[Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders]. / Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.

INTRODUCTION: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. PATIENTS AND METHODS: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. RESULTS: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. CONCLUSIONS: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

TITLE: Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.Introducción. Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos. Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio ­índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15­. Se estudió a 58 pacientes con polisomnografía. Resultados. Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones. En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.

International Cross-Sectional Survey among Healthcare Professionals on the Management of Cow's Milk Protein Allergy and Lactose Intolerance in Infants and Children.

Purpose: The present international survey among healthcare providers aimed to collect data on theoretical knowledge and clinical practices in the diagnosis and management of cow's milk protein allergy (CMPA) and lactose intolerance (LI) in infants. Methods: A global survey was conducted in several countries with diverse health care settings. The survey consisted of multiple-choice questions in 3 main domains: (1) understanding and clinical practices around CMPA and LI; (2) case scenarios; and (3) disease-specific knowledge and potential educational needs. Results: Responses were available from 1,663 participants. About 62% of respondents were general practitioners or general pediatricians, and the remainder were pediatric allergists/gastroenterologists (18%) or other health practitioners (20%). The survey identified knowledge gaps regarding the types of CMPA (IgE-mediated vs. non-IgE-mediated) and the clinical overlap with LI. The survey suggested diverse clinical practices regarding the use of hypoallergenic formulas, as well as misconceptions about the prebiotic benefits of lactose in extensively hydrolyzed formulas in non-breastfed infants with CMPA. Responses to the two case scenarios highlighted varying levels of awareness of the relevant clinical practice guidelines. While respondents generally felt confident in managing infants with CMPA and LI, about 80% expressed an interest for further training in this area. Conclusion: The current survey identified some knowledge gaps and regional differences in the management of infants with CMPA or LI. Local educational activities among general and pediatric healthcare providers may increase the awareness of clinical practice guidelines for the diagnosis and treatment of both conditions and help improve clinical outcomes.

Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño / Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Introducción: Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos: Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio –índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15–. Se estudió a 58 pacientes con polisomnografía. Resultados: Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones: En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.(AU)

Introduction: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients’ pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. Patients and methods: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. Results: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. Conclusions: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.(AU)

Crystallization and preliminary X-ray investigation of a recombinant outer membrane protein from Neisseria meningitidis.

A protein constituent of the outer membrane from Neisseria meningitidis (hereafter called P64K) has been crystallized using the hanging drop technique. Crystals are tetragonal with unit cell dimensions a = b = 136.84 A and c = 78.44 A, compatible with a single monomer of 64 kDa in the asymmetric unit. When exposed to high intensity synchrotron radiation, these crystals diffract X-rays to at least 2.9 A resolution, indicating that a high resolution structure analysis is feasible.

Expression and structural analysis of 14-3-3 proteins.

The 14-3-3 family of proteins plays a role in a wide variety of cellular functions including regulation of protein kinase C and exocytosis. Using antisera specific for the N termini of 14-3-3 isoforms described previously and an additional antiserum specific for the C terminus of epsilon isoform, protease digestion of intact 14-3-3 showed that the N-terminal half of 14-3-3 (a 16 kDa fragment) was an intact, dimeric domain of the protein. Two isoforms of 14-3-3, tau and epsilon, were expressed in E. coli and their secondary structure was shown by circular dichroism to be identical to wild-type protein, and expression of N-terminally-deleted epsilon 14-3-3 protein showed that the N-terminal 26 amino acids are important for dimerization. Intact 14-3-3 is a potent inhibitor of protein kinase C, but the N-terminal domain does not inhibit PKC activity. Site-specific mutagenesis of several regions in the tau isoform of 14-3-3, including the mutation of a putative pseudosubstrate site to a potential substrate sequence, did not alter its inhibitory activity. Intact 14-3-3 proteins are phosphorylated by protein kinase C with a low stoichiometry, but truncated isoforms are phosphorylated much more efficiently by this kinase. This may imply that the proteins may adopt a different structural conformation, possibly upon binding to the membrane, which could modulate their activity. 14-3-3 proteins are found at high concentration on synaptic plasma membranes and this binding is mediated through the N-terminal 12 kDa of 14-3-3.

Multiepitope polypeptide of the HIV-1 envelope induces neutralizing monoclonal antibodies against V3 loop.

A gene encoding a multiepitope polypeptide (MEP) has been synthesized. It contains the information for (1) an 11-amino acid (aa) epitope from the C1 region of gp120 of HIV-1 and (2) 3 epitopes of 15 amino acids each, from the central part of the V3 loop of isolates MN, SC, and WMJII. These four segments are linked by the short spacer peptide AGGGA. This gene was cloned in a plasmid vector and expressed in Escherichia coli as a fusion product with a 62-aa fragment of human IL-2. The recombinant protein TAB1 was purified by washed pellet procedures and reversed-phase HPLC. TAB1 was recognized in ELISAs by 25 of 27 sera from seropositive individuals. Mice were immunized and several hybridomas were obtained. Two of them secrete monoclonal antibodies that react with synthetic peptides from isolates MN, WMJI, WMJIII, and SC with an affinity constant in the range of 10(8) M-1. They also recognized peptides from isolates SF2 and WMJII, but at much lower affinity. The results obtained from peptide ELISAs indicate that the putative epitope recognized by these MAbs lies within the sequence IHIGPGRAFYT. Classic neutralization assays demonstrated that MAb 2C4 neutralizes 50% of the MN isolate at 0.6 micrograms/ml but fails to neutralize IIIB and SF2 strains. The presence of antibodies directed against every one of the component peptides in the sera of rabbits immunized with TAB1 was also documented.

Diagnosis and documentation of central nervous system dysfunctions with craniocorpography after surgical removal of acoustic neurinomas.

Among other tests, craniocorpography (CCG) was performed in 21 patients after acoustic neurinoma surgery. After surgery, 17 patients (81%) had a developing vestibular compensation or an already normal CCG pattern; 3 patients (14%) had signs of persisting central nervous system dysfunction, either localized to the brain stem or in combination with a cerebellar dysfunction, and 1 patient showed a delayed but sufficient compensation after removal of a neurinoma that compressed central nervous system structures. Brain stem and cerebellar dysfunctions caused by tumor compression demonstrated a better vestibular compensation than dysfunctions caused by surgical manipulation, despite no evidence of cerebellar alteration. As an adjunct to complete neuro-otologic and neurologic examinations CCG could become a useful tool in the topodiagnosis of central nervous system dysfunctions after acoustic neurinoma surgery and therefore in the documentation and follow-up process of these patients.

Blink reflex in 57 parkinsonian patients with correlation between the clinical and electrophysiological parameters.

An electrophysiological study of the blink reflex was undertaken in 25 control subjects and in 57 patients with Parkinson's disease. An increase in the ipsilateral and contralateral late response was the most evident finding. The excitability cycle of recovery of the R2 component of the blink reflex after a prior conditioning shock was enhanced in the patients. A statistically significant correlation was established between the increase in the late response and the severity of akinesia and rigidity.

Blink reflex in Parkinson's disease with levodopa-induced dyskinesia.

We have studied the electrically evoked blink reflex (R1 and R2 components) in 40 parkinsonian patients with levodopa-induced dyskinesia (15 with facial dyskinesia, 13 with limb-truncal dyskinesia and 12 with mixed dyskinesia). R2 latencies (both ipsilateral and contralateral) were significantly prolonged in dyskinetic patients. These findings are indicative of decreased excitability of brainstem interneurones in the dyskinetic parkinsonians. We found no correlation between the neurophysiological pattern of blink reflex and the localization of dyskinesia.

[The efficacy of neurophysiological examination in the diagnosis of carpal tunnel syndrome]. / Eficacia del examen neurofisiológico en el diagnóstico del síndrome del túnel del carpo.

INTRODUCTION: The validity of studies of nerve conduction in the diagnosis of carpal tunnel syndrome has been sufficiently demonstrated, especially the speed of nerve conduction across the carpus. It has also been proved that the result of the test varies according to its use. OBJECTIVE: This study is to evaluate the result of the study of nerve conduction in the diagnosis of carpal tunnel syndrome in a population attending a clinical neurophysiology department for examination of suspected neuro-muscular disorders of the upper limit. PATIENTS AND METHODS: We selected the cut-off points of the values of speed of nerve conduction along the median nerve from the thumb (E1) and palm of the hand (E2). Those showing the best sensitivity and specificity were chosen (53 and 51 m/s respectively). We assessed the pre-test and post-test probability to measure the examination result. There was little contribution from this examination to the diagnosis of carpal tunnel syndrome in this population. CONCLUSIONS: The high pre-test probability of a disorder is a cause of low efficacy of the examination done to confirm this and the opposite occurs when it is done to rule it out. The efficacy of an examination should be measured in the setting in which it is used since this does not depend only on its intrinsic characteristics but also on how it is used.

El proceso vasculítico de las úlceras aftosas recidivantes orales podría ser inducido por una microbiota intestinal alterada. segunda parte / Vasculitis process of recurrent aphtae´s ulcers could be induced by altered gut microbiota. Second part

Basados en evidencia clínicas, epidemiológicas e inmunológicas, publicadas en los últimos años, consideramos que, cambios en la microbiota intestinal, pueden desempeñar un rol esencial en la incidencia de numerosos desordenes inflamatorios. Expertos reconocidos han encontrado que una microbiota comensal normal, puede, bajo ciertas circunstancias mutar a patogénica y provocar reacción inmunológica activa e inducir inflamación. En este trabajo se presenta la siguiente hipótesis: "la vasculitis como proceso fisiopatogénico de las RAU estaría inducida en su persistencia, morbilidad y recurrencia por una microbiota intestinal alterada."(AU)

We believe, based on clinical, epidemiological an immunological evidence that could be possible that changes in the intestinal microbiota may be an essential factoring in the incidence of oral inflammatory disorders. Experten have found that a normal microbiota ,, under certain circumstances, produce pathogenic mutations, inducing immunological reaction . This work presents the following hypothesis:: : " Vasculitis as the fisiopathogenic process of RAU coulbe induced in its persistencity, morbidity and recurrence by an altered gut microbiota. " (AU)

El procesovasculítico de las úlceras aftosas recidivantes orales podría ser inducido por una microbiota intestinal alterada. Primera p / Vasculitis process of recurrent aphtae´s ulcers could be induced by altered gut microbiota. First part

Los últimos estudios realizados por expertos en Genética, Biología y Microbiología tratan, entre otros capítulos, sobre la composición de la microbiota intestinal, sus propiedades benéficas y su funcionalidad. Además, especialmente resaltan la relación de esta microbiota con diferentes tejidos del organismo, estableciendo una interrelación con las microbiotas de los distintos órganos del cuerpo humano. En base a ello se establece en esta presentación una hipótesis, teniendo en cuenta la influencia que también podría ejercer la microbiota intestinal sobre la homeostasis y los problemas de inflamación y otras lesiones más severas de la mucosa bucal, por ejemplo, sobre las úlceras aftosas recidivantes (RAU).(AU)

Considering Recurrent Aphthae´s Ulcers, known as RAU, as local vasculitis lesions, with high morbidity, and difficult treatment, its etiology remains unknown until now. It was published about its high incidence and prevalence in HIV+ patients affecting immunocompetent individuals as well. It is referred an immune histochemical study of this illness that included a leucocitoclastic vasculitis It was analized immunology of oral mucosa and RAU microbiota.(AU)

[Trypsic inhibitors in serum and hyaline membrane disease (author's transl)]. / Los inhibidores trípsicos del suero y la enfermedad de la membrana hialina

Alpha1 antitrypsin (A1AT), alpha2 macroglobulin, alpha, quimotrypsin, interalpha1 antitrypsin and trypsin inhibitory capacity in serum of newborn with hyaline membrane disease, are compared with values obtained in other dis orders, and with normal newborn at different gestacional age. Significant decreased level of A1AT and trypsin inhibitory capacity were found in hyaline membrane patients, that were in order to symptoms severity and time in which samples were obtained. A1AT immunofluorescent study of hyaline membrane in died newborns was positive allowing to explain the low levels found in serum. Presence of fibrine IgG, C1a and C3 in hyaline membrane is according to it's composition by plasmatic components. Thus a new pathogenic mecanisme (derived of the plasma viscosity in the alveolar layer) could be present in hyaline membrane formation.

Blink reflex in dyskinetic and nondyskinetic patients with Parkinson's disease.

An electrophysiological study of the blink Reflex was undertaken in 40 dyskinetic and 20 nondyskinetic patients with Parkinson's disease, who were matched for age, stage of disease, duration of illness and amount and nature of antiparkinsonian medication. We found that latencies of R2 responses (both ipsilateral and contralateral) were prolonged in the dyskinetic group compared to the nondyskinetic group. Moreover, the late response was more easily inhibited by conditioning stimulation in dyskinetic patients. This behavior of late response in dyskinetic parkinsonians may be attributed to the reinstatement of dopaminergic suppressive control over the segmental multisynaptic systems belonging to the reflex.

[The state of muscle cramp disease]. / Estado de mal de calambres musculares.

A 65-year-old man presented with daily, almost continuous muscle cramps and painless muscle contractions eight years after being diagnosed as having rheumatoid arthritis. Both cramps and contractions were present at rest, were accentuated by stress and disappeared during sleep. By night-fall the patient was plunged into an extremely disabling condition due to the continuous cramps present in the orofacial, trunk, neck and limb musculature. He even had difficulty speaking. EMG studies demonstrated that both cramps and painless contractions appeared synchronously in muscles innervated by different peripheral nerves. A state of central hyperexcitability is the probable cause of this clinical picture which has remained unchanged over the last six years.

Continuous respiratory support in quadriplegic children by bilateral phrenic nerve stimulation.

Three children, aged 6-10 years, in whom cervical cord injury at the C1-C2 level resulted in apnoea had bilateral implantation of diaphragm pacemakers. With periods of gradual conditioning of the diaphragm muscle to low frequency stimulation and slow respiratory rates they adapted to continuous ventilatory support by simultaneous stimulation of both hemidiaphragms without evidence of fatigue, so far for periods of 23-47 months.

[Multifocal demyelinating neuropathy with persistent conduction blocks and continuous muscular activity]. / Neuropatía desmielinizante multifocal con bloqueos de conducción persistentes y actividad muscular continua.

A patient developed an initially asymmetric sensory-motor neuropathy, with definite predominance in upper limbs. The examination also disclosed a markedly impaired muscle relaxation. The neurophysiological study showed conduction blocks with continuous muscle activity consisting of myokymias fasciculations and muscle cramps which disappeared after the anesthetic block of the distal nerve segments. In the sural nerve biopsy significant abnormalities were not found. After prednisone and carbamazepine therapy in usual doses the symptoms reverted and the conduction blocks persisted. Neuropathy with persistent conduction blocks is an uncommon disease which exceptionally results in a clinically apparent syndrome of continuous muscle activity. Its recognition is important, as symptoms can disappear after correct therapy.

Crystallization of a 14-3-3 protein.

Crystals of the tau (tau) isoform of the 14-3-3 family of proteins were grown and shown to belong to the orthorhombic space group P2(1)2(1)2(1) with cell dimensions a = 70.29, b = 79.3, c = 101.00 A. The crystals were needle-like in morphology and less than 10 micro m in two dimensions. Diffraction data were collected using synchrotron radiation sources from flash-cooled crystals. Native data extended to a resolution of 2.6 A and mercury and platinum derivatives diffracted to 3.4 and 3.9 A, respectively. The structure has been solved recently. Here the protein crystallization procedures, the characterization of the crystals and the correlation between crystal habit and diffraction quality are reported.

Single-step electrotransfer of reverse-stained proteins from sodium dodecyl sulfate-polyacrylamide gel onto reversed-phase minicartridge and subsequent desalting and elution with a conventional high-performance liquid chromatography gradient system for analysis.

Isolation of proteins from polyacrylamide electrophoresis gels by a novel combination of techniques is described. A given protein band from a reverse stained (imidazol-sodium dodecyl sulfate--zinc salts) gel can be directly electrotransferred onto a reversed-phase chromatographic support, packed in a self-made minicartridge (2 mm in thickness, 8 mm in internal diameter, made of inert polymeric materials). The minicartridge is then connected to a high-performance liquid chromatography system and the electrotransferred protein eluted by applying an acetonitrile gradient. Proteins elute in a small volume ( < 700 microL) of high-purity volatile solvents (water, trifluoroacetic acid, acetonitrile) and are free of contaminants (gel contaminants, salts, etc). Electrotransferred proteins were efficiently retained, e.g., up to 90% for radioiodinated alpha-lactalbumin, by the octadecyl matrix, and their recovery on elution from the minicartridge was in the range typical for this type of chromatographic support, e.g., 73% for alpha-lactalbumin. The technique was successfully applied to a variety of proteins in the molecular mass range 6-68 kDa, and with amounts between 50 and 2000 pmol. The good mechanical and chemical stability of the developed minicartridges, during electrotransfer and chromatography, allowed their repeated use. This new technique permitted a single-step separation of two proteins unresolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis due to their different elution from the reversed-phase support. The isolated proteins were amenable to analysis by N-terminal sequencing, enzymic digestion and mass spectrometry of their proteolytic fragments. Chromatographic elution of proteins from the reversed-phase mini-cartridge was apparently independent of the specific loading mode employed, i.e., loading by conventional loop injection or by electrotransfer.