Duplex Scanning or Arteriography for Preoperative Planning of Lower Limb Revascularisation

AbstractObjective: to compare the accuracy of duplex and angiography for the planning of lower limb revascularisation.Patients and methods: Sixty limbs (82% with critical limb ischaemia) were assessed by means of duplex by one surgeon and by angiography by another in terms of the optimum inflow and outflow sites for arterial bypass. These data were then compared with the final operation performed which was used as the gold standard. Surgeons were blinded to the determinations of the other.Results: surgical plans based on duplex scan and angiography were correct in 77% (40/52) and 79% (41/52), respectively and plans based on the one imaging modality was modified by the other in only 1 and 2 instances. The diagnostic agreement between duplex scanning and arteriography was excellent (Kappa value=0.94, 95% C.I. 0.89–0.98).Conclusions: the reliability of duplex scanning is comparable to digital angiography in the preoperative planning of lower extremity arterial reconstruction. However neither exam can be considered as the gold standard because intraoperative arteriography needs to be available in a significant number of infrapopliteal procedures

Cell identity and nucleo-mitochondrial genetic context modulate OXPHOS performance and determine somatic heteroplasmy dynamics

Heteroplasmy, multiple variants of mitochondrial DNA (mtDNA) in the same cytoplasm, may be naturally generated by mutations but is counteracted by a genetic mtDNA bottleneck during oocyte development. Engineered heteroplasmic mice with nonpathological mtDNA variants reveal a nonrandom tissue-specific mtDNA segregation pattern, with few tissues that do not show segregation. The driving force for this dynamic complex pattern has remained unexplained for decades, challenging our understanding of this fundamental biological problem and hindering clinical planning for inherited diseases. Here, we demonstrate that the nonrandom mtDNA segregation is an intracellular process based on organelle selection. This cell type-specific decision arises jointly from the impact of mtDNA haplotypes on the oxidative phosphorylation (OXPHOS) system and the cell metabolic requirements and is strongly sensitive to the nuclear context and to environmental cues

Highlights of the São Paulo ISEV workshop on extracellular vesicles in cross-kingdom communication

In the past years, extracellular vesicles (EVs) have become an important field of research since EVs have been found to play a central role in biological processes. In pathogens, EVs are involved in several events during the host–pathogen interaction, including invasion, immunomodulation, and pathology as well as parasite–parasite communication. In this report, we summarised the role of EVs in infections caused by viruses, bacteria, fungi, protozoa, and helminths based on the talks and discussions carried out during the International Society for Extracellular Vesicles (ISEV) workshop held in São Paulo (November, 2016), Brazil, entitled Cross-organism Communication by Extracellular Vesicles: Hosts, Microbes and Parasites. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.11Ysciescopu

Recomendaciones sobre la valoración integral y multidimensional del anciano hospitalizado. Posicionamiento de la Sociedad Española de Medicina Interna

Este documento de posicionamiento describe los aspectos más relevantes e imprescindibles sobre la valoración integral y multidimensional del anciano hospitalizado. El cambio del patrón demográfico y del perfil epidemiológico de las enfermedades requiere una adaptación de los Servicios de Medicina Interna, que tengan en cuenta las vulnerabilidades de las personas ancianas en este contexto. Una valoración integral y multidimensional y la elaboración multidisciplinar de un plan de atención durante el ingreso pueden tener un impacto para evitar mortalidad, discapacidad e institucionalización al alta. Es necesario que todos los internistas adquiramos competencias para mejorar la experiencia de la hospitalización en la persona mayor y obtengamos mejores resultados en salud en nuestros pacientes. Este documento lo ha desarrollado el Grupo Focal de Envejecimiento y el Grupo de Trabajo de Pluripatología y Edad Avanzada, y está avalado por la Sociedad Española de Medicina Interna. This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment : A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Calcula tu riesgo cardiovascular

• Introduction: In Spain, ischaemic heart disease and vascular-brain disease, which are both of principal forms of cardiovascular disease (CVD), are the leading cause of death globally. The appearance of cardiovascular disease in an epidemic way is closely associated with lifestyle and modifiable risk factors, such as snuff, diabetes, cholesterol, high blood pressure, obesity, etc... Cardiovascular risk (CVR) stratification using scales allows us to estimate probability of suffering either a coronary event or stroke in the next ten years. • Aims: Quantifying cardiovascular risk in people without previous cardiovascular disease. Provide a series of recommendations aimed at promoting heart-healthy lifestyle to reduce cardiovascular risk in these individuals. • Methods: Literature review. Adaptation of the measuring scale of Framingham cardiovascular risk, calibrated for use in Spanish population. Recommendation of the Spanish Society of Cardiology to reduce modifiable cardiovascular risk factors. Election of the poster as a complementary method in Health Education. • Outcomes: The poster was placed in the waiting room of the Coronary Care Unit. During the time of visit, a nurse performed the measurement of cardiovascular risk to relatives of patients admitted, leading to the consultation of primary care nursing to those with a moderate risk (17.5%) or high risk (2.6%) of cardiovascular disease. • Conclusions: Cardiovascular risk stratification using scales is a very useful tool, which facilitates making therapeutic decision in cardiovascular prevention. The role of the nurse as health educator is postulated as a key to act on modifiable cardiovascular risk factors, reducing the morbidity resulting from these and promoting healthy changes in lifestyle• Introducción: En España, las enfermedades cardiovasculares (ECV) y sus dos principales componentes, la cardiopatía isquémica y la enfermedad cerebro-vascular, constituyen la primera causa de muerte para el conjunto de la población. La aparición epidémica de las ECV está estrechamente asociada con hábitos de vida y factores de riesgo modificables (tabaco, diabetes, hipertensión arterial, colesterol, obesidad). La estratificación del riesgo cardiovascular (RCV) mediante escalas, nos permite realizar una estimación probabilística de sufrir un episodio coronario o cerebrovascular en los próximos 10 años. • Objetivos: Cuantificar el RCV en personas sin enfermedad cardiovascular previa. Aportar una serie de recomendaciones dirigidas a promover un estilo de vida cardiosaludable que reduzca el RCV de estas personas. • Material y métodos: Revisión bibliográfica. Adaptación de la escala de medición de RCV Framingham calibrada para uso en población española. Recomendaciones de la Sociedad Española de Cardiología para reducir los factores de RCV modificables. Elección del póster como método complementario en la Educación Sanitaria. • Resultados: El póster se colocó en la sala de espera de la Unidad Coronaria. Durante el periodo de visita, una enfermera efectuaba la medición de RCV a los familiares de los enfermos ingresados, derivando a la consulta de enfermería de atención primaria a aquellas personas con un riesgo moderado (17.5%) o riesgo alto (2.6%) de ECV. • Conclusiones: La estratificación del RCV mediante escalas es un instrumento muy útil que facilita la toma de decisiones terapéuticas en prevención cardiovascular. El papel de la enfermera como educadora para la salud se postula como clave para actuar sobre los factores de RCV modificables, reduciendo la morbimortalidad derivada de estos y favoreciendo cambios saludables en el estilo de vida

Molecular analysis of the replication region of the pCIZ2 plasmid from the multiple bacteriocin producer strain Enterococcus faecium L50

International audienceThe sequence analysis of the 7383 bp plasmid pCIZ2 from Enterococcus faecium L50 enabled the identification of a DNA region involved in its replication. The structural organization of the pCIZ2 replication region is highly similar to those of well-known theta-replicating plasmids. It contains an untranslated region, the putative replication origin (ori), constituted by two sets of direct repeats of 12 and 22 bp (iterons), and followed by three open-reading frames (orf8 to orf10). orf8 encodes the replication initiation protein (RepE). The transcriptional start site of the replication locus was identified 13 nucleotides upstream of the repE start codon. A two-dimensional agarose gel electrophoresis analysis revealed pCIZ2 intermediates profile typical of the theta-type replication mechanism. Subcloning of different DNA fragments of the pCIZ2 replication region in Escherichia coli and, subsequently, in the plasmidless E. faecium L50/14-2 allowed the determination of the minimal replicon on a 1.2 kb DNA fragment containing only the overall ori and repE which also act in trans. The involvement of orf9 in the plasmid copy number and in the plasmid stability was investigated. The pCIZ2 recombinant plasmids constitute narrow-host range shuttle cloning vectors (E. coli–E. faecium) that could be very useful for enterococcal genes studies, allowing an easy identification due to their histochemical recognition

Vascular wall injury and inflammation are key pathogenic mechanisms responsible for early testicular degeneration during acute besnoitiosis in bulls

Background: Bovine besnoitiosis, caused by the apicomplexan parasite Besnoitia besnoiti, is a chronic and debilitating cattle disease that notably impairs fertility. Acutely infected bulls may develop respiratory signs and orchitis, and sterility has been reported in chronic infections. However, the pathogenesis of acute disease and its impact on reproductive function remain unknown. Methods: Herein, we studied the microscopic lesions as well as parasite presence and load in the testis (pampiniform plexus, testicular parenchyma and scrotal skin) of seven bulls with an acute B. besnoiti infection. Acute infection was confirmed by serological techniques (IgM seropositive results and IgG seronegative results) and subsequent parasite detection by PCR and histological techniques. Results: The most parasitized tissue was the scrotal skin. Moreover, the presence of tachyzoites, as shown by immunohistochemistry, was associated with vasculitis, and three bulls had already developed juvenile tissue cysts. In all animals, severe endothelial injury was evidenced by marked congestion, thrombosis, necrotizing vasculitis and angiogenesis, among others, in the pampiniform plexus, testicular parenchyma and scrotal skin. Vascular lesions coexisted with lesions characteristic of a chronic infection in the majority of bulls: Hyperkeratosis, acanthosis and a marked diffuse fibroplasia in the dermis of the scrotum. An intense inflammatory infiltrate was also observed in the testicular parenchyma accompanied by different degrees of germline atrophy in the seminiferous tubules with the disappearance of various strata of germ cells in four bulls. Conclusions: This study confirmed that severe acute besnoitiosis leads to early sterility that might be permanent, which is supported by the severe lesions observed. Consequently, we hypothesized that testicular degeneration might be a consequence of (i) thermoregulation failure induced by vascular lesions in pampiniform plexus and scrotal skin lesions; (ii) severe vascular wall injury induced by the inflammatory response in the testis; and (iii) blood-testis barrier damage and alteration of spermatogenesis by immunoresponse.[Figure not available: See fulltext.