Stereological quantification of extraocular muscles in humans / Cuantificación estereológica de músculos extraoculares en humanos

SUMMARY: The aim of this study is to quantify muscular and connective tissue volumes of extraocular muscles (EOM) in humans with no ophthalmological disease using stereology. EOM from five cadaveric non-strabismic humans were obtained. The number of muscle fibers in 5,000 µm2 and volume density (Vv) of muscle and collagen were measured using stereology. Comparisons between antagonist EOM were conducted using Wilcoxon signed rank test for paired samples. A secondary analysis examining differences between pairs of EOM was also conducted. Bilateral tests were performed, and significance was set at 0.05. The horizontal rectus muscles (medial and lateral rectus) had the highest Vv of muscle and the lowest Vv of collagen. The inferior rectus muscle tended to have a fewer number of fibers per 5,000 µm2 than the rest of the EOM. However, these differences did not reach statistical significance. This is the first published study describing the normal histology of human EOM using stereology. Our investigation, through the quantification of the proportion of muscle and collagen tissue, as well as the number of muscle fibers in 5,000 µ2, establishes normal stereological parameters for EOM of humans without ophthalmological disease.

RESUMEN: El objetivo de este estudio es cuantificar el volumen de tejido muscular y conectivo de los músculos extraoculares en humanos sin enfermedad oftalmológica conocida utilizando estereología. Los músculos extraoculares fueron obtenidos de cinco cadáveres humanos sin estrabismo. El número de fibras musculares en 5.000 µm2 y la densidad de volumen (Vv) de músculo y colágeno fueron medidas usando estereología. Las comparaciones entre músculos extraoculares antagonistas se realizaron a través de la prueba de los rangos con signo de Wilcoxon para muestras pareadas. Un análisis secundario examinando diferencias entre pares de músculos extraoculares también fue llevado a cabo. Se realizaron pruebas bilaterales y la significancia fue fijada en 0,05. Los músculos rectos horizontales (recto medial y lateral) tuvieron el mayor Vv de músculo y el menor Vv de colágeno. El músculo recto inferior tuvo la tendencia a poseer menos número de fibras por 5.000 µm2 que el resto de los músculos extraoculares. No obstante, estas diferencias no llegaron a ser estadísticamente significativas. Este es el primer estudio publicado describiendo la histología normal de los músculos extraoculares usando estereología. Nuestra investigación, a través de la cuantificación de la proporción de tejido de músculo y colágeno, así como el número de fibras musculares en µm2, establece parámetros estereológicos normales para músculos extraoculares en humanos sin enfermedad oftalmológica.

Ecocardiograma transesofágico intraoperatorio: utilidad en reparación de cardiopatías congénitas / Intraoperative transesophagel echocardiogram: Usefulness in congenital heart defects repair

El control ecocardiográfico al momento de la reparación de las cardiopatías congénitas es una estrategia cardiológica para mejorar los resultados quirúrgicos de nuestros pacientes. En este artículo les contamos cómo es el método, qué información nos brinda y cómo influye en la toma de decisiones en el quirófano y en el manejo posoperatorio (AU)

Echocardiographic monitoring at the time of congenital heart defects repair is a strategy to improve the surgical outcomes of our patients. In this article we discuss the method, what information it provides, and how it influences decision-making in the operating room and postoperative management (AU)

Impacto de la cirugía cardiovascular precoz. Resultados en el Hospital Juan P. Garrahan / Impact of early cardiovascular surgery. Results at Hospital Juan P. Garrahan

Objetivos: Describir los resultados actuales en cirugía cardiovascular de pacientes portadores de cardiopatía congénita (CC) intervenidos con circulación extracorpórea (CEC) en menores de un año de vida. Métodos: Se incluyeron todos los pacientes operados de cirugía cardiovascular (CCV) en el Hospital de Pediatría Juan P. Garrahan en el periodo comprendido 2004-2017. Se analizaron los resultados actuales en términos de morbi-mortalidad de neonatos y lactantes menores de 1 año que requirieron cirugía precoz. Se excluyeron todos los pacientes operados que no requirieron cirugía con CEC y aquellos operados que ingresaron al Área de Neonatología. El análisis de mortalidad fue realizado por riesgo estratificado con la escala de RACHS-1. Los datos se obtuvieron de la base de datos de la Unidad de Recuperación Cardiovascular (UCI 35). Resultados: El número anual de pacientes intervenidos en cirugía cardiovascular ha presentado un incremento persistente desde sus comienzos. En el año 2004 se registraron 448 casos y a partir del año 2014, en forma persistente, los pacientes intervenidos superan las 500 cirugías anuales de cardiopatías. A inicios del 2004 el 75% de las cirugías totales eran con CEC, mostrando un ascenso significativo que alcanzo el 89% durante los últimos años. Los menores de 1 años representan más del 50% de las cirugías y en promedio un 15% son neonatos. También se evidenció un importante incremento de cirugías en cardiopatías más complejas, pero se mantuvo un número estable para aquellas cirugías de complejidad intermedia. En la escala RACHS-1, el 55% de las intervenciones correspondieron a un score >3 y más del 10% para categorías 5-6. La mortalidad global fue entre 5- 6% de las cirugías realizadas, y un 15% para la cirugía neonatal. El 10% de los fallecidos eran portadores de síndromes genéticos o presentaban asociación con otras malformaciones mayores. Conclusiones: Es notorio el incremento anual en frecuencia de patologías de mayor severidad que son enfrentadas en forma precoz logrando modificar la historia natural de las cardiopatías complejas. Aumenta el riesgo de morbimortalidad en CC asociadas a síndrome genético y condición clínica desfavorable pre quirúrgica. La intervención quirúrgica correctora precoz mejoraría los resultados en término de crecimiento y desarrollo del niño portador de CC (AU)

Objectives: To describe the current results in cardiovascular surgery of patients with congenital heart defects (CHD) who underwent extracorporeal membrane oxygenation (ECMO) support at less than one year of life. Methods: All patients who underwent cardiovascular surgery (CVS) at the Juan P. Garrahan Pediatric Hospital between 2004 and 2017 were included. Current results regarding morbidity and mortality in neonates and infants under 1 year who required early surgery were analyzed. Patients who did not require ECMO postoperatively and those admitted to the neonatal intensive care unit were excluded. Mortality analysis was performed stratified by risk using the RACHS-1 scale. Data were obtained from the Cardiovascular Recovery Unit (ICU 35) database. Results: The annual number of patients undergoing cardiovascular surgery has steadily increased since its beginning. In 2004, 448 cases were reported and as of 2014, yearly more than 500 patients undergo heart surgery. At the beginning of 2004, 75% of all surgeries were with ECMO, significantly increasing to 89% over the last few years. Children under 1 years of age account for more than 50% of surgeries and around 15% are neonates. A significant increase in surgeries in more complex heart disease was also evident, but a stable number was maintained for those surgeries of intermediate complexity. On the RACHS-1 scale, 55% of the interventions were score >3 and more than 10% were scores 5-6. Overall mortality was between 5-6% of all surgeries performed, and 15% for neonatal surgery. Of the children who died, 10% were carriers of genetic syndromes or had other major malformations. Conclusions: There was a remarkable yearly increase in frequency of more severe conditions that are managed early, modifying the natural history of complex heart disease. In CHD associated with a genetic syndrome and an unfavorable pre-surgical clinical condition the risk of morbidity and mortality is increased. Early surgical intervention may improve outcomes in terms of the growth and development of the child with CHD (AU)

Tissue talks: immunophenotype of cells infiltrating the graft explains histological findings and the benefits of belatacept at 10 years.

Previously, we found a substantial number of regulatory T cells (Tregs ) and fewer senescent and T helper type 17 (Th17) and a decrease in interstitial fibrosis (IF) in 12-month graft biopsies in belatacept versus cyclosporin (CNI)-treated patients [Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial (BENEFIT) study]. Seven years after kidney transplantation (KT), mean estimated glomerular filtration rate (eGFR), patient and graft survival were significantly higher with belatacept versus CNI treatment. The aim of this study was to determine whether the immunophenotypes of inflammatory and regulatory cell subsets infiltrating the grafts contribute to the BENEFIT's clinical findings a decade after KT. Twenty-three adult patients with functionally stable KT treated with belatacept and 10 treated with CNI were enrolled. Biopsies were analyzed by histomorphometry and immunohistochemistry for proliferation, senescence, apoptosis, inflammatory and regulatory cell markers in a blinded manner. Significantly lower percentages of inflammatory/fibrogenic cells [interleukin (IL)-22+ /Th17/Th2/M1 macrophages] were observed in patients treated with belatacept than in patients treated with CNI. By contrast, remarkably higher percentages of regulatory cells [Tregs /Bregs / plasmacytoid dendritic regulatory cells (pDCregs )/M2] were found in belatacept-treated patients than in CNI-treated patients. Conspicuously lower percentages of apoptosis and senescence and higher proliferation markers were found in belatacept-treated patients than in CNI-treated patients. Consequently, there was significantly more inflammation in the microvascular compartments as well as increased tubular atrophy and IF in CNI-treated patients. These findings strongly suggest that regulatory mechanisms, along with the absence of deleterious effects of CNI, contribute to the long-term graft histology and function stability in patients treated with belatacept.

Enhancement of VP6 immunogenicity and protective efficacy against rotavirus by VP2 in a genetic immunization.

VP2/VP6 virus like particles (VLPs) are very effective in inducing protection against the rotavirus infection in animal models. Individually, VP6 can also induce protection. However, there is no information about the immunogenicity of VP2. The aim of this work was to evaluate the efficacy of DNA vaccines codifying for VP2 or VP6, alone or combined, to induce protection against the rotavirus infection. Murine rotavirus VP2 and VP6 genes were cloned into the pcDNA3 vector. Adult BALB/c mice were inoculated three times by intramuscular (i.m.) injections with 100 or 200µg of pcDNA3-VP2 or pcDNA3-VP6 alone or co-administered with 100µg of pcDNA3-VP2/100µg of pcDNA3-VP6. Two weeks after the last inoculation, mice were challenged with the wild type murine rotavirus strain epizootic diarrhea of infant mice (EDIMwt). We found that both plasmids, pcDNA3-VP2 and pcDNA3-VP6, were able to induce rotavirus-specific serum antibodies, but not intestinal rotavirus-specific IgA; only 200µg of pcDNA3-VP6 induced 35% protection against the infection. A similar level of protection was found when mice were co-administered with 100µg of pcDNA3-VP2/100µg of pcDNA3-VP6 (1:1 ratio). However, the best protection (up to 58%) occurred when mice were inoculated with 10µg of pcDNA3-VP2/100µg of pcDNA3-VP6 (1:10 ratio). These results indicate that the DNA plasmid expressing VP6 is a better vaccine candidate that the one expressing VP2. However, when co-expressed, VP2 potentiates the immunogenicity and protective efficacy of VP6.

Pro- and anti-inflammatory cytokine gene single-nucleotide polymorphisms in inflammatory bowel disease.

Anti-inflammatory cytokines have an important role in disease, tumour and transplant processes. Alterations in the regulation of several cytokines have been implicated in a variety of inflammatory disorders, including IBD (inflammatory bowel disease) [Crohn's disease (CD) and ulcerative colitis (UC)]. Cytokine polymorphisms are also known to affect the level of gene expression. Thus, the aim of this study was to determine the relationship between cytokine polymorphisms and the IBD pathologies in a Spanish population. Polymorphisms analysis was performed using PCR-SSOP using a microbeads luminex assay. The following polymorphisms were determined: TNFα [-238G/A (rs361525) and -308G/A (rs1800629)], IFNγ [+874A/T (rs62559044)], TGFß [+869C/T (rs1982073) and +915G/C (rs1800471)], IL10 [-1082A/A (rs1800896), -592A/C (rs1800872), -819C/T (rs1800871)], IL6 [-174C/G (rs1800795)], IL12p40 [3'UTR -1188A/C (rs3212227)], IL1α [-889C/T (rs1800587)], IL1ß [-511C/T (rs1143634) and +3962C/T (rs1143633)], IL1R [Pst-1 1970C/T] and IL1RA [Mspa-1 11100C/T]. No statistical differences in TNFα, IFNγ, TGFß, IL10, IL6, IL1α, IL1ß, IL1R and IL1Ra genotypes and allele distributions between the IBD groups and healthy controls were found. However, we observed significant differences in the 3'UTR -1188A/C polymorphism of IL12p40. So -1188A allele was increased in patients with UC and the -1188C allele (high IL12p40 production) was increased in patients with CD with respect to controls. These data are in concordance with the fact that CD has been shown to be associated with a Th1 T-cell-mediated inflammation model and high IL12/IFNγ production at histological affected sites. These data suggest that cytokine polymorphisms in TNFα, IFNγ, TGFß, IL10, IL6 and IL1α, IL1ß, IL1R and IL1Ra cytokine gene do not seem to be relevant in IBD susceptibility and IL12p40 3'UTR -1188A/C polymorphism seems to be associated with a differential IBD development.

Higher reproductive success of small males and greater recruitment of large females may explain strong reversed sexual dimorphism (RSD) in the northern goshawk.

Reversed sexual dimorphism (RSD), which occurs when the female of a species is larger than the male, is the rule for most birds of prey but the exception among other bird and mammal species. The selective pressures that favour RSD are an intriguing issue in animal ecology. Despite the large number of hypotheses proposed to explain the evolution of RSD, there is still no consensus about the mechanisms involved and whether they act on one or both sexes, mainly because few intrapopulation studies have been undertaken and few raptor species have been investigated. Using the strongly size-dimorphic northern goshawk (Accipiter gentilis L.) as a model, we studied a population with one of the highest densities of breeding pairs reported in the literature in order to understand selective pressures that may favour RSD. We evaluated life-history processes, including recruitment of adult breeders and reproductive success, and we explored the mechanisms thought to act on each sex, including hunting efficiency, diet, body condition and mate choice. We found that smaller males produced more fledglings than larger ones, but there was no relationship between size and reproductive success for females. The mean body size of female breeders was larger than that of female fledglings, but male fledglings and breeders did not differ in size. Male body size was related to the type but not to the amount of prey captured during the nestling stage. We conclude that RSD may be favoured in this goshawk population because small males tend to enjoy higher reproductive success and large females greater recruitment. Our results do not support the hypotheses that evolutionary reduction in male size is driven by hunting efficiency, at least during the nestling stage, or the hypotheses that it is driven by greater recruitment. Our findings also suggest that increase in female size is driven by recruitment, rather than by reproductive success as previously postulated.

Transanal minimal invasive surgery for rectal lesions: should the defect be closed?

AIM: Transanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed. METHOD: Consecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied. RESULTS: Seventy-five patients (68% male) of mean age 67 (± 15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 ± 2.3 cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16). CONCLUSION: Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.

Assessment of the reproducibility of oligoclonal IgM band detection for its application in daily clinical practice.

BACKGROUND: The presence of oligoclonal IgM bands (OCMB) in cerebrospinal fluid (CSF) is an unfavourable prognostic marker in multiple sclerosis. There is no commercial test to investigate OCMB status. However, a sensitive and specific isoelectrofocusing (IEF) and western blot method was described. We aimed to study the inter-centre reproducibility of this technique, a necessary condition for a reliable test to be incorporated into clinical practice. METHODS: The presence of OCMB was analysed by IEF and western blot with prior reduction of pentameric IgM. We assayed the reproducibility of this test in a blinded multicentre study performed in 13 university hospitals. Paired-CSF and serum samples from 52 neurological patients were assayed at every centre. RESULTS: Global analysis rendered a concordance of 89.8% with a kappa value of 0.71. CONCLUSION: These data indicate that OCMB detection by means of IEF and western blot with IgM reduction shows a good interlaboratory reproducibility and thus can be used in daily clinical setting.

Tenosinovitis química de dedo medio por corticoides intraarticulares con evolución a síndrome compartimental en paciente con lupus eritematoso sistémico / Chemical tenosynovitis in middle finger after intra-articular corticosteroids infiltration evolving to compartment syndrome in a patient with systemic lupus erythematosus

Tenosynovitis is the inflammation of the tendon and synovial sheath. It is commonly affects hands and wrist. The etiology may be infectious or inflammatory. In patients with Systemic Lupus Erythematosus (SLE) the periarticular and tendinous commitment is frequent. Intra-articular corticosteroids (CO) are effective as adjuvant of the systemic therapy. Complications of use are infrequent. The case of a female patient is presented, 32 years old, with SLE and chronic renal failure secondary to lupus nephritis, chronic user of oral CO. She is infiltrates with intra-articular deposit betamethasone in metacarpal-phalangeal (MCP), because of articular edema. Twelve days later evolves with Compartment Syndrome (SC). Fasciotomy show findings compatible with chemical synovitis by betamethasone crystals. Currently there are quite few reports in the literature of CS with presentation in fingers. The diagnosis is mainly clinical. The common use of intra-articular CO is not without risk and should be planned and diagnosed early...

Tenosinovitis es la inflamación del tendón y vaina sinovial. Es más frecuente en manos y muñecas. Su etiología es infecciosa o inflamatoria. En pacientes con Lupus Eritematoso Sistémico (LES) el compromiso periarticular y tendíneo es frecuente. Los corticoides (CO) intraarticulares son efectivos como adyuvante de terapia sistémica. Las complicaciones de su uso son infrecuentes. Se presenta el caso de paciente sexo femenino, 32 años, con LES e insuficiencia renal crónica secundaria a nefropatía lúpica, usuaria de CO orales. Por edema articular se le infiltra betametasona de depósito intraarticular en metacarpo-falángica (MCF). Evoluciona doce días después con Síndrome Compartimental (SC). Durante la fasciotomía se evidencian hallazgos compatibles con sinovitis química por cristales de betametasona. Existe escaso reporte en la literatura de SC en dedos de la mano. El diagnóstico es principalmente clínico. El uso común de CO intraarticulares no está exento de riesgos y deben ser previstos y diagnosticados precozmente...

Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study.

OBJECTIVE: To determine the incidence of acute renal failure (ARF) in critically ill patients using the RIFLE and AKIN criteria. DESIGN: A prospective, multicenter observational study with a duration of one year from February 2010 was carried out. RIFLE and AKIN were employed using the urinary (UC) and creatinine criteria (CC) jointly and separately. SCOPE: Nine polyvalent Critical Care Units (CCUs) in Argentina. PATIENTS: A total of 627 critical patients over 18 years of age were admitted to the CCU for more than 48h. EXCLUSION CRITERIA: inability to quantify diuresis, surgical instrumentation of the urinary tract, and need for renal support therapy (RST). VARIABLES OF INTEREST: Calculated hourly diuresis (CHD) was used to apply the UC. RESULTS: The incidence of ARF was 69.4% and 51.8% according to RIFLE and AKIN, respectively. UC detected ARF in 59.5% of cases, while CC identified ARF in 34.7% (RIFLE) and 25.3% (AKIN). The mortality rate was 40.9% and 44.6% according to RIFLE and AKIN respectively, was significantly higher than in patients without ARF, and increased with disease severity (Data processing: Excel, SQL and SPSS. Levene test, comparison of means with Student t and chi-squared, with 95% confidence interval). CONCLUSIONS: RIFLE identified more cases of ARF. UC proved more effective than CC. The presence of ARF and severity levels were correlated to mortality but not to days of stay in the CCU. Implementation of the unified CHD was useful for implementing UC and achieving comparable results.

Transanal access for rectal tumors: the simultaneous use of a flexible endoscope and SILS.

The authors report that TEM with a single-incision laparoscopic surgery (SILS) port can be facilitated by the use of a colonoscope instead of a conventional laparoscopic camera. The colonoscope can be inserted through one of the SILS channels and has the added benefit of flexibility, insufflation, irrigation, suction, and an operative port.

Genetic polymorphisms of tumour necrosis factor alpha (TNF-α) promoter gene and response to TNF-α inhibitors in Spanish patients with inflammatory bowel disease.

Tumour necrosis factor alpha (TNF-α) has an important role in inflammatory response. Alterations in the regulation of TNF-α have been implicated in a variety of inflammatory disorders, including Inflammatory bowel disease (IBD). Indeed, a common treatment for IBD is the use of TNF-α inhibitors. Polymorphisms in the TNF-α promoter region are known to affect the level of gene expression. Our aim was to investigate the influence of these single nucleotide polymorphisms (SNPs) in TNF-α promoter gene play in the risk of IBD in a Spanish population and their individual response to anti-TNF-α treatment. DNA samples from patients with IBD and controls were screened for TNF-α -238G/A (rs361525) and -308G/A (rs1800629) SNPs by PCR-SSOP using a microbeads luminex assay and compared with response to TNF-α inhibitors. There were not statistical differences in -238G/A and -308G/A allele and genotype frequencies between patients. However, we found an increased frequency of -308A allele and -308GA genotype in these nonresponders patients to TNF-α inhibitors with respect to responders patients (Pc < 0.05). This -308GA genotype has been classified as high producer of this cytokine. This fact could actually be interesting to explain the different response of patients with IBD with respect to TNF-α inhibitors. TNF-α promoter gene polymorphism does not seem to play a role in IBD susceptibility, but particular TNF-α genotypes may be involved in the different responses to TNF-α inhibitor treatment in Spanish patients with IBD.

CD43 signals prepare human T cells to receive cytokine differentiation signals.

T cells are increasingly used for passive immunotherapy and bone marrow transplantation. Proper ex-vivo management of the cells is important for the desired therapeutic effects. For differentiation into effector cells of the Th1 and Th2 phenotypes, T-cells require signals from IFNγ and IL-4, respectively. Naïve cells have an extremely low expression of the specific receptors that recognize these cytokines, indicating that in order to differentiate, cells need to perceive other signals that will enable them to sense the cytokine milieu. CD43 has been proposed as one of the molecules that make the initial contacts with antigen presenting cells. We report here that in cord blood, adult naïve and total human T cells, CD43 signals induced the expression of both IFNγ and IL-4 receptors, mediate their capping, increased their signaling and augmented differentiation mediated by these receptors. CD43 signals also stimulated the expression of IFNγ and in neonatal cells that of IL-4 as well. These data demonstrate an important role for CD43 signals in T-cell preparedness for differentiation into effector cells.

Behavior and handling of physically and immunologically castrated market pigs on farm and going to market.

Physical castration is a common management practice on commercial swine farms in the United States to reduce the incidence of boar taint and aggressive behavior. One alternative to physical castration (PC) is to immunologically castrate (IC) male pigs by blocking the gonadotropin-releasing factor (GnRF), thereby reducing levels of LH, FSH, testosterone, and androstenone. The objectives of this study were to evaluate the effects of IC on pig behavior, human-pig interactions, and handling during and after transport. Pigs were given the first immunization at wk 7 of the grower-finisher period, and second immunizations were given at wk 11, 13, or 14 of the grower-finisher period. Behaviors of PC and IC barrows were sampled at 3 time points after entering finishing at 9 wk of age: 7 wk before first injection, 16 wk (after immunization was complete) into finishing, and 1 d before marketing (16 to 19 wk into finishing). Handling during loading and unloading of trailers going to market was also quantified. Before the first injection, intact males showed increased aggression (P=0.014) and mounting (P=0.048), whereas PC barrows spent more (P=0.003) time feeding than intact males. There were treatment×time interactions for lying (P=0.018), aggression (P<0.001), and standing (P=0.009) behaviors. Few differences were observed in pig-human interactions between PC and IC barrows, with IC and PC approaching people in the same amount of time, but IC barrows were more (P<0.001) aggressive in chewing and rubbing on the test person's pant leg and boots. When handling and loading for processing in the home barn, PC barrows were more (P<0.05) vocal than IC barrows. Fewer dead and down pigs were observed among IC (0%) compared with PC barrows (1.17%). Immunological castration may result in similar or improved animal welfare compared to the stress of physical castration without pain relief.

Externación temprana y readmisiones hospitalarias en cirugía cardiovascular pediátrica / Early discharge and hospital readmission in pediatric cardiovascular surgery

Objetivo: describir una estrategia de externación temprana en cirugía cardíaca pediátrica e identificar factores de riesgo de readmisión hospitalaria dentro de los 30 días del procedimiento. Pacientes y métodos: Estudio descriptivo, retrospectivo de cohorte. Se incluyeron los pacientes operados de cardiopatía congénita, egresados vivos en 2010. Se registraron edad, peso, diagnóstico, tipo de cirugía, días de internación, egreso directo de UCI o pase a sala, y readmisiones. Se consideró externación temprana cuando la estadía hospitalaria fue igual o menor de 5 días a partir del procedimiento quirúrgico. Se consideraron factores de riesgo de readmisión: edad < 6 meses, peso < 5 Kg., cirugía previa y síndrome genético. Se compararon las readmisiones de los egresos tempranos, con el total de egresos y se realizó un análisis de factores de riesgo. Resultados: En el periodo definido 327 pacientes egresaron vivos. El 47% (154) dentro de los 5 días de la cirugía, 141 con egreso directo de UCI y 13 pasaron a la sala. Los pacientes con externación temprana fueron de mayor edad y peso que la mediana general y con cirugías de menor complejidad. Reingresaron 40 pacientes (12%), no hubo diferencias entre las readmisiones de los egresos tempranos y el total de egresos; ni entre egresos directos o pases a la sala. La principal causa de readmisión fue fiebre sin foco (33%), seguida de infección de herida quirúrgica. Ningún paciente tuvo eventos de gravedad o falleció en la reinternación. No se encontraron factores de riesgo asociados a readmisión. Conclusión: un protocolo de externación temprana en cirugía cardíaca pediátrica permite reducir la estancia hospitalaria, sin mayor frecuencia de readmisiones, ni eventos de gravedad durante las mismas (AU)

Objective: To describe a strategy for early discharge in pediatric heart surgery and identify risk factors for readmission to the hospital within 30 days of the procedure. Patients and methods: A descriptive, retrospective cohort study was conducted. Patients who underwent surgery for congenital heart disease discharged alive in 2010 were included in the study. Age, diagnosis, weight, type of surgery, days of hospital stay, discharge directly from the ICU or transfer to the ward, and readmissions were recorded. Early discharge was defined as a hospital stay of 5 days or less after the surgical procedure. The following risk factors for readmission were considered: age < 6 months, weight < 5 kg, previous surgery, and genetic syndrome. Readmission rate after early discharge was compared to the total discharge rate and a risk factor analysis was performed. Results: Over the study period 327 patients were discharged alive. Overall 47% (154) was discharged within 5 days of surgery; 141 were discharged directly from the ICU and 13 were transferred to the ward. Patients that were discharged early were older and weighed more than the general population and they had undergone less complex surgeries. Forty patients (12%) were readmitted. No differences were found in readmissions between early discharges and total discharges or between discharges directly from the ICU or transfers to the ward. The main cause of readmission was fever without a focus (33%) followed by surgical wound infection. None of the patients had severe adverse events or died during in-hospital stay. No risk factors associated with readmission were found. Conclusion: A protocol of early discharge in pediatric heart surgery allows to reduce hospital stay without increasing the rate of readmissions or severe adverse events (AU)

Estudio morfométrico de las suturas palatinas humanas en recién nacidos, infantes y niños con fines de tratamiento por distracción osteogénica / Morphometrical study of human palatine sutures in newborns, infants and children for distraction osteogenesis treatment purposes

El conocimiento estructural y dimensional de las suturas palatinas es necesario para el tratamiento temprano de deficiencias transversales y longitudinales por técnicas de expansión o distracción osteogénica (DO). El objetivo fue estudiar el estado de las suturas palatinas y los cambios cambios dimensionales y morfológicos desde el nacimiento a la niñez. Fueron analizados 41 paladares óseos de ambos sexos entre 0 y 13 años, agrupándolos en recién nacidos (RN/n=17), infantes (IN/n=12) y niños (NI/n=12). Se fotografió cada paladar y se marcaron puntos craneométricos para determinar las dimensiones longitudinales y transversales de las suturas palatinas mediana premaxilar (SPPMX), mediana anterior (SPMA), posterior (SPMP), transversa anterior (SPTA) y transversa posterior (SPTP). Además se evaluó el estado sutural y dimorfismo sexual. Los resultados se sometieron a las pruebas OneWay-ANOVA, Bonferroni y t-test. Las suturas SPMA, SPMP y SPTP no presentaron sinostosis. La SPPMX se observo parcialmente sinostosada en 5,9 por ciento de RN y 16,7 por ciento de NI, y la SPTA en 8,3 por ciento de IN y 41,7 por ciento de NI. Al comparar la longitud sutural en los tres grupos, las dimensiones longitudinales estadísticamente significativas en todos los grupos (p<0,001). No hubieron diferencias en las suturas transversales entre IN y NI (p=0,32). Se observó dimorfismo en IN entre las SPMA y SPTP. El sistema sutural palatino juega un rol importante durante el crecimiento por su disposición sagital y transversal, permitiendo un crecimiento bidireccional del paladar. El crecimiento longitudinal es constante, mientras que el transversal muestra un peak hasta los 2 primeros años de vida y luego disminuye, sugiriendo la existencia de diferentes potenciales de crecimiento. Estas observaciones podrían explicar la alta prevalencia de alteraciones de crecimiento transversal en los niños...

Structural and dimensional knowledge of palatal sutures are necessary for early treatment of deficiencies by transverse and longitudinal expansion techniques or distraction osteogenesis (DO). The aim was to study the status and dimensional or morphological changes of palatal sutures from birth to childhood. Forty one bony palates of both sexes, between 0 and 13 yearsandgrouped in newborns (NB/n = 17), infants (IN/n = 12) and children (CH/n=12) were analyzed. All palates were photographed and craniometrics points were scored to determine the longitudinal and transverse dimensions of the palatal sutures: premaxillary (PMX), anterior midpalatal suture (AMPS), posterior midpalatal suture (PMPS), anterior transverse palatal suture (ATPS) and posterior transverse palatal suture (PTPS). In addition, we evaluated the sutural and sexual dimorphism. The results were subjected to tests OneWay - ANOVAandBonferroni t-test. AMPS, PMPS and PTPS no showed synostosis. PMX was observed partially sinostosed in 5.9% of NB and 16.7% of CH, and ATPS in 8.3% of IN and 41.7% of CH. When comparing the sutural length between groups, the differences were significant in all cases (p <0.001). There were no differences in transverse sutures between IN and CH groups (p=0.32). Sexual dimorphism wasobserved between AMPS and PTPS groups. The palatal suture system plays an important role during growth by sagittal and transverse available, allowing bidirectional growth of the palate. Longitudinal growth is constant, while the cross shows a peak until the first 2 years of life and then decreases, suggesting the existence of different potentials growth. These observations may explain the high prevalence of abnormal transverse growth in children...