The Vertebrobasilar Trunk and Its Anatomical Variants: A Microsurgical Anatomical Study.

BACKGROUND: The trunk of the basilar artery has not been included in microanatomy studies. Anatomical variants of the perforant branches of the vertebrobasilar trunk and their relationship with neural structures are very important in surgical approaches. Surgical dissection for the treatment of vascular lesions requires a perfect knowledge of the microsurgical anatomy. METHODS: We conducted a descriptive analysis of 50 brains, which were fixed with formalin at 10% for 2 weeks, and the arterial system was injected with colored latex. After microsurgical dissection, it was divided into three segments: the lower portion went from the anterior spinal artery to the anteroinferior cerebellar artery, the middle segment was raised from the upper limit of the lower portion to the origin of the superior cerebellar artery, and the upper segment ranged from the previous portion until the origin of the posterior cerebral artery. RESULTS: The basilar artery had an average length of 30 mm. The average diameter at its junction with the vertebral arteries was 4.05 mm. The average middle segment was 3.4 mm in diameter and 15.2 mm in length. The diameter of the upper segment was 4.2 mm, and its average length was 3.6 mm. The average number of bulbar arteries was three, and their average diameter was 0. 66 mm. The number of caudal perforator arteries were five on average, with a diameter of 0.32 mm. We found three rare cases of anatomical variants in the vertebra-basilar junction. CONCLUSIONS: The basilar artery emits penetrating branches in its lower, middle, and upper portions. The origin of penetrating branches was single or divided after forming a trunk. However, we observed long branches from perforant arteries.

Latex vascular injection as method for enhanced neurosurgical training and skills.

Background: Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications. Methods: Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection. Results: Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels. Conclusions: Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.

Best Nursing Practice: Safe and Inclusive Healthcare Environments for Transgender People: A Systematic Review.

(1) Background: The aim of this study was to review the scope of the existing scientific literature on creating safe and inclusive healthcare environments for transgender people and provide an overview of the resources and nursing skills required to do so. (2) Methods: With the research question in mind, an exploratory search of six databases was conducted to identify all relevant primary studies. After screening and selection of articles based on the inclusion and exclusion criteria, a total of 41 articles were included and reviewed. (3) Results: The results were classified under four headings: the training of health professionals, the creation of safe spaces, the nurse as facilitator, and best care practice. Most of the evidence indicates that it is essential for nurses and other healthcare staff to be trained in specific skills to provide comprehensive, high-quality care to transgender people; however, there is a lack of material and human resources to do so. (4) Conclusions: The trans-inclusive care competent nurse should use neutral language that respects the person's preferred name and pronouns in a safe healthcare environment that offers and ensures warmth, respect, and inclusivity in the care provided. This study was registered with the Open Science Framework (OSF) on 9 January 2024 (osf.io/rpj6a).

Multilayer network associations between the exposome and childhood brain development.

Growing up in a high poverty neighborhood is associated with elevated risk for academic challenges and health problems. Here, we take a data-driven approach to exploring how measures of children's environments relate to the development of their brain structure and function in a community sample of children between the ages of 4 and 10 years. We constructed exposomes including measures of family socioeconomic status, children's exposure to adversity, and geocoded measures of neighborhood socioeconomic status, crime, and environmental toxins. We connected the exposome to two structural measures (cortical thickness and surface area, n = 170) and two functional measures (participation coefficient and clustering coefficient, n = 130). We found dense connections within exposome and brain layers and sparse connections between exposome and brain layers. Lower family income was associated with thinner visual cortex, consistent with the theory that accelerated development is detectable in early-developing regions. Greater neighborhood incidence of high blood lead levels was associated with greater segregation of the default mode network, consistent with evidence that toxins are deposited into the brain along the midline. Our study demonstrates the utility of multilayer network analysis to bridge environmental and neural explanatory levels to better understand the complexity of child development.

Perfil cognitivo y social en niños y niñas con Trastorno del Espectro Autista / Cognitive and social profile in children with autism spectrum disorder

El Trastorno del Espectro Autista (TEA) es una condición que se caracteriza por presentar fallas en la conducta social y comportamientos repetitivos. Su perfil neuropsicológico muestra hallaz-gos heterogéneos que dependen de la severidad del trastorno. El objetivo del presente trabajo es describir el funcionamiento neuropsicológico de una muestra de niños y niñas con TEA que asisten al Instituto para el Desarrollo Integral del Niño en condición de Autismo (DINA). La muestra estuvo conformada por 78 participantes, 15.4% de género femenino y 84.6% de géne-ro masculino, con edades entre los 6 y los 16 años. Los instrumentos utilizados fueron protocolo neuropsicológico adaptado de la ENI, prorrateo de inteligencia del WISC-IV, Test de Sally y Ann, Test de Expresiones faciales adaptadopor Paul Ekman y el Test de la Mirada para niños, El Test de Metidas de Pata, e Historias Extrañas de Happé. Los resultados se discuten a la luz de la li-teratura científica sobre el tema.

Autism Spectrum Disorder (ASD) is a condition that is characterized by failures in social behav-ior and repetitive behaviors. The neuropsychological profile shows heterogeneous findings that depends on the severity of the disorder. The objective of this paper is to describe the neuropsychological functioning of a sample of children with ASD who attend the Institute for the Integral Development of Children with Autism (DINA). The sample consisted of 78 partici-pants, 15.4% female and 84.6% male, aged between6 and 16 years. The instruments used were the neuropsychological protocol adapted from the ENI, intelligence apportionment from the WISC-IV, Sally and Ann Test, Facial Expressions Test adapted by Paul Ekman and Reading the Mind in the Eye for children, Faux Pas Test, and The Happé’s Strange Stories test. The re-sults are discussed considering the scientific literature on the subject. (AU)

Seno cavernoso: anatomía, histología y terminología.

BACKGROUND: Although the cavernous sinus (CS) has been studied since 1695, its anatomy and name are still under discussion. METHOD: Anatomy and histology of 40 CS from human cadavers were studied, included both from a newborn specimen. RESULTS: Two walls limit the CS, an inferior medial one composed only of the dura's outer layer and a superior lateral one consisting of both dura's layers. Sinusoidal veins pass through the lateral wall of the CS as a transition between venous tributaries and the CS. An endothelial layer covers the inner surface of the CS and the outer surface of the internal carotid artery. The space within the CS shows trabeculae, which are rarer in adults compared to the newborn. The loss of trabeculae in the CS may be a natural process along with life. CONCLUSIONS: In conclusion, the CS is a real sinus, and the term "cavernous sinus" is appropriately applied.

ANTECEDENTES: Si bien el seno cavernoso (SC) ha sido estudiado desde 1695, su anatomía y nombre aún están bajo discusión. MÉTODOS: Se estudiaron la anatomía y la histología de 40 SC de cadáveres humanos, incluyendo los dos de un recién nacido. RESULTADOS: El SC está limitado por dos paredes, una inferomedial compuesta solo por la capa más externa de la duramadre y otra superolateral compuesta por ambas capas de la duramadre. Hay venas sinusoidales que atraviesan la pared lateral del SC formando una transición entre venas tributarias y el SC. Una capa endotelial recubre la superficie interna del SC y la superficie externa de la arteria carótida interna. El espacio dentro del SC presenta trabéculas, las cuales son escasas en el adulto en comparación con el recién nacido. La pérdida de trabéculas en el SC puede ser un proceso natural a lo largo de la vida. CONCLUSIONES: En conclusión, el SC es un verdadero seno, por lo que el término «seno cavernoso¼ se aplica de forma correcta.

Absceso hepático roto / Rupture of liver abscess

RESUMEN Introducción: el absceso hepático es una colección de pus rodeada por una cápsula fibrosa, de alta morbilidad y mortalidad en el mundo. Tiene una incidencia aproximada de 20 por cada 100 000 habitantes y una mortalidad de un 5 % a un 30 %. Objetivo: presentar un caso de absceso hepático roto en cavidad abdominal asociado a colelitiasis. Caso clínico: paciente femenina de 65 años de edad recibida en los servicios de urgencia de cirugía general luego de haber sufrido hacía un mes dolor en hipocondrio derecho acompañado de vómitos copiosos y astenia. Al examen físico se constató íctero, taquicardia, taquipnea, dolor intenso en hipocondrio derecho con defensa y reacción peritoneal (punto de Murphy positivo). Se decide llevar al salón de operaciones, se encontraron abscesos hepáticos rotos asociado a litiasis vesicular y peritonitis fibrinopurulenta, se toma muestra para cultivo, se realiza colecistectomía de cuello a fondo, lavado de la cavidad abdominal y de los cráteres hepáticos. Se deja drenaje subhepático. La evolución fue satisfactoria. Conclusiones: el lavado peritoneal, la colecistectomía y antibioticoterapia de amplio espectro son una alternativa terapéutica efectiva en pacientes afectos de absceso hepático piógeno roto con colelitiasis.

ABSTRACT Introduction: liver abscess is a collection of pus surrounded by a fibrous capsule, of high morbidity and mortality rates in the world. It has an incidence of approximately 20 per 100,000 inhabitants and a mortality of 5 % to 30 %. Objective: to present a case of rupture of liver abscess in the abdominal cavity associated with cholelithiasis. Case report: a 65-year-old female patient was admitted to the emergency general surgery department after a month of pain in the right hypochondriac region accompanied by copious vomiting and asthenia. Physical examination revealed jaundice, tachycardia, tachypnea, intense pain in the right hypochondriac region with defense and peritoneal reaction (positive Murphy's score). It was decided to take the patient to the operating room, finding ruptured liver abscess associated with vesicular lithiasis and fibrinopurulent peritonitis, a sample was taken for culture, a thorough neck cholecystectomy was performed, washing of the abdominal cavity and hepatic craters. Subhepatic drainage was left. Evolution was satisfactory. Conclusions: peritoneal lavage, cholecystectomy and broad spectrum antibiotic therapy is an effective therapeutic alternative in patients with ruptured pyogenic liver abscess with cholelithiasis.

Effect of agave fructans on xanthan rheology: Impact on sodium caseinate emulsion properties.

The influence of agave fructans (AF) (1-10%) and xanthan (from 0.03% to 0.25%) in combination with sodium caseinate (SC) at 1% on the rheological and physicochemical properties of aqueous phases and emulsions was evaluated. Steady-state flow behavior, particle size distribution, and stability studies were used to characterize the systems. The aqueous systems displayed the shear-thinning behavior characteristic of xanthan solutions; however, this behavior was modified by the presence of SC and AF due to interactions between AF-SC and AF-xanthan based on predominant hydrogen bonding because of the hydroxyl groups on AF. In emulsions, an increase in viscosity due to the effect of the AF concentration reflects a probable association of fructan aggregates on the surface of SC particles that reinforce the interfacial layer of SC, while xanthan contributes to an increase in the viscosity of the continuous phase, which effectively prevents coalescence and floc formation even at higher concentrations, despite the possible existence of a depletion flocculation effect attenuated by the interaction between AF-SC and AF-xanthan. PRACTICAL APPLICATION: These results can be of use, in an important way, in the design of stable functional emulsions in which there is an application for agave fructans recognized as dietary fiber, also considering their peculiar way of interacting with xanthan favoring its stabilizing functionality.

Individual differences in frontoparietal plasticity in humans.

Neuroplasticity, defined as the brain's potential to change in response to its environment, has been extensively studied at the cellular and molecular levels. Work in animal models suggests that stimulation to the ventral tegmental area (VTA) enhances plasticity, and that myelination constrains plasticity. Little is known, however, about whether proxy measures of these properties in the human brain are associated with learning. Here, we investigated the plasticity of the frontoparietal system by asking whether VTA resting-state functional connectivity and myelin map values (T1w/T2w ratios) predicted learning after short-term training on the adaptive n-back (n = 46, ages 18-25). We found that stronger baseline connectivity between VTA and lateral prefrontal cortex predicted greater improvements in accuracy. Lower myelin map values predicted improvements in response times, but not accuracy. Our findings suggest that proxy markers of neural plasticity can predict learning in humans.

Neuroanatomical basis of Wallenberg syndrome.

Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery. Its signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia. Neuroanatomical knowledge is essential to its comprehension, study and diagnosis, because the classic neurological manifestations are easy to explain and understand if function and localization of affected anatomical structures are known as if the posterior cerebral circulation is.

El síndrome de Wallenberg, o síndrome bulbar lateral, es la manifestación clínica del infarto en el territorio de irrigación de la arteria cerebelosa posteroinferior. Su presentación incluye vértigo, nistagmo, diplopía, síndrome de Horner, rubicundez y anhidrosis facial homolateral, disfonía, disfagia, disartria, pérdida homolateral del reflejo nauseoso, ataxia homolateral, disgeusia homolateral, dolor y parestesia faciales homolaterales, pérdida o disminución homolateral del reflejo corneal, hipoalgesia y termoanestesia de tronco y extremidades contralaterales, hipoalgesia y termoanestesia facial homolateral. El conocimiento neuroanatómico es imprescindible para su comprensión, estudio y diagnóstico, ya que sus manifestaciones neurológicas clásicas son fácilmente explicables y entendibles si se conocen la función y la localización de las estructuras anatómicas afectadas, así como la irrigación cerebral posterior.

The functional brain networks that underlie visual working memory in the first two years of life.

Visual working memory (VWM) is a central cognitive system used to compare views of the world and detect changes in the local environment. This system undergoes dramatic development in the first two years; however, we know relatively little about the functional organization of VWM at the level of the brain. Here, we used image-based functional near-infrared spectroscopy (fNIRS) to test four hypotheses about the spatial organization of the VWM network in early development. Four-month-olds, 1-year-olds, and 2-year-olds completed a VWM task while we recorded neural activity from 19 cortical regions-of-interest identified from a meta-analysis of the adult fMRI literature on VWM. Results showed significant task-specific functional activation near 6 of 19 ROIs, revealing spatial consistency in the brain regions activated in our study and brain regions identified to be part of the VWM network in adult fMRI studies. Working memory related activation was centered on bilateral anterior intraparietal sulcus (aIPS), left temporoparietal junction (TPJ), and left ventral occipital complex (VOC), while visual exploratory measures were associated with activation in right dorsolateral prefrontal cortex, left TPJ, and bilateral IPS. Results show that a distributed brain network underlies functional changes in VWM in infancy, revealing new insights into the neural mechanisms that support infants' improved ability to remember visual information and to detect changes in an on-going visual stream.

Early adversity in rural India impacts the brain networks underlying visual working memory.

There is a growing need to understand the global impact of poverty on early brain and behavioural development, particularly with regard to key cognitive processes that emerge in early development. Although the impact of adversity on brain development can trap children in an intergenerational cycle of poverty, the massive potential for brain plasticity is also a source of hope: reliable, accessible, culturally agnostic methods to assess early brain development in low resource settings might be used to measure the impact of early adversity, identify infants for timely intervention and guide the development and monitor the effectiveness of early interventions. Visual working memory (VWM) is an early marker of cognitive capacity that has been assessed reliably in early infancy and is predictive of later academic achievement in Western countries. Here, we localized the functional brain networks that underlie VWM in early development in rural India using a portable neuroimaging system, and we assessed the impact of adversity on these brain networks. We recorded functional brain activity as young children aged 4-48 months performed a VWM task. Brain imaging results revealed localized activation in the frontal cortex, replicating findings from a Midwestern US sample. Critically, children from families with low maternal education and income showed weaker brain activity and poorer distractor suppression in canonical working memory areas in the left frontal cortex. Implications of this work are far-reaching: it is now cost-effective to localize functional brain networks in early development in low-resource settings, paving the way for novel intervention and assessment methods.

Evaluating motion processing algorithms for use with functional near-infrared spectroscopy data from young children.

Motion artifacts are often a significant component of the measured signal in functional near-infrared spectroscopy (fNIRS) experiments. A variety of methods have been proposed to address this issue, including principal components analysis (PCA), correlation-based signal improvement (CBSI), wavelet filtering, and spline interpolation. The efficacy of these techniques has been compared using simulated data; however, our understanding of how these techniques fare when dealing with task-based cognitive data is limited. Brigadoi et al. compared motion correction techniques in a sample of adult data measured during a simple cognitive task. Wavelet filtering showed the most promise as an optimal technique for motion correction. Given that fNIRS is often used with infants and young children, it is critical to evaluate the effectiveness of motion correction techniques directly with data from these age groups. This study addresses that problem by evaluating motion correction algorithms implemented in HomER2. The efficacy of each technique was compared quantitatively using objective metrics related to the physiological properties of the hemodynamic response. Results showed that targeted PCA (tPCA), spline, and CBSI retained a higher number of trials. These techniques also performed well in direct head-to-head comparisons with the other approaches using quantitative metrics. The CBSI method corrected many of the artifacts present in our data; however, this approach produced sometimes unstable HRFs. The targeted PCA and spline methods proved to be the most robust, performing well across all comparison metrics. When compared head to head, tPCA consistently outperformed spline. We conclude, therefore, that tPCA is an effective technique for correcting motion artifacts in fNIRS data from young children.

Factores predictores de la evolución en la hidronefrosis prenatal / Predictive factors of the outcomes of prenatal hydronephrosis

OBJETIVO: Determinar predictores independientes prenatales y postnatales de una mala evolución de la función renal, de la resolución espontanea o de la necesidad de cirugía en la hidronefrosis prenatal. MÉTODOS: Estudio retrospectivo en pacientes con hidronefrosis prenatal. Analizamos diferentes variables clínicas prenatales y postnatales, así como, el DAP (diámetro anteroposterior) de la pelvis renal en la ecografía prenatal del tercer trimestre, y en la primera y segunda ecografía postnatal. Las analizamos mediante t de Student, chi-cuadrado, análisis de supervivencia, y curvas de COR. RESULTADOS: Se incluyeron 218 pacientes con 293 UR (unidades renales). Operadas 147/293 (50,2%) UR, resolución espontánea 76/293 (25,9%) UR, y 76/293 (25,9%) UR presentaron mala evolución. Encontramos como factores de riesgo para la cirugía el bajo peso al nacer (OR 3,84; IC 95% 1,24-11,84), la prematuridad (OR; 4,17 IC 95% 1,35-12,88), la duplicidad (OR 4,99; IC 95% 2,21-11,23) y la presencia de patología nefrourológica subyacente (OR 53,54; IC 95% 26,23-109,27). Para la no resolución espontánea se encontraron las alteraciones en el volumen del líquido amniótico (RR 1,46; IC 95% 1,33-1,60) así como la patología nefrourológica subyacente y la duplicidad. Para la mala evolución la alteración del volumen del líquido amniótico (OR 11,99; IC 95% 2,70-53,21), la presencia de patología nefrourológica subyacente (OR 4,81 IC 95% 2,60-8,89) y la cirugía (OR 4,23 IC 95% 2,35-7,60). El DAP en las tres ecografías es fiable para la predicción de cirugía (área bajo la curva 0,65; 0,82; 0,71), para resolución espontánea (área bajo la curva 0,80; 0,91; 0,80) y solo el DAP de la primera ecografía postnatal para mala evolución (área bajo la curva 0,73). Los DAP con mayor sensibilidad y especificidad son los de la primera ecografía postnatal; 14,60mm para cirugía; 11,35mm para resolución espontánea; y 15,50 mm para mala evolución. CONCLUSIÓN: A mayor DAP en la pelvis renal en cualquiera de las tres ecografías las probabilidades de cirugía y de no resolución espontanea son mayores. La primera ecografía es la más fiable para predecir la evolución en la hidronefrosis prenatal. Existen otros factores a tomar en cuenta para predecir la evolución de los pacientes con HN prenatal

OBJECTIVES: To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis. METHODS: We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves. RESULTS: We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21- 11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome. CONCLUSION: The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients

[Effectiveness of Trauma Evaluation and Management course for Mexican senior medical students: When to implement it?]. / Efectividad del curso Evaluación y Manejo del Trauma en estudiantes de Medicina mexicanos: ¿cuándo implementar?

BACKGROUND: Trauma Evaluation and Management course was designed to develop trauma cognitive skills in senior medical students. Its effectiveness has been demonstrated in many regions, except in Latin America, where it has been poorly studied. The objective was to determine the Trauma Evaluation and Management course effectiveness, and whether greater effectiveness is achieved in basic- or clinic-cycle students, as well as student perception. MATERIAL Y METHODS: Descriptive, observational, longitudinal and prospective study. Two tests were performed, pre- and post-course; the manual was read by the students prior to both tests. Students were divided into 2 groups: group A (consisting of 71 basic-cycle medical students) and group B (consisting of 44 clinical-cycle medical students). RESULTS: Group A achieved a 2.45 increase (p<0.01) in the post-course evaluation compared with pre-course test. Group B increased the mean score by 2.25 (p>0.05) from pre- to post-course tests. There was a significant difference between groups in both evaluations (pre-course test p<0.01 and post-course test p>0.05), with no difference in improvement (p>0.05). Using a questionnaire, 92.17% of the students totally agreed that the course improved their trauma knowledge, 76.52% that it increased their trauma clinical skills, with 94.78% being totally satisfied with the course, and 86.09% totally agreed that Trauma Evaluation and Management course should be in Medicine curriculum. CONCLUSIONS: Trauma Evaluation and Management course improves trauma cognitive skills, and undergraduate medical students in Mexico broadly accept it.

[Predictive factors of the outcomes of prenatal hydronephrosis.] / Factores predictores de la evolución en la hidronefrosis prenatal.

OBJECTIVES: To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis. METHODS: We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves. RESULTS: We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21-11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome. CONCLUSION: The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients.

El ruido y las actividades de enfermería: factores perturbadores del sueño / Noise and Nurse Activity: Factors Disturbing Sleep / Barulho e as atividades de enfermagem: fatores perturbadores do sono

En las unidades de cuidado intensivo ningún profesional puede desconocer el medioagresivo a que se expone el paciente crítico y las necesidades insatisfechas, como elsueño; por tal motivo, el profesional de enfermería debe reconocer el sueño como unanecesidad prioritaria en el cuidado del paciente crítico que debe ser satisfecha. Esfundamental que en la práctica diaria se incorpore la valoración integral del patróndel sueño y la identificación de los factores ambientales más frecuentes como el ruidoy las actividades de enfermería, de manera que puedan minimizarse por medio deintervenciones dirigidas a proporcionar un cuidado integral que permita promover elsueño en el paciente crítico como un componente necesario en la recuperación físicay emocional...

No professional can disregard the aggressive environment critical patients are exposedto in intensive-care units, and how their needs, such as sleep, are often interrupted.Due to this, the professional nurse should acknowledge sleep as a priority need in criticalpatient care, which must be satisfied. It is paramount that an integral appraisalof sleep patterns and identification of the more frequent environmental factors such asnoise be incorporated into daily practice, so they can be minimised through interventionsaimed at providing an integral care which includes sleep for critical patients as anecessary component of their physical and emotional recovery...

Nas unidades de cuidados intensivos nenhum profissional pode desconhecer o meioagressivo a que expõe-se o paciente crítico e as necessidades insatisfeitas, como osono; por tal motivo, o profissional de enfermagem deve reconhecer o sono como necessidadeprioritária no cuidado do paciente crítico que deve ser satisfeita. É fundamentalna prática diária incorporar a avaliação integral do padrão do sono e a identificaçãodos fatores ambientais mais frequentes como o barulho e as atividades de enfermagem,de maneira que puderem se minimizar por meio de intervenções encaminhadas a proporcionarum cuidado integral que permita promover o sono no paciente crítico comocomponente necessário na recuperação física e emocional...

[Microsurgical anatomy importance of A1-anterior communicating artery complex]. / Importancia de la anatomía microquirúrgica del complejo A1-arteria comunicante anterior.

BACKGROUND: The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. OBJECTIVE: Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. METHODS: The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. RESULTS: 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. CONCLUSION: It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

Antecedentes: la arteria cerebral anterior se origina de la bifurcación de la arteria carótida interna lateral al quiasma óptico, posteriormente se une con su homóloga contralateral mediante la arteria comunicante anterior. El complejo precomunicante(A1)-arteria comunicante anterior es el lugar más frecuente de variantes anatómicas y el sitio con mayor cantidad de aneurismas (30 a 37%). Objetivo: conocer la anatomía microquirúrgica, las variantes anatómicas y la importancia del complejo segmento precomunicante-arteria comunicante anterior en cirugía neurológica de la patología vascular, principalmente aneurismas, en población mexicana. Material y métodos: estudio prospectivo y descriptivo efectuado en el Departamento de Anatomía de la Facultad de Medicina (UNAM) en 30 encéfalos inyectados. Se estudió la anatomía microquirúrgica (longitud y calibre) del complejo segmento precomunicante-arteria comunicante anterior de la arteria cerebral anterior y sus variantes. Resultados: se encontraron 60 segmentos precomunicantes. La longitud promedio del lado izquierdo fue de 11.35 mm y del derecho de 11.84 mm. El calibre medio en el lado izquierdo fue de 1.67 mm y en el derecho de 1.64 mm. El número promedio de perforantes en el lado izquierdo fue de 7.9 y en el derecho de 7.5. La arteria comunicante anterior se encontró en 29 encéfalos sobre el quiasma óptico, su trayecto dependió de la longitud del segmento A1. La longitud media del segmento fue de 2.84 mm, el calibre fue de 1.41 mm y el número promedio de perforantes de 3.27. En 18 encéfalos (60%) se encontraron variantes del complejo A1-arteria comunicante anterior y dos aneurismas tipo blíster. Conclusión: es necesario entender la anatomía microquirúrgica del complejo segmento precomunicante-arteria comunicante anterior y conocer las variantes para tener una visión en tercera dimensión durante la cirugía de aneurismas.

Simulated GABA synaptic input and L-type calcium channels form functional microdomains in hypothalamic gonadotropin-releasing hormone neurons.

Hypothalamic gonadotropin-releasing hormone (GnRH) neurons integrate the multiple internal and external cues that regulate sexual reproduction. In contrast to other neurons that exhibit extensive dendritic arbors, GnRH neurons usually have a single dendrite with relatively little branching. This largely precludes the integration strategy in which a single dendritic branch serves as a unit of integration. In the present study, we identify a gradient in L-type calcium channels in dendrites of mouse GnRH neurons and its interaction with GABAergic and glutamatergic inputs. Higher levels of L-type calcium channels are in somata/proximal dendrites (i.e., 0-26 µm) and distal dendrites (∼130 µm dendrite length), but intervening midlengths of dendrite (∼27-130 µm) have reduced L-type calcium channels. Using uncaging of GABA, there is a decreasing GABAergic influence along the dendrite and the impact of GABA(A) receptors is dependent on activation of L-type calcium channels. This results in amplification of proximal GABAergic signals and attenuation of distal dendritic signals. Most interestingly, the intervening dendritic regions create a filter through which only relatively high-amplitude, low-frequency GABAergic signaling to dendrites elicits action potentials. The findings of the present study suggest that GnRH dendrites adopt an integration strategy whereby segments of single nonbranching GnRH dendrites create functional microdomains and thus serve as units of integration.

[Association of three anatomical variants of the anterior cerebral circulation]. / Asociación de tres variantes anatómicas de circulación cerebral anterior.

BACKGROUND: As part of a study of the microsurgical anatomy of the pericallosal artery, we describe one brain with three unusual anatomical variants. METHODS: From the autopsy of a 45 year-old female, we extracted the brain and all the arterial blood vessels were washed off with saline solution to be injected afterwards with red latex. The brain was then immersed in 10% formalin for two months. Finally, we dissected and measured the internal carotid artery segments, using a digital Vernier caliper under a Carl Zeiss OPMI surgical microscope with magnification of 6x up to 40x. RESULTS: The brain's weight was 1250 grams and three rare anatomical variants were found: 1) right accessory middle cerebral artery (ACMA-d), 2) right bihemispheric anterior cerebral artery (ACABihem-d), 3) median artery of the corpus callosum (AMCC). CONCLUSION: The association of the anatomical variations described previously is inconstant; furthermore, their appearance in a single case is rare.