Effect of Propionibacterium acnes (PA) injection on intervertebral disc degeneration in a rat model: Does it mimic modic changes?

INTRODUCTION: Multiple reports of bacterial isolates in human disc tissue have suggested a role of low-grade infection on intervertebral disc degeneration and modic changes (MC) generation. Animal models have been extensively used to study IDD; however, until recently, no consideration had been given to eventual infectious processes. To reproduce the phenomena by inoculating an infecting agent would support the infectious hypothesis. Therefore, we studied the effect of Propionibacterium acnes (PA) inoculation on rat-tails and determined whether it would produce MCs on the adjacent endplates. HYPOTHESIS: Disc infection with PA would accelerate IDD compared with the standard model and would also lead to MCs on the adjacent endplates. METHODS: Twelve Sprague-Dawley rats were randomized to receive a needle puncture in a caudal tail disc with either saline (control) or an inoculum of 5×107 CFU of strain 1a PA. Twelve weeks later, the rats were euthanized and the tails were analyzed. The main assessment criteria were obtained from the post-mortem MRI: T2 values of punctured discs and adjacent endplates, as well as disc volumes. A histological grading score for IDD was also used, measuring the morphology and cellularity of the nucleus and annulus, as well as endplate disruption. RESULTS: The median T2 value and disc volume were smaller in PA-punctured discs [T2 value: 30ms (23-44) vs. 61ms (38-132), respectively, P=0.01; 0.01mm3 (0.01-0.05) vs. 0.5mm3 (0.01-5.35), respectively; P=0.049]. There was no change in the adjacent endplates. There was no significant difference in histological grading between the test and control [13 (10-14) vs. 10.5 (6-13); P=0.05]. DISCUSSION: Inoculation of caudal discs with PA generated increased degeneration; however, no MCs were observed on the adjacent endplates. A better understanding of low-grade disc infections is still needed. LEVEL OF EVIDENCE: V (animal study).

Tolerancia y eficacia de una fórmula extensamente hidrolizada en lactantes con alergia a proteínas de leche de vaca mediada por IgE. Estudio JUNGLO (I): hidrolizado extenso de caseína / Tolerance and efficacy of an extensively hydrolyzed formula for infants with IgE-mediated cow’s milk protein allergy. JUNGLO study (part I): Extensively hydrolyzed casein formula

Objetivos: El principal objetivo de este estudio fue evaluar la tolerancia de un nuevo hidrolizado de caseína y su eficacia durante un periodo de 3 meses en lactantes diagnosticados de alergia a las proteínas de leche de vaca (APLV) mediada por IgE. Métodos: El estudio forma parte de un ensayo clínico multicéntrico, aleatorizado y doble ciego, que se llevó a cabo en 15 hospitales españoles. En este artículo se presentan los resultados del grupo de tratamiento que recibió un hidrolizado extenso de caseína, comportándose como un estudio observacional. Se incluyeron lactantes diagnosticados de APLV una vez que se confirmó con la titulación de IgE específica, con el fin de comprobar la tolerancia a la nueva fórmula en más del 97% de los niños. La principal variable de estudio fue la tolerancia a la fórmula, y se evaluó mediante una prueba de provocación realizada en el hospital. La evolución de los síntomas clínicos y del crecimiento se evaluó durante un periodo de 3 meses tras la inclusión. Resultados: Se incluyeron 25 niños y 22 niñas. Todos toleraron la introducción de la fórmula de estudio sin reacciones adversas en el primer día, lo que significa que más del 97% de los lactantes toleraron el tratamiento en el momento de su introducción (p= 0,0112). Ocurrieron tres acontecimientos adversos, a los 4, 6 y 10 días de la introducción de la fórmula, que se consideraron posible o probablemente relacionados con la misma, por lo que la tolerancia efectiva fue del 93%. Al cabo de 1 mes de seguimiento, la situación clínica de los lactantes había mejorado, con una disminución del 40,4 al 13% para los síntomas digestivos, y la desaparición total de todos los demás síntomas. El patrón de crecimiento, levemente disminuido al inicio, se normalizó o al menos mejoró a los 3 meses de tratamiento. Conclusiones: El nuevo hidrolizado de caseína se toleró en más del 97% de los lactantes, y mejora los síntomas clínicos de forma rápida en lactantes con APLV mediada por IgE, al tiempo que se mantiene un crecimiento normal (AU)

Objectives: The main objective of this study was to evaluate the tolerance of a new casein hydrolyzate formula, and its efficacy during a 3 months consumption period by infants with IgE-mediated cow’s milk protein allergy (CMPA). Methods: This study was part of randomized, double blind study performed in 15 Spanish hospitals. In the present paper the results of the arm that received an extensively hydrolyzed casein formula are reported. Full term infants aged up to 9 months were included to check that 97% of them tolerate the formula at introduction. The CMPA was confirmed by a specific IgE dosage before inclusion. An oral food challenge was made with the formula. Over 3 months, the evolution of the clinical symptoms and the growth were evaluated. Results: The 25 boys and 22 girls included tolerated the formula at introduction without any adverse reaction during the first day of formula intake, meaning that 97% of the infants tolerated the treatment at introduction (p= 0.0112). Three adverse events were reported 4, 6 and 10 days later and were considered possibly or probably related to the study formula indicating an effective delayed tolerance of more than 93% of infants. At 1 month of follow-up, the condition of the infants was greatly improved as indicated by the dramatic decrease of the digestive symptoms from 40.4% to 13%, and the total regression of all the other symptoms. The growth of the infants over 3 months showed a normal pattern, in agreement with the World Health Organization (WHO) growth references. Conclusion: This new casein hydrolyzate formula shows a rate of tolerance >97%, it is efficient to rapidly improve clinical symptoms and allows a normal growth pattern in infants with CMPA (AU)

Experiencia: aceptabilidad del uso de simulación clínica en educación médica: la experiencia del curso Síntesis de Conocimientos en Medicina / Experience: acceptability of clinical simulation in medical education: Course experience of Synthesis Medical knowledge

Clinical simulation is a technique with multiple benefits. Supervised professional practice results the best predictor of performance quality of a determined clinical skill. The “Summary of Medical Knowledge” course considers within its objectives enhancing necessary clinical skills before graduating, which is done through clinical simulation. Materials and methods: Voluntary participating activity was developed, considering performance in 5 clinical stations, which were assessed by Objective Structured Clinical Examination (OSCE). This activity was held at the Clinical Skill Centre, Faculty of Medicine, University of Chile. The evaluated skills were chosen based on information provided by graduates 2010-2012 about their own perception of competences. Results: 89 students and 53 teachers participated voluntarily. Over 90 percent of respondents (both teachers and students) stated that the activity was a great contribution to become aware of their own skills and limitations, resulting relevant and essential for medical training. Discussion: Simulation is feasible as a method of training in undergraduates, with a high rate of satisfaction for both students and teachers, encouraging the acquisition of clinical skills.

Valoración del análisis de la pieza operatoria en el cáncer gástrico por el cirujano / Concordance between the surgical piece observation by the surgeon and final pathological report for gastric cancer

Background: The systematic dissection of the surgical piece, performed by the surgeon during surgical treatment of gastric cancer, gives information about borders and lymph node involvement. Aim: To determine the concordance between the findings of the surgeon during initial dissection and the final pathological report. Material and Methods: Prospective study of 48 patients aged 64 +/- 10 years (74 percent males) subjected to curative surgery for gastric cancer. Patients were staged according to 2010 TNM classification. Stomach size from the lesser curvature, oral and caudal limits, macroscopic aspect, tumor diameter and lymph node involvement were determined by the surgeon observing the surgical piece. The concordance of this observation with the final pathological report was assessed. Results: Fifty nine percent of patients were subjected to a total gastrectomy and there was a mean of 30 lymph nodes excised. There was a good concordance between surgeon observation and final pathological report for tumor depth (Kappa = 0.64), macroscopic aspect (Kappa = 0.69) and tumor size (Lin = 0.84). There was a bad concordance for lymph node involvement (Kappa = 0.21). The percentage of retraction of lesser curvature length was 24 percent, 30 percent for oral and 22 percent for caudal limits. Conclusions: There is a good concordance between surgeon observation and pathological report for macroscopic aspect, tumor size and depth but the concordance for lymph node involvement is bad.

Introducción: La disección de la pieza operatoria (PO) en forma sistemática en la cirugía por cáncer gástrico (CG) permite al cirujano obtener información de los bordes, compromiso linfonodal y estandarizar. Objetivos: 1) Determinar la concordancia de los hallazgos de la PO disecada por el cirujano y el informe patológico final; 2) Determinar el porcentaje de retracción del estómago; 3) Mostrar una forma de registrar la PO en el CG. Material y Método: Estudio prospectivo de los pacientes operados con intención curativa desde septiembre de 2009 hasta mayo de 2010. Se etapificó con TNM de 2010. De la PO se registró el tamaño del estómago por curvatura menor, límite oral (LO), límite caudal (LC), profundidad, aspecto macroscópico, diámetro tumoral, grupos ganglionares comprometidos y cantidad de ganglios comprometidos. Se compararon estas variables con el informe patológico. El análisis de concordancia se realizó con el test de Kappa y el test de Lin. Resultados: Fueron estudiados 48 pacientes, 74 por ciento hombres, la edad promedio fue 63,7 años (DE 9,8), 59,5 por ciento fueron gastrectomías totales. El promedio de ganglios disecados fue 30,18 (DE 11,8). Se obtiene una buena concordancia para la profundidad del tumor (Kappa = 0,64), aspecto macroscópico (Kappa = 0,69) y tamaño tumoral (Lin = 0,84). Y una mala concordancia para el compromiso ganglionar (Kappa = 0,21). El porcentaje de retracción del largo por curvatura menor fue 24,3 por ciento, del LO fue 30,1 por ciento, del LC fue 22 por ciento. Conclusión: La concordancia de la PO es buena en la profundidad, aspecto macroscópico del tumor y diámetro tumoral, pero es mala en el compromiso ganglionar. Se determina que la retracción del estómago es mayor al 24 por ciento.

Pseudotumor of the mandible as first presentation of hemophilia in a 2-year-old male: a case report and review of jaw pseudotumors of hemophilia.

Pseudotumor of hemophilia (PTH) is a rare complication seen in approximately 1-2% of cases of hemophilia. Although much more common in long bones, the pelvis, and small bones of the hands and feet than in the jaws, occasionally hemorrhage in the jaws occurs with this result. We present a case in a two-year-old male with a one-month swelling of the right mandible without significant medical history or diagnosis of hemophilia who was subsequently diagnosed as having Factor IX deficiency, or hemophilia B. A review of the literature revealed only 15 reported cases of PTH of the jaws and salient features of PTH in the jaws are discussed. The differential diagnosis of masses occurring in the jaws of children is limited and PTH should be considered when a mass presents with rapid growth and the histopathologic features are not diagnostic for a neoplastic process, even in the absence of a prior diagnosis of hemophilia as PTH may be the initial manifestation of this disease.

Three novel mutations in the CFTR gene identified in Galician patients.

We report three novel CFTR missense mutations detected in Spanish patients from Galicia (North West of Spain). In the first case, a patient homozygous for a novel S1045Y mutation died due to pulmonary problems. In the other two cases, both heterozygous for novel mutations combined with the F508del mutation, clinical symptoms were different depending on the mutation, detected as M595I and A107V.

Prolonged survival of a woman with lung cancer diagnosed and treated with chemotherapy during pregnancy. Review of cases reported.

Lung cancer is the most common cause of cancer death in women in the US, diagnosis during pregnancy is rare and has been reported 34 times. We report a case of a 34-year-old woman with stage III locally advanced lung cancer diagnosed during the 27th week of pregnancy. Chest X-ray and thorax MRI revealed a 9cmx7cm mass in the upper right lung lobe. CT guided FNA biopsy indicated adenocarcinoma. Neoadjuvant chemotherapy was administered with vinorelvine (Navelbine) and cisplatin for three cycles with partial response. At 39 weeks, she delivered a healthy baby. Right upper lobectomy with complete lymphadenectomy was performed 3 weeks later. Final pathology was reported as an adenocarcinoma of 7.5cmx6.2cm with involvement of 16/30 lymph nodes. She received three additional cycles of chemotherapy and radiotherapy. Follow-up with CT scan after 11 months did not show recurrence.

New splicing mutation of MEN1 gene affecting the translocation of menin to the nucleus.

UNLABELLED: Multiple endocrine neoplasia type 1 (MEN1) is a syndrome inherited in an autosomal dominant trait caused by the inactivation of the tumor suppressor gene MEN1. OBJECTIVE: To communicate a family with a new heterozygous germ line mutation in the intronic region of MEN1 gene and to study its influence in the menin expression. PATIENTS AND METHODS: We studied 5 members of a family with symptomatic hyperparathyroidism (HPT). One of them had also a neuroendocrine pancreatic tumor, and 2 had non-functional multinodular cortical adrenal hyperplasia compatible with the diagnosis of MEN1. After the mutation was identified, HSP92II restriction enzyme was used to determine both zygosity and segregation of the mutation. RT-PCR from leukocyte's isolated mRNA and western blot from pancreatic tumor tissue were performed. In vitro studies were done in Chinese hamster ovary (CHO) cells transfected with reporter minigenes carrying the coding regions spanning exon (EX)-intron 9 and EX10 with the mutant and the wild type sequences. RESULTS: We identified a heterozygous G-to-T substitution in the intron-EX junction (IVS9-1 G>T) of MEN1 gene in the index case and the family members. The mRNA from patient's leukocytes was larger (934 bp) in comparison to the normal transcript (717 bp). Immunoblot analysis demonstrated that wild type (67 kDa) and two additional mutant proteins (approximately 55 and approximately 90 kDa) were expressed in the pancreatic tissue. The in vitro study showed a 45% nuclear localization of the mutated menin signal and a 95% in the wild type protein. CONCLUSIONS: We identified a new intronic heterozygous germ line mutation (IVS9-1G>T) of MEN1 gene in a family affected by MEN1 syndrome. This mutation alters the splice acceptor site of intron 9 that promotes an incorrect splicing, generating aberrant proteins without the nuclear localization signals necessary for the normal menin translocation to the nucleus.

Bile secretory function in the obese Zucker rat: evidence of cholestasis and altered canalicular transport function.

BACKGROUND: Obese Zucker rats (ZR) have been used as an experimental model for non-alcoholic fatty liver disease and are particularly susceptible to various types of liver injury. Bile secretory function has not been assessed in ZR. AIM: To study bile secretion and expression of the main hepatobiliary transporters in ZR. METHODS: Bile flow and biliary secretion of lipids and glutathione were determined in eight and 14 week old obese ZR and their lean controls. Protein mass and mRNA of the Na(+)/taurocholate cotransporting polypeptide (Ntcp), the bile salt export pump (Bsep), and the multidrug resistant associated protein 2 (Mrp2) were assessed by western and northern blot, respectively. The effects of administration of a tumour necrosis factor alpha inactivator (etanercept) and an insulin sensitiser (rosiglitazone) were assessed in obese ZR while leptin was given to non-obese rats to study its effect on Mrp2 expression. RESULTS: ZR exhibited increased body weight and hyperlipidaemia. Only 14 week old obese ZR has fatty liver. Decreased bile flow and biliary lipid and glutathione secretion as well as reduced hepatic transport of both taurocholate and bromosulphthalein were found in obese ZR. Hepatic Mrp2 protein mass was markedly reduced (-70%) in obese rats while Ntcp and Bsep protein levels were similar to lean rats. Downregulation of Mrp2 seems to involve both transcriptional and post-transcriptional mechanisms probably related to insulin and leptin resistance. CONCLUSIONS: Obese ZR exhibit an impaired bile secretory function with significant functional and molecular alterations consistent with mild cholestasis. A defective hepatobiliary transport capacity may be a contributory factor in rendering the obese ZR more susceptible to liver injury.

[Community-acquired pneumonia requiring hospitalization in immunocompetent elderly patients: clinical features, prognostic factors and treatment]. / Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuacro clínico, factores pronósticos y tratamiento.

BACKGROUND: Community-acquired pneumonia (CAP) is the leading cause of death from infectious disease among the elderly. This study was carried out to examine the clinical manifestations, etiology, prognostic factors and treatment of CAP in immunocompetent elderly patients requiring hospitalization. RESULTS: A total of 306 elderly (80 +/- 7 years) patients were evaluated: 54% were male, 89% had concurrent diseases (principally cardiovascular and neurological disease, chronic obstructive lung disease and diabetes), and 97% were treated with second-or third-generation cephalosporins. Mean hospital stay was 10 days, and mortality was approximately 10% in hospital and around 13% on follow up at 30 days. As compared to younger CAP patients, multiple comorbidity, altered mental status, hypoxemia, high serum urea nitrogen on hospital admission were more frequent in the elderly. Intermediate care and intensive care unit admissions were also more frequent in the elderly. Hospital length of stay as well as mortality in the hospital and at 30 days were higher in elderly patients. The pathogen was identified as part of routine care in around 25% of cases. The most frequent pathogens were Streptococcus pneumoniae (10.5%), enteric Gram negative bacilli (5.2%), Staphylococcus aureus (4.2%) and Haemophilus influenzae (3.9%). In multivariate analysis the prognostic factors on admission associated with in-hospital mortality were advanced age (> 83 years), absence of cough, low blood pressure and hyperphosphatemia. CONCLUSION: CAP in elderly patients is a prevalent disease with specific clinical and epidemiological characteristics, clinical course and prognosis.

Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuadro clínico, factores pronósticos y tratamiento / Community-acquired pneumonia requiring hospitalization in immunocompetent elderly patients: clinical features, prognostic factors and treatment

FUNDAMENTO Y OBJETIVOS: La neumonía adquirida en la comunidad (NAC) es la principal causa de muerte de origen infeccioso en el anciano. Realizamos este trabajo con el propósito de examinar el cuadro clínico, la etiología, los factores pronósticos y el tratamiento de la NAC en el anciano inmunocompetente que requiere hospitalización. Diseño: estudio clínico prospectivo descriptivo observacional. RESULTADOS: Se evaluó a 306 pacientes (80 ñ 7 años), un 54 por ciento de ellos eran varones, el 89 por ciento presentaba comorbilidad (especialmente cardiovascular, neurológica, enfermedad pulmonar obstructiva crónica, diabetes) y el 97 por ciento fue tratados con cefalosporinas de segunda o tercera generación. La estancia promedio en el hospital fue de 10 días, aproximadamente el 10 por ciento de los pacientes falleció en el hospital y alrededor del 13 por ciento en el seguimiento a los 30 días. En la NAC del anciano, comparada con la del adulto joven, fue más frecuente la presencia de comorbilidad múltiple, estado mental alterado, hipoxemia y nitrógeno ureico sérico elevado en la admisión, así como la necesidad de ingreso en la unidad de cuidado intensivo. Además, la estancia y la mortalidad en el hospital y en el seguimiento a los 30 días fueron más elevadas en la población senescente. En la práctica clínica habitual, la etiología microbiana se estableció en aproximadamente el 25 por ciento de los casos. Los patógenos aislados con mayor frecuencia fueron Streptococcus pneumoniae (10,5 por ciento), bacilos gramnegativos entéricos (5,2 por ciento), Staphylococcus aureus (4,2 por ciento) y Haemophilus influenzae (3,9 por ciento). En el análisis multivariado, los factores medidos en la admisión asociados con mayor riesgo de morir en el hospital fueron la edad avanzada (> 83 años), ausencia de tos, hipotensión arterial e hiperfosfemia. CONCLUSIÓN: La NAC en el anciano es una enfermedad prevalente que presenta características clinicoepidemiológicas, evolución y pronóstico particulares (AU)

Análisis de los resultados de una encuesta nacional sobre el grado de formación durante la residencia en anestesiología y reanimación / Analysis of the results of national survey on training levels in residency programs in anesthesiology and

No disponible

Cuidados y problemas en el niño trasplantado a corto y medioplazo en Atención Primaria / No disponible

No disponible

Fly ash content and distribution in lake sediments around a large power station: inferences from magnetic susceptibility analysis.

The bulk magnetic susceptibility of sediments from artificial and natural lakes around a large coal-fired power station in NE Spain has been measured. Higher magnetic susceptibility values are found in lake sediments located SE of the power station. This distribution of susceptibility values is compatible with environmental and meterological studies of emissions from the power station, which indicate a dominant SE plume direction. Mineralogical studies, by means of X-ray diffraction and scanning electron microscopy, show that the highest susceptibility values found in the sediments are caused by magnetic iron spinels in the fly ash that is transferred to the environment by the power station particulate emissions. After the quantitative mineralogical studies of fly ash, two different methods of fly ash content determination in the sediments have been devised, showing very similar results. The low background magnetic susceptibility of the sediments in the study area and the high susceptibility resulting from the input of magnetic fly ash particles allows both delimitation of the polluted area around the power station, and quantification of the fly ash input into the natural sediments.