Hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: experience in a pediatric oncological institution. / Cistitis hemorrágica tras trasplante alogénico de progenitores hematopoyéticos: experiencia en un centro oncológico pediátrico.

OBJECTIVE: To analyze the risk factors associated with hemorrhagic cystitis (HC) severity and the treatment strategies available in HC patients following allogeneic hematopoietic stem cell transplantation (AHSCT). MATERIALS AND METHODS: A retrospective study of medical records was carried out. Patients with HC following AHSCT treated from 2017 to 2021 were divided into two groups according to severity -mild and severe. Demographic data, disease-specific characteristics, urological sequelae, and overall mortality were compared between both groups. The hospital's protocol was used for patient management. RESULTS: 33 episodes of HC were collected in 27 patients, 72.7% of whom were male. HC incidence following AHSCT was 23.4% (33/141). 51.5% of HCs were severe (grades III-IV). Severe graft host disease (GHD) (grades III-IV) and thrombopenia at HC onset were associated with severe HC (p= 0.043 and p= 0.039, respectively). This group had longer hematuria times (p< 0.001) and required more platelet transfusions (p= 0.003). In addition, 70.6% required bladder catheterization, but only 1 case needed percutaneous cystostomy. None of the patients with mild HC required catheterization. No differences were found in terms of urological sequelae or overall mortality. CONCLUSIONS: Severe HC could be predicted thanks to the presence of severe GHD or thrombopenia at HC onset. Severe HC can be managed with bladder catheterization in most of these patients. A standardized protocol may help reduce the need for invasive procedures in patients with mild HC.

OBJETIVO: Analizar factores de riesgo asociados a la gravedad de la cistitis hemorrágica (CH) y estrategias de tratamiento en pacientes con CH tras trasplante alogénico de progenitores hematopoyéticos (TAPH). MATERIAL Y METODOS: Estudio retrospectivo de historias clínicas. Los pacientes con CH tras TAPH tratados entre 2017 y 2021 se dividieron en dos grupos según la gravedad del cuadro (leve y grave). Se compararon datos demográficos, características específicas de la enfermedad, secuelas urológicas y mortalidad global entre ambos grupos. Se utilizó el protocolo del hospital para el manejo de los pacientes. RESULTADOS: Se recogieron 33 episodios de CH en 27 pacientes, de los cuales el 72,7% fueron varones. La incidencia de CH tras TAPH fue del 23,4% (33/141). El 51,5% de las CH fueron graves (grados III-IV). La enfermedad de injerto contra huésped (EICH) grave (grados III-IV) y la trombopenia al inicio se asociaron a CH grave (p= 0,043 y p= 0,039, respectivamente). Este grupo tuvo mayor tiempo de hematuria (p< 0,001) y necesitó más transfusiones de plaquetas (p= 0,003). Además, el 70,6% precisó sondaje vesical, pero solo un caso cistostomía percutánea. Ningún paciente con CH leve precisó sondaje. No hubo diferencias en las secuelas urológicas ni en la mortalidad global. CONCLUSIONES: Una CH más grave podría predecirse por la presencia de EICH grave o trombopenia al inicio del cuadro. La CH grave puede manejarse con sondaje vesical en la mayoría de estos pacientes. Seguir un protocolo estandarizado puede reducir la necesidad de procedimientos invasivos en pacientes con CH leve.

Cistitis hemorrágica tras trasplante alogénico de progenitores hematopoyéticos: experiencia en un centro oncológico pediátrico / Hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: experience in a pediatric oncological institution

Objetivos: Analizar factores de riesgo asociados a la gravedad de lacistitis hemorrágica (CH) y estrategias de tratamiento en pacientes conCH tras trasplante alogénico de progenitores hematopoyéticos (TAPH).Material y métodos: Estudio retrospectivo de historias clínicas. Lospacientes con CH tras TAPH tratados entre 2017 y 2021 se dividieronen dos grupos según la gravedad del cuadro (leve y grave). Se compararon datos demográficos, características específicas de la enfermedad,secuelas urológicas y mortalidad global entre ambos grupos. Se utilizóel protocolo del hospital para el manejo de los pacientes. Resultados: Se recogieron 33 episodios de CH en 27 pacientes, delos cuales el 72,7% fueron varones. La incidencia de CH tras TAPH fuedel 23,4% (33/141). El 51,5% de las CH fueron graves (grados III-IV).La enfermedad de injerto contra huésped (EICH) grave (grados III-IV) yla trombopenia al inicio se asociaron a CH grave (p= 0,043 y p= 0,039,respectivamente). Este grupo tuvo mayor tiempo de hematuria (p<0,001)y necesitó más transfusiones de plaquetas (p= 0,003). Además, el 70,6%precisó sondaje vesical, pero solo un caso cistostomía percutánea. Ningún paciente con CH leve precisó sondaje. No hubo diferencias en lassecuelas urológicas ni en la mortalidad global. Conclusiones: Una CH más grave podría predecirse por la presenciade EICH grave o trombopenia al inicio del cuadro. La CH grave puedemanejarse con sondaje vesical en la mayoría de estos pacientes. Seguirun protocolo estandarizado puede reducir la necesidad de procedimientosinvasivos en pacientes con CH leve.(AU)

Objective: To analyze the risk factors associated with hemorrhagiccystitis (HC) severity and the treatment strategies available in HC patientsfollowing allogeneic hematopoietic stem cell transplantation (AHSCT). Materials and methods: A retrospective study of medical recordswas carried out. Patients with HC following AHSCT treated from 2017to 2021 were divided into two groups according to severity –mild andsevere. Demographic data, disease-specific characteristics, urologicalsequelae, and overall mortality were compared between both groups.The hospital’s protocol was used for patient management. Results: 33 episodes of HC were collected in 27 patients, 72.7% ofwhom were male. HC incidence following AHSCT was 23.4% (33/141).51.5% of HCs were severe (grades III-IV). Severe graft host disease(GHD) (grades III-IV) and thrombopenia at HC onset were associatedwith severe HC (p= 0.043 and p= 0.039, respectively). This group hadlonger hematuria times (p< 0.001) and required more platelet transfusions (p= 0.003). In addition, 70.6% required bladder catheterization,but only 1 case needed percutaneous cystostomy. None of the patientswith mild HC required catheterization. No differences were found interms of urological sequelae or overall mortality. Conclusions: Severe HC could be predicted thanks to the presenceof severe GHD or thrombopenia at HC onset. Severe HC can be managedwith bladder catheterization in most of these patients. A standardizedprotocol may help reduce the need for invasive procedures in patientswith mild HC.(AU)

Postoperative day one systemic inflammatory response syndrome is a powerful early biomarker of clinically relevant pancreatic fistula.

BACKGROUND: Clinically relevant postoperative pancreatic fistula (CR-POPF) is the most feared complication following pancreaticoduodenectomy (PD). There is increasing evidence that very early postoperative factors can be helpful to identify high-risk patients. The aim of this study is to analyze whether postoperative day one (POD1) systemic inflammatory response can be used as an early biomarker of CR-POPF development. METHODS: All patients undergoing PD from 2014 to 2020 were considered. Variables were extracted from a prospectively held database. Clinical and perioperative variables, including POD1 systemic inflammatory response syndrome (SIRS) and C-reactive protein level were collected. To elucidate the independent role of early CR-POPF biomarkers, multivariate hierarchical logistic regression analyses were planned. RESULTS: Out of 243, 213 patients were included in this analysis. CR-POPF occurred in 49 (23.0%) patients and 90-day mortality was 1.4%. POD1 SIRS was reported in 65 (30.5%) patients. Following hierarchical logistic regression analyses, CR-POPF was independently associated with body mass index (OR = 2.787, p = 0.003), soft pancreatic texture (OR = 4.258, p = 0.002) and POD1 SIRS (OR = 50.067, p = 0.001). CONCLUSION: POD1 SIRS is powerfully associated with CR-POPF and therefore it could be used as a tool to optimize postoperative care of PD patients. Further prospective studies are needed to validate these findings.

Bloqueo retrolaminar ecoguiado como analgesia para el manejo de neuralgia por herpes zóster: a propósito de un caso / Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

Los bloqueos interfasciales (BIF) son el resultado de inyectar un anestésico local en el espacio comprendido entre dos fascias con el objetivo de distribuir el volumen y bloquear la transmisión nerviosa correspondiente. La introducción de los BIF como técnica anestésico-analgésica es relativamente reciente. Su amplia difusión y estandarización en estos últimos años ha venido de la mano del uso de ultrasonidos; como resultado ha aumentado la eficacia de los bloqueos y la seguridad en la práctica de los mismos. El bloqueo retrolaminar (RL) y el bloqueo del plano del erector espinal (ESP) comparten características similares y pueden considerarse una alternativa analgésica para los dolores relacionados con afectación de la pared torácica, siendo el bloqueo RL de gran valor en pacientes con riesgo de neumotórax o en quienes no se obtenga adecuada visualización de la sonoanatomía para el bloqueo ESP. Se describe el caso de un paciente con neuralgia aguda por herpes zóster, a quien se le realizó un bloqueo RL exitoso.(AU)

Interfacial plane blocks (IPB) are the result of the injection of an anesthetic locally in the space created between two fasciae with the purpose of distributing the volume of the medication and block the transmission of the corresponding nerves. The introduction of IPB as an analgesic anesthetic technic is relatively resent, and its widespread and standardization this last few years has come by hand of the ultrasound, as a result the safety and efficiency of the IPB has increased. The retrolaminar block (RB) and the Spinal erector plane block (SPB) share characteristics and could be considered as an alternative to manage the thoracic wall pain pathologies, keeping in mind that the RB is of choice for patients in danger of suffering a pneumothorax or in those in which there is an inappropriate anatomic visualization though the echography for the SPB. In this article a case of a patient with acute neuralgia due to herpes zoster who received a successful RB is described.(AU)

Método sensible para monitorizar la migración de las células madre mesenquimales de la médula ósea en modelos murinos / A sensitive method for monitoring the migration of mesenchymal stem cells from bone marrow in murine models

OBJETIVO: Las células madre mesenquimales (MSCs) son atractivas en la terapia regenerativa de patologías humanas. En los modelos murinos, en los que se trasplantan MSCs humanas, es muy importante poder distinguir el origen de las MSCs identificadas en los órganos de ratones. El objetivo de este estudio fue determinar el rendimiento del análisis basado en PCR de secuencias Alu humanas para detectar ADN humano después de la infusión de células madre de médula ósea humana (hBMSCs) en ratones inmunodeficientes. MATERIAL Y MÉTODO: Las hBMSCs se obtuvieron de la cabeza femoral de pacientes sometidos a cirugía de reemplazo de cadera. Se infundieron 106 hBMSCs por vía intravenosa mediante inyección en el seno retro-orbitario de ratones NOD/SCID. Después se evaluó la presencia de ADN humano en pulmón, hígado y hueso. RESULTADOS: En mezclas de ADN in vitro, el ADN humano se detectó fácilmente con una buena relación logarítmica-lineal. De manera similar, cuando se mezclaron osteoblastos humanos y de ratón, se detectaron fácilmente 1-10 células humanas entre 105 células de ratón. Asimismo, se detectó el ADN humano en los pulmones 1 y 7 días después de las infusiones celulares en ratones NOD/SCID. Sin embargo, el ADN humano se detectó de manera inconsistente en el hígado y los huesos. CONCLUSIÓN: La detección de secuencias Alu es un procedimiento eficaz para detectar ADN humano. Los resultados confirman que la mayoría de las hBMSCs inyectadas por vía intravenosa quedan atrapadas en los pulmones. Por lo tanto, de cara al tratamiento de trastornos esqueléticos, se necesitan procedimientos para aumentar la migración de dichas células al hueso

OBJETIVE: Mesenchymal stem cells (MSCs) are commonly used in regenerative therapy of human diseases. In murine models, in which human MSCs are transplanted, distinguishing the origin of the identified MSCs in the organs of mice is important. The objective of this study was to determine the performance of PCR-based analysis of human Alu sequences to detect human DNA after infusion of human bone marrow stem cells (hBMSCs) in immunodeficient mice. MATERIAL AND METHOD: HBMSCs were obtained from the femoral head of patients undergoing hip replacement surgery. 106 hBMSCs were infused intravenously by injection into the retro-orbital sinus of NOD/SCID mice. The presence of human DNA in lung, liver and bone was then assessed. RESULTS: In in vitro DNA mixtures, human DNA was easily detected with a good logarithmic-linear relationship. Similarly, when human and mouse osteoblasts were mixed, 1-10 cells were easily detected among 105 mouse cells. Likewise, human DNA was detected in the lungs 1 and 7 days after cell infusions in NOD/SCID mice. However, human DNA was inconsistently detected in the liver and bones. CONCLUSION: Detecting Alu sequences is an effective procedure to observe human DNA. The results confirm that most intravenously injected hBMSCs are trapped in the lungs. Thus, for the treatment of skeletal disorders, procedures are needed to increase the migration of these cells to the bone

Spirulina supplementation during the transition period by grazing dairy cattle at tropical highland conditions.

The objective of this experiment was to evaluate the effects of spirulina supplementation on oxidative stress, immunity, and productive performance during the transition period by grazing dairy cattle. Thirty multiparous gestating cows with an initial body weight (BW = 544 ± 57 kg) were enrolled in this experiment and were stratified by expected calving date. Cows were randomly assigned to one of the three experimental groups: (1) control, no supplementation of spirulina; (2) spirulina-15 (15 g/day of spirulina); and (3) spirulina-30 (30 g/day of spirulina). Body weight and body condition score (BCS) were recorded and blood samples were collected at - 21, 1, and 14 days, relative to calving. The day of parturition, colostrum and blood samples from calves were collected to measure IgG concentrations. After parturition milk yield, milk components and somatic cell count were monitored. Body weight, BW loss, BCS, and total antioxidant capacity were not affected by spirulina supplementation (P > 0.23) at any time point measured. Milk yield, milk components, and somatic cell count were not altered by treatment (P > 0.13). Results from this experiment suggest neither positive nor negative effects of spirulina supplementation on oxidative stress and productive performance during the transition period.

Ethyl-cellulose rumen-protected methionine alleviates inflammation and oxidative stress and improves neutrophil function during the periparturient period and early lactation in Holstein dairy cows.

The periparturient period is the most critical phase in the productive cycle of dairy cows and is characterized by impairment of the immune system. Our objective was to evaluate the effect of feeding ethyl-cellulose rumen-protected methionine (RPM) starting at d -28 from expected parturition through 60 d in milk on biomarkers of inflammation, oxidative stress, and liver function as well as leukocyte function. Sixty multiparous Holstein cows were used in a block design and assigned to either a control or the control plus ethyl-cellulose RPM (Mepron, Evonik Nutrition & Care GmbH). Mepron was supplied from -28 to 60 d in milk at a rate of 0.09% and 0.10% dry matter during the prepartum and postpartum period. That rate ensured that the ratio of Lys to Met in the metabolizable protein was close to 2.8:1. Blood samples from 15 clinically healthy cows per treatment were collected at d -30, -14, 1, 7, 21, 30, and 60 and analyzed for biomarkers of liver function, inflammation, and oxidative stress. Neutrophil and monocyte function in whole blood was measured in vitro at -14, 1, 7, 21, and 30 d in milk. The statistical model included the random effect of block and fixed effect of treatment, time, and its interaction. Compared with control, ethyl-cellulose RPM increased plasma cholesterol and paraoxonase after parturition. Among the inflammation biomarkers measured, ethyl-cellulose RPM led to greater albumin (negative acute-phase protein) and lower haptoglobin than control cows. Although concentration of IL-1ß was not affected by treatments, greater IL-6 concentration was detected in response to ethyl-cellulose RPM. Cows supplemented with ethyl-cellulose RPM had greater plasma concentration of ferric-reducing antioxidant power, ß-carotene, tocopherol, and total and reduced glutathione, whereas reactive oxygen metabolites were lower compared with control cows. Compared with control, ethyl-cellulose RPM enhanced neutrophil phagocytosis and oxidative burst. Overall, the results indicate that ethyl-cellulose RPM supply to obtain a Lys-to-Met ratio of 2.8:1 in the metabolizable protein during the periparturient period and early lactation is an effective approach to help mitigate oxidative stress and inflammation as well as enhance liver and neutrophil function in dairy cows.

Relationship of high leptin levels with an adverse lipid and insulin profile in 6-8 year-old children in Spain.

BACKGROUND AND AIMS: Leptin, an adipokine elevated in obesity, may be related to an adverse cardiovascular risk profile in childhood. However, evidence for this relationship in pre-pubertal children is scarce. We aimed to analyze the relationship between leptin levels and lipid and insulin profiles in Spanish children. METHODS AND RESULTS: Our population-based sample included 389 males and 369 females aged 6-8 years. Lipid levels were determined by standard methods, insulin by radioimmunoassay and leptin by sandwich ELISA. Leptin levels were higher in girls (8.6 ng/ml) than boys (4.7 ng/ml) (p < 0.001). Leptin increased from ages 6 to 8 in girls, but remained steady in boys. In both sexes, leptin increased significantly (p < 0.001) across weight category from normal weight to obese. Children in the highest tertile of leptin concentration showed significantly (p < 0.01) lower levels of HDL-cholesterol (HDL-C) and apolipoprotein-AI (apo-AI) and significantly higher triglyceride (TG) levels than children in lower tertiles. However, in linear regression analysis, after adjustment for body mass index (BMI), leptin only accounted for 1.5% of the variance of HDL-C in boys, and 2.6% of the variance of apo-AI in girls. Leptin was strongly and positively correlated with insulin and HOMA. Upon regression analysis, leptin contributed to over 20% of the variability in insulin and HOMA, independent of BMI. CONCLUSION: Leptin levels show sex differences in pre-pubertal children. In this age group, leptin levels are strongly related to insulin, and affect lipid profile -namely HDL-C, apo-AI and TG- particularly when leptin levels are high.

Earlier menarcheal age in Spanish girls is related with an increase in body mass index between pre-pubertal school age and adolescence.

BACKGROUND: Higher body mass index (BMI) has been associated with earlier pubertal development. OBJECTIVE: The aim of this longitudinal study was to determine menarcheal age in a Spanish cohort and to assess its association with anthropometric variables at birth, childhood and adolescence. We also analyse whether the tracking of weight between different ages could affect the timing of menarche. METHODS: The sample population included 195 randomly selected 6-8-year-old girls who participated in the baseline of the Four Provinces Study and in the follow-up of this study at 13-16 years old. Anthropometrical variables were measured and BMI and BMI z-score were calculated. Information regarding birth weight and menarche was obtained by means of self-report questionnaire. RESULTS: Correlation analysis showed a significant negative association of age at menarche with weight, BMI and BMI z-score in the baseline and follow-up groups but not with weight at birth. Fat mass at adolescence is related to a significantly earlier menarcheal age. When comparing weight categories, earliest menarcheal age is associated with an increase of BMI between 6-8-year-old and 13-16-year-old girls. CONCLUSION: In our study, high weight in girls is associated with the earliest age at menarche. This becomes a major influence when weight gain occurs between pre-pubertal school age and adolescence.

Elevada prevalencia de déficit de vitamina D entre los niños y adolescentes obesos españoles / High prevalence of vitamin D deficiency among spanish obese children and adolescents

INTRODUCCIÓN: El déficit de vitamina D ha sido relacionado con manifestaciones extraesqueléticas, como insulinorresistencia, diabetes mellitus tipo 2 y enfermedad cardiovascular. El objetivo de este estudio es determinar la prevalencia del déficit de vitamina D en niños obesos españoles y analizar la relación entre niveles de vitamina D y alteraciones del metabolismo hidrocarbonado. PACIENTES Y MÉTODOS: Estudio descriptivo, transversal, donde se recogieron datos clínicos y analíticos de 120 niños obesos y 50 niños con normopeso atendidos en las consultas externas de Pediatría entre enero del 2011 y enero del 2013. RESULTADOS: Los niveles medios de vitamina D fueron de 19,5 ng/ml en obesos y de 31,6 ng/ml en controles. El 58,3% de los obesos presentaron déficit de vitamina D frente al 10% de los controles. Los niveles de vitamina D eran significativamente menores en invierno. Se encontraron cifras más elevadas de HOMA-SDS (3,8 versus 2,4) y triglicéridos (97 versus 81 mg/dl) en los obesos con déficit de vitamina D respecto a los obesos que no tenían déficit. Se halló una correlación negativa entre los niveles de vitamina D y el valor absoluto de HOMA (r = −0,2; p = 0,04), que no se mantiene al analizar HOMA-SDS. CONCLUSIONES: Existe una elevada prevalencia de déficit de vitamina D entre la población obesa infantil de etiología multifactorial. Los niveles deficitarios de vitamina D podrían influir en el desarrollo de insulinorresistencia y diabetes mellitus tipo 2 en la población obesa

INTRODUCTION: Vitamin D deficiency has been associated with extra-skeletal outcomes such as, insulin resistance, type 2 diabetes, and cardiovascular disease. The aim of this study is to determine the prevalence of vitamin D deficiency among obese children and adolescents in Spain and to analyze the relationship between 25-OH-vitamin D (25-OH-D) levels and markers of abnormal glucose metabolism. PATIENTS AND METHODS: A cross-sectional study was conducted in which the clinical and biochemical data were recorded for 120 obese and 50 non-overweight children in Pediatric Clinics from January 2011 to January 2013. RESULTS: The mean 25-OH-D levels among obese children was 19.5 ng/ml and among non-overweight children was 31.6 ng/ml. 58,3% of obese subjects, and 10% of non-overweight subjects had vitamin D deficiency. Serum 25-OH-D levels were lower in winter. Higher HOMASDS (3.8 versus 2.4), and triglycerides (97 versus 81 mg/dl) were found in vitamin D deficient obese children compared to obese children without vitamin D deficiency. A negative correlation was found between 25-OH-D levels and HOMA in absolute values (r=-0.2; P=0.04) that was not maintained when HOMA-SDS was analyzed. CONCLUSIONS: There is a high prevalence of vitamin D deficiency among obese children with a multifactorial etiology. A lower 25-OH-D level could be a risk factor for developing insulin resistance and type 2 diabetes in obese population

[High prevalence of vitamin D deficiency among spanish obese children and adolescents]. / Elevada prevalencia de déficit de vitamina D entre los niños y adolescentes obesos españoles'

INTRODUCTION: Vitamin D deficiency has been associated with extra-skeletal outcomes such as, insulin resistance, type 2 diabetes, and cardiovascular disease. The aim of this study is to determine the prevalence of vitamin D deficiency among obese children and adolescents in Spain and to analyze the relationship between 25-OH-vitamin D (25-OH-D) levels and markers of abnormal glucose metabolism. PATIENTS AND METHODS: A cross-sectional study was conducted in which the clinical and biochemical data were recorded for 120 obese and 50 non-overweight children in Pediatric Clinics from January 2011 to January 2013. RESULTS: The mean 25-OH-D levels among obese children was 19.5 ng/ml and among non-overweight children was 31.6 ng/ml. 58,3% of obese subjects, and 10% of non-overweight subjects had vitamin D deficiency. Serum 25-OH-D levels were lower in winter. Higher HOMA-SDS (3.8 versus 2.4), and triglycerides (97 versus 81 mg/dl) were found in vitamin D deficient obese children compared to obese children without vitamin D deficiency. A negative correlation was found between 25-OH-D levels and HOMA in absolute values (r=-0.2; P=.04) that was not maintained when HOMA-SDS was analyzed. CONCLUSIONS: There is a high prevalence of vitamin D deficiency among obese children with a multifactorial etiology. A lower 25-OH-D level could be a risk factor for developing insulin resistance and type 2 diabetes in obese population.

High tracking of apolipoprotein B levels from the prepubertal age to adolescence in Spanish children.

AIM: To assess tracking of lipid and apolipoproteins from the prepubertal age (baseline, 6-8 years old) to adolescence (follow-up, 13-16 years old) in Spanish children. METHODS: The sample population included 385 healthy children (179 boys and 206 girls). Tracking was estimated by correlations between baseline and follow-up levels, multiple regression models in which the follow-up lipid was the dependent variable and analysing the percentage of individuals who remained in the same lipid levels status from prepubertal age to adolescence. RESULTS: Correlations between baseline and follow-up levels for low density lipoprotein (LDL)-cholesterol and apolipoprotein B (apo B) were stronger in boys and for high density lipoprotein-cholesterol and apo A-I stronger in girls. Regression analyses showed that, after adjusting by body mass index (BMI), baseline LDL-cholesterol and apo B levels explain 23% and 39% of the variation of follow-up LDL-cholesterol and apo B levels, respectively, in boys and 13% and 22%, respectively, in girls. The strength of tracking for LDL-cholesterol and apo B was 79% and 89%, respectively, in boys and 72% and 82%, respectively, in girls. CONCLUSION: Apolipoprotein B showed the strongest tracking in both sexes, stronger than for LDL-cholesterol, which supports the importance of determining apo B levels as a marker of dyslipidaemia in children.

Relationship of dehydroepiandrosterone sulfate with overweight and insulin sensitivity in 12-16-year-old Spanish children.

DHEA-S is the most abundant steroid hormone in human circulation. Although a relationship of DHEA-S with obesity-related diseases has been reported, the metabolic role of this hormone remains unclear, particularly in children. In our study, we have investigated the relationship of DHEA-S levels with anthropometric variables, insulin, HOMA, and free fatty acids in adolescents. The study sample included 812 healthy 12-16-year-old children (383 boys and 429 girls). Plasma DHEA-S was determined by RIA, insulin concentrations by IRMA, and free fatty acids by using a commercial kit. Insulin resistance was estimated using the HOMA index. No significant differences in plasma DHEA-S levels were found between sexes. DHEA-S levels in overweight children were significantly higher than in normal-weight children. DHEA-S levels were significantly correlated with weight and BMI after adjusting for age. Significant positive correlations between DHEA-S and free fatty acids levels were found after adjusting for age and BMI, particularly in boys, but not between DHEA-S levels and insulin or HOMA in either gender. DHEA-S levels in 12-16-year-old children are correlated with weight and BMI independently of age. We failed to find any association between DHEA-S and insulin levels, but we did find a -significant correlation between DHEA-S and free fatty acids levels, suggesting that its association with free fatty acids may be related to the onset of the association of DHEA-S with insulin resi-stance.

Neoplasia sólido papilar de páncreas: correlación clinicopatológica de punción aspiración con aguja fina dirigida por ecoendoscopia / Solid papillary pancreatic neoplasia: cclinicopathological correlation of fine needle aspiration directed by echoendoscopy

Introducción: La neoplasia sólido papilar del páncreas (NSPP) descrita por Frantz en 1959 es una lesión rara, indolente, cuyo origen no ha sido dilucidado. La OMS lo establece como una neoplasia usualmente benigna, con un incremento en su frecuencia en los últimos años. Se presenta en mujeres jóvenes cuya edad promedio es 30 años. Raros casos son reportados en hombres. El presente estudio tiene como finalidad determinar el patrón al USE de la neoplasia solido papilar y correlacionarlos con los hallazgos citológicos de la punción aspiración por aguja fina. (PAAF). Métodos: Se evaluaron retrospectivamente 10 casos visualizados por USE y diagnosticados por PAAF como NSP durante Julio del 2006 a Junio del 2009. Resultados: 90% de los casos eran de género femenino, cuya edad promedio fue 35,2 años. El 90% fueron tumores únicos, con un tamaño tumoral predominante entre 4 a 6 cm en el 60%. No hubo preferencias en la localización. Al USE las lesiones eran de paredes gruesas, 90% ecomixtas, con áreas hiper e hipoecogénicas, macro, microquistes y áreas sólidas, el 10% mostró calcificaciones. En el 100% de los casos los extendidos citológicos presentaron, estructuras papilares con material metacromático en patrón de letras chinas, células con núcleos uniformes, cromatina finamente granular y hendiduras. Conclusión: La PAAF guiada por USE es un método eficaz para el diagnóstico de las NSPP.

Introduction: Solid papillary neoplasia of the pancreas (NSPP) described by Frantz in 1959 is a rare lesion, indolent, whose origin has not been elucidated. WHO establishes it as a neoplasm usually benign, with an increase in frequency in recent years. It occurs in young women whose average age is 30 years. Rare cases are reported in men. This study aims to determine the USE pattern of the solid papillary neoplasia and correlate them with the cytological findings of fine needle aspiration (PAAF). Methods: 10 cases were evaluated retrospectively visualized by USE and diagnosed by PAAF as NSP during July 2006 to June 2009. Results: 90% of the cases were female, whose average age was 35.2 years. 90% were single tumors with a predominant tumoral size between 4 to 6 cm in 60%. There was no preference in location. At USE the lesions were thick-walled, 90% mixed echogenic images with hyper and hypoechoic areas, macro, micro-cysts and solid areas, 10% showed calcifications. In 100% of the cases the cytological study presented papillary structures with metachromatic material in chinese characters pattern, cells with uniform nuclei, finely granular chromatin and crevices. Conclusion: PAAF guided by USE is an effective method for diagnosis of the NSPP.

Correlación citomorfológica de la imagen ecoendoscópica en pancreatopatía areolar con nuevos hallazgos por punción aspiración con aguja fina / Cytomorphologic correlation of the echoendoscopic image in areolar pancreatopathy with new findings by fine needle aspiration

La pancreatitis crónica es un proceso inflamatorio caracterizado por la destrucción del parénquima pancreático y de estructuras ductales con la formación de fibrosis. El Ultrasonido endoscópico (USE) permite la visualización de cambios en el parénquima y del conducto pancreático, permitiendo la identificación de criterios específicos para pancreatitis crónica en forma temprana. Objetivo: Correlacionar cito morfológicamente los cambios de la ecoestructura del páncreas en patrones areolares con áreas hiper e hipoecogénicas y los cambios cito-histológicos obtenidos por punción con aguja fina sugestivos de pancreatitis crónica, fibrosis y/o esteatosis. Método: Se incluyeron 8 pacientes, a quienes se les realizó USE superior presentando criterios de pancreatopatia crónica areolar leve a severa. Se realizó punción aspiración por aguja fina de las áreas hiperecogenicas e hipoecogénicas siendo procesadas con coloraciones especiales rápidas y estudio de bloque celular, en forma ciega, por separado, para su estudio cito-histológico. Los datos fueron vaciados en tablas y analizados en porcentajes. Resultados: Los cambios más frecuentes en las áreas hiperecogenicas fueron la presencia de infiltrado inflamatorio, fibrosis, calcificaciones, esteatosis y hemorragia. No hubo diferencias en cuanto a la presencia de detritus, necrosis grasa ni material proteináceo. En los tipos celulares no pareciera haber diferencias, sin embargo, se observaron células acinares en mayor proporción, seguidas ductales y ocasionalmente de islotes, en su mayoría con cambios reactivos y degenerativos moderados. Conclusión: Existen cambios reactivos demostrados por cito-histología en pacientes con pancreatopatía de patrones areolares en USE que sugieren inflamación y fibrosis crónica, debiendo realizarse estudios con mayor población para establecer grados de severidad.

Chronic pancreatitis is an inflammatory process characterized by the destruction of pancreatic parenchyma and ductal structures with the formation of fibrosis. Endoscopic Ultrasound (USE) allows the visualization of changes in the parenchyma and pancreatic duct, allowing the identification of specific criteria for chronic pancreatitis early. Objective: Correlate cyto morphologically the changes of the echoestructure of the pancreas in areolar patterns with hyper and hypoechoic areas and cyto-histological changes obtained by fine needle aspiration suggestive of chronic pancreatitis, fibrosis and/ or steatosis. Method: Were included 8 patients who underwent upper USE presenting criteria of areolar chronic pancreatopathy mild to severe. A fine needle aspiration of the hyperechoic and hypoechoic areas was performed and processed with special fast colorations and cell block study, in a blind way, separately, for the cytohistological study. Data were emptied into tables and analyzed in percentages. Results: The most frequent changes in hyperechoic areas were the presence of inflammatory infiltrate, fibrosis, calcification, steatosis and bleeding. There were no differences in the presence of detritus, fat necrosis and proteinaceous material. In cell types do not seems to be differences, however, acinar cells were observed in greater proportion, followed by ductal and occasionally islet, mostly with moderate reactive and degenerative changes. Conclusion: There are reactive changes demonstrated by cytohistology in patients with pancreatopathy in areolar patterns in USE suggesting chronic inflammation and fibrosis, studies with larger populations should be conducted to establish degrees of severity.

Association of the Q223R polymorphism with age at menarche in the leptin receptor gene in humans.

Although genetics clearly influences the onset of menarche, the association of age at menarche (AAM) with variants in genes related to energy homeostasis remains unexplored. Our aim was to analyze the relationship of the Q223R polymorphism in the leptin receptor gene (LEPR(Q223R)) with AAM in a population-based sample of healthy pubertal girls. The study included 338 Spanish girls aged between 11 and 17 yr. Data were collected on AAM. The Q223R polymorphism in LEPR was detected by TaqMan allelic discrimination assays. Girls carrying the RR genotype had a significantly younger AAM (11.5 yr) than those carrying the QR (11.9 yr) or QQ (12.0 yr) genotype (P < 0.05). Furthermore, we found a significantly higher frequency of the RR genotype in girls with an AAM of 11 yr or younger than in girls with an AAM older than 12 yr (23.9% vs. 7.8%, χ(2) = 11.17, P = 0.0008). Also, the RR genotype frequency in girls with an AAM between 11 and 12 yr was significantly higher than in girls with an AAM older than 12 yr (16.8% vs. 7.8%, χ(2) = 3.97, P = 0.0046). The Q223R polymorphism in the LEPR gene is associated with variations in AAM among Spanish girls, with the RR genotype being related to earlier onset.

Comparison of the IOPen and iCare rebound tonometers with the Goldmann tonometer in a normal population.

This study proposes to evaluate the level of accuracy of intraocular pressure (IOP) measurements of a second generation rebound tonometer (IOPen, taking as references the Goldmann Applanation Tonometer (GAT) and the iCare rebound tonometer. The right eyes of 101 consecutive clinical patients were assessed with the three tonometers. The IOPen and iCare measurements were taken by two different optometrists and the GAT by an ophthalmologist. In this study, statistically significant differences were found when comparing the IOPen tonometer with the other two tonometers (p < 0.001). The IOPen underestimated the IOP value when compared to the GAT and the iCare (mean differences were 2.94 +/- 4.65 mmHg and 3.20 +/- 4.72 mmHg (mean +/- S.D.), respectively). The frequency distribution of differences demonstrated that in more than 55% of measurements the IOP readings differed by more than 3 mmHg between the IOPen and the GAT. Based on the present population study, these results suggest that IOPen measurements should be interpreted with caution.

Sex-specific association between leptin receptor polymorphisms and leptin levels and BMI in healthy adolescents.

AIM: To examine the relationship of three common polymorphisms in the leptin receptor (LEPR) gene, implicated in the regulation of body weight, with leptin levels and obesity-related phenotypes in a population-based sample of healthy pubertal children in Spain. METHODS: The study included 806 boys and girls aged 12-16 whose anthropometrical data and body composition were recorded. Serum leptin levels were determined by ELISA. The LEPR Q223R, K109R and K656N polymorphisms were determined by TaqMan® allelic discrimination assays. RESULTS: When analysing the Q223R polymorphism, we observed that female carriers of the RR genotype had significantly higher plasma leptin levels (18.2 vs. 15.1 ng/mL p = 0.016) and significantly higher mean BMI values (22.5 vs. 21.3 Kg/m² p = 0.032) than QR carriers. Furthermore, the frequency of the RR genotype in overweight-obese girls was significantly higher than that found in normal-weight girls. No significant differences were observed in boys. Neither boys nor girls showed significant differences when comparing leptin levels, anthropometric variables or body composition by K109R or K656N genotype. CONCLUSION: The fact, that the Q223R polymorphism in the LEPR gene is significantly associated with leptin levels and BMI only in girls, suggests a sex-specific influence of this polymorphism on these variables.

Common variations in estrogen-related genes are associated with severe large-joint osteoarthritis: a multicenter genetic and functional study.

OBJECTIVE: Several lines of evidence suggest that estrogens influence the development of osteoarthritis (OA). The aim of this study was to explore the association of two common polymorphisms within the aromatase (CYP19A1) and estrogen receptor (ER) alpha (ESR1) genes with severe OA of the lower limbs. METHODS: The rs1062033 (CYP19A1) and rs2234693 (ESR1) single nucleotide polymorphisms were genotyped in 5528 individuals (3147 patients with severe hip or knee OA, and 2381 controls) from four centres in Spain and the United Kingdom. Gene expression was measured in femoral bone samples from a group of patients. RESULTS: In the global analysis, both polymorphisms were associated with OA, but there was a significant sex interaction. The GG genotype at rs1062033 was associated with an increased risk of knee OA in women [odds ratio (OR) 1.23; P=0.04]. The CC genotype at rs2234693 tended to be associated with reduced OA risk in women (OR 0.76, P=0.028, for knee OA; OR=0.84, P=0.076 for hip OA), but with increased risk of hip OA in men (OR 1.28; P=0.029). Women with unfavourable genotypes at both loci had an OR of 1.61 for knee OA (P=0.006). The rs1062033 genotype associated with higher OA risk was also associated with reduced expression of the aromatase gene in bone. CONCLUSIONS: Common genetic variations of the aromatase and ER genes are associated with the risk of severe OA of the large joints of the lower limb in a sex-specific manner. These results are consistent with the hypothesis that estrogen activity may influence the development of large-joint OA.