Prevention of acute kidney injury in Intensive Care Units.

Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition. Apart from these circumstances, a number of situations could lead to AKI, related to the administration of nephrotoxic drugs, intra-tubular deposits, the administration of iodinated contrast media, liver failure and major surgery (mainly heart surgery). In these cases, in addition to hydration, there are other specific preventive measures adapted to each condition.

Comparative RNA editing in autistic and neurotypical cerebella.

Adenosine-to-inosine (A-to-I) RNA editing is a neurodevelopmentally regulated epigenetic modification shown to modulate complex behavior in animals. Little is known about human A-to-I editing, but it is thought to constitute one of many molecular mechanisms connecting environmental stimuli and behavioral outputs. Thus, comprehensive exploration of A-to-I RNA editing in human brains may shed light on gene-environment interactions underlying complex behavior in health and disease. Synaptic function is a main target of A-to-I editing, which can selectively recode key amino acids in synaptic genes, directly altering synaptic strength and duration in response to environmental signals. Here, we performed a high-resolution survey of synaptic A-to-I RNA editing in a human population, and examined how it varies in autism, a neurodevelopmental disorder in which synaptic abnormalities are a common finding. Using ultra-deep (>1000 × ) sequencing, we quantified the levels of A-to-I editing of 10 synaptic genes in postmortem cerebella from 14 neurotypical and 11 autistic individuals. A high dynamic range of editing levels was detected across individuals and editing sites, from 99.6% to below detection limits. In most sites, the extreme ends of the population editing distributions were individuals with autism. Editing was correlated with isoform usage, clusters of correlated sites were identified, and differential editing patterns examined. Finally, a dysfunctional form of the editing enzyme adenosine deaminase acting on RNA B1 was found more commonly in postmortem cerebella from individuals with autism. These results provide a population-level, high-resolution view of A-to-I RNA editing in human cerebella and suggest that A-to-I editing of synaptic genes may be informative for assessing the epigenetic risk for autism.

Kinetic and hydrogen production analysis in the sequential valorization of a Populus clone by cold alkaline extraction and pyrolysis.

This work employed a two-step biorefining process, consisting of a hemicellulose-rich liquor production through ultrasound-assisted cold alkaline extraction (CAE), followed by thermochemical treatment of the resultant solid phase. The post-CAE solid phase's pyrolytic potential was assessed by application of thermogravimetric analysis (TGA) and Friedman's isoconversional method, and also from hydrogen production. The solid phases remaining after the CAE treatment were more reactive than the untreated raw material. Notably, the alkali concentration employed in the first step was the individual variable most pronounced influence on their activation energy (Ea). Thus, at a degree of conversion α = 0.50, Ea ranged from 109.7 to 254.3 kJ/mol for the solid phases, compared to 177 kJ/mol for the raw material; this value decreased with rising glucan content. At maximal degradation, the post-CAE solid phases produced up to 15.57% v/v more hydrogen than did the untreated raw material.

Association between myasthenia gravis and Alzheimer's disease. / Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.

INTRODUCTION: Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). AIM: To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS: We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS: We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION: Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

TITLE: Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.Introducción. La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo. Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos. Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados. Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones. Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG.

[Evaluation of the impact of lockdown on the health and lifestyle of users of the Fundacio Esclerosi Multiple's neurorehabilitation centres in Lleida and Reus]. / Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.

INTRODUCTION: On 13 March 2020, a state of alarm was declared due to the COVID-19 pandemic, resulting in total lockdown in Spain. The neurorehabilitation centres of the Fundacio Esclerosi Multiple (FEM) provide care for people diagnosed with neuroprogressive diseases with significant health deficits. We look at how lockdown can affect their way of life. AIMS: To assess and manage the impact of lockdown on persons with multiple sclerosis (MS) and other neurodegenerative diseases. PATIENTS AND METHODS: Analytical observational study. An anonymous questionnaire was administered to all the patients undergoing comprehensive rehabilitation treatment at two of the FEM centres; the survey included questions on the demographic and clinical characteristics of the subjects, and an assessment of the impact of the pandemic on the physical, social and psychological spheres. RESULTS: A total of 202 surveys were analysed. The average age of the participants was 49.09 years and 77.8% had MS, while 22.2% had other conditions. The most frequently reported physical symptoms were muscle weakness, loss of balance and fatigue. The study population remained active during lockdown. More than half of them did not report any increase in cognitive symptoms, but they did mention an increased sense of worry on an emotional level. CONCLUSIONS: We can state that the actions deployed by the FEM to reduce the consequences of lockdown have been effective and have minimised the occurrence of maladaptive behaviours. The study has also opened the door for us to add new lines of intervention.

TITLE: Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.Introducción. El día 13 de marzo de 2020 se decretó el estado de alarma con motivo de la pandemia de la COVID-19, lo que supuso un confinamiento domiciliario total en España. Los centros neurorrehabilitadores de la Fundació Esclerosi Múltiple (FEM) atienden a personas diagnosticadas de enfermedades neuroprogresivas con déficits de salud importantes. Analizamos cómo el confinamiento puede afectar a su forma de vida. Objetivos. Evaluar y gestionar el impacto del confinamiento en la persona con esclerosis múltiple (EM) y otras enfermedades neurodegenerativas. Pacientes y métodos. Estudio observacional analítico. Se aplicó un cuestionario anónimo a todas las personas que estaban en tratamiento rehabilitador integral en dos de los centros de la FEM, que incluía características demográficas y clínicas de los sujetos, junto con la evaluación del impacto de la pandemia en la esfera física, social y psicológica. Resultados. Se han analizado un total de 202 encuestas. La edad media de los participantes ha sido de 49,09 años. Un 77,8% presenta EM, mientras que un 22,2% tiene otras patologías. Los síntomas físicos que han aparecido más frecuentemente han sido debilidad muscular, pérdida de equilibrio y fatiga. La población estudiada se ha mantenido activa durante el confinamiento. Más de la mitad no refiere aumento en los síntomas cognitivos, pero sí que aparece, a nivel emocional, un aumento de la sensación de preocupación. Conclusiones. Podemos afirmar que las acciones desplegadas desde la FEM, para reducir las consecuencias del confinamiento, han sido efectivas y han bajado al máximo la aparición de conductas desadaptativas. El estudio también nos ha abierto la puerta a añadir nuevas líneas de intervención.

Genetic structure in the Mediterranean seagrass Posidonia oceanica: disentangling past vicariance events from contemporary patterns of gene flow.

The Mediterranean Sea is a two-basin system, with the boundary zone restricted to the Strait of Sicily and the narrow Strait of Messina. Two main population groups are recognized in the Mediterranean endemic seagrass Posidonia oceanica, corresponding to the Western and the Eastern basins. To address the nature of the East-West cleavage in P. oceanica, the main aims of this study were: (i) to define the genetic structure within the potential contact zone (i.e. the Strait of Sicily) and clarify the extent of gene flow between the two population groups, and (ii) to investigate the role of present water circulation patterns vs. past evolutionary events on the observed genetic pattern. To achieve these goals, we utilized SSR markers and we simulated, with respect to current regime, the possible present-day dispersal pattern of Posidonia floating fruits using 28-day numerical Lagrangian trajectories. The results obtained confirm the presence of the two main population groups, without any indices of reproductive isolation, with the break zone located at the level of the Southern tip of Calabria. The populations in the Strait of Sicily showed higher affinity with Western than with Eastern populations. This pattern of genetic structure probably reflects historical avenues of recolonization from relict glacial areas and past vicariance events, but seems to persist as a result of the low connectivity among populations via marine currents, as suggested by our dispersal simulation analysis.

Preparation and thermal-mechanical characterization of nanoclay-unsaturated polyester composites.

Recently polymer nanocomposites have attracted great interest as much as in industry as in research laboratories, due to they often show remarkable improvement in their mechanical and thermal properties when are compared with the virgin polymers. Among nanocomposites, nanoclay-reinforced polymers have been widely studied, specifically, those formed by a thermosetting polymer matrix, like unsaturated polyester crosslinked resin reinforced with layered silicates, like montmorillonite. In this work we have prepared nanocomposites formed by an isophtalic unsaturated polyester crosslinked resin (UP) reinforced with different contents (2-10 wt%) of organic modified montmorillonite (OMMT). The UP/OMMT nanocomposites have been prepared following different procedures and the structural characterization has been carried out by using X-ray diffraction (XRD). In all the cases an increase of the d-spacing between layers of the OMMT has been detected. The objective of this study is to analyze the thermal and mechanical behaviour of nanocomposites. For all of the reinforced systems, the glass transition temperatures values, Tg, obtained by differential scanning calorimetry (DSC) and dynamic-mechanical thermal analysis, (DMTA) are higher than the corresponding ones to neat UP. On the other hand, the OMMTP mechanical behaviour has been evaluated by DMTA and by tensile tests. Both techniques reveal an increase in Young modulus, however, a decrease of the tensile strength is observed in all the reinforced systems.

Immersive virtual reality and antigravity treadmill training for gait rehabilitation in Parkinson's disease: a pilot and feasibility study. / Entrenamiento antigravitatorio e inmersivo de realidad virtual para la rehabilitación de la marcha en la enfermedad de Parkinson: estudio piloto y de viabilidad.

INTRODUCTION: Treadmill training is considered an effective intervention to improve gait ability in patients with Parkinson's disease (PD). In parallel, virtual reality shows promising intervention with several applications in the inpatient medical setting. AIM: To evaluate the feasibility and preliminary efficacy of mechanical gait assistance combined with immersive virtual reality in patients with PD. PATIENTS AND METHODS: This pilot and feasibility study followed a pre-post study design. The intervention consisted of 12 sessions of 30 minutes, distributed regularly over four consecutive weeks. Participants walked on a treadmill with a body-weight support system set at approximately 20% of body weight and equipped with a virtual reality helmet controlled by a two-handed joystick. Feasibility and intervention outcomes were collected at baseline and after four weeks of intervention. RESULTS: Twelve participants of 60 patients were finally enrolled. Nine of them (75%) completed the treatment intervention with an adherence rate of 97%. Two participants left the study, one of them due to sickness associated with virtual reality and another because of a lack of motivation. There were significant differences associated with small-medium effect sizes when comparing the pre and post values for walk distance, walk speed, balance, and quality of life. CONCLUSIONS: The present study provided preliminary evidence supporting the feasibility of the combination of antigravity treadmill and immersive virtual reality system for the rehabilitation of patients with PD.

TITLE: Entrenamiento antigravitatorio e inmersivo de realidad virtual para la rehabilitación de la marcha en la enfermedad de Parkinson: estudio piloto y de viabilidad.Introducción. El entrenamiento en tapiz rodante se considera una intervención eficaz para mejorar la capacidad de la marcha en pacientes con enfermedad de Parkinson (EP). Paralelamente, la realidad virtual se muestra como una intervención prometedora con diversas aplicaciones en el entorno médico hospitalario. Objetivo. Evaluar la viabilidad y la eficacia preliminar de la asistencia mecánica para la marcha combinada con la realidad virtual inmersiva en pacientes con EP. Pacientes y métodos. Este estudio piloto y de viabilidad siguió un diseño pre-post. La intervención consistió en 12 sesiones de 30 minutos, distribuidas regularmente durante cuatro semanas consecutivas. Los participantes deambularon sobre un tapiz rodante con un sistema de descarga del peso corporal establecido aproximadamente en el 20% del peso corporal y equipados con un casco de realidad virtual controlado por un joystick para cada mano. Las mediciones de viabilidad y tratamiento se recopilaron al inicio del estudio y después de cuatro semanas de intervención. Resultados. De un total de 60 pacientes, se reclutó finalmente a 12 participantes. Nueve de ellos (75%) completaron el tratamiento, con una tasa de adhesión del 97%. Dos participantes abandonaron el estudio, uno debido a náuseas asociadas con la realidad virtual y otro por falta de motivación. Hubo diferencias significativas asociadas con un tamaño del efecto pequeño-mediano al comparar los valores pre y post para la distancia recorrida, velocidad de la marcha, equilibrio y calidad de vida. Conclusiones. El estudio proporcionó evidencia preliminar que apoya la viabilidad de la combinación de un tapiz rodante antigravitatorio y un sistema de realidad virtual inmersivo para la rehabilitación de pacientes con EP.

The effect of seasonality of the growing-finishing period on carcass, meat and fat characteristics of heavy barrows and gilts.

A trial was conducted to study the effect of gender (barrows; gilts) and seasonality of growing-finishing period (S, summer; W, winter) on the carcass and meat characteristics and fatty acid (FA) profile of subcutaneous fat of pigs slaughtered at 131kg of body weight. No significant gender×seasonality interaction was detected and the differences between genders were scarce. The S pigs had a 13.2% thinner fat depth over the Gluteus medius muscle and a higher yield of shoulders and loins by 10.6% and 10.0%, respectively than W pigs. Meat from S pigs had 32.5% lower intramuscular fat content and higher cooking losses (9.1%) and shear force (6.4%) than meat from W pigs. Subcutaneous fat from S pigs had a 7.8% higher percentage of saturated FA and 4.9% lower monounsaturated FA than that from W pigs. It is concluded that in Spanish natural-environment facilities, the seasonality of the growing-finishing period affects the carcass, and meat and fat quality of heavy pigs.

Differential regulation of calcium channel coding genes by prolonged depolarization.

Calcium channels must be subjected to a very precise regulation in order to preserve cell function and viability. Voltage gated calcium channels (VGCC) represent the main pathway for calcium entry in excitable cells. This explains why depolarization induces a rapid-onset and short-term inactivation of calcium currents. Contrarily to this well-documented mechanism to maintain calcium below toxic levels, the regulatory pathways inducing longer-lasting changes and cell surface expression of functional calcium channels are largely unknown. Since calcium is a main player in the activity-dependent regulation of many genes, we hypothesize that calcium channel coding genes could be also subjected to activity-dependent regulation. We have used prolonged depolarization to analyze the effects of sustained intracellular calcium elevation on the mRNAs coding for the different alpha(1) pore-forming subunits of the calcium channels expressed in chromaffin cells. Our findings reveal that persistent depolarization is accompanied by a prolonged intracellular calcium elevation and reduction of calcium current. This calcium current inhibition could be mediated, at least partially, by the downregulation of the mRNAs coding for several alpha(1) subunits. Thus, we show here that depolarization inhibits the expression of Ca(V)1.1, Ca(V)1.2, Ca(V)1.3, Ca(V)2.2 and Ca(V)2.3 mRNAs, while the Ca(V)2.1 mRNA remains unmodified. Moreover, such downregulation of channels depends on calcium entry through the L-type calcium channel, as both mRNA and calcium current changes induced by depolarization are abrogated by L-type channel specific blockers.

Fiber-type-specific transcription of the troponin I slow gene is regulated by multiple elements.

The regulatory elements that restrict transcription of genes encoding contractile proteins specifically to either slow- or fast-twitch skeletal muscles are unknown. As an initial step towards understanding the mechanisms that generate muscle diversity during development, we have identified a 128-bp troponin I slow upstream element (SURE) and a 144-bp troponin I fast intronic element (FIRE) that confer fiber type specificity in transgenic mice (M. Nakayama et al., Mol. Cell. Biol. 16:2408-2417, 1996). SURE and FIRE have maintained the spatial organization of four conserved motifs (3' to 5'): an E box, an AT-rich site (A/T2) that binds MEF-2, a CACC site, and a novel CAGG motif. Troponin I slow (TnIs) constructs harboring mutations in these motifs were analyzed in transiently and stably transfected Sol8 myocytes and in transgenic mice to assess their function. Mutations of the E-box, A/T2, and CAGG motifs completely abolish transcription from the TnI SURE. In contrast, mutation of the CACC motif had no significant effect in transfected myocytes or on the slow-specific transcription of the TnI SURE in transgenic mice. To assess the role of E boxes in fiber type specificity, a chimeric enhancer was constructed in which the E box of SURE was replaced with the E box from FIRE. This TnI E box chimera, which lacks the SURE NFAT site, confers essentially the same levels of transcription in transgenic mice as those conferred by wild-type SURE and is specifically expressed in slow-twitch muscles, indicating that the E box on its own cannot determine the fiber-type-specific expression of the TnI promoter. The importance of the 5' half of SURE, which bears little homology to the TnI FIRE, in muscle-specific expression was analyzed by deletion and linker scanning analyses. Removal of the 5' half of SURE (-846 to -811) results in the loss of expression in stably transfected but not in transiently expressing myocytes. Linker scanning mutations identified sequences in this region that are necessary for the function of SURE when integrated into chromatin. One of these sites (GTTAATCCG), which is highly homologous to a bicoid consensus site, binds to nuclear proteins from several mesodermal cells. These results show that multiple elements are involved in the muscle-specific activity of the TnIs promoter and that interactions between upstream and downstream regions of SURE are important for transcription in the context of native chromatin.

Molecular dissection of DNA sequences and factors involved in slow muscle-specific transcription.

Transcription is a major regulatory mechanism for the generation of slow- and fast-twitch myofibers. We previously identified an upstream region of the slow TnI gene (slow upstream regulatory element [SURE]) and an intronic region of the fast TnI gene (fast intronic regulatory element [FIRE]) that are sufficient to direct fiber type-specific transcription in transgenic mice. Here we demonstrate that the downstream half of TnI SURE, containing E box, NFAT, MEF-2, and CACC motifs, is sufficient to confer pan-skeletal muscle-specific expression in transgenic mice. However, upstream regions of SURE and FIRE are required for slow and fast fiber type specificity, respectively. By adding back upstream SURE sequences to the pan-muscle-specific enhancer, we delineated a 15-bp region necessary for slow muscle specificity. Using this sequence in a yeast one-hybrid screen, we isolated cDNAs for general transcription factor 3 (GTF3)/muscle TFII-I repeat domain-containing protein 1 (MusTRD1). GTF3 is a multidomain nuclear protein related to initiator element-binding transcription factor TF II-I; the genes for both proteins are deleted in persons with Williams-Beuren syndrome, who often manifest muscle weakness. Gel retardation assays revealed that full-length GTF3, as well as its carboxy-terminal half, specifically bind the bicoid-like motif of SURE (GTTAATCCG). GTF3 expression is neither muscle nor fiber type specific. Its levels are highest during a period of fetal development that coincides with the emergence of specific fiber types and transiently increases in regenerating muscles damaged by bupivacaine. We further show that transcription from TnI SURE is repressed by GTF3 when overexpressed in electroporated adult soleus muscles. These results suggest a role for GTF3 as a regulator of slow TnI expression during early stages of muscle development and suggest how it could contribute to Williams-Beuren syndrome.

Effects of gamma radiation on phase behaviour and critical micelle concentration of Triton X-100 aqueous solutions.

Ionising radiation used for sterilization can have an effect on the physicochemical properties of pharmaceutically relevant excipient systems, affecting therefore the stability of the formulation. The effect of gamma irradiation on the phase behaviour (cloud point--CP) and critical micelle concentration (CMC) of aqueous solutions of Triton X-100, used as a model nonionic surfactant, is investigated in this paper. Micellar solutions were irradiated with gamma-rays in a dose range between 0 and 70 kGy, including the sterilization range of pharmaceutical preparations. The decreased observed in CP and CMC values of micellar solutions at all absorbed doses was explained in terms of changes in molecular mass distribution of ethoxylated surfactant and the formation of cross-linked species. These results were complemented by mass spectrometry, UV-vis and NMR spectroscopy. Although the findings indicate degradation of polyethoxylated chains by water radical attacks, there was no spectroscopic evidence of radiation damage to aromatic ring or hydrocarbon tail of surfactant. Models based on Flory-Huggins theory were employed to estimate CP from changes in mass distribution and to obtain cross-linking fractions. Surface tension measurements of non-irradiated and irradiated solutions were used for estimating the effectiveness and efficiency of surfactant in the formulation.

[Epidemiology of pseudotumor cerebri]. / Epidemiología del pseudotumor cerebral.

OBJECTIVE: To determine the epidemiology of pseudotumor cerebri (PTC) as seen in patients attending our ophthalmology department. METHODS: The medical records of patients diagnosed with PTC in our hospital during a ten-year period (1994 to 2004) were obtained, with only those patients with PTC diagnosed in our ophthalmology department being considered. The following data were reviewed: sex, age at diagnosis, body mass index (BMI), opening cerebrospinal fluid (CSF) pressure, and the results of CT and MRI. RESULTS: Twenty-nine patients were diagnosed with PTC during this time period. Twenty-six were females (89.6%) and 3 were males (10.4%). The calculated incidence of PTC in our population was 3.2 per 100.000 persons and 5.1 per 100.000 persons in the general population that attend our hospital. CONCLUSION: The incidence of PTC was higher than that previously reported.

[Deposits of perfluoroctane after prolonged use as a post-operative vitreous substitute]. / Depósitos de perfluoroctano en uso prolongado como sustitutivo vítreo postquirúrgico.

CASE REPORT: We describe a 72-year-old woman with a retinal detachment who underwent pars plana vitrectomy (PPV) and intraocular tamponade with a combination of silicone oil and perfluoro-n-octane as a postoperative vitreous tamponade. Three months later, plaque-like deposits of emulsified perfluoro-n-octane were visible on the inferior retina. DISCUSSION: Deposits of emulsified perfluoro-n-octane, as epiretinal plaques, have not been previously been described as adverse reactions following the use of perfluorocarbons in the eye.

[Total prosthetic knee and hip joint infection. Descriptive epidemiology, therapeutics and evolution in a secondary hospital during ten years]. / Infección de prótesis total de rodilla y cadera. Epidemiología descriptiva, terapéutica y evolución en un hospital de segundo nivel durante 10 años.

OBJECTIVE: Epidemiological description, retrospective in its classification, evolution and therapeutics of total prosthesis knee and hip infected among the arthoplasties made between 1st of January 1994 and 31st of December 2003 in our hospital. RESULTS: The global infection rate was 2.4% (confidence interval of 95% [CI 95%], 1.6%-3.2%) over 40 cases in 1,666 joint implants. The average age +/- standard deviation (SD) was 69.5 years old +/- 5.1 years, mainly in women (67.5%). The most common location was the knee, 31 cases (77.5%). In 90.0% of the patients the aetiology was identified: 64,0% were gram-positive cocci (plasmacoagulase-negative staphylococci, and Staphylococcus aureus); 14.0% were gram-negative bacilli and mixed flora (11.0%). Acute infections were found in most of the cases (45,0%). The joint replacement had a healing rate of 66.7% in the first replacement and of 83.3% in the second replacement. CONCLUSIONS: The gram-positive cocci are the main microorganisms in these infections. More extensive studies about multiple aspects are necessary to evaluate the effectiveness of the different surgical techniques, the new antibiotics and the combined antibiotic therapies.

Uso de la balneoterapia y el ejercicio terapéutico en la mejora física y psicosocial en adolescentes con lupus y artritis juvenil: un estudio de método mixto / Use of balneotherapy and therapeutic exercise in physical and psychosocial improvement in adolescents with lupus and juvenile arthritis: A mixed method study

Antecedentes y objetivo: Evaluar los cambios a nivel físico y psicosocial de una intervención combinada de balneoterapia y ejercicio terapéutico en grupo aplicado en jóvenes con lupus eritematoso sistémico y artritis idiopática juvenil. Materiales y métodos: Estudio longitudinal prospectivo pre y postintervención y cualitativo fenomenológico descriptivo. La intervención consistió en un programa combinado de balneoterapia, ejercicio terapéutico en grupo y terapia manual e instrumental. Se evaluaron el dolor percibido (Escala Visual Analógica), el estado funcional (Health Assessment Questionnaire) y la fatiga (Escala de Evaluación Funcional de Terapia de Enfermedades Crónicas-Fatiga). Las entrevistas se analizaron mediante análisis temático. Resultados: Quince adolescentes de 14,1±2,1 años participaron en el estudio. Se observó una mejoría significativa respecto al dolor máximo (p=0,006; TE=1,1), dolor medio (p=0,029; TE=0,5) y estado funcional (p=0,013; TE=0,7). Sin embargo, a pesar de que la fatiga disminuyó, no se encontraron diferencias estadísticamente significativas (p=0,415; TE=0,3). Los temas principales surgidos tras las entrevistas fueron «una experiencia de aprendizaje» y «desventajas», que describen la vivencia de la intervención. Discusión y conclusiones: Parece que la combinación de balneoterapia y el ejercicio terapéutico en grupo es útil para reducir el dolor y mejorar la función física. Ensayos clínicos en diferentes poblaciones reportan resultados similares, hallando una disminución del dolor. Se concluye que la realización de un programa de fisioterapia combinado de balneoterapia y ejercicio terapéutico en grupo produce beneficios con relación al dolor y al estado funcional, favoreciendo además la ampliación de conocimientos y el automanejo de la enfermedad.

Background and objective: To evaluate the physical and psychosocial changes of a combined intervention of balneotherapy and therapeutic exercise applied in young people with systemic lupus erythematosus and juvenile idiopathic arthritis. Materials and methods: Pre- and post-intervention prospective longitudinal and descriptive phenomenological qualitative studies were conducted. The intervention consisted of a combined program of balneotherapy, therapeutic group exercise and physiotherapy techniques. Perceived pain (Visual Analogue Scale), functional status (Health Assessment Questionnaire), and fatigue (Chronic Disease Therapy-Fatigue Functional Assessment Scale) were assessed. The interviews were analysed using thematic analysis. Results: 15 adolescents aged 14.1±2.1 years participated in the study. A significant improvement was observed with respect to maximum pain (P=.006; ES=1.1), mean pain (P=.029; ES=0.5) and functional status (P=.013; ES=0.7). However, despite the decrease in fatigue, no statistically significant differences were found (P=.415; ES=0.3). The main themes that emerged after the interviews were “a learning experience” and “disadvantages of the intervention”. Discussion and conclusions: It seems that the combination of balneotherapy and therapeutic group exercise is effective in reducing pain and improving physical function. Randomized clinical trials performed in different populations report similar results, finding a decrease in pain. It is concluded that carrying out a physiotherapy program combined balneotherapy and therapeutic group exercise produces benefits in relation to pain and functional status, also favoring the expansion of knowledge and self-management of the disease.

Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease.

Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.

Chromosome complement of the fungal plant pathogen Fusarium graminearum based on genetic and physical mapping and cytological observations.

A genetic map of the filamentous fungus Fusarium graminearum (teleomorph: Gibberella zeae) was constructed to both validate and augment the draft whole-genome sequence assembly of strain PH-1. A mapping population was created from a cross between mutants of the sequenced strain (PH-1, NRRL 31084, originally isolated from Michigan) and a field strain from Minnesota (00-676, NRRL 34097). A total of 111 ascospore progeny were analyzed for segregation at 235 loci. Genetic markers consisted of sequence-tagged sites, primarily detected as dCAPS or CAPS (n = 131) and VNTRs (n = 31), in addition to AFLPs (n = 66) and 7 other markers. While most markers exhibited Mendelian inheritance, segregation distortion was observed for 25 predominantly clustered markers. A linkage map was generated using the Kosambi mapping function, using a LOD threshold value of 3.5. Nine linkage groups were detected, covering 1234 cM and anchoring 99.83% of the draft sequence assembly. The nine linkage groups and the 22 anchored scaffolds from the sequence assembly could be assembled into four chromosomes, leaving only five smaller scaffolds (59,630 bp total) of the nuclear DNA unanchored. A chromosome number of four was confirmed by cytological karyotyping. Further analysis of the genetic map data identified variation in recombination rate in different genomic regions that often spanned several hundred kilobases.

[Visual symptoms as the first manifestation of Alzheimer's disease]. / Síntomas visuales como primera manifestación de la enfermedad de Alzheimer.

CASE REPORT: We report a 59-year-old patient with difficulty in visual perception, difficulty reading and episodes of dyschromatopsia. The ocular examination was unremarkable. Structural neuro-imaging and neuro-ophthalmology tests were normal. Positron emission tomography scanning showed decreased metabolism in the parieto-occipital cortex bilaterally. Several months later the patient developed Alzheimer's disease. DISCUSSION: Visual symptoms may be the first manifestation of Alzheimer's disease.