Characterisation of clays from Alicante province (SE Spain) for use in the recovery of degraded soils.

The goal of this paper is the characterisation of seven clays of the province of Alicante (SE Spain) and their possible use to improve the fertility, water absorption and contaminant-retaining capacity of degraded soils. Three soils affected by the dumping of construction debris were also studied to diagnose the problems and possible recovery strategies. Several physicochemical properties were measured, such as the water holding capacity, soil organic matter, lime, pH, EC and CEC. A high correlationship between mineralogical and elemental composition was obtained. Illite was present in all clays and soils. Some of the samples also contained kaolinite and significant amounts of lime. The CEC, as expected, was more closely related to the organic matter content. Soil organic matter was detected in the second derivative of the FTIR spectra by the signals of the CH2 groups at 2850 and 2919. This way, the FTIR spectrum for the soils of the area would make it possible to estimate both the organic matter content and the CEC. Despite their origin, soils did not show heavy metal pollution; however, salinisation risk seemed to be the most probable cause of degradation. According to the organic matter, lime and illite content, two clays were selected as the most suitable for soil degradation recovery. Furthermore, organic matter additions may help to improve the self-depurative ability of the soil.

[Our experience with sirolimus for the treatment of complicated vascular anomalies]. / Nuestra experiencia con la utilización de sirolimus en el tratamiento de anomalías vasculares complejas.

AIM OF THE STUDY: mTOR inhibitors are being used to treat complex vascular anomalies (VA) without response to conventional treatments. We report our results in pediatric patients treated with sirolimus. METHODS: Retrospective review of patients treated with sirolimus between 2014 and 2017, analyzing vascular anomaly type, treatment response and complications. Treatment protocol included patients with complex vascular anomalies, after signing the informed consent. The initial dose was 0.8 mg/m2/12 h, verifying plasmatic levels. Favorable response was defined both in clinical and radiological terms. MAIN RESULTS: Sirolimus was employed in nine patients, median age 14 months old (1 month-14 years), 66% girls. Five complex micro-cystic lymphatic malformations (LM), one multifocal lynphangioendotheliomatosis with thrombocytopenia, one kaposiform lymphangiomatosis, one lymphatic-venous malformation and one kaposiform hemangioendothelioma (KHE) were treated. Median treatment was 4 months (IQR 2-18 months). Resolution or improvement was objectified in four patients (44%). KHE patient presented complete resolution after two months of treatment. Two patients with micro-cystic LM and the one with lymphatic-venous malformation improved after a median treatment of three months. Two patients presented rebound effect after discontinuing treatment. Three patients had hypertransaminasemia and hypercholesterolemia without requiring medical treatment. CONCLUSION: Sirolimus presented mild effects for treatment of complex VA in our study, but was highly resolutive at KHE.

OBJETIVOS: Los inhibidores mTOR se están utilizando para el tratamiento de anomalías vasculares (AV) complejas sin respuesta a tratamientos convencionales. Presentamos nuestros resultados en pacientes pediátricos tratados con sirolimus. METODOS: Análisis retrospectivo de pacientes tratados con Sirolimus, entre 2014 y 2017, describiendo el tipo de anomalía vascular, respuesta al tratamiento y complicaciones derivadas de su empleo. Se incluyeron pacientes con anomalías vasculares complejas, tras firma del consentimiento informado y con dosis inicial de 0,8 mg/m2/12 horas, monitorizando niveles plasmáticos. Se definió respuesta favorable tanto en términos clínicos como radiológicos. RESULTADOS: Recibieron sirolimus 9 pacientes, mediana de edad de 14 meses (RIQ: 1 mes-14 años). El 66% fueron niñas. Se trataron 5 malformaciones linfáticas (ML) microquísticas complejas (en algunas como coadyuvante a otros tratamientos), 1 linfangioendoteliomatosis multifocal con trombopenia, 1 linfangiomatosis kaposiforme, 1 malformación mixta veno-linfática, 1 hemangioendotelioma kaposiforme (HEK). Mediana de tratamiento: 4 meses (2-18 meses). En 6 pacientes (66%) se objetivó resolución o mejoría de las lesiones. El paciente con HEK mostró resolución completa tras 2 meses de tratamiento. En dos pacientes con ML microquística y en el paciente con malformación mixta, se apreció mejoría clínica y disminución del tamaño de las lesiones tras una mediana de tratamiento de 3 meses. Se apreció efecto rebote en dos ML al suspender el tratamiento. Tres pacientes presentaron hipertransaminasemia e hipercolesterolemia, sin precisar tratamiento médico. CONCLUSIONES: En nuestro estudio, objetivamos que el sirolimus tuvo una eficacia moderada en el tratamiento de AV complejas, pero fue resolutivo en el HEK.

[Use of ultrasound for placement of central venous catheters in pediatrics: results of a national survey]. / Uso de la ecografía en la colocación de catéteres venosos centrales en pediatría: resultados de una encuesta nacional.

OBJECTIVES: To study the variability of techniques used for vascular access of central venous devices, totally implanted and external tunneled, as well as polling the use of ultrasound by pediatric surgeons in Spain. MATERIAL AND METHODS: Descriptive study of a survey results, conducted by phone, email and online, about 20 items related to the placement of these devices in children and the use of ultrasound in this procedure. RESULTS: We analyzed 71 surveys from 31 national hospitals. The response rate was 54%. In 66% of the cases the pediatric surgeon is the one who carries out the vascular access. 75% of the respondents place less than 25 catheters/year. Only 28% have attended to an ultrasound-guided vascular puncture course. The vein used more often is the internal jugular (55%), followed by the subclavian (17.4%), with preference for the right side in most of the cases (87%). 64% perform the ultrasound-guided technique, 29% the venous cutdown and 7% the landmark approach. There is no significant association between the technique chosen (landmark vs ultrasound-guided) and the vein used (p= 0,062). The majority of the respondents does not modify the usual approach in case of coagulopathy. We describe the complications associated with the three techniques. CONCLUSIONS: The preferred via for the vascular access by pediatric surgeons is the internal jugular vein, being this access ultrasound-guided in most of the cases. 91.5% consider the use of ultrasound decreases the number of associated complications. Nevertheless, just a minority has attended to a training course.

OBJETIVOS: Estudiar la variabilidad de técnicas en el acceso vascular de catéteres intravenosos centrales totalmente implantados y tunelizados externos, así como indagar sobre la utilización de la ecografía por parte de los cirujanos pediátricos en España. MATERIAL Y METODOS: Estudio descriptivo de los resultados de una encuesta realizada por vía telefónica, correo electrónico y on-line, acerca de 20 ítems relacionados con la colocación de estos dispositivos en niños y el uso de la ecografía. RESULTADOS: Se analizaron 71 encuestas de 31 hospitales españoles. La tasa de respuesta fue del 54%. En el 66% de los casos es el cirujano el que realiza el acceso vascular. El 75% de los encuestados coloca menos de 25 catéteres/año. Solo el 28% realizó algún curso de punción ecoguiada. La vena más utilizada es la yugular interna (55%), seguida de la subclavia (17,4%), prefiriendo la mayoría el lado derecho (87%). Un 64% realiza punción ecoguiada, un 29% venotomía y un 7% punción por referencias anatómicas, sin asociación significativa entre la técnica de punción elegida (referencias anatómicas vs ecoguiada) y la vena utilizada (p= 0,062). La mayoría no modifica la técnica habitual ante la presencia de coagulopatía. Se describen las complicaciones asociadas a las tres técnicas. CONCLUSIONES: La vía preferida por los cirujanos pediátricos encuestados para el acceso vascular es la vena yugular interna, siendo ecoguiado en la mayoría de los casos. Un 91,5% opina que la ecografía disminuye el número de complicaciones asociadas, sin embargo solo una minoría ha realizado algún curso de formación.

[Management protocol in gastroschisis]. / Protocolo de manejo en las gastrosquisis.

AIM: There are two classical managements in gastroschisis: primary or delayed closure. From 2007 on, a multidisciplinary approach protocol based in preterm caesarean delivery at 34-35th gestational age (in order to minimize peel injury) plus primary closure is followed in our institution. Prior to this, term delivery, either by caesarean section or not, was the rule. METHODS: Retrospective study of gastroschisis's patients before (1978-2006) and after (2007-2016) protocol approval. Complex gastroschisis frequency, peel's presence, primary or delayed closure, complications, re-interventions, neonatal intensive care unit (NICU) length of stay, age at onset of enteral nutrition, total parenteral nutrition's length and length of stay were compared. MAIN RESULTS: Study groups: before (12 patients) and after (13 newborns) the protocol implantation (pre/post). Nine complex gastroschisis were observed in the pre-protocol period, compared to one in the post-protocol era (p= 0.001). The re-interventions also decreased: 58.33% in the pre-protocol vs. 15.38% in the post-protocol group (p= 0.025). Complications rate were 66.67% before protocol vs. 23.07% after protocol (p= 0.028). NICU length of stay decreased from 40 ± 32 to 17 ± 12 days (p= 0.025). Parenteral total nutrition length was 61 ± 36 in the pre-protocol vs. 15 ± 6 in the port-protocol eras, respectively (p= 0.043). The age at onset of enteral nutrition was 34 ± 26 vs. 9 ± 5 days (p= 0.004) and hospitalization length was 98 ± 81 days pre vs. 35 ± 15 days post protocol implantation (p= 0.011). CONCLUSIONS: The protocol implantation has allowed primary closure, decreased hospitalization; reduced complications and mortality rate as well.

OBJETIVOS: Clásicamente existen dos manejos de las gastrosquisis: cierre directo o diferido. Nosotros apostamos por el cierre directo aplicando un protocolo de actuación en el que se programa cesárea a las 34-35 semanas de gestación para minimizar el "peel". MATERIAL Y METODO: Estudio retrospectivo de los pacientes con gastrosquisis en los períodos pre (1978-2006) y post (2007-2016) implantación del protocolo, comparando frecuencia de gastrosquisis complejas, la presencia o ausencia de peel, cierre directo o diferido, complicaciones, reintervenciones, días de ingreso en unidad de cuidados intensivos, edad al inicio de nutrición enteral, nutrición parenteral total y días de hospitalización. RESULTADOS: Grupo de estudio: previo (12) y posterior (13) al protocolo (previo/post). La frecuencia de gastrosquisis complejas en el período previo fue de 9 neonatos, en el período post solo 1 (p= 0,001). El número de reintervenciones fue de 58,33% previo vs. 15,38% post (p= 0,025). Las complicaciones postoperatorias fueron 66,67% previo frente a 23,07% post (p= 0,028) y existió una disminución de los días de estancia en la unidad de cuidados intensivos de 40 ± 32 vs. 17 ± 12 (p= 0,025) y de los días de nutrición parenteral (61 ± 36 frente a 15 ± 6; p= 0,043). La edad al inicio de la nutrición enteral fue de 34 ± 26 vs. 9 ± 5 días (p= 0,004) y los días de hospitalización fueron de 98 ± 81 días previo frente a 35 ± 15 días post protocolo (p= 0,011). CONCLUSIONES: La implantación del protocolo ha permitido el cierre directo, la disminución de la estancia hospitalaria, de las complicaciones y de la mortalidad.

[Prevention of the wound infection: little changes, huge results]. / Resultados de la modificación de la actitud ante la asepsia en cirugía neonatal: pequeños cambios, grandes resultados.

INTRODUCTION: Neonatal surgical wound infection occurs in almost 50% of neonatal procedures. It increases the rates of morbimortality in neonatal units. There is no guidelines about prevention of wound infection in neonatal surgery. We present our results after changing our behaviour in neonatal surgery. MATERIALS AND METHODS: Comparative study between 2 groups. In order to decrease wound infection at the end of the procedure gloves, covertures and surgical instruments were changed and saline and antiseptic solutions were used during laparotomy closing. Group P included procedures with these recommendations and Group NP without them. Age, weight, surgery, infection, length of stay, and mortality were analized between groups through a logistic regression model. RESULTS: Group P included 55 procedures in 32 patients, median weight 1,300 g (1,000-2,100), 19 median days of life (6-40), 5 postoperative wound problems (9%). Group NP included 26 procedures in 14 neonates, median weight 1,700 g (700-2,500), 20 median days of life (3-33), 14 wound problems (53.8%). We decrease the wound problems in our patients in 44.8% (p < 0.0001). Additionally, the protection provided by our recommendations was maintained after adjustment by weight, age and type of pathology (0.07) p= 0.000. CONCLUSIONS: Simple changes in during the procedures in neonatal surgery can reduce the appearance of wound infection and morbidity.

OBJETIVOS: La infección de herida quirúrgica neonatal tiene una incidencia de hasta el 50% y produce un aumento de morbimortalidad. No existen recomendaciones preventivas consensuadas en la literatura. Presentamos los resultados tras la implantación de un protocolo creado en nuestro Servicio para cierre de laparotomía en cirugía neonatal contaminada y sucia. MATERIAL Y METODOS: Estudio ambispectivo de las laparotomías neonatales realizadas durante 32 meses comparando los resultados con un grupo de pacientes intervenidos durante un período previo similar. El protocolo incluye cambio de guantes, de campo y material quirúrgico, lavado por planos con antiséptico y sutura antibacteriana en el cierre. Se analizan edad, peso, tipo de intervención, infección, estancia hospitalaria y mortalidad y se compara con un grupo similar de pacientes intervenidos de forma previa a la creación del protocolo (NP) y se analiza la influencia del protocolo en la aparición de infección mediante regresión logística. RESULTADOS: El grupo P incluye 55 laparotomías en 32 neonatos con mediana de peso 1.300 g (1.000-2.100), mediana de edad 19 días (6-40) con 3 infecciones de herida (2 cultivos positivos) y 2 dehiscencias leves (9%). El grupo NP incluyó 26 intervenciones en 14 neonatos, mediana de peso 1.700 g (700-2.500), mediana de edad 20 días (3-33), 14 infecciones (53,8%), 8 cultivos positivos y 2 muertes. Se redujo un 44,8% la aparición de infección (p < 0,0001) y el efecto protector del protocolo se mantuvo después del ajuste por peso, edad y tipo de patología (0,07) p= 0,000. CONCLUSIONES: La sencilla modificación de la asepsia y técnica de cierre ha contribuido a disminuir considerablemente la tasa de infección y morbimortalidad en nuestros pacientes y consideramos que es necesario hacer conciencia de ello.

[Long-term results of hypospadias surgery. Urinary and sexual function, and psychological impact]. / Resultados a largo plazo de la cirugía de hipospadias. Función urinaria, sexual e impacto psicológico.

OBJECTIVES: To determine the current status of the patients operated on for hypospadias in our region, in order to adapt the surgical technique to their real needs. MATERIAL AND METHODS: A descriptive and observational study. Interviews were conducted with hypospadias surgery patients in our hospital between 1976 and 1996, focusing on their urinary and sexual function and psychological impact. We performed a descriptive statistical analysis and comparisons between types of hypospadias (SPSSv19). RESULTS: 566 patients were operated on for hypospadias during the study period, interviewing 100 aged between 18 and 40 years. The 73% were distal and 27% proximal. Of all patients, 30% do not have an orthotopic meatus, 10% have fistula, 18% have some degree of stenosis and 52% have penile curvature. The 13% feel to have had disadvantages in their life. They consider they have a different penis in: size (19%), glans shape (17%), curvature (14%), scars (10%) and lowest hole (7%). Sexual satisfaction was valued at 8.9 on a scale of 1 to 10, with no differences between the types of hypospadias. Proximal hypospadias patients have more ejaculation problems: 42% versus 11% in distal hypospadias. The 68% of the proximal ones would like to improve compared to 20% of the distal in: appearance (17%), size (11%) and way to urinate (11%). CONCLUSIONS: Anatomic abnormalities are maintained but the aspects that values the adult patient differ from those persecuted by practiced surgeries. A significant percentage of patients would try to get another surgery. Keeping the size of the penis and natural appearance of the glans should be a priority in hypospadias surgery.

OBJETIVOS: Conocer el estado actual de los pacientes intervenidos por hipospadias en nuestra región, para adaptar la técnica quirúrgica a sus necesidades reales. MATERIAL Y METODOS: Estudio descriptivo y observacional. Se entrevistó a pacientes intervenidos de hipospadias en nuestro hospital entre 1976 y 1996, incidiendo en su función urinaria, sexual e impacto psicológico. Realizamos análisis estadístico descriptivo y comparaciones entre tipos de hipospadias (SPSSv19). RESULTADOS: 566 pacientes fueron intervenidos de hipospadias en el período estudiado, entrevistándose a 100, con edades entre 18 y 40 años. El 73% fueron distales y 27% proximales. En el 30% el meato no es ortotópico, 10% presenta fístula, 18% presenta algún grado de estenosis y 52% presenta curvatura. El 13% siente haber tenido desventajas en su vida. Consideran su pene diferente en: tamaño (19%), forma glande (17%), curvatura (14%), cicatrices (10%) y orificio más bajo (7%). La satisfacción sexual fue valorada en 8,9 en una escala del 1 al 10, sin diferencias entre los tipos de hipospadias. Los proximales presentan mayores problemas de eyaculación: 42% frente al 11% de los distales. El 68% de los proximales desearían mejorar frente al 20% de los distales, en apariencia (17%), tamaño (11%) y forma de orinar (11%). CONCLUSIONES: Se mantienen alteraciones anatómicas pero los aspectos que más valora el paciente adulto difieren de los perseguidos en las cirugías que se practicaban. Un porcentaje importante de pacientes se reoperaría de nuevo. Mantener el tamaño del pene y aspecto natural del glande debe ser un objetivo prioritario durante la cirugía de hipospadias.

[Animated biofeedback for the dysfunctional voiding syndrome]. / Biofeedback animado para el tratamiento de la micción disfuncional.

OBJECTIVES: To analyze clinical and electromyographic treatment outcome of dysfunctional voiding (DV) with animated Biofeedback (Bfb). Clinical or electromyographic variables associated with higher success rate were checked. PATIENTS AND METHODS: Cross-sectional study of patients with DV, that in 2010- 2015 followed animated Bfb program. Efficacy was measured with Uroflowmetry, Electromyography (EMG) and validated clinical questionnaire. Inclusion criteria: no myelodysplasia, no anatomical malformations and a minumin of 3 Bfb sessions. Clinical variables: age, number of sessions, daytime leaks, nocturnal enuresis, constipation, UTI, VUR. Flow measurement variables: morphology of curves, electromyogram, flows, and elevated post void residual (PVR). RESULTS: Of 37 patients who received Bfb, 27 girls who met inclusion criteria were selected. Mean age: 7.8 years (2.5). Twelve (44%) had detrusor overactivity on urodynamics concomitantly. Globally, all clinical and flowmetry parameters improved. Clinically 33.5% had complete resolution of symptoms, 37% improved (> 50% of symptoms according to criteria ICCS) and 29% had no improvement. In EMG, 74% achieved normal perineal relaxation. Constipation at baseline is associated with lower rates of success (cure: 13 vs. 58%, p = 0.019; cure + improvement: 60% vs. 83% p> 0.05). The absence of RPM at the end of the study was associated with clinical improvement (cure: 66.7% vs. 0%, p = 0.012; cure + improvement: 89% vs. 60%, p> 0.05). CONCLUSIONS: Bfb in DV provides cure or improvement and electromyographic resolution are 69 and 74% respectively. The absence of constipation is associated with higher success rates. The High RPM correlates with persistence of clinics.

OBJETTIVOS: Se pretende analizar resultado clínico y electromiográfico del tratamiento de la micción disfuncional (MD) con Biofeedback (Bfb) animado. Además, se estudia si existen variables clínicas o electromiográficas asociadas a mayor tasa de éxito. PACIENTES Y METODOS: Se realizó corte transversal de pacientes con MD, que en 2010- 2015 siguieron programa de Bfb animado. El control post-tratamiento se realizó con Uroflujometría más Electromiografía y cuestionario validado. Se excluyeron los pacientes con mielodisplasia, malformaciones anatómicas, y a los que recibieron menos de 3 sesiones. Las variables clínicas estudiadas fueron: edad, número de sesiones, fugas diurnas, enuresis nocturna, estreñimiento, ITU, RVU. Las flujométricas fueron: morfología de curvas, electromiograma, flujos, y residuo postmiccional (RPM) elevado. RESULTADOS: De 37 pacientes que recibieron Bfb, se seleccionaron 27 niñas que cumplieron criterios de inclusión. Edad media: 7,8 años (DE: 2,5). Doce (44%) presentaron hiperactividad del detrusor asociado a la MD. De manera global, todos los parámetros clínicos y flujométricos mejoraron. Clínicamente 33,5% presentó resolución completa de síntomas y el 37% mejoraron (desaparecieron más del 50% de los síntomas según criterios ICCS). El 29% no presentó mejoría. Electromiográficamente el 74% logró flujometrías normales. El estreñimiento al inicio del estudio se asocia a tasas menores de éxito (curación: 13 vs. 58%, p= 0,019; curación + mejoría: 60% vs. 83% p > 0,05). La ausencia de RPM al final del estudio se relacionó con la mejoría clínica (curación: 66,7% vs. 0%, p= 0,012; curación + mejoría: 89% vs. 60%, p > 0,05). CONCLUSIONES: El Bfb en la micción disfuncional proporciona tasas de curación/mejoría clínica y de resolución electromiográfica del 69 y 74%, respectivamente. La ausencia de estreñimiento se asocia a mayores tasas de éxito. La persistencia de clínica se relaciona con RPM elevado post-tratamiento.

[Neonatal use of propranolol for segmental facial hemangiomas]. / Uso neonatal del propranolol en hemangiomas segmentarios faciales.

INTRODUCTION: Segmental cervico facial hemangiomas are defined as those longer than 5 cm, affecting a specific facial area. These lesions can be eventually associated with the PHACE syndrome. Our aim is to propose neonatal treatment with propranolol, showing its efficacy/safety, given the scarce evidence on its neonatal use. CLINICAL OBSERVATION: After written informed consent, four patients with segmental facial hemangioma were treated with propranolol in the neonatal period. Adverse effects were registered during initial admission. Three of the four patients had PHACE syndrome. Propranolol was effective in 100% of patients, showing hemangioma´s involution without any adverse effect. COMMENTS: In our series, propranolol was effective and showed no side effects in the neonatal period. If propranolol benefits are greater than its risks, administration of the lowest effective dose is recommended, under hospital surveillance, starting shortly after diagnosis, in order to achieve improved efficacy.

INTRODUCCION: Los hemangiomas cérvico-faciales son considerados segmentarios cuando afectan a un área específica de la cara y miden más de 5 cm y, en ocasiones, forman parte del síndrome de PHACE. Nuestro objetivo es proponer el tratamiento de dichos hemangiomas con propranolol en etapa neonatal, mostrando su eficacia/seguridad dado que existe poca evidencia al respecto. OBSERVACION CLINICA: Revisamos 4 pacientes diagnosticados de hemangioma segmentario facial. Los neonatos fueron tratados de forma hospitalaria inicial con propranolol, tras firma de consentimiento informado, y fueron ingresados para control de aparición de complicaciones. Tres de los cuatro casos clínicos fueron diagnosticados de síndrome de PHACE. El propranolol fue efectivo en el 100% de los pacientes, demostrando involución de los hemangiomas. COMENTARIOS: En nuestra serie el propranolol fue eficaz sin evidenciar complicaciones en el período neonatal. Si los beneficios del propranolol sobrepasan los riesgos, se recomienda administrar la menor dosis eficaz, de forma hospitalaria y precoz para obtener mejores resultados.

Late effects of Wilms' tumor treatment. / Efectos tardíos del tratamiento del tumor de Wilms.

INTRODUCTION: Wilms' tumor (WT) is the most frequent renal tumor in childhood. Therapeutic management progression has increased survival rates, and as a result, long-term adverse effects. MATERIALS AND METHODS: A descriptive retrospective study of a case series from 1977 to 2023 was carried out. The characteristics of the treatments received and the adverse effects listed on medical records were analyzed via phone surveys. RESULTS: 50 patients (25 boys-25 girls) with a mean age of 3.6 years (3 months-11 years) at diagnosis were included. Most of them (94%) were treated according to the protocol established by the European standards of pediatric oncology, which are characterized by the use of neoadjuvant chemotherapy. In one patient, the American treatment scheme was followed. The most common drugs used were vincristine and actinomycin D (78%). Only 12 patients (28%) received anthracyclines. Unilateral nephrectomy was the most frequent surgical technique (84%). Renal disorders were the most common (46%). However, the occurrence of second neoplasias (9%) and reproductive disorders (8% between boys and girls) had a greater impact on patients' quality of life. Multiple - cardiac (23%), endocrine (26%), and pulmonary (15%) - disorders associated with the treatments received were reported. CONCLUSIONS: WT treatment has an impact on health. Adequate and rigorous surgery, close follow-up, and limiting chemotherapy doses and radiation exposure can minimize long-term sequels.

INTRODUCCION: El tumor de Wilms (TW) es el tumor renal más frecuente en la infancia. La evolución del manejo terapéutico ha incrementado la tasa de supervivencia y como consecuencia, los efectos secundarios a largo plazo. MATERIAL Y METODOS: Realizamos un estudio retrospectivo descriptivo a partir de una serie de casos entre 1977 y 2023. Estudiamos las características de los tratamientos recibidos y los efectos secundarios que constan en su historia clínica y a través de cuestionarios telefónicos. RESULTADOS: Localizamos 50 pacientes (25 hombres-25 mujeres) con edad media al diagnóstico de 3,6 años (3 meses-11 años). La mayoría fueron tratados según protocolo vigente de las guías europeas de oncología pediátrica (94%) caracterizadas por el uso de quimioterapia neoadyuvante. En un paciente Se siguió el esquema americano de tratamiento. Los fármacos más utilizados fueron vincristina y actinomicina D (78%); solo 12 pacientes (28%) recibieron antraciclinas. La nefrectomía unilateral fue la técnica quirúrgica más empleada (84%). Las alteraciones renales fueron las más frecuentes (46%). Sin embargo, la aparición de segundas neoplasias (9%) y aquellas alteraciones relacionadas con la reproducción (8% entre hombres y mujeres) suponen un mayor impacto en la calidad de vida de los pacientes. Se describen múltiples alteraciones: cardíacas (23%), endocrinas (26%) o pulmonares (15%) relacionadas con los tratamientos recibidos. CONCLUSIONES: El tratamiento del TW afecta a la salud general. Una cirugía adecuada y rigurosa, limitar las dosis de quimioterapia, minimizar la exposición a la radiación y un seguimiento estrecho puede minimizar las secuelas a largo plazo.

Melatonin-induced methylation of the ABCG2/BCRP promoter as a novel mechanism to overcome multidrug resistance in brain tumour stem cells.

BACKGROUND: Current evidence indicates that a stem cell-like sub-population within malignant glioblastomas, that overexpress members of the adenosine triphosphate-binding cassette (ABC) family transporters, is responsible for multidrug resistance and tumour relapse. Eradication of the brain tumour stem cell (BTSC) compartment is therefore essential to achieve a stable and long-lasting remission. METHODS: Melatonin actions were analysed by viability cell assays, flow cytometry, quantitative PCR for mRNA expression, western blot for protein expression and quantitative and qualitative promoter methylation methods. RESULTS: Combinations of melatonin and chemotherapeutic drugs (including temozolomide, current treatment for malignant gliomas) have a synergistic toxic effect on BTSCs and A172 malignant glioma cells. This effect is correlated with a downregulation of the expression and function of the ABC transporter ABCG2/BCRP. Melatonin increased the methylation levels of the ABCG2/BCRP promoter and the effects on ABCG2/BCRP expression and function were prevented by preincubation with a DNA methyltransferase inhibitor. CONCLUSION: Our results point out a possible relationship between the downregulation of ABCG2/BCRP function and the synergistic toxic effect of melatonin and chemotherapeutic drugs. Melatonin could be a promising candidate to overcome multidrug resistance in the treatment of glioblastomas, and thus improve the efficiency of current therapies.

Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

Fas/Fas ligand regulation mediates cell death in human Ewing's sarcoma cells treated with melatonin.

BACKGROUND: Despite recent advances in cancer therapy, the 5-year survival rate for Ewing's sarcoma is still very low, and new therapeutic approaches are necessary. It was found previously that melatonin induces cell death in the Ewing's sarcoma cell line, SK-N-MC, by activating the extrinsic apoptotic pathway. METHODS: Melatonin actions were analysed by metabolic viability/survival cell assays, flow cytometry, quantitative PCR for mRNA expression, western blot for protein activation/expression and electrophoretic mobility shift assay for transcription factor activation. RESULTS: Melatonin increases the expression of Fas and its ligand Fas L, this increase being responsible for cell death induced by the indolamine. Melatonin also produces a transient increase in intracellular oxidants and activation of the redox-regulated transcription factor Nuclear factor-kappaB. Inhibition of such activation prevents cell death and Fas/Fas L upregulation. Cytotoxic effect and Fas/Fas L regulation occur in all Ewing's cell lines studied, and do not occur in the other tumour cell lines studied where melatonin does not induce cell death. CONCLUSION: Our data offers new insights in the study of alternative therapeutic strategies in the treatment of Ewing's sarcoma. Further attention deserves to be given to the differences in the cellular biology of sensitive tumours that could explain the cytotoxic effect of melatonin and the increase in the level of free radicals caused by this molecule, in particular cancer types.

Three stages MBR (methanogenic, aerobic biofilm and membrane filtration) for the treatment of low-strength wastewaters.

The use of a new three stages MBR process with a first methanogenic UASB stage, a second stage with aerobic biofilm growing on small carrier elements maintained in suspension and third stage with membrane filtration module is presented. The objective of the first methanogenic chamber is to diminish COD of the raw wastewater, producing a biogas rich in methane, and decrease the sludge production. In the second stage, the remaining soluble biodegradable COD is oxidized by heterotrophs. In the third stage, the membrane modules could be operated at higher fluxes than those reported for AnMBR systems, and similar to those obtained in aerobic MBRs. In this sense, the concept of these three stages MBR is to join the advantages of the methanogenic and aerobic membrane bioreactor processes, by reducing energy requirements for aeration, producing biogas with high methane percentage and a permeate with very low COD content. A synthetic wastewater was fed to the three stages MBR. COD in the influent was between 200 and 1,200 mg/L, ammonium ranged from 10 to 35 mg/L and phosphorous concentration was 8 mg/L. OLR in-between 1 and 3 kg COD/(m3 d) and a HRT of 13-21 h were applied. Temperature was between 17.5 and 23.2 degrees C. During the whole operating period the COD removal efficiencies were in the range of 90 and 96% of which in between 40 and 80% was removed in the first methanogenic chamber. Biogas production with methane content between 75 and 80% was observed. With regard to membrane operation, average permeabilities around 150 L/(m2 h bar) were achieved, operating with fluxes of 11-15 L/(m2 h).

Mechanical thrombectomy beyond 6hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital. / Trombectomía mecánica más allá de 6horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting>50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24hours after onset merits study.

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. / Infarto medular: etiología, hallazgos radiológicos y factores pronósticos en una serie de 41 pacientes.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P<.05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

Intravenous thrombolysis for acute ischemic stroke in centenarians.

PURPOSE: The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years. METHODS: Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Clinical variables and functional outcome at 3 months were collected. RESULTS: Four patients, all women, functionally independent (mRS ≤ 2) were included. Treatment with alteplase was applied within 4.5 h of stroke onset. One patient complicated with pneumonia and died. Two patients were functionally independent (mRS ≤ 2) at discharge, while the third was partially dependent (mRS of 3 at discharge), improving after 3 months, (mRS 2). No serious hemorrhagic or systemic adverse events were registered. CONCLUSION: In our experience, intravenous thrombolysis may be beneficial and should be considered in patients over 100 years old with no previous disability.

[The Spanish version of the Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ). Transcultural adaptation and reliability analysis]. / Versión española del NAKQ. Adaptación transcultural y análisis de fiabilidad y validez.

INTRODUCTION: The Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ) has proven to be a valid instrument for asthma knowledge assessment of patients and their parents. The widespread use of the SRS-22 in non-English-speaking countries requires its transcultural adaptation. Our objective was to obtain a version of the NAKQ questionnaire adapted to Spanish and to analyze its validity and reliability. MATERIAL AND METHODS: The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. The questionnaire was administered to 157 parents with high knowledge (n = 78) and low knowledge (n = 79) of asthma. The differences in the number of answers between both groups were analyzed with the chi(2) test. Internal consistency was determined with Cronbach's alpha coefficient and test-retest reliability with the tau-b of Kendall correlation coefficient, and kappa statistics. RESULTS: At the end of the process, 23 of the 31 items were classified as of total equivalence and eight ase of moderate equivalence. The mean score of parents high knowledge was 23 +/- 2.94 and the mean score of parents low knowledge was 16.84 +/- 2.56. The difference between the two groups was statistically significant (p < 0.001). The overall Cronbach's alpha coefficient of the questionnaire was 0.72, the Kendall's tau-b 0,8573 was significant (p = 0.01) and the kappa index showed good or very good consistency in more than half of the items. CONCLUSIONS: The Spanish version of the NAKQ has proven to be acceptable and culturally equivalent to the original version and it has a good degree of consistency, validity and reliability.

[Transanal irrigations in patients with constipation and fecal incontinence: results, indications and follow up in our center]. / Irrigación transanal en pacientes con estreñimiento e incontinencia orgánica refractaria. Resultados, indicaciones y seguimiento en nuestro centro.

AIM OF THE STUDY: To present our results with transanal irrigation (TAI) for management of fecal incontinence and fecal constipation without response to other treatments. METHODS: Retrospective study of patients with fecal constipation and/or fecal incontinence treated with TAI between 2013 and 2017. A Rintala questionnaire(1) was carried out comparing pre and post-treatment results. This study was approved by the ethical committee. MAIN RESULTS: Twenty-five patients were included with a median age of 13 years old (range 6-44 years). Nineteen patients had spinal pathology (76%), four colorectal surgery (16%) and two functional constipation (8%). They presented fecal incontinence in 20% of cases, 12% of fecal constipation and 68% both conditions. After a mean follow-up of 1.5 years (1 month-4 years), 52% of the patients abandoned the treatment. The mean Rintala score was 6.8±4 before treatment, and after, resulted to 11.42±2.75 (p=0.001). The main complications throughout the treatment were pain (68%) and balloon leaks (28%). The patients declared as cause of treatment cessation: reduced mobility (15%), fear or misinformation (32%) and pain (76%). All patients with reduced mobility (n=3) left treatment, versus 45% (n=12) of the patients that had full mobility (p=0.17, OR 8.3 [IC95% 0.3-38]). Complementary treatments such as laxatives, enemas or digital extraction were abandoned in 55% of the patients. CONCLUSIONS: Using TAI seems to improve quality of life in patients with fecal constipation and fecal incontinence refractory compared to other treatments. Our abandonment rate was higher than expected, so we believe it is necessary to create a support group to improve follow-ups.

OBJETIVOS: Presentar nuestros resultados con el uso del irrigador transanal (IT) en el manejo intestinal de pacientes con incontinencia fecal o estreñimiento sin respuesta a otros tratamientos. METODOS: Estudio retrospectivo de pacientes con estreñimiento y/o incontinencia fecal refractaria tratados con IT (2013-2017) con el sistema Peristeen® (Coloplast). Se realizó cuestionario Rintala(1), comparando resultados pre y postratamiento. La realización del estudio fue aprobada por el comité de investigación clínica. RESULTADOS: Fueron incluidos en el estudio veinticinco pacientes, mediana de edad 13 años (6-44 años), cuatro no localizables. Diecinueve presentaban patología medular (76%), cuatro cirugías colorrectales (16%) y dos estreñimiento funcional (8%). El 20% aquejaba incontinencia, 12% estreñimiento y 68% ambas condiciones. Tras una mediana de seguimiento de 1,5 años (1 mes-4 años), el 52% abandonó el tratamiento. La puntuación media pretratamiento fue 6,8±4, frente a 11,42±2,75 tras su empleo (p=0,001), disminuyendo el número de escapes con repercusión positiva en actividades diarias. Las complicaciones principales fueron dolor (68%) y expulsión del balón (28%). Refirieron como causa de abandono: dificultad de uso por movilidad reducida (15%), miedo o desinformación (32%) y dolor (76%). El 100% de pacientes con movilidad reducida (n=3) abandonó el tratamiento, frente al 45% (n=12) en el resto (p=0,17, OR 8.3 [IC95% 0,3-38]). El 55% de los pacientes dejaron de utilizar laxantes, enemas o extracción digital. CONCLUSIONES: El uso de IT parece mejorar la calidad de vida en pacientes con estreñimiento e incontinencia de causa orgánica refractaria. La tasa de abandono fue mayor de la esperada, por lo que creemos necesaria la creación de un grupo de apoyo que mejore el seguimiento.