Enucleación prostática con láser de holmio (HoLEP) mediante cirugía sin ingreso: una alternativa posible y segura / Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option

Objetivo Estudiar la viabilidad de la enucleación prostática con láser de holmio (HoLEP) en circuito de cirugía mayor ambulatoria. Material y métodos Se realiza un estudio prospectivo observacional en el que se incluyen 25 pacientes intervenidos de HoLEP que han sido dados de alta el mismo día de la cirugía según criterios previamente establecidos. Resultados La edad media de los pacientes intervenidos fue de 65,1 años. El volumen prostático medio fue de 45,8cc. Todos los pacientes fueron dados de alta el día de la cirugía (alta efectiva 100%). El porcentaje de complicaciones en nuestra serie fue del 12%, todas ellas grado I según la Clasificación Clavien Dindo. Ningún paciente precisó reingreso en los 30 días posteriores al procedimiento. El porcentaje de satisfacción con el circuito de cirugía ambulatoria fue del 95%. Conclusiones Tras el análisis inicial de nuestros datos podemos concluir que el HoLEP ambulatorio es una técnica eficaz y segura con bajo riesgo de complicaciones. El circuito de cirugía ambulatoria es el preferido por los pacientes intervenidos de HoLEP (AU)

Objective To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. Material and methods Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. Results The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. Conclusions The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP (AU)

A case of natural infection with Dirofilaria immitis in a coati (Nasua narica) from Mexico.

This paper aims to describe the natural infection with Dirofilaria immitis in Nasua narica (white-nosed coati) from Yucatán, Mexico. Two carcasses of N. narica were collected on a highway that crosses through a dense forest with patches used for agriculture and livestock activities. We performed necropsies, and two female adult nematode parasites from the heart of one specimen were collected and preserved for their molecular identification using a conventional PCR directed at a fragment of the small subunit (18S) ribosomal RNA (18S-rRNA) gene. Bioinformatic analysis showed a similarity of 99 % with three sequences from D. immitis (two from Japan). Additionally, we performed a phylogenetic tree with the recovered sequence. All these analyses showed that D. immitis is present in N. narica from Mexico. The transmission of D. immitis toward populations of Nasua sp. may be due to indirect and accidental contact with domestic dogs or wild canids that share the same environment.

Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option.

OBJECTIVE: To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS: Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS: The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS: The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.

Estudio comparativo de la extracción de la pieza de nefrectomía laparoscópica mediante una incisión de tipo Pfannenstiel / Comparative study of intact specimen extraction in laparoscopic nephrectomy by pfannenstiel incision

Objetivos Nuestro objetivo es demostrar que la incisión de Pfannenstiel presenta un perfil más seguro en cuanto a complicaciones postoperatorias frente a otro tipo de incisiones que habitualmente se utilizan para la extracción renal laparoscópica. Material y métodos Estudio retrospectivo y comparativo de 256 pacientes intervenidos de nefrectomía o nefroureterectomía. Dividimos a los pacientes en dos grupos: extracción renal mediante incisión de Pfannenstiel (grupo 1) y extracción renal mediante otro tipo de incisiones (grupo 2). Evaluamos: aparición de eventración y evisceración clínica y subclínica, presencia de infección bacteriana significativa, presencia de dolor, aparición de seroma, hematoma/sangrado, dehiscencia de la herida y parálisis muscular en cada paciente. Resultados Los pacientes del grupo Pfannenstiel presentaron una tasa de complicaciones derivadas de la herida de 11,72% frente a 27,34% en el grupo no-Pfannenstiel, p = 0,002, siendo significativo la menor tasa de dehiscencia (5,5 vs. 12,5%, p = 0,047) y seroma (3,1% vs. 7,8%, p = 0,022). El modelo de regresión logística multivariante mostró que la incisión de Pfannenstiel es un predictor de prevención de complicaciones derivadas de la herida quirúrgica (OR = 0,34, p = 0,005). Conclusiones La elección de una incisión de Pfannenstiel supuso una menor incidencia de dehiscencia y seroma de la herida quirúrgica, permitiendo la extracción de piezas de nefrectomía más voluminosas y con una menor estancia hospitalaria, lo que la convierte en una alternativa válida y segura, con un favorable perfil de complicaciones con respecto a otro tipo de incisiones (AU)

Objectives The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methods Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. Results Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs 27.34% with other incisions, p = 0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs 12.5%, p = 0.047) and seroma (3.1% vs 7.8%, p = 0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR = 0.34, p = 0.005). Conclusions The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select (AU)

Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision.

OBJECTIVES: The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. MATERIALS AND METHODS: Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient. RESULTS: Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005). CONCLUSIONS: The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Carcinoma escamoso híbrido de la planta del pie / Squamous hybrid carcinoma of the sole of the foot

Resumen El carcinoma escamoso (CEC) es un tumor maligno de la epidermis y sus anexos. Es el segundo en frecuencia después del carcinoma basocelular y presenta distintas variantes clinicopatológicas. El subtipo carcinoma verrucoso (CV) es una variante poco frecuente de CEC con características histopatológicas y comportamiento específico. Ocasionalmente, se pueden observar componentes carcinomatosos de células escamosas convencionales en el CV, denominándose a esta entidad tumores "híbridos", los cuales representan el 20% de los casos observados. Reportamos el caso de un paciente varón de 72 años con una gran lesión exofítica que compromete 5to dedo y planta de pie derecho con diagnóstico de carcinoma escamoso híbrido. El objetivo de la presentación es mostrar una asociación infrecuente, haciendo énfasis en su seguimiento cercano ya que puede manifestar cambios en su comportamiento clínico diseminándose a los ganglios linfáticos regionales.

Abstract Squamous carcinoma (SCC) is a malignant tumor of the epidermis and its appendages. It is the second most common after basal cell carcinoma and has different clinicopathological variants. The verrucous carcinoma (VC) subtype is a rare variant of SCC with histopathological characteristics and specific behavior. Occasionally, carcinomatous components of conventional squamous cells can be observed in the VC, this entity being called "hybridized" tumors, which represent 20% of cases.We report the case of a 72-year-old male with a large exophytic lesion involving the 5th right toe and foot with a diagnosis of squamous hybrid carcinoma. The objective of the presentation is to show an infrequent association, emphasizing its close follow-up as it can modify its clinical behavior by spreading to regional lymphnodes.

A phase 2, double-blind, placebo-controlled trial of a valproate/lithium combination in ALS patients.

BACKGROUND: Few treatments are currently available for amyotrophic lateral sclerosis (ALS). A combination of lithium carbonate and valproic acid (VPA-Li) was shown to inhibit motor neuron death and delay disease progression. METHODS: Outpatients with a typical ALS presentation were enrolled in a randomized, placebo-controlled trial to assess the efficacy of orally administered VPA-Li. Changes in a functional scale score (ALSFRS-R) and survival rate were chosen as primary outcome variables. Secondary outcome variables included BMI, respiratory monitoring, quality of life, and a global impression of the treatment. RESULTS: Out of 42 patients enrolled, 20 individuals receiving VPA-Li and 18 on placebo treatment were included in the final analysis. Forty-five percent of patients receiving VPA-Li completed the trial, whereas only 22.22% of patients in the placebo group attended the final visit 18 months later (P = 0.09). Major changes in the ALSFRS-R score were observed, including a decrease of 1.195 points/month in the placebo group (95% CI: 0.7869-1.6031) and of 0.5085 under VPA-Li treatment (95% CI: 0.2288-0.7882) between months 6 and 14. Adverse events included bad mouth taste, constipation, and anorexia. Survival rate, body weight, and quality of life were positive outcomes by the end of the trial despite a high sample reduction, especially in the placebo group. The inclusion of 212 subjects in each group would confirm these differences. CONCLUSIONS: Combined VPA-Li treatment associated with slower ALS progression and better secondary outcomes. This dual treatment overcame the futility threshold and merits further investigation in ALS.

Neurocognitive function in adult residents of a mining district in Mexico after reducing manganese exposure: Follow-up after 11 years.

BACKGROUND: Little is known about the neurotoxic effects of chronic exposure to airborne Mn once exposure has been reduced. The environmentally exposed and the reference adult populations evaluated in 2002 were followed, after an environmental management program (EMP) was implemented to reduce the exposure in a mining district in Mexico. OBJECTIVE: The aim of this study was to compare the association between exposure to Mn and neurocognitive performance in environmentally exposed and reference groups of adults before and after EMP implementation. METHODS: In 2013, the same battery of neurocognitive tests used in the initial study (2002) was applied to 58 adults exposed to airborne Mn and 30 adults from the reference community. A cumulative exposure index (CEI) was estimated for the study population before and after the EMP. Categorical outcomes were analyzed using logistic regression, and the resulting ORs were compared between studies. Continuous outcomes were analyzed using linear regression. All models were adjusted for age, years of education, socioeconomic status and blood lead levels. RESULTS: Exposed adults from the post-EMP study showed an improvement in fine motor and verbal regulation of motor skills (OR < 1) compared to the exposed adults from the pre-EMP study (OR > 1). In both pre- and post-studies, the exposed adults showed a deterioration in their dynamic organization of motor activity compared to the reference group (p < 0.05); however, they showed no significant change in attention and working-memory performance. DISCUSSION: After four years of a significant reduction in airborne Mn levels resulting from EMP implementation, chronically exposed adults showed an improvement in fine motor and verbal regulation of motor skills; however, the remaining areas of their motor and cognitive functions remained impaired.

Non-pancreatic Pseudocyst Presenting as a Giant Retroperitoneal Mass

Objective: To assess the non-pancreatic retroperitoneal pseudocyst in the differenctial diagnosis of retroperitoneal cystic masses. Methods: To report a case. Results: We present a case of a 50-year-old woman with symptoms of pain and a palpable abdominal mass. In imaging studies a 13-cm retroperitoneal cystic mass with left ureterohydronephrosis was observed. Surgical excision of the mass was performed with pathological diagnosis of non-pancreatic retroperitoneal pseudocyst. Conclusion: Non-pancreatic retroperitoneal pseudocyst is an entity with a very low incidence, benign, usually asymptomatic. It can grow compressing on adjacent structures. The definitive diagnosis is histopathological and the treatment is surgical. It's important to carry out complete exeresis to avoid recurrences (AU)

Objetivo: Considerar el pseudoquiste retroperitonealno pancreático en el diagnóstico diferencial de masas quísticas retroperitoneales.Métodos: Presentación de un caso clínico.Resultados: Se presenta el caso de una mujer de 50años con dolor y masa abdominal palpable. En pruebasde imagen complementarias se objetiva una masa quísticaretroperitoneal de 13 cm que condiciona uréterohidronefrosis izquierda. Se realiza exéresis quirúrgica de la masa condiagnóstico anatomopatológico de pseudoquiste retroperitoneal no pancreático.Conclusión: El pseudoquiste retroperitoneal no pancreático es una entidad con una incidencia muy baja, benigna, habitualmente asintomática y que puede alcanzargran tamaño comprometiendo estructuras vecinas. El diagnóstico definitivo es anatomopatológico y el tratamiento esquirúrgico, siendo importante realizar la exéresis completapara evitar recurrencias (AU)

Detection of Candidatus Bartonella odocoilei n. sp. in Lipoptena mazamae associated with white-tailed deer in Campeche, Mexico.

The deer ked Lipoptena mazamae (Diptera: Hippoboscidae) (Róndani), is a blood-feeding obligate ectoparasite of several species of deer and brocket. However, at present little information is available about its role as a vector of hemoparasites. Nonetheless, it is considered a competent vector for the transmission of Bartonella species. The aim of this study was performing the morphological and molecular identification of ked flies and to carry out the detection of Bartonella. We collected specimens from Chiná, Campeche, Mexico associated with white-tailed deer. Using polymerase chain reaction (PCR), of COI, gltA and rpoB genes, we were able to obtain the first barcode for L. mazamae from Mexico and identified a new species of Bartonella which was found with a prevalence of 73%. The data obtained in this study confirmed the presence of L. mazamae associated with white-tailed deer and its possible role as vector of Candidatus Bartonella odocoilei n. sp. in Mexico and we considered that it may also be present in white-tailed deer populations in the U.S.A. Additional investigations into Bartonella species associated with deer ked could provide further insight into their pathogenicity and its role as a zoonotic agent.

Molecular detection of the reptile-associated Borrelia group in Amblyomma dissimile, Mexico.

Recently, the first record of Borrelia associated with reptiles in Mexico was published; however, no studies have been done to assess the role of Mexican ticks as potential vectors of this Borrelia group. Amblyomma dissimile is a hard tick mainly associated with amphibians and reptiles in this country. The aim of this study was to evaluate the presence of Borrelia in A. dissimile from Mexico. We collected 60 A. dissimile individuals attached to 16 Rhinella horribilis. DNA was extracted and all specimens were screened individually for Borrelia by amplification of a fragment of the 16S rDNA and an additional fragment of the flagellin gene. Five ticks were positive for Borrelia, DNA sequences corresponded to Borrelia sp. and group with sequences of the reptile-associated Borrelia group. This is the first report of Borrelia in A. dissimile and the second report of the reptile-associated Borrelia group in Mexico. This study also highlights the importance of this tick species as potential vector of this group.

Queratosis seborreica: variante clonal. reporte de un caso / Seborrheic clonal keratosis. case report

RESUMEN Las queratosis seborreicas son tumores benignos muy frecuentes en la práctica diaria y la mayoría de los pacientes desarrollarán alguna en el transcurso de la vida. La variante clonal es una forma histopatológica rara y su importancia radica en la necesidad de realizar diagnóstico diferencial con otras patologías de mayor relevancia como carcinoma basocelular e incluso melanoma. Se presenta el caso clínico de una paciente de 76 años con una lesión histológicamente compatible con la variante clonal de la queratosis seborreica.

SUMMARY Seborrheic keratoses are benign tumors that are very common in daily dermatology practice and most patients will develop some over the course of their lives. The clonal variant is a rare histopathological form and its importance lies in the need to perform a differential diagnosis with other pathologies of greater relevance such as basal cell carcinoma and even malignant melanoma. We present the clinical case of a 76-year-old female patient with a diagnosis of clonal seborrheic keratosis.

Las concentraciones de glutamina y citrulina reflejan la síntesis del óxido nítrico en el sistema nervioso humano / Glutamine and citrulline concentrations reflect nitric oxide synthesis in the human nervous system

INTRODUCCIÓN: Aunque la citrulina es producida por la sintasa del óxido nítrico (NO) al activarse el receptor glutamatérgico NMDA, nitritos y nitratos (NOx) son considerados los mejores marcadores de síntesis del NO pues citrulina es también metabolizada por otras enzimas. En este estudio se realizó un análisis de correlaciones de concentraciones de citrulina y NOx en líquido cefalorraquídeo humano para evaluar la proporción en que la citrulina refleja la síntesis del NO y la neurotransmisión glutamatérgica. MÉTODOS: Se incluyeron pacientes con trastornos neurológicos agudos a los que se realizó punción lumbar (n = 240). Se determinó la concentración de NOx y aminoácidos por HPLC. RESULTADOS: NOx no fue diferente por la presencia de infección (p = 0,110) o inflamación (p = 0,349). La regresión múltiple mostró que NOx correlacionó con glutamina (r = -0,319, p < 0,001) y citrulina (r = 0,293, p = 0,005) pero no con el cociente citrulina/arginina (r = -0,160, p = 0,173). El ANCOVA confirmó que NOx está asociado con citrulina (F = 7,6, p = 0,007) pero no con el cociente citrulina/arginina (F = 2,2; p = 0,136), ni con la infección (F = 1,8; p = 0,173) o la inflamación (F = 1,4; p = 0,227). NOx no correlacionó con arginina ni con glutamato. CONCLUSIONES: Esto sugiere que citrulina refleja parte de la síntesis del NO a pesar de la contribución de otras vías metabólicas. Además, este estudio muestra que la glutamina es un modulador importante de la actividad de la NOS, y que arginina y glutamato no correlacionan con la concentración de NOx

INTRODUCTION: Although citrulline is produced by nitric oxide (NO) synthase upon activation of the NMDA glutamate receptor, nitrite and nitrate (NOx) concentration is considered the best marker of NO synthesis, as citrulline is also metabolised by other enzymes. This study analyses the correlation between human cerebrospinal fluid NOx and citrulline concentrations in order to determine the extent to which citrulline reflects NO synthesis and glutamatergic neurotransmission. METHODS: Participants were patients with acute neurological diseases undergoing lumbar puncture (n = 240). NOx and amino acid concentrations were determined by HPLC. RESULTS: NOx concentrations did not vary significantly where infection (p = 0,110) or inflammation (p = 0,349) were present. Multiple regression analysis showed that NOx concentration was correlated with glutamine (r = -0,319, p < 0,001) and citrulline concentrations (r = 0,293, p = 0,005) but not with the citrulline/arginine ratio (r = -0,160, p = 0,173). ANCOVA confirmed that NOx concentration was correlated with citrulline concentration (F = 7,6, p = 0,007) but not with the citrulline/arginine ratio (F = 2,2, p = 0,136), or presence of infection (F=1,8, p = 0,173) or inflammation (F = 1,4, p = 0,227). No association was found between NOx and arginine or glutamate concentrations. CONCLUSION: The results suggest that CSF citrulline concentration reflects NOx synthesis to some extent, despite the contribution of other metabolic pathways. In addition, this study shows that glutamine is an important modulator of NO synthase activity, and that arginine and glutamate are not correlated with NOx

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways.

BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

Glutamine and citrulline concentrations reflect nitric oxide synthesis in the human nervous system. / Las concentraciones de glutamina y citrulina reflejan la síntesis del óxido nítrico en el sistema nervioso humano.

INTRODUCTION: Although citrulline is produced by nitric oxide (NO) synthase upon activation of the NMDA glutamate receptor, nitrite and nitrate (NOx) concentration is considered the best marker of NO synthesis, as citrulline is also metabolised by other enzymes. This study analyses the correlation between human cerebrospinal fluid NOx and citrulline concentrations in order to determine the extent to which citrulline reflects NO synthesis and glutamatergic neurotransmission. METHODS: Participants were patients with acute neurological diseases undergoing lumbar puncture (n=240). NOx and amino acid concentrations were determined by HPLC. RESULTS: NOx concentrations did not vary significantly where infection (p=0,110) or inflammation (p=0,349) were present. Multiple regression analysis showed that NOx concentration was correlated with glutamine (r=-0,319, p<0,001) and citrulline concentrations (r=0,293, p=0,005) but not with the citrulline/arginine ratio (r=-0,160, p=0,173). ANCOVA confirmed that NOx concentration was correlated with citrulline concentration (F=7,6, p=0,007) but not with the citrulline/arginine ratio (F=2,2, p=0,136), or presence of infection (F=1,8, p=0,173) or inflammation (F=1,4, p=0,227). No association was found between NOx and arginine or glutamate concentrations. CONCLUSION: The results suggest that CSF citrulline concentration reflects NOx synthesis to some extent, despite the contribution of other metabolic pathways. In addition, this study shows that glutamine is an important modulator of NO synthase activity, and that arginine and glutamate are not correlated with NOx.

Verbal Memory and Learning in Schoolchildren Exposed to Manganese in Mexico.

Manganese (Mn) is an essential nutrient for cellular function, but in high concentrations, it is neurotoxic. Environmental exposure to Mn has been associated with cognitive effects in children. This study aimed to assess the effect of environmental exposure to Mn on verbal memory and learning in schoolchildren residents from two municipalities in the state of Hidalgo, Mexico. Cross-sectional studies were conducted in 2006 and 2013 with a total of 265 schoolchildren of 7 to 11 years old. Children's Auditory Verbal Learning Test-2 (CAVLT-2) was used to assess verbal memory and learning. Mn exposure tertiles were defined according to hair manganese (MnH) levels determined by atomic absorption spectrophotometry. Linear regression models were used to estimate the association between MnH levels and CAVLT-2 scores. The models were adjusted by potential confounders. The lowest and highest exposure tertiles were defined below and above MnH levels of ≤ 0.72 and ≥ 3.96 µg/g, respectively. Mn exposure was significantly associated with an average of 5- to 9-point decrease in learning curves and summary CAVLT-2 scores in the highest tertile. This study adds to the evidence of decreased verbal memory and learning in schoolchildren environmentally exposed to manganese.

Molecular detection of Mycoplasma ovis in an outbreak of hemolytic anemia in sheep from Veracruz, Mexico.

Mycoplasma ovis is a small, pleiotropic bacterium, which parasitizes the external surface of erythrocytes of several species of artiodactyl mammals, especially sheep and goats. We here report an outbreak of ovine mycoplasmosis in a sheep flock of a private ranch (Universidad Veracruzana) in Veracruz, Mexico. For the identification of Mycoplasma and other hemoparasitic bacterial agents, we stained blood smears with the DiffQuick® technique and additionally amplified several fragments of 16S rDNA gene. We detected the presence of morulas in erythrocytes from 30 sick female adult sheep, and found Mycoplasma ovis DNA in all of them. Furthermore, three of these animals also tested positive for Anaplasma ovis. Our findings represent the first record of M. ovis and A. ovis in an outbreak of hemolytic anemia in a sheep flock, leading to severe livestock loss in a ranch of Mexico. This study highlights the importance of establishing an active surveillance of both pathogens in the country.

Nefroureterectomía y desinserción transuretral láser-endoscópica en decúbito lateral sin cambio de posición: adaptación progresiva al abordaje por retroperitoneoscopia / Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach

Introducción: La técnica de desinserción ureteral con rodete vesical continúa su evolución. Presentamos la técnica láser-endoscópica transuretral combinada con abordaje trans y retroperitoneal laparoscópicos en decúbito lateral, sin reposicionamiento del paciente para carcinomas uroteliales del tracto urinario superior. Materiales y métodos: Presentamos 3 nefroureterectomías laparoscópicas, una trans y 2 retroperitoneales. La desinserción se realizó en decúbito lateral utilizando un cistoscopio flexible y una fibra de 365 μ de laser Holmio. La técnica endoscópica se adaptó progresivamente a los abordajes retroperitoneoscópicos de 3 puertos y puerto único. Antes de la manipulación laparoscópica del riñón el uréter fue clipado por debajo del tumor, iniciándose posteriormente la técnica endoscópica. Ambos abordajes se combinaron simultáneamente. Resultados: Se lograron nefroureterectomías con desinserción endoscópica del rodete vesical en bloque, garantizando un sistema cerrado, comparable con la técnica abierta. El segundo caso precisó reconversión por problemas técnicos y prolongación del tiempo quirúrgico. No se diagnosticaron recidivas durante el seguimiento. Conclusión: Los resultados alcanzados son comparables con los de la cirugía abierta y la técnica garantizó el cumplimiento de los principios oncológicos. Permitió la desinserción en decúbito lateral evitando el reposicionamiento del paciente, ahorrando tiempo quirúrgico. Los resultados reflejaron los beneficios de la cirugía mínimamente invasiva en todos los casos

Background: The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. Materials and methods: We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. Results: Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. Conclusion: Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases

Posttransplant monomorphic Burkitt's lymphoma: clinical characteristics and outcome of a multicenter series.

Burkitt's monomorphic posttransplant lymphoproliferative disorder (B-PTLD) is an uncommon subtype of PTLD. Owing to the paucity of this complication, clinical characteristics and outcome has not been fully described. Clinical characteristics and outcomes of 20 patients diagnosed with B-PTLD from 10 transplant centers belonging to the GEL/TAMO group were reviewed. Median time from transplant to B-PTLD was 7.2 years. All the cases fulfill the morphologic and genetic criteria of B-PTLD, whereas Epstein-Barr virus (EBV) was detected in 70% of cases. Patients were treated with different chemotherapy combinations, and three patients received upfront rituximab monotherapy. The great majority of patients receiving CHOP-like regimens attained a complete response (CR) (73%), similar to that obtained with dose-intensive chemotherapy (83% CR). In contrast, patients receiving upfront rituximab monotherapy required subsequent chemotherapy. Two patients (10%) died during treatment due to infection. The median progression-free survival and overall survival (OS) were 16 months and 139 months, respectively. When analyzing variables predicting for OS, we found that patients with bone marrow involvement had an adverse prognosis, with a median OS of 6 months (p = 0.008). In conclusion, B-PTLD is an uncommon complication usually associated with EBV infection and with an aggressive clinical course, particularly in patients with bone marrow involvement. High-dose chemoimmunotherapy obtained similar responses to R-CHOP, suggesting that R-CHOP could be an adequate alternative for these patients. In contrast, rituximab monotherapy does not seem to be effective enough to control the disease.

Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach. / Nefroureterectomía y desinserción transuretral láser-endoscópica en decúbito lateral sin cambio de posición: adaptación progresiva al abordaje por retroperitoneoscopia.

BACKGROUND: The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. MATERIALS AND METHODS: We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-µm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. RESULTS: Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. CONCLUSION: Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases.