Biodegradation of chloroethene compounds under microoxic conditions.

The biodegradation of chloroethene compounds under oxic and anoxic conditions is well established. However, the biological reactions that take place under microoxic conditions are unknown. Here, we report the biostimulated (BIOST: addition of lactate) and natural attenuated (NAT) degradation of chloroethene compounds under microoxic conditions by bacterial communities from chloroethene compounds-contaminated groundwater. The degradation of tetrachloroethene was significantly higher in NAT (15.14% on average) than in BIOST (10.13% on average) conditions at the end of the experiment (90 days). Sporomusa, Paracoccus, Sedimentibacter, Pseudomonas, and Desulfosporosinus were overrepresented in NAT and BIOST compared to the source groundwater. The NAT metagenome contains phenol hydrolase P1 oxygenase (dmpL), catechol-1,2-dioxygenase (catA), catechol-2,3-dioxygenases (dmpB, todE, and xylE) genes, which could be involved in the cometabolic degradation of chloroethene compounds; and chlorate reductase (clrA), that could be associated with partial reductive dechlorination of chloroethene compounds. Our data provide a better understanding of the bacterial communities, genes, and pathways potentially implicated in the reductive and cometabolic degradation of chloroethene compounds under microoxic conditions.

Mexican Coccoloba uvifera L. Leaf and Fruit Extracts: Identification of Pentacyclic Triterpenes and Volatile Profile by GC-MS.

Mexican Coccoloba uvifera fruit contains polyphenols, flavonoids, and anthocyanins, while in the leaves, lupeol, α- and ß-amyrin have been previously identified by HPLC. However, the low resolution by HPLC of pentacyclic triterpenes (PTs) is a limitation. Moreover, the volatile profile of C. uvifera fruit is still unknown. Therefore, this study aimed to identify PTs in C. uvifera leaf and fruit extracts by CG-MS analysis and to determine the volatile profile of C. uvifera pulp by headspace solid-phase microextraction. The results showed trimethylsilylated compounds of standards lupeol, α- and ß-amyrin, indicating that the silylation reaction was suitable. These trimethylsilylated compounds were identified in leaf and fruit extracts. The fruit volatile profile revealed the presence of 278 esters, 20 terpenes, 9 aldehydes, 5 alcohols, and 4 ketones. The fruit showed a high content of esters and terpenes. Due to their flavour properties, esters are essential for the food, cosmetics, and pharmaceutics industries. Moreover, terpenes in the fruit, such as menthone, ß-elemene, junipene, and ß-caryophyllene have the potential as anticancer and phytopathogen agents. The results indicated that GC-MS is an alternative to HPLC approaches for identifying PTs. Besides, identifying volatile compounds in the fruit will increase the value of this plant and expand its application. Identifying PTs and volatile compounds in Mexican C. uvifera leads to a better understanding of the potential benefits of this plant. This would increase the consumption of Mexican C. uvifera fresh or as functional ingredients in nutraceutical or pharmaceutical products.

A mosquito juvenile hormone binding protein (mJHBP) regulates the activation of innate immune defenses and hemocyte development.

Insects rely on the innate immune system for defense against pathogens, some aspects of which are under hormonal control. Here we provide direct experimental evidence showing that the juvenile hormone-binding protein (mJHBP) of Aedes aegypti is required for the regulation of innate immune responses and the development of mosquito blood cells (hemocytes). Using an mJHBP-deficient mosquito line generated by means of CRISPR-Cas9 gene editing technology we uncovered a mutant phenotype characterized by immunosuppression at the humoral and cellular levels, which profoundly affected susceptibility to bacterial infection. Bacteria-challenged mosquitoes exhibited significantly higher levels of septicemia and mortality relative to the wild type (WT) strain, delayed expression of antimicrobial peptides (AMPs), severe developmental dysregulation of embryonic and larval hemocytes (reduction in the total number of hemocytes) and increased differentiation of the granulocyte lineage. Interestingly, injection of recombinant wild type mJHBP protein into adult females three-days before infection was sufficient to restore normal immune function. Similarly, injection of mJHBP into fourth-instar larvae fully restored normal larval/pupal hemocyte populations in emerging adults. More importantly, the recovery of normal immuno-activation and hemocyte development requires the capability of mJHBP to bind JH III. These results strongly suggest that JH III functions in mosquito immunity and hemocyte development in a manner that is perhaps independent of canonical JH signaling, given the lack of developmental and reproductive abnormalities. Because of the prominent role of hemocytes as regulators of mosquito immunity, this novel discovery may have broader implications for the understanding of vector endocrinology, hemocyte development, vector competence and disease transmission.

Bioaccessibility and human exposure to metals in urban soils (Huelva, SW Spain): evaluation by in vitro gastric extraction.

The main purpose of this study was to assess the human health risk of heavy metals in the urban-peri-urban soils from Huelva Township. The soils present high concentrations of potentially toxic elements well beyond the regional screening soil concentration. A site-specific health risk assessment of exposure (oral ingestion, oral inhalation and dermal contact) was conducted according to the regulatory normative. To reduce the uncertainty derived from soil characteristics, bioaccessibility and predicted bioavailability data were included in the assessment. Thereby, in order to evaluate the oral bioaccessibility, a simulation of the gastric condition (pH and T) was applied dissolving the samples in a solution of HCl and 0.4 M glycine. Soils located in industrial areas present higher bioaccessibility than those associated with urban or other uses. The adjusted-relative bioaccessibility total carcinogenic risk for As exceeded the regulatory level in all samples (except samples 7 and 184) indicating that children are more vulnerable, while no detrimental health effects are expected for Pb (except in sample 76, a "greenway" recreational area). The adjusted hazard index for non-carcinogenic effects also overpassed the threshold values in practically all possible scenarios for an adult resident working in Huelva, as well as for a child living and playing in the urban/recreational areas. The main pollutant contributions were related to As and Pb. For this reason, the reported soils exceeding the regulatory levels should be classified as polluted and, therefore, this study should be helpful to initiate necessary soil management interventions to avoid the human health risk.

Hexavalent chromium bioreduction and chemical precipitation of sulphate as a treatment of site-specific fly ash leachates.

Most of the power generation globally is by coal-fired power plants resulting in large stockpiles of fly ash. The trace elements associated with the ash particles are subjected to the leaching effects of precipitation which may lead to the subsequent contamination of surface and groundwater systems. In this study, we successfully demonstrate an efficient and sustainable dual treatment remediation strategy for the removal of high levels of Cr6+ and SO42- introduced by fly ash leachate generated by a power station situation in Mpumalanga, South Africa. The treatment consisted of a primary fixed-bed bioreactor kept at a reduction potential for Cr6+ reduction. Metagenome sequencing clearly indicated a diverse bacterial community containing various bacteria, predominantly of the phylum Proteobacteria which includes numerous species known for their ability to detoxify metals such as Cr6+. This was followed by a secondary BaCO3/dispersed alkaline substrate column for SO42- removal. The combination of these two systems resulted in the removal of 99% Cr6+ and 90% SO42-. This is the first effective demonstration of an integrated system combining a biological and chemical strategy for the remediation of multi-contaminants present in fly ash leachate in South Africa.

Drosophila anti-nematode and antibacterial immune regulators revealed by RNA-Seq.

BACKGROUND: Drosophila melanogaster activates a variety of immune responses against microbial infections. However, information on the Drosophila immune response to entomopathogenic nematode infections is currently limited. The nematode Heterorhabditis bacteriophora is an insect parasite that forms a mutualistic relationship with the gram-negative bacteria Photorhabdus luminescens. Following infection, the nematodes release the bacteria that quickly multiply within the insect and produce several toxins that eventually kill the host. Although we currently know that the insect immune system interacts with Photorhabdus, information on interaction with the nematode vector is scarce. RESULTS: Here we have used next generation RNA-sequencing to analyze the transcriptional profile of wild-type adult flies infected by axenic Heterorhabditis nematodes (lacking Photorhabdus bacteria), symbiotic Heterorhabditis nematodes (carrying Photorhabdus bacteria), and Photorhabdus bacteria alone. We have obtained approximately 54 million reads from the different infection treatments. Bioinformatic analysis shows that infection with Photorhabdus alters the transcription of a large number of Drosophila genes involved in translational repression as well in response to stress. However, Heterorhabditis infection alters the transcription of several genes that participate in lipidhomeostasis and metabolism, stress responses, DNA/protein synthesis and neuronal functions. We have also identified genes in the fly with potential roles in nematode recognition, anti-nematode activity and nociception. CONCLUSIONS: These findings provide fundamental information on the molecular events that take place in Drosophila upon infection with the two pathogens, either separately or together. Such large-scale transcriptomic analyses set the stage for future functional studies aimed at identifying the exact role of key factors in the Drosophila immune response against nematode-bacteria complexes.

[Laparoscopic cholecystectomy in pregnant patient: experience in hospital General de Mexico in a period of 5 years (2008-2012)]. / Colecistectomía laparoscópica en pacientes embarazadas: experiencia del Hospital General de México 2008-2012.

BACKGROUND: Cholecystitis is the second cause of abdominal pain during pregnancy. 1-8 of 10,000 requiring surgery, being performed in the first and second quarter laparoscopically. 100% of patients with cholecystitis, about 12% are associated with pancreatitis with high rates of maternal and fetal morbidity and mortality. OBJECTIVE: To evaluate advantages--disadvantages of maternal-fetal pregnancy laparoscopic cholecystectomy and its preventive character avoiding cases of pancreatitis. We analyze the results obtained in Perinatology Service in General Hospital of Mexico (2008 to 2012) comparing them with the current literature. MATERIAL AND METHODS: A retrospective, cross sectional, descriptive. Analyzing the following variables: maternal age, gestational age, number of gestations, surgical technique, and postoperative complications trans, maternal and perinatal morbidity, gallbladder colic episodes prior, liver ultrasound report--bile ducts, tocolytic management. RESULTS: 20 laparoscopic cholecystectomies were performed in pregnant patients. Maternal age 21-38 years, mostly multigesta. 5 patients was performed at weeks 9, 14, 20 and 25 between the SDG and 1 at 27.5 SDG.Vesicular colicky eight previous USG mostly with gallstones.Two cases of mild acute pancreatitis satisfactorily resolved. No trans or postoperative complications. Open technique for performing pneumoperitoneum (Hasson). Tocolytic management indomethacin in 100% of cases. CONCLUSIONS: The results obtained are consistent with the current literature, confirming that laparoscopic cholecystectomy is the best treatment option with minimal fetal maternal morbidity, reducing the incidence of pancreatitis and maternal- fetal consequences.

Key energy metabolisms in modern living microbialites from hypersaline Andean lagoons of the Salar de Atacama, Chile.

Microbialites are organosedimentary structures formed mainly due to the precipitation of carbonate minerals, although they can also incorporate siliceous, phosphate, ferric, and sulfate minerals. The minerals' precipitation occurs because of local chemical changes triggered by changes in pH and redox transformations catalyzed by the microbial energy metabolisms. Here, geochemistry, metagenomics, and bioinformatics tools reveal the key energy metabolisms of microbial mats, stromatolites and an endoevaporite distributed across four hypersaline lagoons from the Salar de Atacama. Chemoautotrophic and chemoheterotrophic microorganisms seem to coexist and influence microbialite formation. The microbialite types of each lagoon host unique microbial communities and metabolisms that influence their geochemistry. Among them, photosynthetic, carbon- and nitrogen- fixing and sulfate-reducing microorganisms appear to control the main biogeochemical cycles. Genes associated with non-conventional energy pathways identified in MAGs, such as hydrogen production/consumption, arsenic oxidation/reduction, manganese oxidation and selenium reduction, also contribute to support life in microbialites. The presence of genes encoding for enzymes associated with ureolytic processes in the Cyanobacteria phylum and Gammaproteobacteria class might induce carbonate precipitation in hypersaline environments, contributing to the microbialites formation. To the best of our knowledge, this is the first study characterizing metagenomically microbialites enriched in manganese and identifying metabolic pathways associated with manganese oxidation, selenium reduction, and ureolysis in this ecosystem, which suggests that the geochemistry and bioavailability of energy sources (As, Mn and Se) shapes the microbial metabolisms in the microbialites.

Blood feeding and insulin-like peptide 3 stimulate proliferation of hemocytes in the mosquito Aedes aegypti.

All vector mosquito species must feed on the blood of a vertebrate host to produce eggs. Multiple cycles of blood feeding also promote frequent contacts with hosts, which enhance the risk of exposure to infectious agents and disease transmission. Blood feeding triggers the release of insulin-like peptides (ILPs) from the brain of the mosquito Aedes aegypti, which regulate blood meal digestion and egg formation. In turn, hemocytes serve as the most important constitutive defense in mosquitoes against pathogens that enter the hemocoel. Prior studies indicated that blood feeding stimulates hemocytes to increase in abundance, but how this increase in abundance is regulated is unknown. Here, we determined that phagocytic granulocytes and oenocytoids express the A. aegypti insulin receptor (AaMIR). We then showed that: 1) decapitation of mosquitoes after blood feeding inhibited hemocyte proliferation, 2) a single dose of insulin-like peptide 3 (ILP3) sufficient to stimulate egg production rescued proliferation, and 3) knockdown of the AaMIR inhibited ILP3 rescue activity. Infection studies indicated that increased hemocyte abundance enhanced clearance of the bacterium Escherichia coli at lower levels of infection. Surprisingly, however, non-blood fed females better survived intermediate and high levels of E. coli infection than blood fed females. Taken together, our results reveal a previously unrecognized role for the insulin signaling pathway in regulating hemocyte proliferation. Our results also indicate that blood feeding enhances resistance to E. coli at lower levels of infection but reduces tolerance at higher levels of infection.

The economic effects of perceptions of the Russia-Ukraine war in Ecuador.

Background: Using an online questionnaire capturing the immediate economic and social effects of the Russia-Ukraine war. The study assesses the topics of more profound concern for university students and the variation of economic attitudes related to their socio-demographic variables. Methods: Three hundred eighty-five participants, between 18 and 22 years of age, 49% female, leads us to identify significant differences by sex and economic status related to the stock crash, inflation, corruption, and poverty perceptions. However, the effect size and sampling could be improved. Results: Kruskal-Wallis test confirms that the below-average economic status group feels more worried about higher inflation, while females tend to be more concerned about inflation, corruption, and poverty because of the conflict. Ordered logistic regression reveals that participants who express higher levels of concern regarding the impact of increased energy prices and poverty tend to exhibit greater overall worry. Conclusions: Even though convenience sampling imposes constraints to extrapolate the results broadly, the research constitutes a benchmark for similar studies among Latin American and Caribbean countries since economic expectations and economic knowledge from citizens, applied in their decisions, play an essential role in national development.

Radiolytically reworked Archean organic matter in a habitable deep ancient high-temperature brine.

Investigations of abiotic and biotic contributions to dissolved organic carbon (DOC) are required to constrain microbial habitability in continental subsurface fluids. Here we investigate a large (101-283 mg C/L) DOC pool in an ancient (>1Ga), high temperature (45-55 °C), low biomass (102-104 cells/mL), and deep (3.2 km) brine from an uranium-enriched South African gold mine. Excitation-emission matrices (EEMs), negative electrospray ionization (-ESI) 21 tesla Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR MS), and amino acid analyses suggest the brine DOC is primarily radiolytically oxidized kerogen-rich shales or reefs, methane and ethane, with trace amounts of C3-C6 hydrocarbons and organic sulfides. δ2H and δ13C of C1-C3 hydrocarbons are consistent with abiotic origins. These findings suggest water-rock processes control redox and C cycling, helping support a meagre, slow biosphere over geologic time. A radiolytic-driven, habitable brine may signal similar settings are good targets in the search for life beyond Earth.

Guamara and Cocuixtle: Source of Proteases for the Transformation of Shrimp By-Products into Hydrolysates with Potential Application.

Since the fruits of Bromelia pinguin and Bromelia karatas are rich in proteases, the aim of this research was to optimize the hydrolysis process of cooked white shrimp by-products due to the effect of these proteases. A robust Taguchi L16' design was used to optimize the hydrolysis process. Similarly, the amino acid profile by GC-MS and antioxidant capacity (ABTS and FRAP) were determined. The optimal conditions for hydrolysis of cooked shrimp by-products were pH 8.0, 30 °C, 0.5 h, 1 g of substrate and 100 µg/mL of B. karatas, pH 7.5, 40 °C, 0.5 h, 0.5 g substrate and 100 µg/mL enzyme extract from B. pinguin and pH 7.0, 37 °C, 1 h, 1.5 g substrate and 100 µg/mL enzyme bromelain. The optimized hydrolyzates of B. karatas B. pinguin and bromelain had 8 essential amino acids in their composition. The evaluation of the antioxidant capacity of the hydrolyzates under optimal conditions showed more than 80% inhibition of in ABTS radical, B. karatas hydrolyzates had better higher ferric ion reduction capacity with 10.09 ± 0.02 mM TE/mL. Finally, the use of proteolytic extracts from B. pinguin and B. karatas to optimize hydrolysis process allowed obtaining hydrolyzates of cooked shrimp by-products with potential antioxidant capacity.

Molecular mechanisms of aging and immune system regulation in Drosophila.

Aging is a complex process that involves the accumulation of deleterious changes resulting in overall decline in several vital functions, leading to the progressive deterioration in physiological condition of the organism and eventually causing disease and death. The immune system is the most important host-defense mechanism in humans and is also highly conserved in insects. Extensive research in vertebrates has concluded that aging of the immune function results in increased susceptibility to infectious disease and chronic inflammation. Over the years, interest has grown in studying the molecular interaction between aging and the immune response to pathogenic infections. The fruit fly Drosophila melanogaster is an excellent model system for dissecting the genetic and genomic basis of important biological processes, such as aging and the innate immune system, and deciphering parallel mechanisms in vertebrate animals. Here, we review the recent advances in the identification of key players modulating the relationship between molecular aging networks and immune signal transduction pathways in the fly. Understanding the details of the molecular events involved in aging and immune system regulation will potentially lead to the development of strategies for decreasing the impact of age-related diseases, thus improving human health and life span.

Fall-related injuries among youth under 20 years old who were treated in Nicaraguan emergency departments, 2004.

OBJECTIVE: To describe the circumstances of fall-related injuries among youth 0-19 years treated in emergency departments in Nicaragua; to estimate the incidence rates (IR) of falls; and, to identify areas for prevention efforts. MATERIAL AND METHODS: All patients <20 years who were residents of Managua, León, Jinotepe, and Ciudad Sandino (6593) were selected for analysis. Data were collected with the 2004 Injury Surveillance System. RESULTS: In 2004, the IR of falls for youth <20 years old was 104.2 incidents per 10000 persons. The IR for male youth was twice that of female youth. Overall, trees (23.3%) and beds (15.2%) were the main objects involved in falls. Fractures were the leading injuries sustained. CONCLUSIONS: This study identifies three areas that can be addressed: furniture, recreation, and physical environment. Interventions that may be most useful for caregivers and adolescents include changes in the home environment and recreation play areas, as well as educational programs.

Prevalence of antibiotic resistance and virulent factors in nosocomial clinical isolates of Pseudomonas aeruginosa from Panamá.

BACKGROUND: Pseudomonas aeruginosa is an important causative agent of nosocomial infections. As pathogen, P. aeruginosa is of increasing clinical importance due to its ability to develop high-level multidrug resistance (MDR). METHODS: The aim of the present study was to better understand the intrinsic virulence of circulating strains of Pseudomonas aeruginosa, by surveying and characterizing the antibiotic resistance profiles and prevalence of virulence factors in 51 clinical isolates of P. aeruginosa obtained from children admitted to Hospital del Niño-Panamá during the period of October 2016 until March 2017. Antimicrobial susceptibilities were assessed by determining the minimum inhibitory concentration for 12 antibiotics against P. aeruginosa clinical isolates using the VITEK system (https://www.biomerieux.com). Additionally, all isolates were examined by Polymerase Chain Reaction (PCR) for the presence of components of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes and betalactamases resistance genes (ESBL) using gene-specific primers. RESULTS: A total of 51 pyoverdine producing clinical isolates were analyzed, all of which expressed resistance genes such as genes of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes (fpvA). Out of 51 MDR isolates, 22 were ESBL producers. The most common ESBL gene was blaTEM expressed by 43% of the isolates. The isolates tested in this study showed increased resistance to antibiotics in the following categories: (i) penicillins (ampicillin (69%), piperacillin (22%); (ii) pyrimethamines (trimethoprim, 65%); (iii) nitrofurans (nitrofurantoin, 63%), and (iv) third-generation cephalosporin cefotaxime (53%). These results underscore a high prevalence of MDR amongst clinical isolates from Panama. CONCLUSIONS: The present study indicates that prevalence of BlaTEM-carrying strains is increasing with subsequent multidrug resistance in Panamá and as well reported worldwide. The virulent factors identified in this study provide valuable information regarding the prevalence of resistance genes and their potential impact on treatments that exploit the unique physiology of the pathogen. To prevent further spread of MDR, the proportions of resistant strains of Pseudomonas aeruginosa should be constantly evaluated on healthcare institutions of Panamá. More importantly, this information can be used to better understand the evolution and dissemination of strains hoping to prevent the development of resistance in Pseudomonas aeruginosa. Future studies quantifying the expression of these virulent genes will emphasize on the acquisition of multidrug resistance.

Volatile profiles of five jackfruit (Artocarpus heterophyllus Lam.) cultivars grown in the Mexican Pacific area.

The volatile compounds of five kind of cultivars of jackfruit (Artocarpus heterophyllus Lam.) grown in Nayarit, Mexico, was researched by using extraction and chromatographic methods such as headspace-solid phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC-MS). Eighty-six volatile compounds were identified. The most prominent compounds in the analyzed cultivars were alkyl esters of 3-methylbutanoic acid. Ethyl 3-methylbutanoate was the most abundant ester in FMC, JMC and RMC cultivars (190.7-961.2 µg/kg), whereas butyl 3-methylbutanoate (152.8-205.2 µg/kg) and pentyl 3-methylbutanoate (105.1-210.9 µg/kg) were predominant in DMC and BMC cultivars. By utilizing clustering statistical techniques such as principal component analysis was possible to identify certain esters compounds (number and concentration) to differentiate each cultivar.

Edible pectin film added with peptides from jackfruit leaves obtained by high-hydrostatic pressure and pepsin hydrolysis.

Jackfruit (Artocarpus heterophyllus Lam.) is an evergreen tree that produces a high waste of leaves. This study evaluated the obtention of peptides from jackfruit leaves using pancreatin and pepsin, their antifungal activity, and their effect on pectin films. The protein content was 7.64 ± 0.12 g/100 g of jackfruit fresh leaves. Pancreatin produced a higher yield than pepsin in the obtention of peptides (p ≤ 0.05). However, peptides obtained after 2 h by pepsin hydrolysis (Pep-P) had six essential amino acids and inhibited > 99% of mycelial growth and spore germination of Colletotrichum gloeosporioides. Pectin films with Pep-P showed a slight brown color, lower thickness, water vapor permeability, and moisture content, as well as higher thermal stability and better inhibition properties against C. gloeosporioides than pectin films without Pep-P (p ≤ 0.05). Pectin films added with Pep-P from jackfruit leaf could be a green alternative to anthracnose control in tropical fruits.

Comparison of the MDRD and the CKD-EPI equations to estimate the glomerular filtration rate in the general population.

BACKGROUND AND OBJECTIVE: The Chronic Kidney Disease Epidemiology Collaboration (CDK-EPI) equation has been proposed as a replacement for the Modification of Diet in Renal Disease (MDRD) equation to estimate the glomerular filtration rate, but this equation has not yet been evaluated in the general population. PATIENTS AND METHODS: Cross-sectional analysis of a random sample of 858 participants from the general population aged 50-75 years without known kidney disease. The prevalence of low eGFR (< 60 mL/min/1.73 m(2)) was assessed with the MDRD and the CKD-EPI equations in the overall sample and in normoalbuminuric individuals. RESULTS: With the MDRD equation the median eGFRs (interquartile range) in men/women were 63.3(12.2)/56.7(9.4)mL/min/1.73 m(2), and with the CKD-EPI equation 66.6(14.2)/61.3(11.6) mL/min/1.73 m(2). The prevalence of low eGFR in men/women was 35.2%/68.5% and 25.1%/45.7% with the MDRD and the CKD-EPI equations, respectively. Normoalbuminuric women without risk factors for CKD experienced the most pronounced reduction in the number of cases with low eGFR with the CKD-EPI equation. The prevalence of renal impairment in this subgroup still remained even greater than that in men with diabetes, hypertension, or cardiovascular disease. CONCLUSIONS: Compared with the MDRD, the CKD-EPI equation generates a substantial reduction in the prevalence of renal impairment in subjects with diabetes, hypertension, cardiovascular disease, and in subjects without risk factors. The prevalence of renal impairment in normoalbuminuric females may be still overestimated with the CKD-EPI equation.

[Coronary artery bypass graft surgery with bilateral internal mammary artery. Medium-term results.] / Cirugía de revascularización de miocardio usando arteria mamaria interna bilateral. Resultados a mediano plazo.

Introduction: Coronary artery bypass graft (CABG) surgery is one of the main strategies in the treatment of coronary heart disease. The benefit of using the left internal mammary artery (IMA) to revascularize the anterior descending artery is greatly demonstrated, improving long-term survival in patients receiving this graft. On the other hand there are variable currents about the use of two internal mammary arteries, although several studies have already demonstrated the superiority of the use of two mammary arteries over one. Methodology: Retrospective study of Coronary artery bypass graft surgeries with bilateral mammary artery, performed at Instituto Nacional Cardiovascular - INCOR EsSalud between January 2012 and June 2018. The objective was to determine the mortality rate and major adverse cardiovascular events in a medium term follow-up of 30 months. Results: 121 patients were operated with bilateral internal mammary artery. All patients underwent dissection of mammary artery with skeletonized technique. There was one in-hospital death due to mediastinitis. Major adverse cardiovascular events occurred in 5.8% of patients (death 0.8%, stroke 0%, perioperative myocardial infarction 1.6%, need for new coronary intervention 3.3%). The incidence of mediastinitis and/or sternal reconstruction was 0.8%. Conclusions: : CABG with bilateral IMA is a safe procedure, with low mortality rates and low major adverse cardiovascular events in a 30-month follow-up.

[Left Ventricular Mixoma: A case report]. / Mixoma Ventricular Izquierdo.

Myxoma is a primary cardiac tumor of low prevalence in the population, with a predilection for the left atrium followed by the right atrium. The location in the ventricles is infrequent and the symptoms depends of the place of origin. Its associated complications and its particular form of debut can be avoided with timely surgical resection.We present the case of a 15-year-old symptomatic woman with a mass in the left ventricle. The mass was surgically resected, and the histopathological study confirmed a myxoma.