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PURPOSE: To describe pre- to post-treatment changes in clinical activity score (CAS) and exophthalmometry in patients with Graves orbitopathy treated with tocilizumab (TCZ). MATERIAL AND METHODS: Eight Mexican patients presenting with active Graves orbitopathy (CAS>3/7) previously treated with glucocorticoids received 1 monthly dose of TCZ for 6 months. CAS, EUGOGO severity assessment and exophthalmometry were used to evaluate clinical status, with serum measurement of thyroid-stimulating hormone receptor antibodies (TR-Ab) for biochemical evaluation before and after application of TCZ. RESULTS: Eight patients were analyzed: 6 male (75%), 2 female (25%): mean age, 45.9±11.2 years; mean weight, 85±18.3 kg. Mean TR-Ab level at treatment outset was 291.9±96.4%, mean CAS 4.1±0.3 and mean exophthalmometry 21.2±3.2 mm. After TCZ treatment, mean TR-Ab level fell to 172.7±54% (P=0.001), mean CAS to 1.1±0.6 (P=0.001) and mean exophthalmometry to 19.3±2 mm (P=0.02). CONCLUSIONS: TCZ is a therapeutic option for glucocorticoid-resistant orbitopathy, and should be considered in second line due to the cost of treatment or in first line in patients with contraindications to intravenous GC pulse therapy.

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Resumen El síndrome de Prader-Willi en un trastorno multisistémico; se caracteriza en la infancia por hipotonía, dificultades para la alimentación, retraso en el desarrollo e hipoplasia genital. En la adolescencia y edad adulta, la problemática se centra en las alteraciones del comportamiento, la ausencia de saciedad y el retraso mental leve o moderado. Su diagnóstico temprano requiere una alta sospecha clínica y estudios especiales (estudios de metilación e hibridación fluorescente in situ). La detección temprana se realiza con el fin de disminuir la morbilidad y mortalidad de los pacientes. Existe una clara necesidad de un enfoque multidisciplinario para facilitar el diagnóstico temprano y optimizar el manejo y tratamiento para mejorar la calidad de vida. Se presentan seis casos de SPW que tienen seguimiento en la Unidad de Especialidades Médicas a fin de conocer la prevalencia del SPW, ya que en la actualidad no se cuenta con ningún registro que la documente.

Abstract Prader-Willi syndrome in a multisystem disorder; it is characterized in childhood by hypotonia, feeding difficulties, developmental delay and genital hypoplasia. In adolescence and adulthood, the problem focuses on behavioral changes, the absence of satiety and mild or moderate mental retardation. Its early diagnosis requires a high clinical suspicion and special studies (methylation studies and fluorescent in situ hybridization). An early detection reduces the morbidity and mortality of patients. There is a clear need for a multidisciplinary approach to facilitate early diagnosis and optimize management and treatment to improve quality of life. There are six cases of SPW that are followed in the Medical Specialties Unit; we report them in order to know the prevalence of PWS, since at present there is no record documenting it.

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OBJECTIVES: To determine the long-term neurodevelopmental outcome for children after hypoxic-ischemic encephalopathy (HIE) without major disability, and to examine neonatal injury patterns detected on cerebral magnetic resonance imaging (MRI) in relation to later deficits. STUDY DESIGN: Prospectively enrolled children with HIE and neonatal cerebral MRI data (n = 68) were examined at a mean age of 11.2 years (range, 8.2-15.7 years). Eleven children had a major disability (ie, cerebral palsy or mental retardation). Brain injury was scored according to the region and extent of injury. RESULTS: Children without major disability (n = 57) had lower full-scale and performance IQ scores compared with norms (P = .02 and .01, respectively), and the proportion of children with an IQ <85 was higher than expected (P = .04). Motor performance on the Zurich Neuromotor Assessment was affected in the pure motor, adaptive fine motor, and gross motor domains, as well as in the movement quality domain (all P < .001). Watershed injury pattern on neonatal MRI correlated with full-scale and verbal IQ scores (P = .006 and <.001, respectively), but neonatal MRI pattern did not correlate with motor performance in children without major disability. CONCLUSION: Children who sustained neonatal HIE without major disability are at increased risk for long-term intellectual, verbal, and motor deficits. The severity of watershed injury is correlated with later intellectual performance. Long-term follow-up examinations are necessary for early detection of neurodevelopmental impairment and early initiation of adequate therapies.

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In the present study, we evaluated the capability of the plasmid pIDKE2, encoding the HCV (hepatitis C virus) structural proteins Core, E1 and E2, to induce immune response against HCV antigens after injection into rabbits and Macaca irus (crab-eating macaque). Animals were immunized intramuscularly with different amounts of plasmid on weeks 0, 3 and 8. Monkeys received a booster dose on week 46. All rabbits immunized with pIDKE2 generated a positive antibody response and, particularly in rabbits immunized with 2 mg, antibody titres reached values above 1:1500 and 1:400 against the core and the envelope proteins, respectively, 28 weeks after primary immunization. The antibody response in monkeys developed slowly, but antibody titres greater than 1:3500 against HCV structural antigens were detected at week 52. Moreover, anti-E2 antibodies recognized synthetic peptides covering the HVR-1 (hypervariable region-1) from different isolates corresponding to different genotypes. Additionally, a specific lymphoproliferative response against Core and E2 was detected in two out of three monkeys immunized with pIDKE2. The other monkey had a specific proliferative response to E1. Taking all these data together, immunization with pIDKE2 is able to elicit both humoral and cellular immunity against HCV structural antigens in animal models other than mice.

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Copper, zinc and iron concentrations were determined in "aguardiente de Cocuy de Penca" (Cocuy de Penca firewater), a spirituous beverage very popular in the North-Western region of Venezuela, by flame atomic absorption spectrometry (FAAS). These elements were selected for their presence can be traced to the (illegal) manufacturing process of the aforementioned beverages. Linear and quadratic discriminant analysis (QDA), and artificial neural networks (ANNs) trained with the backpropagation algorithm were employed for estimating if such beverages can be distinguished based on the concentrations of these elements in the final product, and whether it is possible to assess the geographic location of the manufacturers (Lara or Falcón states) and the presence or absence of sugar in the end product. A linear discriminant analysis (LDA) performed poorly, overall estimation and prediction rates being 51.7% and 50.0%, respectively. A QDA showed a slightly better overall performance, yet unsatisfactory (estimation: 79.2%, prediction: 72.5%). Various ANNs, comprising a linear function (L) in the input layer, a sigmoid function (S) in the hidden layer(s) and a hyperbolic tangent function (T) in the output layer, were evaluated. Of the networks studied, the (3L:5S:7S:4T) gave the highest estimation (overall: 96.5%) and prediction rates (overall: 97.0%), demonstrating the superb performance of ANNs for classification purposes.

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Plasmids expressing variants of the hepatitis C virus (HCV) core, E1 and E2 proteins individually or as polyproteins were administered to BALB/c mice. All plasmids induced a detectable and specific antibody response. Antibody titres against core, E1 and E2 proteins, 19 weeks after primary immunization, ranged from 1:50 to 1:4500 depending on the inoculated plasmid and the HCV antigen evaluated. Constructs expressing HCV envelope proteins as polyprotein variants including the core amino acid region induced statistically stronger antibody responses than plasmids encoding individual E1 and E2 proteins. Particularly, the pIDKE2 plasmid, expressing the first 650 amino acids in the viral polyprotein, induced a potent and multispecific antibody and lymphoproliferative response against HCV core, E1 and E2 proteins. Anti-E2 antibodies generated by pIDKE2 immunization were cross-reactive to hypervariable region-1 peptides from different genotypes. Immunization with the pIDKE2 also generated a positive cellular immune response against the core antigen, determined by interferon-gamma enzyme-linked immunospot (ELISPOT) assay, and induced detectable levels of interferon-gamma but not interleukin-4 in vaccinated mice. The detection of both antibody and cytotoxic T-lymphocyte responses, potentially targeted to circulating or cell-infecting virions respectively, in mice vaccinated with the pIDKE2 plasmid is very attractive for the effective eradication of HCV infection.

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