Single-nucleus RNA-seq2 reveals functional crosstalk between liver zonation and ploidy.

Single-cell RNA-seq reveals the role of pathogenic cell populations in development and progression of chronic diseases. In order to expand our knowledge on cellular heterogeneity, we have developed a single-nucleus RNA-seq2 method tailored for the comprehensive analysis of the nuclear transcriptome from frozen tissues, allowing the dissection of all cell types present in the liver, regardless of cell size or cellular fragility. We use this approach to characterize the transcriptional profile of individual hepatocytes with different levels of ploidy, and have discovered that ploidy states are associated with different metabolic potential, and gene expression in tetraploid mononucleated hepatocytes is conditioned by their position within the hepatic lobule. Our work reveals a remarkable crosstalk between gene dosage and spatial distribution of hepatocytes.

Neumoperitoneo como complicación de la ventilación mecánica, sin evidencia radiológica de neumotórax / Pneumoperitoneum as complication of mechanical ventilation, without radiologic evidence of pneumothorax

Se define el neumoperitoneo como la presencia de aire libre dentro de la cavidad peritoneal, siendo su causa más frecuente y lo primero a descartar, la perforación de víscera hueca que implica un tratamiento quirúrgico. Existen también neumoperitoneos que no están causados por lesiones intraabdominales, como aquellos que aparecen como complicación de la ventilación mecánica, mucho menos frecuentes, y que normalmente coexisten con neumomediastino y/o neumotórax. Su mecanismo fisiopatológico es el paso de aire a través de las comunicaciones anatómicas de la cavidad torácica a la cavidad abdominal. Presentamos un caso, excepcional por su frecuencia, de neumoperitoneo secundario a barotrauma en el que no se evidencia radiológicamente neumomediastino ni neumotórax (AU)

Pneumoperitoneum is defined as the presence of free air (gas) within the peritoneal cavity; its most frequent cause, and the one which must be ruled out first, is viscus perforation implying surgical management. There are however cases of pneumoperitoneum that are not due to intraabdominal lesions, such as those much less frequent ones occurring as a complication of mechanical ventilation, which usually coexist with pneumomediastinum and/or pneumothorax. The pathophysiological mechanism is the passage of air through the anatomic communications from the thoracic cavity to the abdominal one. We report one case, exceptional because of its low frequency, of pneumoperitoneum secondary to barotrauma in which whether pneumomediastinum nor pneumothorax were radiologically demonstrated (AU)

[Chylothorax secondary to blunt thoracic trauma. Report of 6 cases]. / Quilotórax secundario a traumatismo torácico cerrado. A propósito de 6 casos.

Chylothorax is a rare condition that even more rarely arises as a result of closed thoracic trauma. We report a series of 6 patients who suffered chylothorax after closed trauma, who were diagnosed early and treated conservatively. Either total parenteral feeding or adjusted enteral feeding, depending with circumstances, was started early such that complications from chylothorax were few. Surgery was required in only one case, and outcomes were satisfactory in all patients, none of whom died.

[Enteral nutrition in ICU patients on a high-protein diet]. / Nutrición enteral en pacientes de UCI con dieta hiperproteica.

BASIS: The need for nutritional support is at present beyond question, while the use of early enteral nutrition in critical patients admitted to Intensive Care Units is increasingly common and would appear to offer a set of advantages as nutritional support. PATIENTS: Of a total of 26 consecutive enteral nutrition patients, 22 were studied prospectively (84.6%), and, through a nasal-gastric probe, were administered early high protein enteral polymeric diet with 25% of total calorific value from proteins, for an average of 10 days. The other four (15.4%) did not enter the study, according to the exclusion criteria established, and so were not taken into account in the statistics. METHOD: A design was followed in which the diet was administered progressively until reaching 30 ml/kg/day, in a maximum of three days, during which aspects were analyzed dealing with tolerance and ease of use, on the one hand, and other metabolic and nutritional aspects on the other. Analytical controls were carried out on days 0, 4, 8 and 12. Tolerance and adverse effects were monitored continuously. RESULTS: During the study, one of the twenty-two patients died (4.54%): the other 21 remained alive. In analysis of the metabolic and nutritional parameters, improvement was obtained in all those expected to reach normal levels, with p < 0.001 (glucose, prealbumin, TF, RBP, Zn, Mg and P). Of particular note was the evolution of the nitrogen balance (p < 0.001 and r = 0.77). As to tolerance, diarrhea appeared in two patients (9.09%), ileus in one (4.5%): no cases were detected of abdominal distension, nausea or vomiting. In no case was diet suspended for causes attributable to the enteral nutrition, nor was any therapeutic manipulation required. CONCLUSIONS: Excellent tolerance of enteral nutrition was obtained, with almost no complications associated with its use, despite the gravity of the patients (APACHE 14). On the other hand, an improvement was obtained in metabolic and nutritional parameters, with the particular significance of the nitrogen balance.

[Massive hemoptysis as the onset of pancreatico-bronchial fistula]. / Hemoptisis masiva como presentación de fístula pancreático-bronquial.

OBJECTIVE: A fistula between the pancreas and the bronchial tree is a rare manifestation of pancreatic disease. PATIENTS: We describe a case of a pancreatic pseudocyst that penetrated into the thoracic cavity through the diaphragm, and set up a communication with the bronchial tree developing an episode of massive haemoptysis.