Transfer of trace organic compounds in an operational soil-aquifer treatment system assessed through an intrinsic tracer test and transport modelling.

Soil Aquifer Treatment (SAT) can provide supplementary treatment of trace organic compounds (TrOCs) such as pharmaceutical and industrial compounds present in Secondary Treated Wastewater (STWW). Concern on presence of unregulated TrOCs in natural systems has raised recently as well as the interest in SAT systems for remediation. The present study quantifies, at the field scale over35 m of lateral groundwater flow, the effectiveness of the Agon-Coutainville SAT system (Manche, Normandy, France) for TrOCs removal by sorption and biodegradation through monitoring of seven TrOCs (oxazepam, carbamazepine, benzotriazole, tolyltriazole, caffein, paracetamol, ibuprofen) and major inorganic compounds as intrinsic tracers in STWW and groundwater during a 34-day STWW infiltration experiment during operational use of the SAT. Cationic exchanges and mixing between groundwater and STWW during the experiment were highlighted by major ions and geochemical simulations. Due to the low thickness of the unsaturated zone, a 1D analytical solution of the advection-dispersion equation (ADE) was applied on chloride data. Chloride was used as conservative intrinsic tracer to calibrate the horizontal flow and transport parameters such as the aquifer dispersion coefficient (D) and the average pore water velocity (ν) allowing estimation of the groundwater residence time. Transport and attenuation of the TrOCs were simulated assuming first-order degradation constant (µ) and linear retardation coefficient (R), calibrated to simulate the observed temporal changes in the breakthrough of TrOCs. Sorption was found to play a role in the transport of TrOCs, notably for oxazepam with a higher linear retardation coefficient value of 2.2, whereas no significant differences of retardation were observed for carbamazepine, tolyltriazole, benzotriazole (1.37, 1.35, 1.36 respectively). Estimated first order degradation rate constants, between 0.03d-1 for carbamazepine and 0.09d-1 for tolyltriazole, were generally high compared to the literature, possibly due to favourable redox conditions and important microbial activities within the system. This study provides evidence of the efficiency of the Agon-Coutainville SAT system for the removal of TrOCs.

Use of liver grafts from cadaveric donors: Implementation impact of a local evaluation and procurement team in Mexico.

INTRODUCTION AND AIMS: Cadaveric donor liver graft retrieval is complex in Mexico. The aim of the present article was to present the experience in liver graft use during the first year of work of a local evaluation and procurement team. MATERIALS AND METHODS: We reviewed the organ donation report forms and allocation offer records covering the time frame of December 15, 2017 to December 15, 2018, and registered the donor characteristics, causes of organ discard, causes of declined offers, transport time, and graft and recipient survival at 30 days. RESULTS: There were 17 donations and we completed the evaluation of 14. Two donors were considered ideal (14.2%) and 12 were expanded criteria donors (ECDs) (85.7%). Two grafts with steatosis were not offered (14.2%). Twelve liver grafts were offered 88 times (mean 7.6 offers per graft). The acceptance rate was 6% for public hospitals and 23.6% for private hospitals (p = 0.016). One graft was discarded during the procurement process due to steatosis. The rate of use after evaluation was 78.5% (11/14). All the grafts were procured by the local team and 9 (81.8%) were transported by commercial airline (median 240 min, range 85 min). Graft and recipient survival at 30 days was 100%. CONCLUSIONS: The participation of a local evaluation and procurement team notably increased liver graft use with excellent results. Commercial airline transportation of the grafts to all active transplantation centers of the country resulted in cold ischemia times <6 h.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

Is There a Role for Desmopressin in Liver Transplantation? A Case Report.

Living donor liver transplantation reduces time and mortality on the waiting list. Bleeding is a serious complication; however, "overcorrection" of coagulopathy may lead to hepatic artery thrombosis. We report a case where desmopressin (DDAVP) was used in the management of persistent postreperfusion bleeding (44 red blood cell units transfused). After 1 dose of DDAVP, bleeding improved significantly and the recipient had an unremarkable recovery. DDAVP should be considered for persisting bleeding after correcting common coagulation abnormalities where complexity of the anastomosis may preclude the use of more aggressive procoagulant drugs in liver transplantation.

Duchenne muscular dystrophy in a developing country: challenges in management and genetic counseling.

BACKGROUND AND OBJECTIVE: Multidisciplinary management of Duchenne Muscular Dystrophy (DMD) has achieved outstanding results in developed nations. We aimed to describe the status of diagnosis and management of DMD in a developing country through the experience of non-profit organizations. METHODS: A Multistate, multiple-source, population-based survey was performed from medical records of 432 patients. Data were retrospectively collected, reviewed and curated by health specialists; including clinical features, age at first symptoms, age at diagnosis, disease progression and management, family history, education, age and cause of death. RESULTS: There is a delay in noticing first symptoms and it did not diminish over the past 20 years. Less than 30% of patients obtained definite diagnosis and most of them are in physiotherapy programs but not under steroid treatment. In our study, family history does not anticipate recognition of symptoms compared to sporadic cases (p = 0.05). Approximately 93.33% of our patients attended to education programs. Mean age at death was 18.94 +/- 6.73 years and the most frequent cause was pneumonia. CONCLUSION: Delayed diagnosis of DMD in Mexico is mainly caused by the late detection of first symptoms. There is no difference in early detection of symptoms between familiar and sporadic cases. Lifespan of patients in our cohort is reduced compared to developed countries. The late diagnosis and low percentage of definite cases may affect patient management and genetic counseling and could also preclude participation of patients into novel clinical trials.

Closure of midline contaminated and recurrent incisional hernias with components separation technique reinforced with plication of the rectus muscles.

PURPOSE: Midline incisional hernia reconstruction by defect closure and reinforcement with either prosthetic or biologic materials has shown to significantly decrease recurrence rates even for complex cases. The purpose of this study is to evaluate outcomes regarding large incisional hernia reconstruction with components separation technique using rectus muscle plication as a reinforcement method. METHODS: Thirteen patients having large midline incisional hernias and either history of abdominal wall contamination or recurrence in the presence of mesh were treated between January 2007 and December 2011 with closure using components separation technique reinforced by rectus muscle plication. RESULTS: Average hernia square was 222 cm(2), and mean follow-up was 24 months. Complications occurred in 6 patients with a mean time to resolution of 59 days. One recurrence was present. CONCLUSIONS: When use of mesh or biologic materials is not desired, rectus muscle plication is a feasible tool as a reinforcement method after large hernia closure with components separation.

[Pancreatic-duodenectomy for invasive colon cancer in a patient with Lynch syndrome. Case report.]. / Pancreatoduodenectomía por cáncer de colon invasor en un paciente con síndrome de Lynch; informe de un caso.

Despite the screening efforts in the general population and particularly in families with hereditary colon cancer, locally advanced colon cancer remains a common clinical problem. In block resection is considered mainstay therapy in these patients. The aim of this report is to present a case of right-sided colon cancer with a medullar phenotype invading the duodenum treated through in block resection. A case of a 54-year-old male with a family history of colon and pancreatic cancer with lower gastrointestinal tract bleeding is presented. Colonoscopy and computed tomography scan showed a tumor in the colonic hepatic flexure invading the duodenum. The patient underwent an in block resection of the right colon, duodenum, pancreas and antrum. The histopathological study showed a T4N0M0 adenocarcinoma invading the duodenum, pancreas and antrum with negative margins. His postoperative evolution was complicated with a pancreatic fistula, which resolved with conservative measures. In conclusion, in block resection is the treatment of choice for locally advanced colon cancer with invasion to duodenum and pancreas and should be performed in high-volume centers familiar with this type of procedures. Key words: pancreaticoduodenectomy, colon cancer, Lynch syndrome, pancreas, surgery, Mexico.

Recanalización tardía de injerto ilíaco / Late recanalisation of an iliac graft

Introducción. Las técnicas endovasculares son útiles para el tratamiento de la enfermedad oclusiva ateroscleróticaen el sector aortoilíaco; la angioplastia transluminal percutánea con balón, con o sin la colocación de stent, estáampliamente aceptada. Una proporción importante de oclusiones de la arteria ilíaca puede recanalizarse con una combinaciónde angioplastia y stent, y muchas son las referencias bibliográficas al respecto, pero poco se ha comentado sobrerecanalizaciones tardías en oclusiones crónicas de injertos en este sector. Caso clínico. Mujer de 53 años de edad coninjerto iliofemoral izquierdo realizado hace cuatro años, ingresa por lesión trófica digital y dolor de reposo en pie izquierdo,refiere claudicación corta desde hace 3 meses, y presenta ausencia de pulsos en el miembro inferior izquierdo.En la arteriografía preoperatoria: obliteración de la arteria ilíaca externa en su origen con repermeabilización en la arteriafemoral común. Se logra mediante abordaje percutáneo contralateral la recanalización del bypass iliofemoral colocandodos stents solapados (8 × 37 mm proximal balón expandible y 7 × 100 mm distal recubierto) con buen resultadoangiográfico, recuperación del pulso femoral izquierdo y buena perfusión del pie. Conclusiones. La recanalización percutáneade una oclusión crónica de un injerto iliofemoral parece una excelente opción terapéutica en casos seleccionados,y más aún si se tiene en cuenta que las reintervenciones quirúrgicas son a menudo difíciles, y no exentas de complicaciones

Introduction. Endovascular techniques are useful for treating atherosclerotic occlusive disease in the aortoiliacsegment; percutaneous transluminal angioplasty with balloon, with or without the placement of a stent, is widelyaccepted. A high proportion of occlusions in the iliac artery can be recanalised with a combination of angioplasty andstent, and many cases have been reported in the literature; little has been said, however, about late recanalisations inchronic occlusions of grafts in this segment. Case report. A 53-year-old female with a left iliofemoral graft that had beenperformed four years earlier; the patient was admitted to hospital due to trophic lesions in the toes and rest pain in theleft foot, reported a three-month history of short claudication, and had no pulse in the lower left limb. In the preoperativearteriography: obliteration of the external iliac artery at its origin with restoration of patency in the common femoralartery. Using a contralateral percutaneous approach, the iliofemoral bypass was recanalised by placing two overlappingstents (8 × 37 mm proximal to the expandable balloon and 7 × 100 mm distal covered) with a good angiographicoutcome, recovery of the left femoral pulse and good perfusion of the foot. Conclusions. Percutaneous recanalisation ofa chronic occlusion of an iliofemoral graft seems to be an excellent therapeutic option in selected cases, and even moreso if we bear in mind that surgical reinterventions are often difficult to perform and are not free of complications

Aneurisma de vena facial: caso clínico y revisión de la bibliografía / Facial vein aneurysm: a case report and review of the literature

Introducción. Los aneurismas de la vena facial son excepcionales. Sólo hay cinco casos publicados en la bibliografía.Se presenta el caso de una paciente con trombosis aguda de un aneurisma gigante de vena facial izquierda,tratado mediante resección quirúrgica. Caso clínico. Mujer de 70 años, con tumoración dolorosa, no compresible ni pulsátil,en la parte lateral izquierda del cuello. En la tomografía computarizada se visualizó una masa de 4 × 4 cm, sin captaciónde contraste y adyacente a la vena yugular interna. Se resecó el aneurisma trombosado de la vena facial con ligadurade cabos proximal y distal. No presentó complicaciones perioperatorias. Conclusiones. La edad media de presentaciónde los aneurismas de vena facial es de 36 años (intervalo: 11-70 años) y tiene un ligero predominio en los varones.Se suelen localizar en la rama anterior de la vena y la mitad de los casos son congénitos. El dolor es el síntoma más frecuentey su tamaño medio es de casi 4 cm. No se han descrito complicaciones tromboembólicas. El diagnóstico de imagense hace con ecografía, tomografía computarizada y resonancia magnética. El tratamiento se indica para los casossintomáticos o de gran tamaño. Debemos tener especial precaución en los localizados en la rama retromandibular, porsu íntimo contacto con la parótida y el nervio facial. El diagnóstico diferencial se hace con quistes, laringoceles y otrastumoraciones cervicales

Introduction. Aneurysms of the facial vein (FV) are rare. Only five cases have been reported in the literature.Here, we report the case of a patient with acute thrombosis of a giant aneurysm in the left FV, which was treated bymeans of surgical resection. Case report. Our case involved a 70-year-old female with a painful tumour that was neithercompressible nor pulsatile in the left side of her neck. The computerised tomography (CT) scan showed a 4 x 4 cm mass,with no contrast enhancement, lying adjacent to the internal jugular vein. The thrombosed aneurysm was excised fromthe FV with ligation of the proximal and distal ends. No perioperative complications occurred. Conclusions. The meanage at which aneurysms of the FV appear is 36 years (interval: 11-70 years) and there is a slight predominance in males.They are usually located in the anterior branch of the vein and half the cases are congenital. Pain is the most frequentsymptom and the average size is almost 4 cm. No thromboembolic complications have been reported. Diagnostic imagingis performed with ultrasonography, CT and magnetic resonance scanning. Treatment is indicated for symptomatic orlarge-sized cases. Special care must be taken in those that are located in the retromandibular branch, due to its being inclose contact with the parotid and the facial nerve. Differential diagnosis is carried out with cysts, laryngoceles andneck tumours

Nutrient dynamics as indicators of karst processes: comparison of the Chalk aquifer (Normandy, France) and the Edwards aquifer (Texas, U.S.A.).

Karst aquifers display a range of geologic and geomorphic characteristics in a wide range of climatic and land-use settings; identification of transport dynamics representative of karst aquifers in general could help advance our understanding of these complex systems. To this end, nutrient, turbidity, and major ion dynamics in response to storms were compared at multiple sites in two karst aquifers with contrasting characteristics and settings: the Chalk aquifer (Eure Department, Normandy, France) and the Barton Springs segment of the Edwards Aquifer (Texas, U.S.A.). The Chalk aquifer is typified by high matrix porosity, thick surficial deposits (up to 30 m thick), and agricultural land use; the Barton Springs segment is typified by low matrix porosity, outcropping limestone, and urban land use. Following one to three storms, from 5 to 16 samples from springs and wells were analyzed for major ions, and specific conductance and turbidity were monitored continuously. Comparison of the chemographs indicated some generalized responses, including an increase in turbidity and potassium concentrations and a decrease in major ion and nitrate concentrations with infiltrating storm runoff. Factor analysis of major ions and turbidity revealed strikingly similar behavior of the chemical variables for the two aquifers: The first two factors, explaining more than 75% of the variability, illustrate that dynamics of most major ions (including nitrate) are opposed to those of turbidity and of potassium. The results demonstrate that potassium and nitrate are effective tracers of infiltrating storm runoff and resident ground water, respectively, and the similar results for these two highly contrasting aquifers suggest that the dynamics identified might be applicable to karst systems in general.

Hepatobiliary diseases and insulin resistance.

In recent years, there has been an increasing prevalence of obesity and related diseases. This epidemiological change has increased the interest of researchers in the molecular and biochemical pathways involved in the pathogenesis of hepatic and biliary diseases. Insulin resistance is considered the major mechanism involved in the hepatic and biliary manifestations of obesity. Epidemiological, clinical, and basic research demonstrates that insulin resistance is associated with gallstone disease, nonalcoholic fatty liver disease, and poor outcomes in viral hepatitis C treatments. Fascinating experimental evidence demonstrates that fat-induced hepatic insulin resistance may result from the activation of kinases leading to impaired insulin signaling. The insulin-resistant state is characterized by a failure to suppress hepatic glucose production and glycogenolysis, with enhanced fat accumulation in hepatocytes because of increased lipolysis, increased free fatty acid uptake by hepatocytes, and increased hepatic synthesis of triglycerides. This molecular signaling induces a low-grade chronic inflammatory state, characterized by increased levels of proinflammatory molecules and acute-phase proteins. This review summarizes the most important molecular and biochemical issues in the hepatic and biliary diseases associated with insulin resistance.

Endocannabinoid receptor CB2 in nonalcoholic fatty liver disease.

BACKGROUND AND AIM: Fatty infiltration and fibrosis are major issues in chronic liver disease. Recent reports suggest a role for the endocannabinoid system in these processes. AIM: To characterize localization and expression of CB2 in normal liver and nonalcoholic fatty liver. METHODS: We studied 64 liver biopsies: eight were considered normal; 56 had a diagnosis of nonalcoholic fatty liver disease (NAFLD); 32 with nonalcoholic steatosis and 24 nonalcoholic steatohepatitis (NASH). CB2 immunolocalization was studied in 38 samples in paraffin blocks using immunohistochemistry, and a computerized semiquantitative analysis was carried out. CB2 mRNA expression was assessed through RT-PCR in 26 frozen liver samples and the ratio CB2/beta-actin was used to evaluate differences between groups. Statistical analysis was performed with central tendency measures and the Mann-Whitney U-test. We considered as significant differences those with a P-value <0.05. RESULTS: Neither parenchymal nor nonparenchymal cells in normal liver tissue react towards anti-CB2 antibodies. All the samples from patients with steatosis and nonalcoholic steatohepatitis showed hepatocellular immunoreactivity. Cholangiocytes were positive only in the NAFLD group. Normal liver tissue showed a normalized CB2/beta-actin ratio of 0.001+/-0.01, steatosis 6.52+/-17.3 (P=0.05 vs normal) and NASH 6.49+/-12.2 (P=0.06 vs normal and P=0.6 vs steatosis). CONCLUSION: CB2 receptors are expressed by hepatocytes in nonalcoholic fatty liver disease but not in normal liver.

Adiponectin, structure, function and pathophysiological implications in non-alcoholic fatty liver disease.

Obesity is a major risk factor for the development of the metabolic syndrome, a cluster of diseases including insulin resistance, type 2 diabetes, dyslipidemia, hypertension, microalbuminuria, atherosclerosis, and non-alcoholic steatohepatitis. On the other hand, it is now generally accepted that adipose tissue acts as an endocrine organ producing a number of substances with an important role in the regulation of food intake, energy expenditure and a series of metabolic processes. Adiponectin is a recently discovered hormone produced exclusively by adipocytes. In fact, adiponectin is considered currently as a major factor in obesity-related insulin resistance and atherosclerosis. This new hormone differs from other adipocytokines in that its production and concentrations are actually decreased in insulin resistant subjects. The aim of this review is to summarize the current knowledge about the chemistry and physiology of adiponectin and to discuss its implications in the pathophysiology and potential treatment of insulin resistance and non-alcoholic fatty liver disease.

PAF receptor and PAF acetylhydrolase expression in the endosalpinx of the human Fallopian tube: possible role of embryo-derived PAF in the control of embryo transport to the uterus.

BACKGROUND: Prostaglandin-E(2) and platelet-activating factor (PAF) are embryonic-derived signals that time embryo passage into the uterus in the mare and hamster respectively. PAF-like activity is detectable in the spent media of preimplantation human embryos and it has been suggested that PAF may be the embryonic signal that controls embryo transport to the uterus in our species. The actions of PAF are regulated at the level of its synthesis and degradation as well as the expression of a specific cell surface receptor (PAFr). The enzyme PAF acetylhydrolase (PAF-AH) degrades PAF. This study was undertaken to examine whether or not PAFr and PAF-AH are expressed in the human Fallopian tube and to identify the cell types in which they are expressed. METHODS: The presence of PAFr mRNA in tissue extracts was investigated using reverse transcription-polymerase chain reaction. We amplified the predicted amplicon for PAFr mRNA from RNA samples extracted from Fallopian tubes. The expression of PAF-AH was detected by Western blot and the localization of PAFr and PAF-AH proteins was detected by immunohistochemistry. RESULTS: Utilizing antibodies against PAFr and PAF-AH, co-localization of the two proteins in the epithelium and stromal cells were demonstrated. CONCLUSIONS: These observations show that the human Fallopian tube expresses PAFr and PAF-AH at a location compatible with the proposed paracrine role of early embryo-derived PAF.

Allelopathic agents from Cyrtocymura cincta.

The sesquiterpenoid fractions from the chloroform extracts of roots and aerial parts of the weed Cyrtocymura cincta (Griseb.) H. Robinson (Compositae) were tested to observe the effects on seed germination and growth of three dicot and four monocot species. Promotion and inhibition effects were observed according to the examined compound, specific seed or cultivar, and concentration.

Urodinamia en niños con infección urinaria recurrente, enuresis e incontinencia / Urodynamic studies in enuresis, vesical incontinence and urinary tract infections

Se presentan los resultados clínico-urodinámicos de 50 pacientes pediátricos, 46 de ellos mujeres, neurológicamente normales que consultaron por enuresis, incontinencia o infección urinaria recurrente, aisladas o en asociación. La mayoría de los pacientes (n = 33) presentaba asociación de los tres síntomas y 3 tenían evidencia de reflujo vesicouretral. Cistométricamente la vejiga hiperactiva fue la más frecuente y la hipoactiva la de menor frecuencia. Las presiones de micción son significativamente mayores en las vejigas hipertónicas y menores en las hipotónicas. Sólo las vejigas hipotónicas muestran capacidad significativamente mayor y flujo máximo menor que los valores normales