MEDICAL SCIENCE, 9

Author: Carpio Martínez Nelly.
Year: 2005.
University: MURCIA.
Place of defense: Centro de hemodonación de Murcia.
Place of preparation: Hospital Universitario La Fe de Valencia.

Summary: In the year 2003 the European Union and the European Parliament drafted and issued a directive that affected all countries of the European Union (Directive 2002/98/EC), which provided for the creation of a system Hemovigilancia for "detection recording and analysis of information relating to the adverse effects of the unexpected and blood transfusion. " This directive has been transcribed to our national legislation and published in the Official Gazette in September 2005 (Royal Decree 1088/2005). In order to know the real impact of these adverse effects on our environment, we conducted a retrospective study at the Faith Hospital in Valencia. In the period 2000-2004 were transfused with 271,412 blood were found 847 incidents. Of these 470 are episodes of Rhesus, 305 adverse reactions, 50 incidents ineffective and 23 incidents related to the donation and procurement of components autologous. The incidence of adverse events has been 1.12 per 1,000 components transfused, lower than that published by other authors, the components involved more frequently have been red cells, plasma and platelets and the reactions studied in order of frequency, allergic reactions, fever, hemolytic, errors in the administration of components, acute pulmonary edema associated with transfusion, viral infection, purple postransfusional, volume overload and bacterial contamination. Although the incidence of adverse reactions is less than reflected by other groups, when we remove from the register reactions without clinical significance, our results, except for the lower incidence of bacterial contamination, are consistent with other series. The autologous donation presents a high incidence of adverse reactions, and basically síncopes crisis in which hypotension plays an important role. In our center incidence of adverse reactions with significant morbidity is low compared to other registries (9/100.000 components transfused and is mainly due to EPA-AT (1/33.927 components transfused), bacterial contamination, and hemolytic anemia by administration of red blood cells two platelets (1/59.000). Three patients died in a plasma containing the pool of blood platelets came from a donor multípara antibody anti-HLA Class II. Elsewhere not documented any conflict antigen antibody. De the 46 reactions hemolytic were identified, two were serious management ABO incompatible red cells, the rest were delayed hemolytic serological and without clinical significance. that we were only two cases of red cell administration ABO incompatible (1/58.205 red blood cells transfused), was due random because there were 32 cases of error in the administration of components (1/8.500 components transfused). In most cases involving the red cells and platelets to a lesser extent, plasma and fibrinogen. The 25% of the errors produced at the time of prescription. Identifying patients at the time of trasfusión remains a major cause of morbidity associated with this complication, but the most serious effects occur at the time of transfusion and therefore, the light from these results and to minimize human error, it seems necessary to implement electronic identification between patients and units at the time of transfusion. bacterial contamination has not had an enormous significance in other series. Our sole case was associated with the platelet transfusion and the responsible germ, Staphylococcus Aureus, is a document in the patient as in the component. five cases of viral infection corresponded to a transmission of hepatitis 8 By cua 53e tro cases of transmission of CMV. only one patient died in the context of a severe CMV disease in a patient transplanted in which donor and recipient were negative for CMV The desleucocitación Universal has not translated into a lower rate of adverse reactions in the transfusion of red blood cells and platelets. however, it has been translated into a significant fewer Rhesus compared to red blood cells. Rhesus Our rate compared to red blood cells is low, with no differences between men and women and if not contabilizamos D, C Frequently have been KyE, especially in the group of women aged under 40 years.

Author: BUDIA ALBA ALBERTO.
Year: 2005.
University: VALENCIA.
Place of defense: FACULTAT DE MEDICINA I ODONTOLOGIA DE VALÈNCIA.
Place of preparation: FACULTAT DE MEDICINA I ODONTOLOGIA DE VALÈNCIA.

Summary: Introduction: Approximately 20-30% of renal adenocarcinomas (SR) organoconfinados progressing after surgery despite being tumors a priori good prognosis. New prognostic factors must be evaluated in order to increase the accuracy prognostic in RA. Among them the DNA ploidy has been evaluated in the literature with controversial results. One difficulty in studies with DNA analysis by flow cytometry to detect populations aneuploids in solid tumors is pollution from non-malignant cells. One way to increase the sensitivity is to make a marking mouse monoclonal antibody directed against citoqueratina of tumor cells. This analysis can be conducted more selective and specific tumor cells. Objectives:-Preliminaries: To examine the prognostic value of survival of DNA ploidy in RA. Analizar la ratio de marcaje obtenida con el anticuerpo anticitoqueratina (AA) en las muestras tumorales analizadas. - Major: To compare the percentage of people aneuploids detected by marking with AA with the percentage detected without conducting such a marking. Consider whether there is an association between the positivity of marking with AA and predictors of the biological behavior tumor. - Secondary: Study and compare the proliferative indices (IP) obtained by flow cytometry with iodide propidio (marking Standard (MS) and IP after adding a marking with AA (Double marking (MD). Analyze if the value of the index proliferative obtained by double marking with AA presents correlation with the biological behavior of the tumor. Material and Methods: The study presented two different phases, a first retrospective on 252 patients in which they analyzed the DNA ploidy using flow cytometry and a phase prospective 43 renal tumors (a maximum of 4 samples of each fresh tumor) that analyze DNA content by flow cytometry with simple marking (MS) and after marking with antibodies anticitoqueratina human (MD), by comparing the two results. For the analysis of DNA content was used reagent commercial Coulter DNA-Prep Reagent Kit ® and citómetro Cytoron Absolute (Ortho Diagnostic Systems Inc.). For the acquisition of the samples was used software InmunoCount II version 2.2 (Ortho Diagnostic Systems in the series, the tumor samples were obtained from paraffin blocks, using the technique of Hedley for desparafinización and subsequent analysis as described above. Result: In the first phase of our study, about 252 renal tumors, 66% the tumors were conventional carcinomas, 21.9% papillary, 9% cromofobos and 3.1% undifferentiated. 47.2% were organoconfinados

Author: RODRIGUEZ PEREZ MARIA MERCEDES.
Year: 2005.
University: OVIEDO.
Place of defense: FACULTAD DE BIOLOGIA.
Place of preparation: FACULTAD DE MEDICINA AREA DE MICROBIOLOGIA.

Summary: The work presented here are reviewed in a retrospective clinical and microbiological aspects of salmonellosis extra (including episodes paraintestinales) in Hospital Central de Asturias (HUCA) in the period between the years 1991-2001. We studied 105 episodes that corresponded to 10 patients with typhoid fever, 72 with bacteremia with or without prior gastroenteritis infections and 23 with localized (16 parallel and 7 extraintestinal). The clinical samples from those isolated Salmonella were: blood (80), urine (14), pus of abscess (7), pleural fluid (3), cerebrospinal fluid (CSF) (3), venous catheter, tissue aneurysm, the surgical wound exudate, and liquid peritoneal (2), tracheal aspirate, sputum, spinal puncture, bone tissue, seroma postoperative, lymph node and ascitic fluid (1). A total of 15 patients had two or more samples positive for Salmonella and 24 patients were also isolated in the faeces. Only 78 strains of Salmonella (involved in 78 episodes not tifoideos) could be recovered for study microbiology. These strains were distributed in 14 serotypes, 23 profiles macrorrestricción genomics (XbaI-PFGE) and 20 profiles of antimicrobial resistance (defined by a combination of resistance determinants, including genes, integrones and plasmids). The combination of these (and optionally other) markers was used for the attachment of the strains in 23 genetic types (TG). Most of the TGs of prevalent serotypes (Enteritidis and Typhimurium), as well as those of serotypes Hadar, Virchow, Infantis and Brandenburg were found in stool samples of episodes of gastroenteritis in Asturias (PA), and various infectious processes in other geographical areas or countries. By contrast, 6 strains (3 Enteritidis, 2 Arizonae, 1 Berta) had not been detected in processes diarrhea in the PA. The correlation of clinical and microbiological data showed that serotype Enteritidis and Typhimurium were represented in the various clinical groups, regardless of the status of patient basis. Data supporting the factors related to the host play a more critical role that factors virulent strain producer in the progression of the disease while in a minority of cases could be due to molecular properties unidentified between different strains.

Author: Saá Prieto Paula.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: Facultad de Psicología.
Place of preparation: Universidad de Tejas Rama de Medicina.

Summary: The prions are infectious agents associated with unconventional transmissible spongiform encephalopathies. The prevailing hypothesis proposes that prions are composed exclusively of the prion protein aberrantemente folded and resistant to proteases called PrPSc, which can be replicated in the body in the absence of nucleic acid by inducing its conformation pathogenic isoform in the cell the prion protein (PrPC). Although copious evidence supporting this hypothesis, this is highly controversial and the final demonstration, which depends on the generation of an infectious protein in vitro, is still absent. This thesis shows that the conversion of PrPC in PrPSc can mimic in vitro by the technique of amplifying cyclical abnormally folded proteins or PMCA (which stands for English protein misfolding cyclic amplification), demonstrating that the aberrant protein can keep replicating in vitro indefinitely, even in the absence of any molecule PrPSc derived from the brain. The forms of PrPSc generated in vitro and in vivo, share the same structural and biochemical properties. Surprisingly, the inoculation of wild hamsters of genotype with PrPSc produced in vitro resulted in a spongiform encephalopathy clinical, biochemical and histologically identical to the disease caused by infectious material from the brain of a sick animal, which also can be transmitted and maintain in successive passes in wild animals genotype. These results demonstrate for the first time that the infectious agent can be generated through replication in vitro, and represent the strongest evidence for the "protein-only hypothesis" of transmission of prions. In vitro generation of an infectious protein by overcoming the barrier between two mammalian species that also led to the creation of a new strain of prions in the recipient species, not only supports previous evidence for the hypothesis only protein ", but represented the first time that such a goal is achieved. During the development of this work has been achieved automation and optimization of the technique of PMCA for the specific and efficient amplification of PrPSc. Extraordinarily, several rounds of PMCA automatic led to the detection of such a small amount of PrPSc equivalent to 100 molecules of the protein pathogenic present in a dilution 10 e-12 of a brain infected with scrapie. After amplification PMCA could detect PrPSc in the spleen of animals infected with a 100% sensitivity and specificity. Likewise, four rounds of amplification cyclic PMCA led to the detection of PrPSc in all blood samples from hamsters experimentally inoculated with an LD50 of infectious material. In most prominently, the PMCA automatic serial allowed detection of PrPSc in blood samples from hamsters suffering from scrapie with a 89% sensitivity and 100% specificity, as well as blood samples from animals presintomáticos at different stages of the disease. These findings represent the first time by detecting biochemical PrPSc in blood samples, and suggest that the PMCA automatic detection serial allows efficient, rapid and specific prions, representing a firm promise to develop a system of early diagnosis and noninvasive transmissible spongiform encephalopathies.

Author: PARRA ARRONDO BEATRÍZ.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE BIOLOGIA.
Place of preparation: CENTRO DE INIVESTIGACIÓN EN SANIDAD ANIMAL (INIA).

Summary: Currently, the detection of PrPSc is the basic principle for the diagnosis of transmissible spongiform encephalopathies (EETs). The conventional techniques for the detection of prions are not powerful enough to determine that a sample is free of prions. The most sensitive tool for deteección infectivity in samples suspects is the use of bioassays based mice. In theory, and due to the phenomenon of the species barrier, the pass incicial of prions from cow to rodents requires some very long incubation times and only detects PrPSc in 40% of animals. For this reason, the path to obtain 100% of infectivity is the use of transgenic mice that express the protein homologous to the inoculum. This generated lines of transgenic mice expressing various levels of bovine PrP gene. After infection of these lines with bovine prions, it was observed degeneration of the central nervous system, a feature of these diseases by histopathology at 100% of the mice inoculated confirming the absence of the species barrier to infection with bovine spongiform encephalopathy (BSE). Differences in the incubation times depend on the levels of expression of the PrPc cattle and the amount of prions present in the inoculum. In the absence of clinical signs, markers of the disease could have been detected at the 150 and 196 day postinoculación through analysis by immunohistochemistry and western blot, respectively. Although these animals were susceptible to infection with sheep prions, the incubation times were longer and will only be able to detect PrPSc in 70% of animals inoculated. Moreover, transgenic mice expressing bovine PrP by inserting a octapéptido duplicate (7OR instead of 6OR) showed differences in the course of infection with BSE that was reflected in some incubation times lower when compared with transgenic mice cattle expressing bovine PrP with 6OR with similar levels. Proteins PrPc and PrPSc containing 7 octapéptidos (7OR-PrPc and 7OR-PrPSc) showed a sensitivity to proteases and a non-ionic detergent to insolubility similar to those of their counterparts 6OR-PrPc and 6OR-PrPSc. In addition, the transgenic mice bo7ORTg showed a sensitivity that mayors mice bo6ORTg for detecting prions by infectivity in samples that had been previously diagnosed as negative by conventional biochemical techniques. In the absence of clinical signs, 7OR-PrPSc can be detected within 120 days postinoculación by western blot analysis and immunohistochemistry. On the other hand, based on cell culture bioassays have been very useful for the detection and study of prions. Only a few models allow cellular replication of prions. However, there is currently no specific cellular system for PrPSc bovine. Since there is a non-neuronal cell line (RK13) expressing the PrPc sheep and has been successfully infected with prions sheep, were generated cell lines derived from the RK13 in which it expressed the PrPc bovine (6OR-PrPc) and those with An insertion mutacional of 1 octapéptido duplicate (7OR-PrPc). The PrPc bovine expressed in cell lines RK13 showed metabolic behavior identical to PrPc expressed in the cell line N2A neuroblastoma (murine): There was anchored to the cell surface by a GPI, in domains rich in cholesterol (lipid rafts) and glycosylated correctly.

Author: LÓPEZ SÁNCHEZ NOELIA.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE CIENCIAS.
Place of preparation: FACULTAD DE CIENCIAS.

Summary: The enzyme c-Jun N-terminal kinase (JNK) is well known for its ability to promote cell death in response to various stressful stimuli. This enzyme can also facilitate the survival and proliferation of tumor cells, although the mechanisms by which promotes JNK these effects are still little known. The work presented here, we have observed that in the absence of trophic factors and mitogénicos serum, the cells of schwannoma RN22 remain viable and to proliferate, despite presenting marked morphological changes in the mitochondria, such as fragmentation and swelling. However, these changes were not associated with mitochondrial release of cytochrome c or induction of apoptosis, but with an elevation of mitochondrial membrane potential (? M) and the location of the active form of JNK in this orgánulo. In the absence of serum, the localization of the enzyme active in the mitochondria is essential to maintaining the viability of the cells RN22, and its inhibition leads to cell death by necrosis crops. Inhibition of JNK is also associated with elevated? My levels of ROS, and the elimination of those rescued from the loss of viability that causes inhibition of JNK. In this paper we used the neurotrofinas as trophic factors model for cell RN22. These factors reverse both the morphological changes observed in mitochondria by withdrawal of serum, such as loss of viability caused by the inhibition of JNK in these conditions. In other types of tumor cells of neural origin, such as neuroblastomas N2a and N1E115, the withdrawal of serum also causes fragmentation and mitochondrial localization of active JNK in mitochondria. As in RN22, inhibition of JNK leads to loss of cell viability in these cell lines. However, neither of these events occurs in primary cultures of murine fibroblasts. The results described in this paper suggest that, in tumor cells of neural origin, the activation of JNK in mitochondria can prevent cell death by necrosis associated with the production of ROS in response to withdrawal of trophic factors.

Author: Escartí Nebot Angeles.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: Centro Nacional de Biotecnología, CSIC.
Place of preparation: Centro Nacional de Biotecnología.

Summary: The objective of this dissertation is to obtain equivalent dermo-epidérmicos genetically modified able to secrete therapeutic levels of factor IX, as an alternative to prophylactic treatment of hemophilia B by periodic administration of factor IX. In this paper we develop equivalent dermo-epidérmicos with genetically modified human keratinocytes with retroviral vectors. These equivalents are transplanted into a mouse model, and are able to regenerate a epidermidermis human organized perfectly able to secrete human Antihemophilic Factor IX detectable in the plasma of mice in the long term.

Author: LUCENDO VILLARIN ALFREDO JOSE.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: This paper explores how the prospective described broader range of eosinophilic esophagitis (EE) in adults in its various aspects, which allowed us to know the pathophysiological and clinical characteristics of the disease, beyond the series reduced or isolated cases that so far counted literature. The EE is a disease of recent knowledge determined by infiltration of the oesophageal mucosa eosinophilic leukocytes and manifested by recurrent dysphagia and food impaction in the esophagus. The EE was initially described in pediatric patients (in males) but growing number of adults suffering in industrialized countries. Although little is known about the pathophysiology, most authors consider the EE process inmunoalérgico by hypersensitivity face food or aeroalergenos, which determines epithelial esophageal by eosinophilic infiltration. But so far not been established and universally accepted model pathophysiologic many unknown mechanisms of the disease. Our work analyzes the clinical features, morphological, functional natural history of ES and appreciates the response to topical steroid treatment on the basis of objective parameters. Between 2002 and 2005 studied at the La Paz Hospital in Madrid adult patients diagnosed with EE, excluding other causes of esophageal eosinophilia. Our results determined that ES is an emerging entity with average incidence in the Area Health V Madrid 1.8 casos/100.000 pop / year cumulative prevalence of 7.2 casos/100.000. We analyzed 30 patients (27 v, 3 m) with mean age at diagnosis of 36.2 years (range: 16.5-66.5). Most had chronic dysphagia and intermittent long evolution (63.3%) or impactaciones food (83.3%) who had clarified urgent endoscopy by more than 50%. The average time of evolution of symptoms was 94.7 months (range: 1-385). 27 patients were studied by Allergology: 24 of them showed awareness of food and / or inhalants in the skin prick tests. 12 showed blood eosinophilia. In serum, 15 securities elevated IgE, 15 increased CCA all triptasa normal. Endoscopic findings: 56.7% contraction simultaneous ring, 20% stenosis concentric about 2 / 3 lower body. We classify the appearance of the mucosa in response to its correlation with histological into four patterns: a) an irregular with sobre-elevaciones papular (20%), b) linear longitudinal grooves highlighted by edema (33.3%), c) as mucosal wavy expression of the effect of the muscularis mucosae (3.3%), d) lesions exudativas, accumulations epithelial (microabscesos) of eosinophils (16.6%). The overlap of these lesions gives mucosal aspect fragile and brittle. It objetivaron disorders manométricos restricted to the 2 / 3 lower esophagus (composed of smooth muscle). The esophageal showed 2 types of patterns associated with the time of disease progression (p <0.05): Those with clinical course clipped (9 cases) showed dynamic hipercinéticas (peristaltic waves of large amplitude) while the symptom longer evolution (17 patients) showed esófagos hiccups or aperistálticos, with a low capacity motor. The 73.3% of the cases showed dynamic behavior of the lower esophageal sphincter altered. The study defined histologic changes hiperproliferativos epithelial and dense infiltration of eosinophils, often forming microabcesos taking off the surface epithelium. The estereológico and immunohistochemical analysis of the samples showed that the esophageal epithelium has all the element 8 s cell 10fa res necessary to generate a response immunoallergic locally, and they are increasing dramatically in the United States. We were able to quantify Langerhans cells and a marked increase in T lymphocytes (especially CD8 +) and mast cells, located in the middle and deep portion of the epithelium. The eosinophils were distributed in the most superficial and showed activation markers and degranulation (MBP). In addition, we found IgE + plasma cells, which are responsible for local production of this antibody. After treatment instituted, all patients improved their clinical and quality of life (p <0.05), parallel to the standardization of endoscopic and histological esophagus achieved in 27 cases. Post-tratamiento was detected increased pressure baseline average cardias and standardization of the ability of peristaltic esophageal motor. The stereology showed remission of inflammatory infiltrate epithelial cell densities up close to normal, although the density of mast remained discreetly high. Quantification of gene expression of IL-5 and eotaxina-1 showed that both genes were sobreexpresados before treatment in a variable in most patients analyzed, and that the contribution of these projects in the pathophysiology of EE could interindividual differences. The EE is an allergic disease of the gastrointestinal tract, is an inflammation of the esophageal mucosa after local exposure to different allergens after sensitization prior digestive track, or even epicutaneous inhalation. The esophagus has cells needed for the capture, processing and presentation of antigens to T lymphocytes residing in its epithelium, which initiated a response TH2 mediated by IL-5 with a possible component TH1 and participation of local production of IgE may consider in EE there is a mixed immune disorder, humoral and cell-mediated. Thus, the studies aimed at identifying the allergens cause of the table should consider tests to determine sensibilizaciones mediated Ig Ee cell-mediated delayed hypersensitivity. The inflammatory infiltrate in EE is characterized by intense recruitment of eosinophils and mast cells, which are also attracted and encouraged by the action of T lymphocytes The activation of eosinophils and degranulation epithelial damage caused to destroy antigens that have initiated the inflammatory response. The changes represent the response of epithelial tissue repair. The substances in the granules of these cells act on the neuromuscular component of the esophagus through various mechanisms, altering their driving ability, in a first phase show a hyperkinetic behavior or spastic (manifested by pain and symptoms of GERD) and evolve into a disorder hiccups / aperistáltico by exhaustion (with frequent episodes of food impaction). The topical steroid treatment restores histology esophageal to reverse the inflammatory phenomena, which results in a recovery of normal motility. Fluticasone propionate has a pharmacokinetic profile suitable for inducing remission of endoscopic lesions, histological and symptoms in patients with EE, but should be used with caution in chronic use. Our recommendation would be to establish treatment before patients sistomáticos and keep up the remission of symptoms and the morphologic lesions, while parallel completed studies alergológicos to identify and exclude allergens determinants of the table.

Author: LARRIBA MUÑOZ MARÍA JESÚS.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Colorectal cancer (CRC) is one of the highest cancer incidence and mortality. Preliminary results from our laboratory showed that 1a, 25 (OH) 2D3 and some of its analogues inhibit the proliferation and promote differentiation of epithelial cells SW480-ADH of human colon cancer. These actions are based primarily on the transcriptional induction of the gene CDH1/E-cadherina and blocking the route Wnt / b-catenina frequently altered in CRC. Most, if not all, the actions of the 1a, 25 (OH) 2D3 are mediated through the vitamin D receptor (VDR), a transcription factor of the nuclear receptor superfamily whose expression is lost during the progression of CRC . By contrast, the expression of the transcription factor Snail1, repressor of CDH1 and inducer of the transition epitelio-mesénquima increases during the progression of some carcinomas and has been associated with the acquisition of properties migratory and invasive. The results presented in this report show that the ectopic expression of Snail1 as elevated levels of endogenous cells in the human colon cancer causing fewer RNA and protein VDR. The study in detail has enabled us to see that Snail1 suppresses the expression of VDR at two levels: (a) transcripcionalmente, joining three boxes E, its promoter, and (b) post-transcripcionalmente, decreasing the stability of the RNA. This repression is blocking the regulation of target gene of 1a, 25 (OH) 2D3 and the antagonistic effect it has on the path Wnt / b-catenina. Also Snail1 inhibits the actions pro-diferenciadoras, anti-migratorias and anti-proliferativas of 1a, 25 (OH) 2D3 in colon cancer cells in culture, and the action of its anti similar EB1089 in tumors generated in mice . According to these data, there is an inverse correlation between the expression of SNAIL1 and the VDR and CDH1 in a panel of cell lines of human colon cancer and in samples from patients with CRC. Therefore, the increased expression of SNAIL1 is probably responsible for the declining levels of VDR observed in CRC and carries a similar insensibilización treatment of 1a, 25 (OH) 2D3. Finally, we have analyzed the pattern of gene expression associated with the treatment 1a, 25 (OH) 2D3 or overexpression of Snail1 in cells SW480-ADH.

Author: Linares Gil Cristina.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: Fac. de Med. Depto.Med.Prev. y Sal.Púb..
Place of preparation: U.A.M. Facultad de Medicina.

Summary: The child population is one of the population groups most at risk for environmental factors due mainly to its physiological immaturity and behavior differently from adults. During recent years, and especially in the pediatric population, the incidence of respiratory diseases has increased prominently. These increases are attributed, at least in a significant part to the effects of air pollution associated with traffic in the developed cities. This study was conducted to examine the effect of various environmental factors on the child population in Madrid. As an indicator of disease has been used, the number of hospital admissions per day of unscheduled emergency under ten years of the University General Hospital Gregorio Maranon during the period 1995-2000. The causes of income have been analyzed functional, respiratory and within these income generated by bronchitis and pneumonia. Environmental factors analyzed are divided into weather (temperature, relative humidity, atmospheric pressure) and air pollution (chemical pollutants, noise levels and pollen). The working methodology has been used time series analysis, factors including adequate control (epidemics of influenza, trends, seasonality and autocorrelaciones), making this one of the few jobs that considered together much of the environmental factors that competing in real life. The main result has been the establishment of relations detected statistically significant between the different causes of income analyzed, and especially the noise levels, concentrations of PM10, the concentration of pollen from grasses and low temperatures. Concluding that these environmental factors are those that present greater influence on the number of hospital admissions among children under ten years in Madrid. Moreover, the importance of this study lies not only in establishing the relationship between the number of hospital admissions for various causes in this age group and air pollution, but also allows the development of models able to quantify this association, This is of great importance from the point of view of prevention and management of health resources. The results obtained in this study indicate that the noise and concentrations of PM10 are the main modifiable environmental risk factors on hospital admissions of children in Madrid and the main focus of both the issuer, road traffic, it is necessary steps to implement its control and reduction.

Author: GARCIA LUJAN RICARDO.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA. U.A.M..
Place of preparation: HOSPITAL UNIV. 12 DE OCTUBRE. MADRID.

Summary: We analyze the expression profile of 32 molecular markers belonging to different cellular pathways (cell cycle, apoptosis, adhesion molecules or receptors signal transduction) in samples Carcinoma Broncogénico not Microcítico (CBNM) resected, using tissue matrices , and its relationship with various clinical populations that may be used as screening policies or population screening Carcinoma Broncogénico (CB), in the design of therapeutic targets or to explain the variability of prognostic said carcinoma. The clinical populations in which analyzed the expression of markers were grouped into two subgroups: 1) Sub-risk population CB: defined by the presence of one of the following variables: patient smokers, older patients, the presence of COPD or worse lung function (FEV1%). 2) Sub-CB earlier, as defined by the presence of one of the following variables: with smaller tumors or where the CB was an accidental discovery.

Author: Pozuelos Lopez Julio Luis.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: Facultad de Medicina, U.A.M..
Place of preparation: Facultad de Medicina, U.A.M..

Summary: Study anatomico in which disecó branch motor nerve musculocutaneo in 40 bodies (80 veins) and then measure the length of the motor industry since its separation brachial plexus to the fork of both motor and sensory branches, and then branch motor disecar since this fork until its origin in the plexus, identifying its anatomical position regarding the branch sensitive.

Author: MATEO BARRIENTOS MARIA.
Year: 2005.
University: AUTÓNOMA DE MADRID.
Place of defense: FACULTAD DE MEDICINA U.A.M..
Place of preparation: UNIVERSIDAD AUTONOMA.

Summary: The wide variety of diseases that can be associated with ocular inflammation makes the diagnosis of etiologies of uveitis is extremely changeable and difficult. When comparing two protocols of a study of uveitis with a large battery of tests: baseline survey (hemogram, ESR, biochemistry, urine elementary, chest radiography, Mantoux, VDRL), microbiological study (HLA B27, EEF, ANA, immunoglobulins, Latex, snap), and other smaller covered: basic study (the same as before), HLA B27 and radiography sacroilíacas for uveitis prior to Toxoplasma and serology in uveitis later, it is noted that there is no difference in distribution etiologies that are diagnosed with either protocol. It should select from among all complementary explorations within our grasp, that may be more useful to get a correct etiological diagnosis of uveitis, we believe these are basic analytical study (blood, urine, ESR, biochemistry, radiology chest, Mantoux and VDRL). Likewise HLA B27 and radiography sacroilíacas for uveitis prior to Toxoplasma and serology in the post. The completion of a protocol study validated smaller, not only decrease costs, but will also save time and eliminate the scattering of data that can lead to confusion in diagnosis. Of all the variables analyzed, only location, radiography sacroilíacas and HLA B27 have shown a statistically significant association with the fact that the etiology was idiopathic or not. So in the secondary uveitis predominant location later radiograph sacroilíacas pathological and HLA B 27 positive.

Author: RAMN SAPERNA REGINA LORETO.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTA DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Author: LOPEZ SANCHEZ FRANCISCA.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: UNIVERSIDAD MIGUEL HERNANDEZ.

Summary: Objective. To assess the role of pharmacogenetic polymorphisms Factor XIII valine 34 leucine (FXII Val34Leu) in the efficacy of fibrinolytic therapy for acute myocardial Myocardium (AMI). Introduction. The fibrinolysis systemic treatment is established AMI, but about 40% of patients do not get optimal myocardial reperfusion. The polymorphism of FXIII Val34Leu is one of the most important from the point of view of those described in the hemostatic system. The common allele Leu 34 is associated with an i9ncremento of activity FXIII-transglutaminasa, which results in greater and more rapid stabilization of the fibrin. Method. It performs this genotype polymorphism in 293 consecutive patients with AMI (62 + -12 years, 231 men) from two different European populations. It deals with standard doses of drugs fibrinoliticos. It evaluates the effectiveness of fibrinolysis in a non-invasive through serial electrocardiograms and curves actividad-tiempo of creatin-kinasa. It evaluates the clinical prognosis at 24 hours (death, reinfarction or urgent revascularization). Results. Multivariate analysis showed that carriers Leu34 show lower efficacy associated with fibrinolytic therapy that carriers Val genotype / val (p 0,021; Odds Ratio 1.90, 95% CI 1.10 to 3.28). At 24 hours carrying the allele Leu34 have poorer prognosis (p 0,006, OR 2.14, 95% CI 1.25 to 3.68). Of particular interest is that the combination of allele Leu34 and status of non-smoking increases the risk of non-reperfusion (p.0.003, OR 3.77) and a worse prognosis at 24 hours (p 0,001, OR 4.55). Conclusion. In a cohort of unselected patients with AMI belonging to two different European populations, we show that the presence of allele LEU34 reduces the effectiveness of treatment fibrinolitico.

Author: GARRIDO CHAMORRO RAÚL.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION: We have made 2500 antropometrías to promising athletes in the province of Alicante. Considering those elite athletes who are part of the listings of the Generatitat Valencia elite. And which are published annually in the Dogv. The latest resolution was published in Dogv number: 4744 of 03/05/04. Current guidelines for joining these lists are published in the Dogv 4766 of 02/06/04. The athletes who enter these listings are selected by a committee based on their results in national and international competitions during the previous season. Athletes included in these listings are fellows with the possibility of free access to the Support Services Sports Center for Technology in Alicante. Where among other tests are performed antropometrías that constitute this thesis. The antropometrías have been made by 4 Diploma in Nursing University (DUS), specializing in sports medicine, perfectly formed for the conduct of the same. All of them have passed previously by a period of technical training anthropometry. OBJECTIVES: Primary Objectives: To establish reference values (in terms of averages and percentiles) Percentage Grasso, Mass Muscle Mass and Bone. These values are analyzed both as a dependent regardless of sex. Secondary Objectives: To establish the correlation between anthropometric values. Relacionándolos among themselves and with regard to age, weight, the rate of muscle mass and sums of folds. These values are analyzed both in terms regardless of sex. SCENARIOS FOR WORK: H0: There is correlation between anthropometric variables. H1: There is no correlation between anthropometric variables. CONCLUSIONS: 1) There is no correlation between the percentage fat and age, both globally and divided according to gender, or between weight and fat percentage if we analyze regardless of sex, or between the percentage fat and muscle weight, overall neither the group of boys. 2) If there is positive correlation between the percentage fat and weight in males as in females, between the percentage fat and muscle weight in the subgroup of women between the percentage fat and the sum of six folds with both globally in sub male and female, between the percentage of fat and summation folds senior member of both globally for subgroups with male and female, between the percentage of fat and summation folds of the trunk with both globally for subgroups male and female; among the percentage fat and the summation of folds of the trunk both globally and in the subgroups male and female, between the percentage of fat and summation folds lower limb both globally and in the subgroups and between male and female and the percentage fat index body mass both globally and in the subgroups masculine and feminine. 3) There is a negative correlation between the percentage fat percentage and bone both globally and in the subgroups masculine and feminine. 4) There is no correlation between muscle weight and age both globally and in the subgroups masculine and feminine, or between muscle weight and fat percentage in both globally with the male subgroup, or between muscle weight and percentage bone with both globally for subgroups masculine and feminine. 5) There is correlation between weight and muscle weight with both globally for subgroups male and female; between muscle weight and fat percentage in the subgroup of women; between muscle weight and body mass index both globally and in subgroups male and female. 6) There is no correlation between the percentage bone age and both globally and in the subgroups male and female, between the percentage bone and weight globally, or the percentage between bone and muscle weight both globally and in the subgroups masculine and feminine . 7) There is a positive correlation between the percentage bone and weight in sub male and femeni 8 no. 8) 36b There negative correlation between the percentage bone and the fat percentage both globally and in the subgroups male and female, between the percentage bone and body mass index both globally and in the subgroups masculine and feminine.

Author: SANCHEZ RUIZ TOMAS.
Year: 2005.
University: MIGUEL HERNÁNDEZ DE ELCHE.
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Justification Study which aims to assess the cardiovascular risks and the emergence of cardiovascular events in patients with hypertension, poorly controlled and treated pharmacologically, primary prevention in Spain. Materials and methods The study consists of two phases. A first phase cross, which is an observational study, multicenter descriptive cross prevalence. A second phase longitudinal, which is an observational study, multicenter descriptive cross Incident. The stage had a cross sample size of 8,059 patients with hypertension developed between September 1997 and January 2000, of whom 5,286 patients participated in the longitudinal phase, with an average follow-up of 444.86 days (1.22 years). Conclusions Study Transverse These patients detected an excess of overweight and obesity, high levels of lipid profile and glucose basal, cuantificándose worrisome percentages of hypercholesterolemia undetected, with a high disregard for injury to body tissues. It is concluded that there is insufficient in these patients protocolization justifying the prevalences found. It detects a high percentage of renal hidden when doing creatinine clearance estimated by the formulas of Cockcroft-Gault and MDRD. These discrepancies are justified because the diagnostic concordance between serum creatinine and clearances estimated, are low. It highlights a wide variability between different scales of cardiovascular risk in terms of identifying high-risk or very high. They are worrying that the differences are obtained between the scales REGICOR with Framinghan and SCORE. The correlation coefficients between different scales are acceptable, positive and very significant, so that higher risk obtained on a scale corresponds to an increased risk obtained in the other scales. Only gets a good match to make the intraclass correlation coefficient of the scale when compared to Framinghan with Wilson and REGICOR. Good obtained intraclass correlation between the scale of Framinghan and REGICOR along with the large differences in the identification of high-risk and moderate, between them, we conclude that either there to climb the definition of high risk with the Framinghan in clinical practice, or you need to download the definition of high risk with the REGICOR. When calculating the clinical consistency through the Kappa index, only the table of the Three companies won an acceptable reliability, both with the Framinghan as with SCORE. Conclusions Longitudinal Study scales cardiovascular risk which were validated with real events that occurred in the follow-up study, there were good indicators of validity and clinical utility. It has been possible to quantify the effect on our country and cumulative incidence rates of cardiovascular events in hypertensive patients after one year of follow-up, at baseline had bad control of blood pressure and that in the opinion of their doctors needed change in treatment . Relative risks were found, in most cases, risk factors known and proven in other studies. Indicators of clinical relevance between different scales of cardiovascular risk, shows a wide variation in their results. We have not had differences in cardiovascular morbidity and mortality between good and bad compliant, possibly due to a phenomenon of clinical inertia with respect to systolic blood pressure. The study has helped adjust the scale of Framinghan to better predict the total coronary event and overall cardiovascular, through a simple calculation that has an intraclass correlation coefficient of nearly 1. These adjustments podemo 8 s conclu 516 to go, if a patient has a high or very high risk, is 4 - 5 times more likely to suffer a cardiovascular event with respect to patients who have low risk, mild or moderate. It has been possible to develop a scale itself to be corroborated in future studies, with the main advantage to introduce into their calculations factors such as exercise and weight. Unable to explain the lack of significance you get to snuff, but we think it can be justified in part by the low prevalence found in the study. In subsequent studies should verify whether this finding is biological plausibility in Spanish population.

Author: Gil Loscos Francisco José.
Year: 2005.
University: VALENCIA.
Place of defense: Facultad de Medicina y Odontología.
Place of preparation: Facultad de Medicina y Odontología.

Summary: INTRODUCTION: Hypersensitivity Dentinaria poses a nuisance that affects one out of every seven patients dental and motivates the 3.5% of the total dental consultations. From the point of view periodontal affects 15% of patients undergoing maintenance, rising to 50% in patients undergoing periodontal surgery. From the point of view Etiopatogénico know that the hypersensitivity is caused by the exposure of the dentin tubules oral environment outside. However, the factors that produce sensitivity (Cold, Heat, Sweets, ect.) Are not the ones that have resulted in the exposure of the dentin tubules (Malcepillado, Diet Acid, Digestive Diseases, etc.), and moreover, unaware the mechanisms by which these stimuli cross the dentin and pulp stimulate nerve endings and we can only explain through scenario today is not proven, but the most accepted is the Hydrodynamics stating that the pressure changes in column liquid intratububar are the produce and therefore acceptable treatment may be the obliteration of these tubules and that the greater and more prolonged this is the better its therapeutic effect. OBJECTIVE: The objective of our study was to assess the ability "in vitro" of 8 agents proposed for the treatment of hypersensitivity Dentinaria by sealing the exposed dentin surface. Just as assessing what is the effect that moisture and brushing on their capabilities obliteration of dentin tubules. MATERIALS AND METHODS: a-Selección of the sample: 140 samples collected from 3Âş molars extracted without traumatizing just to satisfy the usual conditions b (Description of the methodology of the survey): the samples are cut and prepared according to the following scheme, leaving a filter for dentin thickness of 1 mm. Approximately are divided into 8 groups of 10 samples are mounted in a perfusion system based on the machine Pashley but maintains a positive pressure on the samples at all times that they are not allowed to disconnect when the application of the product while neither are planed. Each sample is recorded with orthophosphoric acid at 35% and permeability were measured for 1 hour, and this value is considered the baseline (100%). A sample is as a control for scanning electron microscopy (SEM) and the treatment is applied to the other 9, by measuring its permeability in one hour. Reserve a sample as a control for SEM and the remaining 8 are planed way equivalent to brushing 3 weeks, by measuring its permeability in 1 hour and can be seen in SEM. The methodology changes to the recorded glutaraldehyde not performed prior to implementation. The agents are studied oxalate, Glutaraldehyde, fluorides and several dentin adhesives one or more steps (Ami-dent Sealant ®, KDM Flustady ®, Systemp desensitizer ®, Systemp desensitizer ® + Excite ®, Scotchbond 1 ®, Seal & Protect ®, Promp - L-pop ® and Clearfill SE Bond ®), Fluorides (presentation of varnish and lacquer), as well as combinations of two products earlier justified by their clinical use. RESULTS: When comparing the results of the infusion is found that brushing increases permeability in all cases. When done rune simple descriptive statistics and compare the results in a Box-Plot is found that Seal & Protect ® shows the lower perfusion in the samples without brushing (30.54  ± 13.22%) and the cepilladas (42, 87  ± 19, 16%) and the SEM observation is corroborated. DISCUSSION: These results should be analyzed in the light of literature. So it is concluded that the studies on treatments "in vitro" hypersensitivity to use a standard methodology using the "House of Pashley" to measure leaks, and accepted procedure in classical literature from the work of R 8 eeder-Pa 1924 shley in 1978 , and checking these results by Scanning Electron Microscopy of the surface of the sample using a standardized technique also from the work of Mordan-Barber in 1994. In our case has been applying the modifications Del-Nero_de the Macorra. (1996) to the House of Pashsley that facilitate the implementation of product testing, as well as brushing maneuvers without the removal of a sample of the infusion system and that always keeps the fluid pressure on the sample at all times. However, when comparing the results "in vitro" very good, with those of other authors with the same products applied to the clinic, the results are highly variable, and certainly worse, and so, based products oxalate or get glutaraldehyde zero clinical outcomes authors interpreted as a poor resistance to oral fluids and implement the use of washing and brushing the samples "in vitro" to approximate the conditions of these studies to the actual conditions in which treatments will act on the mouth. In our study, a methodology similar to previous studies and a difference only, implementation of products is done without disconnecting samples infusion system that is always connected, and by leaving liquid dentin tubules open for engraving prior, we get some results substantially below the rest of literature already in the first phase of the study, without washing or brushing samples, and the only explanation is the use of a system of positive pressure infusion. Our hypothesis is that this moisture alter the sealing products at the time of its implementation, as opposed to using the camera Pashley where the samples are taken out, he applied the product and re-assemble for perfundirla. Thus, in observing a sample of dentin adhesive Dentinario applied on (our classical or as the article Garro 1988) is that this forms a dense layer and velvety on the dentin, however what we get with the Prompt-L - por ® (adhesive last generation, a single step, autograbante) is this: multiple pores on the surface of the product, which increases to over see leave open tubules in substance. In Scotchbond 1 ® (product similar characteristics) get the same thing, and open tubules defects sealing surface dentinaria, with the appearance of vesicles in the thickness of the adhesive. In Clearfil SE Bond ® obtain similar images. Even the product that best results obtained in our study, it gives the image of a velvety surface bubbles but despite their greater strength, since wearing a stuffed in the court also observed in vesicles inside. Also products such as KDM Flustady ®, which is a fluoride varnish to the humeddd at the time of application should influence little presents images of seal failures. Therefore, from our point of view, this is not considered a factor so far in the treatment of hypersensitivity dentinaria "in vitro" which is the outflow of fluid dentinario by dentin tubules open, and that according to our observations affect significantly to the products used to suffer the effects of moisture and at the time of application, which would alter its commitment to dentin and therefore its therapeutic action even before suffering aggression in the external environment (washing and brushing) and that explains the difference in results between studies in vitro and clinical outcomes that continue to make the problem of Hypersensitivity dentinaria a difficult problem to handle. In the same way as are authors Tay and Pashley in the investigation because of the high presence of postoperative sensitivities after use of adhesives autograbantes have described the emergence of phenomena known as "Vacuolas osmóticas" and "Trees Water" in the interior of the dentin adhesives that can justify and which are the expression of dentin flow that leaves open the tubules by the adhesive autograbante and remains trapped in its interior to polimerizarlos. When chewed, these bubbles of fluid movements caused compression and dilatation in the adhesive to induce movement of fluid inside the dentin tubules giving sensitivity. The same Pashley employs a system of positive pressure to see the spread of the pulp potassium ions of toothpaste. In the case of hypersensitivity dentinaria given the full opening of tubules and the status of irritation pulp which is supposed to increase the pressure intrapulpar, the output of liquid by tubules would be much higher and this would affect an important role in treatment. Our results seem to confirm the above, and thus we see bubbles or defects with lacunar exposure dentin tubules abroad who come to seriously affect sealing treatments. CONCLUSIONS: 1-Todos products reduced perfusion dentinaria to apply and all brushing again increase. 2 - The best results display a sticker with specific filler for the treatment of hypersensitivity Dentinaria. 3 - The use of positive pressure should be seen as a factor more to complete the study model "in vitro" of Hypersensitivity dentinaria and more studies should be conducted to ascertain the exact importance that the positive pressure takes the products developed for the treatment the Hypersensitivity Dentinaria.

Author: LOPEZ ESPINOSA MARIA JOSE.
Year: 2005.
University: GRANADA.
Place of defense: FACULTAD DE MEDICINA..
Place of preparation: FACULTAD DE MEDICINA.

Summary: From the forties of the last century began mass production

Author: Pereira Lestayo Victor.
Year: 2005.
University: SANTIAGO DE COMPOSTELA.
Place of defense: Facultad de Veterinaria.
Place of preparation: Facultad de Veterinaria.

Summary: The need to improve production and prevent various diseases has led nutritionists to incorporate additives livestock, such as monensin, the animal feed bait. However, the entry into force of EU rules, which prohibits the use of this antibiotic from the beginning of the year, has forced her to find credible alternatives can be used as organic malic acid. The latest research was supported in vitro studies, in which it has been observed that malato stimulates growth of Selenomonas ruminantium, a bacterium Gram-negativa representing 51% of the total population of rumen bacterial calves fed diets rich beans. However, although these studies lab have deepened in the mechanisms of action of this acid and its relationship with S. Ruminantium, also have the particularity to have been made under conditions somewhat remote from the reality livestock, it was necessary to consider what effect it could have on organic acid when it was applied in vivo. In older people, many questions remained to be resolved in this regard, most relating to what would be the most appropriate nutritional strategy for achieving maximum performance with this additive. This Doctoral thesis consists of three experimental designs, from which we try to learn a little more about how this organic acid and not just talking about parameters productive, but analyzing different aspects of metabolism internal calves (particularly on the acid-base balance, fluid and electrolyte balance, energy metabolism and L-lactato). With these experiments we intend to not only ensure that the different chemical formulations of malic acid is a valid alternative productive, but is also reliable and safe from the point of view metabolic. To this end we develop different nutritional strategies that will enable us to know under what conditions diet is most effective. The three experimental designs were made in a commercial farm belonging to the company COREN, SCL located in the province of Orense. Regardless of the objective of each specific design, they all felt studying the effectiveness of organic acid throughout the production cycle of calves for fattening (growth and finishing). In a first experiment compared the response of the two promoters, and monensin malato under the same conditions nutritional (rations rich in grain and low percentage of FB) to ascertain whether the malato is a valid alternative for the future. The second experiment was aimed at the possibility of using sodium malato as an alternative in the production of calves to bait monensin, and the need to know under what conditions nutrition is more effective. Specifically, in this experiment we try to learn in detail the operation of malato as an additive in diets rich in grain and with a major contribution from FB. The third experiment main objective was to assess the effects of two chemical forms of malato (malic acid and a salt business malato) on the metabolic parameters and productive. The realization of this Doctoral Thesis has enabled us to conclude that the organic acid malic, in any of its chemical formulations, it is a valid alternative to monensin sodium from the point of view of production. Although, after the analysis of the animal's internal use of the sodium salt form of malato appears to be much safer than the acid on animal health. Anyway, we believe it necessary to conduct further investigations before the supposed concern that the trend towards alcalemia found consistently in all experiments.