Ictus isquémico en niños con cardiopatía: estudio epidemiológico / Ischaemic stroke in children with cardiopathy: An epidemiological study

Introducción: Los ictus isquémicos son poco frecuentes en la infancia. Las cardiopatías tanto congénitas como adquiridas son uno de los factores de riesgo más importante para presentar un ictus en la edad pediátrica. Pacientes y métodos: Estudio retrospectivo descriptivo de niños con cardiopatía diagnosticados de ictus arterial isquémico entre enero del 2000 y diciembre del 2014. Resultados: Cumplieron los criterios de inclusión 74 pacientes, el 60% varones. La mediana de edad del ictus fue de 11 meses. Fallecieron un 20% de los pacientes. La cardiopatía era congénita en un 90%, cianógena en un 60%. El ventrículo izquierdo hipoplásico fue la cardiopatía más frecuente. El ictus estuvo relacionado temporalmente con una cirugía cardiaca, cateterismo o asistencia ventricular en el 70% de los casos. La mayoría de los ictus ocurrieron en el hospital. La forma de presentación más frecuente fue el déficit motor y las convulsiones. El diagnóstico se realizó mediante TC craneal en la mayoría de los casos. El ictus fue múltiple en el 33% de los casos y bihemisférico en el 27%, y afectaba a la circulación anterior y posterior cerebral en el 10%. En un 10% de los casos se produjo una recurrencia del ictus. Conclusiones: Las cardiopatías congénitas complejas y las intervenciones cardiacas, la cirugía y los cateterismos fueron los principales factores asociados con el ictus isquémico. El ictus se produjo en pacientes hospitalizados y el diagnóstico se realizó en las primeras 24 h en la mayoría de los pacientes (AU)

Introduction: Ischaemic stroke is rare during childhood. Congenital and acquired heart diseases are one of the most important risk factors for arterial ischaemic stroke (AIS) in children. Patients and methods: We conducted a retrospective study of all children with AIS and heart disease diagnosed between 2000 and 2014. Results:We included 74 children with heart disease who were eligible for inclusion. 60% were boys with a mean stroke age of 11 months. 20% of the patients died during the study period. 90% of the patients had a congenital heart disease, while cyanotic heart disease was identified in 60%. Hypoplastic left heart syndrome was the most frequent heart disease. In 70% of patients AIS was directly associated with heart surgery, catheterisation or ventricular assist devices. Most patients with AIS were in the hospital. Seizures and motor deficit were the most frequent symptoms. Most patient diagnoses were confirmed by brain CT. The AIS consisted of multiple infarcts in 33% of the cases, affected both hemispheres in 27%, and involved the anterior and posterior cerebral circulation in 10%. Conclusions: Arterial ischaemic strokes were mainly associated with complex congenital heart diseases, and heart procedures and surgery (catheterisation). AIS presented when patients were in-hospital and most of the patients were diagnosed in the first 24hours (AU)

Ischaemic stroke in children with cardiopathy: An epidemiological study. / Ictus isquémico en niños con cardiopatía: estudio epidemiológico.

INTRODUCTION: Ischaemic stroke is rare during childhood. Congenital and acquired heart diseases are one of the most important risk factors for arterial ischaemic stroke (AIS) in children. PATIENTS AND METHODS: We conducted a retrospective study of all children with AIS and heart disease diagnosed between 2000 and 2014. RESULTS: We included 74 children with heart disease who were eligible for inclusion. 60% were boys with a mean stroke age of 11 months. 20% of the patients died during the study period. 90% of the patients had a congenital heart disease, while cyanotic heart disease was identified in 60%. Hypoplastic left heart syndrome was the most frequent heart disease. In 70% of patients AIS was directly associated with heart surgery, catheterisation or ventricular assist devices. Most patients with AIS were in the hospital. Seizures and motor deficit were the most frequent symptoms. Most patient diagnoses were confirmed by brain CT. The AIS consisted of multiple infarcts in 33% of the cases, affected both hemispheres in 27%, and involved the anterior and posterior cerebral circulation in 10%. CONCLUSIONS: Arterial ischaemic strokes were mainly associated with complex congenital heart diseases, and heart procedures and surgery (catheterisation). AIS presented when patients were in-hospital and most of the patients were diagnosed in the first 24hours.

Acidemia propiónica y síndrome QT largo: una asociación potencialmente grave / Propionic acidemia and long QT syndrome: a potentially serious combination

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Phosphorylation of the human respiratory syncytial virus N protein provokes a decrease in viral RNA synthesis.

When HEp-2 cells are infected by human respiratory syncytial virus (HRSV) its N protein becomes phosphorylated at tyrosine (Y) Y38, in a strictly regulated way. To determine how this phosphorylation affects nucleocapsid (NC) template activity during viral RNA synthesis, N protein variants were analysed in which Y38 and nearby Y residues were substituted by phenylalanine (F; Y23F, Y38F and Y69F) or aspartic acid (D; Y23D and Y38D). While the capacity of these proteins to form the NC and to interact with the P protein was maintained, their NC template activity was altered affecting distinctly viral transcription and replication of HRSV based minigenomes. Thus, Y38 phosphorylation of the HRSV N protein modulates NC template activity probably by altering the interactions of the monomeric components of the NC.

Wine industry residues extracts as natural antioxidants in raw and cooked chicken meat during frozen storage.

The effect of Isabel (IGE) and Niagara (NGE) grape seed and peel extracts on lipid oxidation, instrumental colour, pH and sensory properties of raw and cooked processed chicken meat stored at -18°C for nine months was evaluated. The pH of raw and cooked samples was not affected by the addition of grape extracts. IGE and NGE were effective in inhibiting the lipid oxidation of raw and cooked chicken meat, with results comparable to synthetic antioxidants. The extracts caused alterations in colour, as evidenced by the instrumental (darkening and lower intensity of red and yellow colour) and sensory results of cooked samples. In the sensory evaluation of odour and flavour, IGE produced satisfactory results, which did not differ from synthetic antioxidants. These findings suggest that the IGE and NGE are effective in retarding lipid oxidation of raw and cooked chicken meat during frozen storage.

Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level (AU)

Satisfacción con el cuidado de Enfermería del adulto mayor hospitalizado / Satisfaction with the nursing healthcare on hospitalizaed older adults

Los adultos mayores hospitalizados son un grupo vulnerable que requiere cuidado de Enfermería de calidad; esta conlleva satisfacción valorada a través de: relación Enfermera-paciente, comunicación efectiva, información oportuna y habilidad técnica profesional. Para identificar satisfacción de adultos mayores con cuidado de Enfermería se realizó un estudio descriptivo transversal con 45 adultos mayores hospitalizados en Medicina Interna y Cirugía de dos instituciones de salud. Mediante entrevista se aplicó una escala de Likert de 23 reactivos con cinco categorías: De completo acuerdo (5) a total desacuerdo (1). A mayor puntuación mayor satisfacción. Procesamiento y análisis con programa estadístico SPSS. Resultados: Edad media 71 años, escolaridad media 6 años. Completo acuerdo: Enfermera agradable con el paciente (62.2%), debería ser más atenta (60.0%), se siente mejor al platicar con ella (75.6%), le explica en lenguaje sencillo (73.3%), brinda información sobre exámenes (68.9%). Total desacuerdo: Le molesta cuando la Enfermera le habla como si fuera niño (60.0%). Alta puntuación (85%) en evaluación general de satisfacción con el cuidado de Enfermería. Coincidente con estudios previos en que a mayor edad mayor satisfacción con el cuidado de Enfermería.

Older adults hospitalized are a vulnerable group that require quality nursing care ; this imply satisfaction valued through patient-nursing relationship, effective communication and information and professional technical competence. In order to identify older adults' satisfaction with nursing care it was carried out a transactional descriptive study with 45 hospitalized older adults in medical and surgical wards of two health institutions. Through interview it was applied a Likert scale of 23 items and five categories: Complete agree (5) to total disagree (1). Instrument was translated and validated , it was obtained Cronbach's alpha coefficient from .78 (12). Results. Age mean 71, years of school mean 6. Complete agree: Nursing pleasant with patient (62.2%), she should be more attentive with patient (60.0%), the patient feels better when nurse talks with him(75.6%), nurse explains to patient in sample language (73.3%), nurse gives information about exams (68.9%). Total disagree: Patient gets angry when nurse talks him like a child (60.0%). High score (85%) in general evaluation about satisfaction with nursing care. This study is coincident with previous studies about to higher age higher satisfaction with nursing care.

Estudio retrospectivo en pacientes con diagnóstico de carcinoma de pulmón no microcítico estadio avanzado tratados con la combinación gemcitabina y vinorelbina: valoración de la eficacia terapéutica y factores pronósticos / No disponible

Introducción: La Gemcitabina (G), la vinorelbina (V) y su combinación (GV) han demostradosu utilidad en pacientes con Carcinoma de Pulmón no Microcítico (CPNM). El propósito del estudioha sido confirmar la eficacia de GV e identificar factores pronósticos relacionados con los resultadosterapéuticos.Pacientes y Métodos: Se revisó de forma retrospectiva la historia de 144 pacientes conCPNM avanzado tratados entre octubre del 96 y abril del 05 con G (1.000-1.250 mg/m2) + V (25-30mg/m2) administrados el día 1 y 8 cada 21 días.Resultados: El tratamiento fue bien tolerado, desarrollando un 18% de los pacientes leucopeniagrado 3-4 incluyendo un 7% de neutropenia febril como peor toxicidad. La tasa de respuestas objetivasfue del 36,8% (IC al 95: 28,9–44,7) y las medianas de supervivencia libre de progresión y globalfueron de 21 (18–25) y 33 (26–40) semanas respectivamente. En el análisis multivariante sólo la histologíade adenocarcinoma (HR 3; p<,0001), la enfermedad limitada a una o ninguna localización metastática(HR 1,7; p =,02) y el índice Karnofsky (IK) mayor a 70% (HR 1,5; p=,02) tuvieron una asociaciónsignificativa con mayor supervivencia.Conclusiones: La combinación de GV se tolera bien y es eficaz en pacientes con CPNM avanzado.La histología de adenocarcinoma, la enfermedad limitada a una o ninguna localización metastásicay un IK superior a 70% se han identificado como variables independientes relacionadas con unamejor supervivencia

Introduction: Gemcitabine (G), vinorelbine (V) and their combination (GV) have shown to beuseful in patients with non-small cell lung cancer (NSCLC). The purpose of this study is to confirmthe activity of GV administration and to identify prognostic factors related with the clinical outcome.Methods: A retrospective analysis was carried out in relation to 144 patients with NSCL treatedbetween October 1996 and April 2005 with G (1000-1250 mg/m2) + V (25-30 mg/m2) both administeredon days 1 and 8 every three weeks.Results: Treatment was well tolerated, grade 3-4 neutropenia being registered as the worse toxiceffect in 18% cases, including 7% of neutropenic fever. The objective response rate was 36.8% (95%CI: 28.9-44.7) and the median progression free survival and overall survival rates were 21 (18-25) and33 (26-40) weeks respectively. In multivariate analysis only the histology of adenocarcinoma (HR 3;p<0.001), less than two metastatic sites (HR 1.7; p<0.02) and Karnofsky index (KI) above 70% (HR1.5; p<0.02) showed a significant association with longer survival.Conclusion: The GV combination therapy is well tolerated and active in patients with advancedNSCLC. The histology of adenocarcinoma, less than two metastatic sites and KI above 70% were identified as independent variables related with longer survival (AU)

Tratamiento adyuvante en pacientes diagnosticados de carcinoma no microcítico de pulmón: estado de la evidencia científica / Adjuvant treatment of non-small cell lung cancer patients: state of the scientific evidence

La cirugía representa el tratamiento curativo de elección para los pacientes que son diagnosticadosde carcinoma no microcítico de pulmón en estadio local. Sin embargo, gran parte de ellos experimentanuna recurrencia de su enfermedad lo que ha llevado al empleo de opciones terapéuticas tanto localescomo sistémicas con el ánimo de mejorar las posibilidades de curación. Durante las últimas décadasdiversos estudios comparativos heterogéneos y varios meta-análisis publicados en los años 95 y 97no demostraron de forma significativa una ventaja al asociar la quimioterapia y/o radioterapia adyuvantea la cirugía. Desde entonces y hasta nuestros días otros trabajos realizados con un número mayorde pacientes y empleando una quimioterapia más eficaz basada en combinaciones de platino, coincidenen describir un beneficio con su utilización aunque no de forma unánime. Más recientemente, unnuevo meta-análisis recopilando la mayoría de los estudios antes mencionados ha confirmado de formasignificativa una mejoría absoluta del 4% en la supervivencia global de los pacientes sometidos aquimioterapia adyuvante, especialmente en los estadios patológicos II-III tras cirugía y tratados conregímenes que incluyen cisplatino y vinorelbina. Queda por ser determinado el papel que desempeñanotros agentes como el uracilo/tegafur así como la radioterapia en el contexto adyuvante

Surgery is the current treatment of choice in patients with early-stage non-small cell lung cancer.Based on the high rates of recurrence, additional local and systemic treatments have been developed,aimed at improving the cure rates. The comparative studies about the benefits of post-operativeadjuvant chemotherapy and/or radiotherapy, and the meta-analysis studies made during the lastdecades, reviewed in some articles appeared in 95 and 97, did not confirm a significant improvementof the overall survival. Since then, new comparative trials carried out with a higher number of patientsand with more active and standard chemotherapy seem to show a benefit of the administration ofplatinum-based chemotherapy, although it has not gained general acceptance. More recently, a newmeta-analysis, that included the previous studies, has confirmed an overall increase of 4 % in survivalof patients treated by surgery and adjuvant chemotherapy, especially in stages II-III patients receivingschedules of cisplatin and vinorelbine. Further studies are needed to determine the real therapeuticvalue of other agents, as uracil-tegafur and radiotherapy

Tratamiento anti-hormonal adyuvante en mujeres post-menopáusicas con diagnóstico de carcinoma de mama / Adjuvant anti-hormonal treatment of postmenopausal women with breast cancer

Durante las últimas décadas el tratamiento adyuvante anti-hormonal de elección para las pacientespost-menopáusicas con diagnóstico de carcinoma de mama localizado y con receptores hormonalespositivos ha sido el tamoxifeno al disminuir de una forma significativa el riesgo de muerte por tumor.Más recientemente, una serie de estudios comparativos utilizando tres agentes inhibidores aromatásicosde tercera generación y diferentes esquemas de administración, bien tras la cirugía inicial del primarioo después de 2-3 años o 5 años de tamoxifeno, han demostrado una ventaja en la supervivencialibre de enfermedad con respecto al tamoxifeno. Los efectos adversos acompañantes describen perfilesde toxicidad distintos entre ambos tipos de tratamiento anti-hormonal, siendo más comunes y frecuenteslos fenómenos osteo-musculares y cardiovasculares en el grupo de pacientes tratadas con inhibidoresaromatásicos así como los tromboembólicos y patología endometrial en el grupo tratado contamoxifeno. La mejor estrategia para la administración, la forma de prevenir los efectos adversos y eltipo de pacientes que más se pueden beneficiar de los inhibidores aromatásicos, quedan por ser definidoscon mayor precisión

Over the recent decades, tamoxifen has been considered the standard adjuvant treatment of postmenopausalwomen with hormone-receptor positive breast cancer based on its capacity to reduce the annualbreast cancer death. More recently, several major randomized controlled trials carried out with threedifferent new aromatase inhibitors used either from the time of primary surgery or after 2-3 or 5years of adjuvant tamoxifen therapy have shown a significant improvement in disease-free survivalwith respect to tamoxifen therapy. The described treatment-related side effects suggest different profilesof toxicity. Musculoskeletal disorders and cardiovascular events are the most serious side effectsassociated with the use of aromatase inhibitors, as well as the thromboembolic events and endometrialabnormalities are associated with tamoxifen therapy. An optimal treatment strategy for aromatase inhibitorsadministration, interventions to prevent or alleviate treatment-related side effects and identificationof women at higher risk having more benefit with aromatase inhibitors need to be addressed

Las lesiones deportivas atendidas en el área de urgencias / Sports lesions attended at the emergency area

Objetivo: Conocer la prevalencia de las lesiones deportivas en urgencias, determinar la lesión más frecuente, qué deportes generan lesiones y cómo se distribuyen éstas según sexo, edad, mecanismo lesional y abordaje terapéutico desde urgencias. Métodos: Estudio prospectivo, de febrero a julio de 2003, dirigido a la población general atendida en urgencias con lesiones deportivas. Variables estudiadas: edad, sexo, mes de atención, deporte practicado, zona del cuerpo lesionada, mecanismo lesional, estudios complementarios, diagnóstico, tratamiento y destino del paciente. Los resultados son expresados como media y desviación estándar, número y frecuencia, comparación de variables con χ2 considerando significativo p<0,05.Los datos fueron analizados con el programa SPSS 11.0.Resultados: 134 urgencias por lesiones deportivas, con mayor frecuencia en febrero (22,81%), marzo (25,3%), abril (11,27%); 68% varones; edad media 20 años σ= 10,44, 51% menores de 18 años. Los deportes más frecuentes fueron fútbol (37,3%) y esquí (16,4%); 94% consultaron por una lesión; 45,5% miembros inferiores y 36,6% superiores. El mecanismo lesional más frecuente fue traumatismo directo (41%).El diagnóstico más frecuente fue esguince (45,5%). El 41,8% fueron lesiones leves. La prueba más solicitada fue radiografía (94,7%) y el tratamiento más utilizado inmovilización con analgesia/antiinflamatorios. El 91% fueron dados de alta y el 40,3% precisó seguimiento en consulta. Conclusiones: El deportista tipo atendido es varón, de 20 años, que practica fútbol, lesionado en miembros inferiores con esguince de tobillo de pronóstico leve, por torsión externa y traumatismo directo al que se le prescribe inmovilización y tratamiento médico desde urgencias. El servicio de urgencias es eficaz y resolutivo en el diagnóstico y tratamiento de lesiones deportivas. Los deportes generan lesiones atendidas en los servicios de urgencias, por lo que debemos estar familiarizados con ellas (AU)

Aim: To assess the prevalence of sports lesions in the emergency setting and to establish which are the most frequent ones, which sports cause lesions and how are they distributed according to gender, age, lesional mechanism and emergency therapeutic approach. Methods: Prospective study carried out from February to July 2003 on the general population seen at emergency outpatient clinics because of sports lesions. Variables considered: age, gender, month in which seen, sport involved, affected body region, lesional mechanism, complementary studies performed, diagnosis, management and final fate of the patient. The results are expressed as means and standard deviations with number and frequency, and variable comparison with the χ2 test (p<0.05 was considered significant). The SPSS 11.0 software package was used for the analyses. Results: A total of 134 emergency cases due to sports lesions were seen; such lesions were more frequent in February (22.81%), March (25.3%)and April (11.27%). Sixty-eight per cent of the patients were males, and the mean age was 20 ± 0.44 years; 51% of the patients were aged less than 18 years. The most frequently involved sports were soccer (37.3%)and skiing (16.4%); 94% consulted because of a lesion, affecting the lower limbs in 45.5% of the cases and the upper limbs in 36.6%. The most frequent lesional mechanism was direct trauma (41%); the diagnosis most often established was that of sprain (45.5%), and most lesions (41.8%)were mild. The most often requested complementary test was radiography(94.7%). The therapy most often used was immobilisation with analgesics/antiinflammatories. Ninety-one per cent of the patients were discharged, and 40.3% required follow-up in the outpatient clinic. Conclusions: The typical sports lesion patient is a male, 20 years old, practising soccer and with a lesion in the lower limbs which is most often an ankle sprain, and he (..) (AU)

Neumotórax a tensión / Tension pneumothorax

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Infecciones bacterianas en la enfermedad pulmonar obstructiva crónica en pacientes que requieren ingreso en la UCI / Bacterial infection in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit

Fundamento. Son pocos los trabajos que describen los focos de infección y su flora en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y menos los que incluyen la microbiología comunitaria. El objetivo de este estudio es describir las características epidemiológicas, los focos infecciosos y los microorganismos patógenos causales en el paciente con EPOC que requiere ingreso en la unidad de cuidados intensivos. Pacientes y método. Estudio prospectivo descriptivo de los enfermos con EPOC descompensada que ingresaron en nuestra unidad de cuidados intensivos entre enero de 1996 y enero de 2002. Se analizan, entre otras variables, la edad, el sexo, la enfermedad de base, la puntuación APACHE II, la estancia, la mortalidad, la ventilación mecánica, las infecciones, los microorganismos causales y los antibióticos utilizados. Resultados. Se estudió a 119 pacientes (2,3 por ciento) con EPOC descompensada de un total de 4.110 en una unidad de cuidados intensivos polivalente medicoquirúrgica. La diferencia en la edad media del grupo con EPOC, 69,0 (10,4), frente a la del total, 59,2 (18,2), resultó estadísticamente significativa, así como la puntuación APACHE, 19,6 (7,4) frente a 15,1 (9,4) y el sexo masculino, 81 frente a 67,3 por ciento. Las diferencias en la estancia media, 8,8 (9,5) frente a 7,8 (13,6), y la mortalidad, 14,3 frente a 19,3 por ciento, no fueron estadísticamente significativas. La enfermedad de base en el grupo con EPOC fue médica (82 por ciento), traumática (3 por ciento) y posquirúrgica (6 por ciento). Se utilizó ventilación mecánica (invasiva y no invasiva) en el 82 por ciento. El 79 por ciento fue tratado con antibióticos, y en el grupo con EPOC se diagnosticaron 56 infecciones: 31 comunitarias con predominio de Haemophilus y neumococos, nueve extra-UCI con predominio de Pseudomonas y neumococos y 16 intra-UCI con predominio de bacilos gramnegativos. Conclusiones. El grupo con EPOC presenta una mayor gravedad y una edad media más elevada, sin una repercusión significativa en la mortalidad cruda y en la estancia media. Llama la atención la asusencia de P. aeruginosa en la flora infectante comunitaria de nuestro entorno, si bien la identificación microbiológica de este subgrupo es baja (AU)

Structural phosphoprotein M2-1 of the human respiratory syncytial virus is an RNA binding protein.

The structural phosphoprotein M2-1 of human respiratory syncytial virus (HRSV) Long strain shows RNA binding capacity in three different assays that detect RNA-protein complexes: cross-linking, gel retardation, and Northern-Western assays. It is able to bind HRSV leader RNA specifically with cooperative kinetics, with an apparent K(d) of at least 90 nM. It also binds to long RNAs with no sequence specificity. The RNA binding domain has been located between amino acid residues 59 and 85, at the NH(2) terminus of the protein. This region contains the phosphorylatable amino acid residues threonine 56 and serine 58, whose modification decreases the binding capacity of M2-1 protein to long RNAs.

Regulated but not constitutive human respiratory syncytial virus (HRSV) P protein phosphorylation is essential for oligomerization.

Purified human respiratory syncytial virus (HRSV) P phosphoprotein from transfected HEp-2 cells is able to oligomerize forming tetramers. The bulk of constitutive P protein phosphorylation (99. 8%) (serine residues 116, 117, 119, 232 and 237) can be removed without affecting protein oligomerization. However, dephosphorylated P protein, produced in bacteria, is unable to oligomerize. This difference can be explained by a transient P protein phosphorylation, detected in HEp-2 cells, that could be essential for P protein oligomerization.

The bulk of the phosphorylation of human respiratory syncytial virus phosphoprotein is not essential but modulates viral RNA transcription and replication.

The ability of variants of the human respiratory syncytial virus (HRSV) phosphoprotein (P protein) to support RNA transcription and replication has been studied by using HRSV-based subgenomic replicons. The serine residues normally phosphorylated in P during HRSV infection have been replaced by other residues. The results indicate that the bulk of phosphorylation of P (98%) is not essential for viral RNA transcription or replication but that phosphorylation can modulate these processes.

Spinal cord injury in the elderly.

Caring for patients who have sustained an SCI requires the nurse to be knowledgeable in the pathophysiology of the disorder, the sequelae following the injury, and the nursing care activities. Additional knowledge is required of the nurse when the patient with SCI is elderly. The nurse must be familiar with the changes in the body systems caused by aging, the alterations in the spine from aging, and how these changes impact the sequelae and nursing care activities.

Experiences of critical care nurses caring for unresponsive patients.

Grounded theory methodology was utilized to explore the experiences of critical care nurses caring for patients who were unable to respond due to a traumatic brain injury or receiving neuromuscular blocking agents. The registered nurses participating in the study worked in a neuroscience intensive care unit. Saturation of the categories was achieved with 16 interviews. The core category that emerged from the study is Giving the Patient a Chance. The subcategories of Learning about My Patient, Maintaining and Monitoring, Talking to My Patient, Working with Families, Struggling with Dilemmas and Personalizing the Experience all centered upon the focus of doing everything to help the patient attain the best possible outcome. Factors influencing each of the subcategories were identified such as the acuity of the patient, experience level of the nurse and the presence or absence of family members or significant others. These factors accounted for the variations in the nurses' experience. Several reasons accounting for the variations were determined. The study identified areas that need to be addressed in both general nursing education and nursing practice, such as instruction on talking to comatose patients, working with families and orientation information for nurses new to caring for these populations. Recommendations for improvement in these areas, as well as for future studies are discussed.

Interactions between cellular actin and human respiratory syncytial virus (HRSV).

Actin the main component of the cellular microfilament network, is present in human respiratory syncytial virus (HRSV) purified virions, as an internal component. This fact and the results of immunoprecipitation studies indicate that during HRSV infection in HEp-2 cells there are interactions between cellular actin and viral components, that can promote a transitory increase in the polymerization of synthetized actin, mainly of the beta isotype. This increased actin polymerization can be related with the formation of cytoplasmic extensions, that contain beta actin and viral particles observed in the HRSV infected HEp-2 cells. The formation of these structures may indicate that HRSV has developed an actin-based motility system similar to that described for other viral and bacterial systems.