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Stress can be defined as a brain-body reaction towards stimuli arising from the environment or from internal cues that are interpreted as a disruption of homeostasis. The organization of the response to a stressful situation involves not only the activity of different types of neurotransmitter systems in several areas of the limbic system, but also the response of neurons in these areas to several other chemicals and hormones, chiefly glucocorticoids, released from peripheral organs and glands. Thus, stress is probably the process through which body-brain integration plays a major role. Here we review first the responses to an acute stress in terms of neurotransmitters such as dopamine, acetylcholine, glutamate and GABA in areas of the brain involved in the regulation of stress responses. These areas include the prefrontal cortex, amygdala, hippocampus and nucleus accumbens and the interaction among those areas. Then, we consider the role of glucocorticoids and review some recent data about the interaction of these steroids with several neurotransmitters in those same areas of the brain. Also the actions of other substances (neuromodulators) released from peripheral organs such as the pancreas, liver or gonads (insulin, IGF-1, estrogens) are reviewed. The role of an environmental enrichment on these same responses is also discussed. Finally a section is devoted to put into perspective all these environmental-brain-body-brain interactions during stress and their consequences on aging. It is concluded that the integrative perspective framed in this review is relevant for better understanding of how the organism responds to stressful challenges and how this can be modified through different environmental conditions during the process of aging. This article is part of a Special Issue entitled: Brain Integration.

El objeto de aprendizaje (OA) es parte de una filosofía en la elaboración de un material didáctico con soporte digital y está principalmente orientado para su utilización en la educación virtual. Uno de sus propósitos es mejorar las prácticas para la elaboración de material digital, en el sentido de unificar su formato y estructura. En ocasiones, se elaboran material digital para cursos en línea y no hay un verdadero aprovechamiento o posibilidades de mejora a futuro, lo cual supone un uso ineficiente del tiempo. También se podrían estar elaborando materiales que ya existen, pero que no se encuentran en un formato de soporte de fácil edición. Este artículo presenta algunas posibilidades, recomendaciones y beneficios de los objetos de aprendizaje para su implementación en los cursos en línea, así como las condiciones para su almacenamiento en repositorios de objetos de aprendizaje.Palabras clave: Objetos de aprendizaje, repositorios de objetos de aprendizaje, cursos virtuales, virtualidad, plataformas de aprendizaje en línea, educación virtual. AbstractThe learning object (LO) is part of a philosophy in developing a digital teaching material and is mainly targeted for use in virtual education. One of its aims is to improve practices for the production of digital material in the sense of unifying the format and structure. Sometimes they produce digital material for online courses and there is no real use or for improvement in the future, which implies an inefficient use of time. It could also be developing materials that already exist, but not in a user-friendly format edition. This article presents some possibilities, recommendations and benefits of learning objects for deployment in online courses and conditions for storage in repositories of learning objects.Keywords: Learning objects, learning object repositories, online courses, virtuality, online learning platforms, and virtual education.

Cystic fibrosis (CF) is an inherited disorder with a devastating prognosis. Determination of chloride concentration in sweat has been the gold standard test for diagnosing CF for over 50 years and still remains the primary screening test. However, now that the genetic cause is known and can be studied, genetic confirmation is mandatory in every suspected patient. We present a patient who had been clinically diagnosed and whose genetic testing could not confirm CF, leading us to search for other options that may also give a positive sweat test. The patient turned out to suffer type 1 pseudohypoaldosteronism, a condition that may cause severe dehydration, hyponatremia and hyperkalemia episodes if not diagnosed and treated early with sodium supplementation. We found a genetic variation in the epithelial sodium channel gene which has not been reported previously, and we discuss the possibility of it being the cause of our patient’s phenotype. Conclusion: this patient clearly illustrates the usefulness of genetic confirmation for CF for the diagnosis and genetic counselling, even when it is clinically oriented, and describes a novel mutation of the amiloride-sensitive epithelial sodium channel possibly causing type 1 pseudohypoaldosteronism.

The main purpose of this study was to evaluate the effect of aging on plasma and free corticosterone (CORT) levels in the brain in basal conditions and in response to an acute stressor. Microdialysis experiments were performed in the hippocampus (HC) and the prefrontal cortex (PFC) of young adult (6 months) and aged (24 months) male Wistar rats. Basal free levels of CORT in the HC and the PFC were higher in aged animals. Restraint stress increased plasma CORT and free CORT levels in the HC and the PFC both in young and aged animals. However, while the increase of plasma CORT was higher in aged rats compared with young rats, the increases of free CORT in the HC and the PFC were not different between these two groups of rats. These results suggest that the changes produced by aging in the brain may be related to the enhanced basal levels of free CORT and not to the CORT increases in response to stress.

Objectives Aerial transport of injured patients in rural Southeastern Ecuador is provided by humanitarian organizations with no medical personnel or assistance. We sought to evaluate the feasibility and usefulness of a tailored aeromedical transport (AMT) course for nonmedical personnel (pilot and technicians) in the jungles of Ecuador, where there are no formal medical crew members. Methods Fixed-wing aeromedical flights in the Amazon province of Morona Santiago were analyzed to delineate the injury patterns (IP) and reason for transport (RFT). An 8-hour didactic and hands-on AMTC course based on IP and RFT was developed and administered by the Virginia Commonwealth University (VCU) International trauma system development program (ITSDP) and VCU Life Evac with extensive experience in aeromedical education and training. Pre- and post-test course evaluation was used to assess the medical background and knowledge retention of the participants. Results A total of 5,716 fixed-wing aeromedical transports between Jan 2003 and Dec 2005 were analyzed. The course was developed based on 1176 (20%) RFT resulting from traumatic injuries. Course structure based on identified IP included 4 didactic lectures and hands-on skill training in aerial physiology, airway management, bleeding control, shock, musculoskeletal injuries, immobilization and patient transport. Fifteen students (4 pilots, 4 engineers, 2 physicians, 4 aerial staff and 1 flight operator) participated in the course. Pre- and post-test evaluations demonstrated significant improvement in knowledge from 53% (average 10.53, STD 1.6) to 73% (average 14.53, STD 2.13) p-value < 0.0001). Critical deficiencies in information uptake were identified in airway management and flight physiology Conclusion A tailored AMTC may serve as the first step toward the development of a regionally specific aeromedical transport service. Long-term follow-up is needed to evaluate the real impact of this intervention in terms of morbidity and mortality. How to cite this article Aboutanos MB, Mora FE, Nicholson B, Lovelady J, Dhindsa H, Mata LV, Kleiman D, Chin T, King A, Ivatury RR. Trauma Course for an Aerial Medical Transport System in the Amazon Rainforest of Ecuador. Panam J Trauma Critical Care Emerg Surg 2012;1(1):1-5.

Background Neurological trauma represents a major cause of global death and disability, with low and middle income countries representing the greatest burden of disease. The goal of this study was to assess the capability of Ecuadorian hospitals to manage head and spinal cord injury utilizing the International Association for Trauma Surgery and Intensive Care (IATSIC)/World Health Organization (WHO) Guidelines for Essential Trauma Care (EsTC). Materials and methods Site visits were performed at 24 hospitals in 7 provinces of southeastern Ecuador. The 23 human and physical resources required for management of head injury (HI) and spinal injury (SI) were evaluated using EsTC criteria. Resource capabilities were graded as 3 (adequate, >90%), 2 (partially adequate, >50%), 1 (inadequate, Results Five tertiary (TH) and 12 general (GH) public hospitals were included in the final assessment. Initial assessment of neurological injuries was at least partially adequate for HI (100% TH/GH) and partially adequate for SI (100%TH, 83.3% GH). Maintenance of normotension and oxygenation to prevent secondary neurological injury was partially adequate in TH (100% HI/SI) and inadequate in GH (only 58.3% were partially adequate for HI and 67.7% for SI). Surgical capabilities for treatment of neurological injuries were partially adequate with wide variability in TH. Familiarity or compliance with AANS guidelines and international classifi cation systems for HI and SI were absent at all facilities. CT and MRI capabilities were universally inadequate. Conclusion Based on WHO/IATSIC EsTC guidelines, signifi cant improvement in physical and human resources is needed for proper management of neurologically injured patients in Southeastern Ecuador. How to cite this article Aboutanos MB, Johnston EM, Mora FE, Rodas EB, Salamea JC, Ivatury RR. Evaluation of Head and Spinal Cord Injury Care in Ecuador using the IATSIC/WHO Essential Guidelines for Trauma Care. Panam J Trauma Critical Care Emerg Surg 2012;1(1):6-11.

Rapid tuberculosis (TB) detection is critical for disease control, and further quantitation of Mycobacterium tuberculosis (Mtb) in sputum is valuable for epidemiological and clinical studies. We evaluated a simple, robust and cost-efficient in-house DNA extraction and downstream Taqman approach for detection and quantitation of Mtb genomes from sputum of newly-diagnosed TB patients and non-TB controls. DNA was extracted using guanidine isothiocyanate and silica-based spin columns in less than 2 h, stored frozen, and Taqman assays were used to detect Mtb with IS6110 and quantify it targeting RD1 and IS1081. The Taqmans had a sensitivity >95% in 108 culture-confirmed TB patients and specificity of 100% in 43 non-TB controls. Genome counts were correlated with the Mycobacterial Growth Indicator Tubes' (MGIT) time-to-detection values (1/TTD × 1000; rho = 0.66; p < 0.001) in 91 TB patients (33 excluded with MGIT contamination). This linear relationship was nearly identical between mycobacteria isolated from sputum and H37Rv Mtb grown in-vitro to its log phase. TB treatment between 3 and 7 days was associated with lower 1/TTD × 1000 values but not with genome counts. Together, our protocol provides rapid, specific, inexpensive and quantitative detection of Mtb DNA in fresh or stored sputa making it a robust tool for prompt TB diagnosis, and with potential use for clinical and epidemiologic studies.

Aims: to assess oxidative stress in acute pancreatitis, its evolution over time and its relationship with the severity of the disease. Methods: during a two-year period, patients with acute pancreatitis with less than 24 hours of pain were evaluated. Serum was obtained the first, second and fourth day from admittance, if complications were detected, and after recovery. Malondialdehyde was determined by high performance liquid chromatography. Twenty healthy volunteers constituted the control group. Malondialdehyde between groups was compared with Mann-Whitney and Kruskal-Wallis tests; malondialdehyde evolution was studied with Wilcoxon test. Results: one hundred and sixty-nine patients were included (91 women, median age 67 years, range 20-95); 33 suffered a severe episode. Malondialdehyde decreased from first to fourth day (0.600 vs. 0.451 vs. 0.343 μM, respectively, p < 0.05). When complications were detected, malondialdehyde level was similar to that of first and second day (0.473 μM, p > 0.05). In severe attacks malondialdehyde was higher than in control group at day 2 (severe: 0.514; mild: 0.440; control: 0.347 μM, p < 0.05 severe vs. control). Conclusions: an early oxidative stress is observed in acute pancreatitis. In severe attacks, oxidative stress remains high longer than in mild episodes. The onset of complications is associated with high malondialdehyde concentration.

El foro virtual constituye un recurso valioso, el cual se encuentra disponible en los diferentes entornos virtuales de aprendizaje utilizados para la educación. El conocimiento por parte del profesorado de las características del foro, de la forma de moderarlo o guiarlo, y de las posibilidades didácticas, en términos de estrategias y evaluación; todo lo anterior permite que el facilitador de este tipo de espacios académicos obtenga el mayor provecho de esta herramienta. Palabras clave: foro, virtualidad, entornos virtuales de aprendizaje, tutor virtual, moderación, estrategias.AbstractThe virtual forum is a valuable resource which is available in different virtual learning environments used for education. Knowledge by teachers of the features of the forum, how to moderate it or guide it, and learning opportunities, in terms of strategies and evaluation of the above allows the facilitator of such academic areas get the most out this tool. Keywords: forum, virtual, virtual learning environments, virtual tutor, moderation strategies.

USING FREE SOFTWARE FOR DISTANCE EDUCATION CONTEXT: EXPERIENCE WITH USE-LEARNIG EXE AND MOODLE FOR THE IMPLEMENTATION OF ONLINE COURSES Este trabajo describe el uso que se ha dado a dos programas de software libre para los procesos de capacitacion desarrollados en la virtualidad, por parte del Centro de Capacitacion en Educacion a Distancia (CECED) de la Universidad Estatal a Distancia (UNED). El primero de estos programas es la plataforma virtual Moodle y el segundo, el editor de contenidos eXe-Learning, este ultimo ha permitido la elaboracion de contenidos que se pueden integrar de forma sencilla a la plataforma Moodle. Palabras clave: software libre, plataformas virtuales, moodle, eXe-Learing Abstract This paper describes the use which has been given two free software programs for the training processes developed in the virtual, by the Centre for Training in Distance Education (CECED) of the Universidad Estatal a Distancia (UNED). The first of these programs is the virtual platform Moodle and the second editor eXe-Learning content, the latter has allowed the creation of content that can easily integrate the Moodle platform. Keyword: free software, virtual platforms, moodle, eXe-Learnig

El desarrollo de las diferentes aplicaciones en la Web , en especial con la introduccion de la Web 2.0 , esta brindando multiples servicios en linea, los cuales, de forma paulatina, posibilitan la realizacion de ciertas labores, directamente en internet. Los documentos en linea forman parte de esta nueva tendencia. En este trabajo, se pretende, en el contexto de la educacion, mostrar los beneficios y la aplicacion de los documentos en linea, debido a que estos se perfilan como recursos novedosos y de facil uso, los cuales propician la implementacion de dinamicas colaborativas con el estudiantado. Palabras clave: documentos en linea, virtualidad, trabajo colaborativo y Web 2.0 . Abstract The development of different Web applications, especially with the introduction of Web 2.0, is providing many services online. This gradually will make possible to perform certain tasks directly on the internet. Online documents are part of this new trend. The objective of this work, in the context of education, is to show the benefits and implementation of online documents. Because they are emerging as new resources and are easy to use, and they promote the implementation of collaborative dynamics among students. Keywords: documents online, virtual, collaborative and Web 2.0.

La comunidad de aprendizaje apoyada por la virtualidad se perfila como un recurso novedoso, el cual permite la interacción y colaboración en torno a una determinada temática educativa, de forma muy diferente a la que puede conseguirse en un curso virtual. El presente artículo pretende mostrar posibles espacios para la conformación de comunidades de aprendizaje, así como las características mínimas requeridas por este tipo de recursos. También se describen algunas consideraciones iniciales para estructurar una comunidad de aprendizaje apoyada por la virtualidad.Palabras clave: comunidades de aprendizaje, entornos virtuales, aprendizaje colaborativo, colaboración.AbstractThe learning community supported by the virtuality is becoming a really useful resource. It allows interaction and collaboration in a particular educational topic, in a really different way than in a virtual course. This article shows possible areas for the creation of learning communities, as well as the minimum required by this type of resource. It also describes some initial considerations for structuring a learning community supported by the virtual.Keywords: learning communities, virtual environments, collaborative learning, collaboration

ROLE OF THE VIRTUAL TUTOR IN THE DISTANCE EDUCATION (UNED)El tutor virtual se perfila como un componente esencial en el contexto educativo a distancia de la UNED, en especial cuando la Institución está virtualizando paulatinamente sus diferentes cursos. Por esta razón, es deseable que el tutor que tiene la responsabilidad de ser facilitador en la virtualidad conozca algunas de las responsabilidades y funciones que tiene en este tipo de espacios asincrónicos. Así, en este artículo se pretende brindar algunas características deseables para el adecuado desenvolvimiento del tutor en los diferentes cursos que se ofrecen en línea, con el fin de obtener el mayor provecho de la virtualidad en el contexto educativo a distancia.Palabras clave: tutor virtual, virtualidad, educación a distancia, entornos de aprendizaje virtuales.AbstractThe virtual tutor is seen as an essential component in the context of distance education UNED, especially when the institution is gradually virtualizing its various courses. For this reason, it is desirable that the guardian keeps its responsibility of being a facilitator in virtual learn. In some of the responsibilities and functions that has this type of asynchronous spaces. Thus, this article is to provide some desirable features for the proper development of the tutor, in the different courses offered online. In order to get the most out of virtuality, in the context of distance education.

The present study was designed to elucidate the effects of environmental enrichment in adulthood (EE) on the in vivo basal and stimulated extracellular concentration of dopamine in the nucleus accumbens of awake rats. The effects of EE on novelty-induced motor activity in an open field and on the levels of brain-derived neurotrophic factor (BDNF) in the nucleus accumbens and striatum were also analysed. Male Wistar rats (3 months of age) were housed in enriched or control conditions during 12 months. After behavioural testing, animals were subdivided in two groups. In one of the groups, BDNF protein levels were determined. In the second group of rats, microdialysis experiments were performed to monitor dialysate concentrations of dopamine in the nucleus accumbens after the perfusion of the glutamatergic agonist α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA; 100 μM) or potassium (100 mM). Both basal and potassium stimulated dialysate concentrations of dopamine were higher in EE than in control rats (basal: 80%; potassium: 210%). EE did not significantly change the increases of dialysate concentrations of dopamine induced by AMPA although there was a trend towards an enhancement of the effects of AMPA. EE decreased novelty-induced locomotor activity but did not modify the levels of BDNF in the nucleus accumbens or in the striatum. These results suggest that the in vivo activity of the mesolimbic dopamine system is enhanced by housing rats in an enriched environment and that this effect is not mediated by BDNF. These findings may be relevant for the understanding of the effects of EE on motor behaviour.

The purpose of the present study was to evaluate the usefulness of the International Association for Trauma Surgery and Intensive Care (IATSIC)/World Health Organization (WHO)'s Guidelines for Essential Trauma Care (EsTC Guidelines) in providing an internationally applicable and standardized template to assess trauma care capabilities in the South American Region.Field assessment was conducted in seven provinces (urban and rural, pop. 2,239,509) and 24 facilities (5 large hospitals (LH); 15 small hospitals (SH); 4 basic hospitals (BH)) in Ecuador using EsTC criteria. A total of 260 individual items in Human Resources (HR- availability, clinical knowledge, skills) and physical resources (PR) were evaluated via inspection, review of local statistics, and administrative and staff interviews. EsTC was evaluated on a scale as follows: 0 (absent); 1(inadequate; 50%); 2 (partly adequate 50%); 3 (adequate-100%).210,045 Emergency Department (ED) visits and 61,365 (29%) ED trauma visits were recorded (incidence rate 2,740/100,000 population). Deficits were noted in prehospital trauma care (inadequate coordination, communication), education and training (ATLS 30%, TNCC 0%), facility based trauma care (poor physical resources [PR] and human resources [HR]), and quality assurance (1/27 hospitals).The IATSIC/WHO EsTC Guidelines provide a simple and useful template to assess trauma care capability in variable facilities and international settings, and they could serve as a valuable tool for trauma system development. Endorsement of EsTC Guidelines by the Panamerican Health Organization and lead trauma societies (the Panamerican Trauma Society) should be considered.

Background Nocardiosis is a life-threatening opportunistic infection. Solid organ transplant (SOT) recipients are at higher risk (incidence 0.04%-3.5%) of developing nocardiosis. Rate of nocardiosis in the Southwestern US may be high due to environmental factors. Methods We performed a retrospective review study on 54 SOT patients diagnosed with Nocardia between 1997 and 2016 at our center. To explore the association of various risk factors with both the development of disseminated disease and mortality, a series of Fisher's exact tests was used. Findings Incidence of nocardiosis in SOT patients was 2.65%. Fisher's exact tests revealed no association between development of disseminated disease and the following variables: transplant rejection (P = 1), elevated tacrolimus levels (P = .4), and CMV viremia (P = .06). Also, we did not find any association between mortality and the variables we evaluated: type of transplant, transplant rejection, renal failure, disseminated nocardia, and patient's age. Overall mortality and 1-year mortality were 17% and 11%. Interpretation Based on our findings, daily 1 DS TMP/SMX prophylaxis did not appear to provide reliable protection against nocardiosis. However, we could not state definitely that TMP/SMX prophylaxis was or wasn't protective because of lack control group. None of the Fisher's exact tests revealed associations between the tested risk factors and either disease dissemination or mortality. This could be due to a true lack of association between the variables in each pair. However, it is also likely that our relatively small sample size limited our power to detect underlying relationships that may be present. Compared with other studies, 1-year mortality was lower at our institution (11% vs 16%).

The prefrontal cortex (PFC) efferent projections to limbic areas facilitate a top-down control on the execution of goal-directed behaviours. The PFC sends glutamatergic outputs to limbic areas such as the hippocampus and amygdala which in turn modulate the activity of the nucleus accumbens (NAc). Dopamine and acetylcholine neurons in the brainstem and basal forebrain/septal areas, which send outputs to NAc, hippocampus and amygdala, are also regulated by PFC glutamatergic projections, and seem to be of special relevance in modulating motor, emotional and mnemonic functions. Both the physiological and pathological changes in the PFC influence the activity of these limbic areas and the corresponding final-guided behaviours. We revise our most recent studies on PFC-NAc interactions focussed on the role of dopamine and glutamate receptors in the PFC. Specifically, by performing microinjections/microdialysis studies we found that the activation of D2 dopamine receptors and the blockade of glutamate NMDA receptors in the PFC change the release of dopamine and acetylcholine in the NAc. We suggest the possibility that dopamine and glutamate receptors in the PFC could change the activity of dopamine and acetylcholine function in the hippocampus and amygdala. Finally, it is speculated that changes in the function of the PFC, associated with psychiatric disorders or due to environmental-dependent plasticity, can change PFC-limbic system interactions.

As a result of living in an enriched environment, the brain of animals undergoes molecular and morphological changes leading to improvements in learning and memory. These improvements correlate well with increase in neurogenesis, synaptic density, or neurotrophic factors. We review here, in the context of the literature, the experiments performed in our own laboratory on the effects of environmental enrichment on the dynamics of dopamine and acetylcholine in the prefrontal cortex under a situation of acute mild stress. In these last studies we found that the release of dopamine and acetylcholine under stress is reduced in animals housed in an enriched environment. We also reported that the stress-induced release of dopamine but not acetylcholine is lower in aged rats compared with young rats. These results suggest that environmental enrichment reduces the reactivity to stress of the prefrontal dopaminergic and cholinergic systems in the rat. We further hypothesize that the positive effects on stress coping behaviors of housing animals in an enriched environment are associated with reductions, rather than increases, in the release of dopamine and acetylcholine in the prefrontal cortex. Finally we propose that a reduction in the stress-induced release of dopamine observed during aging in control animals might be an index of a better adaptation to stressful stimuli.

One of the many consequences of the pandemic of type 2 diabetes [1] is an increased frequency and severity of infection in diabetic patients, including up to an 8-fold increase in the risk of developing pulmonary tuberculosis [2]. The molecular basis for this susceptibility to tuberculosis is unclear. One possibility is a compromised immune response in diabetic patients that facilitates either primary progressive tuberculosis or reactivation of a latent tuberculosis infection [3]. Studies evaluating immunity to other microbial antigens in diabetic patients suggest that adaptive and innate responses are compromised, particularly in patients with chronic hyperglycemia (measured by elevated glycosylated hemoglobin [HbA1c] level) [4–15]. Immune impairments appear to be reversible with improved glycemic control [10, 16, 17]. Although susceptibility to tuberculosis in diabetic patients has been recognized for more than a century, only now, when we are faced by the current type 2 diabetes epidemic, are we beginning to address the public health impact and potential mechanisms of this association. Cytokines of the innate and adaptive immune systems orchestrate the response to Mycobacterium tuberculosis, with subsequent induction of cellular type 1 immunity, which is critical for protection [18–23]. A recently developed mouse model for diabetes and tuberculosis revealed higher bacterial burden and altered expression of IFN-γ in mice with chronic, but not acute, diabetes [24]. Persistent hyperglycemia apparently plays a significant role in the pathology. In this context, we assessed differences in cytokine secretion in response to an M. tuberculosis antigen in diabetic and nondiabetic patients with tuberculosis, selected from a population of patients known to have elevated rates of type 2 diabetes [25, 26]. To do this, we adapted a relatively simple ex vivo stimulation procedure designed to screen for variations in innate and adaptive immune responses to M. tuberculosis antigens. We hypothesized that, if impairment of the immune response plays a role in susceptibility to tuberculosis in patients with diabetes, we should be able to detect differences in cytokine responses to M. tuberculosis antigens in such patients, particularly in those with poor glycemic control.

The present study investigates the effects of injections of a specific N-methyl-D-aspartic acid (NMDA) antagonist 3-[(R)-2-carboxypiperazin-4-yl]-propyl-1-phophonic acid (CPP) into the prefrontal cortex (PFC) on the extracellular concentrations of dopamine and acetylcholine in the nucleus accumbens (NAc) and on motor activity in the freely moving rat.Sprague-Dawley male rats were implanted with guide cannulas into the medial PFC and NAc to perform bilateral microinjections and microdialysis experiments. Spontaneous motor activity was monitored in the open field.Injections of CPP (1 microg/0.5 microL) into the PFC produced a significant increase of the baseline extracellular concentrations of dopamine (up to 130%), dihydroxyphenylacetic acid (DOPAC; up to 120%), homovanillic acid (HVA; up to 130%), and acetylcholine (up to 190%) in the NAc as well as motor hyperactivity. In the NAc, perfusion of the NMDA and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate antagonists CPP (50 microM)+6,7-dinitroquinoxaline-2,3-dione (DNQX; 50 microM) through the microdialysis probe blocked acetylcholine release, but not DOPAC and HVA increases produced by CPP injections into the PFC. Also, increases in motor activity produced by prefrontal injections of CPP were significantly reduced by bilateral injections into the NAc of a mixed D1/D2 antagonist, flupenthixol (5 and 25 microg/0.5 microL). Injections into the NAc of the muscarinic antagonist scopolamine (1 and 10 microg/0.5 microL) further increased, and of the nicotinic antagonist mecamylamine (1 and 10 microg/0.5 microL) did not change, the increases in motor activity produced by prefrontal CPP injections.These results suggest that the dysfunction of NMDA receptors in the PFC could be a key factor in the neurochemical and motor effects associated with corticolimbic hyperactivity.

The positive regulatory domain containing 1, encoded by the PRDM1 gene, is a transcriptional repressor considered as a master regulator that is required and sufficient for plasma cell differentiation. In the present study we have performed sequence analysis of the upstream region of the human PRDM1 gene to detect the minimal promoter region necessary for PRDM1 gene transcription. This region comprises the region upstream of the initiation site, as well as the first exon. Collectively, deletion and mutation analysis in conjunction with luciferase reporter assays, EMSA and supershift assays identified a phylogenetically conserved GC-box as an essential element for PRDM1 expression. This GC-box element matches to a binding site for multiple transcription factors such as SP1 and SP3 isoforms as well as early growth response 1. Chromatin immunoprecipitation assays confirmed the in vivo binding capability of these factors to the human PRDM1 promoter. These studies together characterize for the first time the basal activity of the human PRDM1 promoter, through which several factors, including SP1, SP3 and early growth response 1, modulate its expression through a conserved GC-box.

‘World class universities’ (WCU) are an issue of intense debate among the academic community. To define a WCU supposes that only those universities that fit the ‘quality’ criteria established under benchmarking conditions can be considered as such. The good news is that several dimensions could be used to defined excellence, not only classical academic and research criteria. This paper intends to address conceptual aspects of WCU with regard to relations between university ‘mission’ development and why, how and when an institution is considered a WCU from non‐classical criteria. The main purpose of this paper is to propose new dimensions to rank University Missions. Going beyond teaching and research, the University Third Mission – services to Society – has at least 3 dimensions: a non profit – social – approach; an entrepreneur focus; and an innovative approximation. This paper will consider the various implications that a third mission measurement and benchmark could introduce in the controversial ranki...

Objectives The aim of this investigation was to evaluate the pancreatographic findings and dynamics of pancreatic duct diameter, as determined by secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP), in patients with acute alcoholic pancreatitis or chronic alcoholic pancreatitis and in a control group. Methods S-MRCP was performed in patients with acute alcoholic pancreatitis who did not manifest the functional and radiological (ultrasonography and computed tomography) criteria of chronic pancreatitis (n = 21), in patients with chronic alcoholic pancreatitis (n = 28) and in a control group (n = 16). The diameter of the main pancreatic duct (MPD) was monitored before secretin administration and at 3 and 10 min after secretin administration. Morphological features were also assessed before and after the administration of secretin. Results All ductal diameters were significantly larger in chronic alcoholic pancreatitis (P < 0.0001). There were no differences in MPD caliber between patients with acute alcoholic pancreatitis and the control group. The percentage of variation between basal MPD diameter and at 3 min post-secretin administration was lower in patients with chronic (35.5%) pancreatitis than in those with acute alcoholic pancreatitis (52.3%) and the control group (52.5%). There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of the frequency of visualization of side branches, ductal narrowing, intraluminal filling defects, and ductal irregularity. One patient with acute alcoholic pancreatitis presented ductal criteria of chronic pancreatitis following the administration of secretin. Conclusions The dynamics of MPD visualized on S-MRCP in patients with acute alcoholic pancreatitis is similar to that observed in the control group and different from that observed in patients with chronic alcoholic pancreatitis. There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of morphological pancreatographic features.

The present study was designed to investigate the effects of a mild acute stress on the in vivo release of dopamine in the prefrontal cortex (PFC) during aging and whether housing animals in an enriched environment changes these effects. Behavioural parameters such as spontaneous motor activity (open-field) and working memory performance in a delayed alternation task (water T-maze) were also studied. Male Wistar rats (3 months of age) were housed during 3, 12, and 21 months (6, 15 and 24 months of age at the end of housing) in enriched or control conditions. After behavioural testing, animals were subdivided in two groups. In one of the groups BDNF protein levels were determined in PFC, hippocampus and amygdala. Rats of the second group were implanted with guide cannula in the PFC to perform microdialysis experiments and to monitor extracellular concentrations of dopamine. The release of dopamine in the PFC produced by handling stress (40 min) was significantly reduced in both enriched and control 24 months animals. However, the increases of dopamine produced by stress were significantly lower in enriched animals when compared to controls. Similarly, the increases of dopamine produced by perfusing K(+) 100 mM into the PFC were also reduced by aging and environmental enrichment. Both spontaneous motor activity and working memory performance were significantly reduced by aging. Moreover, animals housed in an enriched environment did show a lower spontaneous motor activity at all ages studied, though they did not show any change in performing the working memory task, either in basal conditions or after an acute stress. The BDNF protein levels were increased by environmental enrichment in the hippocampus and amygdala, but not in the PFC. These results suggest that both environmental enrichment and aging reduces the activity of the mesocortical dopamine system.

The present study was aimed to investigate the effects of a chronic treatment with the dopamine uptake blocker nomifensine on the in vivo extracellular concentrations of dopamine, acetylcholine, glutamate and GABA in the prefrontal cortex, striatum and nucleus accumbens. Male Wistar rats received intraperitoneal (i.p.) daily injections of nomifensine (10 mg/kg) or saline for 22 days. Microdialysis experiments were performed on days 1, 8, 15 and 22 of treatment to evaluate the effects of the injection of nomifensine or saline. Motor activity of the animals was monitored during microdialysis experiments. Injections of nomifensine increased extracellular concentration of dopamine in striatum and nucleus accumbens, but not in prefrontal cortex. Acetylcholine concentrations in striatum but not in nucleus accumbens were increased by nomifensine on days 15 and 22 of treatment. In prefrontal cortex, nomifensine increased acetylcholine levels without differences among days. No changes were found on glutamate and GABA concentrations in the three areas studied. Injections of nomifensine also increased spontaneous motor activity and stereotyped behaviour without differences among days. These results show that systemic chronic treatment with a dopamine uptake blocker produces differential effects on extracellular concentrations of dopamine and acetylcholine, but not glutamate and GABA, in different areas of the brain.

Extra-oesophageal autonomic dysfunction in idiopathic achalasia is not well documented, due to contradictory results reported. We aimed to study the cardiovascular and pancreatic autonomic function in patients with idiopathic achalasia. Thirty patients with idiopathic achalasia (16M/14F; 34.5 ± 10.8 years) and 30 healthy volunteers (13M/17F; 34.8 ± 10.7 years) were prospectively studied. Age >60 years and conditions affecting results of autonomic evaluation were excluded. Both groups underwent the sham feeding test and plasmatic levels of pancreatic polypeptide (PP) were determined by radioimmunoassay (basal, at 5, 10, 20 and 30 min). Cardiovascular parasympathetic (deep breathing, standing, Valsalva) and sympathetic function (postural decrease of systolic blood pressure, Handgrip test) were assessed. Statistical comparison of basal and increase levels of PP and parasympathetic/sympathetic cardiovascular parameters was performed between groups. Basal levels of PP were similar in controls and patients and maximum increase of PP during sham feeding test. A similar rate of abnormal cardiovascular tests was found between groups (P > 0.05). E/I ratio was the mostly impaired parameter (patients: 36.7%vs controls: 20%, P = 0.15, chi-squared test). Autonomic cardiovascular tests and pancreatic response to vagal stimulus are not impaired in patients with primary achalasia of the oesophagus.

Cajal was probably the first neurobiologist to suggest that plasticity of nerve cells almost completely disappeared during aging. However, we know today that neural plasticity is still present in the brain during aging. In this review we suggest that aging is a physiological process that occurs asynchronously in different areas of the brain and that the rate of that process is modulated by environmental factors and related to the neuronal-synaptic-molecular substrates of each area. We review here some of the most recent results on aging of the brain in relation to the plastic changes that occur in young and aged animals as a result of living in an enriched environment. We highlight the results from our own laboratory on the dynamics of neurotransmitters in different areas of the brain. Specifically we review first the effects of aging on neurons, dendrites, synapses, and also on molecular and functional plasticity. Second, the effects of environmental enrichment on the brain of young and aged animals. And third the effects of an enriched environment on the age-related changes in neurogenesis and in the extracellular concentrations of glutamate and GABA in hippocampus, and on dopamine, acetylcholine, glutamate and GABA under a situation of acute mild stress in the prefrontal cortex.

The advanced trauma life support course is not available or affordable to rural areas in low-income countries. A trauma continuing education course was created to educate physicians of rural hospitals in the jungles of Ecuador.A basic trauma care course was designed based on local resources and location of injury, including rudimentary health posts in the jungle, rural hospitals, and definitive referral centers. Course effectiveness was evaluated by a comparison of test scores before and after the course. A multiple choice questionnaire was given. Comparison to previous test scores was also performed. Paired Student's t test was used for statistical analysis. An objective structured clinical examination (OSCE), based on the course design, was administered.Twenty-six rural physicians participated in the course. Mean test scores significantly improved from pretest to post-test (72% to 79%; p = 0.032). Knowledge deficiencies in prehospital care, extremity injury care, and patient evaluation adjuncts significantly improved from 23% to 87%, 23% to 100%, and 31% to 100%, respectively. Test results after the course showed improvements in all major categories tested. Twelve of the 26 participants were repeat test takers from a course provided 2 years earlier. These participants showed improved pretest scores compared with their highest previous test score (76.8% versus 68.5%; p = 0.0496). Compared with first-time test takers, these participants showed improved pretest (76.8% versus 68.4%) as well as post-test (81% versus 76%) scores. Twenty-five of the 26 physicians participated in the OSCE, with a pass rate of 76%. The OSCE identified various strengths and deficiencies based on patient location and available resources. In rudimentary health posts, management was adequate for hemorrhage control (65%), immobilization (77%), and early transfer to rural hospitals (92%). Prehospital communication was inadequate (53%). Rural hospital management was adequate for primary evaluation (60%) and resuscitation (74%) but poor in secondary patient evaluation (53%), adjuncts (25%), and transfer to definitive referral centers (11%). OSCE scores differed from multiple choice questionnaire test results.Where there is no advanced trauma life support, a tailored trauma course and evaluation can be effective in educating local providers. A well-designed competency evaluation (multiple choice questionnaire and OSCE) is helpful in identifying deficient local aspects of trauma care. The course design and evaluation methods may serve as a model for continuing trauma care education in developing countries.

The aim of the present study was to investigate whether environmental enrichment changes the effects of acute stress on both the release of dopamine and acetylcholine in the prefrontal cortex (PFC) and working memory performance. Male Wistar rats (3 months of age) were housed in enriched or control conditions during 12 months. Behavioural testing was carried out to assess working memory performance in a delayed alternation task (water escape T-maze). Horizontal and vertical motor activity were also monitored in the open field. After behavioural testing (open field and water T-maze), animals were implanted with guide cannula in the PFC to perform microdialysis experiments and to monitor dopamine and acetylcholine extracellular concentrations. Handling stress (40min) produced similar increases of extracellular concentrations of dopamine in the PFC of both enriched and control animals. In contrast, handling stress increased significantly the extracellular concentrations of acetylcholine in the PFC of control, but not enriched, animals. Exposing animals to a lit open field during 10min significantly reduced working memory performance assessed immediately in the water T-maze just in control animals, though these effects were not significantly different between both groups of animals. Spontaneous motor activity in the open field was lower in enriched compared to control animals. These results suggest that environmental enrichment changes acetylcholine, but not dopamine, reactivity to stress in the PFC.

Background and Aims: Amyloidosis is a rare complication of inflammatory bowel disease [IBD]; its low prevalence has hindered both descriptive and therapeutic studies. The aim of this study was to estimate the prevalence of amyloidosis in IBD and the risk factors associated with this complication. Methods: This paper presents an observational study, followed by a systematic review of the epidemiological and clinical characteristics of the disease and a review of the diagnostic and therapeutic options. Results: The prevalence of amyloidosis among IBD patients is 0.53% (95% confidence interval [CI]: 0.32–0.75), although epidemiological data suggest that it may be under-diagnosed. The phenotype most frequently associated with amyloidosis is males with aggressive and extensive Crohn’s disease, fistulising behaviour, perianal disease, and extra-intestinal complications, with the development of proteinuria and renal failure. Conclusions: Identifying risk factors of amyloidosis in IBD patients and screening for proteinuric renal dysfunction are useful to improve diagnostic accuracy. Referral of biopsies to a tertiary centre should also be considered, to improve diagnostic accuracy. Although there is no reliable evidence on the effectiveness of treatment, it seems reasonable to treat the underlying disease with potent immunosuppression to minimise inflammatory activity, thereby switching off amyloidogenesis.

El tutor a distancia, en particular el que se desempeña con apoyo de los entornos virtuales de aprendizaje, debe asumir un rol de asesor pedagógico que oriente y guíe al estudiantado hacia el éxito en el modelo a distancia, esto por medio de diversas funciones, muchas relativas a la comunicación que se ejerce con apoyo de estos espacios virtuales y que permiten incentivar un papel más activo de los estudiantes. En este artículo se expone los resultados de un estudio cuantitativo que perseguían conocer el nivel de capacidades tecno-pedagógicas con los que cuentan los tutores de la Universidad Estatal a Distancia (UNED) de Costa Rica. De este estudio se desprende como se realiza la mediación de algunos cursos en línea por parte del profesorado, desde el inicio del mismo, uso de herramientas de comunicación, evaluación de las actividades y realimentación, de lo anterior se realizan importantes hallazgos que permiten caracterizar las prácticas utilizadas por parte la población estudiada.

SECTION ONE: FOUNDATIONAL ISSUES SECTION TWO: COGNITIVE NEUROSCIENCE OF VISUAL AESTHETICS AND ART SECTION THREE: COGNITIVE NEUROSCIENCE OF DANCE SECTION FOUR: COGNITIVE NEUROSCIENCE OF MUSIC SECTION FIVE: NEUROPSYCHOLOGY OF ART AND AESTHETICS SECTION SIX: THE EVOLUTION OF ART, AESTHETICS, AND THE BRAIN SECTION SEVEN: INTEGRATIVE APPROACHES

Shifting demographics in the U.S. has created an urgent need to reform the policies, practices, and technology associated with delivering healthcare to geriatric populations. Automated monitoring systems can improve the quality of life while reducing healthcare costs for individuals aging in place. For these systems to be successful, both activity detection and localization are important, but most existing research focuses on only one of these technologies and systems that do collect both data treat these data sources separately. Here, we present SLAD {Simultaneous Localization and Activity Detection a novel framework for simultaneously processing data collected from localization and activity classification systems. Using a hidden Markov model and machine learning techniques, SLAD fuses these two sources of data in realtime using a probabilistic likelihood framework, which allows activity data to refine localization, and vice-versa. To evaluate the system, a wireless sensor network was deployed to collect RSSI data and IMU data concurrently from a wrist-worn watch; the RSSI data was processed using a radial basis function neural network localization algorithm, and the resulting position likelihoods were combined with the likelihoods from an IMU acitivty classification algorithm. In an experiment conducted in an indoor office environment, the proposed method produces 97% localization accuracy and 85% activity classification.

Background An increase in body mass index has been found to be associated with an increase in the prevalence of gastroesophageal reflux disease (GERD) symptoms, esophageal mucosal injury, and GERD complications. Few systematic studies with objective tests have evaluated esophageal disorders in the morbidly obese population. Objectives To define more precisely in morbidly obese people the incidence of esophageal symptoms and characterize the esophageal disorders using objective data. Setting University Hospital, Spain. Methods Two hundred twenty-four presurgical morbidly obese patients were submitted to a protocol including a clinical history and objective tests (endoscopy, stationary esophageal manometry, 24-hour esophageal pH monitoring and isotopic emptying of the esophagus). Results In a morbidly obese population, heartburn (50.9%) and regurgitation (28.6%) were the most prevalent symptoms of GERD. Endoscopy registered hiatus hernia (12.5%) and reflux esophagitis (17.3%). Manometry was often abnormal (33.4%), with a hypotensive lower esophageal sphincter as the most common finding. Esophageal pH-metry was abnormal in 54.2% of the cases. Finally, 9.1% of the patients presented with abnormal isotopic esophageal emptying. A correlation between the degree of obesity and the severity of symptoms/objective tests for esophageal abnormalities could not be found. Conclusions In morbidly obese patients, GERD is common, symptoms are unspecific, and there is a high prevalence of pH-metry and manometric abnormalities, unrelated to the degree of obesity.

The possibility of an infectious origin in inflammatory bowel disease (IBD) has been postulated since the first description of Crohn’s disease (CD). Many observations implicate bacteria as a trigger for the development of CD: lesions occur in regions with higher bacterial concentrations; aphthous ulcers occur in Peyer’s patches; inflammation resolves when the fecal stream is diverted and is reactivated following reinfusion of bowel contents; severity of the disease is correlated with bacterial density in the mucosa; granulomas can contain bacteria; and susceptible mice raised in germ-free conditions develop inflammation when bacteria are introduced in the 1990’s, several studies sought to establish a relationship with viral infections and the onset of IBD, finally concluding that no direct link had been demonstrated. In the past fifteen years, evidence relating IBD pathogenesis to Mycobacterium avium paratuberculosis, salmonella, campylobacter, etc., has been found. The tendency now under discussion to regard microbiota as the primary catalyst has led to the latest studies on microbiota as pathogens, focusing on Escherichia coli, mainly in ileal CD. The present review discusses the literature available on these “bugs”.

Transanal advancement flap is a recognized technique for complex fistula. Management of the tract is open to discussion. Excision of the tract by the “core out” technique is difficult and could increase the risk of sphincter damage. Curettage is easier but it could increase the risk of recurrence. The aim of the present study was to assess the effect of both techniques on sphincter function and to study the clinical results. This is a retrospective analysis from a prospective database. One hundred nineteen consecutive patients with high cryptoglandular anal fistula were included. “Core out” technique was performed in 78 patients (group I) and “curettage” in 41 (group II). In both, a full-thickness rectal flap was advanced over the closed internal defect. Anorectal manometry was performed to assess sphincter function. Continence was assessed using the Wexner Scale. Recurrence was defined as the presence of an abscess or fistulization. Manometric results showed a significant decrease in the maximum resting pressure after surgery in both groups. The maximum squeeze pressure was significantly reduced only in group I (p

https://www.scopus.com/inward/record.url?eid=2-s2.0-84939570316&partnerID=40&md5=fcadae8e6c274e8b7efca96099304a7c Successional gradients are ubiquitous in nature, yet few studies have systematically examined the evolutionary origins of taxa that specialize at different successional stages. Here we quantify successional habitat specialization in Neotropical forest trees and evaluate its evolutionary lability along a precipitation gradient. Theoretically, successional habitat specialization should be more evolutionarily conserved in wet forests than in dry forests due to more extreme microenvironmental differentiation between early and late-successional stages in wet forest. We applied a robust multinomial classification model to samples of primary and secondary forest trees from 14 Neotropical lowland forest sites spanning a precipitation gradient from 788 to 4000 mm annual rainfall, identifying species that are old-growth specialists and secondary forest specialists in each site. We constructed phylogenies for the classified taxa at each site and for the entire set of classified taxa and tested whether successional habitat specialization is phylogenetically conserved. We further investigated differences in the functional traits of species specializing in secondary vs. old-growth forest along the precipitation gradient, expecting different trait associations with secondary forest specialists in wet vs. dry forests since water availability is more limiting in dry forests and light availability more limiting in wet forests. Successional habitat specialization is non-randomly distributed in the angiosperm phylogeny, with a tendency towards phylogenetic conservatism overall and a trend towards stronger conservatism in wet forests than in dry forests. However, the specialists come from all the major branches of the angiosperm phylogeny, and very few functional traits showed any consistent relationships with successional habitat specialization in either wet or dry forests. Synthesis. The niche conservatism evident in the habitat specialization of Neotropical trees suggests a role for radiation into different successional habitats in the evolution of species-rich genera, though the diversity of functional traits that lead to success in different successional habitats complicates analyses at the community scale. Examining the distribution of particular lineages with respect to successional gradients may provide more insight into the role of successional habitat specialization in the evolution of species-rich taxa.

Environmental enrichment produces changes in spontaneous and psychostimulant-induced motor activity. Dopamine in the prefrontal cortex (PFC), through the activation of D1 receptors, has been suggested to play a role in modulating motor activity. The present study investigated the effects of environmental enrichment on spontaneous motor activity, prefrontal acetylcholine release following local D1 receptor stimulation and D1 receptor expression in the PFC. Male wistar rats (3 months of age) were housed in enriched or isolated conditions during 90 days. Animals were then implanted with guide cannulae to perform microdialysis experiments in the PFC. Spontaneous motor activity and acetylcholine extracellular concentrations were monitored simultaneously. Also spontaneous motor activity was measured in an open field. On completion of the experiments, the density of D1 receptors in the PFC was studied by immunocytochemistry. Rats housed in an enriched environment showed significantly lower spontaneous motor activity in the open field compared to isolated animals. Perfusion of the D1 agonist SKF38393 (50 microM; 40 min) in the PFC produced long lasting increases of spontaneous motor activity and of local dialysate concentrations of acetylcholine in both groups of rats. However, increases of both motor activity and acetylcholine concentrations were significantly lower in enriched compared to isolated animals. Moreover, the density of D1 receptors in the PFC was significantly reduced in animals housed in an enriched environment. These results are the first evidence suggesting that environmental enrichment during adult life changes the function of D1 dopamine receptors in the PFC.

The aim of the present study was to investigate the effects of stimulation of D2 receptors in the prefrontal cortex (PFC) on spontaneous motor activity and the hyperactivity induced by the psychomimetic phencyclidine (PCP). In addition, the effects of prefrontal D2 stimulation under PCP treatment on dialysate concentrations of acetylcholine, choline, dopamine, DOPAC and HVA in the nucleus accumbens were also investigated. Sprague-Dawley male rats were implanted with guide cannulae to perform bilateral injections into the medial PFC of the D2 agonist quinpirole (1.5 and 5 microg/side). Horizontal and vertical spontaneous motor activity and the motor activity induced by systemic injections of the PCP (5 mg/kg i.p.) were monitored in the open field. PFC injections of quinpirole (1.5 and 5 microg/side) significantly decreased horizontal and vertical spontaneous motor activity in a dose-related manner. These effects were blocked by the D2 antagonist raclopride (5 microg/side). Microinjections of quinpirole (1.5 and 5 microg/side) into the PFC also significantly attenuated the hyperactivity produced by PCP (5 mg/kg i.p.). PCP also increased dialysate concentrations of acetylcholine, and dopamine metabolites in the nucleus accumbens. These increases were also reduced by injections of quinpirole (5 microg/side) into the PFC. These results suggest that the stimulation of prefrontal D2 receptors plays an inhibitory role in regulating spontaneous and PCP-induced motor activity and also in the neurochemical changes produced by PCP in the nucleus accumbens.

In the context of the in vivo neurochemical literature this article reviews some recent microdialysis studies in our laboratory of glutamate-dopamine interaction in the prefrontal cortex (PFC) and its possible role in modulating dopamine and acetylcholine release in the nucleus accumbens. A functional glutamate-dopamine interaction in PFC has been reported by microdialysis studies showing that both stimulation and blockade of prefrontal glutamate receptors produce changes of basal and/or stimulated release of dopamine in this area of the brain. These studies suggest that dopamine function in PFC is modulated locally by prefrontal glutamatergic inputs and that glutamate and dopamine can act simultaneously to regulate GABA release in PFC. In particular, dopamine can enhance the increases of extracellular GABA produced by the stimulation of prefrontal glutamate receptors. We report also that the stimulation of prefrontal D2 and mGluI receptors and their interaction changes the release of dopamine and acetylcholine in the nucleus accumbens.

Background and Aim. Helicobacter pylori is the major cause of peptic ulcer disease, but the proportion of H. pylori-negative peptic ulcers seems to be increasing in developed countries. We investigated the frequency of H. pylori-negative peptic ulcer without intake of nonsteroidal anti-inflammatory drugs (NSAIDs) in a Mediterranean European country. Materials and Methods. We prospectively collected consecutive patients with an endoscopically verified active peptic ulcer over 6 months from different areas of Spain. Helicobacter pylori infection was assessed by rapid urease test and histologic examination (corpus and antral biopsies). A 13C-urea breath test was performed if H. pylori was not detected with the invasive test. Patients were considered H. pylori-negative if all three tests were negative. NSAID use was determined by structured data collection. Results. Of 754 consecutive peptic ulcer patients, 16 (2.1%) were H. pylori-negative and had not used NSAIDs before the diagnosis. Of the 472 patients who had duodenal ulcers, 95.7% (n = 452) were H. pylori-positive and only 1.69% (n = 8) were negative for both H. pylori infection and NSAID use; 193 patients had benign gastric ulcers and 87% (n = 168) of them were infected by H. pylori (p