HCN Channel Phosphorylation Sites Mapped by Mass Spectrometry in Human Epilepsy Patients and in an Animal Model of Temporal Lobe Epilepsy.

Because hyperpolarization-activated cyclic nucleotide-gated (HCN) ion channels modulate the excitability of cortical and hippocampal principal neurons, these channels play a key role in the hyperexcitability that occurs during the development of epilepsy after a brain insult, or epileptogenesis. In epileptic rats generated by pilocarpine-induced status epilepticus, HCN channel activity is downregulated by two main mechanisms: a hyperpolarizing shift in gating and a decrease in amplitude of the current mediated by HCN channels, Ih. Because these mechanisms are modulated by various phosphorylation signaling pathways, we hypothesized that phosphorylation changes occur at individual HCN channel amino acid residues (phosphosites) during epileptogenesis. We collected CA1 hippocampal tissue from male Sprague Dawley rats made epileptic by pilocarpine-induced status epilepticus, and age-matched naïve controls. We also included resected human brain tissue containing epileptogenic zones (EZs) where seizures arise for comparison to our chronically epileptic rats. After enrichment for HCN1 and HCN2 isoforms by immunoprecipitation and trypsin in-gel digestion, the samples were analyzed by mass spectrometry. We identified numerous phosphosites from HCN1 and HCN2 channels, representing a novel survey of phosphorylation sites within HCN channels. We found high levels of HCN channel phosphosite homology between humans and rats. We also identified a novel HCN1 channel phosphosite S791, which underwent significantly increased phosphorylation during the chronic epilepsy stage. Heterologous expression of a phosphomimetic mutant, S791D, replicated a hyperpolarizing shift in Ih gating seen in neurons from chronically epileptic rats. These results show that HCN1 channel phosphorylation is altered in epilepsy and may be of pathogenic importance.

Management of odonto-stomatological emergencies during the COVID-19 alarm state in dental clinics in the Autonomous Community of Madrid (CAM), Spain: An observational study.

BACKGROUND: Odontology practice has been severely compromised by the pandemic caused by COVID-19 and Spain is one of the countries with higher incidence. Our aim with this study is to find out the number of cases and type of odonto-stomatological emergencies (OSE) treated in four dental clinics of the Madrid capital area and region (CAM) in the period covered between March 17th and 4th of May. MATERIAL AND METHODS: We search the cases in the demographic/epidemiological databases of the CAM regional government and the Illustrious Official College of Dentists and Stomatologists of the First Region (Madrid). RESULTS: We found that the most prevalent pathology was acute apical periodontitis whereas odontogenic abscess showed the lowest frequency. Prosthetic-orthodontic OSE represented 14% of cases. CONCLUSIONS: In this period of time, the most prevalent pathology acute apical periodontitis, odontogenic abscess reported the lowest frequency and prosthetic-orthodontic treatments were the third in number of cases. Most of OSE were resolved, without referring the patient to a hospital emergency department.

Auditoría nacional de complicaciones después de la cirugía gástrica por cáncer dentro o no de un protocolo de recuperación intensificada (POWER.4): Protocolo de un estudio prospectivo, multicéntrico, observacional de cohortes / Postoperative Outcomes Within an Enhanced Recovery after surgery protocol in gastric surgery for cancer (POWER.4): Study protocol for a prospective, multicentre, observational cohort study

ANTECEDENTES Y OBJETIVO: Los protocolos de recuperación intensificada o ERAS se han aplicado en cirugía de cáncer gástrico extrapolados desde la cirugía colorrectal. El objetivo del estudio es evaluar la incidencia de complicaciones postoperatorias a los 30 días de la cirugía de resección gástrica por cáncer, con cualquier nivel de cumplimiento del protocolo ERAS. Los objetivos secundarios son evaluar la mortalidad a 30 días, la relación entre la adherencia al protocolo ERAS y las complicaciones, el impacto de cada uno de los ítems del protocolo en las complicaciones postoperatorias y en la estancia hospitalaria, y describir el efecto de las complicaciones postoperatorias en la duración de la estancia hospitalaria. MATERIALES Y MÉTODOS: Estudio multicéntrico, observacional, prospectivo que incluirá todos los pacientes consecutivos que vayan a ser tratados mediante cirugía de cáncer gástrico programada, durante un periodo de 3 meses, con un seguimiento de 30 días en los centros participantes, con cualquier nivel de cumplimiento del protocolo. RESULTADOS: Se ha obtenido la aprobación del Comité Autonómico de Ética de la Investigación de Aragón (C.P.-C.I. PI19/106, del 27 de marzo del 2019). POWER.4 fue registrado en www.clinicaltrials.gov el 7 de marzo del 2019 (NCT03865810). CONCLUSIONES: Los datos en conjunto serán publicados en revistas con revisión por pares. No se harán públicos los datos identificando cada centro participante. Se espera que los resultados de este estudio permitirán identificar áreas potenciales de mejora en las que se necesite realizar una investigación más dirigida

BACKGROUND AND OBJECTIVE: Enhanced recovery pathways or ERAS have been applied in gastric cancer surgery extrapolated from colorectal surgery. The objective of the study is to assess postoperative complications 30 days after gastric surgery for cancer, with any level of compliance with the ERAS protocol. The secondary objectives are to assess 30-day mortality, the relationship between adherence to the ERAS protocol and complications, the impact of each of the items of the protocol on postoperative complications and hospital stay, and to describe the impact of complications on length of hospital stay. MATERIALS AND METHODS: Multicenter, observational, prospective study including all consecutive patients undergoing scheduled gastric cancer surgery, over a period of 3 months, with a 30-day follow-up at participating centers, with any level of compliance with the protocol. RESULTS: The approval of the Comité Autonómico de Ética de la Investigación de Aragón has been obtained (C.P. - C.I. PI19 / 106, 27 th March 2019). POWER.4 was registered at www.clinicaltrials.gov on March 7, 2019 (NCT03865810). CONCLUSIONS: The data as a whole will be published in peer-reviewed journals. The data will not be made public by identifying each participating center. It is expected that the results of this study will identify potential areas for improvement in which more targeted research is needed

La resistencia de los músculos flexores de los dedos de la mano en escaladores / Evaluation of hand's fingers flexor muscles endurance in climbers

Objetivo: evaluar la resistencia de los músculos flexores de los dedos de la mano en escaladores de elite y recreativos. Métodos: estudio descriptivo transversal. Veinte y un escaladores fueron asignados a dos grupos de rendimiento: recreativo y élite. Realizaron un ejercicio isométrico y otro de esfuerzo intermitente en una tabla de entrenamiento multiagarre. Se midieron el tiempo de trabajo total, número de ciclos completados y frecuencia cardíaca media en cada test. Resultados: los escaladores de élite mantuvieron el esfuerzo en suspensión 7.65 minutos más que los recreativos (p < .001) y realizaron 23,14 ensayos más (p < .001). La fiabilidad de las mediciones fue excelente. Conclusiones: la fuerza de agarre de los músculos flexores de los dedos en esfuerzo continuo e intermitente contribuye al rendimiento en escalada, con diferencias significativas entre los escaladores de élite y recreativos. El test específico creado para el estudio ha demostrado una adecuada validez discriminante (AU)

Purpose: To evaluate hand's fingers flexor muscles grip endurance during a specific climbing test, and to find out if there were differences between elite and recreational sport climbers. Methods: For this cross-sectional descriptive study, twenty-one male sport climbers were assigned to two different groups, recreational or elite. The participants performed two exercises on a multi-hold training board, one requiring sustained isometric exercise and the other requiring intermittent exertion. The variables studied were total work time, number of trials completed and mean heart rate per test. Results: Elite climbers endured suspension for an average of 7.64 minutes being this period longer than recreational climbers (p < .001); thus, elite group performed 23.14 more trials than recreational group (p < .001). Reliability in all evaluations was excellent. Conclusions: Hand’s fingers flexor muscles grip endurance in continuous and intermittent exercises are the muscles that have more influence in sport climbing performance. In this regard, we have found significant differences between elite and recreational climbers (AU)

Efectividad de una intervención para mejorar la cumplimentación del listado de verificación de seguridad quirúrgica en un hospital de tercer nivel / Effectiveness of an intervention to improve the implementation of a surgical safety check-list in a tertiary hospital

Objetivo. Conocer el porcentaje de cumplimentación del listado de verificación de la seguridad quirúrgica (LVSQ) y las mejoras introducidas. Diseño. Estudio cuasiexperimental en 28 unidades de gestión clínica con actividad quirúrgica en el Hospital Universitario Virgen del Rocío (HUVR) y Virgen Macarena (HUVM). Se realizó un análisis de situación, para estimar la cumplimentación del LVSQ, tras lo cual se introdujo como elemento de mejora un nuevo sistema de cumplimentación del LVSQ, incluyendo una pizarra vinílica reutilizable. Posteriormente, se realizaron 2 cortes de prevalencia para valorar la efectividad de la intervención. Resultados. Se revisaron 1.964 LVSQ en HUVM y en HUVR en junio (basal) y diciembre de 2013, y en junio del 2014. Se obtuvo un porcentaje de cumplimentación del 65,8, 86,2 y 88% en el HUVR, y del 70,9, 77,2 y 75% en el HUVM. De estos LVSQ, en el HUVR estaban cumplimentados en su totalidad un 15,1% (basal), pasando de un 36,6 (p<0,001) a un 89,8% (p<0,001) en la última medición. En el HUVM se cumplimentaron totalmente un 15,6% (basal), pasando de un 18,3 (p=0,323) a un 29,4% (p=0,001) en la última medición. Conclusión. El porcentaje de cumplimentación LVSQ es similar al descrito en la literatura y oscila en torno al 80%. El rediseño del procedimiento del LVSQ, incluyendo el uso de una pizarra vinílica, la identificación de la figura del coordinador del LVSQ y la formación de los profesionales, es efectivo para mejorar los resultados en cuanto a cumplimentación del LVSQ y a la calidad de la cumplimentación (AU)

Objective. To determine the percentage of verification of a Surgical Safety Checklist and improvements made. Design. Quasi-experimental study in 28 Clinical Management Units with surgical activity in the University Hospital Virgen del Rocio (HUVR) and University Hospital Virgen Macarena (HUVM). A situation analysis was made to estimate the completing of a Surgical Safety Checklist (SSC), after which a new system of completing the SSC was introduced as an element of improvement, which included a reusable vinyl board. Subsequently, the prevalence over two periods was calculated, to assess the effectiveness of the intervention. Results. A total 1,964 SSC were reviewed in the HUVR-HUVM in June (baseline), and in December 2013 and June 2014. A percentage completion of 65.8%, 86.2%, and 88% was obtained in the HUVR, and 70.9%, 77.2%, and 75% in the HUVM, respectively. Of these SSC, 15.1% (baseline) were completed entirely in the HUVR, increasing to 36.6% (P<.001), and 89.8% (P<.001) in the last measurement. In the HUVM, 15.6% (baseline) were fully completed, increasing to 18.3% (P=.323), and 29.4% (P=.001) in the last measurement. Conclusion. The percentage of completion of SSC obtained is around 80%, and is similar to that reported in the literature. The re-design of the SSC procedure, including the use of a vinyl board, the designation of SSC coordinator role, and professional staff training, is effective for improve outcomes in terms of completing the SSC, and quality of the completion (AU)

Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma

Purpose. We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients. Methods and materials. Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60–81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50–70.2 Gy), resulting in a median cumulative dose of 134 Gy (122–148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11–126). Results. The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015). Conclusion. Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity (AU)

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The role of glycogen, glucose and lactate in neuronal activity during hypoxia in the hooded seal (Cystophora cristata) brain.

The brains of diving mammals are repeatedly exposed to hypoxic conditions during diving. Brain neurons of the hooded seal (Cystophora cristata) have been shown to be more hypoxia tolerant than those of mice, but the underlying mechanisms are not clear. Here we investigated the roles of different metabolic substrates for maintenance of neuronal activity and integrity, by comparing the in vitro spontaneous neuronal activity of brain slices from layer V of the visual cortex of hooded seals with those in mice (Mus musculus). Studies were conducted by manipulating the composition of the artificial cerebrospinal fluid (aCSF), containing either 10 mM glucose, or 20 mM lactate, or no external carbohydrate supply (aglycemia). Normoxic, hypoxic and ischemic conditions were applied. The lack of glucose or the application of lactate in the aCSF containing no glucose had little effect on the neuronal activity of seal neurons in either normoxia or hypoxia, while neurons from mice survived in hypoxia only few minutes regardless of the composition of the aCSF. We propose that seal neurons have higher intrinsic energy stores. Indeed, we found about three times higher glycogen stores in the seal brain (∼4.1 ng per µg total protein in the seal cerebrum) than in the mouse brain. Notably, in aCSF containing no glucose, seal neurons can tolerate 20 mM lactate while in mouse neuronal activity vanished after few minutes even in normoxia. This can be considered as an adaptation to long dives, during which lactate accumulates in the blood.

Paciente monorrena con diarrea de 2 semanas de evolución / A solitary kidney patient with diarrhea of 2 weeks duration

Mujer de 78 años con antecedentes personales de agenesia real derecha congénita. Acude por diarrea de 2 semanas de evolución aproximadamente y molestias en ambas piernas tipo calambre. Se realiza analítica donde se encuentra hiperpotasemia grave, hiponatremia y niveles de creatinina discretamente elevados, sin síntomas asociados a dicho hallazgo y con resto de pruebas complementarias normales. Se ingresa en la unidad de cuidados intensivos para tratamiento y tras normalizar los valores se traslada a medicina interna. Se realizan, entre otras pruebas, ACTH que aparece elevada y una RM donde encontramos un adenoma en suprarrenal izquierda. El diagnóstico final ha sido síndrome de Addison en tratamiento con mineralocorticoides y revisiones en consulta externa de medicina interna (AU)

The case is presented of a 78 year old woman with a history of congenital right renal, who suffered from diarrhea of approximately 2 weeks duration and discomfort due to cramp in both legs. The laboratory results showed severe hyperkalemia, hyponatremia, and slightly elevated creatinine levels, with no symptoms associated with this finding and with the rest of the normal laboratory results. She was admitted to the intensive care unit for treatment, and when her results returned to normal she was transferred to internal medicine. Among the other tests performed, the ACTH was shown to be high, and a left adrenal adenoma was found in the MR scan. The final diagnosis was Addison’s syndrome. She was treated with mineralocorticoids with follow-up by internal medicine as an outpatient (AU)

Slow intrinsic oscillations in thick neocortical slices of hypoxia tolerant deep diving seals.

Direct evidence that the mammalian neocortex is an important generator of intrinsic activity comes from isolated neocortical slices that spontaneously generate multiple rhythms including those in the beta, delta and gamma range. These oscillations are also seen in intact animals where they interact with other areas including the hippocampus, thalamus and basal ganglia. Here we show that thick isolated neocortical slices from hooded seals intrinsically generate persistent spontaneous activities, both repetitive non-rhythmic activity with activity states lasting for several minutes, and oscillating activity with rhythms that are much slower (<0.1 Hz) than the rhythms previously described in vitro. These intrinsic activities were very robust and persisted for up to 1 h even in severely hypoxic conditions. We hypothesize that the remarkable hypoxia tolerance of the hooded seal nervous system made it possible to maintain functional integrity in slices thick enough to preserve intact neuronal networks capable of generating these slow oscillations. The observed activities in seal neocortical slices support the notion that mammalian cortical networks intrinsically generate multiple states of activity that include oscillatory activity all the way down to <0.1 Hz. This intrinsic neocortical excitability is an important contributor not only to sleep but also to the default awake state of the neocortex.

When the brain goes diving: glial oxidative metabolism may confer hypoxia tolerance to the seal brain.

Deep diving mammals have developed strategies to cope with limited oxygen availability when submerged. These adaptations are associated with an increased neuronal hypoxia tolerance. Brain neurons of the hooded seal Cystophora cristata remain much longer active in hypoxic conditions than those of mice. To understand the cellular basis of neuronal hypoxia tolerance, we studied neuroglobin and cytochrome c in C. cristata brain. Neuroglobin, a respiratory protein typically found in vertebrate neurons, displays three unique amino acid substitutions in hooded seal. However, these substitutions unlikely contribute to a modulation of O(2) affinity. Moreover, there is no significant difference in total neuroglobin protein levels in mouse, rat and seal brains. However, in terrestrial mammals neuroglobin resided exclusively in neurons, whereas in seals neuroglobin is mainly located in astrocytes. This unusual localization of neuroglobin is accompanied by a shift in the distribution of cytochrome c. In seals, this marker for oxidative metabolism is mainly localized in astrocytes, whereas in terrestrial mammals it is essentially found in neurons. Our results indicate that in seals aerobic ATP production depends significantly on astrocytes, while neurons rely less on aerobic energy metabolism. This adaptation may imbue seal neurons with an increased tolerance to hypoxia and potentially also to reactive oxygen species, and may explain in part the ability of deep diving mammals to sustain neuronal activity during prolonged dives.

Violencia doméstica atendida en urgencias de un hospital comarcal: características sociodemográficas de víctima y agresor / Medical attention for domestic violence in a regional hospital: sociodemographic characteristics of victims and aggressors

Objetivos: Conocer las características sociodemográficas de víctimas y agresores, tipo de maltrato y las circunstancias que lo definen, en los casos de violencia doméstica atendidos en el servicio de urgencias de un hospital comarcal. Como segundo objetivo se investigará si existieron rasgos diferenciales, tanto en la víctima como en el agresor, en función del género. Método: Estudio prospectivo, observacional, de las víctimas de violencia doméstica atendidas del 15 de marzo de 2003 al 14 de marzo de 2004. Durante la atención se cumplimenta un cuestionario socio demográfico y un formulario médico-legal y de actuación clínica. Se realizó el estudio estadístico de las variables diferenciadas en función del género de víctima y agresor. Resultados: Se recogieron 58 casos, 43 (74%) de violencia dentro de la pareja (39 contra mujeres), 2 (3%) de malos tratos al anciano y 5 (9%) de maltrato a menores de 18 años. Las víctimas tienen una edad media de 35 ± 14, y el 82,6% son mujeres, y principalmente casadas (48%), con nivel de estudios bajo (67%) y escaso poder económico autónomo. El agresor es más frecuentemente hombre (90%) de 39±12 años de edad, pareja dela víctima (74%) con la que ha mantenido relaciones prolongadas (60% más de 6 años).La agresión más frecuente es la física aislada (55%), existen agresiones previas en el 65%y amenaza de muerte asociada en el 36%. El agresor tiene trabajo estable (41%) con mayor frecuencia que el agredido (19%; p < 0,05). Con mayor frecuencia el hombre agresor tiene estudios primarios o inferiores (78%) que la mujer agresora (32%; p < 0,05).Conclusiones: La violencia contra la mujer dentro de la pareja es la forma más frecuente de maltrato. El agresor es más frecuentemente hombre, de edad media y conviviente durante largo tiempo con la víctima. El maltrato continuado tiene una alta prevalencia en el estudio (AU)

Aim: The primary objective of the study was to assess the sociodemographic characteristics of victims and aggressors, the type of abuse and the defining circumstances of mistreatment in domestic violence cases attended in the Emergency Department a county hospital. The second aim was to determine gender-related differences between the victim and aggressor. Methods: Prospective, observational study of domestic violence victims who presented at the hospital in the period from March 15, 2003 to March 14, 2004. While being atended every patient completed a sociodemographic questionnaire and a medical-legal and clinical performance evaluation form. Statistical analysis of differential variables based an the gender of the victim and aggressor was performed. Results: A total of 58 persons were included, 43 (74%) reporting couple-related violence (39 against women), 2 (3%) ill-treatment to the elderly and 5 (9%) mistreatment of minors under 18 years of age. The mean age of the subjects was 35 ± 14 years, 82.6% were female, predominantly married (48%), with low education (67%) and poor economic status. The aggressor was most frequently a 39-12 year old male (90%), who was the partner of the victim (74%) with a prolonged relationship (60%, > 6 years). The most frequent aggression was isolated physical injury (55%), previous aggressions had occurred in 65% and associated death threats in 36%. The aggressor more often had a more stable job (41%) than to the victim (19%; p < 0.05). Primary or lower education was more common (78%) in male aggressors compared to female agressors (32%; p < 0.05).Conclusions: Violence against the women within the couple is the most frequent form of mistreatment. Commonly the aggressor is a middle-aged man, who had been cohabiting for a long time with the victim. The prevalence of continued mistreatment in the present study was very high (AU)

Implicación de la astroglía en el daño glaucomatoso / Implications of astroglia in glaucomatous damage

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[Increased secretion of Nt-proBNP immediately after percutaneous coronary intervention: about 90 cases]. / Elévation de la sécrétion du Nt-proBNP dans les 24 heures suivant une angioplastie coronaire: à propos de 90 cas.

Nt-proBNP have emerged as useful biomarker for the diagnosis and prognostic of heart failure but also recently in acute coronary syndrome. Myocardial ischemia is probably an important stimulus for Nt-proBNP release. Transient myocardial ischemia is inducing by balloon inflation during percutaneous coronary intervention (PCI). The authors propose to determine the Nt-proBNP secretion after uncomplicated coronary intervention in patients with preserved cardiac function. Ninety patients were enrolled in this study. Plasma Nt-proBNP was increased significantly from 135.5 to 157.8 pg/ml and 202.5 pg/ml at 8 and 24 hours following PCI, respectively. History of myocardial infarction and complex lesions were the most powerful predictors of higher Nt-proBNP peak concentration. Prognostic value must be evaluated in larger studies.

Estudio comparativo de la inervación coroidea en el hombre y en el conejo (oryctolagus cuniculus) / A comparative study of choroidal innervation in the human and the rabbit (oryctolagus cuniculus)

Objetivo: Analizar las diferencias morfológicas entre la inervación coroidea del hombre y el conejo, especie frecuentemente utilizada como modelo experimental de enfermedades oculares. Método: Se estudiaron montajes planos de coroides (12 humanas y 12 de conejo albino) con la técnica de inmunohistoquímica indirecta de la peroxidasaantiperoxidasa, utilizando un anticuerpo frente al neurofilamento de 200 kD. Resultados: Las fibras nerviosas coroideas pueden ser perivasculares e intervasculares. Las perivasculares rodeaban las arterias formando una red que estaba más desarrollada en la coroides del conejo. En el humano, las fibras intervasculares se concentraban principalmente en el polo posterior donde formaban un plexo más denso y organizado que en el conejo, el cual no tenía una localización preferencial. Las células ganglionares eran más numerosas en el humano, concentrándose en un área circunferencial correspondiente a la entrada de las arterias ciliares cortas posteriores y en el área submacular. En el conejo estas células se situaban sólo en la periferia. Conclusiones: Existen diferencias entre la inervación coroidea humana y del conejo. En el humano, la abundancia de células ganglionares y su distribución, podrían ser necesarias para mantener un flujo sanguíneo constante en el área central de la coroides. La falta de organización nerviosa en el polo posterior del conejo podría estar asociada a la ausencia de mácula. Estas diferencias, junto a las diferencias anatómicas de la vascularización retiniana, deberían ser tenidas en cuenta al utilizar el conejo como modelo experimental para estudiar enfermedades oculares en las que esté implicada la regulación del flujo sanguíneo coroideo

Objective: To analyze morphological differences between the choroidal innervation of the human and the rabbit, the latter being a species frequently used as an experimental model of human ocular diseases. Methods: Twelve human and 12 rabbit choroidal whole mounts were processed using an indirect immunohistochemical technique, peroxidase-anti-peroxidase and antibodies against 200 kD neurofilament. Results: Choroidal nerve fibers were perivascular and intervascular. Perivascular fibers surrounded all arteries forming a network that was more developed in the rabbit. In humans, intervascular fibers were mainly concentrated at the posterior pole where they formed a denser and more highly organized plexus than in the rabbit, which did not exhibit a preferential location for these fibers. Human choroidal ganglion cells were far more numerous than in the rabbit and were concentrated in a circumferential area corresponding to the entrance of the short posterior ciliary arteries of the submacular area. In the rabbit, these cells were restricted to the peripheral choroid. Conclusions: Some differences were observed between human and rabbit choroidal innervation. The abundance of ganglion cells and their preferential distribution could be necessary to maintain a constant blood flow in the central area of the human choroid. The lack of organization of rabbit choroidal innervation at the posterior pole could be associated with an absence of the macula. These differences, along with peculiarities of retinal vascularization, should be taken into consideration when using the rabbit as an experimental model to study human eye diseases in which regulation of choroidal blood flow is involved

Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants.

Alterations in the heart rate were monitored before, during and after the application of a unilateral mechanical impulse to the high cervical spinal cord region which was administered strictly in connection with the so called manual therapy (diagnosis= KISS). The investigation is based on a survey of 695 infants between the ages of 1 and 12 months. A notable change in the heart rate was evident in 47.2% of all examined infants (n= 695). In 40.1% of these infants, the change in heart rate was characterized by heart rate decrease of 15-83% compared to control conditions. Infants in their first 3 months of life responded more often with a severe bradycardia (50-83% decrease), older infants (7-12 months) more often with a mild bradycardia (15-49.9% decrease). This comparison revealed a significantly increased occurrence of severe bradycardia in the younger age group compared to the group of children >3 months (significance 0.0017). In 12.1% (n= 84) of the infants, the bradycardia was accompanied by an apnea. We discuss the hypothesis that mechanical irritation of the high-cervical region serves as a trigger that may be involved in sudden infant death (SID).

Tratamiento endoscópico del dolor en los pacientes con pancreatitis crónica / Endoscopic pain management in chronic pancreatitis patients

Introducción: La Pancreatitis crónica es una enfermedad recurrente, frecuentemente asociada al consumo de alcohol y suele presentarse en la tercera y la cuarta décadas. Las estenosis y las litiasis del conducto pancreático principal producen obstrucción del mismo y consecuentemente dolor. Por tanto la descompresión quirúrgica o endoscópica, del conducto pancreático principal alivia el dolor. Sujetos y métodos: Revisión de nuestra experiencia en el manejo endoscópico en pacientes con pancreatitis crónica. Realizamos CPREs en 42 pacientes para el manejo de su pancreatitis crónica. Las opciones terapéuticas fueron la esfinterotomía, colocación de endoprótesis ó ninguna. El seguimiento medio fue 47,8 (27,2) meses. Resultados: 22 pacientes fueron sometidos a CPRE terapéutica. En ocho pacientes, realizamos esfinterotomía y en 14 pacientes, colocamos endoprótesis con esfinterotomía previa. 8 pacientes estaban asintomáticos, después de un seguimiento medio de 10,8 (11,6) meses. Dos de ellos, fueron sometidos a una esfinterotomía y en seis de ellos, colocamos endoprótesis, previa esfinterotomía. Conclusión: La CPRE es una herramienta que alivia el dolor en un quinto de pacientes con pancreatitis crónica (AU)

Introduction: Chronic Pancreatitis is a recurrent disease, frequently alcohol intake related and tend to occur in the third and the fourth decades. Stenoses and lithiasis in the main pancreatic duct causes obstruction and subsequently pain. Therefore endoscopic or surgical decompression of main pancreatic duct results in pain relief. Subjects and methods: Review our experience in the endoscopic management in patients suffering from chronic pancreatitis. 42 patients underwent ERCP for management of their chronic pancreatitis. Therapeutic options were sphincterotomy alone, prostheses and "do nothing". Follow-up was made by phone call and outpatient office visits. Mean follow-up was 47.8 (27.2) months. Results: 22 patients underwent therapeutic ERCP. In 8 patients we performed sphincterotomy and in 14 patients, a sphincterotomy and prostheses intubation. 8 patients are asymptomatic after a mean follow-up of 10.8 (11.6) months. 2 of them, underwent sphincterotomy and six of them, underwent sphincterotomy and prostheses intubation. Conclusion: Therapeutic ERCP is a tool that relieves pain in a fifth of patients suffering from chronic pancreatitis (AU)