Sustained PGC-1α2 or PGC-1α3 expression induces astrocyte dysfunction and degeneration.

Peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α) transcriptional coactivators are key regulators of energy metabolism-related genes and are expressed in energy-demanding tissues. There are several PGC-1α variants with different biological functions in different tissues. The brain is one of the tissues where the role of PGC-1α isoforms remains less explored. Here, we used a toxin-based mouse model of Parkinson's disease (PD) and observed that the expression levels of variants PGC-1α2 and PGC-1α3 in the nigrostriatal pathway increases at the onset of dopaminergic cell degeneration. This increase occurs concomitant with an increase in glial fibrillary acidic protein levels. Since PGC-1α coactivators regulate cellular adaptive responses, we hypothesized that they could be involved in the modulation of astrogliosis induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Therefore, we analysed the transcriptome of astrocytes transduced with expression vectors encoding PGC-1α1 to 1α4 by massively parallel sequencing (RNA-seq) and identified the main cellular pathways controlled by these isoforms. Interestingly, in reactive astrocytes the inflammatory and antioxidant responses, adhesion, migration, and viability were altered by PGC-1α2 and PGC-1α3, showing that sustained expression of these isoforms induces astrocyte dysfunction and degeneration. This work highlights PGC-1α isoforms as modulators of astrocyte reactivity and as potential therapeutic targets for the treatment of PD and other neurodegenerative disorders.

Towards a standardized initial training program in experimental microsurgery for pediatric surgeons. / Hacia un programa inicial de formación estandarizadoen microcirugía experimental para cirujanos pediátricos.

OBJECTIVE: To describe a basic training program in microsurgery and to analyze the learning curve through the process, including improvement in operating times and functional outcome. MATERIALS AND METHODS: Our learning program included basic, transitional, and experimental models. The experimental model included tail vein cannulation, intestinal resection and anastomosis, dissection, division and anastomosis of the cava and aorta. Wistar rats (66.7% male; 406.9 ± 38.9 grams) were used. The program adhered to the 3R principle and obtained animal welfare committee approval. RESULTS: Mean tail vein cannulation time was 2.4 ± 1.2 minutes. Mean intestinal resection and jejunocolic anastomosis time was 14.8 ± 2.7 minutes and 10.4 ± 3 minutes, respectively. All anastomoses were functionally valid. Mean vessel dissection time was 22.9 ± 7.7 minutes, aortic artery anastomosis was 17.2 ± 7.1 minutes, and vena cava anastomosis was 25.9 ± 7.3 minutes. 66.7% of vena cava anastomoses were functionally valid vs. 88.9% for the aorta. The time required for all procedures decreased after the third attempt, except for vena cava anastomoses, which remained similar in all 9 procedures. CONCLUSIONS: Our model demonstrated that the procedures were suitable for trainer progression in terms of surgical time and functional outcome. Microsurgical training would benefit from standardized programs to optimize results.

OBJETIVO: Describimos un programa de formación básica en microcirugía y analizamos la curva de aprendizaje a través del proceso, incluyendo la mejora en los tiempos operatorios y en el resultado funcional del procedimiento. MATERIAL Y METODOS: Nuestro programa de aprendizaje incluye modelos básicos, de transición y experimentales. Dentro del modelo experimental se incluyeron: canulación de la vena de la cola, resección y anastomosis intestinal, disección, sección y anastomosis de la cava y la aorta. Se emplearon ratas Wistar (66,7% machos; 406,9 ± 38,9 gramos), el programa se adhirió al principio de las 3R y obtuvo la aprobación del comité de bienestar animal. RESULTADOS: El tiempo medio de canulación de la vena de la cola fue de 2.4 ± 1,2 minutos. El tiempo medio de resección intestinal y anastomosis yeyunocólica de 14.8 ± 2,7 minutos y 10.4 ± 3 minutos, respectivamente. Todas las anastomosis fueron funcionalmente válidas. El tiempo medio de la disección de vasos fue de 22,9 ± 7,7 minutos, la anastomosis de la arteria aorta de 17,2 ± 7,1 minutos, mientras que la anastomosis de la vena cava fue de 25,9 ± 7,3 minutos. El 66,7% de las anastomosis de la vena cava fueron funcionalmente válidas en comparación con el 88,9% de la aorta. El tiempo requerido para todos los procedimientos disminuyó después del tercer intento, excepto para las anastomosis de vena cava, que se mantuvo similar en los 9 procedimientos. CONCLUSIONES: Nuestro modelo demostró que los procedimientos eran adecuados para la progresión del entrenador en términos de tiempo quirúrgico y resultado funcional. La formación microquirúrgica se beneficiaría de programas estandarizados para optimizar los resultados.

Hacia un programa inicial de formación estandarizado en microcirugía experimental para cirujanos pediátricos / Towards a standardized initial training program in experimental microsurgery for pediatric surgeons

Objetivo: Describimos un programa de formación básica en microcirugía y analizamos la curva de aprendizaje a través del proceso,incluyendo la mejora en los tiempos operatorios y en el resultado funcional del procedimiento. Material y métodos: Nuestro programa de aprendizaje incluyemodelos básicos, de transición y experimentales. Dentro del modeloexperimental se incluyeron: canulación de la vena de la cola, reseccióny anastomosis intestinal, disección, sección y anastomosis de la cava y laaorta. Se emplearon ratas Wistar (66,7% machos; 406,9 ± 38,9 gramos),el programa se adhirió al principio de las 3R y obtuvo la aprobación delcomité de bienestar animal. Resultados: l tiempo medio de canulación de la vena de la cola fuede 2.4 ± 1,2 minutos. El tiempo medio de resección intestinal y anastomosis yeyunocólica de 14.8 ± 2,7 minutos y 10.4 ± 3 minutos, respectivamente. Todas las anastomosis fueron funcionalmente válidas. El tiempomedio de la disección de vasos fue de 22,9 ± 7,7 minutos, la anastomosisde la arteria aorta de 17,2 ± 7,1 minutos, mientras que la anastomosisde la vena cava fue de 25,9 ± 7,3 minutos. El 66,7% de las anastomosisde la vena cava fueron funcionalmente válidas en comparación con el88,9% de la aorta. El tiempo requerido para todos los procedimientosdisminuyó después del tercer intento, excepto para las anastomosis devena cava, que se mantuvo similar en los 9 procedimientos. Conclusiones: Nuestro modelo demostró que los procedimientoseran adecuados para la progresión del entrenador en términos de tiempo quirúrgico y resultado funcional. La formación microquirúrgica sebeneficiaría de programas estandarizados para optimizar los resultados.(AU)

Objective: To describe a basic training program in microsurgery andto analyze the learning curve through the process, including improve-ment in operating times and functional outcome. Materials and methods: Our learning program included basic,transitional, and experimental models. The experimental model includedtail vein cannulation, intestinal resection and anastomosis, dissection,division and anastomosis of the cava and aorta. Wistar rats (66.7% male;406.9 ± 38.9 grams) were used. The program adhered to the 3R principleand obtained animal welfare committee approval. Results: Mean tail vein cannulation time was 2.4 ± 1.2 minutes.Mean intestinal resection and jejunocolic anastomosis time was14.8 ± 2.7 minutes and 10.4 ± 3 minutes, respectively. All anastomoseswere functionally valid. Mean vessel dissection time was 22.9 ± 7.7minutes, aortic artery anastomosis was 17.2 ± 7.1 minutes, and vena cavaanastomosis was 25.9 ± 7.3 minutes. 66.7% of vena cava anastomoseswere functionally valid vs. 88.9% for the aorta. The time required forall procedures decreased after the third attempt, except for vena cavaanastomoses, which remained similar in all 9 procedures. Conclusions: Our model demonstrated that the procedures weresuitable for trainer progression in terms of surgical time and functionaloutcome. Microsurgical training would benefit from standardized pro-grams to optimize results.(AU)

Diffuse hepatocutaneous hemangiomatosis: an unusual presentation. / Hemangiomatosis hepatocutánea difusa: presentación inusual.

INTRODUCTION: Infantile hemangiomas with multi-organ involvement are rare, and presentation in the form of uncontrollable bleeding is exceptional. CLINICAL CASE: 4-day-old newborn with multiple hepatocutaneous hemangiomas and a purplish vascular lesion in the third finger of the right hand. In the third week of life, the lesion became ulcerated and caused uncontrollable bleeding. Therefore, urgent amputation was required, with a histopathological result of GLUT-1 positive infantile hemangioma, and an architecture compatible with arteriovenous malformation in the deep portion. Imaging tests revealed it was a high-flow lesion. Genetic tests (MAP2KI, RASA 1, EPHB4, GNAQ, and GNA 11) were negative. Patient progression was good, with hepatocutaneous lesions receding and eventually disappearing. DISCUSSION: No explanation has been given yet as to why the same vascular lesion may behave differently in different patients. New mutations may be accountable for this.

INTRODUCCION: Los hemangiomas infantiles con afectación multivisceral son escasos y su presentación en forma de hemorragia incontrolable es excepcional. CASO CLINICO: Recién nacido de 4 días de vida que presentaba múltiples hemangiomas hepatocutáneos y una lesión vascular púrpura-violácea, que abarcaba el tercer dedo de la mano derecha. En la tercera semana de vida, la lesión presentó ulceración y un sangrado incoercible requiriendo amputación urgente, con un resultado histopatológico de hemangioma infantil GLUT-1 positivo, con arquitectura compatible con malformación arteriovenosa en la parte profunda. Las pruebas de imagen mostraron que se trataba de una lesión de alto flujo. La genética (MAP2KI, RASA 1, EPHB4, GNAQ y GNA 11) fue negativa. La evolución del paciente fue buena, con la involución de las lesiones hepatocutáneas hasta su desaparición. COMENTARIOS: La divergencia en el comportamiento de las mismas lesiones vasculares en diferentes pacientes aún no ha encontrado explicación. Es posible que nuevas mutaciones puedan darnos una respuesta.

Hemangiomatosis hepatocutánea difusa: presentación inusual / Diffuse hepatocutaneous hemangiomatosis: an unusual presentation

Introducción: Los hemangiomas infantiles con afectación multivisceral son escasos y su presentación en forma de hemorragia incon-trolable es excepcional.Caso clínico: Recién nacido de 4 días de vida que presentaba múltiples hemangiomas hepatocutáneos y una lesión vascular púrpura-violácea, que abarcaba el tercer dedo de la mano derecha. En la tercera semana de vida, la lesión presentó ulceración y un sangrado incoercible requiriendo amputación urgente, con un resultado histopatológico dehemangioma infantil GLUT-1 positivo, con arquitectura compatible con malformación arteriovenosa en la parte profunda. Las pruebas de imagen mostraron que se trataba de una lesión de alto flujo. La genética (MA-P2KI, RASA 1, EPHB4, GNAQ y GNA 11) fue negativa. La evolución del paciente fue buena, con la involución de las lesiones hepatocutáneas hasta su desaparición.Comentarios: La divergencia en el comportamiento de las mismaslesiones vasculares en diferentes pacientes aún no ha encontrado explicación. Es posible que nuevas mutaciones puedan darnos una respuesta.

Introduction: Infantile hemangiomas with multi-organ involve-ment are rare, and presentation in the form of uncontrollable bleedingis exceptional.Clinical case:4-day-old newborn with multiple hepatocutaneous he-mangiomas and a purplish vascular lesion in the third finger of the righthand. In the third week of life, the lesion became ulcerated and causeduncontrollable bleeding. Therefore, urgent amputation was required, witha histopathological result of GLUT-1 positive infantile emangioma,and an architecture compatible with arteriovenous malformation in thedeep portion. Imaging tests revealed it was a high-flow lesion. Genetic tests (MAP2KI, RASA 1, EPHB4, GNAQ, and GNA 11) were negative.Patient progression was good, with hepatocutaneous lesions recedingand eventually disappearing.Discussion: No explanation has been given yet as to why the samevascular lesion may behave differently in different patients. New muta-tions may be accountable for this.

Impact of SARS-CoV-2 pandemic on emergency department activity at the pediatric surgery unit of a third-level hospital. / Impacto en la actividad de Urgencias en el Servicio de Cirugía Pediátrica de un Hospital de tercer nivel durante la pandemia de SARS-CoV-2.

INTRODUCTION: As a result of the emergence of the SARS-CoV-2 respiratory virus in Wuhan in December 2019, the Spanish Government declared the state of emergency with restrictions such as stay-at-home lockdown. The objective of this study was to analyze emergency activity at a referral pediatric surgery unit in its territory and determine whether surgical pathologies had decreased or not. METHODS: A retrospective study of pediatric patients presenting at the emergency department and referred to the pediatric surgery unit from March 14, 2020 to April 20, 2020 was carried out. The results were compared with those from the same dates of the previous year. Demographic variables, pathologies, and management strategies were studied for each case. The number of patients with abdominal pain requiring surgical assessment was also analyzed. RESULTS: 161 patients were included - 91 from 2019 and 70 from 2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%) were admitted, whereas in 2019, patient distribution was 67 (73.6%) and 24 (26.4%), which means there were fewer admissions in 2020 (p= 0.018). There were no differences in terms of hours to emergency department consultation - just an increase in the case of appendicular pathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30] hours (p =  0.045). CONCLUSION: The current pandemic has not caused emergency surgeries to decrease. It has only increased time to consultation in patients with appendicular pathologies.

INTRODUCCION: A raíz de la aparición del virus respiratorio SARS-CoV-2 en Wuhan en diciembre de 2019, el Gobierno de España decretó el estado de alarma con medidas que han incluido el confinamiento domiciliario. El objetivo de este trabajo es analizar la actividad urgente de un Servicio de Cirugía Pediátrica referente en su Comunidad Autónoma y comprobar si ha existido disminución o no en la patología quirúrgica. METODOS: Estudio retrospectivo de los pacientes pediátricos que acudieron a Urgencias y fueron derivados a Cirugía Pediátrica entre los periodos del 14 de marzo hasta el 20 de abril de 2020, comparándolos con aquellos que acudieron en las mismas fechas del año previo. Se analizaron variables demográficas, la patología y el tipo de manejo en cada caso. Se analizó también el número de pacientes con dolor abdominal que precisaron valoración quirúrgica. RESULTADOS: Se incluyeron 161 pacientes, de los que 91 acudieron en 2019 y 70 acudieron en 2020. De estos últimos, 62 (88,6%) fueron intervenidos y 8 (11,4%) fueron hospitalizados, mientras que en 2019 fueron 67 (73,6%) y 24 (26,4%), respectivamente, observando un menor número de ingresos en 2020 (p=  0,018). El número de horas de evolución hasta la consulta en Urgencias del total de pacientes no demostró diferencias, únicamente existió un aumento en los pacientes con patología apendicular en el periodo de 2020, 24 [23-48] respecto al periodo del año previo 24 [12-30] (p=  0,045). CONCLUSION: La situación actual de pandemia no ha provocado una disminución del número de intervenciones quirúrgicas urgentes. Únicamente aumentó el tiempo hasta la consulta en los pacientes con patología apendicular.

Impacto en la actividad de Urgencias en el Servicio de Cirugía Pediátrica de un hospital de tercer nivel durante la pandemia de SARS-CoV-2 / Impact of SARS-CoV-2 pandemic on emergency department activity at the pediatric surgery unit of a third-level hospital

Introducción: A raíz de la aparición del virus respiratorio SARS-CoV-2 en Wuhan en diciembre de 2019, el Gobierno de España decretóel estado de alarma con medidas que han incluido el confinamiento do-miciliario. El objetivo de este trabajo es analizar la actividad urgente deun Servicio de Cirugía Pediátrica referente en su Comunidad Autónomay comprobar si ha existido disminución o no en la patología quirúrgica. Métodos: Estudio retrospectivo de los pacientes pediátricos queacudieron a Urgencias y fueron derivados a Cirugía Pediátrica entre losperiodos del 14 de marzo hasta el 20 de abril de 2020, comparándoloscon aquellos que acudieron en las mismas fechas del año previo. Seanalizaron variables demográficas, la patología y el tipo de manejoen cada caso. Se analizó también el número de pacientes con dolorabdominal que precisaron valoración quirúrgica. Resultados: Se incluyeron 161 pacientes, de los que 91 acudieronen 2019 y 70 acudieron en 2020. De estos últimos, 62 (88,6%) fue-ron intervenidos y 8 (11,4%) fueron hospitalizados, mientras que en2019 fueron 67 (73,6%) y 24 (26,4%), respectivamente, observandoun menor número de ingresos en 2020 (p= 0,018). El número de horasde evolución hasta la consulta en Urgencias del total de pacientes nodemostró diferencias, únicamente existió un aumento en los pacientescon patología apendicular en el periodo de 2020, 24 [23-48] respectoal periodo del año previo 24 [12-30] (p= 0,045). Conclusión: La situación actual de pandemia no ha provocadouna disminución del número de intervenciones quirúrgicas urgentes.Únicamente aumentó el tiempo hasta la consulta en los pacientes conpatología apendicular.(AU)

Introduction: As a result of the emergence of the SARS-CoV-2respiratory virus in Wuhan in December 2019, the Spanish Governmentdeclared the state of emergency with restrictions such as stay-at-homelockdown. The objective of this study was to analyze emergency activityat a referral pediatric surgery unit in its territory and determine whethersurgical pathologies had decreased or not. Methods: A retrospective study of pediatric patients presentingat the emergency department and referred to the pediatric surgery unitfrom March 14, 2020 to April 20, 2020 was carried out. The resultswere compared with those from the same dates of the previous year.Demographic variables, pathologies, and management strategies werestudied for each case. The number of patients with abdominal painrequiring surgical assessment was also analyzed. Results: 161 patients were included – 91 from 2019 and 70 from2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%)were admitted, whereas in 2019, patient distribution was 67 (73.6%)and 24 (26.4%), which means there were fewer admissions in 2020(p= 0.018). There were no differences in terms of hours to emergencydepartment consultation – just an increase in the case of appendicularpathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30]hours (p = 0.045). Conclusion: The current pandemic has not caused emergency sur-geries to decrease. It has only increased time to consultation in patientswith appendicular pathologies.(AU)

WITHDRAWN: Malformación venosa verrugosa y sobrecrecimiento: a propósito de 2 casos.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.36959/472/363. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Influence of the coronavirus 2 (SARS-Cov-2) pandemic on acute appendicitis.

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ±â€¯3 and 9.3 ±â€¯3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post-COVID-19 group (5.6 ±â€¯5.9 vs 3.2 ±â€¯4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. CONCLUSIONS: The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed.

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ±â€¯3 y 9.3 ±â€¯3.1; P = .073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; P = .013), así como una PCR más elevada (72.7 ±â€¯96.2 vs 31.3 ±â€¯36.2 mg/dl; P = .042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; P = .015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ±â€¯5.9 vs 3.3 ±â€¯4.3 días; P = .041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común.

Influencia de la pandemia por coronavirus 2(sars-cov-2) en la apendicitis aguda. Sars-cov-2 en la apendicitis aguda / Influence of the coronavirus 2 (sars-cov-2) pandemic on acute apendicitis

INTRODUCCIÓN: La apendicitis aguda (AA) es la urgencia quirúrgica abdominal más frecuente. No encontramos estudios específicos que evalúen el impacto de la pandemia causada por el coronavirus 2 (SARS-Cov-2) sobre la AA y su tratamiento quirúrgico. Analizamos la influencia de esta nueva patología sobre la AA. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo en pacientes intervenidos por AA desde enero hasta abril de 2020. Fueron clasificados según el momento de la apendicectomía, antes de la declaración del estado de alarma (Pre-COVID19) y después de la declaración del estado de alarma (Post-COVID19) en España. Se evaluaron variables demográficas, duración de la sintomatología, tipo de apendicitis, tiempo quirúrgico, estancia hospitalaria y complicaciones postoperatorias. RESULTADOS: Se incluyeron 66 pacientes (41 Pre-COVID19; 25 Post-COVID19 con edad media de 10.7 ± 3 y 9.3 ± 3.1; p = 0.073; respectivamente). La fiebre se encontró en un mayor número de pacientes post-COVID19 (52 vs 19.5%; p = 0.013), así como una PCR más elevada (72.7 ± 96.2 vs 31.3 ± 36.2 mg/dl; p = 0.042). Este grupo presentó una mayor proporción de apendicitis complicada al compararle con el Pre-COVID19 (32 vs 7.3%; p = 0.015). La estancia media hospitalaria fue mayor en el grupo Post-COVID19 (5.6 ± 5.9 vs 3.3 ± 4.3 días; p = 0.041). No se encontraron diferencias en el tiempo de evolución de los síntomas ni en el tiempo quirúrgico. CONCLUSIONES: La pandemia por SARS-Cov-2 influye en el momento de diagnóstico de la apendicitis, así como en su grado de evolución y estancia hospitalaria. La peritonitis fue lo más frecuentemente observado. Una sospecha y orientación clínica más temprana, es necesaria para evitar un manejo inadecuado de este trastorno quirúrgico común

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal surgical emergency. No specific studies have been found that evaluate the impact of the coronavirus 2 (SARS-Cov-2) pandemic on AA and its surgical management. An analysis was made on the influence of this new pathology on the clinical course of AA. MATERIAL AND METHODS: Retrospective observational study was conducted on patients operated on for AA from January to April 2020. They were classified according to the time of the appendectomy, before the declaration of the state of alarm (Pre-COVID-19), and after its declaration (Post-COVID-19) in Spain, one the most affected countries in the world. An evaluation was made of demographic variables, duration of symptoms, type of appendicitis, surgical time, hospital stay, and postoperative complications. RESULTS: The study included 66 patients (41 Pre-COVID-19; 25 Post-COVID-19) with mean age of 10.7 ± 3 and 9.3 ± 3.1; P = .073, respectively. Fever was found in a higher number of post-COVID-19 patients (52 vs 19.5%; P = .013), as well as a higher CRP (72.7 ± 96.2 vs 31.3±36.2 mg/dL; P = .042). This group presented with a higher proportion of complicated appendicitis when compared to Pre-COVID-19 (32 vs 7.3%; P = .015). The mean hospital stay was longer in the Post- COVID-19 group (5.6 ± 5.9 vs 3.2 ± 4.3 days; P = .041). No differences were found in the time of onset of symptoms or surgical time. Conclusions. The SARS-Cov-2 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Peritonitis was more frequently seen. As a result of the significant circumstances, delaying diagnosis and treatment of AA during SARS-Cov-2 pandemic, inappropriate management of this common surgical disorder has been noticed

Correlation between amyloid deposits affecting renal compartments and glomerular filtration rate during renal biopsy in a renal amyloidosis case series.

Amyloidosis comprises a group of disorders that accumulate modified autologous proteins in organs, mainly the kidneys. Few studies have addressed the amyloid compartmental distribution and associated clinical outcomes. The aim of this study was to present a case series of renal amyloidosis correlating histopathological data with glomerular filtration rate (GFR) during kidney biopsy. We studied 53 cases reviewed by nephropathologists from 2000 to 2018 in a single kidney biopsy center in Brazil. GFR was estimated using the CKD-EPI formula. Cases were divided into Group A ≥60 and Group B <60 mL·min-1·(1.73 m2)-1 using the estimated GFR during kidney biopsy. Semiquantitative histopathological study was performed, including extension and distribution of amyloid deposits by compartments (glomeruli, tubulointerstitial tissue, and vessels). Statistical analyses were made to understand associations with lower GFR. No difference was seen for age, gender, proteinuria, hematuria, subtype of amyloid protein, arteriosclerosis, interstitial fibrosis/infiltrate, or glomerular and interstitial amyloid deposits. After a previous P value <0.1 in the descriptive analysis, the following variables were selected: globally sclerotic glomeruli, high blood pressure, and the extension of vascular amyloid deposition. A binary logistic regression model with GFR as the dependent variable showed history of hypertension and vascular amyloid to be robust and independent predictors of Group B <60 mL·min-1·(1.73 m2)-1. Beyond the histopathologic diagnosis of amyloidosis, a semiquantitative approach on renal biopsy could provide new insights. Vascular amyloid is an independent predictor of renal dysfunction in cases of renal amyloidosis.

Correlation between amyloid deposits affecting renal compartments and glomerular filtration rate during renal biopsy in a renal amyloidosis case series

Amyloidosis comprises a group of disorders that accumulate modified autologous proteins in organs, mainly the kidneys. Few studies have addressed the amyloid compartmental distribution and associated clinical outcomes. The aim of this study was to present a case series of renal amyloidosis correlating histopathological data with glomerular filtration rate (GFR) during kidney biopsy. We studied 53 cases reviewed by nephropathologists from 2000 to 2018 in a single kidney biopsy center in Brazil. GFR was estimated using the CKD-EPI formula. Cases were divided into Group A ≥60 and Group B <60 mL·min−1·(1.73 m2)−1 using the estimated GFR during kidney biopsy. Semiquantitative histopathological study was performed, including extension and distribution of amyloid deposits by compartments (glomeruli, tubulointerstitial tissue, and vessels). Statistical analyses were made to understand associations with lower GFR. No difference was seen for age, gender, proteinuria, hematuria, subtype of amyloid protein, arteriosclerosis, interstitial fibrosis/infiltrate, or glomerular and interstitial amyloid deposits. After a previous P value <0.1 in the descriptive analysis, the following variables were selected: globally sclerotic glomeruli, high blood pressure, and the extension of vascular amyloid deposition. A binary logistic regression model with GFR as the dependent variable showed history of hypertension and vascular amyloid to be robust and independent predictors of Group B <60 mL·min−1·(1.73 m2)−1. Beyond the histopathologic diagnosis of amyloidosis, a semiquantitative approach on renal biopsy could provide new insights. Vascular amyloid is an independent predictor of renal dysfunction in cases of renal amyloidosis.

Assessment of viral and bacterial contamination of fresh and ripened semi-hard cheeses.

This study aimed to evaluate viral and bacterial contamination from typical Brazilian cheeses, such as Minas (fresh) and Prato (ripened), commercially obtained in the Greater Metropolitan Region of the State of Rio de Janeiro, Brazil. Minas [30], Prato [30] and sliced Prato [30] cheese samples were investigated for norovirus genogroup I and II (NoV GI-II) and human adenovirus (HAdV) by direct nucleic acid extraction using TRIzol and amplification by TaqMan based quantitative polymerase chain reaction. Listeria monocytogenes, Salmonella spp., coagulase-positive staphylococci (CPS) and fecal coliforms were also assessed by using standard counting methods. NoV GI and GII were detected in one sample (1.1%) each and HAdV in nine samples (10.0%) while bacteriological analysis revealed five samples (5.5%) contaminated with L. monocytogenes, 27 (30.0%) with fecal coliforms and 10 (11.1%) with CPS. Salmonella spp. was not detected in any sample. Viruses were detected in 11 samples (12.2%), of which 9 met the microbiological criteria used to evaluate the microbiological quality of the cheeses, stressing the importance of considering virological parameters for monitoring this food matrix.

Human intestinal pro-inflammatory CD11chighCCR2+CX3CR1+ macrophages, but not their tolerogenic CD11c-CCR2-CX3CR1- counterparts, are expanded in inflammatory bowel disease.

Although macrophages (Mϕ) maintain intestinal immune homoeostasis, there is not much available information about their subset composition, phenotype and function in the human setting. Human intestinal Mϕ (CD45+HLA-DR+CD14+CD64+) can be divided into subsets based on the expression of CD11c, CCR2 and CX3CR1. Monocyte-like cells can be identified as CD11chighCCR2+CX3CR1+ cells, a phenotype also shared by circulating CD14+ monocytes. On the contrary, their Mϕ-like tissue-resident counterparts display a CD11c-CCR2-CX3CR1- phenotype. CD11chigh monocyte-like cells produced IL-1ß, both in resting conditions and after LPS stimulation, while CD11c- Mϕ-like cells produced IL-10. CD11chigh pro-inflammatory monocyte-like cells, but not the others, were increased in the inflamed colon from patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Tolerogenic IL-10-producing CD11c- Mϕ-like cells were generated from monocytes following mucosal conditioning. Finally, the colonic mucosa recruited circulating CD14+ monocytes in a CCR2-dependent manner, being such capacity expanded in IBD. Mϕ subsets represent, therefore, transition stages from newly arrived pro-inflammatory monocyte-like cells (CD11chighCCR2+CX3CR1+) into tolerogenic tissue-resident (CD11c-CCR2-CX3CR1-) Mϕ-like cells as reflected by the mucosal capacity to recruit circulating monocytes and induce CD11c- Mϕ. The process is nevertheless dysregulated in IBD, where there is an increased migration and accumulation of pro-inflammatory CD11chigh monocyte-like cells.

IgA nephropathy in Brazil: apropos of 600 cases.

IgA nephropathy (IgAN) is th e commonest primary glomerular disease worldwide. Studies on its prevalence in Brazil are however scarce. Databases and clinical records from 10 reference centres were retrospectively reviewed. Clinical and laboratory features at the moment of the biopsy were retrieved (age, gender, presence of hematuria, serum creatinine [mg/dL], proteinuria [g/24 h]). Renal biopsy findings were classified according to Haas single grade classification scheme and the Oxford Classification of IgAN. 600 cases of IgAN were identified, of which 568 (94.7 %) were on native kidneys. Male to female ratio was 1.24:1. Patients averaged 32.76 ± 15.12 years old (range 4-89, median 32). Proteinuria and hematuria were observed, respectively in 56.63 and 72.29 % of patients. The association of both these findings occurred in 37.95 % of the cases. Serum creatinine averaged 1.65 ± 0.67 mg/dL (median 1.5 mg/dL) at diagnosis. Segmental sclerosis and mesangial hypercellularity were the main glomerular findings (47.6 and 46.2 %) The commonest combination by Oxford Classification of IgAN, was M0 E0 S0 T0 (22.4 %). Chronic tubulo-interstitial lesions with an extension wider than 25 % of the renal cortex could be identified in 32.2 % of the cases. Tubular atrophy and interstitial fibrosis were more strongly associated with higher 24-h proteinuria and serum creatinine levels. Segmental sclerosis (S1) showed a stronger tendency of association with the presence of tubulo-interstitial lesions (T1 and T2) than other glomerular variables. To the best of our knowledge this is the largest series of IgAN in Brazil. It depicts the main biopsy findings and their possible clinical correlates. Our set of data is comparable to previous reports.

Maternal morbid obesity: financial implications of weight management.

The objective of this study was to evaluate health outcomes and costs of pregnancies complicated by extreme maternal obesity (class III obesity, body mass index ≥ 40). We conducted a retrospective case-control descriptive study comparing extremely obese women (cases) and their infants with randomly selected controls. Health outcomes were obtained from the medical records and costs from billing data. Total costs for each mother-infant dyad were calculated. Compared with 85 controls, the 82 cases experienced higher morbidity, higher costs and prolonged hospital stay. However, 26% of cases maintained or lost weight during pregnancy, whereas none of the controls maintained or lost weight during pregnancy. When mother/infant dyads were compared on costs, case subjects who maintained or lost weight experienced lower costs than those who gained weight. Neonatal intensive care consumed 78% of total hospital costs for infants of the obese women who gained weight, but only 48% of costs for infants of obese women who maintained or lost weight. For extremely obese women, weight management during pregnancy was achievable, resulted in healthier neonatal outcomes and reduced perinatal healthcare costs.

Tauroursodeoxycholic acid prevents MPTP-induced dopaminergic cell death in a mouse model of Parkinson's disease.

Mitochondrial dysfunction and oxidative stress are implicated in the neurodegenerative process in Parkinson's disease (PD). Moreover, c-Jun N-terminal kinase (JNK) plays an important role in dopaminergic neuronal death in substantia nigra pars compacta. Tauroursodeoxycholic acid (TUDCA) acts as a mitochondrial stabilizer and anti-apoptotic agent in several models of neurodegenerative diseases. Here, we investigated the role of TUDCA in preventing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurodegeneration in a mouse model of PD. We evaluated whether TUDCA modulates MPTP-induced degeneration of dopaminergic neurons in the nigrostriatal axis, and if that can be explained by regulation of JNK phosphorylation, reactive oxygen species (ROS) production, glutathione S-transferase (GST) catalytic activation, and Akt signaling, using C57BL/6 glutathione S-transferase pi (GSTP) null mice. TUDCA efficiently protected against MPTP-induced dopaminergic degeneration. We have previously demonstrated that exacerbated JNK activation in GSTP null mice resulted in increased susceptibility to MPTP neurotoxicity. Interestingly, pre-treatment with TUDCA prevented MPTP-induced JNK phosphorylation in mouse midbrain and striatum. Moreover, the anti-oxidative role of TUDCA was demonstrated in vivo by impairment of ROS production in the presence of MPTP. Finally, results herein suggest that the survival pathway activated by TUDCA involves Akt signaling, including downstream Bad phosphorylation and NF-κB activation. We conclude that TUDCA is neuroprotective in an in vivo model of PD, acting mainly by modulation of JNK activity and cellular redox thresholds, together with activation of the Akt pro-survival pathway. These results open new perspectives for the pharmacological use of TUDCA, as a modulator of neurodegeneration in PD.

Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia.

WHAT IS KNOWN AND BACKGROUND: Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial-based thought record (TBTR), which targets the restructuring of patients' core beliefs. OBJECTIVE: To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT). METHODS: A two-arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven-column dysfunctional thought record and the positive data log in SAD patients according to DSM-IV. RESULTS: Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0·001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression - Improvement. In addition, a one-way ancova, taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0·01 at mid-treatment and P = 0·004 at post-treatment), and SADS (P = 0·03 at post-treatment). WHAT IS NEW AND CONCLUSION: This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders.

Estudio histológico del tracto digestivo del neón cardenal paracheirodon axelrodi (Characidae) / Histological study of digestive tract of the neón cardenal paracheirodon axelrodi (Characidae)

Paracheirodon axelrodi es el pez ornamental que más se exporta en Colombia. Sin embargo, se desconocen varios aspectos de su biología básica. Se estudió la histología del tracto digestivo. Se sacrificaron 15 ejemplares (MS 222, 0,5 g/L), fijados en formaldehído al 4 por ciento y decalcificados con ácido nítrico 7 por ciento. Se siguió el procedimiento para H&E. El tracto digestivo de P. axelrodi presentó cuatro capas constitutivas: mucosa, submucosa, muscular y serosa. La mucosa de la boca presentó un epitelio escamoso estratificado no queratinizado con células caliciformes y sin botones gustativos, una submucosa de tejido conectivo laxo y una capa de músculo estriado esquelético. Los dientes son cónicos y abundantes. La capa serosa a lo largo del tracto digestivo es delgada compuesta de tejido conectivo laxo. La capa mucosa, submucosa y muscular del esófago posee la misma conformación tisular de la boca, sin embargo, la capa muscular presenta dos orientaciones. La mucosa del estómago está compuesta por epitelio cilíndrico simple con glándulas gástricas, submucosa de tejido conectivo laxo y una capa de músculo liso en dos orientaciones. Las capas del intestino exhi-bieron una composición tisular similar a la del estómago, sin glándulas gástricas. La mucosa presentó células caliciformes especialmente hacia la región posterior y un aumento en la longitud de los pliegues intestinales. La conformación tisular y morfológica del tracto digestivo de P. axelrodi lo ubica como un pez de hábitos alimenticios carnívoros pero de pequeñas presas.

Cardinal neon, Paracheirodon axelrodi is the most exported ornamental fish in Colombia. However, many aspects of its biology are unknown. A histological study of the digestive tract was carried out and 15 specimens were sacrificed with MS 222, 0.5 g/L, fixed in 4 percent formaldehyde and decalcified with 7 percent nitric acid. H&E technique was followed. P. axelrodi digestive tract showed four constitutive layers: mucosae, submucosae, muscular, and serosa. Mouth mucosae presents a stratified nonkeratinized squamous epithelium with many goblet cells, and no taste buds, submucosae with areolar connective tissue, and skeletal muscular layer. Teeth were conical and abundant. Along the whole intestinal tract the serous was a very thin connective tissue layer. Esophagus mucosae, submucosae, and muscular layer were similar to those of the mouth. However, muscular layer presented two layers in different orientations. Stomach mucosae were made of simple cylindrical epithelium with gastric glands. Submucosa did present areolar connective tissue, and muscular layer exhibited smooth muscle in two different orientations. The intestinal layers were similar to those of the stomach, but without gastric glands. Mucosae presented goblet cells especially at the posterior region. Intestinal folds were also observed. Tisular and morphological structure of P. axelrodi digestive tract suggests a small prey carnivorous fish.

Morfología y citoquímica de cultivos celulares de Aedes aegypti (Diptera: Culicidae) y susceptibilidad a Leishmania panamensis (Kinetoplastida: Trypanosomatidae)

Morphology and cytochemistry of Aedes aegypti’s cell cultures (Diptera: Culicidae) and susceptibility to Leishmania panamensis (Kinetoplastida: Trypanosomatidae). The first cellular line of Aedes aegypti was developed by Grace in 1966; afterwards, other cellular lines of this species have been generated. These have been used for the study of pathogenic organisms like viruses, bacteria and parasites, which demonstrates their importance in biomedical applications. This research describes, for the first time, some cytochemical characteristics of A. aegypti cell cultures, that were infected with (MHOM/CO/87CL412) strain of Leishmania panamensis. A morphological study of the cell culture was also carried out. Maintenance of the cell culture, parasites and infection in vitro were carried out in the Laboratory of Entomology, Cell Biology and Genetics of the Universidad de La Salle. The cell cultures infected with the parasite were maintained in a mixture of mediums Grace/L15, supplemented with 10 % fetal bovine serum (FBS) at pH 6.8 and a temperature of 26 ºC, during 3, 6 and 9 post-infection days. After this, these cell cultures were processed through High Resolution Light Microscopy (HRLM) and Transmission Electron Microscopy (TEM) based on standard protocols defined by the Group of Microscopy and Image Analyses of the Instituto Nacional de Salud. Semi-fine slices of 1 µm colored with toluidine blue were used for the morphological analysis of the culture, and ultra fine cuts of 60 to 90 nm stained with uranyl acetate and lead citrate where used for the ultrastructural study. In addition, PAS and peroxidase staining was carried out in cells fixed with methanol. The morphometric study was analyzed with software ImageJ (NIH). In the semi-fine slices, small cells were observed showing fibroblastic appearance 10.84±2.54 µm in length and 5.31±1.26 µm wide; other cells had epithelial appearance with a great peripheral nucleus, voluminous and vacuolated cytoplasm, 23.04±4,00 µm in length and 13.96±3.70 µm wide. These last ones predominated over the ones with fibroblastic appearance. Regarding the PAS coloration, 7.08 % of the cells presented abundant PAS positive cytoplasmatic granules which indicated polysaccharides presence. The peroxidase test gave a negative result. The greatest percentage of infection (18.90 %) of one total of 101 cells, turned up by day 6. Some cells analyzed by TEM presented a vacuolated aspect cytoplasm; some contained parasites, other fibrillar material and others were empty. The results indicate that A. aegypti cell culture can support the internalization and transformation of the parasite, which demonstrates the capacity that these cell cultures have to be infected with L. panamensis and to maintain the infection for approximately one week. Rev. Biol. Trop. 56 (2): 447-458. Epub 2008 June 30.

La primera línea celular de Aedes aegypti fue establecida por Grace en 1966 y desde entonces se han utilizado para el estudio de virus, bacterias y parásitos. En el presente trabajo se describen, por primera vez, algunas características citoquímicas de los cultivos celulares de A. aegypti, infectados con la cepa (MHOM/CO/87CL412) de Leishmania panamensis. También se realizó un estudio morfológico de las células del cultivo. Se observaron 30 células pequeñas con apariencia fibrolastoide de 10.84±2.54 µm de largo y 5.31±1.26 µm de ancho; otras 30 presentaron apariencia epitelioide con 23.04±4.00 µm de largo y 13.96±3.70 µm de ancho; éstas últimas predominaron sobre las de apariencia fibroblastoide. De 113 células, un 7.08%, presentaron abundantes gránulos citoplasmáticos positivos con la coloración de PAS, indicando presencia de polisacáridos. La prueba de peroxidasa dio un resultado negativo. El mayor porcentaje de infección (18.90%), de un total de 101 células, se presentó el día 6. Ultraestructuralmente, las células presentaron un citoplasma con aspecto vacuolado; algunas contenían parásitos, otras material fibrilar y otras estaban vacías. Los resultados indican que los cultivos celulares de A. aegypti pueden ser infectados por L. panamensis y mantener dicho proceso por aproximadamente una semana.