SEDAR/SECCE ECMO management consensus document.

ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial. Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area. This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.

Bovine herpesvirus 1: within-herd seroprevalence and antibody levels in bulk-tank milk.

The aim of the present study was to establish a relationship between the results obtained with the enzyme-linked immunosorbent assay (ELISA) technique for antibodies (against bovine herpesvirus 1) in serum and those in milk at the herd level. For this purpose, 275 samples of bulk-tank milk were analysed with glycoprotein E (gE) antibody ELISA and 207 more were analysed with glycoprotein B (gB) antibody ELISA (482 in total). All of these samples came from dairy herds whose seroprevalence was also evaluated. The results of this study were then used to analyse the sensitivity of the bulk-tankmilk test in detecting herds with a high risk of active infection (>60% seroprevalence) and its specificity in detecting those with few (<20%) or no seropositive animals. In regard to the reference test (results in blood serum), the sensitivity of the bulk-tankmilk test in detecting herds with >60% seropositive animals was 100% for both gE and gB ELISAs. The specificity figures, for gE and gB ELISAs, respectively, were 88.4% and 99.1% for infection-free herds and 72.6% and 96% for herds with <20% seroprevalence. In a quantitative approach, Pearson's correlation coefficients, reported as a measure of linear association between herd seroprevalences and transformed optical density values recorded in bulk-tank milk, were -0.63 for gE ELISA and 0.67 for gB ELISA.

Les auteurs présentent une étude visant à faire ressortir la corrélation entre les résultats obtenus à l'échelle du troupeau au moyen d'une épreuve immunoenzymatique (ELISA) pour la détection d'anticorps dirigés contre l'herpèsvirus bovin de type 1 dans des échantillons de sérum et ceux obtenus dans le lait. À cet effet, 275 échantillons de lait de citerne ont été soumis à un test ELISA visant à déceler la présence d'anticorps dirigés contre la glycoprotéine E (gE) du virus, et 207 autres ont été analysés au moyen d'un test ELISA visant à déceler la présence d'anticorps dirigés contre la glycoprotéine B (gB) (482 échantillons analysés au total). La totalité des échantillons provenait d'élevages laitiers dans lesquels la séroprévalence a également été evaluée. Les résultats de l'étude ont ensuite permis d'analyser la sensibilité du test sur le lait de citerne, c'est-àdire la capacité de ce test à détecter les troupeaux présentant un risque élevé d'infection active (séroprévalence > 60 %), ainsi que sa spécificité, c'est-à-dire sa capacité à détecter les troupeaux dans lesquels le pourcentage d'animaux séropositifs était faible (moins de 20 %) ou nul (0 %). Comparativement au test de référence (analyse des échantillons de sérum), la sensibilité des tests ELISA sur le lait de citerne était de 100 % (détection de tous les troupeaux dotés d'au moins 60 % d'animaux possédant des anticorps dirigés contre la glycoprotéine E ou B). En termes de spécificité des tests ELISA anti-gE et anti-gB, les valeurs étaient, respectivement, de 88,4 % et 99,1 % dans les troupeaux indemnes et de 72,6 % et 96 % dans les troupeaux accusant une séroprévalence inférieure à 20 %. Les coefficients de corrélation de Pearson obtenus par une méthode quantitative pour exprimer la relation linéaire entre les prévalences sérologiques et les valeurs de densité optique modifiées dans le lait de citerne étaient respectivement de ­0,63 pour l'ELISA gE et de 0,67 pour l'ELISA gB.

Los autores describen un estudio encaminado a determinar si existe una relación, y de ser así cuál, entre los resultados del ensayo inmunoenzimático (ELISA) de detección de anticuerpos (contra el herpesvirus bovino 1) en suero y los resultados obtenidos al analizar la leche de rebaños enteros. Para ello se sometieron 275 muestras de leche de tanque a la prueba ELISA de detección de anticuerpos contra la glicoproteína E (gE) y otras 207 muestras a la prueba ELISA de detección de anticuerpos contra la glicoproteína B (gB) (esto es, un total de 482 muestras). Todas esas muestras procedían de rebaños lecheros cuya prevalencia serológica también se calculó. A partir de los resultados del estudio se determinó la sensibilidad de la prueba practicada en la leche de tanque para detectar rebaños con un elevado riesgo de infección activa (más del 60% de animales seropositivos) y su especificidad para detectar aquellos rebaños con pocos (menos del 20%) animales seropositivos o ninguno (0%). En comparación con la prueba de referencia (resultados del análisis sérico), la sensibilidad del análisis de la leche de tanque para detectar rebaños con más de un 60% de animales seropositivos fue del 100% en el caso de ambas pruebas ELISA (gE y gB). En cuanto a la especificidad, las técnicas ELISA para la gE y la gB permitieron detectar respectivamente un 88,4% y un 99,1% de los rebaños libres de infección y un 72,6% y un 96% de los rebaños con menos de un 20% de animales seropositivos. El análisis cuantitativo de los resultados deparó coeficientes de correlación de Pearson, utilizados como medida de la relación lineal entre las seroprevalencias de rebaño y los valores transformados de densidad óptica obtenidos en la leche de tanque, de ­0,63 para el ELISA gE y de 0,67 para el ELISA gB.

Tratamiento quirúrgico conservador del síndrome de HELLP (ELLP) asociado a hematoma hepático subcapsular / Conservative surgical treatment of HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma

Las complicaciones hemorrágicas graves asociadas al embarazo suelen ocurrir en el tercer trimestre del mismo y se relacionan frecuentemente con situaciones de preeclampsia y síndrome HELLP. El síndrome HELLP solo incide en el 0,5-0,9% de las gestaciones, pero su elevada morbimortalidad maternofetal nos obliga a tener en cuenta su diagnóstico en sus diversas formas de presentación clínica. Aunque la gran mayoría de las alteraciones hepáticas que ocurren en el embarazo tienen relación con las escasas hepatopatías inherentes al mismo, la duda diagnóstica ocurre con cierta frecuencia. Presentamos un caso de síndrome HELLP incompleto (variante ELLP) tratado efectivamente mediante actitud quirúrgica conservadora y cuyas peculiaridades inciden en diversos aspectos de esta entidad(AU)

Severe hemorrhagic complications associated with pregnancy usually occur within the third trimester and are frequently linked to preeclampsia and HELLP syndrome. HELLP syndrome affects only 0.5-0.9% of pregnancies but, because it causes high maternal-fetal mortality, a correct diagnosis of the various forms of presentation of this syndrome is essential. Although most of the liver alterations observed during pregnancy are related to pregnancy itself, diagnostic doubts are not infrequent. We present a case of incomplete HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma, which was successfully treated with a conservative surgical approach(AU)

Viroides, pequenos RNAs patogênicos capazes de replicação autônoma: modelos moleculares para o estudo de interações patógeno-hospedeiro e evolução / Viroids, small pathogenic RNAs capable of autonomous replication: molecular models for the study on host-pathogen interactions and evolution

Os viroides, apesar de serem constituídos por um pequeno RNA de fita simples, fortemente estruturado, circular, que não codifica proteínas, são capazes de se replicar de maneira autônoma em plantas superiores e causar doença interagindo diretamente com fatores do hospedeiro. Nesta revisão, serão apresentados e discutidos alguns dos mais recentes trabalhos envolvendo a interação de viroides com fatores do hospedeiro, incluindo aspectos relacionados à replicação, movimento e patogênese, além de suas características evolutivas. Nos últimos anos, alguns grupos de pesquisa têm se aventurado na busca por fatores do hospedeiro e mecanismos moleculares relacionados ao ciclo infeccioso dos viroides, tentando desvendar como esses pequenos RNAs interagem com o hospedeiro induzindo sintomas. Os viroides não codificam proteínas supressoras de silenciamento e, portanto, devem garantir sua existência utilizando estratégias baseadas em sua estrutura secundária, na compartimentalização em organelas, associação com fatores do hospedeiro e eficiência na replicação. A complexidade do ciclo infeccioso desses minúsculos RNAs indica que muitas interações desses patógenos com fatores do hospedeiro ainda devem ser identificadas.

Viroids are small, single-stranded, highly structured, circular RNAs that replicate autonomously in their hosts, without messenger RNA activity. Because they do not encode for proteins, viroids have to interact directly with host factors. This review presents recent progress in understanding the possible role of recently identified viroid-binding host proteins related to replication, trafficking and pathogenesis. It also discusses some aspects on viroid evolution. In recent years, efforts to understand how viroids replicate, cause disease and induce symptoms have prompted details on molecular mechanisms related to the viroid infectious cycle. Inasmuch as viroids lack protein-encoding capacity, including suppressors of gene silencing, their existence could be ensured by their compact conformation, compartimentalization in organelles, association with host factors or by their highly efficient replication. The complexity of the infectious cycle of these tiny pathogenic RNAs indicates that several interactions with host factors remain to be identified.

Citrus viroid V: occurrence, host range, diagnosis, and identification of new variants.

The recently described Citrus viroid V (CVd-V) has been proposed as a new species of the genus Apscaviroid within the family Pospiviroidae. Analysis of 64 samples from different citrus-growing areas has shown that CVd-V is present in the United States, Spain, Nepal, and the Sultanate of Oman. CVd-V found in six sweet orange sources from the Sultanate of Oman was identical to the reference CVd-V variant, whereas three new variants with sequence identities of 98.6% (CVd-VCA), 97.3% (CVd-VST), and 94.9% (CVd-VNE) were identified in sources from California, Spain, and Nepal, respectively. These results suggest that this viroid has not emerged recently and that it is relatively widespread. Transmission assays to sweet orange, mandarin, and mandarin hybrids, clementine, satsuma, lemon, sour orange, Tahiti lime, Palestine sweet lime, calamondin, bergamot, and kumquat have shown that all these citrus species and citrus relatives are hosts for CVd-V. Several indexing approaches, including slot blot, northern blot hybridization, and reverse transcription-polymerase chain reaction, have been evaluated for detecting CVd-V, either using Etrog citron as an amplification host or directly from commercial species and cultivars.

Existence in vivo of the loop E motif in potato spindle tuber viroid RNA.

In vitro experiments have previously identified in potato spindle tuber viroid (PSTVd), the type member of the nuclear viroids, an element of local tertiary structure termed loop E. Here, by direct UV irradiation of PSTVd-infected tomato tissue and subsequent RNA analysis by denaturing polyacrylamide gel electrophoresis, northern blot hybridization and primer extension, we report that PSTVd (+) RNA also forms the loop E in vivo. These results provide strong support for the physiological relevance of this structural motif, which is involved in a wide range of functions including replication, host specificity and pathogenesis.