P34 98. Leiomiomatosis con diseminación intravascular: Desde el útero a cavidades cardíacas y pulmón

ObjetivosLa leiomiomatosis uterina es un tumor mesenquimal poco frecuente, benigno, caracterizado por la proliferación de músculo liso en la luz vascular. Suele presentarse en mujeres de edad media, y presenta una enorme tendencia a la extensión intravascular y cardíaca. El tratamiento principalmente es quirúrgico para reducción de la masa tumoral, asociándose un bloqueo hormonal.MétodoPresentamos el caso de una mujer de 39 años, asintomática, con una plaquetopenia en estudio. Al realizarse una ecografía abdominal, se detecta una tumoración uterina de gran tamaño. La tomografía computarizada toracoabdominal objetivó extensión intravascular, a través de vena cava, extensión cardíaca hasta aurícula y ventrículo derecho, válvula tricúspide y arteria pulmonar hasta lechos parenquimatosos pulmonares.El tratamiento incluyó la realización de una histerectomía y doble anexectomía, asociándose una resección tumoral con acceso abdominal por laparotomía media desde cava inferior, y cirugía cardíaca con parada cardiocirculatoria, hipotermia profunda y perfusión anterógrada vía axilar, para resección tumoral intracardíaca.ResultadosLa evolución postoperatoria fue favorable. El estudio anatomopatológico diagnosticó una leiomiomatosis uterina con diseminación intravascular y cardíaca.ConclusionesLa leiomiomatosis uterina es una tumoración benigna con enorme tendencia a la extensión intravascular y cardíaca. Su tratamiento incluye resección tumoral y bloqueo hormonal de por vida, en mujeres jóvenes, generalmente. El tratamiento quirúrgico para resección tumoral exige control eco-cardiográfico para comprobar la completa resección del mismo

Genome-Wide Transcriptomic Analysis of Intestinal Tissue to Assess the Impact of Nutrition and a Secondary Nematode Challenge in Lactating Rats

Gastrointestinal nematode infection is a major challenge to the health and welfare of mammals. Although mammals eventually acquire immunity to nematodes, this breaks down around parturition, which renders periparturient mammals susceptible to re-infection and an infection source for their offspring. Nutrient supplementation reduces the extent of periparturient parasitism, but the underlying mechanisms remain unclear. Here, we use a genome wide approach to assess the effects of protein supplementation on gene expression in the small intestine of periparturient rats following nematode re-infection.The use of a rat whole genome expression microarray (Affymetrix Gene 1.0ST) showed significant differential regulation of 91 genes in the small intestine of lactating rats, re-infected with Nippostrongylus brasiliensis compared to controls; affected functions included immune cell trafficking, cell-mediated responses and antigen presentation. Genes with a previously described role in immune response to nematodes, such as mast cell proteases, and intelectin, and others newly associated with nematode expulsion, such as anterior gradient homolog 2 were identified. Protein supplementation resulted in significant differential regulation of 64 genes; affected functions included protein synthesis, cellular function and maintenance. It increased cell metabolism, evident from the high number of non-coding RNA and the increased synthesis of ribosomal proteins. It regulated immune responses, through T-cell activation and proliferation. The up-regulation of transcription factor forkhead box P1 in unsupplemented, parasitised hosts may be indicative of a delayed immune response in these animals.This study provides the first evidence for nutritional regulation of genes related to immunity to nematodes at the site of parasitism, during expulsion. Additionally it reveals genes induced following secondary parasite challenge in lactating mammals, not previously associated with parasite expulsion. This work is a first step towards defining disease predisposition, identifying markers for nutritional imbalance and developing sustainable measures for parasite control in domestic mammals

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Increased serum concentrations of estrogen-induced growth factors Midkine and FGF2 in NF1 patients with plexiform neurofibroma.

Neurofibromatosis type 1 (NF1) predisposes to the development of dermal and plexiform neurofibromas and serum of NF1 patients stimulates neurofibroma proliferation in vitro. This study aimed to determine whether, in NF1 patients, serum levels of midkine (MK) and fibroblast growth factor 2 (FGF2) were associated with the number and/or type of neurofibromas. In addition, their concentrations were correlated with serum levels of dehydroepiandrosterone sulfate (DHEAS), a neurosteroid secreted by the peripheral nervous system. We performed a case control-study and measured, by ELISA assay, serum concentrations of MK, FGF2, and DHEAS in 20 NF1 patients and 30 controls. We found increased serum levels of MK and FGF2 in NF1 patients between 30 and 50 years old. Their concentrations were significantly higher in NF1 patients with plexiform neurofibromas than in controls (P=0.003 for MK and P=0.008 for FGF2). As an underlying hormonal regulation was suspected, DHEAS serum levels were measured but no difference was observed between patients and controls. We also observed a strong association between MK and FGF2 levels (P=0.0001) in NF1 patients and controls. In conclusion, we point out MK and FGF2 as biomarkers for plexiform neurofibroma in NF1 patients. As both growth factors are estrogen-responsive genes and neurofibromin is a co-repressor of estrogen receptor alpha activity, we suggest that the increased serum levels of MK and FGF2 observed in NF1 patients might be due to estradiol hypersensitivity

Explosion of Undried and Dried Rice Flour with Ignition Time of 20 ms

In this work, the explosion characteristics of rice flour towards difference concentration at ignition time of 20 ms were analyzed. A series of experiments were performed in a 20 L spherical chamber to obtain a maximum overpressure (Pmax), rate of the pressure rise (dP/dT), and deflagration index (Kst) of undried and dried commercial rice flour. The dust sample and air were ignited by two chemical ignitors. Kistler piezoelectric pressure sensor was used to determine the propagation of pressure wave during the explosion. The moisture content of the samples was measured via proximate analysis. The Pmax was obtained at the highest pressure over the range of concentrations. Pmax for undried rice flour was 10.9 bar at concentration of 1000 kg/m3. Pmax for dried rice flour was 14.4 bar at concentration of 1000 kg/m3. The highest dP/dT rise was 103 bar/s for undried flour achieved at concentration of 750 kg/m3 and 202 bar/s for dried flour achieved at concentration of 1000 kg/m3. Kst for undried and dried rice flour are 27.96 bar.m/s and 54.83 bar.m/s respectively. It was found that the explosion severity increased as the dust flour concentration increases

Variables asociadas al manejo efectivo de la autoridad en docentes

Aim: to analyze the behavior of variables associated with the effective management of the authority on teachers. Method: a descriptive study with cross-sectional and quantitative components. Eight teachers belonging to one secondary education institution and one university, considered by their students as those with effective management of authority, were selected through a survey. In total, 69 students and 8 teachers were interviewed. Results: Teachers with effective management of the authority base their power mainly in strength and wealth, and they use the four functions of power to some extent: prescription, regulation, supervision, and administration. Apparently, authority features such as affinity and charisma, or the difficulty of the subject do not relate to the effective exercise of authority by teachers. These and other variables are eanalyzed concerning the functions of power, in relation to earlier investigations.Objetivo: analisar o comportamento de variáveis associadas à gestão efetiva da autoridade nos decentes. Método: foi feita uma pesquisa quantitativa, de tipo descritivo com desenho transversal. Por meio desta pesquisa foram selecionados 8 docentes de uma instituição educativa de ensino meio e uma universidade, considerados pelos estudantes como docentes com gerenciamento efetivo da autoridade. Como técnica foi usada uma entrevista, aplicada aos 8 docentes e 69 estudantes selecionados. Resultados: os docentes com gerenciamento efetivo da autoridade baseiam seu poder especialmente na força e na riqueza, usam de alguma forma as quatro funções do poder: prescrição, regulação, supervisão e administração. Aparentemente, as características da autoridade (afinidade, carisma) e a dificuldade da assinatura, não se relacionam com o exercício efetivo da autoridade pelos docentes. Estas e outras variáveis são analisadas com relação às funções do poder, em relação com pesquisas anteriores.Objetivo: Analizar el comportamiento de variables asociadas al manejo efectivo de la autoridad en docentes. Método: Se realizó una investigación cuantitativa, de tipo descriptivo con diseño transversal. Por medio de una encuesta se seleccionaron 8 docentes de una institución de educación media y una universidad, considerados por sus estudiantes como aquellos con manejo efectivo de autoridad. Como técnica se utilizó una entrevista que se aplicó a los 8 docentes y 69 estudiantes seleccionados. Resultados: Los docentes con manejo efectivo de la autoridad basan su poder especialmente en la fuerza y la riqueza, utilizan de alguna forma las cuatro funciones de poder: prescripción, regulación, supervisión y administración. Al parecer, características de la autoridad (afinidad, carisma) y la dificultad de la asignatura, no se relacionan con el ejercicio efectivo de la autoridad por los docentes. Se analizan éstas y otras variables respecto a las funciones de poder, en relación con investigaciones antecedentes

Expression of ion channels during differentiation of a human skeletal muscle cell line

An immortal, cloned cell Line (RCMH), obtained from human skeletal muscle was established in our laboratory and shown to express muscle specific proteins. We measured ligand binding to ion channels, ion currents using whole cell patch clamp and intracellular calcium both in cells grown in complete media and in cells grown for 4-40 days in media supplemented with hormones and nutrients (differentiating media). Markers for differentiated muscle, such as the muscle isoform of creatine kinase and the cytoskeletal proteins alpha-actinin, alpha-sarcomeric actin, myosin and titin were present in early stages. Receptors for gamma toxin from Tityus serrulatus scorpion venom, a specific modulator for voltage dependent sodium channels, were present (0.9-1.0 pmol mg(-1) protein) during stage 1 (0-6 days in culture with differentiating media) and increased by 50% in stage 3 (more than 13 days in differentiating media). High and low affinity dihydropyridine receptors present in stage 1 convert into a single type of high affinity receptors in stage 3. Both intracellular calcium release and InsP(3) receptors were evident in stage 1 but ryanodine receptors were expressed only in stage 3. RCMH cells showed no voltage sensitive currents in stage 1. Between 7 and 10 days in differentiating media (stage 2), an outward potassium current was observed. Small inward currents appeared only in stage 3; we identified both tetrodotoxin sensitive and tetrodotoxin resistant sodium currents as well as calcium currents. This pattern is consistent with the expression of voltage dependent calcium release before appearance of both the action potential and ryanodine receptors