Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

Malformaciones fetales graves debidas a la secuencia de bandas amnióticas / Severe fetal malformations due to amniotic band sequence

La secuencia de bandas amnióticas es una entidad que puede presentarse como un amplio espectro de malformaciones fetales, cuyo origen está relacionado con la presencia de bandas amnióticas. Presentamos el caso de una gestante de 17+6 semanas, sin control gestacional previo, en la que se detectaron un gran número de malformaciones fetales con presencia de bandas amnióticas. El diagnóstico de esta entidad se realiza con la ecografía prenatal, sospechándose en presencia de malformaciones fetales diversas que no pertenecen a ningún síndrome conocido. La presencia de una brida amniótica constituye un elemento patognomónico, aunque no siempre está presente. Debemos conocer esta entidad, ya que existe un gran infradiagnóstico debido a su gran variedad clínica. Realizar el diagnóstico prenatal nos permite determinar el pronóstico, así como valorar la necesidad de intervenciones quirúrgicas tanto antes como después del nacimiento.

Amniotic band sequence can show a wide spectrum of fetal malformations, the origin of which is the presence of amniotic bands. We present the case of a pregnant woman of 17+6 weeks, without gestational control. Multiple fetal malformations with presence of amniotic bands were detected on ultrasonography. Echography plays a major role in the diagnosis, with the presence of diverse fetal malformations. The presence of an amniotic band is pathognomonic, but is not always present. We must be aware of this sequence because it is underdiagnosed due to its wide clinical spectrum. Prenatal diagnosis of this entity allows us to determine prognosis of the pregnancy. It also helps us to evaluate possible surgical interventions after and before birth.

Patients with non-tuberculous mycobacteria in respiratory samples: a 5-year epidemiological study.

OBJECTIVE: This study describes the characteristics of patients with positive cultures of non-tuberculous mycobacteria (NTM) in respiratory samples and determines the risk factors that predispose for a reinfection with different NTM species. METHODS: Patients with NTM isolates in respiratory samples between 2013 and 2017 were studied. Additionally, risk factors and comorbidities of reinfected patients were analyzed.. RESULTS: The study was focused on the 280 patients with NTM isolation (28 were reinfected with at least another species). Mycobacterium avium was the main isolated species. 68% were men. Median age was 73.2. Most remarkable risk factors were: tobacco, COPD and bronchiectasis. Bronchiectasis turned out to be a statistically significant risk factor for reinfection. Only 12 patients (12.4%) were treated. CONCLUSIONS: NTM were mainly identified in elderly patients. The most frequent comorbidities were COPD and smoking, whereas the most frequent species was M. avium. Previous bronchiectasis was a predisposing factor for reinfection.

Prognostic factors and recurrence in breast cancer: experience at the national cancer institute of Mexico.

The purpose of this study was to analyze the prognostic and predictive factors that relate to locoregional or distant recurrences in breast cancer patients who have been treated at the National Cancer Institute of Mexico. Multivariate, time-dependent Cox regression analyses indicate that the pN status (positive versus negative lymph node; P = 0.003; HR (hazard ratio), 3.47; CI (confidence interval), 1.52-7.91) and the pathological complete response of the patient to neoadjuvant chemotherapy (yes versus no; P = 0.061; HR, 0.38; CI, 0.14-1.04) were important prognostic factors for recurrence.

Tumor HGF lacks prognostic significance in Mexican breast cancer patients.

Hepatocyte growth factor-scatter factor (HGF-SF) is a pleiotropic protein implicated in tumor formation and metastasis. Since increased levels of HGF-SF were first identified in breast cancer tissue or patient serum, some evidence has suggested that tumor or serum HGF-SF concentration could be one of the most accurate prognostic factors for this disease. However, other recent investigations have not been able to corroborate this finding. The study aims to establish the prognostic significance of HGF-SF in Mexican breast cancer women. Surgical specimens were obtained from 67 incident breast cancer patients at the Mexican National Cancer Institute between 1994 and 1995. Primary breast cancer tissue HGF-SF was measured by quantitative sandwich enzyme immunoassay. Relapse-free and overall survival curves were generated using Kaplan-Meier method. Significance of survival differences was calculated by log-rank test. chi2 was used for the association analysis between prognostic variables. Disease-free survival and overall survival were similar between the high tumor HGF group of patients and the low HGF patients (p = 0.7 and p = 0.36 respectively). No association was found between HGF and other clinicopathological variables (age, menopause status, clinical tumor size, clinical node involvement, metastasis, tumor grade, Estrogen Receptor and Progesterone Receptor). We found no prognostic significance for HGF, nor did we find a clear association between HGF and other known prognostic factors. A firm conclusion cannot be established regarding the role of HGF as a prognostic tool in breast cancer patients.

Síntomas psicosomáticos y teoría transaccional del estrés / Psychosomatic symptoms and transactional mediational theory of stress

Con el objetivo de integrar el estudio de los síntomas psicosomáticos a la teoría transaccional del estrés. Se presenta un modelo explicativo de los síntomas psicosomáticos basados en la teoría transaccional del estrés de Lazarus, en el cual se incluyen análisis de estudios realizados con el propósito de valorar o explicar los síntomas psicosomáticos y, el planteamiento de Sandín respecto al estrés, además de considerar otras variables que han sido relacionadas a los síntomas psicosomáticos

The aim of this paper is to integrate the psychosomatic symptoms' study in to the transactional mediational theory. An explanatory model of the psychosomatic symptoms, based on the Lazarus' transactional mediational theory of stress is presented; Additionally the analysis of studies carried out for the purpose ofvaluing or to explain the psychosomatic symptoms, in the Sandin's approaches of stress are included. Finally we considering other variables that have been related to the psychosomatic symptoms

Histological toxicity of grepafloxacin after intravitreal injection.

PURPOSE: To determine the intravitreal levels of grepafloxacin after intravitreal injection of 80 microg and to evaluate the retinal toxicity after intravitreal injection of different doses of grepafloxacin in rabbit eyes. METHODS: Fifteen female New Zealand white rabbits and 15 female pigmented 'Gigantes de España' rabbits were injected with 80 microg of grepafloxacin into the vitreous cavity. The grepafloxacin concentration was determined with HPLC after 2, 4, 8, 12 and 24 h. Eighteen female rabbits (9 New Zealand white rabbits and 9 pigmented 'Gigantes de España' rabbits) were used for a study of toxicity. The rabbits were divided into 6 treatment groups: group 1 (3 pigmented rabbits) received an intravitreal injection of 80 microg of grepafloxacin in 0.1 ml of saline solution, group 2 (3 white rabbits) 80 microg of grepafloxacin in 0.1 ml, group 3 (3 pigmented rabbits) 800 microg of grepafloxacin, group 4 (3 white rabbits) 800 microg of grepafloxacin, group 5 (3 pigmented rabbits) and group 6 (3 white rabbits) 0.1 ml of saline solution. Clinical examination was performed prior to injection and 24 h and 10 days after surgery. The animals were sacrificed 10 days after the injection, and the eyes were enucleated and fixed for histopathology. The specimens were stained with hematoxylin-eosin and toluidine blue. RESULTS: No relevant complications were found during the clinical follow-up. All the eyes showed no abnormalities in the histologic evaluation. CONCLUSION: Grepafloxacin can be considered as a safe alternative for intravitreal injection for the treatment of intraocular infections.

A new nuclear magnetic resonance algorithm to determine equilibrium constants of the species in the B(III)-H2O system.

Several efforts have been attempted to study species formation by Nuclear Magnetic Resonance (NMR) in systems with several chemical equilibria present. The majority of these are qualitative and only a few have tried to relate component fractions of a distribution diagram with experimental area fractions determined from NMR spectra to obtain equilibrium constants values. In this work we present a new focus that attempts to relate the species concentration fractions in the system with area fractions beneath NMR peaks to achieve this task. 11B-NMR data of B(III)-H2O systems have been processed with the aid of formation constant values (-log *beta) obtained by potentiometry which are 9.17+/-0.01 for B(OH)3, 9.79+/-0.08 for B2O(OH)5-, 19.90+/-0.09 for B3O3(OH)4- and 38.50+/-0.04 for B5O6(OH)4-, form B(III)-H2O systems with 0.075 M< or = [B(III)]total< or = 0.700 M, in agreement with previous reports and NMR behavior. The treatment of NMR data developed in this work gives a new methodology to obtain formation constants and suggests the possibility to establish a generalization of Beer's law to NMR spectroscopy.

Predominance zone diagrams and their application to solvent extraction techniques.

Predominance zone diagrams have been useful tools in solving problems in analytical chemistry. They can be used to establish the best conditions for separation of mixtures or to optimize recovery procedures for a given species. The few reports on predominance zone diagrams for the participant species in liquid-liquid extraction systems, describe their construction as diagrams of the Pourbaix type (epsilon/pH). With the generalized species and equilibria method (GSEM) it is possible to elaborate Predominance zone diagrams for extraction (PZDE) in proper spaces and with parameters strictly related to these processes such as pH and the volume ratio, r. Therefore, using the GSEM, PZDE that allow us to determine the best conditions for the extraction of a given substance have been elaborated. The stoichiometry of the species been extracted can also be determined from the experimental conditions. It has been demonstrated that with the GSEM, PZDE can be constructed for systems of one and two components. In this work, we intend to demonstrate that the algorithm is valid for the elaboration of PZDE in systems of three and four components. Examples of analytical interest are presented such as lead (II) extraction with diphenyltiocarbazone (dithizone) and that for cadmium (II) with 8-hydroxyquinolein (oxine) in chloroform. The influence of a masking agent, the etilendiaminotetraacetic acid (EDTA) over the extraction of both metals was also assessed.

[The short-term effects of air pollution on mortality: the results of the EMECAM project in the city of Pamplona, 1991-95. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en la ciudad de Pamplona, 1991-95.

BACKGROUND: To assess the short-term impact of air pollution on the daily death rate in the city of Pamplona. METHOD: Ecological study with a population of 212,000 inhabitants. A time series data analysis is conducted by means of multiple linear regression and Poisson regression, with the daily death rate data, air pollution levels for Particles and SO2, weather parameters of average relative humidity and temperature daily and number of cases weekly of flu for the 1991-1995 period. RESULTS: The average number of deaths daily for non-external causes is that of 4.15 deaths, with a range from zero to 13 deaths. The city of Pamplona has a mean annual temperature of 12.7 degrees C (-2.3 degrees C to 31.6 degrees C) and a relative humidity of 68.5%. In the model, the temperature (with a one-day time lag and a six-day time lag temperature squared) and the humidity (with a one-day time lag) is related to the death rate for all causes. But the death rate for non-external causes is only related in the model with the temperature (one-day time lag, P: 0.035) and five-day time lag with temperature squared (p: 0.028). The timely estimates of the relative particle-related risk show that the highest risk of dying stems from respiratory causes with a relative risk of 1.13. However, none of these relationships is statistically significant. In the case of Sulfur Dioxide, the estimates closely near the zero figure, and none of them is significant. CONCLUSIONS: The Temperature has an impact of the death rate for all causes, both external and non-external, and the relative humidity solely has an impact on the death rate for non-external causes. It has not been possible to prove any influence of the daily environmental pollution levels on the daily death rate.

Thoracic aortic aneurysm: a new etiology of pulmonary cavity.

The most frequent chest X-ray finding of descending thoracic aortic aneurysm is an enlargement of medial mediastinum. Haemoptysis caused by thoracic aortic aneurysm is rare and, normally, when it occurs, it is due to an aorto-bronchopulmonary fistula. We report the case of an 88 year-old male, heavy smoker with arterial hypertension, who had been operated on for abdominal aneurysm five years before, whose unique symptom was scant haemoptysis and radiologically presented a cavity mass in the upper left lobe. Autopsy revealed that the pulmonary cavity mass was due to a descending thoracic aortic aneurysm.

[Work-related anxiety among nursing personnel]. / Ansiedad laboral en personal de enfermería.

OBJECTIVE: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors. MATERIAL AND METHODS: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random. RESULTS: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively). CONCLUSIONS: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.

Determination of pK(a)'s for thymol blue in aqueous medium: evidence of dimer formation.

Formation constants for recrystallized thymol blue were determined in water, using the SQUAD and SUPERQUAD programs. The best model correlating spectrophotometric, potentiometric and conductimetric data was fitted with the dissociation of HL(-)=L(2-)+H(+)-log K=8.918+/-0.070 and H(3)L(2)(-)=2L(2-)+3H(+)-log K=29.806+/-0.133 with the SUPERQUAD program at variable low ionic strength (1.5x10(-4)-3.0x10(-4) M); and HL=L(2-)+H(+)-log K=8.9+/-0.000, H(3)L(2)(-) =2L(2-)+3H(+)-log K=30.730+/-0.032, H(4)L(2)=2L(2-)+4H(+)-log K=32.106+/-0.033 with SQUAD at 1.1 M ionic strength.

A novel interaction between adrenergic receptors and the alpha-subunit of eukaryotic initiation factor 2B.

The alpha-subunit of eukaryotic initiation factor 2B (eIF-2B), a guanine nucleotide exchange protein that functions in regulation of translation, was observed to associate with the carboxyl-terminal cytoplasmic domains of the alpha2A- and alpha2B-adrenergic receptors in a yeast two-hybrid screen of a cDNA library prepared from 293 cells. This protein association was confirmed in vitro by affinity chromatography and was shown to be specific for a subset of G protein-coupled receptors, including the alpha2A-, alpha2B-, alpha2C-, and beta2-adrenergic receptors, but not the vasopressin (V2) receptor. Association of these proteins in vivo was confirmed by specific co-immunoprecipitation of eIF-2Balpha with full-length beta2-adrenergic receptors expressed in transfected 293 cells and by fluorescence microscopy showing co-localization of these proteins in intact cells. Remarkably, eIF-2Balpha co-localized with receptors exclusively in regions of the plasma membrane that are in contact with the extracellular medium, but failed to associate with membranes making cell-cell contacts. Overexpression of eIF-2Balpha in 293 cells caused a small (approximately 15%) but significant enhancement of beta2-adrenergic receptor-mediated activation of adenylyl cyclase, without affecting forskolin or V2 receptor-mediated activation. These observations suggest a new role for a previously identified guanine nucleotide exchange protein in membrane biology and cell signaling.

The MEKK-JNK pathway is stimulated by alpha1-adrenergic receptor and ras activation and is associated with in vitro and in vivo cardiac hypertrophy.

In neonatal rat ventricular myocytes, stimulation of the alpha1-adrenergic receptor (alpha1-AdrR) activates a program of genetic and morphological changes characterized by transcriptional activation of the atrial natriuretic factor (ANF) gene and enlargement (hypertrophy) of the cells. The low molecular weight GTPase Ras has been established as an important regulator of hypertrophy both in vitro and in vivo. Ras activates a kinase cascade involving Raf, the mitogen-activated protein kinase kinase (MEK), and the extracellular signal-regulated protein kinase (ERK). However, the extent of involvement of this pathway in regulating hypertrophic responses is controversial. We demonstrate here that both alpha1-AdrR stimulation and Ras can also activate the c-Jun NH2-terminal kinase (JNK) in cardiomyocytes. The alpha1-AdrR effect on JNK occurs through a pathway requiring Ras and MEK kinase (MEKK). A constitutively activated mutant of MEKK that preferentially activates JNK, stimulates ANF reporter gene expression, while a dominant negative MEKK mutant inhibits ANF expression induced by PE. Furthermore, JNK activity is increased in the ventricles of mice overexpressing oncogenic Ras, whereas ERK activity is not. These results suggest that the alpha1-AdrR mediates ANF gene expression through a Ras-MEKK-JNK pathway and that activation of this pathway is associated with in vitro and in vivo hypertrophy.

Endothelin ETA receptor regulates signaling and ANF gene expression via multiple G protein-linked pathways.

We have characterized the interaction of endothelin (ET) with cultured neonatal rat ventricular myocytes. Binding studies indicate a single population of ETA receptors [53,000 sites/cell, apparent dissociation constant (Kd) for ET-1 approximately 0.07 nM]. Analysis of mRNA levels for ET receptors using 35 cycles of reverse transcriptase-polymerase chain reaction demonstrates the presence of only ETA-receptor message. Studies with ET-1 and a variety of congeners and antagonists indicate that ETA receptors couple to both the stimulation of phosphoinositide turnover and the inhibition of adenylyl cyclase. In myocytes transfected with an atrial natriuretic factor (ANF) promoter linked to a luciferase reporter gene, ET-1 stimulates luciferase expression through an ETA receptor. These data indicate that the ETA receptor is the exclusive receptor on neonatal ventricular myocytes and that this receptor couples to both phosphoinositide hydrolysis and adenylyl cyclase. ET-1 also induces a threefold increase in mitogen-activated protein kinase (MAPK) activity, an effect that is not sensitive to pertussis toxin (PTx). By contrast, ET-stimulated ANF-luciferase expression is partially inhibited by treatment of cells with PTx, suggesting that both PTx-sensitive (Gi) and PTx-insensitive (Gq) pathways mediate the effects of ET-1 on ANF gene expression in neonatal myocytes and that hormonal regulation of ANF expression may utilize pathways in addition to the activation of MAPK.

Application of SQUAD to the refinement of formal potentials from coulometric steady-state and spectrophotometric measurements.

The application of SQUAD to the refinement of formal potentials from potentiometric or coulometric steady-state and spectrophotometric measurements was tested. The formal potential thus obtained for the Fe(CN) (3-)(6)Fe(CN) (4-)(6) couple in 0.5 M H(2)SO(4) agreed with published data. This method was found to be satisfactory for the determination of typical standard potentials and it is suggested that it may be advantageous when dealing with multi-component systems.

The nuclear deltaB isoform of Ca2+/calmodulin-dependent protein kinase II regulates atrial natriuretic factor gene expression in ventricular myocytes.

Cultured neonatal ventricular myocytes display features of myocardial hypertrophy including increased cell size, myofilament organization, and reexpression of the embryonic gene for atrial natriuretic factor (ANF). KN-93, an inhibitor of multifunctional Ca2+/calmodulin-dependent protein kinase (CaM kinase II), blocked the induction of these responses by the alpha1-adrenergic receptor agonist phenylephrine, whereas its inactive analog KN-92 did not. To directly determine whether CaM kinase II could regulate ANF gene expression, we transiently expressed each of three isoforms of CaM kinase II (alpha, deltaB, and deltaC) along with an ANF promoter/luciferase reporter gene. The deltaB isoform markedly increased luciferase gene expression, whereas comparable levels of the deltaC and alpha isoforms were ineffective. Expression of deltaB-CaM kinase II also potentiated phenylephrine-mediated ANF gene expression, and this effect was blocked by KN-93 but not by KN-92. The ability of deltaB-CaM kinase II to transactivate a truncated ANF promoter, containing a serum response element (SRE) required for phenylephrine-inducible gene expression, was lost when this SRE was mutated. The deltaB isoform of CaM kinase II has been shown to exhibit nuclear localization. Coexpression of the non-nuclear deltaC or alpha isoforms, which can form multimers with the deltaB isoform, prevented the nuclear localization of deltaB-CaM kinase II and also blocked its effects on ANF reporter gene and protein expression. In addition, a chimeric alpha-CaM kinase II which contains the nuclear localization signal of the deltaB isoform was able to induce ANF reporter gene expression, albeit to a lesser extent than deltaB-CaM kinase II. These data are the first to assign a function to the deltaB isoform of CaM kinase II and to link its nuclear localization to subsequent activation of cardiac gene expression.

M1 muscarinic receptors heterologously expressed in cardiac myocytes mediate Ras-dependent changes in gene expression.

Stimulation of alpha 1-adrenergic receptors in neonatal ventricular cardiomyocytes induces hypertrophic changes including activation of the atrial natriuretic factor (ANF) gene. This receptor couples to Gq to activate phospholipase C (PLC) and protein kinase C, which have been implicated as mediators of the hypertrophic response. To directly determine whether receptor coupling to Gq/PLC is sufficient to induce ANF expression, we expressed wild-type and chimeric muscarinic cholinergic receptors (mAChRs) with altered G-protein coupling properties in cardiac myocytes and examined their ability to activate an ANF promoter/luciferase reporter gene. The cholinergic agonist carbachol failed to induce transcriptional activation of the ANF reporter gene through endogenous Gi-linked M2mAChRs or in cells transfected with M2mAChRs. In contrast, in cells transfected with M1mAChRs, which effectively couple to Gq/PLC, carbachol increased ANF reporter gene expression 10-fold and also increased ANF protein, as determined by immunofluorescence. Carbachol-mediated ANF gene expression was inhibited by the mAChR antagonist pirenzepine with a Ki value characteristic of an M1mAChR. Studies using chimeric M1- and M2mAChRs demonstrated that the N-terminal 21 amino acids of the third intracellular loop of the M1mAChR were required for receptor coupling to ANF gene expression. This region, previously shown to specify receptor coupling to Gq/PLC, also conferred partial activity to a chimeric M2 receptor. We further demonstrated that M1mAChR coupling to ANF gene expression was Ras-dependent since co-expression of dominant-interfering Ala-15 Ras inhibited M1mAChR-induced ANF expression by 60%. In contrast, ANF expression induced by the chimeric M2 receptor was not blocked by dominant-interfering Ras. We suggest that receptor coupling to Gq/PLC is sufficient to induce ANF expression and that a Ras-dependent pathway contributes additional signals required for maximal M1mAChR-mediated ANF gene expression.