Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived.

Determinants of the omega-3 index in a Mediterranean population at increased risk for CHD.

The omega-3 index, defined as the sum of EPA and DHA in erythrocyte membranes expressed as a percentage of total fatty acids, has been proposed as both a risk marker and risk factor for CHD death. A major determinant of the omega-3 index is EPA þ DHA intake, but the impact of other dietary fatty acids has not been investigated. In a cross-sectional study on 198 subjects (102 men and 96 women, mean age 66 years) at high cardiovascular risk living in Spain, the country with low rates of cardiac death despite a high prevalence of cardiovascular risk factors, dietary data were acquired from FFQ and blood cell membrane fatty acid composition was measured by GC. The average consumption of EPA þ DHA was 0·9 g/d and the mean omega-3 index was 7·1%. In multivariate models, EPA þ DHA intake was the main predictor of the omega-3 index but explained only 12% of its variability (P,0·001). No associations with other dietary fatty acids were observed. Although the single most influential determinant of the omega-3 index measured here was the intake of EPA þ DHA, it explained little of the former"s variability; hence, the effects of other factors (genetic, dietary and lifestyle) remain to be determined. Nevertheless, the high omega-3 index could at least partially explain the paradox of low rates of fatal CHD in Spain despite a high background prevalence of cardiovascular risk factors.

Planificación educativa en cuatro municipios chilenos

El artículo presenta una experiencia inédita de planificación educativa municipal participativa y deliberativa en cuatro municipios chilenos de la Región de Los Ríos y Los Lagos. Lo que presentamos es una práctica diferente a la centralizada, no inclusiva y tradicional, que hace hincapié en tres ámbitos, por lo general controvertidos y olvidados en la planificación local: la inclusión de otros actores (aparte de los municipales), la corresponsabilidad en las tareas propuestas y el monitoreo y evaluación compartidos de lo planificado; pilares para la generación de confianzas, una planificación aterrizada y la conformación compartida de un horizonte educacional comunal. Queremos, de fondo, enfatizar que en la toma de decisiones locales "muchos es mejor que pocos" y que estos espacios potencian una planificación austera, pero no menos compleja, de acuerdos colaborativos, que pueda permanecer en el tiempo y generar inclusión y decisiones compartidas en la educación municipal.

Cent anys de medicina: la nova Facultat i l'Hospital Clínic de Barcelona: 1906-2006

Es tracta d'una petita publicació rica en fotografies que es va fer per mostrar part de la documentació gràfica recollida per a la exposició en motiu del centenari de l'Hospital Clínic i la Facultat de Medicina.

Polymorphisms in fibronectin binding protein A of Staphylococcus aureus are associated with infection of cardiovascular devices.

Medical implants, like cardiovascular devices, improve the quality of life for countless individuals but may become infected with bacteria like Staphylococcus aureus. Such infections take the form of a biofilm, a structured community of bacterial cells adherent to the surface of a solid substrate. Every biofilm begins with an attractive force or bond between bacterium and substratum. We used atomic force microscopy to probe experimentally forces between a fibronectin-coated surface (i.e., proxy for an implanted cardiac device) and fibronectin-binding receptors on the surface of individual living bacteria from each of 80 clinical isolates of S. aureus. These isolates originated from humans with infected cardiac devices (CDI; n = 26), uninfected cardiac devices (n = 20), and the anterior nares of asymptomatic subjects (n = 34). CDI isolates exhibited a distinct binding-force signature and had specific single amino acid polymorphisms in fibronectin-binding protein A corresponding to E652D, H782Q, and K786N. In silico molecular dynamics simulations demonstrate that residues D652, Q782, and N786 in fibronectin-binding protein A form extra hydrogen bonds with fibronectin, complementing the higher binding force and energy measured by atomic force microscopy for the CDI isolates. This study is significant, because it links pathogenic bacteria biofilms from the length scale of bonds acting across a nanometer-scale space to the clinical presentation of disease at the human dimension.

Document sobre la interrupció voluntària de l'embaràs

El Grup presenta un document d'opinió amb la voluntat d'intervenir en el debat sobre la interrupció voluntària de l'embaràs i proposarmesures normatives que posin fi a l'actual situació d¿inseguretat jurídica derivadade la distorsionada aplicació que s'efectua de la desfasada legislació vigent.L'avortament és un veritable problema de salut pública i tant l'ètica com el drethan de plantejar pautes de conducta assumibles per la majoria dels ciutadans irespectuoses amb les minories, tenint sempre com a marc de referència i principiindeclinable el respecte als Drets Humans.

Edelfosine-induced metabolic changes in cancer cells that precede the overproduction of reactive oxygen species and apoptosis

Background: Metabolic flux profiling based on the analysis of distribution of stable isotope tracer in metabolites is an important method widely used in cancer research to understand the regulation of cell metabolism and elaborate new therapeutic strategies. Recently, we developed software Isodyn, which extends the methodology of kinetic modeling to the analysis of isotopic isomer distribution for the evaluation of cellular metabolic flux profile under relevant conditions. This tool can be applied to reveal the metabolic effect of proapoptotic drug edelfosine in leukemia Jurkat cell line, uncovering the mechanisms of induction of apoptosis in cancer cells. Results: The study of 13C distribution of Jukat cells exposed to low edelfosine concentration, which induces apoptosis in ¿5% of cells, revealed metabolic changes previous to the development of apoptotic program. Specifically, it was found that low dose of edelfosine stimulates the TCA cycle. These metabolic perturbations were coupled with an increase of nucleic acid synthesis de novo, which indicates acceleration of biosynthetic and reparative processes. The further increase of the TCA cycle fluxes, when higher doses of drug applied, eventually enhance reactive oxygen species (ROS) production and trigger apoptotic program. Conclusion: The application of Isodyn to the analysis of mechanism of edelfosine-induced apoptosis revealed primary drug-induced metabolic changes, which are important for the subsequent initiation of apoptotic program. Initiation of such metabolic changes could be exploited in anticancer therapy.

El espacio virtual de intercambio de información sobre recursos humanos en Ciencia y Tecnología de América Latina y el Caribe Del CV Lattes al CvLAC

Se describen los principales problemas de los diferentes sistemas de información para la gestión de la ciencia y tecnología de los países de América Latina y el Caribe y se identifican los retos y las alternativas para promover un mayor intercambio entre países del continente. La creación de un espacio de intercambio de información de los recursos humanos que participan en los sistemas de ciencia y tecnología, a través de una metodología común denominada el CvLAC, se constituye en una respuesta a los problemas identificados. El CvLAC parte de la experiencia brasileña del CvLattes. Se describen los objetivos y resultados esperados del Proyecto del CvLAC, ejecutado con la participación de Brasil, Colombia, Cuba, Chile, México y Venezuela. Se describen los desarrollos y alternativas a partir de los datos existentes en los países participantes en el proyecto, iniciando con Colombia y Chile, destacándose las infinitas posibilidades que las nuevas tecnologías de información digital y los nuevos desarrollos, logrados en este campo, hacen posible en términos de intercambio de datos.

Presencia de Symbiocladius wygodzinskyi Roback, 1965 (Diptera, Chironomidae) en Perú. Notas taxonómicas.

Se cita la presencia de S. wygodzinskyi Roback, 1965 (Diptera: Chironomidae) en dos áreas diferentes de Perú, mucho más al norte de la distribución original y viviendo sobre ninfas del género Meridialaris sp. (Ephemeroptera: Leptophlebiidae), ambas localidades se sitúan en ríos de la zona alta de los Andes, siempre en agua muy frías. Se señalan algunos detalles de la morfología de las larvas y las pupas no bien descritos en los trabajos originales y se discute la posición de los quironómidos sobre su hospedador.

Temporal variation of the biomass and structure of Caulerpa prolifera (Forsskal) Lamouroux meadows in the Mar Menor lagoon (SE Spain).

The temporal changes in the structure, biomass and C, N and P content of meadows of Caulerpa prolifera (Forsskal) Lamouroux in the Mar Menor coastal lagoon (SE Spain) are described over the period from November 1986 to March 1989. C. prolifera meadows showed a unimodal pattern of vegetative development with maximum biomass values (168-173 g d.w. m-2) reached in summer and maintained during autumn, and minimum biomass values (0-57 g d.w. m-2) during late winter and early spring. Leaf area index values changed between 0.37-0.40 m2 m-2 in January-February and 2.60-7.06 m2 m-2 in July. The seasonality in the biomass and structure of the meadow was mainly related to the vegetative development of the secondary fronds. Carbon and phosphorus content of the thallus (32.5-34.8% d.w. and 0.065-0.069% d.w., respectively) had no seasonality, but nitrogen content showed a bimodal annual pattern with higher values in spring and fall (>2.5% d.w.) than in summer and winter (<2.5% d.w.).

Chemical defenses in Sacoglossan Opisthobranchs: Taxonomic trends and evolutionary implications

Sacoglossan sea slugs (Mollusca: Opisthobranchia) are one of the few groups of specialist herbivores in the marine environment. Sacoglossans feed suctorially on the cell sap of macroalgae, from which they 'steal' chloroplasts (kleptoplasty) and deterrent substances (kleptochemistry), retaining intracellularly both host plastids and chemicals. The ingested chloroplasts continue to photosynthesize for periods ranging from a few hours or days up to 3 months in some species. Shelled, more primitive sacoglossans feed only on the siphonalean green algal genus Caulerpa, and they do not have functional kleptoplasty. The diet of sacoglossans has radiated out from this ancestral food. Among the shell-less Plakobranchidae (=Elysiidae), the more primitive species feed on other siphonales (families Derbesiaceae, Caulerpaceae, Bryopsidaceae and Codiaceae) and fix carbon, while the more 'advanced' species within the Plakobranchidae and Limapontioidae have a more broad dietary range. Most of these 'advanced' species are unable to fix carbon because the chloroplasts of their food algae are mechanically disrupted during ingestion. Mesoherbivores are likely to be eaten if they live on palatable seaweeds, their cryptic coloration and form not always keeping them safe from predators. Sacoglossans prefer to live on and eat chemically defended seaweeds, and they use ingested algal chemicals as deterrents of potential predators. The most ancestral shelled sacoglossans (Oxynoidae) and some Plakobranchidae such as Elysia translucens, Thuridilla hopei and Bosellia mimetica have developed a diet-derived chemical defense mechanism. Oxynoids and Thuridilla hopei are able to biomodify the algal metabolites. However, the Plakobranchidae Elysia timida and E. viridis, together with Limapontioidea species, are characterized by their ability to de novo synthesize polypropionate metabolites. A whole analysis of kleptoplasty and chemical defenses in sacoglossans may offer a better understanding of the ecology and evolution of these specialized opisthobranchs. In this paper we summarize some of the latest findings, related mainly to Mediterranean species, and offer a plausible evolutionary scenario based on the biological and chemical trends we can distinguish in them.

High altitude Chironomidae (Diptera) of Serra da Estrela (Portugal): Additions to the Portuguese and Iberian Peninsula fauna

A Chironomidae (Diptera) fauna list for headwater streams of high altitude areas in Serra da Estrela (Portugal) is presented, doubling the previously established species richness for the region. The findings include 17 new records for Portugal, which represent an increase to 219 species for the Continental Portugal Chironomidae fauna. Two new records were detected for the Iberian Peninsula: one species (Tvetenia duodenaria), and one subgenusPsectrocladius (Mesopsectrocladius); and the presence of the genus Natarsia is confirmed. The last two occurrences correspond to monoespecific taxa of the Palearctic region. However, as taxonomic identification has been based on larval material, instead of pupae, pupal exuviae or imagoes, species level assignment is still uncertain. Key words: Diptera, Chironomidae, high mountain streams, Serra da Estrela, Portugal, Iberian Peninsula. RESUMEN Quironómidos (Diptera, Chironomidae) de alta montaña de la Sierra de Estrela (Portugal) y adiciones a la fauna de Portugal y la Península Ibérica Se presenta una lista de especies de Chironomidae (Diptera) recolectados en los ríos de cabecera de zonas de alta montaña en la Serra da Estrela (Portugal). Con esta aportación se duplica la riqueza de especies regional conocida hasta el momento y se eleva la fauna de quironómidos del Portugal continental a 219 especies. Se incluyen dos nuevas citas para la Península Ibérica, una especie (Tvetenia duodenaria) y un subgéneroPsectrocladius (Mesopsectrocladius), y se confirma la presencia del género Natarsia. En los dos últimos casos se trata de larvas de taxones hasta el momento monoespecíficos en la región paleárctica, pero al no haberse recolectado pupas o adultos no se puede asegurar la identificación específica. Palabras clave: Diptera, Chironomidae, ríos de alta montaña, Serra da Estrela, Portugal,

Trichoptera (INSECTA) collected in Mediterranean river basins in the Iberian Peninsula: taxonomic remarks and notes on ecology

As a result of the GUADALMED project, undertaken in Iberian Mediterranean basins, to which were added samples taken by the junior author in the area, we collected numerous caddisfly larvae, pupae and adults. Some larvae were also reared in the lab to obtain adults and allow proper identification. A total of 90 species were identified, which accounts for more than a fourth of the species known in the Iberian Peninsula and Balearic Islands. Here we confirm the presence of doubtful species in the Iberian Peninsula (Glyphotaelius pellucidus) and we expand the distribution range of others (Lype reducta, Micrasema minimum, Limnephilus guadarramicus, Sericostoma pyrenaicum). Moreover, because of the unconformity of morphological larval characteristics with present taxonomical keys (Mesophylax aspersus) or lack of larvae descriptions (Allogamus mortoni, Stenophylax espanioli), here we include some relevant taxonomical aspects that are useful to identify larvae. A brief description of the larva of a possible new species of Hydropsyche (from now on H. gr. instabilis) is also given. Los tricópteros (Insecta) recolectados en las cuencas mediterráneas de la Península Ibérica: notas taxonómicas y requerimientos ecológicos Como resultado de los estudios realizados en el proyecto GUADALMED en las cuencas de los ríos mediterráneos peninsulares y otros muestreos realizados por la primera autora del trabajo se han recolectado numerosas larvas, pupas y adultos de tricópteros. Algunas larvas fueron criadas en el laboratorio para la obtención de adultos y con ello asegurar su identificación. Se han identificado un total de 90 especies que suponen más de una cuarta parte de las especies actualmente conocidas en la Península Ibérica y Baleares. En este trabajo se confirma la presencia, hasta ahora dudosa en la Península Ibérica, de algunas especies (Glyphotaelius pellucidus) y se amplia el área de distribución de otras (Lype reducta, Micrasema minimum, Limnephilus guadarramicus, Sericostoma pyrenaicum). Además, se incluyen algunos aspectos taxonómicos relevantes para la identificación de algunas larvas en futuros estudios, debido a que las claves ya existentes no describen correctamente la larva (Mesophylax aspersus) o porque se trata de larvas sin describir (Allogamus mortoni, Stenophylax espanioli). Se añade también una somera descripción de la larva de una posible nueva especie de Hydropsyche (citada aquí como H. gr. instabilis) y que requiere un estudio más detallado.

Cambios en el estado ecologico de tres rios producidos por el vertido de depuradoras

En el marco del proyecto Sostaqua se ha llevado a cabo la evaluación del efecto de las aguas residuales tratadas en tres depuradoras (dos en la provincia de Barcelona y una en Andorra), sobre la comunidad de macroinvertebrados bentónicos. En cada una de ellas se evaluó mensualmente el estado ecológico aguas arriba y aguas abajo del punto de vertido, utilizando varios índices biológicos. Mientras que en el río de andorra no se observó un efecto sobre los índices biológicos, en los ríos de la provincia de Barcelona (ríos ya perturbados y con una menor disolución del vertido) el efecto fue importante.