Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus percutaneous surgery. / [Artículo traducido] Utilidad del índice de fragilidad modificado de 5 items para predecir complicaciones y reoperaciones después de la cirugía percutánea de hallux valgus.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: 1) non-frail: patients without any of the 5 comorbidities, 2) pre-frail: patients with one comorbidity and 3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct HV deformity, 551 patients were included with a median age of 60 (IQR 48-70). Three hundred eighty-nine patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (P=.11). Frailty patients had worse AOFAS scores at final follow up (P=.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Incidencia de dedo flotante en la osteotomía metatarsiana distal percutánea con osteosíntesis para el tratamiento de la metatarsalgia con dedo en martillo rígido / Incidence of floating toe after distal minimally invasive metatarsal osteotomy with pin osteosynthesis for the treatment of metatarsalgia and rigid hammertoe

Introducción: La metatarsalgia central es una causa frecuente de dolor de antepié. La osteotomía de Weil es el tratamiento quirúrgico más popular y la osteotomía metatarsiana distal percutánea (OMDP) es la técnica percutánea más utilizada. La principal desventaja de estas técnicas es la aparición de dedo flotante que es aún mayor cuando se la asocia a artrodesis interfalángica proximal (AIFP). En esta serie de casos, se combinó la OMDP y la osteosíntesis con clavija de Kirschner para elevar el centro de rotación de la cabeza del metatarsiano con el objetivo de disminuir la presencia de dedos flotantes. Nuestra principal hipótesis fue que esta técnica generará menos dedos flotantes en los pacientes con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido, comparada con la osteotomía de Weil. materiales y métodos: Se realizó un estudio retrospectivo en pacientes adultos con diagnóstico de metatarsalgia mecánica y dedo en martillo rígido. Se los sometió a una OMDP más fijación con clavija de Kirschner en combinación con AIFP. Finalmente, se comparó la presencia de dedos flotantes con un grupo de pacientes operados con la técnica de Weil y AIFP. Resultados: Se realizaron 39 OMDP más AIFP. La tasa de dedos flotantes fue del 31%. No hubo una diferencia estadísticamente significativa comparada con la técnica de Weil (36%, p= 0,634). Conclusión: La OMDP con elevación del centro de rotación asociada con AIFP no proporcionó una menor incidencia de dedos flotantes en comparación con la osteotomía de Weil. Nivel de Evidencia: IV

Introduction: Central metatarsalgia is a common cause of forefoot pain. The most common surgical treatment is Weil osteotomy and the most popular percutaneous technique is distal minimally invasive metatarsal osteotomy (DMMO). However, the main disadvantage of these techniques is the appearance of floating toes, which is even greater when associated with proximal interphalangeal arthrodesis. In this series of cases, DMMO was combined with a pin to elevate the center of rotation of the metatarsal head with the aim of reducing the presence of floating toes. Our main hypothesis was that this technique would result in a lower presence of floating toes in patients diagnosed with mechanical metatarsalgia and rigid hammertoe, compared to Weil osteotomies. Materials and methods: A retrospective observational study was carried out on consecutive adult patients diagnosed with mechanical metatarsalgia and rigid hammertoe. DMMO was performed with pin fixation in combination with proximal interphalangeal (PIP) arthrodesis. Finally, the presence of floating toes was compared with a group of patients operated on with the Weil technique and PIP arthrodesis. Results: A total of 39 DMMOs with PIP arthrodesis were performed. The percentage of floating toes was 31% . There was no statistically significant difference compared to the Weil technique (36%, p = 0.634). Conclusion: DMMO for elevation of the center of rotation associated with PIP arthrodesis fixed with a pin did not provide a lower incidence of floating toes compared to Weil osteotomy. Level of Evidence: IV

Osteotomías supramaleolares en pacientes con artrosis de tobillo: resultados clínicos y radiográficos / Supramalleolar osteotomies for ankle osteoarthritis: Clinical and radiological outcomes

Introducción: Las osteotomías supramaleolares son una opción terapéutica para la artrosis asimétrica de tobillo. El objetivo de este artículo es describir los resultados clínicos, radiográficos y subjetivos obtenidos en pacientes con artrosis de tobillo sometidos a una osteotomía supramaleolar. Materiales y métodos: Estudio observacional descriptivo retrospectivo de pacientes sometidos a una osteotomía supramaleolar por artrosis de tobillo entre enero de 2010 y julio de 2017. Se analizaron las historias clínicas para recabar datos clínicos y radiográficos preoperatorios y posoperatorios. Resultados: Se incluyó a 13 pacientes: 8 con una desalineación del tobillo y retropié en valgo (61,5%) y 5 (38,5%) en varo. El puntaje medio posoperatorio de la escala analógica visual del grupo con deformidad en varo disminuyó de 9 ± 0,45 a 3 ± 1 (p <0,05) y de una media de 7,88 ± 0,35 a 2,15 ± 1,64 (p <0,05) en aquellos con deformidad en valgo. El puntaje medio de la escala de la AOFAS se modificó de 32,8 ± 16,2 antes de la cirugía a 82,1 ± 13,6 en el posoperatorio, en el grupo con deformidad en varo (p <0,05) y de 31 ± 17,3 a 93,1 ± 6,20, respectivamente, en aquellos con deformidad en valgo (p <0,05). Se constató la consolidación radiográfica en 12 pacientes (92,3%), en un promedio de 10.4 semanas. Conclusión:La osteotomía supramaleolar como tratamiento de la artrosis asimétrica de tobillo es una técnica predecible, con muy buenos resultados clínicos y radiográficos a corto y mediano plazo. Nivel de Evidencia: IV

Introduction: Supramalleolar osteotomies are a treatment option for asymmetric ankle osteoarthritis. Our work aims to describe the clinical, radiographic, and subjective outcomes obtained in patients with ankle osteoarthritis who underwent a supramalleolar osteotomy (SMOT). Materials and methods: Retrospective, observational, and descriptive study on patients who underwent SMOT for ankle osteoarthritis between January 2010 and July 2017. The patients' clinical records were analyzed. Results: We included 13 patients who underwent SMOT, 8 patients with valgus (61.5%) and 5 (38.5%) with varus rearfoot and ankle misalignment. The mean varus VAS score decreased from 9 ± 0.45 to 3 ± 1 postoperatively (p <0.05) and, in valgus deformities, from a mean 7.88 ± 0.35 to 2.15 ±1.64 postoperatively (p <0.05). The mean AOFAS score changed from 32.8 ± 16.2 to 82.1 ± 13.6 postoperatively in the varus deformity group (p <0.05) and from 31 ± 17.3 preoperatively to 93.1 ± 6.20 postoperatively in the valgus deformity group (p <0.05). Twelve patients (92.3%) achieved radiographic union in an average time of 10.4 weeks. Conclusion:Supramalleolar osteotomy as a treatment for asymmetric ankle osteoarthritis is a predictable technique with very good clinical and radiological outcomes in the short and medium term. Level of Evidence: IV

Utility of the modified 5-item frail index to predict complications and reoperations after hallux valgus surgery.

INTRODUCTION: The modified 5-item frailty index (mFI-5) has been recently proposed as a useful tool for predicting postoperative complications in orthopedic surgery. We aimed to analyze the utility of this score in predicting complications and reoperations after hallux valgus (HV) deformity surgery. METHODS: 551 patients undergoing percutaneous HV corrective surgery were retrospectively reviewed. The mFI-5 was calculated based and patients were categorized in three groups: (1) non-frail: patients without any of the 5 comorbidities, (2) pre-frail: patients with one comorbidity and (3) frail: patients with two or more comorbidities. Complications and surgical reoperations were recorded. RESULTS: In the study period 772 percutaneous surgeries were performed to correct hallux valgus deformity, 551 patients were included with a median age of 60 (IQR 48-70). 389 patients were non-frail (70.6%), 132 were pre-frail (23.9%) and 30 were frail (5.4%). 75 patients suffered complications (13.6%). Even though the rate of complications was higher in frailty patients (23.3%) compared with pre-frail (13.6%) and non frail (12.8%), no significant differences were observed among groups. 48 patients required reoperation (8.7%) but the rate of reoperations among frailty groups was not significantly different (p=0.11). Frailty patients had worse AOFAS scores at final follow up (p=0.011). CONCLUSION: The mFI-5 was not useful to predict postoperative complications and reoperations after hallux valgus corrective surgery. Therefore, other factors should be considered when analyzing the risk of complications after HV corrective surgery.

Effect of Dentoxol® in the treatment of recurrent mild aphthous ulcers. A prospective observational pilot study

ABSTRACT: Background: Recurrent aphthous stomatitis (RAS) is the most common oral ulceration. Its prevalence in the general population varies between 5% and 60%, and during the acute period, it causes pain and interferes with basic activities, such as eating, swallowing and talking. Dentoxol® is a medical mouthrinse that cleans, moisturizes and lubricates the mouth, mechanically stimulating local epithelial regeneration. The aim of this study was to evaluate the efficacy of Dentoxol® in improving the general state of patient with minor RAS using two different treatment schemes. Material and methods: Thirty-nine patients with RAS were recruited in a prospective observational pilot study. Two dosing regimens, 5 ml of Dentoxol® twice daily and 5 ml of Dentoxol® three times daily were evaluated. Results: Efficacy to improve the general state was significant superior in "Three time daily" group compared with "twice daily" at 72 h (66% vs 33% respectively). No pain was reported in approximately 90% of cases at 96 h of use in both group without significant differences between the groups in any evaluation time-point. Conclusion: Despite the limitations of these preliminary data, Dentoxol® shows promising beneficial properties for the management of minor RAS.

Vibrio mediterranei, a potential emerging pathogen of marine fauna: investigation of pathogenicity using a bacterial challenge in Pinna nobilis and development of a species-specific PCR.

AIMS: Extreme mortality events affecting Pinna nobilis, some associated to Vibrio mediterranei, have depleted many populations of this bivalve. The objective of this study was to demonstrate pathogenicity of V. mediterranei in the host P. nobilis by performing a bacterial challenge in P. nobilis to understand if V. mediterranei has specific virulence in this host. To assist this objective, a secondary objective was to develop a species-specific DNA diagnostic test. METHODS AND RESULTS: Pinna nobilis collected from local bays were used in a challenge experiment with V. mediterranei (strain IRTA18-108). The virulence in the host background of P. nobilis was demonstrated at doses of 103 CFUs per animal. An alignment of published Vibrio sp. atpA sequences was used to design V. mediterranei-specific primers. Furthermore, data mining of published literature and V. mediterranei genomes identified multiple virulence-related genes (vir genes) from which specific primers were designed for PCR detection of selected genes. CONCLUSION: Vibrio mediterranei strain IRTA18-108 is pathogenic in the host P. nobilis. The virulence genes sod, rtx and mshA were identified in this strain. Temperatures of 24°C or higher appear to trigger onset of virulence. Sensitivity and specificity of the Vm atpA PCR is useful for diagnosis of Vibriosis in shellfish. SIGNIFICANCE AND IMPACT OF THE STUDY: The presence of previously described virulence genes have been confirmed in this strain. The specific Vm atpA PCR assay will aid management of future epizootics of this emerging pathogen of aquatic fauna, and improve surveillance capabilities for mortality events where Vibrios are suspect.

Percutaneous hallux valgus surgery: comparison between mini-invasive Chevron and Bosch osteotomies. / Cirugía percutánea para hallux valgus: comparación entre osteotomía en chevron y de Bosch.

BACKGROUND AND OBJECTIVE: Through percutaneous approaches, hallux valgus corrections can be performed with minimal soft tissue injury, less postoperative pain and good cosmetic results. Bosch osteotomy and MICA (Minimally Invasive Chevron Akin) have shown to be effective techniques for the correction of hallux valgus, although there are currently no publications comparing each other. The aim of this study is to compare the radiological and functional results of both techniques. MATERIALS AND METHODS: A retrospective, comparative study was carried out on patients with moderate hallux valgus. They were divided into two groups according to the percutaneous technique performed: Chevron osteotomy and Bosch osteotomy with screw fixation. The metatarsophalangeal, intermetatarsal, and distal articular veneer declination angles of the first metatarsal and the bone consolidation time were evaluated radiologically. The American Orthopaedic Foot and Ankle Surgery (AOFAS) score was used for functional assessment. Complications were registered during the first year. RESULTS: Thirty-eight patients in each group were included for the study. In each of the groups, the radiological angles were compared preoperatively and at final follow-up, showing statistically significant changes in the three variables considered; but no differences were obtained by comparing them with each other. The time of consolidation was also similar in both groups. As for the AOFAS scale, an improvement was obtained with both techniques, but the difference was not significant when comparing them. CONCLUSIONS: Both Bosch and MICA techniques showed comparable results at the end of the follow-up. Further work is needed to determine the advantages of each in the immediate postoperative time.

Fast analysis of relevant contaminants mixture in commercial shellfish.

One of the major challenges currently faced is to develop systematic ways of addressing chemical mixtures in environmental assessment. With this purpose, a simple, rapid, and sensitive method for the detection and quantification of a mixture of relevant contaminants in molluscs has been developed. The method is based on QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) and Ultra-High Performance Liquid Chromatography-High Resolution Mass Spectrometry (UHPLC-HRMS). It includes a mixture of 23 compounds formed by pesticides, endocrine disruptors and pharmaceuticals (metolachlor, simazine, desethylatrazine, atrazine, thiabendazole, diazinon, malathion, bentazone, MCPA, propanil, acetamiprid, imidacloprid, caffeine, bisphenol A, triclosan, triclocarban, methylparaben, ethylparaben, propylparaben, 1H-benzotriazole, sulfamethoxazole, venlafaxine and carbamazepine). The method was developed and validated in 4 different types of shellfish of high commercial interest such as mussel (Mytilus galloprovincialis), oyster (Crassostrea gigas), cockle (Cerastoderma edule) and razor shell (Solen marginatus). The mean percentage of recoveries obtained for all the compounds in each mollusc type (intra-specie) ranged from 96% to 107% showing the good performance of the method developed. The relative standard deviation was under 10% for the intra-day and 17% inter-day analyses. Method detection limits and method quantification limits were below 10 ng/g dry weight for all the species and compounds targeted. Finally, the method was applied to aquaculture samples, oysters and cockles, from Ebro Delta (Spain), after some episodes of mortality occurred in 2017. A high level of bisphenol A was detected in C. edule which may explain the mortality suffered by this organism. C. gigas presented low levels of metolachlor, bentazone, acetamiprid, and methylparaben.

Baseline pathological data of the wedge clam Donax trunculus from the Tyrrhenian Sea (Mediterranean Basin).

In recent years, a collapse in Donax trunculus fishing yields has occurred in the Tyrrhenian Sea (Mediterranean Basin). There is little information available on the impact disease may have had on D. trunculus populations. For the first time, a pathological survey was performed on the natural beds of the bivalve on the Campania and Lazio coasts, western Italy. Detected pathogens and related diseases were analysed, and their prevalence and mean intensity values were calculated. Viral particles, Chlamydia-like organisms, ciliates, coccidians, microcells and trematodes were observed. An unknown ciliate was linked to severe inflammatory and necrotic lesions in the digestive gland. Metacercariae of the trematode Postmonorchis sp. were also strongly represented in almost all samples, reaching high levels of infection; however, none of the pathogens described required the World Organisation for Animal Health to be notified. Initial results indicated that further surveys related to environmental data are necessary in order to assess the relevance of these early observations in managing the declining D. trunculus population in the Tyrrhenian Sea.

A mycobacterial disease is associated with the silent mass mortality of the pen shell Pinna nobilis along the Tyrrhenian coastline of Italy.

Disease is an increasing threat for marine bivalves worldwide. Recently, a mass mortality event (MME) impacting the bivalve Pinna nobilis was detected across a wide geographical area of the Spanish Mediterranean Sea and linked to a haplosporidian parasite. In 2017-2018, mass mortality events affecting the pen shell Pinna nobilis were recorded in two different regions of Italy, Campania and Sicily, in the Tyrrhenian Sea (Mediterranean Sea). Histopathological and molecular examinations of specimens showed the presence of Haplosporidium sp. in only one specimen in one area. Conversely, in all of the surveyed moribund animals, strong inflammatory lesions at the level of connective tissue surrounding the digestive system and gonads and linked to the presence of intracellular Zhiel-Neelsen-positive bacteria were observed. Molecular analysis of all of the diseased specimens (13) confirmed the presence of a Mycobacterium. Blast analysis of the sequences from all of the areas revealed that they were grouped together with the human mycobacterium M. sherrisii close to the group including M. shigaense, M. lentiflavum and M. simiae. Based on pathological and molecular findings, it is proposed that a mycobacterial disease is associated with the mortality episodes of Pinna nobilis, indicating that, at this time, Haplosporidium sp. is not responsible for these events in Campanian and Sicilian waters.

Genetic diversity among air yam (Dioscorea bulbifera) varieties based on single sequence repeat markers.

Dioscorea is the largest genus in the Dioscoreaceae family, and includes a number of economically important species including the air yam, D. bulbifera L. This study aimed to develop new single sequence repeat primers and characterize the genetic diversity of local varieties that originated in several municipalities of Brazil. We developed an enriched genomic library for D. bulbifera resulting in seven primers, six of which were polymorphic, and added four polymorphic loci developed for other Dioscorea species. This resulted in 10 polymorphic primers to evaluate 42 air yam accessions. Thirty-three alleles (bands) were found, with an average of 3.3 alleles per locus. The discrimination power ranged from 0.113 to 0.834, with an average of 0.595. Both principal coordinate and cluster analyses (using the Jaccard Index) failed to clearly separate the accessions according to their origins. However, the 13 accessions from Conceição dos Ouros, Minas Gerais State were clustered above zero on the principal coordinate 2 axis, and were also clustered into one subgroup in the cluster analysis. Accessions from Ubatuba, São Paulo State were clustered below zero on the same principal coordinate 2 axis, except for one accession, although they were scattered in several subgroups in the cluster analysis. Therefore, we found little spatial structure in the accessions, although those from Conceição dos Ouros and Ubatuba exhibited some spatial structure, and that there is a considerable level of genetic diversity in D. bulbifera maintained by traditional farmers in Brazil.

Polymorphism at the ITS and NTS Loci of Perkinsus marinus isolated from cultivated oyster Crassostrea corteziensis in Nayarit, Mexico and phylogentic relationship to P. marinus along the Atlantic Coast.

Prevalence of the protozoan Perkinsus spp. in the gills of the pleasure oyster Crassostrea corteziensis from two estuaries in Nayarit, Mexico, was measured. The protozoan was identified by PCR amplification of the internal transcribed spacer (ITS) region of the rDNA of Perkinsus spp. The pathogen was found in 92% of oysters from Boca de Camichín and 77% of oysters from Pozo Chino. ITS sequences characterized from C. corteziensis showed 96-100% similarity to Perkinsus marinus. The most frequent ITS sequence (GenBank JQ266236) had 100% identity with the ITS locus of P. marinus from New Jersey, Maryland, South Carolina and Texas, and the second most frequent observed sequence (GenBank JQ266240) was 100% identical to ITS sequences of P. marinus from New Jersey, South Carolina, Louisiana, and Bahía Kino, Sonora, Mexico. The 14 sequences from the non-transcribed spacer (NTS) showed 98% similarity to P. marinus from Texas. The most frequent polymorphism identified was at nucleotide 446 of the ITS region; however, the NTS showed the highest nucleotide diversity, thereby suggesting that this region is suitable for genotype identification. Moreover, the most conserved ITS marker is better for species-specific diagnosis. Both the ITS and NTS sequences of P. marinus obtained from C. corteziensis were grouped in two clades, identifying two allelic variants of P. marinus.

Perkinsus chesapeaki observed in a new host, the European common edible cockle Cerastoderma edule, in the Spanish Mediterranean coast.

Histological observations showed the presence of a Perkinsus sp. parasite in Cerastoderma edule tissues for the first time in the Spanish Mediterranean coast. ITS molecular characterization by PCR-RFLP, in situ hybridization and sequencing, identified the parasite as Perkinsus chesapeaki, with a maximum identity of 99-100% with GenBank P. chesapeaki sequences from France and 97% with P. chesapeaki sequences of North American origin when BLAST analysis was carried out. Furthermore, phylogenetic studies placed the European cockle parasite in a well defined cluster together with the other European isolates. This is the first report of P. chesapeaki in the cockle C. edule.

Gentamicina, causa de ataxia vestibular. A propósito de un caso / Gentamicin, a cause of vestibular ataxia. A case report

Los aminoglucósidos son utilizados para la prevención y el tratamiento de distintas infecciones. Entre sus distintos efectos adversos destacan: nefrotoxicidad, ototoxicidad y bloqueo neuromuscular; con incidencia de ototoxicidad entre el 3-16%, que se manifiesta por sensación de desequilibrio, desviación en la marcha y dificultad para mantener la bipedestación. Presentamos el caso de una mujer de 79 años, que tras ser intervenida por colecistitis y después del tratamiento parenteral con gentamicina, refiere inestabilidad en la marcha y sensación de debilidad en los miembros inferiores. La exploración objetivaba marcha con leve aumento de base de sustentación, sin datos de focalidad, dismetría ni otros datos de afectación cerebelosa. Descartada la pérdida auditiva por otorrinolaringología. Se incluyó en rehabilitación con evolución favorable presentando mínima alteración residual. Los aminoglucósidos continúan siendo una opción terapéutica fundamental. A pesar de los esfuerzos por reducir su toxicidad, continúa siendo frecuente y debe tenerse siempre en cuenta en el diagnóstico diferencial de toda alteración del equilibrio (AU)

Aminoglycosides are used for the prevention and treatment of different infections. Standing out among the different adverse effects are nephrotoxicity, ototoxicity and neuromuscular blockade. Ototoxicity incidence ranges from 3-16% and is manifested by a sensation of imbalance, gait deviation and difficulty remaining in an upright position. We present the case of a 79-year old woman who after an operation due to cholecystitis and parenteral treatment with gentamicin presented walking instability and feelings of weakness in lower limbs. The physical examination showed a slightly increased base of support in walking, no neurologic focality, no dysmetria or other data of cerebellar disease. The Ear-Nose-and Throat Department discarded hearing impairment. She entered into rehabilitation, with favorable evolution and minimal residual alteration. Aminoglycosides continue to be an important therapeutic option. In spite of efforts to reduce their toxicity, their use is still common and they should always be taken into account in the differential diagnosis of any balance alteration (AU)

Efecto de la ingesta aguda de vanillina sobre la resistencia insulínica en humanos / Effect of a single oral dose of vanillin on insulin resistance in humans

Background: NADPH oxidase is a source of reactive oxygen species that may contribute to insulin resistance (IR). Aim: To assess the effect of a single oral dose of vanillin (a putative inhibitor of the enzyme) on IR in humans. Material and Methods: Using a crossover, random, double-blind design, eight lean and 10 obese males ingested 600 mg of vanillin or placebo followed by the ingestion of 75g of glucose. Serum/plasma glucose, free-fatty acids, insulin, glutathione, C reactive protein concentrations and red blood cell glutathione concentration were determined. Insulin resistance was estimated by the Matsuda index. Results: Under fasting conditions, obese individuals had higher glucose and insulin and lower red blood cell glutathione levels than their lean counterparts (p < 0.01). Serum free-fatty acids, total and oxidized plasma glutathione concentrations were similar in both groups. After glucose ingestion, obese individuals had a lower red blood cell total glutathione concentration and increased plasma oxidized glutathione concentration than their lean counterparts (p < 0.05). In addition, obese participants had a higher level of IR (p < 0.001) and impaired serum free-fatty acid suppression (p < 0.001) than their lean counterparts. Ingestion of vanillin did not modify any of these variables when compared with placebo in obese individuals. In lean volunteers a reduction in Matsuda index was detected when vanillin was administered, compared to placebo (4.3 +/- 0.6 and 3.6 +/- 0.6 respectively; p < 0.05). Conclusions: IR was ameliorated after vanillin ingestion among lean but not obese participants.

Formation of amino acids and nucleotide bases in a Titan atmosphere simulation experiment.

The discovery of large (>100 u) molecules in Titan's upper atmosphere has heightened astrobiological interest in this unique satellite. In particular, complex organic aerosols produced in atmospheres containing C, N, O, and H, like that of Titan, could be a source of prebiotic molecules. In this work, aerosols produced in a Titan atmosphere simulation experiment with enhanced CO (N(2)/CH(4)/CO gas mixtures of 96.2%/2.0%/1.8% and 93.2%/5.0%/1.8%) were found to contain 18 molecules with molecular formulae that correspond to biological amino acids and nucleotide bases. Very high-resolution mass spectrometry of isotopically labeled samples confirmed that C(4)H(5)N(3)O, C(4)H(4)N(2)O(2), C(5)H(6)N(2)O(2), C(5)H(5)N(5), and C(6)H(9)N(3)O(2) are produced by chemistry in the simulation chamber. Gas chromatography-mass spectrometry (GC-MS) analyses of the non-isotopic samples confirmed the presence of cytosine (C(4)H(5)N(3)O), uracil (C(5)H(4)N(2)O(2)), thymine (C(5)H(6)N(2)O(2)), guanine (C(5)H(5)N(5)O), glycine (C(2)H(5)NO(2)), and alanine (C(3)H(7)NO(2)). Adenine (C(5)H(5)N(5)) was detected by GC-MS in isotopically labeled samples. The remaining prebiotic molecules were detected in unlabeled samples only and may have been affected by contamination in the chamber. These results demonstrate that prebiotic molecules can be formed by the high-energy chemistry similar to that which occurs in planetary upper atmospheres and therefore identifies a new source of prebiotic material, potentially increasing the range of planets where life could begin.

Bonamia exitiosa (Haplosporidia) observed infecting the European flat oyster Ostrea edulis cultured on the Spanish Mediterranean coast.

Bonamia exitiosa and Bonamia ostreae are parasites that reproduce within the haemocytes of several oyster species. In Europe, the host species is the flat oyster Ostrea edulis. The parasite B. ostreae has been responsible for mortalities since the late 1970s throughout the European Atlantic coast. B. exitiosa was first detected, in 2007, on this continent in flat oysters cultured in Galicia (NW Spain). Since then, the parasite has also been detected in France, Italy and the United Kingdom. The bays of the Ebro Delta in the south of Catalonia represent the main bivalve culture area in the Mediterranean coast of Spain. Previous information from the area includes reports of several flat oyster pathogens, including the notifiable parasite Marteilia refringens. However, the status with regard to Bonamia parasites was uncertain. In the present study, a Bonamia parasite was observed in flat oysters cultured in the Alfacs Bay of the Ebro Delta by histology and real-time PCR. PCR-RFLP and sequencing suggested the presence of B. exitiosa. Finally, phylogenetic analyses of the studied Bonamia isolates corroborated B. exitiosa infection. M. refringens was also observed in the same oyster batch, and co-infection with both parasites was also detected. This is the first detection of B. exitiosa, in Catalonia and the Spanish Mediterranean coast. The impact of the parasite on the Mediterranean flat oyster activity needs to be urgently addressed.

Role of IncHI2 plasmids harbouring blaVIM-1, blaCTX-M-9, aac(6')-Ib and qnrA genes in the spread of multiresistant Enterobacter cloacae and Klebsiella pneumoniae strains in different units at Hospital Vall d'Hebron, Barcelona, Spain.

Seven Enterobacter cloacae isolates and seven Klebsiella pneumoniae isolates harbouring a phenotype compatible with the production of a metallo-ß-lactamase were recovered between 2009 and 2011 in three Intensive Care Units of Hospital Vall d'Hebron (Barcelona, Spain). The presence of bla(VIM), bla(IMP), bla(NDM), bla(CTX-M), aac(6')-Ib, qnrA, qnrB and qnrS genes was screened by polymerase chain reaction (PCR) and sequencing. Clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis (PFGE) and, in the case of K. pneumoniae isolates, by multilocus sequence typing (MLST). PCR-based replicon typing, Southern hybridisation, plasmid double-locus sequence typing and MOB relaxase classification methods were used to identify and characterise the plasmids carrying the resistance genes. Transferability of the identified plasmids was tested by conjugation assays. All 14 isolates were found to carry bla(VIM-1), bla(CTX-M-9) (except one isolate), aac(6')-Ib and qnrA genes. Clonality assessment demonstrated that E. cloacae isolates were distributed in three clonal clusters, whereas all of the K. pneumoniae isolates belonged to one unique clone, identified as sequence type ST252. All studied isolates harboured a large conjugative IncHI2 MOB(H11) plasmid carrying all of the detected resistance genes. Plasmid DNA analysis showed that all of them belonged to the ST1 IncHI2 plasmid cluster and shared the same relaxase partial sequence. In conclusion, the present study describes the dissemination within a hospital of multiresistant E. cloacae and K. pneumoniae isolates producing VIM-1. A complex clonal epidemiology of the E. cloacae isolates was observed and plasmid DNA analysis strongly supports horizontal exchanges of the same IncHI2 plasmid between different strains and species.

Etiopatogenia de la obesidad / Etiopathogenesis of obesity

La investigación de los factores etiopatogénicos de la obesidad, sean estos ambientales o genéticos, ha influido fuertemente en el desarrollo de las estrategias para controlar la enfermedad. Se considera a la obesidad como una enfermedad en la cual confluyen factores genéticos y ambientales, pero no se han dilucidado cabalmente los mecanismos de regulación del balance energético, cuyas alteraciones favorecen el incremento de la adiposidad en humanos. Entre los factores ambientales, además de la alimentación alta en calorías y el sedentarismo, se describen factores predisponentes sociales, culturales y familiares, así como situaciones o etapas fisiológicas de la vida que pueden gatillar aumento de peso. Aunque los factores y patologías genéticas se pueden evidenciar en un bajo porcentaje de los sujetos obesos, la predisposición genética a la obesidad se puede expresar a través de algunas características metabólicas, como un bajo gasto energético de reposo, mala oxidación de grasas o un bajo nivel de actividad física espontánea.

The investigation of the etiological factors of obesity, whether genetic or environmental, has strongly influenced the development of strategies to control the disease. Obesity must be considered as a disease in which genetic and environmental factors converge. However, the mechanisms of regulation of the energy balance, which changes favoring increased adiposity in humans, are not fully elucidated. Among environmental factors, in addition to high-calorie diet and sedentary lifestyle, it has been described social, cultural and family predisposing factors, as well as physiological conditions or stages of life that can trigger weight gain. Although genetic factors and pathologies can be evidenced in a low percentage of obese subjects, genetic predisposition to obesity can be expressed through some metabolic characteristics such as low metabolic rate, poor oxidation of fats or a low level of spontaneous physical activity.

Efectos de la técnica de Mulligan en un paciente quemado. A propósito de un caso / Effects of Mulligan's technique on a burn patient. A case report

Las quemaduras son lesiones tisulares que causan severas alteraciones metabólicas, originando importantes secuelas físicas y psicológicas. La técnica de Mulligan ha demostrado su efecto inmediato en la reducción del dolor y la mejoría de la funcionalidad mediante la aplicación de un deslizamiento accesorio en la articulación mientras el paciente realiza el movimiento libre de dolor. Se describe el caso de un paciente al que, tras sufrir una quemadura doméstica, se realiza escisión tangencial de las quemaduras, con autoinjerto en dorso de manos y dedos. Presenta dolor intenso a la flexión en metacarpofalángicas e interfalángicas de ambas manos, con limitación de la movilidad y déficit funcional. Aplicamos la técnica de Mulligan en las articulaciones afectadas utilizando movimientos accesorios variables. Tras 10 sesiones realiza la flexión completa con mínimo dolor (AU)

Burns are tissue lesions that provoke severe metabolic alterations, causing substantial physical and psychological sequels. The Mulligan technique has demonstrated its immediate effect in reducing pain and improving functionality by implementing an accessory glide in the joint while the patient performs the movement without pain. Herein, we describe the case of a patient who, after suffering a domestic burn, was subjected to tangential excision of burns and auto-graft on the back of both hands and fingers. The patient had severe pain in the metacarpophalangeal and interphalangeal flexion of both hands, with limitation of mobility and functional deficit. The Mulligan technique was performed in the affected joints using variable accessory movements. After 10 sessions, the patient performed full flexion with minimal pain (AU)