[Quantitative gait analysis in patients with advanced Parkinson's disease]. / Analisis cuantitativo de la marcha en pacientes con enfermedad de Parkinson avanzada.

AIM: To describe the gait disorders and postural instability in a group of patients with advanced Parkinson's disease (PD). PATIENTS AND METHODS: Gait was analysed in patients in advanced stages of PD on medication. Using a computerised analysis system, we studied the kinematic variables: cadence, number of correct gait cycles (HFPS cycles), total number of cycles, duration of the phases of the cycle, electromyography and a goniometric study of the knee and the ankle. The clinical appraisal of balance and postural instability was completed with the Tinetti and Timed Up and Go tests. RESULTS: The analysis showed alterations in the spatio-temporal parameters with respect to the ranges considered to be normal: reduction of the HFPS cycles, increase in the total number of cycles and alteration of the cadence in many patients. It also revealed that the mean cadence was kept within the limits of normal values, an increase in the duration of the contact phase, reduction of monopodal support and alteration of the joint range of motion of the knee and the ankle. Likewise, changes are also observed in the scores obtained on the clinical scales, which show an increase in the risk factor for falls and mild dependence. CONCLUSION: Quantification by objective analysis of the kinetic and kinematic variables in patients with PD can be used as a tool to establish the influence of the different therapeutic alternatives in gait disorders.

TITLE: Analisis cuantitativo de la marcha en pacientes con enfermedad de Parkinson avanzada.Objetivo. Describir las alteraciones de la marcha e inestabilidad postural en un grupo de pacientes con enfermedad de Parkinson (EP) avanzada. Pacientes y metodos. Se analizo la marcha de pacientes con EP en estadio avanzado on medicacion. Por medio de un sistema de analisis computarizado del movimiento, se estudiaron las variables cinematicas: cadencia, numero de ciclos con apoyo correcto (ciclos HFPS), numero de ciclos totales, duracion de las fases del ciclo, electromiografia, y goniometria de rodilla y tobillo. La valoracion clinica del equilibrio y la inestabilidad postural se completo con los tests Tinetti y Timed Up and Go. Resultados. El analisis mostro alteraciones en los parametros espaciotemporales con respecto a los rangos de normalidad: disminucion de los ciclos HFPS, aumento del numero total de ciclos y alteracion de la cadencia en muchos pacientes, y conservacion de la cadencia media dentro de los limites de la normalidad, aumento de la duracion de la fase de apoyo, disminucion del apoyo monopodal y alteracion del rango articular de la rodilla y el tobillo. Asimismo, se observo una alteracion en las puntuaciones obtenidas en las escalas clinicas, que mostraban un aumento del factor de riesgo de caidas y dependencia leve. Conclusion. La cuantificacion mediante analisis objetivo de las variables cineticas y cinematicas en los pacientes con EP puede emplearse como herramienta para establecer la influencia de las distintas alternativas terapeuticas en el trastorno de la marcha.

Circadian Kisspeptin expression in human term placenta.

Kisspeptin is an essential gatekeeper of reproductive function. During pregnancy high circulating levels of kisspeptin have been described, however the clear role of this neuropeptide in pregnancy remains unknown. We tested the existence of rhythmic kisspeptin expression in human full-term placenta from healthy pregnant women at six different time points during the day. The data obtained by Western blotting were fitted to a mathematical model (Fourier series), demonstrating, for the first time, the existence of a circadian rhythm in placental kisspeptin expression.

TLR2 activation causes tachyphylaxis to ß2 -agonists in vitro and ex vivo: modelling bacterial exacerbation.

BACKGROUND: Asthma is a widespread chronic health problem exacerbated by common viral and bacterial infections. Further research is required to understand how infection worsens asthma control in order to advance therapeutic options in the future. Recent research has revealed that ß2 -adrenergic receptor (ß2 -AR) agonists lose bronchodilatory efficacy because the receptor-mediated molecular pathways responsible for their beneficial actions are desensitized by infection. To date, most studies have focussed on viral infection, leaving the impact of bacterial infection on ß2 -AR desensitization relatively under-investigated. We address this in this study. METHODS AND RESULTS: Utilizing an in vitro model of bacterial exacerbation in airway smooth muscle (ASM) cells, we show that activation of toll-like receptor 2 (TLR2; mimicking bacterial infection) in the presence of an inflammatory stimulus leads to ß2 -AR desensitization. This occurs via TLR2-dependent upregulation of cyclooxygenase 2 (COX-2) mRNA expression and increased secretion of PGE2 . Importantly, PGE2 causes heterologous ß2 -AR desensitization and reduces cAMP production in response to short-acting (salbutamol) and long-acting (formoterol) ß2 -agonists. Thus, bacterial infectious stimuli act in a PGE2 -dependent manner to severely curtail the beneficial actions of ß2 -agonists. The impact of ß2 -AR desensitization is demonstrated by reduced gene expression of the critical anti-inflammatory molecule MKP-1 in response to ß2 -agonists, as well as impaired bronchodilation in a mouse lung slices. CONCLUSIONS: Taken together, our results show that, like viruses, bacteria induce prostanoid-dependent ß2 -AR desensitization on ASM cells. Notably, COX-2 inhibition with the specific inhibitor celecoxib represses PGE2 secretion, presenting a feasible pharmacological option for treatment of infectious exacerbation in asthma in the future.

Characterisation of the sintering behaviour of Waelz slag from electric arc furnace (EAF) dust recycling for use in the clay ceramics industry.

Waelz slag is an industrial by-product from the recovery of electric arc furnace (EAF) dust which is mainly sent to landfills. Despite the different chemical and mineralogical compositions of Waelz slag compared to traditional clays, previous experiments have demonstrated its potential use as a clay substitute in ceramic processes. Indeed, clayey products containing Waelz slag could improve mechanical and environmental performance, fixing most of the metallic species and moreover decreasing the release of some potential pollutants during firing. However, a deeper understanding of the complex phase transformations during its thermal treatment and the connection of this behaviour with the end properties is desirable in order to explain the role that is played by the Waelz slag and its potential contribution to the ceramic process. For this purpose, in the present study, the chemical, mineralogical, thermal and environmental behaviour of both (i) unfired powdered samples, and (ii) pressed specimen of Waelz slag fired up to different temperatures within the typical range of clay based ceramic production, has been studied. The effect of the heating temperature on the end properties of the fired samples has been assessed. In general, an increase of the firing temperature promotes sintering and densification of the products and decreases the open porosity and water absorption which also contributes to the fixation of heavy metals. On the contrary, an increase in the leaching of Pb, Cr and Mo from the fired specimens is observed. This can be attributed to the creation of Fe and Ca molybdates and chromates that are weakly retained in the alkali matrix. On the other side, at temperature above 950 °C a weight gain related to the emission of evolved gases is observed. In conclusion, the firing temperature of the ceramic process is a key parameter that affects not only the technical properties but also strongly affects the leaching behaviour and the process emissions.

Genetic association study in nasal polyposis.

BACKGROUND AND OBJECTIVES: Nasal polyposis (NP) is a chronic inflammatory disease of the upper airways with a variable clinical course and unknown pathogenesis that often coexists with other conditions. Considering the possibility of genetic predisposition, we decided to analyze whether polymorphisms in LTC4S, CYSLTR1, PTGDR, and NOS2A were associated with NP. METHODS: The study population comprised 486 Caucasian individuals. Polyposis and aspirin intolerance were diagnosed following the recommendations of the European Position Paper on Rhinosinusitis and Nasal Polyps. Genotypes were determined using polymerase chain reaction amplification and direct sequencing. RESULTS: The -444A > C LTC4S polymorphism was significantly associated with NP and atopy (P = .033) and with NP and atopic asthma, (P =.012). In addition, a significant association was found when the (CCTTT) repetition of the NOS2A gene was present more than 14 times in patients with NP and asthma (P = .034), in patients with polyposis and intolerance to nonsteroidal anti-inflammatory drugs (P = .009), and in patients with the aspirin triad (P = .005). The PTGDR diplotype CCCT/CCCC (-613CC, -549CC, -441CC and -197TC) was more frequent in patients with NP (P = .043), NP with asthma (P = .013), and the aspirin triad (P = .041). CONCLUSIONS: NP was associated with specific polymorphisms only when it occurred with related phenotypes. Our results suggest that this genetic background plays a more relevant role in the development of the associated clinical features of nasal polyposis than in simple polyposis.

Estimulación cerebral profunda: 12 años de experiencia y 250 pacientes intervenidos con un seguimiento de más de un año / Deep brain stimulation: 12 years experience and 150 patients treated with a follow-up of over a year

Introduction. Deep brain stimulation (DBS) is a widely accepted clinical technique. The main motor symptoms are significantly reduced. The success of the technique depends on the experience of the neurosurgeon, neurologist and neurophysiologist who carry it out. The presentation of extensive series is needed to confirm and further currently held knowledge. Aim. To demonstrate the clinical benefits of a long series of patients treated by a single group with a minimum follow-up of one year and to report new neurophysiological data. Patients and methods. The study examined a total of 250 patients with different diagnoses: most of them with Parkinson’s disease, tremor and dystonia. The nuclei that were chosen were located by magnetic resonance imaging, computerised axial tomography and neurophysiological registers. Neurophysiological exclusion criteria, such as reflex control of heart rate, sympathetic skin response and auditory startle reflex, are employed in order to exclude patients with Parkinson-plus. Results. The motor sub-scale (part III) of the Unified Parkinson’s Disease Rating Scale improves by 64% in the off-medication status with sub-thalamic stimulation at one year after surgery. One year after DBS, patients with dystonia show a significant decrease on the Burke-Fahn-Marsden dystonia scale. The improvement on the scales continues, with a mean descent of 65% in the second year after surgery. Conclusions. DBS is a suitable technique for the treatment of movement disorders. The neuronal activity of the sub-thalamus and the internal globus pallidus presents its own characteristics that reflect the motor symptoms of the patients. Surface electromyography proves to be useful for quantifying the patients’ improvement (AU)

Introducción. La estimulación cerebral profunda (ECP) es una técnica de gran aceptación clínica. Los principales síntomas motores se reducen significativamente. El éxito de la técnica radica en la experiencia del neurocirujano, neurólogo y neurofisiólogo que lo llevan a cabo. La presentación de series extensas es necesaria para confirmar y extender los actuales conocimientos. Objetivo. Demostrar los beneficios clínicos de una larga serie de pacientes intervenidos por un único grupo con un seguimiento mínimo de un año y presentar nuevos datos neurofisiológicos. Pacientes y métodos. Se han estudiado 250 pacientes con diversos diagnósticos; la mayoría con enfermedad de Parkinson, temblor y distonía. Los núcleos elegidos se localizan por resonancia magnética, tomografía axial computarizada y registros neurofisiológicos. Se utilizan criterios de exclusión neurofisiológicos, como el control reflejo de la frecuencia cardíaca, la respuesta simpaticocutánea y el reflejo de sobresalto auditivo, para excluir pacientes con Parkinson-plus. Resultados. La subescala motora (parte III) de la Unified Parkinson’s Disease Rating Scale mejora un 64% en situación off de medicación con la estimulación del subtálamo al año de la cirugía. Los pacientes con distonía muestran, un año después de la ECP, en la escala de distonía Burke-Fahn-Marsden, un descenso significativo. La mejoría en las escalas persiste, con un descenso medio del 65% en el segundo año después de la cirugía. Conclusiones. La ECP es una técnica apropiada para el tratamiento de los trastornos del movimiento. La actividad neuronal del subtálamo y del globo pálido interno presenta características propias que reflejan la sintomatología motora de los pacientes. La electromiografía superficial demuestra ser útil para cuantificar la mejoría de los pacientes (AU)

[Deep brain stimulation: 12 years' experience and 150 patients treated with a follow-up of over a year]. / Estimulación cerebral profunda: 12 años de experiencia y 250 pacientes intervenidos con un seguimiento de más de un año.

INTRODUCTION: Deep brain stimulation (DBS) is a widely accepted clinical technique. The main motor symptoms are significantly reduced. The success of the technique depends on the experience of the neurosurgeon, neurologist and neurophysiologist who carry it out. The presentation of extensive series is needed to confirm and further currently held knowledge. AIM: To demonstrate the clinical benefits of a long series of patients treated by a single group with a minimum follow-up of one year and to report new neurophysiological data. PATIENTS AND METHODS: The study examined a total of 250 patients with different diagnoses: most of them with Parkinson's disease, tremor and dystonia. The nuclei that were chosen were located by magnetic resonance imaging, computerised axial tomography and neurophysiological registers. Neurophysiological exclusion criteria, such as reflex control of heart rate, sympathetic skin response and auditory startle reflex, are employed in order to exclude patients with Parkinson-plus. RESULTS: The motor sub-scale (part III) of the Unified Parkinson's Disease Rating Scale improves by 64% in the off-medication status with sub-thalamic stimulation at one year after surgery. One year after DBS, patients with dystonia show a significant decrease on the Burke-Fahn-Marsden dystonia scale. The improvement on the scales continues, with a mean descent of 65% in the second year after surgery. CONCLUSIONS: DBS is a suitable technique for the treatment of movement disorders. The neuronal activity of the sub-thalamus and the internal globus pallidus presents its own characteristics that reflect the motor symptoms of the patients. Surface electromyography proves to be useful for quantifying the patients' improvement.

Interactions between genes and the environment. Epigenetics in allergy.

Epigenetics is defined as those inheritable changes occurring in gene expression, without actual modification in the genic DNA sequence. Epigenetic factors are chemically stable, potentially reversible, and can be modulated or induced by environmental factors. In the case of allergic disease, epigenetics could explain not only the discordances observed between monozygous twins but also phenomena such as incomplete penetrance, variable expression, gender and progenitor effects, and sporadic cases. In this sense, the hypothesis of hygiene is of great relevance in that it integrates genetic and epidemiological data in the context of environmental exposures. Among the different epigenetic factors, mention must be made of DNA methylation, covalent histone modifications, and other mechanisms that include different protein complexes and RNA-mediated modifications. The regulatory effect of these phenomena upon immune response has important implications for allergic diseases. At present, different lines of pharmacological research are being conducted, based on the modulation of epigenetic factors, modifying expression of the genes that encode for proteins implicated in allergic processes. Among such modulators, mention can be made of antisense oligonucleotides, ribozymes and interference RNA. The applications of epigenetics to the diagnosis and treatment of allergic disorders offer a very promising future of this specialty.

Interactions between genes and the environment. Epigenetics in allergy / Interacciones genes-ambiente. Epigenética en alergia

Epigenetics is defined as those inheritable changes occurring in gene expression, without actual modification in the genic DNA sequence. Epigenetic factors are chemically stable, potentially reversible, and can be modulated or induced by environmental factors. In the case of allergic disease, epigenetics could explain not only the discordances observed between monozygous twins but also phenomena such as incomplete penetrance, variable expression, gender and progenitor effects, and sporadic cases. In this sense, the hypothesis of hygiene is of great relevance in that it integrates genetic and epidemiological data in the context of environmental exposures. Among the different epigenetic factors, mention must be made of DNA methylation, covalent histone modifications, and other mechanisms that include different protein complexes and RNA-mediated modifications. The regulatory effect of these phenomena upon immune response has important implications for allergic diseases. At present, different lines of pharmacological research are being conducted, based on the modulation of epigenetic factors, modifying expression of the genes that encode for proteins implicated in allergic processes. Among such modulators, mention can be made of antisense oligonucleotides, ribozymes and interference RNA. The applications of epigenetics to the diagnosis and treatment of allergic disorders offer a very promising future of this specialty

La Epigenética se define como aquellos cambios heredables que se producen en la expresión génica sin modificar la secuencia de DNA. Los factores epigenéticos se caracterizan por ser químicamente estables, potencialmente reversibles y modulables o inducibles por factores ambientales. En el caso de las enfermedades alérgicas la epigenética podría contribuir a explicar no sólo las discordancias observadas en los gemelos monocigóticos, sino también fenómenos como la penetrancia incompleta, la expresión variable, los efectos del sexo y del progenitor de origen y los casos esporádicos. En este sentido, la hipótesis de la higiene cobra gran relevancia al integrar datos genéticos y epidemiológicos en el marco de las exposiciones ambientales. Entre los factores epigenéticos destacan la metilación del DNA, las modificaciones covalentes de las histonas y otros mecanismos que incluyen distintos complejos proteicos y las modificaciones mediadas por RNA. El efecto regulador de estos fenómenos sobre la respuesta inmune tiene grandes implicaciones en las enfermedades alérgicas. En la actualidad se están desarrollando distintas líneas de investigación farmacológica basadas en la modulación de los factores epigenéticos, modificando la expresión de los genes que codifican proteínas implicadas en los procesos alérgicos. Entre estos moduladores destacan los oligonucleótidos antisentido, las ribozimas y los RNA de interferencia. Las aplicaciones de la epigenética al diagnóstico y tratamiento de las enfermedades alérgicas abre un campo muy esperanzador en el futuro de esta especialidad

Interacciones genes-ambiente. Epigenética en alergia / No disponible

La epigenética se define como aquellos cambios heredables que se producen en la expresión génica sin modificar la secuencia de DNA. Los factores epigenéticos se caracterizan por ser químicamente estables, potencialmente reversibles y modulables o inducibles por factores ambientales. En el caso de las enfermedades alérgicas la epigenética podría contribuir a explicar, no sólo las discordancias observadas en los gemelos monocigóticos sino también fenómenos como la penetrancia incompleta, la expresión variable, los efectos del sexo y del progenitor de origen y los casos esporádicos. En este sentido, la hipótesis de la higiene cobra gran relevancia al integrar datos genéticos y epidemiológicos en el marco de las exposiciones ambientales. Entre los factores epigenéticos destacan la metilación del DNA, las modificaciones covalentes de las histonas y otros mecanismos que incluyen distintos complejos proteicos y las modificaciones mediadas por RNA. El efecto regulador de estos fenómenos sobre la respuesta inmune tiene grandes implicaciones en las enfermedades alérgicas. En la actualidad se están desarrollando distintas líneas de investigación farmacológica basadas en la modulación de los factores epigenéticos, modificando la expresión de los genes que codifican proteínas implicadas en los procesos alérgicos. Entre estos moduladores destacan los oligonucleótidos antisentido, las ribozimas y los RNA de interferencia. Las aplicaciones de la epigenética al diagnóstico y tratamiento de las enfermedades alérgicas abre un campo muy esperanzador en el futuro de esta especialidad (AU)

No disponible

[Knowledge, conduct and opinions of health professionals concerning confidentiality at a hospital]. / Conocimientos, comportamientos y opiniones de los profesionales sanitarios de un hospital en relación a la confidencialidad.

BACKGROUND: To analyse the knowledge, conduct and opinions concerning confidentiality of the medical and nursing personnel who attended the 13 seminars given on this subject at the Virgen del Camino Hospital in Pamplona in the year 2002. METHODS: Distribution before the start of each seminar of a survey of 11 closed questions to be completed anonymously. RESULTS: Ninety-three percent (93.0%) of the 244 professionals attending the seminars responded to the survey (128 doctors and 99 nurses). Ninety-two point one percent (92.1%) of the professionals understand what privacy is, but 58.1% do not know any of the laws that regulate it. Eighty-seven point five percent (87.5%) know when it is legitimate to access the data on a patient, but contrary conduct is recognise in a percentage that increases with age, from 12.5% in the group under 31 years old to 51.9% in those over 50 years of age. More correct practices were recollected amongst nursing personnel even when they show less theoretical knowledge about these questions. Forty-nine point seven percent (49.7%) of the professionals would join another centre if they wanted their diagnosis not to be divulged amongst their colleagues, and 92.2% consider informal comments made in the corridors to be the most frequent way of breaking confidentiality in the hospital. CONCLUSION: It seems timely to call attention to ethical and legal responsibility in our hospital and to encourage reflection amongst professional about this questions of confidentiality in order to improve this key dimension of health care.

[Implantation of a computerised clinical history: survey on the degree of utilisation and satisfaction in a tertiary hospital]. / Implantación de una historia clínica informatizada: encuesta sobre el grado de utilización y satisfacción en un hospital terciario.

BACKGROUND: To assess the utilization of an electronic medical record (EMR), the degree of satisfaction with this tool, as well as to detect problems in its utilization, in a tertiary hospital in Spain. METHODS: A survey was sent by mail to all physicians in the Virgen del Camino Hospital in Pamplona, Spain. RESULTS: Out of 445 staff physicians, 174 answered the survey (39%). Seventy-nine percent considered that the EMR is better than the traditional, paper-based medical record. Sixty-one percent used the EMR for consultation and to introduce clinical data in a regular way. Fifty-five percent agreed that the EMR has advantages for the patient. The main problems detected are a loss in confidentiality, lack of time, insufficient number of computers, and inadequate training. Ninety percent answered that EMR implementation should be continued and only 6% are dissatisfied with the computer application. CONCLUSIONS: There is a high degree of utilization of the EMR in the Virgen del Camino Hospital. Measures should be implemented to resolve the problems detected in this survey.

Arteriovenous fistula after temporomandibular joint arthroscopy successfully treated with embolization.

Temporomandibular joint arthoscopy is a minimal invasive surgical procedure commonly used to effectively treat some internal derangement of the TMJ. However, this method is not free of complications. Arteriovenous fistula (AVF) is a lesion that communicates the high flow arterial system and the low flow venous network. We describe a new case of preauricular traumatic AVF successfully treated with external carotid embolization, along with a review of the medical literature.

[Anterior bulbar compresion with basilar impresion. Surgical management by 2-Piece Le Fort I Transmaxilar Osteotomy]. / Tratamiento quirúrgico de la impresión basilar mediante osteotomía tipo Le Fort I segmentada. A propósito de un caso.

The expansive lesions, whether tumoral or not, originated at the level of the anatomical region of the skull base (SB), show a great histologic variety and clinicaly they cause a variable chronic neurological disfunction. Surgical treatment appears to be the best therapeutic option. An exhaustive knowledge of the topographic anatomy of this area is the mandatory in order to design an appropriate surgical strategy. In many cases, a narrow cooperation with specialists is necesary. As in any other surgical activity, a complete excision of the lesion and an optimal functional and aesthetic rehabilitation, without complications, is the challenge of the surgical team. The approach to the anatomical area of the SB is not single, but is based on a number of procedures, although none of them could be considered the best, or without technical difficulty or any complications. Within the group of transoral approaches, the Le Fort I-Palatal split (LFPS) technique has been considered by different authors an excellent way to approach the clivus and the occipito-vertebral joint. We report the case of a patient, treated in cooperation with the Department of Neurosurgery of our hospital. He was clinical and radiologically diagnosed of basilar impresion with bulbar compression, and the MRI revealed the presence of a located extradural fibrous injury above the odontoid apophysis. Therefore we chose the use of a LFPS to approach this lesion. With an optimal surgical field, a complete excision of the lesion was obtained. The postoperatory result in the subsequent follow-up was highly satisfactory.

[Quality of the spring fountain water in the basic health care area of Sigüenza, Spain]. / Calidad del agua de fuentes de manantial en la zona básica de salud de sigüenza.

BACKGROUND: Spring fountains undergo few or no analytical checks, especially those located far away from centers of population, which poses a health risk due to the possibility of disease-causing microorganisms and undesirable substances being in the water. This study is aimed at studying the spring contamination risk factors and determining the spring fountain water fitness for drinking. METHOD: A cross-sectional, descriptive study, with investigation of the frequency and spread of the contamination risk factors depending upon the developed or undeveloped location of the spring. Two analytical checks, conducted six months apart, of the physicochemical and microbiological parameters selected for assessing the fitness for drinking of the water of 38 fountains included in the study. RESULTS: The most frequent contamination risk factors were: for fountains located in developed areas, grazing (53.8%), weeds (53.8%) and crossing wastewater (53.8%); for those located in undeveloped areas, grazing (72%), weeds (32%) and falling debris (32%). A total of 53.8% of the fountains located in developed areas and 60% of those in undeveloped areas were found fit for drinking in the first test; 76.9% and 68% having respectively been found fit in the second test. Solely 47.4% of the total were found fit for drinking in both of the tests. Microbiological contamination was found in 44.7% of the springs, and the physicochemical contamination in 13.1%. CONCLUSIONS: The contamination risk factors can have a bearing on a spring when sufficient protection is lacking, and the study thereof will provide keys as to the possibility and source of the contamination. When two analytical checks were made, there was a decrease in the percentage of fountains having water fit for drinking, which reveals the risk and susceptibility of these water supplies and the need and importance of regular health department checks.