Individual differences in behaviour are related to metabolism, stress response, testosterone, and immunity in the subterranean rodent Ctenomys talarum.

The growth of personality research has led to the integration of consistent variation of individual behaviour in multidimensional approaches including physiological variables, which are required to continue building a more comprehensive theory about coping strategies. In this study, we used wild-caught males of Ctenomys talarum (tuco-tucos), a solitary subterranean rodent, to assess the relationships among personality traits and several physiological variables, namely stress response, testosterone, immunity, and energy metabolism. Subjects (n = 21) were used in experimental tests assessing behaviour, energy metabolism, testosterone levels, inflammatory cell-mediated and humoral immunity, and stress response to a simulated predator attack. The structural equation model explained a moderate portion of the variance of personality behaviours related to activity (52%), boldness (35%), and socioaversion (30%). More active and bold individuals showed higher oxygen consumption. While those subjects had lower baseline cortisol levels, there was no relationship between cortisol levels of the stress-induced response. Cell-mediated immune response was related to activity levels. Finally, testosterone only affected boldness. Despite some of these relationships diverge in direction to predicted ones, overall they support the existence of coping styles in male C. talarum; and are discussed in the light of current hypotheses and particular behavioural and ecological traits of tuco-tucos.

Relationship among vegetation structure and mixed-species flocks composition along the latitudinal gradient of the subtropical montane forest of the Yungas, Argentina.

The structural and physiognomic characteristics of forests and mountain forest are fundamental aspects that influence the richness, abundance and composition in the bird community. The objective of the present work was to analyse how the vegetation structure could influence the species composition of mixed-species flocks (MSF), along the latitudinal gradient of the subtropical montane forest of the Yungas of Argentina. Eight sites were studied along the 700 km of distribution of the Argentine Yungas. Richness and abundance of MSF were determined. In addition, different variables of composition and structure of the vegetation were analysed. Multivariate analysis indicated that vertical strata coverage and litter depth were the main variables associated with changes in the species composition of MSF along the gradient. Variation in MSF composition within the Yungas was associated with the physiognomy of the subtropical montane forest, which could indicate that it is strongly linked to the condition of the local vegetation. Substantial changes in vegetation could drastically change the composition of the resident flocks. This article is part of the theme issue 'Mixed-species groups and aggregations: shaping ecological and behavioural patterns and processes'.

Are birds more afraid in urban parks or cemeteries? A Latin American study contrasts with results from Europe.

The escape behaviour, measured as flight initiation distance (FID; the distance at which individuals take flight when approached by a potential predator, usually a human in the study systems), is a measure widely used to study fearfulness and risk-taking in animals. Previous studies have shown significant differences in the escape behaviour of birds inhabiting cemeteries and urban parks in European cities, where birds seem to be shyer in the latter. We collected a regional dataset of the FID of birds inhabiting cemeteries and parks across Latin America in peri-urban, suburban and urban parks and cemeteries. FIDs were recorded for eighty-one bird species. Mean species-specific FIDs ranged from 1.9 to 19.7 m for species with at least two observations (fifty-seven species). Using Bayesian regression modelling and controlling for the phylogenetic relatedness of the FID among bird species and city and country, we found that, in contrast to a recent publication from Europe, birds escape earlier in cemeteries than parks in the studied Latin American cities. FIDs were also significantly shorter in urban areas than in peri-urban areas and in areas with higher human density. Our results indicate that some idiosyncratic patterns in animal fearfulness towards humans may emerge among different geographic regions, highlighting difficulties with scaling up and application of regional findings to other ecosystems and world regions. Such differences could be associated with intrinsic differences between the pool of bird species from temperate European and mostly tropical Latin American cities, characterized by different evolutionary histories, but also with differences in the historical process of urbanization.

Juvenile Xanthogranuloma as Differential Diagnosis of a Vulvar Mass: A Case Report.

Vulvar masses in children are an unusual finding but their differential diagnosis is extensive. In case of solid masses, rhabdomyosarcoma (RMS) must always be considered due to the fact that it is the most common tumor in external genitals during childhood. However, RMS has a radiological appearance very similar to juvenile xanthogranuloma (JXG). We present a 16-month-old girl with a 2 cm solid mass on her left labia majora, with four overlying cutaneous papules. After imaging tests, an excisional biopsy was programmed due to high malignancy suspicion. Histopathology of the mass and one of the papules was diagnostic for JXG. After a 12-month follow-up, the patient shows no signs of relapse or complication. Deep JXG is an uncommon entity in childhood and exceptional in the genital area. Therefore, it must be included in the differential diagnosis of a solid vulvar mass, especially if accompanying yellowish xanthomatous cutaneous lesions are present.

Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula: An ARM-Net consortium study.

BACKGROUND: Outcome of patients operated for anorectal malformation (ARM) type rectovestibular fistula (RVF) is generally considered to be good. However, large multi-center studies are scarce, mostly describing pooled outcome of different ARM-types, in adult patients. Therefore, counseling parents concerning the bowel function at early age is challenging. Aim of this study was to evaluate bowel function of RVF-patients at preschool/early childhood age and determine risk factors for poor functional outcome. METHODS: A multi-center cohort study was performed. Patient characteristics, associated anomalies, sacral ratio, surgical procedures, post-reconstructive complications, one-year constipation, and Bowel Function Score (BFS) at 4-7 years of follow-up were registered. Groups with below normal (BFS < 17; subgroups 'poor' ≤ 11, and 'fair' 11 < BFS < 17) and good outcome (BFS ≥ 17) were formed. Univariable analyses were performed to detect risk factors for outcome. RESULTS: The study included 111 RVF-patients. Median BFS was 16 (range 6-20). The 'below normal' group consisted of 61 patients (55.0%). Overall, we reported soiling, fecal accidents, and constipation in 64.9%, 35.1% and 70.3%, respectively. Bowel management was performed in 23.4% of patients. Risk factors for poor outcome were tethered cord and low sacral ratio, while sacral anomalies, low sacral ratio, prior enterostomy, post-reconstructive complications, and one-year constipation were for being on bowel management. CONCLUSIONS: Although median BFS at 4-7 year follow-up is nearly normal, the majority of patients suffers from some degree of soiling and constipation, and almost 25% needs bowel management. Several factors were associated with poor bowel function outcome and bowel management. LEVEL OF EVIDENCE: Level III.

Urological Impact of Epididymo-orchitis in Patients with Anorectal Malformation: An ARM-Net Consortium Study.

INTRODUCTION: To investigate the current experience of the ARM-Net Consortium in the management of epididymo-orchitis (EO) in patients with anorectal malformations (ARMs), and to identify specific risk factors and the need for urological care involvement. MATERIALS AND METHODS: We retrospectively collected data of EO in patients with ARM between 2015 and 2019. Data on urological aspects, ARM type, surgical approach, associated anomalies, diagnosis, and treatment of EO were collected and analyzed. RESULTS: Twenty-nine patients were reported by 12 centers. Twenty-six patients with EO (90%) had ARM with a rectourinary fistula. Median age at first EO was 2 years (range: 15 days-27 years). Twenty patients (69%) experienced multiple EO, and 60% of recurrences were ipsilateral. Associated urological anomalies included vesicoureteral reflux (48%), urethral anomalies (41%), neurogenic bladder (41%), and ectopic vas (10%). A positive urine culture during EO was present in 69%. EO was treated with antibiotics (90%), limiting surgical exploration to 14%. Prevention of recurrences included surgery (bulking agents 15%, vasectomy 15%, and orchiectomy 5%) and antibiotic prophylaxis (20%). CONCLUSION: Urologists may encounter patients with EO in ARM patients, frequently with positive urine culture. An appropriate urologic work-up for most ARM patients is necessary to identify and treat underlying risk factors. A practical scheme for the work-up is suggested for a close collaboration between pediatric surgeons and urologists.

Neonatal Fournier's Gangrene: Avoiding Extensive Debridement.

Fournier's gangrene is a necrotizing fasciitis of the scrotal and inguinal region, associating high mortality and complication rates. It is extremely rare in the neonatal period and may be life threatening. We present an exceptional case of a 24-day-old boy who consulted to the emergency department for fever (39 °C) and an indurated, fluctuating and painful erythema in both groins, left hemiscrotum, left anterior femoral region and perineum for the last 6 hours. Blood analysis showed increased acute phase reactants without leukocytosis. Ultrasound revealed significant soft-tissue involvement. Due to high clinical suspicion and hemodynamic instability (tachycardia and prolonged capillary filling), urgent fasciotomy, placement of Penrose drains and intensive irrigation was performed. Wound care with irrigations was performed 3 times a day. During the 12 days neonatal intensive care unit admission, he required hemodynamic support and orotracheal intubation and sedation for pain control. Broad-spectrum antibiotic therapy (with cefotaxime, clindamycin and cloxacillin) was administered for 2 weeks. Ampicillin-sensitive Streptococcus pyogenes (Group A) was isolated in blood culture at 4th day of admission allowing antibiotic de-escalation. He was discharged on postoperative day 24. He has minimal, inconspicuous scars and no functional sequelae. Fever in neonates requires close observation considering the use of empirical broad-spectrum antibiotics and hospitalization. Early diagnosis, prompt surgical management and broad-spectrum antibiotic therapy are essential to prevent complication. Early fasciotomy with intensive irrigation and close survey may avoid extensive skin debridement.

Management and results of thyroidectomies in pediatric patients with MEN 2 syndrome.

AIM OF THE STUDY: To evaluate the outcome of prophylactic thyroidectomies (PT) in patients with MEN 2 syndrome in a tertiary center. METHODS: A retrospective study was designed, including all patients with MEN 2 syndrome who underwent PT between 2000 and 2019. Demographics, gene mutation, postoperative complications and histopathological findings were registered. MAIN RESULTS: 30 patients were included (29 MEN 2A and 1 MEN 2B) with a median age at surgery time of 7.0 ± 3.2 years. Familiar history was present in all but 3 patients. A therapeutic thyroidectomy was performed in 2 patients due to evidence of medullary thyroid carcinoma (MTC, both were late diagnosis), and in the other 28 cases, a PT was performed. 8 patients had a RET mutation ranked as Moderate Risk (American Thyroid Association): median age at surgery was 7.2 ± 4.2 years, and histological findings were C-cell hyperplasia (n = 6) and no alterations (n = 2). 16 patients had a high risk mutation; median age at surgery time was 6.9 ± 2.8 years and histological findings were normal thyroid gland (n = 1), C Cell Hyperplasia (n = 8), microcarcinoma (n = 6), and MTC (n = 1). The mean hospital stay was 1.4 ± 0.68 days. No intraoperative complications or recurrent laryngeal nerve injuries were registered. 7 patients presented a transient hypoparathyroidism and 1 patient had permanent hypoparathyroidism. CONCLUSIONS: Early PT in patients with MEN 2 syndrome is a safe procedure when performed by an experienced team of Pediatric Surgeons and with a multidisciplinary approach. Early genetic analysis and familial counselling is essential to prevent the development of a MTC.

Complications of Central Venous Access Devices in Patients With Sickle Cell Disease and Thalassemia Major.

Pediatric patients with sickle cell disease and thalassemia major present clinical characteristics that could lead to a higher incidence of central venous access devices-associated complications (CVAD-C). With the objective of analyzing the safety of the use of CVAD in these patients, a retrospective review including all pediatric patients with these pathologies who required the implantation of a CVAD between 2004 and 2019 was performed. In all, 54 patients with 100 CVAD (65 totally implantable venous access port with subcutaneous reservoir, 35 single-lumen or double-lumen partially tunneled catheter) were included. During 60,410 days at risk of suffering a CVAD-C, 55 complications (complication rate [CR]/1000 catheter-days at risk=0.91) were reported in 46 CVAD: 19 mechanicals (CR=0.32), 32 infectious (CR=0.53), and 4 thrombotic complications (CR=0.066). Incidence of mechanical and infectious complications was significantly higher in double-lumen partially tunneled catheter than in totally implantable venous access port with subcutaneous reservoir (P<0.001). Lower age at insertion was related with a higher incidence of any complication (odds ratio=0.88/y, P=0.02). Patients who required a stem cell transplantation (31 patients and 65 CVAD) had no significant higher incidences of CVAD-C. In conclusion, our study supports the safety of using CVAD in these patients, with a low incidence of infectious, thrombotic, and mechanical complications.

Inter- and Intraobserver Variation in the Assessment of Preoperative Colostograms in Male Anorectal Malformations: An ARM-Net Consortium Survey.

Aim: Male patients with anorectal malformations (ARM) are classified according to presence and level of the recto-urinary fistula. This is traditionally established by a preoperative high-pressure distal colostogram that may be variably interpreted by different surgeons. The aim of this study was to evaluate the inter- and intraobserver variation in the assessment by pediatric surgeons of preoperative colostograms with respect to the level of the recto-urinary fistula. Materials and Methods: Sixteen pediatric surgeons from 14 European centers belonging to the ARM-Net Consortium twice scored 130 images of distal colostograms taken in sagittal projection at a median age of 66 days of life (range: 4-1,106 days). Surgeons were asked to classify the fistula in bulbar, prostatic, bladder-neck, no fistula, and "unclear anatomy" example. Their assessments were compared with the intraoperative findings (kappa) for two scoring rounds with an interval of 6 months (intraobserver variation). Agreement among the surgeons' scores (interobserver variation) was also calculated using Krippendorff's alpha. A kappa over 0.75 is considered excellent, between 0.40 and 0.75 fair to good, and below 0.40 poor. Surgeons were asked to score the images in "poor" and "good" quality and to provide their years of experience in ARM treatment. Results: Agreement between the image-based rating of surgeons and the intraoperative findings ranges from 0.06 to 0.45 (mean 0.31). Interobserver variation is higher (Krippendorff's alpha between 0.40 and 0.45). Years of experience in ARM treatment does not seem to influence the scoring. The mean intraobserver variation between the two rounds is 0.64. Overall, the quality of the images is considered poor. Images categorized as having a good quality result in a statistically significant higher kappa (mean: 0.36 and 0.37 in the first and second round, respectively) than in the group of bad-quality images (mean: 0.25 and 0.23, respectively). Conclusions: There is poor agreement among experienced pediatric colorectal surgeons on preoperative colostograms. Techniques and analyses of images need to be improved in order to generate a homogeneous series of patients and make comparison of outcomes reliable.

Perineal Groove: An Anorectal Malformation Network, Consortium Study.

OBJECTIVE: To review the Anorectal Malformation Network experience with perineal groove (PG) focusing on its clinical characteristics and management. STUDY DESIGN: Data on patients with PG managed at 10 participating Anorectal Malformation Network centers in 1999-2019 were collected retrospectively by questionnaire. RESULTS: The cohort included 66 patients (65 females) of median age 1.4 months at diagnosis. The leading referral diagnosis was anal fissure (n = 20 [30.3%]): 23 patients (34.8%) had anorectal malformations. Expectant management was practiced in 47 patients (71.2%). Eight (17%) were eventually operated for local complications. The median time to surgery was 14 months (range, 3.0-48.6 months), and the median age at surgery was 18.3 months (range, 4.8-58.0 months). In the 35 patients available for follow-up of the remaining 39 managed expectantly, 23 (65.7%) showed complete or near-complete self-epithelization by a mean age 15.3 months (range, 1-72 months) and 4 (11.4%) showed partial self-epithelization by a mean age 21 months (range, 3-48 months). Eight patients showed no resolution (5 were followed for ≤3 months). Nineteen patients (28.7%) were primarily treated with surgery. In total, 27 patients were operated. Dehiscence occurred in 3 of 27 operated patients (11.1%). CONCLUSIONS: PG seems to be an underestimated anomaly, frequently associated with anorectal malformations. Most cases heal spontaneously; therefore, expectant management is recommended. When associated with anorectal malformations requiring reconstruction, PG should be excised in conjunction with the anorectoplasty.

Personality underground: evidence of behavioral types in the solitary subterranean rodent Ctenomys talarum.

BACKGROUND: Animal personalities have been studied in a wide variety of taxa, but among rodents, available studies are relatively scarce and have focused mainly on social species. In this study, we evaluated the existence of personality in the solitary subterranean rodent Ctenomys talarum. Specifically, we aimed to test individual differences in behavior that are stable over time and context in males of C. talarum captured in the wild. METHODS: Our experimental design included two series of three behavioral tests each, carried out with a 35 day time interval. Each series included an Open Field test, a Social Encounter test, and an Open Field test with a predator stimulus. RESULTS: Of the total recorded behaviors, 55.55% showed temporal consistency. Principal component analysis of consistent behaviors grouped them into four dimensions that explain inter individual behavioral variability, in order of importance: activity, socioaversion, boldness and exploration. Therefore, our results suggest that the concept of animal personality is applicable to C. talarum and the dimensions found are in accordance with the ecological and behavioral characteristics of this species.

Gynecological anomalies in patients with anorectal malformations.

PURPOSE: The association of gynecological anomalies in all anorectal malformations (ARM) is firmly established. Our goal is to study this pathology in our patients to focus attention to this important issue. METHODS: Retrospective study of female patients operated for ARM and who underwent magnetic resonance imaging in our center. The type of malformation, the presence and type of vaginal, uterine, tubaric and urological anomalies were studied. RESULTS: 63 patients were included: 34.9% cloaca, 28.6% vestibular and 12.7% perineal. Half of patients had some type of müllerian anomaly; 19 vaginal, most frequent being the longitudinal vaginal septum (66.7%); 30 had uterine alterations, most frequent being the uterus didelphys (60%). Eighty percent of patients with complex ARM (cloaca, exstrophy) presented some type of gynecological malformation compared to 21.8% found in simple ARM (stenosis, perineal, vestibular) (p < 0.001). Vaginal anomalies are associated with a uterine anomaly in 100% of cases. Conversely, patients with uterine anomalies have concurrent vaginal anomaly in 63.3% of cases. CONCLUSION: Screening for gynecological anomalies is indicated in all patients with ARM. We recommend a vaginal examination in any girl with ARM during definitive repair and a subsequent MRI during follow-up. Collaboration with a gynecologist is essential.

Digital thoracic drainage: a new system to monitor air leaks in pediatric population.

INTRODUCTION: New digital thoracic drainage systems allow an objective measurement of air leakage. They have proven their usefulness in the postoperative thoracic surgery in adults, but there is little experience with its use in the pediatric population. The objective of our study is to analyze their safety and effectiveness in the postoperative period of the pediatric patients. METHOD: A prospective consecutive observational study was done. All patients submitted to pulmonary resection between 2011 and 2017 and in whom digital thoracic drainage system was used (Thopaz Chest Drain System, Medela, Switzerland) were prospectively enrolled in this study. We analyzed variables: duration of chest tube (CT), days of hospitalization and radiographs in the immediate postoperative period related to the presence of CT. This group was compared with a historical cohort of patients (from 2011 to 2015) with a pulmonary resection in whom the traditional thoracic drainage was used. For the statistical analysis, the Mann-Whitney U-Test was used for independent samples. RESULT: Twenty-six patients were included, Digital drainage system was used in13 patients and traditional drainage was used in 13 patients. The median age was 18 months (12 days-14 years). The mean number of days with the chest tube was 1.69 ±â€¯0.6 in digital drainage group versus 5.38 ±â€¯4 days in traditional drainage group (p < 0.05) The mean number of postoperative radiographs was 2.8 ±â€¯1.1 in digital drainage group versus 6.23 ±â€¯5.2 radiographs in traditional drainage group (p < 0.05). The average hospital stay in digital drainage group was 5.69 ±â€¯2.7 days versus 7 ±â€¯4.7 days in the traditional drainage group (p > 0.05). No complications related to the use of digital drainage group were registered. CONCLUSION: The digital thoracic drainage systems provide an objective measurement of air leakage, allowing early chest tube removal and decreasing the number of radiographs performed postoperatively. Its use in the pediatric population appears to be safe and potentially beneficial. LEVEL OF EVIDENCE: II.

Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium.

PURPOSE: The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers. METHODS: A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium. RESULTS: Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%). CONCLUSIONS: Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.

Endourological management in a newborn with incomplete bladder duplication.

We report an unusual case of a newborn with incomplete bladder duplication and a complete sagittal septum. This malformation was associated with dysplasia of the right kidney, right cryptorchidism, single urethra, and no other genital or gastrointestinal anomalies. At birth, we found severe ureterohydronephrosis in a solitary left kidney caused by the collapse of the left bladder when the right bladder was filled. We performed a neonatal puncture of the bladder septum. At 3 months of life, the patient underwent complete resection of the septum by cystoscopy with monopolar electrocautery. There are no previously reported cases of a newborn with obstructed uropathy. This is the first reported case of incomplete bladder duplication with endourological management.

When allowed, females prefer novel males in the polygynous subterranean rodent Ctenomys talarum (tuco-tuco).

The ability to recognize familiar conspecifics plays an important role at the time of choosing a mating partner in rodents. A laboratory study using preference test was used in order to test the hypothesis that, in the polygynous subterranean rodent Ctenomys talarum, females prefer novel males when offered two odors, or individuals (one familiar and one novel) limited in their movements so that male aggression is prevented. Our findings show that females prefer novel tuco-tucos at three levels of male assessment: odor samples (consisting of shavings soiled with urine, feces, and presumably, other body secretions collected from the male home cage), confined males behind a wire mesh, and full contact with tethered males. Previous studies of this species demonstrated that in the wild, male-male competition and male coercion severely limit the possibility of females mating non-neighbors, i.e. novel males. Females mating neighbors to whom they are familiarized, obtain high quality mating since they are territorial, highly competitive males. Nonetheless, when females have the opportunity, as shown in the two-choice experiments, they choose novel males, probably benefiting their progeny from novel genetic combinations. Hence, combining evidence from laboratory and field studies in C. talarum, it is possible to better understand female preferences in modeling individual reproductive strategies.

Hiperplasia angiolinfoide con eosinofilia. Presentación de un caso y revisión de la literatura / Angiolinfoide hyperplasia with eosinophilia. Report a case and literature review

Presentamos paciente femenina de 30 años de edad con tumoración supraclavicular izquierda recidivante, de tres años de evolución. Asintomática, se obtiene el diagnóstico de Hiperplasia Angiolinfoide con Eosinofilia (HALE) en la tercera ocasión que se realiza biopsia del sitio afectado. Los estudios hematológicos, hemoquímicos, serológicos y por imágenes fueron normales. Se realiza exéresis completa de la lesión como diagnóstico y tratamiento, evolucionando fa- vorablemente. Se revisan los mecanimos patogénicos y el diagnóstico diferencial de esta entidad.

Hiperplasia angiolinfoide con eosinofilia. Presentación de un caso y revisión de la literatura / Angiolinfoide hyperplasia with eosinophilia. Report a case and literature review

Presentamos paciente femenina de 30 años de edad con tumoración supraclavicular izquierda recidivante, de tres años de evolución. Asintomática, se obtiene el diagnóstico de Hiperplasia Angiolinfoide con Eosinofilia (HALE) en la tercera ocasión que se realiza biopsia del sitio afectado. Los estudios hematológicos, hemoquímicos, serológicos y por imágenes fueron normales. Se realiza exéresis completa de la lesión como diagnóstico y tratamiento, evolucionando fa- vorablemente. Se revisan los mecanimos patogénicos y el diagnóstico diferencial de esta entidad.(AU)