Co-designing a Canadian adaptation of a lifestyle-oriented intervention aimed to improve daily functioning of individuals living with chronic pain: a multi-method study protocol of REVEAL(OT) Canada.

Background: Living with chronic pain (CP) often implies major lifestyle changes, including modifications of daily routines and work. Surprisingly, few validated and effective interventions specifically target functional outcomes in this population. Redesign your Everyday Activities and Lifestyle with Occupational Therapy [REVEAL(OT)] is a lifestyle-oriented intervention led by occupational therapists that directly targets the daily functional challenges of living with CP. The intervention was initially developed and studied as an add-on to standard treatment delivered by Danish multidisciplinary specialized pain clinics. Adapting, implementing, and evaluating REVEAL(OT) within the Canadian healthcare system will contribute to broadening the scope of treatments offered in specialized pain clinics that do not yet include occupational therapy. Objective: The proposed study aims to define and refine REVEAL(OT)/CA with partners (authors of original intervention, people with lived experience, clinicians, managers). Methods: This participatory action research will use a multi-method design and follow the ORBIT model for developing behavioral treatments for chronic diseases. A process of co-construction with partners and an advisory committee will take place in two Montreal specialized pain clinics. It consists of two related work packages (WPs). In WP1, a first series of focus groups with partners (n = 86) and workshops with the advisory committee will be conducted to co-develop the hypothetical pathway describing intervention components and their potential mechanisms of action on targeted outcomes, as well as the first version of the adapted intervention manual. WP2 will co-refine REVEAL(OT)/CA by exploring its acceptability, feasibility and mechanisms of action through intervention deliveries (at least twice in each of two specialized pain clinics; n ≥ 60 patients) and focus groups and/or individual interviews with participating patients and partners. At the end of this study, the intervention manual will be generated both in French and English. Discussion: This study will set the stage for subsequent implementation and effectiveness assessment projects and be an important step towards the deployment of interventions aiming to improve engagement in meaningful daily activities among adults living with CP. Registration: OSF Registries, osf.io/8gksa. Registered 3 August 2023, https://osf.io/8gksa.

Rheological properties of ethyl cellulose-monoglyceride-candelilla wax oleogel vis-a-vis edible shortenings.

The gelation process, elasticity, and mechanical recovery after shear were studied in mixed oleogels of ethylcellulose (EC), monoglycerides (MG), and candelilla wax (CW). EC oleogels produced without MG showed grainy texture due to incomplete dissolution of crystalline fractions of raw EC in the vegetable oil (150 °C). These fractions were eliminated by dissolving the raw EC/MG mixture in ethanol, evaporating the solvent, dispersing, and dissolving the solid residue in the vegetable oil (150 °C) prior gelation. The EC polymeric network, and MG, and CW crystals had a positive interaction on the elasticity of mixed oleogels. Mixed oleogels produced under static conditions showed a 100 % of elasticity recovery after shearing, a phenomenon associated with an EC interchain hydrogen bonding mediated by hydroxyl groups of MGs. This tentatively resulted from the formation of junction zones of the type EC-[MG]n-EC. The rheological behavior of these olegels was remarkably close to that of commercial shortenings.

[Short cold ischaemia time optimises transplant results for kidneys from expanded criteria donors]. / El tiempo de isquemia fría corto optimiza los resultados de los trasplantes renales efectuados con donantes con criterios expandidos.

INTRODUCTION: Outcome of renal transplant from expanded criteria donors (ECD) is usually inferior than those from standard criteria donors (SCD) and may be improved decreasing cold ischemia time (CIT) and minimizing preservation injury. We compare the results obtained with CIT <15 hours in kidney transplants from ECD vs SCD. SUBJECTS AND METHODS: Prospective, single center study of kidney transplants performed since June 2003 to December 2007. Minimum follow-up period was 12 months. Data of donors, receptors and transplant outcome from ECD and SCD are compared. RESULTS: CIT (mean +/- SD) was 9.3+/-2.5 hours in transplants from ECD (n=24) and 8.3+/-3.3 hours in those from SCD (N=50), p=0.18. We did not find significant differences among recipients of grafts from ECD and those from SCD regarding: primary non-function (4.2% vs 2%, respectively), delayed graft function (16.7% vs 10%), surgical complications (25% vs 16%) or acute rejection episodes (8.3% vs 2%). Glomerular filtration rate at one year follow-up was 65.8+/-14.9 ml/min in ECD recipients and 49.4+/-12.5 ml/min (p<0.0001). One year graft survival was 95.8% in ECD recipients and 94% in SCD recipients (p=0.75). CONCLUSIONS: Short CIT in kidney transplant from ECD leads to similar outcome than that obtained from SCD, although renal function is inferior in ECD grafts.

Water-in-oil organogel based emulsions as a tool for increasing bioaccessibility and cell permeability of poorly water-soluble nutraceuticals.

The use of organogels in food and pharmaceutical sciences has several technical problems related with restricted diffusion of the drugs and lack of a proper gelator molecule. These features are important into the new product design. An alternative to improve technological properties in organogels is the use of emulsions. However, there is a lack of knowledge about the behavior on bioaccessibility and permeability of bioactives loaded into organogel-based emulsions. The objective of the present experimental work was to study the physical properties of organogel-based emulsions made with vegetable oil loaded with three different bioactives (betulin, curcumin and quercetin) and the influence on their bioaccessibility. Organogels were made of canola or coconut oils and myverol as gelator (10% w/w). Water-in-oil emulsions (at 5, 10 and 12.5 wt% of water content) were prepared by mixing the melted proper organogel and water (80 °C) under high shear conditions (20,000 rpm). Micrographs, rheological tests (amplitude, frequency, temperature sweeps and creep-compliance measurements), DSC and particle size analysis were performed to samples. In vitro digestion (oral, gastric and intestinal phase), lipolysis assays, bioaccessibility and permeability tests by cell culture of Caco-2 were made. Organogels of coconut oil have shown poor emulsification properties.

Structuration, elastic properties scaling, and mechanical reversibility of candelilla wax oleogels with and without emulsifiers.

The crystal network development, elastic properties scaling behavior, and mechanical reversibility of candelilla wax (CW) oleogels with and without emulsifiers were studied. Saturated monoglycerides (MG) and polyglycerol polyricinoleate (PGPR) were added at 1 or 2 times the critical micelle concentration. Although the micelles of both emulsifiers act as nucleation sites for the mixture of aliphatic acids and alcohols of CW, they did not affect the oleogel's thermodynamic stability. It was established that the crystal network of CW consists of at least two types of crystals, one rich in n-hentriacontane and other rich in aliphatic acids. Both crystals species contributed significantly to the oleogel elasticity. The elastic properties scaling behavior of CW oleogels fitted the fractal model within the weak-link regime. The setting temperature and added emulsifier modified the crystal network fractal dimension. During shearing, oleogels had massive breaking of junction zones, causing the loss of fractality in the crystal network, which in turn decreased the system's elasticity.

Secondary amyloidosis associated with histiocytosis X.

We report a 34-year-old man diagnosed with Langerhans cell histiocytosis (LCH) or histiocytosis X in 1980. He had multiple focal osseous lesions, difficult control of the disease activity and was treated many times with chemo- and radiotherapy for symptomatic control. His kidney disease started 20 years after the diagnosis with progressive renal failure and increasing non-nephrotic proteinuria, coinciding with two flares of LCH. A percutaneous renal biopsy demonstrated amyloidosis. There is only one case described in the amyloidosis literature associated with LCH.

Aspectos prácticos de la elección del producto y la titulación con cannabis medicinal para el dolor crónico / Practical aspects of product selection and titration with medical cannabis for chronic pain management

Años de experiencia y multitud de estudios observacionales proponen la eficacia del cannabis medicinal (CM) para aliviar el dolor. La experiencia clínica no se ha podido correlacionar con la evidencia científica. De los países donde el CM se ha legalizado provienen guías basadas en consensos que proporcionan al clínico interesado un conocimiento mínimo esencial para responder a las necesidades de sus pacientes. Esta revisión proporciona aspectos básicos de la selección de pacientes y productos del CM para el especialista en dolor.(AU)

Years of experience and multiple cohort studies suggest the efficacy of medical cannabis (MC) to relieve chronic pain. The clinical experience has not been linked with scientific evidence. In countries where CM has been legalized, guidelines based on consensus have been developed that provide the clinician with the minimum essential knowledge to respond to the needs of his or her patients. This review provides basic aspects of patient and product selection of MC for the pain specialist.(AU)

[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture]. / Mielolipoma suprarrenal gigante: hipertensión, insuficiencia renal y rotura espontánea.

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

Phase behavior, structure and rheology of candelilla wax/fully hydrogenated soybean oil mixtures with and without vegetable oil.

Vegetable oil organogelation is one of the most promising strategies to eliminate trans fatty acids in plastic fats. Organogels prepared with edible wax are stable at refrigerator and room temperature. Some functional properties (i.e., texture) of wax organogels can be improved by adding saturated triacylglycerols. Mixtures of fully hydrogenated soybean oil (FH) and candelilla wax (CW) were studied with and without the addition of high oleic safflower oil (HOSFO). Crystallization and melting behavior, X-ray diffraction, and crystalline microstructure of the mixtures were analyzed. The elastic modulus (G'), and the structural recovery after shear of the organogels were also assessed. Mixtures without HOSFO formed solid dispersions of CW and FH crystals, where up to ~10% CW crystals were incorporated into the FH crystal lattice. The vegetable oil solutions of FH/CW mixtures crystallized from the melt, developed mixed crystal networks composed of FH crystals in the ß polymorph and CW in an orthorhombic subcell packing. As the systems crystallized in the most stable polymorph, only minor microstructural changes were shown along 28days of storage at 25°C. CW and FH crystals showed a synergistic effect on the elasticity of organogels. This was attributed to the large number FH crystals nucleated on the surface of CW crystals. The structural recovery after shear was superior for mixed organogels composed of CW platelets and grainy FH crystals compared to that of CW organogels. A recovery of up to 65.7% the G' of gels formed under static conditions was observed upon shearing.

El hilo de Ariadna: gestión en CMA. Innovaciones accesibles / Ariadna’s thread: management in outpatient surgery. Accessible innovations

Profesionales, sistemas de información y gestores han de compartir codo con codo la primera línea. El conocimiento de la situación no puede quedarse restringido a una distancia y una mazmorra donde tomar las decisiones sin el concurso personal de los implicados en la toma de decisiones. Las herramientas y el desarrollo de TIC, el compartir las ideas in situ, la bidireccionalidad y, por supuesto, la empatía logran agilizar los procesos. Esta es nuestra experiencia y las mejoras que hemos ido introduciendo en base a las sugerencias, observaciones y, cómo no, a la gestión sincronizada con las demandas. El escollo es duro pero no insalva- ble, y permite una respuesta proactiva al corto y medio plazo que seguirá facilitando y retroalimentando para continuar en este trabajo común y apasionante. (AU)

Professionals, information systems and managers have to share the front lineside by side. Knowledge of the situation cannot be restricted to a distance and a dungeon where decisions can be made without the personal assistance of those involved in decision-making. TICS tools and development, sharing ideas on site, bidirectionality and, of course, empathy manage to streamline processes. This is our experience and the improvements that we have been introducing based on suggestions, observations and, of course, on synchronized management with demands. The obstacle is hard but not insurmountable and allows a proactive response in the short and medium term that will continue to facilitate and provide feedback to continue in this common and exciting work. (AU)

[Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation]. / Embolización del injerto renal no funcionante: eficacia y control del estado inflamatorio crónico.

BACKGROUND: The graft intolerance syndrome (fever, pain, haematuria) may lead to a chronic inflammatory disease, with cardiovascular repercussion. Nephrectomy is considered the classical treatment of these cases but nowadays renal vascular embolization has been suggested as a possible alternative treatment. The present study concerns seven cases trated with renal vascular embolization in our hospital summarizing data of graft intolerance syndrome and the chronic inflammatory disease. MATERIAL AND METHODS: Between january 2000 and december 2003 seven renal vascular embolization were performed in nonfunctioning renal allograft. The procedure was made with calibrated particles of 300-500micron. Data about complications related to the technique the same as analitic inflammatory parameters before and after treatment (CRP, ferritin, serum albumin, hemoglobin, erythropoietin) were registered. RESULTS: The patients were two men and five women, with median age of 39,7 +/- 8,8 years. The period beween the dialysis and the embolization was of 10,0 +/-8,2 months. Comparing the perion of admission in the hospital due to nephrectomy which was of 17,86+/-4,41 days, the period because of embolization was shorter, being 8,14 +/- 4,53 days. All analitic parameters studied, clearly improved after embolization with decrease of ferritin and CRP, increase of albumin and better hemoglobin level with lower erythropoietin dose. In five of the seven patients there was no renal captation with CT or gammagraphy. Four patients presented a postembolization syndrome, but no other important complication was registered. Neither reembolization nor renal nephrectomy was neccesary in any of the seven cases. CONCLUSION: Percutaneous renal embolization is a simple, easy, safety and effective technique that must be considered as an alternative treatment to nephrectomy, resolving the chronic inflammatory disease secondary to the graft intolerance syndrome.

[Nephropathia caused by hantavirus puumala: a case report]. / Nefropatía por hantavirus puumala: a propósito de un caso.

We present a patient from Germany with Hantavirus infection, admitted in the Emergency room of our hospital, with fever, thrombocytopenia, acute renal failure, oliguria, mild proteinuria and hematuria. Percutaneous renal biopsy revealed an acute interstitial nephritis without medulla haemorrhages. The virus infection confirmation was made by detection of IgM against Hantavirus Puumala. This infection should be considered in patients with thrombocytopenia, fever and acute renal failure, over all if they are from North and Central Europe.

[Meningoencephalitis by Listeria in the lupus disease]. / Meningoencefalitis por Listeria en el lupus.

We present a patient with lupus nephropathy of 20 years of evolution in treatment with oral steroids who developed a meningoencephalitis associated to bacteraemia by Listeria monocytogenes. The patient was treated successfully with gentamicin and ampicillin for 6 weeks. Infection by Listeria monocytogenes occurs more frequently in individuals with some form of immunodeficiency like lupus disease, with a mortality around 30%.

Analysis of caprine IgG1 and IgG2 subclass responses to Chlamydia psittaci infection and vaccination.

Enzyme-linked immunosorbent assays (ELISAs) specific for caprine IgG(H+L), IgG1 and IgG2 were developed and evaluated for serodiagnosis of Chlamydia psittaci infections in a Tunisian goat flock with currently occurring chlamydial abortions and a clinically inapparent goat flock of an animal research facility. Additionally, ELISAs were applied to record the IgG1 and IgG2 dynamics of four goats vaccinated with inactivated Chlamydia psittaci and Coxiella burnetii. For screening purposes, the IgG(H+L) ELISA proved to be superior to the complement fixation test because it detected a larger number of chlamydial abortions and was easier to perform and to interpret. Analysis of Chlamydia psittaci-specific IgG1 and IgG2 responses to naturally occurring infections by ELISA revealed high IgG1 levels associated with IgG2 in goats with current abortions, whereas clinically inapparent, but seropositive goats were characterized by significantly lower IgG1 levels only (P less than 0.001). Similarly, the four vaccinated goats responded initially with Chlamydia psittaci-specific IgG1, whereas second and third vaccinations induced (as in goats with chlamydial abortions) predominantly IgG1, but also IgG2. The results indicated that clinically inapparent chlamydial infection may be distinguished from overt disease by analysing specific IgG1 and IgG2 responses. Applying Coxiella burnetii- specific ELISAs on field samples, IgG1 alone could be detected in eight, IgG2 alone in one and IgG1 combined with IgG2 in nine goats. The coxiella-specific antibody response of the four vaccinated goats was--in contrast to the chlamydia-specific response--characterized by IgG2 dominance.

Nuclear magnetic resonance investigations of the inclusion complexation of gliclazide with beta-cyclodextrin.

The formation of the gliclazide-beta-cyclodextrin (GL-beta-CD) inclusion compound has been studied in the liquid state by phase solubility techniques and by 1H and 13C NMR spectroscopy. From the initial straight portion of the solubility curve (Bs type), the value of the apparent stability constant (Kc) was calculated as 1094 M(-1). The nuclear magnetic resonance studies confirm that GL yields a complex with beta-CD in aqueous medium, which is mainly due to the penetration of the azabicyclooctyl group of GL into the cavity of beta-CD. The study of the monodimensional nuclear Overhauser effect (NOE) of the H3 proton of CD has shown that the tolyl group also interacts with CD, but to a lesser extent than the azabicyclooctyl moiety. Finally, the application of the continous variation technique confirmed the 1:2 drug:CD stoichiometry of the complex.

Dominance of Chlamydia psittaci-specific IgG2 subclass in the humoral immune responses of naturally and experimentally infected cattle.

Indirect enzyme-linked immunosorbent assays were applied to differentiate Chlamydia (C.) psittaci-specific IgG1 and IgG2 levels in 143 individual serum samples from cattle with naturally occurring chlamydial infections and in 190 sequential serum samples from 26 experimentally infected pregnant cows, calves, and a bull. The mean IgG1:IgG2 ratio of naturally infected cattle was 1:4 indicating a significant (p less than 0.001) IgG2 dominance. Similar ratios were detected in the experimentally infected cattle. The dominance of IgG2 was independent of breed, sex, and age. Twenty-nine cattle had significant immunoglobulin levels to both C. psittaci and Coxiella (C.) burnetii simultaneously. The predominance of C. psittaci-specific IgG2, in contrast to the predominance of C. burnetti-specific IgG1 detected in these same individual serum samples under identical conditions, indicates that the ability to preferentially produce either IgG1 or IgG2 was not limited in these individual cattle. A transient yet significant IgG1 response was also developed in cows following chlamydia-induced abortions (immunotype 1) or in cattle infected with the polyarthritis-serositis-encephalomyelitis agents (immunotype 2). IgG1 levels decreased faster than IgG2 levels. These findings have diagnostic implications and identify the need for determining the immunoglobulin classes and subclasses of the humoral immune responses of animals and man to chlamydial infections.

Leaching of 2,4-D from a soil in the presence of beta-cyclodextrin: laboratory columns experiments.

This study reports on the effect of the presence of beta-cyclodextrin (beta-CD) on the adsorption and mobility of the pesticide 2,4-dichlorophenoxyacetic acid (2,4-D) through soil columns. The previous application of beta-CD to the soil produced a retarded leaching of 2,4-D through the soil column, due probably to herbicide adsorption on the soil through beta-CD adsorbed. However, the application of beta-CD solution to the soil column where 2,4-D had been previously adsorbed, led to the complete desorption of the herbicide, due to the formation of water-soluble 1:1 inclusion complexes between 2,4-D and beta-CD. Beta-CD can be viewed as a microscopic organic-phase extractant. It can be an advantage to remove from soil pesticides which are able to form inclusion complexes with cyclodextrins, making them possible candidates for use in in situ remediation efforts.

Ethyl cellulose polymer microspheres for controlled release of norfluazon.

The pesticide norfluazon has been microencapsulated using ethyl cellulose to develop controlled-release formulations that decrease its mobility through the soil and protect it from photodegradation. Ethyl cellulose microspheres loaded with norfluazon were prepared by the solvent-evaporation method. To obtain the microspheres, certain conditions (pesticide/polymer ratio, percentage of emulsifying agent and solvent) were varied. The shape and size of the microspheres obtained were studied by scanning electron microscopy. Other parameters, such as solids recovery, encapsulation efficiency and pesticide loading, were also studied. The release rate of norfluazon from the different microspheres was slower than that of pure norfluazon. In particular, microspheres obtained with o-xylene, which provided the largest diameter, retarded the initial release of the pesticide relative to microspheres obtained with chloroform, or to pure norfluazon. Moreover, the studies showed that the pesticide/polymer ratio controlled the release of norfluazon, which was slower when this ratio was low. Release rates conformed to a generalised kinetic equation for a diffusion-controlled release mechanism, and the time taken for 50% of the active ingredient to be released into water, t50, was calculated.

Bovine chlamydial abortion: serodiagnosis by modified complement-fixation and indirect inclusion fluorescence tests and enzyme-linked immunosorbent assay.

Sequential serum samples from 11 cows experimentally inoculated with different abortigenic strains of Chlamydia psittaci were tested by a modified complement-fixation (MoCF) test, an indirect inclusion fluorescence antibody (IIFA) test, and an enzyme-linked immunosorbent assay (ELISA). One of these cows was not pregnant, another gave birth at term to a healthy calf, and all the others prematurely delivered infected dead calves or weak live calves. The results achieved with these tests on sera of 3 of the cows were compared with those from the previously used standard complement-fixation (CF) test. Six of 11 cows had detectable preinoculation titers between 1:8 and 1:16 when tested by the MoCF test, yet preinoculation titers were not detected by CF. In contrast, 9 of 11 and 10 of 11 preinoculation samples had detectable chlamydia-specific antibodies when examined by the IIFA test and the ELISA, respectively. The preinoculation IIFA titers ranged from 1:8 to 1:64, and the ELISA optical density values varied from 0.150 to 0.450. All cows responded with significant increases in antibody levels detected by the MoCF test, the IIFA test, and ELISA after they were experimentally inoculated and after they aborted or delivered infected calves. Overall, the dynamics of the antibody responses were found to be similar with the 3 different serologic techniques. When cows aborted later than 36 days after they were inoculated, the antibody response was biphasic, whereby the more pronounced responses occurred after the abortion occurred. The nonpregnant cow and the cow that delivered a healthy calf at term had only one phase of increasing and decreasing titers directly after they were inoculated.