Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial.

BACKGROUND: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. METHODS: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. FINDINGS: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. INTERPRETATION: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. FUNDING: Instituto de Salud Carlos III and the European Regional Development Funds.

Current Concepts in the Management of Patellofemoral Pain Syndrome / Conceptos Actuales en el Manejo del Síndrome de Dolor Patelofemoral

Introduction Patellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methods State of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. Results Hip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. Discussion Conservative treatment remains as the mainstream in the management of patellofemoral pain syndrome.

Introducción El síndrome de dolor patelofemoral (SDPF) es una de las principales causas de dolor de rodilla y se presenta con actividades diarias de la vida cotidiana. Este estudio presenta una revisión de la literatura acerca de las modalidades de tratamiento actual para el SDPF. Materiales y métodos Revisión estado del arte acerca del tratamiento del SDPF con grados de recomendación según la evidencia. Se revisan las intervenciones conservadoras activas y pasivas, así mismo las alternativas quirúrgicas. Resultados El fortalecimiento de los músculos de la cadera y del miembro inferior, así como el estiramiento, son intervenciones activas que ofrecen beneficios en el largo plazo para el SDPF. Las intervenciones pasivas como las rodilleras, el kinesiotaping y las ortesis para los pies, ofrecen alivio rápido pero de corta duración. El tratamiento quirúrgico solamente se recomienda en un subgrupo de pacientes que no han respondido a otros tratamientos y que tienen ciertas anormalidades anatómicas específicas que alteran la articulación patelofemoral. Discusión El tratamiento conservador continúa siendo la piedra angular en el tratamiento del síndrome de dolor patelofemoral

Lipidic Matrixes Containing Clove Essential Oil: Biological Activity, Microstructural and Textural Studies.

Clove essential oil (CEO) is known for having excellent antioxidant and antimicrobial properties, but the poor stability of its components to light and temperature compromise this activity. The aim of this study is to evaluate the textural, antioxidant, antimicrobial and microstructural properties of matrixes produced with representative natural waxes and CEO. Thus, waxy emulsifiers, such as beeswax, candelilla wax, carnauba wax, and ozokerite wax, were employed to create such matrixes. The thermal, microstructural, textural, wetting, antioxidant, antimicrobial and infrared characteristics of the matrixes were then studied. The diverse chemical composition (long-chain wax esters in carnauba wax and short-chain fatty acids and hydrocarbons in beeswax and ozokerite wax, respectively) explained the differences in wetting, texture, melting, and crystallization characteristics. Crystal forms of these matrix systems varied from grainy, oval, to needle-like shape, but keeping an orthorhombic allomorph. The alignment and reorganization of beeswax and ozokerite wax into needle-like crystals increased the matrix strength and adhesion force compared to those of carnauba and candelilla matrixes, which showed weak strength and grainy morphology. The former two waxes and their matrixes also showed the largest plasticity. These lipidic matrixes show potential use for topical applications having acceptable antioxidant and textural properties.

Conducción anestésica perioperatoria en gestante a término con hipertensión pulmonar idiopática / Perioperative anesthetic management in term pregnant women with idiopathic pulmonary hypertension

Introducción: La hipertensión arterial pulmonar es una enfermedad con una baja incidencia en la gestante, aunque trae consigo una alta mortalidad una vez presentada. Un diagnóstico oportuno y un manejo perioperatorio adecuado minimizan el riesgo de desenlace fatal tanto para la madre como el feto. Objetivo: Describir el comportamiento de la hipertensión arterial pulmonar en la gestante a término y su conducción anestésica. Presentación del caso: Paciente de 23 años, antecedentes de salud, edad gestacional de 35.2 semanas. Luego de presentar dolor de espalda y ardor en el pecho relacionado con el esfuerzo, palpitaciones, disnea y bloqueo de rama derecha en electrocardiograma, se ingresa en UTI con sospecha de tromboembolismo pulmonar, el cual queda descartado tras diagnóstico confirmatorio de hipertensión pulmonar después de realizar angio TAC y ecocardiografía. Se decide realizar cesárea programada bajo técnica regional peridural, sin complicaciones tanto para la madre como el niño. Después de 2 días bajo vigilancia intensiva se traslada a su centro hospitalario de cabecera. Conclusiones: La vía del parto, así como una elección adecuada de la técnica anestésica, puede ser la diferencia entre el éxito y la fatalidad. Las técnicas regionales suelen recomendarse por encima de la técnica de anestesia general siempre que no se presenten contraindicaciones(AU)

Introduction: Pulmonary arterial hypertension is a disease with low incidence in the pregnant woman, although it brings about high mortality once presented. Timely diagnosis and adequate perioeprative management minimize the risk of fatal outcome for both mother and fetus. Objective: To describe pulmonary arterial hypertension and its anesthetic management in the term pregnant woman. Case presentation: 23-year-old female patient, with health history and gestational age of 35.2 weeks. After presenting back pain and chest burning associated with exertion, palpitations, dyspnea and right bundle branch block in the electrocardiogram, the patient was admitted to the intensive care unit with suspected pulmonary thromboembolism, which was ruled out due to the confirmatory diagnosis of pulmonary hypertension after performing computerized tomography angiography and echocardiography. Scheduled cesarean section was decided to be perform using the regional peridural technique, without complications for both the mother and the child. After two days under intensive surveillance, she was transferred to her primary hospital. Conclusions: The route of delivery, as well as an adequate choice of the anesthetic technique, can be the difference between success and fatality. Regional techniques are usually recommended over the general anesthesia technique, as long as there are no contraindications(AU)

Evaluation of Antarctic Ozone Profiles derived from OMPS-LP by using Balloon-borne Ozonesondes.

Predicting radiative forcing due to Antarctic stratospheric ozone recovery requires detecting changes in the ozone vertical distribution. In this endeavor, the Limb Profiler of the Ozone Mapping and Profiler Suite (OMPS-LP), aboard the Suomi NPP satellite, has played a key role providing ozone profiles over Antarctica since 2011. Here, we compare ozone profiles derived from OMPS-LP data (version 2.5 algorithm) with balloon-borne ozonesondes launched from 8 Antarctic stations over the period 2012-2020. Comparisons focus on the layer from 12.5 to 27.5 km and include ozone profiles retrieved during the Sudden Stratospheric Warming (SSW) event registered in Spring 2019. We found that, over the period December-January-February-March, the root mean square error (RMSE) tends to be larger (about 20%) in the lower stratosphere (12.5-17.5 km) and smaller (about 10%) within higher layers (17.5-27.5 km). During the ozone hole season (September-October-November), RMSE values rise up to 40% within the layer from 12.5 to 22 km. Nevertheless, relative to balloon-borne measurements, the mean bias error of OMPS-derived Antarctic ozone profiles is generally lower than 0.3 ppmv, regardless of the season.

[Between "knowing and not knowing how to handle alcohol:" Social representations and practices of men and women regarding alcohol consumption in Yucatán]. / Entre "saber y no saber tomar": representaciones y prácticas de varones y mujeres sobre el consumo de alcohol en Yucatán.

This study presents an account of social representations and practices of men and women in a Yucatán municipality regarding the negativity, positivity, and ambivalence over alcohol consumption with respect to their health and social relationships (violent and non-violent), based on the local categories of "knowing how to handle alcohol" and "not knowing how to handle alcohol." This ethnography was conducted within the framework of critical medical anthropology with a relational approach. Fieldwork was carried out over a period of 11 months (2016-2017) in Cuzamá, a municipality in the former henequen-producing area of Yucatán. During this period, the researcher resided in and lived alongside the community. The research was primarily conducted with eight significant actors (four men and four women from 25 to 40 years old), as well as other secondary and tertiary actors, through individual interviews, group interviews, "informal" conversations, and above all participant observation. The results show that in terms of representations, alcohol consumption is primarily discussed from a place of negativity. Although it leads to and is in fact associated with certain health problems, in terms of practices, alcohol consumption is seen as the source of physical, emotional, and relational health benefits. This is evidenced in popular knowledge regarding alcohol consumption, which is characterized by discontinuity and ambivalence more than continuity.

Este trabajo da cuenta de las representaciones y prácticas sociales de varones y mujeres de un municipio de Yucatán, respecto de la negatividad, positividad y ambivalencia del consumo de alcohol en su salud y relaciones sociales (violentas y no violentas), partiendo de las categorías locales del "saber tomar" y el "no saber tomar". La etnografía se desarrolló desde un abordaje de la antropología médica crítica y del enfoque relacional. El trabajo de campo se llevó a cabo durante 11 meses (2016-2017), en Cuzamá, municipio en la zona ex-henequenera de Yucatán (México), tiempo en el que el investigador vivió y convivió en la comunidad. Se trabajó con ocho actores significativos (cuatro varones y cuatro mujeres de 25 a 40 años de edad) y otros secundarios y terciarios, a través de entrevistas individuales, algunas grupales, conversaciones "informales" y, sobre todo, de la observación participante. Los resultados muestran que, a nivel de representaciones, el consumo se enuncia predominantemente desde su negatividad y, si bien se corresponde e incluso se identifica con ciertas afectaciones para la salud, a nivel de las prácticas, el consumo deriva en beneficios para la salud física, emocional y relacional, evidenciándose que los saberes sociales de las personas sobre el consumo de alcohol se caracterizan más por sus discontinuidades y ambivalencias que por sus continuidades.

Rheological, thermal, and microstructural data of lemon essential oil structured with fatty gelators.

Traditionally, oil structuring has been conducted merely in vegetable oils. Alternatively, essential oil structuring provides a great opportunity to develop the topical application of these oils without causing allergic contact dermatitis and improving the sensory properties. The thermal, rheological and microstructure data collection of lipidic matrices produced with representative gelators such as carnauba wax, stearic acid, glyceryl monostearate and hydroxyethyl cellulose in lemon essential oil were carried out by DSC, rheology and phase contrast microscopy measurements. This dataset is valuable to researchers interested in characterizing lipidic matrices produced with several gelators, once incorporated in different topical formulations. These data can be used for quality control of topical formulations having several textural features.

Entre saber y no saber tomar: representaciones y prácticas de varones y mujeres sobre el consumo de alcohol en Yucatán / Between knowing and not knowing how to handle alcohol: Social representations and practices of men and women regarding alcohol consumption in Yucatán

RESUMEN Este trabajo da cuenta de las representaciones y prácticas sociales de varones y mujeres de un municipio de Yucatán, respecto de la negatividad, positividad y ambivalencia del consumo de alcohol en su salud y relaciones sociales (violentas y no violentas), partiendo de las categorías locales del "saber tomar" y el "no saber tomar". La etnografía se desarrolló desde un abordaje de la antropología médica crítica y del enfoque relacional. El trabajo de campo se llevó a cabo durante 11 meses (2016-2017), en Cuzamá, municipio en la zona ex-henequenera de Yucatán (México), tiempo en el que el investigador vivió y convivió en la comunidad. Se trabajó con ocho actores significativos (cuatro varones y cuatro mujeres de 25 a 40 años de edad) y otros secundarios y terciarios, a través de entrevistas individuales, algunas grupales, conversaciones "informales" y, sobre todo, de la observación participante. Los resultados muestran que, a nivel de representaciones, el consumo se enuncia predominantemente desde su negatividad y, si bien se corresponde e incluso se identifica con ciertas afectaciones para la salud, a nivel de las prácticas, el consumo deriva en beneficios para la salud física, emocional y relacional, evidenciándose que los saberes sociales de las personas sobre el consumo de alcohol se caracterizan más por sus discontinuidades y ambivalencias que por sus continuidades.

ABSTRACT This study presents an account of social representations and practices of men and women in a Yucatán municipality regarding the negativity, positivity, and ambivalence over alcohol consumption with respect to their health and social relationships (violent and non-violent), based on the local categories of "knowing how to handle alcohol" and "not knowing how to handle alcohol." This ethnography was conducted within the framework of critical medical anthropology with a relational approach. Fieldwork was carried out over a period of 11 months (2016-2017) in Cuzamá, a municipality in the former henequen-producing area of Yucatán. During this period, the researcher resided in and lived alongside the community. The research was primarily conducted with eight significant actors (four men and four women from 25 to 40 years old), as well as other secondary and tertiary actors, through individual interviews, group interviews, "informal" conversations, and above all participant observation. The results show that in terms of representations, alcohol consumption is primarily discussed from a place of negativity. Although it leads to and is in fact associated with certain health problems, in terms of practices, alcohol consumption is seen as the source of physical, emotional, and relational health benefits. This is evidenced in popular knowledge regarding alcohol consumption, which is characterized by discontinuity and ambivalence more than continuity.

Persistencia de la reemergencia de la rabia canina en el sur del Perú / Persistence of the reemergence of canine rabies in south Peru

En el siglo pasado la rabia canina fue endémica en nuestro país. En la década de los 1990's, el Perú implementó el plan de acción para la eliminación de la rabia urbana por recomendación de la Organización Panamericana de la Salud, logrando un control exitoso de la rabia. Pese a los esfuerzos desplegados, Puno mantuvo focos endémicos persistentes, y en el 2014, Arequipa reportó el primer evento de reintroducción de rabia urbana en Latinoamérica. El brote de rabia se intensificó en los últimos años en Arequipa, Puno y Cusco, con 19 casos de rabia canina el 2015, a 59 casos el 2016, continuando el 2017 con 47 casos, el 2018 con 46, y hasta julio del 2019, 17 casos. Así, hubo reintroducción de la rabia canina, estableciendo una situación de alta endemicidad no controlada. En el presente reporte, abordamos el contexto y persistencia de la reemergencia de la rabia canina en el sur del Perú.

In the last century, canine rabies was endemic in our country. In the 1990s, Peru implemented the action plan for the elimination of urban rabies on the recommendation of the Pan American Health Organization, achieving successful rabies control. Despite the efforts made, Puno maintained persistent endemic foci, and in 2014, Arequipa reported the first event of reintroduction of urban rabies in Latin America. The outbreak of rabies intensified in recent years in Arequipa, Puno and Cusco, with 19 cases of canine rabies in 2015, to 59 cases in 2016, continuing 2017 with 47 cases, 2018 with 46, and until July 2019, 17 cases Thus, there was reintroduction of canine rabies, establishing a situation of uncontrolled high endemicity. In this report, we address the context and persistence of the re-emergence of canine rabies in south Peru.

Elevated synaptic vesicle release probability in synaptophysin/gyrin family quadruple knockouts.

Synaptophysins 1 and 2 and synaptogyrins 1 and 3 constitute a major family of synaptic vesicle membrane proteins. Unlike other widely expressed synaptic vesicle proteins such as vSNAREs and synaptotagmins, the primary function has not been resolved. Here, we report robust elevation in the probability of release of readily releasable vesicles with both high and low release probabilities at a variety of synapse types from knockout mice missing all four family members. Neither the number of readily releasable vesicles, nor the timing of recruitment to the readily releasable pool was affected. The results suggest that family members serve as negative regulators of neurotransmission, acting directly at the level of exocytosis to dampen connection strength selectively when presynaptic action potentials fire at low frequency. The widespread expression suggests that chemical synapses may play a frequency filtering role in biological computation that is more elemental than presently envisioned. Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

iSuRe-Cre is a genetic tool to reliably induce and report Cre-dependent genetic modifications.

Most biomedical research aimed at understanding gene function uses the Cre-Lox system, which consists of the Cre recombinase-dependent deletion of genes containing LoxP sites. This system enables conditional genetic modifications because the expression and activity of the recombinase Cre/CreERT2 can be regulated in space by tissue-specific promoters and in time by the ligand tamoxifen. Since the precise Cre-Lox recombination event is invisible, methods were developed to report Cre activity and are widely used. However, numerous studies have shown that expression of a given Cre activity reporter cannot be assumed to indicate deletion of other LoxP-flanked genes of interest. Here, we report the generation of an inducible dual reporter-Cre mouse allele, iSuRe-Cre. By significantly increasing Cre activity in reporter-expressing cells, iSuRe-Cre provides certainty that these cells have completely recombined floxed alleles. This genetic tool increases the ease, efficiency, and reliability of conditional mutagenesis and gene function analysis.

Dual ifgMosaic: A Versatile Method for Multispectral and Combinatorial Mosaic Gene-Function Analysis.

Improved methods for manipulating and analyzing gene function have provided a better understanding of how genes work during organ development and disease. Inducible functional genetic mosaics can be extraordinarily useful in the study of biological systems; however, this experimental approach is still rarely used in vertebrates. This is mainly due to technical difficulties in the assembly of large DNA constructs carrying multiple genes and regulatory elements and their targeting to the genome. In addition, mosaic phenotypic analysis, unlike classical single gene-function analysis, requires clear labeling and detection of multiple cell clones in the same tissue. Here, we describe several methods for the rapid generation of transgenic or gene-targeted mice and embryonic stem (ES) cell lines containing all the necessary elements for inducible, fluorescent, and functional genetic mosaic (ifgMosaic) analysis. This technology enables the interrogation of multiple and combinatorial gene function with high temporal and cellular resolution.

Asociación de los polimorfismos genéticos de la enzima convertidora de la angiotensina con lupus eritematoso sistémico en pacientes lúpicos bolivianos / Association of angiotensin converting enzyme genetic polymorphisms with systemic lupus erythematosus in bolivian lupus patients

El Lupus Eritematoso Sistémico (LES) es una enfermedad autoinmune sistémica que afecta a diferentes órganos especialmente al riñón. Un gran número de estudios genéticos en diferentes grupos poblacionales han reportado asociaciones entre el polimorfismo en el intrón 16 del gen que codifica la enzima convertidora de la angiotensina (ECA) con la susceptibilidad a LES y a sus manifestaciones clínicas en particular a la nefropatía lúpica. El presente estudio pretende asociar el polimorfismo genotípico y alélico inserción/deleción (I/D) del gen ECA en pacientes bolivianos con susceptibilidad a LES y a las manifestaciones clínicas que presenta el paciente. Se incluyeron 87 pacientes lúpicos que cumplían con al menos cuatro criterios clínicos de la Sociedad Americana de Reumatología y 85 controles sanos. Todos los participantes dieron su consentimiento informado para participar en el estudio. Se detectaron los polimorfismos alélicos y genotípicos ECA I/I, I/D y D/D mediante la Reacción en Cadena de la Polimerasa (PCR). La frecuencia genotípica I/I, I/D y D/D en los pacientes lúpicos era 47.1, 48.3 y 4.6%; en el grupo control era 68.2, 31.8 y 0% respectivamente. En lúpicos la frecuencia alélica era del 71.3 y 28,7%; en controles 84.1 y 15.9% para los alelos I y D respectivamente. Se evidenció que el alelo inserción y sus variantes genotípicas I/I e I/D está sistemáticamente asociado con riesgo al desarrollo de complicaciones clínicas dermatológicas, osteomusculares o hematológicas. En el caso de nefropatía lúpica el alelo inserción es un factor de protección. El polimorfismo estudiado del gen ECA no mostro asociación de riesgo o protección con manifestaciones cardiopulmonares ni neurológicas.

Systemic Lupus Erythematosus (SLE) a systemic autoimmune disease, affects different organs, being kidneys the most frequently affected. Many studies in different population groups have reported associations between the intron 16 of the gene encoding angiotensin converting enzyme (ACE) polymorphism and SLE susceptibility and its clinical manifestations, in particular lupus nephritis. Associate genotypic and allelic insertion/deletion (I/D) of the ACE gene polymorphism in SLE patient's susceptibility and the clinical manifestations were the aims of the present study. 87 lupus patients who met at least four clinical criteria of the American Society of Rheumatology and 85 healthy controls where included. All participants gave their informed consent to participate in the study. Allelic and genotypic ACE I/I, I/D and D/D polymorphisms were detected by polymerase chain reaction (PCR). In patients s with SLE, the genotypic frequency of I/I, I/D and D/D were 47.1, 48.3 and 4.6%; and 68.2, 31.8 and 0% in control group respectively. Allele frequency in SLE represent: Insertion 71.3%, Deletion 28.7% and Insertion 84.1%, Deletion 15.9% in control group. Allele and genotypic variants I/I and I/D of the insertion allele were associated systematically with risk to dermatological, musculoskeletal and hematologic complications. Regarding lupus nephritis allele insertion is a protective factor. ACE gene polymorphism here studied has not been associated to risk or protection with cardiopulmonary or neurological clinical manifestations.

Hernia diafragmática congénita en un niño de 12 años. Reporte de caso / Congenital diaphragmatic hernia in a boy of 12 years-old. Case report

Fundamento: La hernia diafragmática congénita con debut tardío es una anomalía congénita rara, la cual se diagnostica ante una amplia gama y grados diversos de presentación sintomática, o como hallazgos radiológicos, lo que puede llevar a errores diagnósticos y fracasos terapéuticos. Objetivo: Mostrar un caso de presentación tardía de hernia diafragmática congénita dada la importancia de tenerla presente para los posibles diagnósticos a esa edad. Presentación de caso: Niño de 12 años de edad que llegó al cuerpo de guardia con disfagia y disnea progresiva de tres días de evolución. Se realizó rayos X donde se le diagnosticó la enfermedad, se operó y tuvo una evolución satisfactoria. Conclusiones: La identificación oportuna de la afección permitió el éxito del tratamiento y la recuperación(AU)

Background: The Congenital diaphragmatic hernia with late premiere is a strange congenital anomaly, which is diagnosed before a wide range and diverse grades of symptomatic presentation, or as radiological discoveries, what can take to diagnostic errors and therapeutic failures. Objective: To show a case of late presentation of congenital diaphragmatic hernia given the importance of having it present for the possible diagnoses to that age. Case presentation: A 12 years-old boy that arrived to guard's body with dysphagia and progressive dyspnea of three days of evolution. He was carried out X rays where he was diagnosed the illness, he was operated and he had a satisfactory evolution. Conclusions: The opportune identification of the affection allowed the success of the treatment and the recovery(AU)

Hernia diafragmática congénita en un niño de 12 años. Reporte de caso / Congenital diaphragmatic hernia in a boy of 12 years-old. Case report

Fundamento: La hernia diafragmática congénita con debut tardío es una anomalía congénita rara, la cual se diagnostica ante una amplia gama y grados diversos de presentación sintomática, o como hallazgos radiológicos, lo que puede llevar a errores diagnósticos y fracasos terapéuticos. Objetivo: Mostrar un caso de presentación tardía de hernia diafragmática congénita dada la importancia de tenerla presente para los posibles diagnósticos a esa edad. Presentación de caso: Niño de 12 años de edad que llegó al cuerpo de guardia con disfagia y disnea progresiva de tres días de evolución. Se realizó rayos X donde se le diagnosticó la enfermedad, se operó y tuvo una evolución satisfactoria. Conclusiones: La identificación oportuna de la afección permitió el éxito del tratamiento y la recuperación.

Background: The Congenital diaphragmatic hernia with late premiere is a strange congenital anomaly, which is diagnosed before a wide range and diverse grades of symptomatic presentation, or as radiological discoveries, what can take to diagnostic errors and therapeutic failures. Objective: To show a case of late presentation of congenital diaphragmatic hernia given the importance of having it present for the possible diagnoses to that age. Case presentation: A 12 years-old boy that arrived to guard's body with dysphagia and progressive dyspnea of three days of evolution. He was carried out X rays where he was diagnosed the illness, he was operated and he had a satisfactory evolution. Conclusions: The opportune identification of the affection allowed the success of the treatment and the recovery.

Clinical Report: Cognitive decline in a patient with Cardiofaciocutaneous syndrome.

Cardiofaciocutaneous Syndrome (CFCS) is a rare genetic syndrome caused by mutations in one of four genes: BRAF, MAP2K1, MAP2K2, and KRAS. There is tremendous phenotypic heterogeneity in patients with CFCS and so confirmation of diagnosis requires genetic testing. Neurologic and/or cognitive symptoms are present in almost all CFCS individuals. Little is known about cognitive function in older patients with CFCS. In this report, we present the cognitive, neuropsychiatric, and imaging findings of a patient diagnosed with CFCS who after having remained stable developed progressive cognitive/behavioral and motor decline.

Assessing behavioral syndromes in patients with brain tumors using the frontal systems behavior scale (FrSBe).

BACKGROUND: Personality changes following brain tumors may be due to disruption of frontal-subcortical networks. The relation between personality changes and tumor parameters such as volumes of the surgical cavity, residual tumor, or nonspecific white matter abnormalities is unknown. In this study we examined the relation between these tumor parameters and abnormal behaviors typically associated with frontal lobe dysfunction. METHODS: Thirty-one patients with intracranial tumors who completed the Frontal Systems Behavior Scale (FrSBe) during clinical neuropsychological assessment and had a solitary, well-delimited brain lesion on MRI within 3 months of that assessment were included. Tumor parameters were manually segmented using OsiriX. Nonparametric statistics were used to determine the relationship between tumor parameters and frontal behavioral dysfunction as measured by FrSBe scores. RESULTS: Patients reported significantly more behavior problems after tumor diagnosis. Tumor cavity volume was correlated with self-reported Executive Dysfunction (rho = 0.450, P = .047), and there was a trend in the relationship with self-reported Apathy (rho = 0.438, P = .053). Nonspecific white matter abnormality volume was also correlated with self-reported Apathy (rho = 0.810, P = .01). There were no correlations between FrSBe scores and residual tumor volume or summed volumes of tumor-related parameters. CONCLUSION: Our results suggest that tumor parameters have differential effects on behaviors associated with frontal-subcortical networks and corroborate the high frequency of behavioral dysfunction in brain tumor patients. Examination of these relationships in a prospective trial is warranted to establish incidence, prevalence, risk factors, and consequences of behavioral disturbances in brain tumor patients.

Proposal for a modification of the UVI risk scale.

The standardisation of UV information to the public through the UV Index (UVI) has been hugely beneficial since its endorsement by multiple international agencies more than 10 years ago. It has now gained widespread acceptance, and UVI values are available throughout the world from satellite instruments, ground-based measurements, and from forecasts based on model calculations. These have been useful for atmospheric scientists, health professionals (skin and eye specialists), and the general public. But the descriptors and health messages associated with the UVI scale are targeted towards European skin types and UV regimes, and are not directly applicable to the population living closer to the equator, especially for those in the high-altitude Altiplano region of South America. This document arose from discussions at the Latin American Society of Photobiology and Photomedicine's Congress, which was held in Arequipa, Peru, in November 2013. A major outcome of the meeting was the Arequipa Accord, which is intended as a unifying document to ensure co-ordination of UV and health research decisions in Latin America. A plank of that agreement was the need to tailor the UVI scale to make it more relevant to the region and its population. Here we make some suggestions to improve the international applicability of the UVI scale.

UV index values and trends in Santiago, Chile (33.5°S) based on ground and satellite data.

We report on the surface UV index (UVI) variations in Santiago (Chile) a city with high air pollution and complex surrounding topography. Ground-based UV measurements were continuously carried out between January 1995 and December 2011, by using a multi-channel filter radiometer (PUV-510). Ground-based measurements and satellite-derived data retrieved from the Total Ozone Mapping Spectrometer (TOMS), the Ozone Monitoring Instrument (OMI), and the Scanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY), were compared. We found that satellite-derived UVI products largely overestimate surface UVI. Our ground-based UVI measurements were significantly lower than TOMS-derived UVI data: (46.1±6.3)% (in the period 1997-2003), and OMI-derived UVI data: (47.0±6.3)% (in the period 2005-2007). Clear-sky SCIAMACHY-derived UVI were found to be also nearly systematically greater than ground-based UVI measurements in the period 2002-2011. An exceptionally long period of clear skies between December 2010 and January 2011 was used to test further satellite-derived UVI data; in the whole period, OMI and SCIAMACHY data were 53.1% and 38.3% greater than our ground-based measurements, respectively. These differences are presumably due to aerosol load associated with the local pollution and the complex topography surrounding Santiago. In addition, linear regression allowed us to estimate trends that we use for forecasting. Methodological details are provided below.