IE-7925. Contribución de las vacunas antineumocócicas y la pandemia por SARS-CoV-2 en la evolución epidemiológica de la enfermedad neumocócica invasiva en España

Se evaluó la distribución de serotipos de la enfermedad neumocócica invasiva (ENI) por grupos de edad en España, así como el impacto de las vacunas antineumocócicas y el SARS-CoV-2.

Métodos

Estudio descriptivo que incluye 4.297 aislados clínicos de neumococo procedentes de niños y adultos con diagnóstico de ENI y durante el periodo 2019-2022.

Resultados

Se observó una disminución del 58% de los casos de ENI para todas las edades durante el primer año de pandemia por SARS-CoV-2 (2.435 casos en 2019 frente a 1.031 casos en 2020) con una reducción del 22% en 2021 (801 casos) frente a 2020. En los niños, la reducción fue del 53% en 2020 (239 casos en 2019 vs. 112 casos en 2020) con un aumento del 18% en 2021. El serotipo más frecuente en los 3 años fue el 24F. En adultos de 18-64 años y ≥ 65 años se observó una marcada reducción de casos de ENI durante el 2020 en comparación con 2019 (55% para 18-64 años y 61% para ≥ 65 años). Sin embargo, durante el año 2021, la disminución de ENI fue mucho más atenuada en comparación al 2020 (< 28% en ambos grupos de edad) y en lo que llevamos de 2022 han aumentado los casos con respecto al mismo periodo de 2021. En los adultos, el serotipo más frecuente fue el 8 seguido por el 3, representando entre los 2 hasta el 37% de todos los casos de ENI durante 2019-2021.

Conclusiones

La aparición del SARS-CoV-2 en España se asocia a una disminución de los casos de ENI con una recuperación parcial en los niños en el 2021 y en el 2022 tanto en la población pediátrica como adulta. Las nuevas vacunas conjugadas de 15 y 20 serotipos, incrementarán la fracción de la enfermedad prevenible por la vacunación frente a los serotipos circulantes.

Synthesis, Pharmacological, and Biological Evaluation of 2-Furoyl-Based MIF-1 Peptidomimetics and the Development of a General-Purpose Model for Allosteric Modulators (ALLOPTML)

This work describes the synthesis and pharmacological evaluation of 2-furoyl-based Melanostatin (MIF-1) peptidomimetics as dopamine D₂ modulating agents. Eight novel peptidomimetics were tested for their ability to enhance the maximal effect of tritiated N-propylapomorphine ([³H]-NPA) at D₂ receptors (D₂R). In this series, 2-furoyl-l-leucylglycinamide (6a) produced a statistically significant increase in the maximal [³H]-NPA response at 10 pM (11 ± 1%), comparable to the effect of MIF-1 (18 ± 9%) at the same concentration. This result supports previous evidence that the replacement of proline residue by heteroaromatic scaffolds are tolerated at the allosteric binding site of MIF-1. Biological assays performed for peptidomimetic 6a using cortex neurons from 19-day-old Wistar-Kyoto rat embryos suggest that 6a displays no neurotoxicity up to 100 μM. Overall, the pharmacological and toxicological profile and the structural simplicity of 6a makes this peptidomimetic a potential lead compound for further development and optimization, paving the way for the development of novel modulating agents of D₂R suitable for the treatment of CNS-related diseases. Additionally, the pharmacological and biological data herein reported, along with >20 000 outcomes of preclinical assays, was used to seek a general model to predict the allosteric modulatory potential of molecular candidates for a myriad of target receptors, organisms, cell lines, and biological activity parameters based on perturbation theory (PT) ideas and machine learning (ML) techniques, abbreviated as ALLOPTML. By doing so, ALLOPTML shows high specificity Sp = 89.2/89.4%, sensitivity Sn = 71.3/72.2%, and accuracy Ac = 86.1%/86.4% in training/validation series, respectively. To the best of our knowledge, ALLOPTML is the first general-purpose chemoinformatic tool using a PTML-based model for the multioutput and multicondition prediction of allosteric compounds, which is expected to save both time and resources during the early drug discovery of allosteric modulators.

Methanol Synthesis from CO2: A Review of the Latest Developments in Heterogeneous Catalysis

Technological approaches which enable the effective utilization of CO2 for manufacturing value-added chemicals and fuels can help to solve environmental problems derived from large CO2 emissions associated with the use of fossil fuels. One of the most interesting products that can be synthesized from CO2 is methanol, since it is an industrial commodity used in several chemical products and also an efficient transportation fuel. In this review, we highlight the recent advances in the development of heterogeneous catalysts and processes for the direct hydrogenation of CO2 to methanol. The main efforts focused on the improvement of conventional Cu/ZnO based catalysts and the development of new catalytic systems targeting the specific needs for CO2 to methanol reactions (unfavourable thermodynamics, production of high amount of water and high methanol selectivity under high or full CO2 conversion). Major studies on the development of active and selective catalysts based on thermodynamics, mechanisms, nano-synthesis and catalyst design (active phase, promoters, supports, etc.) are highlighted in this review. Finally, a summary concerning future perspectives on the research and development of efficient heterogeneous catalysts for methanol synthesis from CO2 will be presented.

Data on TGA of precursors and SEM of reduced Cu/ZnO catalysts co-modified with aluminium and gallium for methanol synthesis

The modification of Cu–Zn catalysts with low amount of Al and Ga (Al+Ga = 3%) was investigated and data corresponding to its influence on the decomposition of the calcined precursors and on the nanomorphology and surface concentration of reduced catalysts were presented in this contribution. The data presented here are supplementary material of the catalysts presented in the research article “Structure and activity of Cu/ZnO catalysts co-modified with aluminium and gallium for methanol synthesis” published in Catalysis Today [1].

Involvement of neuronal nitric oxide synthase in desensitisation of µ-opioid receptors in the rat locus coeruleus

Nitric oxide (NO) has been recently shown to enhance µ-opioid receptor (MOR) desensitisation in locus coeruleus (LC) neurons. The aim of this study was to evaluate by single-unit extracellular recordings in rat brain slices whether the neuronal NO synthase is involved in MOR desensitisation in LC neurons. As expected, a high concentration of the opioid agonist Met(5)-enkephalin (ME; 10 µM, 10 min) strongly desensitised the inhibition induced by a test application of ME (0.8 µM, 1 min), whereas lower ME concentrations (1 and 3 µM) only weakly desensitised it. The neuronal NO synthase inhibitors 7-nitroindazole (10-100 µM), S-methyl-L-thiocitrulline (0.01-10 µM) and N(ω)-propyl-L-arginine (1-10 µM) attenuated ME (10 µM)-induced opioid desensitisation, although the endothelial NO synthase inhibitor N(5)-(1-iminoethyl)-L-ornithine (3-30 µM) failed to change it. The NO donor sodium nitroprusside (1 mM), but not its inactive analog potassium ferricyanide (1 mM), enhanced the ME (3 µM)-induced desensitisation and prevented the effect of S-methyl-L-thiocitrulline (10 µM). Sodium nitroprusside (1 mM) failed to change the desensitisation of α2-adrenoceptors by noradrenaline (100 µM, 10 min). These results suggest the contribution of NO and a neuronal type of NO synthase in homologous MOR desensitisation in rat LC neurons.

Ethanol reversal of cellular tolerance to morphine in rat locus coeruleus neurons

Consumption of ethanol is a considerable risk factor for death in heroin overdose. We sought to determine whether a mildly intoxicating concentration of ethanol could alter morphine tolerance at the cellular level. In rat locus coeruleus (LC) neurons, tolerance to morphine was reversed by acute exposure of the brain slice to ethanol (20 mM). Tolerance to the opioid peptide [d-Ala(2),N-MePhe(4),Gly-ol]-enkephalin was not reversed by ethanol. Previous studies in LC neurons have revealed a role for protein kinase C (PKC)α in μ-opioid receptor (MOPr) desensitization by morphine and in the induction and maintenance of morphine tolerance, but we have been unable to demonstrate that 20 mM ethanol produces significant inhibition of PKCα. The ability of ethanol to reverse cellular tolerance to morphine in LC neurons was absent in the presence of the phosphatase inhibitor okadaic acid, indicating that dephosphorylation is involved. In human embryonic kidney 293 cells expressing the MOPr, ethanol reduced the level of MOPr phosphorylation induced by morphine. Ethanol reversal of tolerance did not appear to result from a direct effect on MOPr since acute exposure to ethanol (20 mM) did not modify the affinity of binding of morphine to the MOPr or the efficacy of morphine for G-protein activation as measured by guanosine 5'-O-(3-[(35)S]thio)triphosphate binding. Similarly, ethanol did not affect MOPr trafficking. We conclude that acute exposure to ethanol enhances the effects of morphine by reversing the processes underlying morphine cellular tolerance.

μ-Opioid receptor desensitization: homologous or heterologous?

There is considerable controversy over whether μ-opioid receptor (MOPr) desensitization is homologous or heterologous and over the mechanisms underlying such desensitization. In different cell types MOPr desensitization has been reported to involve receptor phosphorylation by various kinases, including G-protein-coupled receptor kinases (GRKs), second messenger and other kinases as well as perturbation of the MOPr effector pathway by GRK sequestration of G protein βγ subunits or ion channel modulation. Here we report that in brainstem locus coeruleus (LC) neurons prepared from relatively mature rats (5–8 weeks old) rapid MOPr desensitization induced by the high-efficacy opioid peptides methionine enkephalin and DAMGO was homologous and not heterologous to α₂-adrenoceptors and somatostatin SST₂ receptors. Given that these receptors all couple through G proteins to the same set of G-protein inwardly rectifying (GIRK) channels it is unlikely therefore that in mature neurons MOPr desensitization involves G protein βγ subunit sequestration or ion channel modulation. In contrast, in slices from immature animals (less than postnatal day 20), MOPr desensitization was observed to be heterologous and could be downstream of the receptor. Heterologous MOPr desensitization was not dependent on protein kinase C or c-Jun N-terminal kinase activity, but the change from heterologous to homologous desensitization with age was correlated with a decrease in the expression levels of GRK2 in the LC and other brain regions. The observation that the mechanisms underlying MOPr desensitization change with neuronal development is important when extrapolating to the mature brain results obtained from experiments on expression systems, cell lines and immature neuronal preparations.

Fluorescence resonance energy transfer-based technologies in the study of protein-protein interactions at the cell surface

Understanding of the molecular mechanisms of protein-protein interactions (PPIs) at the cell surface of living cells is fundamental to comprehend the functional meaning of a large number of cellular processes. Here we discuss how new methodological strategies derived from non-invasive fluorescence-based approaches (i.e. fluorescence resonance energy transfer, FRET) have been successfully developed to characterize plasma membrane PPIs. Importantly, these technologies alone - or in concert with complementary methods (i.e. SNAP-tag/TR-FRET, TIRF/FRET) - can become extremely powerful approaches for visualizing cell surface PPIs, even between more than two proteins and also in native tissues. Interestingly, these methods would also be relevant in drug discovery in order to develop new high-throughput screening approaches or to identify new therapeutic targets. Accordingly, herein we provide a thorough assessment on all biotechnological aspects, including strengths and weaknesses, of these fluorescence-based methodologies when applied in the study of PPIs occurring at the cell surface of living cells.

Enhancement of μ-opioid receptor desensitization by nitric oxide in rat locus coeruleus neurons: involvement of reactive oxygen species

It has previously been shown that nitric oxide (NO) synthase is involved in the development of opioid tolerance. The aim of the present work was to study the effect of NO on μ-opioid receptor (MOR) desensitization. Furthermore, we explored the possible role of reactive oxygen species (ROS) in this effect. Single-unit extracellular and whole-cell patch-clamp recordings were performed on locus coeruleus (LC) neurons from rat brain slices. Perfusion with high concentrations of Met(5)-enkephalin (ME) caused a concentration-related reduction of opioid effect, reflecting the induction of homologous MOR desensitization. The NO donors sodium nitroprusside and diethylamine NONOate markedly enhanced the ME-induced MOR desensitization, although the acute effect of ME on K(+) conductance was not affected by sodium nitroprusside. Continuous perfusion with the antioxidants melatonin, trolox, 21-[4-(2,6-di-1-pyrrolidinyl-4-pyrrimidinyl)-1-piperazinyl]-pregna-1,4,9(11)-triene-3,20-dione(Z)-2-butenedioate (U74389G), and diethyldithiocarbamate prevented the effect of sodium nitroprusside on MOR desensitization, but they did not themselves alter the desensitization. Like sodium nitroprusside, the ROS-generating molecule H(2)O(2) enhanced MOR desensitization induced by ME. However, α(2)-adrenoceptor desensitization induced by noradrenaline was not modified by H(2)O(2), suggesting a selective action of ROS on MOR. Our results suggest that elevated levels of NO, which may be reached in pathological processes, enhance homologous desensitization of MOR in the LC, probably through a mechanism involving ROS generation.

G protein-coupled receptor oligomerization and brain integration: focus on adenosinergic transmission

The control of glutamatergic corticostriatal transmission is essential for the induction and expression of plasticity mechanisms in the striatum, a phenomenon thickly regulated by G protein-coupled receptors (GPCRs). Interestingly, in addition to dopamine receptors, adenosine and metabotropic glutamate receptors also play a key role in striatal functioning. The existence of a supramolecular organization (i.e. oligomer) containing dopamine, adenosine and metabotropic glutamate receptors in the striatal neurons is now being widely accepted by the scientific community. Indeed, these oligomers may enhance the diversity and performance by which extracellular striatal signals are transferred to the G-proteins in the process of receptor transduction, and also may allow unpredictable receptor-receptor allosteric regulations. Overall, here we want to review how formations of adenosine, dopamine and metabotropic glutamate receptors-containing oligomers impinge into striatal functioning in both normal and pathological conditions. This article is part of a Special Issue entitled: Brain Integration.

Endomorphin-2: a biased agonist at the μ-opioid receptor

Previously we correlated the efficacy for G protein activation with that for arrestin recruitment for a number of agonists at the μ-opioid receptor (MOPr) stably expressed in HEK293 cells. We suggested that the endomorphins (endomorphin-1 and -2) might be biased toward arrestin recruitment. In the present study, we investigated this phenomenon in more detail for endomorphin-2, using endogenous MOPr in rat brain as well as MOPr stably expressed in HEK293 cells. For MOPr in neurons in brainstem locus ceruleus slices, the peptide agonists [d-Ala(2),N-Me-Phe(4),Gly(5)-ol]-enkephalin (DAMGO) and endomorphin-2 activated inwardly rectifying K(+) current in a concentration-dependent manner. Analysis of these responses with the operational model of pharmacological agonism confirmed that endomorphin-2 had a much lower operational efficacy for G protein-mediated responses than did DAMGO at native MOPr in mature neurons. However, endomorphin-2 induced faster desensitization of the K(+) current than did DAMGO. In addition, in HEK293 cells stably expressing MOPr, the ability of endomorphin-2 to induce phosphorylation of Ser375 in the COOH terminus of the receptor, to induce association of arrestin with the receptor, and to induce cell surface loss of receptors was much more efficient than would be predicted from its efficacy for G protein-mediated signaling. Together, these results indicate that endomorphin-2 is an arrestin-biased agonist at MOPr and the reason for this is likely to be the ability of endomorphin-2 to induce greater phosphorylation of MOPr than would be expected from its ability to activate MOPr and to induce activation of G proteins.

μ-opioid receptors: correlation of agonist efficacy for signalling with ability to activate internalization

We have compared the ability of a number of μ-opioid receptor (MOPr) ligands to activate G proteins with their abilities to induce MOPr phosphorylation, to promote association of arrestin-3 and to cause MOPr internalization. For a model of G protein-coupled receptor (GPCR) activation where all agonists stabilize a single active conformation of the receptor, a close correlation between signaling outputs might be expected. Our results show that overall there is a very good correlation between efficacy for G protein activation and arrestin-3 recruitment, whereas a few agonists, in particular endomorphins 1 and 2, display apparent bias toward arrestin recruitment. The agonist-induced phosphorylation of MOPr at Ser(375), considered a key step in MOPr regulation, and agonist-induced internalization of MOPr were each found to correlate well with arrestin-3 recruitment. These data indicate that for the majority of MOPr agonists the ability to induce receptor phosphorylation, arrestin-3 recruitment, and internalization can be predicted from their ability as agonists to activate G proteins. For the prototypic MOPr agonist morphine, its relatively weak ability to induce MOPr internalization can be explained by its low agonist efficacy.

The effect of protein kinase C and G protein-coupled receptor kinase inhibition on tolerance induced by mu-opioid agonists of different efficacy

Differences in the mechanisms underlying tolerance and mu-opioid receptor desensitization resulting from exposure to opioid agonists of different efficacy have been suggested previously. The objective of this study was to determine the effects of protein kinase C (PKC) and G protein-coupled receptor kinase (GRK) inhibition on antinociceptive tolerance in vivo to opioid agonists of different efficacy. A rapid (8-h) tolerance-induction model was used where each opioid was repeatedly administered to naive mice. Animals were then challenged with the opioid after injection of a kinase inhibitor to determine its effects on the level of tolerance. Tolerance to meperidine, morphine, or fentanyl was fully reversed by the PKC inhibitor 12-(2-cyanoethyl)-6,7,12,13-tetrahydro-13-methyl-5-oxo-5H-indolo(2,3-a)pyrrolo(3,4-c)carbazole (Gö6976). However, in vivo tolerance to [d-Ala(2),N-Me-Phe(4),Gly(5)-ol]-enkephalin (DAMGO) was not reversed by PKC inhibition. The novel small-molecule GRK inhibitors beta-adrenergic receptor kinase 1 inhibitor and 2-(8-[(dimethylamino) methyl]-6,7,8,9-tetrahydropyridol[1,2-a]indol-3-yl)-3-(1-methylindol-3-yl)maleimide (Ro 32-0432) did not reverse the tolerance to meperidine, fentanyl, or morphine but did reverse the tolerance to DAMGO. To correlate GRK-dependent DAMGO-induced tolerance with mu-opioid receptor desensitization, we used in vitro whole-cell patch-clamp recording from mouse locus coeruleus neurons and observed that the GRK inhibitors reduced DAMGO-induced desensitization of mu-opioid receptors, whereas the PKC inhibitor had no effect. These results suggest that tolerance induced by low- and moderate-efficacy mu-opioid receptor agonists is dependent on PKC, whereas tolerance induced by the high-efficacy agonist DAMGO is dependent on GRK.

Role of protein kinase C and mu-opioid receptor (MOPr) desensitization in tolerance to morphine in rat locus coeruleus neurons

In morphine tolerance a key question that remains to be answered is whether μ-opioid receptor (MOPr) desensitization contributes to morphine tolerance, and if so by what cellular mechanisms. Here we demonstrate that MOPr desensitization can be observed in single rat brainstem locus coeruleus (LC) neurons following either prolonged (> 4 h) exposure to morphine in vitro or following treatment of animals with morphine in vivo for 3 days. Analysis of receptor function by an operational model indicated that with either treatment morphine could induce a profound degree (70–80%) of loss of receptor function. Ongoing PKC activity in the MOPr-expressing neurons themselves, primarily by PKCα, was required to maintain morphine-induced MOPr desensitization, because exposure to PKC inhibitors for only the last 30–50 min of exposure to morphine reduced the MOPr desensitization that was induced both in vitro and in vivo. The presence of morphine was also required for maintenance of desensitization, as washout of morphine for > 2 h reversed MOPr desensitization. MOPr desensitization was homologous, as there was no change in α₂-adrenoceptor or ORL1 receptor function. These results demonstrate that prolonged morphine treatment induces extensive homologous desensitization of MOPrs in mature neurons, that this desensitization has a significant PKC-dependent component and that this desensitization underlies the maintenance of morphine tolerance.

Involvement of PKC alpha and G-protein-coupled receptor kinase 2 in agonist-selective desensitization of mu-opioid receptors in mature brain neurons

BACKGROUND AND PURPOSE

The ability of an agonist to induce desensitization of the mu-opioid receptor (MOR) depends upon the agonist used. Furthermore, previous data suggest that the intracellular mechanisms underlying desensitization may be agonist-specific. We investigated the mechanisms underlying MOR desensitization, in adult mammalian neurons, caused by morphine (a partial agonist in this system) and DAMGO (a high-efficacy agonist).

EXPERIMENTAL APPROACH

MOR function was measured in locus coeruleus neurons, by using whole-cell patch-clamp electrophysiology, in rat and mouse brain slices (both wild-type and protein kinase C (PKC)alpha knockout mice). Specific isoforms of PKC were inhibited by using inhibitors of the receptors for activated C-kinase (RACK), and in vivo viral-mediated gene-transfer was used to transfect neurons with dominant negative mutants (DNMs) of specific G-protein-coupled receptor kinases (GRKs).

KEY RESULTS

Morphine-induced desensitization was attenuated by using RACK inhibitors that inhibit PKCalpha, but not by other isoform-specific inhibitors. Further, the PKC component of morphine-induced desensitization was absent in locus coeruleus neurons from PKCalpha knockout mice. The PKC-enhanced morphine-induced desensitization was not affected by over-expression of a GRK2 dominant negative mutant (GRK2 DNM). In contrast, DAMGO-induced MOR desensitization was independent of PKC activity but was reduced by over-expression of the GRK2 DNM but not by that of a GRK6 DNM.

CONCLUSIONS AND IMPLICATIONS

In mature mammalian neurons, different MOR agonists can induce MOR desensitization by different mechanisms, morphine by a PKCalpha-mediated, heterologous mechanism and DAMGO by a GRK-mediated, homologous mechanism. These data represent functional selectivity at the level of receptor desensitization.

Agmatine-Morphine Interaction on Nociception in Mice

The aim of this study was to investigate the possible participation of nitric oxide in the agmatine-mediated potentiation of morphine-induced analgesia in mice. Agmatine and L-NAME (a nitric oxide synthesis inhibitor) enhanced morphine-induced analgesia in the tail flick test, but not in the hot plate test. L-NAME did not block the agmatine-induced potentiation of morphine effect. Our results indicate that agmatine potentiates morphine-induced spinal but not supraspinal analgesia, and that this effect is not mediated by a nitric oxide-dependent mechanism.

[Changes in the upper airway in patients with sleep obstructive apnea and/or chronic snoring treated with mandibular appliances]

We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.

Gas chromatographic determination of acrinathrine and 3-phenoxybenzaldehyde residues in honey

A procedure involving an extraction step and further gas chromatographic analysis with flame ionization detection to determine residues of acrinathrine and its main metabolite, 3-phenoxybenzaldehyde, in honey is proposed. Residues can be isolated from the matrix by means of liquid-liquid extraction with a mixture of benzene-isopropanol, by solid-phase extraction with octadecylsilane cartridges or Florisil packed columns, the latter method giving higher recoveries. Assays on spiked honey samples are carried out to test the procedures that are afterwards applied to honey samples from treated beehives.

Determination of rotenone residues in raw honey by solid-phase extraction and high-performance liquid chromatography

A method for determining residues of the insecticide rotenone in raw-honey by high-performance liquid chromatography (HPLC) is described. To extract the residues, organic solvents such as ethyl acetate, n-hexane/dichloromethane and solid-phase extraction with octadecylsilane cartridges or Florisil packed columns were tested. Determination was carried out by reversed-phase HPLC using acetonitrile-buffer phosphate (pH 7) (60:40, v/v) as mobile phase and detection at 210 nm. Although the data showed that the two extraction methods were able to isolate the pesticide residues, the extraction on octadecylsilane cartridges was preferred due to its simplicity and higher recovery. Recoveries depended strongly on the fortification level for the two extraction procedures. Practical determination limits of 0.015 mg/kg were obtained. In the analysis of honeys, from beehives treated with rotenone at therapeutical doses for 1 month, residual amounts below 0.2 mg/kg were found.

[Use of double PCR in an experimental mode of HSV-1 infection of the facial nerve]

Recent studies suggested herpes simplex virus type 1 as a major etiologic factor in Bell's palsy. To analyze different aspects of facial nene infections, Swiss mice were inoculated with HSV-l in tongue (41 animals) and auricle (44). Nineteen mice developed unequivocal signs of nevous infection, but only in 1 mouse was evident a facial palsy. Mice were sacrificed at different intervals from inoculation, and facial nerves, Gasser ganglia and brain stem were obtained to test the presence of HSV-1 by nested PCR and viral culture. Virus was detected in the 3 types of samples, but identification was more frequent in animals injected in tongue and sacrificed during the acute infection. Nested PCR was far more sensitive than culture, particularly during viral latency. According with our results, HSV-1 could origin facial palsy, but is possible that lesions are immunomediated and localized at brain stem.

A clinical algorithm for the management of abnormal mammograms. A community hospital's experience

Mammography is an important tool in the early detection of breast cancer, but its use has been criticized for stimulating the performance of unnecessary breast biopsies. We retrospectively reviewed the results of breast biopsies preceded by abnormal mammograms at a community hospital for three 5-month periods--baseline, postintervention, and follow-up--to determine the effectiveness of algorithm-based care for patients with an abnormal mammogram. Cases in which there was a definite or implied recommendation for biopsy by a radiologist revealed a baseline positive predictive value of 4% (2/45), a postintervention positive predictive value of 21% (9/42), and a follow-up phase positive predictive value of 18% (5/28). A Fisher's exact test of the preintervention and postintervention positive predictive values after an abnormal mammogram with a "recommendation for biopsy" was significant (n = 87, P = .023). A Kruskal-Wallis analysis of variance to determine if there had been an increase in the mean lesion size of breast cancers detected over the 3 study periods was not significant. The results of this study suggest that developing a clinical algorithm under the leadership of an opinion leader combined with continuing medical education efforts may be efficacious in reducing the incidence of unnecessary surgical procedures.

[Esophagogastroplasty in childhood: experience in 4 patients]

The most common indications of esophageal replacement in childhood are the esophageal atresia with long gap and caustic strictures. Several techniques has been described, using different components of the digestive tract. Total gastric transposition was performed in 4 children. The indications were esophageal atresia without tracheoesophageal fistula in 3 cases and a caustic stricture in other patient. Follow-up was 12 to 32 months. All patients are normally feed. One patient presented an anastomotic leak that closed spontaneously with total parenteral nutrition but ultimately led to an anastomotic stricture requiring pneumatic dilatation. Other patient presented stricture by sternal compression and required surgical repair. Total gastric transposition is a easy and physiologic technique, with low morbidity and good functional results.

Laparoscopic gastric resection for gastric leiomyoma

Less than 2% of gastric neoplasms that are resected surgically are of smooth-muscle origin. Gastric leiomyomas are not encapsulated, and the distinction of benign from malignant leiomyoma may be difficult. Some of these tumors manifest malignant behavior. The histological basis for the diagnosis of benign or malignant smooth-muscle tumor is not entirely satisfactory, and misclassification occurs in some cases. The aggressiveness of those tumors reported as malignant is usually low, and the term "malignant leiomyoma" is usually used rather than the more ominous "leiomyosarcoma." A case is presented of a patient with a 4.5-cm leiomyoma of the gastric antrum resected by the laparoscopic approach. Four laparoscopy trocars were used and multiple applications of the Endo-GIA were needed. Satisfactory margins of resection were obtained. The patient made an excellent recovery with minimal pain. She promptly returned to work and full physical activity.

Laparoscopic cholecystectomy in the ambulatory surgery setting

Laparoscopic cholecystectomy is now a well-established alternative to open cholecystectomy. It is less invasive and recovery generally is quicker and less painful. Several articles have been published in support of outpatient laparoscopic cholecystectomy. The main benefits are cost savings and patient and surgeon convenience. The main obstacles, however, are patient reluctance and surgeons' concern about sending a patient home without benefit of professional supervision after abdominal surgery and a few hours of general anesthesia. A new approach, consisting of surgery in an Ambulatory Surgery Center (ASC) and overnight observation in a free-standing Post Surgery Recovery Center (PSRC), is presented; and the first 100 patients in the study are reported. Laparoscopic cholecystectomy in the ASC with overnight observation in the PSRC offers the advantages of outpatient surgery, namely, lower cost and greater patient and surgeon satisfaction, while allowing the safety and convenience of remaining under professional supervision for the first 24 hours.

Laparoscopic bilateral orchiectomy for testicular feminization syndrome

A 13-year-old female patient with complete androgen insensitivity (testicular feminization syndrome) had an excision of bilateral intra-abdominal testicles via the laparoscopic approach. The patient had a very smooth, fast recovery from her surgery. The laparoscopic approach should be considered for most patients in need of surgical removal of undescended or intra-abdominal testes.

[Study of fetal malnutrition. IV. Acid-base equilibrium in normal and in intrauterine-growth-deficient newborn infants]

Acid-base equilibrium parameters were studied in 11 full-term newborns with adequate weights for their gestational age and in 10 with deficit in their intrauterine growth, during the first 72 hours of life. Significant differences were found. Apparently, malnourished subjects who overcome chronic asphyxia are able to compensate the metabolic disturbances brought about through hyperventilation. The low figures of PaO2 found in babies show they will need higher concentration of oxygen in the air they inhale.