Mesozooplankton assemblage in the gulf of cádiz estuaries: Taxonomic and trait-based approaches.

In this study, two different approaches based on taxonomic assemblages and on copepod functional groups were used to investigate the mesozooplankton assemblage structure and its relationship with environmental variables in the main estuaries of the Gulf of Cádiz (Guadalquivir, Guadiana and Tinto-Odiel) during the dry-warm season. In general, the mesozooplankton assemblages were dominated by copepods, especially the calanoid Acartia tonsa, which reached its highest abundance in the inner zones while the adjacent coastal zones were characterized by a mixture of copepods and cladocerans, especially Penilia avirostris. Regarding the trait-based approach, three copepod functional groups were identified, principally sorted by their feeding strategy. Group 1 (composed of omnivorous copepods displaying a mixed feeding strategy and broadcast-spawners) was found mainly in the inner areas, while Groups 2 (omnivorous cyclopoids, sac-spawners that feed via active ambush) and 3 (herbivores-omnivores employing a filter feeding strategy and mostly broadcast-spawners) were predominant in the adjacent coastal zones. The relative abundance of copepod functional groups suggested that Group 1 could be considered the most important contributor to secondary production in the estuarine systems of the Gulf of Cádiz. In relation to environmental factors, salinity was the most influential variable on mesozooplankton assemblages in both approaches. Our results suggest that the studied estuaries, although taxonomically different, have mesozooplankton assemblages that perform similar ecological functions. Both methods provide valuable and complementary information about mesozooplankton assemblage dynamics in the main estuaries of the Gulf of Cádiz.

First Mexican Consensus on Crohn's disease.

INTRODUCTION: Crohn's disease (CD) is a subtype of chronic and incurable inflammatory bowel disease. It can affect the entire gastrointestinal tract and its etiology is unknown. OBJECTIVE: The aim of this consensus was to establish the most relevant aspects related to definitions, diagnosis, follow-up, medical treatment, and surgical treatment of Crohn's disease in Mexico. MATERIAL AND METHODS: Mexican specialists in the areas of gastroenterology and inflammatory bowel disease were summoned. The consensus was divided into five modules, with 69 statements. Applying the Delphi panel method, the pre-meeting questions were sent to the participants, to be edited and weighted. At the face-to-face meeting, all the selected articles were shown, underlining their level of clinical evidence; all the statements were discussed, and a final vote was carried out, determining the percentage of agreement for each statement. RESULTS: The first Mexican consensus on Crohn's disease was produced, in which recommendations for definitions, classifications, diagnostic aspects, follow-up, medical treatment, and surgical treatment were established. CONCLUSIONS: Updated recommendations are provided that focus on definitions, classifications, diagnostic criteria, follow-up, and guidelines for conventional medical treatment, biologic therapy, and small molecule treatment, as well as surgical management.

Novel Measurement of the Neutron Magnetic Form Factor from A=3 Mirror Nuclei.

The electromagnetic form factors of the proton and neutron encode information on the spatial structure of their charge and magnetization distributions. While measurements of the proton are relatively straightforward, the lack of a free neutron target makes measurements of the neutron's electromagnetic structure more challenging and more sensitive to experimental or model-dependent uncertainties. Various experiments have attempted to extract the neutron form factors from scattering from the neutron in deuterium, with different techniques providing different, and sometimes large, systematic uncertainties. We present results from a novel measurement of the neutron magnetic form factor using quasielastic scattering from the mirror nuclei ^{3}H and ^{3}He, where the nuclear effects are larger than for deuterium but expected to largely cancel in the cross-section ratios. We extracted values of the neutron magnetic form factor for low-to-modest momentum transfer, 0.6

[Phenotypic and genotypic spectrum of KMT2B dystonia. Description of three Colombian patients]. / Espectro fenotípico y genotípico de la distonía causada por el gen KMT2B. Descripción de tres casos colombianos.

INTRODUCTION: KMT2B-related dystonia is a childhood-onset movement disorder characterized by focal dystonia of the lower extremities progressing to generalized dystonia with predominant cervical, cranial, and laryngeal involvement. So far, fewer than 100 variants have been reported, the vast majority being de novo mutations. The presenting frame of KMT2B dystonia, with dysmorphology features and other complex neurologic symptoms shows the spectrum of KMT2B dystonia as a probable syndromic disease, rather than an isolated early-onset dystonia, which has been the classic view of the condition. CASE REPORTS: We report three patients who presented regression in their neurodevelopment, focal dystonia of the lower limbs with subsequent generalization, in whom two de novo variants were reported in the KMT2B gene, with a mean age of presentation lower than the average reported worldwide. CONCLUSIONS: We describe the largest local series of patients with KMT2B dystonia in Colombia (to our knowledge), which allows us to expand the genotype-phenotype relationship of this genetic dystonia. Although many affected individuals follow a similar disease course, it is important to determine clinical features that may be associated such as neurodevelopmental regression.

TITLE: Espectro fenotípico y genotípico de la distonía causada por el gen KMT2B. Descripción de tres casos colombianos.Introducción. La distonía relacionada con KMT2B es un trastorno del movimiento hipercinético, de inicio en la infancia, caracterizado inicialmente por distonía focal de las extremidades inferiores que progresa a una distonía generalizada con mayor afectación cervical, craneal y laríngea. Hasta el momento se han descrito aproximadamente 100 variantes causantes de enfermedad, y la mayoría son de novo. La presentación clínica de la distonía con hallazgos fenotípicos comunes en los pacientes, asociada a frecuente afectación del neurodesarrollo, afectación intelectual y otros trastornos del movimiento, hace pensar más en el espectro KMT2B como una condición sindrómica, más que en una distonía aislada de inicio temprano, como clásicamente se ha clasificado. Casos clínicos. Se presenta el caso de tres pacientes con regresión del neurodesarrollo, distonía focal de los miembros inferiores con posterior generalización, en quienes se identificaron tres variantes en el gen KMT2B, en dos de los casos de novo (en una de ellas se desconoce la segregación), y dos de ellas comunicadas por primera vez en la bibliografía. La edad media de presentación fue menor a la edad promedio notificada a nivel mundial. Conclusiones. Describimos una serie de pacientes colombianos con distonía DYT-KMT2B (la más grande en nuestro conocimiento a nivel local), lo que nos permite ampliar la relación genotipo-fenotipo de esta distonía genética. Si bien múltiples individuos afectados siguen un curso de enfermedad similar, es importante determinar las características clínicas que pueden estar asociadas, como la regresión del neurodesarrollo y su potencial clasificación como distonía compleja. Describimos, además, dos nuevas variantes asociadas al fenotipo.

Multidimensional frailty connection in older patients with diabetes mellitus.

BACKGROUND AND OBJECTIVE: Patients with diabetes mellitus (DM) experience accelerated aging and, thus, a high prevalence of frailty. Our aim is to outline the type of frailty and prefrailty from a multidimensional perspective and the interaction of these dimensions in this scenery. MATERIAL AND METHODS: Observational study of patients with DM over 60 years-old. Variables related to nutrition, cognitive and emotional status, physical and instrumental functional capacity and social resources were collected. They were divided into three groups (robust, prefrail and frail) according to the Fried scale. Each of the variables in the groups were compared and a correspondence analysis was carried out to see the influence of some dimensions with others in each stage of frailty. RESULTS: 188 patients (mean age 72.6 + 7.5) were analysed. Of them, 105 patients had prefrailty and 66 were frail. With the exception of social resources, the rest of the variables had an increasing prevalence depending on the stage of frailty. However, in the correspondence analysis (with 22.9% of variation explained by two dimensions) it was only patients with frailty who were associated with worse functional capacity, cognitive and emotional situation and mild to moderate social incapacity. CONCLUSIONS: In our sample there was a high prevalence of prefrailty, and frailty associated with an increase in the prevalence of other different dimensions except social resources. However, the interaction between these dimensions was only evident in the case of patients with frailty.

Integrated photon pair source based on a silicon nitride micro-ring resonator for quantum memories.

We report the design of an integrated photon pair source based on spontaneous four-wave mixing (SFWM), implemented in an integrated micro-ring resonator in the silicon nitride platform (Si3N4). The signal photon is generated with emission at 606 nm and bandwidth of 3.98 MHz, matching the spectral properties of praseodymium ions (Pr), while the idler photon is generated at 1430.5 nm matching the wavelength of a CWDM channel in the E-band. This novel, to the best of our knowledge, device is designed to interact with a quantum memory based on a Y2SiO5 crystal doped with Pr3+ ions, in which we used cavity-enhanced SFWM along with dispersion engineering to reach the required wavelength and the few megahertz signal photon spectral bandwidth.

Integration of CTCF Loops, Methylome, and Transcriptome in Differentiating LUHMES as a Model for Imprinting Dynamics of the 15q11-q13 Locus in Human Neurons.

Human cell line models, including the neuronal precursor line LUHMES, are important for investigating developmental transcriptional dynamics within imprinted regions, particularly the 15q11-q13 Angelman (AS) and Prader-Willi (PWS) syndrome locus. AS results from loss of maternal UBE3A in neurons, where the paternal allele is silenced by a convergent antisense transcript UBE3A-ATS, a lncRNA that normally terminates at PWAR1 in non-neurons. qRTPCR analysis confirmed the exclusive and progressive increase in UBE3A-ATS in differentiating LUHMES neurons, validating their use for studying UBE3A silencing. Genome-wide transcriptome analyses revealed changes to 11,834 genes during neuronal differentiation, including the upregulation of most genes within the 15q11-q13 locus. To identify dynamic changes in chromatin loops linked to transcriptional activity, we performed a HiChIP validated by 4C, which identified two neuron-specific CTCF loops between MAGEL2-SNRPN and PWAR1-UBE3A. To determine if allele-specific differentially methylated regions (DMR) may be associated with CTCF loop anchors, whole genome long-read nanopore sequencing was performed. We identified a paternally hypomethylated DMR near the SNRPN upstream loop anchor exclusive to neurons and a paternally hypermethylated DMR near the PWAR1 CTCF anchor exclusive to undifferentiated cells, consistent with increases in neuronal transcription. Additionally, DMRs near CTCF loop anchors were observed in both cell types, indicative of allele-specific differences in chromatin loops regulating imprinted transcription. These results provide an integrated view of the 15q11-q13 epigenetic landscape during LUHMES neuronal differentiation, underscoring the complex interplay of transcription, chromatin looping, and DNA methylation. They also provide insights for future therapeutic approaches for AS and PWS.

Recommendations of the Spanish-Portuguese Internal Medicine services in the fight against climate change and environmental degradation.

Facing the severity of the impact of climate change and environmental degradation on human health, 32 Internal Medicine societies, colleges, and associations of 29 Spanish and Portuguese-speaking countries issue a consensus document in which they call for the implication of doctors and all health professionals in the global fight against the causes of these changes. This commitment requires the cooperation of health-related organizations, elaboration and implementation of good environmental sustainability practices, greater awareness of professionals and population, promotion of education and research in this area, increasing climate resilience and environmental sustainability of health systems, combating inequalities and protecting the most vulnerable populations, adopting behaviors that protect the environment, and claiming Internal Medicine as a core specialty for empowerment of the health system to respond to these challenges.

Effect of the anode material, applied current and reactor configuration on the atenolol toxicity during an electrooxidation process.

Atenolol (ATL) is a beta-blocker pharmaceutical product which is excreted mainly unchanged and may represent a long-term risk for organisms present in the sea and in fresh water. Due to its low biodegradation rate, electrochemical advanced oxidation processes (EAOPs) can be used to remove this compound. In this work, ATL ecotoxicity was analyzed in the presence of sodium sulfate (Na2SO4), which is widely used as supporting electrolyte in EAOPs. Ecotoxicity values were expressed as the pollutant concentration that leads to a 50% inhibition of the root elongation of Lactuca sativa seeds in relation to the control (EC50(5 days)). The obtained values for ATL showed an EC50(5 days) of 1377 mg L-1 towards Lactuca sativa. When Na2SO4 was added, the toxicity of the sample increased but no synergy was detected between both compounds. With 2 g L-1 Na2SO4, ATL showed an EC50(5 days) of 972 mg L-1; and with 4 g L-1 Na2SO4 and higher concentrations, EC50 value for ATL was 0 mg L-1. Statistical tools were used to obtain the zones of the [ATL]-[Na2SO4] plane which are toxic towards Lactuca sativa. Solutions containing ATL and Na2SO4 were treated by electrooxidation. Two anode materials (a boron-doped diamond electrode and a microporous Sb-doped SnO2 ceramic one); three operation currents (0.4, 0.6 and 1 A); and two reactor configurations (one-compartment reactor and two-compartment reactor separated by a cation exchange membrane) were used. Lactuca sativa seeds and Vibrio fischeri bacterium tests were employed to evaluate the toxicity of the solutions before and after applying the electrooxidation process. In all the tests, the ecotoxicity of the treated sample increased. This fact is owing to the persulfate presence in the solution due to the sulfate electrochemical oxidation. Nevertheless, none of the final samples were toxic towards Vibrio fischeri because ecotoxicity values were lower than 10 TU; and, in the case of the one-compartment reactor, practically all of them were also non-toxic towards Lactuca sativa. The toxicity of the treated samples increased when using the two-compartment reactor in the presence of the BDD anode, and when the operation current was increased. This is attributed to the highest formation of persulfates. Amongst all the tests performed in this work, the lowest toxicity value (i.e., 3 TU) together with the complete mineralization and degradation degrees was achieved with the two-compartment reactor using the BDD anode and operating at 0.6 A.

[Interlevel incident management: The experience of a primary care district]. / Gestión de incidencias interniveles. La experiencia de un distrito de atención primaria.

AIM: Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC). DESIGN: Multicenter cross-sectional descriptive study. SITE: Primary care. PARTICIPANTS: Professionals from a Health District and its reference hospitals. INTERVENTIONS: ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician. MAIN MEASUREMENTS: ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ. RESULTS: We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%). CONCLUSIONS: 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.

Clinical and Sociodemographic Features of Alopecia Areata in Five Colombian Cities: An Analysis of the RENAAC Registry.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by non-scaring hair loss and preservation of hair follicles. The information available on disease course, and clinical features of AA is scarce worldwide, and almost nonexistent in Colombia. OBJECTIVE: To determine the clinical and sociodemographic characteristics of patients diagnosed with AA who presented to a dermatology consultation in five Colombian cities. MATERIAL AND METHODS: This was a retrospective and multicenter study on data from an ongoing National Registry of Alopecia Areata in Colombia (RENAAC) collected in Bogota, Cali, Cartagena, Barranquilla, and Medellin, Colombia from March 2022 through April 2023. Data was recorded in a standardized form by trained physicians. The variables were expressed as measures of central tendency and dispersion, and absolute and relative frequencies. RESULTS: A total of 562 patients were included, 59.4% of whom were women, aged between 15 and 49 years (63.9%) with a mean disease course of 1.7 years. The most common finding was multiple plaque (53.2%), the predominant AA subtype was patchy (71.4%), and 29.5% of the patients had a past dermatological history, 18.3% had a past endocrinological history, and 8.9% had a past psychiatric history. The treatments most widely used were steroid injections (76.4%), 5% topical minoxidil (46.4%), followed by high-potency corticosteroids (42.5%). STUDY LIMITATIONS AND CONCLUSIONS: AA was slightly predominant in women. As seen in other populations, this disease had an earlier onset in men vs women. Presentation in pediatric age was uncommon. The previous history of other dermatological diseases was checked in almost one third of the patients. Analysis of the co-presentation of AA with other autoimmune diseases is biased due to excluding patients with systemic erythematous lupus from the study.

Meningoencephalitis caused by Non-O1, non-O139 Vibrio cholerae in an infant from southern Spain.

Non-O1, non-O139 Vibrio cholerae (NOVC) is an emergent pathogen that mainly causes gastroenteritis. Also, it causes ear, wound infections, and bacteremia but the nervous system is rarely affected. We report on a case of NOVC meningoencephalitis in an infant that recovered after antimicrobial therapy but later presented neurologic sequelae.

Treatment of thyroglossal cyst using Koempel's technique: initial experience. / Tratamiento del quiste tirogloso mediante técnica de Koempel. Experiencia inicial.

INTRODUCTION: In spite of being inaccurate in terms of suprahyoid dissection, Sistrunk's procedure is the gold-standard technique in the treatment of thyroglossal cyst. Since it was first described in 2014, the modifications introduced by Koempel have allowed for a more reproducible suprahyoid approach. We present our initial experience with this technique. METHODS: A retrospective study of patients with thyroglossal cyst undergoing Koempel's technique in our institution from 2021 to 2022 was carried out. Demographic, clinical, and histological data was collected. RESULTS: In the study period, 5 patients -3 girls and 2 boys- underwent surgery. Median age and weight were 5 years (2-6) and 16 kg (14-25), respectively. All patients had suffered from previous infections, with 60% having cutaneous fistulization. In 2 patients, surgery was indicated following Sistrunk's procedure as a result of recurrence. Median operating time was 77 minutes (57-110), with the genioglossal muscle plane being identified in the 5 patients. No immediate complications were recorded, and diagnosis of thyroglossal cyst was histologically confirmed in all cases. One of the formerly recurrent patients had recurrence following surgery, but it was subclinical and incidentally diagnosed at control ultrasonography. The remaining patients had no recurrences after a median 8-month (1-12) follow-up period. CONCLUSIONS: Koempel's technique allows for a safe and reproducible approach of the suprahyoid segment. It is an attractive option in complicated cases as a result of previous infection or recurrence.

INTRODUCCION: La intervención de Sistrunk es el gold-standard en el tratamiento del quiste tirogloso pese a su imprecisión en cuanto a la disección suprahioidea. Tras su descripción en 2014, las modificaciones introducidas por Koempel, han permitido un abordaje suprahioideo más reproducible. Presentamos nuestra experiencia inicial con esta técnica. METODOS: Estudio retrospectivo de los pacientes con quiste tirogloso intervenidos mediante técnica de Koempel en nuestro centro en el periodo 2021-2022, recogiéndose datos demográficos, clínicos e histológicos. RESULTADOS: Durante el periodo de estudio se intervinieron 5 pacientes (3 mujeres/2 varones), con una mediana de edad y peso de 5 años (2-6) y 16 kg (14-25) respectivamente. Todos los casos habían sufrido infecciones previas presentando fistulización cutánea el 60%. En 2 de los pacientes se indicó la cirugía por recidiva tras intervención de Sistrunk. La mediana del tiempo quirúrgico fue de 77minutos (57-110) identificándose el plano del músculo geniogloso en los 5 pacientes. No hubo complicaciones inmediatas y el diagnóstico de quiste tirogloso se confirmó histológicamente en todos los casos. Uno de los pacientes del grupo con recidiva previa, presentó recidiva tras la intervención, siendo esta subclínica y diagnosticada incidentalmente tras ecografía de control. El resto de los pacientes no presentó ninguna recurrencia tras un seguimiento mediana de 8 meses (1-12). CONCLUSIONES: La técnica de Koempel permite un abordaje seguro y reproducible del segmento suprahioideo siendo una opción atractiva en casos complicados por infección o recidiva previa.

Development of robust chiroptical systems through spirobifluorenes.

Chiroptical responses are valuable for the structural determination of dissymmetric molecules. However, the development of everyday applications based on chiroptical systems is yet to come. We have been earlier using axially chiral allenes for the construction of linear, cyclic, and cage-shaped molecules that present remarkable chiroptical responses. Additionally, we have developed chiral surfaces through upstanding chiral architectures. Since the goal is to obtain robust chiroptical materials, more recently we have been studying spirobifluorenes (SBFs), a well-established building block in optoelectronic applications. After theoretical and experimental demonstration, the suitability of chiral SBFs for the development of robust chiroptical systems was certified by the construction all-carbon double helices, flexible shape-persistent macrocycles, chiral frameworks for surface functionalization, and structures featuring helical or spiroconjugated molecular orbitals. Here, we give an overview of our contribution to these matters.

Shaping the spectral correlation of bi-photon quantum frequency combs by multi-frequency excitation of an SOI integrated nonlinear resonator.

We reveal the generation of a broadband (> 1.9 THz) bi-photon quantum frequency comb (QFC) in a silicon-on-insulator (SOI) Fabry-Pérot micro-cavity and the control of its spectral correlation properties. Correlated photon pairs are generated through three spontaneous four-wave mixing (SFWM) processes by using a co-polarized bi-chromatic coherent input with power P1 and P2 on adjacent resonances of the nonlinear cavity. Adjusting the spectral power ratio r = P1/(P1 + P2) allows control over the influence of each process leading to an enhancement of the overall photon pair generation rate (PGR) µ(r) by a maximal factor of µ(r = 0.5)/µ(r = 0) ≈ 1.5, compared to the overall PGR provided by a single-pump configuration with the same power budget. We demonstrate that the efficiency aND of the non-degenerate excitation SFWM process (NDP) doubles the efficiency a1 ≈ a2 of the degenerate excitation SFWM processes (DP), showing a good agreement with the provided model.

A Canadian center's experience on whole-gland salvage therapy for radio-recurrent prostate cancer with various modalities.

Salvage radical prostatectomy for localized radio-recurrent prostate cancer has historically been associated with significant morbidity. Prospectively collected data long-term data on salvage whole-gland cryoablation and, to a lesser extent, high-intensity focused ultrasound (HIFU), have shown they are viable treatment alternatives. This article chronicles the experience (cryoablation, n=187; HIFU, n=81) in a high-volume Canadian center and reviews the literature on other salvage ablative therapies. Whole-gland salvage ablation has yielded oncologic results comparable to those of salvage prostatectomy, with cancer-specific survival and metastatic-free survival of approximately 80%, and biochemical disease-free survival of 35%. Freedom from androgen deprivation therapy was 49% at 12 years. Improved ablative technologies and functional diagnostic imaging modalities have rendered focal salvage ablation feasible in selected patients. Preliminary oncologic and functional results of focal salvage ablation using several new ablative technologies are also reviewed in this article.

Muscle of dark and normal beef differs metabolically.

Reduction in muscle glycogen triggered by adverse antemortem handling events alters postmortem energy metabolism and results in a high ultimate pH and dark, firm and dry beef, often referred to as 'dark-cutting'. However, the relationship between atypical dark (AT) beef, postmortem energy metabolism and underlying tissue characteristics remains somewhat unclear. Cattle harvested in the US and Canada representing normal (pH < 5.6), AT dark (pH 5.6-5.8) and dark cutting (DC; pH > 5.8) beef were analyzed for tissue characteristics related to energy metabolism. Results show AT dark beef is more oxidative but similar to normal beef in glycolytic potential and nucleotide abundance. Mitochondria DNA content (P < 0.05, Canada; P < 0.005, US) and oxidative enzymes for DC and AT dark beef were greater (P < 0.01; Canada and US) compared to normal beef. Myoglobin tracked (P < 0.01) with color classification. These findings show both DC and AT beef are inherently more oxidative and raise the possibility that more oxidative muscle may be more prone to develop dark beef.

Clinically isolated syndrome: Diagnosis and risk of developing clinically definite multiple sclerosis.

INTRODUCTION: In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis. DEVELOPMENT: We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3-like protein 1 (CHI3L1) in the CSF and serum. CONCLUSIONS: Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40%-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.

Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in Pediatrics. / Colecistectomía laparoscópica urgente por colecistitis aguda litiásica en Pediatría.

INTRODUCTION: In spite of the increase in the prevalence of cholelithiasis in the last decades, no recommendations regarding the best treatment of acute calculous cholecystitis (AC) in Pediatrics have been developed. CLINICAL CASE: 4-year-old, 20kg male patient with no significant history referred to our institution as a result of abdominal sepsis. The blood count showed leukocytosis, with normal hemoglobin and bilirubin levels, and a normal liver function. The abdominal ultrasonography revealed cholelithiasis, gallbladder hydrops, and an inflammatory process compatible with appendicular plastron. In the diagnostic laparoscopy, the appendix was macroscopically normal, and acute cholecystitis was observed. Given the patient's situation, and in cooperation with the General Surgery Department, laparoscopic cholecystectomy was carried out. The patient recovered uneventfully on hospitalization day 5 under piperacillin-tazobactam treatment. DISCUSSION: There are no recommendations regarding AC treatment in children. In septic patients, cooperation between general and pediatric surgeons allows urgent cholecystectomy to be considered as a safe option.

INTRODUCCION: Pese al aumento en la prevalencia de colelitiasis durante las últimas décadas, no se han desarrollado recomendaciones sobre el mejor tratamiento de la colecistitis aguda litiásica (CA) en Pediatría. CASO CLINICO: Paciente varón de 4 años y 20 kg de peso sin antecedentes de interés, que acude derivado por sepsis de origen abdominal. Analíticamente destaca leucocitosis con hemoglobina, función hepática y bilirrubina normales. La ecografía abdominal muestra colelitiasis, hidrops vesicular y proceso inflamatorio compatible con plastrón apendicular. En laparoscopia diagnóstica se observa apéndice macroscópicamente normal y colecistitis aguda. Ante la situación del paciente se realiza, conjuntamente con Cirugía General, colecistectomía laparoscópica. El paciente se recupera sin incidencias tras 5 días de ingreso bajo cobertura con piperacilina-tazobactam. COMENTARIOS: No existen recomendaciones sobre el tratamiento de la CA en niños. En los pacientes sépticos, la colaboración entre cirujanos pediátricos y cirujanos generales permite contemplar la colecistectomía urgente como una opción segura.