Clinical and molecular description of two cases of neonatal diabetes secondary to mutations in PDX1.

Summary: Pancreatic dysgenesis (PD) is a rare congenital disease, with less than 100 cases reported in the literature. In most cases, patients are asymptomatic and the diagnosis is made incidentally. In this report, we present the case of two brothers with a history of intrauterine growth retardation, low birth weight, hyperglycemia, and poor weight gain. The diagnosis of PD and neonatal diabetes mellitus was made by an interdisciplinary team composed of an endocrinologist, a gastroenterologist, and a geneticist. Once the diagnosis was made, treatment with an insulin pump, pancreatic enzyme replacement therapy, and supplementation with fat-soluble vitamins was decided. The use of the insulin infusion pump facilitated the outpatient treatment of both patients. Learning points: Pancreatic dysgenesis is a relatively rare congenital anomaly; most of the time, patients are asymptomatic and are diagnosed incidentally. The diagnosis of pancreatic dysgenesis and neonatal diabetes mellitus should be made with an interdisciplinary team. Due to its flexibility, the use of an insulin infusion pump facilitated the management of these two patients.

Effects of TiO2 Nanoparticles Incorporation into Cells of Tomato Roots.

In this study, tomato plants were grown in vitro with and without incorporation of TiO2 nanoparticles in Murashige and Skoog (MS) growth medium. The aim of this study was to describe the morphological (area and roundness cell) and mechanical (Young's Modulus) change in the different tissue of tomato root, epidermis (Ep), parenchyma (Pa), and vascular bundles (Vb), when the whole plant was exposed to TiO2 nanoparticles (TiO2 NPs). light microscopy (LM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and atomic force microscopy (AFM), wavelength dispersive X-ray fluorescence (WDXRF) techniques were used to identify changes into the root cells when TiO2 NPs were incorporated. TiO2 NPs incorporation produces changes in the area, roundness, and Young's Modulus of the tomato root. When tomato root is exposed to TiO2 NPs, the Ep and Vb area size decreases from 260.92 µm2 to 160.71 µm2 and, 103.08 µm2 to 52.13 µm2, respectively, compared with the control area, while in Pa tissue the area size was increased considerably from 337.72 mm2 to 892.96 mm2. Cellular roundness was evident in tomato root that was exposed to TiO2 NPs in the Ep (0.49 to 0.67), Pa (0.63 to 0.79), and Vb (0.76 to 0.71) area zones. Young's Modulus in Pa zone showed a rigid mechanical behavior when tomato root is exposed to TiO2 NPs (0.48 to 4.98 MPa control and TiO2 NPs, respectively). Meanwhile, Ep and Vb were softer than the control sample (13.9 to 1.06 MPa and 6.37 to 4.41 MPa respectively). This means that the Pa zone was stiffer than Ep and Vb when the root is exposed to TiO2 NPs. Furthermore, TiO2 NPs were internalized in the root tissue of tomato, accumulating mainly in the cell wall and intercellular spaces, with a wide distribution throughout the tissue, as seen in TEM.

On the role of water in the hydrogen bond network in DESs: an ab initio molecular dynamics and quantum mechanical study on the urea-betaine system.

We herein report an ab initio molecular dynamics study on a natural DES composed of urea and betaine in a 3 : 2 ratio, as a test case for evaluating the water effect. The article deals with a theoretical study using both ab initio molecular dynamics and quantum chemistry computations in order to unravel the role of water in the nanostructure of a urea-betaine mixture. Preliminary molecular dynamics outcomes (both radial and spatial distribution functions) suggest that water promotes the association between urea and betaine by increasing the hydrogen bond network and precluding the aggregation of urea molecules. In other words, the presence of water allows a less restrictive hydrogen bond network, presenting a regimen where the strong hydrogen bond interactions are replaced by a wide variety of weaker hydrogen bond interactions. On the other hand, in a water free DES there is a regimen where strong urea-betaine interactions are dominant. It is shown that second order perturbation theory energy analysis provides cogent insights into charge spreading and hydrogen bond patterns. A vibrational analysis (both IR and power spectrum) over the ab initio molecular dynamics trajectories in the water free DES as well as in the urea-betaine-water systems reveals that our results are consistent with the second order perturbation theory analysis and with the hydrogen bond network pattern.

Thermal Stability Evaluation of Polystyrene-Mg/Zn/Al LDH Nanocomposites.

A series of samples of Mg/Zn/Al LDHs (layered double hydroxides) materials was prepared by the co-precipitation and urea hydrolysis methods. They were modified with organic surfactants (acrylate and oleate anions) and characterized by X-ray diffraction, which corroborated the intercalation of anionic species into the interlayer space. The hydrophobized materials were incorporated at low contents (10 and 15 wt.%) to polystyrene, which was synthesized by emulsion polymerization techniques. The polymeric composites were analyzed by thermogravimetry to determine the decomposition temperature. The results demonstrated that the materials with Zn presented the greatest increment in the degradation temperature (7 °C < T < 54 °C). Moreover, the Friedman, Flynn-Wall-Ozawa, and Coats-Redfern models were compared to obtain the kinetic parameters of degradation process. The obtained order of decomposition of the Coats-Redfern model showed that the decomposition process occurs in at least two stages. Finally, the addition of environmentally friendly modified Layered Double Hydroxides (LDH) nanomaterials to the polystyrene (PS) matrix allowed for obtaining polymeric composites with higher thermal stability, retarding the decomposition process of PS.

Dealing with the tension: how residents seek autonomy and participation in the workplace.

CONTEXT: The workplace can be a strenuous setting for residents: although it offers a wealth of learning opportunities, residents find themselves juggling their responsibilities. Even though supervisors regulate what is afforded to residents, the former find it difficult to strike the proper balance between residents' independence and support, which could create tensions. But what tensions do residents experience during clinical supervision and how do they cope with them to maximise their learning opportunities? Understanding how residents act on different affordances in the workplace is of paramount importance, as it influences their learning. METHOD: Residents from different levels of training and disciplines participated in three focus groups (n = 19) and 10 semi-structured interviews (n = 10). The authors recruited these trainees using purposive and convenience sampling. Audio-recordings were transcribed verbatim and the ensuing scripts were analysed using a constructivist grounded theory methodology. RESULTS: Residents reported that the autonomy and practice opportunities given by their supervisors were either excessive or too limited, and both were perceived as tensions. When in excess, trainees enlisted the help of their supervisor or peers, depending on how safe they recognised the learning environment to be. When practice opportunities were curtailed, trainees tried to negotiate more if they felt the learning environment was safe. When they did not, trainees became passive observers. Learning from each engagement was subject to the extent of intersubjectivity achieved between the actors involved. CONCLUSIONS: Tensions arose when supervisors did not give trainees the desired degree of autonomy and opportunities to participate. Trainees responded in various ways to maximise their learning opportunities. For these different engagement-related responses to enhance workplace learning in specialty training, achieving intersubjectivity between trainee and supervisor seems foundational.

Thoracic aortic aneurysm in a pre-Columbian (210 BC) inhabitant of Northern Chile: Implications for the origins of syphilis.

The aim of this work is to report a probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and to explore the relationship of this case to the only other paleopathological case previously described. We also consider the implications of both cases for the origins of syphilis. This study is based on the macroscopical analysis of human remains recovered during excavation of the Chiu Chiu 273 prehistoric cemetery, in the Antofagasta Region of Northern Chile. Ceramic sherds from the grave have a thermoluminescence date of 2160±100 A.P. or 210 B.C. The skeletal remains of an adult individual display resorptive lesions in both the sternum and the first two thoracic vertebrae, which are suggestive of a thoracic aortic aneurysm. The lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta (ascending portion and arch). We suggest that this aneurysm has a syphilitic etiology, considering the vascular segments compromised, the type of lesions observed, and the prevalent etiology of this kind of cardiovascular pathology in pre-penicillin times. Since the only two cases of thoracic aortic aneurysms reported to date have been found in the Americas and are clearly pre-Columbian, it can be suggested that venereal syphilis was present in the Americas in times before European contact.

Aneurismas de la aorta torácica: historia natural, diagnóstico y tratamiento / Thoracic aortic aneurysm: natural history, diagnosis and management

Los aneurismas corresponden a una dilatación arterial localizada que es producida por una debilidad de la pared; se clasifican en verdaderos y falsos. La incidencia es de aproximadamente 6 - 10 casos por 100.000 habitantes al año y los aneurismas de la aorta ascendente son los más frecuentes dentro del grupo de los aneurismas de la aorta torácica (AAT). Habitualmente se generan como resultado de una necrosis quística de la media que suele estar asociada a otras patologías. Los aneurismas suelen pesquisarse de manera incidental mediante exámenes imagenológicos solicitados por diferentes motivos. Su historia natural no está completamente clarificada, pero en términos generales los AAT tienen un crecimiento promedio de 0,1 cm por año. La angiografía por tomografía computada o por resonancia magnética, son los exámenes de elección para el diagnóstico. Para aquellos pacientes con aneurismas pequeños que no requieren cirugía, las medidas orientadas a la reducción del riesgo de ateroesclerosis son el pilar del tratamiento. Para los aneurismas de la aorta ascendente que cumplan con los requisitos, requieran de revascularización coronaria o reemplazo valvular, se recomienda el tratamiento quirúrgico. En relación a los aneurismas del cayado aórtico las opciones terapéuticas son tres: cirugía, terapia endovascular y terapia combinada. Para los aneurismas de la aorta descendente la terapia endovascular se perfila como la más eficiente. Los pacientes sin indicación de tratamiento quirúrgico o endovascular deben ser controlados de manera seriada con estudios imagenológicos.

Aneurysms are defined as a localized dilatation caused by a weakness in the arterial wall. and may be classified as true or false aneurysm. The incidence is estimated to be 6-10 cases per 100,000 patient years. Aneurysms of the ascending aorta are the most common within the group of thoracic aortic aneurysms (TAA). These often result from cystic medial degeneration, which tends to be associated with other pathologic entities. Aneurysms are diagnosed most commonly on imaging studies performed for an unrelated indication. Although its natural history remains unclear, it is known that current average growth is about 0.1 cm per year. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the preferred imaging tests to detect aortic aneurysms. Measures aimed to reduce atherosclerosis risk are the main treatment objective for patients with smaller aneurysms that do not require surgery. When ascending aortic aneurysms meet the size criteria or coronary revascularization and aortic valvular replacement are necessary, surgical treatment it's recommended. For aortic arch aneurysms, there are three therapeutic alternatives: surgery, endovascular therapy and combined therapy. For descending aortic aneurysms, endovascular therapy is the preferred procedure. Patients with no indication for surgical or endovascular therapy, should be followed up with serial imaging studies.

Tratamiento de las lesiones meniscales de acuerdo con la categorización morfológica: concordancia entre resonancia magnética y artroscopia / Treatment of meniscal lesions according to the morphological categorization: agreement between MRI and arthroscopy

Objetivo: determinar la concordancia entre resonancia magnética (RM) y artroscopia de rodilla como patrón de oro en la escogencia del tipo de tratamiento para una ruptura meniscal con base en su caracterización morfológica. Materiales y métodos: estudio de concordancia diagnóstica de conformidad que incluyó pacientes que consultaron a la Fundación Santa Fe con lesiones meniscales, a quienes se practicó RM con cortes axiales, y fueron llevados a artroscopia. Se correlacionaron posibles tratamientos de acuerdo con configuración de la ruptura según hallazgos imagenológicos y artroscópicos, y se determinó concordancia entre éstos. Resultados: el coeficiente Kappa calculado fue de 0,61. Conclusiones: la concordancia encontrada entre RM y artroscopia es buena permitiendo predecir el posible tratamiento de acuerdo con la configuración de la ruptura.

La salud de los profesionales de la salud / Health of the team care under stressful conditions

Se estudió el desgaste profesional de los enfermeros y médicos que trabajan en la Unidad de Terapia Intensiva del Hospital Francés de Buenos Aires. Se partió de la hipótesis que los enfermeros y médicos de Terapia Intensiva estaban desgastados profesionalmente debido a las características del sector donde desempeñan su rol y presentaban una Realización Profesional baja debido a las características de pacientes que asisten

La salud de los profesionales de la salud / Health of the team care under stressful conditions

Se estudió el desgaste profesional de los enfermeros y médicos que trabajan en la Unidad de Terapia Intensiva del Hospital Francés de Buenos Aires. Se partió de la hipótesis que los enfermeros y médicos de Terapia Intensiva estaban desgastados profesionalmente debido a las características del sector donde desempeñan su rol y presentaban una Realización Profesional baja debido a las características de pacientes que asisten

Evolución postquirúrgica de una población de pacientes de la tercera edad con cirugías mayores / Post surgical evolution of a thir age population with major surgery

De las 936 cirugías mayores en el Hospital Regional Dr. Carl Th. George, San Pedro de Macorís, República Dominicana, durante el período enero-diciembre 1994, 83(9//) correspondieron a pacientes de la tercera edad. El sexo que predominó fue el femenino (51//). La edad predominante de 61-70 años 45//. La infección de la herida fue la complicación más frecuente pos quirúrgica, la mortalidad fue de 2.4//y correspondió a pacientes intervenidos de urgencias, siendo la causa de muerte la sepsis (2 casos). La evolución postoperatoria fue satisfactoria enun 98//, lo cual nos habla de un riesgo quirúrgico mínimo en pacientes de la tercera edad. Cirugía, tercera edad, cirugía mayor