Yersinia ruckeri infection activates local skin and gill B cell responses in rainbow trout.

Teleost fish lack organized structures in mucosal tissues such as those of mammals, but instead contain dispersed B and T cells with the capacity to respond to external stimuli. Nonetheless, there is still a great lack of knowledge regarding how B cells differentiate to plasmablasts/plasma cells in these mucosal surfaces. To contribute to a further understanding of the mechanisms through which fish mucosal B cells are activated, in the current study, we have studied the B cell responses in the skin and gills of rainbow trout (Oncorhynchus mykiss) exposed to Yersinia ruckeri. We have first analyzed the transcription levels of genes related to B cell function in both mucosal surfaces, and in spleen and kidney for comparative purposes. In a second experiment, we have evaluated how the infection affects the presence and size of B cells in both skin and gills, as well as the presence of plasmablasts secreting total or specific IgMs. The results obtained in both experiments support the local differentiation of B cells to plasmablasts/plasma cells in the skin and gills of rainbow trout in response to Y. ruckeri. Interestingly, these plasmablasts/plasma cells were shown to secrete specific IgMs as soon as 5 days after the exposure. These findings contribute to a further understanding of how B cells in the periphery respond to immune stimulation in teleost fish.

Manejo del ictus agudo. Tratamientos y cuidados específicos de enfermería en la Unidad de Ictus / Management of acute stroke. Specific nursing care and treatments in the stroke unit

Objetivo: Proporcionar un conjunto de recomendaciones actualizadas y basadas en la evidenciadisponible para el manejo del ictus agudo. Nuestro objetivo es proporcionar una base para eldesarrollo de los protocolos internos de cada centro, sirviendo de referencia para los cuidadosde enfermería. Métodos: Revisión de evidencias disponibles sobre los cuidados del ictus agudo. Se han consultado las guías nacionales e internacionales más recientes. Los niveles de evidencia y grados derecomendación se han basado en la clasificación del Centro de Medicina Basada en la Evidenciade Oxford. Resultados: Se describen la atención y los cuidados del ictus agudo en la fase prehospitalaria,el funcionamiento de código ictus, la atención por el equipo de ictus a la llegada al hospital,los tratamientos de reperfusión y sus limitaciones, el ingreso en la Unidad de Ictus, los cuidadosde enfermería en la Unidad de Ictus y el alta hospitalaria. Conclusiones: Estas pautas proporcionan recomendaciones generales basadas en la evidenciaactualmente disponible para guiar a los profesionales que atienden a pacientes con ictus agudo.En algunos casos, sin embargo, existen datos limitados demostrando la necesidad de continuarinvestigando sobre el manejo del ictus agudo.(AU)

Objective: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres’ internal protocols, serving as a reference for nursing care. Methods: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. Results: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient’s arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. Conclusions: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.(AU)

Management of acute stroke. Specific nursing care and treatments in the stroke unit.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Health Care Professionals as Relatives in Organ Donation Interviews: Analysis of the Important Role of Health Care Professionals as Family Members.

INTRODUCTION: The organ and tissue donation interview is a vital step in obtaining the donation. Therefore, it is important to obtain as much information as possible regarding the relatives of the potential donor prior to this interview and know if there is a health care professional among the relatives who may act as an interlocutor. OBJECTIVE: The objective of this study is to assess the influence that relatives who are health care professionals may have if present at the interview for the organ and tissue donation request. METHODS: This is a descriptive study of all the organ donations from 1996 to 2019. Variables of the interview record form were completed by the Regional Transplant Coordination Office. Quantitative variables are expressed as mean (standard deviation) or median (interquartile range), and qualitative variables are expressed in percentage. The χ2 test was used for inferential statistics. RESULTS: Health care professionals were present as interlocutors in 8.4% of the total interviews conducted (9279). Organ donation was accepted in 86% of these interviews, while the relative who was a health care professional gave a 93.8% (729) positive response to the donation. Having a health care professional as an interlocutor favors the acceptance of the donation (odds ratio 9.325, 95% confidence interval: 5.054-17.205; P < .001). CONCLUSION: Health care professionals have a very positive attitude toward donation. This attitude positively impacts other relatives' acceptance of the donation.

Management of acute stroke. Specific nursing care and treatments in the stroke unit. / Manejo del ictus agudo. Tratamientos y cuidados específicos de enfermería en la Unidad de Ictus.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Variations of B cell subpopulations in peripheral blood of healthy Mexican population according to age: Relevance for diagnosis of primary immunodeficiencies

BACKGROUND: Peripheral blood B cells include lymphocytes at various stages of differentiation, each with a specific function in the immune response. All these stages show variations in percentage and absolute number throughout human life. The numbers and proportions of B subpopulation are influenced by factors such as gender, age, ethnicity, and lifestyle. This study establishes reference values according to age of peripheral blood B cell subtypes in healthy Mexican population. METHODS: Peripheral blood from healthy new-borns and adults were analysed for total B cell subpopulations, using surface markers such as CD19, IgM, IgD, CD21, CD24, CD27, and CD38, to identify naïve, memory with and without isotype switch, double-negative, transitional, and plasmablast cells. RESULTS: We observed a significant variation in terms of frequency and absolute counts between all groups analysed. Values from each B cell subpopulation show variations according to age. CONCLUSIONS: In order to attempt to elucidate reference values for B cell subpopulation, the present study evaluated a population sample of healthy blood donors from this region. Values reported here can also be used as a tool for diagnosis of diseases in which B cell maturation is affected

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Variations of B cell subpopulations in peripheral blood of healthy Mexican population according to age: Relevance for diagnosis of primary immunodeficiencies.

BACKGROUND: Peripheral blood B cells include lymphocytes at various stages of differentiation, each with a specific function in the immune response. All these stages show variations in percentage and absolute number throughout human life. The numbers and proportions of B subpopulation are influenced by factors such as gender, age, ethnicity, and lifestyle. This study establishes reference values according to age of peripheral blood B cell subtypes in healthy Mexican population. METHODS: Peripheral blood from healthy new-borns and adults were analysed for total B cell subpopulations, using surface markers such as CD19, IgM, IgD, CD21, CD24, CD27, and CD38, to identify naïve, memory with and without isotype switch, double-negative, transitional, and plasmablast cells. RESULTS: We observed a significant variation in terms of frequency and absolute counts between all groups analysed. Values from each B cell subpopulation show variations according to age. CONCLUSIONS: In order to attempt to elucidate reference values for B cell subpopulation, the present study evaluated a population sample of healthy blood donors from this region. Values reported here can also be used as a tool for diagnosis of diseases in which B cell maturation is affected.

Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage.

BACKGROUND AND PURPOSE: An association between high blood pressure (BP) in acute intracerebral hemorrhage (ICH) and hematoma growth (HG) has not been clearly demonstrated. Therefore, the impact of BP changes and course on HG and clinical outcome in patients with acute ICH was determined. METHODS: In total, 117 consecutive patients with acute (<6 h) supratentorial ICH underwent baseline and 24-h CT scans, CT angiography for the detection of the spot sign and non-invasive BP monitoring at 15-min intervals over the first 24 h. Maximum and minimum BP, maximum BP increase and drop from baseline, and BP variability values from systolic BP (SBP), diastolic BP and mean arterial pressure (MAP) were calculated. SBP and MAP loads were defined as the proportion of readings >180 and >130 mmHg, respectively. HG (>33% or >6 ml), early neurological deterioration (END) and 3-month mortality were recorded. RESULTS: Baseline BP variables were unrelated to either HG or clinical outcome. Conversely, SBP 180-load independently predicted HG (odds ratio 1.05, 95% CI 1.010-1.097, P = 0.016), whilst both SBP 180-load (odds ratio 1.04, 95% CI 1.001-1.076, P = 0.042) and SBP variability (odds ratio 1.2, 95% CI 1.047-1.380, P = 0.009) independently predicted END. Although none of the BP monitoring variables was associated with HG in the spot-sign-positive group, higher maximum BP increases from baseline and higher SBP and MAP loads were significantly related to HG in the spot-sign-negative group. CONCLUSIONS: In patients with acute supratentorial ICH, SBP 180-load independently predicts HG, whilst both SBP 180-load and SBP variability predict END.

[Carotid endarterectomy: description, results and clinic evolution in 100 consecutive symptomatic patients]. / Endarterectomía carotídea: descripción, resultados y evolución clínica en 100 pacientes sintomáticos consecutivos.

INTRODUCTION: The efficacy of endarterectomy in symptomatic carotid stenosis greater than 70% in secondary stroke prevention has been demonstrated although the benefit is dependent upon the perioperative morbidity and mortality risk. Despite the recommendation that the results of centres regularly practicing endarterectomies be analysed and reported, few studies have in fact been published. The aim of our study was to analyze the incidence of surgical complications from carotid endarterectomy at our hospital and to describe the stroke profile of the operated patients. MATERIAL AND METHODS: 100 consecutive patients submitted to carotid endarterectomy between 2002 and 2006 were included. We recorded stroke risk factors, clinical presentation, ultrasonography findings including transcranial and carotid eco-Doppler, neuroimaging, intra and perioperative complications including mortality- stroke rate, and clinical outcome at three months. We compare our results with the NASCET, ECST and Spanish published series. RESULTS: Males predominated (74 % vs 26 %). The mean age was 70+/-8.5 years with 36 % of patients older than 75 years. Arterial hypertension was the most common vascular risk factor (74%), 14% had a critical contralateral carotid stenosis or occlusion. Stroke was the most frequent clinical presentation (67 %). The most commonly detected intraoperatory and postoperatory complication was subclinical haemodynamic changes (67% and 45% respectively). Cranial nerve lesions were the most usual local complication. Four patients suffered stroke recurrence, leading to death in one. A further patient died due to a reperfusion syndrome. The rate of stroke-mortality at three months was 5%. CONCLUSIONS: Morbidity and mortality related to carotid endarterectomy for symptomatic stenosis greater than 70 % was within guideline ranges. Surgical risk at every centre should be periodically evaluated in order to guarantee that acceptable standards are maintained.

Endarterectomía carotídea: descripción, resultados y evolución clínica en 100 pacientes sintomáticos consecutivos / Carotid endarterectomy: description, results and clinic evolution in 100 consecutive symptomatic patients

Introducción. La endarterectomía carotídea (EC) ha demostrado ser eficaz en la prevención secundaria de ictus isquémico en pacientes con estenosis sintomática de arteria carótida interna (ACI) mayor del 70%. Este beneficio está condicionado por la morbimortalidad perioperatoria del centro. Pese a la recomendación de analizar y comunicar los resultados de la EC en centros que la realizan de forma habitual, son muy escasas las publicaciones al respecto. El objetivo de nuestro estudio fue analizar el perfil de pacientes intervenidos y riesgo quirúrgico asociado a la EC en nuestro hospital. Material y métodos. Se incluyeron 100 pacientes consecutivos intervenidos entre 2002 y 2006. Se recogieron datos sobre antecedentes patológicos, clínica de inicio, hallazgos ultrasonográficos (incluido Doppler transcraneal y carotídeo), neuroimagen, complicaciones intra y postoperatorias y evolución clínica a los 3 meses. Se compararon con resultados de los estudios previos, incluidos los ensayos clínicos NASCET, ECST y series publicadas en nuestro país. Resultados. En nuestra serie destaca el elevado perfil de riesgo de los pacientes. Hubo predominio masculino (74% frente a 26 %), con una edad media de 70 (8,5) años, un 36% de pacientes mayores de 75 años. En un 42% la estenosis de ACI fue >90% y en un 14% existía una estenosis crítica u oclusión de ACI contralateral. La clínica de presentación más frecuente fue el infarto cerebral establecido (67%). La complicación intra y postoperatoria más frecuente fue la alteración hemodinámica subclínica (67 y 45%, respectivamente). Un 4% de los pacientes presentaron recidiva del ictus y uno un síndrome de reperfusión. Dos pacientes fallecieron. La tasa de ictus-mortalidad a 3 meses se situó en el 5%. Conclusión. Nuestros pacientes presentan un perfil de alto riesgo con una morbimortalidad asociada a la EC dentro de los rangos de seguridad recomendados. Pese a las recomendaciones vigentes, son escasas las auditorías internas evaluando el riesgo quirúrgico en cada centro (AU)

Introduction. The efficacy of endarterectomy in symptomatic carotid stenosis greater than 70% in secondary stroke prevention has been demonstrated although the benefit is dependent upon the perioperative morbidity and mortality risk. Despite the recommendation that the results of centres regularly practicing endarterectomies be analysed and reported, few studies have in fact been published. The aim of our study was to analyze the incidence of surgical complications from carotid endarterectomy at our hospital and to describe the stroke profile of the operated patients. Material and methods. 100 consecutive patients submitted to carotid endarterectomy between 2002 and 2006 were included. We recorded stroke risk factors, clinical presentation, ultrasonography findings including transcranial and carotid eco-Doppler, neuroimaging, intra and perioperative complications including mortality- stroke rate, and clinical outcome at three months. We compare our results with the NASCET, ECST and Spanish published series. Results. Males predominated (74 % vs 26 %). The mean age was 70±8.5 years with 36 % of patients older than 75 years. Arterial hypertension was the most common vascular risk factor (74%), 14% had a critical contralateral carotid stenosis or occlusion. Stroke was the most frequent clinical presentation (67 %). The most commonly detected intraoperatory and postoperatory complication was subclinical haemodynamic changes (67% and 45% respectively). Cranial nerve lesions were the most usual local complication. Four patients suffered stroke recurrence, leading to death in one. A further patient died due to a reperfusion syndrome. The rate of stroke-mortality at three months was 5%. Conclusions. Morbidity and mortality related to carotid endarterectomy for symptomatic stenosis greater than 70 % was within guideline ranges. Surgical risk at every centre should be periodically evaluated in order to guarantee that acceptable standards are maintained (AU)

Donor lymphocyte infusions for relapse of chronic myeloid leukemia after allogeneic stem cell transplantation: prognostic significance of the dose of CD3(+) and CD4(+) lymphocytes.

Between December 1993 and November 2001, 30 patients with chronic myeloid leukemia who relapsed after stem cell transplantation were studied. Seventeen patients were not treated before donor lymphocyte infusion (DLI), eight patients received interferon-alpha (IFN-alpha), and five underwent chemotherapy. The method of DLI was the bulk dose regimen. The median time between DLIs was 6 weeks. The median number of infusions was three; the median time from transplant to relapse was 17 months and from relapse to DLI 2 months. Eleven patients (37%) were in molecular/cytogenetic relapse, 14 (47%) in chronic phase, and five (16%) in accelerated or blastic phase. Seventeen patients (57%) developed acute graft-versus-host disease (GVHD). Chronic GVHD was observed in 15 of 24 (62%) patients. Four (13%) patients developed cytopenia after a median of 30 days. Nineteen (63%) patients achieved response, 15 of them developed GVHD. The response rate according to the disease phase was molecular or cytogenetic relapse: 91%, chronic phase: 57%, and accelerated or blastic phase: 20%. The median time to response was 6 months. Patients treated with IFN-alpha or no treatment as well as those who were in molecular/cytogenetic relapse and those who received a CD3(+) cell dose <1 x 10(8)/kg and CD4(+) <8 x 10(7)/kg had better survival. We conclude that patients who receive lower doses of lymphocytes have better survival. In some patients IFN-alpha seems to be a good choice to potentiate the graft-versus-leukemia (GVL) effect.

Transmission to eels, portals of entry, and putative reservoirs of Vibrio vulnificus serovar E (biotype 2).

Vibrio vulnificus serovar E (formerly biotype 2) is the etiologic agent that is responsible for the main infectious disease affecting farmed eels. Although the pathogen can theoretically use water as a vehicle for disease transmission, it has not been isolated from tank water during epizootics to date. In this work, the mode of transmission of the disease to healthy eels, the portals of entry of the pathogen into fish, and their putative reservoirs have been investigated by means of laboratory and field experiments. Results of the experiments of direct and indirect host-to-host transmission, patch contact challenges, and oral-anal intubations suggest that water is the prime vehicle for disease transmission and that gills are the main portals of entry into the eel body. The pathogen mixed with food can also come into the fish through the gastrointestinal tract and develop the disease. These conclusions were supported by field data obtained during a natural outbreak in which we were able to isolate this microorganism from tank water for the first time. The examination of some survivors from experimental infections by indirect immunofluorescence and scanning electron microscopy showed that V. vulnificus serovar E formed a biofilm-like structure on the eel skin surface. In vitro assays demonstrated that the ability of the pathogen to colonize both hydrophilic and hydrophobic surfaces was inhibited by glucose. The capacity to form biofilms on eel surface could constitute a strategy for surviving between epizootics or outbreaks, and coated survivors could act as reservoirs for the disease.

Effectiveness of different vaccine formulations against vibriosis caused by Vibrio vulnificus serovar E (biotype 2) in European eels Anguilla anguilla.

Vibriosis due to Vibrio vulnificus serovar E (biotype 2) is one of the main causes of mortality in European eels cultured in Europe. The main objective of this study was to develop a vaccine and a vaccination procedure against this pathogen. With this aim, we tested several vaccine formulations (inactivated whole-cells with and without toxoids--inactivated extracellular products--from capsulated and uncapsulated strains, attenuated live vaccines and purified lipopolysaccharide [LPS]) on eels maintained under controlled laboratory conditions using different delivery routes (injection and immersion). To study the immune response we estimated antibody titers and bactericidal/bacteriostatic activity in mucus and serum. To evaluate protection, we calculated the relative percent survival (RPS) after intraperitoneal (i.p.) injection and bath challenge of the pathogen. The overall results indicate that: (1) capsular antigens seem to be essential for protective immunization; (2) vaccines confer the highest protection when administered by i.p. injection; (3) booster is needed to achieve good protection by immersion; (4) enriching the vaccine with toxoids enhances protection to optimal levels (RPS values around 70 to 100%, depending on the delivery route); and (5) the protective effect in serum and mucus depends on the route of administration and seems to be related to the production of specific antibodies.

[Bilateral pneumonia after localized irradiation of a thymoma. Description of a case]. / Neumonitis bilateral tras irradiación localizada en un timoma. Descripción de un caso.

Acute pneumonitis characterized by fever, coughing and moderate dyspnea can appear from 6 to 12 weeks after irradiation. Most patients later show signs of fibrosis confined to the irradiated field. An entity that has been under recent discussion is "radiation-induced sporadic pneumonitis", a bilateral lymphocytic alveolitis of autoimmune origin that leads to generalized pulmonary response after local irradiation. The prognosis for such cases is good. We report a case of early post-irradiation pneumonitis of the type described, which led unexpectedly to the patient's death.