[Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?] / Nefrectomías en riñón no funcionante, ¿estamos haciendo lo correcto?

AIM OF THE STUDY: To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys. METHODS: Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery. MAIN RESULTS: A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents' preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT. CONCLUSIONS: Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications.

OBJETIVOS: Presentar nuestra experiencia en el manejo quirúrgico del riñón poco o no funcionante, revisando las indicaciones de nefrectomía y sus resultados a largo plazo. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes intervenidos de nefrectomía en nuestro centro entre los años 2010 y 2014. Se revisaron sus historias clínicas y se recogieron una serie de variables sociodemográficas y clínicas, prestando especial atención a la resolución o no de la sintomatología que motivó la cirugía. RESULTADOS: Realizamos un total de 18 nefrectomías. La edad media fue de 6,5 años (11 meses - 15 años). La indicación de cirugía se realizó por infecciones del tracto urinario (ITUS) de repetición en 7 casos, hipertensión arterial renovascular (HTAR) en 5, dolor en 2, aumento de tamaño en 2 y dificultad para el seguimiento en otros 2 pacientes. La nefrectomía se realizó vía laparoscópica en 16 casos y abierta en 2. La mediana de la estancia hospitalaria fue de 48 horas. La tasa de complicaciones fue del 5,55% tanto intraoperatoriamente (1 caso de sangrado) como postoperatoriamente (1 caso de enfisema subcutáneo). En todos los casos se objetivó resolución de la sintomatología salvo en 3, 2 pacientes presentaron ITUS y 1 HTA persistente. CONCLUSIONES: La nefrectomía es un procedimiento seguro en niños con una tasa baja de complicaciones. La selección adecuada de los casos y un correcto estudio multidisciplinar previo son aspectos fundamentales para obtener buenos resultados clínicos y evitar complicaciones postoperatorias.

Mesenchymal Stem Cell Therapy for Alzheimer's Disease.

Alzheimer's disease (AD) is a neurodegenerative disease responsible for 60-70% of the 50 million cases of dementia worldwide. It is characterized by neuronal cell death, shrinkage of brain tissue, and progressive cognitive, motor, and behavioral impairment, which often leads to death. Although current treatment has helped improve the patient's quality of life, it has not been able to alter the underlying disease pathology of AD. Studies have shown that mesenchymal stem cells (MSCs)-a group of multipotent stem cells-have the ability to stimulate neuroregeneration and inhibit disease progression. More recently, extracellular vesicles (EVs) from cytokine-preconditioned MSCs have also shown to induce immunomodulatory and neuroprotective effects in AD models. This review will aim to compile pertinent preclinical AD research on transgenic mice as well as clinical trials on MSC-based therapy from diverse sources.

Social marketing-based communications to integrate and support the HEALTHY study intervention.

The HEALTHY study was a randomized, controlled, multicenter, middle school-based, multifaceted intervention designed to reduce risk factors for the development of type 2 diabetes. The study randomized 42 middle schools to intervention or control, and followed students from the sixth to the eighth grades. Participants were a racially, ethnically and geographically diverse cohort from across the United States. Here, we describe the conceptual underpinnings and design of the social marketing-based communications component of the HEALTHY study intervention that combined changes in the school nutrition and physical education (PE) environment with behavior change initiatives. The communications intervention component coordinated multiple elements to deliver campaigns that served to integrate and support all aspects of the HEALTHY intervention. The campaigns unfolded across five semesters of middle school, each targeting a specific theme related to the HEALTHY objectives. Communications campaigns comprised (1) core elements such as branding, posters, banners and visual and verbal messaging, (2) student events supporting the nutrition, PE and behavior intervention components through the application of social marketing and communications strategies, including the incorporation of student-generated media and (3) distribution of premiums and theme enhancers to extend the visibility of the study beyond the intervention environment. Formative research conducted with students, parents and school administrators was used to refine the communications strategy. Student peer communicators selected from the student body were involved to influence the normative student environment. Marketing and creative design experts developed a brand, logo, activities and materials. In the latter half of the study, student-generated messages and media were used to reflect local interests and culture and enhance peer influence. The HEALTHY intervention delivery and impact were strengthened by the communications strategies. The HEALTHY experience provides practical considerations for systematically incorporating a social marketing-based communications approach within future school-based health behavior interventions.

Rationale, design and methods for process evaluation in the HEALTHY study.

The HEALTHY study was a multi-site randomized trial designed to determine whether a 3-year school-based intervention targeting nutrition and physical activity behaviors could effectively reduce risk factors associated with type 2 diabetes in middle school children. Pilot and formative studies were conducted to inform the development of the intervention components and the process evaluation methods for the main trial. During the main trial, both qualitative and quantitative assessments monitored the fidelity of the intervention and motivated modifications to improve intervention delivery. Structured observations of physical education classes, total school food environments, classroom-based educational modules, and communications and promotional campaigns provided verification that the intervention was delivered as intended. Interviews and focus groups yielded a multidimensional assessment of how the intervention was delivered and received, as well as identifying the barriers to and facilitators of the intervention across and within participating schools. Interim summaries of process evaluation data were presented to the study group as a means of ensuring standardization and quality of the intervention across the seven participating centers. Process evaluation methods and procedures documented the fidelity with which the HEALTHY study was implemented across 21 intervention schools and identified ways in which the intervention delivery might be enhanced throughout the study.

Pediatric primary gram-negative nosocomial bacteremia: a possible relationship with infusate contamination.

OBJECTIVE: To evaluate the potential contribution of "extrinsic" contamination of intravenous fluids in hospital bacteremia and infection. DESIGN: Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993. SETTING: A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients. SAMPLES AND PATIENTS: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience. RESULTS: A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P = .59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges. CONCLUSIONS: Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.

Restoration by piroxicam of liver glutathione levels decreased by acute ethanol intoxication.

The effect of piroxicam, a nonsteroidal anti-inflammatory drug, on blood ethanol and on triacylglycerols, malondialdehyde and glutathione levels in liver of fed rats acutely intoxicated with ethanol was studied. As previously reported for fasted rats, piroxicam in fed rats decreases the concentration of ethanol in blood and inhibits the hepatic increase of triacylglycerols and malondialdehyde consequent to ethanol administration. In addition, the hepatic depletion of reduced and reduced plus oxidized glutathione observed 8 and 12h after gavage of ethanol was reversed when piroxicam was administered simultaneously with ethanol. The importance of the finding is discussed in light of the paramount participation of glutathione during the cellular oxidative stress.

Frontiers in Internal Medicine.

Clinical research in Internal Medicine has provided many scientific advances during the past few years. However, the newly generated information overrides the time available to read all of the medical literature regarding advances in Internal Medicine. The goal of this review is to summarize some of the most relevant improvements in clinical practice published over the last few years. From Cardiology to Pulmonology, the authors of this review expose in a succinct way what they and many of their peers consider to be the most transcendental information gathered from thousands of publications. The authors of this review article have attempted to avoid sensationalism by including facts instead of just simply optimistic preliminary findings that can mislead clinicians' decision making. The review is focused on information obtained through well-designed, prospective clinical trials and cohorts where the effectiveness of medical interventions and diagnostic procedures were tested.

Processing across the language boundary: a cross-modal priming study of Spanish-English bilinguals.

A cross-modal naming paradigm was used to assess within- and between-language sentential priming in Spanish-English bilinguals. The paradigm used single-language auditory texts with visual target words under normal, visually degraded, speeded, and delayed naming conditions. Cross-language priming was always observed when the target language was predictable (in the blocked condition), even under speeded conditions. When the target language was unpredictable (in the mixed condition), cross-language priming was observed only when response was delayed (delayed naming) and under a subset of conditions when word recognition was delayed (visual degradation). Results are compatible with the idea that cross-language priming in a sentence context is more likely to involve the use of expectations, strategic processes, or both that allow bilinguals to tune themselves to external conditions. There are enough exceptions to the general rule, however, to warrant a reconsideration of the lexical-postlexical dichotomy. Implication for modular versus interactive models of lexical access are discussed.

Bilingual performance on the boston naming test: preliminary norms in Spanish and English.

A total of 100 young educated bilingual adults were administered the Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1983) in both Spanish and English. Three group performance scores were obtained: English only, Spanish only, and a composite score indicating the total number of items correctly named independent of language. The scores for the entire group were significantly greater in English than in Spanish. An additional set of analyses explored individual differences in picture naming performance across the two languages as measured by the BNT. For a subset of the larger group (n = 25) there were significant differences in composite over single language scoring, but no significant differences between Spanish and English. Item analyses of correct responses were conducted in both languages to explore the construct validity of the standardized administration of the BNT with this population. There was much greater variability in responses over the Spanish items for this bilingual group. The results of a correlation analysis of information obtained from the initial questionnaire with the BNT scores in each language is also reported. The practical implications of this preliminary bilingual BNT normative data are discussed.

In search of the language switch: An fMRI study of picture naming in Spanish-English bilinguals.

For many years, researchers investigating the brain bases of bilingualism have concentrated on two basic questions. The first concerns the nature of language representation. That is, are a bilinguals' two languages represented in distinct or overlapping areas of the brain. The second basic question in the neuropsychology of bilingualism concerns the neural correlates of language switching, that is, the areas that are active when bilinguals switch from one language to the other. Performance between single-language and dual-language picture naming was compared in a group of six Spanish-English bilinguals using behavioral measures and functional magnetic resonance imaging. Participants showed slower reaction times and increased activation in the dorsolateral prefrontal cortex in the mixed language condition relative to single language condition. There was no evidence that each language was represented in different areas of the brain. Results are consistent with the view that language switching is a part of a general executive attentional system and that languages are represented in overlapping areas of the brain in early bilinguals.

[Ca2+]i changes in guinea pig tracheal smooth muscle cells in culture: effects of Na+ and ouabain.

The objective of this work was to confirm that the contractile effects of ouabain and Na(+)-free solutions in guinea pig tracheal rings are associated with increments in the cytosolic free Ca2+ concentration ([Ca2+]i) in cultured tracheal smooth muscle (TSM) cells. Cultured cells were alpha-actin positive. Histamine (50 microM) and Na(+)-free solution elicited a transient increase in [Ca2+]i, while the responses to thapsigargin (1 microM) and ouabain (1 mM) were long lasting. However, carbachol (10, 200, and 500 mM) and high K(+)-solution produced no effect on [Ca2+]i, suggesting that cultured guinea pig TSM cells display a phenotype change but maintain some of the tracheal rings physiological properties. The transient rise in [Ca2+]i in response to the absence of extracellular Na+ and the effect of ouabain may indicate the participation of the Na(+)/Ca2+ exchanger (NCX) in the regulation of [Ca2+]i.

Balancing bilinguals: lexical-semantic production and cognitive processing in children learning Spanish and English.

The present study investigated developmental changes in lexical production skills in early sequential bilinguals, in both Spanish (L1) and English (L2), exploring the effects of age, years of experience, and basic-level cognitive processing (specifically the ability to resist interference) within a timed picture-naming task. To assess resistance to interference, naming was compared in low competition (blocked-single language) vs. high competition (mixed-alternating language) conditions. Participants were 100 individuals, 20 at each of 5 different age levels (5-7, 8-10, 11-13, 14-16, & young adults). All had learned Spanish as a first language in the home, with formal English experience beginning at 5 years. Gains were made in both languages across age. However, there was a developmental crossover from Spanish dominance in the youngest children, through a period of relatively balanced Spanish and English skills in middle childhood, culminating in a clear pattern of English dominance among adolescents and young adults. Although all groups experienced a greater slowing of response times in the mixed-language condition relative to the blocked-language condition, developmental changes in the pattern of speed-accuracy trade-offs in the mixed condition can be interpreted to reflect a change in the ability to resist cognitive interference during word production.

Bienestar: a diabetes risk-factor prevention program.

The Bienester Health Program, a diabetes risk-factor prevention pilot program, targeted fourth grade Mexican American children. The primary goals are to decrease the two established risk factors for diabetes--overweight and dietary fats. Since the health program is based on Social Cognitive Theory, on social systems structure, and on culturally relevant material, it considers the child's social systems on both its health program and process evaluation. Learning activities were developed for four social systems that potentially influence children's health behaviors (parent, classroom, school cafeteria, and after-school care). Preliminary results show that the Bienestar Health Program significantly decreased dietary fat, increased fruit and vegetable servings, and increased diabetes health knowledge.

Retention of granular sludge at high hydraulic loading rates in an anaerobic membrane bioreactor with immersed filtration.

This study shows the results of an Anaerobic Membrane Bioreactor with immersed filtration cartridges for granular biomass retention working at high hydraulic loading rates. Biomass retention capabilities, granular biomass structure and activity, filtration cartridges flux and organic material degradation performance were evaluated. Four reactors with a volume of 0.005 m3 were tested. Two different filtration cartridges were used (10 and 100 microm) with effective surface area of 0.05 m2. The filtration cartridges were submerged in the reactors for suction type filtration. Three organic loading rates were tested in the first two reactors and seven in the other two. Selective biomass washout and an increment in the biomass methanogenic activity was observed in the reactors at hydraulic loading rates between 1.2 and 4.5 m/h. Analyses of biomass granulometry showed an increase of larger size granular biomass. The immersed membrane anaerobic bioreactor maintain most of the advantages without biomass activity loss.

[Unjustified disposal of transfusion blood because of antibodies against brucella]. / Desecho injustificado de sangre de transfusión por anticuerpos contra Brucella.

OBJECTIVES: To compare the slide microagglutination (SMA) test vs a gold standard test (tube agglutination test: SAT) for the detection of Brucella antibodies in order to evaluate the usefulness of SMA to discard transfusion blood units. DESIGN: Prospective, comparative, cross sectional survey. SETTING: City of Leon, State of Guanajuato, an endemic zone of brucellosis. SAMPLES: 48 sera from blood units discarded for transfusion by three blood banks due to Brucella antibodies detected by SMA and 48 controls of accepted units. METHODS: Determination of Brucella antibodies with the SMA and SAT tests. RESULTS: The 48 control samples were negative with both tests; of the 48 discarded samples, in only seven sera we confirmed a titer > or = 1:80 by SAT; thus, 41 blood units (85%) may have been improperly rejected because the only test used by the blood banks was the SMA. In our hands, the SMA showed a sensitivity and negative predictive value of 100%, a specificity of 81%, and positive predictive value of 29%. CONCLUSIONS: There was a high proportion of improper rejection of blood units for transfusion; Brucella antibodies at any titer detected by SMA should be followed by SAT testing.

Comparative tuberculin reactivity to two protein derivatives.

OBJECTIVE: To evaluate the tuberculin reactivity among medical students and the utility of RT-23 (2 tuberculin unit [TU] purified protein derivative [PPD]) produced in Mexico. DESIGN: A blind and comparative study was conducted in a school of medicine using simultaneously RT-23 and an American product (5 TU PPD) randomly assigned to each forearm and read 48 hours later. Ninety eight volunteers were included, 69 from the first year and 29 from the fifth year as medical students. RESULTS: Using 5 TU PPD, 16% of first year students and 41% of fifth grade students were positive (induration > or = 10 mm). The RT-23 worked well and showed a sensitivity of 87% and a specificity of 92%. There was a large difference in the positivity of fifth versus first year students (x2 = 6.00, P = 0.014) with an estimated annual conversion of 5.1%. The high tuberculin conversion rate urges the need to establish preventive and early diagnosis programs for tuberculosis. The utility of RT-23 was found to be comparable to 5 TU PPD in our population.

[Surveillance of therapy with aminoglycosides at a specialized hospital]. / Vigilancia de terapia con aminoglucósidos en un hospital de especialidades.

Aminoglycosides (AG) are excellent antibiotics against gram-negative bacilli infections, but their use implies potential ototoxicity and nephrotoxicity if an excessive dosage is prescribed. In this study we evaluated 105 episodes of AG treatment in 104 patients hospitalized in a specialty hospital in the city of Leon, Mexico. In each case a basal serum creatinine, weight and age were recorded. A single serum AG assay per episode of treatment was done. Either amikacin or gentamicin were one the AG prescribed. Prior to AG administration only 54 treatment episodes (51%) had a before treatment creatinine assay. The initial creatinine clearance showed normal values in 43% (23/54 episodes) and it was altered (below 80 mL/min) in 31 (57%) of the episodes. In the 31 cases with an altered renal function only 15 (48%) underwent dosage adjustment. In summary the AG were prescribed in excess in 54% (29/54) of the episodes. The serum AG levels within toxic range were observed in 11 episodes. These results suggest that in our hospital AG treatment is not adequately done and monitored.

[Pediatric nosocomial bacteremia. Potential usefulness of culturing infusion liquids]. / Bacteriemia nosocomial pediátrica. Utilidad potencial del cultivo de los líquidos de infusión.

Hospital-acquired bacteremia is a common cause of morbidity and mortality, mainly in pediatric units. In a 25 month retrospective study, we analyzed the blood cultures from the Hospital General Regional of the city of Leon, Guanajuato State, Mexico, in order to establish the causal agents of nosocomial bacteremia and infer some associations with contaminated intravenous infusion fluids. In addition we performed a two month study to culture the flasks and intravenous tubing used in our infusions. Five hundred and fifty one blood cultures drawn from August 1990 to September 1992 were analyzed. A total of 135 (24.5%) were positive, most of them (51.8%) with strains of the Klebsielleae tribe (SKT) (Klebsiella, Enterobacter, Serratia). The global incidence of bacteremia in the two year period was 4.3%. In the infusion study, 230 intravenous fluids were cultured, with 68 isolates (30%) most from the SKT tribe. A final consideration is made on the role that inadequate management of intravenous liquids could play in the development of endemic and epidemic nosocomial bacteremia in our hospital, and the eventual utility of making cultures of the i.v. liquids.