[Safety and efficacy of a therapeutic exercise program in young adults with repaired congenital diaphragmatic hernia]. / Seguridad y eficacia de un programa de ejercicio terapéutico en jóvenes intervenidos de hernia diafragmática congénita.

INTRODUCTION AND OBJECTIVE: Patients with congenital diaphragmatic hernia (CDH) can have up to 40 times more frequency of muskuloskeletal deformities and decreased perception of physical activity tan their pairs. The objective of this study is to evaluate the safety and efficacy of an individualized exercise program in late adolescents and young adults with repaired CDH, as well as a description of their basal status. MATERIAL AND METHODS: Non randomized prospective trial of 13 patients with repaired CDH between 1997-2005. An initial physical exploration and a pre-post assessment of bioimpedance (BIA), dynamometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6-minute walk test (6MWT), physical activity level (IPAQ) and quality of life (QoL) was made. The training program last for 4 weeks. For the statistical analysis, the Student's t test for paired samples and Wilcoxon test were used. RESULTS: 77% (n=10) were male with a mean age of 19.23±2.13 years. In baseline BIA, 62% (n=8) had truncal sarcopenia that improved in -0.43±0.58, and P=.016. MIP, MEP, 6MWT and QoL tests increased by -7.27±8.26 cmH2O, P=.008; -11.91±10.20 cmH2O, P=.002; -70.63±17.88 m, P=.001; -42,19±26.79, P=.00 respectively. The IPAQ did not change significantly (P=0.86), however the time dedicated to muscle strengthening increased. No adverse effects were reported. CONCLUSIONS: A personalized rehabilitation program is safe and could improve the respiratory muscle strength and truncal sarcopenia as well as the submaximal effort capacity in late adolescents and young adults with repaired CDH.

Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

Functional and structural characterisation of RimL from Bacillus cereus, a new Nα-acetyltransferase of ribosomal proteins that was wrongly assigned as an aminoglycosyltransferase.

Enzymes of the GNAT (GCN5-relate N-acetyltransferases) superfamily are important regulators of cell growth and development. They are functionally diverse and share low amino acid sequence identity, making functional annotation difficult. In this study, we report the function and structure of a new ribosomal enzyme, Nα-acetyl transferase from Bacillus cereus (RimLBC), a protein that was previously wrongly annotated as an aminoglycosyltransferase. Firstly, extensive comparative amino acid sequence analyses suggested RimLBC belongs to a cluster of proteins mediating acetylation of the ribosomal protein L7/L12. To assess if this was the case, several well established substrates of aminoglycosyltransferases were screened. The results of these studies did not support an aminoglycoside acetylating function for RimLBC. To gain further insight into RimLBC biological role, a series of studies that included MALDI-TOF, isothermal titration calorimetry, NMR, X-ray protein crystallography, and site-directed mutagenesis confirmed RimLBC affinity for Acetyl-CoA and that the ribosomal protein L7/L12 is a substrate of RimLBC. Last, we advance a mechanistic model of RimLBC mode of recognition of its protein substrates. Taken together, our studies confirmed RimLBC as a new ribosomal Nα-acetyltransferase and provide structural and functional insights into substrate recognition by Nα-acetyltransferases and protein acetylation in bacteria.

Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia. / Tiroidectomía transoral endoscópica con abordaje vestibular (TOETVA): una nueva opción para el tratamiento de pacientes pediátricos.

Pediatric pneumonectomies are exceptional nowadays, being reserved for cases with destroyed lungs with frequent exacerbations and reinfections and only two cases of thoracoscopic pneumonectomy have been previously published. We present the case of a 4-year-old patient with no relevant history who developed complete atelectasis of the left lung (LL) after influenza A pneumonia, followed by secondary recurrent infections. A year later a diagnostic bronchoscopy without alterations was performed. A complete loss of volume and hypoperfusion of the LL (right lung perfusion 95%, LL perfusion: 5%) with bronchiectasis and hyperinsufflation and herniation of the right lung into the left hemithorax was observed in a pulmonary perfusion SPECT-CT. After unsuccessful conservative management and recurrent infections a pneumonectomy was indicated. The pneumonectomy was performed through a five-port thoracoscopy. The dissection of the hilum was made using hook electrocautery and sealing device. The left main bronchus was sectioned with an endostapler. There were no intraoperative complications. An endothoracic drain was removed the first postoperative day. The patient was discharged on the fourth postoperative day. The patient has not presented any complications 10 months after surgery. Although pneumonectomy is an exceptional surgery in children, it can be performed by minimally invasive surgery with success and safety in centers with extensive experience in pediatric thoracoscopic surgery.

Hoy en día, las neumonectomías pediátricas son algo excepcional. El procedimiento se reserva para aquellos casos en los que los pulmones están destruidos y presentan exacerbaciones y reinfecciones frecuentes, con tan solo dos casos de neumonectomía toracoscópica publicados hasta la fecha. Presentamos el caso de un paciente de 4 años sin antecedentes de interés que desarrolló atelectasia completa del pulmón izquierdo (PI) tras neumonía por gripe A, seguido de infecciones secundarias recurrentes. Un año después, se le practicó broncoscopia diagnóstica, sin que esta mostrara alteraciones significativas. Tras realizársele un SPECT-CT de perfusión pulmonar, se evidenció pérdida completa de volumen e hipoperfusión del PI (perfusión del pulmón derecho: 95%; perfusión del pulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y herniación del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar el manejo conservador y registrarse infecciones recurrentes, se estableció la indicación de neumonectomía. La neumonectomía se llevó a cabo mediante toracoscopia por cinco puertos. La disección del hilio se realizó mediante gancho de electrocoagulación y dispositivo de sellado. El bronquio principal izquierdo se seccionó con endograpadora. No se registraron complicaciones intraoperatorias. El drenaje endotorácico se retiró al día siguiente de la intervención, mientras que el paciente fue dado de alta a los cuatro días, sin que haya presentado complicaciones transcurridos 10 meses desde la cirugía. Aunque la neumonectomía es una intervención excepcional en niños, puede llevarse a cabo de manera exitosa y segura por cirugía mínimamente invasiva en centros con amplia experiencia en cirugía toracoscópica pediátrica.

Neumonectomía toracoscópica en un niño de 4 años con el pulmón destruido tras neumonía vírica / Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia

Hoy en día, las neumonectomías pediátricas son algo excepcional. Elprocedimiento se reserva para aquellos casos en los que los pulmones estándestruidos y presentan exacerbaciones y reinfecciones frecuentes, con tansolo dos casos de neumonectomía toracoscópica publicados hasta la fecha.Presentamos el caso de un paciente de 4 años sin antecedentes deinterés que desarrolló atelectasia completa del pulmón izquierdo (PI) trasneumonía por gripe A, seguido de infecciones secundarias recurrentes.Un año después, se le practicó broncoscopia diagnóstica, sin que estamostrara alteraciones significativas. Tras realizársele un SPECT-CT deperfusión pulmonar, se evidenció pérdida completa de volumen e hi-poperfusión del PI (perfusión del pulmón derecho: 95%; perfusión delpulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y hernia-ción del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar elmanejo conservador y registrarse infecciones recurrentes, se establecióla indicación de neumonectomía.La neumonectomía se llevó a cabo mediante toracoscopia por cincopuertos. La disección del hilio se realizó mediante gancho de electro-coagulación y dispositivo de sellado. El bronquio principal izquierdose seccionó con endograpadora. No se registraron complicaciones in-traoperatorias.El drenaje endotorácico se retiró al día siguiente de la intervención,mientras que el paciente fue dado de alta a los cuatro días, sin que hayapresentado complicaciones transcurridos 10 meses desde la cirugía.Aunque la neumonectomía es una intervención excepcional enniños, puede llevarse a cabo de manera exitosa y segura por cirugíamínimamente invasiva en centros con amplia experiencia en cirugíatoracoscópica pediátrica.(AU)

Pediatric pneumonectomies are exceptional nowadays, being re-served for cases with destroyed lungs with frequent exacerbations and einfections and only two cases of thoracoscopic pneumonectomy havebeen previously published.We present the case of a 4-year-old patient with no relevant his-tory who developed complete atelectasis of the left lung (LL) afterinfluenza A pneumonia, followed by secondary recurrent infections.A year later a diagnostic bronchoscopy without alterations was per-formed. A complete loss of volume and hypoperfusion of the LL(right lung perfusion 95%, LL perfusion: 5%) with bronchiectasisand hyperinsufflation and herniation of the right lung into the lefthemithorax was observed in a pulmonary perfusion SPECT-CT. Afterunsuccessful conservative management and recurrent infections apneumonectomy was indicated.The pneumonectomy was performed through a five-port thoracos-copy. The dissection of the hilum was made using hook electrocauteryand sealing device. The left main bronchus was sectioned with an en-dostapler. There were no intraoperative complications.An endothoracic drain was removed the first postoperative day. Thepatient was discharged on the fourth postoperative day. The patient hasnot presented any complications 10 months after surgery.Although pneumonectomy is an exceptional surgery in children,it can be performed by minimally invasive surgery with success andsafety in centers with extensive experience in pediatric thoracoscopicsurgery.(UA)

Evidence on differential role for alpha 1 and alpha 2 subtypes of AP-2 adaptin in the central nervous system.

Two subtypes of alpha (α)subunits, α1and α2, belonging to AP-2 complex have been described in the central nervous system (CNS). The specific role of each subtype is still unclear. In this study, we evaluated the expression and interaction with cell membranes of both subtypes in the postnatal developing cerebral cortex and cerebellum in two rat strains that display distinct developmental features. We observed that α2 displays higher variations than α1 during development, and at lesser extent in the rats with delayed rate of development. Additionally, by in vitro binding assays we evaluated the interaction of α subunits with bovine brain membranes. Both subtypes displayed clear differences in their performance, maximum binding of α1 was higher and α2 reached it faster than α1. In addition, both subtypes displayed different binding to membranes when bivalent cations or nucleotides were added. We conclude that both subtypes interact differently with membranes and that they may play different roles in clathrin-mediated endocytosis in the CNS.

Impacto del confinamiento en el patrón epidemiológico del traumatismo pediátrico / Impact of confinement on the epidemiologic pattern of pediatric trauma

Introducción: El trauma es unas de las causas principales de morbilidad y mortalidad en la infancia. El aislamiento de la población durante la pandemia de 2020 provocó cambios en la frecuencia y gravedad de los traumatismos pediátricos, debido a las modificaciones y restricciones en la dinámica social, el miedo al contagio y la reorganización de la atención sanitaria. Objetivos. Analizar el efecto que tiene el confinamiento de la población infantil en los patrones epidemiológicos y la asistencia sanitaria de urgencias a los traumatismos pediátricos, tomando como referencia un hospital de tercer nivel. Material y métodos. Estudio retrospectivo, comparativo y descriptivo. Análisis de los pacientes atendidos por traumatismo a cualquier nivel en el Servicio de Urgencias de un hospital de tercer nivel, durante los primeros quince días de confinamiento (marzo 2020), comparándolo con el mismo periodo prepandemia. Resultados. Del total de 388 pacientes, 40 fueron atendidos durante el confinamiento (88,5% menos que el mismo periodo del año anterior). La media de edad del grupo prepandemia fue significativamente superior. La gravedad, medida con el Índice de Trauma Pediátrico (ITP), fue mayor en pacientes del grupo confinamiento. El lugar más frecuente de lesión durante la pandemia fue en el domicilio, con un aumento de lesiones de localización facial. Conclusiones. Durante el aislamiento poblacional en la pandemia por SARS-CoV-2 se produjo una disminución en la demanda de la atención de traumas pediátricos en Urgencias, objetivándose un aumento en la gravedad de los niños atendidos. El confinamiento de la población produjo cambios en los patrones de lesión, así como en la localización de las lesiones más frecuentes.(AU)

Introduction: Trauma is among the leading causes of morbidity and mortality in childhood. The isolation of the population during the 2020 pandemic caused changes in the frequency and severity of pediatric trauma, due to modifications and restrictions in social dynamics, fear of contagion and reorganization of health care. Objectives. To analyze the impact of the confinement of the pediatric population on epidemiological patterns and emergency health care for pediatric trauma, taking a tertiary level hospital as a reference. Material and methods. Retrospective, comparative and descriptive study. Analysis of patients treated for trauma at any level in the Emergency Department of a tertiary hospital, during the first fifteen days of confinement (March 2020), compared with the same pre-pandemic period. Results. Of the total of 388 patients, 40 were seen during confinement (88.5% less than the same period of the previous year). The mean age of the pre-pandemic group was significantly higher. The severity in patients in the confinement group was higher than in pre-pandemic patients. The most frequent site of injury during confinement was at home, with an increase in facial injuries. Conclusions. During the SARS-CoV-2 pandemic, there was a decrease in the demand for pediatric trauma emergency care, with an increase in the severity of the children seen. There were changes in injury patterns, as well as in the location of the most frequent lesions.(AU)

Quality of life in adolescents who underwent congenital diaphragmatic hernia surgical repair. / Calidad de vida en adolescentes intervenidos de hernia diafragmática congénita.

OBJECTIVE: The advances made in the surgical and postnatal treatment of congenital diaphragmatic hernia (CDH) have considerably improved patient survival, but morbidity remains significant. The objective of this study was to analyze the effect these sequels have on the health-related quality of life (HRQL) of adolescents and young adults who have survived CDH, and to compare it with that of the general population. MATERIALS AND METHODS: A transversal descriptive study of patients diagnosed with CDH in our institution from 1997 to 2004 was carried out. Survival, location, hernia size, herniated organs, need for extracorporeal membrane oxygenation, and mechanical ventilation time were analyzed. In addition, a comparative study of the current HRQL of survivors was conducted using the SF-36 survey (36-Item Health Survey Short Form), which assessed physical function, physical role, body pain, general health, vitality, social function, emotional role, and mental health. Data of 24 healthy adolescents was used as a control group. RESULTS: Of the 29 survivors (70.7%), 21 were successfully contacted, and 16 responded to the survey. They all claimed their overall quality of life was good or very good. The group of adolescents who underwent CDH surgical repair had better results in the vitality (p= 0.001) and mental health (p<0.05) areas, but the overall HRQL score and the remaining health areas were similar. No significant differences were found regarding diaphragmatic size or need for ECMO. CONCLUSION: According to adolescent survivors who underwent CDH surgical repair, their quality of life is similar to that of other individuals of their age. Our results are encouraging and may prove useful for future parents of CDH patients.

OBJETIVO: Los avances en el tratamiento quirúrgico y posnatal han mejorado significativamente la supervivencia de pacientes con hernia diafragmática congénita (HDC). La morbilidad asociada sigue siendo significativa. El objetivo del estudio es evaluar efecto de estas secuelas sobre la calidad de vida relacionada con la salud (CVRS) de adolescentes y adultos jóvenes supervivientes de HDC y compararla con la población general. MATERIAL Y METODOS: Estudio descriptivo transversal de pacientes diagnosticados de HDC entre 1997 y 2004. Supervivencia, localización, tamaño de la hernia, órganos herniados, necesidad de oxigenación por membrana extracorpórea, tiempo de ventilación mecánica. Estudio comparativo de CVRS actual de pacientes supervivientes mediante la encuesta SF-36 (36-Item Health Survey Short Form): función física, rol físico, dolor corporal, salud general, vitalidad, función social, rol emocional, salud mental. Utilizamos datos de 24 adolescentes sanos como grupo control. RESULTADOS: De los 29 supervivientes (70,7%), fueron localizados 21 y contestaron la encuesta 16, que consideraron tener una calidad de vida global buena o muy buena. El grupo de adolescentes intervenidos tuvieron mejores resultados en las esferas de vitalidad (p = 0,001) y salud mental (p<0,05), pero la puntuación de la CVRS global y el resto de dimensiones de salud fueron similares. No se objetivaron diferencias significativas en relación con el tamaño diafragmático ni la necesidad de ECMO. CONCLUSIONES: Los adolescentes supervivientes intervenidos de HDC consideran tener una calidad de vida similar a jóvenes de su misma edad. Los resultados de nuestro estudio son alentadores y permiten un mejor asesoramiento para futuros pacientes con HDC.

Calidad de vida en adolescentes intervenidos de herniadiafragmática congénita / Quality of life in adolescents who underwent congenital diaphragmatic hernia surgical repair

Objetivo: Los avances en el tratamiento quirúrgico y posnatal hanmejorado significativamente la supervivencia de pacientes con herniadiafragmática congénita (HDC). La morbilidad asociada sigue siendosignificativa. El objetivo del estudio es evaluar el efecto de estas se-cuelas sobre la calidad de vida relacionada con la salud (CVRS) deadolescentes y adultos jóvenes supervivientes de HDC y compararlacon la población general. Material y métodos: Estudio descriptivo transversal de pacientesdiagnosticados de HDC entre 1997 y 2004. Supervivencia, localiza-ción, tamaño de la hernia, órganos herniados, necesidad de oxigenaciónpor membrana extracorpórea, tiempo de ventilación mecánica. Estudio comparativo de CVRS actual de pacientes supervivientes mediante laencuesta SF-36 (36-Item Health Survey Short Form): función física,rol físico, dolor corporal, salud general, vitalidad, función social, rolemocional, salud mental. Utilizamos datos de 24 adolescentes sanoscomo grupo control. Resultados: De los 29 supervivientes (70,7%), fueron localizados21 y contestaron la encuesta 16, que consideraron tener una calidad devida global buena o muy buena. El grupo de adolescentes intervenidostuvieron mejores resultados en las esferas de vitalidad (p = 0,001) ysalud mental (p < 0,05), pero la puntuación de la CVRS global y elresto de dimensiones de salud fueron similares. No se objetivaron diferencias significativas en relación con el tamaño diafragmático ni lanecesidad de ECMO. Conclusiones: Los adolescentes supervivientes intervenidos deHDC consideran tener una calidad de vida similar a jóvenes de su mis-ma edad. Los resultados de nuestro estudio son alentadores y permitenun mejor asesoramiento para futuros pacientes con HDC.(AU)

Objective: The advances made in the surgical and postnataltreatment of congenital diaphragmatic hernia (CDH) have consid-erably improved patient survival, but morbidity remains significant.The objective of this study was to analyze the effect these sequelshave on the health-related quality of life (HRQL) of adolescents andyoung adults who have survived CDH, and to compare it with thatof the general population. Materials and methods: A transversal descriptive study of pa-tients diagnosed with CDH in our institution from 1997 to 2004 wascarried out. Survival, location, hernia size, herniated organs, need forextracorporeal membrane oxygenation, and mechanical ventilationtime were analyzed. In addition, a comparative study of the currentHRQL of survivors was conducted using the SF-36 survey (36-Item Health Survey Short Form), which assessed physical function,physical role, body pain, general health, vitality, social function,emotional role, and mental health. Data of 24 healthy adolescentswas used as a control group. Results: Of the 29 survivors (70.7%), 21 were successfullycontacted, and 16 responded to the survey. They all claimed theiroverall quality of life was good or very good. The group of ado-lescents who underwent CDH surgical repair had better results inthe vitality (p= 0.001) and mental health (p< 0.05) areas, but theoverall HRQL score and the remaining health areas were similar.No significant differences were found regarding diaphragmatic sizeor need for ECMO. Conclusions: According to adolescent survivors who underwentCDH surgical repair, their quality of life is similar to that of otherindividuals of their age. Our results are encouraging and may proveuseful for future parents of CDH patients.(AU)

Síndrome de atrapamiento poplíteo / Popliteal entrapment syndrome

El síndrome del atrapamiento de la arteria poplítea, es una entidad nosológica no muy frecuente que afecta no solo a la arteria,sino también el componente venoso y nervioso de los segmentos situados a nivel del hueco poplíteo. Es una patología originada porla compresión de estas estructuras por elementos musculoesqueléticos situados en esta región anatómica que pueden ocasionar unasintomatología mas o menos intensa por la lesión de las estructuras que se comprimen. Existen diferentes formas anatómicas loque soporta una clasificación morfológica. Es preciso realizar el diagnostico diferencial con otros procesos en base a la clínica y lasdiferentes pruebas de imagen que suelen ser fundamentales y decisivas para el diagnóstico. La base del tratamiento es la liberación de la zona eliminando los elementos estructurales compresivos. (AU)

Popliteal artery entrapment syndrome is a rare nosological entity that affects not only the artery, but also the venous and nervouscomponent of the segments located at the level of the popliteal fossa. It is a pathology caused by the compression of these structuresby musculoskeletal elements located in this anatomical region that can cause more or less intense symptoms due to the injury of thestructures that are compressed. There are different anatomical forms which supports a morphological classification.It is necessary to carry out the differential diagnosis with other processes based on the clinic and the different imaging tests thatare usually fundamental and decisive for the diagnosis. The basis of the treatment is the liberation of the area, eliminating the compressive structural elements. (AU)

Laparoscopic learning curves. / Curvas de aprendizaje en laparoscopia.

OBJECTIVES: Laparoscopic learning curves are slow, and there are no uniform surgical skill acquisition models. Therefore, our objective was to assess a laparoscopic skill learning program in individuals without any surgical experience, analyzing the learning curve by means of a certified custom-made simulator, and evaluating whether previous surgical experience had an impact on the learning curve. MATERIAL AND METHODS: A certified custom-made simulator and laparoscopic instruments were used to assess 20 university students who performed 10 repetitions of 3 exercises of growing difficulty (eye-hand coordination, hand-hand coordination, and cutting). Three parameters were analyzed: total time with each hand, total mistakes with each hand, and three items of the OSATS technical skill scale. The two first exercises were compared with a group of 14 experienced surgeons. Statistical analysis using repeated-measures Anova and Student's t-test was carried out (p < 0.05). RESULTS: Significant time improvement with each repetition was demonstrated in the three exercises. Curve stabilization was faster in surgeons (2-4 repetitions) than in students (8-9). Time reduction was noted in the first and second exercises in both groups, with 44.08% and 33.1% shorter times, respectively. CONCLUSIONS: Individuals without surgical experience acquired basic laparoscopic skills using a custom-made simulator, which allows simple surgical techniques to be carried out in an inexpensive, accessible fashion. Previous surgical experience was associated with a shorter learning curve. The custom-made simulator allowed individuals with and without surgical experience to be distinguished from each other.

OBJETIVOS: La curva de aprendizaje en cirugía laparoscópica es lenta y no existen modelos uniformes de adquisición de habilidades quirúrgicas. Tratamos de establecer la idoneidad de un programa de aprendizaje de habilidades laparoscópicas en sujetos sin experiencia quirúrgica, analizando la curva de aprendizaje utilizando un simulador artesanal homologado. Comprobar si la experiencia quirúrgica previa modifica la curva de aprendizaje. MATERIAL Y METODOS: Se empleó un simulador artesanal validado e instrumental laparoscópico para evaluar a 20 estudiantes universitarios que realizaron 10 repeticiones de tres ejercicios de dificultad creciente (coordinación ojo-mano, coordinación mano-mano y corte). Se evaluaron tres parámetros: tiempo total y con cada mano, errores totales y con cada mano y tres ítems de habilidad técnica OSATS. Comparación de los dos primeros ejercicios con un grupo de 14 cirujanos con experiencia. Análisis estadístico mediante Anova para medidas repetidas y t de Student (p < 0,05). RESULTADOS: Se demostró la mejoría significativa del tiempo con cada repetición en los tres ejercicios. La estabilización de la curva fue más precoz entre los cirujanos (2-4 repeticiones) que los estudiantes (8-9). Se comprobó la reducción del tiempo invertido para el primer y segundo ejercicio en ambos grupos, que en los estudiantes fue del 44,08% y 33,1% respectivamente. CONCLUSIONES: Individuos sin experiencia quirúrgica desarrollan habilidades laparoscópicas básicas utilizando un simulador artesanal, que permite practicar técnicas quirúrgicas sencillas de forma barata y accesible. La experiencia quirúrgica previa se asocia con el acortamiento de la curva de aprendizaje. El simulador artesanal permite discriminar entre sujetos con y sin experiencia quirúrgica.

Sordera súbita idiopática. Entidad poco conocida en atención primaria / Idiopathic sudden deafness. A poorly known entity in primary care

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Amigdalitis unilateral: angina de Plaut-Vincent / Unilateral tonsillitis: Plaut-Vincent angina

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Training and accrediting international surgeons.

BACKGROUND: Formal international medical programmes (IMPs) represent an evolution away from traditional medical volunteerism, and are based on the foundation of bidirectional exchange of knowledge, experience and organizational expertise. The intent is to develop multidirectional collaborations and local capacity that is resilient in the face of limited resources. Training and accreditation of surgeons continues to be a challenge to IMPs, including the need for mutual recognition of competencies and professional certification. METHODS: MEDLINE, Embase and Google Scholar™ were searched using the following terms, alone and in combination: 'credentialing', 'education', 'global surgery', 'international medicine', 'international surgery' and 'training'. Secondary references cited by original sources were also included. The authors, all members of the American College of Academic International Medicine group, agreed advice on training and accreditation of international surgeons. RESULTS AND CONCLUSION: The following are key elements of training and accrediting international surgeons: basic framework built upon a bidirectional approach; consideration of both high-income and low- and middle-income country perspectives; sourcing funding from current sources based on existing IMPs and networks of IMPs; emphasis on predetermined cultural competencies and a common set of core surgical skills; a decentralized global system for verification and mutual recognition of medical training and certification. The global medical system of the future will require the assurance of high standards for surgical education, training and accreditation.

Hypoxia-ischemia alters distribution of lysosomal proteins in rat cortex and hippocampus.

Neuronal excitotoxicity induced by glutamatergic receptor overstimulation contributes to brain damage. Recent studies have shown that lysosomal membrane permeabilization (LMP) is involved in ischemia-associated neuronal death. In this study we evaluated the effect of neonatal hypoxia-ischemia (HI), as a model of excitotoxicity, on the lysosomal integrity throughout the distribution of the lysosomal proteins cathepsin D and prosaposin. Rat pups (7 days old) of the Wistar Kyoto strain were submitted to HI and they were euthanized 4 days after treatment and the cerebral cortex (Cx) and hippocampus (HIP) were processed for immunohistochemistry or immunoblotting. Treatment induced an increase of gliosis and also a redistribution of both prosaposin and cathepsin D (as intermediate and mature forms), into the cytosol of the HIP and Cx. In addition, HI induced a decrease of LAMP-1 in the membranous fraction and the appearance of a reactive band to anti-LAMP-1 in the cytosolic fraction, suggesting a cleavage of this protein. From these results, we propose that the abnormal release of Cat D and PSAP to the cytosol is triggered as a result of LAMP-1 cleavage in HI animals, which leads to cell damage. This could be a common mechanism in pathological conditions that compromises neuronal survival and brain function.