[Factors associated with prolonged hospital-stay after appendectomy during the SARS-CoV-2 pandemic]. / Faktory, svyazannye s dlitel'nym prebyvaniem v statsionare posle appendektomii vo vremya pandemii SARS-CoV-2.

OBJECTIVE: To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS: Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION: There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).

Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group.

Introduction: Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods: data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results: The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion: UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.

Data registration for multi-method qualification of additive manufactured components.

This work refines surface registration methods for metrological datasets to improve the multi-method qualification accuracy of additively manufactured (AM) lattices. Datasets acquired from X-ray computed tomography and a coordinate measurement machine of an AM lattice were aligned using derived geometry datum features based on a theoretical supplemental surface definition, which has been established in recent draft standards, but has had limited examination using complex AM structures. A refined sampling registration approach for lattice geometry based on spatially-dependent subsampling is derived and shown to statistically decrease variation between measurement sources. This importance of well-defined sampling practice and definition is highlighted. The applicability of this approach for multi-method qualification of complex AM parts is discussed. This work lays the foundation of utilizing specifications under consideration in a new standard with possible verification techniques that can be employed.

Estimulación cerebral profunda en el núcleo accumbens en pacientes con depresión resistente al tratamiento: reporte de casos / Nucleus accumbens deep brain stimulation in patients with treatment-resistant depression: report of four cases

INTRODUCCIÓN: La estimulación cerebral profunda (DBS) se ha propuesto como una alternativa terapéutica para el manejo de la depresión resistente al tratamiento (DRT). Sin embargo, existen múltiples blancos para neuroestimulación y se desconoce el punto neuroanatómico óptimo en esta patología. Como parte del circuito de recompensa, el núcleo accumbens (NAc) ha sido estudiado en modelos de depresión y anhedonia. El objetivo de este artículo fue describir la experiencia clínica de la implantación de electrodos bilaterales de DBS en el NAc. REPORTE DE CASOS: Se describe la experiencia en cuatro mujeres entre los 17 a 41 años con DRT. Los casos presentaban antecedente de múltiples hospitalizaciones e intentos de suicidio serios, a pesar de haber sido tratadas previamente con terapia farmacológica, psicoterapia y TECAR (Terapia electroconvulsiva con anestesia y relajación). A los 6 meses del inicio del DBS, se observó una mejoría de los síntomas depresivos en la escala de Hamilton y un incremento en la escala de funcionalidad global. La anhedonia y la abulia persistieron luego de la cirugía, aunque con menor intensidad. CONCLUSIÓN: La DBS del NAc puede ser una estrategia efectiva en el tratamiento de pacientes con DRT, impactando en la funcionalidad y en la disminución del riesgo suicida.

INTRODUCTION: Deep brain stimulation (DBS) has been proposed as a therapeutic alternative for Treatment-resistant depression (TRD) patients. However, there are multiple targets for neurostimulation and the optimal neuroanatomical landmark for this pathology is unknown. Nucleus accumbens (NAc) is a crucial part of the reward circuit and has been studied extensively in models of depression and anhedonia. The objective of this study was to describe our clinical experience with DBS of the NAc patients with TRD. CASE SERIES: It described the experience in four females between 17 and 41 years of age. All cases presented with a history of multiple hospitalizations and serious suicide attempts, despite having been treated with optimal pharmacological regimes, psychotherapy and ECT (Electroconvulsive therapy). Six months after the initiation of DBS, an improvement in the Hamilton Depression Scale and in the Global Assessment of Functioning Scale was observed. Anhedonia and abulia persisted after the surgery, although less severe. CONCLUSION: DBS of NAc seems to offer favorable surgical outcomes in patients with TRD, impacting functionality and suicidal risk.

Reassessing the clinical spectrum associated with hereditary leiomyomatosis and renal cell carcinoma syndrome in French FH mutation carriers.

We addressed uncertainties regarding hereditary leiomyomatosis and renal cell carcinoma (HLRCC) by exploring all French cases, representing the largest series to date. Fumarate hydratase (FH) germline testing was performed with Sanger sequencing and qPCR/MLPA. Enzyme activity was measured when necessary. We carried out whenever possible a pathology review of RCC and S-(2-succino)-cysteine (2SC)/fumarate hydratase immunohistochemistry. We estimated survival using non-parametric Kaplan-Meier. There were 182 cases from 114 families. Thirty-seven RCC were diagnosed in 34 carriers (19%) at a median age of 40. Among the 23 RCC with pathology review, 13 were papillary type 2. There were 4 papillary RCC of unspecified type, 3 unclassified, 2 tubulocystic, and 1 collecting duct (CD) RCC, all 2SC+ and most (8/10) FH-. Of the remaining 14, papillary type 2, papillary unspecified, CD, and clear cell histologies were reported. The vast majority of RCC (82%) were metastatic at diagnosis or rapidly became metastatic. Median survival for metastatic disease was 18 months (95%CI: 11-29). 133 cases (73%) had a history of cutaneous leiomyomas, 3 developed skin leiomyosarcoma. Uterine leiomyomas were frequent in women (77%), but no sarcomas were observed. Only 2 cases had pheochromocytomas/paraganglioma. CONCLUSION: Our findings have direct implications regarding the identification and management of HLRCC patients.

Chronic administration of thiamine pyrophosphate decreases age-related histological atrophic testicular changes and improves sexual behavior in male Wistar rats.

Aging is a multifactorial universal process and constitutes the most important risk factor for chronic-degenerative diseases. Although it is a natural process, pathological aging arises when these changes occur quickly and the body is not able to adapt. This is often associated with the generation of reactive oxygen species (ROS), inflammation, and a decrease in the endogenous antioxidant systems, constituting a physiopathological state commonly found in chronic-degenerative diseases. At the testicular level, aging is associated with tissue atrophy, decreased steroidogenesis and spermatogenesis, and sexual behavior disorders. This situation, in addition to the elevated generation of ROS in the testicular steroidogenesis, provides a critical cellular environment causing oxidative damage at diverse cellular levels. To assess the effects of a reduction in the levels of ROS, thiamine pyrophosphate (TPP) was chronically administered in senile Wistar rats. TPP causes an activation of intermediate metabolism routes, enhancing cellular respiration and decreasing the generation of ROS. Our results show an overall decrease of atrophic histological changes linked to aging, with higher levels of serum testosterone, sexual activity, and an increase in the levels of endogenous antioxidant enzymes in TPP-treated animals. These results suggest that TPP chronic administration decreases the progression of age-related atrophic changes by improving the intermediate metabolism, and by increasing the levels of antioxidant enzymes.

Role of hydrogen sulfide in the pain processing of non-diabetic and diabetic rats.

Hydrogen sulfide (H2S) is a gasotransmitter endogenously generated from the metabolism of L-cysteine by action of two main enzymes called cystathionine ß-synthase (CBS) and cystathionine γ-lyase (CSE). This gas has been involved in the pain processing and insulin resistance produced during diabetes development. However, there is no evidence about its participation in the peripheral neuropathy induced by this metabolic disorder. Experimental diabetes was induced by streptozotocin (50mg/kg, i.p.) in female Wistar rats. Streptozotocin injection increased formalin-evoked flinching in diabetic rats as compared to non-diabetic rats after 2 weeks. Peripheral administration of NaHS (an exogenous donor of H2S) and L-cysteine (an endogenous donor of H2S) dose-dependently increased flinching behavior in diabetic and non-diabetic rats. Contrariwise, hydroxylamine (HA, a CBS inhibitor) and DL-propargylglycine (PPG, a CSE inhibitor) decreased formalin-induced nociceptive behavior in both experimental groups. In addition, an ineffective dose of HA and PPG partially prevented the L-cysteine-induced hyperalgesia in diabetic and non-diabetic rats. Interestingly, HA and PPG were three order of magnitude more potent in diabetic rats respect to non-diabetic rats, whereas NaHS was ten times more potent in the streptozotocin-diabetic group. Nine to 11 weeks after diabetes induction, tactile allodynia was observed in the streptozotocin-injected rats. On this condition, subcutaneous administration of PPG or HA reduced tactile allodynia in diabetic rats. Paradoxically, H2S levels were decreased in nerve sciatic, dorsal root ganglion and spinal cord, but not paw nor blood plasma, during diabetes-associated peripheral neuropathy development. Collectively, results suggest that H2S synthesized by CBS and CSE participate in formalin-induced nociception in diabetic and non-diabetic rats, as well as; in tactile allodynia in streptozotocin-injected rats. In addition, data seems to indicate that diabetic rats are more sensible to H2S-induced hyperalgesia than normoglycemic rats.

Psychometric properties of the Perception of Teasing Scale in a Spanish adolescent sample: POTS-S.

The present study examines the psychometric properties of the Spanish version of the Perception of Teasing Scale (POTS-S). Participants were 1559 adolescents. They completed a translated version of the POTS and versions validated in Spanish population of the Rosenberg Self-Esteem Scale, the Body Dissatisfaction and Drive for Thinness subscales of the Eating Disorders Inventory-2, and the Children's Eating Attitudes Test. The results showed that the POTS-S retains the original structure of two factors, weight and competency, with satisfactory fit indices. The POTS-S constitutes a shorter questionnaire than the original version; specifically, it consists of 9 items instead of 11. The POTS-S showed good internal consistency and satisfactory test-retest stability. The relationship between the weight subscale and the variables related to eating and weight were statistically significant. As regards the competency subscale, the correlations were all lower than those for the weight subscale, except in the case of the self-esteem variable. The POTS-S showed good psychometric properties, indicating its suitability as an instrument for assessing the perception of teasing in Spanish adolescents.

Caracterización de las hospitalizaciones realizadas en la Unidad de Trastornos de Personalidad de la Clínica Psiquiátrica de la Universidad de Chile entre los años 2006 y 2008 / Characterization of admissions (hospitalizations) made in the Personality Disorders Unit of the Psychiatric Clinic of the University of Chile between 2006 and 2008

Introducción: Los Trastornos de Personalidad (TP) tienen una alta complejidad, impacto existencial, difícil vínculo terapéutico y cifras de prevalencia muy variables. La Clínica Psiquiátrica Universitaria de la Universidad de Chile (CPU) tiene desde 1997 la unidad multidisciplinaria para pacientes con TP Unidad de Trastornos de Personalidad (UTP). El objetivo de este trabajo es describir demográfica y psicopatológicamente a los pacientes con TP atendidos en la UTP. Método: Revisión de 174 fichas de pacientes atendidos en la UTP entre los años 2006 y 2008, con base de datos prediseñada y análisis estadístico de ella. Resultados: Existió una mayor proporción de pacientes de sexo femenino (3:1), solteros (48 por ciento), con hijos (56 por ciento), con estudios superiores (56 por ciento), trabajo estable (32 por ciento), con múltiples episodios previos (35 por ciento) y para la mayoría fue su primera hospitalización psiquiátrica (51,7 por ciento). El 71 por ciento de los pacientes tiene algún nivel de riesgo suicida. El diagnóstico de TP más frecuente fue el de Trastorno Límite de la Personalidad (48 por ciento). En Trastornos del Eje I un 30 por ciento presentó depresión, pero un 44 por ciento tenía varios trastornos. Conclusión: Los datos analizados son necesarios para la futura implementación y evaluación de intervenciones orientadas al mejor cuidado de los pacientes con TP de ésta y otras unidades especializadas en el tratamiento de este tipo de pacientes.

Introduction: Personality Disorders (PD) have a high complexity, existential impact, difficult therapeutic bond and prevalence values vary widely. University Psychiatric Clinic of the University of Chile (UPC) has since 1997 a multidisciplinary unit for patients with DP Personality Disorders Unit (PDU). The objective of this paper is to describe demographic and psychopathological patients treated with DP in the PDU. Methods: Review of 174 records of patients treated in the PDU between years 2006 and 2008, with predesigned database and statistical analysis of it. Results: There was a higher proportion of female patients (3:1), single (48 percent) with children (56 percent), highly educated (56 percent), stable job (32 percent) with multiple prior episodes (35 percent) and for most it was their first psychiatric hospitalization (51.7 percent). 71 percent of patients have any level of suicidal risk. The most frequent of PD diagnosis was Borderline Personality Disorder (48 percent). In Axis I disorders 30 percent had depression, but 44 percent had multiple disorders. Conclusion: The analyzed data are needed for future implementation and evaluation of interventions to better care for patients with PD from this and other specialized units created to treat such patients.

[The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy]. / Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras.

INTRODUCTION: Surgery for resection of supratentorial lesions near the motor areas and/or internal capsule carries an associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at once. Thus, a small movement may be missed while attention is focused on another site. AIM: To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. PATIENTS AND METHODS: We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. RESULTS: No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. CONCLUSIONS: Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery.

Role of peripheral and spinal 5-HT6 receptors according to the rat formalin test.

The present study assessed the possible pronociceptive role of peripheral and spinal 5-HT(6) receptors in the formalin test. For this, local peripheral administration of selective 5-HT(6) receptor antagonists N-[3,5-dichloro-2-(methoxy)phenyl]-4-(methoxy)-3-(1-piperazinyl)-benzenesulphonamide (SB-399885) (0.01-1 nmol/paw) and 4-iodo-N-[4-methoxy-3-(4-methyl-1-piperazinyl)phenyl]benzene-sulfonamide hydrochloride (SB-258585) (0.001-0.1 nmol/paw) significantly reduced formalin-induced flinching. Local peripheral serotonin (5-HT) (10-100 nmol/paw) or 5-chloro-2-methyl-3-(1,2,3,6-tetrahydro-4-pyridinyl)-1H-indole hydrochloride (EMD-386088) (0.01-0.1 nmol/paw; a selective 5-HT(6) receptor agonist) augmented 0.5% formalin-induced nociceptive behavior. The local pronociceptive effect of 5-HT (100 nmol/paw) or EMD-386088 (0.1 nmol/paw) was significantly reduced by SB-399885 or SB-258585 (0.1 nmol/paw). In contrast to peripheral administration, intrathecal injection of 5-HT(6) receptor antagonists SB-399885 and SB-258585 (0.1-10 nmol/rat) did not modify 1% formalin-induced nociceptive behavior. Spinal 5-HT (50-200 nmol/rat) significantly reduced formalin-induced flinching behavior during phases 1 and 2. Contrariwise, intrathecal EMD-386088 (0.1-10 nmol/rat) dose-dependently increased flinching during phase 2. The spinal pronociceptive effect of EMD-386088 (1 nmol/rat) was reduced by SB-399885 (1 nmol/rat) and SB-258585 (0.1 nmol/rat). Our results suggest that 5-HT(6) receptors play a pronociceptive role in peripheral as well as spinal sites in the rat formalin test. Thus, 5-HT(6) receptors could be a target to develop analgesic drugs.

Identification of the Na+/H+ exchanger 1 in dorsal root ganglion and spinal cord: its possible role in inflammatory nociception.

mRNA and protein presence of Na+/H+ exchanger (NHE) 1 (NHE1) and 5 (NHE5) in dorsal root ganglion (DRG) and dorsal spinal cord as well as its possible role in three inflammatory nociception tests were determined. Local peripheral ipsilateral, but not contralateral, administration of NHE inhibitors 5-(N,N-dimethyl)amiloride hydrochloride (DMA, 0.3-30 microM/paw), 5-(N-ethyl-N-isopropyl)amiloride (EIPA, 0.3-30 microM/paw) and amiloride (0.1-10 microM/paw) significantly increased flinching but not licking behavior in the capsaicin and 5-HT tests. Moreover, DMA and EIPA (0.03-30 microM/paw) as well as amiloride (0.1-1 microM/paw) augmented, in a dose-dependent manner, 0.5% formalin-induced flinching behavior during phase II but not during phase I. Reverse transcription-polymerase chain reaction showed the expression of NHE1 and NHE5 in DRG and dorsal spinal cord. Western blot analysis confirmed the presence of NHE1 in DRG and spinal cord. Moreover, NHE5 was expressed in dorsal spinal cord, but not in DRG where a 45 kDa truncated isoform of NHE5 was identified. Collectively, these data suggest that NHE1, but not NHE5, plays an important role reducing inflammatory pain in rats.

[Arteriovenous malformations in children: a report of four cases]. / Malformaciones arteriovenosas en la infancia: a proposito de cuatro casos.

INTRODUCTION AND AIMS: Vascular malformations are the most frequent cause of intracranial haemorrhage (IH) after the neonatal period that are not due to traumatic injury. Arteriovenous malformations (AVM) are the vascular malformations that most often give rise to symptoms in infancy and are the most common cause of IH in children over one year of age. CASE REPORTS: We reviewed the medical records of all patients under the age of 16 years diagnosed with AVM from the year 2000 to the present. Four cases aged between 7 and 15 years were found, all of whom were examined with computerised tomography and/or magnetic resonance imaging and cerebral arteriography scans. One patient started with headaches and another had learning disabilities. The other two began with IH, the most common clinical manifestations of which were a diminished level of awareness and vomiting. The final diagnosis was established by means of arteriography in all cases. Surgical treatment was carried out in three cases (using surgery, catheter embolisation and stereotaxic radiosurgery) and the patients' progress following the intervention was excellent. CONCLUSIONS: Spontaneous haemorrhage constitutes the most common presenting symptom of AVM. However, there are sometimes earlier manifestations that are a challenge to diagnosis and which should be the target of future research, since preventing IH would lead to a drastic reduction in the morbidity and mortality rate of AVM.

[Aneurysmal bone cyst of the sphenoid sinus]. / Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction.

Unusual changing CT and MR appearance of an epithelial intracranial cyst.

INTRODUCTION: Epithelial cysts are infrequent intracranial lesions and may content cilia and mucosecretant cells that may be responsible for the protein concentration within the contents and the variable radiological appearance on CT and MRI. METHODS AND PATIENTS: We present a case of an extraaxial epithelial cyst with changing CT and MR characteristics. RESULTS: The appearance of our cyst on CT or MRI changed with size and morphology. When CT studies showed an hypodense cyst, the lesion was large but when an hyperdense mass was present, the lesion was smaller. In the later situation MRI showed hyperintensity on T1-weighted images and hypointensity on T2-weighted images and the protein concentration of the cystic contents was high. CONCLUSIONS: We believe that a relatively high protein concentration in our cyst was the major factor for the high attenuation on CT and the hyperintensity or hypointensity on T1- and T2-weighted images, respectively. We believe than these atypical imaging findings were caused by changes in the protein concentration within the cyst.