Study of two approaches for the process water management from hydrothermal carbonization of swine manure: Anaerobic treatment and nutrient recovery.

Hydrothermal carbonization (HTC) is a promising alternative to transform biomass waste into a solid carbonaceous material (hydrochar) and a process water with potential for material and energy recovery. In this study, two alternatives for process water treatment by conventional and acid-assisted HTC of swine manure are discussed. Process water from conventional HTC at 180 °C showed high biodegradability (55% COD removal) and methane production (∼290 mL STP CH4 g-1 CODadded) and the treatment in an upflow anaerobic sludge blanket reactor allowed obtaining a high methane production yield (1.3 L CH4 L-1 d-1) and COD removal (∼70%). The analysis of the microbiota showed a high concentration of Synergistota and Firmicutes phyla, with high degradation of organic nitrogen-containing organic compounds. Acid-assisted HTC proved to be a viable option for nutrient recovery (migration of 83% of the P to the process water), which allowed obtaining a solid salt by chemical precipitation with Mg(OH)2 (NPK of 4/4/0.4) and MgCl2 (NPK 8/17/0.5), with a negligible content of heavy metals. The characteristics of the precipitated solid complied with the requirements of European Regulation (2019)/1009 for fertilizers and amendments in agricultural soils, being a suitable alternative for the recycling of nutrients from wastes.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. / Registro de linfomas cutáneos primarios (RELCP) de la AEDV: datos tras 5 años de funcionamiento.

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Ampollas inducidas por PUVA. Presentación de 5 casos / Blisters Induced by PUVA: A Report of 5 Cases

Las ampollas secundarias al tratamiento con PUVA son un efecto secundario de la fotoquimioterapia poco descrito en la literatura científica. Se caracteriza por la aparición espontánea de ampollas asintomáticas localizadas fundamentalmente en los miembros inferiores, que se resuelven sin necesidad de tratamiento. El diagnóstico diferencial debe plantearse con una reacción fototóxica, con la pseudoporfiria y con el penfigoide ampolloso inducido por PUVA. Presentamos 5 casos de ampollas secundarias a la terapia PUVA, con el objetivo de dar a conocer las características clínicas e histológicas de dicha entidad. Su correcto diagnóstico evitará la interrupción del tratamiento, así como la realización de procedimientos diagnósticos y terapéuticos innecesarios

Blíster associated with PUVA treatments are an adverse effect of photochemotherapy that has been reported in the literature. Asymptomatic blisters appear spontaneously mainly on the lower limbs and resolve without treatment. The differential diagnoses to consider include a phototoxic reaction, pseudoporphyria, and PUVA-induced bullous pemphigoid. We describe the clinical and histologic features in 5 cases of blistering secondary to PUVA treatment. If this adverse effect is accurately diagnosed, photochemotherapy need not be interrupted, and unnecessary diagnostic procedures and additional treatments can be avoided

Blisters Induced by PUVA: A Report of 5 Cases. / Ampollas inducidas por PUVA. Presentación de 5 casos.

Blisters associated with PUVA treatments are an adverse effect of photochemotherapy that has been reported in the literature. Asymptomatic blisters appear spontaneously mainly on the lower limbs and resolve without treatment. The differential diagnoses to consider include a phototoxic reaction, pseudoporphyria, and PUVA-induced bullous pemphigoid. We describe the clinical and histologic features in 5 cases of blistering secondary to PUVA treatment. If this adverse effect is accurately diagnosed, photochemotherapy need not be interrupted, and unnecessary diagnostic procedures and additional treatments can be avoided.

Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana / Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination

Objetivos. Comprobar si la adición de bajas dosis de antibiótico (vancomicina) al suero de lavado del recuperador celular reduce la incidencia de contaminación bacteriana del concentrado de hematíes (CH) autógeno recuperado. Material y método. Estudio experimental, aleatorizado, doble ciego, en forma de grupos paralelos, sobre 20 pacientes consecutivos, programados para cirugía de artrodesis vertebral posterior. La hemorragia intraoperatoria se procesó mediante un recuperador de sangre modelo HaemoLite® 2+, en cuyo proceso los hematíes se lavaron según grupo de aleatorización, con suero fisiológico (grupo control) o con suero fisiológico+10μg/ml−1 de vancomicina (grupo vanco). Se recogieron los datos referentes a edad, peso, volumen procesado y recuperado, hemograma, hemocultivo y concentración de vancomicina del CH obtenido e incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue 843±403ml y el volumen recuperado 121±29ml, con hemoglobina 10,4±5,0g/dl−1 y hematocrito 29,1±15,9% (media±DE). El hemocultivo del CH recuperado fue positivo a Staphylococcus coagulasa negativo en 5 casos (50%) en el grupo control mientras que fue estéril en todos los casos en el grupo vanco (p=0,016). La diferencia entre la concentración teórica de vancomicina administrada y la determinada en CH recuperado fue de 1,31μg/ml−1 (IC 95% 1,19-1,43; p=0,074). Conclusiones. La adición de vancomicina a una concentración de 10μg/ml−1 en el suero de lavado del recuperador consigue concentraciones similares en la sangre autógena recuperada y permite la eliminación de las bacterias, obteniéndose hemocultivos negativos en todos los casos (AU)

Objectives. The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. Material and method. Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml−1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. Results. Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl−1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml−1 (95% CI 1.19 to 1.43; P=.074). Conclusions. The addition of vancomycin at a concentration of 10ug/ml−1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases (AU)

Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. / Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico.

OBJECTIVE: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS: We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.

Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination. / Adición de vancomicina al suero de lavado del recuperador de sangre. Efecto sobre la contaminación bacteriana.

OBJECTIVES: The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD: Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10µg/ml-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. RESULTS: Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31µg/ml-1 (95% CI 1.19 to 1.43; P=.074). CONCLUSIONS: The addition of vancomycin at a concentration of 10ug/ml-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.

Implementación de un programa de alternativas a la transfusión sanguínea en cirugía de escoliosis en pediatría / Implementation of a patient blood management program in pediatric scoliosis surgery

Objetivos. Determinar si la puesta en marcha de un programa de ahorro de sangre y la adopción y asociación progresiva de diferentes métodos reducen las necesidades transfusionales en pacientes pediátricos intervenidos de escoliosis de múltiples etiologías. Material y método. Estudio cuasiexperimental, no aleatorizado y descriptivo, aprobado por el Comité de Ética para la Investigación de nuestra institución. Se incluyeron 50 pacientes pediátricos (ASA I-III) de edades comprendidas entre los 5 y los 18 años, intervenidos de cirugía de escoliosis de cualquier etiología mediante un único tiempo posterior o doble abordaje, anterior y posterior. Se compararon un grupo histórico (recogida retrospectiva de datos), sin alternativas a la transfusión (Grupo No ahorro = 15 pacientes), y otros 3 grupos prospectivamente: Grupo HNA (hemodilución normovolémica aguda) = 9 pacientes, Grupo HNA + Rec (recuperación intraoperatoria) = 14 pacientes, Grupo EPO (HNA + Rec + eritropoyetina ± donación preoperatoria) = 12 pacientes, conforme se implementaron las diferentes alternativas a la transfusión en nuestra institución. Resultados. La tasa de transfusión en los diferentes grupos (No ahorro, HNA, HNA + Rec, EPO) fue del 100, 66, 57 y 0% de los pacientes, con una media ± DE de 3,40 ± 1,59; 1,33 ± 1,41; 1,43 ± 1,50; 0 ± 0 unidades de CH transfundidas por paciente, respectivamente, con diferencias estadísticamente significativas (p < 0,001) tanto en la tasa de transfusión como en el número de unidades. Conclusiones. La aplicación de un programa multimodal de alternativas a la transfusión sanguínea en cirugía de escoliosis pediátrica, individualizado para cada paciente, puede evitar la transfusión en la práctica totalidad de los casos (AU)

Objectives. To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. Material and method. Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro = 15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution) = 9 patients; Group HNA + Rec (intraoperative blood salvage) = 14 patients, and Group EPO (HNA + Rec + erythropoietin ± preoperative donation) = 12 patients; according with the implementation schedule of the transfusion alternatives in our institution. Results. The rate of transfusion in different groups (No ahorro, HNA, HNA + Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean ± SD of 3.40 ± 1.59; 1.33 ± 1.41; 1.43 ± 1.50; 0 ± 0 RBC units transfused per patient, respectively. Statistically significant differences (P < .001) were found in both the transfusion rate and number of RBC units. Conclusions. The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases (AU)

Características y calidad de la sangre autóloga recuperada del campo quirúrgico durante cirugía de escoliosis en pediatría / Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery

Objetivos. Determinar las características hematológicas y microbiológicas de la sangre recuperada mediante el uso de un recuperador celular con campana centrifugadora pediátrica rígida (100 ml) en cirugía de escoliosis en pediatría y comprobar si se ajusta al estándar esperado en el paciente adulto. Material y método. Estudio de cohorte transversal, descriptivo, sobre 24 unidades consecutivas de sangre recuperada del campo quirúrgico procesadas mediante un recuperador de sangre modelo Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.). Se recogieron los datos referentes a edad, peso, abordaje (anterior o posterior) de la cirugía de escoliosis, volumen procesado y volumen de concentrado de hematíes (CH) autógeno recuperado, hemograma y hemocultivo del concentrado obtenido y la incidencia de fiebre tras la reinfusión. Resultados. El volumen procesado fue muy escaso (939 ± 569 ml) con gran variabilidad (coeficiente de variación = 0,6), a diferencia del volumen recuperado 129 ± 50 ml (coeficiente de variación = 0,38). Se estableció correlación estadísticamente significativa entre el volumen procesado y el hematocrito del CH recuperado (Pearson, r = 0,659; p = 0,001) que fue menor del esperado. Los parámetros hematológicos más relevantes de los concentrados recuperados fueron: Hb 11 ± 5,3 g dl−1; HTO: 32,1 ± 15,4%; leucocitos 5,34 ± 4,22 × 103 μl−1; plaquetas 37,88 ± 23,5 × 103 μl−1 (media ± DE). El hemocultivo del CH recuperado fue positivo en 13 casos (54,2%) en los que se aisló Staphylococcus coagulasa (−). Conclusiones. Los recuperadores celulares con campana centrifugadora de volumen fijo (incluso pediátrica) no obtienen la concentración esperada si se procesan bajos volúmenes, por lo que no son la mejor opción en el niño (AU)

Objective. To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100 ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. Material and methods. A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. Results. The processed shed volume was very low (939 ± 569 ml) with high variability (coefficient of variation = 0.6), unlike the recovered volume 129 ± 50 ml (coefficient of variation = 0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11 ± 5.3 g dl−1; haematocrit: 32.1 ± 15.4% (lower than expected); white cells 5.34 ± 4.22 × 103 ul−1; platelets 37.88 ± 23.5 × 103 ul−1 (mean ± SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (−) was isolated. Conclusions. Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery (AU)

Implementation of a patient blood management program in pediatric scoliosis surgery.

OBJECTIVES: To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. MATERIAL AND METHOD: Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. RESULTS: The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. CONCLUSIONS: The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.

Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery.

OBJECTIVE: To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS: A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS: The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS: Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.

Resultados de la miectomía anorrectal posterior en el tratamiento del estreñimiento crónico idiopático / Outcome of posterior anorectal myectomy for the treatment of idiopathic chronic constipation

Objetivo. Evaluar los resultados clínicos del tratamiento quirúrgico de pacientes con estreñimiento crónico incontrolable con tratamiento médico. Material y métodos. Estudio descriptivo de pacientes con estreñimiento crónico severo tratados mediante miectomía anorrectal posterior (técnica de Lynn). Se recogen los resultados de los últimos 15 años, con periodo de seguimiento postoperatorio mínimo de 1 año. Se incluyen pacientes con larga historia de estreñimiento, refractarios a tratamiento médico. Pruebas complementarias: enema opaco, manometría anorrectal y biopsias rectales. El resultado clínico de la técnica se clasifica según los siguientes criterios: Curación: >3 movimientos intestinales por semana, sin incontinencia/encopresis y sin necesidad de tratamiento médico. Mejoría: >3 movimientos intestinales por semana, sin incontinencia/ encopresis y con necesidad de laxante. Resultados. Se realizaron 19 miectomías (edad media de 8,47 años). Tiempo medio de estreñimiento previo de 7,89 años. Los hallazgos en la anatomía patológica fueron: presencia de células ganglionares en 10, ausencia de células ganglionares en 4 y otras alteraciones en 5. Manometría en 6 pacientes, 4 presentaron reflejo inhibitorio anal. Cuatro pacientes se diagnosticaron de enfermedad de Hirschsprung (uno se curó con la miectomía, dos precisaron cirugía correctora y uno no acudió a revisiones). En los 15 restantes, cumplieron criterios de curación 8 pacientes (53,3%), 4 mejoraron (26,6%), 1 sin mejoría sigue tratamiento fisioterápico. Dos pacientes no continuaron las revisiones. No se registró incontinencia fecal ni otras complicaciones. Conclusiones. La miectomía de Lynn es un procedimiento eficaz y seguro para los pacientes con estreñimiento crónico severo refractario al tratamiento médico. También resulta el tratamiento definitivo en la enfermedad de Hirschsprung de segmento ultracorto

Objectives. The aim of this study is to assess the outcome of surgery (Lynn’s myectomy) in patients with chronic persistent constipation and failure of medical treatment. Material and methods. Descriptive study of patients with severe chronic constipation treated by posterior anorectal myectomy (Lynn’s technique). We report data from the last 15 years, with a minimum postoperative follow-up of one year. Patients included in the study suffered from a long-term constipation refractory to medical management. Data regarding contrast enema, anorectal manometry and rectal biopsy were recorded. The procedure’s outcome is classified following clinical criteria: Asymptomatic: >3 bowel movements per week, with no soiling/ incontinence and with no medical treatment. Improvement: >3 bowel movements per week, with no soiling/ incontinence but using laxatives occasionally. Results. Nineteen myectomies were performed (median age of 8.47 years). Median time of constipation before surgery was 7.89 years. Rectal biopsy findings: 10 with ganglion cells, 4 without ganglion cells and other abnormalities in 5. Anorectal manometry was performed in 6 patients, 4 presented rectoanal inhibitory reflex. Four patients were diagnosed of Hirschsprung’s disease (1 was asymptomatic after myectomy, 2 needed further surgery and 1 was lost in follow-up). Of the remaining 15 patients, 8 were asymptomatic (53.3%), 4 experienced improvement (26.6%) and 1 without clinical changes is on pelvic floor physiotherapy. Two were lost in follow-up. There were no other postoperative complications after long term follow-up. Conclusions. Lynn’s myectomy is an effective and safe procedure in patients suffering from persistent chronic constipation despite of medical treatment. It is also the definitive treatment for patients with ultrashort-segment Hirschsprung’s disease

[Outcome of posterior anorectal myectomy for the treatment of idiopathic chronic constipation]. / Resultados de la miectomía anorrectal posterior en el tratamiento del estreñimiento crónico idiopático.

OBJECIVES: The aim of this study is to assess the outcome of surgery (Lynn's myectomy) in patients with chronic persistent constipation and failure of medical treatment. MATERIAL AND METHODS: Descriptive study of patients with severe chronic constipation treated by posterior anorectal myectomy (Lynn's technique). We report data from the last 15 years, with a minimum postoperative follow-up of one year. Patients included in the study suffered from a long-term constipation refractory to medical management. Data regarding contrast enema, anorectal manometry and rectal biopsy were recorded. The procedure's outcome is classified following clinical criteria: Asymptomatic: >3 bowel movements per week, with no soiling/incontinence and with no medical treatment; Improvement: >3 bowel movements per week, with no soiling/incontinence but using laxatives occasionally. RESULTS: Nineteen myectomies were performed (median age of 8.47 years). Median time of constipation before surgery was 7.89 years. Rectal biopsy findings: 10 with ganglion cells, 4 without ganglion cells and other abnormalities in 5. Anorectal manometry was performed in 6 patients, 4 presented rectoanal inhibitory reflex. Four patients were diagnosed of Hirschsprung's disease (1 was asymptomatic after myectomy, 2 needed further surgery and 1 was lost in follow-up). Of the remaining 15 patients, 8 were asymptomatic (53.3%), 4 experienced improvement (26.6%) and 1 without clinical changes is on pelvic floor physiotherapy. Two were lost in follow-up. There were no other postoperative complications after long term follow-up. CONCLUSIONS: Lynn's myectomy is an effective and safe procedure in patients suffering from persistent chronic constipation despite of medical treatment. It is also the definitive treatment for patients with ultrashort-segment Hirschsprung's disease.

OBJETIVO: Evaluar los resultados clínicos del tratamiento quirúrgico de pacientes con estreñimiento crónico incontrolable con tratamiento médico. MATERIAL Y METODOS: Estudio descriptivo de pacientes con estreñimiento crónico severo tratados mediante miectomía anorrectal posterior (técnica de Lynn). Se recogen los resultados de los últimos 15 años, con periodo de seguimiento postoperatorio mínimo de 1 año. Se incluyen pacientes con larga historia de estreñimiento, refractarios a tratamiento médico. Pruebas complementarias: enema opaco, manometría anorrectal y biopsias rectales. El resultado clínico de la técnica se clasifica según los siguientes criterios: Curación: >3 movimientos intestinales por semana, sin incontinencia/encopresis y sin necesidad de tratamiento médico; Mejoría: >3 movimientos intestinales por semana, sin incontinencia/encopresis y con necesidad de laxante. RESULTADOS: Se realizaron 19 miectomías (edad media de 8,47 años). Tiempo medio de estreñimiento previo de 7,89 años. Los hallazgos en la anatomía patológica fueron: presencia de células ganglionares en 10, ausencia de células ganglionares en 4 y otras alteraciones en 5. Manometría en 6 pacientes, 4 presentaron reflejo inhibitorio anal. Cuatro pacientes se diagnosticaron de enfermedad de Hirschsprung (uno se curó con la miectomía, dos precisaron cirugía correctora y uno no acudió a revisiones). En los 15 restantes, cumplieron criterios de curación 8 pacientes (53,3%), 4 mejoraron (26,6%), 1 sin mejoría sigue tratamiento fisioterápico. Dos pacientes no continuaron las revisiones. No se registró incontinencia fecal ni otras complicaciones. CONCLUSIONES: La miectomía de Lynn es un procedimiento eficaz y seguro para los pacientes con estreñimiento crónico severo refractario al tratamiento médico. También resulta el tratamiento definitivo en la enfermedad de Hirschsprung de segmento ultracorto.

Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia.

OBJECTIVES: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. MATERIAL AND METHODS: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). RESULTS: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients. CONCLUSIONS: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients.

Aislamiento y caracterización de las células madre mesenquimales de la pulpa dentaria humana / Isolation and characterization of stem cells mesenchymal of human dental pulp

Las células madre mesenquimales de la pulpa dentaria han surgido como una herramienta promisoria en la medicina regenerativa. El objetivo de la presente investigación es establecer el cultivo de las células madre mesenquimales de la pulpa dentaria humana. Estas fueron aisladas de terceros molares retenidos de pacientes entre 15 y 24 años, con técnica de disgregación enzimática y cultivadas en medio DMEM-F12, suplementado con 15% de SFB , 100 ?M L-ácido ascórbico 2-fosfato, 2 mM L-glutamina, 100 U/mL de penicilina, 100 µg/mL de estreptomicina y 2 µg/mL de anfotericina B . Las células fueron observadas diariamente bajo microscopio. Pruebas inmunohistoquímicas mostraron en las poblaciones de células aisladas la existencia de células mesenquimales STRO-1+, marcador de células madre mesenquimales, también expresaron CD146+ y no expresaron CD45-, marcador de células hematopoyéticas. Las células aisladas mostraron capacidad de autorrenovación y eficiencia de formación de colonias. En el presente estudio, en las poblaciones de células aisladas se identificaron células con características de células madre mesenquimales, como su capacidad de adherirse a las placas plásticas en cultivo, formar colonias altamente proliferativas, su morfología fusiforme y la expresión consistente de marcadores de superficie que caracteriza células madre mesenquimales adultas de pulpa dentaria. Sin embargo, faltaría determinar su capacidad de diferenciación para cumplir con los criterios básicos para definirlas como células madre

Mesenchymal stem cells dental pulp-derived have emerged as a promising tool in regenerative medicine. The objective of the present investigation is to establish the culture of mesenchymal stem cells of dental pulp human. The dental pulp mesenchymal cells were isolated from impacted third molars of patients between 15-24 year-old. The dental pulp tissue was extracted, enzymatic digestion technique and culture in medium DMEM-F12, supplemented with 15% de SFB , 100 ?M L-ascorbic acid 2- phosphate, 2 mM L-glutamine, 100 U/mL de penicillin, 100 µg/mL de streptomycin y 2 µg/mL de amphotericin B. Cells were observed daily under microscope. Immunocytochemistry tests showed cells STRO-1+ mesenchymal stem cell marker. These cells also expressed CD146+ and no expressed CD45- hematopoietic stem cell marker. The isolated cells showed self-renewal capabilities and colony-forming efficiency. In this study, isolated cell populations were identified cells with mesenchymal stem cell characteristics, such as its ability to adhere to plastic culture plates, highly proliferative colony forming, fusiform morphology and consistent expression of surface markers characterized adult mesenchymal stem cells from dental pulp. However, missing differentiating their ability to meet the basic criteria to define them as stem cells

Estimulación cerebral profunda en la enfermedad de Parkinson / Deep brain stimulation in Parkinson's disease

Introducción. Desde su aparición en la década de los noventa, la estimulación cerebral profunda se ha impuesto como una alternativa terapéutica segura y eficaz en la enfermedad de Parkinson, estando indicada cuando aparecen complicaciones motoras incontrolables con el tratamiento farmacológico. Objetivo. Realizar una revisión actualizada de la literatura médica sobre los aspectos más importantes de esta cirugía funcional. Desarrollo. Aunque su mecanismo de acción a día de hoy continúa siendo desconocido, se ha postulado que ejerce una acción inhibitoria sobre la actividad de los núcleos subtalámico y globo pálido interno, que se encuentra exaltada en enfermos parkinsonianos. La técnica quirúrgica de elección es la estimulación del núcleo subtalámico. Ha demostrado tener unos resultados favorables tanto desde el punto de vista motor, con una mejoría significativa de los síntomas cardinales de la enfermedad, como en la calidad de vida de estos pacientes. El éxito de la cirugía depende de tres pasos fundamentales: 1) La adecuada selección del candidato quirúrgico, teniendo en cuenta las recomendaciones de los principales grupos de estudio sobre factores pronóstico como son la edad, el tiempo de evolución y la presencia de síntomas resistentes a la levodopa. 2) La correcta posición del electrodo en la diana quirúrgica. 3) La programación del sistema de estimulación. Conclusión. La estimulación cerebral profunda del núcleo subtalámico es una opción terapéutica claramente establecida en la enfermedad de Parkinson avanzada, cuyo desarrollo en los últimos años, ha favorecido la obtención de unos resultados clínicos favorables cuando el tratamiento farmacológico fracasa (AU)

Introduction. Since its appearance in the nineties, deep brain stimulation has proved itself to be a safe, effective therapeutic alternative in Parkinson's disease, and is indicated when there are motor complications that pharmacological treatment fails to control. Aims. The purpose of this work is to conduct an updated review of the medical literature on the most important aspects of this functional surgery. Development. Although today its mechanism of action remains unknown, it has been suggested that it exerts an inhibitory action on the activity of the subthalamic nuclei and internal globus pallidus, which is found to be overexcited in patients with parkinsonism. The preferred surgical technique is subthalamic nucleus stimulation. This procedure has proved to yield favourable results both from the motor point of view, with a significant improvement in the cardinal symptoms of the disease, and as regards these patients’ quality of life. The success of the surgical procedure depends on three fundamental steps: 1) Selection of a suitable candidate for surgery, taking into account the recommendations of the main study groups on prognostic factors, such as age, time to progression and the presence of symptoms that are resistant to levodopa; 2) The correct position of the electrode on the surgical target; 3) The programming of the stimulation system. Conclusions. Deep brain stimulation of the subthalamic nucleus is a clearly established therapeutic option in advanced Parkinson's disease. Recent developments allow favourable clinical outcomes to be obtained when pharmacological treatment fails (AU)

Mesquite pod extract modifies the reproductive physiology and behavior of the female rat.

Phytoestrogens are non steroidal compounds that can bind to estrogen receptors, mimicking some effects of estradiol (E(2)). These compounds are widespread among legumes, which are used as pasture, and their importance in animal agriculture has increased. Mesquite (Prosopis sp) is a widespread legume, widely used to feed several livestock species in Mexico. The main product of mesquite is the pod, which is considered high quality food. As a legume, it could be assumed that mesquite contains some amounts of phytoestrogens which might induce potential estrogenic effects. However, to our knowledge, there are no reports regarding the possible estrogenic activity of this legume either in livestock or in animal models such as the rat. Therefore, in this study, we evaluated the potential estrogenic effects of mesquite pod extract on several aspects of behavior and reproductive physiology of the female rat. The effects of the extract were compared with those of E(2) and two isoflavones: daidzein (DAI) and genistein (GEN). The following treatments were given to groups of intact and ovariectomized (OVX) female rats: vehicle; mesquite pod extract; E(2); GEN; DAI. Compared to vehicle groups, mesquite pod extract, DAI, GEN, and E(2) increased uterine weight and induced growth in vaginal and uterine epithelia. In intact rats, mesquite pod extract, GEN and DAI altered estrous cyclicity, decreased lordotic quotient and intensity of lordosis. In OVX rats, mesquite pod extract, DAI and GEN induced vaginal estrus, increased vaginal epithelium height, and induced lordosis, although its intensity was reduced, compared with intact rats in estrus and E2-treated rats. These results suggest that mesquite pod extract could have estrogenic activity. However, the presence of phytoestrogens in this legume remains to be confirmed.

Isolation of a new strain of Picochlorum sp and characterization of its potential biotechnological applications.

Selection of new autochthon strains is necessary, and for the moment the best strategy, to find microalgae well adapted to the local climatological conditions able to simultaneously produce several compounds of biotechnological interest and grow at high rates. We describe the isolation and characterization of a new microalgal strain isolated from the marshlands of the Odiel River in the Southwest of Spain. The new microalga belongs to the genus Picochlorum, as deduced from the analysis of its 18S rRNA encoding gene, is able to grow at a high growth rate and thrive with adverse conditions. It has an appreciable constitutive level of lutein (3.5 mg g(-1) DW) and zeaxanthin (0.4 mg g(-1) DW) which is increased to 1.8 mg g(-1) DW at high light intensities. This strain is also characterized by a very low level of linolenic acid (3.8% of total fatty acids) and no polyunsaturated fatty acids with four or more double bonds. Although the total lipid content is not particularly high, 23% of the dry weight, its fatty acid profile makes of Picochlorum sp HM1 a promising candidate for biodiesel production, and the high content in the carotenoids lutein and zeaxanthin indicates that the microalga could also be a good source for natural eye vitamin supplements, which could be obtained as co-products.

Caspase 3 blocking avoids the expression of autoantigens triggered by apoptosis in neonatal Balb/c mice skin.

OBJECTIVE: To assess the effect of caspase 3 inhibition, in the expression of intracellular antigens induced by apoptosis. MATERIAL AND METHODS: Skin explants of neonatal Balb/c mice were used to assess the autoantigen expression. Skin was obtained by punch biopsies, tissues were cultured in DMEM; cell death was induced by chemicals and assessed by TUNEL. The expression of La, Ro, Sm, RNP, Cajal Bodies and NuMa antigens were monitored by immunohistochemistry using autoantibodies or monoclonal antibodies against these antigens. RESULTS: Chemicals used to induce cell death, successfully produced apoptosis or necrosis in more than 60% of keratinocytes, and viability was significantly decreased when it was compared with those in controls. An increased expression of all skin intracellular antigens in skin biopsies treated with chemicals, major antigenic expression was detected with anti-La and anti-Ro antibodies. The caspase 3 inhibitor DEVD-CMK significantly decreased the expression of antigens induced by chemicals. CONCLUSION: By this result we can infer that caspase inhibitors modify apoptosis and decrease the autoantigens associated to cell death.