Diagnosis of right bundle branch block: a concordance study.

BACKGROUND: Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS: The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS: We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION: The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.

Spatial and temporal trace metal distribution of a Peruvian basin: recognizing trace metal sources and assessing the potential risk.

Recent efforts have been made to determine the environmental impact of mining over the past 11 years in the Jequetepeque River basin, in northern Peru. We have now analyzed data from two studies to elucidate the spatial and temporal trace metal distributions and to assess the sources of contamination. These two studies were carried out from 2003 to 2008 by a Peruvian government administration and from 2008 to 2010 by us. We analyzed 249 samples by principal component analysis, measuring: pH, electrical conductivity, total dissolved solids, total suspended solids, chloride, weak-acid-dissociable cyanide, total cyanide, nitrite and nitrate, ammonium, sulfate, and trace metals and metalloids (Al, As, Ca, Cd, Cu, Cr, Fe, Mg, Mn, Ni, Pb, and Zn). Within the spatial distribution of the basin, the highest Al, As, Cu, Fe, Ni, and Pb concentrations were found at the closest point to the mine sites for both periods of time, with the higher peaks measured during the first years of the sampling data. Temporal trends showed higher concentrations of Cu and Fe in samples taken before 2005, at which point the two mines were closed. Risk assessment was quantified by the hazard quotient as related to water ingestion. The risk for human health posed by the concentrations of several trace metals and metalloids was found to be highly adverse (As and Cr), significant (Al, Cd, Cu, Fe, and Pb), or minimal (Ni and Zn).

[Leptomeningeal spread of an intramedullary cervical pilocytic astrocytoma: case report and literature review]. / Diseminación leptomeníngea de un astrocitoma pilocítico cervical en el adulto:publicación de un caso y revisión de la literatura.

BACKGROUND. The rarest location of pilocytic astrocytoma is intramedullary. Gliomas represent up to 24 - 30% of intramedullary tumors in adulthood and are second only after ependymomas. Leptomeningeal dissemination through cerebrospinal fluid is unusual and occurs predominantly in medulloblastomas, ependymoblastomas, central neuroblastomas, ependymomas, germ cell tumors and high-grade gliomas. The majority of spinal cord gliomas reporting metastasis were anaplastic astrocytomas or glioblastomas multiforme and relatively few were low-grade gliomas. The incidence of leptomeningeal spread of low-grade tumors is rare. A rare cranial extension of brain leptomeningeal dissemination in an intramedullary pilocytic astrocytoma during adulthood is reported. CASE REPORT. A 51 year-old-man with a recurrent intramedullary mass at C5-C7 level operated 4 times with all pathological anatomy reports describing the lesion as Pilocytic Astrocytoma developed, after 15 years from the diagnosis, visual hallucinations and his level of consciousness worsened to Glasgow coma score 13/15. The MRI showed highly enhanced cranial and spinal leptomeninges and paquimeninges with a micro nodular-granulomatous aspect associated with intense affectation of basal cisterns, subarachnoid spaces and convexity of both cerebral hemispheres suggestive of leptomeningeal spread of the spinal mass. The patient expired after three days. CONCLUSION. Leptomeningeal spread is a rare phenomenon and when it happens usually doesn't change the primary tumor's behavior. In our case the aggressiveness could be explained by a potential malignization of the primary tumor that it was not documented because of the partial resections from the lasts surgeries or instead the tumor was actually a monomorphous pilomyxoid tumor.

Potential of MMP-9 based nanoparticles at optimizing the cow dry period: pulling apart the effects of MMP-9 and nanoparticles.

The cow dry period is a non-milking interval where the mammary gland involutes and regenerates to guarantee an optimal milk production in the subsequent lactation. Important bottlenecks such as the high risk of intramammary infections complicate the process. Antibiotics have been routinely used as a preventive treatment but the concerns about potential antibiotic resistance open a new scenario in which alternative strategies have to be developed. Matrix metalloproteinase-9 (MMP-9) is an enzyme able to degrade the extracellular matrix, triggering the involution and immune function of cow mammary gland. We have studied the infusion into the mammary gland of MMP-9 inclusion bodies as protein-based nanoparticles, demonstrating that 1.2 mg of MMP-9 enhanced the involution and immune function of the cow mammary gland. However, the comparison of the effects triggered by the administration of an active and an inactive form of MMP-9 led to conclude that the response observed in the bovine mammary gland was mainly due to the protein format but not to the biological activity of the MMP-9 embedded in the inclusion body. This study provides relevant information on the future use of protein inclusion bodies in cow mammary gland and the role of MMP-9 at dry-off.

A new approach to obtain pure and active proteins from Lactococcus lactis protein aggregates.

The production of pure and soluble proteins is a complex, protein-dependent and time-consuming process, in particular for those prone-to-aggregate and/or difficult-to-purify. Although Escherichia coli is widely used for protein production, recombinant products must be co-purified through costly processes to remove lipopolysaccharide (LPS) and minimize adverse effects in the target organism. Interestingly, Lactococcus lactis, which does not contain LPS, could be a promising alternative for the production of relevant proteins. However, to date, there is no universal strategy to produce and purify any recombinant protein, being still a protein-specific process. In this context and considering that L. lactis is also able to form functional protein aggregates under overproduction conditions, we explored the use of these aggregates as an alternative source of soluble proteins. In this study, we developed a widely applicable and economically affordable protocol to extract functional proteins from these nanoclusters. For that, two model proteins were used: mammary serum amyloid A3 (M-SAA3) and metalloproteinase 9 (MMP-9), a difficult-to-purify and a prone-to-aggregate protein, respectively. The results show that it is possible to obtain highly pure, soluble, LPS-free and active recombinant proteins from L. lactis aggregates through a cost-effective and simple protocol with special relevance for difficult-to-purify or highly aggregated proteins.

Pathological complete response following docetaxel-based neoadjuvant chemotherapy for locally advanced gastric adenocarcinoma.

Locally advanced gastric adenocarcinoma has a poor outcome. Neoadjuvant treatment is being tested in locally advanced non-resectable tumours and in those resectable tumours with a high risk of recurrence. Efforts to identify prognostic factors and more active and less toxic preoperative regimens are being searched for. We report the case of a patient achieving a complete histopathological complete response following docetaxel- based neoadjuvant chemotherapy.

A mild carbon-boron bond formation from diaryliodonium salts.

The direct metal-free borylation of diaryliodonium salts with diboron reagents is now demonstrated to be a feasible process toward formation of aryl boronic esters without any additive or catalysts, and it can be extended to a two-step C-C coupling of both aryl groups of the initial diaryliodonium reagent.

Dissociation constants of organophosphinic acid compounds.

The dissociation equilibria of di(2,4,4-trimethylpentyi) phosphinic acid, mono(2,4,4-trimethylpentyl) phosphinic acid, di(n-octyl)phosphinic acid and mono(n-octyl)phosphinic acid have been studied in ethanol-water mixtures by potentiometric titration at 25 degrees C. These data have been analysed both graphically numerically using the program LETAGROP-ZETA. The obtained pK(a) values have been correlated with the corresponding values in water, determined both indirectly by means of extraction measurements and by estimation using the suitable Hammett equation.

Molecular mechanisms for antibody-mediated modulation of peptide-displaying enzyme sensors.

The generation of molecular sensors based on peptide-displaying enzymes for the detection of antibodies or antigens represents an innovative field of protein engineering. The knowledge of the underlying molecular mechanisms of enzymatic modulation in such sensors would be of great importance for the rational construction and improvement of responsiveness of new peptide-enzyme molecules. Here we analyze the enzymatic characteristics of three different kinds of sensors based in engineered beta-galactosidase, alkaline phosphatase and beta-lactamase, to explore a common activation basis. We describe two different categories of enzyme sensors. In one of them, including only some modified beta-lactamases, the enzymatic activity is inhibited upon ligand binding and it seems to be caused by the steric coverage of the active site by the bound antibody. In a second group, embracing members of the three studied enzymes, the ability to be modulated upon effector binding depends on the ratio between the k(cat) of the engineered enzyme and the k(cat) of the intact enzyme. This proves a common mechanism for enzymatic modulation of enzyme biosensors that is probably caused by conformational effects induced by the bound antibody on the enzyme.

[Self care and risk factors of diabetic foot in patients with type II diabetes mellitus]. / Autocuidado y factores de riesgo de pie diabético en pacientes con diabetes mellitus tipo II.

OBJECTIVES: To find the amount of self-care (SC), health education (HE) received and the prevalence of risk factors for diabetic foot (RFDF) in patients with type II Diabetes Mellitus (DM) attended in Primary Care. DESIGN: A descriptive crossover study. SETTING: Primary Care Centre. PATIENTS: 100 DM patients attending over 2 months (May and June 1995) to see the doctor or collect prescriptions. MEASUREMENTS AND MAIN RESULTS: Questionnaire on HE, SC habits and social and demographic data, inspection of the feet and physical investigation of lower extremities. 36% had deficient or very deficient hygiene; 73% did not go regularly to the chiropodist, 76% used scissors, 75% did not check the inside of the shoe. 38% had signs of neuropathy and 17%, of peripheric vasculopathy. 25% were at high risk of diabetic foot. Women had more RFDF. CONCLUSIONS: The amount of self-care is very low, especially in hygiene, which did not improve over time. HE on foot care is extremely poor despite its being a priority. Educational interventions are required to motivate healthworkers and patients, especially those with most RFDF, in the area of SC.

Engineering regulable Escherichia coli beta-galactosidases as biosensors for anti-HIV antibody detection in human sera.

The activity of engineered, peptide-displaying enzymes is modulated by binding to specific anti-peptide antibodies. This new concept of a quantitative antibody detection system allows test kits to be set up for fast diagnosis of infectious diseases. To develop a quick and homogeneous assay for the detection of human immunodeficiency virus (HIV) infection, we have explored two acceptor sites of the bacterial Escherichia coli beta-galactosidase for the accommodation of HIV antigenic peptides. Two overlapping epitopes (namely P1 and P2) from the gp41 envelope glycoprotein, contained in different sized peptides, were inserted in the vicinity of the enzyme active site to generate a set of hybrid, enzymatically active beta-galactosidases. Regulable enzymes of different responsiveness to monoclonal antibody binding were generated with both acceptor sites tested. These biosensors were also sensitive to immune sera from HIV-infected patients. Modeling data provide insight into the structural modifications in the vicinity of the active site induced by peptide insertion that strongly affect the responsiveness of the engineered proteins through different parameters of their catalytic properties.

Pathological complete response following docetaxel-based neoadjuvant chemotherapy for locally advanced gastric adenocarcinoma

Locally advanced gastric adenocarcinoma has a poor outcome. Neoadjuvant treatment is being tested in locally advanced non-resectable tumours and in those resectable tumours with a high risk of recurrence. Efforts to identify prognostic factors and more active and less toxic preoperative regimens are being searched for. We report the case of a patient achieving a complete histopathological complete response following docetaxel- based neoadjuvant chemotherapy (AU)

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