Integrating genetic and clinical data to predict impulse control disorders in Parkinson's disease.

BACKGROUND AND PURPOSE: Impulse control disorders (ICDs) are frequent in Parkinson's disease (PD), with associated clinical and genetic risk factors. This study was aimed at analyzing the clinical features and the genetic background that underlie ICDs in PD. METHODS: We included 353 patients with PD in this study (58.9% men, mean age 62.4 ± 10.58 years, mean age at disease onset 52.71 ± 11.94 years). We used the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease for ICDs screening. Motor, nonmotor, and treatment-related features were evaluated according to the presence of ICDs. Twenty-one variants related to dopaminergic, serotonergic, glutamatergic, and opioid neurotransmitter systems were assessed. Association studies between polymorphisms and ICDs were performed. The combination of clinical and genetic variables was analyzed with receiver operating characteristic curves to assess the predictability of experiencing ICDs. RESULTS: Impulse control disorders appeared in 25.1% of the cases. Patients with ICDs were younger and presented a higher rate of anxiety. Treatment with dopamine agonists increased the risk of ICDs and it was dose dependent (P < 0.05). Genetic association studies showed that the DOPA decarboxylase gene (DDC), rs1451375, might modulate the risk of ICDs. Plotting the clinical-genetic model, the predictability of ICDs increased 11% (area under curve = 0.80; z = 3.22, P = 0.001) when adding the genotype data for single nucleotide polymorphisms. CONCLUSIONS: Polymorphisms in DDC might act as risk markers for ICDs in PD. The predictability of experiencing ICDs increased by adding genetic factors to clinical features. It is therefore important to assess the patient's genetic background to identify individuals at risk for ICDs.

[Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital]. / Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel.

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings.

[Perspectives of patients with Duchenne muscular dystrophy: A focal group to improve healthcare quality]. / Perspectivas de pacientes con distrofia muscular de Duchenne: grupo focal para mejorar la calidad asistencial.

INTRODUCTION: Duchenne muscular dystrophy is a complex disease that requires a multidisciplinary and coordinated approach. Given that therapeutic efforts are centred on improving the quality of life of the patient, the aim of this study is to find out the views of young people and adolescents with Duchenne muscular dystrophy, their families, and health professionals as regards the healthcare provided by the hospital in order to improve their quality of life. METHODS: A qualitative study was conducted using 3 focal groups consisting of patients, families, and healthcare professionals. A thematic guide was prepared, and the information from the interviews was gathered using a sound recorder. In order to analyse the information, the transcriptions were coded and the significant data of each interview were extracted and grouped into various topics. RESULTS/CONCLUSIONS: The main worries of the 3 groups were along the same line. On the one hand, the importance of a coordinated multidisciplinary team in the same unit that provides the integral care. On the other hand, sport as a common interest in these adolescents, and the consideration of a positive relationship between leisure and quality of life, finding that their participation in physiotherapy groups of great use. To achieve this objective, it is necessary to improve the coordination between the hospital and the different groups. The parents also demanded better cover in the social and psychological care offered by the hospital. Lastly, the importance of humanising the care was mentioned (privacy, adapting of structures, transmission of information, sexuality…).

La influencia del exposoma en el cáncer de piel / Influence of the Exposome on Skin Cancer

El cáncer de piel es el más frecuente del ser humano. Aunque la exposición a la radiación solar constituye el factor causal más conocido y relevante, existe una variación en el riesgo individual no explicada completamente. Diferentes estudios epidemiológicos muestran la influencia de otras radiaciones, como las ionizantes, los pesticidas, las partículas de la polución, o los tóxicos contenidos en el agua o algunos alimentos como el arsénico, en el riesgo del cáncer de piel. Además, algunos agentes vivos como los poliomavirus o el VPH son agentes etiológicos de algunos tipos concretos de cáncer cutáneo. Por último, algunos factores asociados al estilo de vida, como el estrés, el sueño, o el ejercicio podrían influir, aunque son muy escasos los estudios que aporten luz en estas áreas. Todo ello constituye el exposoma del cáncer cutáneo, el conjunto de exposiciones ambientales de un ser humano a lo largo de la vida que, combinados con el genoma y el microbioma, determinan la aparición del mismo

Skin cancer is the most frequent type of cancer in humans. While exposure to solar radiation is the most widely known and relevant causal factor, the different degrees of individual risk have not been fully elucidated. Epidemiological studies show how the risk of skin cancer is affected by other types of radiation (eg, ionizing radiation), pesticides, particulate matter in air pollution, toxins (eg, arsenic) in water and some foods. Some living entities, such as polyomavirus and human papillomavirus, can also cause specific types of cancer. Lastly, lifestyle factors such as stress, sleep, and exercise may play a role, although only a few studies shed light on these factors. The abovementioned factors make up the exposome of skin cancer, that is, the set of environmental exposures that, together with the genome and microbiome, determine the onset of disease

Influence of the Exposome on Skin Cancer. / La influencia del exposoma en el cáncer de piel.

Skin cancer is the most frequent type of cancer in humans. While exposure to solar radiation is the most widely known and relevant causal factor, the different degrees of individual risk have not been fully elucidated. Epidemiological studies show how the risk of skin cancer is affected by other types of radiation (eg, ionizing radiation), pesticides, particulate matter in air pollution, toxins (eg, arsenic) in water and some foods. Some living entities, such as polyomavirus and human papillomavirus, can also cause specific types of cancer. Lastly, lifestyle factors such as stress, sleep, and exercise may play a role, although only a few studies shed light on these factors. The abovementioned factors make up the exposome of skin cancer, that is, the set of environmental exposures that, together with the genome and microbiome, determine the onset of disease.

[Perceived quality of care by frequent paediatric healthcare users: A qualitative approach]. / Calidad percibida en población hiperfrecuentadora infantil: una aproximación cualitativa.

INTRODUCTION: Assessing the perceived quality of a healthcare department by its users is essential in a quality management system. In Paediatric Emergency Departments (PED), the demand for urgent care has increased in recent years, as well as an increase in frequent attendance. Paying attention to the opinions of these habitual users by means of qualitative methodology is particularly suitable for assessing the quality of care and identifying opportunities to improve the PED. METHODS: Two focus groups were held with parents of patients (with and without a chronic disease) who visited the PED on 10or more occasions per year in a third level hospital. RESULTS: The participants were satisfied overall with the PED. The treatment received was very positively valued, and they never felt that they had received poorer care due to being frequent users. As main strengths, they also highlighted the professional expertise, the friendliness of staff, the quality of information given, the medication received on discharge from hospital, and the follow-up carried out by the PED. The major improvement opportunities identified included: the contagion risks, the lack of coordination between different levels of care, and the need to improve the inclusion of families in the health care process. CONCLUSIONS: Due to the contributions made by these parents, several improvement strategies have been introduced, such as the implementation of sharing information protocols in shift changes, professional training courses, the establishment of a liaison person between the PED and Primary Care, and a proposal to the Hospital Management Department to assess the identified needs.

Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel / Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital

ANTECEDENTES Y OBJETIVO: Durante la primera onda epidémica del SARS-CoV-2, los hospitales han soportado una importante presión asistencial. Este escenario de incertidumbre, baja evidencia científica y medios insuficientes ha generado una importante variabilidad de la práctica entre diferentes centros sanitarios. En este contexto, planteamos desarrollar un modelo basado en estándares para la evaluación del sistema de preparación y respuesta frente a la COVID-19 en un hospital terciario. MATERIALES Y MÉTODOS: El estudio se llevó a cabo en el Hospital Universitario Vall d'Hebron de Barcelona en dos fases: 1) desarrollo de modelo de estándares mediante revisión narrativa de la literatura, análisis de planes y protocolos del hospital, método Delphi por profesionales expertos y plan de actualización y 2) validación de aplicabilidad y utilidad del modelo mediante autoevaluación y auditoría. RESULTADOS: El modelo consta de 208 estándares distribuidos en nueve criterios: liderazgo y estrategia; prevención y control de la infección; gestión de profesionales y competencias; áreas públicas comunes; áreas asistenciales; áreas de apoyo asistencial; logística, tecnología y obras; comunicación y atención al paciente; sistemas de información e investigación. La evaluación alcanza un 85,2% de cumplimiento, y se identifican 42 áreas de mejora y 96 buenas prácticas. CONCLUSIONES: La implementación de un modelo basado en estándares es útil para identificar áreas de mejora y buenas prácticas en los planes de preparación y respuesta frente a la COVID-19 en un hospital. En el actual contexto, proponemos la conveniencia de adaptar esta metodología a otros ámbitos de atención sanitaria no hospitalaria o de salud pública

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings

Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria / Recommendations on Testing Before Outpatient Dermatologic Surgery

Introducción: La cirugía dermatológica ambulatoria es una práctica clínica cada vez más habitual, basada en la extirpación de tumores cutáneos mediante anestesia local y con un tiempo quirúrgico reducido. Tradicionalmente, la valoración preoperatoria se ha realizado con el fin de detectar alguna alteración o proceso patológico desconocido que pudiera modificar el plan anestésico y/o quirúrgico. Existe una gran variabilidad entre centros y especialistas sobre las pruebas a solicitar en aquellos pacientes que van a ser sometidos a una intervención quirúrgica dermatológica ambulatoria, teniendo en cuenta que, por el perfil de esta cirugía, prácticamente ningún hallazgo podría modificar o contraindicar la intervención. El objetivo es ofrecer una referencia de actuación para la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Métodos: En 2017 se desarrolló en nuestro centro un protocolo para intentar unificar la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria. Se realizó un estudio observacional, descriptivo y retrospectivo analizando las pruebas solicitadas a pacientes sometidos a este tipo de cirugía, comparando antes y después de la aplicación del protocolo. Resultados: Tras la instauración del protocolo se solicitó menor número de pruebas complementarias, sin diferencias estadísticamente significativas en el tipo de cirugía ni complicaciones postoperatorias. Conclusiones: Los pacientes que vayan a ser sometidos, bajo anestesia local, a cirugía dermatológica ambulatoria, y que se encuentren en su estado de salud habitual, podrían no tener indicación de realización de pruebas complementarias preoperatorias

Introduction: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. Methods: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. Results: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. Conclusions: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing

Recommendations on Testing Before Outpatient Dermatologic Surgery. / Recomendaciones en la petición de pruebas preoperatorias en cirugía dermatológica ambulatoria.

INTRODUCTION: Short-duration ambulatory surgery for the removal of skin tumors under local anesthesia is increasingly common in dermatology. Preoperative assessment has traditionally targeted the identification of any unknown diseases or other health conditions that might lead to changes in plans for anesthesia or surgery. Hospitals and specialists differ greatly in the tests they order in patients about to undergo outpatient dermatologic surgery given that hardly any finding would be likely to contraindicate or lead to changes in the procedure. This study aimed to provide guidance for those ordering tests before outpatient dermatologic surgery. METHODS: In 2017 our hospital developed a protocol to standardize preoperative testing for outpatient dermatologic surgery. We designed an observational, descriptive, retrospective analysis of tests ordered for patients scheduled for such surgery before and after the protocol was applied. RESULTS: Fewer tests were ordered after the protocol was introduced. We detected no statistically significant differences in relation to type of surgery planned or postoperative complications. CONCLUSIONS: Patients about to undergo outpatient dermatologic surgery under local anesthesia who have no unusual health risks may not require preoperative testing.

Patrones de microscopia confocal para el cáncer cutáneo no melanoma y aplicaciones clínicas / Confocal Microscopy Patterns in Nonmelanoma Skin Cancer and Clinical Applications

Actualmente la microscopia confocal reflectante es la técnica diagnóstica no invasiva más prometedora para el estudio de estructuras cutáneas situadas entre la capa córnea y la dermis reticular superficial, obteniendo imágenes paralelas a la superficie cutánea en tiempo real y con una resolución microscópica similar a la observada en la histología convencional. Numerosos estudios han señalado las principales características confocales que se observan en distintas enfermedades cutáneas, tanto tumorales como inflamatorias, demostrando una buena correlación con ciertos patrones dermatoscópicos, así como con el examen histológico. Además, se han descrito algoritmos diagnósticos y patrones confocales que han demostrado unas altas tasas de sensibilidad y especificidad para el diagnóstico de tumores cutáneos de tipo melanoma y no melanoma. Las posibles aplicaciones presentes y futuras de esta tecnología son muy amplias, no solo como herramienta diagnóstica no invasiva, sino también para la evaluación de distintos procesos dinámicos como aquellos que ocurren tras la exposición de la piel a la radiación ultravioleta, o la respuesta de los tumores a terapias no invasivas como la terapia fotodinámica. Explicamos con detalle los hallazgos confocales característicos de los principales tumores cutáneos de tipo no melanoma y discutimos las posibles aplicaciones de esta novedosa técnica diagnóstica en la práctica diaria de la consulta dermatológica

Reflectance confocal microscopy is currently the most promising noninvasive diagnostic tool for studying cutaneous structures between the stratum corneum and the superficial reticular dermis. This tool gives real-time images parallel to the skin surface; the microscopic resolution is similar to that of conventional histology. Numerous studies have identified the main confocal features of various inflammatory skin diseases and tumors, demonstrating the good correlation of these features with certain dermatoscopic patterns and histologic findings. Confocal patterns and diagnostic algorithms have been shown to have high sensitivity and specificity in melanoma and nonmelanoma skin cancer. Possible present and future applications of this noninvasive technology are wide ranging and reach beyond its use in noninvasive diagnosis. This tool can also be used, for example, to evaluate dynamic skin processes that occur after UV exposure or to assess tumor response to noninvasive treatments such as photodynamic therapy. We explain the characteristic confocal features found in the main nonmelanoma skin tumors and discuss possible applications for this novel diagnostic technique in routine dermatology practice

Confocal microscopy patterns in nonmelanoma skin cancer and clinical applications.

Reflectance confocal microscopy is currently the most promising noninvasive diagnostic tool for studying cutaneous structures between the stratum corneum and the superficial reticular dermis. This tool gives real-time images parallel to the skin surface; the microscopic resolution is similar to that of conventional histology. Numerous studies have identified the main confocal features of various inflammatory skin diseases and tumors, demonstrating the good correlation of these features with certain dermatoscopic patterns and histologic findings. Confocal patterns and diagnostic algorithms have been shown to have high sensitivity and specificity in melanoma and nonmelanoma skin cancer. Possible present and future applications of this noninvasive technology are wide ranging and reach beyond its use in noninvasive diagnosis. This tool can also be used, for example, to evaluate dynamic skin processes that occur after UV exposure or to assess tumor response to noninvasive treatments such as photodynamic therapy. We explain the characteristic confocal features found in the main nonmelanoma skin tumors and discuss possible applications for this novel diagnostic technique in routine dermatology practice.

Involvement of oxytocin in the nucleus tractus solitarii on central cardiovascular control: interactions with glutamate.

Oxytocin (OT) is a peptide involved in several physiological functions in the central nervous system including central cardiovascular regulation. To clarify the role of endogenous OT in cardiovascular control, one group of anesthetized rats received unilateral microinjections of the OT receptor antagonist [d(CH(2))(5),Tyr(Me)(2),Orn(8)]-vasotocin (OTA) in the nucleus tractus solitarii (NTS) and a second group was injected with specific OT antiserum (Anti-OT). Moreover, the modulation of the cardiovascular effect of L-glutamate (GLU) by OT was also evaluated by cardiovascular analysis using effective and threshold doses of GLU. Mean arterial pressure (MAP) and heart rate (HR) were measured from a femoral catheter. OTA significantly (p<0.01) decreased the vasopressor and tachycardiac long-lasting response elicited by an effective dose of OT. Microinjections of Anti-OT antibody did not modify the values of MAP and HR compared with the control group. With regard to the OT/GLU coinjections, a subthreshold dose of OT significantly (p<0.001) counteracted the vasodepressor and bradycardiac responses induced by GLU. The coinjection of subthreshold doses of OT and GLU did not produce a change in MAP or in HR. These findings seem to exclude an endogenous tonic action of OT on central regulation of MAP and HR, although they confirm the significant role of OT on central cardiovascular control within the NTS. In fact, the modulation of GLU responses by OT supports the importance of OT on the central cardiovascular adjustments likely acting on the baroreceptor reflex sensitivity.

Microorganisms recognition and quantification by lectin adsorptive affinity impedance.

Lectin-based screen-printed gold electrodes are reported for the impedimetric label-free detection of bacteria. The selective interaction of lectins with carbohydrate components from microorganisms surface was used as the recognition principle for their detection and identification. Electrochemical impedance spectroscopy (EIS) was employed for the direct label-free transduction of the bacteria-lectin binding. Biotinylated Concanavalin A (Con A) and Escherichia coli were used for the evaluation of the lectin-bacteria complex formation. This complex was formed in solution, and then adsorbed onto the gold SPE surface. No bacteria immobilization was observed on the sensor prepared in the absence of ConA, demonstrating the absence of non-specific bacteria adsorption onto the gold SPE. On the contrary, the changes in electron transfer resistance allowed monitoring of E. coli-biotinylated Con A complex formation without any amplification step. Experimental variables such as the biotinylated-Con A concentration and the bacteria-lectin incubation time were optimized. The electron transfer resistance varied linearly with the logarithmic value of E. coli concentration over four orders of magnitude, 5.0 x 10(3) and 5.0 x 10(7) cfu mL(-1). The selectivity of the approach was evaluated by checking the impedimetric responses of gold SPE modified with the complexes formed between nine lectins and three different bacteria (E. coli, Staphylococcus aureus and Mycobacterium phlei). Different response profiles were found when the different lectins were used as recognition elements. principal component analysis (PCA) allowed classification and distinction among bacteria. Finally, electrochemical monitoring of beta-galactosidase activity for the surface attached bacteria was demonstrated to be useful to distinguish between E. coli and S. aureus, which exhibit a similar affinity towards biotinylated-Con A.

Prescripción inadecuada en mayores de 75 años en atención primaria: el caso de doxazosina en un área de salud / No disponible

Objetivos: Evaluar la adecuación de la prescripción de doxazosina en mayores de 75 años. Secundarios:Describir la comorbilidad y el tratamiento antihipertensivo asociados, así como el control de la tensión arterial,y analizar los efectos adversos. Material y métodos: Estudio descriptivo transversal. Ámbito: Área desalud con 31 equipos de atención primaria. Población: Mil doscientos ochenta y dos pacientes mayoresde 75 años en tratamiento con doxazosina durante septiembre y noviembre de 2006. Fuente de información:Historia clínica. Variables: Edad, sexo, tratamiento, pauta, comorbilidad, tensión arterial y efectosadversos aparecidos. En 80 historias, mediante muestreo aleatorio estratificado por sexo y equipo. Se consideróprescripción adecuada en caso de hipertrofia benigna de próstata o como antihipertensivo de cuartalínea. Resultados: La prescripción en mujeres fue adecuada en el 26,5% de los casos (índice de confianza[IC] 95%: 10,2-42,8), y en hombres, en el 47,8% (IC 95%: 32,3-63,3). La comorbilidad más frecuente fue ladislipemia, y la más relevante la cardiaca (6,2%, insuficiencia cardiaca; 20%, trastornos del ritmo cardiaco;16,3%, otras enfermedades cardiacas). En el 91,3% de los pacientes, doxazosina estaba asociada a otros antihipertensivos.El 45,5% de los participantes tenían controlada la tensión arterial sistólica. En el 51,3% de lospacientes apareció algún efecto adverso, con un 63,4% de ellos referidos a mareos o caídas. Conclusiones:La indicación fue adecuada en la mitad de los hombres y en una cuarta parte de las mujeres. A pesar de suslimitaciones de uso, algunos pacientes presentaban insuficiencia cardiaca al inicio del tratamiento. Menosde la mitad de los participantes tenían controlada la tensión sistólica. La mitad de los pacientes sufrieronmareos o caídas durante el tratamiento

Objectives: to assess the appropriateness of the prescription of doxazosin in people over the age of 75. Secondaryobjectives: to describe the comorbidity and the associated antihypertensive treatment, as well as theblood pressure control, and to analyse the adverse effects. Materials and methods: a cross-sectional descriptivestudy. Scope: a health care district with 31 primary care teams. Population: one thousand two hundredand eighty-two patients over the age of 75 undergoing a treatment with doxazosin during September andNovember 2006. Information source: medical history. Variables: age, gender, treatment, schedule, comorbidity,blood pressure and adverse effects suffered, in 80 medical histories, by means of a random samplingstratified by gender and team. The prescription was deemed to be appropriate in the cases of benign prostatichyperplasia or as a fourth-line antihypertensive. Results: The prescription in women was appropriate in26.5% of the cases (confidence index [CI] 95%: 10.2-42.8), and in men, in 47.8% (CI 95%: 32.3-63.3). Themost common comorbidity was dyslipidemia, and the most relevant one was cardiac comorbidity (6.2%,cardiac insufficiency; 20%, heart rhythm disorders; 16.3%, other cardiac diseases). In 91.3% of the patients,doxazosin was associated with other antihypertensives. The systolic blood pressure was controlled in 45.5%of the participants. Some kind of adverse effect was experienced by 51.3% of the patients, with 63.4% ofthem of concerning dizziness or falls. Conclusions: The prescription was appropriate in half of the men andin one fourth of the women. In spite of the limitations of its use, some of the patients were suffering fromcardiac insufficiency at the start of the treatment. The systolic pressure was controlled in less than half of theparticipants. Half of the patients suffered from dizziness and falls during the treatment (AU)

Dietary lutein/zeaxanthin partially reduces photoaging and photocarcinogenesis in chronically UVB-irradiated Skh-1 hairless mice.

Lutein and zeaxanthin are xanthophyll carotenoids with potent antioxidant properties protecting the skin from acute photodamage. This study extended the investigation to chronic photodamage and photocarcinogenesis. Mice received either a lutein/zeaxanthin-supplemented diet or a standard nonsupplemented diet. Dorsal skin of female Skh-1 hairless mice was exposed to UVB radiation with a cumulative dose of 16,000 mJ/cm(2) for photoaging and 30,200 mJ/cm(2) for photocarcinogenesis. Clinical evaluations were performed weekly, and the animals were sacrificed 24 h after the last UVB exposure. For photoaging experiments, skin fold thickness, suprapapillary plate thickness, mast cell counts and dermal desmosine content were evaluated. For photocarcinogenesis, samples of tumors larger than 2 mm were analyzed for histological characterization, hyperproliferation index, tumor multiplicity, total tumor volume and tumor-free survival time. Results of the photoaging experiment revealed that skin fold thickness and number of infiltrating mast cells following UVB irradiation were significantly less in lutein/zeaxanthin-treated mice when compared to irradiated animals fed the standard diet. The results of the photocarcinogenesis experiment were increased tumor-free survival time, reduced tumor multiplicity and total tumor volume in lutein/zeaxanthin-treated mice in comparison with control irradiated animals fed the standard diet. These data demonstrate that dietary lutein/zeaxanthin supplementation protects the skin against UVB-induced photoaging and photocarcinogenesis.

[Expression of galanin in melanocytic tumors]. / Estudio sobre la expresión de galanina en tumores melanocitarios.

INTRODUCTION: Galanin is a neuropeptide with wide-ranging effects, especially within the endocrine and nervous systems. Galanin and its receptors are present in human skin. Galanin is expressed in different neural, endocrine and neuroendocrine tumors and, on the other hand, several neuropeptides, particularly alpha-MSH, seem to play a role in the pathogenesis of melanoma. OBJECTIVE: To investigate the expression of galanin in cutaneous melanomas and melanocytic nevi and correlate it with alpha-MSH expression and several prognostic factors for melanoma. MATERIAL AND METHODS: We performed an observational and retrospective study of the immunohistochemical expression of galanin and alpha-MSH in samples of cutaneous melanomas diagnosed in the last 5 years in the San Jorge Hospital, Huesca (Spain). Different types of melanocytic nevi were also analyzed. RESULTS: A total of 130 pigmented lesions were studied: 38 primary cutaneous melanomas, 6 cutaneous melanoma metastases and 86 melanocytic nevi. Immunostaining with galanin and alpha-MSH was significantly higher in melanomas than in melanocytic nevi (p < 0.001), although spindle cell and blue nevi showed significant expression of alpha-MSH. More than 50 % of nodular melanomas and 90 % of superficial spreading melanomas were positive for galanin and alpha-MSH, and the latter also showed the highest percentage of positive cells for galanin (mean 35.09 +/- 28.16) as well as for alpha-MSH (mean 67.64% +/- 35.38). A positive correlation of 71 % was found for immunostaining of both neuropeptides in melanomas. No significant correlation was observed between galanin expression and age, gender, location of the lesions, Breslow index, Clark level and mitotic index. CONCLUSION: Our study shows the expression of galanin in cutaneous melanoma and its significant correlation with alpha-MSH immunostaining.

Estudio sobre la expresión de galanina en tumores melanocitarios / Expression of galanin in melanocytic tumors

Introducción. La galanina es un neuropéptido que controla numerosas funciones en el sistema nervioso y endocrino y que está presente en la piel. Diferentes tumores neurales, endocrinos y neuroendocrinos expresan galanina y, por otro lado, varios neuropéptidos, especialmente la &apha;-MSH, se han involucrado en la patogénesis del melanoma. Objetivo. Estudiar la expresión de galanina en melanomas y nevi melanocíticos cutáneos, comparándola con la de α-MSH, y relacionándola con variables clínicas e histológicas con valor pronóstico en el melanoma. Material y métodos. Estudio observacional, retrospectivo de la expresión de galanina y αMSH mediante inmunohistoquímica en una muestra significativa de secciones histológicas de los melanomas cutáneos diagnosticados en el hospital San Jorge de Huesca en los últimos 5 años, y un número similar de distintos tipos de nevi melanocíticos. Resultados. Se estudiaron un total de 130 lesiones pigmentadas: 38 melanomas cutáneos primarios, 6 metástasis cutáneas de melanoma y 86 nevi melanocíticos. El inmunomarcaje con galanina y α-MSH fue significativamente mayor en melanomas que en nevi (p < 0,001), aunque dentro de los nevi destacan la expresión de α-MSH en los azules y fusocelulares. Más del 50 % de los melanomas nodulares y del 90 % de los de extensión superficial fueron positivos para galanina y α-MSH, y además estos últimos fueron los que mostraron un mayor porcentaje de células positivas tanto para galanina (media = 35,09 ± 28,16 %) como para α-MSH (media = 67,64% ± 35,38 %), siendo la correlación entre ambos en melanomas del 71%. No se encontró asociación estadísticamente significativa entre la expresión de galanina y las variables edad, sexo, localización, índice de Breslow, nivel de Clark y proliferación celular. Conclusión. Nuestro estudio demuestra la presencia de galanina en secciones histológicas de melanoma cutáneo, y esta inmunorreactividad se relaciona significativamente con la de α-MSH

Introduction. Galanin is a neuropeptide with wide-ranging effects, especially within the endocrine and nervous systems. Galanin and its receptors are present in human skin. Galanin is expressed in different neural, endocrine and neuroendocrine tumors and, on the other hand, several neuropeptides, particularly α-MSH, seem to play a role in the pathogenesis of melanoma. Objective. To investigate the expression of galanin in cutaneous melanomas and melanocytic nevi and correlate it with α-MSH expression and several prognostic factors for melanoma. Material and methods. We performed an observational and retrospective study of the immunohistochemical expression of galanin and α-MSH in samples of cutaneous melanomas diagnosed in the last 5 years in the San Jorge Hospital, Huesca (Spain). Different types of melanocytic nevi were also analyzed. Results. A total of 130 pigmented lesions were studied: 38 primary cutaneous melanomas, 6 cutaneous melanoma metastases and 86 melanocytic nevi. Immunostaining with galanin and α-MSH was significantly higher in melanomas than in melanocytic nevi (p < 0.001), although spindle cell and blue nevi showed significant expression of α-MSH. More than 50 % of nodular melanomas and 90 % of superficial spreading melanomas were positive for galanin and α-MSH, and the latter also showed the highest percentage of positive cells for galanin (mean 35.09 ± 28.16) as well as for α-MSH (mean 67.64% ± 35.38). A positive correlation of 71 % was found for immunostaining of both neuropeptides in melanomas. No significant correlation was observed between galanin expression and age, gender, location of the lesions, Breslow index, Clark level and mitotic index. Conclusion. Our study shows the expression of galanin in cutaneous melanoma and its significant correlation with α-MSH immunostaining

Region specific galanin receptor/neuropeptide Y Y1 receptor interactions in the tel- and diencephalon of the rat. Relevance for food consumption.

The aim of this work was to determine the interactions between NPY and GAL receptor (GALR) subtypes in the hypothalamus and the amygdala using quantitative receptor autoradiography to analyze the binding characteristics of NPY-Y1 and Y2 receptor subtypes in the presence and absence of GAL. Food intake in satiated animals was evaluated after intraventricular co-injections of GAL and NPY-Y1 or Y2 agonists. The expression of c-Fos IR in both regions was also investigated. GAL decreases NPY-Y1 agonist binding in the arcuate nucleus by about 15% (p<0.01), but increases NPY-Y1 agonist binding in amygdala (18%) (p<0.01). These effects were blocked with the GAL antagonist M35. Y2-agonist binding was not modified by GAL. GAL blocked the food intake induced by the Y1 agonist (p<0.01). Co-injections of Y1 agonist and GAL also reduced the c-Fos expression induced by the Y1 agonist in the arcuate nucleus and the dorsomedial hypothalamic nucleus but increased c-Fos expression in amygdala. These results indicate the existence of antagonistic interactions between GALR and NPY-Y1 receptors in the hypothalamus and their functional relevance for food intake. In contrast, a facilitatory interaction between GALR and Y1 receptors exists in the amygdala which may be of relevance for fear related behaviour.

Receptor-receptor interactions in central cardiovascular regulation. Focus on neuropeptide/alpha(2)-adrenoreceptor interactions in the nucleus tractus solitarius.

The nucleus tractus solitarii (NTS) is a key nucleus in central cardiovascular control. In this mechanism it is well known the role of the alpha(2)-adrenoreceptors for the modulation of the autonomic pathways. Moreover a number of neuropeptides described in the NTS, including Neuropeptide Y (NPY), Galanin (GAL) and Angiotensin II (Ang II), have different roles in regulating the cardiovascular function within this nucleus. We show in this review several data which help to understand how these neuropeptides (NPY, GAL and Ang II) could modulate the cardiovascular responses mediated through alpha(2)-adrenoreceptors in the NTS. Also we show for the first time the interactions between neuropeptides in the brain, specifically the interactions between NPY, GAL, and Ang II, and its functional relevance for central cardiovascular regulation. These data strength the role of neuropeptides on central autonomic control and provide some evidences to understand the neurochemical mechanisms involved in the cardiovascular responses from the NTS.

Effects of a non-selective beta-blocker on adult rat anterograde axonal transport and retinal ganglion layer after increased intraocular pressure.

The aim of this study was to examine the effects of timolol in an experimental model of elevated intraocular pressure (IOP). Three episcleral veins of rats with normal IOP were cauterized. Three months later we examined the effects on anterograde axonal transport from the retinal ganglion cells (RGCs) to the superior colliculus (SC) as well as on the number of neurons in the retinal ganglion layer (RGL). These parameters were also studied in a group of rats submitted to treatment with timolol after confirming that their IOP was still raised after two weeks. After the surgical procedure, the mean IOP of the experimental eyes increased to 33.5+/-1.06 mmHg (1.25 fold compared to the control group) and three months later the IOP remained significantly elevated; however, after a long period of treatment with timolol the IOP was 14.05+/-0.81 mmHg, similar to that of the control group. In the group with normal IOP, labelling with horseradish rabbit peroxidase (HRP) at 120 minutes and 24 hours postinjection showed continuous staining from the retina to the SC. In the experimental group the optic nerve head (ONH) was completely negative, although in the group treated with timolol there was partial block of axonal transport in the ONH, in which the staining was slightly more intense. The number of neurons in the RGL, counted by immunohistochemical labelling with Neu-N, showed that in eyes with normal and elevated IOP there were 423+/-11 neurons/mm(2) and 283+/-10 neurons/mm(2), respectively. After treatment with timolol the number of neurons (331+/-10 cells/mm(2) increased compared with elevated IOP eyes, although the number did not reach that of the control group. These results indicate that treatment with timolol, started two weeks after the surgical procedure, was partially neuroprotective because the loss of neurons in the RGL was lower than in untreated animals, though not sufficient to re-establish normal axonal transport.