What do we see when we do not see the bladder? Review of the main urinary diversion techniques and their complications.

OBJECTIVE: To review the different types of urinary diversion surgeries (UDS) in order to recognize the expected findings in a postoperative study, using different imaging techniques. To recognize the main postoperative complications, both early and late. CONCLUSION: UDS are surgical procedures whose purpose is to redirect urine flow after cystectomy, generally in an oncologic context. The imaging evaluation of urological surgeries is often a radiological challenge, with CT being the most commonly used image modality. Therefore, it is essential to know the main surgical techniques, the expected postoperative findings and the optimization of imaging techniques for early diagnosis and correct evaluation of postoperative complications.

Serum microRNAs Catalog Asthma Patients by Phenotype.

BACKGROUND AND OBJECTIVES: Asthma is a chronic inflammatory condition of the airways with a complex pathophysiology. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward, making treatment more effective and personalized. Eosinophils are the key inflammatory cells involved in severe eosinophilic asthma. Given the health threat posed by eosinophilic asthma, there is a need for reliable biomarkers to identify affected patients and treat them properly with novel biologics. microRNAs (miRNAs) are a promising diagnostic tool. The aim of this study was to identify serum miRNAs that can phenotype asthma patients. METHODS: Serum miRNAs of patients with eosinophilic asthma (N=40) and patients with noneosinophilic asthma (N=36) were evaluated using next-generation sequencing, specifically miRNAs-seq, and selected miRNAs were validated using RT-qPCR. Pathway enrichment analysis of deregulated miRNAs was performed. RESULTS: Next-generation sequencing revealed 15 miRNAs that were expressed differentially between eosinophilic and noneosinophilic asthma patients, although no differences were observed in the miRNome between atopic and nonatopic asthma patients. Of the 15 miRNAs expressed differentially between eosinophilic and noneosinophilic asthma patients, hsa-miR-26a-1-3p and hsa-miR-376a-3p were validated by RT-qPCR. Expression levels of these 2 miRNAs were higher in eosinophilic than in noneosinophilic asthma patients. Furthermore, expression values of hsa-miR-26a-1-3p correlated inversely with peripheral blood eosinophil count, and hsa-miR-376a-3p expression values correlated with FeNO values and the number of exacerbations. Additionally, in silico pathway enrichment analysis revealed that these 2 miRNAs regulate signaling pathways associated with the pathogenesis of asthma. CONCLUSIONS: hsa-miR-26a-1-3p and hsa-miR-376a-3p could be used to differentiate between eosinophilic and noneosinophilic asthma.

Serum microRNAs Catalog Asthma Patients by Phenotype

Background: Asthma is a chronic inflammatory condition of the airways with a complex pathophysiology. Stratification of asthma subtypes into phenotypes and endotypes should move the field forward, making treatment more effective and personalized. Eosinophils are the key inflammatory cells involved in severe eosinophilic asthma. Given the health threat posed by eosinophilic asthma, there is a need for reliable biomarkers to identify affected patients and treat them properly with novel biologics. microRNAs (miRNAs) are a promising diagnostic tool. Objective: The aim of this study was to identify serum miRNAs that can phenotype asthma patients. Methods: Serum miRNAs of patients with eosinophilic asthma (N=40) and patients with noneosinophilic asthma (N=36) were evaluated using next-generation sequencing, specifically miRNAs-seq, and selected miRNAs were validated using RT-qPCR. Pathway enrichment analysis of deregulated miRNAs was performed. Results: Next-generation sequencing revealed 15 miRNAs that were expressed differentially between eosinophilic and noneosinophilic asthma patients, although no differences were observed in the miRNome between atopic and nonatopic asthma patients. Of the 15 miRNAs expressed differentially between eosinophilic and noneosinophilic asthma patients, hsa-miR-26a-1-3p and hsa-miR-376a-3p were validated by RT-qPCR. Expression levels of these 2 miRNAs were higher in eosinophilic than in noneosinophilic asthma patients. Furthermore, expression values of hsa-miR-26a-1-3p correlated inversely with peripheral blood eosinophil count, and hsa-miR-376a-3p expression values correlated with FeNO values and the number of exacerbations. Additionally, in silico pathway enrichment analysis revealed that these 2 miRNAs regulate signaling pathways associated with the pathogenesis of asthma. Conclusion: hsa-miR-26a-1-3p and hsa-miR-376a-3p could be used to differentiate between eosinophilic and noneosinophilic asthma (AU)

Reproductive fluids, used for the in vitro production of pig embryos, result in healthy offspring and avoid aberrant placental expression of PEG3 and LUM.

BACKGROUND: In vitro embryo production (IVP) and embryo transfer (ET) are two very common assisted reproductive technologies (ART) in human and cattle. However, in pig, the combination of either procedures, or even their use separately, is still considered suboptimal due to the low efficiency of IVP plus the difficulty of performing ET in the long and contorted uterus of the sow. In addition, the potential impact of these two ART on the health of the offspring is unknown. We investigated here if the use of a modified IVP system, with natural reproductive fluids (RF) as supplements to the culture media, combined with a minimally invasive surgery to perform ET, affects the output of the own IVP system as well as the reproductive performance of the mother and placental molecular traits. RESULTS: The blastocyst rates obtained by both in vitro systems, conventional (C-IVP) and modified (RF-IVP), were similar. Pregnancy and farrowing rates were also similar. However, when compared to in vivo control (artificial insemination, AI), litter sizes of both IVP groups were lower, while placental efficiency was higher in AI than in RF-IVP. Gene expression studies revealed aberrant expression levels for PEG3 and LUM in placental tissue for C-IVP group when compared to AI, but not for RF-IVP group. CONCLUSIONS: The use of reproductive fluids as additives for the culture media in pig IVP does not improve reproductive performance of recipient mothers but could mitigate the impact of artificial procedures in the offspring.

[Hypokalemic periodic paralysis: a systematic review of published case reports]. / Parálisis periódica hipocaliémica: revisión sistemática de casos publicados.

INTRODUCTION: Hypokalemic periodic paralysis is a neuromuscular disease characterized by a combination of flaccid paralysis episodes (or muscular weakness) that are related to low levels of potassium in blood. As a consequence of its low prevalence, there are still clinical and management aspects to characterize. PATIENTS AND METHODS: A systematic review of the clinical cases published in the last decade has been developed by analyzing demographic and genetic features, the episodes' characteristics, the received treatments, the response to them and also, the differences and evolution of patients depending on the most prevalent genetic alterations: CACNA1S and SCN4A. RESULTS: A total of 33 articles were included, allowing 40 individuals to be reviewed. The average age of onset of symptoms was 15.3 ± 9.7 years. The most frequent altered gene was CACNA1S in 20 (60.5%) cases. It was observed that subjects presenting an alteration of the gene responsible for the calcium channel, CACNA1S, presented lower serum potassium levels, own triggers and a higher proportion of subjects showing dyspnea during the crisis. Only 50% of the subjects respond to classical oral treatment with acetazolamide. Potassium-sparing diuretics and antiepileptics drugs emerge as an alternative. CONCLUSION: Hypokalemic periodic paralysis has an heterogeneous clinical expression with phenotypic differences linked to different genetic mutations. The common preventive treatment response is suboptimal. Prospective studies are needed to discern the best therapeutic option based on genetic load.

TITLE: Parálisis periódica hipocaliémica: revisión sistemática de casos publicados.Introducción. La parálisis periódica hipocaliémica es una enfermedad neuromuscular hereditaria que se caracteriza por presentar episodios de parálisis flácida o debilidad muscular relacionados con niveles bajos de potasio en sangre. Como consecuencia de su baja prevalencia, todavía hay aspectos clínicos y de manejo por caracterizar. Pacientes y métodos. Se desarrolla una revisión sistemática de los casos clínicos publicados en la última década, analizando las características demográficas y genéticas, las características de los episodios, los tratamientos recibidos y su respuesta, y las diferencias y evolución de los pacientes en función de las mutaciones de los genes más prevalentes: CACNA1S y SCN4A. Resultados. Se incluyeron 33 artículos, que permitieron revisar a 40 sujetos. La edad media del inicio de los síntomas fue de 15,3 ± 9,7 años. El gen alterado con mayor frecuencia fue CACNA1S en 20 (60,5%) casos. Se observó que los sujetos con alteración del gen del canal de calcio CACNA1S presentaron niveles de potasio sérico inferiores, factores desencadenantes propios y una mayor proporción de sujetos con disnea en las crisis. La respuesta al tratamiento oral clásico con acetazolamida sólo alcanzó el 50%. Los diuréticos ahorradores de potasio y los fármacos antiepilépticos emergieron como una alternativa. Conclusiones. La parálisis periódica hipocaliémica tiene una expresión clínica heterogénea con diferencias fenotípicas ligadas a las diferentes mutaciones genéticas. La respuesta al tratamiento preventivo habitual es subóptima. Son necesarios estudios prospectivos para poder discernir la mejor opción terapéutica en función de la carga genética.

Elevación de enzimas hepáticas inducida por COVID-19 en embarazada / Elevated liver enzimes induced by COVID-19 in pregnancy

INTRODUCCIÓN: Las alteraciones del perfil hepático durante el embarazo ocurren en 3-5% de las gestantes. Una nueva etiología que se ha presentado en el contexto de pandemia actual es el síndrome respiratorio agudo severo relacionado con el nuevo coronavirus (SARS-CoV-2). Éste es responsable de alteraciones hepáticas en 2 a 11% de la población general infectada por este virus, y de hasta un 30% en las embarazadas que se infectan con SARS-CoV-2. Con el objetivo de mostrar una presentación poco frecuente del SARS-CoV-2 se expone un caso clínico de elevación de transaminasas en embarazada inducida por este nuevo virus. CASO CLÍNICO: Paciente de 36 años, cursando embarazo de 20+6 semanas, consulta por dolor abdominal asociado a ictericia y coluria. Se solicita estudio donde destaca elevación de transaminasas. Ecografía abdominal con vía biliar fina. Se descartan diferentes etiologías de hepatitis aguda y crónica (dada la falta de antecedentes). Finalmente se solicita PCR para COVID-19 que resulta positiva. CONCLUSIÓN: Luego de un estudio exhaustivo de diferentes etiologías de elevación de transaminasas, se atribuye esta alteración enzimática a SARS-CoV-2. Se decide seguimiento ambulatorio estricto con pruebas hepáticas cada dos semanas. La paciente evoluciona estable con exámenes normales luego de un mes desde que se indica el alta hospitalaria. Después de descartar etiologías frecuentes de elevación de transaminasas durante el embarazo, sugerimos solicitar el estudio de este virus con PCR para COVID-19, ya que podría ser una presentación poco frecuente de SARS-CoV-2.

INTRODUCTION: Approximately 3-5% of women present alterations of hepatic enzymes during pregnancy. Under the new circumstances that the world is facing with the SARS-COV2 pandemic, a new etiology for hepatic enzyme alterations has risen. The severe acute respiratory syndrome that the novel coronavirus causes is responsible for hepatic enzyme alterations in 2 to 11% of the sick population that did not have a previous underlying hepatic condition. Furthermore, hepatic enzyme alterations in pregnant women infected with SARS-COV2 presents in up to 30% of the cases. An infrequent presentation of SARS-COV2 is presented as our clinical case. CLINICAL CASE: A 36-year-old patient with a 20+6 week pregnancy presents abdominal pain, jaundice and choluria. General blood workup shows elevated transaminases. The abdominal ultrasound revealed a thin bile duct. Acute and chronic hepatitis etiologies were discarded. Finally, a PCR of COVID-19 was solicited, which turned out to be positive. CONCLUSIÓN: After an exhaustive study to determine the etiology of the elevated transaminases, the hepatic alterations were attributed to SARS-COV2 infection. A conservative management was adopted, with outpatient follow-up with liver testing every two weeks. The patient progresses with a stable steady decline in hepatic enzyme levels, and one-month post hospital discharge, her transaminases had reached normal values. Based on this clinical case, after ruling out frequent etiologies for elevated transaminases during pregnancy, it seems reasonable to request a PCR for COVID-19, since it could be a rare presentation of SARS-CoV-2.

Mimicking the temperature gradient between the sow's oviduct and uterus improves in vitro embryo culture output.

This work was designed to determine temperature conditions within the reproductive tract of the female pig and study their impact on ARTs. Temperatures were recorded using a laparo-endoscopic single-site surgery assisted approach and a miniaturized probe. Sows and gilts were used to address natural cycle and ovarian stimulation treatments, respectively. According to in vivo values, IVF was performed at three temperature conditions (37.0°C, 38.5°C and 39.5°C) and presumptive zygotes were cultured in these conditions for 20 h, while further embryo culture (EC) (21-168 h post-insemination) was maintained at 38.5°C. After 20 h, different fertility parameters were assessed. During EC, cleavage and blastocyst stages were evaluated. Sperm membrane fluidity at the experimental temperatures was studied by using differential scanning calorimetry and fluorescence recovery after photobleaching techniques. An increasing temperature gradient of 1.5°C was found between the oviduct and uterus of sows (P < 0.05) and when this gradient was transferred to pig in vitro culture, the number of poly-nuclear zygotes after IVF was reduced and the percentage of blastocysts was increased. Moreover, the temperature transition phase for the boar sperm membrane (37.0°C) coincided with the temperature registered in the sow oviduct, and sperm membranes were more fluid at 37.0°C compared with those of sperm incubated at higher temperatures (38.5°C and 39.5°C). These data suggest that there may be an impact of physiological temperature gradients on human embryo development.

Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: Systematic review of the literature.

BACKGROUND: Longitudinal pancreaticojejunostomy, also known as modified Puestow or Partington-Rochelle procedure, is a technique for the treatment of chronic pancreatitis. It is usually performed by laparotomy, but in a very small number of cases it has been performed using a laparoscopic or robot-assisted approach. We carried out a systematic literature review to clarify the current status of laparoscopic longitudinal pancreatojejunostomy (LLPJ). METHODS: Adhering to the PRISMA guidelines, a systematic search for LLPJ was performed in PubMed, Embase, and Cochrane Library, for articles published up to 31 December 2017. RESULTS: 357 articles were evaluated for eligibility and 17 were included for critical appraisal: eight case reports, eight retrospective case series, and one series of cases and controls without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to the CEBM. Patients were relatively young (mean age 37 years), with a slight preponderance of males (ratio 1.3: 1). All had long-standing disease, ERCP prior to surgery and a dilated pancreatic duct (mean 11 mm). The surgery was usually performed laparoscopically using four trocars; the conversion rate was low (5%), bleeding was minimal, the morbidity rate was 11% and no mortality was reported. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short (less than two years). The results for pain control were very good since 90% of patients reported no pain, although visual analog scales were rarely used. CONCLUSIONS: In conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.

Plastinated macroparasites, an alternative resource for use in practical lessons.

The plastination technique is a recently developed option to preserve biological tissues widely used in human and veterinary anatomy. This process allows one to obtain real, safe, clean, dry, resistant and permanently stable material without any additional treatment or maintenance. All these advantages are associated with the rapid expansion of plastination during recent decades in a high number of educational institutions. However, the studies of parasite conservation through plastination are scarce, although the material obtained has a high quality, as prior references have shown. In this study, 141 students of veterinary medicine and pharmacy university degrees used, in a blind study, plastinated specimens (experimental group) or wet specimens (control group) during three consecutive practical sessions. Afterwards all the students completed anonymous questionnaires on both knowledge and satisfaction. The results demonstrated that plastinated parasites are a valid and satisfactory alternative to be used as a teaching/learning tool during practical lessons. Moreover, with regard to the knowledge of morphological structures, the results from the questionnaire of assimilated knowledge showed no differences between the use of plastinated and formaldehyde-preserved parasites.

La technique de plastination est une méthode assez récente de préservation des tissus biologiques qui est désormais largement utilisée en anatomie humaine et vétérinaire. Ce procédé permet d'obtenir des préparations anatomiques réalistes, sûres, sèches, résistantes et stables qui ne nécessiteront pas de traitement ni d'entretien ultérieurs pour préserver leur durabilité. Ces avantages expliquent que le recours à la plastination se soit rapidement développé au cours des dernières décennies dans nombre d'institutions d'enseignement. Néanmoins, rares sont les études portant sur la préservation des parasites par plastination, bien que les spécimens obtenus lors de travaux antérieurs aient été jugés de très bonne qualité. Les auteurs présentent les résultats d'une enquête menée auprès de 141 étudiants préparant leur diplôme de médecine vétérinaire ou de pharmacie, à qui ont été distribués en aveugle des spécimens plastinés (groupe expérimental) et des spécimens conservés dans une solution liquide (groupe de contrôle) lors de trois séances consécutives de travaux pratiques. Il a ensuite été demandé aux étudiants de remplir anonymement un questionnaire portant sur les connaissances acquises lors de ces séances et sur leur degré de satisfaction. Les résultats ont montré que les parasites plastinés constituent une alternative valable et satisfaisante en tant que matériel pédagogique et d'entraînement pendant les leçons pratiques. Par ailleurs, s'agissant de l'étude des structures morphologiques, les résultats du questionnaire sur les connaissances acquises lors des travaux pratiques n'ont pas fait apparaître de différences entre les étudiants ayant travaillé sur des parasites plastinés et ceux ayant travaillé avec des parasites conservés dans le formol.

La técnica de la plastinación es un método de reciente aparición para conservar tejidos biológicos, utilizado con gran frecuencia en anatomía humana y veterinaria. Se trata de un proceso que permite obtener material real, inocuo, limpio, seco, resistente y con una estabilidad permanente sin necesidad de ninguna otra operación de tratamiento o mantenimiento. Todas estas ventajas explican que en los últimos decenios la técnica se haya extendido con rapidez por muy numerosas instituciones de enseñanza. Aun así, hay escasos estudios sobre la conservación de parásitos por plastinación, pese a que el material obtenido, como se desprende de referencias anteriores, es de gran calidad. Los autores describen un estudio ciego en el que 141 estudiantes universitarios en farmacia y medicina veterinaria emplearon muestras plastinadas (grupo experimental) o muestras húmedas (grupo de control) en tres clases prácticas consecutivas, tras lo cual todos los estudiantes respondieron anónimamente a un cuestionario que evaluaba tanto sus conocimientos como su nivel de satisfacción. Los resultados demostraron que los parásitos plastinados constituyen una alternativa válida y satisfactoria como herramienta para impartir y/o recibir clases prácticas. Además, desde el punto de vista del conocimiento de estructuras morfológicas, los resultados del cuestionario sobre conocimientos asimilados no pusieron de manifiesto diferencia alguna entre el uso de parásitos plastinados y el de parásitos conservados en formaldehído .

Mimicking physiological O2 tension in the female reproductive tract improves assisted reproduction outcomes in pig.

STUDY QUESTION: Is O2 tension in the pig oviduct and uterus affected by the estrous cycle stage and the animal's age, and can the outcome of in vitro embryo development be improved by mimicking these physiological values? SUMMARY ANSWER: O2 tension within the pig reproductive organs is affected by the animal's age, and values close to those measured in vivo have a positive impact on embryo development and quality when used during IVF and embryo culture (EC). WHAT IS KNOWN ALREADY: To obtain a healthy embryo in vitro, it is necessary to adopt a culture microenvironment that approximates physiological conditions. Despite advances in surgical procedures and sensitive probes that allow accurate assessment of in vivo O2 tension, few such studies have been conducted recently in mammals. In addition, no reference values of physiological O2 tension in the reproductive tract exist for large animal models such as pig, and the effect of O2 tension on ART outcomes is unknown. STUDY DESIGN, SIZE, DURATION: This study was conducted in pigs. We measured oviductal and uterine O2 tension (n = 29 and 13, respectively) and then examined how the use of the physiological values in pig IVF and EC affected pig ART output (n = 1447 oocytes). PARTICIPANTS/MATERIALS, SETTING, METHODS: The oviductal and uterine O2 tension at the different stages of the estrous cycle was monitored using a laparo-endoscopic single-site surgery (LESS) assisted approach along with a flexible and thin miniaturized luminescent probe. Two groups of pigs, Large-white × Landrace breed, were used: for the first group, 16 pre-pubertal gilts (5 months old and 95 kg) were induced to ovulate with equine chorionic gonadotropin (eCG) and human chorionic gonadotropin (hCG); in the second group 13 mature sows (24-48 months and 185 kg) were used. IVF and EC were performed at two different O2 tensions: Atmospheric O2 (20%) and the mean in vivo value measured (7%). At 18-20 h post-insemination (hpi), a small sample of presumptive zygotes were fixed, stained and examined under epifluorescence microscopy to assess the fertilization rates. At 48 hpi, cleavage was evaluated under the stereomicroscope. Finally, at 180 hpi, development to the blastocyst stage was quantified, blastocyst morphology was assessed, and embryos were fixed and stained to count the mean cell number per blastocyst. MAIN RESULTS AND THE ROLE OF CHANCE: The mean O2 content within the pig oviduct and uterus was always lower than in ambient air. The average O2 percentage was higher in gilts (10.0%) than in sows (7.6%) (P < 0.0001). The cleavage rate of porcine in vitro fertilized embryos maintained under 7% O2 during IVF and EC was significantly higher (60.0 ± 2.3) compared with those cultured under 20% O2 (32.0 ± 2.2) (P < 0.05). An increase in the number of cells in embryos cultured under the low O2 concentration (88.9 ± 5.9) was observed compared to those cultured under 20% O2 (59.0 ± 5.0) (P < 0.05). LARGE SCALE DATA: None. LIMITATIONS, REASONS FOR CAUTION: Although minimally invasive surgery was used the effect of anesthesia and manipulations on O2 tension within the organs are unknown. WIDER IMPLICATIONS OF THE FINDINGS: Using physiological oxygen concentrations in IVF/EC could improve ART outcomes. STUDY FUNDING AND COMPETING INTEREST(S): This study was funded by Spanish Ministry of Economy and Competitiveness (MINECO) and European Regional Development Fund (FEDER). Grants AGL2012-40180-C03-01 and AGL2015-66341-R. The authors declare no conflict of interest.

Expression of the vascular endothelial growth factor system (VEGF) in the porcine oviduct during the estrous cycle.

The expression and localization of VEGFA and its main receptors Flt-1 and KDR is characterized in the oviduct throughout the porcine estrous cycle. Oviducts were sampled from sows at early follicular, late follicular, early luteal and late luteal stages of the estrous cycle and a segment from the mid portion of the ampulla and isthmus studied by real time RT-PCR and quantitative immunohistochemistry. The expression of the three components of the VEGF system was continuous, although differences were observed depending on the oviduct portion, the stage of the estrous cycle and the histological layer. VEGFA and KDR mRNA expressions were higher in ampulla, while Flt-1 mRNA was higher in isthmus. VEGFA protein was also higher in ampulla but Flt-1 and KDR did not show regional differences between ampulla and isthmus. While the mRNA expression of VEGFA, Flt-1 and KDR increased progressively during the luteal period, the amount of VEGFA and Flt-1 protein decreased in the same period (in isthmus only). Contrastinly, KDR protein peaked in ampulla and isthmus just before ovulation. The VEGF system was majorly located in both the secretory and ciliated cells of the oviduct epithelium, but also in the endothelium and fibroblasts of the lamina propia and the muscle fibres and vessels of the tunica muscularis. Our results are consistent with a participation of VEFG in the regulation of the dynamics of oviductal fluid secretion and the oviduct contractibility.

¿Es posible disminuir la incidencia de encefalopatía hipóxico isquémica? / Is it possible to reduce the incidence of hypoxic-ischemic encephalopathy?

Objetivo: Determinar si una política local, establecida en la Maternidad del Hospital Padre Hurtado (HPH), para bajar la incidencia de Encefalopatía Hipóxico Isquémica es efectiva, sin incrementar en forma relevante la tasa de cesáreas. Diseño: Estudio de cohorte. Escenario: Unidad de Gestión Clínica de la Mujer y el Recién Nacido del Hospital Padre Hurtado. Población: Neonatos mayores de 33 semanas de edad gestacional, nacidos en el Hospital Padre Hurtado durante los años 1999 y 2015. Método: Se revisaron los resultados de una política de intervención para prevención de asfixia neonatal establecida en la Maternidad del Hospital Padre Hurtado durante un periodo de 14 años. Resultados: Al analizar los datos de un total de 102.612 nacidos vivos, se constató una disminución en la incidencia de EHI en sus 3 grados de una tasa de 4.75/1.000 nacidos vivos previo a la intervención (grupo control) a una tasa de 1.46 por 1.000 nacidos vivos post intervenciones, con alta significancia estadística (p=0,008), llegando en los últimos 6 años a tasa promedio de 0.87/1.000 nacidos vivos. La tasa de EHI moderada y severa bajó de 1.15 por mil nacidos vivos a 0.62, también con alta significancia estadística (p=0.02). La tasa de cesáreas oscilo entre 26-29 % en estos años. Conclusión: La introducción de intervenciones protocolizadas y sistematizadas por medio de la implementación de guías de manejo del trabajo de parto, la capacitación del equipo de profesionales y la auditoría continua de los casos de EHI en el Servicio de Maternidad del Hospital Padre Hurtado se asoció a una disminución significativa de EHI, manteniendo la tasa de cesáreas bajo 30%.

Objectives: Determine whether a local policy to reduce the incidence of neonatal hypoxic-ischemic encephalopathy (HIE), established at the Maternity Unit of Hospital Padre Hurtado (HPH), is effective without significantly increasing the cesarean rate. Design: Cohort study. Setting: Maternity unit of Hospital Padre Hurtado. Population: Newborns older than 33 weeks born at Hospital Padre Hurtado between 1999 and 2015. Methods: The results of a training policy to prevent HIE and perinatal asphyxia established at the Maternity unit of Hospital Padre Hurtado were reviewed during a period of 14 years. Results: From a total of 102.612 newborns analyzed, results showed a decrease in all grades of HIE incidence, from a rate of 4.75 / 1,000 live births prior to intervention (control group) to a rate of 1.46 per 1,000 live births after interventions, with high statistically significance (p=0.008), it reached an average rate of 0.87/1000 for the last 6 years. The moderate and severe HIE rate decreased from 1.15/1000 to 0.62/1000, also with high statistically significance (p=0.02). During the same period of time, the cesarean rate varied between 26-29%. Conclusion: The introduction of protocolized and systematized interventions trough the implantation of Management guides, obstetrics emergency trainings to the professional team and continues audit of the HIE cases at the Maternity unit Hospital Padre Hurtado was associated to a significant decrease of HIE, maintaining the rate of cesareans below 30%.

Downregulation of neuronal vasoactive intestinal polypeptide in Parkinson's disease and chronic constipation.

BACKGROUND: Chronic constipation (CC) is a common and severe gastrointestinal complaint in Parkinson's disease (PD), but its pathogenesis remains poorly understood. This study evaluated functionally distinct submucosal neurons in relation to colonic motility and anorectal function in PD patients with constipation (PD/CC) vs both CC and controls. METHODS: Twenty-nine PD/CC and 10 Rome III-defined CC patients were enrolled. Twenty asymptomatic age-sex matched subjects served as controls. Colonic transit time measurement and conventional anorectal manometry were evaluated in PD/CC and CC patients. Colonoscopy was performed in all three groups. Colonic submucosal whole mounts from PD/CC, CC, and controls were processed for immunohistochemistry with antibodies for vasoactive intestinal polypeptide (VIP) and peripheral choline acetyltransferase, markers for functionally distinct submucosal neurons. The mRNA expression of VIP and its receptors were also assessed. KEY RESULTS: Four subgroups of PD/CC patients were identified: delayed colonic transit plus altered anorectal manometry (65%); delayed colonic transit (13%); altered manometric pattern (13%); and no transit and manometric impairment (9%). There were no differences in the number of neurons/ganglion between PD/CC vs CC or vs controls. A reduced number of submucosal neurons containing VIP immunoreactivity was found in PD/CC vs controls (P<.05). VIP, VIPR1, and VIPR2 mRNA expression was significantly reduced in PD/CC vs CC and controls (P<.05). CONCLUSIONS AND INFERENCES: Colonic motor and rectal sensory functions are impaired in most PD/CC patients. These abnormalities are associated with a decreased VIP expression in submucosal neurons. Both sensory-motor abnormalities and neurally mediated motor and secretory mechanisms are likely to contribute to PD/CC pathophysiology.

Effect of feed supplementation with live yeast on the intestinal transcriptome profile of weaning pigs orally challenged with Escherichia coli F4.

The ability of live yeasts to modulate pig intestinal cell signals in response to infection with Escherichia coli F4ac (ETEC) has not been studied in-depth. The aim of this trial was to evaluate the effect of Saccharomyces cerevisiae CNCM I-4407 (Sc), supplied at different times, on the transcriptome profile of the jejunal mucosa of pigs 24 h after infection with ETEC. In total, 20 piglets selected to be ETEC-susceptible were weaned at 24 days of age (day 0) and allotted by litter to one of following groups: control (CO), CO+colistin (AB), CO+5×1010 colony-forming unit (CFU) Sc/kg feed, from day 0 (PR) and CO+5×1010 CFU Sc/kg feed from day 7 (CM). On day 7, the pigs were orally challenged with ETEC and were slaughtered 24 h later after blood sampling for haptoglobin (Hp) and C-reactive protein (CRP) determination. The jejunal mucosa was sampled (1) for morphometry; (2) for quantification of proliferation, apoptosis and zonula occludens (ZO-1); (3) to carry out the microarray analysis. A functional analysis was carried out using Gene Set Enrichment Analysis. The normalized enrichment score (NES) was calculated for each gene set, and statistical significance was defined when the False Discovery Rate % was <25 and P-values of NES were <0.05. The blood concentration of CRP and Hp, and the score for ZO-1 integrity on the jejunal villi did not differ between groups. The intestinal crypts were deeper in the AB (P=0.05) and the yeast groups (P<0.05) than in the CO group. Antibiotic treatment increased the number of mitotic cells in intestinal villi as compared with the control group (P<0.05). The PR group tended to increase the mitotic cells in villi and crypts and tended to reduce the cells in apoptosis as compared with the CM group. The transcriptome profiles of the AB and PR groups were similar. In both groups, the gene sets involved in mitosis and in mitochondria development ranked the highest, whereas in the CO group, the gene sets related to cell junction and anion channels were affected. In the CM group, the gene sets linked to the metabolic process, and transcription ranked the highest; a gene set linked with a negative effect on growth was also affected. In conclusion, the constant supplementation in the feed with the strain of yeast tested was effective in counteracting the detrimental effect of ETEC infection in susceptible pigs limits the early activation of the gene sets related to the impairment of the jejunal mucosa.

Perforación de divertículo duodenal: Una complicación poco frecuente / Perforated duodenal diverticulum: An infrequent complication

En torno al 95% de los divertículos duodenales son asintomáticos, siendo su diagnóstico de manera incidental tras la realización de pruebas de imagen por otros motivos. Entre sus complicaciones, la perforación es la menos frecuente. Presentamos el caso de un paciente con abdomen agudo secundario a divertículo duodenal perforado y manejo quirúrgico exitoso. Los divertículos duodenales son en su mayoría adquiridos y de localización periampular. Pueden asociar presencia de sintomatología vaga o desarrollar complicaciones como diverticulitis, obstrucción, sangrado o perforación, que pudiendo ser esta última espontánea, secundaria a diverticulitis o iatrogénica. La recomendación en cuanto al manejo de la perforación intestinal secundaria a divertículo duodenal es el tratamiento quirúrgico. También se ha descrito el manejo conservador con reposo digestivo, antibioterapia, y drenaje percutáneo de colecciones en pacientes con alto riesgo quirúrgico sin datos de sepsis

About 95% of the duodenal diverticula are asymptomatic, with incidental diagnosis after imaging tests for other reasons. Among its complications, perforation is the least frequent. We present a patient with acute abdomen secondary to perforated duodenal diverticulum and successful surgical management. The duodenal diverticula are mostly acquired and periampular localization. They may associate vague symptomatology or develop complications such as diverticulitis, obstruction, bleeding or perforation, which may be spontaneous, secondary to diverticulitis or iatrogenic. The recommendation for management of intestinal perforation secondary to duodenal diverticulum is surgical treatment. Conservative management with digestive rest, antibiotic therapy, and percutaneous drainage of collections have also been described in patients with high surgical risk with no sepsis data

Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study.

INTRODUCTION: Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. MATERIALS AND METHODS: Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. RESULTS: Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. CONCLUSION: The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

Enteroendocrine cells: a review of their role in brain-gut communication.

BACKGROUND: Specialized endoderm-derived epithelial cells, that is, enteroendocrine cells (EECs), are widely distributed throughout the gastrointestinal (GI) tract. Enteroendocrine cells form the largest endocrine organ in the body and play a key role in the control of GI secretion and motility, the regulation of food intake, postprandial glucose levels and metabolism. EECs sense luminal content and release signaling molecules that can enter the circulation to act as classic hormones on distant targets, act locally on neighboring cells and on distinct neuronal pathways including enteric and extrinsic neurons. Recent studies have shed light on EEC sensory transmission by showing direct connections between EECs and the nervous system via axon-like processes that form a well-defined neuroepithelial circuits through which EECs can directly communicate with the neurons innervating the GI tract to initiate appropriate functional responses. PURPOSE: This review will highlight the role played by the EECs in the complex and integrated sensory information responses, and discuss the new findings regarding EECs in the brain-gut axis bidirectional communication.

Comparison of three patterns of feed supplementation with live Saccharomyces cerevisiae yeast on postweaning diarrhea, health status, and blood metabolic profile of susceptible weaning pigs orally challenged with Escherichia coli F4ac.

The development of effective feeding strategies to reduce the detrimental effect of enterotoxigenic F4ac (ETEC) plays a crucial role in reducing the occurrence of therapeutic intervention with antibiotics in livestock. The ability of CNCM I-4407 (SCC), supplied in different patterns to counteract ETEC infection in weaned pigs, was evaluated. Fifty pigs weaned at 24 d were then divided into 5 groups: control (CO), CO + colistin (AB), CO + 5 × 10(10) cfu of SCC/ kg feed, from d 0 to 21 (PR), CO + 5 × 10(10) cfu of SCC/ kg feed from d 7 to 11 (CM), and CO + 1 shot of 2 × 10(11) cfu of SCC when the first diarrhea appeared (CU). On d 7 postweaning, all the pigs were orally challenged with 10(8) cfu of ETEC. Blood samples were taken from the pigs (d 7, 8, 12, and 21) while the fecal excretion of ETEC was assessed on d 7 and 10. Fecal consistency was scored from 12 h before infection to 144 h postinfection (p.i.). On d 21, the pigs were sacrificed. The in vitro adhesion test on the intestinal villi confirmed individual susceptibility to ETEC, excluding the presence of resistant pigs. Growth performance did not differ between the treatments. Mortality was reduced in the AB group (P< 0.01) and, marginally, in the PR group (P = 0.089) when compared to the CO group. The CO group had a higher fecal score than AB in the period of observation (from P = 0.01 to P< 0.001). Yeast administration reduced the fecal score when compared to the CO group 12 and 48 h p.i. (P = 0.04). Total IgA never differed among the treatments, but the ETEC-specific IgA concentration was lower in the AB group than in CO (P = 0.04) at d 12. Four days p.i., the pigs fed live yeast had reduced ETEC excretion compared with the CO pigs (P = 0.05). Blood concentrations of dodecenoyl-L-carnitine (P < 0.01), glutaryl-L-carnitine/hydroxyhex¬anoyl-L-carnitine, phosphatidylcholine diacyl and phosphatidylcholine diacyl (P = 0.01 and P< 0.01, respectively), and α-amino adipic acid (P < 0.01) were reduced in the AB group compared to the CO group; PR + CM reduced the concentration of sphingomyelin-ceramide (P = 0.02) and increased the concentration of decadienyl-L-carnitine (C10:2; P= 0.02) vs. CO. The CM group had an increased concentration of C10:2 (P < 0.01) compared to the PR group. In conclusion, the administration of live yeast, even in concomitance with ETEC infections, reduces pig illness and mortality. The strain of SCC tested did not show a therapeutic effect.

Platelet SERT as a peripheral biomarker of serotonergic neurotransmission in the central nervous system.

Alterations in serotonergic activity have been observed in many pathological conditions, including neuro psychiatric diseases, irritable bowel syndrome, and hypertension. The serotonin (5-hydroxytryptamine; 5-HT) transporter(SERT) in the brain clears 5-HT from extracellular spaces, modulating the strength and duration of serotonergic signaling.Outside the central nervous system, it is also present in platelets, where it takes up 5-HT from plasma, keeping levels very low (i.e., ~1 nM). Importantly, it is generally accepted that SERT protein expressed in platelets is identical to the one found in neurons, displaying similar structural and functional properties in both tissues. At the present time, it is technically difficult to measure SERT binding and function in vivo since imaging methods are limited by a number of factors,especially the cost and the selectivity of the available radioligands. One of the most frequently used molecular imaging techniques to study SERT is positron emission tomography (PET). Although an impressive number of PET radio ligands have been synthesized and validated, there is still a lack of suitable ligands for a large part of the 5-HT system. Interest in determining both the molecular characteristics and the regulation of SERT has been enormous over the last decade, but the difficulty in obtaining human tissues and the ethical limitations in human experiments have turned researchers to look for alternative models. This review summarizes recent clinical and preclinical data relevant to the use of blood platelets asa peripheral marker for the central 5-HT system, and outlines future directions in this field.

Intrinsic innervation of the Persian squirrel (Sciurus anomalus) ileum.

Most investigations related to the characterisation of the enteric nervous system (ENS) are pivoted on the intestine of small rodents, but few studies are available on the ENS of wild or 'unconventional' rodents. Anti-PGP 9.5 and anti-Hu antibodies were utilised to recognise the distribution pattern of neuronal cell bodies and fibres of the ileum of the Persian squirrel (Sciurus anomalus) ENS. The percentages of subclasses of enteric neurones in the total neuronal population were investigated by neuronal nitric oxide synthase (nNOS), choline acetyltransferase (ChAT), calcitonin gene-related peptide (CGRP), substance P (SP), and calbindin (CALB). Myenteric plexus (MP) and submucosal plexus (SMP) neurones showing nNOS immunoreactivity (IR) were 41±4% and 11±6%, respectively, whereas cells expressing ChAT-IR were 56±9% and 74±16%, respectively. nNOS-IR was co-expressed by 21±2% and 9±4% of the MP and SMP cholinergic neurones, respectively, whereas the nNOS-IR MP and SMP neurones co-expressing ChAT-IR were 86±6% and 89±2%, respectively. CGRP-IR and SP-IR were expressed, respectively, by 13±5% and 6±3% of MP and 18±2% and 2±2% of SMP neurones. CALB-IR was expressed by 22±8% and 56±14% of MP and SMP neurones, respectively. MP and SMP cholinergic neurones co-expressed nNOS-IR (21±2% and 9±4%, respectively) and a very high percentage of nNOS-IR neurones showed ChAT-IR (86±6% and 89±2%, respectively). MP and SMP CALB-IR neurones co-expressed ChAT-IR (100% and 63±11%, respectively) and CGRP-IR (89±5% and 26±7%, respectively). Our data might contribute to the neuroanatomical knowledge of the gastrointestinal tract in exotic mammals and provide a comparison with the available data on other mammals.