Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine.

This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.

Do the emotions of tourist agents contribute to improving the sustainable planning of a territory?

The sustainability of a territory is achieved through orderly, balanced and harmonious planning over time. Sustainable tourism planning must incorporate the emotions of interest groups. Based on a scale of negative and positive emotions that has already been validated, a participatory study of a qualitative nature has been developed with 118 hotel managers from the region of Extremadura, in the south-west of Spain. In addition, another quantitative research study has been carried out, using a longitudinal exploratory model analyzed in three phases throughout the years 2021 and 2022, using the SEM-PLS methodology. The objective is to detect if the II Tourism Plan (2021-2023) can influence the willingness of hotel managers to participate, and if this participation generates emotions that enrich the planning process of the tourist authorities. The results highlight the importance of completing decision making (cognitive part) with the measurement of emotions (sensitive part) of private agents to involve them in the planning process.

Pulmonary and cutaneous sarcoidosis in a patient with selective immunoglobulin M deficiency / Sarcidosis pulmonar y cutánea en un paciente con déficit selectivo de inmunoglobulina M

Selective immunoglobulin M deficiency (SIgMD) is a rare primary immunodeficiency characterized by decreased serum levels of immunoglobulin M. The pathogenesis of SIgMD is unclear, as well as its association with various immunopathological disorders. We describe a case of sarcoidosis associated with SIgMD. Toour knowledge, such association has not been reported previously. (AU)

Social Responsibility: Sustainable Development Goals and COVID-19-Perception Scale of Students from Higher Education Institutions.

Social movements and the consequences of the current health crisis resulting from COVID-19 have deepened social injustices and inequities, which can be addressed through the benchmarks set by the Sustainable Development Goals (SDGs). This research is related to the perspective of Higher Education Institutions (HEIs) as social transformation agents. The purpose of this research is to create a scale to measure students' perception of the social responsibilities developed by HEIs from the SDGs' perspective. A matrix solution was found after Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) composed of four dimensions. The constructs that form the four dimensions can be used to design strategies which contribute to the SDGs' goals, for which it is necessary to have the opinions of the actors that are part of the educational community. Future research should consider carrying out comparative studies according to sociodemographic variables for a better understanding of the social phenomenon.

Rhythm disturbances associated with lidocaine administration in four dogs with supraventricular tachyarrhythmias.

OBJECTIVE: To describe arrhythmias associated with administration of lidocaine in dogs treated for supraventricular tachyarrhythmias. CASE SUMMARIES: Four dogs with recent-onset supraventricular tachyarrhythmias: 3 dogs had atrial fibrillation (AF), and 1 had focal atrial tachycardia (FAT), which was thought to be AF at the time of assessment. The substrate of the supraventricular tachyarrhythmia was considered to be due to primary cardiomyopathy in 1 dog, high vagal tone in 2 dogs, and the change in hemodynamics from heavy sedation in 1 dog. Pharmacological cardioversion using lidocaine was only successful in the 2 dogs with vagally mediated AF. In these 2 cases, lidocaine administration resulted in a paroxysmal atrial flutter that was self-limiting and quickly led to sinus rhythm within 10 seconds in 1 dog but did not change over a 5-minute interval and required additional boluses in another dog. In the latter case, the dog showed severe bradycardia for 17.5 seconds prior to achieving sinus rhythm. The 2 unsuccessful cases both developed ventricular arrhythmias shortly after the lidocaine administration, with 1 case degenerating into ventricular fibrillation and cardiac arrest. NEW OR UNIQUE INFORMATION PROVIDED: Arrhythmias associated with lidocaine should be considered when treating dogs with supraventricular tachyarrhythmia.

Bioactive Compounds from Agricultural Residues, Their Obtaining Techniques, and the Antimicrobial Effect as Postharvest Additives.

Agricultural vegetable products always seek to meet the growing demands of the population; however, today, there are great losses in supply chains and in the sales stage. Looking for a longer shelf life of fruits and vegetables, postharvest technologies have been developed that allow an adequate transfer from the field to the point of sale and a longer shelf life. One of the most attractive methods to improve quality and nutritional content and extend shelf life of fruits and vegetables is the incorporation of bioactive compounds with postharvest technologies. These compounds are substances that can prevent food spoilage and the proliferation of harmful microorganisms and, in some cases, act as a dietary supplement or provide health benefits. This review presents an updated overview of the knowledge about bioactive compounds derived from plant residues, the techniques most used for obtaining them, their incorporation in edible films and coatings, and the methods of microbial inhibition.

Malignant Peritoneal Mesothelioma as a Rare Cause of Dyspeptic Complaints and Ascites: A Diagnostic Challenge.

INTRODUCTION: Malignant peritoneal mesothelioma (MPM) is a rare malignancy of the mesothelial cells in the peritoneum. The best-defined risk factor is asbestos exposure, but germline mutations in BAP1 also increase susceptibility to this tumor. The diagnosis of MPM is challenging since clinical manifestations are often nonspecific. CASE PRESENTATION: We describe a case of MPM in a 53-year-old former construction worker with prior asbestos exposure. The clinical presentation was a 3-month history of dyspeptic complaints. As initial workup, abdominal ultrasound and upper gastrointestinal endoscopy were performed. Chronic gastritis due to Helicobacter pylori was detected, which was promptly treated but without symptom relief. Abdominal ultrasound showed small volume ascites with hyperechogenic foci, which was later confirmed on computed tomography scan showing the presence of peritoneal nodules in the greater omentum and mesentery. A thorough investigation was conducted based on the suspicion of peritoneal carcinomatosis. A non-peritoneal primary tumor was not found. Ascitic cytology and immunocytochemical studies were suggestive of mesothelioma. He underwent exploratory laparotomy and inoperable peritoneal disease was observed. Peritoneal biopsy confirmed epithelioid-type MPM. Systemic therapy was initiated with platinum plus pemetrexed with good response. The last follow-up was 38 months after the diagnosis. DISCUSSION/CONCLUSION: The diagnosis of MPM is challenging since it requires a high degree of suspicion. MPM has a poor prognosis. The standard of treatment recommended is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. For those who are inoperable, systemic therapy with pemetrexed-cisplatin combination is the alternative. Given the infrequency of disease, it is imperative to ensure patient participation in clinical trials with the purpose of treatment standardization.

INTRODUÇÃO: O mesotelioma peritoneal maligno (MPM) é uma neoplasia rara das células mesoteliais no peritoneu. O fator de risco mais estabelecido é a exposição aos asbestos, mas as mutações germinativas BAP1 também aumentam a suscetibilidade a esse tumor. O diagnóstico é desafiador, uma vez que as manifestaçõs clínicas são frequentemente inespecíficas. CASO CLÍNICO: Reporta-se o caso de um homem de 53 anos, ex-trabalhador da construção civil, com história de exposição a asbestos. O doente apresentava um quadro de queixas dispépticas com 3 meses de evolução. Para estudo inicial, foram realizadas ecografia abdominal e endoscopia digestiva alta. Na endoscopia foi documentada gastrite crónica por Helicobacter pylori tendo feito tratamento de erradicação, mas sem melhoria sintomática. A ecografia abdominal revelou ascite de pequeno volume com focos hiperecogénicos em suspensão, o que foi posteriormente confirmado em tomografia computorizada, demonstrando a presença de nódulos peritoneais no grande epíplon e mesentério. Uma investigação exaustiva foi conduzida na suspeita de carcinomatose peritoneal, mas não foi encontrado nenhum tumor primário noutra localização. A citologia do líquido ascítico e os estudos imunocitoquímicos foram sugestivos de mesotelioma. O doente foi submetido a uma laparotomia exploradora na qual se documentou doença peritoneal inoperável. A biópsia peritoneal confirmou MPM do tipo epitelióide. Foi iniciado tratamento de quimioterapia com platino em associação com pemetrexed, com boa resposta. Seguimento atual de 38 meses pós-diagnóstico. DISCUSSÃO/CONCLUSÃO: O diagnóstico de MPM é desafiante uma vez que requer um alto grau de suspeição. MPM tem um prognóstico reservado. O tratamento standard recomendado é a cirurgia citorredutora com a quimioterapia intraperitoneal hipertérmica. No entanto, nos doentes inoperáveis, a alternativa é a quimioterapia sistémica com pemetrexed-cisplatina. Dada a raridade da doença, é imperativo integrar estes doentes em ensaios clínicos com o objetivo de padronização do tratamento.

Disseminated Bacillus Calmette-Guérin (BCG) infection with pulmonary and renal involvement: A rare complication of BCG immunotherapy. A case report and narrative review.

Intravesical Bacillus Calmette-Guérin (BCG) instillation is a mainstay of adjunctive therapy for superficial bladder cancer that increases length of disease progression-free survival. Although usually well tolerated, moderate to severe local and systemic infectious complications can occur with this immunotherapy. Diagnosis is difficult and often based on high clinical suspicion since in many cases Mycobacterium bovis is not isolated. Treatment is not fully standardized but the combination of anti-tuberculosis drugs and corticosteroids is advocated in severe cases. The authors present an unusual case of a severe infectious complication following intravesical BCG instillation with pulmonary and kidney involvement. Prompt anti-tuberculosis treatment associated to corticosteroid resulted in a marked clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection. Based on this, the authors aimed to review the literature on this exceptional complication of this immunotherapy.

Development and assessment of a novel precordial lead system for accurate detection of right atrial and ventricular depolarization in dogs with various thoracic conformations.

OBJECTIVE: To assess recording accuracy of right atrial and ventricular depolarization during 12-lead ECG when precordial lead V1 was positioned at each of 5 locations on the thorax of dogs with various thoracic conformations. ANIMALS: 60 healthy client-owned dogs. PROCEDURES: 20 dogs were allocated to each of 3 groups (brachymorphic, mesomorphic, or dolichomorphic) on the basis of thoracic conformation. Each dog remained unsedated and was positioned in right lateral recumbency for a series of five 12-lead surface ECGs, with V1 located adjacent to the sternum in the fifth intercostal space (ICS; control), at the costochondral junction (CCJ) of the right first ICS (1st-R), at the CCJ of the right third ICS, at the right third ICS where the thorax was the widest, and at the CCJ of the left first ICS. Electrocardiographic variables were compared among the 5 ECG tracings. RESULTS: When V1 was at the control location, the P wave was positive for all dogs; however, consistent recording of right atrial and ventricular depolarization (ie, R wave-to-S wave ratio [R/S] < 1) occurred more frequently for brachymorphic dogs (16/20) than for dolichomorphic (7/20) and mesomorphic (6/20) dogs. When V1 was at the 1st-R location, the P wave was negative for most dogs, and R/S was < 1 for the majority of dogs in the brachymorphic (19/20), mesomorphic (17/20), and dolichomorphic (16/20) groups. The median R/S for V1 at the 1st-R location was significantly lower than that for the other 4 V1 locations. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that placement of V1 at the 1st-R location provided correct evaluation of right atrial and ventricular depolarization in most dogs regardless of thoracic conformation.

La escala breve de evaluación del Síndrome de Abstinencia de la Nicotina (NDSS-S) en fumadores españoles / The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers

Se presenta una escala breve derivada de la Escala para la Evaluación del Síndrome de la Dependencia de la Nicotina (NDSS). A una muestra de 1.061 fumadores diarios, evaluados en Centros de Atención Primaria, Unidad de Alcoholismo y Unidad de Tabaquismo, se les aplicó la NDSS y la SCID para evaluar dependencia de la nicotina con criterios DSM-IV. Los resultados indican la existencia de un factor general de dependencia de la nicotina con la NDSS. Seleccionamos los ítems con mayor carga factorial (>0,50), obteniendo una escala corta de 6 ítems. Con ella obtenemos resultados semejantes a los de la escala total en las distintas variables del estudio (sociodemográficas y de consumo de cigarrillos). Su fiabilidad es buena (alfa= 0,79), la correlación entre la escala corta y la total es muy alta (r= 0,95, p<,001) y discrimina a los fumadores en función del consumo de cigarrillos y dependencia de la nicotina, tal y como hemos evaluado con la SCID. Su funcionamiento según las curvas ROC es excelente (área de 0,84 bajo la curva). Todo ello sugiere la utilidad de esta escala breve (NDSS-S) para evaluar la dependencia de la nicotina en fumadores (AU)

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from fi ve Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (alpha= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers (AU)

[The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers]. / La escala breve de evaluación del Síndrome de Dependencia de la Nicotina (NDSS-S) en fumadores españoles.

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from five Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (a= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers.

[Psychometric properties of the Nicotine Dependence Syndrome Scale (NDSS) in a sample of smokers treated for their alcohol dependence]. / Propiedades psicométricas de la Escala del Síndrome de Dependencia de la Nicotina (NDSS) en una muestra de fumadores que solicitan tratamiento por su dependencia del alcohol.

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach's alpha = 0.80). Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63). The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol.

Propiedades psicométricas de la Escala del Síndrome de Dependencia de la Nicotina (NDSS) en una muestra de fumadores que solicitan tratamiento por su dependencia del alcohol / Psychometric properties of the Nicotine Dependence Syndrome Scale (NDSS) in a sample of smokers treated for their alcohol dependence

La evaluación de la dependencia de la nicotina con instrumentos breves es de gran relevancia para una mejor detección de este trastorno. En el presente estudio se presentan los resultados con la Escala del Síndrome de Dependencia de la Nicotina (Nicotine Dependence Syndrome Scale, NDSS) de Shiffman, Waters y Hickcox (2004) en una muestra de 183pacientes que demandaron tratamiento en una Unidad de Alcoholismo y que eran además fumadores de cigarrillos. Los resultados indican que el factor general que evalúa dependencia de la nicotina (NDSS-T) tiene una buena fiabilidad (coeficiente alfa de Cronbach = 0.80). El análisis factorial indica la existencia en esta muestra de cuatro de los cinco factores propuestos en la versión original: impulso, prioridad, continuidad y estereotipia. La fiabilidad de las escalas derivadas factorialmente oscilan de muy buenas (0.80) a moderadas (0.63). La NDSS-T correlaciona significativamente con el Cuestionario de Tolerancia de Fagerström (FTQ), con los criterios de dependencia de la nicotina del DSM-IV evaluados con la entrevista SCID y con el número de cigarrillos fumados diariamente. Las curvas ROC indican que la NDSS-T tiene una puntuación de 0.80 bajo la curva (0.70 para el FTQ), lo que indica que predice adecuadamente la dependencia de la nicotina. Este estudio confirma la utilidad de este nuevo instrumento para evaluar la dependencia de la nicotina en los fumadores que al mismo tiempo abusan o dependen del alcohol (AU)

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach’s alpha = 0.80).Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63).The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol (AU)

Psychometric characteristics of the Spanish version of instruments to measure neck pain disability.

BACKGROUND: The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ). METHODS: Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed. RESULTS: Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. VALIDITY: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15. CONCLUSION: Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance. TRIAL REGISTRATION: Clinical Trials Register NCT00349544.

Prostatic stromal cells derived from benign prostatic hyperplasia specimens possess stem cell like property.

INTRODUCTION: The hyper-proliferative activity of stromal smooth muscle (SM) cells is believed to be responsible for the pathogenesis of benign prostatic hyperplasia (BPH). We have observed that those stromal cells can differentiate into unrelated specialized cells. We thus hypothesize that stromal cells derived from adults prostate specimens may contain adult stem cells. To test this hypothesis, human prostate stromal primary cultures were established and used for characterization of their stem cell properties. METHODS: Immunoblotting, immunohistochemistry, RT-PCR, and tissue culture techniques were used to characterize the primary cultured human prostate-derived stromal cells for their stem cell and differentiation properties. The plasticity of these stromal cells was analyzed using cell culture and histology techniques. RESULTS: Primary cultured prostate stromal cells from BPH patient possess polygonal and elongated fibroblast/myofibroblast cellular morphology. They are positive in CD30, CD34, CD44, NSE, CD133, Flt-1, stem cell factor (SCF), and neuron-specific enolase (NSE), but negative in C-Kit, stem cell antigen (SCA), SH2, CD11b. Expression of SM myogenic markers in these cells may be induced by sodium butyrate (NaBu) treatment. Induction to osteogenic and adipogenic differentiation in these cells is also evident. CONCLUSIONS: Our study on primary stromal cells from BPH patients have yielded many interesting findings that these prostate stroma cells possess: (1) mesenchymal stem cell (MSC) markers; (2) strong proliferative potential; and (3) ability to differentiate or transdifferentiate to myogenic, adipogenic, and osteogenic lineages. These cell preparations may serve as a potential tool for studies in prostate adult stem cell research and the regulation of benign prostatic hyperplasia.

Elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and without prolapse.

OBJECTIVES: To compare elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and with no bladder prolapse. PATIENTS AND METHODS: Full-thickness specimens were obtained from the upper lateral anterior vaginal wall of women having a large cystocele repaired (stage III or IV; prolapse group, 33) and the same location in patients with no prolapse having radical cystectomy (control group, 10). The percentage of elastin-positive tissue and elastic fibre width were measured by immunohistochemistry on 6 microm thick tissue sections from 10 random field readings per sample using image analysis software. The examiner was unaware of sample identity and the patients' clinical history. RESULTS: The age was comparable between the control and prolapse groups (median 70.5 years), and the parity, vaginal deliveries, hormone replacement use, cigarette smokers and body mass index were no different between the groups. Immunohistochemical staining and morphometric analysis indicated that elastin expression in the prolapse group was 10.6%, vs 14.4% in the control group (P = 0.049). The median width of elastic fibres was 0.9 microm in the prolapse and 1.8 microm in the control groups (P < 0.001). Elastin expression and elastic fibre width appeared to be stable with increasing age in the prolapse group. CONCLUSIONS: In this case-control study investigating elastin changes in postmenopausal women with prolapse, the elastin expression and fibre width were significantly lower in the vaginal wall of patients with a large cystocele than in controls of a similar age.

Patología depresiva en pacientes con cardiopatía isquémica. Una relación incierta / Depressive disorder in patients with ischemic heart disease. An unclear association

Contexto: En un elevado porcentaje de pacientes con cardiopatía isquémica se puede apreciar algún grado de depresión, y esta asociación parece incrementar el riesgo de morbilidad y mortalidad. Además de las consecuencias sobre el pronóstico y la calidad de vida, hay dificultades para el diagnóstico y el tratamiento de la depresión en estos pacientes. Objetivo: Detectar la sintomatología depresiva en pacientes hospitalizados por cardiopatía isquémica. Material y método: Se investigaron todos los pacientes hospitalizados por cardiopatía isquémica desde el 1 de mayo de 2003 al 30 de abril de 2004, quedando la muestra constituida por 86 pacientes. Se utilizó el cuestionario GHQ, versión española de 28 ítems (Lobo et al, 1986) y la escala Hamilton para la depresión (Hamilton, 1967). Resultados: El cuestionario GHQ fue positivo en un 38,4% de los pacientes. Se apreció depresión en un 33% de los pacientes con GHQ positivo, que equivale al 11,6% de la muestra total. En el momento del alta del hospital, a 9 pacientes (10,5%) se les prescribió tratamiento psicofarmacológico (fundamentalmente antidepresivos). En el análisis estadístico se alcanzó significación estadística entre la escala GHQ y los antecedentes personales psiquiátricos, en general, y entre la depresión y los antecedentes depresivos. Conclusiones: los pacientes ingresados por cardiopatía isquémica tienen más posibilidades de sufrir malestar psíquico y depresión, incrementándose el uso de antidepresivos. La depresión está más vinculada a la patología psiquiátrica previa y no a la enfermedad cardíaca

Background: A high percentage of patients with ischemic heart disease have some degree of depression and this association seems to increase the risk of morbidity and mortality. In addition to the repercussions on prognosis and quality of life, the diagnosis and management of depression in these patients can pose difficulties. Objective: To detect depressive symptomatology in patients hospitalized for ischemic heart disease. Material and method: All patients admitted to our hospital for ischemic heart disease from May 1, 2003 to April 30, 2004 (n = 86) were studied. The Spanish-validated version of the 28-item General Health Questionnaire (GHQ; Lobo et al, 1986) and the Hamilton scale for depression (Hamilton, 1967) were used. Results: The GHQ was positive in 38.4% of the patients. Depression was found in 33% of the patients with a positive GHQ, representing 11.6% of the whole sample. At discharge, nine patients (10.5%) were prescribed psychopharmacological treatment (mainly antidepressants). Statistically significant associations were found between GHQ score and unspecified personal psychiatric antecedents on the one hand and between depression and a prior history of depression on the other. Conclusions: Patients hospitalized for ischemic heart disease have an increased likelihood of suffering from psychic discomfort and depression and consequently the use of antidepressants has increased. Depression is more closely linked to prior psychiatric disorders than to heart disease

Alpha(2) macroglobulin, a PSA binding protein, is expressed in human prostate stroma.

BACKGROUND: Benign prostatic hyperplasia (BPH) is characterized as a stromal process. The stroma smooth muscle (SM) may alter its phenotype during the progression of BPH. We have identified gene transcripts that may be differentially expressed in BPH using a differential display method. Among the fragments isolated, alpha(2) macroglobulin (alpha(2)-M) is one of the most interesting. alpha(2)-M is a binding protein of a variety of proteinases, including prostatic specific antigen (PSA). It also plays roles in molecular trapping and targeting. In this study, we characterized alpha(2)-M expression in the human prostate. METHODS: Differential display was used to identify and isolate the differentially expressed transcripts between normal prostate and BPH tissues. RT-PCR, Western blot, in situ hybridization, and immunohistochemistry were utilized to confirm and characterize alpha(2)-M expression in the prostate. RESULTS: Real-time RT-PCR results revealed that a 3.2-fold increase in alpha(2)-M mRNA expression is observed in BPH compared with normal prostate tissue. A 1.9-fold increase at protein level was also observed. In situ hybridization and immunohistochemistry showed that alpha(2)-M expression is primarily localized to the stromal compartment. Cultured primary stroma cells maintained alpha(2)-M expression, while prostate epithelial cells had a significantly lower level of alpha(2)-M expression. Furthermore, stromal cells in culture produce and secrete alpha(2)-M in the medium. CONCLUSIONS: We identified alpha(2)-M expression in the human prostate. An increased alpha(2)-M expression appears to be associated with BPH. Considering the unique features of its protein binding and targeting properties, alpha(2)-M expressed in the prostate may play an important role in regulating benign and malignant prostatic growth.

Heterogeneity of 5 alpha-reductase gene expression in benign prostatic hyperplasia.

PURPOSE: The search for molecular markers of benign prostatic hyperplasia in general is based on an analysis of a limited number of biopsy samples. Little is known about the homogeneity of the expression of key genes in different zones of the prostate. We studied the intraprostatic (that is within the same gland) and inter-prostatic (that is between glands) variability of 5 alpha-reductase 2 (5aR2) gene expression. MATERIALS AND METHODS: Ten tissue samples removed by open prostatectomy were the source of tissue specimens. Two frozen sections were generated from each of several random biopsies taken from each adenoma immediately after enucleation, 1 of which was used for 5aR2 gene expression analysis and 1 for morphometric analysis. Results among biopsies were compared using the 5 alpha-reductase index (ratio of 5 alpha-reductase expression to an internal standard measured as electrophoretic band intensity). Morphometric composition was determined for smooth muscle, collagen, epithelium and glandular lumens. Statistical comparisons were performed with ANOVA by pairwise multiple comparison (Dunn) and Spearman's rank correlation procedure. RESULTS: For the 71 biopsies analyzed mean 5 alpha-reductase index was 0.23 +/- 0.16 and overall tissue distribution was smooth muscle 34%, collagen 35%, epithelium 14% and glandular lumens 17%. Inter-prostate and intraprostate variability in 5 alpha-reductase index was statistically significant (p = 0.004) as was the variability in stromal-to-epithelial ratio (p = 0.012). The 5 alpha-reductase index showed strong correlation with stroma (%) and negative correlation with epithelium (%). CONCLUSIONS: Benign prostatic hyperplasia is heterogeneous in terms of tissue morphometry and expression of single important genes. This finding limits the use of single biopsy based markers to predict biological behavior, and has significant impact on the ability of distinguishing longitudinal changes in tissue composition from sampling artifacts.