Nanostructured alkyl carboxylic acid-based restricted access solvents: Application to the combined microextraction and cleanup of polycyclic aromatic hydrocarbons in mosses.

Alkyl carboxylic acid-based nanostructured solvents, synthesized in mixtures of tetrahydrofuran (THF) and water through self-assembly and coacervation, were proved to behave as restricted access liquids. Both physical and chemical mechanisms were found responsible for exclusion of macromolecules such as proteins and polysaccharides. The potential of these solvents for extracting small molecules from complex solid samples, without interference from large biomolecules, was here evaluated. For this purpose, they were applied to the extraction of 14 priority polycyclic aromatic hydrocarbons (PAHs) from mosses prior to their separation by liquid chromatography and fluorescence detection (LC-FLD). Sample treatment involved the vortex shaking of 200 mg of moss with 200 µL of decanoic acid-based solvent for 5 min, subsequent centrifugation for 8 min and analysis of the extract by LC-FLD using external calibration. Proteins precipitated during extraction because of both the decrease of the dielectric constant of the solution caused by THF and the formation of macromolecular complexes with decanoic acid. Polysaccharides were not solubilized in the aqueous cavities of the solvent because of their size exclusion. In-house method validation was performed according to the recommendations of the European Commission Decision 202/657/EC. Method detection and quantification limits for the different PAHs were in the ranges 0.04-0.24 and 0.14-0.80 µg kg(-1), respectively. The method was applied to the determination of different moss species collected in both polluted and unpolluted sites in the South of Spain. Recoveries were within the range 71-110%. The results obtained show that solvents with restricted access properties have the potential to expand the scope of application of restricted access materials to areas other than biological fluids because of their suitability to combine analyte isolation and sample cleanup of solid samples in a single step.

Early growth hormone (GH) treatment promotes relevant motor functional improvement after severe frontal cortex lesion in adult rats.

A number of studies, in animals and humans, describe the positive effects of the growth hormone (GH) treatment combined with rehabilitation on brain reparation after brain injury. We examined the effect of GH treatment and rehabilitation in adult rats with severe frontal motor cortex ablation. Thirty-five male rats were trained in the paw-reaching-for-food task and the preferred forelimb was recorded. Under anesthesia, the motor cortex contralateral to the preferred forelimb was aspirated or sham-operated. Animals were then treated with GH (0.15 mg/kg/day, s.c) or vehicle during 5 days, commencing immediately or 6 days post-lesion. Rehabilitation was applied at short- and long-term after GH treatment. Behavioral data were analized by ANOVA following Bonferroni post hoc test. After sacrifice, immunohistochemical detection of glial fibrillary acid protein (GFAP) and nestin were undertaken in the brain of all groups. Animal group treated with GH immediately after the lesion, but not any other group, showed a significant improvement of the motor impairment induced by the motor lesion, and their performances in the motor test were no different from sham-operated controls. GFAP immunolabeling and nestin immunoreactivity were observed in the perilesional area in all injured animals; nestin immunoreactivity was higher in GH-treated injured rats (mainly in animals GH-treated 6 days post-lesion). GFAP immunoreactivity was similar among injured rats. Interestingly, nestin re-expression was detected in the contralateral undamaged motor cortex only in GH-treated injured rats, being higher in animals GH-treated immediately after the lesion than in animals GH-treated 6 days post-lesion. Early GH treatment induces significant recovery of the motor impairment produced by frontal cortical ablation. GH effects include increased neurogenesis for reparation (perilesional area) and for increased brain plasticity (contralateral motor area).

Visual analogue scales for grading faecal incontinence and quality of life: their relationship with the Jorge-Wexner score and Rockwood scale.

BACKGROUND: The purpose of this study was to determine the probability of substituting two validated methods frequently used for scoring severity and quality of life of faecal incontinence (FI) by a single score represented in a visual analogue scale (VAS). METHODS: One hundred and three consecutive unselected patients affected by FI of different aetiologies were prospectively included in the study. Evaluation of the continence status and quality of life referred to the last month was scored by (1) Jorge-Wexner score, (2) Rockwood FIQL scale, (3) Visual Analogue Scale for Faecal Incontinence (VASFI), and (4) Visual Analogue Scale for Quality of Life (VASQL). Patients unable to respond accurately to one or more of the questionnaires were excluded. The Bland and Altman method was applied to evaluate the agreement between Jorge-Wexner and VASFI. Correlation between both the analogue scales (VASFI and VASQL) and each one with each of the four FIQL scale scores was first determined by an analysis of simple correlation with each subscale and thereafter by multiple regression analysis following the backward strategy. RESULTS: Comparison of VASFI with the Jorge-Wexner score shows that the two methods are neither concordant nor interchangeable, and in a given patient, the differences between both may fluctuate between 5.4 and -10.6 (95 % confidence interval). Correlation of VASFI and VASQL shows that the correlation between both the analogue scales is middling (r (2) = 0.543, ß coefficient -0.538). Correlation of VASFI and FIQL subscales shows that in simple regression analysis, VASFI correlates with lifestyle, coping/behaviour, and embarrassment, but after multiple regression analysis, VASFI correlates significantly only with embarrassment. Correlation of VASQL and FIQL subscales shows that in simple regression analysis, VASQL correlates with lifestyle, coping/behaviour, and embarrassment, but after multiple regression analysis, VASQL only correlates significantly with coping/behaviour. CONCLUSIONS: This study shows that a VAS for FI cannot replace the Jorge-Wexner score and a VAS for quality of life cannot substitute all the four subscales of FIQL. Severity of FI and its impact on quality of life expressed in a VAS only have a fair correlation, showing that they do not assess the same issues, which is also supported by the finding that VASFI correlates significantly only with the embarrassment subscale of FIQL.

Fournier gangrene: first manifestation of occult rectal cancer.

Fournier gangrene is a necrotizing fasciitis of the genital and perineal region. Diverse factors predispose to Fournier gangrene, such as diabetes mellitus, ethylism, liver dysfunction, haematological disorders, obesity or recent regional instrumentation. Rectal tumours can also predispose to Fournier gangrene; most of the reported cases are perforated or unresectable colorectal tumours, but some cases of anorectal cancer diagnosed after recovery from Fournier gangrene have also been reported. In these cases, the presence of a rectal tumour at the time of, or prior to, diagnosis of Fournier gangrene could not be ruled out. We present three cases of rectal cancer whose first manifestation was as Fournier gangrene.

Anal encirclement with a simple prosthetic sling for faecal incontinence.

BACKGROUND: Millions of people suffer from anal incontinence not currently treated due to the complexity and cost of the surgical techniques in use. The purpose of this report is to evaluate the results of anal encirclement with a simple device in a group of patients with faecal incontinence of multiple causes. METHODS: Surgery was performed as a modified Thiersch procedure through minimal perianal incisions, and a flat band of silicone was introduced to encircle the anus. Results were assessed by clinical response and objectively evaluated by comparing pre- and post-operative manometry, Jorge-Wexner and QOL (Rockwood) scores. RESULTS: Over a period of 5 years, this procedure was performed in 20 women and 13 men, mean age 54 years (27-86 years). Causes of incontinence were iatrogenic (5), obstetric (5), idiopathic (5), restorative proctectomy (5), rectal prolapsed (4), congenital (4), neuropathic (3), trauma (1) and mixed (1). Mortality was nil and morbidity was related to early infection (n = 2) and late skin erosion/infection (n = 2). Early or late breaking of the sling occurred in nine patients, due to the inappropriate method of closing the device. There were 13 explants: 3 as definitive and 10 re-implantations. All but one patient improved the clinical status which was objectively assessed by Jorge-Wexner and QOL scores, with significant differences. CONCLUSIONS: This simple, safe and low-cost technique is useful for treating from disturbing soiling to severe incontinence in all those patients with failed sphincteroplasty or not amenable to sphincter repair. However, a proper device needs to be designed.

Effects of growth hormone (GH) replacement and cognitive rehabilitation in patients with cognitive disorders after traumatic brain injury.

OBJECTIVE: To assess the effects of growth hormone (GH) treatment combined with cognitive rehabilitation in patients with adult growth hormone deficiency (GHD) and cognitive disorders occurring after traumatic brain injury (TBI). PARTICIPANTS: Nineteen adult patients with TBI: GHD was found in 11 of them. INTERVENTION: Patients were treated with GH (GHD; sc; 1 mg/day) or vehicle (controls; sc; 1 mg/day); daily cognitive rehabilitation therapy was performed in both groups for 3 months. MAIN OUTCOME MEASURES: The GHRH-arginine test established GHD. The neuropsychological test WAIS was performed before commencing the treatment and 3 months after commencing it. RESULTS: Controls achieved significant improvements in digits and in manipulative intelligence quotient (IQ) (p < 0.05 vs. baseline). GHD achieved significant improvements in more cognitive parameters: understanding, digits, numbers and incomplete figures (p < 0.05 vs. baseline) and similarities, vocabulary, verbal IQ, manipulative IQ and total IQ (p < 0.01). GHD reached significantly greater improvements than controls in similarities (p < 0.01) and in vocabulary, verbal IQ and total IQ (p < 0.05). CONCLUSION: GH administration significantly improved cognitive rehabilitation in GHD patients. Since at the end of treatment period plasma IGF-I levels were similar in both groups it is likely that exogenous GH administration is responsible for the significant differences found.

Hypothyroidism is associated with increased myostatin expression in rats.

Besides its key role in the regulation of muscle growth during development, myostatin also appears to be involved in muscle homeostasis in adults, and its expression is upregulated during muscle atrophy. Since muscle physiology is greatly influenced by thyroid status, and the myostatin promoter region contains several putative thyroid hormone response elements, in the present study we examined the possible role of thyroid hormones in the regulation of myostatin gene expression. Adult male rats were made either hypothyroid or hyperthyroid by means of administration of 0.1% amino- triazole (AMT) in drinking water for 4 weeks, or daily injections of Levo-T4 (L-T4) (100 microg/rat) for 3 weeks, respectively. At the end of the treatment period, both myostatin mRNA and protein content were increased in AMT-treated rats in relation to control rats. In contrast, no changes in myostatin mRNA levels were detected in L-T4-treated rats. The role of thyroid hormones in the regulation of myostatin expression was also investigated in C2C12 cells in vitro. Treatment of C2C12 cells with thyroid hormones stimulated their differentiation into multinucleated myotubes, but did not induce any change in myostatin mRNA abundance. In all, our findings demonstrate that myostatin expression is increased in hypothyroid rats, thus supporting a possible role for this factor in the pathogenesis of the muscle loss that may occur in hypothyroidism.

Extramammary Paget's disease of the groin with underlying carcinoma and fatal outcome.

Extramammary Paget's disease (EMPD) is considered to be an intraepithelial adenocarcinoma. Typically involved anatomical sites are the vulvar, perianal, perineal, scrotal and penile regions. Clinically, the lesions present as well-defined, moist, erythematous plaques usually accompanied by pruritus. An unusual feature of EMPD is its association with cutaneous, adnexal-structure adenocarcinomas and its association with internal malignancies. Histopathological examination shows epidermal acanthosis and elongated rete ridges. Paget's cells are large intraepidermal cells with a large nucleous and abundant pale cytoplasm. Recent studies of perianal and vulvar EMPD have described distinct immunohistochemical subtypes termed cutaneous and endodermal. Cutaneous EMPD is characteristically positive for cytokeratin (CK)7, negative for CK20, and positive for gross cystic disease fluid protein (GCDFP)15+, whereas endodermal EMPD shows a CK7+ CK20+ GCDFP15- phenotype. Surgery remains the treatment of choice, with either wide surgical excision or Mohs' micrographic surgery. We present a case of EMPD with an underlying carcinoma, which combined immunohistochemical findings suggestive of the cutaneous subtype (positive for CK7, GCDFP15, mucin (MUC)1, human epidermal growth factor receptor (HER)2/neu positive) and the endodermal subtype, frequently associated with internal malignancy (CK20, MUC2, CDX-2 positve); however, our patient had no associated internal malignancy.

Massive low gastrointestinal bleeding due to a Dieulafoy rectal lesion.

Massive low gastrointestinal bleedings are often difficult diagnostically and in terms of management. Sometimes, it is not possible to identify the bleeding point after performing diverse diagnostic tests and the patient undergoes a blind subtotal colectomy. With rectal bleeding, this form of surgery is completely useless, as it will not solve the cause of the haemorrhage. The Dieulafoy lesion has been widely described in the stomach, but in the rectum is a very rare entity that can cause massive lower gastrointestinal bleeding. In the literature, there are only 25 described cases of rectal Dieulafoy lesion.

Benign rectovaginal fistulas: management and results of a personal series.

BACKGROUND: Treatment of benign rectovaginal fistula has a high failure rate and entails difficult decisions. The purpose of this retrospective study was to clarify the concepts which may improve its management. METHODS: Between 1983 and 2004, 46 consecutive women of median age 41 years were treated by the same surgeon. Etiology of simple fistulas was iatrogenic (n=6), obstetric (n=4) and septic (n=3). Complex fistulas were due to inflammatory bowel diseases (IBD) (n=18, 11 pouchvaginal) or were iatrogenic (n=9), actinic (n=5) or septic (n=1). Surgical techniques included endorectal or vaginal advancement flaps, fistulectomy and sphincteroplasty, vaginal/rectal closure and epiploplasty, restorative proctectomy and restorative proctocolectomy. In 20 patients, a diverting stoma was performed as a single procedure or concomitant to the curative attempt. RESULTS: Overall, 33 of the 39 fistulas (85%) treated for cure healed, including all simple fistulas and 20 complex fistulas (8 iatrogenic, 3 actinic, 2 ulcerative colitis without restorative proctocolectomy; 5 pouch vaginal; 1 septic; 1 Crohn's disease) (p=0.009). The first operation for the fistula was curative in 20 of 39 fistulas, including 10 of 13 simple and 10 of 26 complex fistulas (p=0.023). There was no significant age difference between cured and not-cured patients. CONCLUSIONS: Simple versus complex fistulas is the most determinant factor for healing. In IBD fistulas, ulcerative colitis shows better prognosis than Crohn's disease. For complex fistulas, a temporary diverting stoma seems necessary.

La miostatina: un regulador autocrino/paracrino del desarrollo muscular / Myostatin: an autocrine/paracrine regulator of muscular development

La miostatina es una proteína perteneciente a la familia del factor de crecimiento de transformación (TGF)-ß, que desempeña un papel fundamental en el control del desarrollo muscular. Como ocurre con el resto de miembros de la familia del TGF-ß, la miostatina se sintetiza en forma de un precursor inactivo que ha de tener un procesamiento proteolítico para dar lugar a la forma madura. La miostatina se expresa de forma casi exclusiva en el músculo esquelético donde actúa de forma autocrina/paracrina al inhibir el desarrollo muscular. En ratones, el bloqueo de la miostatina produce un marcado aumento de la masa muscular y una disminución de la adiposidad. Este efecto sobre el tejido adiposo es tan marcado que el bloqueo de la miostatina es incluso capaz de revertir la obesidad en diversas cepas de ratones. Debido a estas acciones, se está comenzando a estudiar el uso de fármacos capaces de bloquear la miostatina para la prevención y el tratamiento de la obesidad, la diabetes tipo 2, y en enfermedades en las que es necesario favorecer el anabolismo muscular (como ocurre en algunas distrofias musculares o en los cuadros de caquexia) (AU)

Myostatin is a protein belonging to the transforming growth factor (TGF)-ß family, which plays a major role in controlling muscular development. As occurs with other members of the TGF-ß family, myostatin is synthesised as an inactive precursor that needs to undergo proteolytic processing to give rise to the mature peptide. Myostatin is almost exclusively expressed in skeletal muscle, where it acts in an autocrine/paracrine fashion to inhibit muscle growth. In mice, myostatin blockade results in a dramatic increase in muscle mass and decreased adiposity. The effect on adipose tissue is so marked that myostatin blockade is even capable of reverting obesity in several strains of obese mice. Because of these actions, the use of myostatin-blocking agents has been proposed as a new strategy in the prevention or treatment of obesity and type 2 diabetes, as well as in diseases in which muscular anabolism needs to be stimulated (such as some muscular dystrophies and wasting conditions) (AU)

Total anorectal reconstruction: a novel technique.

The aim of this report is to describe a novel technical approach to total anorectal reconstruction after a Miles operation for rectal cancer. Recreation of an internal neosphincter with colonic muscle, the implant of an artificial bowel sphincter (ABS), and the association of a coloplasty constitute a complete substitution of the lost structures and functions. Although the patient developed a late complication which required removal of the ABS, the functional result of the technique can be considered as excellent, to be demonstrated by the incontinence score and quality of life with and without the colostomy.

[Description of psychosocial risk factors in four companies]. / Descripción de los factores de riesgo psicosocial en cuatro empresas.

OBJECTIVE: To describe the distribution of work-related psychosocial risk factor scores in four companies according to the personal and occupational characteristics of the workers. METHODS: Cross-sectional study of a sample of 890 workers in four companies who participated in this study voluntarily. The overall response rate was 34.5%. A self-administrated questionnaire was used to measure the presence of demand, control and social support according to the workers' perceptions. Statistical analyses were performed using median and dispersion measures of psychosocial risk factors for each company separately, as well as description of their distribution according to personal and occupational variables. RESULTS: The median score for social support was almost always equal to 5 for all four companies. However, there was greater variability in psychological demand (between 13 and 16), and for control (between 20 and 26). Comparison of the scores for social and occupational variables revealed similar values for social support but not for control and demand, which showed greater variation according to sex (men), age group (less than 40 years) and occupation (clerks). CONCLUSIONS: Although the low response rate could limit the validity of our results, this is the first study to value the distribution of work-related psychosocial risk factor scores in four companies in Spain. Variability among companies for different groups of workers was found. This study could be useful for future studies exploring the feasibility of defining reference values for use in preventive measures.

Descripción de los factores de riesgo psicosocial en cuatro empresas / Description of psychosocial risk factors in four companies

Objetivo: Describir la distribución de las puntuaciones de los factores de riesgo psicosocial de origen laboral en cuatro empresas según características personales y laborales de los trabajadores. Métodos: Estudio transversal con una muestra de 890 trabajadores que participaron voluntariamente en cuatro empresas, con una tasa de respuesta conjunta del 34,5 por ciento. Los factores de riesgo psicosocial se midieron mediante un cuestionario autoadministrado que valoró la presencia de demanda, control y apoyo social, según la percepción del trabajador. El análisis estadístico se basó en el cálculo de la mediana y medidas de la dispersión de los factores de riesgo psicosocial para cada una de las empresas por separado, además de la descripción de su distribución según variables personales y laborales. Resultados: La puntuación mediana para el apoyo social fue prácticamente igual a 5 en todas las empresas observándose una mayor variabilidad en la demanda psicológica (entre 13 y 16) y en el control (entre 20 y 26). Al comparar respecto a variables sociolaborales, observamos valores similares en el caso del apoyo social, pero no respecto al control y la demanda, que mostraron una mayor variación por sexo (varones), edad (menores de 40 años) y ocupación (administrativos). Conclusión: Aunque la baja tasa de respuesta puede limitar la validez de estos resultados, éste es el primer estudio que valora la distribución de las puntuaciones de los factores de riesgo psicosocial en cuatro empresas diferentes en España, evidenciando la variabilidad entre las empresas para diferentes grupos de trabajadores. Este trabajo puede ser útil para realizar futuros estudios que exploren la factibilidad de definir valores de referencia útiles para la acción preventiva. (AU)

[Emotional disorders in the working population: an emerging problem in occupational health?]. / Trastornos afectivos en la población laboral: un problema emergente en salud laboral?

BACKGROUND: To know the prevalence of emotional disorders in a working population. SUBJECTS AND METHOD: Workers in four companies: construction (A), automobile components (B), electrical and electronic systems (C) and management services (D). The design of the study was cross-sectional with the GHQ-28 questionnaire. RESULTS: The prevalence fluctuated between 8,4% (A) and 24,0% (D). Sex, age, educational level and occupation showed significance differences in some companies. CONCLUSIONS: The results suggest an important prevalence of emotional disorders that likely increase as there will be more firms of services.

Myostatin regulates cell survival during C2C12 myogenesis.

During the myogenic process in vitro, proliferating myoblasts withdraw irreversible from the cell cycle, acquire an apoptosis-resistant phenotype, and fuse into mature myotubes. The key factor regulating both myocyte cell cycle exit and viability during this transition is the the cyclin-dependent kinase inhibitor p21(cip1). Here we show that the expression of myostatin, a TGF-beta superfamily member known to act as a negative regulator of muscle growth, is upregulated in the course of C2C12 cells myogenesis. We also show that transient transfection of C2C12 myobasts with an expression vector encoding mouse myostatin cDNA efficiently inhibits cell proliferation. Paradoxically, myostatin cDNA overexpression also enhances the survival of differentiating C2C12 myocytes, probably by a mechanism involving, at least in part, upregulation of p21(cip1) mRNA. Our results suggest that myostatin role in myogenesis is more complex than initially suggested and involves another level of regulation apart from inhibition of myoblast proliferation.