Effect of polystyrene nanoplastics on the activated sludge process performance and biomass characteristics. A laboratory study with a sequencing batch reactor.

The fate and presence of nanoplastics in wastewater treatment systems is a topic of increasing interest. Furthermore, challenges related to their quantification and identification have made it difficult to set up experimental conditions and compare results between studies. In this study, the effect of 100 nm polystyrene nanoplastics on activated sludge was evaluated. A concentration of 2 µg/L was used to continuously feed a sequencing batch reactor (SBR-NPs). Under the experimental conditions used in this study, no changes were observed in the process performance of the SBR-NPs compared to the reactor used as a control. Neither nitrification nor organic matter removal efficiency, which was 96% for both SBRs, were affected by the presence of 100 nm polystyrene nanoplastics, which suggests that the tested nanoplastics were not sufficiently toxic to the biomass. Although no significant differences in the relative abundances of predominant phyla between SBR-Control and SBR-NPs were observed, a slight shift in the relative abundance of Patescibacteria (1.5 ± 0.6% and 3.7 ± 0.8% in SBR-Control and SBR-NPs, respectively, at the end of the test) occurred. The higher abundance of this phylum in SBR-NPs compared to SBR-Control may suggest that these bacteria have some sensitivity to the presence of 100 nm polystyrene nanoplastics. Furthermore, even with the absence of nitrification inhibition, it was observed stagnation of the growth of Nitrotoga bacteria in SBR-NPs, which also suggests that the polystyrene nanoplastics could have an inhibitory effect on these cells and an impact on nitrification in the long term.

Methodology for removing microplastics and other anthropogenic microparticles from sludge dewatering system.

Anthropogenic microparticles (e.g., microplastics) are present in sewage plants, especially in sludge streams. However, the lack of standardized protocols to scrutinize the presence of anthropogenic microparticles in sludge makes the comparison between studies unfeasible. To tackle the knowledge gap regarding the efficiency of methodologies on the extraction of anthropogenic microparticles from the complex organic matrix, dewatered sludge, and digested sludge was treated with peroxidation and density separation, and the recovery of microparticles from these samples was investigated. The results showed that with the use of a higher density solution (NaI, 1.5 g/cm3) a much better recovery of anthropogenic microparticles from sludge samples (approximately 1000 microparticles/g-dw and 2000 microparticles/g-dw, from dewatered and digested sludge, respectively) was achieved in comparison with the use of a lower density solution (NaCl, 1.2 g/cm3) (200 microparticles/g-dw and 600 microparticles/g-dw from dewatered and digested sludge, respectively). Moreover, although the use of peroxidation is an essential step to break down the sludge structure and to release microparticles to the liquid phase, the use of peroxidation after or before density separation did not affect the overall recovery of microparticles. Polyethylene, polypropylene, and copolymer ethylene-ethyl-acrylate were the main microplastic fragments identified in digested sludge and dewatered sludge. However, no relation was observed between the method applied and the polymer recovered. Regarding the presence of anthropogenic microparticle in centrifuge effluent, 450 ± 212 microparticles/L were counted, and although little is known about this stream, in can be a relevant source of anthropogenic microparticles.

Series of Fourteen Cases of Topical Imiquimod 5% in Lentigo Maligna: Treatment Modalities and Clues for Detecting Recurrences.

Topical imiquimod has been used off-label as monotherapy or adjuvant treatment for lentigo maligna. Our aim is to describe treatment modalities, clinical outcomes, and management of recurrence in patients receiving imiquimod for lentigo maligna. Patients from our unit with lentigo maligna or lentigo maligna melanoma treated with imiquimod 5% as monotherapy or in combination with surgery were included in this study. Fourteen cases were recruited (85.7% lentigo maligna and 14.3% lentigo maligna melanoma). Eight patients (57.1%) received imiquimod without surgery, and six (42.9%) underwent narrow excision before beginning treatment. During the follow-up period, pigmentation reappeared in 6 patients (4 postinflammatory hyperpigmentation and 2 relapses). Relapses were managed with very narrow excision (1mm margin) and retreatment with imiquimod 5%. All imiquimod modalities showed well-tolerated side effects and low recurrence rates, with long periods of follow-up. Imiquimod appears to be a versatile option for treating LM in suitable candidates.

Series of Fourteen Cases of Topical Imiquimod 5% in Lentigo Maligna: Treatment Modalities and Clues for Detecting Recurrences. / [Artículo traducido] Serie de 14 casos de tratamiento con imiquimod tópico al 5% en lentigo maligno: modalidades terapéuticas y claves para detectar recidivas.

Topical imiquimod has been used off-label as monotherapy or adjuvant treatment for lentigo maligna. Our aim is to describe treatment modalities, clinical outcomes, and management of recurrence in patients receiving imiquimod for lentigo maligna. Patients from our unit with lentigo maligna or lentigo maligna melanoma treated with imiquimod 5% as monotherapy or in combination with surgery were included in this study. Fourteen cases were recruited (85.7% lentigo maligna and 14.3% lentigo maligna melanoma). Eight patients (57.1%) received imiquimod without surgery, and six (42.9%) underwent narrow excision before beginning treatment. During the follow-up period, pigmentation reappeared in 6 patients (4 postinflammatory hyperpigmentation and 2 relapses). Relapses were managed with very narrow excision (1 mm margin) and retreatment with imiquimod 5%. All imiquimod modalities showed well-tolerated side effects and low recurrence rates, with long periods of follow-up. Imiquimod appears to be a versatile option for treating LM in suitable candidates.

Multimorbidity as a predictor of health service utilization in primary care: a registry-based study of the Catalan population.

BACKGROUND: Multimorbidity is highly relevant for both service commissioning and clinical decision-making. Optimization of variables assessing multimorbidity in order to enhance chronic care management is an unmet need. To this end, we have explored the contribution of multimorbidity to predict use of healthcare resources at community level by comparing the predictive power of four different multimorbidity measures. METHODS: A population health study including all citizens ≥18 years (n = 6,102,595) living in Catalonia (ES) on 31 December 2014 was done using registry data. Primary care service utilization during 2015 was evaluated through four outcome variables: A) Frequent attendants, B) Home care users, C) Social worker users, and, D) Polypharmacy. Prediction of the four outcome variables (A to D) was carried out with and without multimorbidity assessment. We compared the contributions to model fitting of the following multimorbidity measures: i) Charlson index; ii) Number of chronic diseases; iii) Clinical Risk Groups (CRG); and iv) Adjusted Morbidity Groups (GMA). RESULTS: The discrimination of the models (AUC) increased by including multimorbidity as covariate into the models, namely: A) Frequent attendants (0.771 vs 0.853), B) Home care users (0.862 vs 0.890), C) Social worker users (0.809 vs 0.872), and, D) Polypharmacy (0.835 vs 0.912). GMA showed the highest predictive power for all outcomes except for polypharmacy where it was slightly below than CRG. CONCLUSIONS: We confirmed that multimorbidity assessment enhanced prediction of use of healthcare resources at community level. The Catalan population-based risk assessment tool based on GMA presented the best combination of predictive power and applicability.

Wastewater treatment plant as microplastics release source - Quantification and identification techniques.

The high presence of microplastics (MPs) in different sizes, materials and concentrations in the aquatic environment is a global concern due to their potential physically and chemically harm to aquatic organisms including mammals. Furthermore, the bioaccumulation of these compounds is leading to their ingestion by humans through the consumption of sea food and even through the terrestrial food chain. Even though conventional wastewater treatment plants are capable of eliminating more than 90% of the influent MPs, these systems are still the main source of MPs introduction in the environment due to the high volumes of effluents generated and returned to the environment. The amount of MPs dumped by WWTP is influenced by the configuration of the WWTP, population served and influent flow. Thus, the average of MP/L disposed vary widely depending on the region. In addition to MPs disposed in water bodies, more than 80% of these emerging contaminants, which enter the WWTP, are retained in biosolids that can be applied as fertilizers, representing a potential source of soil contamination. Due to the continuous disposal of MPs in the environment by effluent treatment systems and their polluting potential, separation and identification techniques have been assessed by several researchers, but unfortunately, there are no standard protocols for them. Aiming to provide insight about the relevance of studying the WWTP as source of MPs, this review summarizes the currently methodologies used to classify and identify them.

Evaluation of endovenous sedation using BIS monitoring in dentistry. A systematic review.

BACKGROUND: The aim of the present review was evaluate the utility and validity of the Bispectral Index (BIS) in dental treatment carried out under endovenous sedation, and compare its efficacy with clinical sedation scales. MATERIAL AND METHODS: Electronic and manual literature searches were conducted by two independent reviewers for articles published up to April 2017 in several databases, including Medline and Cochrane Library. RESULTS: Sixteen articles met the inclusion criteria. A correlation was identified between BIS and clinical sedation scales. A BIS range between 75 and 84 showed a high probability of corresponding to an Observer's Assessment of Alertness and Sedation Scale (OAA/S) value of 3; a scored 3 on the Ramsay scale corresponds around 85 on the BIS; while BIS values between 57 and 64 corresponded to a University of Michigan Sedation Scale value of 3. BIS monitoring provides continuous measurement of the patient's hypnotic state or state of consciousness, awareness, and recall. It proved impossible to perform an analysis of statistical data drawn from the studies reviewed due to the disparity of inclusion criteria among the works. CONCLUSIONS: BIS for sedation monitoring might make possible to evaluate sedation levels objectively in real time, reducing the dose of the sedative required, increasing safety, and minimizing secondary effects.

Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial.

BACKGROUND: Prehabilitation may reduce postoperative complications, but sustainability of its health benefits and impact on costs needs further evaluation. Our aim was to assess the midterm clinical impact and costs from a hospital perspective of an endurance-exercise-training-based prehabilitation programme in high-risk patients undergoing major digestive surgery. METHODS: A cost-consequence analysis was performed using secondary data from a randomised, blinded clinical trial. The main outcomes assessed were (i) 30-day hospital readmissions, (ii) endurance time (ET) during an exercise testing, and (iii) physical activity by the Yale Physical Activity Survey (YPAS). Healthcare use for the cost analysis included costs of the prehabilitation programme, hospitalisation, and 30-day emergency room visits and hospital readmissions. RESULTS: We included 125 patients in an intention-to-treat analysis. Prehabilitation showed a protective effect for 30-day hospital readmissions (relative risk: 6.4; 95% confidence interval [CI]: 1.4-30.0). Prehabilitation-induced enhancement of ET and YPAS remained statistically significant between groups at the end of the 3 and 6 month follow-up periods, respectively (ΔET 205 [151] s; P=0.048) (ΔYPAS 7 [2]; P=0.016). The mean cost of the programme was €389 per patient and did not increment the total costs of the surgical process (€812; CI: 95% -878 - 2642; P=0.365). CONCLUSIONS: Prehabilitation may result in health value generation. Moreover, it appears to be a protective intervention for 30-day hospital readmissions, and its effects on aerobic capacity and physical activity may show sustainability at midterm. CLINICAL TRIAL REGISTRATION: NCT02024776.

Effects of the neuromuscular bandage as rehabilitative treatment of patients with drooling and intellectual disability: an interventional study.

BACKGROUND: The aim of this work was to assess the effect of neurological bandages (Kinesio Taping) for managing saliva flow in patients with drooling and intellectual disability. METHODS: Quasi-experimental study included 30 patients (20 male and 10 female participants) mean age of 15 years with intellectual disability and drooling [Public Special Education Centre in Cartagena (Murcia, Spain)]. Treatment consisted of the application of a strip of neuromuscular bandage applied in the suprahyoid area for a 3-month period. Efficacy was assessed by means of three clinical scales: the Sialorrhea clinical scale, the drooling rating scale and the drooling impact scale. These evaluations were performed at baseline, after 1 and 3 months of intervention. RESULTS: Clinical improvements were obtained, showing statistically significant reductions in drooling after 1 month (P < 0.001) and 3 months (P < 0.001). CONCLUSIONS: The application of neuromuscular bandages in the suprahyoid muscle area can be a useful option for managing drooling in patients with intellectual disability.

The role of the operating parameters of SBR systems on the SMP production and on membrane fouling reduction.

In this work, six identical laboratory SBRs treating simulated wastewater were operated in parallel studying the effect of three food-to-microorganisms ratio (F/M ratio; 0.20, 0.35 and 0.50 kg COD·kg MLSS-1·d-1), two hydraulic retention times (HRT; 24 and 16 h) and two values of number of cycles per day (3 and 6). Influence of these operational parameters on the SMPs production and reactor performance, were studied. Results indicated that the highest F/M ratio, HRT and cycles/day produced 72.7% more of SMP. In a second experimental series, biological process yielding the maximal and the minimal SMPs production were replicated and both mixed liquors (ML) and treated effluents were ultrafiltrated. The flux decay in the conditions of minimum and maximum SMPs production were 52% and 72%, when the SBRs effluents were ultrafiltrated while no significant differences in the ultrafiltration of ML were found. In terms of permeability recovery, this was lower for the case of the ML (73% and 49% of initial permeability recovered for effluent and ML ultrafiltration, respectively).

Altrenogest treatment before weaning improves litter size in sows.

The study aimed to assess whether altrenogest treatment, fed before weaning (from -8 to -2 days), could improve fertility of sows showing reproductive seasonality. Ninety sows (50 in winter-spring [WS] and 40 in summer-autumn [SA]) were randomly selected and assigned to control (C; 27 in WS and 20 in SA) or altrenogest treatment (A; 23 in WS and 20 in SA) groups. The diameter and number of ovarian follicles were transrectally scanned at the onset of oestrus. Oestrus was evaluated twice daily from weaning to day 8 post-weaning. Sows in oestrus were post-cervically inseminated at 0 and 24 hr after the onset of oestrus with liquid stored semen (1.5 × 109 sperm/doses), and farrowing rates (FR) and total piglets born (LS) were recorded. More (p < .01) sows showed no signs of oestrus within 8 days after weaning in SA (30%) than in WS (2%), without differences between A and C groups. The diameter (cm) of the follicles at the onset of oestrus was larger in A than in C sows (0.76 ± 0.01 vs 0.73 ± 0.01; p < .01), irrespective of the season. No differences in the number of follicles were found. FR did not differ between seasons and groups, being always above 85%. LS was larger (p < .01) in A (14.00 ± 0.46) than C (12.27 ± 0.44) sows, irrespective of the season. In conclusion, a short-term altrenogest treatment at the end of lactation improves the total number of piglets born from weaned sows, probably by promoting a better and more homogeneous follicular development at the start of oestrus.

Effects of meiotic inhibitors and gonadotrophins on porcine oocytes in vitro maturation, fertilization and development.

This study evaluated the effect of three reversible meiotic inhibitors (MINs) and their interaction with gonadotrophins (Gns) on the meiotic maturation and developmental competence of porcine oocytes. In experiment 1, the oocytes were matured for 22 hr in the presence or absence of dbcAMP (1 mM), cycloheximide (7 µM) or cilostamide (20 µM) with or without Gns, and for an additional 22 hr in the absence of MINs and Gns. At 22 hr of maturation, regardless of the presence of Gns, a higher proportion (p < .001) of oocytes cultured in the presence of MINs were effectively arrested at the germinal vesicle stage compared with the oocytes cultured without MINs. At 44 hr of maturation, the proportion of oocytes that reached MII was higher (p < .05) in groups with Gns compared with groups without Gns. In experiment 2, oocytes that were matured as in experiment 1 were inseminated and cultured for 7 days to evaluate fertilization parameters and blastocyst formation. Only oocytes from the dbcAMP + Gns group had higher (p < .05) efficiency of fertilization compared with the other treatment groups. The presence of dbcAMP during maturation also increased (p < .05) blastocyst formation and efficiency of blastocyst formation in both the presence and absence of Gns. These results indicate that the interaction of Gns with the tested MINs improved meiotic progression. In addition, regardless of supplementation with Gns, the presence of dbcAMP during the first maturation period increased and even doubled the capacity of oocytes to develop to the blastocyst stage.

Changes in the process performance, sludge production and microbial activity in an activated sludge reactor with addition of a metabolic uncoupler under different operating conditions.

Sludge production in wastewater treatment plants is nowadays a big concern due to the high produced amounts and their characteristics. Consequently, the study of techniques that reduce the sludge generation in wastewater treatment plants is becoming of great importance. In this work, four laboratory sequencing batch reactors (SBRs), which treated municipal wastewater, were operated to study the effect of adding the metabolic uncoupler 3,3',4',5-tetrachlorosalicylanilide (TCS) on the sludge reduction, the SBRs performance and the microbial hydrolytic enzymatic activities (MHEA). In addition, different operating conditions of the SBRs were tested to study the effect of the TCS on the process: two dissolved oxygen (DO) concentrations (2 and 9 mg L-1) and two F/M ratio (0.18 and 0.35 g COD·g MLVSS-1·d-1). The sludge production decreased under high DO concentrations. At the same time, the DNA and EPS production increased in the four SBRs. After these stress conditions, the performance of the reactors were recovered when DO was around 2 mg L-1. From that moment on, results showed that TCS addition implied a reduction of the adenosine triphosphate (ATP) production, which implied a decrease in the sludge production. In spite of this reduction, the SBRs performances did not decay due to the increase in the global MHEA. Additionally, the sludge reduction was enhanced by the increase of the F/M ratio, achieving 28% and 60% of reduction for the low and the high F/M ratio, respectively.

The Recipients' Parity Does Not Influence Their Reproductive Performance Following Non-Surgical Deep Uterine Porcine Embryo Transfer.

With the development of the non-surgical deep uterine (NsDU) embryo transfer (ET) technology, the commercial applicability of ET in pigs is now possible. There are, nevertheless, many factors that influence NsDU-ET effectiveness that need to be addressed. The aim of this study was to evaluate the effects of the weaned recipients' parity on fertility and prolificacy following NsDU-ET. The recipients (n = 120) were selected based on their reproductive history and body condition and grouped into three categories according to their parity: primiparous sows, sows of parity 2 and sows of parities from 3 to 5. Thirty fresh embryos (morulae and unhatched blastocysts) were non-surgically transferred into one uterine horn of each recipient. It was possible to insert the NsDU-ET catheter through the cervix along a uterine horn in 98.3% of the recipients. The parity had no influence on the difficulty grade of the insertions or on the percentage of correct insertions. The cervix and uterine wall were not perforated during the insertions, and vaginal discharge was not observed after transfer in any of the recipients. There were no differences in the pregnancy rates (74.8%), farrowing rates (71.2%) or litter sizes (9.6 ± 3.3) between groups. Also, there were no differences between groups regarding to the piglets' birthweights or piglet production efficiency. In conclusion, these results demonstrate that weaned sows from parity 1 to 5 are appropriate to be used as recipients in NsDU-ET programs, which increase the possibilities for the utilization of ET in the recipient farms.

The Effect of Oxidative Stress on Thawed Bulk-Sorted Red Deer Sperm.

The aims of this study were to assess the effects of the sex-sorting process on post-thaw sperm quality as well as on induced oxidative stress damage (H2 O2 0 mm = H000; H2 O2 50 mm = H050; H2 O2 100 mm = H100) and the protective action of reduced glutathione (GSH) and Trolox, when comparing sorted (BSS) and non-sorted (NS) red deer spermatozoa incubated at 37°C. Sperm samples from three stags were collected by electroejaculation and frozen. Immediately after thawing, sperm motility was higher (p < 0.05) for NS (59% ± 3.3) than BSS (36.9% ± 5.8) sperm. Furthermore, the percentage of apoptotic sperm was higher (p < 0.05) for BSS (21.6% ± 5.0) than NS sperm (14.6% ± 1.2). The presence of H2 O2 increased DNA damage in NS (H000 = 4.1% ± 0.9; H050 = 9.3% ± 0.7; and H100 = 10.9% ± 2.3), but not in BSS sperm. However, in the presence of oxidant, GSH addition improved (p < 0.05) sperm motility in both groups of sperm samples as compared to their controls (NS: 44.5 ± 4.8 vs 21.1 ± 3.9 and BSS: 33.3 ± 8.1 vs 8.9 ± 1.8). These results demonstrate that the sperm-sorting process induces sublethal effects, albeit selecting a sperm population with a chromatin more resistant to oxidative stress than that in non-sorted sperm. Moreover, addition of GSH at 1 mm may be a good choice for maintaining the quality of stressed sperm samples, unlike Trolox, which inhibited sperm motility.

Generation of human organs in pigs via interspecies blastocyst complementation.

More than eighteen years have passed since the first derivation of human embryonic stem cells (ESCs), but their clinical use is still met with several challenges, such as ethical concerns regarding the need of human embryos, tissue rejection after transplantation and tumour formation. The generation of human induced pluripotent stem cells (iPSCs) enables the access to patient-derived pluripotent stem cells (PSCs) and opens the door for personalized medicine as tissues/organs can potentially be generated from the same genetic background as the patient recipients, thus avoiding immune rejections or complication of immunosuppression strategies. In this regard, successful replacement, or augmentation, of the function of damaged tissue by patient-derived differentiated stem cells provides a promising cell replacement therapy for many devastating human diseases. Although human iPSCs can proliferate unlimitedly in culture and harbour the potential to generate all cell types in the adult body, currently, the functionality of differentiated cells is limited. An alternative strategy to realize the full potential of human iPSC for regenerative medicine is the in vivo tissue generation in large animal species via interspecies blastocyst complementation. As this technology is still in its infancy and there remains more questions than answers, thus in this review, we mainly focus the discussion on the conceptual framework, the emerging technologies and recent advances involved with interspecies blastocyst complementation, and will refer the readers to other more in-depth reviews on dynamic pluripotent stem cell states, genome editing and interspecies chimeras. Likewise, other emerging alternatives to combat the growing shortage of human organs, such as xenotransplantation or tissue engineering, topics that has been extensively reviewed, will not be covered here.

Sludge reduction by uncoupling metabolism: SBR tests with para-nitrophenol and a commercial uncoupler.

Nowadays cost reduction is a very important issue in wastewater treatment plants. One way, is to minimize the sludge production. Microorganisms break down the organic matter into inorganic compounds through catabolism. Uncoupling metabolism is a method which promote catabolism reactions instead of anabolism ones, where adenosine triphosphate synthesis is inhibited. In this work, the influence of the addition of para-nitrophenol and a commercial reagent to a sequencing batch reactor (SBR) on sludge production and process performance has been analyzed. Three laboratory SBRs were operated in parallel to compare the effect of the addition of both reagents with a control reactor. SBRs were fed with synthetic wastewater and were operated with the same conditions. Results showed that sludge production was slightly reduced for the tested para-nitrophenol concentrations (20 and 25 mg/L) and for a LODOred dose of 1 mL/day. Biological process performance was not influenced and high COD removals were achieved.

[Autologous blood pleurodesis for treatment of spontaneous pneumothorax and persistent air leak in pediatric patients]. / Pleurodesis con sangre autóloga en el tratamiento del neumotórax en pacientes pediátricos.

AIM OF THE STUDY: Recurrent spontaneous pneumothorax (SP) and persistent air leak (PAL) are a therapeutic challenge in some patients. Autologous blood pleurodesis (ABP) is an alternative treatment, but its usefulness in pediatric patients has not been determined yet. MATERIAL AND METHODS: Retrospective study of pediatric patients treated with ABP at our institution between 2010 and 2014, with special assessment of its indications, description of the technique, volume of blood used, complications and outcomes. RESULTS: During this period, 29 patients were treated for SP. 5 of them (17.2%) received ABP. Indications were: 2 patients with recurrent SP after thoracoscopic bullae resection and pleurodesis and 3 patients with PAL (1 after thoracoscopic bullae resection and 2 in lung transplantation candidates who were not suitable for surgery). Median age was 14.3 years (11.9-16.6) and volume of blood used was 50 ml (26-60). The air leak stopped in a median of 2.6 days (1-7). One patient needed a second ABP for PAL and another one presented an ipsilateral recurrence of SP after ABP. Follow up time was 2.21 years (0.49-3.42). No complications were observed. CONCLUSIONS: ABP is a cheap, safe and easy to perform procedure and may be considered as a therapeutic option in some pediatric patients with SP or PAL.

OBJETTIVOS: Los neumotórax recurrentes y la fuga aérea persistente (FAP) plantean dificultades terapéuticas en determinados pacientes. La pleurodesis con sangre autóloga (PSA) constituye una alternativa en su tratamiento, aunque su utilidad en pacientes pediátricos no ha sido determinada. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes pediátricos tratados con PSA en nuestro centro entre los años 2010 y 2014, centrado en las indicaciones, descripción de la técnica de administración, cantidad de sangre empleada, complicaciones y resultados. RESULTADOS: Durante este periodo, 29 pacientes presentaron neumotórax espontáneos. En 5 de ellos (17,2%) se realizó PSA como método de rescate. Las indicaciones fueron: 2 recidivas de neumotórax tras resección de bullas y pleurodesis y 3 casos de fuga aérea persistente (1 tras resección toracoscópica de bullas subpleurales y en 2 candidatos a trasplante pulmonar con bullas en los que se descartó la cirugía). La mediana de edad fue de 14,3 años (11,9-16,6) y la cantidad de sangre empleada 50 ml (26-60). La fuga aérea se resolvió en una media de 2,6 días (1-7). Un paciente requirió una nueva PSA por persistencia de fuga aérea tras la primera administración y otro presentó una recurrencia posterior del neumotórax. El tiempo de seguimiento fue de 2.21 años (0,49-3,42). No se describieron otras complicaciones. CONCLUSIONES: La PSA es un método de fácil aplicación, seguro y económico que puede ser considerado como opción terapéutica de rescate en determinados pacientes pediátricos con neumotórax o fuga aérea persistente.

[Gastric tube esophagoplasty using the retroesternal route in children]. / Sustitución esofágica con estómago tubulizado retroesternal en la infancia.

INTRODUCTION: Esophageal replacement is a surgical alternative once native esophagus can't be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. PATIENTS AND METHODS: We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. RESULTS: Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. CONCLUSIONS: Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can't be preserved. In our experience is a safe option, related to few complications.

INTRODUCCION: La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. PACIENTES Y METODOS: Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. RESULTADOS: Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. CONCLUSIONES: La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones.