Aspirin and spinal haematoma after neuraxial anaesthesia: Myth or reality?

The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete and irreversible cyclooxygenase-1 blockade, and higher doses do not increase the antiplatelet effect. Additional cyclooxygenase-2 blockade by high-dose aspirin might decrease the antithrombotic efficacy by inhibiting endothelial prostacyclin synthesis. Different doses of aspirin have been shown to be safe in a broad population subjected to neuraxial anaesthesia or analgesia. In the few case reports of spinal haematoma involving aspirin therapy, additional complicating factors were present. Considering the available evidence, the majority of national scientific societies agree that the isolated use of aspirin does not increase the risk of spinal haematoma and does not represent a contraindication to neuraxial blocks. The precautions regarding higher doses do not seem to be justified. Although aspirin alone is considered to be safe in neuraxial anaesthesia, the concurrent administration of other antithrombotic drugs significantly increases the risk of spinal haematoma and the recommended safety times for each of these other drugs must be strictly followed. An individualized assessment of the risks and benefits should be performed, before performing a neuraxial technique or catheter removal in a patient receiving aspirin.

Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.

BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.

A multicentre, cross-sectional study on quality of life in patients with cutaneous lupus erythematosus.

BACKGROUND: A study at the University of Pennsylvania (UPenn) Medical Center demonstrated that quality of life in patients with cutaneous lupus erythematosus (CLE) is negatively impacted. Whether patients with CLE in other geographic locations have similar quality of life is unknown. OBJECTIVES: We sought to compare quality of life indicators between patients with CLE at the University of Texas Southwestern (UTSW) Medical Center at Dallas and those at UPenn. METHODS: Patients with CLE (total n=248) at UTSW (n=91) and UPenn (n=157) completed the Skindex-29 +3 and Short Form-36 (SF-36) surveys related to quality of life. Additional information, including demographics, presence of systemic lupus erythematosus (SLE) and disease severity, was collected from UTSW patients with CLE. RESULTS: Most Skindex-29 + 3 and SF-36 subdomain scores between UTSW and UPenn patients with CLE were similar. However, UTSW patients with CLE were significantly more affected in the functioning and lupus-specific Skindex-29 + 3 domains, and physical functioning, role-physical and general health SF-36 subscales than UPenn patients with CLE (P<0·05). Factors related to poor quality of life in UTSW patients with CLE include sex, income, education, presence of SLE, and skin disease activity. CONCLUSIONS: Most quality of life indicators were similar between the two CLE populations. Differences in psychosocial behaviour, and a larger proportion of patients with SLE and females in the UTSW group likely attributed to differences in a minority of Skindex-29+3 and SF-36 subdomains. Capturing data from CLE populations in different locations provides a more thorough picture of the quality of life that patients with CLE experience on a daily basis with special attention to quality of life issues in select patients with CLE.

Fleas associated with non-flying small mammal communities from northern and central Chile: with new host and locality records.

Fleas associated with small mammals from seven localities from northern and central Chile were assessed. We captured 352 small mammals belonging to 12 species from which we obtained 675 fleas belonging to 15 different species. The most frequently captured flea species were Neotyphloceras crassispina crassispina (n = 198) and N. chilensis (n = 175). High values of flea species richness and diversity were found in Fray Jorge National Park (NP), a north-central Chilean site, whereas the highest values of mean abundance (MA) and prevalence were found in three diverse sites that include Los Molles River, a high altitude site located in north-central Chile, Fray Jorge NP and Dichato, in south-central Chile. On the other hand, high values of flea richness and diversity were found on two rodent species, Abrothrix olivacea and A. longipilis, whereas the highest values of MA and prevalence were found on Oligoryzomys longicaudatus, A. longipilis and Phyllotis xanthopygus. A total of three new host recordings, nine new localities and nine new host species and locality recordings are reported. Also, this study represents the first known record of Tetrapsyllus (Tetrapsyllus) comis in Chile and the first ecological analysis of Neotyphloceras chilensis.

Remineralization of artificial enamel lesions by theobromine.

OBJECTIVE: This study investigated the remineralization potential of theobromine in comparison to a standard NaF dentifrice. METHODS: Three tooth blocks were produced from each of 30 teeth. Caries-like lesion was created on each block using acidified gel. A smaller block was cut from each block for baseline scanning electron microscopy imaging and electron-dispersive spectroscopy (EDS) analysis for surface Ca level. A tooth slice was cut from each lesion-bearing block for transverse microradiography (TMR) quantification of baseline mineral loss (Δz) and lesion depth (LD). Then baseline surface microhardness (SMH) of each lesion was measured. The three blocks from each tooth were assigned to three remineralizing agents: (1) artificial saliva; (2) artificial saliva with theobromine (0.0011 mol/l), and (3) NaF toothpaste slurry (0.0789 mol/l F). Remineralization was conducted using a pH cycling model with storage in artificial saliva. After a 28-day cycle, samples were analyzed using EDS, TMR, and SMH. Intragroup comparison of pre- and posttest data was performed using t tests (p < 0.05). Intergroup comparisons were performed by post hoc multistep comparisons (Tukey). RESULTS: SMH indicated significant (p < 0.01) remineralization only with theobromine (38 ± 32%) and toothpaste (29 ± 16%). With TMR (Δz/lD), theobromine and toothpaste exhibited significantly (p < 0.01) higher mineral gain relative to artificial saliva. With SMH and TMR, remineralization produced by theobromine and toothpaste was not significantly different. With EDS, calcium deposition was significant in all groups, but not significantly different among the groups (theobromine 13 ± 8%, toothpaste 10 ± 5%, and artificial saliva 6 ± 8%). CONCLUSION: The present study demonstrated that theobromine in an apatite-forming medium can enhance the remineralization potential of the medium.

Effect of fluoridated milk on enamel and root dentin demineralization evaluated by a biofilm caries model.

Although some studies suggest an anticaries effect of fluoridated bovine milk (F-milk) on enamel, evidence is still considered weak. Even more uncertain, the effect of F-milk on root caries remains largely unknown. This study evaluated the effect of F-milk on enamel and on root dentin demineralization using a validated Streptococcus mutans biofilm model, simulating a high cariogenic challenge. S. mutans (UA159) biofilms were formed on bovine enamel and root dentin saliva-coated slabs after measuring initial surface microhardness (SH). Biofilms were exposed to 10% sucrose 8×/day and treated 2×/day with either: (1) 0.9% NaCl (negative control), (2) bovine milk, (3) F-milk (5.0 ppm F as NaF) or (4) NaF 0.05% (anticaries-positive control). Medium pH was monitored twice/day, as a biofilm acidogenicity indicator. After 5 days for enamel and 4 days for dentin, biofilms were recovered to analyze: biomass, soluble proteins, viable microorganisms, and extra- and intracellular polysaccharides. Enamel and dentin demineralization were estimated by percentage of SH loss. Results were compared by ANOVA and Tukey's test. Neither acidogenicity nor biofilm composition differed among treatment groups in biofilms formed on enamel or dentin (p > 0.05). F-milk, however, significantly reduced enamel and dentin demineralization when compared with the negative control (p < 0.05). Also, F-milk was as efficient as 0.05% NaF to reduce enamel (p > 0.05), but not dentin demineralization (p < 0.05). These findings suggest that milk containing 5.0 ppm of fluoride is effective to control enamel caries and that it may be effective on root dentin caries prevention.

[Comparison of treatment with plates for distal tibia fractures]. / Comparación del tratamiento con placas en fractura de tibia distal.

INTRODUCTION: Currently the surgical treatment of fractures of extraarticular distal tibia is controversial for the multiple techniques and materials of osteosynthesis, the Minimally Invasive Percutaneous Techniques (MIPO) allow us to preserve the periosteal circulation, crucial point in the natural processes of convalescence of the patient, so this technique takes relevance in our study. OBJECTIVE: To observe that this approach to fractures of the distal tibia has fewer complications and better functional result than fixation with open technique. MATERIAL AND METHODS: A longitudinal, ambispective and analytical study was conducted in the period from July 2018 to September 2019 in patients with closed fracture of the extraarticular distal tibia in patients over 18 years of age without previously diagnosed musculoskeletal comorbidities, the calculation was performed with the WinPEPI program (Programs for Epidemiologists for Windows) version 11.43 based on the study by Paul Toogooda et al (2018) with a confidence interval of 95% a minimum total of 20 patients for each group. Measures of central tendency, correlations between technique and variable were used. RESULTS: Two groups of 20 patients were analyzed comparing MIPO vs conventional technique in a period of 6 months postsurgical evaluating risk of infection, wound dehiscence, radiographic bone consolidation, joint functionality and demographic data; showing positive statistical superiority for MIPO technique. CONCLUSION: Relevant data were obtained in favor of MIPO with bone consolidation and higher functional score at six months.

INTRODUCCIÓN: Actualmente el tratamiento quirúrgico de fracturas de tibia distal extraarticular es controversial por las múltiples técnicas y materiales de osteosíntesis, las técnicas Mínimo Invasivo Percutánea (MIPO) nos permiten preservar la circulación perióstica, punto crucial en los procesos naturales de convalecencia del paciente, por ello esta técnica es de gran relevancia en nuestro estudio. OBJETIVO: Observar que este abordaje de fracturas de tibia distal tiene menos complicaciones y mejor resultado funcional que la fijación con técnica abierta. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo longitudinal, ambispectivo y analítico en el período de Julio de 2018 a Septiembre de 2019 en pacientes adultos con fractura cerrada de tibia distal extraarticular sin comorbilidades, el cálculo se realizó con el programa WinPEPI (Programs for Epidemiologists for Windows) versión 11.43 basado en el estudio de Paul Toogooda, con un intervalo de confianza de 95% se obtuvo un total mínimo de 20 pacientes por cada grupo. Se usaron medidas de tendencia central, correlaciones entre técnica y variable. RESULTADOS: Se analizaron dos grupos de 20 pacientes comparando la técnica MIPO vs. la convencional en un período de seis meses postquirúrgico evaluando riesgo de infección, dehiscencia de herida, consolidación ósea radiográfica, funcionalidad articular y datos demográficos, mostrando superioridad estadística positiva para la técnica MIPO. CONCLUSIONES: Se obtuvieron datos relevantes a favor de MIPO con consolidación ósea y mayor puntaje funcional articular a los seis meses.

XMAP from Xenopus eggs promotes rapid plus end assembly of microtubules and rapid microtubule polymer turnover.

We have used video-enhanced DIC microscopy to examine the effects of XMAP, a Mr 215,000 microtubule-associated protein from Xenopus eggs (Gard, D.L., and M. W. Kirschner. 1987. J. Cell Biol. 105:2203-2215), on the dynamic instability of microtubules nucleated from axoneme fragments in vitro. Our results indicate that XMAP substantially alters the parameters of microtubule assembly at plus ends. Specifically, addition of 0.2 microM XMAP resulted in (a) 7-10-fold increase in elongation velocity, (b) approximately threefold increase in shortening velocity, and (c) near elimination of rescue (the switch from rapid shortening to elongation). Thus, addition of XMAP resulted in the assembly of longer, but more dynamic, microtubules from the plus ends of axonemes which upon catastrophe disassembled back to the axoneme nucleation site. In agreement with previous observations (Gard, D.L., and M. W. Kirschner. 1987. J. Cell Biol. 105:2203-2215), the effects of XMAP on the minus end were much less dramatic, with only a 1.5-3-fold increase in elongation velocity. These results indicate that XMAP, unlike brain MAPs, promotes both polymer assembly and turnover, and suggests that the interaction of XMAP with tubulin and the function of XMAP in vivo may differ from previously characterized MAPs.

A restriction site to differentiate Plasmodium and Haemoproteus infections in birds: on the inefficiency of general primers for detection of mixed infections.

Avian Plasmodium and Haemoproteus parasites are easily detected by DNA analyses of infected samples but only correctly assigned to each genus by sequencing and use of a phylogenetic approach. Here, we present a restriction site to differentiate between both parasite genera avoiding the use of those analyses. Alignments of 820 sequences currently listed in GenBank encoding a particular cytochrome B region of avian Plasmodium and Haemoproteus show a shared restriction site for both genera using the endonuclease Hpy CH4III. An additional restriction site is present in Plasmodium sequences that would initially allow differentiation of both genera by differential migration of digested products on gels. Overall 9 out of 326 sequences containing both potential restriction sites do not fit to the general rule. We used this differentiation of parasite genera based on Hpy CH4III restriction sites to evaluate the efficacy of 2 sets of general primers in detecting mixed infections. To do so, we used samples from hosts infected by parasites of both genera. The use of general primers was only able to detect 25% or less of the mixed infections. Therefore, parasite DNA amplification using general primers to determine the species composition of haemosporidian infections in individual hosts is not recommended. Specific primers for each species and study area should be designed until a new method can efficiently discriminate both parasites.

Diversidad de ninfas de Leptohyphidae (Ephemeroptera) en el río Quenane-Quenanito, piedemonte llanero colombiano / Diversity of Leptohyphidae (Ephemeroptera) nymphs in the Quenane-Quenanito river, Colombian plain foothills

Resumen Introducción: Varias presiones antrópicas sufren los ecosistemas acuáticos del piedemonte llanero en Colombia. La respuesta a estresores ambientales aún se desconoce en organismos bioindicadores como Leptohyphidae. Objetivo: Determinar la diversidad de ninfas de Leptohyphidae del río Quenane-Quenanito, en dos periodos hidrológicos contrastantes y su relación con algunas variables fisicoquímicas. Métodos: En diciembre (2014) y febrero (2015) se recolectaron organismos con red Surber en seis estaciones a lo largo del río. Se analizó la diversidad alfa y beta y se aplicó análisis de redundancia y modelos lineales generalizados con el fin de establecer la relación entre los taxones y las variables ambientales. Resultados: Se identificaron 369 organismos pertenecientes a cuatro géneros (Amanahyphes, Traverhyphes, Tricorythopsis y Tricorythodes), dos especies y ocho morfoespecies. Se reporta por primera vez para el departamento del Meta Amanahyphes saguassu. Se registró la mayor diversidad de ninfas en la transición a la sequía y la mayor abundancia en sequía. La diversidad beta señaló que la configuración del ensamblaje cambia a nivel espacial y temporal. Conclusiones: Los organismos de Leptohyphidae prefieren hábitats de corrientes, particularmente en el periodo de sequía, donde hallan alimento (hojarasca, detritos) y refugio para establecerse exitosamente; actividades antrópicas como la urbanización afectan notablemente la diversidad. La alta diversidad registrada en este pequeño río de piedemonte llanero refleja la necesidad de incrementar este tipo de trabajos y esfuerzos de recolección de material de estudio en la región.

Abstract Introduction: Various anthropic pressures affect the aquatic ecosystems of the foothills of Colombia. The response to environmental stressors is still unknown in bioindicator organisms such as Leptohyphidae. Objective: To determine the diversity of Leptohyphidae nymphs of the Quenane-Quenanito river, in two contrasting hydrological periods and its relationship with some physicochemical variables. Methods: In December (2014) and February (2015), organisms were collected with a Surber net at six stations along the current. Alpha and beta diversity was analyzed and redundancy analysis and generalized linear model were applied to establish the relationship between taxa and environmental variables. Results: Were identified 369 organisms belonging to four genera (Amanahyphes, Traverhyphes, Tricorythopsis, and Tricorythodes), two species, and eight morphospecies. Amanahyphes saguassu is reported for the first time for the Meta department. High diversity of Leptohyphidae nymphs was recorded in the transition to drought season and greater abundance in drought. Beta diversity indicated that the configuration of the assemblage changes spatially and temporally. Conclusions: Leptohyphidae organisms prefer fast habitats, particularly in the dry period where they find food (leaf litter, detritus) and shelter to establish themselves successfully; anthropic activities such as urbanization notably affect diversity. The high diversity recorded in this small river in the foothills of the plains reflects the need to increase this type of works and collection efforts of study material in the region.

Biogeographic patterns of metazoan parasites of the bigeye flounder, Hippoglossina macrops, in the southeastern Pacific coast.

We examined the metazoan parasite fauna of the bigeye flounder, Hippoglossina macrops, in a latitudinal gradient of the southeastern Pacific (ca. 25 degrees S-33 degrees S) to assess whether their parasites show latitudinal and/or biogeographical patterns, and to determine if these patterns agree well with those observed for free-living organisms. In total, 331 fish from 6 localities were analyzed. Eighteen parasite species, including 5 ecto- and 13 endoparasites, were found in the bigeye flounder. Neoheterobothrium chilensis, Floridosentis sp., and Corynosoma australe were the most prevalent parasite species. Ecto- and endoparasites of H. macrops showed different latitudinal patterns. Only endoparasite species show a distributional pattern concordant with biogeographic areas recognized for free-living organisms; this finding was supported by cluster analyses showing 2 major divisions. The first joined the most northern localities (25 degrees S-26 degrees S), and the second consisted of 2 subgroups: (1) 28 degrees S-30 degrees S, and (2) 31 degrees S-32 degrees S. A multivariate analysis of infracommunities showed significant differences in the parasitic load of H. macrops from different latitudes. The latitudinal differences in the prevalence and abundance of the parasites might be explained by differing oceanographic conditions in water masses. These physical conditions could affect the dispersal ability of the infective stages of ecto-parasites, and produce zoogeographical breaks that could affect the distribution of intermediate hosts (invertebrate and vertebrate prey), subsequently affecting the transmission of endoparasites.

Carotid artery restenosis in a Hispanic population.

BACKGROUND AND PURPOSE: Carotid endarterectomy is one of the main surgical procedures used for carotid stenosis and its recurrence. Besides the setting of a randomized controlled trial for asymptomatic and symptomatic carotid artery stenosis, there is little information about the rate of restenosis after carotid endarterectomy in Hispanics. The purpose of this study is to describe the results of carotid endarterectomy on the basis of restenosis in a Hispanic population. METHOD: A retrospective revision of 47 endarterectomies performed on 43 patients by a single surgeon at the VA Caribbean Health Care System and Pavia Hospital, during an eight year period (1990-1998), was conducted. Information about endarterectomies, restenosis and known risk factors for carotid stenosis were obtained from medical records. RESULTS: Of the 43 patients, 31 were male (72%) and 12 female (28%), with a mean age of 67.9 years. Re-operations for recurrent carotid stenosis were performed in 2 patients (4.7%). Restenosis cases were asymptomatic, hence diagnosed through followup ultrasound Duplex studies and confirmed by angiography after 3 and 4 years of the first surgical procedure. The degree of restenosis (70% to 99%) after the initial endarterectomy was 4.3%. The major risk factors found among patients were hypertension (58%), hypercholesterolemia (50%), smoking (46%), and alcohol (34%). CONCLUSIONS: Carotid endarterectomy with primary closure is safe and durable. Repeated surgery using patch grafts in this Hispanic population was also safe. The concordance of risk factors and incidence of carotid stenosis correlated well with other studies.

Nanomolar concentrations of nocodazole alter microtubule dynamic instability in vivo and in vitro.

Previous studies demonstrated that nanomolar concentrations of nocodazole can block cells in mitosis without net microtubule disassembly and resulted in the hypothesis that this block was due to a nocodazole-induced stabilization of microtubules. We tested this hypothesis by examining the effects of nanomolar concentrations of nocodazole on microtubule dynamic instability in interphase cells and in vitro with purified brain tubulin. Newt lung epithelial cell microtubules were visualized by video-enhanced differential interference contrast microscopy and cells were perfused with solutions of nocodazole ranging in concentration from 4 to 400 nM. Microtubules showed a loss of the two-state behavior typical of dynamic instability as evidenced by the addition of a third state where they exhibited little net change in length (a paused state). Nocodazole perfusion also resulted in slower elongation and shortening velocities, increased catastrophe, and an overall decrease in microtubule turnover. Experiments performed on BSC-1 cells that were microinjected with rhodamine-labeled tubulin, incubated in nocodazole for 1 h, and visualized by using low-light-level fluorescence microscopy showed similar results except that nocodazole-treated BSC-1 cells showed a decrease in catastrophe. To gain insight into possible mechanisms responsible for changes in dynamic instability, we examined the effects of 4 nM to 12 microM nocodazole on the assembly of purified tubulin from axoneme seeds. At both microtubule plus and minus ends, perfusion with nocodazole resulted in a dose-dependent decrease in elongation and shortening velocities, increase in pause duration and catastrophe frequency, and decrease in rescue frequency. These effects, which result in an overall decrease in microtubule turnover after nocodazole treatment, suggest that the mitotic block observed is due to a reduction in microtubule dynamic turnover. In addition, the in vitro results are similar to the effects of increasing concentrations of GDP-tubulin (TuD) subunits on microtubule assembly. Given that nocodazole increases tubulin GTPase activity, we propose that nocodazole acts by generating TuD subunits that then alter dynamic instability.

Conjunctival lymphoma in right eye: Case report. / Linfoma conjuntival de ojo derecho: a propósito de un caso.

CASE REPORT: A 43-year-old woman presented with a salmon-coloured patch of 0.7mm diameter in the right eye that extended into the lower fornix in the bulbar and tarsal conjunctiva, with irregular edges, and highly vascularised. Incisional biopsy was performed, showing it to be a low-grade conjunctival non-Hodgkin B cell lymphoma (or a mucosa associated lymphoid tissue [MALT] lymphoma). DISCUSSION: The lesion remained stable for 24 months of follow-up, when a relapse of the condition occurred, producing an enlargement of the initial lesion. The definitive diagnosis is made by biopsy of the affected tissue and histopathologic study.

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

[Bibliometric map of Spain 1994-2002: biomedicine and health sciences]. / Mapa bibliométrico de España 1994-2002: biomedicina y ciencias de la salud.

BACKGROUND AND OBJECTIVE: The present study is a 1994-2002 update of the Spanish biomedical bibliometric map that follows other reports already published in Medicina Clinica concerning the previous periods 1986-1989 and 1990-1993. MATERIAL AND METHOD: The results are restricted to citable documents, items that were classified in 70 categories according to 1996 JCR. Bibliometric analysis was based on simple (number of documents and number of received citations) and composite indicators (international collaboration, or percent of non cited documents). RESULTS: Spain occupies the eleventh place in the world, and the seventh place among the European countries. Despite Spanish contribution to the world biomedical production is 2,4% it accounts for only 1,8% of the whole citations. Spanish health sector is responsible for nearly the half of the total biomedical output. The 24,8% of documents are published in international collaboration, a proportion that accumulates the 45,5% of biomedical citations received. Catalonia stands out for its clinical research profile, Madrid for its CSIC high density centres while Andalusia and Valencia for their activity from university sector. CONCLUSIONS: Although the sustained growth in the number of documents, the ratio of citations per document remains below the international average. Despite of the international publication is greater than the world average, it remains under the European countries average. The analysis of the geographical and centre documents distribution shows a similar structure of biomedical scientific system when compared to preceding analyses, nevertheless with better results.

[Beta-blockers in septic shock: a review]. / Bloqueadores beta en shock séptico: una revisión.

In septic shock, high adrenergic stress is associated with cardiovascular and systemic adverse effects, which can negatively affect the results. Beta-adrenergic receptor block has been shown to be effective in controlling the disproportionate increase in heart rate, maintaining a favorable hemodynamic profile and apparently improving the efficiency of the cardiovascular system in order to maintain tissue perfusion. They have also been shown to modulate favorably catecholamine-induced immunosuppression and to decrease insulin resistance, protein catabolism, and proinflammatory cytokine expression associated with cardiovascular dysfunction. Selective beta-1 blockers appear to provide better results than non-selective blockers, even suggesting a positive impact on mortality. Future clinical trials are still needed to confirm these findings and define the scope of their benefits.

An improved method for detection and titration of antibodies cytophilic for macrophages.

A new microtechnique for detection and titration of antibodies cytophilic for homologous macrophages is introduced and experiments designed to determine the optimum conditions for its performance reported. The technique employs a series of small chambers formed on a microscope slide by the application of a plastic film in which holes have been punched. The procedure uses 5 x 10(4) cells and 25 microliter of serum per chamber, and each test can be completed in 2 h. A permanent preparation results which can be examined as and when convenient.