Anatomical eligibility of the renal vasculature for catheter-based renal denervation in hypertensive patients.

OBJECTIVES This study sought to determine the vascular anatomical eligibility for catheter-based renal artery denervation (RDN) in hypertensive patients. BACKGROUND Arterial hypertension is the leading cardiovascular risk factor for stroke and mortality globally. Despite substantial advances in drug-based treatment, many patients do not achieve target blood pressure levels. To improve the number of controlled patients, novel procedure- and device-based strategies have been developed. RDN is among the most promising novel techniques. However, there are few data on the vascular anatomical eligibility. METHODS We retrospectively analyzed 941 consecutive hypertensive patients undergoing coronary angiography and selective renal artery angiography between January 1, 2010, and May 31, 2012. Additional renal arteries were divided into 2 groups: hilar (accessory) and polar (aberrant) arteries. Anatomical eligibility for RDN was defined according to the current guidelines: absence of renal artery stenosis, renal artery diameter ≥4 mm, renal artery length ≥20 mm, and only 1 principal renal artery. RESULTS A total of 934 hypertensive patients were evaluable. The prevalence of renal artery stenosis was 10% (n = 90). Of the remaining 844 patients without renal artery stenosis, 727 (86%) had nonresistant hypertension and 117 (14%) had resistant hypertension; 62 (53%) of the resistant hypertensive and 381 (52%) of the nonresistant hypertensive patients were anatomically eligible for sympathetic RDN. CONCLUSIONS The vascular anatomical eligibility criteria of the current guidelines are a major limiting factor for the utilization of RDN as a therapeutic option. Development of new devices and/or techniques may significantly increase the number of candidates for these promising therapeutic options.

Disastrous Portal Vein Embolization Turned into a Successful Intervention

Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

La desamortización de tierras civiles corporativas en México : ¿una ley agraria, fiscal o ambas? Una aproximación a las tendencias en la historiografía

El trabajo hace una revisión historiográfica que problematiza la hipótesis de que la desamortización despojó de sus tierras o pauperizó a los pueblos de indios en México. Ello permite hilar otros cuestionamientos sobre actores políticos, sociales e institucionales, que no han recibido mucha atención de los historiadores respecto de los efectos de la Ley de 1856, como los ayuntamientos, los abogados y tinterillos. Apunta, además, a problemas metodológicos sobre la interpretación del tipo de tierras que fueron desamortizadas en virtud de que no se ha hecho un análisis corográfico, ni del paisaje de las mismas

La desamortización de tierras civiles corporativas en México : ¿una ley agraria, fiscal o ambas? Una aproximación a las tendencias en la historiografía

El trabajo hace una revisión historiográfica que problematiza la hipótesis de que la desamortización despojó de sus tierras o pauperizó a los pueblos de indios en México. Ello permite hilar otros cuestionamientos sobre actores políticos, sociales e institucionales, que no han recibido mucha atención de los historiadores respecto de los efectos de la Ley de 1856, como los ayuntamientos, los abogados y tinterillos. Apunta, además, a problemas metodológicos sobre la interpretación del tipo de tierras que fueron desamortizadas en virtud de que no se ha hecho un análisis corográfico, ni del paisaje de las mismas

La desamortización de tierras civiles corporativas en México : ¿una ley agraria, fiscal o ambas? Una aproximación a las tendencias en la historiografía

El trabajo hace una revisión historiográfica que problematiza la hipótesis de que la desamortización despojó de sus tierras o pauperizó a los pueblos de indios en México. Ello permite hilar otros cuestionamientos sobre actores políticos, sociales e institucionales, que no han recibido mucha atención de los historiadores respecto de los efectos de la Ley de 1856, como los ayuntamientos, los abogados y tinterillos. Apunta, además, a problemas metodológicos sobre la interpretación del tipo de tierras que fueron desamortizadas en virtud de que no se ha hecho un análisis corográfico, ni del paisaje de las mismas

Impaired long-term potentiation induction in dentate gyrus of calretinin-deficient mice

Calretinin (Cr) is a Ca2+ binding protein present in various populations of neurons distributed in the central and peripheral nervous systems. We have generated Cr-deficient (Cr−/−) mice by gene targeting and have investigated the associated phenotype. Cr−/− mice were viable, and a large number of morphological, biochemical, and behavioral parameters were found unaffected. In the normal mouse hippocampus, Cr is expressed in a widely distributed subset of GABAergic interneurons and in hilar mossy cells of the dentate gyrus. Because both types of cells are part of local pathways innervating dentate granule cells and/or pyramidal neurons, we have explored in Cr−/− mice the synaptic transmission between the perforant pathway and granule cells and at the Schaffer commissural input to CA1 pyramidal neurons. Cr−/− mice showed no alteration in basal synaptic transmission, but long-term potentiation (LTP) was impaired in the dentate gyrus. Normal LTP could be restored in the presence of the GABAA receptor antagonist bicuculline, suggesting that in Cr−/− dentate gyrus an excess of γ-aminobutyric acid (GABA) release interferes with LTP induction. Synaptic transmission and LTP were normal in CA1 area, which contains only few Cr-positive GABAergic interneurons. Cr−/− mice performed normally in spatial memory task. These results suggest that expression of Cr contributes to the control of synaptic plasticity in mouse dentate gyrus by indirectly regulating the activity of GABAergic interneurons, and that Cr−/− mice represent a useful tool to understand the role of dentate LTP in learning and memory.

Apoptosis and proliferation of dentate gyrus neurons after single and intermittent limbic seizures

Neuronal apoptosis was observed in the rat dentate gyrus in two experimental models of human limbic epilepsy. Five hours after one hippocampal kindling stimulation, a marked increase of in situ terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) of fragmented DNA was observed in nuclei located within and on the hilar border of the granule cell layer and in the polymorphic region. Forty kindling stimulations with 5-min interval produced higher numbers of labeled nuclei compared with one stimulation. The increase of TUNEL-positive nuclei was prevented by the protein synthesis inhibitor cycloheximide but not affected by the N-methyl-d-aspartate receptor antagonist MK-801. Kainic acid-induced seizures lead to a pattern of labeling in the hippocampal formation identical to that evoked by kindling. A large proportion of cells displaying TUNEL-positive nuclei was double-labeled by the neuron-specific antigen NeuN, demonstrating the neuronal identity of apoptotic cells. Either 1 or 40 kindling stimulations also gave rise to a marked increase of the number of cells double-labeled with the mitotic marker bromodeoxyuridine and NeuN in the subgranular zone and on the hilar border of the dentate granule cell layer. The present data show that single and intermittent, brief seizures induce both apoptotic death and proliferation of dentate gyrus neurons. We hypothesize that these processes, occurring early during epileptogenesis, are primary events in the development of hippocampal pathology in animals and possibly also in patients suffering from temporal lobe epilepsy.

Long-term potentiation activates the GAP-43 promoter: Selective participation of hippocampal mossy cells

Perforant path long-term potentiation (LTP) in intact mouse hippocampal dentate gyrus increased the neuron-specific, growth-associated protein GAP-43 mRNA in hilar cells 3 days after tetanus, but surprisingly not in granule cells, the perforant path target. This increase was positively correlated with level of enhancement and restricted to central hilar cells on the side of stimulation. Blockade of LTP by puffing dl-aminophosphonovalerate (APV), an N-methyl-d-aspartate (NMDA) receptor blocker into the molecular layer, eliminated LTP-induced GAP-43 mRNA elevation in hilar cells. To determine whether the mRNA elevation was mediated by transcription, LTP was studied in transgenic mice bearing a GAP-43 promoter-lacZ reporter gene. Promoter activity as indexed by Transgene expression (PATE) increased as indicated by blue staining of the lacZ gene product, β-galactosidase. Potentiation induced a blue band bilaterally in the inner molecular layer of the dentate gyrus along the entire septotemporal axis. Because mossy cells are the only neurons in the central hilar zone that project to the inner molecular layer bilaterally along the entire septotemporal axis and LTP-induced activation of PATE in this zone was confined to the side of stimulation, we concluded that mossy cells were unilaterally activated, increasing synthesis of β-galactosidase, which was transported bilaterally. Neither granule cells nor pyramidal cells demonstrated increased PATE or increased GAP-43 mRNA levels. These results and recent evidence indicating the necessity of hilar neurons for LTP point to previously unheralded mossy cells as potentially critical for perforant path LTP and the GAP-43 in these cells as important for LTP persistence lasting days.

Axon pathology in Parkinson’s disease and Lewy body dementia hippocampus contains α-, β-, and γ-synuclein

Pathogenic α-synuclein (αS) gene mutations occur in rare familial Parkinson’s disease (PD) kindreds, and wild-type αS is a major component of Lewy bodies (LBs) in sporadic PD, dementia with LBs (DLB), and the LB variant of Alzheimer’s disease, but β-synuclein (βS) and γ-synuclein (γS) have not yet been implicated in neurological disorders. Here we show that in PD and DLB, but not normal brains, antibodies to αS and βS reveal novel presynaptic axon terminal pathology in the hippocampal dentate, hilar, and CA2/3 regions, whereas antibodies to γS detect previously unrecognized axonal spheroid-like lesions in the hippocampal dentate molecular layer. The aggregation of other synaptic proteins and synaptic vesicle-like structures in the αS- and βS-labeled hilar dystrophic neurites suggests that synaptic dysfunction may result from these lesions. Our findings broaden the concept of neurodegenerative “synucleinopathies” by implicating βS and γS, in addition to αS, in the onset/progression of PD and DLB.

Ultrastructural localization of zinc transporter-3 (ZnT-3) to synaptic vesicle membranes within mossy fiber boutons in the hippocampus of mouse and monkey

Zinc transporter-3 (ZnT-3), a member of a growing family of mammalian zinc transporters, is expressed in regions of the brain that are rich in histochemically reactive zinc (as revealed by the Timm’s stain), including entorhinal cortex, amygdala, and hippocampus. ZnT-3 protein is most abundant in the zinc-enriched mossy fibers that project from the dentate granule cells to hilar and CA3 pyramidal neurons. We show here by electron microscopy that ZnT-3 decorates the membranes of all clear, small, round synaptic vesicles (SVs) in the mossy fiber boutons of both mouse and monkey. Furthermore, up to 60–80% of these SVs contain Timm’s-stainable zinc. The coincidence of ZnT-3 on the membranes of SVs that accumulate zinc, and its homology with known zinc transporters, suggest that ZnT-3 is responsible for the transport of zinc into SVs, and hence for the ability of these neurons to release zinc upon excitation.

Arte de cultivar las moreras, el de criar los gusanos de seda, y curar sus enfermedades, y el de la hilanza de la seda en organcim ... /

Mode of access: Internet.

Indumentaria y cultura de las apariencias en la Biblioteca Histórica

El objetivo de la exposición es ofrecer una visión de diferentes aspectos de la cultura de las apariencias y de la indumentaria entre los siglos XVI y XVIII a través de libros, documentos y grabados de la Biblioteca Histórica, así como una selección de prendas del Museo Pedagógico Textil. El deseo de vestirse y adornarse es tan antiguo como la humanidad. El vestido es uno de los elementos que se emplea para atraer y gustar a los demás. La apariencia física a través del traje permite a la persona expresarse de manera voluntaria o involuntaria y tiene un papel importante en la comunicación. Pero en muchas ocasiones el deseo de agradar convertido en vanidad ,desvirtúa la función natural del vestido, su protección moral o de pudor, para convertirse en ostentación de riqueza. Aunque esta ostentación se haga a través de posesiones, joyas, viajes, etc. es el vestido su mayor exponente. Traje y riqueza mantienen una estrecha relación, ya sea por los tejidos exclusivos, confección profesional, elementos decorativos como pasamanerías y bordados, zapatos, cinturones… Que se van introduciendo poco a poco en el traje popular, como signo de riqueza, aunque a menor escala.La demanda de moda, de trajes que cambian por capricho y aportan novedad crece. Nos situamos en el siglo XVIII para conocer algunos inventos que mejoran la calidad y la producción de vestidos en Francia y que se extienden por toda Europa. Instrumentos como la máquina de hilar, que evoluciona en su manejo, o tratados de sastrería donde se fijan las normas de un arte complicado. En su constante evolución, la indumentaria se irá renovando.Para atraer al público se requiere una publicidad: los franceses serán los pioneros, no sólo en el arte del buen hacer, sino en el del buen vender.

Cholangiocarcinoma: from molecular biology to treatment

Cholangiocarcinoma is a rare tumor originating in the bile ducts, which, according to their anatomical location, is classified as intrahepatic, extrahepatic and hilar. Nevertheless, incidence rates have increased markedly in recent decades. With respect to tumor biology, several genetic alterations correlated with resistance to chemotherapy and radiotherapy have been identified. Here, we highlight changes in KRAS and TP53 genes that are normally associated with a more aggressive phenotype. Also IL-6 and some proteins of the BCL-2 family appear to be involved in the resistance that the cholangiocarcinoma presents toward conventional therapies. With regard to diagnosis, tumor markers most commonly used are CEA and CA 19-9, and although its use isolated appears controversial, their combined value has been increasingly advocated. In imaging terms, various methods are needed, such as abdominal ultrasound, computed tomography and cholangiopancreatography. Regarding therapy, surgical modalities are the only ones that offer chance of cure; however, due to late diagnosis, most patients cannot take advantage of them. Thus, the majority of patients are directed to other therapeutic modalities like chemotherapy, which, in this context, assumes a purely palliative role. Thus, it becomes urgent to investigate new therapeutic options for this highly aggressive type of tumor.

Purtscher-like retinopathy

Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis. Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots. Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications.

Aspiração de corpo estranho na criança: um perigo escondido

Introdução: A aspiração de corpo estranho (ACE) é uma emergência pediátrica e uma causa importante de morte acidental na criança. A maioria dos casos ocorre com objetos orgânicos e inorgânicos de pequenas dimensões, sobretudo em idade pré-escolar. A ACE cursa com amplo espectro de manifestações e o seu diagnóstico representa muitas vezes um desafio. Caso clínico: Descrevemos o caso clínico de uma criança de dois anos que recorreu ao Serviço de Urgência por tosse, disfonia e disfagia. Ao exame objetivo apresentava acessos de tosse estridulosa, tiragem supra-esternal ligeira e auscultação pulmonar com sibilos inspiratórios/expiratórios e roncos dispersos bilateralmente. A telerradiografia do tórax evidenciava um reforço hilar bilateral, mais notável à direita. A avaliação por Otorrinolaringologia, incluindo a nasolaringofibroscopia, não de- mostrou alterações. A broncoscopia revelou a presença de corpo estranho vegetal condicionando obstrução superior a 50% do lúmen do brônquio principal direito. Conclusão: Pretendemos com este caso salientar a necessidade de manter alto índice de suspeição perante a possibilidade de ACE, pois o atraso no seu reconhecimento condiciona o seu tratamento e o eventual aparecimento de sequelas irreversíveis.