As principais complicações em cirurgias plásticas em pacientes pós-bariátrica: Uma revisão integrativa da literatura / The main complications in plastic surgery in post-bariatric patients: An integrative review of the literature

Introdução: As intervenções cirúrgicas pós-bariátricas vêm se tornando cada vez mais frequentes e englobam a abdominoplastia, a cirurgia plástica interna da coxa, a braquioplastia e a mastopexia. Porém, devido ao caráter disabsortivo e restritivo do paciente bariátrico, esse estudo tem como objetivo apresentar as complicações advindas de procedimentos estéticos realizados nestes pacientes, expondo os fatores de risco mais associados às sequelas e levantando opções para um melhor desfecho. Método: Foi realizada uma revisão integrativa da literatura, de caráter qualitativo, segundo a pergunta norteadora: "Quais as principais complicações em cirurgias plásticas realizadas em pacientes bariatricados?". A busca foi realizada nas plataformas Biblioteca Virtual de Saúde (BVS) e PubMed. Os artigos incluídos no estudo foram analisados pelo método de conteúdo. Resultados: No total foram incluídos 6 artigos, nos quais observou-se que as principais complicações de cirurgias de contorno corporal, tais como a abdominoplastia e a braquioplastia, em pacientes bariatricados foram, principalmente, deiscência de feridas, seromas e hematomas, complicações, essas, relacionadas principalmente ao índice de massa corporal (IMC) do paciente, às suas comorbidades e ao tabagismo. Conclusão: Percebe-se, hoje, uma maior demanda pelas cirurgias plásticas reparadoras pósbariátrica, principalmente pela abdominoplastia. Consequentemente, houve, também, um aumento no número de complicações intraoperatórias, destacando-se o seroma e a deiscência de feridas. Para amenizá-las, a melhor solução é trabalhar no controle de fatores de risco pré-operatórios do paciente, tais como o IMC elevado e o tabagismo, além de comorbidades que levam à deficiência de cicatrização.

Introduction: Post-bariatric surgical interventions have become increasingly frequent, including abdominoplasty, inner thigh plastic surgery, brachioplasty, and mastopexy. However, due to bariatric patients' malabsorptive and restrictive nature, this study aims to present complications arising from aesthetic procedures performed on these patients, exposing the risk factors most associated with sequelae and raising options for a better outcome. Method: An integrative qualitative literature review was carried out according to the guiding question: "What are the main complications in plastic surgeries performed on bariatric patients?". The search was conducted on the Biblioteca Virtual de Saúde (BVS) and PubMed platforms. The articles included in the study were analyzed using the content method. Results: In total, 6 articles were included, in which it was observed that the main complications of body contouring surgeries, such as abdominoplasty and brachioplasty, in bariatric patients were mainly wound dehiscence, seromas and hematomas, complications, these, mainly related to the patient's body mass index (BMI), their comorbidities and smoking. Conclusion: Today, there is a greater demand for post-bariatric reconstructive plastic surgery, especially abdominoplasty. Consequently, there was also an increase in intraoperative complications, notably seroma and wound dehiscence. To alleviate them, the best solution is to work on controlling the patient's preoperative risk factors, such as high BMI and smoking, as well as comorbidities that lead to poor healing.

Risk of Developing Seizures in Children With Abnormal EEG Findings During Polysomnography.

BACKGROUND: Polysomnography (PSG) utilizes abbreviated electroencephalogram (EEG) to stage sleep. The aim of this study was to determine whether epileptiform abnormalities on this limited EEG coverage correlated with abnormalities on routine EEG (rEEG) and an increased risk for seizures in children without a prior diagnosis of epilepsy. METHODS: A six-year retrospective chart review was performed assessing children with abnormalities on EEG during PSG. Children who underwent subsequent rEEG were included; children with a prior diagnosis of seizures were excluded. The main outcome measures were rEEG results and subsequent diagnosis of epilepsy. RESULTS: A total of 67 children met inclusion criteria. Average age was six years, and 43 (64%) were male. rEEG was normal in 16 (24%). Epileptiform abnormalities were focal in 36 (54%), generalized in eight (12%), and mixed in five (8%). An additional two (3%) had slow background rhythm without epileptiform discharges. Thirty-one patients had neurology clinic follow-up with an average duration of 31 months (range 4 to 65 months). Of these, nine (29%) developed seizures, including all three with generalized epileptiform discharges, four of 19 (21%) with focal epileptiform discharges, and two of five (40%) with mixed epileptiform discharges or background slowing. None of the four patients with a normal rEEG had seizures. Eight of the nine patients with seizures were treated with antiepileptic drugs. CONCLUSIONS: Children with no history of seizures found to have abnormal EEG during PSG are likely to have an abnormal rEEG. Additionally, they have an increased risk for developing seizures.

Síndrome autoimune induzida por adjuvantes (ASIA) sinais e sintomas experienciados por mulheres / Implementation of an intravenous therapy team based on convergent-assistance research / Síndrome autoinmune inducido por adyuvante (ASIA) signos y síntomas experimentados por mujeres

Objetivo: Identificar sinais e sintomas experienciados por mulheres com síndrome autoimune induzida por adjuvantes (ASIA) devido ao uso de prótese mamária e os tratamentos realizados. Método: Estudo de campo de abordagem qualitativa realizado por meio de entrevistas online utilizan-do-se a técnica bola de neve. Incluíram-se 13 participantes. Resultados: A partir da análise dos dados, foram elencadas quatro categorias: conhecimento acerca da síndrome; sinais e sintomas; tratamento; e cuidados e implicações de Enfermagem. Identificaram-se mais de 120 sinais e sintomas, e o explante foi mencionado como tratamento definitivo por todas as entrevistadas. Os sinais e sintomas apresentados pelas participantes vão ao encontro do que é descrito pela literatura. Conclusão: Antes da descoberta da doença, as participantes realizaram tratamento com foco no alívio dos sintomas. Após o diag-nóstico, todas as mulheres procederam com o explante

Objective: To identify signs and symptoms experienced by women with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) due to the use of breast implants and the treatments performed. Method: Field study with a qualitative approach carried out through online interviews using the snowball technique. 13 participants were included. Results: Based on data analysis, four categories were listed: knowledge about the syndrome; signs and symptoms; treatment; and nursing care and implications. Over 120 signs and symptoms were identified, and the explant was mentioned as a defi-nitive treatment by all interviewees. The signs and symptoms presented by the participants are in line with what is described in the literature. Conclusion:Before discovering the disease, the participants underwent treatment focused on symptom relief. After diagnosis, all women proceeded with the explant.Keywords: Autoimmune diseases. Prothesis implantation. Breast implantation. Silicones. Perioperative nursing

Objetivo: Identificar los signos y síntomas experimentados por mujeres con síndrome autoinmune inducido por adyuvantes (ASIA) debido al uso de implantes mamarios y los tratamientos realizados. Método: Estudio de campo con enfoque cualitativo realizado a través de entrevistas en línea utilizando la técnica de bola de nieve. Se incluyeron 13 participantes. Resultados: Con base en el análisis de los datos, se enumeraron cuatro categorías: conocimiento sobre el síndrome; signos y síntomas; tratamiento; y cuidados e implicaciones de enfermería. Se identificaron más de 120 signos y sínto-mas, y todos los entrevistados mencionaron el explante como tratamiento definitivo. Los signos y síntomas presentados por los participantes están en línea con lo descrito en la literatura. Conclusión: Antes de descubrir la enfermedad, los participantes realizaban un tratamiento enfocado en el alivio de los síntomas. Después del diagnóstico, todas las mujeres procedieron al explante

L-carnitine solution used on Rhamdia quelen thawed sperm activation boosts sperm movement, maintains larval quality, and permits to optimize the sperm use.

The activation of cryopreserved sperm with solutions containing L-carnitine can improve sperm quality after thawing, owing to its involvement in several metabolic pathways. Sperm movement and viability for fertilization, hatching, and larval normality were assessed in Rhamdia quelen thawed sperm activated with L-carnitine solutions. Sperm from 24 males were cryopreserved in 0.25 mL straws. After thawing, the sperm movement was assessed by CASA (Computer-Assisted Sperm Analysis) in samples activated with distilled water containing 0.0 (control), 47.8, 96.2, 144.5, 192.3, and 240.7 mM L-carnitine, and another one with 79.9 mM D-fructose (control). Sperms from another 24 males were cryopreserved in an identical manner and used in the fertilization assays. Considering the sperm movement, fertilization assays were carried out using 0.0, 96.2, and 144.5 mM L-carnitine, and 79.9 mM D-fructose solutions. Greater motility and velocity were achieved with 144.5 mM L-carnitine at 28 and 18 s after activation, respectively. Linearity was not affected by time. The greater mean motility was provided by 144.5 mM as well as the greater mean velocity and linearity by 192.3 mM L-carnitine. Fertilization and hatching were not influenced; however, 144.5 mM L-carnitine and 79.9 mM D-fructose solutions produced more normal larvae. In summary, the L-carnitine solution increased sperm movement and maintained larval quality and production, similar to a conventional fructose activation solution.

Standard CPR versus interposed abdominal compression CPR in shunted single ventricle patients: comparison using a lumped parameter mathematical model.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) in the shunted single-ventricle population is associated with poor outcomes. Interposed abdominal compression-cardiopulmonary resuscitation, or IAC-CPR, is an adjunct to standard CPR in which pressure is applied to the abdomen during the recoil phase of chest compressions. METHODS: A lumped parameter model that represents heart chambers and blood vessels as resistors and capacitors was used to simulate blood flow in both Blalock-Taussig-Thomas and Sano circulations. For standard CPR, a prescribed external pressure waveform was applied to the heart chambers and great vessels to simulate chest compressions. IAC-CPR was modelled by adding phasic compression pressure to the abdominal aorta. Differential equations for the model were solved by a Runge-Kutta method. RESULTS: In the Blalock-Taussig-Thomas model, mean pulmonary blood flow during IAC-CPR was 30% higher than during standard CPR; cardiac output increased 21%, diastolic blood pressure 16%, systolic blood pressure 8%, coronary perfusion pressure 17%, and coronary blood flow 17%. In the Sano model, pulmonary blood flow during IAC-CPR increased 150%, whereas cardiac output was improved by 13%, diastolic blood pressure 18%, systolic blood pressure 8%, coronary perfusion pressure 15%, and coronary blood flow 14%. CONCLUSIONS: In this model, IAC-CPR confers significant advantage over standard CPR with respect to pulmonary blood flow, cardiac output, blood pressure, coronary perfusion pressure, and coronary blood flow. These results support the notion that single-ventricle paediatric patients may benefit from adjunctive resuscitation techniques, and underscores the need for an in-vivo trial of IAC-CPR in children.

A Case Report of Myelopathy Following Heroin Overdose in a Child.

Neurologic complications secondary to heroin abuse in the adult population have been widely described in the literature. With the recent opioid epidemic and increasing rates of heroin abuse in adolescents, pediatricians are now encountering the diagnostic and management challenge of similar complications in children. We report a case of a 16-year-old girl who presented with complete paraplegia after a heroin overdose. Spinal magnetic resonance imaging showed diffuse thoracic spinal cord abnormalities. She rapidly recovered after high dose intravenous corticosteroids and, upon hospital discharge 2 weeks later, required minimal assistance with ambulation. This case represents the youngest patient reported with the rare complication of myelopathy associated with heroin use.

Epidermal growth factor receptor signaling uncouples germ cells from the somatic follicular compartment at ovulation.

Germ cells are physically coupled to somatic support cells of the gonad during differentiation, but this coupling must be disrupted when they are mature, freeing them to participate in fertilization. In mammalian females, coupling occurs via specialized filopodia that project from the ovarian follicular granulosa cells to the oocyte. Here, we show that signaling through the epidermal growth factor receptor (EGFR) in the granulosa, which becomes activated at ovulation, uncouples the germ and somatic cells by triggering a massive and temporally synchronized retraction of the filopodia. Although EGFR signaling triggers meiotic maturation of the oocyte, filopodial retraction is independent of the germ cell state, being regulated solely within the somatic compartment, where it requires ERK-dependent calpain-mediated loss of filopodia-oocyte adhesion followed by Arp2/3-mediated filopodial shortening. By uncovering the mechanism regulating germ-soma uncoupling at ovulation, our results open a path to improving oocyte quality in human and animal reproduction.

Mice born to females with oocyte-specific deletion of mitofusin 2 have increased weight gain and impaired glucose homeostasis.

Offspring born to obese and diabetic mothers are prone to metabolic diseases, a phenotype that has been linked to mitochondrial dysfunction and endoplasmic reticulum (ER) stress in oocytes. In addition, metabolic diseases impact the architecture and function of mitochondria-ER contact sites (MERCs), changes which associate with mitofusin 2 (MFN2) repression in muscle, liver and hypothalamic neurons. MFN2 is a potent modulator of mitochondrial metabolism and insulin signaling, with a key role in mitochondrial dynamics and tethering with the ER. Here, we investigated whether offspring born to mice with MFN2-deficient oocytes are prone to obesity and diabetes. Deletion of Mfn2 in oocytes resulted in a profound transcriptomic change, with evidence of impaired mitochondrial and ER function. Moreover, offspring born to females with oocyte-specific deletion of Mfn2 presented increased weight gain and glucose intolerance. This abnormal phenotype was linked to decreased insulinemia and defective insulin signaling, but not mitochondrial and ER defects in offspring liver and skeletal muscle. In conclusion, this study suggests a link between disrupted mitochondrial/ER function in oocytes and increased risk of metabolic diseases in the progeny. Future studies should determine whether MERC architecture and function are altered in oocytes from obese females, which might contribute toward transgenerational transmission of metabolic diseases.

Melaleuca leucadendron (L.) L. flower extract exhibits antioxidant and photoprotective activities in human keratinocytes exposed to ultraviolet B radiation.

Recently, there has been a demand for the replacement of chemical sunscreens with natural compounds that could prevent or restore UV-induced skin damage. Here, we investigated the photoprotective influence of the Melaleuca leucadendron ethanolic flower extract (EEMec) on factors involved in cellular and molecular UVB-induced oxidative stress in human skin keratinocytes (HaCaT). The phytochemical constituents, antioxidant potential by DPPH assay, content of total phenolic and flavonoid compounds in EEMec were evaluated. HaCaT cells were treated with EEMec followed by irradiation with UVB. CAT activity; GSH and ROS levels; and SOD1, GPx, CAT and COX-2 expression assays were employed to verify the oxidative stress, as well as EEMec effect on transmembrane transport, and pro-inflammatory and pro-apoptotic protein expression. EEMec reverted the viability loss of HaCaT cells after irradiation with UVB, exhibited significant antioxidant capacity and free radical scavenging activity in vitro, inhibited COX-2 expression and ensure protection of DNA-damage. EEMec shown a great photoprotective property to prevent keratinocytes damage induced by UV radiation and, thus a candidate potential to application as an adjuvant in sunscreen formulations as a strategy to reduce risk of sunburn and prevent skin diseases associated with UV-induced inflammation and cancer.

Mitofusin 1 is required for oocyte growth and communication with follicular somatic cells.

Mitochondrial function, largely regulated by the dynamics of this organelle, is inextricably linked to the oocyte health. In comparison with most somatic cells, mitochondria in oocytes are smaller and rounder in appearance, suggesting limited fusion. The functional implications of this distinct morphology, and how changes in the mitochondrial shape translate to mitochondrial function in oogenesis is little understood. We, therefore, asked whether the pro-fusion proteins mitofusins 1 (MFN1) and 2 (MFN2) are required for the oocyte development. Here we show that oocyte-specific deletion of Mfn1, but not Mfn2, prevents the oocyte growth and ovulation due to a block in folliculogenesis. We pinpoint the loss of oocyte growth and ovulation to impaired PI3K-Akt signaling and disrupted oocyte-somatic cell communication. In support, the double loss of Mfn1 and Mfn2 partially rescues the impaired PI3K-Akt signaling and defects in oocyte development secondary to the single loss of Mfn1. Together, this work demonstrates that the mitochondrial function influences the cellular signaling during the oocyte development, and highlights the importance of distinct, nonredundant roles of MFN1 and MFN2 in oogenesis.

Safety and Efficacy of Brivaracetam in Pediatric Refractory Epilepsy: A Single-Center Clinical Experience.

Brivaracetam is a new antiepileptic drug with limited data in children. The objective of this study was to assess the efficacy/tolerability of brivaracetam. This is a retrospective chart review of children/adolescents with refractory epilepsy treated with brivaracetam from 2016 to 2018. The primary outcome was seizure reduction (decrease in seizure frequency >50%). Twenty-three patients were identified. Mean age at initiation was 12.5 years. Fourteen were females. Epilepsy was focal in 11, generalized in 6, and mixed in 3. Average dose was 3.9 mg/kg/d. The mean duration of treatment was 8.2 months. Eight had greater than 50% decrease in seizure frequency, of which 7 had focal epilepsy, and 1 had Lennox-Gastaut/mixed epilepsy. Two had drowsiness and 3 behavioral complaints. One experienced tingling and dizziness. Our retrospective review suggests that brivaracetam is an effective therapy for refractory focal epilepsy in children older than 4 years of age.

Effect of the gradual increase of salt on stability and microbial diversity of granular sludge and ammonia removal.

Two sequential batch reactors were operated, aiming at forming aerobic granular sludge and studying the effects of the gradual increase of the NaCl concentration on the granule. structure and microbial diversity, and on the efficiency of ammonia removal. The reactors were fed with ammonia-enriched synthetic effluent and 5 g L-1 of NaCl per week were applied. A decrease in the size of the granules was observed until they were completely disintegrated as the salt concentration increased up to 10 g L-1. However, the ammonia removal efficiency remained high in all the salinities applied. By sequencing the 16S rRNA amplicon gene, the microbial community structure allowed the verification of the presence of several genera affiliated with the bacteria that perform both heterotrophic nitrification and aerobic denitrification, besides those involved in the conventional nitrification and denitrification and the ANAMMOX process. Salinity affected the microbial population related to the formation and stability of the granules.

Functionalized rifampicin-loaded nanostructured lipid carriers enhance macrophages uptake and antimycobacterial activity.

Tuberculosis is an infectious bacterial disease that causes millions of deaths worldwide. Current treatment recommended by WHO is effective, however it is an extensive and arduous process associated to severe adverse effects, which induces a low patient compliance and the emerging of multidrug resistant tuberculosis. Thus, as a main goal of this study, rifampicin nanoparticles were surface functionalized with a tuftsin-modifed peptide to selectively recognize receptors located on infected alveolar macrophages, enhancing nanoparticles uptake by these cells and improving antimycobacterial activity. A tuftsin-based modified peptide was synthesized and successfully attached to nanoparticles interface (NP-pRIF). In parallel, nanoparticles without peptide were also developed for comparison (NP-RIF). Physicochemical characterization demonstrated that stable and monodisperse nanodelivery systems were obtained, with a controlled drug release profile and non-cytotoxic potential. Moreover, nanoparticles containing peptide were significantly more internalized by macrophages than nanoparticles without peptide over a wide range of time. Both nanoparticles were 2-fold more effective against M. tuberculosis than free rifampicin, suggesting NP-pRIF as a promising strategy for the management of tuberculosis treatment.

Equipe de enfermagem e complexidades do cuidado no processo de morte-morrer / Nursing team and the complexities of care in in the death/dying process / Equipo de enfermería y complejidades del cuidado en el proceso de muerte-morir

Resumo Compreender como os trabalhadores da equipe de enfermagem se percebem na inter-relação complexa no cuidado ao indivíduo enfermo e seu familiar cuidador no processo de morte e morrer. Pesquisa qualitativa, desenvolvida em Hospital Universitário no período de março a junho de 2016, inspirada na metodologia de Leininger. Participaram 24 familiares cuidadores e 47 trabalhadores da equipe de enfermagem como informantes gerais, dos quais 18 como informantes-chave. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, cujo enfoque foi a autopercepção da equipe no referido processo, contemplando os obstáculos e a complexidade nessas inter-relações no ambiente hospitalar. Mediante análise, com base no referencial teórico da complexidade de Edgar Morin, destacam-se como principais obstáculos: a sobrecarga de trabalho, o despreparo do profissional e a falta de apoio institucional. Quanto à complexidade das relações, destacam-se questões relacionadas: à competência profissional do cuidado, às necessidades das famílias, à valorização dos trabalhadores e sua repercussão para a inter-relação com o indivíduo enfermo e familiar cuidador. Acredita-se que tal estudo poderá levar os profissionais de enfermagem a uma reflexão e avaliação do seu fazer diário em relação aos cuidados com os indivíduos em seu processo de morte e morrer e seu familiar cuidador.

Abstract To understand how the nursing team workers perceive themselves in the complex interrelationship in the care provided to the ill individual and their family member who acts as carer in the death/dying process. This qualitative research was conducted in a university hospital between March and June 2016 and inspired by the Leininger methodology. A total of 24 family members who were carers and 47 nursing team workers as general informants, 18 of which were key informants. Data collection was performed through semistructured interviews, whose focus was the self-perception of the team regarding the aforementioned process, contemplating the obstacles and the complexity of these interrelationships in the hospital setting. Through an analysis based on Edgar Morin's theoretical framework of complexity, the work overload, the lack of competence on the part of the professional, and the lack of institutional support stand out as the main obstacles. Regarding the complexity of the relationships, questions related to the professional competence regarding the care, the needs of the family, the appreciation of the workers and its repercussion to the interrelationship with the ill individual and their relative that acts as carer stand out. We believe this study can cause the nursing professional to reflect upon and assess their daily practices in relation to the care provided to the individuals in their death/dying process and to their relatives that act as carers.

Resumen Comprender como los trabajadores del equipo de enfermería se perciben en la interrelación compleja en el cuidado al individuo enfermo y su familiar cuidador en el proceso de muerte y morir. Estudio cualitativo, desarrollado en Hospital Universitario en el período de marzo a junio de 2016, inspirado en la metodología de Leininger. Participaron 24 familiares cuidadores y 47 trabajadores del equipo de enfermería como informantes generales, de los cuales 18 como informantes-clave. La obtención de datos fue realizada por medio de entrevistas semiestructuradas, cuyo enfoque fue la autopercepción del equipo en el referido proceso, contemplando los obstáculos y la complejidad en esas interrelaciones en el ambiente hospitalario. Mediante análisis, con base en el referencial teórico de la complejidad de Edgar Morin, se destacan como principales obstáculos: la sobrecarga de trabajo, la falta de preparación del profesional y la falta de apoyo institucional. En cuanto a la complejidad de las relaciones, se destacan cuestiones relacionadas: a la competencia profesional del cuidado, a las necesidades de las familias, a la valorización de los trabajadores y su repercusión para la interrelación con el individuo enfermo y familiar cuidador. Se cree que tal estudio podrá llevar a los profesionales de enfermería a una reflexión y evaluación de su rutina diaria en relación a los cuidados con los individuos en su proceso de muerte y morir y su familiar cuidador.

Tremors: Essential Tremor and Beyond.

Tremor is a fairly common movement disorder presenting to an outpatient pediatric neurology practice. Tremors can be primary or secondary to underlying neurologic or systemic diseases. When assessing a child with tremor, it is paramount to evaluate the phenomenology of the tremor, determine the presence or absence of other neurologic signs and symptoms, and the possible modifying influence of medications. Proper classification is essential for specific diagnosis and prompt adequate management. Treatment considerations should take into account objective assessment of tremor severity and the degree of disability or impairment experienced by the child. Overall effectiveness of pharmacologic treatments of tremor is unfortunately disappointing. In this article we review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the different forms of tremor is outlined, and treatment options are discussed.

A case report of hypersomnia in tetrasomy X improved with medical therapy.

Tetrasomy X is a rare chromosomal anomaly in which sleep disorders have not been previously reported. We report on one patient with tetrasomy X and hypersomnia successfully treated with psychostimulant therapy. Sleep disorders are rarely reported in chromosomal anomalies. Clinicians should screen patients for sleep disorders and manage them appropriately.

The role of mitochondria in the female germline: Implications to fertility and inheritance of mitochondrial diseases.

Mitochondria play a fundamental role during development of the female germline. They are fragmented, round, and small. Despite these characteristics suggesting that they are inactive, there is accumulating evidence that mitochondrial dysfunctions are a major cause of infertility and generation of aneuploidies in humans. In addition, mitochondria and their own genomes (mitochondrial DNA-mtDNA) may become damaged with time, which might be one reason why aging leads to infertility. As a result, mitochondria have been proposed as an important target for evaluating oocyte and embryo quality, and developing treatments for female infertility. On the other hand, mutations in mtDNA may cause mitochondrial dysfunctions, leading to severe diseases that affect 1 in 4,300 people. Moreover, very low levels of mutated mtDNA seem to be present in every person worldwide. These may increase with time and associate with late-onset degenerative diseases such as Parkinson disease, Alzheimer disease, and common cancers. Mutations in mtDNA are transmitted down the maternal lineage, following a poorly understood pattern of inheritance. Recent findings have indicated existence in the female germline of a purifying filter against deleterious mtDNA variants. Although the underlying mechanism of this filter is largely unknown, it has been suggested to rely on autophagic degradation of dysfunctional mitochondria or selective replication/transmission of non-deleterious variants. Thus, understanding the mechanisms regulating mitochondrial inheritance is important both to improve diagnosis and develop therapeutic tools for preventing transmission of mtDNA-encoded diseases.

Cost-Effectiveness of Evaluation of Children With Epilepsy in the Emergency Department: Need for Investment in Patient Education.

We aimed to study cost-effectiveness of seizure evaluation of children with epilepsy in the emergency department (ED). We reviewed epilepsy patients seen at our ED for 1 year. Age, laboratory and neuroimaging results, treatment, disposition, and usefulness of the visit (need for hospitalization, clinical improvement) were analyzed. We identified 330 patients, aged 23 days-21 years, 190 (57.5%) had blood tests, 45 (13.6%) urinalysis, 2 (0.6%) cerebrospinal fluid testing, and 44 neuroimaging studies (13.3%). Tests' positive yield were 41%, 11%, 0%, and 4.5%, respectively. One-third of patients (n = 122) were treated with antiepileptic drugs. Other treatments were administered to 44 (13.3%). One hundred eighteen patients (35.7%) were admitted to our hospital, 208 (63%) discharged to home. Two hundred eight visits were useful (63%). One-third of visits did not provide useful patient care. Their visits were expensive and not very cost-effective. Investment in patient education could decrease unnecessary ED visits.

Oocyte mitochondria: role on fertility and disease transmission.

Oocyte mitochondria are increased in number, smaller, and rounder in appearance than mitochondria in somatic cells. Moreover, mitochondrial numbers and activity are narrowly tied with oocyte quality because of the key role of mitochondria to oocyte maturation. During oocyte maturation, mitochondria display great mobility and cluster at specific sites to meet the high energy demand. Conversely, oocyte mitochondria are not required during early oogenesis as coupling with granulosa cells is sufficient to support gamete's needs. In part, this might be explained by the importance of protecting mitochondria from oxidative damage that result in mutations in mitochondrial DNA (mtDNA). Considering mitochondria are transmitted exclusively by the mother, oocytes with mtDNA mutations may lead to diseases in offspring. Thus, to counterbalance mutation expansion, the oocyte has developed specific mechanisms to filter out deleterious mtDNA molecules. Herein, we discuss the role of mitochondria on oocyte developmental potential and recent evidence supporting a purifying filter against deleterious mtDNA mutations in oocytes.