Pax3 loss of function delays tumour progression in kRAS-induced zebrafish rhabdomyosarcoma models.

Rhabdomyosarcoma is a soft tissue cancer that arises in skeletal muscle due to mutations in myogenic progenitors that lead to ineffective differentiation and malignant transformation. The transcription factors Pax3 and Pax7 and their downstream target genes are tightly linked with the fusion positive alveolar subtype, whereas the RAS pathway is usually involved in the embryonal, fusion negative variant. Here, we analyse the role of Pax3 in a fusion negative context, by linking alterations in gene expression in pax3a/pax3b double mutant zebrafish with tumour progression in kRAS-induced rhabdomyosarcoma tumours. Several genes in the RAS/MAPK signalling pathway were significantly down-regulated in pax3a/pax3b double mutant zebrafish. Progression of rhabdomyosarcoma tumours was also delayed in the pax3a/pax3b double mutant zebrafish indicating that Pax3 transcription factors have an unappreciated role in mediating malignancy in fusion negative rhabdomyosarcoma.

Preclinical evaluation of the effects on the gastrointestinal tract of the antineoplastic drug vincristine repeatedly administered to rats.

BACKGROUND: Vincristine is a commonly used chemotherapeutic agent. It is associated with undesirable digestive side effects. However, the impact of vincristine on gastrointestinal structure and motility or its long-term effects have not been deeply studied in animal models. This could be useful in order to develop therapeutic or preventive strategies for cancer patients. The aim of this study was to analyze such effects. METHODS: Rats received saline or vincristine (0.1 mg kg-1 , ip) daily for 10 days. Evaluations were performed during treatment and 2-6 weeks after. Somatic mechano-sensitivity was assessed using von Frey hairs. Gastrointestinal motor function was studied by means of radiographic still images and colonic propulsion of fecal pellets using fluoroscopy videos. Histological assessment of the gut morphology and immunohistochemistry for HuC/D and nNOS were performed in whole-mount myenteric plexus preparations. KEY RESULTS: Peripheral sensitivity was increased in animals treated with vincristine and did not subside 2 weeks after treatment finalization. Vincristine treatment inhibited gastrointestinal motility although this was recovered to normal values with time. Damage in the digestive wall after vincristine treatment was greater in the ileum than in the colon. Villi shortening (in ileum) and large inflammatory nodules still remained 2 weeks after treatment finalization. Finally, the proportion of nNOS-immunoreactive neurons was increased with vincristine and continued to be increased 2 weeks after treatment finalization. CONCLUSIONS AND INFERENCES: Vincristine alters gastrointestinal motility, peripheral sensitivity and mucosal architecture. Vincristine-induced neuropathy (somatic and enteric), intestinal mucosa damage and inflammatory infiltrations are relatively long-lasting.

[Valproate-induced hyperammonemic encephalopathy]. / Encefalopatia hiperamonemica inducida por acido valproico.

TITLE: Encefalopatia hiperamonemica inducida por acido valproico.

Computer vision-based diameter maps to study fluoroscopic recordings of small intestinal motility from conscious experimental animals.

BACKGROUND: When available, fluoroscopic recordings are a relatively cheap, non-invasive and technically straightforward way to study gastrointestinal motility. Spatiotemporal maps have been used to characterize motility of intestinal preparations in vitro, or in anesthetized animals in vivo. Here, a new automated computer-based method was used to construct spatiotemporal motility maps from fluoroscopic recordings obtained in conscious rats. METHODS: Conscious, non-fasted, adult, male Wistar rats (n=8) received intragastric administration of barium contrast, and 1-2 hours later, when several loops of the small intestine were well-defined, a 2 minutes-fluoroscopic recording was obtained. Spatiotemporal diameter maps (Dmaps) were automatically calculated from the recordings. Three recordings were also manually analyzed for comparison. Frequency analysis was performed in order to calculate relevant motility parameters. KEY RESULTS: In each conscious rat, a stable recording (17-20 seconds) was analyzed. The Dmaps manually and automatically obtained from the same recording were comparable, but the automated process was faster and provided higher resolution. Two frequencies of motor activity dominated; lower frequency contractions (15.2±0.9 cpm) had an amplitude approximately five times greater than higher frequency events (32.8±0.7 cpm). CONCLUSIONS & INFERENCES: The automated method developed here needed little investigator input, provided high-resolution results with short computing times, and automatically compensated for breathing and other small movements, allowing recordings to be made without anesthesia. Although slow and/or infrequent events could not be detected in the short recording periods analyzed to date (17-20 seconds), this novel system enhances the analysis of in vivo motility in conscious animals.

Prevalence and Phylogenetic Analysis of Bartonella Species of Wild Carnivores and Their Fleas in Northwestern Mexico.

The host-parasite-vector relationship of Bartonella spp. system in wild carnivores and their fleas from northwestern Mexico was investigated. Sixty-six carnivores belonging to eight species were sampled, and 285 fleas belonging to three species were collected during spring (April-May) and fall (October-November) seasons. We detected Bartonella species in 7 carnivores (10.6%) and 27 fleas (9.5%) through either blood culture or PCR. Of the 27 Bartonella-positive fleas, twenty-two were Pulex simulans, three were Pulex irritans and one was Echidnophaga gallinacea. The gltA gene and ITS region sequences alignment revealed six and eight genetic variants of Bartonella spp., respectively. These variants were clustered into Bartonella rochalimae, Bartonella vinsonii subsp. berkhoffii and another genotype, which likely represents a novel species of Bartonella spp. Although experimental infection studies are required to prove the vector role of P. simulans, our results suggest that this flea may play an important role in the Bartonella transmission. The results indicated possible host-specific relationships between Bartonella genotypes and the families of the carnivores, but further studies are needed to verify this finding. The presence of zoonotic species of Bartonella spp. in wild carnivores raises the issue of their potential risk for humans in fragmented ecosystems.

May cannabinoids prevent the development of chemotherapy-induced diarrhea and intestinal mucositis? Experimental study in the rat.

BACKGROUND: The antineoplastic drug 5-fluoruracil (5-FU) is a pirimidine analog, which frequently induces potentially fatal diarrhea and mucositis. Cannabinoids reduce gastrointestinal motility and secretion and might prevent 5-FU-induced gut adverse effects. Here, we asked whether cannabinoids may prevent diarrhea and mucositis induced by 5-FU in the rat. METHODS: Male Wistar rats received vehicle or the non-selective cannabinoid agonist WIN 55,212-2 (WIN; 0.5 mg kg-1 injection-1 , 1 injection day-1 , 4 consecutive days) by intraperitoneal (ip) route; on the first 2 days, animals received also saline or 5-FU (150 mg kg-1 injection-1 , cumulative dose of 300 mg kg-1 ). Gastrointestinal motor function was radiographically studied after barium contrast intragastric administration on experimental days 1 and 4. Structural alterations of the stomach, small intestine and colon were histologically studied on day 4. PAS staining and immunohistochemistry for Ki67, chromogranin A and CD163 were used to detect secretory, proliferating, and endocrine cells, and activated macrophages respectively. KEY RESULTS: As shown radiographically, 5-FU induced significant gastric emptying delay (on days 1 and 4) and diarrhea (on day 4). WIN did not significantly alter the motility curves obtained for either control or 5-FU-treated animals but tended to reduce the severity of 5-FU-induced diarrhea and increased permanence of barium from day 1 to the beginning of day 4 in 5-FU-treated animals. 5-FU-induced mucositis was severe and not counteracted by WIN. CONCLUSIONS AND INFERENCES: 5-FU-induced diarrhea, but not mucositis, was partly prevented by WIN at a low dose. Cannabinoids might be useful to prevent chemotherapy-induced diarrhea.

¿Complementa la dosis baja de ketamina al bloqueo paravertebral? / Do low ketamine doses complement the paravertebral block?

Objetivo: El cáncer de mama es el tumor maligno más frecuente entre las mujeres del mundo desarrollado. En España se diagnostican alrededor de 16.000 casos/año, con incidencia máxima entre 45-65 años. Nuestro objetivo fue evaluar la eficacia de la adición de dosis bajas de ketamina para complementar la analgesia postoperatoria proporcionada por el bloqueo paravertebral en la cirugía oncológica de mama no reconstructiva. Material y métodos: Estudio de cohortes, retrospectivo, descriptivo y observacional de 62 pacientes sometidos a cirugía oncológica de mama no reconstructiva, a los que se les realizó bloqueo paravertebral mediante triple punción en el extremo inferior de las apófisis transversas de T2-T4-T6. A un grupo se le añadió ketamina intravenosa a dosis bajas y al otro nada. Se les sedó con propofol en perfusión continua mediante bomba durante la cirugía y se recogió la necesidad de analgesia postoperatoria en las 72 h posteriores a la cirugía. El estudio se realizó de acuerdo con los principios de la declaración de Helsinki, y los datos recogidos han sido tratados conforme la Ley Orgánica 15/99, de 13 de diciembre, de protección de datos de carácter personal. Resultados: Se concluyó que la adición de dosis bajas de ketamina disminuyó la necesidad de analgesia postoperatoria en las 72 horas posteriores a la cirugía siendo ésta estadísticamente significativa a las 48 y 72 horas (p < 0,05). Conclusiones: La adición de dosis bajas de ketamina al bloqueo paravertebral torácico con triple punción consiguió reducir los analgésicos demandados por el paciente en las 72 h posteriores a la cirugía. Las limitaciones del estudio fueron la no utilización del EVA para medir la necesidad de analgesia postoperatoria al tratarse de un estudio retrospectivo y la administración de analgesia pautada en las primeras 24 h postoperatorias (paracetamol, AINE o paracetamol + AINE) (AU)

Objective: Breast cancer is the most frequent malignant tumor among women in the development world. In Spain, they are diagnosed around 16,000 cases/year, with peak incidence between con 45-65 years old. Our objective was to evaluate the effectiveness of additional low ketamine doses to complement the postoperative analgesia provided by the paravertebral block in breast cancer surgery. Material and methods: Cohort, retrospective, descriptive and observational study of 62 patients undergoing oncologic surgery of breast to wich we performed paravertebral blockade by triple puncture in the lower end of the transverse processes of T2-T4-T6. A group was added intravenous ketamine at low doses and the other nothing. We sedated them with propofol in continuous perfusion by pump and we collected the need of postoperative analgesia in the 72 h after surgery. Results: It was concluded that the addition of low-dose ketamine decreased the need for postoperative analgesia in the 72 hours after the surgery being statistically significant at 48 to 72 hours (p <0,05). Conclusion: The addition of low doses of ketamine to thoracic paravertebral blockade with triple puncture was able to reduce pain relievers demanded by the patient in the 72 h after surgery. Limitations of the study were the non utilization of EVA to measure the need for postoperative analgesia and the administration of analgesia scheduled in the first 24 postoperative hours (paracetamol, nonsteroidal anti-inflammatory or paracetamol + nonsteroidal anti-inflammatory) (AU)

In vitro and non-invasive in vivo effects of the cannabinoid-1 receptor agonist AM841 on gastrointestinal motor function in the rat.

BACKGROUND: Cannabinoids have been traditionally used for the treatment of gastrointestinal (GI) symptoms, but the associated central effects, through cannabinoid-1 receptors (CB1R), constitute an important drawback. Our aims were to characterize the effects of the recently developed highly potent long-acting megagonist AM841 on GI motor function and to determine its central effects in rats. METHODS: Male Wistar rats were used for in vitro and in vivo studies. The effect of AM841 was tested on electrically induced twitch contractions of GI preparations (in vitro) and on GI motility measured radiographically after contrast administration (in vivo). Central effects of AM841 were evaluated using the cannabinoid tetrad. The non-selective cannabinoid agonist WIN 55,212-2 (WIN) was used for comparison. The CB1R (AM251) and CB2R (AM630) antagonists were used to characterize cannabinoid receptor-mediated effects of AM841. KEY RESULTS: AM841 dose-dependently reduced in vitro contractile activity of rat GI preparations via CB1R, but not CB2R or opioid receptors. In vivo, AM841 acutely and potently reduced gastric emptying and intestinal transit in a dose-dependent and AM251-sensitive manner. The in vivo GI effects of AM841 at 0.1 mg/kg were comparable to those induced by WIN at 5 mg/kg. However, at this dose, AM841 did not induce any sign of the cannabinoid tetrad, whereas WIN induced significant central effects. CONCLUSIONS & INFERENCES: The CB1R megagonist AM841 may potently depress GI motor function in the absence of central effects. This effect may be mediated peripherally and may be useful in the treatment of GI motility disorders.

Effects of chronic dietary exposure to monosodium glutamate on feeding behavior, adiposity, gastrointestinal motility, and cardiovascular function in healthy adult rats.

BACKGROUND: Monosodium glutamate (MSG) is a flavor-enhancer widely used as a food additive. However, its safe dietary concentration and its toxicity, including its possible implication in the recent metabolic syndrome pandemia, is still a controversial issue. Therefore, a deep knowledge of its effects upon regular dietary use is needed. Our aim was to evaluate the effects of chronic exposure to MSG on feeding behavior, abdominal fat, gastrointestinal motility, and cardiovascular function in rats. METHODS: Two groups of adult male Wistar rats were used: control and treated with MSG (4 g/L in drinking water) for 6 weeks. Different functional parameters were determined and the histological structure was analyzed in tissues of interest. KEY RESULTS: Compared to control animals, chronic MSG increased water intake but did not modify food ingestion or body weight gain. Neither the abdominal fat volume nor the fat fraction, measured by magnetic resonance imaging, was modified by MSG. Monosodium glutamate did not alter general gastrointestinal motility, but significantly increased the colonic response to mechanical stimulation. It slightly reduced endothelium-dependent relaxation in aorta, without significantly modifying any other cardiovascular parameters. No significant histological alterations were detected in salivary glands, intestinal wall, aorta, heart, and kidney. CONCLUSIONS & INFERENCES: Chronic treatment with MSG in the adult rat increased water intake. This supports its potential to improve acceptance of low-fat regimens and to increase hydration in the elderly and sportspeople, often at risk of dehydration. Changes in colonic contractility and cardiovascular function could have some long-term repercussions warranting further research.

Synthesis and complementary self-association of novel lipophilic π-conjugated nucleoside oligomers.

A series of lipophilic nucleosides comprising natural and non-natural bases that are π-conjugated to a short oligophenylene-ethynylene fragment has been synthesized. These bases comprise guanosine, isoguanosine, and 2-aminoadenosine as purine heterocycles, and cytidine, isocytosine and uridine as complementary pyrimidine bases. The hydrogen-bonding dimerization and association processes between complementary bases were also studied by (1)H NMR and absorption spectroscopy in order to obtain the relevant association constants.

La influencia de factores individuales, relacionados con el trabajo, socioeconómicos y de organización del sistema sanitario sobre la duración de la incapacidad temporal / The influence of individual, work-related, socioeconomic, and the health system organization factors on the duration of sick-leave

Objetivo: Estudiar la frecuencia de aparición de Eventos Adversos (EA) atribuibles a la atención sanitaria en el hospital Severo Ochoa de Leganés y analizar el tipo de EA detectado. Material y método: Se realizó un estudio descriptivo de carácter retrospectivo en pacientes dados de alta durante 2004 en dicho hospital, que constó de dos fases. En la primera fase o de screening se identificaron los casos con riesgo de aparición de un EA. En la segunda fase o de confirmación se realizó la revisión de los casos cribados para confirmar o descartar la existencia del EA. Se consideró EA tanto los Efectos Adversos como los incidentes. Los casos confirmados se analizaron tipificando sus consecuencias y valorando si eran prevenibles o no. Resultados: Se seleccionaron 240 historias clínicas, de las cuales 90 (38%) pasaron a la segunda fase de análisis del estudio. De estas 90 historias, en 47 (52%) se había producido al menos un EA. En 34 pacientes se estimó que se había producido al menos un EA y en 13 un incidente. Del total de EA detectados, el 56% se consideraron prevenibles y el 87% se produjeron durante la hospitalización. El 50% de los EA se consideraron moderados, el 36% leves y el 14% graves. La consecuencia más frecuente de los EA detectados fue haber provocado una «lesión sin secuela con prolongación de la estancia». Conclusión: La tasa de pacientes con EA fue de un 14,2%, y la tasa de pacientes con incidentes de un 5,4%. El estudio ha permitido conocer las áreas prioritarias en las cuales centrar esfuerzos para detectar y prevenir los EA (AU)

Objective: To estimate the frequency of occurrence of Adverse Events (AE) that may be attributed to health care iin Hospital Severo Ochoa de Leganés, an investigation was performed by a descriptive, retrospective study using a random sample of patients released during the year 2004. Material and method: This study is carried out by reviewing clinical records. Results: Out of 240 patients included initially in the study, 90 (38%) were taken for the second stage of the study. At least one AE was considered to have occurred in 47 (52%) of them. At least one AE occurred in 34 of them, and in 13 just an incident occurred. From the total of AE detected, 56% were considered that could be prevented, 87% happened while staying in the hospital. The 50% of the AE were considered mediums, the 36% minor and the 14% serious and the most frequent consequence detected was an «injury with no consequence with an extension of the stay in the hospital». Conclusions: The rate of patients with AE was 14,2% and the rate of patients with an incident was 5.4%. Additionally, this study has contributed to identify the main areas where the efforts should be dedicated for the detection and prevention of AE (AU)

Cannabinoids may worsen gastric dysmotility induced by chronic cisplatin in the rat.

BACKGROUND: Although cannabinoids have traditionally been used for the treatment and/or prevention of nausea and/or emesis, anorexia and weight loss induced by clinical use of antineoplastic drugs, their efficacy and safety in long-term treatments are still controversial. Our aim was to analyze the effects of the non-selective cannabinoid agonist WIN 55 212-2 (WIN) on gastrointestinal (GI) dysmotility and other adverse effects induced by repeated cisplatin administration in the rat. METHODS: Male Wistar rats received two intraperitoneal injections once a week for 4 weeks: the first one was WIN, at non-psychoactive doses (0.5 or 1 mg kg(-1)), its vehicle or saline; the second one was cisplatin (2 mg kg(-1)) or saline. Radiographic techniques were used to determine the acute (after first dose), chronic (after last dose), and residual (1 week after treatment finalization) effects of cisplatin and/or WIN on GI motility. Bodyweight gain, food ingestion, and mechanical sensitivity were also tested. KEY RESULTS: Weekly cisplatin induced mechanical allodynia, which WIN prevented, as well as weight gain reduction and anorexia, which WIN did not. Gastric emptying was dose-dependently delayed by cisplatin and this effect was enhanced upon chronic treatment. WIN aggravated cisplatin-induced gastric dysmotility. One week after treatment finalization, only minor alterations of GI motor function were found in rats treated with cisplatin, WIN or both. CONCLUSIONS & INFERENCES: WIN weekly administered at low doses prevents neuropathy, but does not prevent anorexia or weight loss and aggravates gastric dysmotility induced by cisplatin. Cannabinoids should be handled with caution if chronically administered during chemotherapy.

Ram seminal plasma improves pregnancy rates in ewes cervically inseminated with ram semen stored at 5 °C for 24 hours.

In this study, we compared pregnancy rates obtained using ram semen stored at 5 °C for 24 h, with ram or bull seminal plasma (SP) added to TRIS-egg yolk extender. During the breeding period, 670 adult Corriedale ewes were cervically inseminated with semen (2 × 10(8) sperm in a volume of 0.2 mL) from eight adult Corriedale rams. Ejaculates, obtained using an artificial vagina, were split into three aliquots and diluted with the following: TRIS-egg yolk based extender (T), T + 30% ram SP (R), or T + 30% bull SP (B). Samples were refrigerated and stored at 5 °C for 24 h until used for AI. Pregnancy was assessed by ultrasonography 35 to 40 d after AI. Pregnancy rate was not affected by ram (P = 0.77) or breeding period (P = 0.43), and there were no interactions between extender and ram (P = 0.94), or extender and breeding period (P = 0.24). However, there was an effect of extender (P = 0.0009) on pregnancy rates; ram SP, but not bull SP, increased pregnancy rates compared with extender without SP (49.7, 38.1, and 31.1%, for R, B, and T respectively). In conclusion, ram SP added to TRIS-egg yolk extender had a beneficial effect on the pregnancy rate of ram sperm stored at 5 °C for 24 h and used for cervical insemination of ewes.

Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica / No disponible

Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%), punción hemática (8,7%), parestesias (8,2%), técnica dificultosa (5,2%), analgesia ineficaz (2,7%), hipotensión arterial (2,5%) y bloqueo subdural (0,2%). En el postparto: lumbalgia (18,5%), retención urinaria (3,4%), cefalea postpunción dural (1,4%), neuropatías periféricas (0,9%) e hipoestesia prolongada (0,2%). Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz (AU)

Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and pathogenesis. Patients and methods: Prospective and descriptive study in pregnant women who received an epidural analgesia for labour in a third level hospital over a 11-month period. The following data were registered: demographic mother and child information, labour, type of childbirth and complications during the procedure and during the peripartum and postpartum periods. All women were followed up to their hospitable discharge with an identification and treatment of the observed complications up to their resolution. Results: We enrolled 438 patients. Complications were separated in 2 phases: peripartum and postpartum. In the peripartum period were identified, from bigger than minor frequency, the following complications: unilateral analgesia (16,4%), hematic punction (8.7%), paresthesias (8.2%), difficult technique (5.2%), ineffective analgesia (2.7%), hypotension (2.5%) and subdural block (0.2%). In the postpartum period: lumbar pain (18.5%), urinary retention (3.4%), post-dural puncture headache (1.4%), peripheral neurophaty (0.9%) and prolonged hypoesthesia (0.2%). All complications were resolved ad integrum by a conservative treatment except one patient who needed an epidural blood patching because of a refractory headache. Conclusions: The high frequency of failure of the epidural analgesia in obstetrics as well as the possibility of neurological complications can be solved following several norms of a good practice that include the previous aspiration to the injection, the test-dose and the continuous inspection of the catheter. It´s essential to know these complications for their evaluation and precocious treatment (AU)

Lesión de nervios periféricos en anestesia obstétrica: descripción de cuatro casos / No disponible

El abordaje neuroaxial es de elección para el control del dolor en obstetricia, pero no está exento de riesgos. Las neuropatías periféricas posparto pueden producirse por diferentes condiciones médicas, quirúrgicas y anestésicas, por lo que debemos tenerlas presentes para diagnosticarlas y tratarlas precozmente y así evitar que se atribuyan, por defecto, a la técnica anestésica. Presentamos cuatro casos que se diagnosticaron en el periodo periparto, 2 meralgias parestésicas, 1 neuropatía del femoral y 1 lumbociatalgia, de las cuales solo la lumbociatalgia pudo ser atribuida parcialmente a la técnica anestésica. Tras confirmar su diagnóstico se instauró tratamiento conservador que resolvió ad integrum, dentro de los primeros siete días, todas las neuropatías salvo la lumbociatalgia. La baja incidencia de neuropatías periféricas tras técnicas neuroaxiales en obstetricia puede ser superior a la que se diagnostica. Resulta imprescindible una buena anamnesis preanestésica y conocer los diferentes mecanismos fisiopatológicos que pueden desencadenar neuropatías periféricas (AU)

A neuroaxial approach is of choice for the management of pain in obstetrics but is not exempt of risks. Postpartum peripheral neuropathy may occur because of various medical, surgical, and anesthetic conditions, hence we should have them in mind in order to recognize them and treat them early enough to prevent their deffault attribution to the anesthetic technique. We report four cases diagnosed during the peripartum – 2 paresthetic meralgias, 1 femoral neuropathy, and 1 lumbosciatalgia, of which only the lumbosciatalgia could be partly attributed to the anesthetic technique. Once the diagnosis was confirmed a conservative therapy was initiated that solved ad integrum all neuropathies, except for the lumbosciatalgia episode, within seven days. The low incidence of peripheral neuropathy following neuroaxial techniques in obstetrics may be higher than diagnosed. Adequate history taking before anesthesia is crucial, as is an understanding of the various pathophysiological mechanisms that may trigger peripheral neuropathy (AU)

[Epidural analgesia in obstetrics: is there an effect on labor and delivery?]. / Analgesia epidural en obstetricia: cómo afecta al desarrollo y finalización del parto?

BACKGROUND AND OBJECTIVE: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. PATIENTS AND METHODS: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. RESULTS: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P < .01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P < .001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P < .01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge's first plane decreased risk 2.7-fold and 3.03-fold, respectively. CONCLUSIONS: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery.

Analgesia epidural en obstetricia: ¿cómo afecta al desarrollo y finalización del parto? / Epidural analgesia in obstetrics: Is there an effect on labor and delivery?

Introducción: La analgesia epidural es el estándar de la analgesia obstétrica, pero se le atribuye una posible influencia en la dinámica del parto que puede provocar un aumento de los partos instrumentados y cesáreas. Nuestro objetivo fue valorar en una cohorte de pacientes obstétricas la finalización del parto en relación con el tipo de analgesia empleado. Pacientes y método: Estudio prospectivo de cohorte de gestantes a término divididas en 2 grupos. El grupo A recibió analgesia epidural y el grupo B no recibió analgesia epidural. Se compararon las variables demográficas materno-fetales, obstétricas y tipo de parto en cada grupo y se estudiaron la influencia de la analgesia epidural y las causas probables que provocaron partos distócicos. Resultados: Se incluyeron 602 pacientes: 462 en grupo A y 140 en grupo B. La analgesia epidural se relacionó con una mayor tasa de partos instrumentales pero no de cesáreas (p < 0,01), mayor necesidad de oxitócicos (30,7% en grupo A vs 0% en grupo B, p < 0,001) y una mayor duración de las fases del parto (fase de dilatación 6,4 ± 4,2 h en grupo A frente a 4,7 ± 3,5 h en grupo B y fase expulsivo 1,0 ± 0,6 h frente a 0,7 ± 0,6 h, p < 0,01), sin influir en la tasa de desgarros, episiotomías ni otras variables. La mayor duración del primer (OR 1,2 IC95% 1,1-1,3) y segundo estadios del parto (OR 2,3 IC95% 1,3-3,9) del trabajo de parto y la obesidad materna (OR: 1,1 IC95% 0,9-1,2) se relacionaron con aumento del riesgo de partos distócicos, mientras que la multiparidad e iniciar la analgesia epidural con una presentación en el I plano de Hodge o superior lo disminuyeron 2,7 y 3,03 veces respectivamente. Discusión: Pese a que clásicamente se ha relacionado la analgesia epidural con un aumento de partos distócicos, en nuestra cohorte dicha influencia es discutible. El posible incremento pareció deberse a factores obstétricos como mayor duración de los estadios del parto, mayor índice de masa corporal y la primiparidad(AU)

Background and objective: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. Patients and methods: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. Results: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P<.01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P<.001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P<.01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge’s first plane decreased risk 2.7-fold and 3.03-fold, respectively. Conclusions: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery(AU)

New method to enhance ajmalicine production in Catharanthus roseus cell cultures based on the use of cyclodextrins.

The joint use of cyclodextrins and methyljasmonate, when accompanied by a short exposure to UV, enhanced extracellular ajmalicine accumulation to 1040 ± 26.6 mg/l in suspension cultured cells of Catharanthus roseus. The success of this strategy is due to the use of cyclodextrins, which not only induce ajmalicine biosynthesis but also promote adduct formation. This removes ajmalicine from the medium, reduces feedback inhibition and ajmalicine degradation, and allows its accumulation in the culture medium at elevated concentrations.

Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas / Post-operative analgesia in hip surgery: a comparison of 3 techniques

Introducción. Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y la edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos. Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, el inicio de rehabilitación y los costes económicos en cada grupo. Pacientes y método. Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en tres grupos aleatorios: A: solo analgesia intravenosa; B: bloqueo iliofascial, y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y la satisfacción con la analgesia, el tiempo transcurrido hasta el inicio de la sedestación, el consumo total de analgésicos postoperatorios, los efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados. La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (escala visual analógica [EVA] media 2,14±1,24, satisfacción 3,75±0,8) que en los que solo recibieron analgesia intravenosa (EVA media 5,57±0,64, satisfacción 2,83±0,7) (p<0,001), con una duración superior a las 24h (p<0,01) y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01), iniciaron la rehabilitación más precozmente (31,2±5,01h frente a 44,62±7,9h) (p<0,001) y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente frente a 30,26±1,88€/paciente), no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de las EVA media, grado de satisfacción ni gasto económico entre los pacientes que recibieron algún tipo de bloqueo. Conclusiones. Los bloqueos realizados son una técnica efectiva, fácil y segura, que proporciona numerosas ventajas: analgesia postoperatoria prolongada, recuperación más rápida, menor coste y escasas complicaciones (AU)

Introduction. The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives. Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods. A prospective study of 90 patients undergoing hip surgery. Patients were randomised to receive intravenous analgesia only, fascia iliaca compartment block or blockade of the obturator and femoral cutaneous nerves. In each group we recorded visual analogue scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. Results. Analgesia and level of patient satisfaction were significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.14 [1.24], mean [SD] satisfaction scores 3.75 [0.8] and mean [SD] VAS scores, 5.57 [0.64], mean [SD] satisfaction scores 2.83 [0.7], respectively) (p<0.001). Patients with nerve blocks also had a pain-free period of more than 24h (p<0.01), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (p<0.01), started rehabilitation earlier (31.2 [5.01] hours vs. 44.62 [7.9] hours) (p<0.001), generated less expenditure (€13.26 [€6.34]/patient vs. €30.26 [€1.88]/patient), with no complications in the blocking techniques. No significant differences were found between the efficacy of both blocks, VAS scores, level of satisfaction or cost between the patients who received a block. Conclusions. The nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications (AU)