Haemodynamic response and effectiveness of tracheal intubation with Airtraq® versus Macintosh laryngoscope in paediatric patient undergoing elective surgery: Prospective, randomised and blind clinical trial. / Respuesta hemodinámica y efectividad de la intubación orotraqueal con Airtraq® versus laringoscopio Macintosh en pacientes pediátricos sometidos a cirugía electiva: estudio prospectivo, aleatorizado y ciego.

OBJECTIVE: To compare the haemodynamic response and effectiveness of tracheal intubation with Airtraq® device and Macintosh laryngoscope, for airway management of patients between 2 and 8 years undergoing elective surgery. METHODS: A prospective, comparative, randomised and blind clinical trial where the effectiveness of tracheal intubation in 80 paediatric patients undergoing elective surgery was determined. Patients were divided into 2 groups of 40 subjects each: group A, intubated with Airtraq® optical laryngoscope; and group M, intubated with Macintosh laryngoscope. Haemodynamic changes, time and number of attempts at intubation and its complications were evaluated in both. RESULTS: Heart rate was higher in group M from minute 1 to 5 with statistically significant difference (p: .001). The mean, systolic and diastolic blood pressure and EtCO2 values were higher in group M. There were no statistically significant differences in SO2. There was a statistically significant difference in time (group A: 18 ± 4seconds, group M: 27 ± 7seconds) and the number of attempts for intubation were lower for group A (p: .001). Seven patients in group M had post-intubation complications while only one subject had in group A. CONCLUSION: Intubation with Airtraq® device is more effective than Macintosh laryngoscope in terms of reduction of haemodynamic changes, SO2, EtCO2, time and number of attempts for intubation and complications in paediatric patients undergoing elective surgery.

[Heparan sulphates, amyloidosis and neurodegeneration]. / Heparan sulfatos, amiloidosis y neurodegeneracion.

INTRODUCTION: A number of neurodegenerative disorders have been linked directly to the accumulation of amyloid fibres. These fibres are made up of proteins or peptides with altered structures and which join together in vivo in association with heparan sulphate-type polysaccharides. AIMS: To examine the most recent concepts in the biology of heparan sulphates and their role in the aggregation of the peptide Abeta, of tau protein, of alpha-synuclein and of prions. The study also seeks to analyse their implications in neurodegenerative disorders such as Alzheimer's and Parkinson's disease and prion diseases. DEVELOPMENT: In vitro, heparan sulphates have played an important role in the process of oligomerisation and fibrillation of amyloidogenic proteins or peptides, in the stabilisation of these bodies and their resistance to proteolysis, thereby participating in the formation of a wide range of amyloid fibres. Heparan sulphates have also been related to the internalisation of pro-amyloid fibres during the process of intercellular propagation (spreading), which is considered to be crucial in the development of proteinopathies, the best example of which is Alzheimer's disease. CONCLUSION: This study suggests that the fine structures of heparan sulphates, their localisation in cells and tissues, together with their local concentration, may regulate the amyloidosis processes. The advances made in the understanding of this area of glyconeurobiology will make it possible to improve the understanding of the cell and molecular mechanisms underlying the neurodegenerative process.

TITLE: Heparan sulfatos, amiloidosis y neurodegeneracion.Introduccion. Numerosos trastornos neurodegenerativos se han asociado directamente a la acumulacion de fibras amiloides. Estas fibras estan formadas por proteinas o peptidos con conformaciones alteradas y que se agregan in vivo en asociacion con polisacaridos de tipo heparan sulfatos. Objetivos. Examinar los conceptos mas recientes sobre la biologia de los heparan sulfatos y su papel en la agregacion del peptido Abeta, de la proteina tau, de la alfa-sinucleina y de los priones, y analizar sus implicaciones en trastornos neurodegenerativos como las enfermedades de Alzheimer y de Parkinson y las enfermedades prionicas. Desarrollo. In vitro, los heparan sulfatos han desempeñado un papel importante en el proceso de oligomerizacion y fibrilacion de proteinas o peptidos amiloidogenos, en la estabilizacion de estos cuerpos y su resistencia a la proteolisis, participando asi en la formacion de una gran variedad de fibras amiloides. Los heparan sulfatos se han relacionado tambien con el proceso de internalizacion de fibras proamiloides durante el proceso de propagacion intercelular (spreading) considerado como central en la evolucion de las proteinopatias, cuyo mejor ejemplo es la enfermedad de Alzheimer. Conclusion. Este trabajo sugiere que las estructuras finas de los heparan sulfatos, sus localizaciones celulares y tisulares, asi como sus concentraciones locales, pueden regular los procesos de amiloidosis. Avances en la comprension de esta area de la gliconeurobiologia permitiran mejorar la comprension de los mecanismos celulares y moleculares del proceso neurodegenerativo.

Braf V600E mutation in melanoma: translational current scenario.

Melanoma was one of the translational cancer examples in clinic, including target therapy related to specific biomarkers impacting in the outcome of melanoma patients. Melanomagenesis involved a wide variety of mutations during his evolution; many of these mutated proteins have a kinase activity. One of the most cited proteins in melanoma is BRAF (about 50-60 % of melanomas harbors activating BRAF mutations), for these the most common is a substitution of valine to glutamic acid at codon 600 (p.V600E). Therefore, the precise identification of this underlying somatic mutation is essential; knowing the translational implications has opened a wide view of melanoma biology and therapy.

Multiobjective optimization and multivariable control of the beer fermentation process with the use of evolutionary algorithms.

This paper describes empirical research on the model, optimization and supervisory control of beer fermentation. Conditions in the laboratory were made as similar as possible to brewery industry conditions. Since mathematical models that consider realistic industrial conditions were not available, a new mathematical model design involving industrial conditions was first developed. Batch fermentations are multiobjective dynamic processes that must be guided along optimal paths to obtain good results. The paper describes a direct way to apply a Pareto set approach with multiobjective evolutionary algorithms (MOEAs). Successful finding of optimal ways to drive these processes were reported. Once obtained, the mathematical fermentation model was used to optimize the fermentation process by using an intelligent control based on certain rules.

Polyphenol oxidase activity, color changes, and dehydration in table grape rachis during development and storage as affected by n-(2-chloro-4-pyridyl)-n-phenylurea.

Flame Seedless grapes were sprayed with N-(2-chloro-4-pyridyl)-N-phenylurea (CPPU) at 0, 2.5, and 5.0 ppm to develop rachis resistant to browning and dehydration. Rachis polyphenol oxidase (PPO) activity was determined during cluster development. Cluster components were weighed at commercial (CM), and physiological maturity (PM). PPO activity, rachis color changes (L and a), and cluster weight loss were evaluated at 0 degrees C for 8, 16, 32, and 56 days. CPPU-treated rachis had a decrease of 36% in PPO activity and a week delay in peak activity. At PM, dry weight of CPPU-treated rachis increased by 3 g. Postharvest rachis PPO activity declined with CPPU application, and color changes followed the same pattern for CM and PM. After 32 days of storage, L and a in lateral branches were significantly superior in CPPU treatments. Weight losses below 2.1% were significantly lowest in CPPU-treated clusters for 16 days of storage regardless of cluster maturity.

Leukocyte accumulation and hemodynamic changes in the cerebral microcirculation during early reperfusion after stroke.

BACKGROUND AND PURPOSE: Leukocytes contribute to cerebral ischemia-reperfusion injury. However, few experimental models examine both in vivo behavior of leukocytes and microvascular rheology after stroke. The purpose of the present study was to characterize patterns of leukocyte accumulation in the cerebral microcirculation and to examine the relationship between leukocyte accumulation and microcirculatory hemodynamics after middle cerebral artery occlusion and reperfusion (MCAO-R). METHODS: Male rats (250 to 350 g) were anesthetized and ventilated. Tail catheters were inserted for measurement of arterial blood gases and administration of drugs. Body temperature was maintained at 37 degrees C. Animals were subjected to 2 hours of MCAO by the filament method. A cranial-window preparation was performed, and the brain was superfused with warm, aerated artificial cerebrospinal fluid. Reperfusion was initiated by withdrawing the filament, and the pial microcirculation was observed by use of intravital fluorescence microscopy. Leukocyte accumulation in venules, arterioles, and capillaries; leukocyte rolling in venules; and leukocyte venular shear rate were assessed during 1 hour of reperfusion. RESULTS: We found significant leukocyte adhesion in cerebral venules during 1 hour of reperfusion after 2 hours of MCAO. Leukocyte trapping in capillaries and adhesion to arterioles after MCAO-R tended to increase compared with controls, but the increase was not significant. We also found that shear rate was significantly reduced in venules during early reperfusion after MCAO. CONCLUSIONS: A model using the filament method of stroke and fluorescence microscopy was used to examine white-cell behavior and hemodynamics in the cerebral microcirculation after MCAO-R. We observed a significant increase in leukocyte rolling and adhesion in venules and a significant decrease in blood shear rate in the microcirculation of the brain during early reperfusion. Leukocytes may activate and damage the blood vessels and surrounding brain cells, which contributes to an exaggerated inflammatory component to reperfusion. The model described can be used to examine precisely blood cell-endothelium interactions and hemodynamic changes in the microcirculation during postischemic reperfusion. Information from these and similar experiments may contribute to our understanding of the early inflammatory response in the brain during reperfusion after stroke.

Stereo matching using Hebbian learning.

This paper presents an approach to the local stereo matching problem using edge segments as features with several attributes. We have verified that the differences in attributes for the true matches cluster in a cloud around a center. The correspondence is established on the basis of the minimum distance criterion, computing the Mahalanobis distance between the difference of the attributes for a current pair of features and the cluster center (similarity constraint). We introduce a learning strategy based on the Hebbian Learning to get the best cluster center. A comparative analysis among methods without learning and with other learning strategies is illustrated.

Risk factors for osteoporotic hip fractures in Mexicans.

BACKGROUND: Osteoporosis (OP) and its fractures are a major problem due to their impact in morbidity and mortality in the elderly. Although this entity is well studied in other countries, OP and its fractures have not been evaluated carefully in our population. The objective was to assess risk factors for osteoporotic hip fracture in Mexicans. METHODS: A total of 295 subjects, 152 cases and 143 controls, were studied. Cases were patients with hip fracture, of both sexes and 45 years of age or older. Controls were healthy subjects who were in hospital waiting rooms accompanying patients without hip fractures. A questionnaire covering known possible risk factors for osteoporotic hip fracture was administered by the same evaluator to all subjects. Pelvic roentgenograms, anterior-posterior view, were obtained in both cases and controls to perform the Singh index and the cortical index of the femur. RESULTS: Fractures were present in (72.2%) of women. Weight and any alcohol ingestion were associated with an increased risk of hip fracture. The odds ratio (OR) for low weight by the Quetelet Index was 4.03 (95% CI 1.93-8.39) p < 0.001. Any alcohol intake was associated with an OR of 1.73 (95% CI 1.04-2.90) p < or = 0.03 for the total group, and 2.78 (95% CI 1.25-6.14) p < or = 0.003 for women. Controls had a significantly higher mean daily calcium intake compared to cases (mean, SD 575.9 +/- 297.2 vs. 490.4 +/- 245.5, p < or = (0.007). Family history, smoking, physical activity, pregnancies, breastfeeding or concomitant diseases were not associated with risk of hip fracture. CONCLUSIONS: This study confirmed the risk factors for osteoporotic hip fracture in Mexicans, previously shown for other ethnic groups. Further research in different factors, such as rate of bone turnover, anthropometric dimensions, and genetic studies (osteoporosis gene) are needed in order to define the differences among ethnic groups.

[Chronic end-stage kidney failure in Mexico]. / Algunas reflexiones sobre la insuficiencia renal crónica terminal en México.

Chronic renal failure is an expanding and complex problem in Mexico. This work analyzes its current situation and finds a clear imbalance between supply and demand for specialized services, that favors the latter. To explain said imbalance, it invokes four factors: the recent innovation in nephrology and parallel disciplines; educational deficit of medical schools; high costs of rehabilitation of the uremic patient, and the absence of specifically designed mechanisms for financing the treatment of this disease.

Continuous regional cerebral cortical blood flow monitoring in head-injured patients.

Continuous regional cerebral cortical blood flow (rCoBF) was monitored with thermal diffusion flowmetry in 56 severely head-injured patients. Adequate, reliable data were accumulated from 37 patients (21 acute subdural hematomas, 10 cerebral contusions, 4 epidural hematomas, and 2 intracerebral hematomas). The thermal sensor was placed at the time of either craniotomy or burr hole placement. In 15 patients, monitoring was initiated within 8 hours of injury. One-third of the comatose patients monitored within 8 hours had rCoBF measurements of 18 ml per 100 g per minute or less, consistent with previous reports of significant ischemia in the early postinjury period. Initial rCoBF measurements were similar in the patients with Glasgow Coma Scale scores of 3 to 7 and in those with scores of 8 or greater. In patients with poor outcomes, rCoBF measurements did not change significantly from initial measurements; however, in those patients who had better outcomes, final rCoBF measurements were higher than initial rCoBF measurements. The patients who had better outcomes experienced normalization of rCoBF during the period of monitoring, and patients with poor outcomes had markedly reduced final rCoBF. These changes were statistically significant. When management was based strictly upon the intracranial pressure, examples of inappropriate treatment were found. For example, hyperemia and increased intracranial pressure treated with mannitol caused further rCoBF increase, and elevated intracranial pressure with low cerebral blood flow treated with hyperventilation increased the severity of ischemia. In 3 (5%) of 56 patients, wound infections developed. Continuous rCoBF monitoring in head-injured patients offers new therapeutic and prognostic insights into their management.

[An analysis of bone mass and remodeling in women with pharmacological inhibition of ovarian function. The response to nasal calcitonin]. / Análisis de masa y remodelado óseo en mujeres con inhibición farmacológica de función ovárica. Respuesta a calcitonina nasal.

Pharmacological inhibition of ovarian function (PIOF) in young women is associated with hypoestrogenism and very low estrogen levels. These alterations can trigger osteopenia, either by delayed peak bone mass or by active bone destruction, and therefore, an increased risk of osteoporosis at later years. Twenty-one women (mean age: 32 years) with diagnosis of endometriosis, who were submitted to PIOF with leuprolide acetate, were prospectively studied. As a result of treatment for bone resorption with nasal spray salmon calcitonin, 200 UI/day, a decreased femoral and lumbar bone mass density was identified in these women through densitometry. Regarding bone remodelling biochemistry, changes were seen in urinary markers suggesting bone destruction inhibition, while bone formation markers showed stimulation. Biochemical markers of bone turnover and bone mass measurements are useful during follow-up of young women with osteopenia.

Prevalence of hepatitis C virus among candidates for blood donation at the Hospital General de Mexico.

Among the NonA-nonB hepatitis, only hepatitis C is exclusively of parenteral transmission. The reported seroprevalence among blood donors in the world ranges from 0.5 to 6.0%. In order to discover the seroprevalence of anti-HCV in candidates for blood donation at the General Hospital of Mexico, 330 individuals were studied. Determination of anti-HCV was performed by the UBI HCV EIA diagnostic test. Risk factors such as history of major surgery, transfusions, drug addiction, etc were also assessed. There were only 4 seropositive patients (1.2%), 95% CI = (0, 2.75%). Only major surgery was associated with seropositivity. It was not possible to exclude hemotransfusion during surgery as a risk factor.

[Risk factors in osteoporosis: clinical and epidemiologic evidence]. / Factores de riesgo en la osteoporosis: evidencias clínicas y epidemiológicas.

The mechanisms of bone loss involve a predominance of osteodestructive cell activity over bone repair. Age and gender are the most significant biological risk factors; perimenopausal women constitute the most susceptible population group. Hormone-related phenomena, such as pregnancies and lactational performance, as well as heredity and ethnic origin, are also associated with osteoporosis. Alcohol and caffeine have been linked with progressive bone demineralization. A reduced body mass increases the probability of fractures. Dietary factors, such as adequate intakes of calcium, phosphates, and vitamin D, exert a protective action while the effect of fluoride and dietary fiber is still controversial. A constant physical activity promotes an appropriate development and maintenance of bone mass and architecture.

Combinación de insulina con sulfonilureas en pacientes diabéticos tipo II con control deficiente: estudio abierto / Combination therapy of insulin and sulfonylureas in type II diabetic patients with deficient control. An open study

El tratamiento combinado con insulina y sulfonilureas en pacientes diabéticos tipo II que no responden al tratamiento oral con hipoglucemiantes ha sido un tema de interés reciente. Varios estudios han demostrado mejoría en el control metabólico de la glucemia; sin embargo, no se han determinado las características que presentan los pacientes en los que se obtiene un mayor beneficio. En este estudio, durante 12 semanas evaluamos los resultados alcanzados con el tratamiento combinado de hipoglucemiantes orales por la mañana y de insulina a bajas dosis antes de la cena, en 35 pacientes diabéticos tipo II con falla secundaria a las sulfonilureas. Se demostró una mejoría significativa en el grupo estudiado, tanto en la glucemia de ayuno (de 14.9 a 7.81 mmol/l) como en la postprandial (de 14.09 a 10.86 mmol/l). Fue más notorio el beneficio en aquellos que al inicio del estudio presentaron cifras más altas de glucemia y de péptido C, así como en quienes tuvieron una mejor función renal valorada por medio del filtrado glomerular. La edad, el peso y el tiempo de evolución de la diabetes, no mostraron correlación. Se concluye que la terapia combinada es una buena elección, más aún si tomamos en cuenta los marcadores que correlacionan con un mayor beneficio

Hydroxychloroquine compared with placebo in rheumatoid arthritis. A randomized controlled trial.

OBJECTIVE: To assess the efficacy of hydroxychloroquine, 400 mg daily, for rheumatoid arthritis. DESIGN: Six-month, double-blind, randomized trial. SETTING: Ambulatory referral clinic in a Mexico City, Mexico, teaching hospital. PATIENTS: A total of 126 patients with early rheumatoid arthritis were randomly assigned to receive hydroxychloroquine, 400 mg/d, or placebo; 121 patients completed the study. RESULTS: Hydroxychloroquine showed a clinically and statistically significant improvement over placebo in joint score (20% greater mean improvement; 10% more patients improved by > 50%); pain (40% greater mean improvement; 19% more patients improved by > 50%); grip strength (22% greater mean improvement; 21% more patients improved by > 50%); patient global assessment (16% more patients stated they had improved); and physician global assessment (12% more patients were judged to have improved). Side effects were mild, and no patients in the hydroxychloroquine group required discontinuation of therapy. Patient compliance with the study medication was high. CONCLUSION: Hydroxychloroquine is moderately effective in early rheumatoid arthritis.

Chest expansion in healthy adolescents and patients with the seronegative enthesopathy and arthropathy syndrome or juvenile ankylosing spondylitis.

OBJECTIVE: To determine chest expansion measurements in healthy children and those with juvenile spondyloarthropathies. METHODS: Chest expansion, as defined by the difference between maximal inspiration and maximal expiration was measured in 157 healthy adolescents (112 boys and 45 girls) aged 11 to 15 years, 20 patients with the seronegative enthesopathy and arthropathy (SEA) syndrome and 15 with juvenile ankylosing spondylitis (AS). RESULTS: The median and mean chest expansion (+/- 2 SD) were 5.0 cm and 5.6 cm (+/- 3.52) for the whole group of healthy adolescents, 6.0 cm and 5.9 cm (+/- 3.64) for boys and 5.0 cm and 4.8 cm (+/- 2.69) for girls. The frequency distribution of the values was leptokurtic and skewed to the right and did not follow the normal pattern; nearly 90% of the measurements fell within the interval from 3 to 9 cm. Of all variables analyzed (age, height, weight, sex and health/disease status), only height correlated with chest expansion (r = 0.20, p = 0.01). Even so, the effect of all these variables explained only 13% of the total variance of the measurements. Interobserver and intraobserver intraclass correlation coefficients were moderate (0.58 and 0.67, respectively). Mean values and cumulative frequency distribution in asymptomatic and symptomatic SEA syndrome and patients with juvenile AS were similar to those from healthy adolescents. CONCLUSION: Measuring chest expansion does not seem to be a useful method for the rare cases of early involvement of the chest joints in SEA syndrome and juvenile AS.

[Infections caused by gram negative anaerobic bacteria and other associated bacterial strains]. / Infecciones por anaerobios gram-negativos y otras especies bacterianas asociadas.

Between November 1975--December 1977, in the Laboratory of Microbiology, National Institute of Nutrition, Mexico, 156 cultures for anaerobic bacteria were grown on 118 cases with a clinical picture suggestive of anaerobic infection. There were 42 positive cultures (26.9%) from which 18 (42.8%) grew a mixed flora (aerobicanaerobic). Those 42 cultures came from 35 patients (29.6%) and the 18 mixed cultures came from 18 cases (15.25% global and 51.42% of the cases with anaerobic flora). The highest positive marks were obtained from material provenient from the abdominal cavity, and lesser indexes were obtained from lungs, blood, bone and sinovial cavities. The overall mortality was registered in 24 cases (20.33%) but only in 6 cases (5.8% global and 25% of the total cases) a positive anaerobic culture was obtained. In these 6 cases the cause of death was secondary to the principal disease, and only in one case the patient died from septicemia. The diagnosis of anaerobic infection resides mainly in the clinical findings, secondly in a positive gram stain, and thirdly in the identification of the etiologic agent, that will aid in the choice of a more specific therapy, which must include a surgical excision of the affected tissues.

[Dysgeusias]. / Disgeusias.

This is a review of multiple pathologic conditions associated with altered taste perception and identification. We stated the steps and the molecular basis of this sense. This paper includes two cases that exemplify two distinct types of dysgeusia; case, 1 a 48 year old man who had clinical manifestations of hypogeusia and dysgeusia for one year, probably secondary to air pollutants. Case 2, a 37 year old man who worked in the same factory and also had dysgeusia; we concluded that it was secondary to thermal and chemical agression of the oropharynx; his plasma and urinary levels of zinc were normal. Many medications and contaminants of air and water are related with changes in serum and urine levels of zinc, which is a determinant at several levels for the correct integration of the taste system. Namely it is important for synthesis of the metalloprotein, gustin, a parotid gland protein secreted into saliva, which in turns is very important to make union of the sapid substance (SS) with its receptor in the surface of the gustatory epithelium a the taste buds. Zinc is also related with neurotransmission of the electrical stimulus generated in the bud cell and ending in the central nervous system. There is an acute zinc loss syndrome, seen in patients treated with histidine, which simulates the steps in which taste sensation is integrated. A clinical approach for diagnosis of hypogeusic or dysgeusic patients must include a careful evaluation of the diat elements, an assesment of hereditary disorders, the type of work and contact with pollutants known to be related with dysgeusia. A special care regarding physical examination must be considered in particular a meticulous review of the oropharynx in order to diagnose inflammatory, neoplastic or neurological disorders. The levels of perception an identification of flavors: sweet, bitter, sour and salt, must be determined using the forced scale triple choice technic. Serum and urinary levels of zinc should be determined in each patient using a flameless atomic absorption spectrophotometer. A quantification of the activity of leucocyte alkaline phosphatase, a zinc metalloenzyme, is a useful aid, liver function tests. 13 and 14 determinations and serum protein electrophoresis are mandatory because many pathologic states of these organ systems are known to be related with disorders of taste. We wish to remark the important function of zinc in the taste system, the role of essential trace elements is receiving increased atention and these alterations are good examples of their clinical importance.