Impacto de la septoplastia en el curso clínico de la rinitis alérgica en pacientes que asocian esta entidad y desviación septal

Programa Oficial de Doutoramento en Ciencias da Saúde. 5007V01[Resumen] Introducción: La rinitis alérgica (RA) es una de las enfermedades más comunes y representa un problema de salud global, afectando al 30% de la población general, con un continuo incremento de la prevalencia y asociando importantes comorbilidades y complicaciones. Existe un número importante de pacientes que asocian desviación septal y RA, debido a la alta prevalencia en la población de ambas patologías. La mayoría de la evidencia bibliográfica hasta el momento refiere que la septoplastia (STP) no es el mejor tratamiento en pacientes con RA y desviación septal, pues la rinitis les impide a los pacientes objetivar el grado de mejora. En nuestro estudio nos planteamos verlo al revés, se trata de comprobar si la STP modifica el curso clínico de la RA. Objetivo: El objetivo de nuestro estudio es describir y comparar la evolución de los síntomas en pacientes diagnosticados de rinitis alérgica (RA) y desviación septal antes y después de la cirugía de septoplastia (STP). Material y Métodos: Se trata de un estudio quasi-experimental de pacientes con RA y desviación septal elegidos de las consultas de Alergia y de Otorrinolaringología del hospital que están pendientes de ser intervenidos de STP o que ya hayan sido intervenidos de STP. Nos proponemos cuantificar el uso de medicación antes y después de la cirugía, comparar los valores de la escala analógica visual (EVA) subjetiva de síntomas, así como la puntuación de calidad de vida obtenida en el cuestionario ESPRINT de calidad de vida en pacientes con rinitis, antes y después de la cirugía. Finalmente, también mediremos mediante un procedimiento objetivo como la RNM, el nivel de obstrucción nasal antes y después de la cirugía, realizando ésta a los pacientes antes de ser intervenidos y a los 12 meses de la misma. 11 Resultados: En el estudio han participado 42 sujetos. La edad de los pacientes cuando se les realizó la STP era de 34.16 ± 9.74 años, con un rango entre 18 y 64. De estos 42 sujetos, 27 son varones (64.3%) y 15 mujeres (35.7%). Los pacientes antes de la STP tenían una puntuación de 8.52 ± 1.13 en la escala EVA y tras la cirugía se reduce de forma importante a 3.74 ± 2.1. Previamente a la cirugía la puntuación total del ESPRINT fue de 62.24 ± 14.84 reduciéndose tras la cirugía 23.48 ± 18.28. Por tanto, tras la STP mejoran de forma significativa los parámetros de calidad de vida. Existe una correlación positiva significativa entre el ESPRINT y el EVA antes de la STP (r=0.32, p=0.036) y esta correlación aumenta tras la STP (r=0.69, p=0.00). También existe correlación negativa entre los valores de RNM tras la STP con el cuestionario ESPRINT (r=-43, p=005). Conclusiones: La STP modifica el curso clínico de la RA en pacientes que asocian esta entidad a desviación septal, permite una reducción en el uso de la medicación, mejora la clínica subjetiva observada por los pacientes, así como el flujo nasal y el grado de obstrucción.[Abstract] Introduction: Allergic rhinitis (AR) is one of the most common diseases and represents a global health problem, affecting 30% of the general population, with a continuous increase in prevalence and associating important comorbidities and complications. There is a significant number of patients who associate septal deviation and AR, due to the high prevalence in the population of both pathologies. Most of the bibliographic evidence to date refers that septoplasty (STP) is not the best treatment in patients with AR and septal deviation, since rhinitis prevents patients from objectifying the degree of improvement. In our study we considered seeing it the other way around, it is a question of verifying whether STP modifies the clinical course of AR. Objectives: The objective of our study is to describe and compare the evolution of symptoms in patients diagnosed with allergic rhinitis (AR) and septal deviation before and after septoplasty surgery (STP). Material and Methods: This is a quasi-experimental study of patients with AR and septal deviation chosen from the Allergy and Otorhinolaryngology consultations at the hospital who are awaiting surgery for STP or who have already been operated on for STP. We propose to quantify the use of medication before and after surgery, compare the subjective of visual analogic scale (VAS) values of symptoms as well as the HRQoL score obtained in the ESPRINT quality of life questionnaire in patients with rhinitis, before and after surgery. Finally, we will also measure through an objective procedure such as MRI, the level of nasal obstruction before and after surgery, performing this on patients before being operated on and 12 months after it. Results: 42 subjects participated in the study. The age of the patients when the STP was performed was 34.16 ± 9.74 years, with a range between 18 and 64. Of these 42 subjects, 27 are men (64.3%) and 15 women (35.7%). The patients before the STP had a score of 8.52 ± 1.13 on the VAS scale and after surgery it was significantly reduced to 3.74 ± 2.1. The total ESPRINT score prior to surgery. It was 62.24 ± 14.84, reducing after surgery 23.48 ± 18.28. Therefore, after STP the HRQoL parameters improve significantly. There is a significant positive correlation between ESPRINT and VAS before STP (r = 0.32, p = 0.036) and this correlation increases after STP (r = 0.69, p = 0.00). There is also a negative correlation between the MRI values after the STP with the Sprint questionnaire (r = -43, p = 005). Conclusions: STP modifies the clinical course of AR in patients who associate this entity with septal deviation, allows a reduction in the use of medication, subjective clinical improvement observed by patients and improves nasal flow and the degree of obstruction.[Resumo] Introdución: A rinite alérxica (RA) é unha das enfermidades máis comúns e representa un problema de saúde mundial, que afecta ao 30% da poboación en xeral, cun incremento continuo da prevalencia e que asocia importantes comorbilidades e complicacións. Hai un número significativo de pacientes que asocian a desviación septal e a RA, debido á alta prevalencia na poboación de ambas patoloxías. A maioría das evidencias bibliográficas ata a data refiren que a septoplastia (STP) non é o mellor tratamento en pacientes con RA e desviación do septal, xa que a rinite impide aos pacientes obxectivar o grao de mellora. No noso estudo consideramos velo ao revés, trátase de verificar se stp modifica o curso clínico da rinite alérxica (AR). Obxectivos: O obxectivo do noso estudio é describir e comparar a evolución dos síntomas en pacientes diagnosticados de rinite alérxica (RA) e desviación septal antes e despois da cirurxía de septoplastia (SPT). Material e métodos: trátase dun estudo cuasi-experimental de pacientes con RA e desviación do septos elixidos entre as consultas de alerxia e otorrinolaringoloxía no hospital que están á espera de operarse de TEP ou que xa foron operados de STP. Propoñemos cuantificar o uso de medicamentos antes e despois da cirurxía, comparar os valores subjetivos de dos síntomas (EVA), así como a puntuación de calidade de vida obtida no cuestionario de calidade de vida ESPRINT en pacientes con rinite, antes e despois da cirurxía. Por último, tamén mediremos mediante un procedemento obxectivo como a resonancia magnética, o nivel de obstrución nasal antes e despois da cirurxía, realizándoo en pacientes antes de ser operados e 12 meses despois. Resultados: 42 suxeitos participaron no estudo. A idade dos pacientes cando se realizou a STP foi de 34,16 ± 9,74 anos, cun rango entre 18 e 64. Destes 42 suxeitos, 27 son homes (64,3%) e 15 mulleres (35,7%). Os pacientes antes da STP tiveron unha puntuación de 8,52 ± 1,13 na escala VAS e despois da cirurxía reduciuse significativamente a 3,74 ± 2,1. A puntuación total de ESPRINT antes da cirurxía. Foi 62,24 ± 14,84, reducíndose despois da cirurxía 23,48 ± 18,28. Polo tanto, despois do STP os parámetros de calidade de vida melloran significativamente. Hai unha correlación significativa entre ESPRINT e VAS antes de STP (r = 0,32, p = 0,036) e esta correlación aumenta despois de STP (r = 0,69, p = 0,00). Tamén hai unha correlación negativa entre os valores de RMN despois do STP co cuestionario Sprint (r = -43, p = 005). Conclusións: A STP modifica o curso clínico da RA en pacientes que asocian esta entidade coa desviación septal, permite unha redución no uso de medicamentos, mellora clínica subxectiva observada polos pacientes e mellora o fluxo nasal e o grao de obstrució

Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep

Sperm Subpopulations in Iberian Red Deer Epididymal Sperm and Their Changes Through the Cryopreservation Process

P. 316–327We have applied a statistical protocol based on principal component analysis, clustering methods, and discriminant analysis for the identification of sperm subpopulations in computer-assisted sperm analysis (CASA) data. Samples were obtained from the cauda epididymis of 11 Iberian red deer and cryopreserved following a standard protocol. Motility by CASA was analyzed just after sperm recovery, just before freezing, and after thawing, and eight motility descriptors for each individual spermatozoon were recorded. Sperm viability and acrosomal status were also assessed. Subpopulation analysis was performed in four sequential steps: principal component analysis using the eight motility descriptors; nonhierarchical clustering analysis (k-means) using the first two principal components; hierarchical clustering analysis (UPGMA); and selection of the final number of clusters. Three clusters were obtained for each motility analysis: slow and nonlinear; rapid and linear; and rapid, high ALH, nonlinear. We detected variations in the clusters between treatments (initial, prefreezing and postthawed). Indeed, motility increased and linearity decreased in the prefreezing analysis. A discriminant analysis isolated three descriptors that were used again in the same statistical analysis, giving four clusters that resembled the pattern found in the first classification. We also performed a clustering analysis of the males according to prefreezing/postthawed variation of total motility, viability, and acrosomal status. The proportion of the linear subpopulations in the prefreezing treatment, in both clustering analyses, correlated positively with postthawed viability recovery. Our results show that clustering analysis of CASA data gives useful and practical information that is not obtained by conventional sperm analysis.S

estudio proteómico en corazones de ratones deficientes en el canal iónico voltaje-dependiente TPCN1

Comunicaciones a congreso

Season effect on genitalia and epididymal sperm from Iberian red deer, roe deer and Cantabrian chamois

P. 1857-1875Seasonality deeply affects the physiology and behavior of many species, and must be taken into account when biological resource banks (BRBs) are established. We have studied the effect of seasonality on many reproductive parameters of free-ranging Iberian red deer, roe deer and Cantabrian chamois, living in Spain. Testicles from hunted animals were collected and sent to our laboratory at different times during the year. We recorded the weight and volume of testis, the weight of the epididymis and its separate parts (caput, corpus, and cauda), the weight of the sperm sample collected from the cauda epididymis, and several sperm parameters (sperm concentration, spermatozoa recovered, motility, HOS test reactivity, acrosomal status, and viability). We studied the data according to several periods, defined accordingly to each species. For red deer, we defined rut (mid-September to mid-October), post-rut (mid-October to mid-December), and non-breeding season (February). For roe deer, they were pre-rut (June), rut (July), post-rut (first fortnight of August), and non-breeding season (September). For chamois: non-breeding season (June to mid-September) and breeding season (October–November). The rut/breeding season yielded significantly higher numbers for almost all parameters. However, in the case of red deer, sperm quality was higher in the post-rut. For roe deer, testicular weight was similar in the pre-rut and in the rut, and sperm quality did not differ significantly between these two periods, although we noticed higher values in the rut. In the case of chamois, sperm quality did not differ significantly from the breeding season, but data distribution suggested that in the non-breeding season there are less males with sperm of good quality. On the whole, we find these results of interest for BRB planning. The best season to collect sperm in this species would be the breeding season. However, post-rut in red deer, pre-rut in roe deer, and non-breeding season in chamois could be used too, because of the acceptable sperm quality, despite the lower quantity salvaged. More in-depth research needs to be carried out on the quality of sperm salvaged at different times of the year in order to confirm these findings.S

Comparison of two methods for obtaining spermatozoa from the cauda epididymis of Iberian red deer

P. 471-485We have compared two methods for salvaging epididymal sperm from post-mortem samples from Iberian red deer. Of each pair of testicles (29 samples), one cauda epididymis was processed by means of cuts (sperm was immediately diluted with extender) and the other was detached from the corpus and flushed from the vas deferens with 1 mL of extender. Sperm was processed for cryopreservation, and analyzed just after recovery, pre-freezing and post-thawing. Total spermatozoa recovered, contamination (concentration of epididymal cells and red blood cells (RBCs)) and quality (motility by CASA, and acrosomal status, viability and mitochondrial status by flow cytometry) were used to compare both methods. The number of recovered spermatozoa was similar for both methods. Contamination was higher for the cuts method, but when considering the final dilution before freezing, only RBCs concentration was significantly higher. Motility was similar just after extraction, but higher for both pre-frozen and post-thawed flushed sperm. Pre-freezing acrosomal status (P < 0.05) and viability (P < 0.1) were better for flushing; however post-thawing results were similar for the two methods. A clustering analysis using CASA data showed that the subpopulation pattern of motile sperm was different depending on the method, being better for flushing. With regard to yield, lower contamination (especially RBCs) and, in general, better quality results, flushing seems to be a more recommendable method for post-mortem sperm recovery. The cuts method may be more practical on certain occasions, but care must be taken in order to achieve rapid extension of the sample and to avoid contamination in order to improve sample condition.S

Improvement Strategies in Ovine Artificial Insemination

P. 30-42Artificial insemination in ram is scarcely widespread comparing with other domestic species. This has been due not only to fertility results being irregular and low but also because of the difficulty in the application of enhancements such as the use of frozen‐thawed sperm. Although there is a lot of information on the use of different options to improve these AI results (such as transcervical application, the use of thawed sperm, etc.) commercial programmes can be classified on two general categories: those using refrigerated semen (15°C) by superficial intracervical deposition (vaginal), and, more restricted, those using thawed sperm by intrauterine deposition (laparoscopy). In the present work, we have summarized our viewpoint on three general research lines for the improvement of AI results in sheep: semen preservation, AI procedures and semen assessment. Briefly, in ram it is necessary to develop a medium term methodology of sperm refrigeration (3–5 days), which would allow the distribution of sperm doses to a widespread area. Nevertheless, it is also necessary to develop an intrauterine transcervical AI technique, which allows thawed semen to be applied by vaginal insemination. Besides, the low predictive value of classic assessment techniques limits the ability to adjust the number of spermatozoa per dose according to its actual fertility

In Vitro Generation of Zebrafish PGC-Like Cells

[EN] The possibility of generating primordial germ cells (PGCs) in vitro from noncommitted embryonic cells represents an extremely useful tool in current research. Primordial germ cell in vitro differentiation has been successfully reported in mammals. However, contrary to fish, PGC specification in mammals is an inductive mechanism. This study is the first to date to describe a rapid method for PGC in vitro differentiation in teleosts. Primordial germ cell-like cells were characterized by several lines of evidence, including gene expression, cell complexity, size, and image analysis for the quantification of fluorescence under vasa promoter. Moreover, differentiated cells were able to colonize the genital ridge after transplantation. Differentiation treatments increased the number of PGCs in culture, causing differentiation of cells rather than inducing their proliferation. These results open up the possibility of differentiating genetically modified embryonic cells to PGC-like cells to ensure their transmission to the progeny and could be crucial for an in-depth understanding of germline differentiation in teleostsSISupported by Fundación Ramón Areces and Ministerio de Ciencia e Innovación grant MICINN AGL2009-06994, Ramón y Cajal Program grant RYC-2008-02339, Junta de Castilla y León grants E-24-2009-0036681 and EDU/346/2013, and Fondo Social Europeo. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscrip

DNA fragmentation assessment by flow cytometry and Sperm–Bos–Halomax (bright‐field microscopy and fluorescence microscopy) in bull sperm

P. 88-98The aim of this study was to find the relationship between fertility (as 90‐day non‐return rates) and DNA fragmentation assessed by two techniques [sperm chromatin structure assay (SCSA) and Sperm–Bos–Halomax (SBH)]. Furthermore, other quality parameters were achieved (motility, morphological abnormalities, cytoplasmic droplets, viability, capacitation and acrosomal and mitochondrial status) and their correlations with fertility were analysed. Bulls were divided into three fertility groups: high [non‐return rate (NRR) ≥ 80], medium (80  40). The results of this study indicate that there is a good correlation between fertility and different parameters of sperm quality (SBH and SCSA parameters, % of spermatozoa with head, neck and total abnormalities, and % of spermatozoa with proximal cytoplasmic droplets) and differences between fertility groups were observed in some of them (SBH and SCSA parameters and % of spermatozoa with head, neck and total abnormalities). In this sense, SBH parameters rendered good correlations with fertility (r = −0.42 using bright light microscope and r = −0.47 with fluorescence). Also, standard deviation of DNA fragmentation index (SD‐DFI) and DFIh (cells with High DNA fragmentation index) showed good correlations with fertility (r = −0.41 and r = −0.29). No correlations were observed between SCSA and SBH parameters. A multiple regression shows that four parameters (% of proximal cytoplasmic droplets, % of intact acrosomes in total population, SD‐DFI and percentage of fragmented DNA detected by bright light microscope) present a good predictive value of the fertility of sperm samples (r2 = 0.34, p < 0.001

Metastases of renal cell carcinoma to the thyroid gland with synchronous benign and malignant follicular cell-derived neoplasms

Clear cell renal cell carcinoma (CCRCC) is the most common origin for metastasis in the thyroid. A 51-year-old woman was referred to our hospital for a subcarinal lesion. Ten years before, the patient had undergone a nephrectomy for CCRCC. Whole-body fluorodeoxyglucose positron emission tomography revealed elevated values in the thyroid gland, while the mediastinum was normal. An endoscopic ultrasonography-guided fine-needle aspiration biopsy of the mediastinal mass was consistent with CCRCC, and this was confirmed after resection. The thyroidectomy specimen also revealed lymphocytic thyroiditis, nodular hyperplasia, one follicular adenoma, two papillary microcarcinomas, and six foci of metastatic CCRCC involving both thyroid lobes. Curiously two of the six metastatic foci were located inside two adenomatoid nodules (tumor-in-tumor). The metastatic cells were positive for cytokeratins, CD10, epidermal growth factor receptor, and vascular endothelial growth factor receptor 2. No BRAF gene mutations were found in any of the primary and metastatic lesions. The patient was treated with sunitinib and finally died due to CCRCC distant metastases 6 years after the thyroidectomy. In CCRCC patients, a particularly prolonged survival rate may be achieved with the appropriate therapy, in contrast to the ominous prognosis typically found in patients with thyroid metastases from other origins