A review of bidimensional acculturation and STI/HIV-related sexual risk behaviours among Hispanic youth.

A growing body of research suggests that acculturation may play a role in the disproportionate likelihood of sexual risk behaviour and STI/HIV infection among Hispanic youth in the USA. We systematically reviewed the relationship between acculturation and STI/HIV-related sexual risk behaviour among Hispanic youth aged 13-24 by reviewing studies that have used a bidimensional acculturation approach. Electronic databases were searched with the searches limited to articles published in 1992 when the concept of bidimensional acculturation was introduced or later. Two independent researchers screened the full data set to assess eligibility. Six studies were included. Three studies used cross-sectional data, while the other three used longitudinal data. We discovered that sexual risk behaviours differed by Hispanic youth acculturation types and were moderated by gender. We found that Hispanic acculturated youth had lower odds of having multiple sex partners than US acculturated youth. However, the relationship between acculturation and condom use yielded contradictory results and we could find no report on bi-culturation and sexual behaviour. Additional research is needed to explore whether adopting both US and Hispanic-heritage cultures at the same time may reduce or increase the odds of engaging in sexual risk behaviour among Hispanic youth in the USA.

Pancreatic Ductal Adenocarcinoma (PDAC) circulating tumor cells influence myeloid cell differentiation to support their survival and immunoresistance in portal vein circulation.

The portal venous circulation provides a conduit for pancreatic ductal adenocarcinoma (PDAC) tumor cells to the liver parenchyma sinusoids, a frequent site of metastasis. Turbulent flow in the portal circulation promotes retention of PDAC shed circulating tumor cells (CTC) and myeloid-derived immunosuppressor cells (MDSC). Excessive colony stimulating factor-1 receptor (CSF1R) signaling can induce myeloid differentiation to MDSC and transformation of MDSC to myeloid-derived fibroblasts (M-FB). Interactions between PDAC CTC and M-FB in the portal blood promotes the formation of immunoresistant clusters that enhance CTC proliferation, migration, and survival. Analysis of portal and peripheral blood samples collected intraoperatively from 30 PDAC patients undergoing pancreatico-duodenectomy showed that PDAC patient plasma contained high levels of macrophage colony stimulating factor (M-CSF/CSF1), granulocyte-macrophage colony stimulating factor (GM-CSF/CSF2), interleukin-8 (IL-8), and interleukin-34 (IL-34) compared to healthy control levels. Moreover, the level of M-CSF in portal blood was significantly higher than that detected in the peripheral blood of PDAC patients. PDAC CTC aseptically isolated by fluorescence activated cell sorting (FACS) out of freshly collected patient portal blood mononuclear cells (PortalBMC) had elevated RNA expression of IL34 (IL-34 gene) and CSF1 (M-CSF/CSF1 gene) which both signal through CSF1R. PDAC CTC also had high levels of RNA expression for CXCL8, the gene encoding chemokine interleukin-8 (IL-8) which can attract myeloid cells through their CXCR2 receptors. FACS-isolated portal PDAC CTC and M-FB co-cultured ex vivo had increased CTC proliferation, motility, and cluster formation compared to CTC cultured alone. CSF1R and CXCR2 cell surface expression were found on PDAC portal blood CTC and M-FB, suggesting that both cell types may respond to M-CSF, IL-34, and IL-8-mediated signaling. Portal PDAC CTC displayed enhanced RNA expression of CSF1 and IL34, while CTC+M-FB+ clusters formed in vivo had increased RNA expression of CSF2 and IL34. Portal M-FB were found to have high CSF1R RNA expression. CTC isolated from ex vivo 7-day cultures of PDAC patient portal blood mononuclear cells (PortalBMC) expressed elevated CSF1, IL34, and IL8 RNA, and CSF1 expression was elevated in M-FB. Treatment with rabbit anti-CSF1R antibodies decreased CTC proliferation. Treatment of PortalBMC cultures with humanized anti-CSF1R, humanized anti-IL-8, or anti-IL-34 antibodies disrupted CTC cluster formation and increased CTC apoptosis. U937 myeloid precursor cell line cultures treated with conditioned media from PortalBMC ex vivo cultures without treatment or treated with anti-IL-8 and/or anti-CSF1R did not prevent myeloid differentiation in the myeloid precursor cell line U937 to macrophage, dendritic cell, MDSC, and M-FB phenotypes; whereas, U937 cultures treated with conditioned media from PortalBMC ex vivo cultures exposed to anti-IL-34 were significantly inhibited in their myeloid differentiation to all but the M-FB phenotype. PDAC patient T cells that were found phenotypically anergic (CD3+CD25+CTLA4+PD1L1+) in PortalBMC could be re-activated (CD3+CD25+CTLA4-PD1L1-), and displayed increased interferon gamma (IFNγ) production when PortalBMC ex vivo cultures were treated with anti-CSF1R, anti-IL-8, and anti-IL-34 antibodies alone or in combination. These findings suggest that PDAC CTC have the potential to influence myeloid differentiation and/or antigen presenting cell activation in the PDAC portal blood microenvironment, and that disruption of CTC/M-FB interactions may be potential targets for reversing the immunosuppression supporting CTC survival in the portal blood.

Pancreatic metastasectomy of renal cell carcinoma: a single institution experience.

INTRODUCTION: Renal cell carcinoma (RCC) is the most common primary neoplasia that metastasizes to the pancreas. Pancreatic metastasis (PM) occur in asymptomatic older patients and are identified during follow up. If resectable, surgery is the treatment of choice for long term survival. Our goal is to analyze outcomes of patients with RCC-PM. MATERIAL AND METHODS: We reviewed all patients with metastatic RCC (mRCC) who underwent resection, from known primary RCC and RCC-PM. RESULTS: There were 16 patients (mean age of 67 ± 8 years, male 8 (50%), mean BMI 29 ± 5.36 kg/m2). Half of them were asymptomatic. Diagnosis was incidental in 56.25% with a median lesion size of 25 mm (12-80). Pancreatic resections performed were: pancreatoduodenectomy (31.25%), distal pancreatectomy (56.25%) and total pancreatectomy (12.5%). Median estimated blood loss was 225 mL (15-2,200), median operative time was 242 min (63-420). Median length of stay was 6 days (2-30). New-onset diabetes was 6.25%. The minor complication and reoperation rates, were 37.5% and 6.25%, respectively. The median number of harvested lymph nodes was 17 (4-31), all were negative. All had a R0 resection. Recurrence of disease was 18.75% with a median time after surgery of 3 years (2-6). The median follow up was 9 years (0-15). Thirteen (81.25%) patients are still alive, eight are disease free. Three (18.75%) died. CONCLUSIONS: Long term survival can be achieved with surgical resection of PM from RCC in selected patients in whom complete resection is possible.

Concomitant neuroendocrine tumor and gastrointestinal stromal tumor in a duodenal fine needle aspiration: A cytologic clue for neurofibromatosis type 1.

The identification of two cell populations displaying different cytologic characteristics in the same fine needle aspiration (FNA), one with an epithelioid appearance and the other spindle cell morphology, is an extremely rare phenomenon and potentially represents a source of diagnostic confusion. Depending on the lineage and relationship of the two cell types, the differential diagnosis is broad and encompasses a wide spectrum of entities. The current case describes the presence of nests and clusters of neuroendocrine cells associated with rare spindle cell fragments of gastrointestinal stromal tumor (GIST) in the same fine needle aspiration of a duodenal mass. Our literature analysis revealed that such combined cytologic findings were hitherto never reported and the concurrence of well-differentiated neuroendocrine tumor (NET) and GIST is almost pathognomonic for neurofibromatosis type 1 (NF-1).

Examining Perceptions of Spanish Language Health Information Among Hispanics Living in the United States: A Qualitative Study Assessing Videos, Brochures, and Websites.

BACKGROUND: Nationally, Hispanics experience health disparities manifested as a higher prevalence of chronic diseases in comparison to non-Hispanic Whites. Factors that influence health disparities in this population include inadequate dissemination of culturally and linguistically appropriate health information. METHOD: Our qualitative analysis is based on data obtained from three focus groups with Spanish-speaking Hispanic adults conducted at a clinic in Nebraska. Participants were asked about their perceptions of health information in the form of videos, brochures, and websites. We followed the consolidated criteria for reporting qualitative research and used the theoretical framework of content analysis. RESULTS: For videos, attributes associated with higher levels of trust included a friendly health professional, the logo or name of a health care institute, and a reference specifying "se habla Español." For brochures, attributes associated with trust included use of visual aids, use of numerous colors and big font sizes, the year of printing, and a health care agency logo. For websites, characteristics associated with trust were inclusion of plain language, use of pictures and videos, and date of last update. In all focus groups, participants perceived the use of mixed English/Spanish language in health information from pamphlets and websites as unprofessional. The use of unknown governmental logos in health promotional videos and websites was perceived as untrustworthy information. CONCLUSIONS: Spanish-speaking Hispanics prefer health information supported by a health care agency or delivered by a health care professional. Health communication strategies should avoid the use of mixed English/Spanish language in sensitive information especially when combined with governmental logos.

Health Professions Students' Assessment of an Interprofessional Rural Public Health-Focused Rotation: A Pilot Study Based on the Community-Oriented Primary Care Approach.

Using a community-oriented primary care (COPC) approach, the format for this interprofessional rural rotation was a public health focused team project based in a local health department and primary care setting. The target audience included fourth-year dental students, fourth-year undergraduate students in imaging science, second-year master of public health students, third-year medical students enrolled in the MD/MPH program, second-year nurse practitioner students, fourth-year pharmacy students, second-year MSN nursing students, and first-year PhD students. The specific learning objectives of the curriculum were drawn from emphasis areas of the Interprofessional Education Collaborative's competency domains and included the development of students' knowledge to function as a member of an interprofessional team to (1) engage diverse health care professionals, (2) communicate with team members to clarify each member's responsibility in executing components of a public health intervention, (3) choose effective communication tools and techniques, (4) integrate knowledge and experience of other professions, and (5) engage themselves and others to constructively manage disagreements. Additional learning objectives centered on 10 competencies from the Master's Degree in Public Health Core Competency Project. Assessment of 13 student participants, as a group, showed increased perceived knowledge in 4 out of 5 selected interprofessional emphasis areas and 9 out of 10 public health competencies. Our curriculum provides promising evidence for one interprofessional rural education model with proven short-term effectiveness among six health professions disciplines, in increasing student knowledge in interprofessional emphasis areas and public health competencies.

Preoperative high respiratory quotient correlates with lower weight loss after bariatric surgery.

BACKGROUND: The respiratory coefficient (RQ), as determined by indirect calorimetry (IC), classifies diet as being carbohydrate rich (RQ = 0.7-0.8), fat rich (RQ = 0.9-1.0), or overfeeding (RQ > 1). We hypothesized that preoperative RQ may be associated with weight-loss outcomes after bariatric surgery. METHODS: From 2016 to 2018, 137 obese patients were enrolled in a Bariatric Registry and underwent dietary and behavioral counseling, followed by preoperative IC. Resting energy expenditure (REE) and RQ of all patients was measured. Patients were classified as over-feeders (OF; 42, 31%) with RQ > 1 or non-over-feeders (NOF; 95, 69%) with RQ < 1. At baseline, there was no difference between groups in gender [female: 105 (76.6%), male: 32 (23.4%)], body mass index (BMI; OF: 46.8 ± 7.8 vs. NOF: 44.8 ± 7.4 kg/m2, p = 0.40), or baseline REE (OF: 1897 ± 622 vs. NOF: 1874 ± 579, p = 0.74), although OF were younger [mean age (OF: 47.1 ± 13.0 years vs. NOF: 43.1 ± 13.4; p = 0.009). At 6-month follow-up 94 patients [53.28%; OF: 35 (83%) vs. NOF: 59 (62%), p = 0.016] were seen and 48 [35.03%; OF: 23 (55%) vs. NOF: 25 (59%), p = 0.001] at 12-month follow-up. On preoperative psychological assessment, OF had a significantly higher rate of childhood neglect (OF: 28 (47.46%) vs. NOF: 40 (28.99%); p = 0.01). RESULTS: At 1 year postoperatively, the OF had a significantly higher BMI (OF: 34.3 ± 6.5 vs. NOF: 29.3 ± 5.1 kg/m2, p = 0.009). Differences in weight were not significant at 6-month (OF: 36.0 ± 6.5 vs. NOF: 33.5 ± 5.9 kg/m2, p = 0.07). There was no difference between type of operation and RQ group (RYGB; OF: 55 (75%) vs. NOF: 18 (25%) and SG; OF: 40 (62%) vs. NOF: 24 (38%), p = 0.14), nor in BMI loss after operation. CONCLUSION: Evidence of overfeeding in the preoperative period prior to bariatric surgery is associated with higher resultant BMI at 1 year. Calculation of the RQ with IC has prognostic significance in bariatric surgery, and calculation of REE based on assumed normal RQ potentiates error. It is unclear if overfeeding is purely behavioral or secondary to potentially reversible metabolic etiology.

Smartphone Application as an Education Platform in Hepato-Pancreato-Biliary Surgery.

Background. There are no data to assess the need for smartphone applications (SA) as an educational tool in hepato-pancreato-biliary (HPB) surgery. The primary objective of this study was to assess if SA can be used as an educational tool in HPB surgery. The secondary objective was to assess if SA can help as a decision-making tool for fellowship applicants in HPB surgery. Methods. A preapproved questionnaire was e-mailed by International Hepato-Pancreato-Biliary Association to all its 2350 members. Results. Two hundred seventy-one surgeons responded to the survey. Eight were excluded for incomplete data. A total of 48.7% of responders were between 28 and 43 years old (generation X) and 45.2% between 44 and 62 years old (baby boomers). A total of 37.6% of the responders considered SA as an effective method to teach future trainees, and there were slightly higher odds of choosing SA as a teaching tool if the responder considered themselves as an innovator (odds ratio: 2.24). A total of 87.8% of the responders believe that SA in HPB surgery can be directed toward surgical trainees' education, and 91.6% believed SA can be directed toward a fellow. Ninety-five percent of the responders believed that SA in HPB surgery can possibly help a future applicant to choose an HPB fellowship program. Conclusion. SA can complement other teaching techniques and educational tools in HPB surgery. In addition, it can potentially be used as a platform for HPB surgery fellowship by helping in making a decision regarding appropriate fellowship programs.

Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience.

BACKGROUND: Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years. METHODS: The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017. RESULTS: There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation 23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1-14) and 4 (2-279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3-286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period. CONCLUSION: Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.

Influencia del viento Zonda en las enfermedades cardiovasculares / Influence of the Zonda wind on cardiovascular diseases

INTRODUCCIÓN La influencia de los fenómenos meteorológicos sobre la salud y las consecuencias relacionadas en lo referente a la morbi-mortalidad cardiovascular y respiratoria, han sido estudiadas en cohortes humanas y de animales. La evidencia de los efectos de la temperatura del aire y la presión atmosférica sobre la morbilidad cardiovascular es todavía limitada y controvertida. El Viento Zonda es característico de varias zonas ubicadas inmediatamente cercanas a cadenas montañosas. En Argentina afecta desde el norte de la provincia de Neuquén, transcurre por la Región de Cuyo finalizando en las provincias del norte; soplando preferentemente desde fines del otoño, durante el invierno y la primavera. Hasta la fecha no existen investigaciones que hayan comprobado esta situación, por lo que se desarrolló un estudio prospectivo, observacional, de tipo de control de sí mismo y multicéntrico. OBJETIVO Evaluar la asociación entre la incidencia de consultas (admisiones) en Salas de emergencias/ guardias externas por Hipertensión y consultas cardiológicas más frecuentes que requieren internación en guardia y/o posterior ingreso a unidad coronaria (Síndrome Coronario Agudo tipo ST y NST, Insuficiencia cardíaca descompensada, Arritmias Supraventriculares y Ventriculares, Síncope, Urgencias, Emergencias hipertensivas, Accidente cerebrovascular y Muerte) con variables meteorológicas relacionadas con el viento Zonda durante el periodo comprendido entre el 15 de mayo del 2017 hasta el 30 de Abril del 2018 en provincias de la región cordillerana de la República Argentina. MÉTODO Las variables nominales se expresaron como porcentajes (%) y las cuantitativas según su distribución sea paramétrica o no paramétrica, como medias (+- desvío standard) o como medianas (percentilos 25-75). Se comparó el promedio de consultas (admisiones) en servicios de emergencias hospitalarias en los días sin viento Zonda y el promedio de consultas en los días afectados por el mismo. Para ello se utilizaron el Test de Mann Whitney o Test de T según el tipo de distribución de los datos. La información sobre los fenómenos de Zonda, sus estaciones meteorológicas reportantes, variables como duración, dirección, temperatura ambiente, sensación térmica, humedad y velocidad del viento fueron reportados por el Centro de Información Meteorológica, perteneciente al Servicio Meteorológico Nacional. Se realizaron ajustes multivariados a fin de poder identificar qué variables meteorológicas se asociaron con la mayor incidencia de eventos. RESULTADOS Se obtuvo en forma prospectiva 1782 consultas (admisiones) hospitalarias de pacientes mayores de 18 años, 706 fueron consultas en guardia externa por Hipertensión Arterial y 1076 internaciones en áreas críticas por causas cardiovasculares. La edad media fue 60 años (18-96) y 43 % fueron hombres para las consultas por Hipertensión Arterial mientras que para las admisiones de otras causas la edad media fue de 58 años (18-96) y 60% hombres. Durante el periodo del estudio (15 de mayo del 2017 al 30 de abril del 2018) el Centro de Información del Servicio Meteorológico Nacional reportó 13 episodios de viento Zonda. El promedio diario de admisiones por hipertensión arterial fue mayor durante los días afectados por el fenómeno en forma significativa en las ciudades de San Juan y Catamarca Test de Mann Whitney Wilcoxon (p < 0.005 y p < 0.04 respectivamente). Mientras que el mayor promedio diario de internaciones en unidad coronaria durante los días afectados por el viento Zonda fue en la ciudad de Mendoza Test de Mann Whitney Wilcoxon (p < 0.04) y con tendencia en La Rioja Test de Mann Whitney Wilcoxon (p < 0.07). DISCUSIÓN El presente constituye el primer estudio observacional, prospectivo, multicéntrico que analizó la asociación entre el Viento Zonda y los eventos cardiovasculares. Se observó en las ciudades mayormente por el número de episodios, un incremento de consultas por hipertensión e internaciones por causas cardiovasculares. Estos resultados tendrían implicancias sanitarias relevantes para prevenir eventos en las poblaciones afectadas por el mencionado fenómeno climático

A Cadaveric Investigation of the Dorsal Scapular Nerve.

Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The purpose of this study was to document the DSN's anatomy and measure the oblique course it takes with regard to the middle scalene muscle. From 20 embalmed adult cadavers, 23 DSNs were documented regarding the nerve's spinal root origin, anatomical route, and muscular innervations. A transverse plane through the laryngeal prominence was established to measure the distance of the DSN from this plane as it enters, crosses, and exits the middle scalene muscle. Approximately 70% of the DSNs originated from C5, with 74% piercing the middle scalene muscle. About 48% of the DSNs supplied the levator scapulae muscle only and 52% innervated both the levator scapulae and rhomboid muscles. The average distances from a transverse plane at the laryngeal prominence where the DSN entered, crossed, and exited the middle scalene muscle were 1.50 cm, 1.79 cm, and 2.08 cm, respectively. Our goal is to help improve clinicians' ability to locate the site of DSN entrapment so that appropriate management can be implemented.

Trends in the Use of Endoscopic Retrograde Cholangiopancreatography for the Management of Chronic Pancreatitis in the United States.

GOALS: The aim of this study was to characterize current trends in the use of endoscopic retrograde cholangiopancreatography (ERCP) in the United States for patients hospitalized with chronic pancreatitis. BACKGROUND: Historically, ERCP was the primary tool for diagnostic and therapeutic management of chronic pancreatitis. With increased availability of magnetic resonance imaging and endoscopic ultrasound, indications for ERCP are being redefined. STUDY: We performed a retrospective cohort study using the Nationwide Inpatient Sample from 1998 to 2010. We identified patients with a primary discharge diagnosis of chronic pancreatitis who underwent ERCP. We excluded patients diagnosed with biliary, gallbladder, or pancreatic neoplasm and patients who underwent gallbladder or pancreatic operation during the same admission. We analyzed patient and hospital characteristics, length of stay, and in-hospital mortality, and adjusted for weighted sample schema. RESULTS: During the study period, 29,318 patients with chronic pancreatitis (mean age 52 y, 57.2% female) underwent ERCP during their hospitalization. The majority of patients were white (56.1%). The majority of procedures were performed at large (72.4%), urban (95.2%), and academic (69.0%) hospitals. Mean hospital charges were $32,929 (SE= $1605). Mean length of stay was 6 days (SE=0.3), with in-hospital mortality of 0.76%. Over the study period, the number of procedures has decreased significantly (P<0.001). CONCLUSIONS: In the United States, ERCP has been an important diagnostic and therapeutic tool for chronic pancreatitis. Over the last decade, ERCP has become an uncommon inpatient procedure for chronic pancreatitis.

Spontaneous Hepatic Hemorrhage: A Single Institution's 16-Year Experience.

Spontaneous hemorrhage from hepatic tumors is an uncommon but serious complication. Recently, interventional radiologic (IR) techniques are being used increasingly in the management of these patients. We report our 16-year experience in managing spontaneous hemorrhage from liver tumors. Twenty-six consecutive patients were diagnosed with spontaneous liver hemorrhage between 1995 and 2011. Initial management was operative in eight, IR in six, and supportive in 12 patients. Of those managed operatively, five were segmentectomies; one hemihepatectomy; one wedge resection; and one packing who later died from coagulopathy. In the IR patients, seven had an angiographic embolization; two required reembolization; one underwent resection of a hepatic adenoma 21 days after angiographic embolization. The malignant lesions included hepatocellular carcinoma (n = 6), angiosarcoma (n = 1), metastatic squamous cell carcinoma (n = 1), metastatic leiomyosarcoma (n = 1), nonsquamous cell carcinoma (n = 1), or metastatic angiosarcoma (n = 1). Benign diseases included hepatic adenoma (n = 5), end-stage liver disease (n = 1), and polycystic liver (n = 1). Spontaneous hemorrhage from the liver occurs evenly from benign or malignant causes, one-third of which are primary liver disease. If the patients presents emergently, angiographic embolization may control the bleeding and allow for elective resection once the sequelae of bleeding have resolved.

Impact of controlled intraabdominal pressure on the optic nerve sheath diameter during laparoscopic procedures.

BACKGROUND: Acute elevations of intraabdominal pressure (IAP) are seen in many clinical scenarios with a consequent elevation in intracranial pressure (ICP). With the optic nerve sheath (ONS) being a part of the dura mater and the optic nerve surrounded by cerebral spinal fluid, a change in pressure within the subarachnoid space would be detected by ultrasonography, and invasive methods could be avoided. The study objective was to evaluate ultrasonographic modifications observed on the optic nerve sheath diameter during acute elevations of IAP in patients undergoing laparoscopic procedures. STUDY DESIGN: We prospectively collected data from patients who underwent laparoscopic procedures between July and August 2013. The optic nerve sheath diameter was measured sagittally with a 12-MHz transducer. The measurements were obtained at baseline, 15 and 30 min, and at the end of surgery. RESULTS: There were 16 females (36.4%) and 28 males (63.6%), with a mean age of 44.22 ± 10.44 years (range 23-66) and body mass index of 29.45 ± 6.53 kg/m(2) (range 21-39). The mean optic nerve sheath diameter was 4.8 ± 1.0 mm at baseline, 5.5 ± 1.1 mm at 15 min, 5.9 ± 1.0 mm at 30 min, and 5.1 ± 1.2 mm after deflation of pneumoperitoneum. The diameter increased significantly at 15 min by a median of 0.6 mm (interquartile range 0.3, 0.8; p < 0.0001) and at 30 min by a median of 1.0 mm (interquartile range 0.7, 1.4; p < 0.0001), returning close to baseline after surgery. CONCLUSION: The acute elevation in IAP during laparoscopy significantly increased the optic nerve sheath diameter. The changes in the ONSD reflect a temporary and reversible increase in the ICP due to the acute elevation of IAP.

Bilateral symmetrical supernumerary heads of biceps brachii with rare pectoralis major insertion.

During a routine dissection of a 51-year-old Caucasian male cadaver, bilateral symmetrical supernumerary heads (SH) of the biceps brachii muscles with insertion into the pectoralis major (PM) muscles were discovered. Multiple case reports have documented supernumerary heads for the biceps brachii; however, none have shown bilateral insertion into the pectoralis major. This study describes a previously undocumented variation of the SH that has potential for clinical impact. Healthcare providers could be confounded by patients presenting with shoulder pain or muscle tears as a result of the anomaly. Furthermore, MRI studies on patients with possible shoulder muscle tears could reveal unexpected results. Such cases would warrant consideration of SH anomaly and treatment should be adjusted accordingly. The significant bulk and angle of the SH insertion on the PM we observed changes force vectors which would have an unknown effect in performance, surgical interventions and pain syndromes. A second biceps brachii anomaly was observed on the left brachium in addition to the bilateral SH. We postulate that these variants provide the potential for clinical complications regarding muscular injury to these aforementioned muscle groups.

Rare accessory slip of the deltoid muscle conjoined with teres minor

Routine dissection of a 69-year-old American Caucasian female revealed a unique accessory slip of the deltoid muscle which was conjoined with the proximal portion of teres minor. The variant muscle bundle was united with the distal portion of the deltoid, but deviated superomedially and fused with the origin of teres minor. This discovery possesses clinical relevance with respect to surgical repair of shoulder pathology or trauma. Shoulder injuries and their respective repairs are very common. Therefore, consideration of this variant is necessary for the correct diagnosis and treatment of massive trauma or other shoulder pathology that is refractory to standard treatments

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3D-model of adult cardiac stem cells promotes cardiac differentiation and resistance to oxidative stress.

The regenerative inadequacy of the injured myocardium leads to adverse remodeling, cardiac dysfunction, and heart disease. Stem cell-replacement of damaged myocardium faces major challenges such as inappropriate differentiation, cellular uncoupling, scar formation, and accelerated apoptosis of transplanted cells. These challenges can be met by engineering an in vitro system for delivering stem cells capable of cardiac differentiation, tissue integration, and resistance to oxidative stress. In this study, we describe the formation of three-dimensional (3D) cell aggregates ("cardiospheres") by putative stem cells isolated from adult dog myocardium using poly-L-ornithine. De novo formation of cardiospheres in growth factor-containing medium occurred over a period of 2-3 weeks, but accelerated to 2-3 days when seeded on poly-L-ornithine. Older cardiospheres developed foci of "beating" cells upon co-culture with rat neonatal cardiomyocytes. Cardiospheres contained cells that exhibited characteristics of undifferentiated cells; differentiating cardiomyocytes with organized contractile machinery; and vascular cells capable of forming "vessel-like" networks. They exhibited strong resistance to elevated concentrations of hydrogen peroxide in culture and survived subcutaneous injections without undergoing neoplastic transformation up to 3 weeks post-transplantation. These findings suggest that cardiospheres are potentially useful for delivering functional stem cells to the damaged heart.

La piretanida en el tratamiento de la insuficiencia cardíaca / Piretanide in the management of cardiac failure

Se utilizó la piretanida, en comprimidos, en la dosis de 6 mg/día, a fin de evaluar su eficacia clínica, y su tolerancia clínica y biológica, en el tratamiento de la insuficiencia cardíaca. El estudio se efectuó en abierto sobre 20 pacientes internados. Las modificaciones observadas en los parámetros clínicos y bioquímicos, directamente relacionados con la acción diurética fueron el aumento del volumen urinario y la consecuente disminución de la densidad urinaria. El primero aumentó de 1443 ml en promedio a 2020 ml el último día, con un pico máximo de 2357, 5 ml el tercer día. La densidad urinaria disminuyó de 1014 a 1009. Los valores de la natriuria se levaron como consecuencia del tratamiento mientras que la caliuria aumentó pero este incremento no fue significativo. Los valores de la natremia al comienzo del ensayo eran en promedio de 136,37 mEq/l y al final del ensayo de 134,14 mEq/l, mientras que la caliemia que era de 3,915 mEq/1 al comienzo del ensayo fue de 3,95 a la finalización del tratamiento. Se debe tener en cuenta que 15 pacientes recibieron suplementos de potasio por vía oral en la dosis promedio de 35 mEq/día. Finalmente, tomando en cuenta la apreciación global del resultado terapéutico de acuerdo a las modificaciones favorables clínicas, biológicas y al aumento de la diuresis, pudo considerarse como satisfactorio el resultado obtenido en 18 pacientes y regular el resultado obtenido en 2 pacientes. Con respecto a la tolerancia debe destacarse ue no hubo signos ni síntomas de efectos secundarios atribuibles a la droga en ensayo

La piretanida en el tratamiento de la insuficiencia cardíaca / Piretanide in the management of cardiac failure

Se utilizó la piretanida, en comprimidos, en la dosis de 6 mg/día, a fin de evaluar su eficacia clínica, y su tolerancia clínica y biológica, en el tratamiento de la insuficiencia cardíaca. El estudio se efectuó en abierto sobre 20 pacientes internados. Las modificaciones observadas en los parámetros clínicos y bioquímicos, directamente relacionados con la acción diurética fueron el aumento del volumen urinario y la consecuente disminución de la densidad urinaria. El primero aumentó de 1443 ml en promedio a 2020 ml el último día, con un pico máximo de 2357, 5 ml el tercer día. La densidad urinaria disminuyó de 1014 a 1009. Los valores de la natriuria se levaron como consecuencia del tratamiento mientras que la caliuria aumentó pero este incremento no fue significativo. Los valores de la natremia al comienzo del ensayo eran en promedio de 136,37 mEq/l y al final del ensayo de 134,14 mEq/l, mientras que la caliemia que era de 3,915 mEq/1 al comienzo del ensayo fue de 3,95 a la finalización del tratamiento. Se debe tener en cuenta que 15 pacientes recibieron suplementos de potasio por vía oral en la dosis promedio de 35 mEq/día. Finalmente, tomando en cuenta la apreciación global del resultado terapéutico de acuerdo a las modificaciones favorables clínicas, biológicas y al aumento de la diuresis, pudo considerarse como satisfactorio el resultado obtenido en 18 pacientes y regular el resultado obtenido en 2 pacientes. Con respecto a la tolerancia debe destacarse ue no hubo signos ni síntomas de efectos secundarios atribuibles a la droga en ensayo (AU)