Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience.

PURPOSE: Postmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting. METHODS: We conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source. RESULTS: Most commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma. CONCLUSIONS: Clinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.

Combining conventional tree-ring measurements with wood anatomy and strontium isotope analyses enables dendroprovenancing at the local scale.

Dendroprovenancing provides critical information regarding the origin of wood, allowing further insights into economic exploitation strategies and source regions of timber products. Traditionally, dendroprovenancing relies on pattern-matching of tree rings, but its spatial resolution is limited by the geographical coverage of species-specific chronologies available for crossdating and, in the case of short-distance trades, by scarce environmental variability. Here, we present an approach to provenance timber with high spatial resolution from forested areas that have been exploited intensively throughout history, with the aim to understand the sustainability of the various woodland management practices used to supply timber products. To this end, we combined tree-ring width (TRW), wood anatomical and geochemical analyses in addition to multivariate statistical validation procedures to trace the origin of living oak trees (Quercus robur) sampled in four stands located within a 30-km radius around the city of Limoges (Haute-Vienne, France). We demonstrate that TRW and wood anatomical variables (and in particular cell density) robustly discriminate the eastern from the western site, while failing to trace the origin of trees from the northern and southern sites. Here, strontium isotopic ratios (87Sr/86Sr) and Ca concentrations identify clusters of trees which could not be identified with TRW or wood anatomy. Ultimately, our study demonstrates that the coupling of wood anatomy with geochemical signatures allows to correctly pinpoint the origin of trees. Given the small geographic scale of our study and the limited differences in elevation and climate between study sites, our results are particularly promising for future dendroprovenancing studies. We thus conclude that the combination of multiple approaches will not only increase the accuracy of dendroprovenancing studies at local scales, but could also be implemented at much larger scales to identify trends in historic timber supply throughout Europe.

Acute myelomonocytic leukemia with multifocal manifestation and spinal cord infiltration in a dog.

INTRODUCTION: Few cases of myelomonocytic leukemia associated with neurological signs have been described in dogs; none have been related to intraparenchymal spinal cord infiltration by neoplastic cells. This short communication describes a case of acute myelomonocytic leukemia subtype M4 in a dog with spinal cord infiltration. A 3-year-old male Golden Retriever was presented with a history of hyperthermia, lymphadenomegaly, leukocytosis with circulating blast cells, anemia and thrombocytopenia, and acute onset paraplegia. Immunophenotyping of peripheral blood by flow cytometry was consistent with acute myelomonocytic leukemia subtype M4. The dog was euthanized because of clinical deterioration and unfavourable prognosis. Postmortem examination revealed multi-organ neoplastic infiltration, including the spinal cord. To our knowledge, this is the first case of acute myelomonocytic leukemia subtype M4 in a dog with spinal cord infiltration. Our findings hold importance for including myelomonocytic leukemia in the differential diagnosis of patients with neurological signs due to spinal cord localisation.

INTRODUCTION: Peu de cas de leucémie myélomonocytaire associés à des signes neurologiques ont été décrits chez le chien ; aucun n'était lié à une infiltration intraparenchymateuse de la moelle épinière par des cellules néoplasiques. Cette courte communication décrit un cas de leucémie aiguë myélomonocytaire de sous-type M4 chez un chien avec infiltration de la moelle épinière. Un Golden Retriever mâle de 3 ans a été présenté avec une anamnèse d'hyperthermie, de lymphadénomégalie, de leucocytose avec des cellules blastiques circulantes, d'anémie et de thrombocytopénie et de paraplégie d'apparition aiguë. L'immunophénotypage du sang périphérique par cytométrie de flux était compatible avec une leucémie myélomonocytaire aiguë de sous-type M4. Le chien a été euthanasié en raison de la détérioration de son état clinique et du pronostic défavorable. L'examen post-mortem a révélé une infiltration néoplasique multi-organique, y compris la moelle épinière. À notre connaissance, il s'agit du premier cas de leucémie aiguë myélomonocytaire de sous-type M4 chez un chien avec infiltration de la moelle épinière. Nos résultats sont importants pour inclure la leucémie myélomonocytaire dans le diagnostic différentiel chez les patients présentant des signes neurologiques dus à une localisation médullaire.

Recent atmospheric drying in Siberia is not unprecedented over the last 1,500 years.

Newly developed millennial δ13C larch tree-ring chronology from Siberia allows reconstruction of summer (July) vapor pressure deficit (VPD) changes in a temperature-limited environment. VPD increased recently, but does not yet exceed the maximum values reconstructed during the Medieval Warm Anomaly. The most humid conditions in the Siberian North were recorded in the Early Medieval Period and during the Little Ice Age. Increasing VPD under elevated air temperature affects the hydrology of these sensitive ecosystems by greater evapotranspiration rates. Further VPD increases will significantly affect Siberian forests most likely leading to drought and forest mortality even under additional access of thawed permafrost water. Adaptation strategies are needed for Siberian forest ecosystems to protect them in a warming world.

Space-directional approach to improve blood vessel visualization and temporal resolution in laser speckle contrast imaging.

Blood flow is a parameter used to diagnose vascular diseases based on flow speed, blood pressure, and vessel size. Different techniques have been developed to estimate the relative blood flow speed and to improve the visualization of deep blood vessels; one such technique is laser speckle contrast imaging (LSCI). LSCI images contain a high level of noise mainly when deep blood vessels are imaged. To improve their visualization, several approaches for contrast computation have been developed. However, there is a compromise between noise attenuation and temporal resolution. On the one hand, spatial approaches have low spatial resolution, high temporal resolution, and significant noise attenuation, while temporal approaches have the opposite. A recent approach combines a temporal base with a directional process that allows improving the visualization of blood vessels. Nevertheless, it still contains a high level of noise and requires a high number of raw frames for its base. We propose, a space-directional approach focused on improving noise attenuation and temporal resolution for contrast computation. The results of reference approaches and the proposed one are compared quantitatively. Moreover, it is shown that the visualization of blood vessels in LSCI images can be improved by a general morphological process when the noise level is reduced.

Tree-ring reconstruction of snow avalanche activity: Does avalanche path selection matter?

In the current context of anthropogenic global warming, one of the purposes of dendrogeomorphic analyses is to provide long and continuous chronologies of mass movements, so as to detect potential trends or shift related to increasing temperatures. However, on documented slopes, the comparison between historical archives and tree-ring records suggests that dendrogeomorphic reconstructions systematically underestimate the natural activity of the process under investigation. In the specific case of snow avalanches, underestimation generally amounts to 50% and the main causes generally given for this difference are related to the magnitude of past events. In this study, we hypothesize that the morphometric characteristics of avalanche paths and their forest cover could have significant impacts on the length and reliability of tree-ring reconstructions. In order to test this hypothesis, we selected four adjacent, albeit differently structured, avalanche paths from the Queyras massif (French Alps), with the aim to compare their potential for a continuous reconstruction of past avalanche activity. On the most active avalanche paths characterized by high-altitude release areas (covered only by shrubby vegetation), tree-ring reconstructions do not exceed one century in length, with recurrence intervals of high magnitude events >25 years. By contrast, on forested couloirs where lower slopes and forest coverage up to the release areas limits the intensity of events, the frequency of reconstructed snow avalanches is 2.5 times higher, the reconstructions span longer periods and the convergence rate with historical archives attest to the reliability of the dendrogeomorphic approach. These results suggest that a careful selection of couloirs is essential and that priority should be given to forested sites as (i) they allow for exhaustive and (ii) reliable reconstructions over (iii) long periods of time.

Climate-growth relationships in a Larix decidua Mill. network in the French Alps.

A better understanding of the respective role of key climatic variables on tree growth is crucial for an accurate assessment of how ongoing global changes may affect both dynamics and distribution of forest tree species in the future. The aim of this study was (i) to explore growth patterns of European larch (Larix decidua Mill.) through a network of tree-ring chronologies developed for the French Alps and (ii) to identify the main climatic drivers explaining radial growth. Climate-growth relationships were coupled with a hierarchical analysis. This relationship revealed significant variability expressed spatially by the existence of five clusters, initially discriminated by an elevational contrast related to (i) a negative correlation between summer temperatures and larch growth at lower elevations and (ii) a stronger response of low-elevation larch stands to winter precipitation. In the high-elevation clusters, tree growth depends on previous autumn and current summer temperatures and water supply in July. The differentiation, that portrays a strong geographical coherence, is mainly related to the latitudinal gradient; (i) the northwestern stands are mostly sensitive to high temperatures in summer; (ii) the growth of the southernmost clusters is equally driven by temperatures during autumn, winter, and summers; (iii) the populations of a cluster located in a transitional zone of the inner French Alps, subject to both Mediterranean and Continental influences, exhibit negative correlations to late winter and early spring precipitation. This significant spatial heterogeneity of climate-tree ring relationships in L. decidua clearly underlines the high plasticity of the species to adapt its growth to local climate conditions.

Acidosis tubular renal. Diagnóstico prenatal / Distal renal tubular acidosis. Prenatal diagnosis

Objetivo: Demostrar la utilidad del diagnóstico prenatal de la acidosis tubular renal distal (ATRD), permitiendo el tratamiento y seguimiento temprano del recién nacido, mejorando así el pronóstico de la enfermedad. Conclusiones: En la actualidad, los avances en el estudio génico permiten conocer los genes involucrados en múltiples enfermedades, de origen desconocido hasta la fecha. En nuestro caso, el diagnóstico prenatal de la ATRD ha permitido iniciar un tratamiento y seguimiento precoz adecuado, permitiendo prevenir la aparición de complicaciones en un futuro, lo que permitirá una mejor calidad de vida del paciente

Objective: To show the usefulness of prenatal diagnosis of distal renal tubular acidosis (DRTA), allowing the treatment and early follow-up of the newborn and thus improving the prognosis of the disease. Conclusions: Nowadays, advances in gene study provide an insight into multiple genes involved in diseases of previously unknown origin. In our case the prenatal diagnosis of DRTA has allowed us to start early and appropriate monitoring, thus allowing the prevention of some future complications, which will provide a better quality of life for patients

SURF1 knockout cloned pigs: Early onset of a severe lethal phenotype.

Leigh syndrome (LS) associated with cytochrome c oxidase (COX) deficiency is an early onset, fatal mitochondrial encephalopathy, leading to multiple neurological failure and eventually death, usually in the first decade of life. Mutations in SURF1, a nuclear gene encoding a mitochondrial protein involved in COX assembly, are among the most common causes of LS. LSSURF1 patients display severe, isolated COX deficiency in all tissues, including cultured fibroblasts and skeletal muscle. Recombinant, constitutive SURF1-/- mice show diffuse COX deficiency, but fail to recapitulate the severity of the human clinical phenotype. Pigs are an attractive alternative model for human diseases, because of their size, as well as metabolic, physiological and genetic similarity to humans. Here, we determined the complete sequence of the swine SURF1 gene, disrupted it in pig primary fibroblast cell lines using both TALENs and CRISPR/Cas9 genome editing systems, before finally generating SURF1-/- and SURF1-/+ pigs by Somatic Cell Nuclear Transfer (SCNT). SURF1-/- pigs were characterized by failure to thrive, muscle weakness and highly reduced life span with elevated perinatal mortality, compared to heterozygous SURF1-/+ and wild type littermates. Surprisingly, no obvious COX deficiency was detected in SURF1-/- tissues, although histochemical analysis revealed the presence of COX deficiency in jejunum villi and total mRNA sequencing (RNAseq) showed that several COX subunit-encoding genes were significantly down-regulated in SURF1-/- skeletal muscles. In addition, neuropathological findings, indicated a delay in central nervous system development of newborn SURF1-/- piglets. Our results suggest a broader role of sSURF1 in mitochondrial bioenergetics.

Eating flowers? Exploring attitudes and consumers' representation of edible flowers.

Edible flowers have gained more attention in recent years thanks to their perceived health benefits. Despite this attention, it seems that edible flowers are not popularized for consumption in South America, being considered unfamiliar for some cultures from this continent. In this context, the general goal of the present study was to investigate the three dimensions of social representation theory, the representational field, the information and the attitude of the two conditions of edible flowers: a more general "food made with flowers" and more directional product "yoghurt made with flowers", using Brazilian consumers. To achieve this goal, a free word association task was applied. A total of 549 consumers participated in this study. Participants were divided into two conditions, in which the inductor expressions for the free word association task changed: (a) food products made with flowers and (b) yoghurt made with flowers. Results showed a very positive attitude to both situations, and consumers associated Food products made with flowers to "health care" while the central core of yoghurt made with flowers reflected the innovative condition of this product, supported here by their unpredictable character (information generated).

Gully evolution and geomorphic adjustments of badlands to reforestation.

Badlands and gullied areas are among those geomorphic environments with the highest erosion rates worldwide. Nevertheless, records of their evolution and their relations with anthropogenic land transformation are scarcer. Here we combine historical data with aerial photographs and tree-ring records to reconstruct the evolution of a badland in a Mediterranean environment of Central Spain. Historical sources suggest an anthropogenic origin of this badland landscape, caused by intense quarrying activities during the 18th century. Aerial photographs allowed detection of dramatic geomorphic changes and the evolution of an emerging vegetation cover since the 1960s, due to widespread reforestation. Finally, tree-ring analyses of exposed roots allowed quantification of recent channel incision of the main gully, and sheet erosion processes. Our results suggest that reforestation practices have influenced the initiation of an episode of incision in the main channel in the 1980s, through the hypothesized creation of disequilibrium in water-sediment balance following decoupling of hillslopes from channel processes. These findings imply an asymmetry in the geomorphic response of badlands to erosion such that in the early evolution stages, vegetation removal results in gullying, but that reforestation alone does not necessarily stabilize the landforms and may even promote renewed incision.

Warm summers and moderate winter precipitation boost Rhododendron ferrugineum L. growth in the Taillefer massif (French Alps).

Rhododendron ferrugineum L. is a widespread dwarf shrub species growing in high-elevation, alpine environments of the Western European Alps. For this reason, analysis of its growth rings offers unique opportunities to push current dendrochronological networks into extreme environments and way beyond the treeline. Given that different species of the same genus have been successfully used in tree-ring investigations, notably in the Himalayas where Rhododendron spp. has proven to be a reliable climate proxy, this study aims at (i) evaluating the dendroclimatological potential of R. ferrugineum and at (ii) determining the major limiting climate factor driving its growth. To this end, 154 cross-sections from 36 R. ferrugineum individuals have been sampled above local treelines and at elevations from 1800 to 2100masl on northwest-facing slopes of the Taillefer massif (French Alps). We illustrate a 195-year-long standard chronology based on growth-ring records from 24 R. ferrugineum individuals, and document that the series is well-replicated for almost one century (1920-2015) with an Expressed Population Signal (EPS) >0.85. Analyses using partial and moving 3-months correlation functions further highlight that growth of R. ferrugineum is governed by temperatures during the growing season (May-July), with increasingly higher air temperatures favoring wider rings, a phenomenon which is well known from dwarf shrubs growing in circum-arctic tundra ecosystems. Similarly, the negative effect of January-February precipitation on radial growth of R. ferrugineum, already observed in the Alps on juniper shrubs, is interpreted as a result of shortened growing seasons following snowy winters. We conclude that the strong and unequivocal signals recorded in the fairly long R. ferrugineum chronologies can indeed be used for climate-growth studies as well as for the reconstruction of climatic fluctuations in Alpine regions beyond the upper limits of present-day forests.

Debris-flow risk analysis in a managed torrent based on a stochastic life-cycle performance.

Two key factors can affect the functional ability of protection structures in mountains torrents, namely (i) infrastructure maintenance of existing infrastructures (as a majority of existing works is in the second half of their life cycle), and (ii) changes in debris-flow activity as a result of ongoing and expected future climatic changes. Here, we explore the applicability of a stochastic life-cycle performance to assess debris-flow risk in the heavily managed Wartschenbach torrent (Lienz region, Austria) and to quantify associated, expected economic losses. We do so by considering maintenance costs to restore infrastructure in the aftermath of debris-flow events as well as by assessing the probability of check dam failure (e.g., as a result of overload). Our analysis comprises two different management strategies as well as three scenarios defining future changes in debris-flow activity resulting from climatic changes. At the study site, an average debris-flow frequency of 21 events per decade was observed for the period 1950-2000; activity at the site is projected to change by +38% to -33%, according to the climate scenario used. Comparison of the different management alternatives suggests that the current mitigation strategy will allow to reduce expected damage to infrastructure and population almost fully (89%). However, to guarantee a comparable level of safety, maintenance costs is expected to increase by 57-63%, with an increase of maintenance costs by ca. 50% for each intervention. Our analysis therefore also highlights the importance of taking maintenance costs into account for risk assessments realized in managed torrent systems, as they result both from progressive and event-related deteriorations. We conclude that the stochastic life-cycle performance adopted in this study represents indeed an integrated approach to assess the long-term effects and costs of prevention structures in managed torrents.

Protocolo de alta precoz tras apendicectomía en niños / Fast track protocol for children undergoing appendicectomy

Objetivos. Existen múltiples modalidades de tratamiento antibioterápico tras una apendicectomía en niños. Nuestro objetivo es desarrollar un nuevo protocolo para el tratamiento de las apendicitis que permita acortar la estancia hospitalaria sin aumentar las complicaciones. Material y métodos. Estudio prospectivo que analiza a los pacientes intervenidos de apendicitis tratados según el nuevo protocolo de antibioterapia durante un periodo de 7 meses. Dicho protocolo consiste en profilaxis quirúrgica en todos los casos y continuar con triple antibioterapia en las evolucionadas, con una duración variable según criterios clínico-analíticos establecidos previamente. Se comparan los resultados con los de un grupo histórico de pacientes tratados con el protocolo clásico (profilaxis y 48 horas de doble antibioterapia en las flemonosas y 5 días de triple en las evolucionadas). Resultados. Se estudian un total de 196 pacientes (96 grupo actual y 100 grupo histórico). En las apendicitis flemonosas la estancia hospitalaria postquirúrgica media es significativamente menor en el grupo actual sin encontrar diferencias estadísticas en la tasa de complicaciones. El 52,9% de las apendicitis evolucionadas del grupo actual fueron dadas de alta antes del 5º día sin aumentar la tasa de complicaciones. De los pacientes que presentaron una complicación infecciosa el 52% asociaban trombocitosis y la clínica más frecuente fue de vómitos prolongados. Conclusiones. No es necesario tratamiento antibioterápico postoperatorio en apendicitis simples. En las evolucionadas un tratamiento corto de antibióticos según criterios clínico-analíticos permite un alta precoz sin mayor morbilidad asociada. Los vómitos prolongados y la trombocitosis son indicadores de complicaciones infecciosas postoperatorias

Background. Multiple approaches to the treatment of simple and complicated (gangrenous or perforated) appendicitis in children have been promoted. Our goal is to develop a new protocol for these patients that allow shorter hospital stays without increasing complications rates Methods. Prospective collected data of patients undergoing appendicitis treated according to the new protocol for a period of 7 months were reviewed. This protocol consists on antibiotic prophylaxis in all cases continued with triple antibiotic regimen in complicated appendicitis. Antibiotics were stopped when specific clinical and laboratory criteria were met. Outcomes are compared to a historical group of patients treated under standard protocol (antibiotic prophylaxis followed by 48 hours of dual antibiotic therapy in simple appendicitis or 5 day-course of triple antibiotic therapy in complicated as postooperative antibiotic regimen). Results. A total of 196 patients (96 current groups and 100 historical group) were reviewed. In simple appendicitis average length of postoperative hospitalization was significantly lower in the current group (no statistical difference). 52.9% of complicated appendicitis in the current group were discharged home before 5th day without increasing the complication rate. When a wound infection or intraabdominal abscess occurs thrombocytosis (52%) and prolonged vomiting are the most frequent symptoms Conclusion. No further postoperative treatment is needed in simple appendicitis. In complicated appendictis a short course of antibiotics according to clinical and laboratory criteria allows early discharge without major morbidity. Prolonged postoperative vomiting and thrombocytosis suggest infectious complications

[Fast track protocol for children undergoing appendicectomy]. / Protocolo de alta precoz tras apendicectomía en niños.

BACKGROUND: Multiple approaches to the treatment of simple and complicated (gangrenous or perforated) appendicitis in children have been promoted. Our goal is to develop a new protocol for these patients that allows shorter hospital stays without increasing complications rates. METHODS: Prospective collected data of patients undergoing appendicitis treated according to the new protocol for a period of 7 months were reviewed. This protocol consists on antibiotic prophylaxis in all cases continued with triple antibiotic regimen in complicated appendicitis. Antibiotics were stopped when specific clinical and laboratory criteria were met. Outcomes are compared to a historical group of patients treated under standard protocol (antibiotic prophylaxis followed by 48 hours of dual antibiotic therapy in simple appendicitis or 5 day-course of triple antibiotic therapy in complicated as postooperative antibiotic regimen). RESULTS: A total of 196 patients (96 current group and 100 historical group) were reviewed. In simple appendicitis average length of postoperative hospitalization was significantly lower in the current group (no statistical difference). 52.9% of complicated appendicitis in the current group were discharged home before 5th day without increasing the complication rate. When a wound infection or intraabdominal abscess occurs thrombocytosis (52%) and prolonged vomiting are the most frequent symptoms. CONCLUSION: No further postoperative treatment is needed in simple appendicitis. In complicated appendictis a short course of antibiotics according to clinical and laboratory criteria allows early discharge without major morbidity. Prolonged postoperative vomiting and thrombocytosis suggest infectious complications.

OBJETIVOS: Existen múltiples modalidades de tratamiento antibioterápico tras una apendicectomía en niños. Nuestro objetivo es desarrollar un nuevo protocolo para el tratamiento de las apendicitis que permita acortar la estancia hospitalaria sin aumentar las complicaciones. MATERIAL Y METODOS: Estudio prospectivo que analiza a los pacientes intervenidos de apendicitis tratados según el nuevo protocolo de antibioterapia durante un periodo de 7 meses. Dicho protocolo consiste en profilaxis quirúrgica en todos los casos y continuar con triple antibioterapia en las evolucionadas, con una duración variable según criterios clínico-analíticos establecidos previamente. Se comparan los resultados con los de un grupo histórico de pacientes tratados con el protocolo clásico (profilaxis y 48 horas de doble antibioterapia en las flemonosas y 5 días de triple en las evolucionadas). RESULTADOS: Se estudian un total de 196 pacientes (96 grupo actual y 100 grupo histórico). En las apendicitis flemonosas la estancia hospitalaria postquirúrgica media es significativamente menor en el grupo actual sin encontrar diferencias estadísticas en la tasa de complicaciones. El 52,9% de las apendicitis evolucionadas del grupo actual fueron dadas de alta antes del 5º día sin aumentar la tasa de complicaciones. De los pacientes que presentaron una complicación infecciosa el 52% asociaban trombocitosis y la clínica más frecuente fue de vómitos prolongados. CONCLUSIONES: No es necesario tratamiento antibioterápico postoperatorio en apendicitis simples. En las evolucionadas un tratamiento corto de antibióticos según criterios clínico-analíticos permite un alta precoz sin mayor morbilidad asociada. Los vómitos prolongados y la trombocitosis son indicadores de complicaciones infecciosas postoperatorias.

Modeling amyotrophic lateral sclerosis in hSOD1 transgenic swine.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that occurs in two clinically indistinguishable forms: sporadic (SALS) and familial (FALS), the latter linked to several gene mutations, mostly inheritable in a dominant manner. Nearly 20% of FALS forms are linked to mutations in the Cu/Zn superoxide dismutase (SOD1) gene. Research on ALS relies on transgenic models and particularly on mice carrying a glycine-to-alanine conversion at the 93rd codon (G93A) of the hSOD1 gene. Although G93A transgenic mice have been widely employed in clinical trials and basic research, doubts have been recently raised from numerous reliable sources about their suitability to faithfully reproduce human disease. Besides, the scientific community has already foreseen swine as an attractive and alternative model to nonhuman primates for modeling human diseases due to closer anatomical, physiological and biochemical features of swine rather than rodents to humans. On this basis, we have produced the first swine ALS model by in vitro transfection of cultured somatic cells combined with somatic cell nuclear transfer (SCNT). To achieve this goal we developed a SOD1(G93A) (superoxide dismutase 1 mutated in Gly93-Ala) vector, capable of promoting a high and stable transgene expression in primary porcine adult male fibroblasts (PAF). After transfection, clonal selection and transgene expression level assessment, selected SOD1(G93A) PAF colonies were used as nuclei donors in SCNT procedures. SOD1(G93A) embryos were transferred in recipient sows, and pregnancies developed to term. A total of 5 piglets survived artificial hand raising and weaning and developed normally, reaching adulthood. Preliminary analysis revealed transgene integration and hSOD1(G93A) expression in swine tissues and 360° phenotypical characterization is ongoing. We believe that our SOD1(G93A) swine would provide an essential bridge between the fundamental work done in rodent models and the reality of treating ALS.

["Fast-track" in pediatric urologic surgery: pronenephrectomy]. / Fast-track en urología infantil: nefrectomía en prono ambulatoria.

UNLABELLED: INTRODUCTION AND OBJETIVES: Minimal invasive surgery trends to get prompt recovery in terms of inmediate deambulation and early discharge from hospital, without increasing patient's discomfort neither postoperative complications. This "fast-track" protocol is being progresively introduced in a crescent number of urological procedures. We are evaluating the viability of applying it in retroperitoneoscopic prone- position nephrectomy. METHODS AND MATERIALS: We have performed a retrospective review of the clinical reports of the patients submitted to prone nephrectomy with hospitalization between 2007 and 2011 and we present patients submitted to this procedure in an outpatient basis (less than 8 hours hospital stay) from 2011. We have recorded epidemiological factors, diagnosis, surgical time, first postoperative week analgesic requirements, parents cofort and postoperative complications. RESULTS: All the procedures were performed retroperitoneoscopically in prone position using two trocars. We included 34 nephrectomies with a mean surgical time of 107 minutes. Mean postoperative stay was under 24 hours in 23 patients, two of them were discharged in the first 8 hours after the procedure. Hospital stay over this time was due to concomitant pre-existent pathology in 6 patients and to non urological fever in the remaining 3. Analgesia was excellent in every patient with endovenous non-steroid drugs, registering no pain after administering them orally. There were no complications. CONCLUSIONS: We believe that "fast-track" requirements can be applied to prone-retroperitoneoscopic nephrectomy in pediatric population, as long as they have no associated pathology. In our experience this surgical procedure can be included in day-case surgery, increasing patient's confort and with a positive economical impact.

[Current problems in training of minimally invasive surgery: vision of residents in pediatric surgery]. / Problemas actuales en la formación en cirugía mínimamente invasiva: visión de los residentes de Cirugía pediátrica.

INTRODUCTION: Minimally Invasive Surgery (MIS) is getting more and more important in our specialty. However, the formation of the residents on MIS is, in many cases, irregular. The purpose of this study is to assess the state of training in MIS among the residents of Pediatric Surgery and their potential weaknesses. MATERIAL AND METHODS: An electronic survey was distributed among 71 residents of Pediatric Surgery from 17 national hospitals. RESULTS: The response rate was 70.2%.100% of the residents are interested in a broadening of training activities in MIS. The main areas of interest are gastrointestinal (92%) and thoracic (47%) surgery. Only 57% have access to training facilities and less than half of them attend to courses and conferences. 80% believe that they are not given adequate attention from specialized associations. 52% think they should do rotations at referral centers, 86% that courses and seminars should be enhanced, and 44% that the responsibility of the resident in surgery should be increased. The main defects encountered in their training are scarce volume of patients, lack of financial support and overcoming the learning curve of surgeons in their services. CONCLUSIONS: Despite the advance of the MIS, resident's training in this discipline still has shortcomings, as expressed in their views. Knowledge of the current state of training should be the starting point for designing a training strategy that ensures adequate skills.

Fast-track en urología infantil: nefrectomía en prono ambulatoria / "FaSt-traCK" in pediatriC urologiC Surgery: Pronenepherectomy

INTRODUCCIÓN Y OBJETIVOS: El objetivo de la cirugía mínimamente invasiva es lograr el alta hospitalaria precoz, sin aumentar el discon-fort del paciente ni las complicaciones postoperatorias. Este protocolo fast-track se lleva a cabo cada vez en más procedimientos urológicos, en nuestro centro estamos evaluando su viabilidad en la nefrectomía retroperitoneoscópica en posición de prono.Material y métodos. Revisamos y evaluamos el grupo de pacien-tes intervenidos entre 2007 y enero de 2011 bajo criterios de cirugía con hospitalización y presentamos los pacientes intervenidos a partir de 2011 usando criterios de cirugía ambulatoria (ingreso menor de 8 horas). Se revisaron los factores epidemiológicos, el diagnóstico, el tiempo quirúrgico, los requerimientos analgésicos en el postoperatorio inmediato (primera semana tras la intervención), la sensación de confort transmitida por los padres y las complicaciones aparecidas. RESULTADOS: En todos los pacientes el abordaje retroperitoneoscópi-co se llevó a cabo a través de 2 puertos. En total realizamos 34 nefrec-tomías, con un tiempo quirúrgico medio de 107 minutos. La estancia media fue inferior a 24 horas en 23 pacientes, dos de los cuales fueron dados de alta en las 8 primeras horas postquirúrgicas. El ingreso superior a este tiempo se debió a multipatología preexistente en 6 pacientes y a foco febril no urológico en otros 3. Todos los pacientes presentaron excelente control analgésico con AINES intravenosos al inicio, sin dolor tras administración oral. No se registraron complicaciones a corto ni medio plazo. CONCLUSIONES: Pensamos que los criterios fast-track son aplicables a la nefrectomía retroperitoneoscópica en pacientes sin patología aso-ciada. En nuestra experiencia podría ser incluida en los programas de cirugía ambulatoria, con aumento del confort para el paciente y con un impacto económico positivo

INTRODUCTION AND OBJETIVES: Minimal invasive surgery trends to get prompt recovery in terms of inmediate deambulation and early dis-charge from hospital, without increasing patient's discomfort neither postoperative complications. This "fast-track" protocol is being pro-gresively introduced in a crescent number of urological procedures. We are evaluating the viability of applying it in retroperitoneoscopic prone- position nephrectomy.Methods and materials. We have performed a retrospective review of the clinical reports of the patients submitted to prone nephrectomy with hospitalization between 2007 and 2011 and we present patients submitted to this procedure in an outpatient basis (less than 8 hours hospital stay) from 2011. We have recorded epidemiological factors, diagnosis, surgical time, first postoperative week analgesic requirements, parents cofort and postoperative complications.Results. All the procedures were performed retroperitoneoscopi-cally in prone position using two trocars. We included 34 nephrectomies with a mean surgical time of 107 minutes. Mean postoperative stay was under 24 hours in 23 patients, two of them were discharged in the first 8 hours after the procedure. Hospital stay over this time was due to concomitant pre-existent pathology in 6 patients and to non urological fever in the remaining 3. Analgesia was excellent in every patient with endovenous non-steroid drugs, registering no pain after administering them orally. There were no complications.Conclusions. We believe that "fast-track" requirements can be ap-plied to prone-retroperitoneoscopic nephrectomy in pediatric popula-tion, as long as they have no associated pathology. In our experience this surgical procedure can be included in day-case surgery, increasing patient ́s confort and with a positive economical impact

Problemas actuales en la formación en cirugía mínimamente invasiva: visión de los residentes de Cirugía Pediátrica / Current problems in training of minimally invasive Surgery: Vision of residents in pediatric surgery

Introducción. La cirugía mínimamente invasiva (CMI) ocupa una parcela cada vez mayor de nuestra especialidad. Sin embargo, la formación de los residentes en CMI es, en muchos casos, irregular. El propósito de este estudio es evaluar el estado de la formación en CMI entre los residentes de Cirugía Pediátrica y sus posibles deficiencias. Material y métodos. Se distribuyó una encuesta electrónica entre 71 residentes de Cirugía Pediátrica de 17 hospitales nacionales. Resultados. La tasa de respuesta fue 70,2%. El 100% de los residentes está interesado en que se potencien actividades formativas en CMI. Las áreas de mayor interés son cirugía digestiva (92%) y torácica (47%). Solo un 57% tiene acceso a medios de entrenamiento y menos de la mitad acuden a cursos y congresos. Un 80% cree que no se les presta adecuada atención desde las asociaciones especializadas. Un 52% cree que se deberían realizar rotaciones en centros de referencia, un 86% que se deberían potenciar cursos y seminarios, y un 44% que se debería aumentar la responsabilidad del residente en las intervenciones quirúrgicas. Los principales defectos que encuentran en su formación son el volumen escaso de pacientes, la falta de ayudas económicas y la superación de la curva de aprendizaje por los adjuntos de su servicio. Conclusiones. A pesar del avance de la CMI, la formación de los residentes en esta disciplina tiene todavía deficiencias, tal como expresan sus opiniones. El conocimiento del estado actual de la formación debería ser el punto de partida para diseñar una estrategia docente que asegure una formación adecuada (AU)

Introduction. Minimally Invasive Surgery (MIS) is getting more and more important in our specialty. However, the formation of the residents on MIS is, in many cases, irregular. The purpose of this study is to assess the state of training in MIS among the residents of Pediatric Surgery and their potential weaknesses. Material and methods. An electronic survey was distributed among 71 residents of Pediatric Surgery from 17 national hospitals. Results. The response rate was 70.2%.100% of the residents are interested in a broadening of training activities in MIS. The main areas of interest are gastrointestinal (92%) and thoracic (47%) surgery. Only 57% have access to training facilities and less than half of them attend to courses and conferences. 80% believe that they are not given adequate attention from specialized associations. 52% think they should do rotations at referral centers, 86% that courses and seminars should be enhanced, and 44% that the responsibility of the resident in surgery should be increased. The main defects encountered in their training are scarce volume of patients, lack of financial support and overcoming the learning curve of surgeons in their services. Conclusions. Despite the advance of the MIS, resident’s training in this discipline still has shortcomings, as expressed in their views. Knowledge of the current state of training should be the starting point for designing a training strategy that ensures adequate skills (AU)