The sex differences of the behavior response to early Life immune stimulation: Microglia and astrocytes involvement.

It is well known that inflammatory challenge during the prenatal period results in permanent changes in glial cells and behavior in adulthood. However, it is unknown whether inflammatory challenge during the infantile period may have permanent sexually-dimorphic effects on microglia and astrocytes in vivo, which in turn may be associated with sex differences in adult behavior. In this study, we have evaluated whether postnatal injection of lipopolysaccharide (LPS; 250µg/kg, i.p. on postnatal day 14) induces depressive and less anxiety-like behaviors, glial cell activation, pro-inflammatory cytokine (TNF-alpha) secretion and sexually dimorphic responses in adulthood. Postnatal day 14 (P14) male and female Wistar rats received an intraperitoneal (ip) injection of LPS or PBS. Three months later, animals were tested in the Open Field (OF), the Elevated Plus Maze (EPM) and the Forced Swimming Test (FST) to assess the level of anxiety and depression-like behavior. Hippocampal proinflammatory cytokine TNF-alpha concentration and the number of astrocytes and microglia were estimated in the dentate gyrus, CA1, and CA3 in two regions of the hippocampus (ventral and dorsal). Our results showed that the administration of LPS resulted in less anxiety and depression-like behavior in males but not in females. However, the LPS-administration increased the number of microglia in the dorsal and ventral hippocampus areas in females more than male, while no significant differences in TNFα level had been detected between the LPS-rats treated and their controls. Interestingly, LPS resulted in an increase in the number of astrocytes in both areas of the hippocampus in a female. While in a male, our results showed a decrease in astrocytes number in the dorsal hippocampus, but no significant differences observed in ventral hippocampus. These findings indicate that an immune challenge in infantile rats induces a ventral and dorsal hippocampus damage in female more than in male, without affecting significantly the affective behavior changes in the female. The results also showed that small changes in the male hippocampus can affect the behavior and induce a depression-like behavior.

Apoyo a la autonomía en las clases de educación física: percepción versus realidad / Supporting autonomy in physical education: perception versus reality

Esta investigación se centró, por una parte en la percepción de apoyo a la autonomía en las clases de Educación física, que tienen tanto el alumnado como el profesorado, y por otra, en la coherencia entre percepción y la realidad observada en las clases. Se aplicaron dos escalas al profesorado y al alumnado con el objeto de conocer con qué frecuencia se producen comportamientos instructivos favorables al desarrollo de la autonomía, y se observaron y grabaron en video clases impartidas por el profesorado. Los resultados muestran que la frecuencia de los comportamientos instructivos de apoyo a la autonomía durante la intervención de enseñanza es significativamente menor que la percibida por el alumnado y el profesorado. La realidad observada muestra un perfil de profesorado con gran margen de mejora en comportamientos como: calidad de la comunicación, funcionalidad de las tareas, fomento del pensamiento del alumnado, situaciones en las que el alumnado pueda expresar su opinión sobre las tareas y motivación intrínseca (AU)

This investigation, on the one hand it focuses on students´ and teachers´ perception about autonomy support during Physical Education instruction, and on the other hand, in the coherence between perception and reality observed in the classes. Two scales were administered to determine the frequency of instructional behaviors favoring the development of autonomy, and teacher´s classes were observed and videotaped. The results show that the observed frequency of instructional behavior favoring autonomy support during classes is significantly lower than that perceived by students and teachers. The observed reality reveals a teacher profile with room for improvement in behaviors such as: communication quality, task functionality, promotion of students’ thinking, creation of situations in which students can express their opinions of the tasks, and increasing intrinsic motivation (AU)

Study of permeation and blocker binding in TMEM16A calcium-activated chloride channels.

We studied the effects of mutations of positively charged amino acid residues in the pore of X. tropicalis TMEM16A calcium-activated chloride channels: K613E, K628E, K630E; R646E and R761E. The activation and deactivation kinetics were not affected, and only K613E showed a lower current density. K628E and R761E affect anion selectivity without affecting Na(+) permeation, whereas K613E, R646E and the double mutant K613E + R646E affect anion selectivity and permeability to Na(+). Furthermore, altered blockade by the chloride channel blockers anthracene-9-carboxylic acid (A-9-C), 4, 4'-Diisothiocyano-2,2'-stilbenedisulfonic acid (DIDS) and T16inh-A01 was observed. These results suggest the existence of 2 binding sites for anions within the pore at electrical distances of 0.3 and 0.5. These sites are also relevant for anion permeation and blockade.

Effects of vibration therapy on hormone response and stress in severely disabled patients: a double-blind randomized placebo-controlled clinical trial.

PURPOSE: To assess the effects of vibration therapy (VT) on quality of life and hormone response in severely disabled patients compared with placebo. DESIGN: A longitudinal prospective, double-blind, randomized placebo-controlled trial, with pre and postintervention assessments. METHODS: A total of 20 severely disabled individuals were recruited from a National Reference Centre in Spain: 13 (65%) men and 7 (35%) women, 45.5 ± 9.32 years of age (range 41: 22-63). We evaluated their physical stress and state anxiety. RESULTS: No statistically significant changes were found in the socio-psychological variables studied, while in the experimental group state anxiety decreased significantly with p < 0.01 (Z = 2.38; one-tailed p = .009) and, among the biological variables, the level of cortisol fell (p = 0.03). CONCLUSION: Short periods of exposure to low-frequency and low-amplitude local vibration are a safe and effective mechanical stimulus that can have a positive effect in terms of hormone response. CLINICAL RELEVANCE: VT can be considered to have an anti-stress effect.

Crystal structure of ethyl 3-anilino-2-{[bis-(methyl-sulfan-yl)methyl-idene]amino}-3-oxopropano-ate.

The mol-ecular conformation of the title compound, C14H18N2O3S2, is stabilized by intra-molecular N-H⋯N and C-H⋯O hydrogen bonds. The crystal packing is characterized by a series of C-H⋯O hydrogen bonds, resulting in a three-dimensional network.

Anion permeation in calcium-activated chloride channels formed by TMEM16A from Xenopus tropicalis.

Calcium-activated chloride channels (CaCC) formed by anoctamin1/TMEM16A subunits are ubiquitously expressed, and these channels are known to prevent polyspermy in amphibian oocytes. Here, we describe a TMEM16A clone isolated from Xenopus tropicalis oocytes (xtTMEM16A) and how the anion permeation properties are modified in single-site mutants of the ion pore. The anion permeability sequence was SCN(-) > I(-) > Br(-) > Cl(-) > gluconate (relative permeabilities 5.6:3.0:2.1:1:0.2, respectively). Dose-response curves indicated that the voltage-dependent half-maximal concentration for Ca(2+) activation (K d of the Hill equation at +100 mV) was 120 nM in normal external Cl(-), whereas it was displaced leftward to 75 nM Ca(2+), when I(-) replaced Cl(-). The I(-):Cl(-) mole fraction (MF) of the external solution was varied in order to gain insight into the permeation mechanism of the pore. No anomaly in MF behavior was observed for conductance, but it was observed for current reversal potential, which deviated from the prediction of the Goldman-Hodgkin-Katz equation. Mutations of positively charged amino acids in the pore, R646 and R761, to glutamate resulted in reduction of the relative permeability to I(-). Data from the wild type and mutants could be well fitted by a three-barrier, two-site permeation model. This suggests a multi-ion pore with at least two binding sites for anions, with R646 mole fraction closer to the extracellular membrane surface--being important for the stability of both sites--and R761--located deeper within the membrane--mainly affecting the innermost binding site. Considerations of xtTMEM16A putative pore region topology are discussed in the light of two alternative topological models of the protein.

[Does Alzheimer's disease exist in all primates? Alzheimer pathology in non-human primates and its pathophysiological implications (II)]. / ¿Existe la enfermedad de Alzheimer en todos los primates? Patología Alzheimer en primates no humanos y sus implicaciones fisiopatológicas (II).

INTRODUCTION: In the ageing process there are some species of non-human primates which can show some of the defining characteristics of the Alzheimer's disease (AD) of man, both in neuropathological changes and cognitive-behavioural symptoms. The study of these species is of prime importance to understand AD and develop therapies to combat this neurodegenerative disease. DEVELOPMENT: In this second part of the study, these AD features are discussed in the most important non-experimental AD models (Mouse Lemur -Microcebus murinus, Caribbean vervet -Chlorocebus aethiops, and the Rhesus and stump-tailed macaque -Macaca mulatta and M. arctoides) and experimental models (lesional, neurotoxic, pharmacological, immunological, etc.) non-human primates. In all these models cerebral amyloid neuropathology can occur in senility, although with different levels of incidence (100% in vervets;<30% in macaques). The differences between normal and pathological (Alzheimer's) senility in these species are difficult to establish due to the lack of cognitive-behavioural studies in the many groups analysed, as well as the controversy in the results of these studies when they were carried out. However, in some macaques, a correlation between a high degree of functional brain impairment and a large number of neuropathological changes ("possible AD") has been found. CONCLUSIONS: In some non-human primates, such as the macaque, the existence of a possible continuum between "normal" ageing process, "normal" ageing with no deep neuropathological and cognitive-behavioural changes, and "pathological ageing" (or "Alzheimer type ageing"), may be considered. In other cases, such as the Caribbean vervet, neuropathological changes are constant and quite marked, but its impact on cognition and behaviour does not seem to be very important. This does assume the possible existence in the human senile physiological regression of a stable phase without dementia even if neuropathological changes appeared.

¿La enfermedad de Alzheimer existe en todos los primates? Alzheimer patología en los primates no humanos y sus implicaciones fisiopatológicas (I) / Does Alzheimer's disease exist in all primates? Alzheimer pathology in non-human primates and its pathophysiological implications (I)

Introducción: Muchas publicaciones consideran que la enfermedad de Alzheimer (EA) es exclusivo de la especie humana, y que ningún otra especie animal sufre de la enfermedad. Sin embargo, diversos estudios han demostrado que algunas especies pueden presentar algunas de las características definitorias de la enfermedad humana, incluyendo tanto los cambios neuropatológicos y síntomas cognitivo-conductuales. Desarrollo: En este trabajo, los resultados publicados (PubMed) sobre cambios en el cerebro senil en los primates no humanos con diferentes grados de evolución, se revisan. Los cambios neuropatológicos asociados con la acumulación de amiloide o proteína tau fosforilada altamente son raras fuera del orden de los primates, pero en todos los sub-órdenes, familias, géneros y especies de primates no humanos que se han estudiado, algunos individuos seniles han demostrado amiloide acumulación en el cerebro. De hecho, en algunas especies la presencia de estos depósitos en la senilidad es constante. Cambios relacionados con la acumulación de la proteína tau son siempre de muy poca importancia, y se han detectado sólo en algunas especies de primates no humanos, tanto poco evolucionados y altamente evolucionada. En diferentes especies de primates no humanos, algunos tipos de cambios cognitivo-conductuales son más comunes en algunos individuos seniles en comparación con los individuos adultos normales y otras personas seniles de la especie. La importancia de determinar la longevidad de la especie en hábitats diferentes hábitats naturales, los hábitats nuevos, semi-cautividad, cautividad) se hace hincapié en estos estudios. Conclusiones: Las características morfológicas, histoquímicas y cognitivo-conductuales similares a los observados en los seres humanos de edad avanzada están presentes en seniles los primates no humanos. Además, otras características se observan en los primates no humanos podría ser indicativo de una patología «tipo Alzheimer» envejecimiento (AU)

Introduction: Many publications consider that Alzheimer's disease (AD) is exclusive to the human species, and that no other animal species suffers from the disease. However, various studies have shown that some species can present with some of the defining characteristics of the human disease, including both neuropathological changes and cognitive-behavioural symptoms. Development: In this work, the results published (PubMed) on senile brain changes in non-human primates of different degrees of evolution, are reviewed. The neuropathological changes associated with the accumulation of amyloid or highly phosphorylated tau protein are rare outside the primate order, but in all the sub-orders, families, genera and species of non-human primates that have been studied, some senile individuals have shown amyloid accumulation in the brain. In fact, in some species the presence of these deposits in senility is constant. Changes related to the accumulation of tau protein are always of very little significance, and have been detected only in some non-human primate species, both little evolved and highly evolved. In different species of non-human primates, some types of cognitive-behavioural changes are more common in some senile individuals when compared with both normal adult individuals and other senile individuals of the species. The importance of determining the longevity of the species in different habitats (natural habitats, new habitats, semi-captivity, captivity) is stressed in these studies. Conclusions: Morphological, histochemical and cognitive-behavioural features similar to those observed in elderly humans are present in senile non-human primates. Moreover, other characteristics seen in non-human primates could be indicative of a pathological «Alzheimer type» ageing (AU)

Efficacy of florfenicol injection in the treatment of Mycoplasma hyopneumoniae induced respiratory disease in pigs.

This study investigated the efficacy of a single intramuscular injection of a new formulation of florfenicol to treat clinical respiratory disease following experimental Mycoplasma hyopneumoniae infection. M. hyopneumoniae-free piglets were allocated to three groups, namely, a treatment group (TG) and a positive control group (PCG), which were both inoculated endotracheally with a highly virulent isolate of M. hyopneumoniae, and a negative control group. At the onset of clinical disease, the TG received a single injection of florfenicol (30 mg/kg). All pigs were euthanased 4 weeks post-infection. Clinical symptoms were significantly reduced in the TG in comparison with the PCG. Average daily gain, feed conversion ratio, mortality and lung lesions were improved in the TG compared to the PCG, but the differences were not statistically significant.

[Does Alzheimer's disease exist in all primates? Alzheimer pathology in non-human primates and its pathophysiological implications (I)]. / ¿Existe la enfermedad de Alzheimer en todos los primates? Afección de Alzheimer en primates no humanos y sus implicaciones fisiopatológicas (I).

INTRODUCTION: Many publications consider that Alzheimer's disease (AD) is exclusive to the human species, and that no other animal species suffers from the disease. However, various studies have shown that some species can present with some of the defining characteristics of the human disease, including both neuropathological changes and cognitive-behavioural symptoms. DEVELOPMENT: In this work, the results published (PubMed) on senile brain changes in non-human primates of different degrees of evolution, are reviewed. The neuropathological changes associated with the accumulation of amyloid or highly phosphorylated tau protein are rare outside the primate order, but in all the sub-orders, families, genera and species of non-human primates that have been studied, some senile individuals have shown amyloid accumulation in the brain. In fact, in some species the presence of these deposits in senility is constant. Changes related to the accumulation of tau protein are always of very little significance, and have been detected only in some non-human primate species, both little evolved and highly evolved. In different species of non-human primates, some types of cognitive-behavioural changes are more common in some senile individuals when compared with both normal adult individuals and other senile individuals of the species. The importance of determining the longevity of the species in different habitats (natural habitats, new habitats, semi-captivity, captivity) is stressed in these studies. CONCLUSIONS: Morphological, histochemical and cognitive-behavioural features similar to those observed in elderly humans are present in senile non-human primates. Moreover, other characteristics seen in non-human primates could be indicative of a pathological «Alzheimer type¼ ageing.

Maternal deprivation and adolescent cannabinoid exposure impact hippocampal astrocytes, CB1 receptors and brain-derived neurotrophic factor in a sexually dimorphic fashion.

We have recently reported that early maternal deprivation (MD) for 24 h [postnatal day (PND) 9-10] and/or an adolescent chronic treatment with the cannabinoid agonist CP-55,940 (CP) [0.4 mg/kg, PND 28-42] in Wistar rats induced, in adulthood, diverse sex-dependent long-term behavioral and physiological modifications. Here we show the results obtained from investigating the immunohistochemical analysis of CB1 cannabinoid receptors, glial fibrillary acidic protein (GFAP) positive (+) cells and brain-derived neurotrophic factor (BDNF) expression in the hippocampus of the same animals. MD induced, in males, a significant increase in the number of GFAP+ cells in CA1 and CA3 areas and in the polymorphic layer of the dentate gyrus (DG), an effect that was attenuated by CP in the two latter regions. Adolescent cannabinoid exposure induced, in control non-deprived males, a significant increase in the number of GFAP+ cells in the polymorphic layer of the DG. MD induced a decrease in CB1 expression in both sexes, and this effect was reversed in males by the cannabinoid treatment. In turn, the drug "per se" induced, in males, a general decrease in CB1 immunoreactivity, and the opposite effect was observed in females. Cannabinoid exposure tended to reduce BDNF expression in CA1 and CA3 of females, whereas MD counteracted this trend and induced an increase of BDNF in females. As a whole, the present results show sex-dependent long-term effects of both MD and juvenile cannabinoid exposure as well as functional interactions between the two treatments.

Effect of dilution temperature on boar semen quality.

As boar semen is very sensitive to cold shock and changes in temperature during semen processing can have a profound impact on semen quality, the effect of the extender temperature at the time of dilution was investigated in a two-step dilution protocol for boar semen being processed for liquid storage. Fifteen boars of different breeds and ages from a commercial artificial insemination centre were included. One ejaculate per boar was collected and processed with Beltsville Thawing Solution semen extender. Each ejaculate was diluted (1 : 1) at 30 °C, and subsequently, the samples were diluted (30 × 10(6) sperm/ml) with either preheated extender [29.3 °C ± 0.2 °C, group A (GA)] or extender at room temperature [22.7 °C ± 0.6 °C, group B (GB)]. Samples were transported to the Faculty of Veterinary Medicine (University of Ghent, Belgium) in two isotherm boxes (one per group), stored at 17 °C and investigated for three consecutive days (D0 to D2). At D0, D1 and D2, motility parameters [computer-assisted semen analysis (CASA)] and the per cent of sperm with intact membrane (% IM) by eosin nigrosin staining were evaluated. At D0 and D2, the % of sperm with intact acrosome (% IA) was studied by Pisum sativum agglutinin staining. The average temperature of the 1 : 1 dilution was 29.4 °C ± 1.1 °C immediately after extender addition. No significant differences were found between groups for per cent motility [79.3 ± 9.0 for GA and 81.1 ± 9.2 for GB (p = 0.372)], % progressive motility [56.5 ± 13.3 for GA and 58.4 ± 13.8 for GB (p = 0.737)] or any CASA parameter. No differences were found for % IM [85.1 ± 10.7 and 84.5 ± 3.8 for GA and GB, respectively (p = 0.761)] and % IA [72.2 ± 9.4 for GA and 68.3 ± 16.6 for GB (p = 0.792)]. In conclusion, when a two-step dilution is performed, preheating the extender for the second dilution to match the semen temperature did not result in better semen quality compared to a dilution at a moderate room temperature.

Comparison of oral versus parenteral iron supplementation on the health and productivity of piglets.

The aim of this study was to compare oral iron supplementation in feed with a standard iron injection and assess the impact on the health and productivity of pigs. The reliability of a quick test (HemoCue) for the measurement of blood haemoglobin concentration was also investigated. Three pig herds, with a total of 88 sows and their piglets, were included in the study. Piglets in treatment group O were fed a special iron-rich feed on days 2 to 4, 5 to 7 and 8 to 12 of lactation using a specially designed feeding device. Piglets in group IM received 200 mg of an iron dextran complex intramuscularly at three days of age. Haemoglobin concentrations and performance of the piglets were compared between groups. The mean haemoglobin concentrations in pigs at weaning were 131.4 and 116.4 g/l for pigs in groups O and IM, respectively (P<0.01). Daily weight gain (253.9 v 248.8 g/day) and piglet mortality (11.4 v 12.2 per cent) were slightly better in group O than in group IM (P>0.05).

Espondilitis, absceso epidural, meningitis y endoftalmitis por Streptococcus agalactiae / Spondylitis, epidural abscess, meningitis and endophthalmitis due to Streptococcus agalactiae

No disponible

Análisis de la violencia del paciente en atención primaria / Analysis of patients’ violence in primary care

Objetivo. Determinar la frecuencia de la violencia en atención primaria y analizar sus causas. Estudiar las consecuencias y su relación con el burnout y la desmotivación profesional. Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria. Participantes. Participaron en el estudio 68 médicos de atención primaria de 4 distritos de la provincia de Jaén (n = 350; 19%). Mediciones principales. Cuestionario diseñado ad hoc, autoadministrado y enviado por correo, que incluía datos de filiación, laborales y opinión sobre causas de burnout y violencia, consecuencias de ésta y actitudes del Servicio Andaluz de Salud y organizaciones profesionales (fiabilidad global, alfa de Cronbach: 0,7898). Resultados. El 58% de los encuestados había presentado alguna agresión (un 85% abuso verbal, un 67,5% amenazas y un 12,5% agresión física). Ser agredido se asoció a atribuir a los pacientes la responsabilidad (odds ratio [OR] = 7,6; intervalo de confianza [IC] del 95%, 2,5-23), hacer guardias (OR = 6,3; IC del 95%, 1,2-33), rigidez (OR = 3,5; IC del 95%, 1,2-10,7), manejo inadecuado de situaciones emotivas (OR = 3,2; IC del 95%, 1,1-9,2) e incompetencia (OR = 5,2; IC del 95%, 1,6-17). La violencia fue la causa menos valorada de burnout y se asoció a menor gratificación del trabajo (OR = 2,9; IC del 95%, 1,0-7,8). También se asoció a irritación contra el Servicio Andaluz de Salud (OR = 2,8; IC del 95%, 1,0-7,5) y a temor a la desmotivación (OR = 2,8; IC del 95%, 1,0-7,5), la cual a su vez se asoció a la pérdida de prestigio social (p < 0,01), a sentimiento de baja autoestima (p < 0,01) y a depresión (p < 0,01). Conclusiones. La frecuencia es mayor que los datos de la Organización Internacional del Trabajo. La violencia se asocia a desconfianza, falta de comunicación asistencial e incompetencia. Es la causa menos valorada de burnout y se asocia a menor gratificación laboral y mayor temor a la desmotivación

Objective. Main aim: to determine the frequency of violence in primary care. Secondary aims: to analyse its causes, consequences and connection with professional burnout and reduced motivation. Design. Transversal, descriptive study. Setting. Primary care. Participants. 68 primary care doctors from 4 districts in the province of Jaén (350, 19%). Main measurements. Self-administered questionnaire with an ad hoc design, sent out by mail and including personal and job details and doctors' views on the causes and consequences of burnout and violence, and the attitudes of the Andalusian Health Service (SAS) and professional bodies (overall reliability, Cronbach's alpha =.7898). Results. 58% had suffered aggression (85% verbal abuse, 67.5% threats, 12.5% physical aggression). Being attacked was linked with attributing the responsibility to the patients (odds ratio [OR]=7.6, 95% confidence interval [CI], 2.5-23), with doing extra shifts (OR=6.3; 95% CI, 1.2-33), rigidity (OR=3.5; 95% CI, 1.2-10.7), inadequate handling of emotive situations (OR=3.2; 95% CI, 1.1-9.2,) and incompetence (OR=5.2; 95% CI, 1.6-17). Violence scored the lowest as cause of burnout and was linked to the job being less rewarding (OR=2.9; 95% CI, 1.0-7.8). It was linked to irritation with the SAS (OR=2.8; 95% CI, 1.0-7.5) and fear of reduced motivation (OR=2.8; 95% CI, 1.0-7.5), with this latter being linked to loss of social prestige (P<.01), feeling low self-esteem (P<.01), and depression (P<.01). Conclusions. Violence is more common than in the figures given by the International Labour Organisation. It is associated with distrust, lack of communication in health care delivery and incompetence. It is the cause of burnout that is least appreciated and it is linked to the job being less rewarding and to greater fear of reduced motivation

[Analysis of patients violence in primary care]. / Análisis de la violencia del paciente en atención primaria.

OBJECTIVE: Main aim: to determine the frequency of violence in primary care. Secondary aims: to analyse its causes, consequences and connection with professional burnout and reduced motivation. DESIGN: Transversal, descriptive study. SETTING: Primary care. PARTICIPANTS: 68 primary care doctors from 4 districts in the province of Jaén (350, 19%). MAIN MEASUREMENTS: Self-administered questionnaire with an ad hoc design, sent out by mail and including personal and job details and doctors' views on the causes and consequences of burnout and violence, and the attitudes of the Andalusian Health Service (SAS) and professional bodies (overall reliability, Cronbach's alpha =.7898). RESULTS: 58% had suffered aggression (85% verbal abuse, 67.5% threats, 12.5% physical aggression). Being attacked was linked with attributing the responsibility to the patients (odds ratio [OR]=7.6, 95% confidence interval [CI], 2.5-23), with doing extra shifts (OR=6.3; 95% CI, 1.2-33), rigidity (OR=3.5; 95% CI, 1.2-10.7), inadequate handling of emotive situations (OR=3.2; 95% CI, 1.1-9.2,) and incompetence (OR=5.2; 95% CI, 1.6-17). Violence scored the lowest as cause of burnout and was linked to the job being less rewarding (OR=2.9; 95% CI, 1.0-7.8). It was linked to irritation with the SAS (OR=2.8; 95% CI, 1.0-7.5) and fear of reduced motivation (OR=2.8; 95% CI, 1.0-7.5), with this latter being linked to loss of social prestige (P<.01), feeling low self-esteem (P<.01), and depression (P<.01). CONCLUSIONS: Violence is more common than in the figures given by the International Labour Organisation. It is associated with distrust, lack of communication in health care delivery and incompetence. It is the cause of burnout that is least appreciated and it is linked to the job being less rewarding and to greater fear of reduced motivation.

Estudio multicéntrico sobre la asociación entre variables relacionadas con la resucitación y la mortalidad en la sepsis grave / Multicenter study on the association between variables related to resuscitation and mortality in severe sepsis

Objetivo. Estimar la asociación entre parámetros indicativos de retraso y fracaso en la resucitación con la mortalidad en pacientes con sepsis grave, y describir el patrón de uso de fármacos vasoactivos en pacientes con shock séptico. Diseño. Estudio prospectivo de cohortes. Ámbito. Siete Unidades de Cuidados Intensivos (UCI) polivalentes en España. Pacientes y método. Enfermos diagnosticados de sepsis grave ingresados de forma consecutiva en las UCI participantes durante un período de un mes. Variables de interés principales. Se recogieron variables relacionadas con intervenciones de resucitación, persistencia de un estado de resucitación insuficiente, disfunción de órganos, uso de fármacos vasoactivos y mortalidad en UCI. Resultados. La mortalidad global fue del 40%. En comparación con los enfermos que sobreviven, los que fallecen presentan mayor puntuación Simplified Acute Physiology Score II (SAPS II) (p = 0,02), mayor número de órganos disfuncionantes (p = 0,01), y menor escala de coma de Glasgow (GCS) en el momento del ingreso (p = 0,001). La duración de la oliguria y de la hipotensión, así como la duración de la necesidad de administración de fármacos presores, se relacionaron de forma univariante con el pronóstico. El patrón de uso de fármacos vasoactivos más prevalente fue noradrenalina sola (60% de los enfermos con hipotensión) o en combinación con dopamina a dosis inferiores a 5 µg/kg/min (32% de los enfermos con hipotensión).Conclusión. No sólo parámetros indicativos de hipoperfusión tisular presentes al ingreso, sino también la duración de la hipoperfusión tisular y del shock, son variables que se relacionan con la mortalidad en la sepsis grave. Estos resultados apoyan el concepto de que la resucitación y la aplicación de medidas terapéuticas de forma precoz que eviten o disminuyan la duración de la hipoperfusión tisular pueden mejorar el pronóstico de la sepsis grave

Objective. To establish the association between parameters indicative of delay and failure in the resuscitation and mortality in patients with severe sepsis, and to describe the pattern of use of vasoactive drugs in patients with septic shock. Design. Prospective cohorts study. Context. Seven polyvalent Intensive Care Units (ICU) in Spain. Patients and method. Patients with severe sepsis admitted consecutively in the participating UCIs over 1 month. Primary endpoints. Variables related to resuscitation interventions, persistence of a state of insufficient resuscitation, organs dysfunction, use of vasoactive drugs, and mortality in ICU were evaluated. Results. Global mortality was 40%. In comparison with patients who survive, those which die show greater SAPS II scoring (p = 0.02), greater number of organs with failure (p = 0.01), and lower GCS scores at admission (p = 0.001). Oliguria and hypotension lenght, as well as the period of vasopressor drugs administration were univariately related to prognosis. The more prevalent pattern of vasoactive drugs use was that of norepinephrine alone (60% of patients with hypotension) or that of norepinephrine in combination with dopamine with doses lower than 5 µg/kg/ min (32% of patients with hypotension). Conclusion. In severe sepsis not only indicative parameters of tissue hypoperfusion at admission are variables related to mortality, but also the lenght of tissue hypoperfusion and shock. These results support the concept that early application of resuscitation and therapeutic measures that avoid or diminish the lenght of tissue hypoperfusion can improve the prognosis of severe sepsis

Alteraciones de la coagulación en la sepsis / Coagulation disorders in sepsis

Aunque es infrecuente que los enfermos con sepsis presenten manifestaciones clínicas de coagulación intravascular, hoy sabemos que todos los pacientes con sepsis grave tienen signos bioquímicos de activación de la coagulación (elevación de los complejos trombina-antitrombina, dímero D, disminución del factor VII, proteína C, etc.). Avances recientes han permitido identificar las bases moleculares que explican la íntima relación entre la respuesta inflamatoria y coagulopática. Algunas citocinas son capaces de activar la coagulación (por ejemplo el factor de necrosis tumoral [TNF] aumenta la expresión de factor tisular), y productos de la coagulación (por ejemplo la trombina) activan la inflamación. La activación de la coagulación se debe a un aumento de la expresión de factor tisular en las células endoteliales y en los monocitos inducido por el TNF. Es, pues, la activación de la vía extrínseca la responsable de la formación de fibrina y su depósito en la microcirculación. Las manifestaciones clínicamente aparentes de la coagulopatía asociada a la sepsis consisten en hemorragia. Sin embargo, es la situación marcadamente procoagulante y la formación masiva de fibrina que se deposita en la microcirculación el cambio fisiopatológico que induce disfunción de órganos. El tratamiento con proteína C activada se ha demostrado eficaz para disminuir la mortalidad de enfermos con sepsis grave y disfunción de más de un órgano

Although is infrequent that patients with sepsis show clinical manifestations of intravascular coagulation, today we know that all patients with severe sepsis evolve with biochemical signs of coagulation activation (elevation in the levels of thrombin-antithrombin complex, D-dimer, reduction of factor VII, protein C, etc.). Recent progress has made possible to identify the molecular bases that explain the close relationship between the inflammatory and coagulopathy response. Some citokines can activate the coagulation sequence (i.e., TNF increases the expression of tissue factor), and the products of coagulation (i.e., thrombin) activate inflammation. Activation of coagulation is due to a TNF-induced increase in the expression of tissue factor in endothelial cells and in monocytes. In this way, the activation of extrinsic pathway is responsible for the formation of fibrin and for its deposit in microvasculature. Clinically visible manifestations of sepsis-related coagulopathy include hemorrhage. However, the strong pro-coagulant situation and the massive formation of fibrin that is deposited in the microvasculature are the physiopathological changes that give rise to organ system failure. Treatment with activated protein C has shown effective in order to reduce mortality in patients with severe sepsis and dysfunction of more than one organ system

Primary mesenteric liposarcoma of jejunum: presentation like a cystic mass.

This report describes a rare case of intra-abdominal liposarcoma in a 67-year-old woman. The patient presented at Internal Medicine Unit in May 2004, to study of thyroid pathology. The clinical examination was normal, except for the finding of an asymptomatic mass in the abdomen. The patient knew the existence of tumor since time ago, but she confesses to have only occasional discomfort. In the abdominal ultrasonography a solid mass with large cystic component was detected but relation with other organs was not clear. Computed tomography revealed the presence of a mass with solid and cystic components, in contact with small intestine in the left side of abdomen. A complete resection of tumor arising from mesentery of jejunum was performed successfully with end to end anastomosis. The gross specimen was lobulated and measured 8.5 x 7.5 cm. The histopathology analysis showed proliferating lipoblasts with irregular nuclei on a myxoid background, with plexiform vascular pattern, characteristics belongs to myxoid type liposarcoma. The patient is alive and well one year after removal of tumor. The uncommon site and the exceptional cystic morphology of tumor are discussed, and so it must be included the primary mesenteric liposarcoma in the differential diagnosis of intra-abdominal tumors with cystic large areas.