that blockade of A2A receptors results in increased CB2 R-mediated signaling. This heteromer-specific feature suggests that A2A R antagonists would potentiate, via microglia, the neuroprotective action of endocannabinoids with implications for AD therapy.

Wildfires in the wildland-urban interface in Catalonia: Vulnerability analysis based on land use and land cover change.

The crisis in traditional forest and farming activities that began in the second half of the 20th century has given way to a new territorial structure, characterised by greater forest density and an acceleration of urban sprawl, which has affected the impact of fires on the territory and especially on the inhabitants. The increased vulnerability of homes located at the wildland-urban interface (WUI) and the differences in the intensity of fire impact makes it necessary to identify different typologies of WUI zones. Characterization of WUI typologies was based on four forest fires with distinct characteristics, selected from fires that occurred in Catalonia in 2003 and 2012. Based on the different landscape units that have been studied and the dynamics of the changes that have occurred in the study area over the past 15 years, together with the occurrence of fires during this period, identified three major WUI zone typologies: a) metropolitan, b) agroforest and c) mountain agrosilvopastoral. The results, based on Kappa index and Rate of Change, show significant changes in Land Use and Land Cover between 2003 and 2009 in each study area, but the economic and social context in each region generated different territorial dynamics for each typology. This diagnosis contributes to knowledge that expands the available planning and management tools to mitigate the effects of wildfires.

N-Methyl-D-Aspartate Receptor Link to the MAP Kinase Pathway in Cortical and Hippocampal Neurons and Microglia Is Dependent on Calcium Sensors and Is Blocked by α-Synuclein, Tau, and Phospho-Tau in Non-transgenic and Transgenic APPSw,Ind Mice.

N-methyl-D-aspartate receptors (NMDARs) respond to glutamate to allow the influx of calcium ions and the signaling to the mitogen-activated protein kinase (MAPK) cascade. Both MAPK- and Ca2+-mediated events are important for both neurotransmission and neural cell function and fate. Using a heterologous expression system, we demonstrate that NMDAR may interact with the EF-hand calcium-binding proteins calmodulin, calneuron-1, and NCS1 but not with caldendrin. NMDARs were present in primary cultures of both neurons and microglia from cortex and hippocampus. Calmodulin in microglia, and calmodulin and NCS1 in neurons, are necessary for NMDA-induced MAP kinase pathway activation. Remarkably, signaling to the MAP kinase pathway was blunted in primary cultures of cortical and hippocampal neurons and microglia from wild-type animals by proteins involved in neurodegenerative diseases: α-synuclein, Tau, and p-Tau. A similar blockade by pathogenic proteins was found using samples from the APPSw,Ind transgenic Alzheimer's disease model. Interestingly, a very marked increase in NMDAR-NCS1 complexes was identified in neurons and a marked increase of both NMDAR-NCS1 and NMDAR-CaM complexes was identified in microglia from the transgenic mice. The results show that α-synuclein, Tau, and p-Tau disrupt the signaling of NMDAR to the MAPK pathway and that calcium sensors are important for NMDAR function both in neurons and microglia. Finally, it should be noted that the expression of receptor-calcium sensor complexes, specially those involving NCS1, is altered in neural cells from APPSw,Ind mouse embryos/pups.

Colecistitis y fístula duodenal como complicaciones del EndoBarrier®. Tratamento mínimamente invasivo / Cholecystitis and duodenal fistula as EndoBarrier®-associated complications. Minimally invasive treatment

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Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital.

OBJECTIVE: To describe the profile of the bariatric surgery patients that were admitted to the Emergency Department (ED). METHOD: A retrospective review of the reasons why bariatric surgery patients go to our ED. We analyzed the first 30 days after the surgery. We evaluated the number and indications of admissions, the examinations ordered, and final diagnosis and destination of the patients. RESULTS: From January 2010 to July 2012, 320 patients underwent bariatric surgery at our Institution. Fifty three patients (16.6%) were admitted to the ED at least once. We found 58 admissions (1.1 admissions by patient). Patients who had duodenal switch and Roux-en-Y gastric bypass were the most representative (74%). The main indications for admission were abdominal pain (50%), and problems related to the surgical wounds (22.4%). Blood test was the most performed examination (75.9%). The most frequent final diagnosis was unspecific abdominal pain in 27 cases (46.6%), and complications of the surgical wound in 10 patients (17.2%). Nineteen patients (35.84%) were admitted to the surgical ward from the ED, and 5 of them required surgical revision (9.4%). Multivariate analyses showed that the type of surgery was the only predictor variable for the ED admission. CONCLUSIONS: Attending ED after bariatric surgery is not common, and less than a third of the patients required hospital admission. Just a small percentage of the examinations showed any pathological value. Readmission rate is very low. Surgical procedure is the only predictor for ED admission.

Descripción de la asistencia en urgencias de pacientes intervenidos de cirugía bariátrica en un centro de referencia / Evaluation of bariatric surgery patients at the emergency department of a tertiary referral hospital

OBJETIVO: describir el perfil de consulta en el servicio de Urgencias de pacientes intervenidos de cirugía bariátrica (CB). MÉTODO: análisis retrospectivo de las consultas al servicio de Urgencias de pacientes intervenidos de CB. Se analizan las visitas realizadas en los primeros 30 días tras el alta. Se evalúan número y motivos de consulta/reconsulta, exploraciones complementarias realizadas, diagnóstico clínico establecido y destino de los pacientes. RESULTADOS: entre enero de 2010 y julio de 2012 se intervinieron de 320 pacientes de CB, 53 enfermos (16,6 %) consultaron al menos una vez en Urgencias. Se registraron 58 consultas (1,1 visitas/paciente). Los pacientes intervenidos de cruce duodenal y bypass gástrico representaron el 74 %. Los motivos de consulta más frecuentes fueron dolor abdominal (50 %) y problemas relacionados con la herida quirúrgica (22,4 %). La analítica sanguínea fue la exploración complementaria más solicitada (75,9 %). El diagnóstico más frecuente fue dolor abdominal inespecífico en 27 casos (46,6 %), y problemas de herida quirúrgica en 10 casos (17,2 %). Diecinueve pacientes (35,84 %) requirieron ingreso hospitalario desde Urgencias y 5 de ellos precisaron reintervención quirúrgica (9,4 %). El análisis multivariante muestra que la única variable en relación a las visitas a Urgencias es el tipo de cirugía. CONCLUSIONES: las visitas a Urgencias de pacientes intervenidos de cirugía bariátrica son poco frecuentes, menos de un tercio de ellos precisan ingreso hospitalario. Las exploraciones complementarias sólo mostraron resultados patológicos en un pequeño porcentaje de los casos. La tasa de reconsultas es baja. La técnica quirúrgica es el único predictor de consulta en Urgencias

OBJECTIVE: To describe the profile of the bariatric surgery patients that were admitted to the Emergency Department (ED). METHOD: A retrospective review of the reasons why bariatric surgery patients go to our ED. We analyzed the first 30 days after the surgery. We evaluated the number and indications of admissions, the examinations ordered, and final diagnosis and destination of the patients. RESULTS: From January 2010 to July 2012, 320 patients underwent bariatric surgery at our Institution. Fifty three patients (16.6 %) were admitted to the ED at leas t once. We found 58 admissions (1.1 admissions by patient). Patients who had duodenal switch and Roux-en-Y gastric bypass were the most representative (74 %). The main indications for admission were abdominal pain (50 %), and problems related to the surgical wounds (22.4 %). Blood test was the most performed examination (75.9 %). The most frequent final diagnosis was unspecific abdominal pain in 27 cases (46.6 %), and complications of the surgical wound in 10 patients (17.2 %). Nineteen patients (35.84 %) were admitted to the surgical ward from the ED, and 5 of them required surgical revision (9.4 %). Multivariate analyses showed that the type of surgery was the only predictor variable for the ED admission. CONCLUSIONS: Attending ED after bariatric surgery is not common, and less than a third of the patients required hospital admission. Just a small percentage of the examinations showed any pathological value. Readmission rate is very low. Surgical procedure is the only predictor for ED admission

One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach.

INTRODUCTION: The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome. PRESENTATION OF CASE: A 52 year-old male patient with a BMI of 53kg/m(2) was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome. DISCUSSION: Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy. CONCLUSION: Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach.

Gastroplastia tubular plicada, una nueva técnica para el tratamiento de la obesidad mórbida / Laparoscopic Gastric Plication: a new surgery for the treatment of morbid obesity

Introducción La gastroplastia tubular plicada es una nueva técnica que deriva de la gastrectomía vertical. La plicatura de la curvatura mayor genera un mecanismo restrictivo que ocasiona la pérdida ponderal. En este trabajo se presentan los resultados de los primeros casos en los que se ha aplicado esta técnica en nuestro centro. Métodos Revisión de pacientes intervenidos en nuestro centro entre noviembre de 2009 y diciembre de 2010. Bajo anestesia general y por la paroscopia se realiza la plicatura de la curvatura mayor gástrica sobre sí misma con 3 líneas de sutura y con una sonda orogástrica como guía. Se presentan los resultados relativos a morbilidad, mortalidad y pérdida ponderal. Resultados Se han intervenido 13 pacientes (7 mujeres). El IMC máximo oscila entre 37,11kg/m2 y 51,22kg/m2 en el momento de la intervención. La morbilidad más frecuentemente encontrada son náuseas y vómitos. Dos pacientes requirieron reintervención por vómitos incoercibles y disfagia absoluta, en uno se deshizo la plicación y en el segundo se convirtió a gastrectomía vertical. La pérdida ponderal a los 3 y 6 meses es equivalente a la de la gastrectomía vertical. Conclusiones La gastroplastia tubular plicada es una nueva técnica quirúrgica que presenta resultados a corto plazo equivalentes a los de la gastrectomía vertical. Se trata de una técnica reproductible y reversible con resultados e indicaciones aún por validar (AU)

Introduction: Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented. Methods: A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed undergeneral anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probeas a guide. The results of the morbidity, mortality and weight loss are presented. Results: A total of 13 patients were operated on (7 women). The maximum body mass index(BMI) varied between 37.11 kg/m2 and 51.22 kg/m2 at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy. Conclusions: Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated (AU)

[Laparoscopic Gastric Plication: a new surgery for the treatment of morbid obesity]. / Gastroplastia tubular plicada, una nueva técnica para el tratamiento de la obesidad mórbida.

INTRODUCTION: Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented. METHODS: A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed under general anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. The results of the morbidity, mortality and weight loss are presented. RESULTS: A total of 13 patients were operated on (7 women). The maximum body mass index (BMI) varied between 37.11 kg/m² and 51.22 kg/m² at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy. CONCLUSIONS: Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated.

Teratoma quístico de páncreas / Cystic teratoma of the pancreas

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Individual and family eating patterns during childhood and early adolescence: an analysis of associated eating disorder factors.

To examine whether there is an association between individual and family eating patterns during childhood and the likelihood of developing an eating disorder (ED) later in life. The sample comprised 261 eating disorder patients [33.5% [N=88] anorexia nervosa (AN), 47.2% [N=123] with bulimia nervosa (BN) and 19.3% [N=50] with Eating Disorders Not Otherwise Specified (EDNOS)] and 160 healthy controls from the Province of Catalonia, Spain, who were matched for age and education. All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to DSM-IV criteria. Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire (CCQ), a retrospective measure of childhood eating attitudes and behaviours. In the control group, also the General Health Questionnaire-28 (GHQ-28) was used. During childhood and early adolescence, the following main factors were identified to be linked to eating disorders: eating excessive sweets and snacks and consuming food specially prepared for the respondent. Conversely, regular breakfast consumption was negatively associated with an eating disorder. Compared to healthy controls, eating disorder patients report unfavourable eating patterns early in life, which in conjunction with an excessive importance given to food by the individual and the family may increase the likelihood for developing a subsequent eating disorder.

Blood levels of brain-derived neurotrophic factor correlate with several psychopathological symptoms in anorexia nervosa patients.

BACKGROUND: Evidence of a role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of eating disorders (ED) has been provided by association studies and by murine models. BDNF plasma levels have been found altered in ED and in psychiatric disorders that show comorbidity with ED. AIMS: Since the role of BDNF levels in ED-related psychopathological symptoms has not been tested, we investigated the correlation of BDNF plasma levels with the Symptom Checklist 90 Revised (SCL-90R) questionnaire in a total of 78 ED patients. METHODS: BDNF levels, measured by the enzyme-linked immunoassay system, and SCL-90R questionnaire, were assessed in a total of 78 ED patients. The relationship between BDNF levels and SCL-90R scales was calculated using a general linear model. RESULTS: BDNF plasma levels correlated with the Global Severity Index and the Positive Symptom Distress Index global scales and five of the nine subscales in the anorexia nervosa patients. BDNF plasma levels were able to explain, in the case of the Psychoticism subscale, up to 17% of the variability (p = 0.006). CONCLUSION: Our data suggest that BDNF levels could be involved in the severity of the disease through the modulation of psychopathological traits that are associated with the ED phenotype.