Perception of learning by anatomy teachers in the COVID-19.

The discipline of anatomy is one of the pillars of training in higher education courses in health area. Since its origin, this discipline has used the traditional method as an educational strategy. Since then, the discipline has undergone changes, including other teaching methods, such as active methodologies. With the COVID-19 pandemic, declared in March 2020 and the closure of higher education institutions, the teaching of anatomy was impacted, since it was necessary to adapt the modality of face-to-face teaching to remote teaching. The present study aims to evaluate the perception of teachers regarding students' anatomy learning in relation to the types of methodologies applied in remote teaching during the pandemic. For such, a cross-sectional study was carried out, which analyzed the answers of 101 anatomy teachers. The results showed that there was no statistically significant difference regarding teachers' perception of learning in relation to the type of methodology used in remote teaching during the pandemic. There was also no difference in comparing perceptions regarding the type of methodology used before and during the pandemic. Given this, these data encourage the need for reflection in the academic community and new studies with educators and students, in order to identify factors that may improve the quality of anatomy learning.

Intervenciones cognitivas a través de realidad virtual en personas con Deterioro Cognitivo Leve: Una Revisión Sistemática

Introducción: La posibilidad de reversión del Deterioro Cognitivo Leve (DCL) ha generado diversas investigaciones en búsqueda de tratamiento, entre ellas la estimulación cognitiva a través de realidad virtual (RV). No obstante su uso, no existe aún evidencia acerca de las modalidades y efectos en personas con DCL. Objetivo: Sistematizar las características de los estudios que han utilizado intervenciones cognitivas con RV en personas con DCL, describir sus efectos y establecer recomendaciones para futuras investigaciones en base a las limitaciones reportadas. Métodos: revisión sistemática de estudios publicados entre 2010 y 2020, en las bases de datos Web of Science, Scopus y Pubmed. Resultados: Se identificaron 14 estudios con programas que emplearon mayoritariamente RV de tipo inmersiva, con el "supermercado" como escenario virtual más frecuente. En siete trabajos se intervino una función cognitiva, siendo la memoria y las funciones ejecutivas las más intervenidas. Los instrumentos de evaluación se concentraron en medidas cognitivas, con escasa evaluación de variables neuropsiquiátricas y de calidad de vida. Trece estudios informaron mejoras a nivel cognitivo general o por dominio específico. Conclusiones: La utilización de RV, inmersiva y no inmersiva, ha tenido resultados positivos en el rendimiento cognitivo general o específico por dominio, de personas con DCL, sin embargo, debido a la incipiente y limitada evidencia de su uso en personas con esta patología, no es posible determinar la sostenibilidad de estos resultados y la generalización de estas intervenciones hacia las actividades de la vida diaria. Se recomienda realizar intervenciones con entornos reales y seguimiento post-intervención.

Introduction: The possibility of Mild Cognitive Impairment (MCI) reversal has generated numerous studies in search of treatment, including cognitive stimulation through virtual reality (VR). Despite its use, there is still no evidence about the modalities and effects in people with MCI. Aim: To systematize the characteristics of the studies that have used cognitive interventions with VR cognitive in people with MCI, describe their effects and to establish recommendations for future research based on the limitations reported. Methods: systematic review of studies published between 2010 and 2020, in the Web of Science, Scopus and Pubmed databases. Results: 14 studies were identified with programs that mostly used immersive VR, with the "supermarket" as the most frequent virtual scenario. In seven studies only one cognitive function was involved, with memory and executive functions being the most intervened. The assessment instruments focused on cognitive measures, with little assessment of neuropsychiatric and quality of life variables. Thirteen studies reported improvements on the general cognitive level or by specific domain. Conclusions: The use of immersive and non-immersive VR has had positive results in the general or domain-specific cognitive performance of people with MCI, however, due to the incipient and limited evidence of its use in people with this pathology, it is not possible to determine the sustainability of these results and the generalization of these interventions regarding daily living activities. Interventions with real environments and post-intervention follow-up are recommended.

Plant-based drinks for vegetarian or vegan toddlers: Nutritional evaluation of commercial products, and review of health benefits and potential concerns.

There is an increasing trend today towards plant-based diets in western society, often resulting in milk restriction. In the case of very young children, the direct substitution of milk by other foods, without proper nutritional advice, may lead to a lack of nutrients and hence to growth and development alterations. This study focuses on the nutritional assessment of various commercially available plant-based drinks, to determine their adequacy as alternatives to ruminant milk, in relation to the nutritional requirements of toddlers (1-3 years old), and to establish whether other sources of nutrient supplementation may be needed, as well as any other possible positive and /or negative health effects associated to their consumption. A sample of 179 commercial plant-based drinks (almond, coconut, hemp, oat, rice, soy, tigernut) were chosen and their nutrient contents were compared to the EFSA nutrient reference values for toddlers. The scientific literature on the presence of bioactive and/or undesirable compounds was reviewed. None of the plant-based drinks studied should be considered as a milk substitute, since they are different food products with a different composition. However, from the results obtained, the best choice for toddlers who do not consume milk would be to consume at least 250 mL/day of fortified soy drink (for its higher amount and quality of protein, polyunsaturated fatty acids and phytosterols), and always in the context of a carefully-balanced diet. Almond, hemp or oat drinks are other alternatives that can be used in combination or for soy-allergic toddlers. The key nutrients that should be fortified in plant-based drinks are: vitamins A and B12, calcium, zinc and iodine, as they represent the most significant nutritional differences with milk; vitamin D would also be desirable. Of these, vitamins A, B12, D and calcium, are easily found in many commercial plant-based drinks on the Spanish market (most frequently in soy drinks), unlike iodine and zinc, which were not added to any. Given the fish restriction in vegetarians/vegans and the fact that plant-based drinks provide high amounts of phytates and tannins, which act as antinutrients, a good strategy for the industry would be to fortify plant-based drinks with iodine and zinc to improve the nutritional value of products aimed to vegetarians/vegans.

Intra-articular human deciduous dental pulp stem cell administration vs. pharmacological therapy in experimental osteoarthritis rat model.

OBJECTIVE: The aim of the present study was to compare the molecular and morphological effects of diacerein and glucosamine-chondroitin drug treatment and intra-articular injection therapy of human deciduous dental pulp stem cells (hDPSCs) in a rat knee model of induced osteoarthritis (OA). MATERIALS AND METHODS: Thirty-six adult male rats were randomly separated into six groups: Control group (without induction of OA), osteoarthritis group 60 (induction of OA, saline gavage started on day 14 and performed for 60 days, followed by euthanasia), osteoarthritis group (induction of OA and euthanasia after 14 days), diacerein group, glucosamine-chondroitin group, and mesenchymal stem cell group. The drug-treated groups were gavaged with 50 mg/kg of diacerein and 400/500 mg/kg of glucosamine-chondroitin starting on dat 14 for 60 days. The cell therapy-treated group received an intra-articular single dose of 8 × 105 hDPSCs on day 14, and euthanasia was performed after 60 days. Lateral femoral condyles were collected and prepared for immunohistochemistry and light microscopy procedures. RESULTS: The morphological features and immunoexpression of SOX-5, IHH, MMP-8, MMP-13, and Type II collagen were statistically analysed. Our data suggest that hDPSC therapy contributes more actively and effectively in the structural reorganization of lateral femoral condyles. In contrast, the glucosamine-chondroitin sulphate treatment was more effective in inflammatory control, while diacerein showed better results associated with the maintenance of the primordial cartilage. CONCLUSIONS: The positive therapeutic effect of daily administered conventional drugs can be confirmed in a rat model of OA. However, one single dose of locally administered hDPSCs provides significant improvement in tissue regeneration in an OA model.

Intra-articular human deciduous dental pulp stem cell administration vs. pharmacological therapy in experimental osteoarthritis rat model

OBJECTIVE: The aim of the present study was to compare the molecular and morphological effects of diacerein and glucosamine-chondroitin drug treatment and intra-articular injection herapy of human deciduous dental pulp stem cells (hDPSCs) in a rat knee model of induced osteoarthritis OA. MATERIALS AND METHODS: Thirty-six adult male rats were randomly separated into six groups: Control group without induction of OA, osteoarthritis group 60 induction of OA, saline gavage started on day 14 and performed for 60 days, followed by euthanasia, osteoarthritis group induction of OA and euthanasia after 14 days, diacerein group, glucosamine-chondroitin group, and mesenchymal stem cell group. The drug-treated groups were gavaged with 50 mg/kg of diacerein and 400/500 mg/kg of glucosamine-chondroitin starting on dat 14 for 60 days. The cell therapy-treated group received an intra-articular single dose of 8 × 105 hDPSCs on day 14, and euthanasia was performed after 60 days. Lateral femoral condyles were collected and prepared for immunohistochemistry and light microscopy procedures. RESULTS: The morphological features and immunoexpression of SOX-5, IHH, MMP-8, MMP-13, and Type II collagen were statistically analysed. Our data suggest that hDPSC therapy contributes more actively and effectively in the structural reorganization of lateral femoral condyles. In contrast, the glucosamine-chondroitin sulphate treatment was more effective in inflammatory control, while diacerein showed better results associated with the maintenance of the primordial cartilage. CONCLUSIONS: The positive therapeutic effect of daily administered conventional drugs can be confirmed in a rat model of OA. However, one single dose of locally administered hDPSCs provides significant improvement in tissue regeneration in an OA model.

[Epidemiology of the carbapenemase-producing Enterobacteriaceae spread in a community acute hospital and a non-acute rehabilitation hospital in Madrid]. / Epidemiología de la diseminación de enterobacterias productoras de carbapenemasas en un hospital comarcal y un hospital de media estancia en Madrid.

OBJECTIVE: In Spain, the overall prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing. We describe the epidemiological, clinical and microbiological characteristics features of patients with colonization or infection due to CRE in two hospitals in the north-west of Madrid during two years. One hospital was a community acute hospital and the second one was a non-acute rehabilitation hospital. METHODS: A total of 197 CPE isolates were detected during 2013-2014. Microbiological, epidemiological and clinical data were collected, since the first isolate was found in March 2013. RESULTS: A 33.5% of patients with CRE had symptomatic infection and the remaining 66.5% were colonizations. Klebsiella pneumoniae (87.8%) was the most prevalent species and OXA-48 the most frequent carbapenemase (91.9%). We found intra-interhospital spread and some differences in the epidemiology of CRE depending on the hospital, such as more genetic variability in the non-acute rehabilitation hospital. CONCLUSIONS: Studying the CRE transmission we founded an increased incidence in a short period of time and a rapid dissemination of strains between both hospitals. This highlights the need to standardize screening measures for potential carriers and infection control programs in our hospitals.

A pharmacokinetic analysis of posaconazole oral suspension in the serum and alveolar compartment of lung transplant recipients.

Invasive fungal infections cause significant morbidity and mortality after lung transplantation. Fungal prophylaxis following lung transplantation is not standardised, with transplant centres utilising a variety of regimens. Posaconazole is a broad-spectrum antifungal triazole that requires further investigation within the setting of lung transplantation. This prospective, single-centre, observational study explored the pharmacokinetics of posaconazole oral suspension (POS) in the early perioperative period following lung transplantation in 26 patients. Organ recipients were scheduled to receive 400mg POS twice daily for 6 weeks as primary antifungal prophylaxis. Therapeutic drug monitoring (TDM) of serum posaconazole levels was performed in accordance with local clinical protocols. Bronchoalveolar lavage fluid (BALF) was sampled during routine bronchoscopies. Posaconazole levels were measured both in serum and BALF using mass spectrometry. Posaconazole levels were highly variable within lung transplant recipients during the perioperative period and did not achieve 'steady-state'. Serum posaconazole concentrations positively correlated with levels within the BALF (r=0.5527; P=0.0105). Of the 26 patients, 10 failed to complete the study for multiple reasons and so the trial was terminated early. Unlike study findings in stable recipients, serum posaconazole levels rarely achieved steady-state in the perioperative period; however, they do reflect the concentrations within the airways of newly transplanted lungs. The role of POS as primary prophylaxis in the perioperative period is uncertain, but if used TDM may be helpful for determining attainment of therapeutic levels.

Mucosal immunization of BALB/c mice with DNA vaccines encoding the SEN1002 and SEN1395 open reading frames of Salmonella enterica serovar Enteritidis induces protective immunity.

Salmonella Enteritidis is the main cause of foodborne salmonellosis worldwide. The limited effectiveness of current interventions against this pathogen has been the main incentive to develop new methods for the efficient control of this infection. To investigate the use of DNA vaccines against S. Enteritidis in humans, immune responses stimulated by two plasmids containing the genes designated SEN1002, located in the pathogenicity island SPI-19 and encoding a Hcp protein involved in transport mechanisms, and SEN1395, located in the genomic island ΦSE14 and encoding a protein of a new superfamily of lysozymes, were evaluated. Humoral and cellular responses following intranasal immunization of two groups of BALB/c mice with the plasmids pV1002 and pV1395 plus adjuvant were evaluated and it was observed that the IgG2a/IgG1 ratios were sixfold higher than control groups. Both plasmids stimulated specific secretory IgA production. Increased proliferation of lymphocytes and IFN-γ production were detected in both experimental groups. DNA-vaccinated mice developed protective immunity against a virulent strain of S. Enteritidis, with nearly 2 logs of protection level compared to the negative control values in the spleen. Therefore, DNA vaccines are efficient at stimulating cellular and humoral immune responses at systemic and mucosal levels.

"Hanging donors": are we still skeptical about the lungs?

BACKGROUND: Suicidal hanging may cause compression of the neck blood vessels and the airway leading, to hypoxic brain damage caused by cerebral ischemia and respiratory distress. Hanging engenders global tissue hypoxia, particularly affecting the lungs as the result of pulmonary edema and barotrauma. There is scant evidence about outcomes of transplantation with the use of lungs from "hanging donors." This study evaluates the outcomes of lung transplantations (LTx) that use organs from this group. METHODS: We retrospectively analyzed lung "organ offers" and LTx at our center between January 2007 and November 2013. The outcomes of LTx with lungs from donors with hanging as the cause of death ("hanging group") were compared with those with donors having other causes of death (control group), with the use of an unadjusted model as well as propensity score matching. RESULTS: LTx (n = 302) were performed during this period and were grouped on the basis of the cause of death in donors: the hanging group (n = 8) and the control group (n = 294). No statistically significant difference was found in the donor characteristics except for the incidence of cardiac arrest, which was significantly higher in hanging donors. Preoperative characteristics in recipients in both groups were comparable. Intra-operative and post-LTx variables including PaO2/FiO2 ratios, duration of mechanical ventilation, and intensive care unit and hospital stays were comparable. One-year and 3-year survival rates were also comparable in both groups. Two recipients in the hanging group required extracorporeal life support after LTx and could not survive. CONCLUSIONS: Suicidal hanging is a relatively rare cause of death for potential organ donors. Because it does not appear to negatively affect outcomes after LTx, it should not be considered per se a contraindication for lung donation. A word of caution is necessary until we gather larger experience with lungs from hanging donors.

Concurrent interspecies and clonal dissemination of OXA-48 carbapenemase.

Several isolates of four different carbapenemase-producing Enterobacteriaceae species were recovered from a patient hospitalized for 4 months in a teaching hospital in Madrid. These species comprised seven Klebsiella pneumoniae belonging to ST15, four Escherichia coli belonging to ST2531, two Serratia marcescens and one Citrobacter freundii. This patient was the index case of a small outbreak of four patients infected and/or colonized by carbapenemase-producing K. pneumoniae. Molecular results identified the bla(OXA-48) gene in all Enterobacteriaceae isolates from the index case and in all isolates from the other three patients, suggesting intra- and interpatient dissemination. Our results highlight the great ability of OXA-48 carbapenemase to spread among different enterobacterial species by both clonal and nonclonal dissemination.

Utilization of the Organ Care System Lung for the assessment of lungs from a donor after cardiac death (DCD) before bilateral transplantation.

In this manuscript, we present the first experience of evaluating donation after circulatory death (DCD) lungs, using the normothermic preservation Organ Care System (OCS) and subsequent successful transplantation. The OCS could be a useful tool for the evaluation of marginal lungs from DCD donors as it allows a proper recruitment and bronchoscopy in such donations in addition to continuous ex-vivo perfusion and assessment and treatment during transport. The OCS could potentially be a standard of care in the evaluation of marginal lungs from DCD.

Outcomes in patients receiving HeartMate II versus HVAD left ventricular assist device as a bridge to transplantation.

OBJECTIVE: Ventricular assist devices have become a standard treatment for patients with advanced heart failure. We present data comparing results after implantation of HeartMate II (HM II) versus HVAD (HW) left ventricular assist devices (LVADs) for the past 7 years at our institution. METHODS: From July 2006 to August 2012, 121 consecutive patients underwent LVAD implantation: 70 (57.9%) received HM II and 51 (42.1%) HW. Patient demographics, perioperative characteristics, and laboratory parameters as well as postoperative outcome were compared retrospectively. RESULTS: Patients in the HM II group were significantly younger (P < .01), with more deranged liver function (higher bilirubin [P = .02] and alanine aminotransferase [P = .01] levels), and had a significantly higher rate of preoperative infections requiring antibiotic treatment (P = .02) and a higher body core temperature (P < .01). Other demographic and preoperative parameters did not show statistical differences. Most postoperative characteristics were also similar between the two groups. HM II patients had a significantly higher transfusion rate, but there were no differences in incidence of resternotomy (P = .156). Recovery and VAD explantation were more likely in the HM II group (P = .02). Although there was no significant difference in survival (log rank test: P = .986; Breslow test: P = .827), HM II patients were more likely to develop a percutaneous site infection (P = .01). CONCLUSIONS: Both HM II and HW provide similar early postoperative outcome and good long-term survival. The differences observed between the groups may be related to demographic and preoperative factors rather than the type of the device used.

Listeriosis outbreak caused by Latin-style fresh cheese, Bizkaia, Spain, August 2012.

Two cases of laboratory-confirmed listeriosis were detected in Bizkaia, Spain, at the end of August. The epidemiological investigation indicated that these two cases were associated with the consumption of Latin-style fresh cheese made from pasteurised milk in Portugal. Different batches of the same cheese were analysed and confirmed as contaminated with Listeria monocytogenes. The product was withdrawn from the market and the population was advised not to consume this kind of cheese.

Mutagenicity and cytotoxicity assessment in patients undergoing orthodontic radiographs.

OBJECTIVES: The aim of the present study was to evaluate DNA damage (micronucleus) and cellular death (pyknosis, karyolysis and karyorrhexis) in exfoliated buccal mucosa cells from individuals following radiography. METHODS: Lateral and frontal cephalometric X-ray and panoramic dental X-rays were taken of a total of 18 healthy patients (6 male and 12 female) referred for orthodontic therapy. Exfoliated oral mucosa cells were collected immediately before X-ray exposure and after 10 days. RESULTS: The results revealed no statistically significant difference (P > 0.05) in the frequency micronucleated oral mucosa cells after X-ray exposure. However, X-ray was able to increase other nuclear alterations closely related to cytotoxicity, such as karyorrhexis, pyknosis and karyolysis. CONCLUSIONS: Data indicated that exposure to certain radiography may not be a factor in inducing chromosomal damage, but it does promote cytotoxicity.

Eggshell membrane as a biodegradable bone regeneration inhibitor.

The efficiency of chicken eggshell membranes combined with a minimally invasive small osteotomy procedure of the ulna to accomplish an efficient release of the radius so that it can continue to grow in an unstressed manner was tested in rabbits. Eggshell membranes were extracted from chicken eggs, rinsed, dried and sterilized with ethylene oxide for 24 h. For reactivity testing, four separate subcutaneous pockets were created in 10 rats in the paravertebral region by blunt dissection and eggshell membranes were implanted in two of them. After 1-16 weeks, the implants were retrieved with the surrounding soft tissues and submitted to histological examination. Subsequently, 10 rabbits were anaesthetized and a complete 0.5 mm wide osteotomy was performed in both the right and the left distal ulna. A piece of eggshell membranes was interposed in the osteotomy site of one ulna. The opposite osteotomized ulna was left as a negative control. The rabbits were injected with oxytetracycline at the time of surgery and this was repeated every 7 days for labelling new bone formation. After 1-16 weeks, ulnar osteotomized regions were histologically examined. After histological, fluorescence microscopy and radiological evaluation, we demonstrate here for the first time that eggshell membranes as interpositional material in rabbit osteotomized ulnar experiments acted as an active barrier against bone bridging. The degradation of the eggshell membrane, due to host reaction, appeared sufficiently late to cause the desirable delay of bone healing that is compatible with the time needed for a corrective response.

[System of dynamic neutralization in the lumbar spine: experience on 94 cases]. / Sistema de neutralización dinámica en la coluna lumbar. SISTEMA DYNESYS. Experiencia en 94 casos

OBJECTIVE: To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions. MATERIAL AND METHODS: We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work. RESULTS: The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections. CONCLUSIONS: The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.

Sistema de neutralización dinámica en la columna lumbar. SISTEMA DYNESYS Experiencia en 94 casos / System of dynamic neutralization in the lumbar spine. Experience on 94 cases

Objetivo. Valorar los resultados obtenidos con la utilización del sistema Dynesys (Dynamic Neutralización System for the spine), en un grupo de 94 pacientes, como nuevo concepto para el tratamiento de la patología degenerativa lumbar basado en la estabilización lumbar con conservación de la función articular encontrar de la restricción de la artrodesis clásica. Material y métodos. Presentamos 94 pacientes en los que se utilizó este sistema de los cuales 62 fueron hombres y 32 mujeres con una edad media de 46.4 años. La patología de los pacientes fue de hernia discal en 27casos, discopatía degenerativa en 54 casos y estenosis decanal en 13 casos. Se realizó un seguimiento entre 14 t24 meses valorando la clínica según la escala de Oswestry y la reincorporación al trabajo. Resultados. Los resultados en la escala de Oswestry fue del 21.4% definitivo con respecto al 56.8% previo al tratamiento y la reincorporación al trabajo fue del82%. El cuadro ciático ha remitido prácticamente en todos los casos, así como la lumbalgia y una mejoría del60% en casos de claudicación. Como complicaciones reseñamos dos casos debidas a la técnica, con mal posición de tornillos en un caso y rotura pedicular en otro, dos casos de seroma subcutáneo y dos infecciones subclínicastardías. Conclusiones. La neutralización dinámica obtenida mediante este sistema, no debe ser considerada como una artrodesis. El tratamiento con Dynesys amplía la población de pacientes en los que se puede intervenir a aquellos que en principio no son tributarios de una fijación estándar, pero que planteaban dudas al cirujano al aplicar técnicas sin apoyo instrumental, incorporando el concepto de funcionalidad frente a la restricción del movimiento. Se puede definir como una prótesis díscal colocada extra-discalmente. Hemos obtenido un buen resultado en la mayoría de nuestros pacientes, aunque pensamos que es preciso ampliar el tiempo de seguimiento

Objective. To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients This new system for treating lumbar degenerative pathologie is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions. Material and methods. We analyze series of 94 patients in whom this system was used. 62 were males and 32females with an average age of 46,4 years. The pathologies streated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and24 months, assessing the clinical picture according to the Oswestry scale and the return to work. Results. The final results on the Oswestry scale were21,4% with respect to 56,8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections. Conclusions. The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe hut the follow-up should be increased

[Analysis of factors associated with anticoagulant treatment indication in chronic atrial fibrillation. Prospective study of 170 patients admitted at an internal medicine service]. / Análisis de los factores asociados a la indicación de tratamiento anticoagulante en la fibrilación auricular crónica. Estudio prospectivo de 170 pacientes ingresados en un servicio de Medicina Interna.

BACKGROUND: Anticoagulant therapy reduces the risk of stroke among patients with chronic atrial fibrillation. The objective of this study was to evaluate the use of anticoagulant therapy and to analyze the factors associated with the indication of anticoagulants in patients with chronic atrial fibrillation. PATIENTS AND METHODS: Prospective study of all patients with chronic atrial fibrillation admitted to our Department of Internal Medicine from February 1997 to September 1998. From each patient data related to the cause of atrial fibrillation, other associated vascular risk factors, use of anticoagulant and/or antiplatelet agents and contraindication to anticoagulants were recorded. RESULTS: A total of 170 patients with chronic atrial fibrillation were studied. The mean age of patients was 77 years (range: 49-94). One hundred and four patients (61%) were older than 75 years. Atrial fibrillation was the main cause for admission only in 11 patients (6.5%). One hundred and sixty-seven patients (98%) had indication for receiving anticoagulant therapy; however, it was indicated in only 67 patients (39%). In other 68 patients (40%), antiplatelet agents were used. Patients over 75 years received anticoagulants less frequently (p < 0.0001). Factors associated with the prescription of anticoagulants in the bivariate analysis included: diabetes mellitus (p = 0.046), high cholesterol level (p = 0.023), age < or = 75 years old (p < 0.0001), history of previous embolic events (p = 0.001) and valvular atrial fibrillation (p < 0.0001). The multivariate analysis showed that only two factors were indeed associated with the prescription of anticoagulants: age < or = 75 years (OR: 6.15) and valvular atrial fibrillation (OR: 4.24). CONCLUSIONS: Anticoagulant therapy is underused in patients with chronic atrial fibrillation, particularly in elderly patients.

Subcellular localization of aldolase B.

The localization of the aldolase B isozyme was determined immunohistochemically in rat kidney and liver using a polyclonal antibody. Aldolase B was preferentially localized in a nuclear region of hepatocytes from the periportal region and was absent in those from the perivenous region. Aldolase B was also preferentially localized in the proximal tubules and was absent in other structures of the renal cortex as well as in the renal medulla. Using reflection confocal microscopy, the enzyme was preferentially localized in a nuclear position in liver and renal cells, which was similar to the cellular and intracellular location found for the gluconeogenic enzyme fructose-1,6-bisphosphatase (Sáez et al. [1996] J. Cell. Biochem. 63:453-462). Subcellular fractionation studies followed by enzyme activity assays revealed that aldolase activity was associated with subcellular particulate structures. Overall, the data suggest that different aldolase isoenzymes are needed in the glycolytic and gluconeogenic pathways.