Obesity aggravates acute kidney injury resulting from ischemia and reperfusion in mice.

In critically ill patients, overweight and obesity are associated with acute respiratory distress syndrome and acute kidney injury (AKI). However, the effect of obesity on ischemia-reperfusion injury (IRI)-induced AKI is unknown. We hypothesized that obesity would aggravate renal IRI in mice. We fed mice a standard or high-fat diet for eight weeks. The mice were divided into four groups and submitted to sham surgery or IRI: obese, normal, normal + IRI, obese, and obese + IRI. All studies were performed 48 h after the procedures. Serum glucose, cholesterol, and creatinine clearance did not differ among the groups. Survival and urinary osmolality were lower in the obese + IRI group than in the normal + IRI group, whereas urinary neutrophil gelatinase-associated lipocalin levels, tubular injury scores, and caspase 3 expression were higher. Proliferating cell nuclear antigen expression was highest in the obese + IRI group, as were the levels of oxidative stress (urinary levels of thiobarbituric acid-reactive substances and renal heme oxygenase-1 protein expression), whereas renal Klotho protein expression was lowest in that group. Expression of glutathione peroxidase 4 and peroxiredoxin 6, proteins that induce lipid peroxidation, a hallmark of ferroptosis, was lower in the obese + IRI group. Notably, among the mice not induced to AKI, macrophage infiltration was greater in the obese group. In conclusion, greater oxidative stress and ferroptosis might aggravate IRI in obese individuals, and Klotho could be a therapeutic target in those with AKI.

Emerging histological and serological biomarkers in oral squamous cell carcinoma: Applications in diagnosis, prognosis evaluation and personalized therapeutics (Review).

Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and accounts for >90% of all oral cancers. Despite advances in diagnostic procedures and therapeutic interventions, overall survival has not improved significantly in recent decades, primarily due to late diagnosis, locoregional recurrence and treatment resistance. Identifying reliable biomarkers for early detection, prognosis evaluation and treatment response prediction is critical for improving clinical outcomes in patients with OSCC. In the present review, the prognostic and predictive utility of circulating biomarkers, such as circulating tumour cells, serological biomarkers and histological and genetic biomarkers, were explored in the context of OSCC. In addition, the potential role of immune checkpoints in the treatment of OSCC was highlighted and the rapidly evolving field of liquid biopsy and its potential to revolutionize diagnosis, prognosis evaluation and treatment were examined. The existing evidence for the clinical utility of these biomarkers was critically evaluated and the challenges and limitations associated with their introduction into routine clinical practice were addressed. In conclusion, the present review highlights the promising role of biomarkers in improving the current understanding of the pathogenesis of OSCC and offers potential avenues for improving patient care through personalized medicine approaches.

AIF1: Function and Connection with Inflammatory Diseases.

Macrophages are a type of immune cell distributed throughout all tissues of an organism. Allograft inflammatory factor 1 (AIF1) is a calcium-binding protein linked to the activation of macrophages. AIF1 is a key intracellular signaling molecule that participates in phagocytosis, membrane ruffling and F-actin polymerization. Moreover, it has several cell type-specific functions. AIF1 plays important roles in the development of several diseases: kidney disease, rheumatoid arthritis, cancer, cardiovascular diseases, metabolic diseases and neurological disorders, and in transplants. In this review, we present a comprehensive review of the known structure, functions and role of AIF1 in inflammatory diseases.

Clinical and Translational Applications of Serological and Histopathological Biomarkers in Metastatic Breast Cancer: A Comprehensive Review.

Breast cancer is one of the most common malignancies worldwide and the most common form of cancer in women. A large proportion of patients begin with localized disease and undergo treatment with curative intent, while another large proportion of patients debuts with disseminated metastatic disease. In the last subgroup of patients, the prognosis in recent years has changed radically, given the existence of different targeted therapies thanks to the discovery of different biomarkers. Serological, histological, and genetic biomarkers have demonstrated their usefulness in the initial diagnosis, in the follow-up to detect relapses, to guide targeted treatment, and to stratify the prognosis of the most aggressive tumors in those with breast cancer. Molecular markers are currently the basis for the diagnosis of metastatic disease, given the wide variety of chemotherapy regions and existing therapies. These markers have been a real revolution in the therapeutic arsenal for breast cancer, and their diagnostic validity allows the classification of tumors with higher rates of relapse, aggressiveness, and mortality. In this sense, the existence of therapies targeting different molecular alterations causes a series of changes in tumor biology that can be assessed throughout the course of the disease to provide information on the underlying pathophysiology of metastatic disease, which allows us to broaden our knowledge of the different mechanisms of tissue invasion. Therefore, the aim of the present article is to review the clinical, diagnostic, predictive, prognostic utility and limitations of the main biomarkers available and under development in metastatic breast cancer.

Concentración de metales en sangre de cordón umbilical debido a exposición prenatal en una cohorte de la Ciudad de México / Prenatal exposure to metals and concentration thereof in umbilical cord blood in a Mexico City cohort

Resumen Antecedentes: En México es exigua la evidencia sobre la exposición prenatal a metales. Objetivo: Estimar la concentración de arsénico, cadmio, manganeso y plomo en sangre de cordón umbilical (SCU), y su asociación con las concentraciones en sangre materna durante el embarazo y parto. Material y métodos: Se analizó la concentración de los metales en sangre materna durante el embarazo (n = 901), parto (n = 732) y en la SCU (n = 512) de participantes de la cohorte PROGRESS, residentes en la Ciudad de México. Se estimó la asociación entre la concentración en SCU y los biomarcadores maternos mediante modelos lineales generalizados, ajustados por covariables relevantes. Resultados: La media (μg/L) de plomo, arsénico y manganeso en SCU fue 27.14 (25.28-29.14), 0.77 (0.71-0.84) y 42.60 (40.45-44.83), respectivamente. El valor del cadmio no se pudo estimar porque 86.2 % de las mediciones fueron inferiores al límite de detección. Las concentraciones de plomo y manganeso en SCU se asociaron significativamente a los biomarcadores maternos durante el embarazo y el parto; solo se observó asociación con arsénico en el parto. Conclusiones: La exposición prenatal a metales tóxicos en periodos sensibles de la organogénesis evidencia un problema de salud pública desatendido. Se requiere un biomonitoreo poblacional y establecer regulación dirigida a proveer atención a población vulnerable.

Abstract Background: In Mexico, there is a paucity of evidence on the magnitude of prenatal exposure to metals. Objective: To estimate the concentration of arsenic, cadmium, manganese and lead in umbilical cord blood (UCB) and its association with maternal blood concentrations during pregnancy and delivery. Material and methods: Metal concentration in maternal blood was analyzed during pregnancy (n = 901), delivery (n = 732) and in UCB (n = 512) from participants of the PROGRESS cohort residing in Mexico City. The association between concentrations in UCB and maternal biomarkers was analyzed using generalized linear models, adjusted for relevant covariates. Results: Mean concentrations (μg/L) of lead, arsenic and manganese in UCB were 27.14 (25.28-29.14), 0.77 (0.71-0.84) and 42.60 (40.45-44.83), respectively. Cadmium concentration could not be estimated because 86.2% of measurements were below the detection limit. Lead and manganese concentrations in UCB were significantly associated with maternal biomarkers during pregnancy and delivery; at delivery, association was only observed with arsenic. Conclusions: Prenatal exposure to toxic metals in sensitive periods of organogenesis shows a neglected public health problem. Biomonitoring of the population and establishment of regulations aimed at providing care to vulnerable populations is required.

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES).

This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.

Reporte nacional de niveles de plomo en sangre y uso de barro vidriado en población infantil vulnerable / National report of blood lead levels and lead-glazed ceramics use in vulnerable children

Resumen: Objetivo: Estimar la prevalencia de niveles elevados (≥5.0μg/dL) de plomo en sangre (PbS) y su asociación con el uso de loza de barro vidriado con plomo (LBVPb). Material y métodos: En 2018 se midió PbS capilar en una muestra representativa de niños de 1 a 4 años de edad residentes en localidades de México menores de 100 000 habitantes (Ensanut 100k). Se indagó sobre uso de LBVPb para consumo de alimentos. Para estimar su asociación con PbS, se generaron modelos logit multinomial estratificados por región. Resultados: La prevalencia de niveles elevados de PbS fue de 21.8%. En las regiones Norte, Centro y Sur las prevalencias fueron 9.8, 20.7 y 25.8%, respectivamente. La asociación con uso y frecuencia de LBVPb fue altamente significativa y diferencial por región. Conclusiones: La exposición a plomo permanece como un problema de salud pública en México, particularmente en el Centro y Sur, y está fuertemente asociada con el uso de LBVPb.

Abstract: Objective: To estimate the prevalence of elevated (≥5.0μg / dL) blood lead levels (BLL) and its association with the use of lead glazed ceramics (LGC). Materials and methods: In 2018, we measured capillary BLL in a representative sample of children 1 to 4 years old residing in Mexican localities under 100 000 inhabitants (Ensanut 100k). We inquired about use of LGC for food preparation and consumption. To estimate its association with BLL, multinomial logit models stratified by region were generated. Results: The prevalence of elevated BLL levels was 21.8%. For the North, Central and South regions, the prevalence were 9.8, 20.7 and 25.8%, respectively. The association with use and frequency of LGC was highly significant and differential by region. Conclusions: Lead exposure remains a public health problem in Mexico, particularly in the Central and South regions, and is strongly associated with the use of LGC.

Automatic segmentation of the spine by means of a probabilistic atlas with a special focus on ribs suppression.

PURPOSE: The development of automatic and reliable algorithms for the detection and segmentation of the vertebrae are of great importance prior to any diagnostic task. However, an important problem found to accurately segment the vertebrae is the presence of the ribs in the thoracic region. To overcome this problem, a probabilistic atlas of the spine has been developed dealing with the proximity of other structures, with a special focus on ribs suppression. METHODS: The data sets used consist of Computed Tomography images corresponding to 21 patients suffering from spinal metastases. Two methods have been combined to obtain the final result: firstly, an initial segmentation is performed using a fully automatic level-set method; secondly, to refine the initial segmentation, a 3D volume indicating the probability of each voxel of belonging to the spine has been developed. In this way, a probability map is generated and deformed to be adapted to each testing case. RESULTS: To validate the improvement obtained after applying the atlas, the Dice coefficient (DSC), the Hausdorff distance (HD), and the mean surface-to-surface distance (MSD) were used. The results showed up an average of 10 mm of improvement accuracy in terms of HD, obtaining an overall final average of 15.51 ± 2.74 mm. Also, a global value of 91.01 ± 3.18% in terms of DSC and a MSD of 0.66 ± 0.25 mm were obtained. The major improvement using the atlas was achieved in the thoracic region, as ribs were almost perfectly suppressed. CONCLUSION: The study demonstrated that the atlas is able to detect and appropriately eliminate the ribs while improving the segmentation accuracy.

Problemas de comportamiento, problemas emocionales y de atención en niños y adolescentes que viven en acogimiento residencial / Behavioral problems, emotional problems and attention in children and adolescents living in residential care

Resumen El objetivo general del estudio es comparar la información aportada por padres, profesores y cuidadores sobre el comportamiento problemático y los problemas emocionales de preadolescentes y adolescentes venezolanos institucionalizados y que viven con sus familias, cuyas edades están comprendidas entre 11 y 16 años. La muestra estuvo constituida por 111 participantes institucionalizados en asociaciones civiles y entidades de protección del Estado, y 111 preadolescentes y adolescentes que conformaron la muestra control y pertenecían a colegios públicos, privados o subsidiados. Se valoraron los síntomas emocionales, el déficit de atención e hiperactividad, problemas con los compañeros, problemas de conducta y comportamiento prosocial. Los comportamientos problemáticos y los problemas emocionales fueron medidos a través del Cuestionario de Capacidades y Dificultades (SDQ), con la información proveniente de padres/cuidadores y profesores, y los problemas de atención fueron evaluados a través de la Escala para la evaluación del Trastorno por Déficit de Atención con Hiperactividad (EDAH) con la información de los profesores. Las conclusiones del estudio permiten afirmar que los participantes que viven en las instituciones presentan mayor nivel de problemas de comportamiento, problemas emocionales y de atención que los preadolescentes y adolescentes que conviven con sus familias de acuerdo a los informes de los padres, profesores y cuidadores.

Abstract The general objective of the study is to compare the information provided by parents, teachers and caregivers about pre-adolescents and Venezuelan adolescents institutionalized and living with their families, whose ages are between 11 and 16 years old. The sample was constituted by 111 participants institutionalized in civil associations and state protection entities, and 111 preadolescents and adolescents who conformed the control sample and belonged to public, private or subsidized schools. Emotional symptoms, attention deficit and hyperactivity, problems with peers, behavior problems and prosocial behavior were assessed. Problematic behaviors and emotional problems were measured through the Capacities and Difficulties Questionnaire (SDQ), with information from parents / caregivers and teachers, and care problems were assessed through the Scale for the Evaluation of Disorder Attention Deficit Hyperactivity Disorder (EDAH) with information from teachers. The conclusions of the study allow us to affirm that the participants living in the institutions present a higher level of behavior problems, emotional problems and attention than the preadolescents and adolescents who live with their families according to the reports of parents, teachers and caregivers.

Relación entre el tiempo de uso de las redes sociales en Internet y la salud mental en adolescentes colombianos / Relationship between the time spent on Internet social networking and mental health in Colombian adolescents / Relação entre o tempo de uso das redes sociais na Internet e a saúde mental dos adolescentes colombianos

El objetivo de esta investigación es determinar si hay diferencias entre grupos de adolescentes de grado 7° de la ciudad de Bogotá, con diferentes tiempos de uso de las redes sociales en problemáticas de tipo internalizante, externalizante, la soledad percibida, el funcionamiento familiar y el sexo. El estudio con diseño ex post facto valoró el efecto del tiempo de uso de redes sociales a tres niveles (bajo, medio y alto) a través de un cuestionario socio demográfico diseñado para tal fin: el LSRQ, el FACES III, CDI y el YSR. Participaron 96 estudiantes con un rango de edades entre los 11 y 15 años. Se encontró que entre los participantes con un elevado tiempo de uso de las redes sociales, eran mayores los problemas de tipo externalizante (conducta agresiva, ruptura de reglas y problemas de atención). Se discute la necesidad de que en futuras investigaciones se enfaticen los factores positivos que para el desarrollo de los adolescentes puede tener el uso de las redes sociales a través de Internet.

The aim of this study was to explore the relationship between the amount of time spent in social networking and the presence of internalizing and externalizing behavior problems in adolescents. Participants were 96 seventh grade students aged between 11 and 15 years who were attending schools in Bogotá, Colombia. An ex-post facto design was used and the amount of time spent in social networking was divided into three categories: high, medium and low. The instruments included a sociodemographic questionnaire especially designed for this purpose, the Loneliness and Social Dissatisfaction Questionnaire by Cassidy & Asher (LSDQ for its English acronym), the Youth Self- Report by Achenbach (YSR, for its English acronym), the Child Depression Inventory by Kovacs (CDI, for its English acronym) and the Family Adaptability and Cohesion Evaluation Scales by Olson, Portner & Lavee (FACES III, for its English acronym). Findings showed that participants with a greater amount of time spent on social networking had more externalyzing disorders (aggressive behavior, rule breaking and attention deficits) than students in the other two categories. The need for future research that stresses the positive factors that the use of Internet social networking can have on adolescents' development is discussed.

El objetivo desta pesquisa é determinar se existem diferenças entre grupos de adolescentes da 7° série da cidade de Bogotá, com diferentes tempos de uso das redes sociais em problemáticas de tipo internalizante, externalizante, a solidão percebida, o funcionamento familiar e o sexo. O estudo com desenho ex pós fato avaliou o efeito do tempo de uso de redes sociais em três níveis (baixo, médio e alto) através de um questionário sóciodemográfico desenhado para esse fim: o LSRQ, o FACES III, CDI e o YSR. Participaram 96 estudantes da faixa etária de 11 a 15 anos. Encontrou-se que entre os participantes com um elevado tempo de uso das redes sociais, eram maiores os problemas de tipo externalizante (conduta agressiva, ruptura de regras e problemas de atenção). Discute-se a necessidade de que em pesquisas futuras sejam enfatizados os fatores positivos que para o desenvolvimento dos adolescentes pode ter o uso das redes sociais através de Internet.

Fully automatic spinal canal segmentation for radiation therapy using a gradient vector flow-based method on computed tomography images: A preliminary study.

Nowadays, radiotherapy is one of the key techniques for localized cancer treatment. Accurate identification of target volume (TV) and organs at risk (OAR) is a crucial step to therapy success. Spinal cord is one of the most radiosensitive OAR and its localization tends to be an observer-dependent and time-consuming task. Hence, numerous studies have aimed to carry out the contouring automatically. In CT images, there is a lack of contrast between soft tissues, making more challenge the delineation. That is the reason why the majority of researches have focused on spinal canal segmentation rather than spinal cord. In this work, we propose a fully automated method for spinal canal segmentation using a Gradient Vector Flow-based (GVF) algorithm. An experienced radiologist performed the manual segmentation, generating the ground truth. The method was evaluated on three different patients using the Dice coefficient, obtaining the following results: 79.50%, 83.77%, and 81.88%, respectively. Outcome reveals that more research has to be performed to improve the accuracy of the method.

Problemas de comportamiento y competencias psicosociales en niños y adolescentes institucionaliz / Behavior Problems and Psychosocial Skills in Institutionalized Children and Adolescents

El objetivo principal de este estudio es analizar los problemas de comportamiento de una muestra de preadolescentes y adolescentes venezolanos institucionalizados (acogimiento residencial), de edades comprendidas entre los 11 y 16 años. La muestra estuvo compuesta por 111 participantes institucionalizados en asociaciones civiles y entidades de protección del Estado y 111 controles igualados, provenientes de colegios tanto públicos como privados o subsidiados. Se evaluaron las habilidades psicosociales y académicas y los problemas de comportamiento internalizados y externalizados reportados por los informes de los padres, los cuidadores y los autoinformes mediante el Youth Self-Report (YSR) y la Child Behavior Checklist (CBCL). Los resultados del estudio muestran que los niños y adolescentes institucionalizados tienen menores competencias psicosociales y académicas, así como más problemas de comportamiento que los jóvenes que conviven con sus padres. Los padres y cuidadores apreciaron menores diferencias entre ambos grupos.

The main objective of this study is analyze behavior problems of a sample of institutionalized (residential care) Venezuelan tweens and teens, ages between 11 and 16. The sample consisted of 111 participants institutionalized in civil associations and institutions state protection, and 111 matched controls from schools public and private or subsidized. The psychosocial and academic was assessed skills and internalizing and externalizing behavior problems reported by the reports of parents, carers and self reports. The Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) were completed. The results of the study show that children and adolescents are less institutionalized psychosocial and academic skills, as well as, more externalized behavior problems and internalized self-reported that young people living with their parents. Parents, teachers and caregivers appreciated minor differences between the two groups. Findings obtained support the influence of early deprivation on psychosocial skills, emotional issues and behavioral in children and adolescents. It is considered that institutionalization is a risk factor for the harmonious development of young people.

Mixosarcoma de la mano / Myxosarcoma of the hand

Se presenta el caso clínico de un maestro de 51 años de edad, quien fue atendido en la consulta de Ortopedia y Traumatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar aumento de volumen en el dorso de la mano derecha, desde hacía 12 meses aproximadamente. Los estudios clínicos e imagenológicos, además de los resultados de la biopsia, confirmaron que se trataba de un mixosarcoma. Se realizó la amputación del cuarto metacarpiano y, luego de rehabilitación durante 8 semanas, el paciente pudo reincorporarse a sus actividades sociales y laborales.

The case of a 51 year-old teacher is reported who was treated at the Orthopedics and Traumatology Department of "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital in Santiago de Cuba due to an increased volume in the back of the right hand for about 12 months. Imaging and clinical studies and the biopsy results confirmed the presence of a myxosarcoma. Amputation of the four metacarpal bone was performed and after rehabilitation during 8 weeks the patient could return to his social and work activities.

Angioleiomiomas de la mano / Hand angioleiomyomas

Los angioleiomiomas son tumores benignos poco frecuentes en la mano. Tienen mayor incidencia a partir de la cuarta década de la vida, con igual distribución por sexo. Rara vez se realiza un diagnóstico preoperatorio correcto, pues suelen confundirse con gangliones y lipomas, entre otros. Se describen 11 casos clínicos tratados en el Centro de Diagnóstico Integral "Santa Bárbara de Zulia" en la República Bolivariana de Venezuela durante un trienio. Luego de la escisión simple la evolución fue favorable y no hubo recidiva.

Angioleiomyomas are rare benign tumors of the hand. They have higher incidence from the fourth decade of life, with equal gender distribution. A correct preoperative diagnosis is rarely made, because they are usually mistaken for ganglions and lypomas, among others. Eleven clinical cases treated at "Santa Bárbara de Zulia" Comprehensive Diagnosis Center in the Bolivarian Republic of Venezuela during a triennium are described. After the simple excision, outcome was favorable and there were not relapses.

Miositis osificante de los aductores de la cadera / Ossifying myositis of hip adductors

Se presenta el caso clínico de un paciente de 24 años de edad, asistido en la Escuela de Trabajadores Sociales de Santiago de Cuba por aumento de volumen en la cadera izquierda y limitación funcional total, no dolorosa, de esa parte del cuerpo. Se comprobó clínica y radiográficamente que se trataba de una miositis osificante de los aductores de la cadera, pero no pudo ser operado en esta provincia porque regresó a su país natal.

The clinical case of a 24-year-old patient attended at Social Workers School in Santiago de Cuba due to increased left hip size and total functional limitation without pain of that body area was presented. It was clinically and radiographically documented that the diagnosis was ossifying myositis of hip adductors. However, surgery could not be done in that province because the patient travelled back to his country.

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial.

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial / Procedimento TRREMS (reparo transanal de retocele e mucosectomia retal com um grampeador circular): estudo multicêntrico prospectivo

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7 percent) and grade 3 (73.3 percent) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0 percent) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3 percent) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6 percent). Forty-nine patients (65.3 percent) required 1 hospitalization day, the remainder (34.7 percent) 2 days. Postoperatively, 3 (4.0 percent) patients complained of persistent rectal pain and 7 (9.3 percent) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6 percent). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7 por cento), grau III (73,3 por cento) associado a prolapso mucoso e intussuscepção (52 por cento). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3 por cento) pacientes, sutura grampeada incompleta em 2 (2,6 por cento) e dor retal persistente em 3 (4,0 por cento). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3 por cento) e 2 dias em 34,7 por cento. Ocorreu redução na linha de sutura em 7 (9,3 por cento), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6 por cento). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.

Influencia de la preparación de la corteza de Rhizophora mangle L. en el proceso de extracción sólido-líquido / Effect of the Rhizophora mangle L. bark preparation on the process of solid-liquid extraction

Introducción: la corteza de Rhizophora mangle L., rica por su contenido de taninos, es la fuente de materia prima en la obtención de productos farmacéuticos desarrollados en el Centro Nacional de Sanidad Agropecuaria. Para que los extractos obtenidos a partir de esta corteza tengan la calidad requerida, esta debe ser secada y molinada antes de pasar a la etapa de lixiviación. Objetivos: evaluar diferentes métodos de secado y diferentes tamaños de partículas sobre el rendimiento del extracto acuoso de la corteza de R. mangle. Métodos: se emplearon 3 métodos de secado (en estufa, al sol y a la sombra) y 2 tamaños promedios de partículas de la corteza de R. mangle para evaluar la calidad del extracto por determinación del contenido de sólidos solubles totales, taninos totales y actividad antimicrobiana in vitro. Para la comparación estadística de los resultados se utilizó el programa Statgraphycs. Resultados: se observó que el secado en estufa y al sol son los más recomendados para este fin, además se obtuvieron extractos con cortezas molinadas con diferentes tamaños promedios de partículas y no se encontraron diferencias significativas en la evaluación de estos. Conclusiones: los métodos de secado estudiados permitieron obtener buenos resultados en la evaluación de la corteza; con el secado en estufa seguido del secado al sol se lograron los menores tiempos de operación.

Introduction: Rhizophora mangle L. bark, rich in tannin content, is the source of raw material for pharmaceuticals manufactured at the National Center for Animal and Plant Health (CENSA). For the extracts obtained from the bark to have the required quality, it is necessary that the bark be dried and grounded before lixiviation. Objectives: to evaluate different drying methods and several particle sizes on account of R. mangle aqueous extract yield. Methods: Three drying methods (oven, sun and shade) and 2 average bark particle sizes were used to evaluate the extract quality by determining the total soluble solid content, total tannins and in vitro antimicrobial activity. The Statgraphycs program was used to statistically compare the results. Results: it was observed that the oven drying and the sun drying were the most recommended methods; additionally, no significant differences were found in the extracts obtained from several average grounded bark particle sizes. Conclusions: the studied drying methods allowed achieving good results in the evaluation of the bark. The oven drying followed by the sun drying accounted for the shortest operating times.

Obesity is not associated with mild asthma diagnosis in a population of Spanish adults.

BACKGROUND: Several studies have suggested a relationship between asthma and obesity. Moreover, atopy is an important risk factor for asthma, but the relationship between obesity and atopy is uncertain. METHODS: A cross-sectional multicenter study was conducted in a population of Spanish adults between November 2007 and July 2008. The subjects included had experienced asthma symptoms in the last year but had a forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) > 70%. Mild asthma diagnosis was confirmed by measuring airway hyperresponsiveness to methacholine. Body mass index in kg/m(2) was used as measure of obesity. Subjects were considered atopic when they had at least one positive skin prick test to common aeroallergens. Adjusted odd ratios (OR) were obtained by logistic regression. RESULTS: A total of 662 subjects were included and 234 subjects (35.3%) were diagnosed with asthma (consistent symptoms and positive methacholine test). After adjusting the model for age, gender, atopy, baseline FEV(1), and FEV(1)/FVC ratio, there was no association between overweight or obesity with asthma diagnosis, with OR of 0.889 (95% CI, 0.60-1.38) and 0.925 (95% CI, 0.577-1.48), respectively. A multivariable logistic regression analysis confirmed that atopy increases the risk of asthma (p = 0.008). The non-atopic obese group had an increased risk of asthma compared to the non-atopic group with normal weight or overweight (p = 0.0032). CONCLUSIONS: In this study obesity was not associated with a diagnosis of asthma. The presence of atopy was a risk factor for asthma, independent of obesity. Obesity, however, may be a risk factor for the development of asthma among non-atopic subjects.

Evaluación de factores asociados a la ansiedad social y a otras psicopatologías en adolescentes / Assessment of factors associated to social anxiety and other psychopatologies in adolescents

Introduction The study of factors associated with anxiety and social phobia is a subject of recent interest in mental health. Specifically, shyness in children seems to act as an early expression of social phobia that may later consolidate into a clinical entity. The presence of certain psychopathologies and particular styles of child rearing in parents, are perceived by their children, are associated with the emergence of social phobia in adolescence. On the other hand, social anxiety disorder during adolescence or early adulthood may predict subsequent depressive disorders. The presence of both disorders (anxiety and social phobia) during adolescence increases the probability of suffering from them recurrently in early adulthood. Family structure and cohesion as well as stressful life events have been found to be associated with mood disorders during the childhood-youth period. However, studies conducted with young subjects are scarce, even though understanding the factors associated to different psychopathologies in the youth has proven of great value in clinical practice and epidemiology. For this reason, we attempt to evaluate, in a sample of three groups of adolescents (social anxiety, other psychopathologies and without psychopathologies) the possible demographical factors, competences and clinical indexes that could be associated with the different conditions under consideration. Methodology A sample of 1012 adolescents (582 women and 430 men) with an average age of 15.80 years (SD = 1.48) fulfilled a series of tests to assess demographical variables, psychosocial competences and clinical indexes. Results The difference between the average scores in the Escala de Ansiedad en Interacción Social -SIAS- was significant for the variables sex and the school year. Sex and couple relationships significantly affect the probability of manifesting social anxiety and other psychopathologies, respectively. Some competences significantly affect the probability of social anxiety, whereas others affect the probability of developing other psychopathologies. The majority of the 46 clinical indexes assessed demonstrate a significant effect on the probability of developing both conditions. Discussion and conclusions The results indicate that, in line with previous studies, the average score of women in the SIAS is slightly higher than in men. The average score in the SIAS of the young people from formative cycles was slightly higher than in the subjects from the obligatory secondary education and high schools. Very few studies have informed on the differences in social anxiety associated with the educational level. Women presented significantly higher probability of suffering from social anxiety than men. Unexpectedly, adolescents who maintained couple relationships also showed significantly higher probabilities than the rest of suffering from other psychopathologies. Some psychosocial competences, especially those related to the situations of social interactions, have a significant effect on the probability of developing social anxiety, whereas others (social and behavioural) influence other psychopathologies. In general and to a large extent, the findings are coherent and explainable, although some of them are contradictory. This could be caused by the difficulty to evaluate the complex construct of psychosocial competences. The majority of the evaluated clinical indexes showed a significant effect on the probability of developing of social anxiety and other psychopathologies. This effect is more evident in the group of young people with other psychopathologies than in the group of adolescents with social anxiety. Previous studies have found similar results, especially in the indexes referring to the general measures of anxiety and depression, specific measures of anxiety and avoidance of social situations and personality.

Introducción El estudio de factores asociados a la ansiedad y fobia social constituye un tema de reciente interés. Concretamente, la timidez infantil parece actuar como una expresión temprana de la fobia social que más tarde se puede consolidar como cuadro clínico. La percepción de los hijos sobre la presencia de ciertas psicopatologías y de determinados estilos de crianza de los padres se asocia a la aparición de la fobia social en la adolescencia. El trastorno de ansiedad social durante la adolescencia o la adultez temprana puede predecir trastornos depresivos subsecuentes. La presencia de ambos trastornos (ansiedad y fobia social) durante la adolescencia incrementaría la probabilidad de padecerlos de manera recurrente a lo largo de la adultez temprana. La estructura y la cohesión familiar, así como los sucesos estresantes de la vida, se han asociado con trastornos afectivos en la etapa infanto-juvenil. En la actualidad, los estudios realizados en estas edades son escasos, aun cuando el entendimiento de los factores asociados a distintas psicopatologías en la edad temprana reviste importancia clínica y epidemiológica. Por ello, pretendemos evaluar en una muestra de adolescentes formada por tres grupos (ansiedad social, otras psicopatologías y sin psicopatologías) los posibles factores demográficos, de competencias e índices clínicos que pueden estar asociados a las diferentes condiciones estudiadas. Metodología Una muestra de 1012 adolescentes (582 mujeres y 430 hombres) con una edad media de 15.80 años (DT = 1.48) completó en su medio escolar una serie de pruebas que evalúan variables demográficas, competencias psicosociales e índices clínicos. Resultados La diferencia de medias en las puntuaciones de la Escala de Ansiedad en Interacción Social -SIAS- fue significativa para las variables sexo y curso escolar. El sexo y la relación de pareja ejercieron un efecto significativo en la probabilidad de manifestar ansiedad social y otras psicopatologías, respectivamente. Algunas competencias mostraron un efecto significativo en la probabilidad de presentar ansiedad social, mientras que otras lo hicieron en la probabilidad de desarrollar otras psicopatologías. La mayoría de los 46 índices clínicos evaluados mostró un efecto significativo en la probabilidad de sufrir ambas condiciones. Discusión y conclusiones Los resultados indican que la puntuación media de las mujeres en la SIAS superó ligeramente a la de los hombres, lo que coincide con estudios previos. La puntuación media en la SIAS de los jóvenes que formaron los ciclos formativos fue ligeramente superior a la de los procedentes de educación secundaria obligatoria y de bachillerato. Hay pocos estudios que informen de diferencias en la ansiedad social asociadas al nivel de estudios. Las mujeres presentaron una probabilidad significativamente mayor que los hombres de sufrir ansiedad social. Los adolescentes que mantenían relaciones de pareja también mostraron significativamente más posibilidades que el resto de presentar otras psicopatologías, el cual es un resultado inesperado. Algunas competencias psicosociales, especialmente las que se relacionan con las situaciones de interacción social, han mostrado un efecto significativo en la probabilidad de sufrir ansiedad social, mientras que otras (sociales y de actuación) lo han hecho en la probabilidad de desarrollar otras psicopatologías. En general, gran parte de estos hallazgos tienen coherencia y explicación, aunque algunos son contradictorios, lo que puede deberse a la dificultad de evaluar el constructo de competencias psicosociales por su complejidad. Por último, la mayoría de los índices clínicos evaluados presentó un efecto significativo en la probabilidad de desarrollar ansiedad social y otras psicopatologías. Este último efecto fue más notorio en el grupo de jóvenes con otras psicopatologías que en el grupo de adolescentes con ansiedad social. Diversos estudios encuentran resultados parecidos a los hallados en éste, especialmente en los índices referentes a medidas generales de ansiedad o depresión, específicas de ansiedad y evitación en situaciones sociales, y de personalidad.