Millisecond timescale reactions observed via X-ray spectroscopy in a 3D microfabricated fused silica mixer. Corrigendum.

A figure in the article by Huyke et al. [(2021), J. Synchrotron Rad. 28, 1100-1113] is corrected.

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring.

The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.

Millisecond timescale reactions observed via X-ray spectroscopy in a 3D microfabricated fused silica mixer.

Determination of electronic structures during chemical reactions remains challenging in studies which involve reactions in the millisecond timescale, toxic chemicals, and/or anaerobic conditions. In this study, a three-dimensionally (3D) microfabricated microfluidic mixer platform that is compatible with time-resolved X-ray absorption and emission spectroscopy (XAS and XES, respectively) is presented. This platform, to initiate reactions and study their progression, mixes a high flow rate (0.50-1.5 ml min-1) sheath stream with a low-flow-rate (5-90 µl min-1) sample stream within a monolithic fused silica chip. The chip geometry enables hydrodynamic focusing of the sample stream in 3D and sample widths as small as 5 µm. The chip is also connected to a polyimide capillary downstream to enable sample stream deceleration, expansion, and X-ray detection. In this capillary, sample widths of 50 µm are demonstrated. Further, convection-diffusion-reaction models of the mixer are presented. The models are experimentally validated using confocal epifluorescence microscopy and XAS/XES measurements of a ferricyanide and ascorbic acid reaction. The models additionally enable prediction of the residence time and residence time uncertainty of reactive species as well as mixing times. Residence times (from initiation of mixing to the point of X-ray detection) during sample stream expansion as small as 2.1 ± 0.3 ms are also demonstrated. Importantly, an exploration of the mixer operational space reveals a theoretical minimum mixing time of 0.91 ms. The proposed platform is applicable to the determination of the electronic structure of conventionally inaccessible reaction intermediates.

Composition and abundance of anopheline species according to habitat diversity in Mexico.

OBJECTIVE: To determine the abundance and geographic distribution of the main malaria vectors, which are influenced by habitat characteristics and ecological factors that directly impact adult density and the dynamics of malaria transmission in Mexico. MATERIALS AND METHODS: Samples of larvae were collected from 19 states in Mexico. Each larval habitat was characterized in situ determining the following parameters: water depth, turbidity, percentage of vegetation cover, amount of detritus, presence of algae, light intensity, type of vegetation, amount of predators, habitat stability, altitude, and hydrologic type. RESULTS: A total of 21 687 larvae corresponding to 13 anopheline species were obtained from 149 aquatic habitats. The most abundant species were Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) and An. franciscanus (5.29%). The multiple logistic regression analysis showed a negative association between An. pseudopunctipennis and water turbidity (ß=-1.342; Wald=6.122; p=0.013) and the amount of detritus (ß=-2.206; Wald=3.642; p=0.050). While in An. albimanus, there was a significant positive association with water turbidity (ß=1.344; Wald=4.256; p=0.039), a negative correlation was found with the altitude (ß=-3.445; Wald=5.407; p =0.020). The highest mosquito species diversity index was found in Chiapas (Fisher's α=1.20) and the lowest diversity in Chihuahua (Fisher's α=0.26). The greatest richness was found in streams (n=11). CONCLUSIONS: The two most abundant species were: An. albimanus and An. pseudopunctipennis. Detailed knowledge of the distribution and characteristics of their larval habitats will be useful for the effective implementation of control strategies in Mexico.

OBJETIVO: Determinar la abundancia y la distribución geográfica de los principales vectores de la malaria, las cuales están influenciadas por las características del hábitat y los factores ecológicos que afectan directamente la densidad de los adultos y la dinámica de la transmisión de la malaria en México. MATERIAL Y MÉTODOS: Se obtuvieron muestras de larvas de 19 estados de México. Cada hábitat larvario se caracterizó in situ determinando los siguientes parámetros: profundidad del agua, turbidez, porcentaje de cobertura vegetal, cantidad de detritus, presencia de algas, intensidad de luz, tipo de vegetación, cantidad de depredadores, estabilidad del hábitat, altitud y tipo hidrológico. RESULTADOS: Se identificaron un total de 21 687 larvas pertenecientes a 13 especies de anofelinos, de 149 hábitats acuáticos. Las tres especies más abundantes fueron Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) y An. franciscanus (5.29%). El análisis de regresión logística múltiple mostró una asociación negativa para An. pseudopunctipennis y la turbidez del agua (ß=-1.342; Wald= 6.122; p=0.013) y la cantidad de detritus (ß=-2.206; Wald= 3.642; p=0.050). Para An. albimanus se encontró una asociación positiva significativa con la turbidez del agua (ß=1.344; Wald= 4.256; p=0.039) y una correlación negativa con la altitud (ß=-3.445; Wald=5.407; p=0.020). El índice de diversidad más alto se encontró en Chiapas (α de Fisher=1.20) y la diversidad más baja en Chihuahua (α de Fisher=0.26). La mayor riqueza se encontró en los arroyos (n=11). CONCLUSIONES: Las dos especies más abundantes fueron An. albimanus y An. pseudopunctipennis. El conocimiento detallado de la distribución y características de sus hábitats larvales será útil para la implementación efectiva de las estrategias de control en México.

The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections.

BACKGROUND: Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. METHODS: We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 µg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.5(1.3 - 4.9)(p < 0.01) and 2.8(1.2 - 6.7)(p < 0.05), respectively. CONCLUSIONS: In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing.

LECT2 Amyloidosis in Kidney Transplantation: A Report of 5 Cases.

Leukocyte chemotactic factor 2 (LECT2) amyloidosis is a recently recognized entity that often affects the kidneys. Little information is available regarding kidney transplant outcomes in patients with LECT2 amyloidosis or who received kidney allografts containing LECT2 amyloid. We present clinical findings and allograft outcomes of 5 patients who received kidneys with donor-derived LECT2 amyloidosis. In all 5, LECT2 amyloidosis was discovered during protocol biopsies or in evaluation of suspected rejection. Less than 10% of kidney parenchyma was involved, with mostly interstitial and vascular deposits. Allograft function was not impaired and the amyloid deposits persisted for up to 8 years of follow-up. We conclude that kidneys with limited and localized LECT2 amyloid deposits that are otherwise suitable for transplantation need not be automatically discarded.

EVALUATION OF THE ROYAL FREE HOSPITAL CIRRHOSIS GLOMERULAR FILTRATION RATE FORMULA IN HISPANIC PATIENTS WITH CIRRHOSIS: AN EXTERNAL VALIDATION.

BACKGROUND AND AIMS: Glomerular filtration rate (GFR) measurement in patients with liver cirrhosis (LC) is the ideal method for adequate evaluation of kidney function. However, it is invasive, costly, and not widely accessible. Moreover, GFR estimation in patients with cirrhosis has been inaccurate. The aim of the present study was to evaluate and validate the recently described Royal Free Hospital (RFH) formula in a Hispanic cohort of patients with LC and compare it with other formulas, including the CKD-EPI cystatin C equation. METHODS: GFR was measured through the renal clearance of Tc-99m DTPA; it was cross-sectionally evaluated and compared with GFRs that were estimated utilizing the following formulas: RFH, Cockcroft-Gault, 6-variable Modification of Diet in Renal Disease-6, CKD-EPI cystatin C, CKD-EPI Creatinine, and CKD-EPI Cystatin C-Creatinine. RESULTS: We included 76 patients (53% women). The mean measured GFR in the entire cohort was 64 ml/min/1.73m2; 54% of the patients had a GFR < 60 ml/min/1.73 m2 at the time of evaluation. The RFH formula and the CKD-EPI cystatin C formula showed the best performance, with a p30 of 62% and 59%, respectively. All formulas performed poorly when GFR was < 60 ml/min/1.73 m2. CONCLUSIONS: The RFH formula showed a better performance than the other formulas based on serum creatinine in a Hispanic population with LC. There was no difference in performance between the RFH formula and the CKD-EPI cystatin C formula.

PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS. EVIDENCE ACQUISITION: We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome. EVIDENCE SYNTHESIS: We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I2=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I2=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I2-98%). No difference was observed regarding operative time. CONCLUSIONS: RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.

Effect of irrigation solution temperature on complications of percutaneous nephrolithotomy: a systematic review of the literature, meta-analysis and trial sequential analysis of randomized clinical trials.

INTRODUCTION: The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time. EVIDENCE ACQUISITION: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data. EVIDENCE SYNTHESIS: The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I2=33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I2=0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I2=82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid. CONCLUSIONS: There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.

Concurrent uper limb and hip fracture in the elderly: experience at our centre. / Fracturas concomitantes de miembro superior y cadera en pacientes mayores de 65 años: experiencia en nuestro centro.

INTRODUCTION: The incidence of hip fracture in the elderly is on the rise, occasionally accompanied by concurrent upper limb fractures. Our investigation aims to determine whether these patients experience poorer functional outcomes, prolonged hospitalization, or higher mortality rates when compared to those with isolated hip fracture. MATERIAL AND METHODS: We retrospectively reviewed 1088 elderly patients admitted to our centre with hip fracture between January 2017 and March 2020. We recorded the presence of concomitant fractures and their treatment. We analyzed the duration of hospital stay, in-hospital mortality and function. RESULTS: We identified 63 patients with concomitant upper limb fracture (5.6%). Among them, 93.7% were women, and the average age was 86.4 years. 80.9% of the upper limb fractures were distal radius or proximal humerus. Patients with concomitant fracture had increased length of stay (mean, 19.6 vs 12.8, p=0.002), decreased proportion of patients returning to their own home at discharge (23.6% vs 26.3%, p=0.042) and increased in-hospital mortality rate (9.5% vs 5.9%, p=0.003). CONCLUSIONS: Patients with concomitant upper limb fracture require a longer length of stay and exhibit an elevated in-hospital mortality rate. Furthermore, this condition is associated with a reduced short-term functional recovery, thereby decreasing the chances of the patient returning home upon hospital discharge.

17ß-estradiol induces hyperresponsiveness in guinea pig airway smooth muscle by inhibiting the plasma membrane Ca2+-ATPase.

High serum estrogen concentrations are associated with asthma development and severity, suggesting a link between estradiol and airway hyperresponsiveness (AHR). 17ß-estradiol (E2) has non-genomic effects via Ca2+ regulatory mechanisms; however, its effect on the plasma membrane Ca2+-ATPases (PMCA1 and 4) and sarcoplasmic reticulum Ca2+-ATPase (SERCA) is unknown. Hence, in the present study, we aim to demonstrate if E2 favors AHR by increasing intracellular Ca2+ concentrations in guinea pig airway smooth muscle (ASM) through a mechanism involving Ca2+-ATPases. In guinea pig ASM, Ca2+ microfluorometry, muscle contraction, and Western blot were evaluated. Then, we performed molecular docking analysis between the estrogens and Ca2+ ATPases. In tracheal rings, E2 produced AHR to carbachol. In guinea pig myocytes, acute exposure to physiological levels of E2 modified the transient Ca2+ peak induced by caffeine to a Ca2+ plateau. The incubation with PMCA inhibitors (lanthanum and carboxyeosin, CE) partially reversed the E2-induced sustained plateau in the caffeine response. In contrast, cyclopiazonic acid (SERCA inhibitor), U-0126 (an inhibitor of ERK 1/2), and choline chloride did not modify the Ca2+ plateau produced by E2. The mitochondrial uniporter activity and the capacitative Ca2+ entry were unaffected by E2. In guinea pig ASM, Western blot analysis demonstrated PMCA1 and PMCA4 expression. The results from the docking modeling demonstrate that E2 binds to both plasma membrane ATPases. In guinea pig tracheal smooth muscle, inhibiting the PMCA with CE, induced hyperresponsiveness to carbachol. 17ß-estradiol produces hyperresponsiveness by inhibiting the PMCA in the ASM and could be one of the mechanisms responsible for the increase in asthmatic crisis in women.

Embryonic and larval development of Eugerres mexicanus (Perciformes: Gerreidae) in Tenosique, Tabasco, Mexico.

Most studies on Eugerres mexicanus mainly consider biogeographic and systematic aspects and rarely address reproductive characteristics, which are useful for fishery population management plans. This study aimed at evaluating the ontogeny of E. mexicanus, based on 30 embryos and 30 larvae sampled by induced spawning of breeders, taken in February 2009 from the Usumacinta River in Tenosique, Tabasco, Mexico. All descriptions of the embryonic development were based on morphometric and meristic data and followed standard methods. Eggs, recovered at the gastrula stage, had an average diameter of 1.17mm (SD=0.08). The bud stage appeared during the first three hours of development, in which the posterior side was adhered to the vitellus; Kupffer's vesicle was visible. Yolk-sac larvae hatched 18 hours after fertilization, exhibiting a light brown color and an average total length of 2.94mm (SD=0.70); the preflexion stage was reached eight days after hatching, with a total average length of 4.67mm (SD=0.50) and a total notochord length of 4.45mm (SD=0.50). The flexion stage was reached on the 16th day, with an average total length of 6.66mm (SD=1.53), while postflexion was reached on the 24th day, with 10.33mm (SD=1.45). The pre-juvenile stage was reached on the 33rd day, with a total length of 14.30mm (SD=0.93), showing IX spines and 10 rays and III spines and eight rays in the dorsal and anal fins, respectively. The juvenile stage was reached by the 45th day, with an average length of 28.16mm (SD=1.93) and average weight of 4.75g (SD=1.49). Prejuveniles showed an initial pigmentation with dark colored dots in the superior and inferior jaw and dispersed on the head, while juveniles presented the same pigmentation pattern, decreasing towards the margin of the caudal peduncle. In conclusion, the embryonic developmental stages of E. mexicanus were typical for the Gerreidae group. However, their morphometric characters were slightly different since the diameter and size of the drop of oil were bigger than those reported for marine species. In addition, regarding pigmentation, the yolk-sac larvae of E. mexicanus were olive and yellow on the margin of the notochord, which differs from those reported for other species. This is the first recorded report on the reproductive biology and early life development of this species.

Suicidal behaviour in adolescents: Educational interventions in Mexico.

Suicide in adolescents constitutes a public health problem throughout the world. The objective of this study was to identify the prevalence of suicidal behaviour in a public middle school in Mexico and to implement appropriate educational interventions in the school and community contexts. Our work took place from September 2017 to July 2018. We conducted a quasi-experimental, mixed-methodology study with 12-year-old students in first year of middle school (n = 29), using an educational intervention approach within the frame of the Life Skills Education methodology. We included family members and academic staff in the study with the view of sensitising them to suicidal behaviour. At the community level, we worked with the adolescent and adult populations to form 'gatekeepers' (guardians). We administered a questionnaire on psychosocial indicators of depression and suicide risk to 383 students in their first-to-third years of middle school. Other questionnaires were applied, and life skills focus groups (FGs) were organised with the educational intervention participants. The questionnaires addressed suicidal behaviour in adolescents, alcohol consumption, life skills and prosociality. Prevalence of attempted suicide cases came to 14.1% (95 CI% 10.7-17.9), the average age of those who reported having hurt themselves with the purpose of taking their lives was 12.9 years, 75% of those who had attempted suicide were female and 64.8% had consumed alcohol. The educational intervention with students achieved a statistically significant increase in the life skills of participants, specifically as regards self-awareness and overall scores. The family members in the FGs developed greater awareness of suicidal behaviour, and the adolescents engaged at the community level significantly broadened (p < .05) their knowledge of depression. In developing countries such as Mexico, it is essential not only to increase the number of interventions for preventing suicidal behaviour in adolescents, but also to improve instruments for measuring the extent of the problem.

COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry.

Background: The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN. Methods: We collected serial information on kidney-related and -unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use. Results: After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P<0.001). GN patients developing AKI were less likely to recover pre-COVID-19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times pre-COVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR. Conclusions: Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.

Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults.

PURPOSE: Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time. MATERIALS AND METHODS: We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed. RESULTS: Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period. CONCLUSIONS: This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery.

Reconstructive laparoscopy in pediatric urology.

PURPOSE OF REVIEW: Minimally invasive surgery used to play a role only as a diagnostic tool in pediatric urology, being used in a narrow range of conditions like cryptorchidism. With the breakthrough of laparoscopic techniques, skilled surgeons and remarkably the advances in robotic-assisted surgery, laparoscopy has gained a role for treatment purposes in pediatric urology. RECENT FINDINGS: Many reconstructive laparoscopic procedures notably with the aid of robotic-assisted surgery such as pyeloplasty and ureteral reimplantation and even more challenging procedures like appendicovesicostomy became feasible with similar results to those with open surgery. Even though minimally invasive approaches may have the drawback of greater technical difficulty, they have the advantages of shorter hospital stays, lesser postoperative pain and better cosmesis. SUMMARY: There is still a lack of controlled prospective randomized trials assessing the differences between open and minimally invasive techniques for reconstructive pediatric urology. Nevertheless, the minimally invasive approach has proven itself to be feasible and well tolerated for most reconstructive procedures.

Plasmodium vivax CSP-Pvs25 variants from southern Mexico produce distinct patterns of infectivity for Anopheles albimanus versus An. pseudopunctipennis, in each case independent of geographical origin.

BACKGROUND: The susceptibility of Anopheles albimanus and An. pseudopunctipennis to local Plasmodium vivax has been associated in southern Mexico with two ookinete surface proteins (Pvs25/28) polymorphism. Perhaps parasite population selection (i.e. adaptation to local vectors) contributes to this phenomenon. It is also possible that certain molecular interactions exist between P. vivax and each mosquito species independently of geographical origin. This study aimed to explore the susceptibility of An. albimanus and An. pseudopunctipennis (collected from different geographical sites) to P. vivax cspVk/Pvs25-130 haplotypes from southern Mexico. RESULTS: Of the 120 P. vivax-infected blood samples used to simultaneously feed An. albimanus and An. pseudopunctipennis mosquitoes originating from various geographical sites, 80 produced at least one infected mosquito species. Three parasite haplotypes were identified in infected blood: Vk210/Pvs25-A (12.5%), Vk210/Pvs25-B (20%) and Vk247/Pvs25-B (67.5%). Two parameters (the proportion of infected mosquitoes and number of oocysts/mosquito) showed a similar pattern for each mosquito species (independently of geographical origin). For An. albimanus mosquitoes (from the Pacific coast, Mexican gulf and Lacandon Forest lowlands), these two parameters were higher in specimens infected with P. vivax Vk210/Pvs25-A versus Vk210/Pvs25-B or Vk247/Pvs25-B (P < 0.001). For An. pseudopunctipennis mosquitoes (from the Pacific coast, northeast Mexico and east Guatemala foothills), the same two parameters were higher in specimens infected with Vk247/Pvs25-B or Vk210/Pvs25-B versus Vk210/Pvs25-A (P < 0.001). Higher infection rates were caused by Vk247/Pvs25-B than Vk210/Pvs25-B parasites in An. pseudopunctipennis (P = 0.011) and An. albimanus (P = 0.001). The greatest parasitaemia, gametocytaemia and microgamete formation was observed in Vk247/Pvs25-B infected blood, and each of these parameters correlated with each other and with the number of oocysts in An. pseudopunctipennis from the sympatric colony. CONCLUSIONS: Plasmodium vivax Vk247/Pvs25-B infections were the most prevalent, likely due to the higher parasitaemia produced in the susceptible vector (especially An. pseudopunctipennis). The analysis of mosquito-parasite interactions indicate that An. pseudopunctipennis and An. albimanus each have a unique pattern of transmitting genetic variants of P. vivax, and this is not dependent on geographical origin. The present findings highlight the importance of parasite genotyping to understand transmission dynamics and vectorial participation.

Degradation capacities of bacteria and yeasts isolated from the gut of Dendroctonus rhizophagus (Curculionidae: Scolytinae).

Bark beetles (Curculionidae: Scolytinae) feed on the xylem and phloem of their host, which are composed of structural carbohydrates and organic compounds that are not easily degraded by the insects. Some of these compounds might be hydrolyzed by digestive enzymes produced by microbes present in the gut of these insects. In this study, we evaluated the enzymatic capacity of bacteria (Acinetobacter lwoffii, Arthrobacter sp., Pseudomonas putida, Pseudomonas azotoformans, and Rahnella sp.) and yeasts (Candida piceae, Candida oregonensis, Cyberlindnera americana, Zygoascus sp., and Rhodotorula mucilaginosa) isolated from the Dendroctonus rhizophagus gut to hydrolyze cellulose, xylan, pectin, starch, lipids, and esters. All isolates, with the exception of C. piceae, showed lipolytic activity. Furthermore, P. putida, P. azotoformans, C. americana, C. piceae, and R. mucilaginosa presented amylolytic activity. Esterase activity was shown by A. lwoffii, P. azotoformans, and Rahnella sp. Cellulolytic and xylanolytic activities were present only in Arthrobacter sp. and P. azotoformans. The pectinolytic activity was not recorded in any isolate. This is the first study to provide evidence on the capacity of microbes associated with the D. rhizophagus gut to hydrolyze specific substrates, which might cover part of the nutritional requirements for the development, fitness, and survival of these insects.

The Effectiveness of a Systematic Algorithm for the Management of Vascular Injuries during the Laparoscopic Surgery.

OBJECTIVES: Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies. MATERIALS AND METHODS: The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed. RESULTS: After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302). CONCLUSION: A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.

Composition and abundance of anopheline species according to habitat diversity in Mexico / Composición y abundancia de especies de anofelinos según la diversidad de hábitats en México

Abstract: Objective: To determine the abundance and geographic distribution of the main malaria vectors, which are influenced by habitat characteristics and ecological factors that directly impact adult density and the dynamics of malaria transmission in Mexico. Materials and methods: Samples of larvae were collected from 19 states in Mexico. Each larval habitat was characterized in situ determining the following parameters: water depth, turbidity, percentage of vegetation cover, amount of detritus, presence of algae, light intensity, type of vegetation, amount of predators, habitat stability, altitude, and hydrologic type. Results: A total of 21 687 larvae corresponding to 13 anopheline species were obtained from 149 aquatic habitats. The most abundant species were Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) and An. franciscanus (5.29%). The multiple logistic regression analysis showed a negative association between An. pseudopunctipennis and water turbidity (ß=-1.342; Wald=6.122; p=0.013) and the amount of detritus (ß=-2.206; Wald=3.642; p=0.050). While in An. albimanus, there was a significant positive association with water turbidity (ß=1.344; Wald=4.256; p=0.039), a negative correlation was found with the altitude (ß=-3.445; Wald=5.407; p=0.020). The highest mosquito species diversity index was found in Chiapas (Fisher's α=1.20) and the lowest diversity in Chihuahua (Fisher's α=0.26). The greatest richness was found in streams (n=11). Conclusions: The two most abundant species were: An. albimanus and An. pseudopunctipennis. Detailed knowledge of the distribution and characteristics of their larval habitats will be useful for the effective implementation of control strategies in Mexico.

Resumen Objetivo: Determinar la abundancia y la distribución geográfica de los principales vectores de la malaria, las cuales están influenciadas por las características del hábitat y los factores ecológicos que afectan directamente la densidad de los adultos y la dinámica de la transmisión de la malaria en México. Material y métodos: Se obtuvieron muestras de larvas de 19 estados de México. Cada hábitat larvario se caracterizó in situ determinando los siguientes parámetros: profundidad del agua, turbidez, porcentaje de cobertura vegetal, cantidad de detritus, presencia de algas, intensidad de luz, tipo de vegetación, cantidad de depredadores, estabilidad del hábitat, altitud y tipo hidrológico. Resultados: Se identificaron un total de 21 687 larvas pertenecientes a 13 especies de anofelinos, de 149 hábitats acuáticos. Las tres especies más abundantes fueron Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) y An. franciscanus (5.29%). El análisis de regresión logística múltiple mostró una asociación negativa para An. pseudopunctipennis y la turbidez del agua (ß=-1.342; Wald= 6.122; p=0.013) y la cantidad de detritus (ß=-2.206; Wald= 3.642; p=0.050). Para An. albimanus se encontró una asociación positiva significativa con la turbidez del agua (ß=1.344; Wald= 4.256; p=0.039) y una correlación negativa con la altitud (ß=-3.445; Wald=5.407; p=0.020). El índice de diversidad más alto se encontró en Chiapas (α de Fisher=1.20) y la diversidad más baja en Chihuahua (α de Fisher=0.26). La mayor riqueza se encontró en los arroyos (n=11). Conclusiones: Las dos especies más abundantes fueron An. albimanus y An. pseudopunctipennis. El conocimiento detallado de la distribución y características de sus hábitats larvales será útil para la implementación efectiva de las estrategias de control en México.