Microbialites show a distinct cyanobacterial phylogenetic structure and functional redundancy in Bacalar lagoon and Cenote Azul sinkhole, Yucatan Peninsula, Mexico.

Cyanobacterial components of microbialites from two geographically close systems, the Bacalar lagoon (BL) and the Cenote Azul sinkhole (CA) in Quintana Roo, Mexico, were characterized. BL and CA systems were studied along a longitudinal gradient (north to south) and a depth gradient (5-30 m), respectively. Microscopic observations, 16S rRNA amplicon sequencing, and shotgun metagenomics were used to characterize Cyanobacteria. Both systems showed similar metabolic/functional profiles but harbored completely different cyanobacterial taxa. BL was dominated by Nostocales, including a population of previously undescribed Chakia sp., while CA was dominated by an unknown taxon of Chroococcales, comprising 70% of relative abundance through all depths. Interestingly, cyanobacterial assemblages in microbialites exhibited phylogenetic overdispersion in most of the BL sites, while CA sites exhibited phylogenetic clustering, these differences were attributed to depth/light conditions and possibly different times of geological formation for BL and CA systems.

Evaluación de protocolo de bajas dosis en radioscopía para nefrolitotomía percutánea. Comparación de resultados y seguridad en un estudio prospectivo y randomizado / Evaluation of low dose protocol in fluoroscopy for percutaneous nephrolithotomy. Comparison of results and safety in a prospective randomized study

INTRODUCCIÓN: Tradicionalmente, durante la Nefrolitotomía Percutánea (NPL), la radioscopía se efectúa en modo Continuo a 10 FPS (imágenes por segundo). Existe escasa experiencia en la literatura urológica sobre disminución de dosis de radiación durante la radioscopía y su efecto en el éxito de la NPL (eficacia y seguridad). Series de casos, demuestran resultados similares usando radioscopía en modo Pulsado (1-4 FPS), determinando un Tiempo de Radioscopía inferior al modo Contínuo. Dichas experiencias no son basadas en diseños randomizados, ni reportan Dosimetría Directa. Hipótesis: usando radioscopía pulsada, se logran iguales resultados y con igual seguridad, que con radioscopía Contínua, y con exposición a radiación significativamente más baja. MATERIAL Y MÉTODO: Estudio prospectivo, randomizado, ciego simple y experimental (aprobado por Comité de Ética). Muestra de 19 pacientes, entre Abril y Agosto de 2017. De forma aleatoria, aproximadamente la mitad de los pacientes fueron sometidos a NPL con radioscopía Contínua (10 FPS) y la otra mitad con modalidad Pulsada (2 FPS). Intervenidos en el mismo establecimiento, con 1 trayecto, utilizando el mismo equipo de Radioscopía. Se registró Dosimetría Directa, Tiempo de Radioscopía, resultado (Stone Free) y complicaciones, en cada procedimiento. El análisis estadístico se realizó con medidas de tendencia central, se verificó distribución normal de la muestra y comparación de variables mediante t-Test, con intervalo de confianza del 95 por ciento. RESULTADOS: En 8 pacientes se utilizó radioscopía Contínua, y en 11, radioscopía Pulsada. La Dosimetría del grupo radioscopía Contínua promedió 2,7 mSv, para radioscopía Pulsada el promedio fue 3,1 mSv. El Tiempo de Radioscopía del grupo radioscopía Contínua fue de 286,4 s, del grupo radioscopía Pulsada fue de 365,7 s. Ambas diferencias no son estadísticamente significativas (p 0,6 y p 0,3 respectivamente). En relación al Resultado y Complicaciones, no hubo diferencias entre ambos grupos. CONCLUSIONES: Para los pacientes estudiados a la fecha, no se demuestra beneficioso realizar radioscopía Pulsada: la Dosimetría Directa y el Tiempo de Radioscopía fueron mayores en el grupo de modalidad Pulsada. Nuestros resultados son diferentes a lo reportado en la literatura, lo cual hace necesario evaluar el impacto de esta intervención, y considerar otros factores que pudieran influir (AU)

INTRODUCTION: Traditionally, during Percutaneous Nephrolithotomy (PCNL), fluoroscopy is performed in Continuous mode at 10 FPS (images per second). There is little experience in the urological literature on the reduction of radiation dose during fluoroscopy and its effect on the success of the PCNL (efficacy and safety). Several case show similar results, using Pulsed radioscopy (1-4 FPS), determining a Radioscopy Time inferior to the one in Continuous mode. These experiences are not based on randomized designs, nor do they report Direct Dosimetry. Hypothesis: using pulsed fluoroscopy, the same results are obtained and equally safe than with Continuous radioscopy and with exposure to significantly lower radiation. MATERIAL AND METHOD: Prospective, randomized, simple and experimental blind study (approved by the Ethics Committee). Sample of 19 patients, between April and August 2017. Randomly, approximately half of the patients underwent PCNL with continuous radioscopy (10 FPS) and the other half with Pulsed modality (2 FPS). They were intervened in the same establishment, in one journey, using the same Radioscopy equipment. Direct Dosimetry, Radioscopy Time, and complications results (Stone Free) were registered in each procedure. The statistical analysis was performed with central trend measures, normal distribution of the sample was verified and comparison of variables by t-Test, with 95 % confidence interval. RESULTS: Continuous fluoroscopy was used on eight patients, and Pulsed radioscopy on eleven. The Dosimetry of the Continuous fluoroscopy group averaged 2.7 mSv. Pulsed fluoroscopy average was 3.1 mSv. The Radioscopy Time of the Continuous fluoroscopy group was 286.4 s. Pulsed radioscopy group time it was 365.7 s. Both differences are not statistically significant (p 0.6 and p 0.3 respectively). In relation to the Result and Complications, there were no differences between the two groups. CONCLUSIONS: Performance of Pulsed Radioscopy benefits are not shown in the patients studied to date: Direct Dosimetry and Radioscopy Time were greater in the Pulsed modality group. Our results are different from those reported in the literature, which makes it necessary to evaluate the impact of this intervention, and consider other factors that could influence.(AU)

Síndrome de Prader-Willi: diagnóstico en el periodo neonatal / Neonatal presentation of Prader-Willi syndrome: report of a case

El síndrome de Prader-Willi debe formar parte del diagnóstico diferencial en los casos de hipotonía de presentación neonatal de origen central, especialmente cuando se acompaña de otras características clínicas típicas de la enfermedad. La importancia de su diagnóstico precoz, ya sea en el ámbito hospitalario o desde las consultas de Atención Primaria, reside tanto en la necesidad de instaurar una adecuada estimulación y fisioterapia por parte de los Servicios de Atención Temprana como de un correcto soporte nutricional en los que debutan con trastorno importante de succión. Así mismo es importante ofrecer un correcto consejo genético para planificar futuras gestaciones. Presentamos el caso clínico de un recién nacido con hipotonía de presentación neonatal junto con criptorquidia bilateral y fenotipo peculiar, en el que se confirmó, mediante estudio genético, el diagnóstico de sospecha de síndrome de Prader-Willi (AU)

Prader-Willi syndrome should be part of the differential diagnosis in cases of central neonatal hypotonia, especially when accompanied by other typical clinical features of the disease. The importance of an early diagnosis, either in hospital or in primary care center lies both in the need to establish an early care and nutritional support, which will improve the quality of life of patients suffering from this syndrome, and genetic counselling that should be made to parents of affected children to plan future pregnancies. We present the case of a new-born with neonatal hypotonia, bilateral cryptorchidism and peculiar phenotype, in which the suspected diagnosis of Prader-Willi syndrome was confirmed by genetic study. We also present a review of the etiology, phenotypic findings and clinical course over the stages of life, management and prognosis of the entity (AU)

Síndrome de Sweet: revisión de la literatura a propósito de un caso / Sweet syndrome: review of the literature about a case

Sweet (SS) syndrome is a neutrophilic dermatosis, characterized by a rapid onset of painful erythematous-purplish papules, nodules or plaques, accompanied by fever and associated with a dermal neutrophil infiltrate. CASE REPORT: Male, 69 years old, with a history of mild plaque psoriasis, arterial hypertension, gastroesophageal reflux and chronic sinusitis. He consulted for a 24-hour period characterized by headache and pain in the scalp. The examination highlights fever (38.5°), with slight erythema, sensitivity to palpation and some psoriasis plaques on the scalp. 48 hours later, it presents extensive painful erythematouspurplish plaques, present only on his right face and scalp. Biopsy was informed as Sweet Syndrome. He completed 14 days on prednisone, with excellent clinical evolution. DISCUSSION Sweet syndrome is classified into three categories: classic or idiopathic (most common), drug induced and associated with malignancy. In addition, other conditions have been described which may be related to: infections, autoimmune diseases, pregnancy. The management is focused on investigating an underlying cause and the use of corticosteroids, as a first line therapy. We report a case of idiopathic Sweet syndrome with atypical presentation, which was initially interpreted as facial cellulitis, with a rapid response to systemic corticosteroids. (AU)

Results of uncemented hemiarthroplasty as primary treatment of severe proximal humerus fractures in the elderly.

OBJECTIVES: The purpose of this study was to analyze functional and radiologic results of a consecutive series of elderly patients who underwent uncemented hemiarthroplasty as primary treatment of complex proximal humeral fractures. METHODS: Twenty-one patients with severe proximal humerus fracture (three or four fragments and three- or four-fragment fracture dislocations) were treated with uncemented proximal humerus hemiarthroplasty. Patients were evaluated using the Constant-Murley Score, the Quick scale Disabilities of Arm, Shoulder and Hand (Quick-DASH) Score, range of motion, residual pain, radiographic parameters, and complications including clinical and radiologic data of mobilization. RESULTS: After a mean postoperative period of 20.57 months (range 12-42 months), the mean Constant-Murley Score was 44 points (20-57), the mean Quick-DASH score was 24 points (16-39), postoperative pain according to a mean visual analogue scale was 1 (0-8), active abduction was 50° (30-135), and active flexion 70° (20-120). There were no cases of infection, deep vein thrombosis, dislocation, blood transfusions, or reoperation because of prosthetic loosening. Bivariate analysis of demographic data, radiologic findings, and other variables showed associations between duration of surgery and a higher Quick-DASH score (0.606; p = 0.037), and the number of sessions of rehabilitation with a higher Quick-DASH score (0.708; p = 0.015). CONCLUSIONS: The results of treatment of severe proximal humerus fractures in the elderly with an uncemented hemiarthroplasty are safe and promising; however, a comparative cohort study (cemented vs. uncemented) and long-term follow-up are still needed.

Concordancia interobservador de la clasificación de Eaton-Littler de la artrosis trapeciometacarpiana / Inter-observer agreement on the Eaton-Littler classification of trapeziometacarpal joint osteoarthritis

Objetivo. Estudiar la concordancia de la clasificación radiográfica de Eaton-Littler para el diagnóstico de la artrosis de la articulación trapeciometacarpiana (ATM). La hipótesis nula consideró que la concordancia era debida al azar, y la alternativa que la concordancia no era debida al azar. Material y método. Se estudiaron las radiografías de 46 pacientes con síntomas y signos clínicos de artrosis de la ATM. Se clasificaron independientemente por 5 facultativos: tres expertos en extremidad superior, uno en radiodiagnóstico y un residente en COT de cuarto año. Se estudió la concordancia de las observaciones mediante el índice kappa global. Discusión. El diagnóstico de la artrosis de la ATM se basa fundamentalmente en la clínica, siendo la radiografía un método complementario de confirmación. La clasificación de Eaton-Littler propone 4 estadios evolutivos de la enfermedad, con una implicación terapéutica. Conclusiones. La concordancia de la clasificación radiográfica de Eaton-Littler es moderada (AU)

Objective. To study the concordance of the radiographic classification of Eaton-Littler for the diagnosis of basal thumb joint osteoarthritis (BTJO). The null hypothesis was that the concordance was due to chance and the alternative was that the concordance was not due to chance. Material and method. We have observed the x-rays of 46 patients with symptoms and clinical signs of BTJO. They were independently classified by five physicians: three experts in upper extremity, one in radiology and a fourth year resident of Orthopedics. We studied the concordance in the observations through the global Kappa. Discussion. The diagnosis of BTJO is based primarily on clinical exploration, radiology is a complementary method of confirmation. The classification of Eaton-Littler proposes 4 stages of the disease, with a therapeutic involvement. Conclusions. The concordance of the radiographic classification of Eaton-Littler is moderate (AU)

[Inter-observer agreement on the Eaton-Littler classification of trapeziometacarpal joint osteoarthritis]. / Concordancia interobservador de la clasificación de Eaton-Littler de la artrosis trapeciometacarpiana.

OBJECTIVE: To study the concordance of the radiographic classification of Eaton-Littler for the diagnosis of basal thumb joint osteoarthritis (BTJO). The null hypothesis was that the concordance was due to chance and the alternative was that the concordance was not due to chance. MATERIAL AND METHOD: We have observed the x-rays of 46 patients with symptoms and clinical signs of BTJO. They were independently classified by five physicians: three experts in upper extremity, one in radiology and a fourth year resident of Orthopedics. We studied the concordance in the observations through the global Kappa. DISCUSSION: The diagnosis of BTJO is based primarily on clinical exploration, radiology is a complementary method of confirmation. The classification of Eaton-Littler proposes 4 stages of the disease, with a therapeutic involvement. CONCLUSIONS: The concordance of the radiographic classification of Eaton-Littler is moderate.

In vitro and in vivo pharmacological profile of UFP-512, a novel selective delta-opioid receptor agonist; correlations between desensitization and tolerance.

BACKGROUND AND PURPOSE: Delta-opioid receptors (DOP receptors) could represent a novel target in the treatment of depressive disorders. To explore this new field of interest, the development of highly selective DOP receptor agonists is essential. UFP-512 [H-Dmt-Tic-NH-CH(CH2-COOH)-Bid], was recently shown to behave in vitro as a selective and potent DOP receptor agonist and to promote antidepressant- and anxiolytic-like effects in vivo (Vergura et al., 2007). Here, we have characterized the pharmacological properties of UFP-512 and established a link between desensitization and tolerance. EXPERIMENTAL APPROACH: Studies were performed in the human neuroblastoma SK-N-BE cells to establish i) binding parameters for UFP-512 ii) signalling pathways activated after acute and chronic treatment iii) regulation (phosphorylation and trafficking) of human DOP (hDOP) receptors after sustained activation by UFP-512. In vivo, we studied UFP-512-induced antidepressant-like effects after acute or chronic treatment in the mouse forced swimming test. KEY RESULTS: In vitro, UFP-512 was a high affinity agonist for DOP receptors. While UFP-512 induced marked phosphorylation of DOP receptors on Ser363, we observed a low desensitization of the cAMP pathway, associated with receptor endocytosis and recycling without any reduction on extracellular signal-regulated protein kinase 1/2 activation. In vivo, acute administration of UFP-512 produced an antidepressant-like effect, without any sign of tolerance after chronic administration. CONCLUSIONS AND IMPLICATIONS: There was a correlation between weak desensitization, significant internalization and recycling of the human DOP receptors and lack of tolerance to UFP-512. This suggests that this compound would be a promising drug prototype for exploring innovative treatments for mood disorders.

A fortifier comprising protein, vitamins, and calcium-glycerophosphate for preterm human milk.

BACKGROUND: The infant's own mother's milk, fortified with proteins, minerals, and vitamins, is considered the best food for low-birth-weight infants. This paper describes the process to obtain a liquid human milk fortifier. METHODS: The fortifier comprises a protein concentrate, calcium, phosphate, and zinc salts, as well as vitamins A and D. A powdered whey protein extracted from bovine milk was concentrated from 31.5-76.8 g/100 g using repetitive dialysis. The protein concentrate was dissolved in a 0.2 M phosphate buffer pH 7.4 and mixed with calcium-glycerophosphate and calcium-gluconate, vitamins A and D, folic acid, and zinc. Each 10 mL of this liquid fortifier has 0.78 g protein, 53 mg calcium, 36 mg phosphate, and 0.93 mg zinc. RESULTS: Repetitive dialysis did not modify the protein structure as demonstrated by electrophoresis. A total of 95% of lactose content was discarded. Enriching human milk using this human milk fortifier increased the concentration per deciliter of all added nutrients; proteins increased from 1.68-2.35 g, calcium from 26-90 mg, and phosphorus, from 15-51 mg. CONCLUSIONS: A liquid human milk fortifier was successfully manufactured using a noncomplex procedure. An intake of 180-200 mL/kg/day of the fortified human milk by the premature infant would satisfy the infant's nutritional requirements and achieve expected growth and development.

Reparación protésica de pared posterior de tráquea por destrucción secundaria a tuberculosis esofágica / Prosthetic repair of posterior tracheal wall by secondary destruction due to esophageal tuberculosis

La fístula traqueoesofágica del adulto es poco frecuente, siendo su origen más común las neoplasias primarias malignas, lo que generalmente le confiere mal pronóstico. Cuando es causada por lesiones benignas el pronóstico es más favorable, siempre que se realice un adecuado tratamiento quirúrgico. Se presenta el caso de un hombre de 28 años que, a raíz de un accidente de tránsito, resultó politraumatizado. Entre sus lesiones se constató un traumatismo torácico y durante su hospitalización se descubrió una tuberculosis pulmonar, para la cual se inició tratamiento específico. Posterior al alta, fue reingresado diagnosticándose una fístula traqueoesofagíca. El tránsito esofágico mostró salida del medio de contraste a tráquea y bronquios, y la fibrobroncoscopía confirmó una lesión de 6 a 7 cm en el tercio medio de la parted posterior de la tráquea que se prolongaba hasta el bronquio fuente derecho. Fue operado de urgencia practicándose esofagectomía torácica, con esofagostoma cervical y gastrostomía transtorácica.La reparación de la porción membranosa de la tráquea requirió de una plastía que se realizó con 2 láminas de colágeno. El paciente evolucionó satisfactoriamente, con epitelización total de la superficie traqueal reparada al cabo de 60 días. El estudio histopatológico de la pieza operatoria reveló tuberculosis esofágica

Hepatitis aguda fulminante no A no B en el embarazo: un caso clínico de probable hepatitis esporádica producida por virus E / Fulminating acute non A non B hepatitis in pregnancy: a clinical case of probably sporadic hepatitis produced by E virus

Se destaca la mayor gravedad de la hepatitis E en la embarazada y la alta mortalidad materna y fetal en la hepatitis aguda fulminante. Se presneta el caso clínico de una paciente de 19 años, primigesta, embarazo de 29 semanas con diagnóstico de hepatitis aguda fulminante no A no B, probable E por el cuadro clínico, que evoluciona con muerte fetal y ante la gravedad del cuadro se planteó un transplante hepático que no se logra por falta de donante; la paciente fallece el día 16 desde su ingreso. En el estudio histopatológico de hígado destaca una necrosis hepática masiva y un shock terminal

Circadian variation and changes after a meal in volume and lipid production of human milk from rural Mexican women.

This research was designed to evaluate the circadian variation in the lipid content of the milk obtained from 10 lactating Mexican women as well as the effects of a meal eaten by the mother and of previous milk sampling on the milk volume and fat yield. In addition, predictions were made to determine the most appropriate sampling schedule to obtain a milk sample representative of 24-hour production. Every 4 h over a 24-hour period, the contents of the left breast of predominantly breast-feeding volunteers were completely extracted, using an Engell pump, and analysed for lipid content. In a separate experiment, 6 volunteers were sampled hourly from 9.00 to 13.00 h on 2 consecutive days, one after eating breakfast and the second while fasting. Significant circadian variations of volume (p < 0.05) and lipid yield (p < 0.001) were noted, peaking at 8.00-12.00 and 16.00-20.00 h, respectively. No effects of eating breakfast or of the volume and fat content of the preceding pumping on the actual volume or fat yield were found. In this population, sampling at 12.00, 20.00 and 24.00 h is the most representative of the 24-hour lipid yield, tending to overestimate it by 2.59 g/24 h with a predictive range of 97-124%.

[Hormone profile of the essential hypertension patient with ischemic cardiopathy. I. Renin, angiotensin and aldosterone]. / El perfil hormonal del hipertenso esencial con cardiopatía isquémica. (I) Renina, angiotensina y aldosterona.

To evaluate the characteristics that the renin and aldosterone profile could present in essential hypertensive patients complicated with ischemic heart disease, and as a contribution to the knowledge of the roll that these hormones could have as possible "risk factors" of coronary heart disease, sixty male patients were studied. These were divided in three groups: group I, formed by 15 essential hypertensive patients with objectively demonstrated ischemic heart disease; group II integrated by 15 essential hypertensives with no ischemic heart disease and group III with 30 normal volunteers. Serum levels of plasma renin activity (PRA) and aldosterone determined by radioimmunoassay, and of urinary sodium excretion were measured in all the patients. The distribution of cases with high, normal and low renin and aldosterone were similar in group I and in group II. It was interesting to find that the four patients of group I who were non-smokers, presented the lower renin levels (from 0.36 to 2.8 ng/ml/h). The relation between PRA and the number of occluded coronary arteries revealed an increased number of patients and affected arteries in the subgroup with renin levels above 5 ng/ml/h in comparison with the subgroup with PRA from 0 to 5, although the difference was not statistically significant. By our study, we cannot conclude that the PRA and aldosterone behave in a different fashion in essential hypertensives from those complicated with ischemic heart disease.

Medicion de 25 hidroxicolecalciferol en plasma. / Measurement of 25 hydroxycholecalciferol in plasma

Los metodos para determinar 25 hidroxicolecalciferol (25OHD3) presentam grandes problemas para solubilizar esta hormona en un sistema de radioensayo. Se describe una tecnica en la que se utiliza etanol para extraer del plasma y solubilizar en un sistema de radioanalisis la 25OHD3. La eficiencia de extraccion fue de 85+/-1.3 por ciento.La sensibilidad del metodo fue de 1.36 ng/l, la variacion intraensayo de 6.2 por ciento y la interensayo fue de l6.5 por ciento. Las concentraciones plasmaticas de un grupo de adolescentes sanos fueron de 34.8+/-12,7 ng/l, mientras que las de un grupo de obreras pobremente expuestas al sol (23.6+/-12.2 ng/l) y los de un grupo de lactantes con hipocalcemia (6.6+/-3.8) fueron significativamente menores. La sensibilidad y precision del procedimiento, asi como las concentraciones plasmaticas de 25OHD3, son comparables a las obtenidas con otros metodos

Bloqueo de la respuesta hipofisaria de TSH en ninos mediante dosis elevadas de TRH oral. / Large single doses of oral TRH blockade the TSH response in children

Se administraton dosis unicas de 5,10 y 20 mg de TRH oral a 15 ninos sanos con baja talla primordial. La respuesta mas importante en la secrecion de TSH hipofisaria se obtuvo con la dosis de 10 mg, mientras que se obtuvo una respuesta significativamente mas baja con 20 mg (limites de p de 0.02 a 0.001). La respuesta mas pobre se observo con 5 mg. Las concentraciones sericas de T3 y T4 se incrementaron de manera paralela a los incrementos de TSH; asi se descarto que el mecanismo de retroalimentacion fuera el encargado de la inhibicion paradojica de TSH producida por la dosis mayor de TRH. Este efecto inhibitorio sobre la secrecion de TSH puede atribuirse a cambios en el numero, la afinidad o ambas cosas de los receptores hipofisarios para TSH, en lugar de un efecto inhibitorio de la T3