[Perceived needs regarding school health care]. / Necesidades percibidas sobre atención a la salud escolar.

BACKGROUND AND OBJECTIVE: Changes in infant morbidity require adaptations to preserve their proper development and academic performance. The objective of this study was to know the perceived needs of teachers, pediatricians and pediatric nurses regarding the training of schools to deal with emergences related to chronic pathology and accidents. METHOD: Cross-sectional study using an ad hoc validated questionnaire on digital support (Google Forms) that included sociodemographic variables and a structured survey that collected information on chronic pathology, health care and safety in case of emergency in the school. RESULTS: Data from 266 questionnaires (134 teachers, 132 pediatricians and pediatric nurses) were analyzed. 73.9% of the teachers stated that they have had students with chronic pathology during the last year and 45.5% confirmed the existence of protocols for their assistance, although 68.7% did not receive specific training for their care. 25% of pediatricians and nurses stated that the parents of children with chronic disease always notify the schools and 17.4% stated that they knew about the existence of specific protocols. 35.6% collaborated in training related to specific pathology or emergencies in schools, with a greater predominance of primary health care (P<.001). 50.7% of the pediatricians and 79.7% of the nurses stated as a medium-high priority the need to have a school nurse in the centers. CONCLUSIONS: The health care of students with chronic diseases in schools can be improved for teachers, pediatricians and pediatric nurses, considering the figure of school nurse as the main improvement measure.

Caracterización del perfil de usuarios policonsultantes en urgencia Hospital San Camilo, pertenecientes al CESFAM San Felipe el real, San Felipe Autores/as / Characterization of the profile of polyconsultant users in the emergency Hospital san Camilo, belonging to a Family Health Center, San Felipe

INTRODUCCIÓN. El sistema de salud chileno se basa en el modelo de atención primaria. En este contexto, la demanda generada por la atención de usuarios policonsultantes constituye una problemática universal. Surge entonces la necesidad de identificar a esta población para implementar medidas. El objetivo de este estudio es caracterizar el perfil de usuarios policonsultantes en el servicio de urgencia del Hospital San Camilo, pertenecientes al CESFAM San Felipe El Real, entre junio 2018-mayo 2019. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo y descriptivo. Los datos fueron obtenidos desde base de datos anonimizada de usuarios atendidos en el servicio de salud; se seleccionaron pacientes pertenecientes al Centro con 7 o más consultas anuales en urgencia del Hospital San Camilo y se analizaron variables como sexo, edad, previsión y patologías consultadas. RESULTADOS. De 128 pacientes pertenecientes al CESFAM catalogados como policonsultantes, dos tercios del total son del sexo femenino, con un claro predominio de los primeros dos tramos de FONASA. En ambos sexos la población es mayormente pediátrica y le sigue a esto la población femenina de edad media. DISCUSIÓN. Con estos resultados se caracteriza a los usuarios policonsultantes del centro estudiado, lo que permite focalizar planes para estas personas implementando mejoras en resolutividad.

INTRODUCTION. The Chilean health system is based on the primary care model. In this context, the demand generated by the attention of polyconsultant users constitutes a universal problem. Is necessary to identify this population to implement measures. The objective of this study is to characterize the profile of polyconsultant users in the emergency department of San Camilo Hospital, belonging to the CESFAM San Felipe El Real, between June 2018-May 2019. MATERIALS AND METHODS. Observational, retrospective and descriptive study. From an anonymized database that collects information from users treated in the health service, patients belonging to the Center were selected if they had 7 or more annual consultations in the emergency care of the San Camilo Hospital. Variables such as sex, age, prevention and pathologies were analyzed. RESULTS. Of 128 patients belonging to CESFAM cataloged as polyconsultant, two thirds of the total are female, with a clear predominance of the first two sections of FONASA. In both sexes the population is mostly pediatric, and this is followed by the middle-aged female population. DISCUSSION. With these results, the polyconsultant users of the center studied are characterized, which allows to focus plans on these people and improve the resolution in these areas.

Política de formación médica para la atención primaria de salud en Chile, crisis y desafíos / In search of a Medical Education for Chile

El presente ensayo pretende realizar un análisis crítico de la formación médica actual a la luz de los requerimientos de la atención de salud para responder a las necesidades de la población.(AU)

1-42 ß-amyloid peptide requires PDK1/nPKC/Rac 1 pathway to induce neuronal death.

1-42 ß-Amyloid (Aß(1-42)) peptide is a key molecule involved in the development of Alzheimer's disease. Some of its effects are manifested at the neuronal morphological level. These morphological changes involve loss of neurites due to cytoskeleton alterations. However, the mechanism of Aß(1-42) peptide activation of the neurodegenerative program is still poorly understood. Here, Aß(1-42) peptide-induced transduction of cellular death signals through the phosphatidylinositol 3-kinase (PI3K)/phosphoinositol-dependent kinase (PDK)/novel protein kinase C (nPKC)/Rac 1 axis is described. Furthermore, pharmacological inhibition of PDK1 and nPKC activities blocks Rac 1 activation and neuronal cell death. Our results provide insights into an unsuspected connection between PDK1, nPKCs and Rac 1 in the same signal-transduction pathway and points out nPKCs and Rac 1 as potential therapeutic targets to block the toxic effects of Aß(1-42) peptide in neurons.

Una nueva propuesta de reforma neoliberal del sistema de salud chileno / A new neoliberal reform proposal about Chilean health sistem

Una de las primeras medidas que tomó el nuevo gobierno de derecha en Chile, fue formar comisiones de expertos en salud, la mayoría de ellos vinculados al sector privado, para realizar propuestas de cambio en la materia. En 2011, se emitieron los informes que sentaron las bases un proyecto de ley actualmente en discusión. El presente ensayo tiene por finalidad realizar un análisis crítico de la propuesta de cambios, basado fundamentalmente en los planteamientos políticos actuales de la OMS en relación a los sistemas de salud. La propuesta plantea la creación de un plan básico de salud, lo que mantiene la tendencia de delimitación explícita del derecho a la salud, alejando aún más al sistema sanitario de la recomendación de la OMS de reducir la brecha de ofertas de servicios para alcanzar la universalidad. Las principales conclusiones del análisis crítico realizado son que existe un riesgo elevado de aumento de la inequidad en el acceso a la prestación de servicios debido a que las personas con más dinero podrán mantener o aumentar sus beneficios actuales y aquellas con menos ingresos tenderán a disminuir su acceso por el aumento del pago de bolsillo. Se puede asegurar que se trata de una propuesta que consolida las reformas neoliberales instaladas en Chile desde la década del 80.

Notch1 signaling promotes survival of glioblastoma cells via EGFR-mediated induction of anti-apoptotic Mcl-1.

The Notch1-mediated signaling pathway has a central role in the maintenance of neural stem cells and contributes to growth and progression of glioblastomas, the most frequent malignant brain tumors in adults. Here, we demonstrate that the Notch1 receptor promotes survival of glioblastoma cells by regulation of the anti-apoptotic Mcl-1 protein. Notch1-dependent regulation of Mcl-1 occurs cell type dependent at a transcriptional or post-translational level and is mediated by the induction of epidermal growth factor receptor (EGFR). Inhibition of the Notch1 pathway overcomes apoptosis resistance and sensitizes glioblastoma cells to apoptosis induced by ionizing radiation, the death ligand TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) or the Bcl-2/Bcl-XL inhibitor ABT-737. In conclusion, targeting Notch1 might represent a promising novel strategy in the treatment of glioblastomas.

Optical Photoacoustic Detection of Circulating Melanoma Cells In Vitro.

The purpose of this research was to investigate the sensitivity of a system for the detection of circulating melanoma cells based on the thermoelastic properties of melanoma. The method employs photoacoustic (PA) excitation coupled with an optical transducer capable of determining the presence of cells within the circulating system in vitro. The transducer is based on stress wave-induced changes of the optical reflectance of a glass-water interface, probed with a continuous laser beam that is incident at an angle close to the critical angle of total internal reflection. A frequency tripled Nd:YAG laser pumping an optical parametric oscillator was employed to provide 532 nm and 620 nm laser light with a pulse duration of 10 ns. A custom-made flow chamber was used as an excitation and acoustic wave collection device. The targets were a human melanoma cell line HS 936 with an average diameter of about 15 µm. Melanoma cells were suspended in 10 mL of two types of media. The first one was Tyrode's buffer in concentrations ranging from 10 to 50 cells per µL, and the second one included 10(6) healthy white blood cells per mL of Tyrode's buffer. PA pressure waves were detected by an optical stress transducer. Detection trials resulted in a detection threshold of the order of one individual cell, indicating the effectiveness of the proposed mechanism. Results imply the potential to assay simple blood samples, from healthy and metastatic patients, to test the presence of cancerous melanoma providing an unprecedented method for screening metastatic disease.

Retiro de ventilación mecánica prolongada: experiencia de seis años con la aplicación de protocolo especializado / Weaning of prolonged mechanical ventilation: specialized protocol

La Ventilación Mecánica Prolongada (VMP) ha sido definida como aquella mayor de 21 días por al menos 6 horas diarias. Este fenómeno es un creciente problema para las Unidades de Cuidados Intensivos (UCI) en todo el mundo. Los consensos internacionales señalan que los pacientes con VMP deben ser tratados en unidades diferentes a las UCI, con protocolos especializados multiprofesionales dedicados a intentar el retiro del respirador. En nuestro Centro hemos recibido desde el año 2002 a 31 pacientes con VMP y les hemos aplicado un Protocolo de Rehabilitación Respiratoria Integral para ese objetivo. Las patologías predominantes fueron neuromusculares. El protocolo tiene 4 etapas progresivas, las 2 primeras comprenden la evaluación general y el inicio de terapias multiprofesionales. Las 2 siguientes consisten en retiro progresivo del respirador y continuación de terapias. Se midió la presión inspiratoria, presión espiratoria espiratoria máximas (PImáx y PEmáx) y la presión inspiratoria máxima sostenida (PIms), también se evaluó la actividad muscular de cuello, tronco y extremidades, así como el estado general y nutritivo, el nivel de conciencia y la calidad del apoyo familiar. Se entra a etapa 3 cuando los valores de PImáx y PEmáx son 60 y 50 cmH2O, respectivamente. Fueron excluidos de llegar a las últimas 2 etapas 7 pacientes, quienes no lograron este nivel de presiones. Resultados: 19pacientes (61 por ciento) con promedio de edad de 44 años (16-77), fueron retirados del respirador, 5 están aún en etapas 2 y 3; el promedio de VMP fue de 238 días y de 74 días a contar desde el ingreso a etapa 3. El promedio de mejoría de PImax fue de 59 por ciento, la PEmáx 60 por ciento y la PIms 61 por ciento, todos valores con significación estadística (p <0,001). El control cefálico y de tronco mejoró con las terapias. También el daño cognitivo, la depresión y la alteración de la función deglutoria...

Prolonged mechanical ventilation (PMV) is defined as greater than 21 days of mechanical ventilation for at least 6hours per day and is an increasing problem for the Intensive Care Units in all over the world. Many expert consensus groups recommend that long-term facilities may be a useful resource of care to implement integrated and specialized protocols for weaning from PMV. Since 2002 our center admitted 31 patients in PMV who were included on an Integral Respiratory Rehabilitation Protocol that was applied for our primary outcome of weaning success. Neuromuscular diseases were the main cause requiring PMV. The protocol applied consists of 4 successive stages, the first two oriented to evaluation and initiation of multiprofessional therapies, the next two are dedicated to progressive weaning and continuation of therapy. Peak inspiratory and expiratory pressures, and maximal sustained inspiratory pressure (PImax, PEmax and PIms) were measured, additionally muscular activity from neck, trunk and legs, general and nutritional condition, conscience level and family support were evaluated. Entry to stage 3 was defined when the PImax and PEmax were 60 and 50 cmH2O. Seven patients who failed to achieve this pressure levels were excluded. Results: 19 patients (61 percent) with a mean age of 44 years (16-77) had successful weaning and 5 patients are still in stage 2 or 3. Mean duration of PMV was 238 days. Mean Time on Mechanical Ventilation from the beginning of stage3 until the final weaning was 74 days. PImax, PEmax and PIms increased in 59, 60 and 61 percent each, all with statistical significance p <0.001, cephalic and trunk muscle control was increased with integrated therapies. The cognitive impairment, depression and swallowing disorders were professionally treated. Conclusion: A specialized, multiprofessional integrated protocol for PMV in our center permitted a successful weaning rate comparable to the best international series.

Insulin receptor and IGF1R are not required for oocyte growth, differentiation, and maturation in mice.

In mammals, insulin and insulin-like growth factors (IGFs: IGF1 and IGF2) act through 2 structurally related receptors, the insulin receptor (INSR) and the type 1 IGF receptor (IGF1R), both of which are expressed in developing oocytes. IGF1 plays an important role in female reproduction, and female Igf1 knockout mice fail to ovulate and are infertile. On the other hand, little is known about the in vivo role of the insulin signaling pathway in oocytes during follicular development, although exposure to insulin or IGF1 in vitro improves oocyte maturation. To further address the significance of insulin/IGF signaling, we used conditional mutant mice and ablated the function of the genes encoding INSR, IGF1R, or both receptors specifically in developing mouse oocytes. Our genetic evidence showed unexpectedly that the female reproductive functions are not affected when Insr, Igf1r or both Insr;Igf1r are ablated in oocytes, as the female mice are fertile and exhibit normal estrous cyclicity, oocyte development and maturation, parturition frequency, and litter size. In view of these novel observations indicating that the insulin/IGF signaling is not essential in oocytes, the IGF1-dependent female fertility is re-evaluated and discussed.

Neural and cancer stem cells in tumor suppressor mouse models of malignant astrocytoma.

Malignant astrocytomas are highly invasive brain tumors that portend poor prognosis and dismal survival. Mouse models that genetically resemble the human malignancy provide insight into the nature and pathogenesis of these cancers. We previously reported tumor suppressor mouse models based on conditional inactivation of human astrocytoma-relevant genes p53, Nf1, and Pten. These mice develop, with full penetrance, varying grades of astrocytic malignancy that recapitulate the human condition histologically and molecularly. Our studies indicate a central role for neural stem cells and stem-cell-like cancer cells in tumor initiation and progression. These mouse models thus represent powerful tools for investigating various aspects of tumor development that otherwise cannot be explored in humans. Further studies will provide a better understanding of the biology of these tumors and will hopefully pave the way for more effective therapeutic approaches for these devastating diseases.

Tumor microenvironment and neurofibromatosis type I: connecting the GAPs.

The human disease von Recklinghausen's neurofibromatosis (Nf1) is one of the most common genetic disorders. It is caused by mutations in the NF1 tumor suppressor gene, which encodes a GTPase activating protein (GAP) that negatively regulates p21-RAS signaling. Dermal and plexiform neurofibromas as well as malignant peripheral nerve sheath tumors and other malignant tumors, are significant complications in Nf1. Neurofibromas are complex tumors and composed mainly of abnormal local cells including Schwann cells, endothelial cells, fibroblasts and additionally a large number of infiltrating inflammatory mast cells. Recent work has indicated a role for the microenvironment in plexiform neurofibroma genesis. The emerging evidence points to mast cells as crucial contributors to neurofibroma tumorigenesis. Therefore, further understanding of the molecular interactions between Schwann cells and their environment will provide tools to develop new therapies aimed at delaying or preventing tumor formation in Nf1 patients.

Site-directed antibodies to low-voltage-activated calcium channel CaV3.3 (alpha1I) subunit also target neural cell adhesion molecule-180.

Synthetic peptides of defined amino acid sequence are commonly used as unique antigens for production of antibodies to more complex target proteins. We previously showed that an affinity-purified, site-directed polyclonal antibody (CW90) raised against a peptide antigen (CNGRMPNIAKDVFTKM) anticipated to be specific to a T-type voltage-dependent Ca(2+) channel subunit identified recombinant rat alpha1I/Ca(V)3.3 and two endogenous mouse proteins distinct in their developmental expression and apparent molecular mass (neonatal form 260 kDa, mature form 190 kDa) [Yunker AM, Sharp AH, Sundarraj S, Ranganathan V, Copeland TD, McEnery MW (2003) Immunological characterization of T-type voltage-dependent calcium channel Ca(V)3.1 (alpha 1G) and Ca(V)3.3 (alpha 1I) isoforms reveal differences in their localization, expression, and neural development. Neuroscience 117:321-335]. In the present study, we further characterize the biochemical properties of the CW90 antigens. We show for the first time that recombinant alpha1I/Ca(V)3.3 is modified by N-glycosylation. Using peptide:N-glycosidase F (PNGase F), an enzyme that removes polysaccharides attached at Asn residues, and endoneuraminidase-N (Endo-N), which specifically removes polysialic acid modifications, we reveal that differential glycosylation fully accounts for the large difference in apparent molecular mass between neonatal and adult CW90 antigens and that the neonatal form is polysialylated. As very few proteins are substrates for Endo-N, we carried out extensive analyses and herein present evidence that CW90 reacts with recombinant alpha1I/Ca(V)3.3 as well as endogenous neural cell adhesion molecule-180 (NCAM-180). We demonstrate the basis for CW90 cross-reactivity is a five amino acid epitope (AKDVF) present in both alpha1I/Ca(V)3.3 and NCAM-180. To extend these findings, we introduce a novel polyclonal anti-peptide antibody (CW678) that uniquely recognizes NCAM-180 and a new antibody (CW109) against alpha1I/Ca(V)3.3. Western blot analyses obtained with CW678, CW109 and CW90 on a variety of samples confirm that the endogenous CW90 signals are fully attributed to the two developmental forms of NCAM-180. Using CW678, we present novel data on differentiation-dependent NCAM-180 expression in human neuroblastoma IMR32 cells. These results strongly suggest the need for careful analyses to validate anti-peptide antibodies when targeting membrane proteins of low abundance.

Transcriptional regulation of Trk family neurotrophin receptors.

The Trk family of neurotrophin receptors plays essential roles in cell fate specification, survival, growth, and differentiation. Their expression patterns are complex and dynamically regulated under many physiological and pathological conditions. However, the molecular mechanisms that control their tissue-specific expression are largely unknown. In this report, we review current knowledge about the transcriptional regulation of Trk receptors.

An activity-dependent increased role for L-type calcium channels in exocytosis is regulated by adrenergic signaling in chromaffin cells.

Chromaffin cells of the adrenal medulla represent a primary output of the sympathetic nervous system. Their electrical stimulation evokes the fusion of large dense core granules with the cell membrane and the exocytic release of multiple transmitter molecules into the circulation. There the transmitters contribute to the regulation of basic metabolism of the organism. Under physiological activity, granule fusion and transmitter release are limited by activity-dependent Ca(2+) influx, entering through multiple isoforms of voltage-gated calcium channels. In this study we utilize perforated-patch voltage-clamp recordings and depolarize mouse chromaffin cells in situ with action potential-like waveforms to mimic physiological firing. We measure calcium influx through specific isoforms and measure cell capacitance as an index of granule fusion. Combining these approaches we calculate specific stimulus-secretion efficiencies for L-type, N-type, P/Q-type and R-type calcium channels under varied physiological activity levels. Current influx through all channel subtypes exhibited an activity-dependent depression. As expected P/Q-type channels, while responsible for modest Ca(2+) influx, are tightly coupled to catecholamine secretion under all conditions. We further find that stimulation designed to match sympathetic input under the acute stress response recruits L-type channels to a state of enhanced stimulus-secretion efficiency. N- and R-type channels do not undergo activity-dependent recruitment and remain loosely coupled to the secretion. Thus, only L-type channels exhibit activity-dependent changes in their stimulus-secretion function under physiological stimulation. Lastly, we show that treatment with the beta-adrenergic agonist, isoproterenol, specifically blocks the increase in the stimulus-secretion function of L-type channels. Thus, increased cell firing specifically enhances stimulus-secretion coupling of L-type Ca(2+) channels in chromaffin cells in situ. This mechanism is regulated by an adrenergic signaling pathway.

Mucosectomía con estapler (PPH) como alternativa quirúrgica para los hemorroides / PPH stapling mucosectomy as treatment for hemorrhoids

La hemorroidectomía es una excelente técnica para hemorroides grado III a IV pero va asociada invariablemente a dolor postoperatorio. La mucosectomía con estapler (PPH, Ethicon®) ha demostrado menores cifras de dolor y recuperación más rápida pero los seguimientos han sido aún breves. Objetivo: Se presenta nuestra experiencia con la técnica PPH, evaluando dolor postoperatorio, complicaciones y recidiva a largo plazo. Material y método: Se analizan los protocolos prospectivos de pacientes operados de hemorroides grado III- IV ó prolapso mucoso entre Abril de 2000 y Junio de 2004 en nuestro servicio, seleccionándose según posibilidad de adquirir el instrumento PPH. Se evaluó dolor postoperatorio con escala EVA, siendo el seguimiento semanal por 1 mes, a los 6 meses y finalmente control telefónico. Resultados: Se estudian 62 pacientes (29 hombres, 33 mujeres). La hospitalización promedio fue de 1,4 días (1-3) y el tiempo quirúrgico de 39 minutos (20-60). El 94 por ciento de los pacientes no refirió dolor o éste fue leve (EVA 0-3). Seis pacientes (10 por ciento) presentaron sangrado postoperatorio leve que cedió espontáneamente. Dos pacientes se reoperaron precozmente, uno por fisura anal persistente y otro por trombosis de hemorroides externos. En una media de seguimiento de 22 meses (rango 4 a 54 meses) a 43 pacientes (70 por ciento de la serie), la recidiva fue de 9,3 por ciento.

Bax limits adult neural stem cell persistence through caspase and IP3 receptor activation.

Neural stem cells in the mammalian brain persist and are functional well into adulthood. There is, however, little insight into mechanisms that control adult neural stem cell survival. Mice deficient in the proapoptotic molecule Bax exhibit increased numbers of multipotent progenitor cells in the adult subventricular zone. In vitro, these progenitors behave as neural stem cells and utilize Bax and caspase activation to direct cell death. We demonstrate that the predominate mechanism underlying caspase and Bax-mediated adult neural stem cell death lies in the modulation of calcium flux through interaction with the IP3 receptor.

Modeling neurofibromatosis type 1 tumors in the mouse for therapeutic intervention.

Von Recklinghausen's neurofibromatosis is a dominantly inherited cancer syndrome. Its gene encodes neurofibromin, a protein with ras GTPase-activating function (rasGAP) and, therefore, all NF1-associated pathology is thought to originate from selective deregulation of the ras pathway. We have constructed a variety of mouse models for NF1 that permit recapitulation of the most common tumors seen in patients. In addition, these mouse models offer insights into tumor origin and into paracrine interactions. Given the molecular and pathological fidelity of the mouse tumors to the human counterparts, it is hoped that these mouse strains will serve as effective tools for therapeutic discovery.

Spatial genome organization during T-cell differentiation.

The spatial organization of genomes within the mammalian cell nucleus is non-random. The functional relevance of spatial genome organization might be in influencing gene expression programs as cells undergo changes during development and differentiation. To gain insight into the plasticity of genomes in space and time and to correlate the activity of specific genes with their nuclear position, we systematically analyzed the spatial genome organization in differentiating mouse T-cells. We find significant global reorganization of centromeres, chromosomes and gene loci during the differentiation process. Centromeres were repositioned from a preferentially internal distribution in undifferentiated cells to a preferentially peripheral position in differentiated CD4+ and CD8+ cells. Chromosome 6, containing the differentially expressed T-cell markers CD4 and CD8, underwent differential changes in position depending on whether cells differentiated into CD4+ or CD8+ thymocytes. Similarly, the two marker loci CD4 and CD8 showed distinct behavior in their position relative to the chromosome 6 centromere at various stages of differentiation. Our results demonstrate that significant spatial genome reorganization occurs during differentiation and indicate that the relationship between dynamic genome topology and single gene regulation is highly complex.

Altered regulation of brain-derived neurotrophic factor protein in hippocampus following slice preparation.

Brain-derived neurotrophic factor (BDNF) and its cognate receptor tyrosine kinase B (TrkB) play important roles in regulating survival, structure, and function of CNS neurons. One method of studying the functions of these molecules has utilized in vitro hippocampal slice preparations. An important caveat to using slices, however, is that slice preparation itself might alter the expression of BDNF, thereby confounding experimental results. To address this concern, BDNF immunoreactivity was examined in rodent slices using two different methods of slice preparation. Rapid and anatomically selective regulation of BDNF content followed slice preparation using both methodologies; however, different patterns of altered BDNF immunoreactivity were observed. First, in cultured slices, BDNF content decreased in the dentate molecular layer and increased in the CA3 pyramidal cell layer and the mossy fiber pathway of the hippocampus after 30 min. Furthermore, an initially "punctate" pattern of BDNF labeling observed in the mossy fiber pathway of control sections changed to homogenous labeling of the pathway in vitro. In contrast to these findings, slices prepared as for acute slice physiology exhibited no change in BDNF content in the molecular layer and mossy fiber pathway 30 min after slicing, but exhibited significant increases in the dentate granule and CA3 pyramidal cell layers. These findings demonstrate that BDNF protein content is altered following slice preparation, that different methods of slice preparation produce different patterns of BDNF regulation, and raise the possibility that BDNF release and TrkB activation may also be regulated. These consequences of hippocampal slice preparation may confound analyses of exogenous or endogenous BDNF on hippocampal neuronal structure or function.

Cirugía laparoscópica colorrectal / Laparoscopy in colorectal surgery

Se presenta la experiencia en cirugía laparoscópica colorrectal realizada hasta la fecha en el Hospital del Salvador. Se estudian 44 pacientes, siendo las técnicas más frecuentes la reconstitución por operación de Hartmann en 15 casos, prolapso rectal en 6 casos, operación de Miles en 5, sigmoidectomía en 5 casos. Seis pacientes se operaron por cáncer colorrectal. El tiempo operatorio promedio fue 122,5 min, la realimentación a los 2,64 días y la estadía hospitalaria fue de 6,7 días. Se convirtieron 13,9 por ciento de los pacientes, la mayoría por mala visualización. Complicaciones intraoperatorias ocurrieron en un 6,9 por ciento y postoperatorias en 16 por ciento. Falleció un paciente, por dehiscencia de sutura en un operación de Duhamel, siendo usuario de corticoides. Al comparar algunas técnicas con cirugía abierta fueron significativos un mayor tiempo operatorio en sigmoidectomía laparoscópica y una menor estadía hospitalaria en reconstitución laparoscópica. La cirugía laparoscópica es factible de realizar para diversas técnicas colorrectales con cifras de complicaciones similar a cirugía abierta, tiempos operatorios inicialmente mayores en cirugía resectiva, pero con reducción en la estadía hospitalaria especialmente en reconstitución de tránsito.