Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale. / Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional.

INTRODUCTION: Dysphagia is defined as difficulty swallowing. Up to 84% of patients undergoing esophageal atresia surgery have dysphagia beyond the neonatal period. MATERIALS AND METHODS: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. The Functional Oral Intake Scale (FOIS) was used to assess dysphagia in 4 age groups (< 1 year old, 1-4 years old, 5-11 years old, and > 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversion were regarded as dysphagia. RESULTS: 63 patients were analyzed. 74% (47/63) had dysphagia during follow-up. Prevalence was 50% in patients < 1 year old (FOIS mean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patients aged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOIS mean 6.8). The most frequent causes of dysphagia were stenosis, which occurred in 38% of the patients (n=24), and gastroesophageal reflux (n=18), which was present in 28% of the patients. Both conditions were associated with significantly lower mean FOIS scores (p< 0.05) in the patients under 11 years of age. Differences (p< 0.05) were found in the dysphagia-associated perinatal factors in the various age groups, with longer ventilation assistance times, parenteral nutrition, and hospital stays. CONCLUSIONS: Dysphagia is an extremely frequent symptom at any given age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.

INTRODUCCION: La disfagia se define como dificultad en el proceso de alimentación. Hasta un 84% de pacientes intervenidos de atresia de esófago tienen disfagia más allá del periodo neonatal. MATERIAL Y METODOS: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS (Functional Oral Intake Scale) para cuantificar la disfagia en 4 grupos de edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años). Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria. RESULTADOS: Se obtuvieron datos de 63 pacientes. El 74% (47/63) presentó disfagia durante el seguimiento. La prevalencia fue del 50% < 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11 años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causas más frecuentes de disfagia fueron la estenosis, que presentó un 38% de los pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentó a su vez un 28% de los pacientes. Ambas condiciones se asociaron con unos valores medios de FOIS significativamente menores (p< 0,05) en los pacientes menores de 11 años. Se encontraron diferencias (p< 0,05) en factores perinatales asociados a disfagia en los distintos periodos de edad, a destacar mayor tiempo medio de: asistencia ventilatoria, nutrición parenteral e ingreso hospitalario. CONCLUSIONES: La disfagia es un síntoma extremadamente frecuente a cualquier edad en los pacientes intervenidos de atresia de esófago. Un seguimiento estandarizado y multidisciplinar es esencial para mejorar la calidad de vida de estos pacientes.

Disfagia en pacientes intervenidos de atresia de esófago: valoración con una escala funcional / Dysphagia in patients undergoing esophageal atresia surgery: Assessment using a functional scale

Introducción: La disfagia se define como dificultad en el procesode alimentación. Hasta un 84% de pacientes intervenidos de atresia deesófago tienen disfagia más allá del periodo neonatal.Material y métodos: Estudio retrospectivo de serie de casos intervenidos por atresia de esófago 2005-2021. Se utilizó la escala FOIS(Functional Oral Intake Scale) para cuantificar la disfagia en 4 gruposde edad (menores de 1 año, 1-4 años, 5-11 años y mayores de 11 años).Se consideró disfagia cualquier valor de FOIS < 7 o síntomas de atragantamiento, impactación o aversión alimentaria.Resultados: Se obtuvieron datos de 63 pacientes. El 74% (47/63)presentó disfagia durante el seguimiento. La prevalencia fue del 50%< 1 año (media FOIS 4.32), 77% 1-4 años (media FOIS 5.61), 45% 5-11años (media FOIS 5.87) y 38% > 11 años (media FOIS 6.8). Las causasmás frecuentes de disfagia fueron la estenosis, que presentó un 38% delos pacientes (n= 24) y el reflujo gastroesofágico (n= 18), que presentóa su vez un 28% de los pacientes. Ambas condiciones se asociaron conunos valores medios de FOIS significativamente menores (p< 0,05) enlos pacientes menores de 11 años. Se encontraron diferencias (p< 0,05)en factores perinatales asociados a disfagia en los distintos periodosde edad, a destacar mayor tiempo medio de: asistencia ventilatoria,nutrición parenteral e ingreso hospitalario. Conclusiones: La disfagia es un síntoma extremadamente frecuentea cualquier edad en los pacientes intervenidos de atresia de esófago. Unseguimiento estandarizado y multidisciplinar es esencial para mejorarla calidad de vida de estos pacientes(AU)

Introduction: Dysphagia is defined as difficulty swallowing. Up to84% of patients undergoing esophageal atresia surgery have dysphagiabeyond the neonatal period. Materials and methods: A retrospective study of patients undergoing esophageal atresia surgery from 2005 to 2021 was carried out. TheFunctional Oral Intake Scale (FOIS) was used to assess dysphagia in 4age groups (< 1 year old, 1-4 years old, 5-11 years old, and 11 years old). FOIS scores < 7 or symptoms of choking, impaction, or food aversionwere regarded as dysphagia. Results: 63 patients were analyzed. 74% (47/63) had dysphagiaduring follow-up. Prevalence was 50% in patients < 1 year old (FOISmean 4.32), 77% in patients aged 1-4 (FOIS mean 5.61), 45% in patientsaged 5-11 (FOIS mean 5.87), and 38% in patients > 11 years old (FOISmean 6.8). The most frequent causes of dysphagia were stenosis, whichoccurred in 38% of the patients (n=24), and gastroesophageal reflux(n=18), which was present in 28% of the patients. Both conditions wereassociated with significantly lower mean FOIS scores (p< 0.05) in thepatients under 11 years of age. Differences (p< 0.05) were found in thedysphagia-associated perinatal factors in the various age groups, withlonger ventilation assistance times, parenteral nutrition, and hospital stays. Conclusions: Dysphagia is an extremely frequent symptom at anygiven age in patients undergoing esophageal atresia surgery. A standardized, cross-disciplinary follow-up is key to improve quality of life.(AU)

Impact of a novel multilayer imager on metal artifacts in MV-CBCT.

Objective. Megavoltage cone-beam computed tomography (MV-CBCT) imaging offers several advantages including reduced metal artifacts and accurate electron density mapping for adaptive or emergent situations. However, MV-CBCT imaging is limited by the poor efficiency of current detectors. Here we examine a new MV imager and compare CBCT reconstructions under clinically relevant scenarios.Approach. A multilayer imager (MLI), consisting of four vertically stacked standard flat-panel imagers, was mounted to a clinical linear accelerator. A custom anthropomorphic pelvis phantom with replaceable femoral heads was imaged using MV-CBCT and kilovoltage CBCT (kV-CBCT). Bone, aluminum, and titanium were used as femoral head inserts. 8 MU 2.5 MV scans were acquired for all four layers and (as reference) the top layer. Prostate and bladder were contoured on a reference CT and transferred to the other scans after rigid registration, from which the structural similarity index measure (SSIM) was calculated. Prostate and bladder were also contoured on CBCT scans without guidance, and Dice coefficients were compared to CT contours.Main results. kV-CBCT demonstrated the highest SSIMs with bone inserts (prostate: 0.86, bladder: 0.94) and lowest with titanium inserts (0.32, 0.37). Four-layer MV-CBCT SSIMs were preserved with bone (0.75, 0.80) as compared to titanium (0.67, 0.74), outperforming kV-CBCT when metal is present. One-layer MV-CBCT consistently underperformed four-layer results across all phantom configurations. Unilateral titanium inserts and bilateral aluminum insert results fell between the bone and bilateral titanium results. Dice coefficients trended similarly, with four-layer MV-CBCT reducing metal artifact impact relative to KV-CBCT to provide better soft-tissue identification.Significance. MV-CBCT with a four-layer MLI showed improvement over single-layer MV scans, approaching kV-CBCT quality for soft-tissue contrast. In the presence of artifact-producing metal implants, four-layer MV-CBCT scans outperformed kV-CBCT by eliminating artifacts and single-layer MV-CBCT by reducing noise. MV-CBCT with a novel multi-layer imager may be a valuable alternative to kV-CBCT, particularly in the presence of metal.

The influence of electrolytes in the adsorption kinetics of reactive BF-5G blue dye on bone char: a mass transfer model.

The discharge of harmful dyes in water bodies is a serious pollution problem, dangerous for the ecosystem's equilibrium and human health. In this sense, the aim of this work was to determine the influence of electrolytes (NaCl, KCl, CaCl2 and MgCl2) in the adsorption of Reactive Blue BF-5G dye, the most common dye used in industrial process for fabric colouring, using bovine bone char as the adsorbent. The bovine bone char was characterized by pH of point of zero charge (pHPZC), N2 adsorption-desorption isotherms, Fourier transform-infrared spectroscopy (FT-IR) and X-ray diffractometry (XDR). The characterization revealed a mesoporous structure (pore mean diameter of 94 Šand SBET ∼107 m2 g-1) with negative charge distribution at the surface (pHPZC = 3.8). The adsorption experiments revealed that the presence of KCl enhanced the material adsorption capacity (qmax = 195 mg g-1), that the Sips isotherm best fitted the experimental data (R2 > 0.9 except for KCl solution) and the adsorption process was mono- and multilayered. The kinetic adsorption experiments indicated that the inorganic electrolytes increased the initial adsorption velocity and the data was best modelled by the surface diffusional model (SDM), implying a resistance (aqueous > CaCl2 > NaCl > MgCl2 > KCl) to mass transfer at the surface of the pores which, in turn, prevented the dye diffusion to the interior of the adsorbent (qe = 71 mg g-1). Therefore, small quantities of KCl can be used to lower the mass transfer resistance and provide higher adsorption capacity with reduced time of operation, thus increasing the overall process efficiency.

DNA methylation profile of a rural cohort exposed to early-adversity and malnutrition: An exploratory analysis.

Barker's hypothesis affirms that undernourishment in early-life induces metabolic reprogramming that compromises organism functions later in life, leading to age-related diseases. We are exposed to environmental and social conditions that impact our life trajectories, leading to ageing phenotypes as we grow. Epigenetic mechanisms constitute the link between both external stimuli and genetic programming. Studies have focused on describing the effect of early adverse events such as trauma, famines, or childhood labor on epigenetic markers in adulthood and the elderly. However, we lack information on epigenetic programming in individuals born in rural communities from underdeveloped countries, exposed to negative influences during fetal and postnatal development, particularly chronic malnutrition. Hence, in this exploratory analysis, we characterize the epigenome of individuals and some parents from Tlaltizapan (a rural community in Mexico originally studied almost 50 years ago) and collect anthropometric data on growth and development, as well on the living conditions of the families. Our results help build a biological hypothesis indicating that most of the epigenetic age measures of the subjects are significantly different among them. Interestingly, the most affected methylated regions correspond to pathways involved in neuronal system development, reproductive behaviour, learning and memory regulation.

What urethrogram sees and a surgeon does not. / Lo que una uretrografía ve y un cirujano no.

INTRODUCTION: Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology. CLINICAL CASE: 11-year-old male patient with significant urethrorrhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonography: fusiform anechoic image in the corpus spongiosum of the penile root. Retrograde urethrogram: normal anterior urethra, extraluminal contrast passage in the ventral aspect of the bulbar urethra. Cystoscopy: no pathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper's gland duct; Maizels' type 3 perforated syringocele. DISCUSSION: Cowper's syringocele is a rare pathology. It can occur at any stage of childhood in the form of urinary infection, obstructive voiding symptoms, or urethrorrhagia. Urethrogram is key for diagnostic purposes, since most Cowper's syringoceles are detected following urethrogram or cystoscopy. Cases with functional repercussions for the urinary system require surgical treatment. Otherwise, a wait-and-see approach is feasible.

INTRODUCCION: La uretrorragia es un signo infrecuente en la infancia que debe distinguirse de la hematuria dada la diferente etiología de las mismas. CASO CLINICO: Varón de 11 años con uretrorragia franca. Sedimento urinario: hematíes++. Ecografía pélvica: imagen anecoica fusiforme en cuerpo esponjoso de raíz peneana. Uretrografía retrógrada: uretra anterior normal, paso de contraste extraluminal ventral en uretra bulbar. Cistoscopia: sin hallazgos patológicos en uretra ni vejiga. Uretrografía retrógrada de control: dilatación quística del conducto de las glándulas de Cowper; siringocele perforado tipo 3 de Maizels. COMENTARIOS: El siringocele de Cowper es una patología infrecuente que puede debutar en cualquier momento de la infancia como infección urinaria, síntomas miccionales obstructivos o uretrorragia. La uretrografía es fundamental en su diagnóstico ya que la mayoría se objetivan por este medio o cistoscopia. Los casos con repercusión funcional del sistema urinario requieren tratamiento quirúrgico. En caso contrario podrá realizarse actitud expectante.

Lo que una uretrografía ve y un cirujano no / What urethrogram sees and a surgeon does not

Introducción: La uretrorragia es un signo infrecuente en la infancia que debe distinguirse de la hematuria dada la diferente etiología de lasmismas. Caso clínico: Varón de 11 años con uretrorragia franca. Sedimento urinario: hematíes++. Ecografía pélvica: imagen anecoica fusiforme en cuerpo esponjoso de raíz peneana. Uretrografía retrógrada: uretra anterior normal, paso de contraste extraluminal ventral en uretra bulbar.Cistoscopia: sin hallazgos patológicos en uretra ni vejiga. Uretrografíaretrógrada de control: dilatación quística del conducto de las glándulasde Cowper; siringocele perforado tipo 3 de Maizels.Comentarios: El siringocele de Cowper es una patología infrecuente que puede debutar en cualquier momento de la infancia como infección urinaria, síntomas miccionales obstructivos o uretrorragia.La uretrografía es undamental en su diagnóstico ya que la mayoría se objetivan por este medio o cistoscopia. Los casos con repercusión funcional del sistema urinario requieren tratamiento quirúrgico. En caso ontrario podrá realizarse actitud expectante.

Introduction: Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology.Clinical case: 11-year-old male patient with significant urethror-rhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonog-raphy: fusiform anechoic image in the corpus spongiosum of the penileroot. Retrograde urethrogram: normal anterior urethra, extraluminal con-trast passage in the ventral aspect of the bulbar urethra. Cystoscopy: nopathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper’s gland duct; Maizels’ type 3perforated syringocele.Discussion: Cowper’s syringocele is a rare pathology. It can occurat any stage of childhood in the form of urinary infection, obstructivevoiding symptoms, or urethrorrhagia. Urethrogram is key for diagnos-tic purposes, since most Cowper’s syringoceles are detected followingurethrogram or cystoscopy. Cases with functional repercussions for theurinary system require surgical treatment. Otherwise, a wait-and-seeapproach is feasible

Testicular volume in adult patients undergoing cryptorchidism surgery in childhood, and impact on paternity. / Volumen testicular en pacientes adultos operados de criptorquidia en edad infantil y su efecto sobre la paternidad.

OBJECTIVE: To determine the impact of orchiopexy on testicular volume. To determine whether age at surgery impacts testicular volume. To determine whether paternity is associated with testicular volume. METHODS: Patients born between 1961 and 1985 who had undergone cryptorchidism surgery at the Pediatric Surgery Department of Miguel Servet University Hospital were included. Testis location and macroscopic appearance data were collected. Control testicular ultrasonographies and paternity surveys were carried out. Initially, the study was descriptive, and subsequently, inferential. RESULTS: Ultrasonography was performed in 216 testicular units a mean of 14.9 years following surgery, whereas the paternity survey was conducted among 157 respondents a mean of 41.9 years following surgery. There were significant differences (p = 0.0038) in testicular volume distribution according to epididymal dissociation. There was a linear correlation between older age at surgery and lower testicular volume, but without statistical significance. Significant differences (p < 0.0001) in testicular volume according to groups - operated and non-operated -, as well as between unilateral and bilateral cases, were found. No differences in paternity rates according to testicular volume were noted. CONCLUSION: Operated testes have lower volumes than normally descended testes. Older age at surgery may contribute to lower final volumes. Testes with full epididymal-testicular dissociation have lower total volumes. No relation between testicular volume and paternity rates was found. Further long-term studies are required.

OBJETIVOS: Determinar el efecto de la orquidopexia sobre el volumen testicular. Determinar si la edad de intervención afecta el volumen testicular. Determinar si la paternidad se asocia al volumen testicular. METODOS: Pacientes nacidos entre los años 1961 y 1985, intervenidos de criptorquidia por el Servicio de Cirugía Pediátrica del Hospital Universitario Miguel Servet, tomando datos de la localización del teste y aspecto macroscópico. Se realizan ecografías testiculares de control y encuestas de paternidad. Realizamos un estudio inicial descriptivo y posteriormente inferencial. RESULTADOS: La ecografía se realizó con una media de 14,9 años postoperatorios en 216 unidades testiculares y la encuesta de paternidad con una media 41,9 años postoperatorios a 157 participantes. Existen diferencias significativas (p = 0,0038) en la distribución del volumen testicular según disyunción del epidídimo. Hay correlación lineal entre mayor edad de tratamiento quirúrgico y menor volumen testicular sin llegar a significancia estadística. Se observan diferencias significativas (p < 0,0001) en el volumen testicular según grupos de operados y no operados, como también entre los unilaterales y los bilaterales. No se observan diferencias en índices de paternidad según volumen testicular. CONCLUSION: El teste intervenido presenta un volumen testicular menor que el teste de descenso normal. Una mayor edad de tratamiento quirúrgico puede contribuir a un menor volumen final del teste. Los testículos con disyunción epidídimo testicular completa, tienen menor volumen total. No observamos relación entre el volumen testicular y índices de paternidad. Más estudios a largo plazo son necesarios.

Volumen testicular en pacientes adultos operadosde criptorquidia en edad infantil y su efectosobre la paternidad / Testicular volume in adult patients undergoing cryptorchidism surgery in childhood, and impact on paternity

Objetivos: Determinar el efecto de la orquidopexia sobre el volu-men testicular. Determinar si la edad de intervención afecta el volumentesticular. Determinar si la paternidad se asocia al volumen testicular.Métodos: Pacientes nacidos entre los años 1961 y 1985, interveni-dos de criptorquidia por el Servicio de Cirugía Pediátrica del HospitalUniversitario Miguel Servet, tomando datos de la localización del testey aspecto macroscópico. Se realizan ecografías testiculares de controly encuestas de paternidad. Realizamos un estudio inicial descriptivo yposteriormente inferencial.Resultados: La ecografía se realizó con una media de 14,9 añospostoperatorios en 216 unidades testiculares y la encuesta de paternidadcon una media de 41,9 años postoperatorios a 157 participantes. Existendiferencias significativas (p = 0,0038) en la distribución del volumentesticular según disyunción del epidídimo. Hay correlación lineal entremayor edad de tratamiento quirúrgico y menor volumen testicular, sinllegar a significancia estadística. Se observan diferencias significativas(p = <0,0001) en el volumen testicular según grupos de operados y nooperados, como también entre los unilaterales y los bilaterales. No seobservan diferencias en índices de paternidad según volumen testicular.Conclusión: El teste intervenido presenta un volumen testicularmenor que el teste de descenso normal. Una mayor edad de tratamientoquirúrgico puede contribuir a un menor volumen final del teste. Lostestículos con disyunción epidídimo testicular completa tienen menorvolumen total. No observamos relación entre el volumen testicular eíndices de paternidad. Más estudios a largo plazo son necesarios.

Objective: To determine the impact of orchiopexy on testicularvolume. To determine whether age at surgery impacts testicular volume.To determine whether paternity is associated with testicular volume.Methods: Patients born between 1961 and 1985 who had under-gone cryptorchidism surgery at the Pediatric Surgery Department ofMiguel Servet University Hospital were included. Testis location andmacroscopic appearance data were collected. Control testicular ultra-sonographies and paternity surveys were carried out. Initially, the studywas descriptive, and subsequently, inferential.Results: Ultrasonography was performed in 216 testicular units amean of 14.9 years following surgery, whereas the paternity survey wasconducted among 157 respondents a mean of 41.9 years following sur-gery. There were significant differences (p = 0.0038) in testicular volumedistribution according to epididymal dissociation. There was a linearcorrelation between older age at surgery and lower testicular volume,but without statistical significance. Significant differences (p = <0.0001)in testicular volume according to groups –operated and non-operated–,as well as between unilateral and bilateral cases, were found. No dif-ferences in paternity rates according to testicular volume were noted.Conclusion: Operated testes have lower volumes than normallydescended testes. Older age at surgery may contribute to lower finalvolumes. Testes with full epididymal-testicular dissociation have lowertotal volumes. No relation between testicular volume and paternity rateswas found. Further long-term studies are required.

Sustainable tourism policies in Peru and their link with renewable energy: analysis in the main museums of the Moche route.

Tourism activity in Peru has been experiencing significant growth in the last ten years, positioning this economic sector as the third largest contributor to the National Gross Domestic Product (GDP). Likewise, Peru has a high ecological and climate diversity, which makes it the possessor of renewable energy potential, specifically solar and wind power. The rapid growth of tourism is leading to generating prospects for becoming a sustainable destination. In this sense, it is important to understand and evaluate the Peruvian legislative framework for sustainable tourism and the current state of the implementation of the scenarios provided by the governmental entity in terms of sustainability, and its link with tourism activity. Based on what has been described, this study is aimed at evaluating the four most relevant museums in the northern part of Peru; in addition, it contributes to the studies that exist at the intersection of tourism and sustainability in the chains of activities related to tourism and calls for rationality applied to tourism management in this region of Latin America. The results of the literature review of the Peruvian legal framework reveal a lack of specific laws and regulations on sustainable tourism; on the contrary, there are policies in force that contribute to promoting the development of sustainable tourism. The quantified evaluation of the solar and wind potentials of the geographical area under study indicates the minimum renewable energy potential necessary for its transformation and use in the development of sustainable museums and its contribution to sustainable tourism.

What's up with my neck? Ultrasound and surgical findings in cervical midline tumors. / ¿Qué tengo en el cuello? Hallazgos ecográficos y quirúrgicos en tumoraciones de línea media cervical.

OBJECTIVE: Evaluate ultrasound (US) sensitivity and specificity in suspected thyroglossal duct cysts (TGDC) undergoing surgery in our hospital, and their correlation with surgical findings. MATERIAL AND METHODS: Retrospective study of 150 patients undergoing surgery for midline neck mass suggestive of TGDC (2008-2018). We analyzed epidemiological variables and compared the correlation between diagnostic ultrasound imaging and surgical findings, considering previous episodes of local infection. RESULTS: Mean age at surgery was 3.96 years (0.75-12.58 years). Of the 150 patients, 81 were male and 69 were female. Following ultrasound examination, 110 were suspected to have TGDC, and diagnosis was confirmed after surgery in 80 cases. Of the remaining 40 cases without TGDC-compatible US examination, TGDC was confirmed in 15 cases. The rest were diagnosed with dermoid cyst (49), lymphadenopathy (4), and vascular malformation (2). US sensitivity was 84%, while specificity was 45%, with a positive predictive value of 73%, and a negative predictive value of 62%. In 62.1% (59) of TGDCs, a previous infection episode had been described, with 16.7% of cases requiring surgical drainage. 13.6% had recurrence after Sistrunk technique. There was no statistically significant relationship between previous infection episodes and postsurgical recurrence, or between surgical or spontaneous drainage and cyst recurrence. CONCLUSIONS: Even though US role in eutopic thyroid gland identification cannot be doubted, it provides with low specificity in the study of midline neck masses. Therefore, the physician's opinion should be prioritized.

OBJETIVO: Evaluar la sensibilidad y especificidad de la ecografía en las sospechas de quistes del conducto tirogloso (QCT) intervenidas en nuestro centro y su correlación con los hallazgos quirúrgicos. MATERIAL Y METODOS: Estudio retrospectivo de 150 pacientes intervenidos por nódulo en línea media cervical sugestivo de QCT (2008-2018). Recogida de variables epidemiológicas y comparación de la correlación de imagen ecográfica con hallazgos quirúrgicos, considerando la presencia de episodios de sobreinfección previos. RESULTADOS: La edad media de intervención fue de 3,96 años (0,75-12,58 años), siendo 69 mujeres y 81 hombres. De 150 pacientes, 110 presentaron ecografía compatible con QCT, confirmándose el diagnóstico por anatomía patológica en 80 casos. De los 40 pacientes con ecografía no compatible, en 15 se confirmó diagnóstico de QCT. En 95 pacientes del total se identificó QCT. El resto fueron diagnosticados de quiste dermoide (49), adenopatía (4) y malformación vascular (2). La sensibilidad ecográfica fue del 84% y la especificidad del 45%, el valor predictivo positivo del 73% y valor predictivo negativo del 62%. El 62,1% (59) de los QCT tuvo episodio de sobreinfección, precisando drenaje quirúrgico 16,7%. El 13,6% presentó recidiva tras técnica de Sistrunk. No se encontró relación estadísticamente significativa entre episodios previos de infección y recidiva postquirúrgica, ni entre drenaje (espontáneo o quirúrgico) y recidiva del quiste. CONCLUSIONES: A pesar de la importancia de la ecografía para valorar tiroides eutópico en sospechas de QCT, su resultado en el estudio de quistes cervicales tiene baja especificidad, debiendo primar el criterio del facultativo.

¿Qué tengo en el cuello? Hallazgos ecográficos y quirúrgicos en tumoraciones de línea media cervical / What's up with my neck? Ultrasound and surgical findings in cervical midline tumors

Objetivo: Evaluar la sensibilidad y especificidad de la ecografía en las sospechas de quistes del conducto tirogloso (QCT) intervenidas en nuestro centro y su correlación con los hallazgos quirúrgicos. Material y métodos: Estudio retrospectivo de 150 pacientes intervenidos por nódulo en línea media cervical sugestivo de QCT (2008-2018). Recogida de variables epidemiológicas y comparación de la correlación de imagen ecográfica con hallazgos quirúrgicos, considerando la presencia de episodios de sobreinfección previos. Resultados: La edad media de intervención fue de 3,96 años (0,75-12,58 años), siendo 69 mujeres y 81 hombres. De 150 pacientes, 110 presentaron ecografía compatible con QCT, confirmándose el diagnóstico por anatomía patológica en 80 casos. De los 40 pacientes con ecografía no compatible, en 15 se confirmó diagnóstico de QCT. En 95 pacientes del total se identificó QCT. El resto fueron diagnosticados de quiste dermoide (49), adenopatía (4) y malformación vascular (2). La sensibilidad ecográfica fue del 84% y la especificidad del 45%, el valor predictivo positivo del 73% y valor predictivo negativo del 62%. El 62,1% (59) de los QCT tuvo episodio de sobreinfección, precisando drenaje quirúrgico 16,7%. El 13,6% presentó recidiva tras técnica de Sistrunk. No se encontró relación estadísticamente significativa entre episodios previos de infección y recidiva postquirúrgica, ni entre drenaje (espontáneo o quirúrgico) y recidiva del quiste. Conclusiones: A pesar de la importancia de la ecografía para valorar tiroides eutópico en sospechas de QCT, su resultado en el estudio de quistes cervicales tiene baja especificidad, debiendo primar el criterio del facultativo

Objective: Evaluate ultrasound (US) sensitivity and specificity in suspected thyroglossal duct cysts (TGDC) undergoing surgery in our hospital, and their correlation with surgical findings. Materials and methods: Retrospective study of 150 patients under-going surgery for midline neck mass suggestive of TGDC (2008-2018). We analyzed epidemiological variables and compared the correlation between diagnostic ultrasound imaging and surgical findings, considering previous episodes of local infection. Results: Mean age at surgery was 3.96 years (0.75-12.58 years). Of the 150 patients, 81 were male and 69 were female. Following ultrasound examination, 110 were suspected to have TGDC, and diagnosis was confirmed after surgery in 80 cases. Of the remaining 40 cases without TGDC-compatible US examination, TGDC was confirmed in 15 cases. The rest were diagnosed with dermoid cyst (49), lymphadenopathy (4), and vascular malformation (2). US sensitivity was 84%, while specific-ity was 45%, with a positive predictive value of 73%, and a negative predictive value of 62%. In 62.1% (59) of TGDCs, a previous infection episode had been described, with 16.7% of cases requiring surgical drainage. 13.6% had recurrence after Sistrunk technique. There was no statistically significant relationship between previous infection episodes and postsurgical recurrence, or between surgical or spontaneous drain-age and cyst recurrence. Conclusions: Even though US role in eutopic thyroid gland identification cannot be doubted, it provides with low specificity in the study of midline neck masses. Therefore, the physician’s opinion should be prioritize

Aircraft soot from conventional fuels and biofuels during ground idle and climb-out conditions: Electron microscopy and X-ray micro-spectroscopy.

Aircraft soot has a significant impact on global and local air pollution and is of particular concern for the population working at airports and living nearby. The morphology and chemistry of soot are related to its reactivity and depend mainly on engine operating conditions and fuel-type. We investigated the morphology (by transmission electron microscopy) and chemistry (by X-ray micro-spectroscopy) of soot from the exhaust of a CFM 56-7B26 turbofan engine, currently the most common engine in aviation fleet, operated in the test cell of SR Technics, Zurich airport. Standard kerosene (Jet A-1) and a biofuel blend (Jet A-1 with 32% HEFA) were used at ground idle and climb-out engine thrust, as these conditions highly influence air quality at airport areas. The results indicate that soot reactivity decreases from ground idle to climb-out conditions for both fuel types. Nearly one third of the primary soot particles generated by the blended fuel at climb-out engine thrust bear an outer amorphous shell implying higher reactivity. This characteristic referring to soot reactivity needs to be taken into account when evaluating the advantage of HEFA blending at high engine thrust. The soot type that is most prone to react with its surrounding is generated by Jet A-1 fuel at ground idle. Biofuel blending slightly lowers soot reactivity at ground idle but does the opposite at climb-out conditions. As far as soot reactivity is concerned, biofuels can prove beneficial for airports where ground idle is a common situation; the benefit of biofuels for climb-out conditions is uncertain.

Observational pilot study of patients with carpal tunnel syndrome treated with Nucleo CMP Forte™.

AIM: Carpal tunnel syndrome (CTS) is a very common entrapment neuropathy characterized by pain and paresthesia in the territory of the median nerve. Although this syndrome has a considerable impact on the patient's quality of life, its medical treatment is far from optimal. MATERIAL & METHODS: We performed an observational study to evaluate Nucleo CMP ForteTM in patients with electromyography-confirmed, mild-moderate CTS. Pain was assessed using a visual analog scale, electromyogram and the SF-36. RESULTS: Pain decreased significantly after 6 months. Quality of life improved significantly in the pain dimensions. No significant differences were observed in electromyographic findings. No adverse events were reported. CONCLUSIONS: Nucleotides could prove useful for the nonsurgical treatment of CTS. Further studies are necessary to confirm this.

Encefalitis límbica: la gran desconocida / Limbic encephalitis: The great unknown

No disponible

Prevalence of Sarcopenia in Community-Dwelling Chilean Elders According to an Adapted Version of the European Working Group on Sarcopenia in Older People (EWGSOP) Criteria.

BACKGROUND: Sarcopenia is the progressive loss of mass and skeletal muscle strength and has serious consequences on older people's health. The Chilean older population has a high life-expectancy, but the prevalence of functional dependence is also high. OBJECTIVE: To determine the prevalence of sarcopenia in Chilean older adults and its relationship with age, gender, and body mass index (BMI). DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: 1,006 non-disabled, community-dwelling subjects aged 60 years or older living in Santiago. MEASUREMENTS: Anthropometric measurements, handgrip strength, physical performance tests, and dual-energy-x-ray-absorptiometry (DXA) scan were performed. Sarcopenia was defined using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP). Muscle mass was measured with DXA scan; skeletal muscle mass index (SMI) and hand dynamometry were defined with cut-off points obtained for the Chilean population. For a 3m walking speed we used the cut-off point of the EWGSOP definition. Nutritional status and obesity were defined according to World Health Organization standards. Association between sarcopenia and age, gender, BMI and lean/fat mass ratio was estimated by logistic regression models. RESULTS: The prevalence of sarcopenia was 19.1% (95%CI: 16.8%-21.8%), similar in men and women. There was an increasing trend of sarcopenia by age group and a decreasing trend with nutritional status. After logistic regression, sarcopenia was positively associated with age (OR=1.10; 95%CI:1.06-1.15) and falls (OR=1.83; 95%CI:1.07-3.15) and negatively associated with overweight (OR=0.31; 95%CI:0.16-0.59), obesity (OR=0.02; 95%CI:0.004-0.11), lean mass/fat mass ratio (OR=0.69; 95%CI:0.48-0.9997), knee height (OR=0.78; 95%CI:0.68-0.89) and calf circumference (OR=0.87; 95%CI:0.77-0.97). CONCLUSIONS: The total prevalence of sarcopenia was 19.1% increasing with age reaching 39.6% in people of 80 or more years of age. A negative association of sarcopenia with overweight, obesity and lean/fat mass ratio was observed. Although the high prevalence of obesity (35.9%), only 2% of obese people were sarcopenic.

Family Members, Transplantation Candidates, and Patients Who Underwent Liver Transplantation Had Insufficient Information About the Procedure.

INTRODUCTION: Adherence to treatment is essential for a successful liver transplantation (LT) because LT requires information, abilities, and competencies of patients and family members. OBJECTIVES: This study sought to identify whether the information received about the LT process was enough for either patients or family members who attended a liver transplant center in a school hospital. METHODS: This was a transversal study using questionnaires to verify received information on LT. It included 50 patients on the waiting list for LT, 50 transplanted patients, and 50 family members. RESULTS: There was a prevalence of men (82%) among patients, age range from 19 to 67 years (average: 46.87 ± 10.99), and of women (74%) among family members, age range from 18 to 80 years (average: 43.5 ± 11.77). The majority of subjects (88%) had a low education level. The most frequent etiology of hepatic cirrhosis was viral hepatitis associated with alcohol. A significant number of the listed and transplanted patients as well as all family members reported insufficient information about the process of the transplantation. The kind of insufficient information varied according to the period of treatment. The best way to obtain information, as reported by patients and family members, was a combination of oral and written information. CONCLUSIONS: Our data show the need for improvement in the means of delivering information to patients and family members, and an explanatory manual was created from this study.

Insulin receptor isoforms: an integrated view focused on gestational diabetes mellitus.

The human insulin receptor (IR) exists in two isoforms that differ by the absence (IR-A) or the presence (IR-B) of a 12-amino acid segment encoded by exon 11. Both isoforms are functionally distinct regarding their binding affinities and intracellular signalling. However, the underlying mechanisms related to their cellular functions in several tissues are only partially understood. In this review, we summarize the current knowledge in this field regarding the alternative splicing of IR isoform, tissue-specific distribution and signalling both in physiology and disease, with an emphasis on the human placenta in gestational diabetes mellitus (GDM). Furthermore, we discuss the clinical relevance of IR isoforms highlighted by findings that show altered insulin signalling due to differential IR-A and IR-B expression in human placental endothelium in GDM pregnancies. Future research and clinical studies focused on the role of IR isoform signalling might provide novel therapeutic targets for treating GDM to improve the adverse maternal and neonatal outcomes.