Wind-driven upwelling of iron sustains dense blooms and food webs in the eastern Weddell Gyre.

The Southern Ocean is a major sink of anthropogenic CO2 and an important foraging area for top trophic level consumers. However, iron limitation sets an upper limit to primary productivity. Here we report on a considerably dense late summer phytoplankton bloom spanning 9000 km2 in the open ocean of the eastern Weddell Gyre. Over its 2.5 months duration, the bloom accumulated up to 20 g C m-2 of organic matter, which is unusually high for Southern Ocean open waters. We show that, over 1997-2019, this open ocean bloom was likely driven by anomalies in easterly winds that push sea ice southwards and favor the upwelling of Warm Deep Water enriched in hydrothermal iron and, possibly, other iron sources. This recurring open ocean bloom likely facilitates enhanced carbon export and sustains high standing stocks of Antarctic krill, supporting feeding hot spots for marine birds and baleen whales.

Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia: A Prospective Real-life Study.

BACKGROUND: Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored. AIM: To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice. MATERIALS AND METHODS: A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters, Helicobacter pylori ( H. pylori), and duodenal histology were evaluated. RESULTS: FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients were H. pylori+ . Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14; P <0.0001), adjusting for age, gender, H. pylori and nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28; P <0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particular H. pylori- , was highly accurate for PDS with the area under the curve 0.731 compared with H. pylori+ area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy. CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non- H. pylori FD patients and could be a useful marker of treatment response.

Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia.

BACKGROUND AND AIM: Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD. METHODS: A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated. RESULTS: Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902). CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.

Sociodemographic characteristics, comorbidity, and baseline functional status of older patients treated in emergency departments during the COVID-19 pandemic and associations with mortality: an analysis based on the EDENCOVID cohort. / Sociodemografía, comorbilidad y situación funcional basal de los pacientes mayores atendidos en urgencias durante la pandemia de COVID y su relación con la mortalidad: análisis a partir de la cohorte EDEN-Covid.

OBJECTIVES: To describe the sociodemographic characteristics, comorbidity, and baseline functional status of patients aged 65 or older who came to hospital emergency departments (EDs) during the first wave of the COVID-19 pandemic, and to compare them with the findings for an earlier period to analyze factors of the index episode that were related to mortality. MATERIAL AND METHODS: We studied data from the EDEN-COVID cohort (Emergency Department and Elder Needs During COVID-19) of patients aged 65 years or older treated in 40 Spanish EDs on 7 consecutive days. Nine sociodemographic variables, 18 comorbidities, and 7 function variables were registered and compared with the findings for the EDEN cohort of patients included with the same criteria and treated a year earlier in the same EDs. In-hospital mortality was calculated in the 2 cohorts and a multivariable logistic regression model was used to explore associated factors. RESULTS: The EDEN-COVID cohort included 6806 patients with a median age of 78 years; 49% were women. The pandemic cohort had a higher proportion of men, patients covered by the national health care system, patients brought from residential facilities, and patients who arrived in an ambulance equipped for advanced life support. Pandemic-cohort patients more often had diabetes mellitus, chronic kidney disease, and dementia; they less often had connective tissue and thromboembolic diseases. The Barthel and Charlson indices were worse in this period, and cognitive decline was more common. Fewer patients had a history of depression or falls. Eight hundred ninety these patients (13.1%) died, 122 of them in the ED (1.8%); these percentages were lower in the earlier EDEN cohort, at 3.1% and 0.5%, respectively. Independent sociodemographic factors associated with higher mortality were transport by ambulance, older age, male sex, and living in a residential facility. Mortalityassociated comorbidities were neoplasms, chronic kidney disease, and heart failure. The only function variable associated with mortality was the inability to walk independently. A history of falls in the past 6 months was a protective factor. CONCLUSION: The sociodemographic characteristics, comorbidity, and functional status of patients aged 65 years or older who were treated in hospital EDs during the pandemic differed in many ways from those usually seen in this older-age population. Mortality was higher than in the prepandemic period. Certain sociodemographic, comorbidity, and function variables were associated with in-hospital mortality.

OBJETIVO: Investigar sociodemografía, comorbilidad y situación funcional de los pacientes de 65 o más años de edad que consultaron a los servicios de urgencias hospitalarios (SUH) durante la primera oleada epidémica de COVID, compararlas con un periodo previo y ver su relación. METODO: Se utilizaron los datos obtenidos de la cohorte EDEN-Covid (Emergency Department and Elder Needs during COVID) en la que participaron 40 SUH españoles que incluyeron todos los pacientes de $ 65 años atendidos durante 7 días consecutivos. Se analizaron 9 características sociodemográficas, 18 comorbilidades y 7 variables de funcionalidad, que se compararon con las de la cohorte EDEN (Emergency Department and Elder Needs), que contiene pacientes con el mismo criterio de inclusión etario reclutados por los mismos SUH un año antes. Se recogió la mortalidad intrahospitalaria y se investigaron los factores asociados mediante regresión logística multivariable. RESULTADOS: La cohorte EDEN-Covid incluyó 6.806 pacientes (mediana edad: 78 años; 49% mujeres). Hubo más varones, con cobertura sanitaria pública, procedentes de residencia y que llegaron con ambulancia medicalizada que durante el periodo prepandemia. Presentaron más frecuentemente diabetes mellitus, enfermedad renal crónica, enfermedad cerebrovascular y demencia y menos conectivopatías y enfermedad tromboembólica, peores índices de Barthel y Charlson, más deterioro cognitivo y menos antecedentes de depresión o caídas previas. Fallecieron durante el episodio 890 pacientes (13,1%), 122 de ellos en urgencias (1,8%), porcentajes superiores al periodo prepandemia (3,1% y 0,5%, respectivamente). Se asociaron de forma independiente a mayor mortalidad durante el periodo COVID la llegada en ambulancia, mayor edad, ser varón y vivir en residencia como variables sociodemográficas, y neoplasia, enfermedad renal crónica e insuficiencia cardiaca como comorbilidades. La única variable funcional asociada a mortalidad fue no deambular respecto a ser autónomo, y la existencia de caídas los 6 meses previos resultó un factor protector. CONCLUSIONES: La sociodemografía, comorbilidad y funcionalidad de los pacientes de 65 o más años que consultaron en los SUH españoles durante la primera ola pandémica difirieron en muchos aspectos de lo habitualmente observado en esta población. La mortalidad fue mayor a la del periodo prepandémico. Algunos aspectos sociodemográficos, de comorbilidad y funcionales se relacionaron con la mortalidad intrahospitalaria.

Management of Chylous Ascites After Laparoscopic Nephrectomy for Living Kidney Donor: A Case Report and Literature Review.

Kidney transplant is currently the elective treatment of choice for end-stage renal disease. Laparoscopic living donor nephrectomy (LLDN) has substantial advantages over open nephrectomy. Chylous ascites (CA) is a rare surgical complication after the LLDN; there are few reports in the literature. We present a case report of a 58-year-old woman who started CA on the 21st day post operation. The recommended initial therapeutic approach to suspend the fat in the diet and place percutaneous drainage was not enough. It was decided to jointly introduce fasting and total parenteral nutrition with the administration of octreotide, resolving the complication completely in 15 days with no need for the patient to undergo surgery. The conservative management, during the first 4 to 8 weeks after the diagnosis is the best option. Surgery is generally recommended if conservative management fails. The prevalence of CA varied between 0% and 6.2% of LLDNs. In our experience of 87 LLDNs, we only presented 1.15% for this complication. There are 62 cases reported in the international literature. The mean presentation was 14 days after LLDN. All patients underwent conservative treatment, and only 15 patients (24%) went to surgery after the failure of conservative management. It would be highly useful, considering the disparity of the prevalence, if the bibliographic reports detail what hemostatic and sealing techniques are used in an LLDN. In this way it would be possible to identify which factor affects a complication like this one.

Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report.

In the XIX century, the surgeon faces surgical challenges due to the creation of new technologies. Accidental or compressed air-induced injury to the colon and rectum is rare. We present the case of a 45-year-old patient who consults the emergency department, then a high-pressure rectal pneumatic trauma, with clinical findings of peritonism, managed with a Hartmann-type colostomy. and anterior resection of the rectum using laparoscopy, with findings of rectosigmoid perforation. With this, it can be demonstrated that minimally invasive surgery is a feasible approach in hemodynamically unstable patients without contraindication for pneumoperitoneum.

Respuesta a la prueba de caminata de seis minutos en niños con riesgo cardiovascular / Response to the six-minute walk test in children with cardiovascular risk

INTRODUCCIÓN: El riesgo cardiovascular (RCV) se define como la posibilidad que tiene un sujeto de sufrir una enfermedad cardiovascular dentro de un determinado plazo de tiempo. Si bien la patología se hace sintomatica en etapa adulta, los cambios fisiopatológicos comienzan a desarrollarse en edades tempranas. OBJETIVO: Establecer la relación entre capacidad cardiorrespiratoria, estimada a través de la prueba de caminata de seis minutos (PC6M), y el RCV en niños con síndrome metabólico. PACIENTES Y MÉTODO: Se analizaron 42 niños, edad 5 a 15 años, que asistieron a la Unidad de Cardiología Infantil del Hospital Carlos Van Buren entre los años 2015 y 2017. Cada participante se categorizó de acuerdo al puntaje de RCV de Alustiza, que define 3 niveles de riesgo: bajo (0 a 6 puntos), medio (7 a 8 puntos) y alto (9 o más puntos), lo que se traduciría en una mayor probabilidad de desarrollar una enfermedad cardiovascular, y realizó concomitantemente la PC6M. RESULTADOS: La edad media del grupo de ni ños fue de 10,9 ± 2,7 años, con un Índice de Masa Corporal (IMC) = 31,0 ± 4,6 kg/m2 (z-score 3,2 ± 0,7). Los niños recorren 75,2 ± 8,9 por ciento de la distancia teórica, con un porcentaje de frecuencia cardíaca de reserva (FCR) = 31,0 ± 9,4. No se observaron relaciones estadísticamente significativas entre RCV y PC6M. CONCLUSIONES: No se encuentra relación entre la capacidad cardiorrespiratoria y RCV. Se cuestiona la utilidad de la PC6M para valorar el RCV en la población de estudio.

INTRODUCTION: Cardiovascular risk (CVR) is defined as the possibility of a subject suffering from car diovascular disease within a certain period. Although the pathology appears in adult life, the physiopathological changes start to develop at an early age. OBJECTIVE: To establish the relationship bet ween cardiorespiratory capacity (CRC)and CVR in children with metabolic syndrome. PATIENTS AND METHODS: We analyzed data corresponding to 42 children aged from 5 to 15 years who were seen at the Children's Cardiology Unit of the Carlos Van Buren Hospital between 2015 and 2017. Each parti cipant was categorized according to the Alustiza's CVR score, which defines 3 levels of risk: low (0 to 6 points), medium (7 to 8 points) and high (9 or more points), which representing a greater probability of developing cardiovascular disease, and performed 6MWT. RESULTS: The mean age of the children was 10.9 ± 2.7 years, body mass index (BMI) = 31.0 ± 4.6 kg/m2 (z-score 3.2 ± 0.7), percentage of theoretical distance walked = 75.2 ± 8.9, and percentage of heart rate reserve (HRR) = 31.0 ± 9.4. There was no statistical association between 6MWT and CVR. CONCLUSIONS: There is no relationship between the cardiorespiratory capacity and the CVR. The use of the 6MWT is questioned as an ins trument to assess CVR in the population under study.

Conventional and nano-copper pesticides are equally toxic to the estuarine amphipod Leptocheirus plumulosus.

Modern nano-engineered pesticides have great promise for agriculture due to their extended, low dose release profiles that are intended to increase effectiveness but reduce environmental harm. Whether nanopesticides, including copper (Cu) formulations, cause reduced levels of toxicity to non-target aquatic organisms is unclear but important to assess. Predicting how aquatic species respond to incidental exposure to Cu-based nanopesticides is challenging because of the expected very low concentrations in the environment, and the two forms of exposure that may occur, namely to Cu ions and Cu nanoparticles. We conducted Cu speciation, tissue uptake, and 7-day toxicity laboratory experiments to test how a model estuarine organism, the amphipod Leptocheirus plumulosus, responded to two popular Cu-based nanopesticides, CuPRO and Kocide, and conventional CuCl2. Exposure concentrations ranged from 0 to 2.5 ppm, which were similar to those found in estuarine water located downstream of agricultural fields. Cu dissolution rates were much slower for the nanopesticides than the ionic formula, and Cu body burden in amphipods increased approximately linearly with the nominal exposure concentration. Amphipod survival declined in a normal dose-response manner with no difference among Cu formulations. Growth and movement rates after 7 days revealed no difference among exposure levels when analyzed with conventional statistical methods. By contrast, analysis of respiration rates, inferred from biomass measurements, with a bioenergetic toxicodynamic model indicated potential for population-level effects of exposure to very low-levels of the two nanopesticides, as well as the control contaminant CuCl2. Our results indicate that toxicity assessment of environmental trace pollutant concentrations may go undetected with traditional ecotoxicological tests. We present a process integrating toxicity test results and toxicodynamic modeling that can improve our capacity to detect and predict environmental impacts of very low levels of nanomaterials released into the environment.

Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. / Impacto de las variables geriátricas en la mortalidad a 30 días de los ancianos atendidos por insuficiencia cardiaca aguda?

OBJETIVE: To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS: Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS: We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0­4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9­3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0­3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0­4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9­11.4; P=.01). CONCLUSIONS: Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.

OBJETIVOS: Estudiar el impacto de las variables geriátricas en la mortalidad a 30 días entre los ancianos con insuficiencia cardiaca aguda (ICA). MÉTODO: Análisis retrospectivo del registro Older Acute heart failure Key data (OAK) que incluye prospectivamente a pacientes consecutivos 65 años con ICA en 3 servicios de urgencias españoles durante 4 meses (noviembre-diciembre 2011 y enero-febrero 2014). Se realizó una valoración geriátrica adaptada a urgencias durante los días laborales de 8 am a 10 pm. Se recogieron variables demográficas, clínicas, analíticas y geriátricas (comorbilidad, polifarmacia, fragilidad, situación basal funcional, cognitiva y social, despistaje de síndrome confusional, deterioro cognitivo y depresión, y situación nutricional). La variable de resultado fue la mortalidad por cualquier causa a los 30 días. RESULTADOS: Se incluyeron 565 pacientes con edad media 83 años (DE 7,1), 346 mujeres (61,6%). Sesenta y cinco sujetos (11,5%) fallecieron a los 30 días. La presencia de síndrome confusional agudo (OR ajustada = 2,2; IC95% 1,0-4,8; p = 0,04), de enfermedad aguda (OR ajustada = 1,8; IC95% 0,9-3,4; p = 0,05) o pérdida de apetito (OR ajustada = 1,8; IC95% 1-3,4; p = 0,04) en los últimos 3 meses, y de fragilidad (OR ajustada = 2,0; IC95% 1,0-4,1; p = 0,05) o dependencia funcional grave (OR ajustada = 4,4; IC95% 1,9-11,4; p = 0,01) fueron factores independientes asociados con mortalidad a los 30 días. CONCLUSIONES: Existen ciertas variables geriátricas que debieran contemplarse en la estratificación de riesgo a corto plazo de los pacientes ancianos con ICA.

La contemporización biliar percutánea como estrategia en el tratamiento de la lesión quirúrgica de la vía biliar / Percutaneous biliary interventon as an inital treatment for injury of the bile duct

Antecedentes: El drenaje biliar percutáneo (DBP) se ha utlizado para tratar lesiones quirúrgicas de la vía biliar y como complemento de la cirugía de reparación. Objetivo: Presentar los resultados del drenaje biliar percutáneo en una serie consecutiva de pacientes con lesiones quirúrgicas o secuelas de reparaciones quirúrgicas de la vía biliar. Material y Métodos: Se analizaron los pacientes tratados inicialmente mediante DBP. Se utlizó la cla-sificación de Strasberg y se registró: tpo de operación, vía de abordaje, número de reintervenciones, intentos de reparación biliar y presentación clínica. En los pacientes con continuidad bilioentérica, la primera opción fue el tratamiento percutáneo. Se evaluó el DBP en el pre, intra y postoperatorio y pre dilatación percutánea Resultados: En el hospital Argerich, período 2000 a 2014, se incluyeron 76 enfermos, 68.4% mujeres y post colecistectomía 97%. El 77,6% fueron lesiones Tipo E2 a E5. El porcentaje de enfermos con control de síntomas pre cirugía o dilatación percutánea fue: ictericia 59%, colestasis 5%, colangits 91%, fistula biliar 87%, prurito 90%, retro del hepaticostoma o Kehr 91%. En 13 de 16 pacientes con fistula biliar externa se internalizó el catéter biliar a la cavidad abdominal. En el 70% de 52 pacientes operados, el catéter facilitó la identificación de la vía biliar proximal. En el postoperatorio, no hubo fistulas biliares de la anastomosis bilioentérica, y se detectaron 3 pacientes con estenosis biliar residual y 2 con segmentos biliares aislados que fueron tratados. Conclusión: El DBP resulta útl en el preoperatorio, intraoperatorio y postoperatorio de los pacientes con lesiones quirúrgicas biliares.

Background: Percutaneous biliary drainage (PtibD) has been used to treat surgical bile duct injuries and as an adjunct to repair surgery. Objective: To present the results of PtidB in a consecutive series of patents with surgical injuries or sequelae of surgical repairs of the bile duct. Material and methods: Patents initally treated with PtibD were analyzed. Strasberg classificaton was used and recorded: type of operaton, surgical approach, number of reoperatons, biliary repair atempts and clinical presentaton. In patents with bilioenteric continuity, percutaneous biliary treatment was the frst opton. PtibD was evaluated in the pre, intra and postoperative period and in the pre dilataton period. Results: At the Hospital Argerich, from 2000 to 2014, 76 patents were included, 68.4% women and 97% post cholecystectomy. The lesions were Type E2 to E5 in 77% of cases. The percentage of patents with controlled symptoms before surgery or percutaneous dilataton was: jaundice 59%, cholestasis 5%, cholangits 91%, biliary fistula 87%, pruritus 90%, withdrawal hepaticos-toma or T-Kehr 91%. In 13 of 16 patents with external biliary fistula, the catheter could be internalized to abdominal cavity. In 70% of 52 operated patents, the catheter facilitated the identificaton of the proximal biliary duct. In the postoperative period, there were no biliary fistulas of the bilioenteric anastomoses and 3 patents with residual biliary stenosis and 2 with isolated biliary segments were detected and treated. Conclusion: PtibD is helpful in the pre, intra and postoperative treatment of patents with surgical bile duct injuries.

Malformación arteriovenosa pancreática como causa de pancreatitis aguda tratada por vía endovascular / Pancreatic arteriovenous malformation as cause of acute pancreatitis treated by endovascular access

La malformación arterio-venosa (MAV) en el páncreas es una anomalía anatómica poco frecuente que puede ser causa de pancreatitis aguda. Presentamos el caso de un paciente de 46 años cuyo diagnóstico se sospechó por los hallazgos de la tomografía computarizada con contraste endovenoso y por resonancia magnética y se confirmó mediante una arteriografía del tronco celíaco y de la arteria mesentérica superior. El tratamiento recibido fue por vía endovascular, aunque la otra opción válida para el tratamiento de esta enfermedad es la resección quirúrgica. El objetivo de esta comunicación es presentar un caso de pancreatitis aguda por MAV tratada por vía endovascular.

Arteriovenous malformation in the pancreas is a rare anatomic abnormality that may produce acute pancreatitis. The diagnosis was suspected by computed tomography with intravenous contrast and by magnetic resonance imaging and it was confirmed by arteriography of the celiac trunk and superior mesenteric artery. The treatment received was endovascular, although the other valid option for the treatment of this disease is the surgical resection. The objective of this communication is to present a case of acute pancreatitis due to arteriovenous malformation treated by endovascular approach.

Técnica de reconstrucción laparoscópica en la duodenopancreatectomía cefálica / Laparoscopic reconstructon technique of cephalic duodenopancreatectomy

Antecedentes: la duodenopancreatectomía cefálica (DPC) es la cirugía indicada para el tratamiento de los tumores ampulares y periampulares. El abordaje totalmente laparoscópico es técnicamente dificil de realizar pues requiere mucha destreza y experiencia por parte del equipo quirúrgico. La dificultad técnica de la pancreato-yeyuno anastomosis es quizás el factor limitante para confeccionar la duode-nopancreatectomía cefálica enteramente por vía laparoscópica. Objetivo: mostrar la técnica de reconstrucción laparoscópica con la pancreato-yeyuno anastomosis ductomucosa con la técnica de Blumgart modificada. Lugares de aplicación: Sanatorio de la Trinidad Mitre, Hospital Luciano y Mariano de la Vega, Hospital Argerich. Material y Métodos: se analizaron los pacientes operados enteramente por vía laparoscópica. Dichos pacientes fueron reconstruidos con una sola asa, realizando una pancreato-yeyuno anastomosis con la técnica de Blumgart modificada. Resultados: en los pacientes con DPC totalmente laparoscópica, el páncreas fue de textura intermedia en 3 pacientes y en 2 con textura blanda. El tempo operatorio medio fue 384 minutos. La estadía hospitalaria media fue 12 días. Dos pacientes desarrollaron fistula pancreática tipo A. Un paciente presentó retardo del vaciamiento gástrico que resolvió espontáneamente. Conclusiones: la reconstrucción completa por vía laparoscópica es factble y totalmente reproducible con la misma técnica que se utliza por vía laparotómica.

Background: pancreatoduodenectomy is the procedure indicated for the treatment of ampullary and periampullary tumors. The total laparoscopic approach for pancreatoduodenectomy is technically dificult to perform requiring skill and great experience of the surgical team. The technical dificulty of the pancreatojejunostomy is perhaps the limiting factor to perform the pancreatoduodenectomy totally laparoscopic. Objective: to describe the technique of the laparoscopic reconstructon using the pancreatojejunos-tomy according to the Blumgart modifed technique. Material and methods: patentis operated entrely by totally laparoscopic approach were analyzed. These patentis were reconstructed performing a pancreatojejunostomy with the Blumgart modifed technique. Resultis: in patentis with totally laparoscopic approach, pancreas texture was intermediatein 3 pa-tentis and 2 had sof texture. The average operating tme was 384 minutes. The average hospital stay was 12 days. Two patentis developed pancreatic fistula type A. One patent had delayed gastric emp-tying which resolved spontaneously. Conclusion: total laparoscopic reconstructon is feasible and reproducible with the same technique used by laparotomy.

Single-cell electroporation using a multifunctional pipette.

We present here a novel platform combination, using a multifunctional pipette to individually electroporate single-cells and to locally deliver an analyte, while in their culture environment. We demonstrate a method to fabricate low-resistance metallic electrodes into a PDMS pipette, followed by characterization of its effectiveness, benefits and limits in comparison with an external carbon microelectrode.

Superioridad del derrame pleural sobre los criterios múltiples en el pronóstico de la pancreatitis aguda biliar / Pleural effusion is superior to multiple factor scoring system in predicting acute pancreatitis outcome

Introducción: existen numerosos trabajos sobre sistemas pronósticos en pancreatitis aguda. Sin embargo, todavía existe controversia sobre cuál es el mejor sistema pronóstico. Objetivo: analizar la exactitud pronóstica de la presencia de derrame pleural evaluada por ecografía al ingreso y compararla con tres sistemas de criterios múltiples (RANSON, APACHE II; APACHE II O). Pacientes y métodos: ingresaron al estudio todos los pacientes con diagnóstico de pancreatitis aguda biliar en el período 2002 a 2006. Se excluyeron pacientes en los que se realizaron CPRE temprana y aquellos en los cuales no se pudo realizar ecografía al ingreso. Se determinó la severidad del ataque de acuerdo a los criterios de Atlanta. Los sistemas pronósticos estudiados fueron evaluados para predecir en forma independiente complicaciones sistémicas, complicaciones locales y complicaciones totales (sistémicas más locales). Se utilizó la razón de verosimilitud como índice más adecuado para comparar la exactitud pronóstica de los 4 sistemas pronósticos evaluados. Resultados: ingresaron al estudio 178 pacientes, se excluyeron 35 (CPRE temprana=32, imposibilidad de ecografía al ingreso= 3). De los 143 pacientes estudiados, 29 pacientes (20, 2%) desarrollaron pancreatitis aguda grave. El derrame pleural evaluado por ecografía presentó valores superiores de exactitud pronóstica en la predicción de complicaciones sistémicas (razón de verosimilitud= 6,3), complicaciones locales (razón de verosimilitud= 11) y complicaciones totales (razón de verosimilitud= 16,1). Conclusión: la evaluación de la presencia de derrame pleural por ecografía predijo con aceptables cifras de razón de verosimilitud la presencia de un ataque grave. El derrame pleural por ecografía mostró cifras superiores de razón de verosimilitud cuando se lo comparó con 3 sistemas de criterios múltiples (RANSON, APACHE II y APACHE II O).

Introduction: there are many studies about prognostic scores in acute pancreatitis but the best one has yet to be determined. Objective: to analyze the pleural effusion (diagnosed by ultrasound) as a prognostic factor and to compare it with three multiple criteria scores (RANSON, APACHE II, APACHE II O). Patients and Methods: all patients with acute gallstone pancreatitis were included in the study during the period 2002- 2006. Patients treated with ERCP at admission and those in whom ultrasonography was not done were excluded. The severity of the attack was set according to the Atlanta Classification criteria. The prognostic scores used were analyzed to predict separately systemic complications, local complications and total complications (local and systemic). The likelihood positive ratio was used as the most accurate index to compare the prognostic accuracy of the 4 prognostic scores. Results: 178 patients were included. 35 patients were excluded (ERCP at admission=32, ultrasonography not done at admission=3). 29 patients of 143 patients developed severe acute pancreatitis. The pleural effusion evaluated by ultrasonography showed the great accuracy at predicting the development of systemic complications (likelihood positive ratio=6.3), local complications (likelihood positive ratio=11) and total complications (likelihood positive ratio=16.1). Conclusion: the pleural effusion evaluated by ultrasonography can predict with great levels of accuracy a severe acute attack. When it was compared with 3 multiple criteria scores (RANSON, APACHE II, APACHE II O) showed to be more accurate at predicting disease severity.

Consumo de tabaco en población escolar de Chile / Tobacco consumption in Chilean school children

El hábito de consumo de tabaco en escolares se inicia precozmente por lo que su prevención representa un desafío para los médicos. En las altas tasas de consumo de tabaco en escolares de Chile, influye el consumo de los padres y la baja percepción de riesgo.

A fork-clearing role for UvrD.

The inactivation of a replication protein causes the disassembly of the replication machinery and creates a need for replication reactivation. In several replication mutants, restart occurs after the fork has been isomerized into a four-armed junction, a reaction called replication fork reversal. The repair helicase UvrD is essential for replication fork reversal upon inactivation of the polymerase (DnaE) or the beta-clamp (DnaN) subunits of the Escherichia coli polymerase III, and for the viability of dnaEts and dnaNts mutants at semi-permissive temperature. We show here that the inactivation of recA, recFOR, recJ or recQ recombination genes suppresses the requirement for UvrD for replication fork reversal and suppresses the lethality conferred by uvrD inactivation to Pol IIIts mutants at semi-permissive temperature. We propose that RecA binds inappropriately to blocked replication forks in the dnaEts and dnaNts mutants in a RecQ- RecJ- RecFOR-dependent way and that UvrD acts by removing RecA or a RecA-made structure, allowing replication fork reversal. This work thus reveals the existence of a futile reaction of RecA binding to blocked replication forks, that requires the action of UvrD for fork-clearing and proper replication restart.