Unusual winter Saharan dust intrusions at Northwest Spain: Air quality, radiative and health impacts.

Saharan air masses can transport high amounts of mineral dust particles and biological material to the Iberian Peninsula. During winter, this kind of events is not very frequent and usually does not reach the northwest of the Peninsula. However, between 21 and 22 February 2016 and between 22 and 23 February 2017, two exceptional events were registered in León (Spain), which severely affected air quality. An integrative approach including: i) typical synoptic conditions; ii) aerosol chemical composition; iii) particle size distributions; iv) pollen concentration; v) aerosol optical depth (AOD); vi) radiative forcing and vii) estimation of the impact of aerosols in the respiratory tract, was carried out. In the global characterization of these events, the exceedance of the PM10 daily limit value, an increase in the coarse mode and a rise in the iron concentration were observed. On the 2016 event, an AOD and extinction-related Ångström exponent clearly characteristic of desert aerosol (1.1 and 0.05, respectively) were registered. Furthermore, pollen grains not typical of flowering plants in this period were identified. The chemical analysis of the aerosol from the 2017 event allowed us to confirm the presence of the main elements associated with mineral sources (aluminum, calcium, and silica concentrations). An increase in the SO42-, NO3- and Cl- concentrations during the Saharan dust intrusion was also noted. However, in this event, there was no presence of atypical pollen types. The estimated dust radiative forcing traduced a cooling effect for surface and atmosphere during both events, corroborated by trends of radiative flux measurements. The estimated impact on the respiratory tract regions of the high levels of particulate matter during both Saharan dust intrusions showed high levels for the respirable fraction.

Cross-cultural adaptation of the Zurich Claudication Questionnaire.Validation study of the Spanish version.

BACKGROUND: In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffering from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish population. METHODS: The Zurich Claudication Questionnaire was translated and cross-culturally adapted to Spanish and the psychometric characteristics of the new version were then studied. Seventy-six patients were selected who were to undergo epidural steroid injection or were seen in the Hospital Complex of Navarre Spinal Unit. RESULTS: The Spanish version of the Zurich Claudication Questionnaire shows high Cronbach alpha internal consistency values, high reproducibility, a good correlation with the most important low back condition questionnaires used worldwide and good sensitivity for detecting clinical change in patients who undergo epidural steroid injection. CONCLUSION: This study resulted in a version of the Zurich Claudication Questionnaire or Swiss Spinal Stenosis Questionnaire translated and cross-culturally adapted to Spanish, with highly reliable, valid and sensitive psychometric characteristics. These proven properties make the Zurich Claudication Questionnaire available for the Spanish population, to evaluate outcomes and health status as perceived by patients with spinal stenosis and claudication syndrome.

Cross-cultural adaptation of the Zurich Claudication Questionnaire. Validation study of the Spanish versión / Adaptación transcultural de Cuestionario de Claudicación Zurich. Estudio de validación de la versión española

Background: In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffering from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish population. Methods: The Zurich Claudication Questionnaire was translated and cross-culturally adapted to Spanish and the psychometric characteristics of the new version were then studied. Seventy-six patients were selected who were to undergo epidural steroid injection or were seen in the Hospital Complex of Navarre Spinal Unit. Results: The Spanish version of the Zurich Claudication Questionnaire shows high Cronbach alpha internal consistency values, high reproducibility, a good correlation with the most important low back condition questionnaires used worldwide and good sensitivity for detecting clinical change in patients who undergo epidural steroid injection. Conclusion: This study resulted in a version of the Zurich Claudication Questionnaire or Swiss Spinal Stenosis Questionnaire translated and cross-culturally adapted to Spanish, with highly reliable, valid and sensitive psychometric characteristics. These proven properties make the Zurich Claudication Questionnaire available for the Spanish population, to evaluate outcomes and health status as perceived by patients with spinal stenosis and claudication sindrome (AU)

Introducción: En los últimos años, los instrumentos de medida de resultados y calidad de vida percibida por el paciente, se han convertido en herramientas de gran utilidad clínica. El Cuestionario de Claudicación de Zurich es uno de los principales instrumentos para el estudio de los pacientes afectos de estenosis del canal lumbar. Actualmente, no se ha publicado una versión validada para su uso en la población española. Métodos: El Cuestionario de Claudicación de Zurich ha sido traducido y adaptado transculturalmente al español, y se han estudiado las características psicométricas de la nueva versión. Se seleccionaron 76 pacientes a los que se les iba a realizar una infiltración epidural de esteroides o que eran vistos en consultas de la Unidad de Raquis Quirúrgico del Complejo Hospitalario de Navarra. Resultados: La versión española del Cuestionario de Claudicación de Zurich muestra altos valores de consistencia interna alfa de Cronbach, alta reproducibilidad, una buena correlación con los cuestionarios de patología lumbar más importantes a nivel mundial, y una buena sensibilidad para detectar cambios clínicos en pacientes a los que se les realiza una infiltración epidural de corticoides. Conclusión: Se ha obtenido una versión del Cuestionario de Claudicación de Zurich traducida y adaptada transculturalmente al español, con altos valores en las características psicométricas de fiabilidad, validez y sensibilidad. Esto permite, en la población española, evaluar los resultados y el estado de salud percibido por los pacientes con estenosis de canal y síndrome de claudicación (AU)

El triaje en urgencias en los hospitales españoles / Triage in Spanish hospitals

El objetivo del presente artículo es conocer el modelo de triaje utilizado y sus características principales en los hospitales de la red sanitaria nacional pública. Se hizo un estudio descriptivo transversal en los hospitales públicos con más de 100 camas para el ingreso. Se envió un formulario a 123 hospitales, y se obtuvo respuesta en el 54,5%. Los sistemas de triaje empleado son el Modelo Andorrano de Triaje (MAT) o Sistema Español de Triaje(SET) en el 37,3% de los casos y el Sistema de Triaje de Manchester (MTS) en el 23,9%.En los 58 hospitales que tienen implantado algún sistema, no se realizó estudio previo de implantación en el 53,4% de los casos. Los profesionales encargados de realizar el triajeson el enfermero (DUE) en el 77,6% de los casos y el facultativo (FEA) en el 6,9%. No existe una comisión/grupo de triaje en el 53,7% de los casos. El grado de satisfacción (1-5) es para el FEA de 3,16; para el médico interno residente (MIR) de 3,28 y para el DUE de 3,23. Cambiarían el sistema el 49,2% de los centros encuestados. No se observan diferencias significativas de implantación en cuanto a los modelos MAT-SET y MTS (AU)

The objective to determine what triage systems are being used in Spanish national health service hospitals and to define the characteristics of the models in place. Cross-sectional descriptive survey of hospitals with more than 100 beds in the Spanish national health service. Responses to a questionnaire sent to 123 hospitals were received from 54.5% of the facilities. The Andorran Triage Model adapted for use as the Spanish Triage System (ATM-STS) was used in 37.3% of the hospitals. The Manchester Triage System was used in 23.9%. Of the 58 hospitals that use some triage system, 53.4% had not carried out a study before starting to apply the selected system. The professionals in charge of triage are nurses in 77.6% of the hospitals and physicians in 6.9%. No triage committee or group had been established in 53.7% of the hospitals responding to the survey. The degree of satisfaction with the chosen system expressed on a scale of 1 to 5 was 3.16 for physicians, 3.28 for residents in training, and 3.23 for nurses. Another system would be chosen by 49.2% of the respondents. The difference in the numbers of hospitals using the ATM-STS and the MTS was not great (AU)

Hemocultivos... ¿Qué te han contado y qué haces? / Blood cultures... What they tell you and what you do

Objetivo: Objetivo principal: Conocer la variabilidad práctica de los enfermeros/as (DUE's) del Hospital General Nuestra Señora del Prado, sobre la técnica para la extracción de hemocultivo. Objetivos específicos: Determinar las condiciones de asepsia/ esterilidad de la técnica. Establecer la utilización (desinfección, orden de llenado, volumen, cambio de aguja) de los frascos de hemocultivos. Método: Estudio descriptivo transversal realizado en el Hospital General Nuestra Señora del Prado. Ha consistido en la entrega de un cuestionario para autocumplimentación a los profesionales de enfermería, donde se han incluido variantes tanto cuantitativas como cualitativas. Resultados: Se han recogido 52,9% encuestas de los 363 DUE's del centro hospitalario, con una experiencia profesional media de 12,9 años [DE±7,9]. El 57,8% cree que no es necesario técnica estéril para el procedimiento. 94,7% utiliza un único antiséptico. 78,6% afirman que en la extracción de acceso venoso central desecha los primeros 10cc que extrae. Conclusiones: Consideramos un alto índice de respuesta, ya que es superior al 40% para cuestionarios autocumplimentados. Hemos observado que la mayoría de DUE's utilizan técnica aséptica y en los protocolos estudiados no existe un consenso entre la utilización de técnica estéril y aséptica. Este estudio nos revela que la mayoría de los DUE's utilizan un único antiséptico, sin embargo la mayoría de los protocolos recomiendan la utilización primero de alcohol y luego povidona yodada para la desinfección de la piel (AU)

Aims: Main aim: To ascertain differences in nurses at the Hospital General Nuestra Señora del Prado, in blood extraction and blood culture techniques. Specific aims: To determine the asepsis/sterility conditions of the technique; to establish the use (disinfection, filling order, volume, needle change) of the blood culture vials. Method: Transversal descriptive study made at the Hospital General Nuestra Señora del Prado. A self-completion questionnaire including quantitative and qualitative variants was delivered to nursing professionals. Results: 52.9% of the questionnaires were collected from the 363 DUE's at the hospital. Mena working experience was 12.9 years [DE±7,9]. 57,8% believe sterile technique for the procedure was not necessary. 94.7% use a single antiseptic. 78.6% stated that they discard the first 10 cc extracted from the central vein. Conclusions: We consider that the response is high, with over 40% of the questionnaires being completed. We observed that most DUE's use aseptic techniques and in the protocols studied there was no consensus about the use of sterilization and septic techniques. The study reveals that the majority of the DUE's use a single antiseptic, even though most protocols recommend the use of alcohol, followed by povidone.iodine to disinfect the skin (AU)

Profile of NF-κBp(65/NFκBp50) among prostate specific antigen sera levels in prostatic pathologies.

AIM: The aim of this work was to characterise the immunoexpression of NF-κB (p50/p65) in human prostatic pathologies and to study its profiles of activation among sera prostate specific antigen antigen (PSA) according the three groups: 0-4ng/mL, 4-20ng/mL and >20ng/mL. PATIENTS AND METHODS: Twenty-four men with benign prostate hyperplasia (BPH); 19 men with prostate cancer (PC) and five men with normal prostates (NP). Immunohistochemical and western blot analysis was performed. Serum levels of PSA were assayed by immulite autoanalyser. RESULTS: In BPH and PC samples, immunoexpressions were observed for NF-κBp65 and NF-κBp50; while in NP samples, only were detected NF-κBp50. PC samples showed immunoreactions to NF-κBp65 and NF-κBp50 more intense (respectively 24.18±0.67 and 28.23±2.01) than that observed in BPH samples (respectively18.46±2.04 and 18.66±1.59) with special localisation in the nucleus. Different profiles of NF-κBp65 immunoexpressions were observed and BPH patients with sera PSA levels between 0-4ng/mL presented a significant weak percentage compared to BPH patients with sera PSA levels between 4-20ng/mL and >20ng/mL. No immunoreactions to NF-κBp65 were observed in PC patients with sera PSA levels between 4-20ng/mL. CONCLUSION: The sensibility of both NF-κB and PSA to inflammation allowed confirming the relationship between these two molecules and its involvement in prostatic diseases progression (inflammatory and neoplasic).

Diagnóstico de situación de la relación atención primaria-asistencia rehabilitadora en el Sistema Nacional de Salud / Diagnosis of the current relationship between family medicine and rehabilitation in the publicly-funded health system

La relación entre la medicina de familia (MF) y la atención rehabilitadora (AR) está evolucionando de forma constante en las últimas décadas. Existen elementos comunes en el conjunto del Sistema Nacional de Salud (SNS). Al mismo tiempo, se observan diferencias entre las diferentes comunidades. El principal objetivo es conocer la situación actual de la relación atención primaria-atención rehabilitadora en el SNS. Como objetivo secundario, explorar el conocimiento de los médicos de familia acerca de la especialidad de medicina física y rehabilitación (MFyR). Mediante la cumplimentación de un cuestionario, se registran variables relacionadas con aspectos organizativos de la relación MF-MFyR; los datos han sido analizados con el paquete de programas estadísticos SPSS. Las variables cualitativas se describen con la distribución de frecuencias de cada una de las categorías y las cuantitativas con la media y la desviación estándar. El 52% de los médicos de atención primaria encuestados dispone de unidad de fisioterapia en su centro de trabajo. El 21% refiere que cuenta con apoyo especializado por MFyR en su centro de trabajo. El 49,4% dispone de ese apoyo a menos de 5 km de distancia. El 64,9% no realiza sesiones conjuntas con facultativos especialistas en MFyR y el 23,3% lo hace con poca frecuencia. El desconocimiento de la especialidad de MFyR por parte de MF condiciona la relación. La ubicación de centros de rehabilitación en el área de la atención primaria puede mejorar el conocimiento y la accesibilidad. La realización de actividades conjuntas se objetiva como un área de mejora imprescindible (AU)

The relationship between family medicine (FM) and physical medicine and rehabilitation (PM&R) has steadily evolved in the last few decades. Although there are common elements in the publicly-funded health system in Spain, there are differences among the distinct autonomous regions. The main objective of this study was to determine the current status of the relationship between FM and PM&R in the publicly-funded health system. A secondary goal was to assess family doctors’ knowledge of the specialty of PM&R. A questionnaire was used to gather information on variables related to organizational aspects of the relationship between FM and PM&R. The data were analyzed using the SPSS statistical software package. Qualitative variables were described by using frequency distributions of each of the categories and quantitative variables were analyzed using means and standard deviation. Among the family doctors surveyed, 52% had a physiotherapy unit in the workplace; 21% reported there was a specialist in PM&R in the workplace; 49% reported that this support was less than 5 km away; 64.9% did not perform joint sessions with PM&R specialists and 23.3% did so infrequently. Family doctors were largely unaware of PM&R, which has tended to restrict the use of this specialty. Locating rehabilitation centers in the primary care catchment area could improve familiarity with and access to this specialty. Joint activities are a crucial area for improvement (AU)

TNF-alpha/IL-1/NF-kappaB transduction pathway in human cancer prostate.

TNFalpha exerts apoptosis throughout an intracellular transduction pathway that involves the kinase proteins TRAF-2 (integration point of apoptotic and survival signals), ASK1 (pro-apoptotic protein), MEK-4 (p38 activator and metastasis suppressor gene), JNK (stress mitogen activated protein kinase) and the transcription factor AP-1. TNFalpha also exerts proliferation by p38 activation, or when TRAF-2 simultaneously induces the transcription factor NF-kappaB by NIK. NIK and p38 may also be activated by IL-1. P38 activated several transcription factors such as Elk-1, ATF-2 and NF-kappaB. NIK also may activate NF-kappaB. The aim of the present article was to evaluate the different components of this TNFalpha/IL-1 transduction pathway in human prostate carcinoma (PC) in comparison with normal human prostate. In prostate cancer, pro-apoptotic TNFalpha/AP-1 pathway is probably inactivated by different factors such as p21 (at ASK-1 level) and bcl-2 (at JNK level), or diverted towards p38 or NIK activation. IL-1alpha enhances proliferation through IL-1RI that activates either NIK or p38 transduction pathway. P38 and NIK activate different transcription factors related with cell proliferation and survival such as ATF-2, Elk-1 or NF-kappaB. In order to search a possible target to cancer prostate treatment we proposed that inhibition of several proinflamatory cytokines such as IL-1 and TNFalpha might be a possible target for PC treatment, because decrease the activity of all transduction pathway members that activate transcription factors as NF-kappaB, Elk-1 or ATF-2.

TNF/IL-1/NIK/NF-kappa B transduction pathway: a comparative study in normal and pathological human prostate (benign hyperplasia and carcinoma).

AIMS: Tumour necrosis factor (TNF)-alpha induces death or cell proliferation by activation of nuclear factor (NF)-kappaB, also activated by interleukin (IL)-1 alpha. The aim was to investigate upstream and downstream components of NIK transduction pathway in normal (NP), benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma (PC). METHODS AND RESULTS: Immunohistochemistry and Western blotting were performed. In NP, the cytoplasm of epithelial cells was intensely immunoreactive to IL-1 receptor-associated kinase (IRAK), TNF receptor-associated factor (TRAF)-6, NF-kappaB inducing kinase (NIK), I kappa kappa alpha/beta, I kappaB alpha and p-I kappaB; weakly to NF-kappaB-p50; and negative to NF-kappaB-p65. BPH samples were intensely immunoreactive to IRAK, TRAF-6, NIK, I kappa kappa alpha/beta, I kappaB alpha, p-I kappaB; weakly to NF-kappaB-p50 and NF-kappaB-p65. Whereas low-grade PIN showed intermediate results between NP and BPH, results in high-grade PIN were similar to those found in PC (low Gleason). In PC, immunoreactivity was intense for IRAK, TRAF-6, NIK, I kappa kappa alpha/beta (increasing with Gleason), I kappaB alpha, p-I kappaB (decreasing with Gleason); weak for NF-kappaB-p50 and NF-kappaB-p65 (decreasing with Gleason). Nuclear NF-kappaB was observed in PC. CONCLUSIONS: NF-kappaB enhances cell proliferation, but also ATF-2 or Elk-1. Since IL-1 and TNF-alpha are related to inflammation and their immunoexpression increases in PC, inhibition of these cytokines might be a possible target for PC treatment, because they decrease the activity of all transduction pathway members that activate transcription factors such as NF-kappaB, Elk-1 or ATF-2.

P38 MAPK protects against TNF-alpha-provoked apoptosis in LNCaP prostatic cancer cells.

PURPOSE: One of the most relevant aspects in cell death regulation is the signalling of apoptosis by the serine/threonine kinases MAPKs. The aim of this study was to investigate the effects of TNF-alpha stimulation on MAPK activation, and the pro- or anti-apoptotic role of these kinases in LNCaP and PC3 cells. MATERIAL AND METHODS: Treatments were carried out using several TNF-alpha concentrations, as well as specific pharmacological inhibitors of MAPKs. Apoptosis rates were evaluated by DAPI staining and flow cytometry. MAPK phosphorylation/activation was measured by Western blot. RESULTS: TNF-alpha induced apoptosis in a dose-dependent manner in LNCaP but not in PC3 cells. The MAPK inhibitors revealed that the apoptotic rate in LNCaP cells increased significantly following p38 inhibition. The kinase inhibitors failed to cause changes in apoptosis in PC3 cells. CONCLUSIONS: The potentiation of apoptosis by p38 inhibition points to this kinase as a possible target for the treatment of androgen-dependent prostatic cancer.

Cell cycle control related proteins (p53, p21, and Rb) and transforming growth factor beta (TGFbeta) in benign and carcinomatous (in situ and infiltrating) human breast: implications in malignant transformations.

A comparative study of the products of the cell cycle control genes p53 (mutated form), p21, Rb (nonphosphorylated and phosphorylated form) and TGFbeta was performed by immunohistochemistry and Western blot, in benign breast disorders and breast cancer (in situ and infiltrating tumors). For the five proteins studied, the relative numbers of positively stained cells were higher in in situ carcinoma than in benign breast diseases. In infiltrating breast tumors, the relative numbers of positively stained cells were even higher than in in situ tumors except for the percentage of pRb immunostained cells, which decreased slightly in infiltrative tumors. For the other four proteins, the percentages of positively stained cases were similar to those found in in situ tumors. In the three groups of patients, TGFbeta immunoreaction appeared in the cytoplasm while immunoreactions to p53, p21, Rb, and pRb were found always in the nucleus except for p21 in in situ tumors, which showed cytoplasmic immunoreaction. Present results suggest that accumulation of mutated p53, cytoplasmic p21, and pRb in breast gland epithelium might be a crucial point in the development of in situ adenocarcinoma. In the infiltrating tumors, the expression of p21 in the nuclei and the decrease in pRb expression suggest an insufficient attempt to hinder cell proliferation.

The p38 transduction pathway in prostatic neoplasia.

It has been proposed that, among other cellular responses, TNF-alpha induces not only cell death, but also cell proliferation by activation of p38. It has also been reported that IL-1-alpha favours cell proliferation by p38 activation. The aim of the present study was to evaluate upstream (alpha-PAK, MEK-6) and downstream (Elk-1 and ATF-2) components of the p38 transduction pathway in normal prostate, benign prostatic hyperplasia (BPH), and prostate carcinoma (PC). Immunohistochemical and western blot analyses were performed in 20 samples of normal prostate, 47 samples of BPH, and 27 samples of PC. In all normal prostates, immunoreactivity for p-Elk-1 and p-ATF-2 was observed in epithelial cell nuclei, but no expression of alpha-PAK or MEK-6. In BPH, there was expression of alpha-PAK (cytoplasm) and MEK-6 (cytoplasm), while the proportions of lesions that were immunoreactive for p-Elk-1 (nucleus and cytoplasm) and p-ATF-2 (nucleus) decreased. In PC, the percentages of cells that were immunoreactive for alpha-PAK (cytoplasm) or MEK-6 (cytoplasm) rose slightly in comparison with BPH, while the percentages of cells that were immunoreactive for p-Elk-1 (nucleus and cytoplasm) or p-ATF-2 (nucleus and cytoplasm) were much higher than in BPH. It is concluded that overexpression of alpha-PAK, MEK-6, p38, p-Elk-1, and p-ATF-2 in BPH, and more intensely in PC, enhances cell proliferation. In BPH, such proliferation is triggered by IL-1 and in part counteracted by the TNF-alpha/AP-1 pathway, which promotes apoptosis. In PC, proliferation is triggered by IL-1 and TNF-alpha (the TNF-alpha/AP-1 pathway is diverted towards p38 activation). Since in a study of the same patients immunoexpression of IL-1alpha and IL-1RI was previously observed to be increased in PC, inhibition of p38 is a possible target for PC treatment, as this inhibition would both decrease IL-1-induced cell proliferation and increase TNF-alpha-induced cell death.

Influence of thyroid hormone receptors on breast cancer cell proliferation.

BACKGROUND: The involvement of thyroid hormones in the development and differentiation of normal breast tissue has been established. However, the association between breast cancer and these hormones is controversial. Therefore, the objective of the present study was to determine the protein expression pattern of thyroid hormone receptors in different human breast pathologies and to evaluate their possible relationship with cellular proliferation. PATIENTS AND METHODS: The presence of thyroid hormone receptors was evaluated by immunohistochemistry and western blot analysis in 84 breast samples that included 12 cases of benign proliferative diseases, 20 carcinomas in situ and 52 infiltrative carcinomas. RESULTS: TR-alpha was detected in the nuclei of epithelial cells from normal breast ducts and acini, while in any pathological type this receptor was located in the cytoplasm. However, TR-beta presented a nuclear location in benign proliferative diseases and carcinomas in situ and a cytoplasmatic location in normal breast and infiltrative carcinomas. The highest proliferation index was observed in carcinomas in situ, although in infiltrative carcinomas an inverse correlation between this index and the TR-alpha expression was encountered. CONCLUSIONS: The results of this study reveal substantial changes in the expression profile of thyroid hormone receptors suggesting a possible deregulation that could trigger breast cancer development.

Análisis de la demanda de interconsultas psiquiátricas en los hospitales generales de Pamplona / Analysis of the psychiatric consultation-liason in general

En este trabajo realizamos un estudio prospectivo de cuatro meses de duración sobre la psiquiatría de enlace en los dos Hospitales Públicos de Pamplona, Hospital Virgen del Camino y Hospital de Navarra, en el cual describimos y reflexionamos sobre la situación actual de la psiquiatría de interconsulta en Navarra. Asimismo, comparamos nuestros resultados con los obtenidos en un estudio realizado a mediados de los años 90 en el Hospital Provincial de Navarra, reseñando las semejanzas y las diferencias que se desprenden de ambos estudios e intentando analizar las posibles causas que pudieran conducir a las mismas

In this work we make a four months prospective study about the consultation-liaison service in the General Hospitals of Pamplona, Hospital Virgen del Camino and Hospital de Navarra, where we describe and reflect on the present situation of the Liaison Psychiatry of Navarra. Also, we compare our results with a study made in the middle of the nineties in the Provincial Hospital of Navarra, describing the similarities and the differences that exist between both studies and trying to analyze its possible causes

IL-6, its receptors and its relationship with bcl-2 and bax proteins in infiltrating and in situ human breast carcinoma.

AIMS: To characterize the expression pattern of IL-6 and its receptors (IL-6R(alpha) and gp130), to relate this pattern to bcl-2 and bax expression and to elucidate the effects on the proliferation/apoptosis equilibrium in benign conditions and in situ and infiltrating breast cancer. METHODS AND RESULTS: The immunoexpression of IL-6 and its receptors (IL-6R(alpha) and gp130), and their relationship with bcl-2 and bax proteins, were studied in in situ and infiltrating tumours and in benign breast lesions by means of Western blotting and immunohistochemistry. The percentages of samples positive for IL-6, bcl-2 and bax and their immunoreaction densities were higher in in situ carcinomas and infiltrating tumours than in benign lesions; although in in situ lesions were not so high as in infiltrating tumours, except for bax, whose immunoexpression was as weak as in benign conditions, resulting in a bcl-2/bax ratio higher than in infiltrating tumours. CONCLUSIONS: The high expression of IL-6 and its receptors in tumours might be related to the enhanced cell proliferation occurring in breast cancer. IL-6 could act by increasing bcl-2 expression and thus altering the proliferation/apoptosis balance toward neoplastic cell proliferation. The increased bax immunoreactivity observed only in infiltrating tumours, which was not so high as the increase in bcl-2 immunoreactivity, might be interpreted as an attempt to hinder cell proliferation.

Estudio nacional de vigilancia de infección nosocomial en unidades de cuidados intensivos. Informe del año 2002 / National surveillance study of hospital- acquired infections in intensive care units. Report on the year 2002

Objetivo. Identificar las tasas nacionales de las infecciones hospitalarias adquiridas en Unidades de Cuidados Intensivos (UCI) relacionadas con instrumentalización, correspondientes al año 2002, así como conocer sus etiologías y la evolución de las resistencias de aquellos microorganismos más prevalentes. Diseño. Estudio de serie de casos, observacional y prospectivo. Ambito. 85 UCI, servicios o unidades de Cuidados Intensivos u otras unidades en donde se ingresan pacientes críticos, pertenecientes a 80 hospitales distintos. Pacientes y métodos. Se han incluido de forma continuada los pacientes ingresados durante más de 24 horas en las UCI participantes, que fueron seguidos hasta su alta de UCI o hasta un máximo de 30 días. Las infecciones objeto de vigilancia han sido: neumonías relacionadas con ventilación mecánica (N-VM), infecciones urinarias relacionadas con sonda uretral (IU-SU), bacteriemias primarias (BP) y relacionadas con catéteres vasculares (B-CVC) y bacteriemias secundarias. Resultados. Se han incluido 6.868 pacientes. En 684 (10%) pacientes se han detectado 1.019 infecciones, 445 N-VM (43,7%), 229 IU-SU (22,5%), 100 BP (9,8%), 135 B-CVC (13,2%) y 110 bacteriemias secundarias (10,8%). Las densidades de incidencia en relación con los días de exposición al factor de riesgo han sido 18,0 N-VM por 1.000 días de ventilación mecánica, 6,0 IU-SU por 1.000 días de sonda uretral y 4,5 BP-CVC por 1.000 días de catéter venoso central. La etiología predominante en las N-VM precoces ha sido Staphylococcus aureus sensible a meticilina y Haemophilus influenzae y en las N-VM tardías Pseudomonas aeruginosa y Acinetobacter baumannii. Las IU-SU han estado originadas predominantemente por Escherichia coli y Enterococcus faecalis y las BP-CVC por Staphylococcus epidermidis y Staphylococcus coagulasa negativo. Entre los marcadores de resistencia destacan por su frecuencia: P. aeruginosa resistente a imipenem-cilastatina (34,7%) y a ceftazidima (29,5%), S. aureus resistente a meticilina (35,3%), A. baumannii resistente a imipenem (33,9%) y E. coli resistente a ciprofloxacino (20,0%). No se ha detectado ninguna cepa de Enterococcus spp. o de Staphylococcus aureus resistente a vancomicina. Conclusiones. Se han identificado, para el año 2002, las tasas nacionales de las infecciones nosocomiales relacionadas con ventilación mecánica, sonda uretral y catéter venoso central, así como los agentes patógenos que predominan en cada una de ellas y el estado de los marcadores de multirresistencia

Objective. To identify national rates of hospital-acquired infections acquired in ICUs and related to instrumentalization, corresponding to the year 2002, as well as to define their etiologies and the evolution of the resistances of more prevalent microorganisms. Design. A study of cases series, observational and prospective.Context. Eighty five ICUs, Intensive Care Units departments, or other units where critical patients are admitted, from 80 different hospitals.Patients and methods. Patients included were consecutively admitted during more than 24 hours in the participating ICUs, with follow-up to their discharge of ICU or until 30 days post-admission. Infections evaluated were: respirator-associated pneumonias (RAM), urinary tract infections secondary to urethral catheter (UTI), primary bacteremias (PB) and bacteremias related to vascular catheters (BCVC), and secondary bacteremias. Results. 6,868 admitted patients were included. In 684 (10%) patients 1,019 infections were detected, 445 RAM (43.7%), 229 UTI (22.5%), 100 PB (9.8%), 135 BCVC (13.2%) and 110 secondary bacteremias (10.8%). The incidence-density with regard to the days of exposure to the risk factor were 18.0 RAM for 1,000 days of respirator, 6.0 UTI for 1,000 days of urethral catheter, and 4.5 BCVC for 1,000 days of central venous catheter. Predominant etiologies in early RAM were methicillin sensitive Staphylococcus aureus and Haemophilus influenzae, and in late RAM were Pseudomonas aeruginosa and Acinetobacter baumannii. Escherichia coli and Enterococcus faecalis were the predominant etiology in UTI, and Staphylococcus epidermidis and coagulase-negative Staphylococcus in BCVC. Among the resistance markers pointed out because of their frequency: P. aeruginosa resistant to imipenem-cilastatin (34.7%) and to ceftazidime (29.5%); S. aureus resistant to methicillin (35.3%); A. baumannii resistant to imipenem (33.9%), and E. coli resistant to ciprofloxacin (20.0%). No Enterococcus spp. or Staphylococcus aureus strains resistant to vancomycin were detected. Conclusions. In this study we have been identified for the year 2002 the national rates of hospital-acquired infections related to respirator, urethral catheter, and central venous catheter, as well as the pathogens that predominate in each one and the state of the markers of multiple resistance

Expression of vitamin D3 receptor and retinoid receptors in human breast cancer: identification of potential heterodimeric receptors.

Vitamin D3 (VD) and all-trans-retinoic acid (ATRA) have been postulated as a novel treatment option for breast carcinoma. Since the combined effects of retinoids and VD derivatives are attributed to heterodimeric interactions between members of the nuclear receptor family, the expression patterns of the heterodimers formed by vitamin D3 receptor (VDR) and the retinoid receptors RARs (RAR-alpha, RAR-beta and RAR-gamma) and RXRs (RXR-alpha, RXR-beta and RXR-gamma) have been studied by immunohistochemistry in benign and malignant breast tissues. Present results revealed that immunoexpressions to all receptor types studied were higher in both in situ and infiltrative carcinomas than in benign breast diseases. In a variable number of cases of infiltrative carcinoma, immunostaining appeared in the nucleus, whereas in the other two disorders immunostaining was only cytoplasmic. The correlation established between VDR and the different isoforms of retinoid receptors revealed that VDR seems to select mainly RAR-alpha to form heterodimers and to exert their properties as transcription factor. The results of this study suggest that this heterodimer plays a critical role in cancer malignancy, and its presence indicates those patient groups presenting a better response to adjuvant therapies based on the combination of vitamin D and ATRA.

Influencia de la neumonía asociada a ventilación mecánica sobre la mortalidad de los pacientes críticos.¿Una historia interminable? / Influence of ventilator-associated pneumonia on mortality in critically-ill patients. A never-ending story?

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First immunocytochemical study of echinoderm smooth muscle: the Antarctic cushionstar Odontaster validus Koehler (Echinodermata, Asteroidea).

Our immunocytochemical observations reveal that the muscle present in the tips of the arms of the Antarctic cushionstar Odontaster validus contains caldesmon and calponin but not troponin. Thus, the muscle clearly belongs to the smooth muscle category. Distributions of contractile proteins such as actin, myosin (the latter a typical vertebrate muscle filament protein), paramyosin, and miniparamyosin (the latter two being characteristic of thick invertebrate muscle filaments) were also determined immunocytochemically. The results suggest that the thin filaments of the starfish smooth muscle are similar to those of the vertebrate muscle, but that the thick filaments differ from those of vertebrates and possess traits that are also seen in the muscle organization of invertebrates. The absence from the O. validus muscle of titin and nebulin, proteins so far known almost exclusively from the striated vertebrate muscle, comes as no surprise, but immunoreactivity to mini-titin (a protein of the same family as titin and its replacement in invertebrates) was strong and unambiguously recognizable between filaments. Odontaster validus' histochemical characteristics may be a reflection of the phylogenetic position of the echinoderms as deuterostome invertebrates or they may express an adaptation of the muscle to the harsh environmental conditions under which it has to function in the Antarctic water.

Immunohistochemical detection of the retinoid acid receptors (RXR-alpha, -beta, -gamma) and Farnesoid X-activated receptor (FXR) in the marbled newt along the annual cycle.

Retinoid acid receptors (RXR-alpha, -beta, -gamma) and Farnesoid X-activated receptor (FXR) expression in the testis of the marbled newt were investigated with special attention to the changes during the annual testicular cycle, using light microscopy immunohistochemistry and Western blot analysis. The annual testicular cycle of the marbled newt (Triturus marmoratus marmoratus) comprises three periods: (a) proliferative period (germ cell proliferation from primordial germ cells to round spermatids, April-June); (b) spermiogenesis period (July-September); and (c) quiescence period (interstitial and follicular cells form the glandular tissue, October-April). In the proliferative period, primordial germ cells and primary spermatogonia immunostained intensely to the three types of RXRs and also to FXR. In the other periods, immunostaining to these antibodies was weak or absent. Secondary spermatogonia stained weakly to the four antibodies in the proliferative period, and only to FXR, also weakly, in the spermiogenesis period. Immunoreactive primary spermatocytes were weakly labeled with the RXR antibodies in the proliferative period. Spermatids and spermatozoa did not stain to any antibody in any period. Follicular cells only immunostained to RXR-gamma and only in the quiescence period when they are forming the glandular tissue, together with the interstitial cells. As follicular cells, interstitial cells only immunostained in the quiescence period; however, they immunoreacted to the three types of RXRs. These findings suggest that in the newt, RXRs and FXR are involved in spermatogenesis control by regulating the proliferation of primordial germ cells and spermatogonia. In addition, RXR-gamma seems to be also involved in the development of the glandular (steroidogenic) tissue.