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Resumen Cuando hablamos de bypass gástrico, en realidad nos referimos a un conglomerado de técnicas que tienen en común la creación de un reservorio gástrico de pequeño tamaño sobre el cual se realiza una anastomosis gastroyeyunal en "Y" de Roux. La diversidad de métodos por los que esto se consigue hace que los resultados globales de la técnica no puedan ser extrapolados, de forma inequívoca, a todos los pacientes con obesidad mórbida. El objetivo de este artículo es revisar los resultados con aquellas variaciones que tienen más importancia, la creación de la anastomosis gastroyeyunal y la longitud de los distintos tramos intestinales que se crean, así como evaluar cual es el papel que ocupa el bypass gástrico actualmente en el arsenal de técnicas de las que disponemos en el tratamiento quirúrgico de la obesidad mórbida.

Diabet. Med. 27, 1178–1187 (2010) Abstract Aims Beradinelli–Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation. Methods Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy. Results The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts. Conclusions The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

Multivariate techniques have been applied to the set of data obtained after one year sampling of volatile organic compounds (VOCs), including volatile aldehydes in the area of Madrid in order to evaluate the possible correspondence among groups of analysed compounds, as far as modelling of different emission sources in relation to location and season. The measurements were carried out at four sites in Madrid, characteristic for urban and suburban areas. Additionally, as reference, a rural area 100 km far from the city was considered. Results of correlation analysis, factor and cluster analysis are presented. Higher correlations were found between variables related with traffic emissions. Factor analysis results showed two main significant variables related to anthropogenic and biogenic emissions respectively. In relation to cluster analysis, samples were grouped according to sampling site and seasonal variations.

ObjectiveToxic thyroid adenoma (TA) is a common cause of hyperthyroidism. Mutations in the TSH receptor (TSHR) gene, and less frequently in the adenylate cyclase-stimulating G alpha protein (GNAS) gene, are well established causes of TA in Europe. However, genetic causes of TA remain unknown in a small percentage of cases. We report the first study to investigate mutations in TSHR, GNAS, protein kinase, cAMP-dependent, regulatory, type I alpha (PRKAR1A) and RAS genes, in a large series of TA from Galicia, an iodine-deficient region in NW Spain.Design and methodsEighty-five TA samples were obtained surgically from 77 hyperthyroid patients, operated on for treatment of non-autoimmune toxic nodular goitre. After DNA extraction, all coding exons of TSHR, GNAS and PRKAR1A genes, and exons 2 and 3 of HRAS, KRAS and NRAS were amplified by PCR and sequenced. Previously unreported mutants were cloned in expression vectors and their basal constitutive activities were determined by quantification of cAMP response element (CRE)-luciferase activity in CO7 cells transfected with wild-type and mutant plasmids.ResultsTSHR gene mutations were found in 52 (61.2%) samples, GNAS gene mutations in 4 (4.71%) samples and no PRKAR1A or RAS mutations were found. Only three previously unreported mutations were found, two affecting the TSHR, A623F and I635V, and one affecting the G-protein α-subunit (Gsα), L203P. All mutant proteins showed higher CRE-luciferase activity than their wild-type counterparts.ConclusionsTA in a hyperthyroid population living in Galicia, a Spanish iodine-deficient region, harbours elevated frequencies of TSHR and GNAS mutations activating the cAMP pathway. However, the genetic cause of TA was undetermined in 34% of the TA samples.

Background Ankylosing spondylitis produces a progressive decrease in spinal mobility with the evolution of the disease. This decrease is due to inflammation and structural damage at radiological level that occurs in neck and spine. Several indices have been validated to quantify this grade of affectation. The most used index to assess structural damage is the mSASSS. This index is evaluated between 0 to 72 points and it measures equally the affectation grade of the neck and lower back. Recently a new index based on motion analysis has been defined wich produces accurate and objective information about mobility, the UCOASMI [1] index. For calculating this index, two cervical mobility and three lumbar mobility measures are used, so cervical UCOASMI and lumbar UCOASMI can be defined. With the evolution of the disease UCOASMI and mSASSS indexes increases with more structural damage and loss of mobility, but what is the relation between lumbar and cervical damage with the evolution of AS? Objectives To analyze the evolution of AS in terms of radiological damage and mobility at the cervical and lumbar area. Methods 76 patients diagnosed with AS (75% male, age 44.1±11.5 years, duration 13.6±9.4 years) were analyzed. A radiologist assessed radiographs for calculating mSASSS. At the Motion Analysis Laboratory of the Reina Sofia University Hospital, UCOTrack system was used to calculate UCOASMI index. For both indices, coefficient cervical/lumbar ratio was calculated to identify which part was more affected. Results Table shows affectation grade in mobility (UCOASMI) and radiographic damage (mSASSS) in total sample and grouped by gender, duration, and affectation grade in mobility. Differences between groups are also showed indicating whether these are statistically significant. Conclusions The relation between affectation of cervical and lumbar part seems to be balanced around 50% according to both structural damage and mobility. Mobility differences in genre were not appreciated. While there are differences in the structural damage between male and female, this difference appears similarly in both areas. According to our results, only at initial stages of the disease, lower back is most affected, especially as far as mobility is concerned. References Garrido-Castro JL, Escudero A, Medina-Carnicer R, Galisteo AM, Gonzalez-Navas C, Carmona L, Collantes-Estevez E. Validation of a new objective index to measure spinal mobility: the University of Cordoba Ankylosing Spondylitis Metrology Index (UCOASMI). Rheumatol Int. 2013 Dec 20. [Epub ahead of print] Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3280

Background Osteoarthritis of the knee (OA) is the most common disease affecting the musculoskeletal system and one of the most important causes of disability among elderly population. Patients are assessed by questionnaires whose response may be influenced to some subjectivity (WOMAC, VAS, SF36). Gait analysis and ground reaction forces (GRF) produce objective and quantitative results of patient status with well-defined patterns. Vertical force curves are characterized by showing two peaks and a valley, showing a graph like an inverted W. Intra-articular injections of hyaluronic acid for the treatment of knee OA have been shown to reduce pain and improve joint function. In this work we have used GRF as evaluation tool in patients with knee OA before and after applying intra-articular treatments. Objectives To analyze ground reaction forces in patients with knee OA before and after intraarticular treatment. Methods 26 patients with knee OA (57.68±8.06 years, 1.65±0.88 m, 87.74±13.06 kg) with a high level of affectation (grade II-III according to Kellgren and Lawrence scale) and 6 healthy subjects as control group with similar characteristics (55.33±5.07 years, 1.70±0.77 m,. 88.52±10.15 kg) were analyzed. Intraarticular injections of hyaluronic acid were applied to patients before and after measurements (one and three months). Vertical, mediolateral and anteroposterior GRF were evaluated using a triaxial force plate (Bertec ® FP4060) Results GRF in three axis and some temporary values as support time and first peak time in vertical force are showed in table. Significant differences between patients and control group in almost all parameters analyzed were found, showing a biomechanical altered gait. Regarding treatment sensitive measures, we could highlight first time peak in vertical force, force in the valley and difference between peak and valley. Sensitive measures also appear in the other two axis with larger braking and impulse forces. Also a shorter support time appears. Conclusions Our study shows that GRF clearly improved approximating to values obtained for control group after intraarticular treatment. The evaluation of GRF in gait could be used as an evaluation tool, not only to demonstrate the biomechanical alteration produced by knee OA, but also as a tool for evaluating the effectiveness of treatment. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3313

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease which causes a reduction in the patient mobility. Several studies show that, at radiological level, structural damage is much higher in men. There are few studies about gender differences in spinal mobility. Recently new technologies as motion capture have been introduced for assessing spinal mobility[1]. Objectives To analyze, using measures obtained by a motion capture system, gender differences in spinal mobility of patients with AS in the medium and long term. Methods 70 AS patients were analized (76.7% men). Two groups of patients were defined: medium and long term according disease duration (long term > 10 years). Cervical and spinal mobility were assessed using a motion capture system, the UCOTrack© [1]. Questionnaries about function and activity, conventional metrology (BASMI), and radiological scores (mSASSS) were also obtained. From motion capture several measurements were analyzed included a metrological index, the UCOASMI, based on motion capture measurements. Results No significant differences between men and women in self-rated questionnaires were found, although women obtain worse scores particularly in the medium term. Occiput-wall distance differences was found between sexes. Some measures obtained by the motion capture system were different between genders: UCOASMI, lateral spinal flexion and cervical flexion. Conclusions Results obtained by motion analysis corroborate similarities between genders as shown by several authors. Men have better mobility at medium term, inverting this difference at long term due mainly to structural damage. Motion capture provided additional accuracy information that can be useful in the diagnosis and therapeutic management of the disease. References Assessment of spinal mobility in ankylosing spondylitis using a video-based motion capture system. Garrido-Castro J.L, Medina-Carnicer R, Schiottis R., Galisteo A.M, Collantes E., Gonzalez-Navas C. Manual Therapy 2012 Oct;17(5):422-6. Disclosure of Interest None Declared

Background Knee osteoarthritis (OA) is the most common disease affecting human locomotion, and one of the most important causes of disability among the elderly population. In order to assess health status of patients self-evaluated questionnaires are commonly used, wich may be influenced by certain degree of subjectivity. Hialuronic acid is a common used treatment to improve knee OA. A force plate connected to a computer allows to analyze postural stability evaluating the center of pressure (CoP) sway in the lateral and sagittal planes. These methods of assessment the postural stability have shown excellent reliability in previous studies. Objectives Analyze the assessment of postural stability in patients with Knee OA using a triaxial force plate. Methods 10 patients with knee OA were analyzed (6 women and 4 men, age 55.3±3.2 years, weight 82.5±12.9 Kgr.) and 6 healthy subjects (4 women and 6 men, age 53.1±1.6 years, weight 78.3±10.4 Kgr.) as control group. Patients had a II-II degree of knee OA according to Kellgren and Lawrence scale. Hyaluronic acid injections were applied into the affected knee. Measures were taken before and after (4 weeks) treatment. A triaxial force plate (Bertec © FP5040) was used to assess postural balance. Patiens remained quiet for 10 seconds on the force plate, first with their eyes open (EO) and then another 10 seconds with their eyes closed (EC). Following parameters were recorded: total CoP distance, distance covered in antero-posterior and medio-lateral directions, area covered, and Romberg test (relation between EC and EO area). Patients fulfilled questionnaires in each test in order to calculate indexes: VAS general, VAS pain, WOMAC, SF-36 and OARSI criteria. Results Significant differences were observed in CoP area in both EO and EC, and in Romberg test, between pre and post treatment measures. Differences between control group and patients were significant in almost all parameters. In questionnaires based indexes, improvements were showed, although these differences were not statistically significant. Correlations were found between CoP sway with EC (p Conclusions Despite being a pilot study, with a very reduced sample, measurements of postural stability obtained from the force plate were sensitive to treatment. It was also interesting correlations between balance and pain level according to VAS, wich seems to show that pain in knee OA produces certain postural imbalance, as previous studies shown. Future studies with larger sample size may demonstrate our hypothesis, so this kind of technology can be used to assess outcome in knee OA patients and to show effectiveness treatments. Disclosure of Interest None Declared

Three aminoglycosidic antibiotics: tobramycin, amikacin and sisomicin were administered to rats. There was an increase in the activity of N-acetyl-beta-D-glucosaminidase (NAG) excreted in the urine and this was characterized by a change in the isoenzyme profiles eluted from DEAE--cellulose. The largest increase in NAG activity was observed following sisomicin administration due mainly to an increase in the B-form of NAG with a concomitant fall in the intermediate (I-form). Separation of urinary proteins by SDS-polyacrylamide gel electrophoresis demonstrated a mixed tubular and glomerular proteinuria following administration of sisomicin. It is concluded that the separation of NAG isoenzymes and urinary proteins provides valuable additional information on the nature and severity of antibiotic nephrotoxicity.

Glycosidases are generally glycoproteins from lysosomal origin that catalyze the hydrolysis of glycoproteins, glycolipids and glycosaminoglycans, as well as synthetic substrates. They accomplish a very important role (partially known) in physiological circumstances, and their dysfunction causes pathological processes, where they have been mainly studied in connection to the lysosomal storage diseases. After a brief review on the biosynthesis and catabolism of glycosidases and the factors influencing their activity, the present review article summarizes our own results on some glycosidase activities (-N-acetylhexosaminidase, c-L-fucosidase, o—D—galactosidase, —D—galactosidase, cx—D—glucosidase, —D—glucosidase, 0—D-mannosidase, —D—glucuronidase and -D—fucosidase) determined in sera from patients of several acquired diseases (diabetes, pancreatitis, hepatitis, cirrhosis, breast and gastric carcinomas, myocardial infarction and renal deficiencies). Related papers of other authors are also quoted. In addition, we discuss our own results on some glycosidase activities determined in sera from patients who ingested a toxic oil and those from the same patients in their convalescence period; these determinations are an example of glycosidases as a useful index which contributes to follow the course of a disease. The signification of these enzymes in some renal disorders is also discussed. Finally, the convenience of introducing some glycosidase determinations (specially -N-acetylhexosaminidase) in the routine work of Clinical Enzymology is proposed.

A simple spectrophotometric method is described for the sialic acids which utilizes the reaction with resorcinol and extraction with butyl acetate-n-butanol as a solvent. Normal values for adults, utilizing N-acetylneuraminic acid as a standard, were found to be 60 ± 10.4 mg./100 ml. Values for newborn babies averaged 40.4 ± 5.7. Similar values were found for specimens from 2-month-old infants to 27-year-old adults. Higher values were noted in the case of rickets, severe burns, rheumatic disease, and tuberculosis.

N-Acetylneuraminic, 2-deoxy-2,3-didehydro-N-acetylneuraminic acid and the beta anomer of methoxyneuraminic acid (Neu5Ac, Neu5Ac2en, MeONeu) have been used as probes for the catalytic mechanism of the activities of the outer membrane-bound haemagglutinin-neuraminidase (HN) from newcastle disease virus (NDV). Neu5Ac and Neu5Ac2en produced a competitive inhibition of the sialidase (= neuraminidase) activity, whereas MeONeu had no effect on this activity. This lack of inhibition can be explained by the free amino-acid group lacking the acetyl substituent in the MeONeu. Neu5Ac2en produced the highest inhibition. Based on the effect of the inhibitors, a reaction mechanism is suggested. On the other hand, the above mentioned inhibitors of the sialidase activity had no effect on haemagglutinating activity, suggesting different active sites for the both activities.