Influence of biotic and abiotic factors of seagrass Posidonia oceanica recruitment: Identifying suitable microsites.

The period between seed germination and successful seedling establishment is considered the most vulnerable phase for plant development. To better predict recruitment patterns within plant communities, it is essential to identify the abiotic constrains and biotic interactions that allow for the colonization of substrates by plant species. We evaluated which combination of factors are associated with successful survival and development of seedlings of the seagrass Posidonia oceanica in order to identify the most important microsite features acting together on recruitment success. Our results show that P. oceanica seedlings are rather specific in their environmental requirements during their first 18 months of life, when their development and survival are favored in microsites of consolidated substratum (solid rock, and to a lesser extent P. oceanica matte) covered by macroalgae (mainly crustose algae) and located in sheltered locations (with energy flux values not exceeding 7 × 105 kg s-2 m s-1). After this phase, their probability of surviving becomes more independent from external conditions.

Nicorandil Affects Mitochondrial Respiratory Chain Function by Increasing Complex III Activity and ROS Production in Skeletal Muscle Mitochondria.

Adenosine triphosphate (ATP)-dependent potassium channels openers (KATP) protect skeletal muscle against function impairment through the activation of the mitochondrial KATP channels (mitoKATP). Previous reports suggest that modulators of the mitochondrial KATP channels have additional effects on isolated mitochondria. To determine whether the KATP channel opener nicorandil has non-specific effects that explain its protective effect through the mitochondrial function, chicken muscle mitochondria were isolated, and respiration rate was determined pollarographically. The activity of the electron transport chain (ETC) complexes (I-IV) was measured using a spectrophotometric method. Reactive oxygen species (ROS) levels and lipid peroxidation were assessed using flow cytometry and thiobarbituric acid assay, respectively. Both KATP channel opener nicorandil and KATP channel blocker 5-hydroxydecanoate (5-HD) decreased mitochondrial respiration; nicorandil increased complex III activity and decreased complex IV activity. The effects of nicorandil on complex III were antagonized by 5-HD. Nicorandil increased ROS levels, effect reverted by either 5-HD or the antioxidant N-2-mercaptopropionyl glycine (MPG). None of these drugs affected lipid peroxidation levels. These findings suggest that KATP channel opener nicorandil increases mitochondrial ROS production from complex III. This results by partially blocking electron flow in the complex IV, setting electron carriers in a more reduced state, which is favored by the increase in complex III activity by nicorandil. Overall, our study showed that nicorandil like other mitochondrial KATP channel openers might not act through mitoKATP channel activation.

Negative effects of warming on seagrass seedlings are not exacerbated by invasive algae.

The observed and projected rise in sea surface temperature challenges marine biodiversity worldwide, and particularly in temperate ecosystems dealing with the arrival of novel species of tropical provenance. When the impacted biota are early life stages of ecosystem engineers, the effects of those impacts are of major concern for ecologists and coastal managers. We experimentally examined the individual and potential additive effects of seawater warming and the presence of the invasive algae on the development of seedlings of the seagrass Posidonia oceanica in a three-month mesocosm experiment. Whereas the presence of the invasive algae (Caulerpa cylindracea and Lophocladia lallemandii) did not result in detrimental effects on seedlings, warming negatively affected seedling development. Interestingly, the presence of both invasive algae may ameliorate the negative effects of warming.

Expression of genes associated with inflammation and iron metabolism in 3T3-L1 cells induced with macrophages-conditioned medium, glucose and iron.

Obesity is characterized by a chronic inflammatory process, with an increased volume of total adipose tissue, especially visceral, which secretes pro-inflammatory cytokines such as TNF-α and IL-6. Hepcidin (Hpc), a main iron metabolism regulator, is synthetized by an IL-6 stimuli, among others, in liver and adipose tissue, favoring an association between the inflammatory process and iron metabolism. Still there are questions remain regarding the interaction of these factors. Our aim was to study the effect of a macrophage-conditioned medium (MCM) on adipocyte cells challenged with glucose and/or iron. We studied the mRNA relative abundance of genes related to inflammation in differentiated 3T3-L1 cells challenged with Fe (40 µM), glucose (20 mM) or Fe/glucose (40 µM/20 mM) with or without MCM for 24 h. We also measured the intracellular iron levels under these conditions. Our results showed that when adipocytes were challenged with MCM, glucose and/or Fe, the intracellular iron and mRNA levels of pro-inflammatory cytokines increased. These responses were higher when all the stimuli were combined with MCM from macrophages. Thus, we showed that combined high glucose/high Fe alone or with MCM may contribute to an increase on intracellular iron and inflammatory response in 3T3-L1 differentiated cells, by increased mRNA levels of IL-6, TNF-α, MCP-1, Hpc and reducing adiponectin levels, enhancing the inflammatory processes.

Field transplantation of seagrass (Posidonia oceanica) seedlings: Effects of invasive algae and nutrients.

Seedlings are a key life stage in seagrasses, providing genetic diversity and being a useful tool for restoration. We examined the influence of increased sediment nutrients and the presence of the invasive macroalga Caulerpa cylindracea on the success of in situ transplanting Posidonia oceanica seedlings in a six-month experiment. Our results indicate that one-year old seedlings successfully survive in the field and their survival and growth are positively affected by the presence of C. cylindracea. Furthermore, nutrient addition in the sediment had positive effects on both C. cylindracea (increasing its cover) and seedlings (increasing leaf development), and the increased C. cylindracea cover did not result in detrimental effects on seedlings. Therefore, biological invasions and nutrient addition do not reinforce each other in the short term to negatively impact transplanted seedlings, which highlights facilitative interactions between invasive algae and native seagrass and provides useful information for successful strategies of seagrass restoration.

Pasado y presente pensando en el futuro / Past and present thinking about the future

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Edad al momento del trasplante: ¿Quiénes tienen riesgo de mala evolución ? / Age at transplantation: who are at risk of a poor outcome ?

Introducción: Si bien la sobrevida de paciente e injerto en niños con trasplante renal (TxR) ha mejorado, algunos sugieren que la edad al TxR es predictora de malos resultados, y los mayores tendrían peor evolución. Objetivo: Definir sobrevida de paciente e injerto según edad al TxR, y factores pronósticos de fracaso en aquellos con peor evolución. Material y métodos: Cohorte retrospectivo de todos los pacientes con TxR en el Hospital Garrahan desde el 01-01-2002 hasta el 01-03-2016. Resultados: de 431 pacientes, 44, (10%) tenían < 6a, 179 (42%)> 6 y <12 y 208 (48%) ≥12 años. La sobrevida del paciente a 8 años fue 97%, 99% y 95% (p=0,2), y la del injerto de: 86%, 69% y 30% respectivamente (p=<0,001). En los ≥ de 12 años, con peor evolución, se incluyeron al análisis univariado como factores de riesgo de pérdida de injerto: GSFS como causa de IRC : HR: 9,4; (p<0,001), Rechazo Agudo (RA) temprano: HR: 8,1; (p<0,001), RA tardío: HR: 4,3; (p<0.001), DGF: HR: 4,1; (p<0,001), No adherencia: HR: 2,3; (p=0,02), Edad de DC > 35a: HR: 1,95 (p=0,1), Tiempo en diálisis: HR: 1,1 (p=0,1), Número de incompatibilidades HLAB y HLADR: HR: 0,8 (p=0,3), Tiempo de Isquemia : 0,9 (p=0,5), Sexo del receptor: HR:0,8 (p=0,6), Donante Cadavérico: HR: 1,2; (p=0,6), 2do TxR : HR: 1,2; (p=0,7). En análisis multivariado: RA tardío: HR: 12,9 (p<0,001), GSFS como causa de IRC: HR: 12,5 (p<0,001), RA temprano: HR: 9 (p<0,001), y DGF: HR: 4,9 (p<0,001). Conclusión: la sobrevida del injerto en adolescentes es inferior. Merecen atención, la prevención de la no adherencia asociada a rechazo, el paciente con GSFS y el retardo de la función pos TxR (AU)

Introduction: Although patient and graft survival of children with a kidney transplantation (KTx) has improved, it has been suggested that older age at KTx is a predictive factor of poor outcome. Aim: To evaluate patient and graft survival according to age at KTx and define predictive factors in those with a poor outcome. Material and methods: A retrospective cohort study was conducted in all patients who underwent KTx at Garrahan Hopital between 01-01-2002 and 01-03-2016. Results: Of 431 patients, 44 (10%) were <6yr, 179 (42%) >6yr, and <12yr, and 208 (48%) ≥12yr. Eight-year patient survival was 97%, 99%, and 95% (p=0.2) and graft survival was 86%, 69%, and 30% (p=<0.001), respectively. In children ≥12 yr, with a worse outcome, the following risk factors of graft loss were included in univariate analysis: FSGS-related CFR: HR: 9.4; (p<0.001), early acute rejection (AR): HR: 8.1; (p<0.001), late AR: HR: 4.3; (p<0.001), DGF: HR: 4.1; (p<0.001), non-adherence: HR: 2.3; (p=0.02), age of deceased donor >35yr: HR: 1.95 (p=0.1), time on dialysis: HR: 1.1 (p=0.1), number of HLA-B and HLA-DR mismatches: HR: 0.8 (p=0.3), cold ischemia time: 0.9 (p=0.5), recipient sex: HR:0.8 (p=0.6), deceased donor: HR: 1.2; (p=0.6), second KTx: HR: 1.2; (p=0.7; and in multivariate analysis: late AR: HR: 12.9 (p<0.001), FSGS-related CFR: HR: 12.5 (p<0.001), early AR: HR: 9 (p<0.001), and DGF: HR: 4.9 (p<0.001). Conclusion: Graft survival is lower in adolescents. Prevention of rejection associated with non-adherence, FSGS, and post-KTx DGF should be taken into account (AU)

Sobrevida de pacientes e injerto en niños con trasplante renal: experiencia del Hospital Garrahan en dos períodos / Patient and graft survival in children with a kidney transplant: The experience at Garrahan Hospital over two periods

En adultos y niños con trasplante renal (TxR) la sobrevida de paciente e injerto ha mejorado. En Argentina no existen datos de sobrevida en niños con TxR en diferentes décadas. El objeto de este trabajo fue valorar en niños con TxR sobrevida de paciente e injerto y analizar causas de muerte, perdida de injerto y factores de riesgo de pérdida. Dado que desde el año 2001 se unificaron prácticas de diagnóstico y tratamiento, se compararon dos periodos: 1988-2000 y 2001-2015. Se incluyeron 773 niños. A 1, 3, 5, 7 y 10 años, En TxR de DV (n=327), la sobrevida del paciente fue de 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% y 96% (p=0.74); la del injerto de 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81% y 76% (p=0.81). En TxR de DC (n=446) la sobrevida de paciente fue de 97%, 93%, 90%, 89% y 87% en el 1er. periodo vs. 100%, 99% y 98% 98% y 98% en el 2do (p<0.001); la del injerto de 83%, 75%, 68%, 64% y 52% vs. 95%, 87%, 83%, 76% y 61% respectivamente (p<0. 001). El Rechazo Crónico fue la 1er causa de perdida (61% vs 62%); la 2da la muerte del paciente con injerto funcionante. La sepsis bacteriana fue la 1era causa de muerte (56% vs 67%). Ningún niño falleció por neoplasia entre el 2001 y 2015. En DV, fueron predictores de perdida de injerto: DGF (HR: 4.8; p<0.001), edad al TxR > 12 años (HR: 2.7; p=0.002) y RA tardío (HR: 2.1; p=0.009). En DC la necesidad de diálisis en la 1er semana post TxR (DGF): (HR: 4.4; p<0.001), el rechazo agudo (RA) tardío (HR: 3.7; p<0.001), GSFS como causa de IRC (HR: 2.5; p=0.01), y RA temprano (HR: 2.2; p=0.02). Conclusión: En el 2do periodo la sobrevida de paciente e injerto los TxR con DC mejoro, y en los TxR con DV no tuvo cambios. El rechazo crónico continúa siendo la 1era causa de perdida. Ningún paciente tuvo neoplasia (AU)

Patient and graft survival in kidney transplantation (KTx) has improved. In Argentina there are no data comparing transplant outcomes in children over different eras. The aim of this study was to evaluate patient and graft survival in children with KTx and to analyze cause of death, graft loss, and risk factors of graft loss. As diagnostic and treatment practices were unified in 2001, two periods were compared: 1988-2000 and 2001-2015. Overall, 773 children were included. Survival at 1, 3, 5, 7, and 10 years after a living-related donor (LRD) KTx was 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% and 96% (p=0.74); graft survival was 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81%, and 76% (p=0.81). Patient survival after deceased donor (DD) KTx (n=446) was 97%, 93%, 90%, 89%, and 87% in the 1st period vs. 100%, 99% y 98% 98%, and 98% in the 2nd (p<0.001); graft survival was 83%, 75%, 68%, 64%, and 52% vs. 95%, 87%, 83%, 76%, and 61%, respectively (p<0. 001). Chronic rejection was the first cause of graft loss (61% vs 62%); the second was death of the patient with a functioning graft. Bacterial sepsis was the first cause of death (56% vs 67%). None of the patients died because of malignancies between 2001 and 2015. Among LRD transplants predicting factors of graft loss were: DGF (HR: 4.8; p<0.001), age at KTx >12 years (HR: 2.7; p=0.002), and late acute rejection (AR) (HR: 2.1; p=0.009). Among DD need for dialysis in the first week post-KTx (DGF): (HR: 4.4; p<0.001), late AR (HR: 3.7; p<0.001), FSGS-related CFR (HR: 2.5; p=0.01), and early AR (HR: 2.2; p=0.02). Conclusion: In the second period patient and graft survival after DD improved, while that of KTx with LRD remained unchanged. Chronic rejection continues being the first cause of graft loss. None of the patients developed malignancies.

Transición de pacientes con enfermedad renal crónica / Transition of patients with chronic kidney disease

Existe actualmente un creciente interés en los problemas asociados a la transición desde la atención de los adolescentes y jóvenes con enfermedad renal crónica en centros pediátricos a los de adultos. Los pacientes y ambos equipos experimentan diferentes visiones y sensaciones de insatisfacción. Aún falta mucho para que el proceso sea exitoso por las características distintivas de este grupo y sus propias historias personales. El objetivo de este trabajo es mediante una herramienta objetiva, determinar cuál de las competencias deseables de obtener para lograr una adecuada transición de la atención pediátrica a la del adulto es la menos desarrollada en los pacientes con enfermedad renal. Se encontró que el manejo de la propia vida es el ítem menos logrado, sobre todo en los varones adolescentes. Concluimos que fortalecer la autonomía de estos adolescentes y jóvenes debe ser un objetivo a trabajar por todo el equipo de salud para puedan completar este proceso transicional exitosamente (AU)

Currently there is a growing interest in problems associated with transition of care from pediatric to adult centers of adolescents and young adults with chronic kidney disease. The patients and both teams have different views and feelings of frustration. Much is still lacking for the process to become successful due to the typical features of this group of patients and their personal histories. The aim of this study was to determine through an objective tool the necessary skills to achieve an adequate transition from pediatric to adult care that have not been developed in patients with kidney disease. It was found that control over their own life was the item that was less achieved, particularly in adolescent boys. We conclude that strengthening the autonomy of these adolescents and young adults should be an aim of the whole health team for the successful transition of these patients (AU)

Paratiroidectomía subtotal: último recurso en el tratamiento de hiperparatiroidismo secundario en los pacientes con enfermedad renal crónica / Subtotal parathyroidectomy: last resource in the treatment of secondary hyperparathyroidism in patients with chronic kidney disease

El fracaso del tratamiento médico del HPTs hace necesario la utilización de una solución más agresiva. La paratiroidectomía subtotal (PTXs) ha sido efectiva en el control de los niveles de PTH para disminuir las complicaciones derivadas de su secreción descontrolada: astenia, dolores y deformidades óseas y calcificaciones vasculares que serán finalmente responsables de la muerte por trastornos cardiacos en edades tempranas de los pacientes renales crónicos. Se describe la eficiencia de la ecografía y centellografía con sestamibi para la correcta ubicación, número y tamaño de las glándulas paratiroideas y la determinación del descenso del nivel de PTH intraquirúrgico como factor predictor del éxito quirúrgico (AU)

Failure of medical management of hyperparathyroidism has warranted a more aggressive solution. Subtotal parathyroidectomy (sPTX) has been effective in the control of parathyroid hormone (PTH) levels decreasing complications related to uncontrolled secretion: asthenia, bone pain and deformities, and vascular calcifications leading to death due to early heart disease in patients with chronic kidney disease. Here we describe the efficiency of ultrasonography and sestamibi whole body scan for the precise location and evaluation of number and size of the parathyroid glands and determination of the intraoperative decrease of PTH levels as a predictive factor for surgical success (AU)

Prevalence of stereotypies in thoroughbred race horses at Club Hípico Concepción, Chile / Prevalencia de estereotipias en caballos fina sangre de carrera del Club Hípico Concepción, Chile

Objective. To determine the prevalence of classic stereotypies in Thoroughbred racehorses at the Club Hípico Concepción (CHC) in Chile and its association with sex and age. Materials and methods. The entire population of resident horses at the CHC was studied (n=341). Each horse trainer (n=23) was asked for the name, sex and age of the horses under his/her supervision. After that, all the animals were continuously observed inside their stalls for 8 hours by only one person, to record the absence or presence of classic stereotypies (cribbing, weaving, stall-walking). To analyze the data, the animals were divided by sex into 3 groups: stallions, geldings and mares. According to age, they were divided into 2 groups: < 5 years old and 5 years old or more. Descriptive statistics were used and association was tested using the chi square test using p≤0.05. Results. 13.2% of all CHC's horses displayed stereotypies: cribbing (4.99%), weaving (2.93%) and stall-walking (5.28%). No association was found between the presence of stereotypies and sex or age. Conclusions. Thoroughbred race horses at the CHC showed a high prevalence of classic stereotypies, especially stall-walking.

Objetivo. Determinar la prevalencia de estereotipias clásicas en caballos fina sangre de carrera (FSC) del Club Hípico Concepción (CHC), Chile y su asociación con el sexo y la edad. Materiales y métodos. Se estudió la totalidad de los caballos FSC (n=341) residentes en el CHC. A cada entrenador (n=23), se le consultó nombre, sexo y edad de los caballos a su cargo. Luego, con la finalidad de detectar la presencia o ausencia de estereotipias clásicas (aerofagia, balanceo y caminar en pesebrera), durante 8 horas una sola persona observó directamente los caballos mientras se encontraban en sus pesebreras. Los caballos se dividieron por sexo en 3 grupos: machos enteros, machos castrados y hembras. De acuerdo con la edad se dividieron en 2 grupos: <5 años y 5 años o más. Los resultados en la parte descriptiva se entregan como porcentajes simples y para el análisis estadístico de las variables sexo y edad, se utilizó la prueba de X2, con un nivel de significancia de p<0.05. Resultados. El 13.2% de los caballos de CHC presentaron estereotipias: aerofagia (4.99%), balanceo (2.93%) y caminar en pesebrera (5.28%). No se encontró asociación entre la presencia de estereotipias y las variables sexo y edad. Conclusiones. Los caballos FSC del CHC presentan una alta prevalencia de estereotipias clásicas, principalmente caminar en pesebrera.

Transportation fuel production by combination of LDPE thermal cracking and catalytic hydroreforming.

Fuel production from plastics is a promising way to reduce landfilling rates while obtaining valuable products. The usage of Ni-supported hierarchical Beta zeolite (h-Beta) for the hydroreforming of the oils coming from LDPE thermal cracking has proved to produce high selectivities to gasoline and diesel fuels (>80%). In the present work, the effect of the Ni loading on Ni/h-Beta is investigated in the hydroreforming of the oils form LDPE thermal cracking. h-Beta samples were impregnated with Ni nitrate, calcined and reduced in H2 up to 550°C to achieve different Ni contents: 1.5%, 4%, 7% and 10%. Larger and more easily reducible metal particles were obtained on Ni 7%/h-Beta and Ni 10%/h-Beta. Hydroreforming tests were carried out in autoclave reactor at 310°C, under 20 bar H2, for 45 min. Ni content progressively increased the amount of gases at the expenses of diesel fractions, while gasoline remained approximately constant about 52-54%. Maximum selectivity to automotive fuels (∼81%) was obtained with Ni 7%/h-Beta. Ni loading also enhanced olefins saturation up to Ni 7%/h-Beta. High cetane indices (71-86) and octane numbers (89-91) were obtained over all the catalysts. Regarding the different studied Ni contents, Ni 7%/h-Beta constitutes a rather promising catalyst for obtaining high quality fuels from LDPE thermal cracking oils.

Effect of calcium, tannic acid, phytic acid and pectin over iron uptake in an in vitro Caco-2 cell model.

Calcium, phytic acid, polyphenols and fiber are major inhibitors of iron absorption and they could be found in excess in some diets, thereby altering or modifying the iron nutrition status. The purpose of this study is to evaluate the effect of calcium, tannic acid, phytic acid, and pectin over iron uptake, using an in vitro model of epithelial cells (Caco-2 cell line). Caco-2 cells were incubated with iron (10-30 µM) with or without CaCl2 (500 and 1,000 µM) for 24 h. Then, cells were challenged with phytic acid (50-150 µM); pectin (50-150 nM) or tannic acid (100-500 µM) for another 24 h. Finally, (55)Fe (10 µM) uptake was determined. Iron dialyzability was studied using an in vitro digestion method. Iron uptake in cells pre-incubated with 20 and 30 µM Fe was inhibited by CaCl2 (500 µM). Iron uptake decreased in cells cultured with tannic acid (300 µM) and CaCl2 (500-1,000 µM) (two-way ANOVA, p = 0.002). Phytic acid also decreased iron uptake mainly when cells were treated with CaCl2 (1,000 µM) (two-way ANOVA; p < 0.05). Pectin slightly decreased iron uptake (p = NS). Iron dialyzability decreased when iron was mixed with CaCl2 and phytic or tannic acid (T test p < 0.0001, for both) but not when mixed with pectin. Phytic acid combined with calcium is a strong iron uptake inhibitor. Pectin slightly decreased iron uptake with or without calcium. Tannic acid showed an unexpected behavior, inducing an increase on iron uptake, despite its low Fe dialyzability.

Genetic diversity and insecticide resistance during the growing season in the green peach aphid (Hemiptera: Aphididae) on primary and secondary hosts: a farm-scale study in Central Chile.

The seasonal dynamics of neutral genetic diversity and the insecticide resistance mechanisms of insect pests at the farm scale are still poorly documented. Here this was addressed in the green peach aphid Myzus persicae (Sulzer) (Hemiptera: Aphididae) in Central Chile. Samples were collected from an insecticide sprayed peach (Prunus persica L.) orchard (primary host), and a sweet-pepper (Capsicum annum var. grossum L.) field (secondary host). In addition, aphids from weeds (secondary hosts) growing among these crops were also sampled. Many unique multilocus genotypes were found on peach trees, while secondary hosts were colonized mostly by the six most common genotypes, which were predominantly sensitive to insecticides. In both fields, a small but significant genetic differentiation was found between aphids on the crops vs. their weeds. Within-season comparisons showed genetic differentiation between early and late season samples from peach, as well as for weeds in the peach orchard. The knock-down resistance (kdr) mutation was detected mostly in the heterozygote state, often associated with modified acetylcholinesterase throughout the season for both crops. This mutation was found in high frequency, mainly in the peach orchard. The super-kdr mutation was found in very low frequencies in both crops. This study provides farm-scale evidence that the aphid M. persicae can be composed of slightly different genetic groups between contiguous populations of primary and secondary hosts exhibiting different dynamics of insecticide resistance through the growing season.

Seguridad y eficacia de la colocación del catéter de diálisis peritoneal aguda por punción en pacientes con síndrome urémico hemolítico asociado a diarrea / Safety and efficacy of percutaneous acute peritoneal dialysis catheter placement in patients with post-diarrheal hemolytic uremic syndrome

Introducción: La diálisis peritoneal aguda (DPA) es la modalidad dialítica preferentemente seleccionada para niños con injuria renal aguda por síndrome urémico hemolítico postdiarreico (SUH D+). Evaluamos la seguridad y eficacia de la colocación por punción percutánea del catéter de DPA con anestesia local en niños con SUH D+. Pacientes y métodos: Se revisaron las historias clínicas de todos los pacientes con SUH D+ internados entre el 1 de enero de 1998 y el 31 de diciembre de 2008 en el Hospital de Pediatría Prof. Dr. Juan P. Garrahan. La seguridad se evaluó por la presencia de eventos adversos mayores relacionados con la colocación del catéter (per foración de vísceras y/o vasos mayores abdominales, sangrado que requiera transfusión) y menores (infección del sitio de salida y peritonitis dentro de las 48 hs del procedimiento). La eficacia se evaluó a través de la colocación exitosa del catéter y su buen funcionamiento. Además se registró la necesidad de recambio luego de su uso por mal funcionamiento. Resultados: Identificamos 149 pacientes que realizaron DPA, edad de 20.2 meses (rango 2,9-111) y peso de 11,35 kg (rango 5-24.4). Recuento de plaquetas previo al procedimiento de 89000 (22000-148000) mm3. Seguridad: el único efecto adverso detectado fue el desarrollo de peritonitis en un paciente. No se registró perforación de órganos ni de vasos mayores abdominales, ni sangrado severo, ni infección del sitio de salida. Eficacia: en todos los casos el catéter fue colocado exitosamente y en 48 pacientes (32.2%) hubo que recambiarlo por mal funcionamiento. Tanto la colocación como el recambio fueron realizadas en todos los casos por el nefrólogo al pie de la cama. Conclusión: la colocación del catéter de DPA por punción es un procedimiento seguro y eficaz.

ntroduction: Acute peritoneal dialysis (DPA) is the dialytictreatment of choice for children with acute kidney injury dueto post-diarrheal hemolytic uremic syndrome (D+HUS). In thisstudy safety and efficacy of percutaneous placement of anAPD catheter under local anesthesia in children with D+HUSwas assessed. Patients and methods: We reviewed the cli-nical charts of all patients with D+HUS admitted to thePediatric Hospital Prof. Dr. Juan P. Garrahan betweenJanuary 1, 1998 and December 31, 2008. Safety was eva-luated based on the presence of major (perforation of theviscera and/or major abdominal vessels, bloody dialysaterequiring red-blood-cell transfusion) and minor (exit-siteinfection and peritonitis within 48 hs of the procedure) adverse events associated with catheter insertion. Efficacy was assessed based on successful catheter insertion and func-tioning. Additionally, the need for catheter replacement dueto malfunction was recorded. Results: We identified 149patients with a mean age of 20.2 months (range, 2.9-111)and weight of 11.35 kg (range, 5-24.4) who underwent APD.Median platelet count previous to the procedure was 89000(range, 22000-148000) mm3. Safety: The only adverse eventfound was the development of peritonitis in one patient.Organ or major vessel perforation, severe bleeds, or exit-site infection were not observed. Efficacy: In all patients the catheter was successfully inserted and in 48 patients (32.2%) the catheter had to be replaced due to malfunctioning. Both placement and replacement were performed by a nephrologist at the bedside in all cases. Conclusion: Percutaneous APD catheter insertion is a safe and efficacious procedure.

Desarrollo y conducta adaptativa en niños con insuficiencia renal crónica en DPCA / Development and adaptative behavior in children with chronic renal insuffiency on CAPD

Los niños con enfermedad renal crónica encuentran un riesgo aumentado de presentar compromiso de su neurodesarrollo. El objetivo de este trabajo fue la evaluación cognitiva y adaptativa de 15 niños con insuficiencia renal crónica en tratamiento de reemplazo con diálisis peritoneal ambulatoria. El desarrollo cognitivo fue normal o superior en 3 pacientes (20%) y retrasado en 12 (80%). La conducta adaptativa fue adecuada en 8 (53%) y baja o muy baja en 7 (47%). No hubo relación entre el desarrollo cognitivo y la escolaridad materna o el nivel socio económico, ni entre la conducta adaptativa y el nivel de escolaridad materna. La relación entre el NSE y la conducta adaptativa fue significativa (p 0.04). Esto sugeriría que si bien la enfermedad renal crónica compromete el desarrollo cognitivo, un nivel socioeconómico medio/alto puede proveer oportunidades para una mejor conducta adaptativa.

Children with chronic kidney disease are at increased riskof having impaired neurodevelopment. The objective of thepresent study was to perform a cognitive and adaptive eva-luation of 15 children with chronic renal insufficiency onoutpatient peritoneal dialysis. Cognitive development wasnormal or above normal in 3 patients (20%) and delayed in12 (80%). Adaptive behavior was adequate in 8 (53%) andlow or very low in 7 (47%). No correlation was found eitherbetween cognitive development and maternal education orsocio-economic level or between adaptive behavior andeducation of the mother. A significant correlation was foundbetween socio-economic level and adaptive behavior (p0.04). This would suggest that although chronic kidney dise-ase compromises cognitive development, middle or uppersocio-economic level may provide opportunities for impro-ved adaptive behavior.