Láser Excimer en Vitiligo. ¿Tratamiento efectivo y seguro para esta enfermedad? Revisión sistemática de la literatura

Introducción: El vitíligo es una enfermedad prevalente en nuestro medio con una prevalencia del 2% de la población mundial. Los síntomas de esta enfermedad son principalmente estéticos al manifestarse como máculas acrómicas, simétricas en las extremidades y en rostro donde genera la mayor estigmatización de los pacientes. Actualmente ningún tratamiento provee mejoría pronta y permanente de los síntomas. Objetivo: Determinar la efectividad del Láser Excimer 308 nm en el tratamiento del vitíligo por medio de una revisión sistemática de la literatura. Métodos: Búsqueda sistemática de ensayos clínicos y estudios cuasiexperimentales en las bases de datos más importantes acerca de la efectividad del Láser Excimer 308 nm en la repigmentación de los pacientes adultos con vitíligo. Se evaluó su calidad metodológica. Resultados: De 862 artículos encontrados se escogieron 40 artículos potenciales de los cuales dos fueron incluidos en esta revisión. El láser Excimer 308 nm como monoterapia presenta una pigmentación efectiva (≥50%) en 28.03% de las áreas tratadas, de los cuales 72.9% se localizaron en áreas sensibles a radiación ultravioleta y 27.02% en zonas no sensibles. Inicio de pigmentación a la sesión número 13 (un mes post inicio del tratamiento). El láser fue seguro y bien tolerado. Conclusión: La evidencia sugiere que el tratamiento con Láser Excimer 308 nm, como monoterapia, es una alternativa terapéutica para lograr repigmentación pronta de las máculas acrómicas del vitíligo en áreas sensibles a radiación ultravioleta. Deben considerarse estudios que evalúen combinaciones de fármacos y Láser en el tratamiento de vitíligo.

"Whole-Exome Sequencing Enables Rapid Determination of Xeroderma Pigmentosum Molecular Etiology"

Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder haracterized by extreme sensitivity to actinic pigmentation changes in the skin and increased incidence of skin cancer. In some cases, patients are affected by neurological alterations. XP is caused by mutations in 8 distinct genes (XPA through XPG and XPV). The XP-V (variant) subtype of the disease results from mutations in a gene (XPV, also named POLH) which encodes for Polg, a member of the Y-DNA polymerase family. Although the presence and severity of skin and neurological dysfunctions differ between XP subtypes, there are overlapping clinical features among subtypes such that the sub-type cannot be deduced from the clinical features. In this study, in order to overcome this drawback, we undertook whole-exome sequencing in two XP sibs and their father. We identified a novel homozygous nonsense mutation (c.897T.G, p.Y299X) in POLH which causes the disease. Our results demonstrate that next generation sequencing is a powerful approach to rapid determination of XP genetic etiology.

Predictores de cambio en la función ventricular izquierda posterior a implante valvular aórtico transcateter comparado con reemplazo valvular aórtico quirúrgico en el hospital universitario fundación Cardioinfantil instituto de cardiología – Bogotá

Objetivos: Identificar predictores de recuperación de la función ventricular izquierda y comparar los hallazgos ecocardiográficos en pacientes con estenosis aórtica crítica sometidos a reemplazo quirúrgico de la válvula aórtica (RVA) o implantación de válvula aórtica transcatéter (TAVI). Métodos: Cuarenta y cuatro pacientes tratados con RVA se compararon con 34 pacientes con TAVI, los datos ecocardiográficos fueron retrospectivamente obtenidos antes de la intervención y previo al alta. Resultados: Se analizaron retrospectivamente pacientes tratados en la FCI - IC desde 2009 - 2015 (n = 78 pacientes, con una media de edad 70,29 ± 11,63, EuroSCORE logístico 3,75 (3-8,55) en RVA y 20,4 (15 , 47-23,32) en TAVI. Ambos grupos mostraron una disminución en los gradientes de la válvula aórtica, más en pacientes de TAVI, con un gradiente transaórtico pico (24,5 vs 18,5, p = 0,001) y medio (14 vs 10, p = 0,002) En comparación con RVA, TAVI presentó un mayor número de pacientes con insuficiencia aórtica paravalvular (47,1% frente a 2,3% p = 0.000). En total, el 61,5% presentó mejoría precoz de la función ventricular, el predictor en severo compromiso de la función del ventrículo izquierdo fue un alto índice de masa ventricular izquierda. Conclusiones: La implantación transcatéter de válvula aórtica es una alternativa al reemplazo quirúrgico de la válvula aórtica en pacientes con estenosis aórtica y alto riesgo quirúrgico. La recuperación postoperatoria precoz de la función ventricular izquierda en pacientes con severo compromiso de la función ventricular estuvo asociada a alto índice de masa ventricular izquierda.

Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

A atividade física em amputados transtibiais

A atividade física é um bom indicador de saúde para a população em geral. Os amputados abaixo do joelho também beneficiam com o exercício físico regular. Este trabalho pretendeu analisar a atividade física dos amputados transtibais. Para a sua realização executou-se um manuscrito da revisão sistemática da literatura e um manuscrito com base em artigos científicos. A revisão sistemática da literatura teve como objetivo analisar a atividade física, medida por instrumentos próprios, dos amputados transtibais. O outro manuscrito visou verificar quais as diferenças de atividade física em amputados vasculares e traumáticos, expor fatores que possam influenciar a atividade física e determinar um possível tempo de recomendação de exercício físico para esta população. Os resultados indicam que os amputados são menos ativos fisicamente que os indivíduos aparentemente saudáveis. Os amputados traumáticos têm uma atividade física maior que os vasculares, mas a etiologia da amputação não é a principal razão que influencia a atividade física. Esta pode ser influenciada pelo nível de amputação, pelo tempo de uso da prótese, pela funcionalidade do amputado com a prótese e a idade do amputado. A partir dos 100 minutos de atividade moderada a vigorosa já poderá ser recomendável a amputados transtibiais. Será importante a realização de estudos que abordem os amputados, uma vez que em Portugal são raras as investigações que indicam a incidência e prevalência de amputados. Mais estudos que avaliam a atividade física também seriam bem-vindos, para uma maior diversidade de opiniões e conhecimento.

Predation in Ground-Nesting Birds: an Experimental Study Using Natural Egg-Color Variation

We tested the hypothesis that cryptically colored eggs would suffer less predation than conspicuous eggs in the ground-nesting red-legged partridge, Alectoris rufa. We used A. rufa as a model species because it has a wide range of natural egg colors, the eggs are widely available from breeding farms, and nests are easily mimicked because they are scrapes containing no vegetation. The study was conducted in the spring of 2001 in forest and fallow fields of central Spain in Castilla La Mancha, Ciudad Real. We used 384 clutches of natural eggs that were white, white spotted, brown, or brown spotted. Within clutches, eggs were consistent in color and size; among clutches, color differences were distributed across habitats. Clutches were checked once after 2 wk of exposure. Cryptic coloration had a survival advantage that was dependent on the local suite of predators. Rodent predation was nonselective with respect to clutch color; however, avian predation was significantly higher for conspicuous clutches. In addition, there was an interaction of landscape and egg color for avian predation. In forest landscapes, the clutches with highest survival were brown spotted, whereas in fallow landscapes, brown and brown spotted clutches had higher survival than white and white potted clutches. Thus, both the predator suite and the landscape had significant effects on the value of cryptic egg coloration. Our study is relevant for conservationists and managers in charge of restocking programs in hunting areas. The release of other partridge species or their hybrids could result in hybridization with wild partridges, potentially leading to nonoptimal clutch pigmentation and reduced survival of the native species. We therefore recommend that local authorities, managers, and conservationists be cautious with the use of alien species and hybrids and release only autochthonous species of partridges within their natural ranges.

The tissue-specific processing of pro-opiomelanocortin

It is just over 30 years since the definitive identification of the adrenocorticotrophin (ACTH) precursor, pro-opiomelanocotin (POMC). Although first characterised in the anterior and intermediate lobes of the pituitary, POMC is also expressed in a number of both central and peripheral tissues including the skin, central nervous tissue and placenta. Following synthesis, POMC undergoes extensive post-translational processing producing not only ACTH, but also a number of other biologically active peptides. The extent and pattern of this processing is tissue-specific, the end result being the tissue dependent production of different combinations of peptides from the same precursor. These peptides have a diverse range of biological roles ranging from pigmentation to adrenal function to the regulation of feeding. This level of complexity has resulted in POMC becoming the archetypal model for prohormone processing, illustrating how a single protein combined with post-translational modification can have a diverse number of roles.

A comparison of the Oxford and Manus intelligent hand prostheses

Historically, commercial hand prosthesis have adopted a low level of innovation mainly due to the strict conditions such a system must undergo. The difficult feedback to the prosthesis user has limited the functional range of commercial systems. Nevertheless, the use of advanced sensors in combination with performing hand mechanisms and microcontrollers could lead to more natural and functional prototypes. The Oxford and Manus intelligent hand prostheses are examples of innovative approaches. This paper compares and contrasts the technological solutions implemented in both systems to address the design conditions.

Thought communication and control: a first step using radiotelegraphy

A signalling procedure is described involving a connection, via the Internet, between the nervous system of an able-bodied individual and a robotic prosthesis, and between the nervous systems of two able-bodied human subjects. Neural implant technology is used to directly interface each nervous system with a computer. Neural motor unit and sensory receptor recordings are processed real-time and used as the communication basis. This is seen as a first step towards thought communication, in which the neural implants would be positioned in the central nervous systems of two individuals.

Genetic diversity of red-fleshed apples (Malus)

Anthocyanins are flavonoid pigments imparting red, blue, or purple pigmentation to fruits, flowers and foliage. These compounds are powerful antioxidants in vitro, and are widely believed to contribute to human health. The fruit of the domestic apple (Malus x domestica) is a popular and important source of nutrients, and is considered one of the top ‘functional foods’—those foods that have inherent health-promoting benefits beyond basic nutritional value. The pigmentation of typical red apple fruits results from accumulation of anthocyanin in the skin. However, numerous genotypes of Malus are known that synthesize anthocyanin in additional fruit tissues including the core and cortex (flesh). Red-fleshed apple genotypes are an attractive starting point for development of novel varieties for consumption and nutraceutical use through traditional breeding and biotechnology. However, cultivar development is limited by lack of characterization of the diversity of genetic backgrounds showing this trait. We identified and cataloged red-fleshed apple genotypes from four Malus diversity collections representing over 3,000 accessions including domestic cultivars, wild species, and named hybrids. We found a striking range of flesh color intensity and pattern among accessions, including those carrying the MYB10 R 6 allele conferring ectopic expression of a key transcriptional regulator of anthocyanin biosynthesis. Although MYB10 R 6 was strongly associated with red-fleshed fruit among genotypes, this allele was neither sufficient nor required for this trait in all genotypes. Nearly all red-fleshed accessions tested could be traced back to ‘Niedzwetzkyana’, a presumed natural form of M. sieversii native to central Asia.

Genome-wide association mapping to candidate polymorphism resolution in the unsequenced barley genome

Although commonplace in human disease genetics, genome-wide association (GWA) studies have only relatively recently been applied to plants. Using 32 phenotypes in the inbreeding crop barley, we report GWA mapping of 15 morphological traits across ∼500 cultivars genotyped with 1,536 SNPs. In contrast to the majority of human GWA studies, we observe high levels of linkage disequilibrium within and between chromosomes. Despite this, GWA analysis readily detected common alleles of high penetrance. To investigate the potential of combining GWA mapping with comparative analysis to resolve traits to candidate polymorphism level in unsequenced genomes, we fine-mapped a selected phenotype (anthocyanin pigmentation) within a 140-kb interval containing three genes. Of these, resequencing the putative anthocyanin pathway gene HvbHLH1 identified a deletion resulting in a premature stop codon upstream of the basic helix-loop-helix domain, which was diagnostic for lack of anthocyanin in our association and biparental mapping populations. The methodology described here is transferable to species with limited genomic resources, providing a paradigm for reducing the threshold of map-based cloning in unsequenced crops.

Ancillary narratives: maids, sleepwalking, and agency in nineteenth-century literature and culture

The limited coverage of servants in nineteenth-century literature may plausibly be ascribed to the tenuous nature of the roles they play in primary texts, and especially to the problematic nature of their agency. This idea is implicit in the arguments of Bruce Robbins, whose The Servant’s Hand remains the most cogent approach to giving servants a palpable role in critical narrative: for Robbins, the agency that acts through the servant ‘prosthesis’ rebounds on the master, granting the servant figure a sometimes exorbitant textual agency. The figure of the sleepwalking maid, and the analogies between sleepwalking and domestic service implicit in it, will help to complicate this picture. In anecdotes of spontaneous sleepwalking, and their subsequent appropriation by mesmerists, maids are cast as non-agents in terms of ownership of narrative: their subjectivity is immaterial to the public fate of the story which their acts generate. But this apparent non-agency is itself derived from their spontaneity; from an autonomous, albeit unconscious, self-will. As such, sleepwalking subjectivity is a gift to paternalism; a mastery it does not have to produce. In conclusion, it is this undetermined quality, rather than a simple lack of agency, that characterizes the maid in the novel, and which continues to exclude domestic servants from critical narrative.

Effect of repeated torque/mechanical loading cycles on two different abutment types in implants with internal tapered connections: an in vitro study

Internal tapered connections were developed to improve biomechanical properties and to reduce mechanical problems found in other implant connection systems. The purpose of this study was to evaluate the effects of mechanical loading and repeated insertion/removal cycles on the torque loss of abutments with internal tapered connections. Sixty-eight conical implants and 68 abutments of two types were used. They were divided into four groups: groups 1 and 3 received solid abutments, and groups 2 and 4 received two-piece abutments. In groups 1 and 2, abutments were simply installed and uninstalled; torque-in and torque-out values were measured. In groups 3 and 4, abutments were installed, mechanically loaded and uninstalled; torque-in and torque-out values were measured. Under mechanical loading, two-piece abutments were frictionally locked into the implant; thus, data of group 4 were catalogued under two subgroups (4a: torque-out value necessary to loosen the fixation screw; 4b: torque-out value necessary to remove the abutment from the implant). Ten insertion/removal cycles were performed for every implant/abutment assembly. Data were analyzed with a mixed linear model (P <= 0.05). Torque loss was higher in groups 4a and 2 (over 30% loss), followed by group 1 (10.5% loss), group 3 (5.4% loss) and group 4b (39% torque gain). All the results were significantly different. As the number of insertion/removal cycles increased, removal torques tended to be lower. It was concluded that mechanical loading increased removal torque of loaded abutments in comparison with unloaded abutments, and removal torque values tended to decrease as the number of insertion/removal cycles increased. To cite this article:Ricciardi Coppede A, de Mattos MdaGC, Rodrigues RCS, Ribeiro RF. Effect of repeated torque/mechanical loading cycles on two different abutment types in implants with internal tapered connections: an in vitro study.Clin. Oral Impl. Res. 20, 2009; 624-632.doi: 10.1111/j.1600-0501.2008.01690.x.

Correlation between vertical misfits and stresses transmitted to implants from metal frameworks

An inappropriate prosthetic fit could cause stress over the interface implant/bone. The objective of this study was to compare stresses transmitted to implants from frameworks cast using different materials and to investigate a possible correlation between vertical misfits and these stresses. Fifteen one-piece cast frameworks simulating bars for fixed prosthesis in a model with five implants were fabricated and arranged into three different groups according to the material used for casting: CP Ti (commercially pure titanium), Co-Cr (cobalt-chromium) or Ni-Cr-Ti (nickel-chromium-titanium) alloys. Each framework was installed over the metal model with all screws tightened to a 10 N cm torque and then, vertical misfits were measured using an optical microscope. The stresses transmitted to implants were measured using quantitative photoelastic analysis in values of maximum shear stress (T), when each framework was tightened to the photoelastic model to a 10 N cm standardized torque. Stress data were statistically analyzed using one-way ANOVA and Tukey`s test and correlation tests were performed using Pearson`s rank correlation (alpha = 0.05). Mean and standard deviation values of vertical misfit are presented for CP Ti (22.40 +/- 9.05 mu m), Co-Cr (66.41 +/- 35.47 mu m) and Ni-Cr-Ti (32.20 +/- 24.47 mu m). Stresses generated by Co-Cr alloy (tau = 7.70 +/- 2.16 kPa) were significantly higher than those generated by CP Ti (tau = 5.86 +/- 1.55 kPa, p = 0.018) and Ni-Cr-Ti alloy (tau =5.74 +/- 3.05 kPa, p = 0.011), which were similar (p = 0.982). Correlations between vertical misfits and stresses around the implants were not significant as for any evaluated materials. (C) 2011 Elsevier Ltd. All rights reserved.

Digital image correlation analysis of the load transfer by implant-supported restorations

This study compared splinted and non-splinted implant-supported prosthesis with and without a distal proximal contact using a digital image correlation method. An epoxy resin model was made with acrylic resin replicas of a mandibular first premolar and second molar and with threaded implants replacing the second premolar and first molar. Splinted and non-splinted metal-ceramic screw-retained crowns were fabricated and loaded with and without the presence of the second molar. A single-camera measuring system was used to record the in-plane deformation on the model surface at a frequency of 1.0 Hz under a load from 0 to 250 N. The images were then analyzed with specialist software to determine the direct (horizontal) and shear strains along the model. Not splinting the crowns resulted in higher stress transfer to the supporting implants when the second molar replica was absent. The presence of a second molar and an effective interproximal contact contributed to lower stress transfer to the supporting structures even for non-splinted restorations. Shear strains were higher in the region between the molars when the second molar was absent, regardless of splinting. The opposite was found for the region between the implants, which had higher shear strain values when the second molar was present. When an effective distal contact is absent, non-splinted implant-supported restorations introduce higher direct strains to the supporting structures under loading. Shear strains appear to be dependent also on the region within the model, with different regions showing different trends in strain changes in the absence of an effective distal contact. (C) 2011 Elsevier Ltd. All rights reserved.